Kenya is committed to eliminating preventive chemotherapy neglected tropical diseases (PC- NTDs) that continue to be of public health importance in the country. Although the World Health Organization (WHO) has identified schistosomiasis (SCH) and soil transmitted helminthiasis (STH) for control, the country, through the Breaking Transmission Strategy (BTS) 2019-2023, has committed to work towards the elimination of these two diseases. The commitment to eliminate SCH and STH has necessitated a change in strategy from school age children (SAC) to a community approach. The distribution of drugs has also shifted to community-based distribution. In addition, the threshold for treatment has been reduced from 10% prevalence to 2% for SCH and STH, respectively. The efforts to implement the BTS led to advocacy and mobilization of resources from donors including medicines from pharmaceutical companies to cover the expanded scope. With the support of Merck and Johnson and Johnson, through the WHO, the country has been able to acquire adequate praziquantel (PZQ) and mebendazole (MBZ), respectively. Funding support for the distribution was provided by Unlimit Health and the END Fund for specific regions of Kenya.
The mass drug administration (MDA) of PZQ for schistosomiasis and MBZ for STH took place in Homa Bay County, located in the Lake Region of Kenya. The MDA was informed by the results of a granular mapping exercise conducted in November – December 2022 in five counties (Busia, Homa Bay, Kisumu, Migori and Siaya). With a population of about 1.3 million, Homa Bay was better placed to utilize available tablets in the country compared to the other 4 counties. The PZQ drug distribution targeted 22 wards that had a SCH prevalence of 10% and above, while the MBZ drug targeted all wards irrespective of their STH prevalence. The Division of Vector Borne and Neglected Tropical Diseases (DVBNTD) provided leadership to this work with the support of the African Institute for Health and Development (AIHD).
The process took four weeks – from April 12th to May 3rd , 2023. The key activities included: (i) conducting a training of trainers (ToT) that brought together the Homa Bay County health team; (ii) advocacy at the county and sub-county levels; (iii) social mobilization using a range of channels including radio, posters, public address system and social media; (iv) mass drug administration (MDA) in the respective wards (door-to-door); and (v) reverse cascade that ensured all medicines and materials used (dosing polls, registers) were collected and returned to the program team. Monitoring was done throughout the process and remedial measures undertaken on site (such as redistribution of medicine).