1. MAPPING OF PODOCONIOSIS

Ifotrode is currently playing a leading role in the country mapping of podoconiosis. This exercise is being supported by the Sussex Medical university funded by the Wellcome Trust UK. The exercise though limited by resources, has had seven out of 45 endemic districts of the Country surveyed. The mapping however will be conclusive if the district surveyed are raised to at least 15 (30%). However the initial results have been disseminated to Government of Uganda through the Ministry of Health. Ifotrode hopes to get support not only to conclude the mapping exercise but to initiate further studies to teest various treatment options.

• KAP STUDY

Ifotrode seems to be enjoying public support due to the successes registered against all interventions it has so far made (Tungiasis, scabies, Podoconiosis and health education). But there is need for documentation of these successes. Ifotrode thus plans actively seek feed back in form of satisfaction surveys. We shall also need to carry out a second KAP study that will help to clarify on differences between animal tungiasis and human infestation.

• EXTENSION TO OTHER AREAS WITH DIFFERENT CHARACTERISTICS

The tungiasis project has solely been implemented in the typical nomadic people areas of Karamoja. But information available to Ifotrode indicate that some parts of Karamoja especially the Southern Part (Namalu and Nabilatuk) are equally affected with both tungiasis and podoconiosis but their lifestyle is more of permanent settlements and farming. Ifotrode therefore would wish to extend the project to some of these areas not only because there is need but there is also need to study other areas with different characteristics.

•  HMIS INTERGRATION

To confirm that Tungiasis and worse still podoconiosis is neglected, there is total lack of data collection by all the districts health information systems of Uganda. Ifotrode plans in this phase to concentrate through workshops and one on one meetings on sensitization of entire Napak district leadership with emphasis to district health department to start data collection on the two diseases. Its then hoped that the Ministry of Health will get encourage to commence nationwide data collection and reporting on these diseases.

• INTERAGENCY COLLABORATION

In the two years Ifotrode has been on the ground in Napak, it has been realized that there are other players in the district though playing different but related roles. CUAMM for example is supporting health systems in most of health facilities in the district, Moroto Catholic Diocese own and runs a number of health facilities such as Matany Hospital in the district. Ifotrode therefore during this phase, plans to seek cooperation from these relevant organisations to enhance its objectives

• SCHOOL PROGRAMME

Ifotrode see sees a key to long-term goal to control tungiasis in systematic and sustainable treatment on site since its easy to self-diagnose and treat given the high prevalence, high stigma, and unprepared health care infrastructure. Schools as a place of treatment makes sense because children are most affected by tungiasis and children can also be “multipliers” for what they have learned about diagnostics and treatment. Prefect-pupils and prefect-teachers will acquire reliable knowledge in diagnostics and treatment of tungiasis and spread this acquired practice to their communities. This will eventually decrease the prevalence and intensity of tungiasis gradually in communities and pupil attendance and performance in schools will increase with time.

The school health programme will thus be the first implementation study for the systematic treatment of tungiasis.

• SOIL ANALYSIS

At the beginning of the project in January 2021 some samples of soil were collected from homes of the tungiasis severely affected homesteads with a view of trying to quantify the soil contamination with various forms of tungiasis. The samples were taken to Makerere university for analysis but process has been difficult mainly because of lack of budget line to pay for the analysis. This analysis is very critical as it supports our proof of principle of eliminating tungiasis from the soil by continuous treatment thus preventing fresh eggs contaminating the soil. Ifotrode has not been able to secure support for this analysis.

• FOOT WEAR

Tungiasis and worse still podoconiosis are stigmatized diseases. Key step in their control is feet protection by use of shoes. Most of the 50 cases of podoconiosis, Ifotrode has been managing in Napak have improved to the level that they can now wear shoes. Through other donors, Ifotrode has managed to get shoes to some of them. Its therefore suggested that foot wear should be part of the successful management and prevention of both tungiasis but more so podoconiosis.

• ANIMAL TREATMENT

Ifotrode has experienced a number of challenges regarding the diagnosis and treatment rounds for animals. Due to insecurity in Karamoja (cattle rustling and theft) the households take their animals to secure but distant locations. Our teams could thus not access the animals most of the time. This has made the number of examined and treated animals too small to provide data of statistical significancy. However, even if the animals eventually return the numbers of animals will be too large for our small ill-equipped field teams to handle. Ifotrode will however continue to dialogue on this issue either to find the best lasting approach or discard the idea altogether.

Persistence of tungiasis in some families has been in some quarters attributed to presence of rodents (rats and mice). Ifotrode therefore will try to investigate the role played by these rodents in persistent transmission of tungiasis.

1. FINANCIAL MANAGEMENT

To manage its finances and human resources professionally, Ifotrode has developed and closely implementing the procurement and human resource manuals/guidelines. Activities like workshops, benchmarking and consultation are key to the successful writing and implementation of the tools.

1. SUSTAINABILITY

Despite the successes registered the project is still faced with a question of sustainability. This is however being discussed at all levels from the communities themselves through the district leadership to the National level.

The strategic plan for the Neglected Tropical Diseases Control Program, (2020-2025) emphasizes the following three objectives:

1. the integration of all medicines and supplies for NTD case management in the MoH routine supply chain.
   1. the full integration of NTD services in the existing healthcare system by 2025 by addressing gaps and
   1. the integration of NTD data in the HMIS/DHIS2 information system for routine surveillance of NTDs in Uganda.
   1. IFOTRODE however has made important contributions concerning Tungiasis and podoconiosis management and sustainability by:

1. Presentation and dissemination of project results at various key departments like the Ministry of Health for policy changes, National Drug Authority (NDA) for importation of NYDA and other health partners for adoption and dissemination of treatment methods.
   1. Promising to supporting the MoH in the design and implementation of an official Tungiasis and Podoconiosis management manual. This manual will include recommendations on medicines, medical instruments and health promotion messages. This document will eventually positively impact and define data collection in DHIS2.

In this phase of Tungiasis elimination project, focus has changed from the current scientific study approach to more community leaning Health System Strengthening approach. This means through lobbying and extensive sensitisation, more data collection will be done through the health facilities or community-based health care with direct entry into the DHIS2. Field activities will eventually be handed over to VHTs and health center staff and other stakeholders such as teachers as the podoconiosis activities are stepped up. Ifotrode will eventually remain with the responsibilty of prevalence surveys.

1. Health education: cleaning floors, smearing all floors, washing feet with soap; GM, FM, HMn, Mike

1. Development of training and education material; curriculum for schools; GM, HMn; teacher

Training material (IEC) have been developed by the Ifotrode team in close consultations with the Napak District Health Education Officer

1. Access to water, implementation of WASH; Schools, households with tungiasis; patients with podoconiosis and scabies; GM, water management office.

Napak district just like all Karamoja district get one rain season lasting only 4 months. This therefore means there is shortage of water for much of the year. The district water department however with support from development partners have sunk at least two bore holes in each village. Altogether there are over 500 boreholes, about 300 are functioning at any one time. Those that are not functioning require repairs most of which are minor. The most expensive is replacement of pistons and rings due to overuse. The typical cost of a major repair is about 1 million (250 euros) Uganda shillings. However, some parts of Napak have very deep and unreachable water table. There areas require piped water from the areas that have working boreholes.  Ifotrode wishes that all areas of operation are well served with water. The wishes to se that the nonfunctioning boreholes are repaired and probably those areas in water shadows be supplied with piped water. The overall cost of these repairs is much lower and sustainable than sinking new boreholes