AFRICAN PROGRAM FOR ONCHOCERCIASIS CONTROL (APOC)

YEAR l REPORT ON

COMMT]NITY DIRECTED TREATMENT WITHIYERMECTIN (cDrr) I

L. ,i Action lo:

-l c t ,r.9,, c!,r, ,.i. ' ";-'t' t 't _'t \ , ('f l r A,i ,' / )-l €ri+ j,/.8.$o For lnformotlon To, ;r p

JUNE, 1999 TO MAY , 2000.

on the 1. BAqKGRo:**D#?ilXl#IStonsola State in August leel is located Adamawa State, crt northeastern Part of ' llyzo and 14 !/ao East:' 7o 28r and 10o 551 and longitude The State "lies between latitude ^gtttteg TherearelllocalGovernmentCouncilareas(LGAs).TheStatelieswithintwonotabletfi"" a1a spafe trees in the the sub-SuOon Su'unnatr *itf' rhe vesetational zones, ,iirQ ;'itn in the southern zone' nolth.rn part and,i,.'E i"r*"S.;;".h where three major rivers along the camerooniui-iora","rl^9fi;;t presence of few d;J;;ntains 'l"t"i;ffi';,t* These with has given th, .watercourses for and have their sources ji"ri,r," .ntiir"trd;"* luna ur.u into arable place traversed and.turriJ their tributaries have Damnosum' breeding sites for the Similium agriculturat activitill ;;;;" The rainy season begins in the dry and the rainy seasons. The state has two main seasons, tsq in the northern parts and ;,* l%i*.;;;1f4i'"; wettest April and ends in ;il'b;i;t* and" Toungo LGAs' The in the southern part, parti^cyiarif?i"rq fanye The dry l0l lmm rainfalls' *"lLugutt aid' September' signify the perio-d of ftJni"'t January and months, which oo"urr? ooJi, *i tt th; ;#J months being season starts rror,r'iti" "ro'oi il;",y when humidity is as low as l3o/o' groups Their rural cultures' languages and dialect State is multi-ethnic with varied not along socro- The ,utJriitJ'grt"prl*f,ich are often than settrements are in large and ,.un cultural, and language lineage' together by their natural hospitality, diversity the peopre are still bound Despite this apparent tgi'''on languages Hausa and d; St'te and ft* 'like as political/administrati"vl'r,."iur. "fff i' il ii to E;;lish' wtrictr has been adopted Fultude which are widely spoken. "Jiition tft" off,"i"f medium of communication' State' There are nine hyper- in 17 out of the 2l LGAs in the onchocerciasis is prevalent Meso-endemic LGAs only endemic LGAs' In some endemic LGAs and eight Meso "i'ttt i.* t.uuY foci have been noticed' with onlynine(9)LGAsoutofthelTLGAsarepresentlyenjoyingthesupportofAfricanth. p.ogrun,it ii, tri" State of expansion program ro, on"t o."r.l"ri, control. Ho*"n.., area with *t'i'f' has almost t"J"a every endemic the Mectizan Distribution Prograr, Mectizan drug in this treatment season'

Approximately|,364communitieswerereceivingMectizantreatmentbeforeAPOCuno", Mectizan Treatment has in. The ,rJ; oi.oroo'uniti.r assistance started coming and CDTI implementafion the AP6c rrpp"n.. T]rlsupport now increased to 2,6i6'6ril*ing the State who were earlier I I M;; Bnatti" LGd of - have been extended toit r",,uiiing " Treatment approach. on using Co mmu nit,"ilJ irermeitin

I 2 Trcrtmcnt undcr Mcso Endemlc h APOC Round Endcmlc Trcrbncnt bcforc includcd S/N LGA Comrnunltlcs 7 213 161 7 I 189 189 4 2 HONG 105 280 7 3 SONG 107 ,, 80 4 61 61 6 5 95 95 6 6 138 138 4 7 GA}TYE 164 289 8 JADA 147 147 4 18 9 52 1 94 l0 94 2 11 104 104 I 98 l2 98 5 13 24 24 1 YOLA 100 l4 100 1 60 l5 60 2 98 16 98 l5r l&1 t7 630 15 TOTAL

3 #of #of #of #of #of #of CommJvll Commsflllleg #of Comms/Vllhgcs comms/Vlllegcs cs Comms/Vll ilccftlcd legcs wtth Prlng Commtlc Comrns/Yllh thet dccldcd on whlch CDDs ln Cash wftlch lages months tnlncd srYlllegcs gcs mclhod of on thc orklnd. thclr whlch thc CDDs sctcctcd Dtrtrlbu0on of Treatmcnt CDIh Collecttd I 6 1 161 1 6 I I 6 1 161 161 189 AGALI 161 189 189 1 MAD 189 189 189 189 280 280 2 HONG 280 280 280 280 280 80 80 3 SONG 80 80 80 80 61 80 61 6l 4 GOMBI 61 61 6l 6l 95 95 5 GIREI 95 95 95 95 138 95 138 138 6 138 138 289 138 138 289 289 7 GA].IYE 289 289 289 289 147 147 8 JADA 147 147 147 147 52 BELwA t47 52 52 9 MAYO 52 52 52 52 94 94 l0 94 94 94 94 104 94 104 104 ll 104 104 104 104 98 98 t2 98 98 98 98 24 98 24 24 l3 24 24 24 24 100 100 t4 100 100 100 100 60 100 60 60 15 GTIYIJK 60 60 60 60 98 98 DEMSA 98 98 l6 98 98 t7 98 TOTAL

2 by the participation and suppon_1o-gDDs has been an appreciabre community There bamako Initiative (CBBI) Committees' members through the.C^ommunity-Based in community There has been no much diffrculty which exist both at that I-GA and co.,rirriiyl;;;ir were already io the fact that the communities adopting .DTI implementation appro.;"d; in' r.tJirit g treatment before APOC came

1n.,..eabe113obilizedatotalof2070Communitiesto supplement the HKI n'iO ffff ptouiatd vehicles with the presence and support 9f "uff' logistics iequirement of the project' PHc staff and was by approaching the LGA process of community mobili zationadopted Traditional The who act as u glia". rfr'e paramoxnt invariabry tr,e lca 6"c'to io-ordirator community leaders p..ronlirno will sermT,in" subordinite Leader will be the next contact Ato used as a means of A."-io-face contact, town *"tL for briefing eprrt it, "ti;;; Based Bamako Initiative to the *L'U"t'' Coi'nunity getting information across "on,t.,nit, of communitv members' members were arso ir;d; il;;-;"bilization and committee include pootit' information brochure Materials used during the mobilization''*,-"i" Mobilization/llealth vroUiri'ation, r'au""tio' HKI Booklet on Corimunity "5"i'"u*tnt(rz1 LGAs as.against six LGAs was ."rii.a'o* in Seventeen Education of the communities were treated during the year (1g;;;. in" uoai ional l i l6es covered in the last treatment early Part ofthe Year'

of MOII -No ofNGDO AdvocecY Vtrlt to No. No. of ln strlf lnvolvcd ln No. of No. or Rcglonol StalT lnvolvcd s/ll rectlvcd IIE ebout Stete Moblllze6on Comm./ whlch of IIcalth rnoblllz,rtlon Importrnce of Extmdcd Dlrcctors Vlllegcs ) 2 1 98 98 2 I FUFORE 2 I 6l 6l 7 2 GIREI 2 J 280 280 3 SONG 3 2 80 2 4 GOMBI 80 3 2 161 z MADAGALI 161 , I 1 24 24 1 6 YOLA SOUTH 1 I 98 98 2 7 2 I 100 100 2 8 GUYUK 2 I 52 52 9 2 3 95 95 l0 TOUNGO 2 3 138 138 1l GA}IYE ) 3 289 289 t2 JADA ) 3 A 147 t47 13 MAYO BELw 2 J 60 60 l4 DEMSA 2 3 189 189 l5 HONG 2 3 104 104 l6 MICHIKA 2 3 94 94 t2 t7 MAIHA 2 39 TOTAL 2 se was satisfactory a. Mobilization exerci was evidenced bY the level of resPonded favorablY. This b. Most communities have Based Bamako to the The CommunitY communitY involvement and suPPort Programme. of fully involved in the mobilization and education Initiative Committee members were their communitY members'

3 LOGT members time for community mobilization' In order to address the issue of limited of c. six d";;i per health zone, comprising spent more time in the commuriti". a;;r;of 2 - 3 districts or 12 communtttes'

5 in the involved in the control of Onchocerciasis conducted for the various staff 44 Training was State Control Team Members, update workshoP for the seven State. These include an 2,068 CDDs for the next Supervisors (PHC level), and LGA Trainers, 225 District Health in the 17 LGAs. round of Mectizan distribution No. Trelnlng PHC Targetcd No. ofTOT No. Ccntcr No of Tralntng Workcrs CDDs Traincd s/I{ DISTRICT/LGA Tratncd Tralned Undcrtrkcn Traincd 81 74 2 I 4 I 8 I TOI.]NGO 124 trz 7 4 J 7 I 384 7 2 4 9 400 2 4 6 3 JADA 215 168 I 4 3 9 4 MAYO BELwA 50 47 6 2 2 6 2 8l 5 5 ) 2 26 I 00 I 3 6 GUYUK 20 98 98 I 3 3 7 ,, 60 54 2 J 4 DEMSA I 16 I 8 ,, 2 2 24 I 6 9 YOLA SOUTH 8 98 32 3 2 - l0 FUFORE I 6l 4l 3 2 2 6 GIREI 2 170 9 ll ) 1 6 253 I 4 10 t2 SONG 24 173 155 2 4 4 2l t3 GOMBI 40 340 122 I 4 3 l4 HONG 100 94 8 3 3 t2 I 11 15 MAIHA 16 254 l14 2 4 4 t6 MICHIKA 369 306 l0 4 2 l2 t7 MADAGALI 2 l17 55 44 225 TOTAL 1 &2 730h 8I o/o

and PHC workers. out was to train 3,055 prog.ramme staff a. The annual training objective ofthis,2,34Sweretrainedforthelvermectindistributionprogram. Flipchart' provided by Training Manual, cDD Guide' and b The materials used were cDD ff"L" itffer Worldwide and APOC respectively'

c.Thereisneedtoincreasetrainingoftrainers,sothateachtrainercantraincDDsat communities' training centres very close to their

6. ACHIEVEMENTS: recorded: ir,. ror@have been (cDDs) in GDTI' & LeA ilJs) and 2,o6sDistributors a. Training of 280 T-rain.i, ts,u,"

b.Atotalof2,0T0communitiesweremobilizationforMectizanuptakeandtosupportthe CDTI imPlementation Program

4 pickup centres and by the communities from designated Drugs have been co,ected c. going' trffi"nt for the Year 2000 is on 1999 TREATMENT FIGURE FOR No. of No. ofTreettd No. of of cllglblc Cost Pcr Distrlbudons Communities/ville DlstrlcUlGA No. Comm./Vlllogcs wlth summarY s/ll Pcnon supcrvlscd bY gcs pcntons whlch CDDs ls r Trcetcd treattd I 1 6 1 0.23 I MADAGALI 64 910 I 280 93 83 0.23 80 2 SONG I 35 008 0.23 52 3 GOMBI I 29 957 023 6l 4 I 15 486 0.23 289 5 GIREI 1 53 1l 0.23 923 6 JADA 1 291 TOTAL jmg Tablets. ffeated with Mectizan Nole These six LGAswere of No. of Trcatcd No' of No. No. of cllglblc Cost Pcr Dlstrlbudons CommunltlcJvllla Comm./a'illeges summarY s/N penrolul Ptnon bY gcs wlth whlch CDDs ls o supcwlscd Treated treated I 189 N/A None 8l ,940 aa 97 I HONG aa I 23 996 98 2 MOBI NORTH aa 1 974 30 aa 104 3 MOBI SOUTH ,,) a I 056 (< 138 4 tvUCgn

TreatmentfortheYear2000isgoingonandreportswillbesentrvhencompiled.

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S Need for more training o Inadequate Training a Training was orgtniz.ed materials. Tnanvnrc: by the Materials be and conducted a a More trainers should a Too manY trainees at NGDO for SOCT, LOCT trained session. and PHC workers who in turn trained the CDDs at designated centres in the LGAS. time is required for to reach and tullY a More particiPation a InabilitY mobilization and IIEALTE a CommunitY interact with all the communitY was quite-Stat"' encouragrng on the health education EDUCATION/IVIOBI with LGA and communities LIzATION concept of CDTI' NGDO offrcials involved' toh at a More PHC Workers a lnadequate Trainers a Dedicated and committed trained on CDTI SrA'ffnVCt CommunitY level programme staff' a PHC District SuPervtsors have been incorPorated and trained for CDTI lmplementation. advocacY the a Need to intensifY a financial SuPPort to recognized the to the LGA executives. LGA a Have is inadequate' visits of Oncho in programme PARTICIPATION problems their areas to a There is willingness supPort the LOCTs in more some LGAs. a There should be the a No satisfactorY communitY a Most have accepted involvement COfvfrUUmrY involvement during the communitY programme. during Planning stage' PARTICIPATION planning stage. and a SupPorted the Progamtne nrequent visits financiallY. mobilization of some of the to a Selected their CDDs' communities who are Yet a Provided measurrng the sticks. a NGDO, State and LGCs a N" motorcYcles, which a AvailabilitY of vehicles be encouraged to could be used in areas should from M.O.H' , APOC and support the programme with where vehicle could not, NGDO. vehicles and motorcYcles. be reached' a Inadequate logistics LGCs a Adequate time and attention a Limited time arrd attention a Involvement of be $ven for to communitics during should CommunitY Based interaction with the mobilization. Bamako Initiative communities when visited. have ensured their Committees a Should aPPreciate sustainability. contributions and encourage have 3 Some communities them to do more. accepted the Programme to be their own and have started suPPorting CDDs and collecting drugs from collection centres

i;..nvolvementirrtheimp1ementationofCDTIin their various communities'

6 community members' and mobilization of their involved in creating awar.eness were learn during training' uid *illingness to going from Exhibit a lot of interest ;?ilection"centres and going to Shown commitment by same'"ott."tTffifi"* house to house to distribute ;il;;ll in completing treatment forms'

Bamako Initiative 9 CommunitY Based members through the to The communitY their commitment and supPort continued to demonstrate Committee (CBBI) have the programme through:- . a (CDDs)' Directed Distributors Selection of their CJfr*unity trffi*,jd,I"J,:[q,,ls_,,ill!I*."::::-:eshaveof cDDs during ::t,,:t,ff?J5[ffi inloived in th" The GBBI committees that *"r" 'up"*ision centres to collect Mectizan' ffi:l1ilDs when going to the co,ection in the State control 10 ffiontinued to activelv-I*::*" awareness onchocerciasisactivities-invariousways;superuising-sometrainingsessions,,iritr, il"i'ni"ut and public undertake high level advocacy 'uppJttt campaigns.

their 11 on and T:'1"::1.::*:".""""#i"*ff#,JT#spersonal money to carry rir-ir'*"r- ,hown by ;;; of their responsibilities. *r'"n apoC tundi were not available' complete the treat#rit ;;;;;t;

t2 include:- made bY the Stat" Gouernment The contributions so far 1. 1 Tovota Hilux Wagon 2. I Peugeot 504 Station 3. or. Health ror the State sp?ce- at the Ministry 4. Srfi?:"tril"to*r. for program plannirlg and execution' Onchocerciasis Control unit

and 13 re involved in Community Mobilization some staff for the program' communiy ettigned Advocacy visits to some 1eai"r* the required offrce space' p"V u"ff t.faries and provide

of their members t4 ,*trnX+1, ryIglveMEIIi.^,.. involved in the mobilization requirements incruding *u.lrmrl""ffT#ffi"::lfibute for the program incentives for the CDDs' assistance to the ThefacilitatingNGoo,HelenKellerlnternationalh.asalsoplayeditsrolebytogi'lt9t' il;;g";?i nnan"iat providing t."t'ni"ui-'-i"'ia' '*a a sound CDTI in the State' program in order to ttioUfitn

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ACEEVEME, I{I-9=F TIrE PROJECT: l5 MAJOR to cover the endemic areas with a) Training of7,o68 cDDs in ll7 Centres Ivermectin distribution' b) in z,o7o and LGA officiars in communitv c) ffiii:r#tjrTll?ff'MoH and supervi sion olcj]T I activ it i es' end em ic rnou iiiuaion "olnruniti "r' to ;6p"* the cDTI approach especially d) Mobilizatio n of z,oiocommunities cDDs Leaders and LGA offrciars during e) +f#rr:r".,T:;:?:"t#*mmunity Training' 6mg tablets ---r^ with-..i+r. 3mg2m, and 273'660 people with f) iit"tt"Irt of 291,955 people ofMectizan in 1999

l6 trainers a) Inadequate number of oflicials during to LOCT members bY the council b) Lack of adequate suPPort regularlY to meet with the LGA authorities CDTI activities. There is the need to be more committed to the Programme' to encourage them as their own to embrace and accept the programme c) Some communities are Yet adequate as motorcycles and bicvcres for d) illr'*T,i'riHffiSJJppoft;lch level' programme .or"rug.1t it'" LGC an!.!-ommunity e) NonreleaseoftheStateGovernments.o*..,"p*,.n,"a".gofN3millionhashamperedthe ;;r,i;t;;+.iallv when APOC tunds were not available'

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