‘IRREGULAR CDD’ AND ‘MOSAIC PATTERN OF WASH’ ACTIVITIES TOWARDS ‘STH’ CONTROL: A CASE STUDY OF AGULERI, ANAMBRA-EAST LGA, ANAMBRA STATE, NIGERIA.
Main Article Content
Abstract
Persistence of Soil Transmitted Helminthiasis, usually due to Ascaris lumbricoides, in endemic communities has been attributed to gaps in intervention coverage and compliance, especially in rural communities. This study therefore evaluated ‘Community Directed Distributors’ (CDDs) activities and assessed ‘Water, Sanitation and Hygiene’ (WASH) indicators in Aguleri, Anambra-East LGA, Anambra state, Nigeria. The study was community based, with Cross- sectional design; a semi-structured and pre-tested questionnaires were used (as checklist and as in-depth interview (IDI) guide) for data collection. Mass Drug Administration by CDDs, reported to be less often (60.0%), had mostly Mebendazole given (55.0 %). Last distribution by CDDs was in September 2024, with Albendazole supplied by the state government to all Primary Health Centers. ‘Unavailability of anthelminthic drugs from the government’ and ‘limited drug supply by philanthropists’ were reported as a hindrance to continued and wider coverage distribution. Mosaic patterns of WASH conditions were observed for all the variables investigated: drinking water source, type of toilet use, hand washing facility and soap for hand wash. These research findings revealed non-uniform gaps in intervention coverage and compliance towards STH control. Strengthened community-based control measures are highly recommended in the study area.
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Chidozie, G. N., Egbuche, C. M., Amoke, C. O., Okeke, A. U., Egbuche, F. G., Obi, O. J., Chimezie, M. C., & Nwachukwu, C. A. (2026). ‘IRREGULAR CDD’ AND ‘MOSAIC PATTERN OF WASH’ ACTIVITIES TOWARDS ‘STH’ CONTROL: . The Bioscientist Journal, 13(2), 15-26. https://doi.org/10.54117/the_bioscientist.v13i2.190
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This work is licensed under a Creative Commons Attribution 4.0 International License.
References
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Amazigo, U. V., Leak, S. G. A., Zoure, H.G.M., Okoronkwo, C., Diop Ly, M., Isiyaku, S., Crump, A., Okeibunor, J.C., and Boatin, B. (2021). Community-directed distributors-the ‘foot soldiers’ in the fight to control and eliminate neglected tropical diseases. PLOS Neglected Tropical Diseases, 15(3).
Anunobi, J., Okoye, I., Aguzie, I., Ndukwe, Y., and Okpasuo, O (2019). Risk of Soil-Transmitted Helminthiasis among Agrarian Communities of Kogi State, Nigeria. Annals of Global Health, 85(1):120.
Aribodor, O. B., Jacob, E. C., Azugo, N. O., Ngenegbo, U. C., Obika, I., Obikwelu, E. M., and Nebe, O. J. (2025). Soil-transmitted helminthiasis among adolescents in Anaocha Local Government Area, Anambra State, Nigeria: Insights and recommendations for effective control. PLoS ONE, 20(1), e0292146.
Bethony, J., Brooker, S., Albonico, M, Geiger, S.M., Loukas, A., Diemert, D. and Hotez, P.J. (2006). "Soil-transmitted helminth infections: ascariasis, trichuriasis, and hookworm". The Lancet. 367 (9521): 1521–1532.
Brooker, S., Clements, A.C., and Bundy, D.A.P. (2006). Global epidemiology, ecology and control of soil-transmitted helminth infections. Advances in Parasitology, 62,221-261.
Chami, G. F., Kabatereine, N. B., and Tukahebwa, E.M. (2019). Profiling the best-performing community medicine distributors for mass drug administration: a comprehensive, data driven analysis of treatment for schistosomiasis, lymphatic filariasis, and soil-transmitted helminths in Uganda. BMC Med, (17):69.
Chopra, P., Shekhar, S., Dagar, V. K., and Pandey, S. (2022). Prevalence and risk factors of soil-transmitted helminthic infections in the pediatric population in India: A systematic review and meta-analysis. Journal of Laboratory Physicians, 15(1), 4-19.
de Silva, N.R., Brooks, S., Hotez, P.J., Montresor, A., Engels, D., and Savioli, L. (2003) Soil-transmitted helminth infections: Updating the global picture. Trends in Parasitology, 19(12),547-551.
Egbuche, C. M., Chukwu, I., Ezihe, C. K., and Ngenegbo, U. C. (2017). Impact of Control Measures on the Prevalence of Intestinal Parasite Infections among Primary School Pupils. International Journal of Research in Pharmacy and Biosciences; 4(5): 1 – 5
Egbuche, F. G., Iwueze, M. O., Egbuche, C. M., Anyasodor, A. E., and Amoke, O. C. (2024). Geo-helminth infections and WASH practices among primary school pupils in Mgbakwu, Awka North LGA, Anambra State Nigeria. The Bioscientist Journal, 12(1), 47-58.
Egbuche, C., Amoke, C., Okalu, U., Egbuche, F., Obiakor, U. and Chimezie, M. (2025). Status of School-Based Water, Sanitation, Hygiene (WASH) Resources and Soil Transmitted Helminth (STH) Infections in Rural Nigeria: A Pilot Study. Journal of Health and Environmental Research, 11(2): 38 – 47
Fleming, F., Matovu, F., Hansen, K.S., and Webster, J.P. (2016). A mixed methods approach in evaluating community drug distributor performance in the control of neglected tropical diseases. Parasite Vectors, 9:345.
Freeman, M. C., Akogun, O., Belizario, V. S. Jr., Brooker, S. J., Gyorkos, T. W., Imtiaz, R., Krolewiecki, A., Lee, S., Matendechero, S. H., Pullan, R. L., and Utzinger, J. (2019). Challenges and opportunities for control and elimination of soil-transmitted helminth infection beyond 2020. PLOS Neglected Tropical Diseases, 13(4), e0007201.
Gyapong, M., Gyapong, J.O., and Owusu-Banahene G. (2001) Community-directed treatment: the way forward to eliminating lymphatic filariasis as a public-health problem in Ghana. Annals of Tropical Medical Parasitology. 95(1):77–86.
Hotez, P.J., Brindley, P.J., Bethony, J.M., King, C.H., Pearce, E.J., and Jacobson, J. (2008). Helminth infections: the great neglected tropical diseases. Journal of Clinical Investigation, 118:1311–1321.
Hotez, P. J., Molyneux, D. H., Fenwick, A., Ottesen, E., Ehrlich Sachs, S., and Sachs, J. D. (2006). Incorporating a rapid-impact package for neglected tropical diseases into programs for health systems strengthening. PLoS Medicine, 3(10), e323.
Jourdan, P. M., Lamberton, P. H. L., Fenwick, A., and Addis, D. G. (2018). Soil-transmitted helminth infections. The Lancet, 391(10117), 252-265.
Katabarwa, N. M., Mutabazi, D., and Richards, F. O. Jr. (2000) Controlling onchocerciasis by community-directed ivermectin-treatment programmes in Uganda: why do some communities succeed and others fail? Annals of Tropical Medical Parasitology. 94(4):343–52.
Karshima, S. N. (2018). Prevalence and distribution of soil-transmitted helminth infections in Nigerian children: A systematic review and meta-analysis. Infectious Disease of Poverty, 7, 69.
Lee, T.H., Park, S.H., Lee, C.K., Lee, S.O., Chung, I.K., and Kim, S.J. (2012) Ascaris lumbricoides induced acute pancreatitis. Gasrointestinal Endoscopy, 75:192-193
Ndukwe, Y. E., Obiezue, R. N. N., Aguzie, I. O. N., Anunobi, J. T., & Okafor, F. C. (2019). Mapping of Urinary Schistosomiasis in Anambra State, Nigeria. Annals of Global Health, 85(1), 52.
Ndyomugyenyi, R., and Kabatereine, N. (2003). Integrated community-directed treatment for the control of onchocerciasis, schistosomiasis and intestinal helminths infections in Uganda: Advantages and disadvantages. Trop Med Int Health, 8(11):997–1004.
Nock, I. H., Duniya, N. and Galadima, M. (2003). Geohelminth eggs in the soil and stool of pupils of some primary school in Samaru, Zaria, Nigeria. The Nigerian Journal of Parasitology, 24, 115-122.
Nwankwo, A.C., Onyebueke, A.C., Irikannu, K.C., Nzeukwu, C.I., Onwuzulike, I.V., and Okafor, N.M. (2021). Soil-Transmitted Helminths Infection and Associated Risk Factors among Primary School Pupils in Omogho and Awa Communities, Anambra State, Nigeria. International Journal of Tropical Disease & Health, 42(8):56-64.
Nzeukwu, C. I., Irikannu, K. C., Ihejie, P. O., Umeanaeto, P. U., Nzeukwu, A. C., Elosiuba, N. V., Onwuachusi, G. L., Obiefule, I. E., and Aniefuna, C. O. (2022). Prevalence and risk factors for soil-transmitted helminth infections among pupils in Awka South L.G.A, Anambra State, Nigeria. The Bioscientist Journal, 10(2), 156–166.
Okafor, N. M., Aribodor, D. N., Ekezie, C. C., Ahanonu, G. E., Okafor, N. P., Ihemanma, C. A. and Obiefoka, S. O. (2023). Prevalence of Soil-Transmitted Helminth Infection in Umunze, Anambra State, Nigeria. South Asian Journal of Parasitology, 6(3): 103 – 112.
Onyido, A.E., Okoye, M.M., Irikannu, K.C., Okafor, E.N., Ugha, C.N., Umeanaeto, P.U., Egbuche, C.M, Iwueze, M.O. and Ezeani, A.C. (2016). Intestinal helminth infections among primary school pupils in Nimo community, Njikoka local government area, Anambra state, southeastern Nigeria. Journal of Advance Research in Biology and Pharmacy Research, 1(4):44-48.
Senecal, J., Nordin, A. and Vinnerås., B. (2020). Fate of Ascaris at various pH, temperature and moisture levels. Journal of Water and Health, 18 (3): 375–382.
Singh, K. and Idris, A. (2016). Prevalence of soil transmitted helminths among boarding school children in Sokoto, Nigeria. World Journal of Environmental Biosciences 5(4):1-3.
Strunz, E.C., Addiss, D.G., Stocks, M.E., Ogden, S., Utzinger, J., and Freeman, M.C. (2014). Water, sanitation, hygiene, and soil-transmitted helminth infection: A systematic review and meta-analysis. PLoS Medicine, 11(3).
Ukibe, S., Ukibe, N., Obi-Okaro, A., and Iwueze, M. (2018). Prevalence and Pattern of Soil Transmitted Helminths (Sths) among Primary School Children at Nnewi, Nnewi- North Local Government Area, Anambra State, Nigeria. Annual Research & Review in Biology, 28(1): 1-6.
World Health Organization (2022). Soil-transmitted helminthiases. (Fact sheet) https://www.who.int/news-room/fact-sheets/detail/soil-transmitted-helminth-infections.
World Health Organisation. (2017). Background. Guideline: Preventive chemotherapy to control soil-transmitted helminth infections in at risk population groups. 2: 9 – 14. https://apps.who.int/iris/handle/10665/259205
World Health Organisation. (2024). Monitoring and Evaluation Framework. Assessing schistosomiasis and soil-transmitted helminthiases control programmes 4: 13 – 40.
Yaro, C. A., Kogi, E., and Luka, S. A. (2018). Spatial distribution and modeling of soil-transmitted helminths infection in Nigeria. Advances in Infectious Diseases, 8(2), 73–88.
Amazigo, U. V., Leak, S. G. A., Zoure, H.G.M., Okoronkwo, C., Diop Ly, M., Isiyaku, S., Crump, A., Okeibunor, J.C., and Boatin, B. (2021). Community-directed distributors-the ‘foot soldiers’ in the fight to control and eliminate neglected tropical diseases. PLOS Neglected Tropical Diseases, 15(3).
Anunobi, J., Okoye, I., Aguzie, I., Ndukwe, Y., and Okpasuo, O (2019). Risk of Soil-Transmitted Helminthiasis among Agrarian Communities of Kogi State, Nigeria. Annals of Global Health, 85(1):120.
Aribodor, O. B., Jacob, E. C., Azugo, N. O., Ngenegbo, U. C., Obika, I., Obikwelu, E. M., and Nebe, O. J. (2025). Soil-transmitted helminthiasis among adolescents in Anaocha Local Government Area, Anambra State, Nigeria: Insights and recommendations for effective control. PLoS ONE, 20(1), e0292146.
Bethony, J., Brooker, S., Albonico, M, Geiger, S.M., Loukas, A., Diemert, D. and Hotez, P.J. (2006). "Soil-transmitted helminth infections: ascariasis, trichuriasis, and hookworm". The Lancet. 367 (9521): 1521–1532.
Brooker, S., Clements, A.C., and Bundy, D.A.P. (2006). Global epidemiology, ecology and control of soil-transmitted helminth infections. Advances in Parasitology, 62,221-261.
Chami, G. F., Kabatereine, N. B., and Tukahebwa, E.M. (2019). Profiling the best-performing community medicine distributors for mass drug administration: a comprehensive, data driven analysis of treatment for schistosomiasis, lymphatic filariasis, and soil-transmitted helminths in Uganda. BMC Med, (17):69.
Chopra, P., Shekhar, S., Dagar, V. K., and Pandey, S. (2022). Prevalence and risk factors of soil-transmitted helminthic infections in the pediatric population in India: A systematic review and meta-analysis. Journal of Laboratory Physicians, 15(1), 4-19.
de Silva, N.R., Brooks, S., Hotez, P.J., Montresor, A., Engels, D., and Savioli, L. (2003) Soil-transmitted helminth infections: Updating the global picture. Trends in Parasitology, 19(12),547-551.
Egbuche, C. M., Chukwu, I., Ezihe, C. K., and Ngenegbo, U. C. (2017). Impact of Control Measures on the Prevalence of Intestinal Parasite Infections among Primary School Pupils. International Journal of Research in Pharmacy and Biosciences; 4(5): 1 – 5
Egbuche, F. G., Iwueze, M. O., Egbuche, C. M., Anyasodor, A. E., and Amoke, O. C. (2024). Geo-helminth infections and WASH practices among primary school pupils in Mgbakwu, Awka North LGA, Anambra State Nigeria. The Bioscientist Journal, 12(1), 47-58.
Egbuche, C., Amoke, C., Okalu, U., Egbuche, F., Obiakor, U. and Chimezie, M. (2025). Status of School-Based Water, Sanitation, Hygiene (WASH) Resources and Soil Transmitted Helminth (STH) Infections in Rural Nigeria: A Pilot Study. Journal of Health and Environmental Research, 11(2): 38 – 47
Fleming, F., Matovu, F., Hansen, K.S., and Webster, J.P. (2016). A mixed methods approach in evaluating community drug distributor performance in the control of neglected tropical diseases. Parasite Vectors, 9:345.
Freeman, M. C., Akogun, O., Belizario, V. S. Jr., Brooker, S. J., Gyorkos, T. W., Imtiaz, R., Krolewiecki, A., Lee, S., Matendechero, S. H., Pullan, R. L., and Utzinger, J. (2019). Challenges and opportunities for control and elimination of soil-transmitted helminth infection beyond 2020. PLOS Neglected Tropical Diseases, 13(4), e0007201.
Gyapong, M., Gyapong, J.O., and Owusu-Banahene G. (2001) Community-directed treatment: the way forward to eliminating lymphatic filariasis as a public-health problem in Ghana. Annals of Tropical Medical Parasitology. 95(1):77–86.
Hotez, P.J., Brindley, P.J., Bethony, J.M., King, C.H., Pearce, E.J., and Jacobson, J. (2008). Helminth infections: the great neglected tropical diseases. Journal of Clinical Investigation, 118:1311–1321.
Hotez, P. J., Molyneux, D. H., Fenwick, A., Ottesen, E., Ehrlich Sachs, S., and Sachs, J. D. (2006). Incorporating a rapid-impact package for neglected tropical diseases into programs for health systems strengthening. PLoS Medicine, 3(10), e323.
Jourdan, P. M., Lamberton, P. H. L., Fenwick, A., and Addis, D. G. (2018). Soil-transmitted helminth infections. The Lancet, 391(10117), 252-265.
Katabarwa, N. M., Mutabazi, D., and Richards, F. O. Jr. (2000) Controlling onchocerciasis by community-directed ivermectin-treatment programmes in Uganda: why do some communities succeed and others fail? Annals of Tropical Medical Parasitology. 94(4):343–52.
Karshima, S. N. (2018). Prevalence and distribution of soil-transmitted helminth infections in Nigerian children: A systematic review and meta-analysis. Infectious Disease of Poverty, 7, 69.
Lee, T.H., Park, S.H., Lee, C.K., Lee, S.O., Chung, I.K., and Kim, S.J. (2012) Ascaris lumbricoides induced acute pancreatitis. Gasrointestinal Endoscopy, 75:192-193
Ndukwe, Y. E., Obiezue, R. N. N., Aguzie, I. O. N., Anunobi, J. T., & Okafor, F. C. (2019). Mapping of Urinary Schistosomiasis in Anambra State, Nigeria. Annals of Global Health, 85(1), 52.
Ndyomugyenyi, R., and Kabatereine, N. (2003). Integrated community-directed treatment for the control of onchocerciasis, schistosomiasis and intestinal helminths infections in Uganda: Advantages and disadvantages. Trop Med Int Health, 8(11):997–1004.
Nock, I. H., Duniya, N. and Galadima, M. (2003). Geohelminth eggs in the soil and stool of pupils of some primary school in Samaru, Zaria, Nigeria. The Nigerian Journal of Parasitology, 24, 115-122.
Nwankwo, A.C., Onyebueke, A.C., Irikannu, K.C., Nzeukwu, C.I., Onwuzulike, I.V., and Okafor, N.M. (2021). Soil-Transmitted Helminths Infection and Associated Risk Factors among Primary School Pupils in Omogho and Awa Communities, Anambra State, Nigeria. International Journal of Tropical Disease & Health, 42(8):56-64.
Nzeukwu, C. I., Irikannu, K. C., Ihejie, P. O., Umeanaeto, P. U., Nzeukwu, A. C., Elosiuba, N. V., Onwuachusi, G. L., Obiefule, I. E., and Aniefuna, C. O. (2022). Prevalence and risk factors for soil-transmitted helminth infections among pupils in Awka South L.G.A, Anambra State, Nigeria. The Bioscientist Journal, 10(2), 156–166.
Okafor, N. M., Aribodor, D. N., Ekezie, C. C., Ahanonu, G. E., Okafor, N. P., Ihemanma, C. A. and Obiefoka, S. O. (2023). Prevalence of Soil-Transmitted Helminth Infection in Umunze, Anambra State, Nigeria. South Asian Journal of Parasitology, 6(3): 103 – 112.
Onyido, A.E., Okoye, M.M., Irikannu, K.C., Okafor, E.N., Ugha, C.N., Umeanaeto, P.U., Egbuche, C.M, Iwueze, M.O. and Ezeani, A.C. (2016). Intestinal helminth infections among primary school pupils in Nimo community, Njikoka local government area, Anambra state, southeastern Nigeria. Journal of Advance Research in Biology and Pharmacy Research, 1(4):44-48.
Senecal, J., Nordin, A. and Vinnerås., B. (2020). Fate of Ascaris at various pH, temperature and moisture levels. Journal of Water and Health, 18 (3): 375–382.
Singh, K. and Idris, A. (2016). Prevalence of soil transmitted helminths among boarding school children in Sokoto, Nigeria. World Journal of Environmental Biosciences 5(4):1-3.
Strunz, E.C., Addiss, D.G., Stocks, M.E., Ogden, S., Utzinger, J., and Freeman, M.C. (2014). Water, sanitation, hygiene, and soil-transmitted helminth infection: A systematic review and meta-analysis. PLoS Medicine, 11(3).
Ukibe, S., Ukibe, N., Obi-Okaro, A., and Iwueze, M. (2018). Prevalence and Pattern of Soil Transmitted Helminths (Sths) among Primary School Children at Nnewi, Nnewi- North Local Government Area, Anambra State, Nigeria. Annual Research & Review in Biology, 28(1): 1-6.
World Health Organization (2022). Soil-transmitted helminthiases. (Fact sheet) https://www.who.int/news-room/fact-sheets/detail/soil-transmitted-helminth-infections.
World Health Organisation. (2017). Background. Guideline: Preventive chemotherapy to control soil-transmitted helminth infections in at risk population groups. 2: 9 – 14. https://apps.who.int/iris/handle/10665/259205
World Health Organisation. (2024). Monitoring and Evaluation Framework. Assessing schistosomiasis and soil-transmitted helminthiases control programmes 4: 13 – 40.
Yaro, C. A., Kogi, E., and Luka, S. A. (2018). Spatial distribution and modeling of soil-transmitted helminths infection in Nigeria. Advances in Infectious Diseases, 8(2), 73–88.