Ivermectin Distribution and the Cultural Context of Forest Onchocerciasis in South Province, Cameroon

Abstract

Abstract. This investigation examined the cultural context of forest onchocerciasis in several communities in the Dja-Lobo Division of southern Cameroon. The study sought to elucidate behaviors that would enhance or diminish health status relative to forest onchocerciasis and other filarial infections, and to make culturally sensitive and appropriate recommendations regarding the development of health education materials and the long-term sustainability of the ivermectin distribution program in Dja-Lobo. The study consisted of two sequential components; the first was a qualitative study of a few severely affected villages and the second was a quantitative study of 2I2 randomly selected heads of households from eight villages. The Boulou and Baka peoples in these communities defined general filariasis (minak) as small worms under the skin, identified flies as important transmitters of the illness, and indicated that blindness and other skin and ocular problems were a consequence of the illness. Illness of the Dja (referring to an illness found near the Dja River) was another illness that was closely linked to onchocerciasis; local people indicated it was transmitted by the black flies found near the Dja River, resulting in severe itching and leopard skin. These and other cultural-behavioral data on filariasis were used to implement a health education and distribution program. The informants that identified flies as important vectors for filariasis were asked to specify which species of fly. Most The Baka in the qualitative village study were the first to suggest that leopard skin (ngangambo ) was not linked to filaria (bibili), but rather to illness of the Dja, and sometimes old age. The village study was almost finished when this was mentioned, but it was discussed with several Boulou and they concurred that a primary cause of leopard skin (menve) was illness of the Dja caused by living close to the Dja, getting bitten by black flies, scratching the bites, the bites getting infected and eventually healing. The white spots on the skin were perceived as scarification that takes place as the skin healed.Signs and consequences. Figure 1 summarizes knowledge of the signs and symptoms of filariasis. Virtually all respondents associated itching (eeyae) and a rash (mebib) with minak (filariasis) and more than 6OVo also recogmzed swelling of the skin and leopard skin (menve) as manifestations of filariasis. With respect to ocular manifestations, nearly all respondents said that swelling and redness of the eye, as well as diminished vision and blindness were consequences of filariasis. Also very important was that virtually all believed that a worm could migrate across the eye with filariasis.

Perception and attitude of people toward onchocerciasis (river blindness) in south western Nigeria

“…Most people with the disease live in rural areas beyond the reach of government health services. This scenario is similar to studies in Cameroon8 and the Edo State of Nigeria 9. The majority of the respondents were aware of the menacing disease, hence its local name “Inarun” (fire from heaven) which depicts the characteristic unsightly hypo-/hyperpigmented skin lesions.…”

“…Hence, a majority (71.6%) of the respondents attributed the disease to an obvious skin infection. This is similar to the Cameroon study8 where 60% recognized “leopard” skin as manifestation of onchocerciasis. Unlike the Cameroon study where 90% were aware that the black fly was responsible for transmission, the level of awareness in our study was low, with only 2.4% of the respondents associating a blackfly bite with onchocerciasis.…”

Loiasis — a neglected and under-estimated affliction: endemicity, morbidity and perceptions in eastern Cameroon

“…Although each ethnic group has a different name for eye-worm, most of these names are simply derived from the terms for 'worm' and 'eye'. That the signs and symptoms of L. loa infection are generally well known in the affected communities of Eastern province (55) should facilitate any community involvement in the local control of L. loa and any related health education and promotion (Hewlett et al, 1996). The translations of the local names for Calabar swellings were less consistent than those of the names for eye worm.…”

A quantitative analysis of the socio-economic determinants of health seeking behaviour related to bancroftian filariasis and its impact on elimination: a case-control study in Pondicherry, India

“…Therefore, by imparting health education on disease prevention, diagnosis and treatment, awareness about mosquito breeding and control can be achieved. This has been emphasized in other studies also (Ramaiah et al 1996;Eberhard et al 1996;Hewlett et al 1996). Similarly, it is clear that in addition to knowledge on various aspects of the disease, standard of living, which is clearly a function of income, plays a major role in achieving effective prevention practice against mosquito biting.…”