A mixed methods approach to evaluating community drug distributor performance in the control of neglected tropical diseases

Fleming, Fiona; Matovu, Fred; Hansen, Kristian Schultz; Webster, Joanne P.

doi:10.1186/s13071-016-1606-2

Cited by 38 publications

(85 citation statements)

References 34 publications

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“…The need for integrating these individuals into the primary health care (PHC) system has already been highlighted, specifically in onchocerciasis programmes [ 21 ]. Nevertheless, the role of CHWs in delivering health services has not been addressed adequately [ 22 , 23 ], creating further obstacles to NTD elimination efforts.…”

Section: (Main Text)mentioning

confidence: 99%

Neglected tropical diseases: exploring long term practical approaches to achieve sustainable disease elimination and beyond

Ortu

Williams

2017

Infect Dis Poverty

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BackgroundRemarkable progress has been made in the fight against neglected tropical diseases, but new challenges have emerged. Innovative diagnostics, better drugs and new insecticides are often identified as the priority; however, access to these new tools may not be sufficient to achieve and sustain disease elimination, if certain challenges and priorities are not considered.Main bodyThe authors summarise key operational challenges, and based on these, identify two major priorities: strengthening the capacity of the primary health care health system in correctly diagnosing and managing neglected tropical diseases; and establishing an effective disease surveillance process.Five steps are proposed as concrete actions to build an effective primary health care service for neglected tropical diseases, and a health management information system capable of accurately reporting these diseases. Community engagement and formalization of community health workers role are proposed as essential components of these steps.Shift of financial support from disease oriented programmes to disease integrated interventions, improved access to international guidelines for primary health care staff, and availability of donated drugs in health care structures are also suggested as key elements of the proposed process.ConclusionThe authors conclude that failure to address these priorities now may lead to further challenges on the long path towards neglected tropical disease elimination and beyond.Electronic supplementary materialThe online version of this article (doi: 10.1186/s40249-017-0361-8) contains supplementary material, which is available to authorized users.

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Section: (Main Text)mentioning

confidence: 99%

Neglected tropical diseases: exploring long term practical approaches to achieve sustainable disease elimination and beyond

Ortu

Williams

2017

Infect Dis Poverty

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“… 30 CDDs are a critical bridge between the community and health programmes. 31 They have underused tacit knowledge about the challenges, opportunities and concerns of different community members with respect to MDA, and how these are shaped by gender and other axes of marginality. Creating forums through which CDDs can share their experiences has the potential to strengthen the responsiveness of NTD programmes and ensure that programmes are adaptable to the realities that community members face.…”

Section: Introductionmentioning

confidence: 99%

20 years of gender mainstreaming in health: lessons and reflections for the neglected tropical diseases community

et al. 2017

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Neglected tropical diseases (NTDs) affect the poorest of the poor. NTD programmes can and should rise to the challenge of playing a part in promoting more gender equitable societies. Gender equity shapes poverty and the experience of disease in multiple ways; yet to date, there has been little attention paid to gender equity in NTD control efforts. Drawing on a synthesis of relevant literature, the tacit knowledge and experience of the authors, and discussions at a meeting on women, girls and NTDs, this analysis paper distills five key lessons from over 20 years of gender mainstreaming in health. The paper links this learning to NTDs and Mass Drug Administration (MDA). Our first lesson is that tailored gender frameworks support gender analysis within research and programming. We present a gender review framework focusing on different MDA strategies. Second, gender interplays with other axes of inequality, such as disability and geographical location; hence, intersectionality is important for inclusive and responsive NTD programmes. Third, gender, power and positionality shape who is chosen as community drug distributors (CDDs). How CDDs interact with communities and how this interface role is valued and practised needs to be better understood. Fourth, we need to unpack the gender and power dynamics at household level to assess how this impacts MDA coverage and interactions with CDDs. Finally, we need to collect and use sex disaggregated data to support the development of more equitable and sustainable NTD programmes.

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“…The study does not address the old and intense debate regarding payment of CDDs as a means to improve performance. 28,29 Increasing the transport reimbursement-without increasing the number or quality of CDDs-did not seem to improve coverage. Perhaps this measure was deployed too late to generate more or better CDDs and insufficient to overcome other weaknesses in the program.…”

Section: Discussionmentioning

confidence: 96%

Evaluation of Treatment Coverage and Enhanced Mass Drug Administration for Onchocerciasis and Lymphatic Filariasis in Five Local Government Areas Treating Twice Per Year in Edo State, Nigeria

Griswold

Eigege

Ityonzughul

et al. 2018

The American Journal of Tropical Medicine and Hygiene

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The western region of Edo state in southern Nigeria is highly endemic for onchocerciasis. Despite years of mass drug administration (MDA) with ivermectin (IVM), reports suggest persistently high prevalence of onchocerciasis, presumably because of poor coverage. In 2016, twice-per-year treatment with IVM (combined with albendazole for lymphatic filariasis in the first round where needed) began in five local government areas (LGAs) of Edo state. We undertook a multistage cluster survey within 3 months after each round of MDA to assess coverage. First-round coverage was poor: among 4,942 people of all ages interviewed from 145 clusters, coverage was 31.1% (95% confidence intervals [CI]: 24.1-38.0%). Most respondents were not offered medicines. To improve coverage in the second round, three LGAs were randomized to receive MDA through a "modified campaign" approach focused on improved supervision and monitoring. The other two LGAs continued with standard MDA as before. A similar survey was conducted after the second round, interviewing 3,362 people in 87 clusters across the five LGAs. Coverage was not statistically different from the first round (40.0% [95% CI: 31.0-49.0%]) and there was no significant difference between the groups ( = 0.7), although the standard MDA group showed improvement over round 1 ( < 0.01). The additional cost per treatment in the modified MDA was 1.6 times that of standard MDA. Compliance was excellent among those offered treatment. We concluded that poor mobilization, medicine distribution, and program penetration led to low coverage. These must be addressed to improve treatment coverage in Edo state.

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A mixed methods approach to evaluating community drug distributor performance in the control of neglected tropical diseases

Cited by 38 publications

References 34 publications

Neglected tropical diseases: exploring long term practical approaches to achieve sustainable disease elimination and beyond

Neglected tropical diseases: exploring long term practical approaches to achieve sustainable disease elimination and beyond

20 years of gender mainstreaming in health: lessons and reflections for the neglected tropical diseases community

Evaluation of Treatment Coverage and Enhanced Mass Drug Administration for Onchocerciasis and Lymphatic Filariasis in Five Local Government Areas Treating Twice Per Year in Edo State, Nigeria

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