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Knowledge/perception and attitude/practices of populations of two first-line communities of the Centre Region of Cameroon regarding onchocerciasis and black fly nuisance and bio-ecology. Parasit Vectors 2021; 14:546. [PMID: 34688311 PMCID: PMC8542320 DOI: 10.1186/s13071-021-05048-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 10/01/2021] [Indexed: 11/29/2022] Open
Abstract
Background Despite high black fly densities in persisting onchocerciasis foci in Cameroon, no vector control has ever been carried out to complement Community-Directed Treatment with Ivermectin (CDTI). As a prelude to community-based vector control, this study explored knowledge/perception and attitude/practice (KAP) of populations of two first-line communities regarding onchocerciasis, black fly nuisance and bio-ecology. Methods A cross-sectional survey was conducted in two communities of the Bafia Health District, following a household-based interview approach using a structured questionnaire. KAP scores were calculated and categorised as good or poor based on the number of correct or positive responses. Associations between KAP and socio-demographic parameters were explored using logistic regression models. Results A total of 215 individuals aged 15–100 years were interviewed. Positive associations were observed between good knowledge/perception and age and the duration of residency in the community. Most respondents (91.6%) described having post-biting sequels (oedema, itching) and more than half (69.3%) admitted that black fly bites affect their productivity. Although 81.4% of the respondents stated that black fly densities are higher during the rainy season, only 10.7% of them knew that they breed in the river. Also, 59.5% of the interviewees stated that black flies bite not only outdoors but also indoors, and 78.6% of enrolees were ready to help to fight against black flies. Most of the respondents were well aware of onchocerciasis, even though the transmission mode and vector bio-ecology were not well known. Conclusion This study revealed the need to implement community-based vector control to support CDTI in the fight against onchocerciasis and to reduce black fly nuisance. Graphical abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1186/s13071-021-05048-y.
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Murdoch ME. Mapping the burden of onchocercal skin disease. Br J Dermatol 2020; 184:199-207. [PMID: 32302410 DOI: 10.1111/bjd.19143] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2020] [Indexed: 02/06/2023]
Abstract
Onchocerciasis is a neglected tropical disease caused by a nematode parasite, Onchocerca volvulus, and transmitted by bites of Simulium blackflies which breed near fast-flowing rivers. In humans, thousands of microfilariae (immature worms) migrate to the skin and eyes where they cause pathology. Historically, much research was devoted to the serious effect of blindness, from which the disease earns its alternative name of 'river blindness'. Mapping the burden of onchocercal skin disease (OSD) was expedited by the development of a clinical classification and grading system that facilitated comparison of data from different countries. After successful field testing in Nigeria, the classification scheme was used in a multicountry study in seven endemic sites, to estimate the true burden of OSD across Africa. High levels of OSD were found, affecting 28% of the population. A new control programme, the African Programme for Onchocerciasis Control (APOC) was launched in 20 countries using annual doses of ivermectin, donated by Merck & Co., Inc. The multicountry study also found a close correlation between the levels of itching and OSD with the level of endemicity, as determined by the prevalence of onchocercal nodules. This enabled APOC to use Rapid Epidemiological Mapping of Onchocerciasis, which entailed identifying likely vector breeding sites near rivers, then sampling 50 adult males in nearby villages to determine the prevalence of nodules and delineate which villages required treatment. Onchocerciasis is now targeted for elimination in Africa, and the challenge is to complete Onchocerciasis Elimination Mapping of hypoendemic areas using serology.
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Affiliation(s)
- M E Murdoch
- Department of Dermatology, West Herts Hospitals NHS Trust, Watford General Hospital, Watford, WD18 0HB, UK
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Onchocerciasis in the Democratic Republic of Congo: Survey of knowledge, attitude and perception in Bandundu province. J Infect Public Health 2017; 10:600-607. [PMID: 28215917 DOI: 10.1016/j.jiph.2017.01.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 01/16/2017] [Accepted: 01/28/2017] [Indexed: 11/23/2022] Open
Abstract
A community-directed treatment with ivermectin (CDTI) for fighting onchocerciasis was started in 2003 in the hyperendemic province of Bandundu, Democratic Republic of Congo (DRC); such initiative was supported by the African Programme for Onchocerciasis Control (APOC). As the APOC stopped at the end of 2015, there was an urgent need to assess the sustainability of an ivermectin treatment. A cross-sectional survey of knowledge, attitude and perception was conducted to determine the awareness level of local population regarding the disease. A multi-stage random sampling technique allowed the selection of 450 heads of households. Most respondents (96.9%) knew about onchocerciasis as a disease. The black-fly was viewed as the causing agent of onchocerciasis by 49.9% of respondents. The most commonly cited clinical manifestations were nodules (34.4%) and pruritus (31.1%), while blindness was the most frequently reported complication (90.7%). Approximately 55.1% of respondents had a good knowledge of onchocerciasis and CDTI. Overall, only 37% of participants had a favourable attitude and 46% a positive perception. Good knowledge was associated with school attendance (adjusted OR=1.9, 95%CI: 1.3-2.8, p=0.001), while education and continuation of treatment were related with good attitude (adjusted OR=9.7, 95%CI:4.8-19.5 and adjusted OR=19.8, 95%CI: 9.7-40.6, respectively, both with p<0.001). Good perception was associated with being at least 46 years old, non-Catholic and continuing the treatment (adjusted OR=3.2, 95%CI:1.2-9.1; adjusted OR=29.6, 95%CI:14.1-62.2 and adjusted OR=5.1, 95%CI:1.6-16.0 respectively, all with p<0.001). A good level of knowledge, attitude and perception is needed for a massive adherence of population to onchocerciasis control programmes. In the area of study (Moanza, DRC), good attitude and perception motivated the continuation of treatment in the population. In the future, different plans should focus on educational strategies to maintain a massive adherence and reduce onchocerciasis prevalence.
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Noormahomed EV, Akrami K, Mascaró-Lazcano C. Onchocerciasis, an undiagnosed disease in Mozambique: identifying research opportunities. Parasit Vectors 2016; 9:180. [PMID: 27030247 PMCID: PMC4815156 DOI: 10.1186/s13071-016-1468-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Accepted: 03/22/2016] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The objective of this paper is to summarise and critically review the available data about onchocerciasis in Mozambique, in order to report epidemiological and clinical aspects related to the disease and identify gaps in knowledge. The paper is intended to raise awareness of the existence and importance of this disease and to define research priorities. METHODS We examined the scarce epidemiological data at our disposal: two diagnostic studies in 1997 and 1998 (first reports on the existence of onchocerciasis in Mozambique), and two Rapid Epidemiological Mapping of Onchocerciasis (REMO) surveys in 2001 and 2007. We examined differences in study designs and methodologies as well as the differing geographical locations to explain the divergence in findings among the studies. RESULTS Evidence indicates that onchocerciasis is hypoendemic in Mozambique (with national and imported cases), but still largely remains an undiagnosed illness. There is no awareness of the clinical aspects of the disease and nor of the differential diagnosis with lepromatous leprosy and dermatitis caused by Scabies spp. The use of skin biopsy and a symptom screening questionnaire, combined with nodule rate, in the first two studies may have captured even atypical or subacute presentations. Both REMO surveys relied solely on nodule detection and in the six years between the two studies, the prevalence of nodules detected more than doubled. CONCLUSIONS The epidemiology and clinical aspects of the disease are unknown in Mozambique. Since the last REMO took place in 2007 and since the population is subject to large-scale movement and displacement, it is important to develop tools to identify and analyse populations that are at high risk for onchocerciasis. Cases of onchocerciasis may be misdiagnosed as leprosy or scabies that fail to improve despite being subjected to treatment against leprosy. Techniques to enable a differential diagnosis need to be established by training health professionals on the recognition of this undiagnosed disease. It is equally necessary to identify the blackfly vectors and where they breed.
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Affiliation(s)
- Emilia V. Noormahomed
- />Department of Microbiology, Universidade Eduardo Mondlane, Maputo, Mozambique
- />Department of Medicine, University of California, San Diego, CA USA
- />Universidade Lúrio, Reitoria, Bairro de Marrere, Rua 4250, Km 2,3, Caixa Postal 360 Nampula, Moçambique
| | - Kevan Akrami
- />Department of Medicine, University of California, San Diego, CA USA
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Dunn C, Callahan K, Katabarwa M, Richards F, Hopkins D, Withers PC, Buyon LE, McFarland D. The Contributions of Onchocerciasis Control and Elimination Programs toward the Achievement of the Millennium Development Goals. PLoS Negl Trop Dis 2015; 9:e0003703. [PMID: 25996946 PMCID: PMC4440802 DOI: 10.1371/journal.pntd.0003703] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
In 2000, 189 member states of the United Nations (UN) developed a plan for peace and development, which resulted in eight actionable goals known as the Millennium Development Goals (MDGs). Since their inception, the MDGs have been considered the international standard for measuring development progress and have provided a blueprint for global health policy and programming. However, emphasis upon the achievement of priority benchmarks around the "big three" diseases--namely HIV, tuberculosis (TB), and malaria--has influenced global health entities to disproportionately allocate resources. Meanwhile, several tropical diseases that almost exclusively impact the poorest of the poor continue to be neglected, despite the existence of cost-effective and feasible methods of control or elimination. One such Neglected Tropical Disease (NTD), onchocerciasis, more commonly known as river blindness, is a debilitating and stigmatizing disease primarily affecting individuals living in remote and impoverished areas. Onchocerciasis control is considered to be one of the most successful and cost-effective public health campaigns ever launched. In addition to improving the health and well-being of millions of individuals, these programs also lead to improvements in education, agricultural production, and economic development in affected communities. Perhaps most pertinent to the global health community, though, is the demonstrated effectiveness of facilitating community engagement by allowing communities considerable ownership with regard to drug delivery. This paper reviews the contributions that such concentrated efforts to control and eliminate onchocerciasis make to achieving select MDGs. The authors hope to draw the attention of public policymakers and global health funders to the importance of the struggle against onchocerciasis as a model for community-directed interventions to advance health and development, and to advocate for NTDs inclusion in the post 2015 agenda.
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Affiliation(s)
- Caitlin Dunn
- Health Programs, The Carter Center, Atlanta, Georgia, United States of America
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Kelly Callahan
- Health Programs, The Carter Center, Atlanta, Georgia, United States of America
| | - Moses Katabarwa
- Health Programs, The Carter Center, Atlanta, Georgia, United States of America
| | - Frank Richards
- Health Programs, The Carter Center, Atlanta, Georgia, United States of America
| | - Donald Hopkins
- Health Programs, The Carter Center, Atlanta, Georgia, United States of America
| | - P. Craig Withers
- Health Programs, The Carter Center, Atlanta, Georgia, United States of America
| | - Lucas E. Buyon
- Health Programs, The Carter Center, Atlanta, Georgia, United States of America
- College of Arts and Sciences, Emory University, Atlanta, Georgia, United States of America
| | - Deborah McFarland
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
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Litt E, Baker MC, Molyneux D. Neglected tropical diseases and mental health: a perspective on comorbidity. Trends Parasitol 2012; 28:195-201. [PMID: 22475459 DOI: 10.1016/j.pt.2012.03.001] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Revised: 03/04/2012] [Accepted: 03/04/2012] [Indexed: 12/15/2022]
Abstract
Mental health conditions will be the largest contributor to the global health burden by 2030. Our review suggests that neglected tropical diseases (NTDs) predispose individuals to poor mental health. Factors predisposing to poor mental health include stigma and discrimination, exclusion from participating fully in society, reduced access to health and social services, lack of educational opportunities, exclusion from income-generation and employment opportunities, and restrictions in exercising civil and political rights. These characteristics are all features of NTDs, but the mental health of these sufferers has been ignored. This review raises an issue of concern and highlights the opportunities for research by psychiatrists and psychologists on NTDs.
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Affiliation(s)
- Elizabeth Litt
- Centre for Neglected Tropical Diseases, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
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Amuyunzu-Nyamongo M, Tchounkeu YFL, Oyugi RA, Kabali AT, Okeibunor JC, Manianga C, Amazigo UV. Drawing and interpreting data: Children's impressions of onchocerciasis and community-directed treatment with ivermectin (CDTI) in four onchocerciasis endemic countries in Africa. Int J Qual Stud Health Well-being 2011; 6:QHW-6-5918. [PMID: 21637349 PMCID: PMC3105904 DOI: 10.3402/qhw.v6i2.5918] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/18/2011] [Indexed: 11/14/2022] Open
Abstract
Although the depiction of a child leading a blind man is the most enduring image of onchocerciasis in Africa, research activities have hardly involved children. This paper aims at giving voice to children through drawings and their interpretation. The study was conducted in 2009 in Cameroon, Democratic Republic of Congo (DRC), Nigeria and Uganda. Children aged 6-16 years were asked to draw their perceptions of onchocerciasis and community-directed treatment with ivermectin (CDTI) in their communities. A total of 50 drawings were generated. The drawings depicted four main aspects of onchocerciasis: (1) the disease symptoms, (2) the negative consequences of onchocerciasis among children and in the community generally, (3) the ivermectin distribution process, and (4) the benefits or effects of taking ivermectin. Out of the 50 drawings, 30 were on symptoms, 7 on effects of the disease on children, 8 on distribution process, and 5 represented multiple perceptions on symptoms, drug distribution processes, benefits, and effects of treatment. The lack of clarity when treatment with ivermectin can be stopped in endemic areas requires working with children to ensure continued compliance with treatment into the future. Children's drawings should be incorporated into health education interventions.
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Abstract
PURPOSE OF REVIEW This review is timely because awareness of the burden of disease from onchodermatitis has increased significantly over recent years. Recent progress in the field is reviewed with emphasis on publications within the past 2 years. RECENT FINDINGS Advances have been made in understanding immunopathogenesis and in diagnosis and treatment. The World Bank/WHO African Programme for Onchocerciasis Control (APOC), which uses annual community-directed treatment with ivermectin (CDTI) via the Mectizan Donation Programme, now covers 19 African countries. Development of ivermectin resistance is a concern. Unlike ivermectin, which is a microfilaricide, doxycycline, which targets Wolbachia endosymbiotic bacteria, sterilizes adult female worms and has a macrofilaricidal effect. Moxidectin, which sterilizes or kills adult worms has started a phase III trial with ivermectin. Additional primary healthcare interventions have been successfully integrated with CTDI. In Latin America, transmission has been interrupted in half of the original endemic foci and Colombia is the first nation to have achieved countrywide interruption of transmission. The first report of elimination using ivermectin in an African setting is a milestone. Two African foci using vector control plus CDTI have reported vector elimination. SUMMARY Results of the longer-term impact of large-scale ivermectin distribution by the APOC are awaited. Research is needed into new drug targets within Wolbachia's metabolic pathways. Elimination of transmission of disease is on the horizon but more research is needed on when and where ivermectin treatment can be stopped.
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Dimomfu BL, Lubeji DK, Noma M, Sékétéli A, Boussinesq M. African Programme for Onchocerciasis Control (APOC): sociological study in three foci of central Africa before the implementation of treatments with ivermectin (Mectizan®). Trans R Soc Trop Med Hyg 2007; 101:674-9. [PMID: 17433391 DOI: 10.1016/j.trstmh.2007.03.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2006] [Revised: 03/07/2007] [Accepted: 03/07/2007] [Indexed: 10/23/2022] Open
Abstract
The African Programme for Onchocerciasis Control (APOC) has put in place a study to assess the long-term impact of the community-directed treatments with ivermectin on various clinical and entomological indicators of onchocerciasis. As the results obtained would depend on community participation in the treatments, surveys were also conducted at the study sites to assess the people's knowledge, attitudes and practices regarding onchocerciasis and its treatment. This article presents the anthropological observations made before the implementation of the treatments in three sites: one in the Central African Republic, and two in the Democratic Republic of Congo. The information collected shows that the populations have a relatively poor knowledge of the manifestations and mode of transmission of onchocerciasis. The communities' attitudes towards those individuals afflicted with the disease vary from one site to another. Regarding treatment, the populations use both traditional and 'modern' treatments, but the beneficial effects of ivermectin are not well known. The differences recorded between the sites surveyed demonstrate that the messages to be delivered to the populations before the distributions should take into account the local epidemiological and socio-anthropological context.
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Affiliation(s)
- Bruno Lapika Dimomfu
- Centre de coordination des recherches et de la documentation en sciences sociales pour l'Afrique sub-saharienne (CERDAS), Université de Kinshasa, BP 836, Kinshasa IX, République Démocratique du Congo
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Abstract
Onchocerciasis control has been very successful in Africa and research has played a critical role. An overview of the main epidemiological and implementation research activities undertaken over the last 20 years in collaboration with the African onchocerciasis control programmes and of the impact this research had on control is given. The research included the development of epidemiological modelling and its application in programme evaluation and operational planning, research on disease patterns and disease burden in different bioclimatic zones to justify and guide control operations, community trials of ivermectin to determine its safety for large-scale use and its impact on transmission, rapid assessment methods to identify target communities for treatment and community-directed treatment for sustained drug delivery. Lessons learned during this unique collaboration between research and control are discussed.
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Affiliation(s)
- Jan H F Remme
- Intervention Development and Implementation Research, UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases, WHO, Geneva, Switzerland.
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Kennedy MH, Bertocchi I, Hopkins AD, Meredith SE. The effect of 5 years of annual treatment with ivermectin (Mectizan) on the prevalence and morbidity of onchocerciasis in the village of Gami in the Central African Republic. ANNALS OF TROPICAL MEDICINE AND PARASITOLOGY 2002; 96:297-307. [PMID: 12061976 DOI: 10.1179/000349802125000736] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
To assess the impact of 5 years of annual community treatment with ivermectin (Mectizan) on the prevalence of onchocerciasis and onchocerciasis-associated morbidity, data collected, before and after such treatment, in the village of Gami, in a hyper-endemic area of the Central African Republic, were analysed. Skin snips from all the villagers treated in 1990 and/or 1995 were used to assess the prevalence and intensity of infection with Onchocerca volvulus. Ocular and dermatological morbidity was assessed by ophthalmological and clinical examinations of the same subjects. Following the five annual treatments, there was a reduction in the prevalence of infection and a dramatic decrease in the microfilarial load of the community. The prevalences of pruritus, onchocercal nodules and impaired vision were all significantly reduced. The results emphasise the long-term benefits of the mass-treatment programmes, particularly for children aged <10 years.
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Affiliation(s)
- M H Kennedy
- Task Force for Child Survival, Mectizan Donation Program, 750 Commerce Drive, Decatur, GA 30030, USA.
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Murdoch ME, Asuzu MC, Hagan M, Makunde WH, Ngoumou P, Ogbuagu KF, Okello D, Ozoh G, Remme J. Onchocerciasis: the clinical and epidemiological burden of skin disease in Africa. ANNALS OF TROPICAL MEDICINE AND PARASITOLOGY 2002; 96:283-96. [PMID: 12061975 DOI: 10.1179/000349802125000826] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
An attempt was made to assess the true public-health importance of onchocercal skin disease throughout the African region and hence provide an objective basis for the rational planning of onchocerciasis control in the area. The seven collaborative centres that participated in the study (three in Nigeria and one each in Ghana, Cameroon, Tanzania and Uganda) were all in areas of rainforest or savannah-forest mosaic where onchocercal blindness is not common. A cross-sectional dermatological survey was undertaken at each site following a standard protocol. At each site, the aim was to examine at least 750 individuals aged 5 years and living in highly endemic communities and 220-250 individuals aged 5 years and living in a hypo-endemic (control) community. Overall, there were 5459 and 1451 subjects from hyper-and hypo-endemic communities, respectively. In the highly endemic communities, the prevalence of itching increased with age until 20 years and then plateaued, affecting 42% of the population aged 20 years. There was a strong correlation between the prevalence of itching and the level of endemicity (as measured by the prevalence of nodules; r=0.75; P<0.001). The results of a multivariate logistic regression analysis showed that, at the individual level, the presence of onchocercal reactive skin lesions (acute papular onchodermatitis, chronic papular onchodermatitis and/or lichenified onchodermatitis) was the most important risk factor for pruritus, with an odds ratio (OR) of 18.3 and 95% confidence interval (CI) of 15.19-22.04, followed by the presence of palpable onchocercal nodules (OR=4.63; CI=4.05-5.29). In contrast, non-onchocercal skin disease contributed very little to pruritus in the study communities (OR=1.29; CI=1.1-1.51). Onchocercal skin lesions affected 28% of the population in the endemic villages. The commonest type was chronic papular onchodermatitis (13%), followed by depigmentation (10%) and acute papular onchodermatitis (7%). The highest correlation with endemicity was seen for the prevalence of any onchocercal skin lesion and/or pruritus combined (r=0.8; P<0.001). Cutaneous onchocerciasis was found to be a common problem in many endemic areas in Africa which do not have high levels of onchocercal blindness. These findings, together with recent observations that onchocercal skin disease can have major, adverse, psycho-social and socio-economic effects, justify the inclusion of regions with onchocercal skin disease in control programmes based on ivermectin distribution. On the basis of these findings, the World Health Organization launched a control programme for onchocerciasis, the African Programme for Onchocerciasis Control (APOC), that covers 17 endemic countries in Africa.
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Affiliation(s)
- M E Murdoch
- Department of Biology, Imperial College of Science, Technology and Medicine, Prince Consort Road, London SW7 2BB, UK.
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Sékétéli A, Adeoye G, Eyamba A, Nnoruka E, Drameh P, Amazigo UV, Noma M, Agboton F, Aholou Y, Kale OO, Dadzie KY. The achievements and challenges of the African Programme for Onchocerciasis Control (APOC). ANNALS OF TROPICAL MEDICINE AND PARASITOLOGY 2002; 96 Suppl 1:S15-28. [PMID: 12081247 DOI: 10.1179/000349802125000628] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
The main strategy of APOC, of community-directed treatment with ivermectin (CDTI), has enabled the programme to reach, empower and bring relief to remote and under-served, onchocerciasis-endemic communities. With CDTI, geographical and therapeutic coverages have increased substantially, in most areas, to the levels required to eliminate onchocerciasis as a public-health problem. Over 20 million people received treatment in 2000. APOC has also made effective use of the combination of the rapid epidemiological mapping of onchocerciasis (REMO) and geographical information systems (GIS), to provide information on the geographical distribution and prevalence of the disease. This has led to improvements in the identification of CDTI-priority areas, and in the estimates of the numbers of people to be treated. A unique public-private-sector partnership has been at the heart of APOC's relative success. Through efficient capacity-building, the programme's operations have positively influenced and strengthened the health services of participating countries. These laudable achievements notwithstanding, APOC faces many challenges during the second phase of its operations, when the full impact of the programme is expected to be felt. Notable among these challenges are the sustainability of CDTI, the strategy's effective integration into the healthcare system, and the full exploitation of its potential as an entry point for other health programmes. The channels created for CDTI, could, for example, help efforts to eliminate lymphatic filariasis (which will feature on the agenda of many participating countries during APOC's Phase 2). However, these other programmes need to be executed without compromising the onchocerciasis-control programme itself. Success in meeting these challenges will depend on the continued, wholehearted commitment of all the partners involved, particularly that of the governments of the participating countries.
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Affiliation(s)
- A Sékétéli
- African Programme for Onchocerciasis Control (APOC), Ouagadougou, Burkina Faso.
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Guderian RH, Lovato R, Anselmi M, Mancero T, Cooper PJ. Onchocerciasis and reproductive health in Ecuador. Trans R Soc Trop Med Hyg 1997; 91:315-7. [PMID: 9231206 DOI: 10.1016/s0035-9203(97)90089-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
A retrospective study was performed comparing the number of spontaneous abortions in a hyperendemic area for onchocerciasis in Ecuador before and after invermectin treatment with that of a comparable non-endemic area. The frequency of spontaneous abortions was associated with a change in the community microfilarial load, suggesting that there may be a relationship between spontaneous abortions and infection with Onchocerca volvulus. In the endemic area, a significantly greater rate of spontaneous abortions was seen in the period before ivermectin distribution compared to that after the start of ivermectin treatments every 6 months. In the non-endemic area, no change in the rate of spontaneous abortions was seen over the same time period. In addition to the well-documented improvements in skin and ocular disease, ivermectin may also improve the reproductive health of endemic populations.
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Affiliation(s)
- R H Guderian
- National Onchocerciasis Control Programme, Hospital Vozandes, Quito, Ecuador
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Affiliation(s)
- S B Macfarlane
- Unit for Statistics and Epidemiology, Liverpool School of Tropical Medicine, England
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