Lessons from integrating mental health as part of lymphatic filariasis morbidity management and disability prevention services in Jigawa State, Nigeria.

Lymphatic filariasis (LF) is a neglected tropical disease affecting >120 million people worldwide. LF has debilitating effects on humans and leads to morbidity and sometimes irreversible disability. A significant proportion of persons affected by LF morbidity also suffer from ill health, such as depression, anxiety, pain, stigma and social isolation due to disfigurement, as well as loss of mobility, livelihood and income. Mental health is often overlooked as a component of morbidity management and disability prevention (MMDP) services, despite the high prevalence of depression and anxiety among people affected by LF. To address this gap, Christian Blind Mission (CBM) piloted a comprehensive approach providing morbidity management and disability prevention by integrating mental health as part of the MMDP care package. The participatory evaluation of the project reviewed the project documents and a review meeting, small group discussions and in-depth interviews with project stakeholders. Findings suggest that project training and service delivery targets were exceeded in most cases. In addition, the disability and gender disaggregated data highlights the interplay of gender and disability in accessing care and the existence of unmet mental health needs. The financial cost of transportation to utilise referrals or access other MMDP services, such as replenishing treatment supplies, was a major constraint in accessing services for LF morbidity patients and low levels of awareness, fear of hydrocoele surgery and social stigmatisation were reported. The project outcomes demonstrate the feasibility and effectiveness of integrating mental health as part of a comprehensive MMDP package of care. Integration strategies should target training of MMDP providers in basic mental health skills, screening for mental health issues and the provision of mental health services and other MMDP services within the same facilities. Integration is an important step towards comprehensive care for people affected by LF and other NTD morbidities and disabilities.

Lessons from the field: delivering trachoma mass drug administration safely in a COVID-19 context.

The first coronavirus disease 2019 (COVID-19) interim guidance released by the World Health Organization recommended suspension of non-urgent community health interventions, including mass drug administration (MDA) for neglected tropical diseases. However, with no end in sight for the COVID-19 pandemic, it was crucial to find ways to restart MDA while testing measures to reduce the risk of COVID-19 transmission between health workers, volunteers and communities. Consequently, guidelines were developed for delivering MDA safely in a COVID-19 context and the training and implementation were assessed through an observation checklist. The study also gathered data on the feasibility of using the MDA platform to disseminate COVID-19 health education. The results suggest that delivering MDA safely in a COVID-19 context is possible but revealed significant challenges in using the MDA platform for COVID-19 education.