Where would I be without ivermectin? Capturing the benefits of community-directed treatment with ivermectin in Africa

Abstract

Objectives: To document peoples' perceptions of the benefits of taking ivermectin, as an important predictor of sustained compliance with long-term ivermectin treatment, and to identify the socio-demographic correlates of perceived benefits of ivermectin treatment.

Methods: Multisite study in Cameroon, DRC, Nigeria and Uganda. A structured questionnaire was administered to 1600 persons randomly selected from household treatment records. Community leaders, community-directed drug distributors (CDDs) and health workers were interviewed using in-depth interview guides, while focus group discussions (FGDs) were held with community members to capture factors that reflected their perception of benefits of community-directed treatment with ivermectin (CDTI). Case histories of persons with special experiences with onchocerciasis were collected.

Results: In this study, 84.7% of respondents indicated that ivermectin treatment has many benefits. The social benefits of CDTI included improved ability to work, peer acceptance and improved school attendance. Other individual benefits included self-respect/esteem, election to political office and improved relationship in the homes. The health benefits included improved skin texture and less ill health. Important demographic factors that influenced perception of the benefits of taking ivermectin, include marital status (P=0.012), age (P=0.029) and length of stay in onchocerciasis-endemic communities (P<0.001). Another factor was individual perception of susceptibility to onchocerciasis infection (P<0.0001).

Conclusion: A programmatic focus on the benefits of CDTI could provide a basis for motivating communities to comply with long-term treatment with ivermectin. The results illustrate the importance of capturing beneficiaries' perceptions towards CDTI as a resource for producing health education materials for increasing the sustainability ivermectin distribution in endemic countries.