How cultural awareness can help fight NTDs

Over three days, I learned first-hand from programme and health ministry officials, observed activities geared towards eliminating neglected tropical diseases (NTDs) and sought to understand the impact of our work.

After taking a plane and a long journey by road, I arrived in Benue, a semi-urban region in north-central Nigeria. Benue is home to a diverse group of people and cultures in a state known as the food basket of the nation.

My first port of call was the Benue State Health Ministry, where the state coordinator for NTDs, Terhemba Mark Debam, told me that the region was once endemic for trachoma, river blindness and lymphatic filariasis (LF). However, through the support of Sightsavers and other partners, Benue has now eliminated trachoma as a public health problem and the transmission of river blindness is suspected to have been interrupted.

I learned from Terhemba that the diverse population is reflected in the state’s approach to health programming. Using the models of distributing NTD treatments and public health communications to illustrate this point, he explained how the mixed rural and semi-urban demographics require different strategies to ensure no one is left behind.

Communicating about NTDs to the three major ethnic groups and minority tribes in the state is a challenging task, which involves adopting localised sensitisation materials and radio jingles for rural dwellers, while urban residents are targeted through digital media.

The strategy of delivering treatments also differs between the different populations. In rural areas, medication is distributed to communities through house-to-house mass drug administration (MDA). Yet, this approach alone isn’t effective in reaching the upwardly mobile population in larger towns. Instead, the ministry has designated areas in public buildings where urban dwellers can also walk in to receive treatment. At one of these posts, I received my first-ever treatments for river blindness and LF.

My next stop was Mbaatsongo, a rural settlement in the Gboko district of Benue State, where I saw a river blindness MDA taking place. This activity is typically carried out by volunteers who are trained to distribute medication in their communities. There, I met Moses Ateh, who has volunteered in this role with Sightsavers for three years.

As I watched him on his daily rounds measuring people with the dose pole to determine the correct dose of medication, administering ivermectin tablets and filling his logbook, it was clear that community members aren’t passive recipients. They were lively – chatting with Moses, calling out to household members and neighbours who are yet to take the medication, and reprimanding those who have already received treatment from taking a double dose.

I was intrigued to hear a woman in her fifties ask in the local dialect, “How about the white, sweet one?” After hearing the translation, I realised she was talking about albendazole, a tablet used to treat LF with a somewhat sweet taste. She knew about the treatment rounds and understood that both medications are usually administered together, which is the case in a state like Benue, where river blindness and LF are both endemic.

Sightsavers’ programme officer Abraham Aba accompanied me on the trip. As we followed the MDA, I spotted some of the challenges.

First, is the age disparity in the logbook records. Most people in rural communities do not keep track of their ages or birthdays. We were often met with blank stares, head-scratching or guesswork whenever Moses asked about their age. For children, an accurate age is important to ensure we do not give medications to children younger than five. It can also affect recordkeeping, as health ministries use this process to collect population data. I later met Mbaember, who couldn’t remember her age but regaled us with tales of getting married during the Nigerian Civil War, leading us to believe she must be in her seventies.

The second challenge is insecurity. When we arrived at one of the households, we met a young mother surrounded by almost a dozen children, half of whom had just been displaced from a neighbouring community due to farmer-herder conflicts. A sudden population surge due to displacement could mean drug shortages and socioeconomic hardships for previously stable regions.