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Table 1 Problems identified and recommendations made from studies to improve communication strategies in co-endemic areas

From: Programmatic and Communication Issues in Relation to Serious Adverse Events Following Ivermectin Treatment in areas Co-endemic for Onchocerciasis and Loiasis

Problems Identified

Recommendations made

Absence of a global IEC strategy. [10, 24]

Develop an overall communication strategy from community-based research. [10, 24] The plan should include disseminating clear, consistent and complete tested messages to demystify SAEs, allay fears and motivate participation in CDTI via multiple, appropriate channels to reinforce messages from national to community level. [10, 23]

Incomplete messages given in communities cause doubt and allowing rumours to continue [3, 11, 23] (i.e. SAEs emphasized without explaining cause and prognosis. CDDs don't inform people about potential side effects because they do not want to be seen as distributing a dangerous drug. [10]

SAE training, materials and messages include complete information – why side effects happen, how all medications can have side effects, what are particular side effects of ivermectin, how long side effects last, effectiveness of treatment of side effects, the system to take charge of side effects, the efficacy of ivermectin, and health problems associated with onchocerciasis. [3, 10, 11, 21, 23]

Mistrust of government enhances negative rumours related to SAEs and ivermectin. [23] Insufficient implication of administrative authorities in sensitisation activities. [24]

Have an official launching ceremony with health, traditional and administrative officials and media. [10, 23] Conduct advocacy at the highest levels to reinforce messages given in the communities. [24]

Messages are not motivating to behaviour change – are not creating demand for ivermectin in communities and are not well enough crafted to vanquish fear of SAEs. [10, 11] There is insufficient community involvement in developing the messages. [24]

Design messages based on KAP survey done in and with communities. [10, 24] Message must appeal to the population at the physical, emotional and practical level so the risk and fear of SAEs is less important than the treatment for onchocerciasis. [23, 38] Evaluate the communication strategy to know if the messages were motivating enough to change behavior. Apply lessons learned to continually improve the strategy and messages. Encourage the use of testimonials of villagers. Monitor villages to know if the messages are being heard and understood. [10]

Health personnel are not reinforcing CDD messages adequately: source is important on medical issues like SAEs. [10, 11, 23]

Systematize sensitization activities by nurses before, during and after the distribution. [10, 22, 23]

There is insufficient competence in communication techniques at all levels. [10, 23, 24]

Include practicum on communication techniques in nurse and CDD training. [10, 23, 24] Encourage a positive, caring attitude among CDDs and health personnel toward SAE cases. [11] Reinforce skills during supervision. [23]

Visual supports are not well understood without explanation, nor are they often used to give health education. [10, 22] There are insufficient IEC materials related to SAEs for health professionals and communities. [11, 22, 24]

Develop IEC supports that motivate, are graphic and self-explanatory based on information from community research. Explain the content of supports during health education sessions. [10] Produce enough materials for wide distribution in villages. Finalize supports specifically for health professionals on SAE management. [10, 11, 22]

Communities are not adequately informed or implicated in management of SAEs. There is a lack of information at the village level. [3, 10–12, 21–24]

Train CDDs and community leaders on SAEs, detection and referral. [11] Train church, school and social leaders to help sensitize the community and counsel SAE cases. [10, 11, 23] Train medical staff to counsel recovering SAE cases. [11] Sensitize communities before, during, and after distribution, including improved health education of families to understand the signs of alarm for SAEs and to know what to do about them. [3, 11, 21, 23]

Absence of advocacy materials. [24]

Develop an advocacy kit to target resources. [24]

Insufficient number of IEC experts. [24]

Identify experts outside Onchocerciasis control program that could be tapped. [24]

Insufficient data on the relationship between SAEs and coverage. [11, 23, 24]

Conduct well-designed study to assess the relative importance of SAEs to coverage levels. [11, 23, 24]