Onchocerca volvulus/Loa loa co-infection in rural communities of southeast Nigeria-Implication for ivermectin therapy

Abstract

Background: Ivermectin therapy for onchocerciasis poses a great danger to health in areas that are co-endemic with Loa loa. Individuals with high microfilarial loads of Loa loa are at increased risk of neurologic serious adverse (SAE) events following ivermectin treatment against onchocerciasis. RAPLOA (Rapid Assessment Procedure for loiasis), is a very useful tool to identify areas at potential risk of Loa loa post ivermectin treatment encephalopathy. Several rural communities in Ebonyi state are edemic for onchocerciasis with suspected cases of loaisis. Ivermectin distribution in going on. Methods & Materials: The survey was carried out from 29th April to 16th May, 2015 using the standard procedure as outlined in the Guidelines for the Rapid Assessment of Loa loa. Fifty-seven villages in 13 local government areas of Ebonyi state, southeast Nigeria were covered. The Rapid Assessment Procedure for loiasis was based on the restricted definition of the eye worm; the past experience of eye worm, confirmed by a photograph of Loa loa adult worm in the white part of the eye and with the duration of the most recent episode being between 1 to 7 days The questionnaires were administered in the English language, pidgin English, and the local dialect and where necessary, interpreters from the community assisted in the interview process according to the RAPLOA guidelines. Results: Out of the 57 villages surveyed, 11 exceeded the 40% prevalence. They are as follows: Ohofia Agba, Ishielu – 55%, Okpoto, Ishielu - 45%, Agodo, Ohaukwu - 42.5%, Omocha Emezam Amoffia, Ohaukwu - 47.5%, Ndierukwu, Izzi - 51.3%, Ndiokpoto, Izzi - 45%, Ndiaja Ndiagu Okpoitumo, Abakaliki - 43.8%, Afikpo, Ivo - 43.8%, Ezeigwu Itim, Afikpo North - 50%, Okpo Ezi, Afikpo South - 51.3%, Unwana, Afikpo North- 41.3% respectively.These endemic villages are distributed in 7 out of the 13 local government areas of Ebonyi state. They are; Ishielu, Ohaukwu, Izzi, Abakaliki, Ivo, Afikpo North, and Afikpo South Conclusion: Sensitization/mobilization was found to be poor in some places. Adequate mobilization is critical to the success of a survey of this nature and must be seen to have been achieved before embarking on the survey.