Understanding the best uses of the Supervisor's Coverage Tool for monitoring school-based distributions
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 determine the feasibility and best practices of using the Supervisor's Coverage Tool to monitor community and school-based distribution and integrated MDA.
The Supervisor’s Coverage Tool (SCT) is a rapid, simple, and inexpensive tool designed for use in Neglected Tropical Diseases (NTD) programs mass drug administration (MDA) to monitor drug coverage and compliance, to supervise community drug distributors (CDD), and to identify areas that may need mop-up. After successfully piloting the SCT in Ethiopia and Nigeria in 2015, additional testing of the tool was suggested to assess the feasibility of the tool in different regions and new settings. Therefore, the SCT was implemented in the Philippines in July 2016.
After the completion of training, the field work was conducted in two provinces, in six Supervision Areas (SA) consisting of one or more puroks (subdivisions) per barangay (village). Two survey populations were represented in the SCT implementation covering a community-based distribution for Lymphatic Filariasis (LF), excluding children aged 5-18 years and a school-based distribution for LF for all children aged 5-18 years.
Findings and lessons learned:
- The most common reasons for not swallowing drugs were fear of side effects, not feeling well, forgetting, being too busy, and the taste of the medicine.
- When an accurate register of all the households in the SA exists, it is possible to complete the SCT in each SA in less than a day because the registers greatly aid the random selection process.
- Implementing the SCT during the last week or two of the MDA was advantageous as it enabled the program to implement the action plan to improve the current MDA using the personnel, budget, and infrastructure that was already in place for the MDA.
- It is important to consider whether or not Community Drug Distributors (CDD) should accompany the SCT teams during interviews, as their presence may influence the answers of the respondents.
- It is strongly recommended that when possible, CDDs use directly observed treatment (DOT). If DOT is not possible, CDDs should remind participants that there is no advantage in delaying swallowing the drugs, and that it is actually better when everyone swallows the drugs at the same time.
- Overall, the Philippines SCT pilot was a success, as it was the first time it was implemented in the Western Pacific region, and it was also used to monitor multiple distributions (both school- and community-based).
Determine the Schistosoma prevalence in the Mekong River Basin on the border of Laos and Cambodia
Develop a mobile reader application for use at the point-of care for the POC-CCA assay used for mapping and surveillance of Schistosoma mansoni. The reader apk will provide results consistent with the visual human reading of the test. Distinguishing intensity bands and reading 'Trace' results can be problematic and leads commonly to 'false positive' readings. The apk being developed will utilize a testing algorithm to better distinguish between true positive and false positive "Trace" test results.
The purpose of this study is to determine differences between cure rates vs re-infection levels. The fundamental question is to see what the prevalence and intensity are before MDA, and then, see what those are 7 to 8 weeks after MDA. Since there are villages that continue to have high prevalence from year to year, we will determine if this primarily represents reinfection occurring since the last annual MDA or if it is related more to treatment efficacy.
A selected number of 5 villages near Lake Victoria shown to maintain very high levels of infection with S. mansoni following at least three rounds of annual praziquantel chemotherapy will be compared with 5 villages where infection rates have been much more responsive to similar levels of treatment, with respect to the following general considerations and questions:
1) What is the general situation for each village with respect to proximity of water bodies where intensive human contact occurs?
2) For each village, what is the role of each major habitat in transmission, as assessed by three separate techniques: water filtration; use of sentinel mice; and standard snail survey techniques?
What should be the content of a toolkit to assess and monitor morbidity and disability across NTDs?
Innovative approach to exploit ongoing STH- SCH survey to conduct integrated surveillance for LF and oncho that will serve as a model for other programs
To complete mapping of NTDs in AFRO and support transitioning of new diagnostics tools into program use.
Rapid Integrated Mapping of Schistosomiasis and Soil-Transmitted Helminthiasis Using POC-CCA and Kato-Katz Tests
Complete mapping of NTDs in AFRO. Support transitioning of new diagnostics tools into program use. (Refer to 23.1, 23.2, 23.3, 23.4, 23.5, 23.6, 23.7, 23.8, 23.9, 23.10.)