Additional file 2: of Progress towards onchocerciasis elimination in the participating countries of the African Programme for Onchocerciasis Control: epidemiological evaluation results

ONCHOSIM simulations: brief model description, input assumptions and simulations that were done (DOCX 64 kb

Additional file 1: of Progress towards onchocerciasis elimination in the participating countries of the African Programme for Onchocerciasis Control: epidemiological evaluation results

Multilingual abstracts in the six official working languages of the United Nations. (PDF 732 kb

Factors Associated with Ivermectin Non-Compliance and Its Potential Role in Sustaining <i>Onchocerca volvulus</i> Transmission in the West Region of Cameroon

<div><p>Background</p><p>Community Directed Treatment with ivermectin is the cornerstone of current efforts to eliminate onchocerciasis. However recent studies suggest there are foci where long-term annual distribution of the drug alone has failed to ensure elimination thresholds are reached. It is important to achieve high levels of compliance in order to obtain elimination targets. An epidemiological and entomological evaluation conducted in the western region of Cameroon in 2011 revealed that two health districts remained with a high prevalence of infection, despite long-term distribution of ivermectin since 1996. This paper explores potential factors that may have contributed to the non-interruption of transmission, focusing on ivermectin treatment compliance and the importance of systematic non-compliance within the population.</p><p>Methodology/Principal findings</p><p>A mixed methods approach was used, including a population-based survey to assess treatment compliance and factors associated and qualitative assessments including focus group discussions and in-depth interviews with key programme stakeholders and drug distributors. Compliance was reported at 71.2% (95%CI: 61.7–79.2%;n = 853/1198). The key factors related to compliance in the most recent round related to either programmatic and delivery issues, primarily absenteeism at the time of the campaign or alternatively individual determinants. An individual’s experience of side effects in the past was strongly associated with non-compliance to ivermectin. Other factors included ethnicity, how long lived in the village and age. There was a high percentage of reported systematic non-compliance at 7.4% (95% CI: 4.3–12.3%; n = 86/1165), higher amongst females. This group may be important in facilitating the sustainment of on-going transmission.</p><p>Conclusions/Significance</p><p>Efforts to reduce the number of systematic non-compliers and non-compliance in certain groups may be important in ensuring the interruption of transmission in the study area. However, in areas with high pre-control force of transmission, as in these districts, annual distribution with ivermectin, even if sustaining high levels of compliance, may still be inadequate to achieve elimination. Further studies are required to better understand the transmission dynamics and focus of on-going transmission in the study districts.</p></div

Adjusted odds ratios for the association of various explanatory variables and ivermectin compliance (multi-variate analysis).

<p>Adjusted odds ratios for the association of various explanatory variables and ivermectin compliance (multi-variate analysis).</p

Geographic and therapeutic treatment rates in Massangam and Foumbot from 2004 to 2014.

<p>(Source: Respective district health officials, 2016).</p

Main reasons for not taking ivermectin during last mass drug administration round given during quantitative survey.

<p>Main reasons for not taking ivermectin during last mass drug administration round given during quantitative survey.</p