Breaking New Ground in South Sudan

Community drug distributors and a health supervisor in South Sudan.
© CBM/Igwala

A programme for the treatment for lymphatic filariasis and onchocerciasis has reached parts of South Sudan which have not hitherto benefited from drug interventions.

CBM, in partnership with the national health authorities and Crown Agents (a UK-based non-profit) ​through the ASCEND programme (the UK government's flagship programme to eliminate NTDs) has implemented a mass drug administration in 29 counties in South Sudan where the communities have, until now, remained vulnerable to the devastation wrought by these diseases. 

Lymphatic filariasis is a parasitic infection caused by thread-like worms which enter the human lymph system through mosquito bites. The painful and disfiguring manifestations of the disease, lymphoedema, elephantiasis and scrotal swelling occur later in life and can lead to permanent disability. These patients are not only physically disabled, but often also carry a mental burden, experience social exclusion and suffer economic losses. 

22-year-old Lorwakale Lotuk who has symptoms of lymphatic filariasis, talks about the impact on him:

I used to do farming and plant maize. I started feeling sick a long time ago, my leg started swelling from my ankle to my knee. I was taking local herbs from the bush, pound them, mix with water and drink as treatment, but this did not improve the pain in my leg. Recently I took the drugs that were given by the community health workers. Since then there has been some change already. I can sleep at night without my leg itching and hurting.

Rose Achiro who is 46 years old, expresses her gratitude that the treatment is now being given to the whole population:

It hurts me when I see victims suffering from diseases we didn’t know, there was no way to help them. I heard through the public announcements in the village that there are drugs available to cure people. We did not know these drugs existed till this treatment campaign in our village started, now we learned that the drugs are treating people who are suffering and also preventing everyone else from getting the diseases.

How to reach vulnerable communities

Awareness activities on the administration of mass drugs in local communities.

© CBM/Igwala

The organisation of a drugs distribution and treatment campaign requires a lot of support from many people. At the East Equatoria States Health Department, health supervisors are trained in the distribution and administration of the drugs. They then recruit and train community health workers and drug distributors from the villages. This chain system provides a way of ensuring that those giving the drugs are trusted members of their communities and work in their own localities. 

The community drug distributors take the drugs from house to house, ensuring that they treat everyone in every household. It can be difficult as some of the areas are remote and difficult to access, and houses are frequently kilometres apart. In addition, some people are suspicious of the medicine and the distributors need to explain how the drugs improve their health.  

The work is done in teams of three - one person to measure an individual to ascertain the amount of medicine they need, another to act as a recorder of who lives in the household and takes the drugs, and the third to give the drugs and ensure they are swallowed. All team members work under COVID-19 protection guidelines to keep themselves and others safe. Alongside this, the health supervisors check that everyone takes the treatment, and that no one is left behind. The aim of this campaign is to treat more than 4 million people against lymphatic filariasis and onchocerciasis. 

Moses Duku, CBM’s Monitoring and Evaluation Officer in Juba, explains the importance of the treatment campaigns:

People suffering from lymphatic filariasis or onchocerciasis are stigmatised because of the symptoms and the ignorance about the disease. They feel they are not important and are being ignored by their communities. They are often unable to move around or to walk to the market, some cannot wear shoes or flipflops and must wear loose garments to lessen the pain of their condition. They often are unable to work and earn a living for their family or even to look after the children, this affects their relationships and social life.

The fact that this mass drug administration has reached areas of the country which have never been reached before, is a big step forward. To achieve the full elimination of these neglected tropical diseases, it is essential that future programmes build on this progress and continue for several years.