AFRTCAN PROGRAM FOR oNcHocERcIASIS CONTROL (APOC)

YEAR 4 ANNUAL REPORT ON

COMMLTNITY DIRECTED TRE,ATMENT WITHIVERMECTN (cDrI)

Legend Oncho Endemic LGAs

Not Oncho Endemic LGAs ).Itu

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2003. For lnformatlon ! io,Ir[. ! fi ii;iii lieii I t Ap t I ! EXECUTIVE SUMMARY

Borno State of Nigeria is located at the northeastern part of the country and shares international border with Cameroon, Chad and Niger. The State has two vegetation zones, the arid - desert zone in the northern half and grassland savannas in the south, suitable for breeding of the Black fly - the vector for transmission of Onchocerciasis.

The State has a population of 3.5 million people (projected from 1991 National

Census figures), 27 Local Government Areas (LGAs) and twelve of these

LGAs are Onchocerciasis endemic (5 hyper and 7 meso). The total population of the endemic LGAs is 1,047,909 people.

The Project during the period between April 2002 and May 203 have been able to treat 589,183 people with 1 ,630,978 tablets of Mectizan. With this,

760/o and 99% therapeutic and geographical coverage have been achieved.

I BORNO STATE

Year 4 Annual eoort on CDTI lmplementatio in Borno State

SECTION I:

1. BACKGROUND INFORMATION

Borno State of Nigeria is located in the northeastern part of the country. lt shares lnternational Border with Niger and Chad in the north and Cameroon in the east, Adamawa State in the Southeast, Gombe in the South and Yobe State in the West. The total land mass area of the State is 69,436.sq. km.

The State has two notable vegetational zones with the grassland savanna in the southern half and Sahel desert zone in the northern half. Onchocerciasis is endemic in the southern half, which is endowed with seasonal and perennial fast flowing rivers; that make the land suitable for agricultural activities, and also breeding sites for black fly - (Simulium damnosum species), the vector for river bllndness.

The State has two seasons, the dry and wet seasons. The raining season begins in late May and ends in early October when the dry season commences until mid May. The average rainfall in the State is 760mm. The wettest period is around August, September and the driest months being January, February and March with humidity as low as 12%.

The total population of Borno State is 3.5 million people (projected from the 1991 National Population Census results), with over 80% of the people living in the rural communities. There are 27 Local Government areas (LGAs) and 12 of these LGAs are Onchocerciasis endemic (5 Hyper and 7 Meso endemic). The endemic LGAs have a total population of 1,047,909 people who are invariably at the risk of infection.

The project initially covered 10 LGAs, but has expanded to 12 LGAs with the addition of two LGAs i.e. Kala Balge and Bama in the 3'd year treatment cycle.

Before the commencement of CDTI in June 1999, the State Onchocerciasis Control Programme had covered only 523 communities with the Mectizan drug. Presently the programme has expanded geometrically to a total of 1,191 communities.

2 SECTION 2:

IMPLEMENTATION OF CDTI

Table 1 below provides the break-down of communities covered with the CDTI activities.

Table l: Number of Endemic Communities

S/n DistncULGA Hyper- Meso Communitres under Communities Treatment Endemrc Endemic treatment before rncluded under Round APOC APOC

1 BIU 129 90 39 7 2 118 82 36 7 3 SHANI 116 50 66 7 4 KWAYA-KUSAR 84 53 31 7 5 BAYO 101 38 63 7 6 80 47 14 7 7 121 8 104 7 8 89 50 39 7 9 DlKWA 70 70 4 10 ASKIRA UBA 141 77 64 7 11 BAMA 83 83 3 12 KALA BALGE 68 68 3 TOTAL 548 652 523 677

The project is yet to achieve IOOYo geographical coverage.

3 TR/AINING OF THE DIFFERENT LEVELS OF STAFF INVOLVED IN CDTI IMPLEMENTATION

Most of the trainings conducted were targeted for replacement of project personnel who have left or in those areas where stafl were weak. The breakdown is as contained in the table below:

Table ll: Traininq at Various Levels s/N DistncULGA #oI # of TOT LOCTs PHC Staff # of CDDs Trained Trarnrng Trained undertake SOCTs n Tarqet trarned Target Trained Tarqet Trarned

1 BIU 4 4 4 16 15 162 159 2 HAWUL 4 4 4 16 15 198 194 3 SHANI 4 4 4 15 14 203 200 4 KWAYA-KUSAR 4 4 4 15 14 48 45 5 BAYO 4 4 4 15 14 118 115 6 DAMBOA 4 4 4 15 15 114 110 7 GWOZA 4 4 4 15 15 124 121 8 ASKIRA-UBA 4 4 4 15 15 146 143 9 CHIBOK 4 4 4 15 14 87 84 10 4 4 4 15 14 73 70 11 BAMA 4 4 4 15 15 153 150 12 KALA BALGE 4 4 4 15 14 124 126 TOTAL 4 I 48 48 183 174 1,550 1,5O7

Table Ill: Mobilization And Education Of Tarqet Communities

Mobilization and Health education was concentrated and intensified on communities where their response towards the support of CDTI activities have been low. This was done through the use of the following methods:

a Production of more l.E.C. materials and distribution of same to the endemic communities.

o Training of CDTI personnel on principles of effective mobilization

a Having regular advocacy workshops with the stakeholders

o lnvolvement of Community Based Organization and Religious groups in the mobilization of community members.

1 Details of the activities is as shown in Table lll below.

# of MOH # of NGDO Staff S/n District/LGA #of # of CommA/rllages which # of advocacy CommA/illag recetved H.E. about Visits to State or Staff rnvolved tn es Mobtlzed importance of Extended Regtonal rnvolved in Mobilzation Treatment Directors of Mobiltzation Health 2 1 BIU 129 129 5 2 2 HAWUL 118 118 5 2 2 3 SHANI 116 116 5 2 2 4 KWAYA-KUSAR 84 84 5 2 2 5 BAYO 101 101 5 2 2 6 DAMBOA 71 71 5 2 2 7 GWOZA 121 121 5 2 2 8 ASKIRA-UBA 141 141 5 2 2 9 CHIBOK 89 89 5 2 2 10 DIKWA 70 70 5 2 2 11 BAMA 83 83 5 2 2 12 KALA BALGE 68 68 5 2 2 TOTAL 1 ,191 1,191 60 24 24

SECTION 3:

ACHI MENTS

The details of the treatment according to LGAs and drugs used is hereby presented in table lV below: Table lV: TREATMENT SUMMARY FOR 2003

S/N LGAs Communities Total Census No. of People No of Tablets Population People Trealed Used Eliqible

1 BIU 129 57,981 49,556 47,164 127,405 2 DAMBOA 71 58,861 51 ,1 36 49,839 127,167 3 GWOZA 121 99,947 82,601 92,137 252,832 4 HAWUL 118 150,255 114,383 112,881 308,676 5 SHANI 116 56,656 42,0O1 34,444 92,038 b KWAY-KUSAR 84 34,902 28,845 25,650 64,648 7 CHIBOK 89 41,893 34,623 31,567 84,320 8 ASKIRA-UBA 141 77,996 64,460 60,070 190,774 9 BAYO 101 50,490 41,728 41,271 104,066 10 DIKWA 70 35,335 17,902 17,433 46,744 11 BAMA 83 87,569 78,703 75,837 201,225 12 KALA BALGE 68 22,162 11,272 10,890 31,083 TOTAL 1,191 774,047 617,216 589,183 1,630,979

_5 a The Annual Treatment Objective (ATO) for the year was to treat 685,080. o A total number of people treated was 589,183 with 1,630,978 Mectizan tablets.

a Therapeutic coverage rate No. of P e Treated x 100 Total Population

589,183 x 100 774,O47

760/0

a Geographical coverage = No. of Communities Treated x 100 Targeted Communities

1.191 x 100 1,200

99%

6 COMMUNITY SELF.MONITORING lmplementation of Community-Self Monitoring have commenced in the project During the first phase 8 SOCTs, 16 LOCTs in four LGAs; 100 bommunity Monitors in 25 communities were trained. The reports of exercise carried out in the communities are yet to be compiled. The tables shown below presents the trainings, which have been carried out.

COMMUNITY SE F.MONITORING

Table V: Number of Health Staff Trained in CSM in 2002 and 2003

Districts/LGAs 2002 2003 BIU 4 HAWUL 4 BAYO 4 SHANI 4 TOTAL 16

Table Vl Name of Number of Cornmunities No. of No. of Monitors DistricULGAs Communities Planned for CSM Cornrnunities Selected by Under CDTI 2003 where GSM was Communities and lmplemented 2003 Trained (Partial Result) BIU 129 65 5 25 HAWUL 118 59 5 25 BAYO 101 51 5 25 SHANI 116 58 5 25 TOTAL 464 233 25 100

7 5. STRENGTHS:

a. COM M U NITY PARTICIPATION : . Some communities have increased their support to CDDs. o lmplementation of community self-monitoring have encouraged those community members to have a sense of belonging, which has led to increased awareness and commitment to the programme'

b. SUSTAINABILITY: The State Government has continued to show its commitments by prompt release of counterpart financial contribution.

c. LOGISTICS: o HKI continued to support the project with logistics during programme activities o The Statement have purchased additional vehicle and repaired one of the vehicles and two motorcycles left to them by Africare.

6. WEAKNESS

a. LGAS CONTRIBUTION: lrregular or non-counterpart financial contribution by LGAs has led to adequate transport for supervision by LOCTS.

b CDDs SUPPORT: Some communities are still not willing to support their CDDs. This resulted to CDDs attrition.

7 STATE GOVERNMENT CONTRIBUTION: The State Government through the MOH have released the sum of two million Naira (N2 million) to the project as counterpart funding for the year 2002.

8 LOCAL GOVERNMENT COUNCILS: Even though some of the PHC Co-ordinators are more involved in CDTI activities at the LGA and community levels, it is not appreciable as it should be. There is need for more advocacy visit to solicit their support.

I CDDs PERFORMANCE CDDs are getting better informed of their tasks. This is shown by their level involvement in mobilization of community members; dosing; recording and reporting.

tt 10 COM M U NITY PARTICIPATION : porting their CDDs. The religious and other Community Based Organizations are fully involved in the mobilization of their members.

11 MAJOR ACHIEVEMENTS: o Mobilization/education of 1 ,191 communities for Mectizan uptake. o Training of 1,749 programme personnel on CDTI. o Technical, Material and financial support by Helen Keller lnternational. o Treatment of 589,183 out of 617 ,216 eligible population . VA supplementation using CDTI as a vehicle.

12 CONSTRAI NTS/C HALLENG E a There is still the need for continuous training to fill in for the CDTI personnel who have left.

a lnadequate logistics and remuneration of LocTs by some LGAs

a lncreased level of insecurity due to arm banditry in the project areas.

a Non-release of counterpart funds by the State and endemic LGAs for the 2OA2 treatment year.

() BORNO STATE CDTI PROJECT

YEAR 4 PLAN OF ACTIVITIES FOR 2003.

April May Jun July Aug SeP Oct Nov Dec S/n Activity Jan Feb Mar

1 State review meeting

2 Organization of Sta keholders meeting

3 Training of SOCTs/LOCTS in Commut Self Mon S 4 Community Mobilization/Public Awareness cam 5 Training/Re-training of CDDs

6 Up-date Community Registration

7 Community Self Monitoring

I Distribution

9 Monitoring and SuPervision

10 Collection and Collation of Treatment Re 11 Analysis of the Reports

12 ZOTF Meeting

13 APOC Quarterly

14 APOC Six Months RePorts

15 APOC Annual RePorts

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