Experiences and perspectives of community health workers from implementing treatment for schistosomiasis using the community directed intervention strategy in an informal settlement in Kisumu City, western Kenya

Abstract

BackgroundThe Community Directed Intervention (CDI) strategy has been used to conduct various health interventions in Africa, including control of Neglected Tropical Diseases (NTDs). Although the CDI approach has shown good results in the control of onchocerciasis and lymphatic filariasis with respect to treatment coverage using community drug distributors, its utility in the control of schistosomiasis among urban poor is yet to be established. Using a longitudinal qualitative study, we explored the experiences, opportunities, challenges as well as recommendations of Community Health Workers (CHWs) after participation in annual mass drug administration (MDA) activities for schistosomiasis using the CDI approach in an urban setting.MethodsUnstructured open-ended group discussions were conducted with CHWs after completion of annual MDA activities. Narratives were obtained from CHWs using a digital audio recorder during the group discussions, transcribed verbatim and translated into English where applicable. Thematic decomposition of data was done using ATLAS.ti. software, and themes explored using the principle of interpretative phenomenological analysis (IPA).ResultsFrom the perspective of the CHWs, opportunities for implementing CDI in urban settings, included the presence of CHWs, their supervisory structures and their knowledge of intervention areas, and opportunity to integrate MDA with other health interventions. Several challenges were mentioned with regards to implementing MDA using the CDI strategy among them lack of incentives, fear of side effects, misconceptions regarding treatment and mistrust, difficulties working in unsanitary environmental conditions, insecurity, and insufficient time. A key recommendation in promoting more effective MDA using the CDI approach was allocation of more time to the exercise.ConclusionFindings from this study support the feasibility of using CDI for implementing MDA for schistosomiasis in informal settlements of urban areas. Extensive community sensitization and provision of incentives may help address the aforementioned challenges associated with implementing MDA using the CDI strategy. Opportunities highlighted in this study may be of value to other programmes that may be considering the adoption of the CDI strategy for rolling out interventions in the urban setting.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-3662-0) contains supplementary material, which is available to authorized users.

Mass drug administration and the sustainable control of schistosomiasis: Community health workers are vital for global elimination efforts

“…Knowledge of disease prevention has been a problem in many endemic countries. Similar to the findings presented here, avoiding contact with infected water was identified by only a small proportion of endemic populations in Kenya, Tanzania, Yemen, and Swaziland (Sady et al, 2015;Mazigo et al, 2010;Odhiambo et al, 2016;Mwanga et al, 2004;Maseko et al, 2016). There was also poor awareness of preventive chemotherapy as a means of disease prevention, which is consistent with the findings in Yemen and Uganda (Sady et al, 2015;Kabatereine et al, 2014).…”

“…However, becoming infected with Schistosoma through contact with infected water was not a very common response in surveys conducted in China and Swaziland (Maseko et al, 2016;Liu et al, 2014). Similar to the present study findings, the misconception that the infection can be acquired by the consumption of contaminated water or food was also found to be a common response in African surveys (Acka et al, 2010;Odhiambo et al, 2016;Mwanga et al, 2004;Maseko et al, 2016).…”

“…Poor knowledge of disease transmission, prevention, and treatment has been observed in Nigeria, Mozambique, and Kenya (Dawaki et al, 2015;Mwai et al, 2016;Rassi et al, 2016). The most common misconception is that schistosomiasis is acquired by drinking or eating contaminated food and water (Acka et al, 2010;Kabatereine et al, 2014;Musuva et al, 2014;Odhiambo et al, 2016;Person et al, 2016). Others believe it is transmitted through sexual contact (Rassi et al, 2016;Mwanga et al, 2004).…”

Health workers’ perspectives on the outcomes, enablers, and barriers to the implementation of HIV “Treat All” guidelines in Abuja Nigeria

“…The study finding was consistent with reports by Nzinga et al and Odhiambo et al . Both studies observed that knowledge of the benefits from implementing guidelines was a major motivational factor to utilizing guidelines [15,23]. The study results suggest that new public health initiatives such as guidelines or policy changes will require significant health worker and patient education to increase the chances of successful implementation and improved patient outcomes.…”

Perceptions and Experiences of School Teachers During the Implementation of a School-Based Deworming Activity in Kenya

“…The Ministry of Health and Welfare in India recommended using a mix of media sources that are culture-specific or most effective in the local context, such as print media, posters and newspapers, radio, public announcements, or television. 26 Odhiambo et al 27 reported that more involvement of local community leaders who are respected in the community is also encouraged as they play a pivotal role in sensitising the community and can lead to increased ownership and acceptability of the programmes. Similarly, results of the present study demonstrate that teachers highly recommend the use of media sources (posters, radio, public announcements and television) and local leaders through village meetings (barazas) to sensitise community members on deworming activities.…”