Traditional kinship system enhanced classic community-directed treatment with ivermectin (CDTI) for onchocerciasis control in Uganda

Abstract

The challenges of community-directed treatment with ivermectin (CDTI) for onchocerciasis control in Africa have been: maintaining a desired treatment coverage, demand for monetary incentives, high attrition of community distributors and low involvement of women. This study assessed how challenges could be minimised and performance improved using existing traditional kinship structures. In classic CDTI areas, community members decide upon selection criteria for community distributors, centers for health education and training, and methods of distributing ivermectin. In kinship enhanced CDTI, similar procedures were followed at the kinship level. We compared 14 randomly selected kinship enhanced CDTI communities with 25 classic CDTI communities through interviews of 447 and 750 household members and 127 and 64 community distributors respectively. Household respondents from kinship enhanced CDTI reported better performance (P<0.001) than classic CDTI on the following measures of program effectiveness: (a) treatment coverage (b) decision on treatment location and (c) mobilization for CDTI activities. There were more female distributors in kinship enhanced CDTI than in classic CDTI. Attrition was not a problem. Kinship enhanced CDTI had a higher number of community distributors per population working among relatives, and were more likely to be involved in additional health care activities. The results suggest that kinship enhanced CDTI was more effective than classic CDTI.

Strengthening Malaria Service Delivery through Supportive Supervision and Community Mobilization in an Endemic Indian Setting: An Evaluation of Nested Delivery Models

“…These findings are consistent with the evidence from similar Asian and African settings about leveraging local capacity to ensure sustainability of community health approaches [34]. The thrust of the intervention was to identify and empower local stakeholders especially CBOs and women's groups on building up social trust, cohesion, support, mutual capacity building and thereby improving positive health-seeking behaviour [35,36]. Locally constituted women's groups are wellpoised to be cost-effective and sustainable change makers for community mobilization and gradual behaviour changes [30,31,33].…”

Synergies, strengths and challenges: findings on community capability from a systematic health systems research literature review

“…Traditionally, the social and legal systems in Ugandan communities restrict women from individually providing services beyond their families. In a community-directed treatment intervention with ivermectin, women covered a large area beyond their kinship, which put them in conflict with social legal systems, jeopardized their reputation and limited participation [74]. …”

“…Cohesiveness, a measure of community’s motivation and willingness to stay together as a group was discussed in a handful of articles [19, 22, 31, 53, 55, 58, 69, 74, 75]. A sense of serving ones’ community led to highly motivated community volunteers [34, 50, 64, 67].…”

“…A sense of serving ones’ community led to highly motivated community volunteers [34, 50, 64, 67]. In a community-directed treatment intervention with ivermectin in Uganda, community-drug distributors selected from kinship networks viewed their responsibilities in serving other kinsmen as a moral obligation [74]. …”

“…Efficacy, defined as the factors that enable communities to work together, was infrequently discussed and was mentioned in only 7 of the 64 articles discussing rich community participation related to service delivery and governance [31, 52, 57, 69, 74, 76, 77]. Key institutional processes that were supportive of efficacy that were described included how communities informally conducted meetings at specific intervals to identify problems, discuss health plans and implement programmatic decisions, and often formed local councils, boards, committees or other types of groups to support community participation.…”