Knowledge, attitudes and practices during a community-level ivermectin distribution campaign in Guatemala

Abstract

Community acceptance and participation are essential for the success of mass ivermectin chemotherapy programmes for onchocerciasis (river blindness). To explore the local understanding of the purpose of ivermectin and willingness to continue taking the drug, we performed questionnaire surveys in four communities with hyperendemic onchocerciasis after each of three ivermectin treatment rounds. More than 100 respondents participated in each KAP survey, representing the heads of 30% of the households in each community. The respondents rarely stated that the goal of the ivermectin treatment programme was to prevent visual loss. Instead, they said they were taking the drug for their general well-being, to cure the onchocercal nodule (filaria), or to cure the microfilaria, a term newly introduced by agents of the treatment programme. The principal reason identified for refusal to take ivermectin was anxiety about drug-related adverse reactions, and there were marked differences between communities in acceptance of treatment. In one community over 50% of residents initially refused to take ivermectin, although participation rates improved somewhat after programmatic adjustments. We recommend that ivermectin distribution programmes establish surveillance activities to detect where acceptance is poor, so that timely and community-specific adjustments may be devised to improve participation.

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

“…We agree with Richards et al 15. that community acceptance and participation are essential for the success of mass ivermectin chemotherapy programme for onchocerciasis.…”

Knowledge, practices and perceptions of geo-helminthes infection among parents of pre-school age children of coastal region, Kenya

“…Recent studies support that both individual and community perceptions and attitudes of parasitic worm infections and their prevention and treatment are important factors [16, 18–19]. Although it is recognized that the control and prevention of parasitic diseases depend upon adequate knowledge of human behaviour [18] the literature on this subject is limited and few studies have considered people's perceptions and attitudes toward worm infection, treatment and control [20–21]. …”

One Hundred Years After Its Discovery in Guatemala by Rodolfo Robles, Onchocerca volvulus Transmission Has Been Eliminated from the Central Endemic Zone

“…In the 1990s, several key studies seeking to determine how to best use ivermectin MDA to break O. volvulus transmission were conducted in the CEZ by MSPAS, CDC, the UVG, the University of Arizona, and other partners. 10,12,13,34 The OEPA strategy of providing at least semiannual (every 6 month) treatment rounds in all affected communities, each achieving "effective" (≥ 85% directly observed treatment of eligibles) coverage, was based largely on the findings from these studies. An important challenge was that ivermectin, a potent oral microfilaricidal drug, is not immediately lethal to the adult O. volvulus worms.…”

“…The area is largely populated by people of Mayan Indian descent who make their living by working on large coffee or tea estates (fincas). 6,10 There are 321 endemic communities in the CEZ, with a total population at risk of onchocerciasis during the last year of MDA (in 2011) calculated to be 124,498, and a treatment eligible population (which excludes pregnant women and children under 5 years of age) of 112,338 persons. Over 90% of the population and communities are in two provinces: Suchitepéquez and Chimaltenango (Table 1).…”

“…6 Within 1 year of the 1987 Merck donation of the oral microfilaricidal medicine ivermectin (Mectizan Merck & Co., Whitehouse Station, NJ) to treat onchocerciasis, these brigades initiated mass drug administration (MDA) in parts of the CEZ; in 1990, the MSPAS adopted MDA, with related health education, as the primary intervention for all onchocerciasis-endemic areas of the country. 10 In this report, we review the history of the CEZ MDA program and the monitoring and evaluation activities that led to a 2015 declaration that transmission of O. volvulus had been eliminated, based on fulfillment of the 2001 World Health Organization (WHO) guidelines for elimination of onchocerciasis.…”