Drug Distribution Campaign in Burkina Faso
Between the 18 and 27 October 2004, a mass drug
distribution campaign of Praziquantel and Albendazole took place in Burkina
Faso.
The Secretary General of the Ministry of Health had specifically
dedicated these 10 days to the “Deworming campaign”, and all health posts
and staff had been alerted and mobilised for this specific task.
The treatment was organised as a campaign, on the model of National
Vaccination Days, and the target was school-aged children 5-15 years. Both
schools and villages were visited, in order to cover as many children as
possible, including both those who attend school, and those who do not.
Numbers
The target geographical area covered by the campaign included about one
third of the country’s surface. In total, 4 Regional Directorates of Health,
19 Health Districts and more than 300 Health Posts (CSPS) were involved. The
total target population of children from 5 to 15 was about 1.25 million.
Organisation
The “Médecin Chef de District (MCD)” ( Head District Doctor), who is
responsible for a Health District (which usually includes 15 to 20 Health
Posts) was in charge of organising the campaign in the area under his
responsibility, in collaboration with the Epidemiologist (CISSE) who is
based in each Health District.
Actual distribution activities at field level were implemented by the
“Infirmier Chef de Poste” (nurse), responsible for each Health Post . He/she
was asked to organize one or more distribution teams to cover the area under
his/her responsibility.
Usually one team remained based at the Health Post, while the other
distribution teams followed the itinerary also used for vaccination
campaigns, reaching schools and communities. At the schools teaching staff
were involved in the campaign; in the villages, traditional authorities and
leaders were also involved.
Supervision
The MCD was responsible for the supervision of the Health Posts in his
area, visiting the distribution teams and checking their work.
A team from the Regional Directorate of Health visited Health Districts
and Health Posts.by car.
Teams from the National Control Programme were based in each of the 4
Regions and visited Regional Directorates, Health Districts and Health posts
to check the quality of the work and help in case of need.
At the end of the campaign, each Health District organised a meeting with
the ICPs (nurses) from each Health Post to discuss the campaign: the strong
points, weak points, recommendations for next year’s campaign etc. Staff
from the National Programme attended some of these meetings. The outcomes of
these discussions will be forwarded to the National Coordinator of the
“Programme de Lutte contre la Schistosomiase” (PNLSc).
Logistics
Drugs: drugs were distributed to Health Districts by car from
Ouagadougou, by National Programme staff, in quantities proportional to
the target population. The MCD (doctor) was in charge of allocating drugs
to the different Health Posts. The ICPs (nurses) from different health
posts travelled to the Health District and collected their drugs.
Dose poles, bins for water, water cups: these followed the same
route as drugs
Treatment record forms: forms to be used at Regional, District,
Health Post and Distribution Team level were forwarded to the 4 Regional
Directorates of Health who photocopied them and distributed them to the
Districts and from there to the Health Posts.
Training
People from each of the Health Districts involved in the campaign and
from each of the 4 Regional Directions of Health were invited to Ouagadougou
in September for a training session on drug distribution, completing forms,
social mobilisation, etc. The rationale, purpose and the operational methods
of the campaign were explained.
Subsequently, at Health District level, a similar activity was organised
under the responsibility of the MCD and the CISSE to train the ICPs
(Nurses).
Involvement of Partners
A high level meeting was organised in Ouagadougou in August. The
Secretary-General of the Ministry of Education attended the meeting as the
most important partner of the Ministry of Health (also represented by the
Secretary-General ). Representatives from The World Food Programme (WFP) and
other NGOs involved in school health also participated.
A special partner of the PNLSc is the Lymphatic Filariasis Control
Programme, especially as far as albendazole distribution is concerned. It
was agreed between the coordinators of the two programmes that the PNLSc
would distribute albendazole to the 5 to 15 years old population, and the
Lymphatic Filariasis programme would cover the adult population, in order to
share the task.
Social Mobilisation
In the field, social mobilisation activities took place both at school
and village level to sensitise communities to the treatment campaign.
Teachers were involved, as well as community leaders. A TV spot was also
broadcasted for the whole period of the campaign.
Outcomes
Coverage was very good, higher than 95%. About one third of the target
population was reached at schools; about two thirds outside schools.
People were very keen to be treated, especially with albendazole,
described as “the drug that kills all the worms in your belly” and much in
demand. This probably contributed to the good coverage rate. Distribution
teams had the impression that deworming drugs were better accepted than
vaccination (the polio campaign had taken place two weeks before).
Weak points (as identified by field staff)
- Social mobilisation was too late and insufficient
- Resources (including money) were made available too late. The per diem
paid, lower than that paid for National Immunisation Days, was judged too
low
- The period of the year was not optimal:
- Distribution took place during the Ramadan, and a small percentage
of children refused to be treated. They were therefore given drugs after
the sunset.
- It was harvest period and it was difficult and time-consuming
reaching children out in the fields.
- Dose-poles were provided by the PNLSc and made of wood. They proved
to be too heavy for transport (distribution teams use mopeds to reach
communities), but also too weak. Some of them were broken before use.
- Treatment record forms were judged “too heavy” and time-consuming.
Forms used for schools did not take into account secondary schools,
attended by many boys of the older age groups targeted (13-15).
- Side-effects were very rare, but some ICPs recorded side effects in up
to 10% of the treated population. The most common were abdominal pain and
vertigo. It should be realised that many children treated in the morning
had not eaten anything since the previous evening.
- Difficulties were reported in estimating age at village level, where
no record exists.
- Younger children (5-6 years) had problems in swallowing tablets.
- In one Regional Directorate of Health, the Regional Director shortened
the duration of the campaign from 10 to 4 days. The time was judged
insufficient by many health workers.
- In some health posts, drugs were not sufficient, especially
albendazole, which was provided in a 1:1 ratio to target population.
- In some districts, the budget for traditional authorities at village
level was very small
- Some districts suggested that more emphasis on prevention of disease
would be welcomed.
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