RESUMEN
Community-directed treatment is a relatively new strategy that was adopted in 1997 by the African Programme for Onchocerciasis Control (APOC), for large-scale distribution of ivermectin (Mectizan). Participatory monitoring of 39 of the control projects based on community-directed treatment with ivermectin (CDTI) was undertaken from 1998-2000, with a focus on process implementation of the strategy and the predictors of sustainability. Data from 14,925 household interviews in 2314 villages, 183 complete treatment records, 382 focus-group discussions, and the results of interviews with 669 community leaders, 757 trained community-directed drug distributors (CDD) and 146 health personnel (in 26 projects in four countries) were analysed. The data show that CDD dispensed ivermectin to 65.4% of the total population (71.2% of the eligible population), with no significant gender differences in coverage (P > 0.05). Treatment coverage ranged from 60.2% of the eligible subjects in Cameroon to 76.9% in Uganda. There was no significant relationship between the provision of incentives to CDD and treatment coverage (P > 0.05). The frequency of treatment refusal was highest in Cameroon (29.2%). Although most (72.1%) of the communities investigated selected their CDD on the basis of a community decision at a village meeting, only 37.9% chose their distribution period in the same way. There is clearly a need to improve communication strategies, to address the issues of absentees and refusals, to emphasise community ownership and to de-emphasise incentives for CDD. The investigation of the 'predictor indicators' of sustainability should enable APOC to understand the determinants of project performance and to initiate any appropriate changes in the programme.
Asunto(s)
Servicios de Salud Comunitaria/normas , Filaricidas/uso terapéutico , Cooperación Internacional , Ivermectina/uso terapéutico , Oncocercosis Ocular/prevención & control , Adolescente , Adulto , África , Femenino , Encuestas Epidemiológicas , Humanos , MasculinoRESUMEN
Human onchocerciasis is reported to occur in all States of the Federal Republic of Nigeria with serious medical, social and economic impact on affected communities. Attempted control schemes have failed because of reinvasion caused by limited area coverage, short duration of the scheme and non-involvement of the affected communities. As the Nigeria National Onchocerciasis Control Programme (NOCP) takes off with baseline data collection, it is essential to point out the need for community participation in the programme. Information obtained from group interviews in 8 villages in Akamkpa Local Government Area of Cross River State, Nigeria, reveal that ignorance of the cause of onchocerciasis. Location of villages and farms near fast flowing waters and outdoor working habits, have resulted in continued endemicity of the disease in the affected poor farming communities. For successful control of the disease, the communities should be involved in all stages of the control programme. During the preparatory stage, control officials should carry out intensive health education; encourage, and assist in, formation of village health committees (VHC) and selection of village based workers (VBW); and work with the VHC and VBW in developing skeletal control plans and deciding on input from community. During screening for prevalence, communities will, if adequately mobilized, accommodate field workers, act as field guides and interpreters and cooperate despite conflicting religions and traditional beliefs and practices. Before chemical treatment of breeding sites of Simulium, permission will be required from the communities, members of which will, if trained, take part in the exercise.(ABSTRACT TRUNCATED AT 250 WORDS)