Onchocerciasis in the Democratic Republic of Congo: Survey of knowledge, attitude and perception in Bandundu province

Abstract

A community-directed treatment with ivermectin (CDTI) for fighting onchocerciasis was started in 2003 in the hyperendemic province of Bandundu, Democratic Republic of Congo (DRC); such initiative was supported by the African Programme for Onchocerciasis Control (APOC). As the APOC stopped at the end of 2015, there was an urgent need to assess the sustainability of an ivermectin treatment. A cross-sectional survey of knowledge, attitude and perception was conducted to determine the awareness level of local population regarding the disease. A multi-stage random sampling technique allowed the selection of 450 heads of households. Most respondents (96.9%) knew about onchocerciasis as a disease. The black-fly was viewed as the causing agent of onchocerciasis by 49.9% of respondents. The most commonly cited clinical manifestations were nodules (34.4%) and pruritus (31.1%), while blindness was the most frequently reported complication (90.7%). Approximately 55.1% of respondents had a good knowledge of onchocerciasis and CDTI. Overall, only 37% of participants had a favourable attitude and 46% a positive perception. Good knowledge was associated with school attendance (adjusted OR=1.9, 95%CI: 1.3-2.8, p=0.001), while education and continuation of treatment were related with good attitude (adjusted OR=9.7, 95%CI:4.8-19.5 and adjusted OR=19.8, 95%CI: 9.7-40.6, respectively, both with p<0.001). Good perception was associated with being at least 46 years old, non-Catholic and continuing the treatment (adjusted OR=3.2, 95%CI:1.2-9.1; adjusted OR=29.6, 95%CI:14.1-62.2 and adjusted OR=5.1, 95%CI:1.6-16.0 respectively, all with p<0.001). A good level of knowledge, attitude and perception is needed for a massive adherence of population to onchocerciasis control programmes. In the area of study (Moanza, DRC), good attitude and perception motivated the continuation of treatment in the population. In the future, different plans should focus on educational strategies to maintain a massive adherence and reduce onchocerciasis prevalence.

Reaching the last mile: main challenges relating to and recommendations to accelerate onchocerciasis elimination in Africa

“…Emphasis should be given to identifying systematic non-compilers. A community’s awareness and correct perception of onchocerciasis and MDA is important for successful implementation and sustainability of a CDTI program [197]. Community-based social research is also needed to determine the community’s awareness and perception of onchocerciasis [74] and other factors contributing to program weakness [45].…”

Review of the National Program for Onchocerciasis Control in the Democratic Republic of the Congo

“…Several authors mentioned the presence of the disease vector in these foci, in particular by the Simulium of the damnosum complex ( S. squamosum ), but also S. albivirgulatum [26,27]. APOC reported that the DRC is a global reservoir of onchocerciasis [28] in which almost 38 million people are at risk [11], of whom approximately 13 million were affected in 2013; the number of people blinded was estimated at 70 thousand [17,28,29,30]. The most recently available data in the 2016 study Global Burden of Disease (GBD) estimated a global prevalence of 14.65 million [2] people, including 12.22 million suffering from the skin disease and 1.03 million cases of sight loss due to onchocerciasis [2].…”

Community Participation in and Perception of Community-Directed Treatment with Ivermectin in Kinshasa, DRC

“…According to WHO, HZ is defined as the operational unit whose development remains the prerequisite for implementing health policy, HA is a well delimited geographic entity composed of several villages in rural areas/several streets in urban environments, established according to sociodemographic affinities, and the district is the level where health policies and health sector reforms are interpreted and implemented [5].…”

“…On the socio-economic level, it leads to the abandonment of work, the depopulation of fertile lands, and various other consequences up to the loss of social status (rejection and stigmatization), especially when the afflicted becomes blind [4]. It leads to absenteeism among school children and deprives them of their youth since they become, in certain regions, the “seeing eye guides” of blind people [5]. Onchocerciasis is one of eleven neglected tropical diseases (NTDs), recently targeted by the World Health Organization (WHO) for elimination out of the twenty existing ones, affecting poor populations living in the tropics and subtropics areas [6].…”