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Zambia: Survey of Community Drug Distributors

During a Mass Drug Administration (MDA), millions of tablets are distributed to the population at risk over the course of a couple of weeks.  This huge undertaking would not be possible without the assistance and local knowledge of Community Drug Distributors (CDDs), who deliver drugs door to door or at fixed distribution points. 

Whilst small incentives may be available in some countries, these CDDs are usually unpaid field workers, providing a service to their communities. CNTD has surveyed these experienced and invaluable colleagues to get their feedback on the training and support they need and to gain valuable insight on how MDA’s can be improved in the future. To ensure the best value for money, these surveys are integrated into existing initiatives, such as coverage verification surveys.  In 2015, Zambia undertook its 1st national round of MDA for Lymphatic Filariasis which was followed by a coverage verification survey and a parallel survey of 160 CDDs.  

Training and support

CDDs reported high satisfaction with training in most districts. However, of the 35 respondents from Ndola, half said that they received either no or too little training. Nearly 100% of CDDs knew which drugs were distributed during the MDA and were aware that they were to prevent Hydrocele. However, 34% were not aware that the MDA was also to combat lymphoedema. This reflects the high emphasis on hydroceles in the sensitisation campaign and a significant failing in the training which should be addressed.

Perceptions of the MDA, challenges and suggestions from CDDs

137 (87%) CDDs reported that they became CDDs in order to contribute to their community.  A similar number reported enjoying high levels of community participation and awareness during the MDA which, along with the high coverage figures found in the parallel study, reflects a very successful public awareness campaign.  70% of those that had distributed at both distribution points and house-to-house felt that the house-to-house approach was preferable. This has been fed back and will assist in the design of future campaigns.

The number and type of challenges experienced during the MDA varied significantly between districts. These were reported to the relevant provincial team to incorporate into future planning. The majority (129 CDDs) reported a problem with transport. 37 CDDs reported that time was a challenge. Other reported problems were minimal with high levels of satisfaction with supervision, community involvement and drug availability.

Adverse events

52 of the CDDs reported that some people they supplied drugs to had adverse reactions, mostly dizziness or headaches. Vomiting and diarrhoea was reported by 15 CDDs.  The action taken by CDDs in such cases was split between offering reassurance and referring to a health facility. 49 CDDs offered suggestions for how support for adverse events may be improved including, better education on side effects, the provision of drugs or first aid kits to treat side effects and better transport to health facilities in case of problems.  

The CDD survey has now been integrated into the standard monitoring and evaluation protocol deployed by CNTD.