Community directed interventions for malaria, tuberculosis and vitamin A in onchocerciasis endemic districts of Tanzania

• Published in: Tanzania journal of health research Vol. 10; no. 4
• Main Authors: Kisinza, W.N, Kisoka, W.J, Mutalemwa, P.P, Njau, J, Tenu, F, Nkya, T, Kilima, S.P, Magesa, S.M
• Format: Journal Article
• Language: English
• Published: Health User's Trust Fund (HRUTF) 02-07-2009
• Subjects: Community directed intervention, malaria, tuberculosis, vitamin A, Tanzania
• ISSN: 1821-6404

In recognising the success attained through community-directed
treatment with Ivermectin, there has been a growing interest to use a
similar approach for delivery of interventions against other
communicable diseases. This study was conducted in 2007 to evaluate the
impact of community directed intervention (CDI) on delivering five
health interventions namely Vitamin A supplementation (VAS),
community-directed treatment with Ivermectin (CDTi), distribution of
insecticide-treated nets (ITN), directly observed treatment of
tuberculosis (DOTS), and home-based management of malaria (HMM). The
study was carried out in onchocerciasis endemic districts of Kilosa,
Muheza, Lushoto, Korogwe and Ulanga districts in Tanzania. A total of
250 households were involved in the study for the period of two years.
During the first year, one new intervention was added in each study
district. A second new intervention was then added in the same manner
during the second study year. In the control district all
interventions, with the exception of Ivermectin distribution, continued
to be delivered in the traditional manner throughout the study period.
Results showed that Ivermectin treatment coverage in the CDI districts
(88%) was significantly (P<0.005) higher than in the control
district (77%). The coverage of VAS was 84 + 7%, showing very little
difference between control and intervention districts (P>0.05). The
DOTS treatment completion rate was observed only in Korogwe where 4 out
7 patients had completed their treatment. The proportions of pregnant
women and <5 years children sleeping under ITN in the CDI districts
(range: 83-100%) were significantly higher (P< 0.05) than those in
the control district (40-43%). There was also a higher proportion of
malaria cases referred in the intervention districts (42%) than in the
control district (21%) (P<0.005). Likewise, the proportion of <5
years children who were presumptively diagnosed with malaria and
received appropriated treatment within 24 hours in the intervention
districts (17-29%) was higher than those in the control district (4%)
(P<0.005). The costs incurred per integrated programme in the
intervention districts were much lower than those in the control
district. In conclusion, our results showed higher coverage of
interventions in the CDI districts without necessarily increasing the
cost.