Coverage Evaluation Survey and Supervisor's Coverage Tool Implementation in Kenya for Triple Drug Therapy
Coverage Evaluation Survey
Is coverage, or a combination of coverage and systematic non-compliance, more effective than a diagnostic tool at predicting when it is safe to stop triple drug therapy?
Supervisor's Coverage Tool
Is the use of the SCT during IDA feasible to implement at the sub-county scale and does it lead to increased coverage?
Would the same programmatic decisions for Oncho Elimination Mapping be made based off of the Ov16 rapid diagnostic test results as compared to the Ov16 SD ELISA results?
Improving Access to Mass Drug Administration for Lymphatic Filariasis Elimination using a Participatory Approach among Communities of Coastal Kenya
To assess the socio-economic factors contributing to low access to MDA, to identify the existing health services opportunities and other outlets specific to various socio-economic groups that could be used for improving access to MDA, and to develop feasible field-applicable strategies that can be used to reach groups with consistently low access to MDA.
Equitable access to Mass Drug Administration for trachoma elimination: an ethnographic study to understand factors associated with low coverage in Kenya and Tanzania
Main objectives are firstly to identify and understand better the factors behind low and unequal MDA coverage and compliance in trachoma endemic areas in Tanzania and Kenya with nomadic populations, secondly to prioritize factors in terms of amenability to intervention. The researcher will then use the evidence generated to design specific interventions that could improve the reach and impact of campaigns of Zithromax MDA in both countries. While there are contextual differences between nomadic societies throughout Africa, research among the Masai in Tanzania and Kenya should inform programme services in other settings with nomadic populations. Particular attention will be given to gender-sensitivity; that is, interventions that will improve access and use by women as well as men.
To assess the programmatic feasibility of and determine the most appropriate age group and sample strategy for an onchocerciasis mapping survey for ivermectin-naïve areas.
Understanding the best uses of the Supervisor's Coverage Tool (SCT) for monitoring school-based distributions
- To use the Supervisor's Coverage Tool (SCT) to monitor school-based deworming;
- To determine the feasibility of utilizing the Lot Quality Assurance Sampling (LQAS) methodology in a school-based SCT; and
- To apply a checklist in schools to elicit information about the performance of the MDA.
While the Supervisor’s Coverage Tool (SCT), a rapid in-process monitoring tool for improving mass drug administration (MDA) coverage, has been approved by WHO for use in communities, questions still remain about its utility for school-based sampling. As a result, the SCT was implemented in 20 randomly selected schools in each of six sub-counties (used as Supervision Areas) in three Kenyan counties in March 2017. A total of 120 students were selected and interviewed.
Findings and lessons learned:
- The coverage for albendazole was classified as “good”, meaning above the WHO threshold, in 5 of the 6 SAs; however, only 1 SA was classified as having “good” coverage for praziquantel. In 3 of the 6 SAs, the Praziquantel coverage was classified as “inadequate”, including an SA that did not receive a supply of praziquantel to distribute.
- The most common reasons for not swallowing the drugs were students’ absences and drugs being out of stock or expired. The most common reasons for refusing intake of praziquantel were fear of side effects and religious beliefs, including misinformation coming from teachers to students about beliefs that albendazole was safe for all children, whereas praziquantel was dangerous and only reserved for sick children.
- Some of the challenges during the SCT activity were schools that operated half day, schools that had ongoing examinations, and unforeseen closure of a school on the day of SCT implementation, which made the random selection of students difficult. In addition, when an absent student or a student over 15 years of age (ineligible due to age range) was selected, it resulted in a loss of time since the selection needed to be repeated. Class interruptions to conduct the study were also not welcomed by some schools.
- While implementing the SCT in schools seems efficient compared to community SCT implementation, it is important to make sure that enrolment registers are accurate. Often, teachers at the schools with incomplete registers do not want to be held accountable.
- The cost of the SCT could be greatly reduced by implementing it in a shorter time period of three days instead of five, and with a pair of individuals per SA instead of four. The SCT can easily be integrated into routine supervisory activities as part of the MDA, and it can be conducted immediately after the MDA. It is a feasible activity that should be considered for widespread adoption.
TakeUp: Testing the Impact of Incentives on Compliance with Community-based Mass Deworming through a Field Experiment in Kenya
•What is the influence of social and behavioural incentives on the increase in cost-effective demand for deworming medication among adult population?
•What is the impact of social incentives on take-up and cost-effectiveness of deworming treatment?
•What is the impact of consumption incentives on take-up and cost-effectiveness deworming treatment?
•Can any increase in takeup be attributed to signaling effect wherein individuals are motivated to access treatment in order to demonstrate that they have engaged in pro-social behavior?
To determine the current status of LF using a combination of seroepidemiological tools to determine prevalence of circulating filarial antigen (CFA) and antifilarial antibodies.
Preliminary study findings:
- 2,976 individuals (age: 2 to 100 years) were tested for circulating filariail antigen using the immunochromatographic (ICT) test during daytime visits. Night-time blood samples to detect microfilariae (MF) were requested from those who tested positive via the ICT test.
- Out of the 38 persons found to be positive for LF infection by ICT test, 33 provided a night-time blood sample for examination of MF. Overall, nine individuals were found to be MF positive, with the highest prevalence in Ndau Island.
- The current study suggests that LF transmission may be absent in Taita-Taveta and Tana River counties in coastal Kenya and therefore transmission assessment surveys (TAS) should be considered with a view to stopping MDA. By contrast, evidence for ongoing transmission in Kwale, Kilifi and Lamu counties indicates the need for further MDA rounds in these counties.
- Additionally, the study demonstrated the feasibility of conducting integrated serosurveillance of several infectious diseases of public health interest, as well as levels of seroprotection against vaccine preventable diseases. The findings of the current study underscore the added value of using multiplex antibody measurements to guide and monitor LF elimination efforts.
POC/CCA screening/mapping tool initial Studies