Highlighting Program Effectiveness With Treatment Coverage Metrics

Mon, 2012-05-14 16:42 -- Eric Strunz

Uganda NurseMetrics are critical for determining the effectiveness of disease control programs like CWW. Learn how we monitor treatment coverage, how we verify the accuracy of the data collected, and other guidance we use in monitoring our treatment coverage.

Treatment coverage, the percentage of individuals in a defined population that ingested a specific administered drug or drug combination, is a critical measurement that disease control programs like Children Without Worms (CWW) can make to demonstrate program effectiveness. As a program with numerous stakeholders, including program sponsors, country governments, partners and volunteers, as well as the people in its target communities, CWW understands the importance of capturing and reporting this metric.

The Importance of Monitoring Treatment Coverage

Monitoring drug treatment coverage provides numerous benefits to a disease control or Preventive Chemotherapy (PCT) program, providing information that:

  • Enables informed decision- and policy-making.
  • Reveals problems, like drug distribution issues, so that corrective action can be taken
  • Provides evidence to program funders, drug donors, and country governments to justify maintaining the program.
  • Increases program compliance by target communities when community members know that many people are being treated.
  • Improves morale of program partners and volunteers when they see the positive impact of their efforts.
  • Strengthens advocacy for the program because stakeholders know that in-need populations are getting treated.
  • Assists in forecasting future drug supply needs.

The CWW Approach to Monitoring Treatment Coverage

CWW tapped into the expertise of the neglected tropical disease (NTD) groups at both RTI and the World Health Organization (WHO) to develop a well-constructed approach to and guidelines for monitoring treatment coverage. In this approach, CWW defines treatment coverage as:

PCT Equation
Establishing a clear denominator in the equation--all school-age children (5 to 14 years old) living in a targeted district--was critical, as this can be easily taken from national census data and is clearly understood by all program stakeholders. And because CWW defines the implementation unit as a district, coverage rates can be easily compared across districts. Also, if a national deworming campaign uses more than one type of benzimidazole or different sources of the same type of benzimidazole, CWW requests programs use only mebendazole donated by Johnson & Johnson to treat school age children in targeted districts. This approach ensures that only those who have ingested mebendazole from Johnson & Johnson are included in the tally for the numerator and the program can more accurately monitor for adverse effects and drug efficacy because the drug quality is consistent in a defined area.

To verify the accuracy of collected data, CWW is field-testing a survey protocol in Cambodia and Cameroon. The survey, developed with assistance from the Centers for Disease Control and Prevention (CDC), verifies the reported coverage rate and also helps determine how accessible mebendazole is to school-age children not enrolled in school in areas where school attendance is low. The survey tool additionally assesses knowledge, attitudes, and practices around STH infection and helps determine the prevalence, accessibility and use of sanitary latrines and potable water at schools.

Further Guidance on Monitoring Treatment Coverage

CWW's approach and guidelines for monitoring treatment coverage are complementary to those published in Monitoring Drug Coverage for Preventive Chemotherapy, a guide developed by the WHO's Department of NTDs that was released in July of this year. The guide provides best practices and information around monitoring treatment coverage for PCT programs to control NTDs and is a recommended source other PCT programs can turn to when they need to monitor treatment coverage.