Evidence Action

• 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.