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Abdissa D, Kebede Y, Sudhakar M, Abraham G, Bulcha G, Shiferaw T, Berhanu N, Teshome F, Miecha H, Birhanu Z. Community's knowledge, perceptions and preventive practices on Onchocerciasis in Jimma zone, Ethiopia, formative mixed study. PLoS Negl Trop Dis 2024; 18:e0011995. [PMID: 38478481 PMCID: PMC10936768 DOI: 10.1371/journal.pntd.0011995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 02/14/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND In Ethiopia, Onchocerciasis is a prevalent neglected tropical disease, currently targeted for elimination with mass drug administration and community behavioral changes towards sustained control and eventual elimination. This study aimed to elucidate the awareness, perceptions and practices of endemic communities in Jimma Zone, Ethiopia. METHODS AND MATERIALS Community-based cross-sectional study triangulated with qualitative method was conducted from October-November, 2021. A multistage sampling was employed and data were collected using a pre-tested interviewer-administered structured questionnaire. Logistic regression was used to identify the predictors of comprehensive knowledge and preventive practice. Adjusted odds ratios were calculated at 95% confidence interval (CI) and considered significant with a p-value of <0.05. Kruskal-Whallis and Mann-whitney tests were used to compare median risk perception score by socio-demographic factors. Qualitative data were collected through focus group discussions and key informant interviews and transcribed verbatim. Then the data were coded, categorized, and themes were developed. RESULT The overall prevalence of adequate comprehensive knowledge was 48.8% (95% CI: 44.9, 52.3), high risk perception was 18.7% (95%CI15.9, 21.4) and preventive practice was 46.9%(95%CI:(43.3,50.4). High risk perception[AOR = 1.95 95%CI: (1.32, 2.89] was statistically significant with comprehensive knowledge, likewise knowledge of mode of transmission [AOR = 2.64 95% CI: (1.44, 4.85)], knowledge of consequences [AOR = 2.12 95%CI: (1.21, 3.72)] and knowledge of preventive measures [AOR = 15.65,95%CI:(10.1, 24.2)] were statistically significant with preventive practice. The median risk perception was varied significantly between the groups by educational status, study district and age category. Qualitative evidence showed that there were great community knowledge gap about the disease. CONCLUSION Community knowledge, perceptions, and practices are unacceptably low. Risk perception was significantly associated with comprehensive knowledge, likewise knowledge of mode of transmission, consequences and preventive measures were significantly associated with preventive practice. This implies knowledge is a key component of effective prevention strategies as it is a necessary condition for the behavior change.
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Affiliation(s)
- Daba Abdissa
- Department of Biomedical Sciences, Jimma University, Jimma, Ethiopia
| | - Yohannes Kebede
- Department of Health, Behavior and Society, Jimma University, Jimma, Ethiopia
| | - Morankar Sudhakar
- Department of Health, Behavior and Society, Jimma University, Jimma, Ethiopia
| | - Gelila Abraham
- Department of Health Policy and Management, Jimma University, Jimma, Ethiopia
| | | | | | | | - Firanbon Teshome
- Department of Health, Behavior and Society, Jimma University, Jimma, Ethiopia
| | - Hirpa Miecha
- Oromia, regional health bureau, Oromia, Ethiopia
| | - Zewdie Birhanu
- Department of Health, Behavior and Society, Jimma University, Jimma, Ethiopia
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Otabil KB, Basáñez MG, Ankrah B, Bart-Plange EJ, Babae TN, Kudzordzi PC, Darko VA, Raji AS, Datsa L, Boakye AA, Yeboah MT, Fodjo JNS, Schallig HDFH, Colebunders R. Non-adherence to ivermectin in onchocerciasis-endemic communities with persistent infection in the Bono Region of Ghana: a mixed-methods study. BMC Infect Dis 2023; 23:805. [PMID: 37974087 PMCID: PMC10655298 DOI: 10.1186/s12879-023-08806-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 11/08/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND The World Health Organization has proposed that onchocerciasis elimination (interruption) of transmission be verified in 12 (approximately a third) endemic countries by 2030. The strategy to reach this goal is based on ivermectin Mass Drug Administration (MDA) with high geographical and therapeutic coverage. In addition to coverage, high levels of treatment adherence are paramount. We investigated factors associated with ivermectin intake in an area of Ghana with persistent Onchocerca volvulus infection. METHODS In August 2021, a cross-sectional mixed-methods study was conducted in 13 onchocerciasis-endemic communities in the Bono Region of Ghana. Individuals aged ≥ 10 years were invited to participate in a questionnaire survey. A total of 48 focus group discussions and in-depth interviews with 10 community drug distributors and 13 community leaders were conducted. RESULTS A total of 510 people participated in the study [median age: 32, interquartile range 30 (20‒50) years]; 274 (53.7%) were females. Of the total, 320 (62.7%) declared that they adhered to each treatment round and 190 (37.3%) admitted they had not taken ivermectin during at least one MDA round, since becoming eligible for treatment. Of 483 participants with complete information, 139 (28.8%) did not take ivermectin during the last round (March 2021), and 24 (5.0%) had never taken ivermectin (systematic non-adherers). Reasons for not taking ivermectin included previous experience/fear of side-effects, being absent during MDA, pregnancy, the desire to drink alcohol, and drug distribution challenges. Being male, having good knowledge and perception of the disease, and not having secondary or higher level of formal education were significantly associated with higher odds of ivermectin intake. CONCLUSIONS A relatively high level of non-adherence to ivermectin treatment was documented. There is a need for targeted educational and behavioural change campaigns to reverse these trends and ensure a steady course toward meeting onchocerciasis elimination targets in Ghana.
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Affiliation(s)
- Kenneth Bentum Otabil
- Centre for Research in Applied Biology, School of Sciences, University of Energy and Natural Resources, Sunyani, Bono Region, Ghana.
- Department of Biological Science, School of Sciences, University of Energy and Natural Resources, Sunyani, Bono Region, Ghana.
- Global Health Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
| | - María-Gloria Basáñez
- Department of Infectious Disease Epidemiology, MRC Centre for Global Infectious Disease Analysis (MRC GIDA), London Centre for Neglected Tropical Disease Research, School of Public Health, Imperial College London, London, UK
| | - Blessing Ankrah
- Centre for Research in Applied Biology, School of Sciences, University of Energy and Natural Resources, Sunyani, Bono Region, Ghana
| | - Emmanuel John Bart-Plange
- Centre for Research in Applied Biology, School of Sciences, University of Energy and Natural Resources, Sunyani, Bono Region, Ghana
| | - Theophilus Nti Babae
- Centre for Research in Applied Biology, School of Sciences, University of Energy and Natural Resources, Sunyani, Bono Region, Ghana
| | - Prince-Charles Kudzordzi
- Centre for Research in Applied Biology, School of Sciences, University of Energy and Natural Resources, Sunyani, Bono Region, Ghana
| | - Vera Achiaa Darko
- Centre for Research in Applied Biology, School of Sciences, University of Energy and Natural Resources, Sunyani, Bono Region, Ghana
- STU Clinic, Sunyani Technical University, Sunyani, Bono Region, Ghana
| | - Abdul Sakibu Raji
- Department of Biological Science, School of Sciences, University of Energy and Natural Resources, Sunyani, Bono Region, Ghana
| | - Lydia Datsa
- Deo Gratias Medical Laboratories, Sunyani, Bono Region, Ghana
| | | | - Michael Tawiah Yeboah
- Ghana Health Service, Regional Neglected Tropical Diseases (RNTD) Office, Regional Health Directorate, Sunyani, Bono Region, Ghana
| | - Joseph Nelson Siewe Fodjo
- Global Health Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Henk D F H Schallig
- Department of Medical Microbiology, Experimental Parasitology Unit, Academic Medical Centre at the University of Amsterdam, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Robert Colebunders
- Global Health Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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3
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Gbogbo S, Amu H, Dowou RK, Ayanore MA. Management of onchocerciasis among adolescents in nkwanta north district of Ghana: Qualitative study of adolescents' perception, community and health system support. PLoS Negl Trop Dis 2023; 17:e0011577. [PMID: 37643153 PMCID: PMC10464985 DOI: 10.1371/journal.pntd.0011577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 08/07/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Onchocerciasis affects the quality of life to a greater extent among affected individuals. The World Health Organization (WHO)'s Onchocerciasis Control Program (OCP) has effectively reduced the prevalence of onchocerciasis by interrupting the transmission of the parasite and by mass population treatment in the regions at risk of the disease. Despite the successful reduction of the prevalence of onchocerciasis by WHO, the socioeconomic burden resulting from the disabilities caused by onchocerciasis are still immense. This study sought to explore the adolescents' perception regarding the management of onchocerciasis, community and health system support in Nkwanta North District of Ghana. METHOD This study adopted a qualitative phenomenological design and exploratory, descriptive qualitative approach. An in-depth interview guide was developed to collect data for the study. One-on-one interview was conducted. Data collected from 16 onchocerciasis adolescent patients were analysed thematically using ATLAS.ti v7.5.7. Quotes from the participants were presented verbatim to substantiate the themes realised. RESULTS Most of the 12 participants (75.0%) were aged 15-18 years old. It was noted that 6(37.50%) of participants were in Junior High School (JHS), while 4(25.0%) were in Senior High School (SHS). It was noted that community members have diverse understandings and perceptions of onchocerciasis, including beliefs that Onchocerciasis is a serious disease that can cause blindness; it is caused by the consumption of some types of food products or stressful work. Adolescents believed that onchocerciasis was caused by insect bite blood infection, poor environmental hygiene, sun or could have been inherited from parents. Ivermectin treatment was noted by adolescents to have helped relieve the symptoms of ochocerciasis they were experiencing. However, the adolescents indicated that they had experienced some side effects, including fever, headache, body itching, rushes, swollen body and blurred vision from the drug. CONCLUSION Inadequate education and communication about onchocerciasis resulted in diverse and erroneous meanings of onchocerciasis among community members. Our research recognises that community and health system supports is very important in the effective management of Onchocerciasis, contributing to the attainment of Sustainable Development Goal (SDG) 3.3, which is targeted at ending the epidemic of NTDs like onchocerciasis by 2030.
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Affiliation(s)
- Sitsofe Gbogbo
- Department of Population and Behavioural Sciences, School of Public Health, University of Health and Allied Science, Hohoe, Ghana
| | - Hubert Amu
- Department of Population and Behavioural Sciences, School of Public Health, University of Health and Allied Science, Hohoe, Ghana
| | - Robert Kokou Dowou
- Department of Epidemiology and Biostatistics, School of Public Health, University of Health and Allied Science, Hohoe, Ghana
| | - Martin Amogre Ayanore
- Health Policy Planning and Management, University of Health and Allied Science, Hohoe, Ghana
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Djune-Yemeli L, Domché A, Nana-Djeunga HC, Donfo-Azafack C, Lenou-Nanga CG, Masumbe-Netongo P, Kamgno J. Relationship between skin snip and Ov16 ELISA: Two diagnostic tools for onchocerciasis in a focus in Cameroon after two decades of ivermectin-based preventive chemotherapy. PLoS Negl Trop Dis 2022; 16:e0010380. [PMID: 35499993 PMCID: PMC9098087 DOI: 10.1371/journal.pntd.0010380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 05/12/2022] [Accepted: 03/31/2022] [Indexed: 11/28/2022] Open
Abstract
Background Onchocerciasis elimination currently relies on repeated ivermectin-based preventive chemotherapy. Current World Health Organization’s guidelines strongly recommend, though with low evidence of certainty, the use of Ov16 serology testing in children younger than 10 years old to assess whether mass drugs administration can be safely stopped. Therefore, more evidences are needed to support the use of this marker as sero-evaluation tool. This study aimed at determining the relationship between microfilaridermia and anti-Ov16 IgG4, and their variation according to age, gender and ivermectin intake history. Methodology A cross-sectional survey was conducted in an area where ivermectin-based MDA has been implemented since more than 20 years. A questionnaire was used to record ivermectin intake history for the last 5 years. All volunteers aged ≥2 years were tested for microfilaridermia. IgG4 antibodies against Ov16 antigen were determined using the Standard Diagnostic Ov16 IgG4 ELISA kits and the recombinant anti-Ov16 AbD19432 antibodies. Prevalences, microfilaridermia counts and IgG4 concentrations were compared with regards to age, gender and history of ivermectin intake. Principal findings The prevalence of skin microfilariae was 23.4% (95% CI: 23.4–30.8), whereas Ov16 seroprevalence was 53.2% (95% CI: 47.9–58.4). A moderate positive percentage agreement (50.4%) and a high negative percentage agreement (69.2%) was found between skin snip and Ov16 serology in the whole population, while in children aged <10 years, the agreements were higher (positive percentage agreement: 62.6%; negative percentage agreement: 83.5%). In addition, no associations were found between ivermectin intake, Mf counts and estimated IgG4 concentration of participants. Anti-Ov16 IgG4 were higher in individuals harboring microfilariae than their negative counterparts (p<0.0001), though a negative correlation was found between skin microfilarial counts and anti-Ov16 IgG4 levels (r = -0.2400; p = 0.03). No variation in microfilarial counts according to age and gender was observed. Though positively correlated with age (r = 0.4020; p<0.0001), IgG4 was significantly different between the different age classes (p<0.0001). Conclusion/Significance Our results revealed moderate positive and negative agreements between parasitological and immunological parameters of onchocerciasis infection after several rounds MDA. Anti-Ov16 IgG4 levels increased with age but decreased with microfilarial counts, suggesting a variation of anti-Ov16 IgG4 as a result of constant exposure and accumulation of infection. This brings evidence sustaining the use of Ov16 serology in children as evaluation tool. However, additional investigations are needed to further reshape the appropriate age range among children aged <10 years old. The elimination of onchocerciasis places high demands on monitoring and evaluation. The current WHO’s guidelines recommend the use of serological test (ELISA) to determine the presence of IgG4 antibodies to the O. volvulus specific antigen Ov16 among children aged <10 years old, thought with low evidence of certainty. In this paper, we explored the relationship between anti-Ov16 IgG4 antibodies and microfilaridermia counts, and assessed their variation according to age, gender and history of ivermectin intake. Our findings revealed no variation of Mf count and IgG4 with ivermectin intake. However, we observed that anti-Ov16 IgG4 decrease with microfilaridermia counts, but an increasing trend was observed with age. This brings evidence sustaining the use of Ov16 serology testing as exposition marker in children younger than 10 years. However, children age 2 to 4 years seem to have a very low anti-Ov16 IgG4 concentration, this finding should be considered when defining the age class for seroprevalence evaluation.
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Affiliation(s)
- Linda Djune-Yemeli
- Centre for Research on Filariasis and other Tropical Diseases (CRFilMT), Yaoundé, Cameroon
- Molecular Diagnosis Research Group, Biotechnology Centre-University of Yaoundé I (BTC-UY-I), Yaoundé, Cameroon
| | - André Domché
- Centre for Research on Filariasis and other Tropical Diseases (CRFilMT), Yaoundé, Cameroon
- Parasitology and Ecology Laboratory, Department of Animal Biology and Physiology, Faculty of Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Hugues C. Nana-Djeunga
- Centre for Research on Filariasis and other Tropical Diseases (CRFilMT), Yaoundé, Cameroon
| | - Cyrille Donfo-Azafack
- Centre for Research on Filariasis and other Tropical Diseases (CRFilMT), Yaoundé, Cameroon
| | - Cedric G. Lenou-Nanga
- Centre for Research on Filariasis and other Tropical Diseases (CRFilMT), Yaoundé, Cameroon
| | - Palmer Masumbe-Netongo
- Molecular Diagnosis Research Group, Biotechnology Centre-University of Yaoundé I (BTC-UY-I), Yaoundé, Cameroon
- Department of Biochemistry, Faculty of Science, University of Yaoundé 1, Yaoundé, Cameroon
| | - Joseph Kamgno
- Centre for Research on Filariasis and other Tropical Diseases (CRFilMT), Yaoundé, Cameroon
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
- * E-mail:
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5
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Hendy A, Krit M, Pfarr K, Laemmer C, De Witte J, Nwane P, Kamgno J, Nana-Djeunga HC, Boussinesq M, Dujardin JC, Post R, Colebunders R, O'Neill S, Enyong P, Njamnshi AK. Onchocerca volvulus transmission in the Mbam valley of Cameroon following 16 years of annual community-directed treatment with ivermectin, and the description of a new cytotype of Simulium squamosum. Parasit Vectors 2021; 14:563. [PMID: 34727965 PMCID: PMC8561987 DOI: 10.1186/s13071-021-05072-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 10/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The onchocerciasis focus surrounding the lower Mbam and Sanaga rivers, where Onchocerca volvulus is transmitted by Simulium damnosum s.l. (Diptera: Simuliidae), was historically the largest in the southern regions of Cameroon. Annual community-directed treatment with ivermectin (CDTI) has been taking place since 2000, but recent studies have shown that new infections are occurring in children. We aimed to investigate blackfly biting and O. volvulus transmission rates along the lower Mbam river 16 years after the formal onset of annual CDTI. METHODS Black flies were collected for three consecutive days each month between July 2016 and June 2017 at two riverside villages and two inland sites situated 4.9 km and 7.9 km from the riverside. Specimens collected at each site were dissected on one of the three collection days each month to estimate parity rates and O. volvulus infection rates, while the remaining samples were preserved for pool screening. RESULTS In total, 93,573 S. damnosum s.l. black flies were recorded biting humans and 9281 were dissected. Annual biting rates of up to 606,370 were estimated at the riverside, decreasing to 20,540 at 7.9 km, while, based on dissections, annual transmission potentials of up to 4488 were estimated at the riverside, decreasing to 102 and 0 at 4.9 km and 7.9 km, respectively. However, pool screening showed evidence of infection in black flies at the furthest distance from the river. Results of both methods demonstrated the percentage of infective flies to be relatively low (0.10-0.36%), but above the WHO threshold for interruption of transmission. In addition, a small number of larvae collected during the dry season revealed the presence of Simulium squamosum E. This is the first time S. squamosum E has been found east of Lake Volta in Ghana, but our material was chromosomally distinctive, and we call it S. squamosum E2. CONCLUSIONS Relatively low O. volvulus infection rates appear to be offset by extremely high densities of biting black flies which are sustaining transmission along the banks of the lower Mbam river.
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Affiliation(s)
- Adam Hendy
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium. .,Department of Pathology, University of Texas Medical Branch, Galveston, TX, USA.
| | - Meryam Krit
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Kenneth Pfarr
- Institute for Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Bonn, Germany.,German Center for Infection Research, Partner Site Bonn-Cologne, Cologne, Germany
| | - Christine Laemmer
- Institute for Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Bonn, Germany.,German Center for Infection Research, Partner Site Bonn-Cologne, Cologne, Germany
| | - Jacobus De Witte
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Philippe Nwane
- Centre for Research on Filariasis and Other Tropical Diseases (CRFilMT), Yaoundé, Cameroon
| | - Joseph Kamgno
- Centre for Research on Filariasis and Other Tropical Diseases (CRFilMT), Yaoundé, Cameroon.,Department of Public Health, Faculty of Medicine and Biomedical Sciences, The University of Yaoundé I, Yaoundé, Cameroon
| | - Hugues C Nana-Djeunga
- Centre for Research on Filariasis and Other Tropical Diseases (CRFilMT), Yaoundé, Cameroon
| | - Michel Boussinesq
- Institut de Recherche pour le Développement (IRD), Montpellier, France
| | - Jean-Claude Dujardin
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Rory Post
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK.,School of Natural Sciences and Psychology, Liverpool John Moores University, Liverpool, UK
| | | | - Sarah O'Neill
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.,CR 5, Ecole de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium
| | - Peter Enyong
- Research Foundation in Tropical Diseases and Environment, Buea, Cameroon
| | - Alfred K Njamnshi
- Neuroscience Lab, Faculty of Medicine and Biomedical Sciences, The University of Yaoundé I, Yaoundé, Cameroon.,Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon.,Brain Research Africa Initiative (BRAIN), Geneva, Switzerland.,Neurology Department, Central Hospital Yaoundé, Yaoundé, Cameroon
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6
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Forrer A, Wanji S, Obie ED, Nji TM, Hamill L, Ozano K, Piotrowski H, Dean L, Njouendou AJ, Ekanya R, Ndongmo WPC, Fung EG, Nnamdi DB, Abong RA, Beng AA, Eyong ME, Ndzeshang BL, Nkimbeng DA, Teghen S, Suireng A, Ashu EE, Kah E, Murdoch MM, Thomson R, Theobald S, Enyong P, Turner JD, Taylor MJ. Why onchocerciasis transmission persists after 15 annual ivermectin mass drug administrations in South-West Cameroon. BMJ Glob Health 2021; 6:bmjgh-2020-003248. [PMID: 33431378 PMCID: PMC7802695 DOI: 10.1136/bmjgh-2020-003248] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 11/11/2020] [Accepted: 11/27/2020] [Indexed: 12/11/2022] Open
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.
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Affiliation(s)
- Armelle Forrer
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, Merseyside, UK
| | - Samuel Wanji
- Department of Disease Control, Research Foundation for Tropical Diseases and the Environment (REFOTDE), Buea, Cameroon.,Parasites and Vector Biology research unit (PAVBRU), Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon
| | - Elisabeth Dibando Obie
- Department of Disease Control, Research Foundation for Tropical Diseases and the Environment (REFOTDE), Buea, Cameroon.,Parasites and Vector Biology research unit (PAVBRU), Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon
| | - Theobald Mue Nji
- Department of Disease Control, Research Foundation for Tropical Diseases and the Environment (REFOTDE), Buea, Cameroon.,Department of Sociology and Anthropology, University of Buea, Buea, Cameroon
| | - Louise Hamill
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, Merseyside, UK
| | - Kim Ozano
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, Liverpool, UK
| | - Helen Piotrowski
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, Liverpool, UK
| | - Laura Dean
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, Liverpool, UK
| | - Abdel J Njouendou
- Department of Disease Control, Research Foundation for Tropical Diseases and the Environment (REFOTDE), Buea, Cameroon.,Parasites and Vector Biology research unit (PAVBRU), Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon
| | - Relindis Ekanya
- Department of Disease Control, Research Foundation for Tropical Diseases and the Environment (REFOTDE), Buea, Cameroon.,Parasites and Vector Biology research unit (PAVBRU), Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon
| | - Winston Patrick Chounna Ndongmo
- Department of Disease Control, Research Foundation for Tropical Diseases and the Environment (REFOTDE), Buea, Cameroon.,Parasites and Vector Biology research unit (PAVBRU), Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon
| | - Ebua Gallus Fung
- Department of Disease Control, Research Foundation for Tropical Diseases and the Environment (REFOTDE), Buea, Cameroon.,Department of Sociology and Anthropology, University of Buea, Buea, Cameroon
| | - Dum-Buo Nnamdi
- Department of Disease Control, Research Foundation for Tropical Diseases and the Environment (REFOTDE), Buea, Cameroon.,Department of Sociology and Anthropology, University of Buea, Buea, Cameroon
| | - Raphael A Abong
- Department of Disease Control, Research Foundation for Tropical Diseases and the Environment (REFOTDE), Buea, Cameroon.,Parasites and Vector Biology research unit (PAVBRU), Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon
| | - Amuam Andrew Beng
- Department of Disease Control, Research Foundation for Tropical Diseases and the Environment (REFOTDE), Buea, Cameroon.,Parasites and Vector Biology research unit (PAVBRU), Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon
| | - Mathias Esum Eyong
- Department of Disease Control, Research Foundation for Tropical Diseases and the Environment (REFOTDE), Buea, Cameroon.,Parasites and Vector Biology research unit (PAVBRU), Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon
| | - Bertrand L Ndzeshang
- Department of Disease Control, Research Foundation for Tropical Diseases and the Environment (REFOTDE), Buea, Cameroon.,Parasites and Vector Biology research unit (PAVBRU), Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon
| | - Desmond Akumtoh Nkimbeng
- Department of Disease Control, Research Foundation for Tropical Diseases and the Environment (REFOTDE), Buea, Cameroon.,Parasites and Vector Biology research unit (PAVBRU), Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon
| | - Samuel Teghen
- Department of Disease Control, Research Foundation for Tropical Diseases and the Environment (REFOTDE), Buea, Cameroon.,Parasites and Vector Biology research unit (PAVBRU), Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon
| | - Anicetus Suireng
- Department of Disease Control, Research Foundation for Tropical Diseases and the Environment (REFOTDE), Buea, Cameroon
| | - Ernerstine Ebot Ashu
- Department of Disease Control, Research Foundation for Tropical Diseases and the Environment (REFOTDE), Buea, Cameroon
| | - Emmanuel Kah
- Department of Disease Control, Research Foundation for Tropical Diseases and the Environment (REFOTDE), Buea, Cameroon.,Parasites and Vector Biology research unit (PAVBRU), Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon
| | - Michele M Murdoch
- Watford General Hospital, West Herts Hospitals NHS Trust, Watford, UK
| | - Rachael Thomson
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, Merseyside, UK
| | - Sally Theobald
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, Liverpool, UK
| | - Peter Enyong
- Department of Disease Control, Research Foundation for Tropical Diseases and the Environment (REFOTDE), Buea, Cameroon.,Parasites and Vector Biology research unit (PAVBRU), Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon
| | - Joseph D Turner
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, Merseyside, UK
| | - Mark J Taylor
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, Merseyside, UK
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7
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Molyneux D, Bush S, Bannerman R, Downs P, Shu'aibu J, Boko-Collins P, Radvan I, Wohlgemuth L, Boyton C. Neglected tropical diseases activities in Africa in the COVID-19 era: the need for a "hybrid" approach in COVID-endemic times. Infect Dis Poverty 2021; 10:1. [PMID: 33397494 PMCID: PMC7779653 DOI: 10.1186/s40249-020-00791-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 12/21/2020] [Indexed: 12/12/2022] Open
Abstract
With the coronavirus disease 2019 (COVID-19) pandemic showing no signs of abating, resuming neglected tropical disease (NTD) activities, particularly mass drug administration (MDA), is vital. Failure to resume activities will not only enhance the risk of NTD transmission, but will fail to leverage behaviour change messaging on the importance of hand and face washing and improved sanitation-a common strategy for several NTDs that also reduces the risk of COVID-19 spread. This so-called "hybrid approach" will demonstrate best practices for mitigating the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by incorporating physical distancing, use of masks, and frequent hand-washing in the delivery of medicines to endemic communities and support action against the transmission of the virus through water, sanitation and hygiene interventions promoted by NTD programmes. Unless MDA and morbidity management activities resume, achievement of NTD targets as projected in the WHO/NTD Roadmap (2021-2030) will be deferred, the aspirational goal of NTD programmes to enhance universal health coverage jeopardised and the call to 'leave no one behind' a hollow one. We outline what implementing this hybrid approach, which aims to strengthen health systems, and facilitate integration and cross-sector collaboration, can achieve based on work undertaken in several African countries.
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Affiliation(s)
- David Molyneux
- Department of Tropical Diseases Biology, Centre for Neglected Tropical Diseases, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK.
| | - Simon Bush
- Neglected Tropical Diseases, Sightsavers, Airport, P O Box KIA18190, Accra, Ghana
| | - Ron Bannerman
- Neglected Tropical Diseases (Ascend West and Central Africa), Sightsavers, 35 Perrymount Rd, Haywards Heath, RH16 3BZ, UK
| | - Philip Downs
- Neglected Tropical Diseases, Sightsavers, 23 Beverly Dr., Durham, NC, 27707, USA
| | - Joy Shu'aibu
- Programme Operations, Sightsavers, Nigeria Country Office-No 1 Golf Course Road, P.O. Box 503, Kaduna, Nigeria
| | - Pelagie Boko-Collins
- Neglected Tropical Diseases, Sightsavers, Benin Country Office-3rd Floor of the Riveria Golf Building, Akpakpa, Lot 4002 F, Old Bridge, Republic of Benin
| | - Ioasia Radvan
- Neglected Tropical Diseases, Sightsavers, 35, Perrymount Rd, Haywards Heath, RH16 3BZ, UK
| | - Leah Wohlgemuth
- Neglected Tropical Diseases, Sightsavers, 35, Perrymount Rd, Haywards Heath, RH16 3BZ, UK
| | - Chris Boyton
- M&C Saatchi World Services, 36 Golden Square, London, W 9EE, UK
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8
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Molyneux DH, Aboe A, Isiyaku S, Bush S. COVID-19 and neglected tropical diseases in Africa: impacts, interactions, consequences. Int Health 2020; 12:367-372. [PMID: 32725145 PMCID: PMC7443717 DOI: 10.1093/inthealth/ihaa040] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 06/22/2020] [Indexed: 01/17/2023] Open
Affiliation(s)
- David H Molyneux
- Emeritus Professor, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
| | - Agatha Aboe
- Global Trachoma Coordinator, Sightsavers, PO Box KIA 18190, Airport, Accra, Ghana
| | - Sunday Isiyaku
- Country Director Ghana and Nigeria, Sightsavers, 1 Golf Course Road, Kaduna, Nigeria
| | - Simon Bush
- Director, Neglected Tropical Diseases, Sightsavers, PO Box KIA 18190, Airport, Accra, Ghana
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9
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Finda MF, Christofides N, Lezaun J, Tarimo B, Chaki P, Kelly AH, Kapologwe N, Kazyoba P, Emidi B, Okumu FO. Opinions of key stakeholders on alternative interventions for malaria control and elimination in Tanzania. Malar J 2020; 19:164. [PMID: 32321534 PMCID: PMC7178586 DOI: 10.1186/s12936-020-03239-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 04/16/2020] [Indexed: 03/03/2023] Open
Abstract
Background Malaria control in Tanzania currently relies primarily on long-lasting insecticidal nets and indoor residual spraying, alongside effective case management and behaviour change communication. This study explored opinions of key stakeholders on the national progress towards malaria elimination, the potential of currently available vector control interventions in helping achieve elimination by 2030, and the need for alternative interventions that could be used to supplement malaria elimination efforts in Tanzania. Methods In this exploratory qualitative study, Focus group discussions were held with policy-makers, regulators, research scientists and community members. Malaria control interventions discussed were: (a) improved housing, (b) larval source management, (c) mass drug administration (MDA) with ivermectin to reduce vector densities, (d) release of modified mosquitoes, including genetically modified or irradiated mosquitoes, (e) targeted spraying of mosquito swarms, and (f) spatial repellents. Results Larval source management and spatial repellents were widely supported across all stakeholder groups, while insecticide-spraying of mosquito swarms was the least preferred. Support for MDA with ivermectin was high among policy makers, regulators and research scientists, but encountered opposition among community members, who instead expressed strong support for programmes to improve housing for poor people in high transmission areas. Policy makers, however, challenged the idea of government-supported housing improvement due to its perceived high costs. Techniques of mosquito modification, specifically those involving gene drives, were viewed positively by community members, policy makers and regulators, but encountered a high degree of scepticism among scientists. Overall, policy-makers, regulators and community members trusted scientists to provide appropriate advice for decision-making. Conclusion Stakeholder opinions regarding alternative malaria interventions were divergent except for larval source management and spatial repellents, for which there was universal support. MDA with ivermectin, housing improvement and modified mosquitoes were also widely supported, though each faced concerns from at least one stakeholder group. While policy-makers, regulators and community members all noted their reliance on scientists to make informed decisions, their reasoning on the benefits and disadvantages of specific interventions included factors beyond technical efficiency. This study suggests the need to encourage and strengthen dialogue between research scientists, policy makers, regulators and communities regarding new interventions.
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Affiliation(s)
- Marceline F Finda
- Environmental Health and Ecological Sciences Department, Ifakara Health Institute, P. O. Box 53, Ifakara, Tanzania. .,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 1 Smuts Avenue, Braamfontein, 2000, South Africa.
| | - Nicola Christofides
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 1 Smuts Avenue, Braamfontein, 2000, South Africa
| | - Javier Lezaun
- Institute for Science, Innovation and Society, School of Anthropology and Museum Ethnography, University of Oxford, Oxford, UK
| | - Brian Tarimo
- Environmental Health and Ecological Sciences Department, Ifakara Health Institute, P. O. Box 53, Ifakara, Tanzania
| | - Prosper Chaki
- Environmental Health and Ecological Sciences Department, Ifakara Health Institute, P. O. Box 53, Ifakara, Tanzania
| | - Ann H Kelly
- Department of Global Health and Social Medicine, King's College, London, UK
| | - Ntuli Kapologwe
- President's Office, Regional Administration and Local Government, P. O Box 1923, Dodoma, Tanzania
| | - Paul Kazyoba
- National Institute for Medical Research, 3 Barack Obama Drive, Dar es Salaam, Tanzania
| | - Basiliana Emidi
- National Institute for Medical Research, 3 Barack Obama Drive, Dar es Salaam, Tanzania.,National Malaria Control Programme, P. O. Box 743, Dodoma, Tanzania
| | - Fredros O Okumu
- Environmental Health and Ecological Sciences Department, Ifakara Health Institute, P. O. Box 53, Ifakara, Tanzania.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 1 Smuts Avenue, Braamfontein, 2000, South Africa.,Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, G12 8QQ, UK.,School of Life Science and Bioengineering, The Nelson Mandela African Institution of Science and Technology, P. O. Box 447, Arusha, Tanzania
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10
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Answer to October 2019 Photo Quiz. J Clin Microbiol 2019; 57:57/10/e01266-18. [DOI: 10.1128/jcm.01266-18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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11
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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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12
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Dissak-Delon FN, Kamga GR, Humblet PC, Robert A, Souopgui J, Kamgno J, Ghogomu SM, Godin I. Barriers to the National Onchocerciasis Control Programme at operational level in Cameroon: a qualitative assessment of stakeholders' views. Parasit Vectors 2019; 12:246. [PMID: 31109348 PMCID: PMC6528230 DOI: 10.1186/s13071-019-3497-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 05/09/2019] [Indexed: 11/16/2022] Open
Abstract
Background The global burden of onchocerciasis is the heaviest in sub-Saharan Africa. Studies have shown the importance of the role of Community-Directed Distributors (CDDs) and nurses in onchocerciasis control, but little is known about their experience in implementing onchocerciasis control programmes. Our aim was to document the barriers that CDDs and local health administrators face in implementing onchocerciasis control activities. Methods We conducted a qualitative survey consisting of 16 in-depth interviews and 8 focus group discussions (FGDs) across three health districts of Cameroon. We interviewed a total of 9 local health officials at the district and Health Area levels, and 7 CDDs. Eight FGDs were conducted with CDDs and Health Committee members. Results The major barriers to the implementation of Community Directed Treatment with Ivermectin that we identified were linked and interrelated. Examples of these barriers included: contextual factors (geographical and cultural background), top-to-bottom planning, insufficient human and material resources, and lack of transparency in the management of the programme’s funds. Conclusions The CDTI at operational level still faces many obstacles which negatively affect therapeutic coverages. This can lead to the non-adhesion of the communities to the programme, consequently jeopardizing the sustainability of the onchocerciasis elimination programme. We recommend that the national programme planners put in place a transparent management and planning system for onchocerciasis elimination activities, with better communication with local programme stakeholders.
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Affiliation(s)
- Fanny Nadia Dissak-Delon
- Ministry of Public Health, N°8, Rue 3038 quartier du Lac, Yaounde, Cameroon. .,Ecole de Santé Publique - Campus Erasme, Université Libre de Bruxelles, Route de Lennik 808 CP591, 1070, Brussels, Belgium. .,Molecular and Cell Biology Laboratory, Department of Biochemistry and Molecular Biology, University of Buea, P.O. Box 63, Buea, Cameroon.
| | - Guy-Roger Kamga
- Ministry of Public Health, N°8, Rue 3038 quartier du Lac, Yaounde, Cameroon.,Molecular and Cell Biology Laboratory, Department of Biochemistry and Molecular Biology, University of Buea, P.O. Box 63, Buea, Cameroon.,Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Clos Chapelle-aux-champs 30 bte B1.30.13, 1200, Brussels, Belgium
| | - Perrine Claire Humblet
- Ecole de Santé Publique - Campus Erasme, Université Libre de Bruxelles, Route de Lennik 808 CP591, 1070, Brussels, Belgium
| | - Annie Robert
- Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Clos Chapelle-aux-champs 30 bte B1.30.13, 1200, Brussels, Belgium
| | - Jacob Souopgui
- Institute of Molecular Biology and Medicine, Université Libre de Bruxelles, Rue des professeurs Jeener et Brachet 12, Gosselies, 6041, Charleroi, Belgium
| | - Joseph Kamgno
- Centre for Research on Filariasis and other Tropical Diseases, P.O. Box 5797, Yaounde, Cameroon.,Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, P.O. Box 1364, Yaounde, Cameroon
| | - Stephen Mbigha Ghogomu
- Molecular and Cell Biology Laboratory, Department of Biochemistry and Molecular Biology, University of Buea, P.O. Box 63, Buea, Cameroon
| | - Isabelle Godin
- Ecole de Santé Publique - Campus Erasme, Université Libre de Bruxelles, Route de Lennik 808 CP591, 1070, Brussels, Belgium
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13
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Siewe Fodjo JN, Tatah G, Tabah EN, Ngarka L, Nfor LN, Chokote SE, Mengnjo MK, Dema F, Sitouok AT, Nkoro G, Ntone FE, Bissek ACZK, Chesnais CB, Boussinesq M, Colebunders R, Njamnshi AK. Epidemiology of onchocerciasis-associated epilepsy in the Mbam and Sanaga river valleys of Cameroon: impact of more than 13 years of ivermectin. Infect Dis Poverty 2018; 7:114. [PMID: 30501640 DOI: 10.1186/s40249-018-0497-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 10/18/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A high epilepsy prevalence has been reported in several onchocerciasis-endemic villages along the Mbam and Sanaga river valleys in Cameroon, including Bilomo and Kelleng. We sought to determine the prevalence of epilepsy in these two villages following more than 13 years of community-directed treatment with ivermectin (CDTI). METHODS Door-to-door surveys were performed on the entire resident population in the villages in August 2017 and January 2018. Epilepsy was diagnosed using a 2-step approach: administration of a standardized 5-item questionnaire followed by confirmation by a neurologist. Previously published diagnostic criteria for onchocerciasis-associated epilepsy (OAE) were used. Ov16 serology was done for children aged 7-10 years to assess onchocerciasis transmission. Findings were compared with previous data from these two villages. RESULTS A total of 1525 individuals (1321 in Bilomo and 204 in Kelleng) in 233 households were surveyed in both villages. The crude prevalence of epilepsy was 4.6% in Bilomo (2017) and 7.8% in Kelleng (2018), including 12 (15.6% of cases) persons with epilepsy (PWE) with nodding seizures. The age and sex-standardized prevalence in Kelleng decreased from 13.5% in 2004 to 9.3% in 2018 (P < 0.001). The median age of PWE shifted from 17 (IQR: 12-22) years to 24 (IQR: 20-30) years in Bilomo (P < 0.001); and slightly from 24 (IQR: 14-34) years to 28 (IQR: 21.25-36.75) years in Kelleng (P = 0.112). Furthermore, 47.6% of all tested children between 7 and 10 years had Ov16 antibodies. CONCLUSIONS There is a decrease in epilepsy prevalence after 13 years and more of CDTI in both villages. The age-shift observed in PWE suggests that ivermectin may prevent OAE in younger residents. Ov16 seropositivity in children indicates ongoing onchocerciasis transmission possibly due to suboptimal control measures. Our findings support the existence of OAE in Cameroon and highlight the need to strengthen onchocerciasis elimination programs.
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Affiliation(s)
| | - Godwin Tatah
- Neurology Department, Yaoundé Central Hospital, Yaoundé, Cameroon.,Neurology Department, CH Saint-Nazaire, Saint-Nazaire, France.,Neuroscience Laboratory, FMBS, The University of Yaoundé I, Yaoundé, Cameroon
| | - Earnest Njih Tabah
- Neurology Department, Yaoundé Central Hospital, Yaoundé, Cameroon.,Ministry of Public Health, Yaoundé, Cameroon
| | - Leonard Ngarka
- Neurology Department, Yaoundé Central Hospital, Yaoundé, Cameroon.,Neuroscience Laboratory, FMBS, The University of Yaoundé I, Yaoundé, Cameroon
| | - Leonard Njamnshi Nfor
- Neuroscience Laboratory, FMBS, The University of Yaoundé I, Yaoundé, Cameroon.,Neurology Department, CHU Brugman, Brussels, Belgium
| | - Samuel Eric Chokote
- Neurology Department, Yaoundé Central Hospital, Yaoundé, Cameroon.,Neuroscience Laboratory, FMBS, The University of Yaoundé I, Yaoundé, Cameroon
| | - Michel K Mengnjo
- Neurology Department, Yaoundé Central Hospital, Yaoundé, Cameroon.,Neuroscience Laboratory, FMBS, The University of Yaoundé I, Yaoundé, Cameroon
| | - Fidèle Dema
- Neurology Department, Yaoundé Central Hospital, Yaoundé, Cameroon.,Yoko District Hospital, Yaoundé, Cameroon
| | - Aurélien Tele Sitouok
- Neurology Department, Yaoundé Central Hospital, Yaoundé, Cameroon.,Neuroscience Laboratory, FMBS, The University of Yaoundé I, Yaoundé, Cameroon
| | - Grace Nkoro
- Neuroscience Laboratory, FMBS, The University of Yaoundé I, Yaoundé, Cameroon
| | - Félicien E Ntone
- Neuroscience Laboratory, FMBS, The University of Yaoundé I, Yaoundé, Cameroon
| | - Anne-Cécile Zoung-Kanyi Bissek
- Neuroscience Laboratory, FMBS, The University of Yaoundé I, Yaoundé, Cameroon.,Ministry of Public Health, Yaoundé, Cameroon
| | - Cédric B Chesnais
- UMI 233, Institut de Recherche pour le Développement (IRD), Montpellier, France.,Université Montpellier, Montpellier, France.,INSERM Unité 1175, Montpellier, France
| | - Michel Boussinesq
- UMI 233, Institut de Recherche pour le Développement (IRD), Montpellier, France.,Université Montpellier, Montpellier, France.,INSERM Unité 1175, Montpellier, France
| | | | - Alfred K Njamnshi
- Neurology Department, Yaoundé Central Hospital, Yaoundé, Cameroon.,Neuroscience Laboratory, FMBS, The University of Yaoundé I, Yaoundé, Cameroon.,Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon
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14
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Kamga GR, Dissak-Delon FN, Nana-Djeunga HC, Biholong BD, Ghogomu SM, Souopgui J, Kamgno J, Robert A. Audit of the community-directed treatment with ivermectin (CDTI) for onchocerciasis and factors associated with adherence in three regions of Cameroon. Parasit Vectors 2018; 11:356. [PMID: 29921312 PMCID: PMC6009063 DOI: 10.1186/s13071-018-2944-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 06/07/2018] [Indexed: 11/23/2022] Open
Abstract
Background After more than 15 years of community-directed treatment with ivermectin (CDTI) in the Centre 1, Littoral 2 and West CDTI projects in Cameroon, the epidemiological evaluation conducted in 2011 revealed that onchocerciasis endemicity was still high in some communities. To investigate the potential reasons explaining this high endemicity, a cluster coverage survey was conducted in April-May 2015 in three health districts (HD), to assess the implementation of the CDTI, the 2014 therapeutic coverage and the five-year adherence to treatment. A two-stage cluster design was considered during analyses, with data weighted proportionally to age and gender distribution in the population. Results In the three HDs, 69 community leaders, 762 heads of households, 83 community drug distributors (CDD) and 2942 household members were interviewed. The CDTI organization and the involvement of heads of households were in average weak, with 84.0% (95% CI: 81.2–86.4%) of them who had not participated in activities during the 2014 mass drug administration (MDA). On average, six of ten community leaders declared that the period of treatment was decided by the health personnel while the CDDs selection was made during a community meeting for only 43.4% of them. The 2014 weighted therapeutic coverage was 64.1% (95% CI: 56.8–70.9%), with no significant difference in the three HDs. The survey coverages were lower than the reported coverages with a significant difference varying from 14.1% to 22.0%. Among those aged 10 years and above, 57.8% (95% CI: 50.2–65.1%) declared having taken the treatment each time during the last five MDAs with no significant difference among HDs, while 9.8% (95% CI: 7.5–12.8%) declared that they had never taken the drug. In multivariate analysis, the most important factors associated with the five-year adherence to treatment were high involvement in CDTI and age (40+ years). Conclusions Despite more than 15 years of CDTI, there was still weak community participation and ownership, a lower coverage than reported and an average five-year adherence in the surveyed HDs. The reinforcement of the community ownership by the Ministry of Public Health officials and the timely procurement of ivermectin as requested by the communities are some measures that should be implemented to improve the therapeutic coverage, adherence to treatment and hence achieve onchocerciasis elimination. Further anthropological and entomological studies would provide better insights into our understanding of the persistence of the disease in these three CDTI projects.
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Affiliation(s)
- Guy-Roger Kamga
- Ministry of Public Health, N°8, Rue 3038 quartier du Lac, Yaoundé, Cameroon. .,Centre for Research on Filariasis and other Tropical Diseases (CRFilMT), P.O. Box 5797, Yaoundé, Cameroon. .,Institut de Recherche Expérimentale et Clinique, Faculté de santé publique, Université catholique de Louvain, Clos Chapelle-aux-champs 30 bte B1.30.13, BE-1200, Brussels, Belgium.
| | - Fanny N Dissak-Delon
- Ministry of Public Health, N°8, Rue 3038 quartier du Lac, Yaoundé, Cameroon.,Centre for Research on Filariasis and other Tropical Diseases (CRFilMT), P.O. Box 5797, Yaoundé, Cameroon.,Institute of Biology of Molecular Medicine, Rue des professeurs Jeener et Brachet 12 BE-6041 Gosselies, Université Libre de Bruxelles, Brussels, Belgium
| | - Hugues C Nana-Djeunga
- Centre for Research on Filariasis and other Tropical Diseases (CRFilMT), P.O. Box 5797, Yaoundé, Cameroon.,Parasitology and Ecology Laboratory, Faculty of Science, University of Yaoundé 1, PO, Box 812, Yaoundé, Cameroon
| | | | - Stephen Mbigha Ghogomu
- Molecular and Cell Biology Laboratory, Department of Biochemistry and Molecular Biology, University of Buea, P.O. Box 63, Buea, Cameroon
| | - Jacob Souopgui
- Institute of Biology of Molecular Medicine, Rue des professeurs Jeener et Brachet 12 BE-6041 Gosselies, Université Libre de Bruxelles, Brussels, Belgium
| | - Joseph Kamgno
- Centre for Research on Filariasis and other Tropical Diseases (CRFilMT), P.O. Box 5797, Yaoundé, Cameroon.,Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, P.O. Box 1364, Yaoundé, Cameroon
| | - Annie Robert
- Institut de Recherche Expérimentale et Clinique, Faculté de santé publique, Université catholique de Louvain, Clos Chapelle-aux-champs 30 bte B1.30.13, BE-1200, Brussels, Belgium
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15
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Boussinesq M, Fobi G, Kuesel AC. Alternative treatment strategies to accelerate the elimination of onchocerciasis. Int Health 2018; 10:i40-i48. [PMID: 29471342 PMCID: PMC5881258 DOI: 10.1093/inthealth/ihx054] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 10/30/2017] [Accepted: 11/14/2017] [Indexed: 02/06/2023] Open
Abstract
The use of alternative (or complementary) treatment strategies (ATSs) i.e. differing from annual community-directed treatment with ivermectin (CDTI) is required in some African foci to eliminate onchocerciasis by 2025. ATSs include vector control, biannual or pluriannual CDTI, better timing of CDTI, community-directed treatment with combinations of currently available anthelminthics or new drugs, and 'test-and-treat' (TNT) strategies requiring diagnosis of infection and/or contraindications to treatment for decisions on who to treat with what regimen. Two TNT strategies can be considered. Loa-first TNT, designed for loiasis-endemic areas and currently being evaluated using a rapid test (LoaScope), consists of identifying individuals with levels of Loa microfilaremia associated with a risk of post-ivermectin severe adverse events to exclude them from ivermectin treatment and in treating the rest (usually >97%) of the population safely. Oncho-first TNT consists of testing community members for onchocerciasis before giving treatment (currently ivermectin or doxycycline) to those who are infected. The choice of the ATS depends on the prevalences and intensities of infection with Onchocerca volvulus and Loa loa and on the relative cost-effectiveness of the strategies for the given epidemiological situation. Modelling can help select the optimal strategies, but field evaluations to determine the relative cost-effectiveness are urgently needed.
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Affiliation(s)
- Michel Boussinesq
- IRD UMI 233-INSERM U1175-Montpellier University, 34394 Montpellier, France
| | - Grace Fobi
- African Programme for Onchocerciasis Control, Ouagadougou, Burkina Faso
| | - Annette C Kuesel
- UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases, Geneva, Switzerland
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