title: Monitoring ivermectin distributors involved in integrated health care services through community-directed interventions--a comparison of Cameroon and Uganda experiences over a period of three years (2004-2006).
abstract: OBJECTIVE
  To assess and compare the effectiveness of ivermectin distributors in attaining 90% treatment coverage of the eligible population with each additional health activity they take up.
  
  
  METHODS
  Random sampling was applied every year to select distributors for interviews in community-directed treatment with ivermectin (CDTI) areas of Cameroon and Uganda. A total of 288 in 2004, 357 in 2005 and 348 in 2006 distributors were interviewed in Cameroon, and 706, 618 and 789 in Uganda, respectively. The questions included treatment coverage, involvement in additional activities, where and for how long these activities were provided, and whether they were supervised.
  
  
  RESULTS
  At least 70% of the distributors in Cameroon and Uganda during the study period were involved in CDTI and additional health activities. More of the distributors involved in CDTI alone attained 90% treatment coverage than those who had CDTI with additional health activities. The more the additional activities, the less likely the distributors were to attain 90% treatment coverage. In Uganda, distributors were more likely to attain 90% coverage (P < 0.001 if they worked within 1 km of their homesteads were selected by community members, worked among kindred, and were responsible for <20 households.
  
  
  CONCLUSIONS
  Additional activities could potentially undermine the performance of distributors. However, being selected by their community members, working largely among kindred and serving fewer households improved their effectiveness.
authors.affiliation: Emory University, The Carter Center, Atlanta, GA, USA. mkataba@emory.edu
authors.forename: Moses
authors.initials: M
authors.lastname: Katabarwa
authors.forename: Peace
authors.initials: P
authors.lastname: Habomugisha
authors.forename: Albert
authors.initials: A
authors.lastname: Eyamba
authors.forename: Stella
authors.initials: S
authors.lastname: Agunyo
authors.forename: Catherine
authors.initials: C
authors.lastname: Mentou
mesh_terms: D002163:Cameroon; D003153:Community Health Services / Q000458:organization & administration*; D003150:Community Health Workers / Q000458:organization & administration*; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D004363:Drug Utilization / Q000706:statistics & numerical data; D005369:Filaricides / Q000627:therapeutic use*; D006801:Humans; D007559:Ivermectin / Q000627:therapeutic use*; D009855:Onchocerciasis / Q000517:prevention & control*; D014454:Uganda
chemical_list: D005369:Filaricides; D007559:Ivermectin