Testing Alternative Record Keeping Formats Not Requiring Literacy Skills: Onchocerciasis Control at the Village Level

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Abstract
Keeping accurate health records at the village level is a challenge since many rural dwellers have low or no literacy skills. The African Programme for Onchocerciasis Control (APOC) is distributing the drug ivermectin at the village level by villagers themselves, and requires an accounting of drugs dispensed and villagers treated. Recently, pictorial tally sheets were developed for Community Directed Distributors (CDDs) of ivermectin. At that same time a question arose concerning indigenous record keeping methods and whether such methods could also be adapted to ivermectin distribution. This study identified two indigenous methods, counting beans/pebbles and chalk/charcoal marks on walls and compared them with the pictorial tally sheets in three clusters of onchocerciasis-endemic villages in Kajola Local Government Area (LGA) of Oyo State, Nigeria. Field staff trained the CDDs using standard APOC procedures and after distribution, collected their treatment records. A household survey was then conducted for comparison with CDD records. The tally sheet users scored the lowest mean and median percentage point difference between reported and surveyed coverage (6.6 and 4.8) compared to chalk boards (19.0, 5.6) and pebbles (15.2, 9.2), but since the village was the unit of analysis, the differences observed were of only boarderline significance ( p = 0.08). Because the tally sheets proved to be both cheaper and easier to use, they are recommended for community ivermectin programs as well as other primary health care activities at the village level.