CNTD works with project countries to ensure that women and girls are provided with equal access to medication during MDAs. As pregnant women and women immediately post-partum may not be eligible for MDA (depending on which drugs are used), it is also important to ensure that this does not unduly affect MDA coverage among women of child-bearing age. The MDA coverage verification surveys used therefore include gender and age as measures, and results are analysed to ensure that there are no groups that are systematically underrepresented. On average, 51% of medication recipients during MDAs are female and no significant under representation of women and girls has been found in any of our project countries.
We work with project countries to provide training to both health workers and community volunteers. To ensure that women have full access to such training, the gender of all training recipients is recorded to monitor that such training is equally available to men and women. In several countries, existing female-centred networks have been utilised to carry out voluntary work, therefore strengthening the status and role of women in those communities.
While men and women have been shown to be equally susceptible to filarial infections (Bancroftian filariasis), the clinical manifestations of the disease affect both genders disproportionately. While hydrocele only affects men, lymphoedema affects women more frequently than men. There are also differences in the management options for the two conditions; hydrocele surgery is a single treatment that resolves the condition whereas lymphoedema treatment requires long-term management to improve the patients' quality of life and prevent the condition getting worse. It is important to ensure that lymphoedema management is given a proportional level of focus and funding in MMDP programmes and that resources are in place to provide access to care for the lifetime of the patient.
SUPPORTING CARE GIVERS
Women and girls (usually family members or domestic partners) are the main care-givers for people with clinical LF. Often, these care-givers are children. Even if physical care is not required, they may be required to earn money or perform household tasks because the person affected by LF is unable to do this themselves. In the case of girls, this may impact on their ability to attend school and spend time with friends.
Whilst measuring the impact of LF has traditionally focused on the patients themselves, CNTD recognises this broader impact and has started looking at the impact on these care-givers and supporters through focused surveys and questionnaires. In 2016, such surveys were carried out in Malawi.