Expanding Access to Preventive Chemotherapy Among Mobile and Migrant Populations

Официальное название

A Community Mapping and Participatory Research Protocol for Expanding Access to Preventive Chemotherapy Among Mobile and Migrant Populations Through Social and Occupational Networks in Nigeria: MISSION Nigeria

Обзор

Neglected Tropical Diseases (NTDs) are among the most common groups of diseases affecting over one billion people globally and are disproportionately concentrated in remote, underserved, and marginalized communities. Efforts toward NTD elimination have largely relied on preventive chemotherapy (PC), large-scale distribution of free, safe, and effective medicines to at-risk populations. One major challenge threatening elimination efforts is the poor participation of mobile and migrant populations (MMPs) in treatment programs. Despite this gap, few studies have explored strategies to improve access among these underserved populations. This study aims to determine the burden of NTDs among MMPs and explore strategies for expanding access to preventive chemotherapy through social and occupational networks using community mapping and participatory action research approaches in Nigeria. This project is a multi-site implementation research study involving 15 communities across three Nigerian states-Taraba, Akwa Ibom, and Ondo-representing pastoralist, fishing, and agrarian settings, respectively. The study comprises four phases. The first two formative phases will assess the baseline burden of NTDs and coverage of preventive chemotherapy interventions using community surveys, parasitological and serological assessments, mapping, and participatory workshops to identify migration patterns, anchor points, and social and occupational networks that could support expansion of PC. The third phase will use participatory approaches to co-construct context-specific strategies for expanding access to preventive chemotherapy among MMPs. In the fourth phase, the co-developed strategies will be implemented and evaluated for impact using established implementation research frameworks and mixed methods approaches. Through this project, investigators will develop and evaluate a novel strategy for expanding access to PC among MMPs. The study will generate evidence on the feasibility, acceptability, reach, and sustainability of the proposed approach and is expected to inform adaptable implementation models for inclusive NTD programming in Nigeria and similar endemic settings.

Подробное описание

Neglected tropical diseases (NTDs) are among the most common groups of diseases globally, affecting more than one billion people and disproportionately burdening remote, underserved, and marginalized populations. The World Health Organization (WHO) broadly classifies most NTDs into two categories based on their recommended management approaches. Case-management NTDs-including Buruli ulcer, human African trypanosomiasis, rabies, Guinea worm disease, lymphoedema, leprosy, trichiasis, leishmaniasis, yaws, dengue, and mycetoma-require individualized diagnosis and treatment because of management complexity or the absence of effective large-scale diagnostic and therapeutic tools. In contrast, preventive chemotherapy NTDs (PC-NTDs), such as onchocerciasis, schistosomiasis, lymphatic filariasis, trachoma, and soil-transmitted helminthiasis, are primarily controlled through mass drug administration (MDA) delivered to at-risk populations to reduce morbidity and interrupt transmission. Other NTDs that do not neatly fit within these categories, such as rabies, snakebite envenoming, and dengue, require alternative prevention and control approaches. In many endemic countries, PC-NTDs constitute the largest proportion of the NTD burden and therefore have well-established control programs.

Over the last decade, NTDs have increasingly gained recognition as a major global health priority, culminating in the WHO NTD Road Map 2021-2030, which outlines ambitious targets for the control, elimination, or eradication of all NTDs in alignment with the Sustainable Development Goals. Despite these commitments, progress toward achieving the 2030 elimination targets for several PC-NTDs remains insufficient. In the African Region, where more than 40% of the global NTD burden is concentrated, only 19 of 54 countries had eliminated at least one NTD as of 2025. Persistent gaps in intervention coverage among vulnerable and underserved populations continue to threaten progress toward NTD elimination goals. Several programmatic bottlenecks have been identified, including but not limited to poor community awareness, perceived severity of the disease, perceived benefits of interventions, inadequate human and financial resources for programming, conflict and insecurity, political instability, and increasing migration and population mobility. While many of these barriers have received considerable global attention, migration and population mobility are increasingly emerging as critical yet understudied challenges. Population movement may occur because of conflict, insecurity, environmental pressures, seasonal labor, or other livelihood-related factors (trade, pastoralism, fishing, leisure, schooling), all of which may disrupt access to routine public health interventions. However, the specific implications of migration for MDA delivery, treatment continuity, and coverage remain poorly understood. Similarly, evidence-based strategies for optimizing PC-NTD programs among highly mobile and migrant populations remain limited.

Nigeria, the most populous country in sub-Saharan Africa, accounts for approximately one-quarter of the continent's NTD burden and has yet to eliminate any major NTD. For more than a decade, our team has collaborated with the Nigerian government and implementing partners to support NTD elimination efforts across the country. Although substantial progress has been made in reducing disease prevalence, improving morbidity management, and responding to outbreaks, migration continues to pose a major challenge to achieving optimal treatment coverage and has received limited attention within existing elimination strategies. Population movement within Nigeria and across neighboring borders are often driven by seasonal climatic patterns, insecurity and economic opportunities, and is facilitated by extensive river systems, trade corridors, grazing routes, and arable lands that sustain economic activities. These populations, herein referred to as mobile and migrant populations (MMPs), are frequently absent during MDA campaigns. Consequently, they often experience non-treatment, limited awareness of MDA activities, limited engagement with health-workers, and increasing community fatigue. Collectively, these dynamics may contribute to treatment refusals, sustain disease transmission, and slow progress toward elimination goals. The investigators therefore posit the need to improve MDA access, reach, and coverage among MMPs through approaches that strengthen involvement, trust, ownership, and the perceived value of MDA among MMPs that have historically been underrepresented in routine health programs.

This study aims to develop and evaluate a novel delivery model that utilizes community mapping and participatory research approaches to strengthen access to MDA among MMPs. The process will begin by generating a detailed understanding of migration realities, including migratory routes, movement timing, seasonal patterns, and key drivers of mobility, to identify where, when, and how MMPs move across different settings. The study will also explore the social and occupational networks that exist along these migratory pathways and assess how these networks can be strategically leveraged to expand MDA access and delivery. Ultimately, the overarching aim of the study is to evaluate whether this co-constructed delivery model can improve access, reach, and coverage of MDA among MMPs in Nigeria compared with standard delivery approaches. Specifically, the study will explore migratory routes, movement patterns, and drivers influencing participation in MDA; identify the social and occupational structures that shape mobility and access to healthcare; and examine how these existing networks can be strategically leveraged to improve MDA delivery, reporting, and community engagement. In addition, the study will assess the livelihood-linked incentives and complementary services prioritized by MMPs and evaluate how integrating these preferences into intervention design may strengthen demand for and participation in preventive chemotherapy programs. Finally, the study will examine the contextual, behavioral, and structural factors influencing implementation, while exploring how participatory processes foster trust, ownership, inclusivity, feasibility, sustainability, and scalability of the proposed delivery model across diverse migratory settings in Nigeria.

Вмешательства

• Другое Modified Mass Administration of Medicines Strategy
  Unlike routine MAM, which primarily relies on fixed household-based distribution strategies, the modified MAM will be developed through community-based participatory research (CBPR) with MMPs and other stakeholders to better accommodate their mobility patterns and livelihood activities. The intervention will include: (i) selection of convenient and accessible community anchor sites for medicine distribution; (ii) flexible timing of medicine distribution to coincide with periods when MMPs are ava
• Препарат Albendazole 400 mg
  Medicines administered to prevent and treat soil-transmitted helminthiasis
• Препарат Praziquantel 40 mg/kg
  Medicines administered to prevent and treat schistosomiasis
• Препарат Ivermectin
  Medicines administered to prevent and treat onchocerciasis
• Препарат Ivermectin + albendazole
  Medicines administered to prevent and treat lymphatic filariasis

Первичные конечные точки

• Reach percentage measured as the proportion of eligible mobile and migrant populations (MMPs) offered preventive chemotherapy during the modified mass administration of medicines (MAM) campaign [Срок оценки: Baseline ( to estimate reach in the previous MAM) and immediately after completion of the modified MAM campaign (up to 4 weeks after intervention).]
• Coverage percentage measured as the proportion of eligible MMPs who swallowed preventive chemotherapy during the modified MAM campaign [Срок оценки: Baseline (previous MAM campaign) and immediately after completion of the modified MAM campaign (up to 4 weeks after intervention).]
• Compliance percentage measured as the proportion of MMPs who swallowed all medicines received during the modified MAM campaign [Срок оценки: Baseline (previous MAM campaign) and immediately after completion of the modified MAM campaign (up to 4 weeks after intervention).]
• Acceptability rate (%) of the modified MAM strategy among mobile and migrant populations measured using a study-specific binary questionnaire informed by Proctor's Implementation Outcomes Framework [Срок оценки: Immediately after completion of the modified MAM campaign (up to 4 weeks after intervention).]
• Prevalence of preventive chemotherapy-targeted neglected tropical diseases among mobile and migrant population children [Срок оценки: Baseline (prior to implementation of the modified MAM strategy; within the fourth month of the study).]
• Adoption rate (%) measured as the proportion of planned anchor sites intending to implement the modified mass administration of medicines (MAM) strategy [Срок оценки: Immediately following validation of the modified MAM strategy during the final participatory planning meeting (within the fourth month of the study).]
• Penetration rate (%) measured as the proportion of planned anchor sites implementing the modified mass administration of medicines (MAM) strategy [Срок оценки: Immediately after completion of the modified MAM campaign (up to 4 weeks after intervention).]
• Implementation fidelity (%) measured as adherence to the planned components of the modified mass administration of medicines (MAM) strategy [Срок оценки: Throughout implementation of the modified MAM campaign and immediately after campaign completion (up to 4 weeks after intervention initiation).]
• Appropriateness rate (%) of the modified mass administration of medicines (MAM) strategy among mobile and migrant populations and community drug distributors measured using a study-specific binary questionnaire informed by Proctor's Implementation Outcom [Срок оценки: Immediately after completion of the modified MAM campaign (up to 4 weeks after intervention).]
• Feasibility rate (%) of the modified mass administration of medicines (MAM) strategy among mobile and migrant populations and community drug distributors measured using a a binary questionnaire informed by Proctor's Implementation Outcomes Framework [Срок оценки: Immediately after completion of the modified MAM campaign (up to 4 weeks after intervention).]

Вторичные конечные точки (5)

• Spatial migration patterns of mobile and migrant populations identified through participatory mapping [Срок оценки: Baseline (during participatory workshops conducted prior to implementation of the modified MAM strategy; within the fourth month of the study).]
• Temporal migration patterns of mobile and migrant populations identified through participatory mapping [Срок оценки: Baseline (during participatory workshops conducted prior to implementation of the modified MAM strategy; within the fourth month of the study).]
• Migration drivers identified among mobile and migrant populations through participatory assessment [Срок оценки: Baseline (during participatory workshops conducted prior to implementation of the modified MAM strategy; within the fourth month of the study).]
• Community-defined implementation priorities for the modified MAM strategy [Срок оценки: Baseline (during participatory workshops conducted prior to implementation of the modified MAM strategy; within the fourth month of the study).]
• Community-prioritized livelihood support interventions to enhance participation in the modified MAM strategy [Срок оценки: Baseline (during participatory workshops conducted prior to implementation of the modified MAM strategy; within the fourth month of the study).]

Критерии участия

Критерии включения

Participants will be eligible for inclusion if they:

• Are children aged 5-14 years or adult heads of households residing in households identified as belonging to mobile or migrant populations.
• Reside permanently or semi-permanently within the study communities
• Have missed one or more previous rounds of onchocerciasis and/or lymphatic filariasis MDA.
• Are willing to provide the required biological specimens and participate in interviews, surveys, and participatory workshops or discussions as required by the study protocol.
• Provide informed consent or assent with parental/guardian consent where applicable for minors.

Критерии исключения

Participants will be excluded if they:

• Are temporary visitors without meaningful residence in the study communities.
• Do not belong to the identified mobile or migrant populations targeted by the study.
• Are unable or unwilling to provide the required biological specimens or participate in study procedures.
• Decline informed consent or assent, or whose parent or guardian declines consent for participation.
• Are severely ill or have medical conditions that, in the opinion of study personnel, would make participation unsafe or inappropriate.

Критерии приведены из реестра в оригинале (на английском). Окончательную оценку соответствия проводит исследовательский центр.

Здоровые добровольцы: Да

Дизайн исследования

Распределение

Не применимо

Модель

Одна группа

Маскирование

Открытое

Основная цель

Организация здравоохранения

Центры проведения

Nigeria · 1 центр

• Recruitment is done at the Household level in selected communities — Ondo

Публикации

• Schürmann, A., J. Kleemann, M. Teucher, C. Fürst, and C. Conrad. 2022. Migration in West Africa: a visual analysis of motivation, causes, and routes. Ecology and Society. 27(3):16. Available at https://ecologyandsociety.org/vol27/iss3/art16/
• Mogaji H, Alexandra Alzate LY, Figueredo LA, Araujo Virgens JH, Aliaga MA, Argibay HD, Salles I, Pereira Moreira A, Lima E Silva TJ, Cristina Dos Santos S, Batista R, Cardoso E, Neves Santos EC, Leal Dos Santos E, Rodrigues Dos Santos E, da Mata Barreto T, Dos Santos Mattos TA, Nery N Jr, Cruz J, Carneiro I, Lustosa R, Dedavid Ferreira VC, Reis M, Ko AI, Costa F, Begon M, Khalil H. Co-production o PMID 41883820
• 36. RE-AIM Framework. Available at https://re-aim.org/
• Proctor E, Silmere H, Raghavan R, Hovmand P, Aarons G, Bunger A, Griffey R, Hensley M. Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda. Adm Policy Ment Health. 2011 Mar;38(2):65-76. doi: 10.1007/s10488-010-0319-7. PMID 20957426
• Wallerstein N, Duran B. Community-based participatory research contributions to intervention research: the intersection of science and practice to improve health equity. Am J Public Health. 2010 Apr 1;100 Suppl 1(Suppl 1):S40-6. doi: 10.2105/AJPH.2009.184036. Epub 2010 Feb 10. PMID 20147663
• Sangare M, Coulibaly YI, Ravichandran P, Diabate AF, Duguay C, Vlassoff C, Kulkarni MA, Krentel A. Exploring the impact of mobile and migrant populations on mass drug administration coverage and effectiveness in Africa: A scoping review protocol. PLoS One. 2025 May 29;20(5):e0324949. doi: 10.1371/journal.pone.0324949. eCollection 2025. PMID 40440352
• Sangare M, Diabate AF, Coulibaly YI, Tanapo D, Thera SO, Dolo H, Dicko I, Coulibaly O, Sall B, Traore F, Doumbia S, Kulkarni MA, Nutman TB, Krentel A. Understanding the barriers and facilitators related to never treatment during mass drug administration among mobile and migrant populations in Mali: a qualitative exploratory study. BMJ Glob Health. 2024 Oct 9;9(10):e015671. doi: 10.1136/bmjgh-2024- PMID 39384331
• 25. UN Migration. Climate change, disasters, insecurity, and displacement: The impact of flooding on youth marginalization and human mobility in Nigeria. Available at https://environmentalmigration.iom.int/blogs/climate-change-disasters-insecurity-and-displacement-impact-flooding-youth-marginalization-and-human-mobility-nigeria

Идентификаторы

NCT: NCT07707817 · IRB/26/017 · NTDSC 291F

Первоисточники (государственные реестры)

• ClinicalTrials.gov (NIH, США)

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