Abstract
The African Programme for Onchocerciasis Control (APOC), the main objective of which was the Community-Directed Treatment with Ivermectin (CDTI), was closed by the end of 2015. The purpose of this study was to describe untreated villages in DRC and to assess the factors associated with the absence of CDTI in endemic villages, between 2001 and 2014. This retrospective study was descriptive. Several annual technical reports of the National Onchocerciasis Task Force (NOTF) and national technical reports of CDTI projects were analysed; 21 projects implemented to control the disease were considered, representing the coverage of 42,778 endemic villages. Data were collected over a 3 month-period, between October and December 2016. Only 15,700 endemic villages were not treated through an annual CDT with Mectizan, i.e. 36.7%. The population at risk totalled 29,712,381 individuals and 7,681,995 of them were not treated, i.e. 25.9%. Eight projects recorded high proportions of untreated villages, i.e. 7,100 endemic entities (16.6%). Factors independently associated with non-treatment were the fear of serious side effects (adjusted OR: 10.6; 95% CI: 4.5-27.7), supply impaired by insecurity (adjusted OR: 15.9; 95% CI: 6.7-41.4) and geographical inaccessibility (adjusted OR: 19; 95% CI: 6.9-63.9). After 15 CDTI-cycles in DRC, the mean geographical coverage and therapeutic coverage rates reached 63.3% and 74.1%, respectively. The 2025 target of onchocerciasis eradication, as advocated by APOC, will not be reached. Untreated areas are partly responsible for such results. Many weaknesses persist in the National Program for Onchocerciasis Control (NPOC) and new strategies of disease control should be investigated.
Highlights
The African Programme for Onchocerciasis Control (APOC), the main objective of which was the Community-Directed Treatment with Ivermectin (CDTI), was closed by the end of 2015
Study design Our study focused retrospectively on the 21 projects implemented between 2001 and 2014 that covered 42,778 villages endemic with onchocerciasis which participated in the Community-Directed Treatment (CDT) with Mectizan
Over the 21 projects implemented to ensure the coverage of 42,778 onchocerciasis-endemic villages, beneficiaries of 15 cycles-CDTI, 15,700 entities were not treated, i.e. 36.7%
Summary
The African Programme for Onchocerciasis Control (APOC), the main objective of which was the Community-Directed Treatment with Ivermectin (CDTI), was closed by the end of 2015. The purpose of this study was to describe untreated villages in DRC and to assess the factors associated with the absence of CDTI in endemic villages, between 2001 and 2014. Several annual technical reports of the National Onchocerciasis Task Force (NOTF) and national technical reports of CDTI projects were analysed; 21 projects implemented to control the disease were considered, representing the coverage of 42,778 endemic villages. Human beings acquire the infection through the bites of black flies, i.e. Simulium damnosum species complex, which carry infective larvae of Onchocerca volvulus [2] They are the definitive host of the parasite whereas simuliid vectors feed on a range of animals. Its pathogeny is closely related to the immune reaction caused by dead or young immature microfilariae in skin and eyes Murdoch referred to it as a chronic systemic disease [4]
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