Sociodemographic characteristics of the study respondents
A total of 5 community drug distributors were interviewed, and their ages ranged from 25 years to 70 years. All CDDs interviewed were self-employed and residents of the Ulanga district, as shown in Table 1.
Experience, selection and training of CDDs
Of the five CDDs interviewed, four were appointed by the village executive officer and members of the village committee because of their experience in community services and hard work, except for only one who volunteered. This shows that community members in Ulanga do not participate in the selection of CDDs they want.
The results showed that only two CDDs had worked in their position for 15 to 20 years and the remaining CDDs had worked in their position for less than 10 years. The following are some of their statements:
“………I have been working as a volunteer CDD for 15 years; I volunteered to work in this position because at that time no one wanted to work in this position” (Female respondent, Uponera, 55 years).
“……..I was a nurse assistant at the time CDTI programme started in 1997 people used to come and take ivermectin at the district hospital, so when the distribution of drug started directly in the community I was appointed by village executive officer to help my community because of my experience” (Female respondent, Isongo, 49 years).
When the CDDs were asked and probed on the type of training that was given for their position, all of them stated that they were trained every year before the distribution of the ivermectin. One of the CDDs, for example, had this to say:
“…….The training is given once every year to remind each other on how to distribute drugs, the measurement to be taken to know the exact dose taken by a person, and how to manage side effects as a result of treatment” (Male respondent, Uponera, 70 years).
Community participation, distribution and coverage on the CDTI programme
CDDs were asked to state how they distributed ivermectin and how they ensured community participation in the CDTI programme. The results showed that “house-to-house distribution” was the main approach that was employed to distribute ivermectin, and in regard to participation of the community in the programme, the CDDs said they had the following roles:
“……. After taking the medication from the district hospital, I must announce to community members, emphasize them to take medication and then I distribute the drugs from one house to another in the entire hamlets” (Female respondent, Uponera, 55 years)
“…….In the past community members used to collect medication at my house, but now I must pass house to house so as to ensure people take medication and if people are not there I must come back or leave the message for them to come to collect the medication” (Male respondent, Uponera, 70 years).
It was observed that according to gender, the coverage and taking of ivermectin was higher in women than men, as confirmed by one of the CDDs;
“…….Women are highly participating in the control programme compared to men except those who are sick, pregnant or have delivered within five days at the time of drug distribution” (Male respondent, Isongo, 51).
Challenges faced by CDDs on implementation of CDTI programme and recommendation for improvement
CDDs were interviewed on the challenges they were facing during ivermectin distribution because these challenges affected the use of ivermectin in the community and hindered the effective success of the CDTI programme to control onchocerciasis disease. The challenges mentioned were mainly geographical relating to the location of the hamlets. Some of the hamlets were hard to reach, which led to the failure of CDDs to cover all houses; long distances between houses made the CDDs walk extra miles and spent many days distributing the drugs. Another challenge was the low compliance of community members to medication due to fear of side effects experienced before and mistrust of methods of dose calculation. The absence of people from their houses was another challenge; in Ulanga, many community members were migratory farmers. The CDTI programme was conducted during the farming season when many community members were involved in agricultural activities. Another challenge was the duration of drug distribution. The time allocated for drug distribution was short, and CDDs were required to return the ivermectin to the health centers after a month. The following are some of their responses as revealed by two CDDs:
“…… There are several challenges that I face as a CDD. Some community members refuse to take medication because of side effects, such as wasting time going to a certain house and talking to them and ultimately refusing to take medication. Also, the geographic location of our village is the problem because houses are far from each other so it’s difficult to reach every house” (Female respondent, Isongo, 49 years).
Another CDD mentioned transport to be a critical problem;
“……Transport is the problem in our village which makes the distribution to be difficult hence some of the houses are left unattended. The number of days for distribution of medicines are few that we are supposed to return the remaining medicines to district hospital after a month” (Male respondent, Isongo, 51 years).
On recommendations for improving the CDTI programme, the CDDs gave the following recommendations as a strategy to mitigate the challenges faced in the implementation of the CDTI programme. The distribution of drugs should be done after the farming season when people are at home and are free to participate. Transport fees should be given so that drugs can be distributed in all villages. Training that is given before the distribution of drugs should be done for at least three days because they are different in understanding and these drugs are poison. Health education about onchocerciasis should be given to community members at least once a year to avoid all misconceptions about the treatment.
Finally, all CDDs recommended allowance to be given to them to increase their morale for work as they were not benefiting anything from being CDDs and the work was very difficult.