Country operational research priorities pending.
To sustain the gains of active community drug distributors (CDDs) by enhancing their performance through intervention at the individual, community and primary health care center levels to reach NTD elimination and control goals.
Through funding from the Wellcome Trust to develop a global atlas of podoconiosis. We aim to advance new knowledge on the geographical distribution and spatial epidemiology of the disease.
i. Conduct national cross-sectional surveys in selected countries to validate the environmental predictive model developed using the mapping data in Ethiopia.
ii. Create evidence consensus maps, develop risk maps and ground-truthing work and delineate the spatial distribution and geographical limits of podoconiosis globally.
iii. Estimate the global burden of podoconiosis by quantifying the number affected, the population at risk and DALYs attributable.
iv. Estimate how much it will cost to control or eliminate podoconiosis globally.
Which strategies best strengthen strategic decision making for resilient and responsive health systems at the district level in Ghana, Malawi, Uganda and Tanzania?
How do we motivate community drug distributors (CDDs)?
To determine the feasibility of the use of entomological traps by community members for onchocerciasis and lymphatic filariasis entomological assessments.
To compare coverage evaluation methods to identify a method that is statistically rigorous and feasible for programs. This study will focus on assessing MDA coverage for lymphatic filariasis by comparing the cost, time and feasibility of 3 different methods: the EPI approach (n=1768), LQAS design (n=95) and probability sampling alternatives (n=1768).
Primary Findings and Lessons Learned
Coverage surveys are an important tool for programs to evaluate their reporting systems and to determine whether effective MDA coverage has been achieved. However, for various reasons coverage surveys are seldom implemented. Some key challenges are: perceived technical difficulty, lack of resources, and lack of standardized guidance on how to conduct coverage surveys. This protocol seeks to address the 1st and 3rd points by comparing the feasibility of three different coverage survey methods (EPI approach, LQAS, and segmentation). This study was completed in 3 districts in Burkina Faso. All 3 districts found that their survey coverage was above the WHO target threshold (65% for LF). Furthermore, in all 3 cases the survey coverage validated (or nearly validated) the reported coverage. Taken together this suggests that the Burkina Faso program is working well. The feasibility results found all 3 methods to be very similar with regards to time, cost and perceived difficulty. Because only the segmentation approach results in a probability sample, this method was recommended by the M&E Working Group and ultimately approved by the STAG. Since the approval, significant work has been underway to create guidelines for conducting coverage surveys for preventive chemotherapy. An excel tool was created to improve the usability of the tool and online learning modules are currently in the works.
Determine the best data-capture system and implementation model to overcome data flow challenges faced by national MDA programs. Test and compare the effectiveness of 4 different data-tracking platforms currently in use (or development) in NTD endemic countries: 1) Build on existing national capacity, 2) Cloud-based SMS system, 3) Robo-call platform.
Preliminary study findings:
o The current process for tracking treatment information through paper-based forms can be complicated and leaves room for human error, as multiple aggregations of data must be collected manually between administrative levels before reaching the national level.
o This study found that the process of collecting and reporting paper records on the stock and delivery of ivermectin, albendazole and Praziquantel took between two and three months.
o The study found that robo-call surveys have the potential to add a new stream of information on drug stock between national supervisors and sub-district implementation teams, allowing program staff to take corrective actions in response to issues with drug supply.
o The proactive timing of the calls as well as the interactive component of responding to verbal questions through the phone makes this system useful to supervisors.
o Robo-calls were found to be helpful to monitor drug levels prior to MDA at sub-district level and to ensure appropriate quantities of drug stock were reaching lower administrative level, but as post-MDA drug stock is returned to the district level, physical observation of district-level storerooms was the most effective way to assess drug quantities post-MDA.
o SMS reporting made data accessible at the national level and to administrative units in real time.
o Less than half of the registered supervisors submitted SMS reports, resulting in a significant difference in the number and type of treatments reported when compared to paper forms.
o Greater training and ongoing management is needed to take full advantage of the speed and data accuracy improvements from robo-call and SMS surveys.
Analyze the relationships between the prevalence of the clinical sign follicular trachoma (TF) and the prevalence of infection and antibody to determine whether it may be appropriate to consider one or more alternative indicators for deciding whether trachoma programs can stop MDA.
POC/CCA screening/mapping tool initial Studies