Community-directed distributors—The “foot soldiers” in the fight to control and eliminate neglected tropical diseases

Abstract

The neglected tropical diseases (NTDs) affect hundreds of millions of people, predominantly in rural, often difficult-to-access areas, poorly served by national health services. Here, we review the contributions of 4.8 million community-directed distributors (CDDs) of medicines over 2 decades in 146,000 communities in 27 sub-Saharan African countries to control or eliminate onchocerciasis and lymphatic filariasis (LF). We examine their role in the control of other NTDs, malaria, HIV/AIDS interventions, immunisation campaigns, and support to overstretched health service personnel. We are of the opinion that CDDs as community selected, trained, and experienced “foot soldiers,” some of whom were involved in the Ebola outbreak responses at the community level in Liberia, if retrained, can assist community leaders and support health workers (HWs) in the ongoing Coronavirus Disease 2019 (COVID-19) crisis. The review highlights the improved treatment coverage where there are women CDDs, the benefits and lessons from the work of CDDs, their long-term engagement, and the challenges they face in healthcare delivery. It underscores the value of utilising the CDD model for strong community engagement and recommends the model, with some review, to hasten the achievement of the NTD 2030 goal and assist the health system cope with evolving epidemics and other challenges. We propose that, based on the unprecedented progress made in the control of NTDs directly linked to community engagement and contributions of CDDs “foot soldiers,” they deserve regional and global recognition. We also suggest that the World Health Organization (WHO) and other international stakeholders promote policy and guidance for countries to adapt this model for the elimination of NTDs and to strengthen national health services. This will enhance the accomplishment of some Sustainable Development Goals (SDGs) by 2030 in sub-Saharan Africa.

Community Knowledge, Attitudes and Practices Regarding Onchocerciasis in Rural Villages With a High Epilepsy Prevalence in Mahenge, Tanzania: A Qualitative Study

“…Reported challenges for the CDTI programme included poor geographical CDTI coverage, lack of incentives for CDDs, lack of prophylactic medications for ivermectin side effects, refusal of the community members to take the drug and negligence of CDDs and village leaders to adhere to WHO stipulated guidelines to administer the ivermectin dose to children based on height. Similar challenges were reported in other studies [28,29]. Poor programme management with lack of supervision and monitoring of CDDs were also reported.…”

Podoconiosis instruction at nursing schools in Kenya, Rwanda, and Uganda

“…Nurses could, therefore, be trained alongside students from other backgrounds, such as veterinary medicine, social sciences and environmental health for more comprehensive knowledge. This training could extend to community health aides, such as CHWs, community volunteers and community health educators who are already active and more likely to support the nurses’ work in the local community [ 25 , 39 – 41 ].…”

Reducing onchocerciasis-associated morbidity in onchocerciasis-endemic foci with high ongoing transmission: a focus on the children.

“…Due to community-directed treatment with ivermectin (CDTI), introduced by the African Program for Onchocerciasis Control (APOC) ( Amazigo et al., 2021 ), onchocerciasis ceased to pose a public health problem in several African countries ( Brattig et al., 2021 ). In 2010, and after evidence emerged that (annual or 6-monthly) mass drug administration (MDA) with ivermectin could lead to the elimination of transmission (EOT) ( Diawara et al., 2009 ), APOC's focus shifted from morbidity control to EOT (Brattig, 2009).…”