Abstract
BackgroundIvermectin-based preventive chemotherapy (PC) is distributed annually to all at-risk populations eligible for ivermectin treatment to control and/or eliminate onchocerciasis. Information on the impact of mass ivermectin administration on onchocerciasis transmission is scanty, and it is tricky to appreciate the progress towards elimination and engage corrective measures. To fill that gap in the Centre Region in Cameroon, the current onchocerciasis endemicity level in the Ndikinimeki Health District after about two decades of mass treatments was assessed.MethodsA cluster-based cross-sectional survey was carried out in the Ndikinimeki Health District and all volunteers aged ≥ 5 years were (i) interviewed on their compliance to ivermectin over the past five years and (ii) underwent clinical (nodule palpation and visual search for onchocercal lesions) and parasitological examinations (skin snip) for onchocerciasis.ResultsThe overall Onchocerca volvulus prevalence was 7.0% (95% CI: 5.2–9.3%). The prevalence of the disease was significantly higher in the communities Kiboum 1 and Kiboum 2 compared to the other communities (highest prevalence in Makénéné Town Water: 8.5%; 95% CI: 2.3–20.4%) (χ2 = 51.314, df = 11, P = 0.0001). The proportion of systematic non-compliers to ivermectin was 23.3% (95% CI: 19.9–27.1%) among individuals interviewed. In the sentinel sites (Kiboum communities), onchocerciasis prevalence decreased from 95.2% (95% CI: 88.3–98.1%) to 23.7% (95% CI: 14.7–36.0%).ConclusionsThis study has revealed that the Ndikinimeki Health District is hypo-endemic for onchocerciasis after about two decades of preventive chemotherapy. However, transmission is ongoing, with potential hotspots in the Kiboum 1 and Kiboum 2 communities, which are known as first-line communities (closest to the breeding sites of the vector). Alternative or complementary strategies to annual ivermectin appear compulsory to accelerate the momentum towards onchocerciasis elimination.
Highlights
Ivermectin-based preventive chemotherapy (PC) is distributed annually to all at-risk populations eligi‐ ble for ivermectin treatment to control and/or eliminate onchocerciasis
A total of 603 participants aged 5 to 88 (median: 32; interquartile range (IQR): 42) years were examined in 12 clusters of the six Health Areas of the Ndikinimeki Health District
The prevalence of onchocerciasis was significantly higher in the Boutourou Health Area (21.6% (χ2 = 48.708, df = 5, P = 0.0001), among males (11.1%; 95% confidence interval (CI): 7.7–15.1%) (χ2 = 16.301, df = 1, P = 0.0001) and among younger adults (20–34 yearsold) (18.3%; 95% CI: 11.0–27.6%) (χ2 = 25.727, df = 3, P = 0.0001) (Table 1)
Summary
Ivermectin-based preventive chemotherapy (PC) is distributed annually to all at-risk populations eligi‐ ble for ivermectin treatment to control and/or eliminate onchocerciasis. In Cameroon, onchocerciasis is endemic in all the ten regions with approximately six million people infected and about 60% of the population living in high risk areas for the disease [3]. This disease is caused by the parasitic nematode Onchocerca volvulus and transmitted via the bites of female blackflies of the genus Simulium during blood-feeding. People at highest risk of acquiring onchocerciasis are those living or working near fast-flowing and well-oxygenated streams or rivers appropriate to blackfly breeding This infection rarely causes death but imposes suffering, stigmatization, and hardship to affected individuals and communities. The pathogenesis of the diseases is essentially due to microfilariae, while adult worms usually induce no pathology or stimulate the development of characteristic subcutaneous nodules
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