Core Group

The Integration of Vitamin A Supplementation into Community-Directed Treatment with Ivermectin: A Practical Guide for Africa

Helen Keller International

Why integrate Vitamin A supplementation into Community-Directed Treatment with Ivermectin?

In the last 20 years numerous studies have demonstrated the correlation between vitamin A deficiency and childhood mortality. Vitamin A supplementation (VAS) has proven to be successful at reducing vitamin A deficiency (VAD) and has therefore become one of the key interventions for child survival.

Onchocerciasis

Onchocerciasis or river blindness is the second leading infectious cause of blindness worldwide and a major impediment to economic development throughout Africa

Onchocerciasis is endemic throughout much of sub-Saharan Africa. Although onchocerciasis is usually not national in scope, the disease is found in some of the most remote places where government health services usually do not reach.

The primary strategy used to deliver the drug of choice, ivermectin (Mectizan®), once per year in order to control the symptoms of the disease is called Community-Directed Treatment with Ivermectin (CDTI). CDTI is an innovative strategy that brings the responsibility for control of a disease, onchocerciasis, to the community.

The community is empowered to implement and sustain ivermectin distribution in concert with the established health care system. Community volunteers, or community-directed distributors (CDDs), are trained to sensitize other community members about the disease and its treatment and to organize a campaign to distribute ivermectin to all eligible members of the community each year for at least 15 to 20 years.

Considering that there is no one sustainable vitamin A delivery mechanism to cover the at risk population now or in the foreseeable future, and there are dwindling onchocerciasis resources, integrating VAS into onchocerciasis control programs seemed doable and logical.

By integrating the two interventions, two very real and serious public health problems can be addressed and sustained in communities for the next 15 to 20 years - until other solutions are found. An integrated CDTI and vitamin A supplementation program can leverage funds from multiple sources to better build and ensure this sustainability. In addition, vitamin A supplementation and ivermectin delivery are synergistic, relying on similar systems.

They both require sustained supply systems and some support from outside the community, particularly from the Ministry of Health. Both vitamin A capsules and ivermectin tablets are relatively simple to deliver effectively and safely to the target groups by trained community volunteers.

How to Scale-up this Approach

With CORE support, Helen Keller International created the following resources to assist others in implementing this strategy: Integrating Vitamin A Supplementation into Community-Directed Treatment with Ivermectin: A Practical Guide for Africa. The manual gives an overview of the vitamin A and onchocerciasis problems and provides concrete information on the practical steps and considerations for integration VAS into CDTI. It is available in both English and French:

• English Version  (2004)
• French Version   (2004)
• Reaching the end of the road in Africa: Using community-directed treatment with ivermectin to deliver vitamin A supplements  - Nancy J. Haselow, M.P.H.

Additional materials and more information on onchocerciasis control are available on the HKI website: www.onchohki.org