Maintaining effective mass drug administration for lymphatic filariasis through in-process monitoring in Sierra Leone

Particle and Fibre Toxicology

Santigie Sesay¹  Florence MacCarthy¹  Abdulai Conteh¹  Hamid Turay²  Mustapha Sonnie²  Mary H Hodges² 

[1] National Neglected Tropical Disease Control Program, Ministry of Health and Sanitation, New England, Freetown, Sierra Leone;Helen Keller International, Freetown, Sierra Leone, 35 Nelson Lane, Tengbeh Town, Freetown, Sierra Leone

关键词: Urbanization;    Supply chain management;    Community health workers;    Mass drug administration;    Monitoring and evaluation;    Lymphatic filariasis;   

Others  :  1229074
DOI  :  10.1186/1756-3305-5-232

 received in 2012-07-20, accepted in 2012-10-02,  发布年份 2012

【 摘 要 】

Background

Since 2007 Sierra Leone has conducted mass drug administration (MDA) for the elimination of lymphatic filariasis (LF) implemented by unpaid community health volunteers (CHVs). Other health campaigns such as Mother and Child Health Weeks (MCHW) pay for services to be implemented at community level and these persons are then known as community health workers (CHWs). In 2010, the LF MDA in the 12 districts of the Southern, Northern and Eastern Provinces un-expectantly coincided with universal distribution of Long Lasting Insecticide Treated Nets (LLITNs) during the MCHW. In-process monitoring of LF MDA was performed to ensure effective coverage was attained in hard to reach sites (HTR) in both urban and rural locations where vulnerable populations reside.

Methods

Independent monitors interviewed individuals eligible for LF MDA and tallied those who recalled having taken ivermectin and albendazole, calculated program coverage and reported results daily by phone. Monitoring of coverage in HTR sites in the 4 most rapidly urbanizing towns was performed after 4 weeks of LF MDA and again after 8 weeks throughout all 12 districts. End process monitoring was performed in randomly selected HTR sites not previously sampled throughout all 12 districts and compared to coverage calculated from the pre-MDA census and reported treatments.

Results

Only one town had reached effective program coverage (≥80%) after 4 weeks following which CHWs were recruited for LF MDA in all district headquarter towns. After 8 weeks only 4 of 12 districts had reached effective coverage so LF MDA was extended for a further month in all districts. By 12 weeks effective program coverage had been reached in all districts except Port Loko and there was no significant difference between those interviewed in communities versus households or by sex. Effective epidemiological coverage (≥65%) was reported in all districts and overall was significantly higher in males versus females.

Conclusions

The challenges to LF MDA included the late delivery in country of ivermectin, the availability and motivation of unpaid CHVs, concurrent LLITN distribution and the MCHW, remuneration for CHWs, rapid urbanization and employment seeking population migrations. 'In process' monitoring ensured modifications of LF MDA were made in a timely manner to ensure effective coverage was finally attained even in HTR locations.

【 授权许可】

   
2012 Hodges et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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