How do you provide treatment for neglected tropical diseases like river blindness when you can’t find some of the people who are most at risk?
In Massangam in the West region of Cameroon, nomadic communities regularly move around, living in different areas at different times of the year. This means they can miss out on mass drug administration (MDA) programmes to treat and prevent river blindness – a disease which if left untreated can cause irreversible blindness.
It’s essential these communities receive the medicine because their camps are usually set up near riverbanks, which puts them at higher risk of being bitten by the disease-carrying flies that breed near fast-flowing water.
But without knowing where nomadic communities are and how to reach them, dispensing treatment is a huge challenge. That’s why we’re working to identify, track and record where these nomadic communities are and take treatment directly to them.
How do we do it? Watch the video below to follow Sightsavers’ researcher Kareen in her adventurous journey through areas that are so remote that their geographic information isn’t recorded on maps.
Sightsavers’ research in action
We’re committed to using evidence to inform and improve our programmes. Recent research led by Sightsavers showed that an alternative treatment strategy was successful in reducing the transmission of river blindness in the Massangam area. However, our findings showed that fewer members of the nomadic community received treatment compared to the settled population.
Because nomadic communities often miss receiving treatment through MDA, it’s critical we find ways to ensure they are not left behind and receive equal treatment to settled populations. Nomadic communities could also be at risk of perpetuating the transmission of river blindness, impeding elimination efforts. This is because, if they are not treated, the flies that spread the disease become re-infected from this untreated group of people and bring the disease back to areas where treatment is happening successfully.
To address these challenges, we developed a tailored approach to better reach the nomadic population. This includes using nomadic guides and nomadic drug distributors, creating materials in the local language (Fulfulde), and using satellite imagery to find where nomadic camps are located.
Our research team in the UK uses special software to analyse images taken by satellites. This imagery enables our researchers to map areas where we work much more accurately than we have done before, which is critical when planning new work or conducting fieldwork. This is especially helpful in remote areas like Massangam where there aren’t established roads.
Combined with data collected in the field, the images can help identify where nomadic camps may be located. The team can plot these potential sites onto maps, as well as detailing streams, forests and other natural features.
Nomadic communities live in remote and dispersed settlements, meaning that field teams have to find different methods of travel to reach them.
Sangou, a community volunteer from a settled comunity, givess treatment to Aicha after screening as taken place in camp Mohamadou, Njinjouet.
Our research can’t take place unless the head of camp gives consent, which we obtain respecting cultural sensitivities. Once our translator explains what is involved, our field teams ask the head of camp to give their consent by allowing us to take their fingerprint. Once the camp head has approved, other members can follow.
Using his fingerprint, the head of the camp gives his consent to be screened for river blindness.
Laolo, a community drug distributor, obtains consent from the head of a camp to conduct screening.
There is a degree of trial and error involved: for instance, in satellite imagery, the shapes of trees and nomadic camps can look very similar. For this reason, the maps are shared with our field team working on the ground in Cameroon, who can assess whether they are accurate. The field team can also validate the identified camps by using photographs they have taken, and by working alongside local guides.
The maps can be downloaded onto mobile phones, which means that, along with using a geographic information system machine, the field teams can easily find the location of the settlements at any time – even without an internet connection – reach them safely and input their findings accurately. As this information is stored, subsequent searches become more accurate and efficient.
We started data collection in October 2019, but the project was initially paused due to COVID-19. We have now restarted it, ensuring that the field teams follow local safety guidance and precautions. While the teams survey nomadic camps, they also provide the communities with information on the signs and symptoms of COVID-19, as well as prevention measures.
In Cameroon, many of the government-led communication initiatives to prevent COVID-19 are only accessible to people who live in or near cities, and are often in French or English, which are largely unfamiliar to nomadic communities. To help address this, our field teams have taken handwashing facilities, setting them up in the camps and demonstrating the best way to use them to prevent the spread of disease.