Factors affecting the attrition of community-directed distributors of ivermectin, in an onchocerciasis-control programme in the Imo and Abia states of south-eastern Nigeria.

In areas of Nigeria where onchocerciasis is endemic, community-directed distributors (CDD) distribute ivermectin annually, as part of the effort to control the disease. Unfortunately, it has been reported that at least 35% of the distributors who have been trained in Nigeria are unwilling to participate further as CDD. The selection and training of new CDD, to replace those unwilling to continue, leads to annual expense that the national onchocerciasis-programme is finding difficult to meet, given other programme priorities and the limited resources. If the reported levels of attrition are true, they seriously threaten the sustainability of community-directed treatment with ivermectin (CDTI) in Nigeria. In 2002, interviews were held with 101 people who had been trained as CDD, including those who had stopped serving their communities, from 12 communities in south-eastern Nigeria that had high rates of CDD attrition. The results showed that, although the overall reported CDD attrition was 40.6%, the actual rate was only 10.9%. The CDD who had ceased participating in the annual rounds of ivermectin blamed a lack of incentives (65.9%), the demands of other employment (14.6%), the long distances involved in the house-to-house distribution (12.2%) or marital duties (7.3%). Analysis of the data obtained from all the interviewed CDD showed that inadequate supplies of ivermectin (P<0.01), lack of supervision (P<0.05) and a lack of monetary incentives (P<0.001) led to significant increases in attrition. Conversely, CDD retention was significantly enhanced when the distributors were selected by their community members (P<0.001), supervised (P<0.001), supplied with adequate ivermectin tablets (P<0.05), involved in educating their community members (P<0.05), and/or involved in other health programmes (P<0.001). Although CDD who were involved in other health programmes were relatively unlikely to cease participating in the distributions, they were more likely to take longer than 14 days to complete ivermectin distribution than other CDD, who only distributed ivermectin. Data obtained in interviews with present and past CDD appear vital for informing, directing, protecting and enhancing the performance of CDTI programmes, in Nigeria and elsewhere.

Community mobilization for blood donation, Cross River State, Nigeria. The Calabar PMM Team.

PRELIMINARY STUDIES: A study of institutions in Cross River State, Nigeria, revealed poor storage facilities and inadequate availability of blood. Focus group discussions highlighted people's fears and misconceptions about blood donations as important factors contributing to the problem. INTERVENTIONS: Blood facilities were upgraded in the teaching hospital and a secondary institution. Fifteen community mobilization sessions to improve attitudes and stimulate voluntary blood donation were conducted over three months in 1994. Non-cash incentives were offered, including certificates of honor, free blood screening and assurance of priority if a family member needed blood. RESULTS: Blood donations to the teaching hospital maternity increased from 40 pints per month in 1991 to 81 in 1994. However, national strikes interrupted service and the increase was not sustained. At the secondary facility, blood transfusions increased from 14 in 1991 to 35 in 1995, with 100% of donations from volunteers. COSTS: The cost of community mobilization for blood donation was US $17,531. CONCLUSIONS: Increasing voluntary blood donations through non-cash incentives and community mobilization is possible. No conclusions may be drawn regarding sustainability, however.

Serologic study of guinea pigs exposed for 12 months to cotton dust.

A guinea pig animal model of byssinosis has been described that demonstrates both acute and chronic effects of cotton dust inhalation (Ellakkani et al., 1984, 1987). During the latter study in which guinea pigs were exposed to 21 mg/m3 cotton dust 5 d/wk, 6 h/d for 52 wk, blood samples were taken from animals (20 exposed, 20 sham-exposed) prior to exposure and monthly during the exposure period. Sera were evaluated for quantities of the major protein fractions, and for IgG antibodies to cotton dust components. At the completion of the study, blood was evaluated for total and differential leukocytes. At 6 mo of exposure, each of the five protein fractions was significantly different from the corresponding fraction in the control animals. Antibodies reactive with an aqueous cotton dust extract (ACDE) were prominent by 2 mo of exposure and the titer was increased with continued exposure. The extract was composed of 2.6% protein, 12.8% reducing sugar, and 4.1% nucleic acid, with the remainder being largely simply sugars and inorganic material. A fraction of the antibodies showed reactivity with gram-negative bacteria and specifically with Enterobacter agglomerans, the most prevalent gram-negative microorganism in the dust. Minimal antibody response was detected using lipopolysaccharide from this microorganism or gram-positive bacteria. These results indicate that exposure of guinea pigs to cotton dust resulted in hematologic changes and in specific antibody formation. The presence of antibodies in each of the animals suggests their possible use as an indicator of cotton dust exposure.