This project intends to assess the effectiveness of using the Community Directed Intervention (CDI) approach as a vehicle for delivery of mass drug administration (MDA) campaigns against targeted NTDs namely, schistosomiasis and soil-transmitted helminths (STH) such as Ascaris lumbricoides (roundworms), Trichuris trichiura (whip worms) and Ancylostoma sp. (hookworms) in selected districts of Malawi. The idea is to take advantage of the logistical setup, organizational strength and high degree of efficiency of the national NTD programme to improve delivery of the current MDA efforts to control selected and highly prioritized NTDs of schistosomiasis and STH and to enhance community ownership of the interventions in selected rural and remote communities by using the CDI approach. The primary research question is: Can the CDI approach be effectively used to deliver MDA to control NTDs at community level in rural Malawian districts?
Urban dwellers have frequently been included as "hard to reach" when examining MDA coverage and uptake. Poor coverage in urban settings is a key factor that prevents programs in some settings from achieving success. This research study proposes a community-based participatory action research (CBPAR) strategy to better understand the reasons why this population isn’t reached and/or their decision not to participate in onchocerciasis and lymphatic filariasis MDAs. The results will help identify last mile strategies for urban populations and will generate a technical toolkit for how to conduct rapid participatory research in areas that require novel outreach methods amongst hard-to-reach populations. This form of social science methodology has not been used frequently within the NTD community and this proposal offers an opportunity to build the evidence base for these methods within the context of hard to reach populations.
The researchers plan to conduct a number of activities in order to determine the effectiveness of the participatory approach in targeting urban populations as compared to the standard mobilization and delivery approach.
Rapid ethnographic interviews, a new technique aimed at rapidly collecting and analyzing qualitative data, to gather community feedback regarding barriers in accessing treatment
An intervention development workshop with community leaders, health workers, researchers, and the ministry of health
Deliver the newly designed strategy in Za-Kpota district and compare coverage in urban settings to Ouinhi district
Finalize a rapid participatory approach toolkit and conduct a time-motion study of the approach to improve the business case to the MoH for uptake 5. Surveys and individual interviews with key stakeholders to determine acceptability, appropriateness, and feasibility of the proposed approach and toolkit
To develop and pilot a standardised analytical framework for the spatial and temporal analysis of routinely collected gender disaggregated NTD programme data. This will allow increased understanding and spatial visualisation of the influence of gendered programmatic inputs, external geographic and social factors on the equity of programmatic outputs, particularly access to mass administration of medicines (MAM).
What is the indicator(s) and accompanying M&E strategy that enables country programs to determine when the risk of ongoing transmission of lymphatic filariasis has been reduced so that triple drug therapy with ivermectin, diethylcarbamazine, and albendazole (IDA) can be stopped with little risk of resurgence of transmission?
Can the use of a tailored social mobilization package be used to strengthen community and health system participation and achieve >80% coverage for IDA in Kenya?
A pilot study to identify meaningful and measurable targets for detecting the control of schistosomiasis-related morbidity in Africa. The overall study is designed to answer the following primary evaluation questions:
What are the infection levels of Schistosoma mansoni and S. haematobium below which there is little, or no, detectable schistosomiasis-associated morbidity?
What are the optimal morbidity markers for S. mansoni and S. haematobium?
What are the optimal species-specific morbidity goals for which schistosomiasis control programs should be aiming?
What is the effectiveness of appropriately dosed IDA in clearing microfilariae (Mf) from Mf positive people who (i) reported taking triple drug therapy with ivermectin, diethylcarbamazine, and albendazole (IDA) in August 2018, and (ii) did not report recently taking IDA.
This will be investigated by:
assessing the baseline (current) Mf presence and density before re/treatment with IDA, against which post-treatment Mf presence and density can be compared
assessing the peak plasma concentration levels of ivermectin, DEC and albendazole in treated Mf positive individuals to identify whether the recommended dosages of medications are sufficient for achieving effective plasma concentrations
assessing Mf clearance one week following directly observed IDA re/treatment