Research Project

Co-Delivery of Preventative Chemotherapies Against Onchocerciasis and Soil-Transmitted Helminths

Along With Complementary Social and Behavioral Change Communication Interventions in Ethiopia

Summary

Jimma University conducted a study on the effectiveness of co-delivered mass drug administration campaigns for controlling onchocerciasis and soil-transmitted helminths in Ethiopia together with the partial integration of other health campaigns.

Ethiopia

Oromia Region

Neglected Tropical Diseases.

Onchocerciasis and soil-transmitted helminths

  • Facilitate collaborative planning and capacity building among co-delivery partners
  • Develop locally tailored messaging around the co-delivered and partially integrated interventions
  • See all promising practices

Key Messages

Jimma University conducted a mixed-methods study to better understand the implications of co-delivering campaigns for  onchocerciasis chemotherapy and deworming of children and women of reproductive age, and partially integrating additional health campaigns with this effort in Ethiopia’s Oromia region. The partially integrated campaigns addressed social and behavioral change communication around COVID-19 and water, sanitation, and hygiene, as well as the identification of children under one year of age who were not fully vaccinated. Through this study, researchers assessed community attitudes and views around co-delivery and facilitated stakeholder development and implementation of a co-delivery approach.

  • The co-delivery of onchocerciasis and STH interventions proved feasible and resulted in positive outcomes, including strong treatment coverage. Co-delivery appears to be a viable approach for strengthening neglected tropical disease (NTD) interventions in Ethiopia.
  • Stakeholders in Ethiopia are receptive to implementing co-delivered NTD campaigns.
  • Key components of successful co-delivery of NTD interventions include:
    • Locally tailored social and behavioral change communication
    • Well-aligned co-delivery tools, formats, and protocols
    • Engagement and empowerment of frontline health care workers
    • Support from stakeholders, including volunteers and policymakers
    • Training to build capacity among campaign personnel
    • Focused efforts to establish a common understanding across stakeholders
    • Collaborative micro-plan development at the community level
    • A clear strategy for engaging and orienting volunteers
    • Ongoing education and mobilization at the community level

Background

Context

As highlighted in the World Health Organization’s road map for neglected tropical diseases, an integrated approach to neglected tropical disease (NTD) campaigns can improve program efficiency, effectiveness, and management, thus enhancing health outcomes. In line with this finding, Ethiopia aims to accelerate the control of NTDs by integrating NTD interventions.

View the slides for detail on the research methods.

Problem or Gap

In Ethiopia, the integration of health campaigns often falls short of the coordination level needed to improve health outcomes. Further, prior to this study, minimal data were available on the feasibility of NTD campaign co-delivery in Ethiopia.

Study Objectives

The objectives of this study were to:

  • Evaluate the effectiveness of the co-administration of onchocerciasis chemotherapy and deworming of STH along with three other complementary health interventions
  • Assess the acceptability and feasibility of the co-delivery strategy from the perspectives of beneficiaries and stakeholders

Results

Summary

Researchers assessed co-delivery and integration effectiveness by analyzing changes in treatment coverage and community knowledge and practices. The findings illustrate that co-delivery of onchocerciasis and soil-transmitted helminths (STH) interventions led by Health Extension Workers (HEWs) and supported by volunteers promotes strong coverage. As such, the study results suggest that co-delivery of these campaigns warrants further exploration and adoption in other contexts within Ethiopia.

Scroll down for more key findings. 

Zewdie Birhanu, PhD, professor at Jimma University, discusses the key findings and lessons of the project.

Key Findings

  • Stakeholders viewed the co-delivery approach as effective and feasible. They also perceived it as advantageous for increased access, greater equity, improved efficiency and quality of mass drug administration, and reduced misuse of drugs for NTD treatment.
  • The co-delivered campaigns attained the intended treatment coverage, reaching 89.5% of the population for onchocerciasis treatment, 84.1% for STH treatment, and 83.2% for combination therapy.
  • Other positive outcomes included community acceptance and trust, quality service delivery, and safety.
  • Few adverse events were reported after treatment.
  • 4% of community members reported a high level of satisfaction with the co-delivery, and 96.3% said they would like to receive treatment in the same manner again.
  • Probable reasons for community acceptance of the interventions included:
    • Direct involvement of HEWs
    • Perceived fairness in and quality of drug administration
    • Increased access to the needed drugs
    • Enhanced transparency in drug distribution
    • The provision of health education information along with medication
  • 88.5% of the survey respondents reported exposure to health information campaign messaging during the co-delivery campaign.
  • Informational campaign activities were among the most challenging components of this implementation study due to a high volume of patients for the drug administration and insufficient time for health education during co-delivery.
  • After the delivery of the partially integrated campaigns, community knowledge of onchocerciasis, STH, COVID-19, and associated symptoms and prevention approaches was significantly higher than baseline levels.
  • Through partially integrated campaigns, 12.7% of infants under age one were found to be unvaccinated or incompletely vaccinated and were referred to the health center.

“The community is really happy to take the drugs from HEWs … as the HEWs have a good understanding of the drugs. The HEWs also advise the community very well. They also have a very good relationship with the community.” -Focus group participant

  • Begin co-delivery efforts by first establishing a common understanding across campaign partners about how to execute the co-delivered campaigns and engaging them in collaborative planning and capacity building.
  • Complement co-delivered campaigns with behavioral change interventions that promote awareness and prevention of disease.
  • Re-orient volunteers as community mobilizers instead of drug distributors.
  • Engage and empower the frontline health care workers who will be involved in co-delivery.
  • Prioritize follow-up and timely feedback, as well as supportive supervision of health care personnel.
  • Based on community input, develop locally appropriate educational messaging that addresses current community concerns, knowledge, and practices.
  • Create tools and protocols for co-delivery that align across campaigns.
  • Enable community members to register for treatment ahead of time.