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Why onchocerciasis transmission persists after 15 annual ivermectin mass drug administrations in South-West Cameroon

Forrer, Armelle, Wanji, Samuel, Dibando Obie, Elisabeth, Mue Nji, Theobald, Hamill, Louise, Ozano, Kimberley, Piotrowski, Helen, Dean, Laura ORCID: https://orcid.org/0000-0002-4910-9707, Njouendou, Abdel J, Relindi, Ekanya, Ndongmo, Winston Patrick Chounna, Fung, Ebua Gallus, Nnamdi, Dum-Buo, Abong, Raphael A, Beng, Amuam Andrew, Eyong, Mathias Esum, Ndzeshang, Bertrand L, Nkimbeng, Desmond Akumtoh, Teghen, Samuel, Suiren, Anicetus, Ashu, Ernerstine Ebot, Kah, Emmanuel, Murdoch, Michele M, Thomson, Rachael, Theobald, Sally ORCID: https://orcid.org/0000-0002-9053-211X, Enyong, Peter, Turner, Joseph ORCID: https://orcid.org/0000-0002-2185-5476 and Taylor, Mark ORCID: https://orcid.org/0000-0003-3396-9275 (2021) 'Why onchocerciasis transmission persists after 15 annual ivermectin mass drug administrations in South-West Cameroon'. BMJ Global Health, Vol 6, Issue 1, e003248.

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Abstract

Introduction Onchocerciasis is targeted for elimination mainly with annual community-directed treatment with ivermectin (CDTI). High infection levels have been reported in South-West Cameroon, despite ≥15 years of CDTI. The aim of this study was to assess factors associated with continued onchocerciasis transmission and skin disease.

Methods A large-scale cross-sectional study was conducted in 2017 in 20 communities in a loiasis-risk area in South-West Cameroon. A mixed-methods approach was used. Associations between infection levels, skin disease and adherence to CDTI were assessed using mixed regression modelling. Different community members’ perception and acceptability of the CDTI strategy was explored using semi-structured interviews.

Results Onchocerciasis prevalence was 44.4% among 9456 participants. 17.5% of adults were systematic non-adherers and 5.9% participated in ≥75% of CDTI rounds. Skin disease affected 1/10 participants, including children. Increasing self-reported adherence to CDTI was associated with lower infection levels in participants aged ≥15 years but not in children. Adherence to CDTI was positively influenced by perceived health benefits, and negatively influenced by fear of adverse events linked with economic loss. Concern of lethal adverse events was a common reason for systematic non-adherence.

Conclusion CDTI alone is unlikely to achieve elimination in those high transmission areas where low participation is commonly associated with the fear of adverse events, despite the current quasi absence of high-risk
levels of loiasis. Such persisting historical memories and fear of ivermectin might impact adherence to CDTI also in areas with historical presence but current absence of loiasis. Because such issues are unlikely
to be tackled by CDTI adaptive measures, alternative strategies are needed for onchocerciasis elimination where negative perception of ivermectin is an entrenched barrier to community participation in programmes.

Item Type: Article
Subjects: QV Pharmacology > Anti-Inflammatory Agents. Anti-Infective Agents. Antineoplastic Agents > QV 250 Anti-infective agents (General)
WA Public Health > Preventive Medicine > WA 110 Prevention and control of communicable diseases. Transmission of infectious diseases
WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
WC Communicable Diseases > Tropical and Parasitic Diseases > WC 680 Tropical diseases (General)
WC Communicable Diseases > Tropical and Parasitic Diseases > WC 695 Parasitic diseases (General)
WC Communicable Diseases > Tropical and Parasitic Diseases > WC 885 Onchocerciasis
Faculty: Department: Biological Sciences > Department of Tropical Disease Biology
Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI): https://doi.org/10.1136/bmjgh-2020-003248
Depositing User: Cathy Waldron
Date Deposited: 12 Jan 2021 10:09
Last Modified: 12 Jan 2021 10:09
URI: https://archive.lstmed.ac.uk/id/eprint/16643

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