Community Directed Treatment of Soil-Transmitted Helminths Among Young Children in Zambia
Condition: Soil-Transmitted Helminth Infection; Growth
MeSH terms: Helminthiasis
Study type: Observational

Summary: 
      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.
    

Detailed description: 
      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.
    

Intervention name(s): Community directed treatment
Intervention type(s): Behavioral
Time perspective: Prospective
Keywords: Community directed treatment,; soil-transmitted helminth infections,; treatment coverage,; Zambia