Implementation Challenges of Community Directed Treatment with Ivermectin Program for Control of Onchocerciasis in Ulanga, Tanzania

Mushi, Vivian

doi:10.24248/eahrj.v5i2.661

Cited by 7 publications

(12 citation statements)

References 12 publications

(20 reference statements)

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“…Similar to previous studies in Mahenge (22), Nigeria (23) and Ethiopia (24,25), witchcraft, and supernatural powers were not mentioned as causes of onchocerciasis. This is in contrast with persistent misconceptions about epilepsy in the Mahenge area (20).…”

Section: Discussionsupporting

confidence: 86%

“…All study participants had a basic knowledge about onchocerciasis and used local names to describe the clinical manifestations of the disease. Similar to observations in 2018 in Mahenge, in the villages of Isongo and Uponera, most participants associated the transmission of onchocerciasis with blackflies ("vifuna") (22). Some participants further described that blackflies carrying larvae obtained during a blood meal infect other humans during a subsequent bite.…”

Section: Discussionsupporting

confidence: 63%

“…Such fear is not justified as there is no evidence that ivermectin at the therapeutic dose given during CDTI will affect the persons libido (29). Similarly to a previous study, the acceptability of the CDTI was high among the respondents (22) and the onchocerciasis disease burden was described to have decreased in Mahenge since the implementation of CDTI.…”

Section: Discussionsupporting

confidence: 60%

“…Particularly men were afraid of reduced libido. This was also reported in another study in Tanzania (28). Such fear is not justified as there is no evidence that ivermectin at the therapeutic dose given during CDTI will affect the persons libido (29).…”

Section: Discussionmentioning

confidence: 84%

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Factors associated with low-uptake of ivermectin in Mahenge, an area with high prevalence of onchocerciasis and epilepsy in Tanzania: A qualitative perspective

et al. 2023

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IntroductionDespite over 20 years of community-directed treatment with ivermectin (CDTI) in Mahenge area in Tanzania, the prevalence of onchocerciasis has remained high (over 40% in children 6-10 years using antibody testing and 49% using skinsnips in adults). The area has one of the highest prevalence of epilepsy, exceeding 3.5% in some of rural villages.MethodsBetween June and July 2019, in four rural villages using qualitative methods, we assessed factors potentially associated with the persistence of high Onchocerca volvulus transmission.ResultsEleven focus group discussions were organized with persons with epilepsy and their caretakers, community resource persons, and community drug distributors (CDDs), and two in-depth interviews with district programme coordinators of neglected tropical diseases (NTD). Factors considered being responsible for the persistence of onchocerciasis transmission included not taking ivermectin during CDTI for fear of adverse reactions such as itching, swelling and misconception that the drug causes infertility. Challenges for high CDTI coverage included, long walking distance by CDDs to deliver drugs to households, persons being away for farming, low awareness of the disease including the association between onchocerciasis and epilepsy and limited supervision by the NTD coordinators.ConclusionIvermectin uptake in Mahenge should be optimised by continuous advocacy about the importance of taking ivermectin to prevent onchocerciasisassociated morbidity and by improving supervision during CDTI.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionsupporting

confidence: 63%

Section: Discussionsupporting

confidence: 60%

Section: Discussionmentioning

confidence: 84%

See 2 more Smart Citations

Factors associated with low-uptake of ivermectin in Mahenge, an area with high prevalence of onchocerciasis and epilepsy in Tanzania: A qualitative perspective

et al. 2023

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“…Particularly men were afraid of reduced libido. This was also reported in another study in Tanzania [26]. Such fair is not justified as there is no evidence that ivermectin at the therapeutic dose given during CDTI will not affect the persons libido [27].…”

Section: Discussionmentioning

confidence: 72%

Community Knowledge, Attitudes and Practices Regarding Onchocerciasis in Rural Villages With a High Epilepsy Prevalence in Mahenge, Tanzania: A Qualitative Study

Bhwana¹,

Massawe²,

Mushi³

et al. 2022

Preprint

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Despite of over 20 years of community directed treatment with ivermectin (CDTI), a high prevalence of onchocerciasis and onchocerciasis-associated epilepsy were observed in rural villages in Mahenge, Tanzania. Therefore, we assessed the knowledge, attitude and practice about onchocerciasis in four rural villages in the Mahenge area. This was a qualitative study conducted between June and July 2019. Eleven focus group discussions were organized with persons with epilepsy and their caretakers, community resource persons, and community drug distributors (CDDs), and two in-depth interviews with district programme coordinators of neglected tropical diseases (NTD). Most participants were aware about symptoms of onchocerciasis using local terminologies such as “ukurutu/rough dry skin” and “kuwashwa/itching”. A small proportion of people did not take ivermectin during CDTI for fear of adverse reactions such as itching and swelling. Some men believed that ivermectin may decrease libido. Challenges for high CDTI coverage included, long walking distance by CDDs to deliver drugs to households, persons being away for farming, low awareness of the disease and limited supervision by the NTD coordinators. In conclusion, ivermectin uptake in Mahenge should be optimised by continuous advocacy about the importance of taking ivermectin to prevent onchocerciasis-associated morbidity and by improving supervision during CDTI.

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Onchocerca volvulus microfilariae in the anterior chambers of the eye and ocular adverse events after a single dose of 8 mg moxidectin or 150 µg/kg ivermectin: results of a randomized double-blind Phase 3 trial in the Democratic Republic of the Congo, Ghana and Liberia

Kanza,

Nyathirombo,

Larbelee

et al. 2024

Parasites Vectors

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Background After ivermectin became available, diethylcarbamazine (DEC) use was discontinued because of severe adverse reactions, including ocular reactions, in individuals with high Onchocerca volvulus microfilaridermia (microfilariae/mg skin, SmfD). Assuming long-term ivermectin use led to < 5 SmfD with little or no eye involvement, DEC + ivermectin + albendazole treatment a few months after ivermectin was proposed. In 2018, the US FDA approved moxidectin for treatment of O. volvulus infection. The Phase 3 study evaluated SmfD, microfilariae in the anterior chamber (mfAC) and adverse events (AEs) in ivermectin-naïve individuals with ≥ 10 SmfD after 8 mg moxidectin (n = 978) or 150 µg/kg ivermectin (n = 494) treatment. Methods We analyzed the data from 1463 participants with both eyes evaluated using six (0, 1–5, 6–10, 11–20, 21–40, > 40) mfAC and three pre-treatment (< 20, 20 to < 50, ≥ 50) and post-treatment (0, > 0–5, > 5) SmfD categories. A linear mixed model evaluated factors and covariates impacting mfAC levels. Ocular AEs were summarized by type and start post-treatment. Logistic models evaluated factors and covariates impacting the risk for ocular AEs. Results Moxidectin and ivermectin had the same effect on mfAC levels. These increased from pre-treatment to Day 4 and Month 1 in 20% and 16% of participants, respectively. Six and 12 months post-treatment, mfAC were detected in ≈5% and ≈3% of participants, respectively. Ocular Mazzotti reactions occurred in 12.4% of moxidectin- and 10.2% of ivermectin-treated participants without difference in type or severity. The risk for ≥ 1 ocular Mazzotti reaction increased for women (OR 1.537, 95% CI 1.096–2.157) and with mfAC levels pre- and 4 days post-treatment (OR 0: > 10 mfAC 2.704, 95% CI 1.27–5.749 and 1.619, 95% CI 0.80–3.280, respectively). Conclusions The impact of SmfD and mfAC levels before and early after treatment on ocular AEs needs to be better understood before making decisions on the risk-benefit of strategies including DEC. Such decisions should take into account interindividual variability in SmfD, mfAC levels and treatment response and risks to even a small percentage of individuals. Graphical Abstract

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Implementation Challenges of Community Directed Treatment with Ivermectin Program for Control of Onchocerciasis in Ulanga, Tanzania

Cited by 7 publications

References 12 publications

Factors associated with low-uptake of ivermectin in Mahenge, an area with high prevalence of onchocerciasis and epilepsy in Tanzania: A qualitative perspective

Factors associated with low-uptake of ivermectin in Mahenge, an area with high prevalence of onchocerciasis and epilepsy in Tanzania: A qualitative perspective

Community Knowledge, Attitudes and Practices Regarding Onchocerciasis in Rural Villages With a High Epilepsy Prevalence in Mahenge, Tanzania: A Qualitative Study

Onchocerca volvulus microfilariae in the anterior chambers of the eye and ocular adverse events after a single dose of 8 mg moxidectin or 150 µg/kg ivermectin: results of a randomized double-blind Phase 3 trial in the Democratic Republic of the Congo, Ghana and Liberia

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