Country operational research priorities pending.
1. Can MDA resume and achieve high performance while minimizing risk of COVID-19 transmission through adherence to SOPs?
2. Can local teams easily implement the recommended modifications to MDAs; what is the added cost; and how do the above vary by context?
3. What aspects of local context influence implementation of SOPs?
Are NTD programs in Anambra State, Nigeria, adopting and implementing prevention measures for COVID-19 in their drug delivery activities? What adaptations are required by staff and volunteers to adopt these measures? What are the barriers to doing so? What are the incremental costs associated with conducting MDA during a global pandemic?
To develop and pilot a standardised analytical framework for the spatial and temporal analysis of routinely collected gender disaggregated NTD programme data. This will allow increased understanding and spatial visualisation of the influence of gendered programmatic inputs, external geographic and social factors on the equity of programmatic outputs, particularly access to mass administration of medicines (MAM).
This study is designed as a proof-of-concept to test the feasibility and acceptability of a proposed intervention package outlined in a soon to be published WHO manual on NTDs and mental health. The primary output of this study is to adapt a model of intervention from the soon to be published WHO guide on Mental Health and NTDs. The team aims to achieve this output through:
- Screening 300 individuals for symptoms of depression and anxiety, refer where necessary, and sample 30 of those individuals for participation in qualitative interviews.
- Conducting peer-led focus group discussions (separate groups for leprosy and LF) to better understand the needs, priorities, and barriers related to affected individuals’ mental wellbeing and quality of life.
- Conducting a workshop with health leaders, community health workers, nurses, service users, family/caregivers, and experts to develop a feasible and applicable theory of change that aligns with WHO guidelines.
- Conducting in depth interviews with key stakeholders to assess the developed model’s feasibility and accessibility Conducting quantitative measures for feasibility and acceptability to assess the stepped-care approach model which involves: improved screening, referral, uptake of service, knowledge uptake following training, and an assessment of whether supervision was carried out. They also plan to triangulate health information data to determine uptake of services.
- Conducting follow-up FGDs with those 30 individuals after a one-month period to understand their experience with primary health center mental health services.
This study includes an assessment of the Sightsavers rollout of a DHIS2 based tool for data collection in the NTD program in 2 states in Nigeria. In particular, the research project seeks to evaluate the health system strengthening effects of the tool for planning, monitoring and reporting of MDA. They plan to examine:
- the functionality of the tool at scale
- ease of integration across different NTD interventions
- data accessibility, accuracy, timeliness, and usefulness.
The team also aims to understand whether the implementation of this tool would enhance government ownership of the data and the NTD programme in general. This research will aid in identifying barriers and opportunities for potential scale up of the tool throughout Nigeria. The team also plans to focus on understanding how the data will be used at different levels of the health system.
Primary Objective: To evaluate and develop MMDP services in Nigeria to be responsive to patient and provider perspectives using community based participatory research approaches in a participatory action research cycle
Formative research question: To what extent are the support needs of people affected by NTDs being met?
Intervention research question: How can new programme strategies be adapted to meet outstanding need?
To increase onchocerciasis treatment coverage and to optimize service delivery through community mobilization, disease sensitization, training and strengthening of community health extension workers (CHEW), and community control advocates
To investigate the presence and epidemiology of Schistosoma hybrids in Nigeria. The acquisition of new genes through hybridization may generate new phenotypes that might differ in virulence, drug resistance, pathology, and host use, ultimately leading to the emergence of new diseases. Hybrids can develop into a new emerging pathogen, necessitating new control strategies in zones where both parental species overlap, an intense and rapid control response is required to minimize further spread of the hybrid and possible escalation of human schistosomiasis.
To study the glutathione-S-transferase (OvGST1) gene expression pattern in the life cycle stages critical for the establishment of infection by Onchocerca volvulus.
To determine the viability of utilizing the polio program’s Vaccination Tracking System (VTS) to generate more accurate population, drug requirement and coverage estimates in NTD programs
To study the feasibility of LF and Oncho (Filariases) integrated transmission assessment survey iTAS) according to both LF and Onchocerciasis WHO elimination guidelines
- To define a cost-effective and accurate method to map ivermectin-naïve districts for Onchocerciasis, Lymphatic Filariasis and Loiasis and identify districts eligible for safe treatment with ivermectin MDA.
- To validate a statistical model of Loiasis prevalence and intensity by comparing the model results to data from a prevalence assessment.
To compare the feasibility and programmatic implications of employing the Supervisor's Coverage Tool in schools vs. communities to monitor a school-based MDA.
The Supervisor’s Coverage Tool (SCT) is a rapid in-process monitoring tool for improving mass drug administration (MDA) coverage that has been approved by WHO for use in communities. However, questions remain as to whether it may also serve as a useful tool when implemented in schools. To answer this question, a direct comparison of school- vs. community-based SCT implementation was conducted in 13 Supervision Areas (SAs) in 7 Local Government Areas (LGAs), in 3 states in Nigeria. Within each SA, one SCT was conducted in the school and an independent SCT was conducted in a village within the catchment area of the same school. The SCTs were all monitoring the coverage for the same school-based MDA for praziquantel and mebendazole. The goal was to understand how the information learned through the SCT would vary based on the two different sampling frames.
Findings and lessons learned:
- The SCT helped find targeted schools for which a mass drug administration (MDA) was planned but were missed. Several unregistered (illegal) schools were missed as their existence was not known, therefore they were not targeted and included in the MDA; however, upon identification of these schools through the SCT, the schools were reached during mop-up and added to the database for future MDAs.
- An existing school feeding program increased students’ praziquantel intake in all northern Nigeria schools that were visited.
- In two SAs, school SCT results showed good coverage; however, the actual reported school coverage was below the recommended threshold. The discrepancy was due to a great number of student absences because of farming activities or drop outs after enrolment. Since any selected student who is absent is skipped by the SCT and a new student is selected in their place, the resulting coverage classification could be an inflation of the true coverage.
- Surveyors preferred SCT implementation in schools vs. community because household enumeration can be time-consuming.
- When SCT results from the school and the village were directly compared for the same population, the community-based SCT always resulted in an equal or lower classification of coverage, likely because community-based SCTs include the entire target population in the sampling frame, as opposed to being limited to school-attending children.
To develop a health education game on Soil Transmitted Helminthiasis (STH) transmission and to evaluate the potential of the game to promote behavioural changes among school children for the prevention of STH infections after treatment. Our primary research questions are: 1. Can our health education board game (Worms and Ladders) developed to teach transmission and control of STH cause any significant changes in the health behaviours of school aged children to reduce reinfection and transmission of STH after mass treatment? 2. Will the health messages learnt while playing our board game promote significant knowledge about the causes, transmission and control of STH among school children? 3. Will the combination of intervention (mass chemotherapy/Health education) have any significant impact of reducing STH reinfection in school children?
To pilot a rapid coverage supervision tool (now known as the Supervisor's Coverage Tool) that can be used to determine if the supervision areas under investigation are likely to have exceeded the WHO threshold for coverage and to serve as an in-process monitoring tool for supervising the MDA distribution. Report to WHO M&E working group; potential for inclusion in future WHO program assessment guidelines.
The Supervisor’s Coverage Tool (SCT) is a quick, simple, and inexpensive monitoring tool that can be used to assess preventive chemotherapy coverage of a mass drug administration (MDA). During the development and optimization process of the tool, the SCT was piloted in communities in Nigeria and Ethiopia. The pilot study in Cross River State, Nigeria, included seven first-level Supervision Areas (SA), which corresponded to villages in four Local Government Areas (LGAs). Drug coverage was assessed for ivermectin and albendazole in four SAs and only Ivermectin in three SAs.
Findings and lessons learned:
- The main reasons for not swallowing medicines were community drug distributor (CDD) not showing up, respondent being away at time of drug distribution or not collecting drug from a fixed point of distribution, fear of side effects, drug supply running out, recent migration, and lack of awareness about drug distribution.
- The SCT permitted LGA coordinators to supervise the drug distribution systematically, which allowed them to find out that in most parts of one LGA treatment was suspended despite the CDD claiming the completion of treatment in the area.
- Some treatment registers did not include all people living in the SA, therefore some households were not included in the CDDs treatment boundaries. On the other hand, some LGAs had very good treatment registers, proper documentation of treatment from CDDs, and their community also commended them during village gatherings expressing their gratitude.
- All CDDs were making remarkable effort with little or no reward. Unlike previous monitoring visits where supervisors have to field numerous complaints around incentives, because the SCT gave supervisors an objective evaluation of their work, many CDDs did not feel justified in complaining about incentives.
- Overall, the SCT was deemed feasible to implement at the supervisory area and the information generated led to programmatic action to improve treatment coverage.
Assess the performance of LF and Oncho diagnostic tools after stopping LF MDA but continuing Oncho MDA.