Distribution of Health Commodities in Community

 
 Definition of Commodities and MDA Definition of Commodities

•  Health Commodities are goods and supplies which are used for the aim of preventing diseases, conditions and/or promote health.

Definition of Mass Administration (MDA)

•  Mass drug administration is administration of drugs to the whole population irrespective of disease status in order to control, prevent or eliminate common or wide spread of diseases.
•  Mass drug administration (MDA) is a means of delivering safe and inexpensive essential medicines based on the principles of preventive chemotherapy, where populations or sub-populations are offered treatment without individual diagnosis.

 Health Commodities with their Specific Target Population

•  Condoms

1.  Sexually active youth and adult males and females
2.  Commercial sex workers and those who engage in risky sexual activities

•  Refilling Family Planning pills

1.  Adolescents and women of child bearing age 15-49 year

•  Treated bed nets

1.  Pregnant women and children under-five years.

• Supplementary feeds

1. Under-fives with poor nutritional status from various causes, orphans, those with chronic disease conditions such as TB, HIV

•  Information Education Communication (IEC) materials

1.  To all community members

 Target Population for MDA

•   Mass drug administration is done for all individuals in entire population depending on the targeted disease
•  In Tanzania the target groups are as follows:-

 o Lymphatic filariasis              - entire population
o Onchecerciasis                       - entire population
o Schistosomiasis                      - School aged children
o Soil transmitted helmiths       - school aged children
o Trachoma                                -entire population

 Steps for Distribution of Health Commodities in Community

•  Assess the need of the commodities in the community
•  Enter in a register, details of targeted community members, households or venues in need of the various health commodities
•  Implement a social marketing campaign for products for advantage and disadvantage to the community members emphasizing on the benefits of the commodities.
•  Prepare distribution list and schedule
•  Gather resources using a checklist
• Check the label of commodities (name of the product, manufacturer, expiry dates, formulation, effect to the body, storage condition, recommended daily dose and warnings)
•  Adhere to recommended storage conditions to each type of commodities throughout the activity such as

1.  Protect commodities from direct sunlight
2.  Do not keep them in floor
3.  Keep the commodities in a well ventilated, dry and clean areas
4.  Recommended temperature

•  Distribute the commodities to the community.
•  Prepare inventory of commodities (number for each types)

1.  Keep record of commodities movement.

• Refer community member in need of further health services to a place where the required services are offered
•  Submit report to the relevant authorities for their record and further action
•  Follow up to ensure community members adherence to the commodity use and recommended further steps, this is a continuous process.
• Prepare activity report basing on commodity distribution format.

Procedure for 

MDA MDA in Africa for NTDs is given according to Height. (However in special cases weight can be used such as in physical disabilities where height is difficult to get.)
The following is recommended procedure for different MDA Before mass drug administration the community health worker has to do the following:

•  To register all people in his/her catchment area in special register provided
•  To educate the community on importance of MDA

During mass drug administration community health worker has to do the following:

•  To administer drug in each house in his/her catchment area
•  To fill in the register the amount of drug administered
•  To fill in the register the names and reasons for those who didn‟t swallow the drug.
•  To report any problems to the village leader or incharge of the facility

After mass drug administration community health worker

•  To fill the data of MDA activity in summary register page.
• To handle over the remaining drugs to the incharge of facility
• To handle the register for MDA to the incharge of health facility

 Distribution of Health Commodities According to Community Needs

Documentation of Commodities and Medicine Distributed

•  Keep record of the number of community members needing health commodities
•  Keep record of amount of commodities received and distributed to the community for each type of the commodities
•  Keep record of remained commodities after community distribution
•  Keep record of expiry dates for the remained commodities
•  Keep record of commodities unusable due to leakage, change of color, lack of labels or tearing
•  Note down reported unwanted events associated with the use of distributed commodities
•  Keep record of main events encountered during the distribution of commodities in the community

Mass Drug Administration

•  .Mass drug administration (MDA) is a means of delivering safe and inexpensive essential medicines based on the principles of preventive chemotherapy, where populations or sub-populations are offered treatment without individual diagnosis. High-coverage MDA in endemic areas aims to prevent and alleviate symptoms and morbidity on the one hand and can reduce transmission on the other, together improving global health. MDA is the recommended strategy of the World Health Organisation to control or eliminate several neglected tropical diseases (NTDs). More than 700 million people now receive these essential NTD medicines annually. The combined cost of integrated NTD MDA has been calculated to be in the order of $0.50 per person per year. Activities have recently been expanded due, in part, to the proposed attempt to eliminate certain NTDs in the coming two decades. More than 1.9 billion people need to receive MDA annually across several years if these targets are to be met. Such extensive coverage will require additional avenues of financial support, expanded monitoring and evaluation focusing on impact and drug efficacy, as well as new diagnostic tools and social science strategies to encourage adherence. MDA is a means to help reduce the burden of disease, and hence poverty, among the poorest sector of populations. It has already made significant improvements to global health and productivity and has the potential for further successes, particularly where incorporated into sanitation and education programmes. However logistical, financial and biological challenges remain.
•  Communicable diseases which require mass drug administration are:

1.  Lymphatic filariasis
2.  Onchecerciasis
3. Schistosomiasis
4.  Soil transmitted helmiths
5.  Trachoma

Methods for MDA

• There are two methods for mass drug administration.

1. Direct method
2.  Indirect method

Direct Methods for mass drug a therapeutic dose of the drug, usually in the form of tablets, is given to an entire population. Example antimalaria.

 Indirect method is drug is added to food stuff, usually salt or drinking water. Example Iodine is added in salt also Vitamin and mineral added to some food

 Procedure for MDA
 MDA in Africa for NTDs is given according to Height. (However in special cases weight can be used such as in physical disabilities where height is difficult to get.) The following is recommended procedure for different MDA

Responsibility of Community health worker before mass drug administration

•  To register all people in his/her catchment area in special register provided
•  To educate the community on importance of MDA
•  To administer drug in each house in his catchment area
•  To fill in the register the amount of drug administered
•  To fill in the register the names and reasons for those who didn‟t swallow the drug.
•  To report any problems to the village leader or incharge of the facility
•  To fill the data of MDA activity in summary register page.
•  To handle over the remaining drugs to the incharge of facility
•  To handle the register for MDA to the incharge of health facility.

Dose for Common Drugs Used in MDA

•  Soil transmitted helmiaths- drug of choice is Albendazole for over five years old
•  Onchorceasis(River Blindness) - Drug of choice is Mectizan.
•  Lymphatic filariasis - Albendazole and Mectizan
•  Albendazole – One tablet
• Mectizan (Ivermectin)

1.  Below 90cm – 119cm: One tablet
2.  120 – 139 cm: Two tablets
3.  140 – 159 cm: Three tablets
4.  Above 159cm; Four Tablets

•  Albendazole and Mectizan are taken together
•  Praziquantel
•  Praziquantel is recommended for treatment and prevention of schistosomiasis (Bilhazia)
•  Praziquantel should be given 2 hours after meal.

1.  Below 94cm: No tablet
2.  94 -110cm: One tablet
3.  111 – 125cm: One and half tablet
4.  126 -138cm: Two tablets
5.  139 – 150cm: two and half tablets
6.  151 – 160cm: Three tablets
7.  161 -178cm: Four tablets
8.  Above 178cm: Five tablets

Zithromax Tablets Zithromax used for treatment and prevention of Trachoma as follows:

•  Below 74.0cm: No tablets
•  74.0 -87.8cm: One tablet
•  87.9 – 120.3: Two tablets
•  120.4 – 137.6cm Three tablets
•  Above 137.6 cm – Four tablets

Zithromax Syrup.

• 50.6 – 53.7cm: 2ml
•  53.8 -65.4cm: 4ml
•  65.5 – 76.4cm 6ml
•  76.5 -87.4cm: 8ml
•  87.5 -98.3cm: 10ml
•  98.4-110.2cm: 12ml
•  110.3 -122.2cm:14ml
•  122.3-130cm:16ml

Contraindications for MDA

•  Zithromaz is contraindicate to a child who is below six months
•  Albendazole, Mectizan,andPraziquantel are contraindicate to a child who is below five years old
•  Zithromaz, Albendazole, Mectizan, and Praziquantel are contraindicate to all pregnant mother
•  Zithromaz, Albendazole, Mectizan, and Praziquantel are contraindicated to seriously ill patients.

Summary

•    Mass drug administration (MDA) it means of delivering safe and inexpensive essential medicines based on the principles of preventive chemotherapy, where populations or sub-populations are offered treatment without individual diagnosis
•  The commodities which are distributed in the communities include condoms for sexually active population, refilling family planning for women of child bearing, treated bed nets for pregnant and under-fives and information education communication material to all community members.
•   Mass drug administration in Tanzania is done to the entire population depending on the targeted diseases for elimination
•  When distributing commodities adhere to stipulated procedures and ensure record keeping throughout the activity