Growth Clinical Trial
Official title:
Community-Directed Treatment in the Control of Soil-Transmitted Helminths Among Children Aged 12-59 Months in Mazabuka District of Zambia
The WHO Special Programme for Research and Training in Tropical Diseases (TDR) developed a
Community-Directed Treatment (COMDT) approach, which has been adopted in the control of
onchocerciasis and lymphatic filariasis. WHO has recommended the use of COMDT approach in
the control of schistosomiasis and STH infections. The COMDT approach has been compared with
the school based programmes in certain African countries,but not with the health-facility
based approach.
The project will be implemented in Mazabuka district of Zambia where COMDT approach will be
implemented in the catchment area of Rural Health Centres (RHC) as a supplement to the
health-facility-based approach. After each round of treatmenttreatment coverage and factors
responsible for the treatment coverage will be measured in both areas. The health impact of
the health facility based approach with and without the COMDT approach will be compared. The
effect of the COMDT as a control approach of STH infections will be monitored on infections
in the community of children aged 12 to 59 months.
Soil-transmitted helminth (STH) infections are of public health importance and widespread in
large part of the world, particularly in the poorest sections of the populations residing in
the least developed countries. The infections can be controlled by several measures, but
currently delivering anthelminthic drugs through schools and health centres is believed to
be the most effective as it takes advantage of existing infrastructure. In Zambia,
anthelminthic drugs are delivered to children aged 12 to 59 months twice a year through
health facilities during the child health promotion week. However, it has been observed that
treatment coverage is low in certain areas. Therefore, there is a need to identify the
factors associated with the treatment coverage patterns, and to provide evidence of an
effective intervention approach that could increase the proportion of children receiving
treatment.
The WHO Special Programme for Research and Training in Tropical Diseases (TDR) developed a
Community-Directed Treatment (COMDT) approach, which has been adopted in the control of
onchocerciasis and lymphatic filariasis. WHO has recommended the use of COMDT approach in
the control of schistosomiasis and STH infections. The COMDT approach has been compared with
the school based programmes in certain African countries, but has never been used in Zambia
and never been compared with the health-facility based approach in the control of these
infections in children below school age. It is against this background that this project is
being proposed.
The project will be implemented in Mazabuka district of Zambia. Two Rural Health Centres
(RHCs) will be selected in the district and mapped for treatment coverage of the
health-facility based approach. Focus group discussions (FGDs) and in-depth interviews will
be conducted with community members to explore the reasons for existing treatment coverage
of the health facility approach. The COMDT approach will then be implemented in the
catchment area of one of the RHCs as a supplement to the health-facility-based approach.
After each round of treatment, coverage and factors influencing coverage will be measured in
both areas. The health impact of the health facility based approach with and without the
COMDT approach will be compared. Parameters for health impact will be child growth,
prevalence and intensity of STH infections and number of illness episodes requiring
treatment. The effect of the COMDT as a control approach of STH infections will be monitored
on infections in the community of children aged 12 to 59 months, and the appropriateness of
the approach will be evaluated using the African Programme for Onchocerciasis Control
grading system. The whole project is expected to take 3 years.
;
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