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  • Community-directed healthcare 'effective', finds study

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Community-administered healthcare is effective in combating a range of illnesses including river blindness and malaria as well as micronutrient deficiencies, according to a study of over two million people in three African countries.

The researchers say restrictive health department policies on who can administer medications should be altered so that other illnesses can be tackled in a similar fashion.

Community-directed drug intervention (CDI) has proved successful in delivering the drug Ivermectin to treat river blindness, also known as onchocerciasis. In the strategy, family members help deliver drugs and administer treatment, instead of patients visiting a clinic.

The study looked at the effectiveness of CDI in strategies to fight river blindness, later pairing it with treatments against malaria, tuberculosis and micronutrient deficiencies, in Cameroon, Nigeria and Uganda. Community dispensing of drugs, vitamin A supplements and insecticide-treated mosquito nets was compared with conventional delivery strategies over three years.

Researchers found that the number of feverish children receiving the right antimalarial treatment doubled, exceeding the 60 per cent target set by the Roll Back Malaria campaign. The use of insecticide-treated bednets also doubled.

Vitamin A supplementation coverage was also significantly higher in districts using CDI compared with those that did not. But community-directed interventions for tuberculosis proved only as effective as treatment from clinics.

Samuel Wanji, a researcher at the University of Buéa who conducted the southwest Cameroon part of the study, says the African Programme for Onchocerciasis Control — linked to the WHO and with 19 health ministers on the board — has given the go-ahead to extend the use of CDI for river blindness in countries that have lower, but still significant, levels of the disease.

The expanded programme will investigate whether CDI works as well in places where disease infection is less intense, and is scheduled to begin before the end of the year. Dispensing of other medications will be added as the programme progresses.

"The study's approach is very useful for increasing access to health and will reduce the burden on health facilities," says Hans Remme of the WHO Special Programme for Research and Training in Tropical Disease.

But a shortage of drugs and other materials remains a drawback, according to a WHO report of the study.

 

Link to WHO CDI report

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