Hikabasa Halwindi

Impact of community-directed treatment on soil transmitted helminth infections in children aged 12 to 59 months in Mazabuka District, Zambia.

This study assessed the impact of adding community-directed treatment (ComDT) to the routine health facility (HF)-based treatment on prevalence and intensity of soil transmitted helminth (STH) infections among children aged 12 to 59 months. Repeated cross-sectional surveys were conducted among randomly selected children of this age group from the intervention area (HF+ComDT area) and the comparison area (HF area) at baseline (n=986), 12 months (n=796) and 18 months (n=788) follow-up. The prevalence of Ascaris lumbricoides was significantly higher in the HF+ComDT as compared to the HF area at baseline (P=0·048), but not at 12 and 18 months follow-up. At baseline the HF+ComDT area had significantly higher intensities of A. lumbricoides compared to the HF area (P<0·001), but not at 12 and 18 months follow-ups. Prevalence and intensity of hookworm did not differ significantly between treatment arms at any time. Analysis of trends showed a significant decrease in prevalence of A. lumbricoides and hookworm in the HF+ComDT area (P<0·001), of hookworm in the HF area (P<0·05), but not of A. lumbricoides in the HF area. It is concluded that the ComDT approach generally enhanced the treatment effect among under-five year children and that this alternative approach may also have advantages in other geographical settings.

Factors Perceived by Caretakers as Barriers to Health Care for Under-Five Children in Mazabuka District, Zambia

In rural areas of Zambia primary health care is provided by rural health centres (RHCs). However, accessibility to these services is limited. In the catchment areas of two RHCs in Mazabuka district (Chivuna and Magoye RHCs) we investigated factors that caretakers perceived as barriers to health care for under five children and how they cope with the barriers. Ten Focus Group Discussions (FGDs) with caretakers of children under-five years of age and key informant interviews with six health workers from the two RHCs, and eight community health workers were conducted in May 2006. The major factors perceived as barriers were poor quality of health services, unavailability of medicines, financial constraints, weak outreach programmes, bad scheduling of health programmes, poor communication, long distance to RHCs and low awareness levels of the importance of taking children for child health week among caretakers. Caretakers’ main coping strategy was the use of the folk sector of health care. The findings of this study highlight the challenges that exist in accessing of health care in resource-poor settings and underscore that the provision of health care services of good quality remains a major challenge.

Effect on treatment coverage of adding community-directed treatment to the health facility-based approach of delivering anthelminthic drugs to under-five children during child health week in Mazabuka District Zambia.

The current approach of delivering anthelminthic drugs to children aged 12-59 months through health facilities during child health week (CHW) results in low treatment coverage in certain areas of Zambia. This study was designed to determine the impact on treatment coverage of adding community-directed treatment (ComDT) to the health facility (HF) approach. Treatment coverage was compared in two areas, one with the HF approach alone (HF area) and the other where ComDT was added to the HF approach (HF + ComDT area). Cross-sectional surveys were conducted every 6 months between June 2006 and December 2007 to monitor CHWs. χ(2) tests, odds ratios (OR) and their 95% CI were used to compare treatment coverage between and within each treatment arm. Addition of ComDT to the HF approach resulted in significantly higher treatment coverage in the HF + ComDT area compared with the HF area during CHW1, CHW2, CHW3 and CHW4, with ORs (and 95% CIs) of a child being treated in the HF + ComDT area of 2.17 (1.90-2.48), 3.07 (2.68-3.52), 11.17 (9.25-13.48) and 5.07 (4.27-6.01), respectively. We conclude that ComDT has the potential to raise treatment coverage significantly during CHWs. [ClinicalTrials.gov Identifier: NCT00349323].

POTENTIAL CONTRIBUTION OF ADULT POPULATIONS TO THE MAINTENANCE OF SCHISTOSOMIASIS AND SOIL-TRANSMITTED HELMINTH INFECTIONS IN THE SIAVONGA AND MAZABUKA DISTRICTS OF ZAMBIA.

A majority of Zambian children live in impoverished communities that lack safe water and proper sanitation, exposing them to urogenital and intestinal helminths. Efforts to mitigate this plight have been implemented through mass drug administration aimed at deworming school-age and under-five children against schistosomiasis and soil-transmitted helminths. However, the disease status of adults living in the same communities as the treated children remains unknown. The aim of this study was to describe the potential contribution of infected adult populations to the transmission of these infections in southern Zambia. A cross-sectional study was conducted in April and May 2013 as part of baseline survey for a larger study in Mazabuka and Siavonga Districts. Stool and urine samples of 2829 adults from five catchment areas were collected and processed using Kato-Katz and urine filtration methods, respectively. Adults from Siavonga had a 13.9% combined prevalence of Schistosoma haematobium and S. mansoni, and 12.1% combined prevalence of Ascaris lumbricoides and hookworm. There was no S. mansoni in Mazabuka, and only a 5.3% prevalence of S. haematobium and 7.4% combined prevalence of A. lumbricoides and hookworm. Additionally, no Trichuris trichiura infections were observed in the two districts. Despite most of these infections being categorized as light intensity, heavy infection intensities were also found for all four parasite species. If this infected adult population is left untreated, the possibility of it acting as a reservoir of infections and ultimately transmitting the infections to treated children remains. Therefore, there is need to consider alternative treatment strategies that incorporate adults, thereby reducing the risk of contaminating the environment and perpetuating transmission to children.

RE-ASSESSING COMMUNITY-DIRECTED TREATMENT: EVIDENCE FROM MAZABUKA DISTRICT, ZAMBIA

Cross-sectional surveys with carers, health workers, community drug distributors (CDDs) and neighbourhood health committees were conducted to identify factors associated with utilization of community-directed treatment (ComDT) of soil-transmitted helminths in children aged 12-59 months in Mazabuka district, Zambia. The surveys took place in December 2006 and December 2007. In addition child treatment records were reviewed. The factors that were found to be significantly associated (p < 0.05) with treatment of children by the CDDs were: (1) the perception of soil-transmitted helminth infections as having significant health importance, (2) the community-based decision to launch and subsequently implement ComDT, (3) the use of the door-to-door method of drug distribution, (4) CDDs being visited by a supervisor, (5) CDDs receiving assistance in mobilizing community members for treatment, (6) CDDs having access to a bicycle and (7) CDDs having received assistance in collecting drugs from the health centre. Despite the effectiveness of ComDT in raising treatment coverage there are factors in the implementation process that will still affect whether children and their carers utilize the ComDT approach. Identification and understanding of these factors is paramount to achieving the desired levels of utilization of such interventions.

Socio-demographic factors associated with treatment against soil-transmitted helminth infections in children aged 12–59 months using the health facility approach alone or combined with a community-directed approach in a rural area of zambia

A health facility-based (HF) approach to delivering anthelminthic drugs to children aged 12-59 months in Zambia was compared with an approach where community-directed treatment (ComDT) was added to the HF approach (HF+ComDT). This paper reports on the socio-demographic factors associated with treatment coverage in the HF+ComDT and HF areas after 18 months of implementation. Data were collected by interviewing 288 and 378 caretakers of children aged 12-59 months in the HF+ComDT and HF areas, respectively. Bivariate and multivariate logistic regression analyses were used for data analysis. Statistically significant predictors of a child being treated were: a child coming from the HF+ComDT area, being 12-36 months old, the family having lived in the area for >20 years, coming from a household with only one under-five child and living ≤3 km from the health facility. It is concluded that socio-demographic factors are of public health relevance and affect treatment coverage in both the HF+ComDT and the HF approaches. The implementation and strengthening of interventions like ComDT that bring treatment closer to households will enable more children to have access to treatment.

A systematic review of factors that shape implementation of mass drug administration for lymphatic filariasis in sub-Saharan Africa

BackgroundUnderstanding factors surrounding the implementation process of mass drug administration for lymphatic filariasis (MDA for LF) elimination programmes is critical for successful implementation of similar interventions. The sub-Saharan Africa (SSA) region records the second highest prevalence of the disease and subsequently several countries have initiated and implemented MDA for LF. Systematic reviews have largely focused on factors that affect coverage and compliance, with less attention on the implementation of MDA for LF activities. This review therefore seeks to document facilitators and barriers to implementation of MDA for LF in sub-Saharan Africa.MethodsA systematic search of databases PubMed, Science Direct and Google Scholar was conducted. English peer-reviewed publications focusing on implementation of MDA for LF from 2000 to 2016 were considered for analysis. Using thematic analysis, we synthesized the final 18 articles to identify key facilitators and barriers to MDA for LF programme implementation.ResultsThe main factors facilitating implementation of MDA for LF programmes were awareness creation through innovative community health education programmes, creation of partnerships and collaborations, integration with existing programmes, creation of morbidity management programmes, motivation of community drug distributors (CDDs) through incentives and training, and management of adverse effects. Barriers to implementation included the lack of geographical demarcations and unregistered migrations into rapidly urbanizing areas, major disease outbreaks like the Ebola virus disease in West Africa, delayed drug deliveries at both country and community levels, inappropriate drug delivery strategies, limited number of drug distributors and the large number of households allocated for drug distribution.ConclusionMass drug administration for lymphatic filariasis elimination programmes should design their implementation strategies differently based on specific contextual factors to improve implementation outcomes. Successfully achieving this requires undertaking formative research on the possible constraining and inhibiting factors, and incorporating the findings in the design and implementation of MDA for LF.