Helen Keller International Programs in Niger

Country Profile:
Total population: GNI per capita: Life expectancy at birth: U5 mortality rate: Infant mortality rate: Adult illiteracy rate: Onchocerciasis prevalence: Vitamin A Deficiency prevalence: Trachoma prevalence : Cataract backlog:
HKI Programs in Niger:

History of Helen Keller International in Niger:

After 27 years of intensive actions and interventions, several studies carried out in affected countries revealed that transmission of the disease has practically been interrupted. For these countries, the issue is now to preserve the accomplishments made under OCP.
Onchocerciasis, as a disease, is therefore no more a public health problem. Rather, the development of "freed zones", formerly deserted by the populations, and now repopulated, after the elimination of the disease is the major concern for these countries and their development partners.
In Niger, the National Onchocerciasis Devolution Program (NODP) focuses its interventions in the health districts of Tera, Say, Kollo, Boboye and Gaya.

In 1993/1994, Helen Keller International observed that no educational activities were planned to support and sustain efforts intended to exterminate of the major vector of the disease, the black fly. As a response, HKI decided to fill this gap, with the provision of assistance to the program in the implementation of Information, Education and Communication (IEC) activities, targeted at the populations of the intervention areas. This assistance started first with a 10-month financial support from USAID.
Since 1996, assistance to implement the IEC component of the National Program has been provided by HKI , with the financial support of the Nippon Foundation

ACHIEVEMENTS

Strategies:
Major control strategies are based on: IEC and epidemiological and entomological surveillance.
Every year, some twenty sentinel villages are surveyed, to determine the presence of the disease among the human populations through snipping, and to perform entomological surveillance, and the dissection of trapped simulies in some rest places, on onchocercosiasis infested water courses.
The prevalence rate, observed at village level, is almost equal to zero, and dissected simulies no longer carry the onchocercia vulvulus parasites.
The HKI-supported IEC Strategy is a cycle, comprising 6 strongly interrelated steps, and the populations are involved in the dynamics of this cycle all the way through. The cycle successively involves qualitative/quantitative research, development of educational strategies and messages, pre-test of materials, training of educators, education campaign, monitoring and evaluation. The dissemination of educational messages is done through educators' outreach interventions, sensitization by the community workers in villages, and classes organized by teachers in schools.

Region	Districts	Total	Population covered	School children
TILLABERY	TERA	346 453	115 484	6311
	KOLLO	306 597	61 319	2749
	SAY	228 366	76 122	4065
DOSSO	GAYA	204 513	68 171	5322
	BOBOYE	254 603	50 920	2662
TOTAL	5	1 340 532	372 076	21 109

:: FINDINGS OF THE SURVEY ON THE IEC COMPONENT

Introduction:
A quantitative survey on KAP (knowledge, Attitudes and Practices) of the populations, and on activities has been implemented at the end of the program in June 2001.

Objectives:
To collect qualitative data that would be used to:
Assess the IEC Onchocerciasis activities conducted by field staff in order to improve their work
Determine the knowledge, attitudes and practices of the populations, in order to have their suggestions and proposals for improvement.

Methodology:
" A total of 36 villages (11 villages in Tera, 7 in Say; 4 in Kollo, 7 in Boboye; 7 in Gaya) were surveyed;
" In each village, 10 households were randomly sampled; in each household, 2 people (1 man and 1 woman), aged 15 or more, were interviewed; 20 people per village; or a total of 717 people interviewed.
" Other people interviewed: Community health workers (39); nurses (13); teachers (87) and group leaders (36).

Major findings:

Socio-demographic characteristics of the Community Health Workers and Villages:

The analysis points to a reasonable health coverage at village level. More than 50% of the sampled villages are within 0-10 kilometers from a health center. Though the villages are well served, in terms of roads and schools, they lack functional television facilities.

IEC Activities:

Training of community health workers: CHWs have received initial and refresher trainings, on an average once to twice, every three years and a half;
Sensitization techniques: home visits, focus group discussions and public meetings
Material used: Posters, Flipcharts, and Sketches
Training of teachers: 100% in Tera, 64% in Say, 54% in Kollo, 100% in Boboye, 100% in Gaya
Lessons on onchocercosiasis at school
Training of health workers and district level health communicators

Impact on community:

Knowledge of the disease:
When asked whether they knew about Onchocerciasis, the respondents gave the following answers:
Yes: 85% of men and 61% of women in Tera, 94% of men and 86% of women in Say, 60% of men and 39% of women in Kollo, 94% of men and 87% of women in Boboye and 66% of men and 59% of women in Gaya.
Knowledge of the vector:
The major vector (black fly) that causes the disease is also known to the populations:
Yes: 86% in Tera, 87% in Say, 70% in Kollo, 91% in Boboye and 94% in Gaya
Transmission mode:
The bite of black fly which is the transmission mode is also well known:
Yes: 91% in Tera, 82% in Say, 70% in Kollo, 88% in Boboye and 90% in Gaya
Preventive measures:
The preventive measures are not well known to the populations:
" Immunization: 11% in Say, 35% in Tera, 33% in Kollo, 20% in Boboye and 12% in Gaya
" Extermination of the black fly: 25% in Tera, 16% in Say, 13% in Kollo, 29% in Boboye and 28% in Gaya
" Water purification: 14% in Tera, 19% in Say, 15% in Kollo, 12% in Boboye and 9% in Gaya
Consequences of the disease:
The consequences of the disease are quite well known to the population:
Causes blindness - Yes: 73% in Tera, 73% in Say, 83% in Kollo, 60% in Boboye and 43% in Gaya
Itching - Yes: 41% in Tera, 53% in Say, 28% in Kollo, 48% in Boboye and 74 in Gaya
Nodules - Yes: 55% in Tera, 24% in Say, 30% in Kollo, 73% in Boboye and 81% in Gaya
Low vision -Yes: 4% in Tera, 13% in Say, 31% in Boboye and 26% in Gaya
Risk of recrudescence:
To the question whether the disease still exists in the village, the respondents gave the follow answers:
Yes: 9% in Tera, 12% in Say, 14% in Kollo, 72% in Boboye and 64% in Gaya
In the health districts of Tera, Say and Kollo, for most respondents, onchocerciasis does not exist today. But, in Boboye and Gaya, the respondents think that onchocerciasis still exists, as a disease.
To the question whether there still exist risks of recrudescence in their villages, the populations responded:
Yes: 22% in Tera, 24% in Say, 50% in Kollo, 45% in Boboye and 42% in Gaya

The IEC Component of the program made efforts, as part of its activities, to provide training to the workers in charge of sensitizing the populations on the disease. This important accomplishment should be highlighted.
According to the findings of the survey, these workers (community health workers, teachers, and nurses) are, to a large extent, responsible for the enhancement of knowledge on onchocerciasis.
After seven years of implementation, a bigger segment of the population should have been educated on the disease. Thus, knowledge among the populations on the important preventive measures should have been better, with more than 500 teachers trained in Oncho IEC to educate their school children, more than 200 community health workers and more than 30 CSI nurses trained.
These workers certainly have methodological and motivational problems in their activities.