Maintaining effective mass drug administration for lymphatic filariasis through in-process monitoring in Sierra Leone

Abstract

BackgroundSince 2007 Sierra Leone has conducted mass drug administration (MDA) for the elimination of lymphatic filariasis (LF) implemented by unpaid community health volunteers (CHVs). Other health campaigns such as Mother and Child Health Weeks (MCHW) pay for services to be implemented at community level and these persons are then known as community health workers (CHWs). In 2010, the LF MDA in the 12 districts of the Southern, Northern and Eastern Provinces un-expectantly coincided with universal distribution of Long Lasting Insecticide Treated Nets (LLITNs) during the MCHW. In-process monitoring of LF MDA was performed to ensure effective coverage was attained in hard to reach sites (HTR) in both urban and rural locations where vulnerable populations reside.MethodsIndependent monitors interviewed individuals eligible for LF MDA and tallied those who recalled having taken ivermectin and albendazole, calculated program coverage and reported results daily by phone. Monitoring of coverage in HTR sites in the 4 most rapidly urbanizing towns was performed after 4 weeks of LF MDA and again after 8 weeks throughout all 12 districts. End process monitoring was performed in randomly selected HTR sites not previously sampled throughout all 12 districts and compared to coverage calculated from the pre-MDA census and reported treatments.ResultsOnly one town had reached effective program coverage (≥80%) after 4 weeks following which CHWs were recruited for LF MDA in all district headquarter towns. After 8 weeks only 4 of 12 districts had reached effective coverage so LF MDA was extended for a further month in all districts. By 12 weeks effective program coverage had been reached in all districts except Port Loko and there was no significant difference between those interviewed in communities versus households or by sex. Effective epidemiological coverage (≥65%) was reported in all districts and overall was significantly higher in males versus females.ConclusionsThe challenges to LF MDA included the late delivery in country of ivermectin, the availability and motivation of unpaid CHVs, concurrent LLITN distribution and the MCHW, remuneration for CHWs, rapid urbanization and employment seeking population migrations. 'In process' monitoring ensured modifications of LF MDA were made in a timely manner to ensure effective coverage was finally attained even in HTR locations.

Effectiveness of a Pre-treatment Snack on the Uptake of Mass Treatment for Schistosomiasis in Uganda: A Cluster Randomized Trial

“…However, even in the presence of a snack, more than a third of the children in the snack group reported to have experienced the side effects. A comparable proportion of children experiencing similar side effects after taking praziquantel with a snack was reported in Ghana (28%), Tanzania (31%) [48], and in Sierra Leon (30%) [50]. The probable explanation for the occurrence of side effects even when the drug is taken with food is the presence of moderate intensity of schistosomiasis infection among the children before treatment.…”

A systematic review of factors that shape implementation of mass drug administration for lymphatic filariasis in sub-Saharan Africa

“…Dembele et al, 2012 [37]/Mali/2005–2011Integrated NTD control programme reportNationalTo report on the progress made by the integrated national NTD control programme in Mali, drawing from objectives achieved, documented experiences and pertinent lessons learned of the program from 2007 to 2011, and focusing on only aspects of integrated MDA activities.For the long-term sustainability, NTD programmes require to be integrated into primary healthcare systems at local level.Delays in drugs reaching the country resulted in MDA postponement, which not only increased the difficulty in the campaign but also minimized the impact of MDA.Local collaborations with the African Programme for Onchocerciasis Control (APOC) and the Onchocerciasis Control Programme (OCP) was essential to sustaining the Mali NTD integration programme.Achieved Improved national geographical coverage achieved for LF from 25% in 2006 to 100% in 2009.Community participation, programme sustainability and coverage9. Hodges et al, 2012 [23]/Sierra Leone/June 2010–2011Programme evaluation11,824 participants interviewed in the end process evaluation of hard to reach (HTR) sites.(Urban and rural settings)12 districts and 4 large towns from southern, eastern and northern provinces.To identify the challenges to effective mass drug administration implementation for LF and the corrective measures taken.Challenges affecting MDA for implementation included: late country delivery of ivermectin, the availability and motivation of unpaid CHVs, remuneration for CHWs, rapid urbanization and employment seeking population migrations.‘In process’ monitoring ensured modifications of LF MDA were made in a timely manner to ensure effective coverage was finally attained in HTR locations.Community participation and Coverage10. Njomo1 et al, 2012 [24]/Kenya/December 2008Mixed- method studyQuantitative data: 965 household heads or adult representatives.…”

“…West and East AfricaGhana, Kenya, Mali, Nigeria, Sierra Leone and TanzaniaInvolvement of key health systems representatives and local leaders in health education. ( n  = 7) [22, 23, 25, 34, 36, 37, 41]. West and East AfricaGhana, Kenya, Mali, Sierra Leone and Tanzania.Selection, training and financial incentives provided to CDDs ( n  = 5) [22, 25, 34, 35, 37, 45], and provision of mobile phones and other forms of motivation [45] ( n  = 1) …”

“…Use of traditional leadership and community structures for health education programmes in rural areas was essential for achieving maximum community participation [22, 25, 34]. Involving the community and local structures in MDA for LF programme implementation activities created a sense of ownership by the communities resulting in higher levels of participation. Innovative and locally relevant means to conduct health education The use of innovative, locally relevant and context specific strategies by community led health education programmes facilitated implementation of MDA for LF [22, 23, 36, 37]. A study from Sierra Leone showed that use of innovative and more “modern” sensitization approaches such as the recurrent dissemination of information on frequently asked questions (FAQs), community radio stations (as platforms for phone-ins, text messaging and chatting with LF experts) as well as use of social media, enabled the reaching of individuals and institutions that had otherwise been unaware of MDA for LF [22].…”

“…Two Nigerian studies further reported that conducting knowledge attitude and practices (KAP) surveys enabled the LF programme to design target specific, responsive and widely accepted IEC materials [36, 42]. Other benefits included being able to incorporate local understandings and terminologies of LF related conditions on the IEC materials. Partnerships and collaborations Partnerships and collaborations were essential for sustained and successful implementation of MDA for LF [22, 23, 36, 37, 40, 42, 43]. One of the main reasons for a successful MDA for LF programme in Togo, despite limited resources and political challenges, was formation of strategic international partnerships with institutions like the United States’ Center for Disease Control and Prevention (CDC), Health Development International (HDI) and the Department for International Development (DfID) [39].…”