Gender and neglected tropical disease front-line workers: Data from 16 countries.

BACKGROUND: Delivery of preventive chemotherapy (PC) through mass drug administration (MDA) is used to control or eliminate five of the most common neglected tropical diseases (NTDs). The success of an MDA campaign relies on the ability of drug distributors and their supervisors-the NTD front-line workers-to reach populations at risk of NTDs. In the past, our understanding of the demographics of these workers has been limited, but with increased access to sex-disaggregated data, we begin to explore the implications of gender and sex for the success of NTD front-line workers. METHODOLOGY/PRINCIPAL FINDINGS: We reviewed data collected by USAID-supported NTD projects from national NTD programs from fiscal years (FY) 2012-2017 to assess availability of sex-disaggregated data on the workforce. What we found was sex-disaggregated data on 2,984,908 trainees trained with financial support from the project. We then analyzed the percentage of males and females trained by job category, country, and fiscal year. During FY12, 59% of these data were disaggregated by sex, which increased to nearly 100% by FY15 and was sustained through FY17. In FY17, 43% of trainees were female, with just four countries reporting more females than males trained as drug distributors and three countries reporting more females than males trained as trainers/supervisors. Except for two countries, there were no clear trends over time in changes to the percent of females trained. CONCLUSIONS/SIGNIFICANCE: There has been a rapid increase in availability of sex-disaggregated data, but little increase in recruitment of female workers in countries included in this study. Women continue to be under-represented in the NTD workforce, and while there are often valid reasons for this distribution, we need to test this norm and better understand gender dynamics within NTD programs to increase equity.

Measuring treatment coverage for neglected tropical disease control programs: analysis of a survey design.

Monitoring of treatment coverage following mass drug administration is essential to ensure program success. Coverage results reported by drug administrators are often validated by using population surveys. This study evaluates the design of a multistage cluster sample survey conducted in 2007-2008 and implemented at the district level to assess drug coverage in the 4 African countries of Burkina Faso, Ghana, Niger, and Uganda. Estimates of precision of coverage were calculated, and factors contributing to the observed variance were analyzed. Precision of ±5 percentage points was obtained in 39% (n = 12) of cases, and precision of ±10 percentage points was obtained in 77% (n = 24) of cases. The factor having the largest impact on the actual precision obtained in these surveys was the high level of clustering, the impact of which is incorporated in the design effect. Key recommendations are made for the design and analysis of future surveys; guidelines are presented for thinking through the number of clusters that should be selected and how a cluster should be designed.