Assessment of community knowledge and participation in onchocerciasis programme, challenges in ivermectin drug delivery, distribution and non-compliance in Ogun State, southwest Nigeria

Stock-outs of essential medicines among community health workers (CHWs) in low- and middle-income countries (LMICs): a systematic literature review of the extent, reasons, and consequences

BACKGROUND

This paper explores the extent of community-level stock-out of essential medicines among community health workers (CHWs) in low- and middle-income countries (LMICs) and identifies the reasons for and consequences of essential medicine stock-outs.

METHODS

A systematic review was conducted and reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Five electronic databases were searched with a prespecified strategy and the grey literature examined, January 2006-March 2021. Papers containing information on (1) the percentage of CHWs stocked out or (2) reasons for stock-outs along the supply chain and consequences of stock-out were included and appraised for risk of bias. Outcomes were quantitative data on the extent of stock-out, summarized using descriptive statistics, and qualitative data regarding reasons for and consequences of stock-outs, analyzed using thematic content analysis and narrative synthesis.

RESULTS

Two reviewers screened 1083 records; 78 evaluations were included. Over the last 15 years, CHWs experienced stock-outs of essential medicines nearly one third of the time and at a significantly (p < 0.01) higher rate than the health centers to which they are affiliated (28.93% [CI 95%: 28.79-29.07] vs 9.17% [CI 95%: 8.64-9.70], respectively). A comparison of the period 2006-2015 and 2016-2021 showed a significant (p < 0.01) increase in CHW stock-out level from 26.36% [CI 95%: 26.22-26.50] to 48.65% [CI 95%: 48.02-49.28] while that of health centers increased from 7.79% [95% CI 7.16-8.42] to 14.28% [95% CI 11.22-17.34]. Distribution barriers were the most cited reasons for stock-outs. Ultimately, patients were the most affected: stock-outs resulted in out-of-pocket expenses to buy unavailable medicines, poor adherence to medicine regimes, dissatisfaction, and low service utilization.

CONCLUSIONS

Community-level stock-out of essential medicines constitutes a serious threat to achieving universal health coverage and equitable improvement of health outcomes. This paper suggests stock-outs are getting worse, and that there are particular barriers at the last mile. There is an urgent need to address the health and non-health system constraints that prevent the essential medicines procured for LMICs by international and national stakeholders from reaching the people who need them the most.

Knowledge, Attitude, and Practice of Community towards an Onchocerciasis Elimination Program from South West Ethiopia

Onchocerciasis is a neglected tropical disease that is prevalent throughout Africa, including developing countries such as Ethiopia. It affects around 37 million people, the majority of whom are from Africa. As a result, the study was designed to look into the community’s knowledge, attitude, and practice about the onchocerciasis elimination campaign. Four communities from Gesha town, Southwest Ethiopia, were chosen. The population was selected using a basic random selection procedure, and 312 people were identified for the study based on the eligibility requirements, with 302 (96.79%) of them responding correctly. The data were analyzed using the descriptive method with the SPSS program version 20. It was discovered that the majority of communities (89.4%) are aware of onchocerciasis. They also have a good awareness of the severity, preventability, therapy, and mode of transmission, yet they have certain misunderstandings. The communities attitude towards community directed therapy (CDT) using Ivermectin is positive (68.5%). According to 56% of the community, offering incentives for community drug distributors (CDD) has the potential to make the elimination campaign more successful. Different measures, such as avoiding any activities near the river, are important in the process of eradicating this disease at the community level. As a result, the respondent demonstrates that covering the lower body part lessens the black fly’s vulnerability because they may attack below the knee. In general, community awareness and attitude are required to eradicate this disease from the district. In addition, increased stakeholder participation and offering motivating rewards for CDT are required to make the elimination program a success.