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School-Based Deworming in Oyo State, Nigeria Process Monitoring and Coverage Validation Report October 2018 Round

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School-Based Deworming in Oyo State, Nigeria Process Monitoring and Coverage Validation Report October 2018 Round School-based Deworming in Oyo State, Nigeria Process Monitoring and Coverage Validation Report October 2018 Round April 2019 Contents Acknowledgement........................................................................................................................ 2 Glossary ....................................................................................................................................... 2 1.0 Executive summary ...........................................................................................................3 2.0 Introduction ..................................................................................................................... 4 3.0 Methodology........................................................................................................................ 4 4.0 Results ................................................................................................................................ 6 4.1 Review of teacher training ................................................................................... 6 4.2 Deworming Day assessment ....................................................................................... 8 4.3 Community sensitization ........................................................................................ 11 4.4 School hygiene facilities .................................................................................... 13 4.5 Coverage Validation ................................................................................................. 13 5.0 Lessons Learned .............................................................................................................. 17 5.1 What worked well ........................................................................................................ 18 5.2 What needs to improve ............................................................................................. 18 Acknowledgement Evidence Action acknowledges the organizational and logistical support provided by Oyo state's Neglected Tropical Diseases (NTD) Unit of the State Ministry of Health (SMoH), State Ministry of Education, Science and Technology, and State Universal Basic Education Board (SUBEB). The contribution of all other program stakeholders to the generation of this report, including Infotrak Research and Consulting, are highly appreciated. Glossary FLHF. Frontline health facility PC. Preventive chemotherapy FMOH. Federal Ministry of Health SAE. Severe adverse event LGA. Local government area SPHCB. State Primary Healthcare Board MDA. Mass drug administration STH. Soil-transmitted helminths NTD. Neglected tropical disease WHO. World Health Organization 2 1.0 Executive summary In October 2018, Oyo state’s Neglected Tropical Diseases (NTD) Unit under the State Primary Healthcare Board (SPHCB) within the State Ministry of Health (SMoH) carried out the second round of school-based deworming of children aged 5-14 in 13 of 33 local government areas (LGAs), according to endemicity for soil-transmitted helminths (STH). In total, 4,435 public and private primary and junior secondary schools were targeted for treatment. To assess the effectiveness of implementation and identify areas for improvement, Evidence Action designed data collection tools and a sampling method to observe and measure the quality of teacher training and deworming activities, and implemented coverage validation to affirm the treatment results reported by head teachers. Through a competitive selection process, Evidence Action recruited an independent firm, Infotrak Research and Consulting, to collect data from a sample of 51 teacher trainings, 67 schools, and 67 communities participating in school-based deworming. Prior to deworming, teachers were trained to administer safe and effective STH treatment (mebendazole). Infotrak monitors observed 51 teacher training sessions, and found that required training materials were handed out in over 90% of trainings, except for the severe adverse event (SAE) protocol, which was given in 63% of trainings. Eight of the nine topics were completely covered in at least 80% of the trainings. Attendance at trainings stood at 66% of the expected attendees; most of those who did not attend cited late or lacking communication of the event details. Some trainers conducted mop-up trainings in the days leading up to the deworming exercise to ensure that more teachers were trained in preparation for MDA. On Deworming Day, monitors visited schools and found that teachers adhered to the majority of the key mass drug administration (MDA) procedures; 98% of teachers were seen administering the correct dosage of mebendazole, and use of the treatment registers was noted in 85% of schools. Overall awareness of Deworming Day was generally high (88%); albeit slightly higher among the parents of enrolled children (91%) than those of non-enrolled children (84%). This, combined with the fact that the majority of parents (90%) indicated that they would send at least one of their children for deworming, attests to the effectiveness of the sensitization messages in reaching and influencing their intended recipients. Parents’ key sources of deworming information were the child (51%) and the radio (44%). Coverage validation was conducted in two randomly selected LGAs, Afijio and Iseyin. Both LGAs were found to have surveyed coverage (children who reported having swallowed the drugs) of 68%, lower than the World Health Organization’s (WHO) recommended target of 75%. The reported coverage (Afijio - 82%, Iseyin - 86%) from head teachers was therefore not validated by the surveyed coverage, an indication that the population denominator might need to be revised or that reported treatments may have been inflated. The program reach (children who were offered the drug) in Afijio and Iseyin was 72% and 70% respectively. A 3 disaggregation by enrollment status revealed a lower program reach for the non-enrolled population (58% in Afijio, 49% in Iseyin) as compared to the enrolled (72% in Afijio, 73% in Iseyin). A large proportion of children who were not offered the drugs cited that a distributor did not come to the deworming venue (56% in Iseyin and 32% in Afijio) or the unavailability of the child on deworming day (18% in Iseyin and 21% in Afijio). 2.0 Introduction Parasitic worm infections, such as STH and schistosomiasis, interfere with children’s nutrient uptake, causing anemia, malnourishment, and impaired mental and physical development. These symptoms pose a serious threat to a child’s health, education, and economic potential. Infected children are often too sick or tired to concentrate in school, or to attend at all. Parasitic worms also pose a massive threat to human capital, hindering schooling and economic development in parts of the world that can least afford it. School-age children typically harbor the highest intensity of infection from STH and schistosomiasis, and therefore the WHO and Nigeria’s Federal Ministry of Health (FMoH) recommend large-scale school-based deworming to control these diseases. Evidence Action provides technical support to several Nigerian state governments working to eliminate the public health threat of worms through school-based deworming. In October 2018, the Oyo State NTD Unit, under the SPHCB of the SMoH, conducted the second round of statewide school-based deworming in 13 LGAs in the state according to their endemicity for STH. A mop-up treatment day was scheduled two days after the Deworming Day to treat children who were sick, on medication, or unavailable on Deworming Day to receive treatment. Enrolled and non-enrolled children aged 5-14 received mebendazole in both public and private primary and junior secondary schools. Teachers received a one-day training to properly administer the safe and effective tablets. Independent monitoring was conducted to identify any challenges arising in the implementation of deworming, as well as to inform the program on areas of improvement in future deworming rounds. Coverage validation was also conducted to validate the treatment data reported by head teachers. 3.0 Methodology Infotrak recruited a total of 76 monitors and 10 supervisors, using pre-defined criteria, to monitor a random sample of 51 teacher training sessions and 67 schools where deworming took place. Evidence Action rigorously trained monitors in two batches for three days each from October 8 – 13, 2018. The curriculum covered an overview of the NTD program, with emphasis on school-based deworming, the basics of conducting a survey/administering a questionnaire, paper and electronic survey tools, field logistics, and data collection protocols. All participants took both pre and post-training tests to ensure they fully understood their roles, and to determine the level of knowledge attained during training. Only participants who scored at least 70% in the post-test were selected for the monitoring exercise. 4 Prior to Deworming Day, teachers from all 4,435 targeted schools received a one-day training on MDA, conducted by the LGA team (education secretaries, frontline health facility (FLHF) staff, NTD coordinators), who had been trained by the state level master trainers. To assess the quality of teacher training, as well as the implementation of deworming, Evidence Action used stratified sampling to randomly select 51 of the 199 teacher training sessions, and 67 of the 4,435-targeted schools for observation by independent monitors. The sample size was determined to ensure a 90% confidence level
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