Maintaining effective mass drug administration for lymphatic filariasis through in-process monitoring in Sierra Leone
Identifieur interne : 002B19 ( Pmc/Curation ); précédent : 002B18; suivant : 002B20Maintaining effective mass drug administration for lymphatic filariasis through in-process monitoring in Sierra Leone
Auteurs : Mary H. Hodges [Sierra Leone] ; Mustapha Sonnie [Sierra Leone] ; Hamid Turay [Sierra Leone] ; Abdulai Conteh [Sierra Leone] ; Florence Maccarthy [Sierra Leone] ; Santigie Sesay [Sierra Leone]Source :
- Parasites & Vectors [ 1756-3305 ] ; 2012.
Abstract
Since 2007 Sierra Leone has conducted mass drug administration (MDA) for the elimination of lymphatic filariasis (LF) implemented by unpaid community health volunteers (CHVs). Other health campaigns such as Mother and Child Health Weeks (MCHW) pay for services to be implemented at community level and these persons are then known as community health workers (CHWs). In 2010, the LF MDA in the 12 districts of the Southern, Northern and Eastern Provinces un-expectantly coincided with universal distribution of Long Lasting Insecticide Treated Nets (LLITNs) during the MCHW. In-process monitoring of LF MDA was performed to ensure effective coverage was attained in hard to reach sites (HTR) in both urban and rural locations where vulnerable populations reside.
Independent monitors interviewed individuals eligible for LF MDA and tallied those who recalled having taken ivermectin and albendazole, calculated program coverage and reported results daily by phone. Monitoring of coverage in HTR sites in the 4 most rapidly urbanizing towns was performed after 4 weeks of LF MDA and again after 8 weeks throughout all 12 districts. End process monitoring was performed in randomly selected HTR sites not previously sampled throughout all 12 districts and compared to coverage calculated from the pre-MDA census and reported treatments.
Only one town had reached effective program coverage (≥80%) after 4 weeks following which CHWs were recruited for LF MDA in all district headquarter towns. After 8 weeks only 4 of 12 districts had reached effective coverage so LF MDA was extended for a further month in all districts. By 12 weeks effective program coverage had been reached in all districts except Port Loko and there was no significant difference between those interviewed in communities versus households or by sex. Effective epidemiological coverage (≥65%) was reported in all districts and overall was significantly higher in males versus females.
The challenges to LF MDA included the late delivery in country of ivermectin, the availability and motivation of unpaid CHVs, concurrent LLITN distribution and the MCHW, remuneration for CHWs, rapid urbanization and employment seeking population migrations. 'In process' monitoring ensured modifications of LF MDA were made in a timely manner to ensure effective coverage was finally attained even in HTR locations.
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DOI: 10.1186/1756-3305-5-232
PubMed: 23062561
PubMed Central: 3503583
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Maintaining effective mass drug administration for lymphatic filariasis through in-process monitoring in Sierra Leone</title><author><name sortKey="Hodges, Mary H" sort="Hodges, Mary H" uniqKey="Hodges M" first="Mary H" last="Hodges">Mary H. Hodges</name><affiliation wicri:level="1"><nlm:aff id="I1">Helen Keller International, Freetown, Sierra Leone, 35 Nelson Lane, Tengbeh Town, Freetown, Sierra Leone</nlm:aff><country xml:lang="fr">Sierra Leone</country><wicri:regionArea>Helen Keller International, Freetown, Sierra Leone, 35 Nelson Lane, Tengbeh Town, Freetown</wicri:regionArea></affiliation></author><author><name sortKey="Sonnie, Mustapha" sort="Sonnie, Mustapha" uniqKey="Sonnie M" first="Mustapha" last="Sonnie">Mustapha Sonnie</name><affiliation wicri:level="1"><nlm:aff id="I1">Helen Keller International, Freetown, Sierra Leone, 35 Nelson Lane, Tengbeh Town, Freetown, Sierra Leone</nlm:aff><country xml:lang="fr">Sierra Leone</country><wicri:regionArea>Helen Keller International, Freetown, Sierra Leone, 35 Nelson Lane, Tengbeh Town, Freetown</wicri:regionArea></affiliation></author><author><name sortKey="Turay, Hamid" sort="Turay, Hamid" uniqKey="Turay H" first="Hamid" last="Turay">Hamid Turay</name><affiliation wicri:level="1"><nlm:aff id="I1">Helen Keller International, Freetown, Sierra Leone, 35 Nelson Lane, Tengbeh Town, Freetown, Sierra Leone</nlm:aff><country xml:lang="fr">Sierra Leone</country><wicri:regionArea>Helen Keller International, Freetown, Sierra Leone, 35 Nelson Lane, Tengbeh Town, Freetown</wicri:regionArea></affiliation></author><author><name sortKey="Conteh, Abdulai" sort="Conteh, Abdulai" uniqKey="Conteh A" first="Abdulai" last="Conteh">Abdulai Conteh</name><affiliation wicri:level="1"><nlm:aff id="I2">National Neglected Tropical Disease Control Program, Ministry of Health and Sanitation, New England, Freetown, Sierra Leone</nlm:aff><country xml:lang="fr">Sierra Leone</country><wicri:regionArea>National Neglected Tropical Disease Control Program, Ministry of Health and Sanitation, New England, Freetown</wicri:regionArea></affiliation></author><author><name sortKey="Maccarthy, Florence" sort="Maccarthy, Florence" uniqKey="Maccarthy F" first="Florence" last="Maccarthy">Florence Maccarthy</name><affiliation wicri:level="1"><nlm:aff id="I2">National Neglected Tropical Disease Control Program, Ministry of Health and Sanitation, New England, Freetown, Sierra Leone</nlm:aff><country xml:lang="fr">Sierra Leone</country><wicri:regionArea>National Neglected Tropical Disease Control Program, Ministry of Health and Sanitation, New England, Freetown</wicri:regionArea></affiliation></author><author><name sortKey="Sesay, Santigie" sort="Sesay, Santigie" uniqKey="Sesay S" first="Santigie" last="Sesay">Santigie Sesay</name><affiliation wicri:level="1"><nlm:aff id="I2">National Neglected Tropical Disease Control Program, Ministry of Health and Sanitation, New England, Freetown, Sierra Leone</nlm:aff><country xml:lang="fr">Sierra Leone</country><wicri:regionArea>National Neglected Tropical Disease Control Program, Ministry of Health and Sanitation, New England, Freetown</wicri:regionArea></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">23062561</idno><idno type="pmc">3503583</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3503583</idno><idno type="RBID">PMC:3503583</idno><idno type="doi">10.1186/1756-3305-5-232</idno><date when="2012">2012</date><idno type="wicri:Area/Pmc/Corpus">002B20</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">002B20</idno><idno type="wicri:Area/Pmc/Curation">002B19</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">002B19</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Maintaining effective mass drug administration for lymphatic filariasis through in-process monitoring in Sierra Leone</title><author><name sortKey="Hodges, Mary H" sort="Hodges, Mary H" uniqKey="Hodges M" first="Mary H" last="Hodges">Mary H. Hodges</name><affiliation wicri:level="1"><nlm:aff id="I1">Helen Keller International, Freetown, Sierra Leone, 35 Nelson Lane, Tengbeh Town, Freetown, Sierra Leone</nlm:aff><country xml:lang="fr">Sierra Leone</country><wicri:regionArea>Helen Keller International, Freetown, Sierra Leone, 35 Nelson Lane, Tengbeh Town, Freetown</wicri:regionArea></affiliation></author><author><name sortKey="Sonnie, Mustapha" sort="Sonnie, Mustapha" uniqKey="Sonnie M" first="Mustapha" last="Sonnie">Mustapha Sonnie</name><affiliation wicri:level="1"><nlm:aff id="I1">Helen Keller International, Freetown, Sierra Leone, 35 Nelson Lane, Tengbeh Town, Freetown, Sierra Leone</nlm:aff><country xml:lang="fr">Sierra Leone</country><wicri:regionArea>Helen Keller International, Freetown, Sierra Leone, 35 Nelson Lane, Tengbeh Town, Freetown</wicri:regionArea></affiliation></author><author><name sortKey="Turay, Hamid" sort="Turay, Hamid" uniqKey="Turay H" first="Hamid" last="Turay">Hamid Turay</name><affiliation wicri:level="1"><nlm:aff id="I1">Helen Keller International, Freetown, Sierra Leone, 35 Nelson Lane, Tengbeh Town, Freetown, Sierra Leone</nlm:aff><country xml:lang="fr">Sierra Leone</country><wicri:regionArea>Helen Keller International, Freetown, Sierra Leone, 35 Nelson Lane, Tengbeh Town, Freetown</wicri:regionArea></affiliation></author><author><name sortKey="Conteh, Abdulai" sort="Conteh, Abdulai" uniqKey="Conteh A" first="Abdulai" last="Conteh">Abdulai Conteh</name><affiliation wicri:level="1"><nlm:aff id="I2">National Neglected Tropical Disease Control Program, Ministry of Health and Sanitation, New England, Freetown, Sierra Leone</nlm:aff><country xml:lang="fr">Sierra Leone</country><wicri:regionArea>National Neglected Tropical Disease Control Program, Ministry of Health and Sanitation, New England, Freetown</wicri:regionArea></affiliation></author><author><name sortKey="Maccarthy, Florence" sort="Maccarthy, Florence" uniqKey="Maccarthy F" first="Florence" last="Maccarthy">Florence Maccarthy</name><affiliation wicri:level="1"><nlm:aff id="I2">National Neglected Tropical Disease Control Program, Ministry of Health and Sanitation, New England, Freetown, Sierra Leone</nlm:aff><country xml:lang="fr">Sierra Leone</country><wicri:regionArea>National Neglected Tropical Disease Control Program, Ministry of Health and Sanitation, New England, Freetown</wicri:regionArea></affiliation></author><author><name sortKey="Sesay, Santigie" sort="Sesay, Santigie" uniqKey="Sesay S" first="Santigie" last="Sesay">Santigie Sesay</name><affiliation wicri:level="1"><nlm:aff id="I2">National Neglected Tropical Disease Control Program, Ministry of Health and Sanitation, New England, Freetown, Sierra Leone</nlm:aff><country xml:lang="fr">Sierra Leone</country><wicri:regionArea>National Neglected Tropical Disease Control Program, Ministry of Health and Sanitation, New England, Freetown</wicri:regionArea></affiliation></author></analytic><series><title level="j">Parasites & Vectors</title><idno type="eISSN">1756-3305</idno><imprint><date when="2012">2012</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>Since 2007 Sierra Leone has conducted mass drug administration (MDA) for the elimination of lymphatic filariasis (LF) implemented by unpaid community health volunteers (CHVs). Other health campaigns such as Mother and Child Health Weeks (MCHW) pay for services to be implemented at community level and these persons are then known as community health workers (CHWs). In 2010, the LF MDA in the 12 districts of the Southern, Northern and Eastern Provinces un-expectantly coincided with universal distribution of Long Lasting Insecticide Treated Nets (LLITNs) during the MCHW. In-process monitoring of LF MDA was performed to ensure effective coverage was attained in hard to reach sites (HTR) in both urban and rural locations where vulnerable populations reside.</p></sec><sec><title>Methods</title><p>Independent monitors interviewed individuals eligible for LF MDA and tallied those who recalled having taken ivermectin and albendazole, calculated program coverage and reported results daily by phone. Monitoring of coverage in HTR sites in the 4 most rapidly urbanizing towns was performed after 4 weeks of LF MDA and again after 8 weeks throughout all 12 districts. End process monitoring was performed in randomly selected HTR sites not previously sampled throughout all 12 districts and compared to coverage calculated from the pre-MDA census and reported treatments.</p></sec><sec><title>Results</title><p>Only one town had reached effective program coverage (≥80%) after 4 weeks following which CHWs were recruited for LF MDA in all district headquarter towns. After 8 weeks only 4 of 12 districts had reached effective coverage so LF MDA was extended for a further month in all districts. By 12 weeks effective program coverage had been reached in all districts except Port Loko and there was no significant difference between those interviewed in communities versus households or by sex. Effective epidemiological coverage (≥65%) was reported in all districts and overall was significantly higher in males versus females.</p></sec><sec><title>Conclusions</title><p>The challenges to LF MDA included the late delivery in country of ivermectin, the availability and motivation of unpaid CHVs, concurrent LLITN distribution and the MCHW, remuneration for CHWs, rapid urbanization and employment seeking population migrations. 'In process' monitoring ensured modifications of LF MDA were made in a timely manner to ensure effective coverage was finally attained even in HTR locations.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Melrose, Wd" uniqKey="Melrose W">WD Melrose</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Addiss, D" uniqKey="Addiss D">D Addiss</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Koroma, Jb" uniqKey="Koroma J">JB Koroma</name></author><author><name sortKey="Bangura, M" uniqKey="Bangura M">M Bangura</name></author><author><name sortKey="Hodges, Mh" uniqKey="Hodges M">MH Hodges</name></author><author><name sortKey="Bah, Ms" uniqKey="Bah M">MS Bah</name></author><author><name sortKey="Zhang, Y" uniqKey="Zhang Y">Y 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sortKey="Zhang, Y" uniqKey="Zhang Y">Y Zhang</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hodges, Mh" uniqKey="Hodges M">MH Hodges</name></author><author><name sortKey="Koroma, Jb" uniqKey="Koroma J">JB Koroma</name></author><author><name sortKey="Kennedy, N" uniqKey="Kennedy N">N Kennedy</name></author><author><name sortKey="Sonnie, M" uniqKey="Sonnie M">M Sonnie</name></author><author><name sortKey="Cotter, E" uniqKey="Cotter E">E Cotter</name></author><author><name sortKey="Macarthur, C" uniqKey="Macarthur C">C MacArthur</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Michael, E" uniqKey="Michael E">E Michael</name></author><author><name sortKey="Malecela Lazaro, Mn" uniqKey="Malecela Lazaro M">MN Malecela-Lazaro</name></author><author><name sortKey="Kabali, C" uniqKey="Kabali C">C Kabali</name></author><author><name sortKey="Snow, Lc" uniqKey="Snow L">LC Snow</name></author><author><name sortKey="Kazura, Jw" uniqKey="Kazura J">JW Kazura</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Michael, E" uniqKey="Michael E">E Michael</name></author><author><name sortKey="Malecela Lazaro, Mn" uniqKey="Malecela Lazaro M">MN Malecela-Lazaro</name></author><author><name sortKey="Maegga, Bt" uniqKey="Maegga B">BT Maegga</name></author><author><name sortKey="Fischer, P" uniqKey="Fischer P">P Fischer</name></author><author><name sortKey="Kazura, Jw" uniqKey="Kazura J">JW Kazura</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Baker, Mc" uniqKey="Baker M">MC Baker</name></author><author><name sortKey="Mcfarland, Da" uniqKey="Mcfarland D">DA McFarland</name></author><author><name sortKey="Gonzales, M" uniqKey="Gonzales M">M Gonzales</name></author><author><name sortKey="Diaz, Mj" uniqKey="Diaz M">MJ Diaz</name></author><author><name sortKey="Molyneux, Dh" uniqKey="Molyneux D">DH Molyneux</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Blackburn, Bg" uniqKey="Blackburn B">BG Blackburn</name></author><author><name sortKey="Eigege, A" uniqKey="Eigege A">A Eigege</name></author><author><name sortKey="Gotau, H" uniqKey="Gotau H">H Gotau</name></author><author><name sortKey="Gerlong, G" uniqKey="Gerlong G">G Gerlong</name></author><author><name sortKey="Miri, E" uniqKey="Miri E">E Miri</name></author><author><name sortKey="Hawley, Wa" uniqKey="Hawley W">WA Hawley</name></author><author><name sortKey="Mathieu, E" uniqKey="Mathieu E">E Mathieu</name></author><author><name sortKey="Richards, F" uniqKey="Richards F">F Richards</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Koroma, Ds" uniqKey="Koroma D">DS Koroma</name></author><author><name sortKey="Turay, Ab" uniqKey="Turay A">AB Turay</name></author><author><name sortKey="Moihua, Mb" uniqKey="Moihua M">MB Moihua</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Goldman, As" uniqKey="Goldman A">AS Goldman</name></author><author><name sortKey="Guisinger, Vh" uniqKey="Guisinger V">VH Guisinger</name></author><author><name sortKey="Aikins, M" uniqKey="Aikins M">M Aikins</name></author><author><name sortKey="Amarillo, Ml" uniqKey="Amarillo M">ML Amarillo</name></author><author><name sortKey="Belizario, Vy" uniqKey="Belizario V">VY Belizario</name></author><author><name sortKey="Garshong, B" uniqKey="Garshong B">B Garshong</name></author><author><name sortKey="Gyapong, J" uniqKey="Gyapong J">J Gyapong</name></author><author><name sortKey="Kabali, C" uniqKey="Kabali C">C Kabali</name></author><author><name sortKey="Kamal, Ha" uniqKey="Kamal H">HA Kamal</name></author><author><name sortKey="Kanjilal, S" uniqKey="Kanjilal S">S Kanjilal</name></author><author><name sortKey="Kyelem, D" uniqKey="Kyelem D">D Kyelem</name></author><author><name sortKey="Lizardo, J" uniqKey="Lizardo J">J Lizardo</name></author><author><name sortKey="Malecela, M" uniqKey="Malecela M">M Malecela</name></author><author><name sortKey="Mubyazi, G" uniqKey="Mubyazi G">G Mubyazi</name></author><author><name sortKey="Nitlema, Pa" uniqKey="Nitlema P">PA Nitlèma</name></author><author><name sortKey="Ramzy, Rmr" uniqKey="Ramzy R">RMR Ramzy</name></author><author><name sortKey="Streit, Tg" uniqKey="Streit T">TG Streit</name></author><author><name sortKey="Wallace, A" uniqKey="Wallace A">A Wallace</name></author><author><name sortKey="Brady, Ma" uniqKey="Brady M">MA Brady</name></author><author><name sortKey="Rheingans, R" uniqKey="Rheingans R">R Rheingans</name></author><author><name sortKey="Ottesen, Ea" uniqKey="Ottesen E">EA Ottesen</name></author><author><name sortKey="Haddix, Ac" uniqKey="Haddix A">AC 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<front><journal-meta><journal-id journal-id-type="nlm-ta">Parasit Vectors</journal-id><journal-id journal-id-type="iso-abbrev">Parasit Vectors</journal-id><journal-title-group><journal-title>Parasites & Vectors</journal-title></journal-title-group><issn pub-type="epub">1756-3305</issn><publisher><publisher-name>BioMed Central</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">23062561</article-id><article-id pub-id-type="pmc">3503583</article-id><article-id pub-id-type="publisher-id">1756-3305-5-232</article-id><article-id pub-id-type="doi">10.1186/1756-3305-5-232</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research</subject></subj-group></article-categories><title-group><article-title>Maintaining effective mass drug administration for lymphatic filariasis through in-process monitoring in Sierra Leone</article-title></title-group><contrib-group><contrib contrib-type="author" corresp="yes" id="A1"><name><surname>Hodges</surname><given-names>Mary H</given-names></name><xref ref-type="aff" rid="I1">1</xref><email>mhodges@hki.org</email></contrib><contrib contrib-type="author" id="A2"><name><surname>Sonnie</surname><given-names>Mustapha</given-names></name><xref ref-type="aff" rid="I1">1</xref><email>msonnie@hki.org</email></contrib><contrib contrib-type="author" id="A3"><name><surname>Turay</surname><given-names>Hamid</given-names></name><xref ref-type="aff" rid="I1">1</xref><email>thamid@hki.org</email></contrib><contrib contrib-type="author" id="A4"><name><surname>Conteh</surname><given-names>Abdulai</given-names></name><xref ref-type="aff" rid="I2">2</xref><email>abteh2000@yahoo.com</email></contrib><contrib contrib-type="author" id="A5"><name><surname>MacCarthy</surname><given-names>Florence</given-names></name><xref ref-type="aff" rid="I2">2</xref><email>floramco02@yahoo.com</email></contrib><contrib contrib-type="author" id="A6"><name><surname>Sesay</surname><given-names>Santigie</given-names></name><xref ref-type="aff" rid="I2">2</xref><email>sanniesey@gmail.com</email></contrib></contrib-group><aff id="I1"><label>1</label>Helen Keller International, Freetown, Sierra Leone, 35 Nelson Lane, Tengbeh Town, Freetown, Sierra Leone</aff><aff id="I2"><label>2</label>National Neglected Tropical Disease Control Program, Ministry of Health and Sanitation, New England, Freetown, Sierra Leone</aff><pub-date pub-type="collection"><year>2012</year></pub-date><pub-date pub-type="epub"><day>12</day><month>10</month><year>2012</year></pub-date><volume>5</volume><fpage>232</fpage><lpage>232</lpage><history><date date-type="received"><day>20</day><month>7</month><year>2012</year></date><date date-type="accepted"><day>2</day><month>10</month><year>2012</year></date></history><permissions><copyright-statement>Copyright ©2012 Hodges et al.; licensee BioMed Central Ltd.</copyright-statement><copyright-year>2012</copyright-year><copyright-holder>Hodges et al.; licensee BioMed Central Ltd.</copyright-holder><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by/2.0"><license-p>This is an Open Access article distributed under the terms of the Creative Commons Attribution License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/2.0">http://creativecommons.org/licenses/by/2.0</ext-link>), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p></license></permissions><self-uri xlink:href="http://www.parasitesandvectors.com/content/5/1/232"></self-uri><abstract><sec><title>Background</title><p>Since 2007 Sierra Leone has conducted mass drug administration (MDA) for the elimination of lymphatic filariasis (LF) implemented by unpaid community health volunteers (CHVs). Other health campaigns such as Mother and Child Health Weeks (MCHW) pay for services to be implemented at community level and these persons are then known as community health workers (CHWs). In 2010, the LF MDA in the 12 districts of the Southern, Northern and Eastern Provinces un-expectantly coincided with universal distribution of Long Lasting Insecticide Treated Nets (LLITNs) during the MCHW. In-process monitoring of LF MDA was performed to ensure effective coverage was attained in hard to reach sites (HTR) in both urban and rural locations where vulnerable populations reside.</p></sec><sec><title>Methods</title><p>Independent monitors interviewed individuals eligible for LF MDA and tallied those who recalled having taken ivermectin and albendazole, calculated program coverage and reported results daily by phone. Monitoring of coverage in HTR sites in the 4 most rapidly urbanizing towns was performed after 4 weeks of LF MDA and again after 8 weeks throughout all 12 districts. End process monitoring was performed in randomly selected HTR sites not previously sampled throughout all 12 districts and compared to coverage calculated from the pre-MDA census and reported treatments.</p></sec><sec><title>Results</title><p>Only one town had reached effective program coverage (≥80%) after 4 weeks following which CHWs were recruited for LF MDA in all district headquarter towns. After 8 weeks only 4 of 12 districts had reached effective coverage so LF MDA was extended for a further month in all districts. By 12 weeks effective program coverage had been reached in all districts except Port Loko and there was no significant difference between those interviewed in communities versus households or by sex. Effective epidemiological coverage (≥65%) was reported in all districts and overall was significantly higher in males versus females.</p></sec><sec><title>Conclusions</title><p>The challenges to LF MDA included the late delivery in country of ivermectin, the availability and motivation of unpaid CHVs, concurrent LLITN distribution and the MCHW, remuneration for CHWs, rapid urbanization and employment seeking population migrations. 'In process' monitoring ensured modifications of LF MDA were made in a timely manner to ensure effective coverage was finally attained even in HTR locations.</p></sec></abstract><kwd-group><kwd>Lymphatic filariasis</kwd><kwd>Monitoring and evaluation</kwd><kwd>Mass drug administration</kwd><kwd>Community health workers</kwd><kwd>Supply chain management</kwd><kwd>Urbanization</kwd></kwd-group></article-meta></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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