Sightsavers, Nigeria Country Office, Kaduna State, Nigeria.
Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom.
PLoS Negl Trop Dis. 2020 Nov 25;14(11):e0008857. doi: 10.1371/journal.pntd.0008857. eCollection 2020 Nov.
Nigeria has the highest burden of NTDs in sub-Saharan Africa. Commitments to reach the control and elimination of many Neglected Tropical Diseases (NTDs), particularly those amenable to preventive chemotherapy (onchocerciasis, schistosomiasis, soil transmitted helminths, lymphatic filariasis and trachoma) by 2020 are detailed in the London declaration. Strategies to reach targets build on existing approaches, one of which is the use of community directed intervention (CDI) methods to deliver the mass administration of medicines (MAM). However, treatment using this approach has been inconsistent and there are questions about the acceptability and adaptability of these interventions during periods of programmatic, social, and political change. This paper explores the current strengths and weaknesses of CDI approaches in MAM delivery. We consider the acceptability and adaptability of existing MAM approaches to ensure equity in access to essential treatments. Using qualitative methods, we explore implementer perspectives of MAM delivery. We purposively selected programme implementers to ensure good programmatic knowledge and representation from the different levels of health governance in Nigeria. Data collection took place across two States (Kaduna and Ogun). Our results indicate that CDI approaches have underpinned many historic successes in NTD programme acceptance in Nigeria, specifically in Kaduna and Ogun State. However, our results also show that in some contexts, factors that underpin the success of CDI have become disrupted presenting new challenges for programme implementers. Capturing the tacit knowledge of health implementers at varying levels of the health system, we present the current and changing context of MAM delivery in Kaduna and Ogun States and consolidate a platform of evidence to guide future programme delivery and research studies. We situate our findings within the broader NTD literature, specifically, in identifying how our findings align to existing reviews focused on factors that shape individual acceptance of MAM.
尼日利亚是撒哈拉以南非洲国家中受被忽视热带病（NTDs）影响最严重的国家。《伦敦宣言》详细说明了 2020 年实现控制和消除许多被忽视热带病（NTDs），特别是那些可通过预防性化疗（盘尾丝虫病、血吸虫病、土壤传播性蠕虫病、淋巴丝虫病和沙眼）来控制和消除的疾病的承诺。为实现目标而制定的战略是基于现有方法，其中之一是利用社区定向干预（CDI）方法来进行大规模药物管理（MAM）。然而，这种方法的治疗效果一直不一致，并且在方案、社会和政治变革期间，人们对这些干预措施的可接受性和适应性存在疑问。本文探讨了当前在大规模药物管理中使用社区定向干预方法的优缺点。我们考虑了现有 MAM 方法的可接受性和适应性，以确保公平获得基本治疗。我们使用定性方法探讨了 MAM 交付的实施者观点。我们有目的地选择方案实施者，以确保在尼日利亚不同卫生治理层面有良好的方案知识和代表性。数据收集在两个州（卡杜纳州和奥贡州）进行。我们的研究结果表明，社区定向干预方法在尼日利亚的 NTD 方案接受方面取得了许多历史性的成功，特别是在卡杜纳州和奥贡州。然而，我们的研究结果也表明，在某些情况下，支持社区定向干预成功的因素已经被打乱，给方案实施者带来了新的挑战。我们从卫生系统各级卫生实施者那里获取了隐性知识，展示了卡杜纳州和奥贡州 MAM 交付的当前和不断变化的背景，并整合了一个证据平台，以指导未来的方案交付和研究。我们将研究结果置于更广泛的 NTD 文献中，特别是在确定我们的发现如何与现有侧重于影响个人对 MAM 接受度的因素的综述相吻合。
