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Kura K, Milton P, Hamley JID, Walker M, Bakajika DK, Kanza EM, Opoku NO, Howard H, Nigo MM, Asare S, Olipoh G, Attah SK, Mambandu GL, Kennedy KK, Kataliko K, Mumbere M, Halleux CM, Hopkins A, Kuesel AC, Kinrade S, Basáñez MG. Can mass drug administration of moxidectin accelerate onchocerciasis elimination in Africa? Philos Trans R Soc Lond B Biol Sci 2023; 378:20220277. [PMID: 37598705 PMCID: PMC10440165 DOI: 10.1098/rstb.2022.0277] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 04/11/2023] [Indexed: 08/22/2023] Open
Abstract
Epidemiological and modelling studies suggest that elimination of Onchocerca volvulus transmission (EoT) throughout Africa may not be achievable with annual mass drug administration (MDA) of ivermectin alone, particularly in areas of high endemicity and vector density. Single-dose Phase II and III clinical trials demonstrated moxidectin's superiority over ivermectin for prolonged clearance of O. volvulus microfilariae. We used the stochastic, individual-based EPIONCHO-IBM model to compare the probabilities of reaching EoT between ivermectin and moxidectin MDA for a range of endemicity levels (30 to 70% baseline microfilarial prevalence), treatment frequencies (annual and biannual) and therapeutic coverage/adherence values (65 and 80% of total population, with, respectively, 5 and 1% of systematic non-adherence). EPIONCHO-IBM's projections indicate that biannual (six-monthly) moxidectin MDA can reduce by half the number of years necessary to achieve EoT in mesoendemic areas and might be the only strategy that can achieve EoT in hyperendemic areas. Data needed to improve modelling projections include (i) the effect of repeated annual and biannual moxidectin treatment; (ii) inter- and intra-individual variation in response to successive treatments with moxidectin or ivermectin; (iii) the effect of moxidectin and ivermectin treatment on L3 development into adult worms; and (iv) patterns of adherence to moxidectin and ivermectin MDA. This article is part of the theme issue 'Challenges in the fight against neglected tropical diseases: a decade from the London Declaration on NTDs'.
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Affiliation(s)
- Klodeta Kura
- London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London W2 1PG, UK
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London W2 1PG, UK
| | - Philip Milton
- London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London W2 1PG, UK
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London W2 1PG, UK
| | - Jonathan I. D. Hamley
- London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London W2 1PG, UK
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London W2 1PG, UK
| | - Martin Walker
- London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London W2 1PG, UK
- Department of Pathobiology and Population Sciences, Royal Veterinary College, Hatfield AL9 7TA, UK
| | - Didier K. Bakajika
- Expanded Special Project for Elimination of Neglected Tropical Diseases (ESPEN), African Regional Office of the World Health Organization (WHO/AFRO/ESPEN), Brazzaville, Democratic Republic of Congo
| | - Eric M. Kanza
- Programme Nationale de Lutte contre les Maladies Tropicales Négligées à Chimiothérapie Préventive (PNLMTN-CTP), Ministère de la Santé Publique, Kinshasa, Democratic Republic of the Congo
| | - Nicholas O. Opoku
- Department of Epidemiology and Biostatistics, School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Hayford Howard
- Liberia Institute for Biomedical Research (LIBR), Monrovia, Liberia
| | - Maurice M. Nigo
- Institut Supérieur des Techniques Médicales de Nyankunde, Bunia, Democratic Republic of the Congo
| | | | - George Olipoh
- Precious Minerals Marketing Company, National Assay Centre, Technical Department, Diamond House, Accra, GA-143-2548, Ghana
| | - Simon K. Attah
- Department of Medical Microbiology, University of Ghana Medical School, College of Health Sciences, Accra, Ghana
| | - Germain L. Mambandu
- Inspection Provinciale de la Santé de la Tshopo, Kisangani, Democratic Republic of the Congo
| | - Kambale Kasonia Kennedy
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Kambale Kataliko
- Centre de Santé CECA 20 de Mabakanga, Beni, Nord Kivu, Democratic Republic of the Congo
| | - Mupenzi Mumbere
- Medicines Development for Global Health, 18 Kavanagh Street, Southbank, Victoria 3006, Australia
| | - Christine M. Halleux
- UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organization, 1211 Geneva 27, Switzerland
| | - Adrian Hopkins
- Neglected and Disabling Diseases of Poverty Consultant, Gravesend, Kent DA11 OSL, UK
| | - Annette C. Kuesel
- UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organization, 1211 Geneva 27, Switzerland
| | - Sally Kinrade
- Medicines Development for Global Health, 18 Kavanagh Street, Southbank, Victoria 3006, Australia
| | - Maria-Gloria Basáñez
- London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London W2 1PG, UK
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London W2 1PG, UK
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Shintouo CM, Shey RA, Yengo BN, Yaah NE, Teh RN, Ngwese RA, Ayong L, Vanhamme L, Souopgui J, Ghogomu SM, Njemini R. Effects of the suspension of mass drug administration during the COVID-19 pandemic on onchocerciasis prevalence in the Bandjoun and Massangam health districts, West Region of Cameroon. Acta Trop 2023; 246:106999. [PMID: 37549841 DOI: 10.1016/j.actatropica.2023.106999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 07/26/2023] [Accepted: 08/04/2023] [Indexed: 08/09/2023]
Abstract
Onchocerciasis is an infectious disease of public health and socio-economic importance in most parts of Sub-Saharan Africa. The objective of this study was to evaluate the effects of the suspension of implementation activities towards combating onchocerciasis in the Bandjoun and Massangam health districts in the West Region of Cameroon as a consequence of the COVID-19 pandemic. Data on socio-demographic and clinical characteristics were obtained using a structured questionnaire. All participants in both health districts were examined for the presence of clinical manifestations of onchocerciasis. In addition, two skin snips were obtained from the knee of each participant and examined for the presence of microfilaria. All data were categorized, coded, entered in a database, and analysed using SPSS version 23.0. A total of 229 participants in the Bandjoun health district and 378 in the Massangam health district were recruited for the study. In both health districts, there was no significant difference between male and female participants in terms of the clinical manifestations of onchocerciasis. The prevalence of nodules was 8.7% in the Bandjoun health district and 20.6% in the Massangam health district while the prevalence of microfilaria carriers in Bandjoun and Massangam health districts was 3.5% and 3.7%, respectively. Except for the Tsesse and Lemgo communities in the Bandjoun health district, there was a reduction in the prevalence of microfilaria in the communities that were studied when compared to previous data obtained before the disruption of control programmes activities. Overall, in both health districts, elderly individuals bear the largest burden of onchocerciasis. Based on the results obtained, we conclude that the temporary suspension of Neglected Tropical Disease control programme activities by the World Head Organization as a result of COVID-19 may have resulted to recrudescence of O. volvulus transmission in hypoendemic communities in the Bandjoun health district.
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Affiliation(s)
- Cabirou Mounchili Shintouo
- Department of Gerontology, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Laarbeeklaan 103, B-1090 Brussels, Belgium; Frailty in Ageing Research Group, Vrije Universiteit Brussel, Laarbeeklaan 103, B-1090 Brussels, Belgium; Department of Biochemistry and Molecular Biology, Faculty of Science, University of Buea, P.O. Box 63 Buea, Cameroon
| | - Robert Adamu Shey
- Department of Biochemistry and Molecular Biology, Faculty of Science, University of Buea, P.O. Box 63 Buea, Cameroon; Department of Molecular Biology, Institute of Biology and Molecular Medicine, IBMM, Université Libre de Bruxelles, Gosselies Campus, 126040 Gosselies, Belgium
| | - Bernis Neneyoh Yengo
- Department of Biochemistry and Molecular Biology, Faculty of Science, University of Buea, P.O. Box 63 Buea, Cameroon
| | - Ntang Emmaculate Yaah
- Department of Biochemistry and Molecular Biology, Faculty of Science, University of Buea, P.O. Box 63 Buea, Cameroon
| | - Rene Ning Teh
- Department of Zoology and Animal Physiology, University of Buea, Buea, Cameroon
| | - Roland Akwelle Ngwese
- Department of Biochemistry and Molecular Biology, Faculty of Science, University of Buea, P.O. Box 63 Buea, Cameroon
| | - Lawrence Ayong
- Malaria Research Unit, Centre Pasteur Cameroon, Yaounde´, Cameroon
| | - Luc Vanhamme
- Department of Molecular Biology, Institute of Biology and Molecular Medicine, IBMM, Université Libre de Bruxelles, Gosselies Campus, 126040 Gosselies, Belgium
| | - Jacob Souopgui
- Department of Molecular Biology, Institute of Biology and Molecular Medicine, IBMM, Université Libre de Bruxelles, Gosselies Campus, 126040 Gosselies, Belgium.
| | - Stephen Mbigha Ghogomu
- Department of Biochemistry and Molecular Biology, Faculty of Science, University of Buea, P.O. Box 63 Buea, Cameroon.
| | - Rose Njemini
- Department of Gerontology, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Laarbeeklaan 103, B-1090 Brussels, Belgium; Frailty in Ageing Research Group, Vrije Universiteit Brussel, Laarbeeklaan 103, B-1090 Brussels, Belgium.
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Otache AE, Ezenwosu IL, Ossai EN, Nwobi EA, Abah SO, Uzochukwu BS. Disease perception, impacts and coping strategies for onchocerciasis in Southeast Nigeria: a qualitative study among patients and program managers. BMC Public Health 2023; 23:841. [PMID: 37165379 PMCID: PMC10170812 DOI: 10.1186/s12889-023-15821-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 05/05/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND Onchocerciasis is a disease of public health concern due to the devastating consequences of the disease which impacts negatively on the lives of the people. The negative impact of the disease may affect its perception and lead to the adoption of some coping strategies. Therefore, understanding the disease perception, impacts and coping strategies used by onchocerciasis patients will help plan health interventions aimed at improving their general well-being. METHODS This was a community-based study that employed a qualitative method through Key informant interviews (KII) with program managers and focus group discussions (FGD) among people who had Onchocerciasis. Four sessions of FGDs with a total of thirty-two (32) participants and eleven KIIs were conducted to ascertain their in-depth experience in five thematic areas. RESULTS In these communities, onchocerciasis is perceived to have been caused mainly by the bite of blackflies. Other presumed causes by the patients included drinking polluted water, poor environmental sanitation and witchcraft. The disease had a significant detrimental influence on both the physical and financial aspects of life with limited emotional and social impacts. The long-term clinical manifestations of onchocerciasis triggered pain and insufficient mobility. Thus, onchocerciasis patients experienced impairment in normal daily life activities (farming, etc.), dependency, depression and inability to participate in social events. These manifestations stimulated various coping strategies, mainly, nodulectomy by traditional healers. Others included self-medication, taking an overdose of ivermectin, and the use of alcohol. CONCLUSION Misconceptions about the cause of onchocerciasis still exist among people with the disease. The consequences of the disease impact negatively on various aspects of their lives and stimulate various coping strategies. Therefore, health promotion messages to the public should aim at dispelling misconceptions about the disease and promote healthy coping strategies.
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Affiliation(s)
- Adah E Otache
- Department of Community Medicine, University of Nigeria Teaching Hospital, Enugu, Enugu State, Nigeria
- Department of Community Medicine, Federal Medical Center, Makurdi, Benue State, Nigeria
| | - Ifeyinwa L Ezenwosu
- Department of Community Medicine, University of Nigeria Teaching Hospital, Enugu, Enugu State, Nigeria.
| | - Edmund N Ossai
- Department of Community Medicine, College of Health Sciences, Ebonyi State University, Abakaliki, Nigeria
| | - Emmanuel A Nwobi
- Department of Community Medicine, University of Nigeria Teaching Hospital, Enugu, Enugu State, Nigeria
| | - Stephen O Abah
- Department of Community Medicine, Federal University of Health Sciences, Otukpo, Benue State, Nigeria
| | - Benjamin Sc Uzochukwu
- Department of Community Medicine, University of Nigeria Teaching Hospital, Enugu, Enugu State, Nigeria
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Kibe LW, Kimani BW, Okoyo C, Omondi WP, Sultani HM, Njomo DW. Towards elimination of Lymphatic Filariasis in Kenya: improving advocacy, communication and social mobilization activities for mass drug administration, a qualitative study. Trop Dis Travel Med Vaccines 2022; 8:16. [PMID: 35668465 PMCID: PMC9167906 DOI: 10.1186/s40794-022-00172-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 05/16/2022] [Indexed: 12/05/2022] Open
Abstract
Introduction The Kenya Breaking Transmission Strategy for Neglected Tropical Diseases (NTD) from 2019 to 2023 intensifies advocacy, coordination, and partnerships. The purpose of this study was to explore views and experiences of stakeholders and health workers on ways of improving the Advocacy, Communication and Social Mobilization (ACSM) activities of Mass Drug Administration (MDA) for Lymphatic Filariasis (LF) programs through participatory approaches in Kilifi County, Kenya. Methods Two wards were purposely selected in the Kaloleni sub-county, Kilifi County, where there was an average treatment coverage of 56% in 2015, 50.5% in 2016. Qualitative data collection methods were employed, which included participatory meetings with county stakeholders to understand their views, experiences, and suggestions on how ACSM strategies can be improved in MDA for LF. Twelve In-Depth Interviews (IDIs) were conducted (six with opinion leaders and six with Community Health Extension Workers (CHEWs) and two semi-structured interviews (SSIs) were held with county and sub-county coordinators involved in MDA administration. The aim was to better to understand their perceptions of the NTD program about ACSM, challenges to ACSM strategies, and ways to improve the strategies for ACSM in MDA for LF. The Data was organized and classified into codes and themes using QSR NVIVO version 12. Results The study observed the low participation of stakeholders in the ACSM activities of MDA for LF and identified potential areas for stakeholders’ involvement to strengthen the activities. Challenges hindering effective implementation of ACSM activities include late delivery of Information, Educational and Communication (IEC) and few IEC materials, insufficient funding, inadequate time allocated to reach the assigned households with messages, messaging, and packaging of information for dissemination due to the vastness of the area. The stakeholders recommended innovative strategies and techniques to improve ACSM activities. Discussion and conclusion The results of this study show key challenges to ACSM implementation of MDA for LF. Implementers need to pay attention to these challenges to enhance the effectiveness of MDA per the Kenya NTD Breaking Transmission Strategy. ACSM efforts in MDA for LF control and elimination should be linked with overarching efforts to mainstream partnerships and coordination in control and elimination. Supplementary Information The online version contains supplementary material available at 10.1186/s40794-022-00172-8.
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Baker MC, Bardosh K, Fitch E, Mbabazi PS, Mwingira U, Direny A, Dean L, Sutherland EG, Krentel A. Incorporating qualitative research methods into the monitoring and evaluation of neglected tropical disease programmes: a scoping literature review. Int Health 2021; 13:504-513. [PMID: 34614183 PMCID: PMC8643435 DOI: 10.1093/inthealth/ihab059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/25/2021] [Accepted: 09/10/2021] [Indexed: 11/12/2022] Open
Abstract
This publication addresses the limited use of qualitative methods in neglected tropical disease (NTD) programmes. It describes a scoping literature review conducted to inform the development of a guide to inform the use of rapid qualitative assessments to strengthen NTD mass drug administration (MDA) programmes. The review assessed how qualitative methods are currently used by NTD programmes and identified qualitative approaches from other health and development programmes with the potential to strengthen the design of MDA interventions. Systematic review articles were reviewed and searched using key terms conducted on Google Scholar and PubMed. Results show that methods used by NTD programmes rely heavily on focus group discussions and in-depth interviews, often with time-consuming analysis and limited information on how results are applied. Results from other fields offered insight into a wider range of methods, including participatory approaches, and on how to increase programmatic uptake of findings. Recommendations on how to apply these findings to NTD control are made. The topic of human resources for qualitative investigations is explored and a guide to improve MDAs using qualitative methods is introduced. This guide has direct applicability across the spectrum of NTDs as well as other public health programmes.
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Affiliation(s)
- Margaret C Baker
- Global Health Division, Research Triangle Institute (RTI) International, Washington DC, WA 20005, USA
| | - Kevin Bardosh
- Center for One Health Research, School of Public Health, University of Washington, Seattle, WA 98195, USA
| | - Elizabeth Fitch
- Global Health Division, Research Triangle Institute (RTI) International, Washington DC, WA 20005, USA
| | - Pamela S Mbabazi
- Department of Neglected Tropical Diseases, World Health Organization, 1221 Geneva 27, Switzerland
| | - Upendo Mwingira
- Global Health Division, Research Triangle Institute (RTI) International, Washington DC, WA 20005, USA
| | - Abdel Direny
- CORUS International, Washington DC, WA 20036, USA
| | - Laura Dean
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Elizabeth G Sutherland
- Global Health Division, Research Triangle Institute (RTI) International, Washington DC, WA 20005, USA
| | - Alison Krentel
- School of Epidemiology and Public Health, University of Ottawa, K1G5Z3, Canada
- Bruyere Research Institute, Ottawa, K1N 5C8, Canada
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Nji TM, Piotrowski H, Dum-Buo N, Fung EG, Dean L, Theobald S, Thomson R, Wanji S, Ozano K. Eliminating onchocerciasis within the Meme River Basin of Cameroon: A social-ecological approach to understanding everyday realities and health systems. PLoS Negl Trop Dis 2021; 15:e0009433. [PMID: 34077416 PMCID: PMC8202923 DOI: 10.1371/journal.pntd.0009433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 06/14/2021] [Accepted: 05/02/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Onchocerciasis affects some of the world's most marginalized people, perpetuating poverty and inequalities. Mass Drug Administration (MDA) with Ivermectin has taken place within the Meme River basin region in Cameroon for over 15 years. Despite this, onchocerciasis is still prevalent in the region due to existing and emerging contextual challenges. Using a social-ecological approach we explore the everyday realities of communities, highlighting the challenges and potential solutions that could support Neglected Tropical Disease (NTD) programmes when transitioning from control to elimination of onchocerciasis in this highly endemic area and other similar communities. METHODOLOGY/PRINCIPAL FINDING In-depth interviews (71) with community members and Community Drug Distributors (CDDs) were conducted to understand current knowledge, attitudes, and behaviours in relation to transmission, prevention and treatment of onchocerciasis. Through application of the social-ecological model, four key themes were identified: 1. Contextual factors on health promotion interventions (Onchocerciasis history and understanding of the disease, prevention and mitigation strategies and MDA experience); 2. Social determinants (poverty and livelihoods, economic and social impacts on CDD volunteers and stigma); 3. Environmental determinants (exposure, housing, occupation and poverty); and 4. health seeking pathways and decision making for treatment (access, cost and preferable treatment routes). We discuss these core and cross cutting themes (gender differences and community participation/ownership) in relation to intersectoral collaboration, gender equity and health systems support, making recommendations for NTD programmes within the context of integrated and interdisciplinary approaches. These include the need for; intersectional and gender analysis at the local level, addressing environmental dimensions of onchocerciasis through integrated and regular health promotion, vector control strategies and access to safe water sources; reflection and action that embeds responses to social and economic barriers to MDA; integrated case detection and management that is responsive to onchocerciasis symptoms and related stigma and a fair and just support network for CDDs. CONCLUSION/SIGNIFICANCE NTD programmes need to respond to diverse community circumstances and behaviours. Communities are not a homogeneous risk group and treating them in this way will delay elimination. A deeper understanding of individual needs and their capacity to seek prevention and treatment must be considered if onchocerciasis is to be eliminated and the remaining impacts managed.
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Affiliation(s)
- Theobald Mue Nji
- Department of Sociology and Anthropology, Faculty of Social and Management Sciences, University of Buea, Research Foundation in Tropical Diseases and Environment, Buea, Cameroon
| | - Helen Piotrowski
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Nnamdi Dum-Buo
- Department of Sociology and Anthropology, Faculty of Social and Management Sciences, University of Buea, Research Foundation in Tropical Diseases and Environment, Buea, Cameroon
| | - Ebua Gallus Fung
- Department of Sociology and Anthropology, Faculty of Social and Management Sciences, University of Buea, Research Foundation in Tropical Diseases and Environment, Buea, Cameroon
| | - Laura Dean
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Sally Theobald
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Rachael Thomson
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Samuel Wanji
- Department of Microbiology and Parasitology, Faculty of Science, University of Buea, Research Foundation in Tropical Diseases and Environment, Buea, Cameroon
| | - Kim Ozano
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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In pursuit of a cure: The plural therapeutic landscape of onchocerciasis-associated epilepsy in Cameroon - A mixed methods study. PLoS Negl Trop Dis 2021; 15:e0009206. [PMID: 33621233 PMCID: PMC7946181 DOI: 10.1371/journal.pntd.0009206] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 03/10/2021] [Accepted: 02/04/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND A high prevalence of epilepsy has been observed in several onchocerciasis-endemic villages in the Sanaga River basin, Cameroon. Recent studies suggest that ivermectin, a drug that is distributed annually with the aim of eliminating onchocerciasis, may have a protective effect against acquiring onchocerciasis-associated epilepsy (OAE). This study, therefore, provides an in-depth understanding of both the complex therapeutic landscape for epilepsy as well as the experiences related to the 'community-directed treatment with ivermectin' (CDTI) campaign in order to identify a more trenchant path forward in the fight against epilepsy. METHODOLOGY/PRINCIPAL FINDINGS Based on a mixed methods study combining a qualitative strand with a quantitative survey, we found that epilepsy was perceived to have had an epidemic emergence in the past and was still considered an important health issue in the study area. Socio-economic status, availability and accessibility of drugs and practitioners, as well as perceived aetiology shaped therapeutic itineraries for epilepsy, which included frequenting (in)formal biomedical health care providers, indigenous and/or faith healing practitioners. Ivermectin uptake for onchocerciasis was generally well known and well regarded. The CDTI faced structural and logistical bottlenecks undermining equal access and optimal adherence to the drug. CONCLUSIONS/SIGNIFICANCE Locally accessible, uninterrupted, sustainable and comprehensive health-service delivery is essential to help alleviate the epilepsy burden on afflicted households. Addressing structural challenges of CDTI and communicating the potential link with epilepsy to local populations at risk could optimize the uptake of this potentially significant tool in OAE prevention.
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Entomological Assessment of Onchocerca Species Transmission by Black Flies in Selected Communities in the West Region of Cameroon. Pathogens 2020; 9:pathogens9090722. [PMID: 32887231 PMCID: PMC7559537 DOI: 10.3390/pathogens9090722] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 08/29/2020] [Accepted: 08/31/2020] [Indexed: 12/20/2022] Open
Abstract
The enormity of the public health burden of onchocerciasis motivated the creation of various large-scale control programs that have depended principally on mass treatment of endemic communities with ivermectin for the elimination of the disease. Parasitological evaluation of Onchocerca species in the West Region of Cameroon indicates significant progress in the interruption of parasite transmission in some communities under ivermectin treatment. However, to verify the complete elimination of onchocerciasis, entomological assessment through O-150 PCR poolscreen of black flies is mandatory. Thus, in the present study, we assessed transmission of Onchocerca species using an O-150 PCR technique to screen pools of black flies—in seven onchocerciasis endemic communities (Makouopsap, Bankambe, Lemgo, Tsesse, Ndionzou, Kouffen, and Bayon) in Cameroon. Two thousand black flies were assessed—in each community—for the presence of Onchocerca species DNA. Our results show that the frequency of infective flies was 0.6% in Makouopsap and 0.0% in the other communities. On the other hand, the frequency of infected flies was 0.8% in Makouopsap, 0.2% in Bankambe, 0.1% in Bayon, and 0.0% in Lemgo, Tsesse, Ndionzou, and Kouffen. These results provide entomologic evidence for continuous transmission of Onchocerca species in Makouopsap, risk of active transmission in Bankambe, and Bayon, and a suppressed transmission in the four other studied communities.
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Do Communities Really "Direct" in Community-Directed Interventions? A Qualitative Assessment of Beneficiaries' Perceptions at 20 Years of Community Directed Treatment with Ivermectin in Cameroon. Trop Med Infect Dis 2019; 4:tropicalmed4030105. [PMID: 31311093 PMCID: PMC6789878 DOI: 10.3390/tropicalmed4030105] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 07/11/2019] [Accepted: 07/13/2019] [Indexed: 11/21/2022] Open
Abstract
Recent studies in Cameroon after 20 years of implementation of the Community Directed Treatment with ivermectin (CDTI) strategy, revealed mixed results as regards community ownership. This brings into question the feasibility of Community Directed Interventions (CDI) in the country. We carried out qualitative surveys in 3 health districts of Cameroon, consisting of 11 individual interviews and 10 Focus Group Discussions (FGDs) with specific community members. The main topic discussed during individual interviews and FGDs was about community participation in health. We found an implementation gap in CDTI between the process theory in the 3 health districts. Despite this gap, community eagerness for health information and massive personal and financial adhesion to interventions that were perceived important, were indicators of CDI feasibility. The concept of CDI is culturally feasible in rural and semi-urban settlements, but many challenges hinder its actual implementation. In the view of community participation as a process rather than an intervention, these challenges include real dialogue with communities as partners, dialogue and advocacy with operational level health staff, and macroeconomic and political reforms in health, finance and other associated sectors.
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