Abstract
The African Program for Onchocerciasis Control (APOC) was launched in 1995 with the main goal being to boost the fight against onchocerciasis in Africa. In 2011, over 80 million people benefited from this intervention thanks to the contribution of 268.718 Community-Directed Distributors (CDD). These significant results obscure the role of women CDD in this fight. Indeed, the insufficient involvement of female CDD has been identified as a concern by the APOC partners early in the program. The present study aims to assess the contribution and performance of women involved in a strategy to control onchocerciasis by community-directed treatment with ivermectin in sub Saharan Africa. We searched the following electronic databases from January 1995 to July 2013: Medline, Embase (Excerpta Medica Database), CINAHL (Cumulative Index to Nursing and Allied Health Literature), LILAS (Latin American and Caribbean Literature on Health Sciences), International Bibliography of Social Sciences, Social Services s, and Sociological s. Two research team members independently conducted data extraction from the final sample of articles by using a pre-established data extraction sheet. The primary outcome was the contribution of female CDD in the control of onchocerciasis by community-directed treatment with Ivermectin. Of 25 hits, 7 papers met the inclusion criteria. For the management of onchocerciasis, female CDDs are elected by the health committee from the communities they will serve. The significant proportion of those treated (about 61%) were women, although only 24% of CDDs were women. Many community members reported that women were more committed, persuasive and more patient than men in the distribution of ivermectin. Some studies have identified underutilization of female CDD as one reason for the limited effectiveness or, in some cases, pure failure related to the distribution of Ivermectin interventions in the fight against onchocerciasis in sub-Saharan Africa. Evidence from this review suggests that female CDD contribute to the treatment of onchocerciasis with Ivermectine in sub-Saharan Africa. Large-scale rigorous studies including Randomized controlled trials (RCTs) are needed to compare Community-Directed intervention involving men and women CDDs.
Highlights
Onchocerciasis is a neglected tropical disease caused by the parasite Onchocerca volvulus, which is transmitted by the black fly [1]
The following search strategy was modified for the various databases and search engines: («contribution» OR «role» OR «impact» AND «female CommunityDirected Distributors» OR «female Community Distributors» OR «female Community Health Worker» OR «Lay Health Worker» OR « female Community Health Aide » OR « female Community Worker » OR «female Village Health Worker» OR « female Barefoot Doctor» AND «treatment» OR «distribution» AND «Ivermectin» OR «Mectizan» AND «Onchocerciasis» OR «Onchocerca volvulus» AND «Sub Saharan Africa» OR «Endemic country»)
This is good because women are hard working and we always appreciate them" In Kilosa district, a village leader at Zombo Playa had this to add"Community-directed treatment with ivermectin selection considers gender balance whereby, from each hamlet they are supposed to have two Community-Directed Distributors (CDD), a man and a woman" [13]
Summary
Onchocerciasis is a neglected tropical disease caused by the parasite Onchocerca volvulus, which is transmitted by the black fly [1]. In 2011, over 80 million people of 103 million have benefited from this intervention in 16 countries thanks to the contribution of 682.091 Community-Directed Distributors [4] These significant results obscure the role of female Community-Directed Distributor (CDD) in this fight. The general objective was to assess the contribution and performance of women involved in a strategy to control onchocerciasis by CommunityDirected Treatment with Ivermectin in Africa. Specific objectives were assess and compare the performance of female and male CDD regarding; coverage and speed of distribution, referral and follow-up of absentees and non eligible people; evaluate perceived benefits to communities as a result of active female involvement in communitydirected intervention; and identify factors in the existing health services which promote, support or hamper female involvement
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