Predictors of compliance with community-directed treatment with ivermectin for onchocerciasis control in Kabo area, southwestern Ethiopia

Abstract

BackgroundCompliance with annual ivermectin treatment is a major challenge in community-directed treatment with ivermectin (CDTI) implementation. There are individuals who do not comply with the annual mass treatment, which contributes to the continuity for disease transmission. Hence, ensuring high treatment coverage and sustained compliance should be given due emphasis in the control of onchocerciasis. The aim of this study was to determine CDTI compliance rate and predictors of compliance where the CDTI was in its 9th round in Kabo area, southwestern Ethiopia.MethodsCommunity-based cross-sectional study was conducted in Kabo area, three weeks after the 9th round of annual ivermectin distribution. Systematic random sampling was used to select head of households and structured, pre-tested questionnaire was used to interview the study participants. Data was analyzed using SPSS version 16. Descriptive statistics was used to compute mean and standard deviation of continuous variables and frequency for categorical variables, while bivariate and multivariate logistic regressions were used to assess the effects of independent variables on the outcome variable. Variables which showed association in multivariate analysis were considered as final predictors of compliance and strength of association was measured through adjusted odds ratio (AOR).ResultsA total of 308 respondents (age range 18-70, mean age ± SD, 32.21 ± 9.64) participated in the study. Of these, 249 (80.8%) reported that they took ivermectin during the 9th round annual treatment. Significantly higher rate of treatment compliance was reported by participants age ≥35 years (AOR = 5.48, 95% CI; 1.97 - 15.23), participants who stayed in the area for more than ten years (AOR = 3.86, 95% CI; 1.83- 8.11), participants who perceive that they are at risk of contracting the disease(AOR = 7.05, 2.70- 18.43), participants who perceive community drug distributors (CDDs) are doing their work well (AOR = 2.35 95% CI; 1.15- 4.83) and participants who know at least one CDD in their village (AOR = 2.83, 95% CI; 1.26- 6.40).ConclusionThe majority of the study participants in the present study area complied with ivermectin treatment. Nevertheless, intervention packages should consider factors such as age, residence duration and community’s perception of the disease to improve compliance and make drug distribution sustainable.

Adherence to ivermectin is more associated with perceptions of community directed treatment with ivermectin organization than with onchocerciasis beliefs

“…Multivariable regression analysis revealed a strong association between CDTI program perception and adherence (adjusted for age, sex, location and duration of stay in the village), whereas the association between beliefs on onchocerciasis and ivermectin adherence was not significant in this study. These findings are consistent with those of recent authors who found that strong predictors of adherence were related to perception on CDTI program, especially perception of CDDs work [ 10 , 11 , 16 , 17 ].…”

“…For instance in a zone of 50% of onchocerciasis prevalence, there are 50% of “healthy” people (but with high risk of developing the disease) who have to comply in a yearly treatment which is accompanied by constraints such as stop alcohol intake the day of treatment, and potential side effects including tiredness with resultant impact in their daily activities, knowing that alcohol consumption and fear of side effects are documented reasons for ivermectin avoidance [ 13 , 14 ]. More generally, the main factors associated with compliance to ivermectin found in the literature include non-modifiable characteristics like age and gender, and also modifiable factors such as perceived susceptibility to onchocerciasis, perception of program organization, social influence and support, and perceived benefits and risks of ivermectin [ 10 , 12 , 15 – 17 ].…”

Knowledge, Attitude and Practices Towards Onchocerciasis Prevention and Control in Bench Maji Zone, South Western Ethiopia

“…Respondents socio-demographic characteristics in the study area In the present study the highest percentage of male (55 %) than female (45 %) was observed, which was in a good agreement with the results of various scholars in the country (Dana et al, 2015;Adugna et al, 2015;Fitsum et al, 2016). The result on educational level obtained in the current study indicated majorities (32.9 %) were attained primary education, which was also in line with the findings of Fitsum et al (2016).…”

Determinants of community-led ivermectin treatment adherence for onchocerciasis control in Western Ethiopia: a case-control study

“…The odd of ivermectin treatment adherence was 2.1 times more in individuals' perceived threat of contracting onchocerciasis as serous disease. This finding is compliment with other scholarly findings [16,22,23,25,28,32,33,36]. This might be attributed to the fact that if communities' vulnerability to onchocerciasis is anticipated to be high then the uptake of the CLTI program is also high.…”

“…Various theories and studies suggested that adherence to onchocerciasis treatment with ivermectin was associated with sex [21,22], ethnicity [21,23], age [21][22][23], length of stay [21,23], familiarity of community-directed drug distributer [23], fear of drug side effects [21], perceived needs of support for intake of ivermectin [22,23], perceived performance of community drug distributer [21,23,24], religion [22], education [22], risk perception to oncocerciasis [23], measuring height the best way to determine a person's treatment dose [24], educational level [25], and perceived effectiveness of onchocerciasis treatment with ivermectin [21,23].…”