The study conducted by the Countdown Consortium in Cameroon examines equity issues in the mass drug distribution campaigns for schistosomiasis and soil-transmitted helminthiasis, highlighting that marginalized groups such as farming communities, migrant populations, and women of reproductive age are often overlooked. It identifies barriers to inclusion and provides recommendations for improving program implementation and sensitization efforts to ensure these groups receive necessary treatments. The qualitative research involved various stakeholders and utilized methods such as in-depth interviews and focus group discussions across multiple regions.

1. Christine Makia
Centre for Schistosomiasis, COUNTDOWN Project 2019
Yaoundé, Cameroon
Towards Strengthening Equity and
Inclusiveness in NTD approaches :
Who is left behind in Mass Drug
Distribution Campaigns?

2. This study was part of the multidisciplinary research undertaken
in Cameroon by the COUNTDOWN Consortium
Used a qualitative approach to assess and highlight how equity
enhanced or limited the delivery of Schistosomiasis and Soil
Transmitted-Helminthiasis interventions during preventive
chemotherapy mass drug administration campaigns, in ensuring
no one is left behind.
FOCUS

3. Method (1)
• This is a qualitative study which consisted of an ethnographic process
with in-depth interviews, focused group discussions and participant
observation with resulting field diaries, photographs and informal
discussions, with the continuous presence of researchers for at least
five weeks in each site, to enable observation and participation.
• Ethical Approval was obtained from the Cameroon National Ethical
Committee on Human Health Research, and Informed consent was
obtained from sampled participants

4. Method (2)
 Case study sites consisted of 4 regions in Cameroon - Littoral,
Centre, West and South West Regions. The first three mentioned
sites were selected based on collaborating parasitological tests and
identified level of endemicity, and the fourth site was selected as a
result of the presence of most strategic level partners.
 109 in-depth interviews and 6 focus group discussions were
recorded across different stakeholders, all drawn purposively with
snow ball and sign post sampling most common

5. Method (3)
 Stakeholders met consisted community members, parents, teachers,
drug distributors, village leaders, health officials, council workers,
WASH partners, and strategic level partners
 Data were generated in English, French and the local Pidgin-English,
later translated to English after transcription, and organized by
themes using a thematic framework approach and coded into Nvivo
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6. Main Findings:
• Farming communities, migrant populations, children and women of
reproductive age have a huge burden of NTDs like Female Genital
Schistosomiasis and other sexual, reproductive and mental health
challenges, but yet are still consistently left out due to policy gaps
and implementation challenges.

7. Who is
missed
Why are they missed Who can help How can they help
Farming
communities
• Absence during
distribution
• Insufficient
sensitization (time and
content)
• Short Distribution
period
Programme
implementation
(National Programs)
• By adapting MDA programs to
community calendars
• By upgrading sensitization efforts
through increased time and more
informative sensitization (more on side
effects, why the medicines are needed,
effects of not taking, etc)

8. Migrant
populations
• Absence of migrant
communities during
distribution
• Context/cultural
differences leaving
populations left out
in sensitization and
distribution
• Program
implementation
• Quarter heads and
village leaders
• Programs should include community leaders
in distribution to easily identify people left
out and meet up with them,
• Community leaders can inform on why
populations are missed and how to
encourage people to adhere if involved.
• Train them for continuous sensitization to
cut reinfection and encourage behavioral
changes
Who is
missed
Why? Who can help? How can they help?

9. Young girls
and women
of
reproductive
age
• Most Pregnant and lactating
mothers and young girls
are not given praziquantel
in expanded treatments
• Fear and mistrust due to
insufficient sensitization
• Gaps in Training of CDDs in
relation to this group of
women
• National Policy hesistates
on treating these women
Program policy
and program
implementation
• Carryout research and upgrade national
Policy specifications on the distribution of
drugs to pregnant women
• Communicate information around
distribution to these girls and women to
health districts and include in the training
on CDDs
• Content of sensitization messages should
include information on this, such as need
for medicines and side effects, to wipe out
myths and fears around pregnancy and
fertility of young girls.
Who is
missed
Why are they missed Who can help How can they help

10. Children • Out school of children
not met
• Private schools mostly
left out
• Programme
policy
• Education
Sector
partners
• Health
Sector
partners
• Include, implement and monitor clear plan
for distribution of drugs to out of school
children during school-based distribution
• Program planning and implementation to
consider ways to also cover private schools
being left out
Who is missed Why are they missed Who can help How can they help

11. THANK YOU!