Mass 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.