Abstract
BackgroundOnchocerciasis control in Côte d’Ivoire started with aerial insecticide spraying in 1974 and continued with community directed treatment with ivermectin (CDTi) from 1992 to the present. Onchocerciasis and lymphatic filariasis (LF) are co-endemic in 46 of the 81 health districts in the country. Fourteen and 12 districts are endemic for only LF or onchocerciasis, respectively. This paper aims to review the impact of past interventions on onchocerciasis in Côte d’Ivoire between 1975 and 2013, and review plans for disease elimination.MethodsWe reviewed microfilaria (MF, skin snip) prevalence and community microfilarial load (CMFL) data from published reports from 53 health districts during two major epidemiological assessment periods. Data from 1975 through 1991 provided information on the impact of vector control, and data from 1992 through 2016 provided information on the impact of CDTi.ResultsWeekly aerial insecticide spraying in 8 endemic districts between 1975 and 1991 reduced the overall MF prevalence by 68.1% from 43.5% to 13.9%. The CMFL also decreased in 7 out of 8 surveyed communities by 95.2% from 9.24 MF/snip to 0.44 MF/snip. Ivermectin distribution started in 1992. The coverage targets for control (65% of the total population) was reached in most endemic districts, and some areas achieved 80% coverage. Two sets of surveys were conducted to assess the impact of CDTi. Results from the first repeat surveys showed a significant decrease in overall MF prevalence (by 75.7%, from 41.6% to 10.1%). The second follow-up evaluation showed further improvement in most endemic districts and also documented major reductions in CMFL compared to baseline.ConclusionsExtensive data collected over many years document the very significant impact of interventions conducted by the National Onchocerciasis and other Eyes Diseases Control Programme during challenging times with periods of civil unrest. The Health Ministry has now integrated efforts to control neglected tropical diseases and adopted the goal of onchocerciasis elimination.
Highlights
Onchocerciasis is a serious public health problem that has hindered socioeconomic development in endemic areas in sub-Saharan Africa [1]
Aerial insecticide spraying in 8 endemic districts between 1975 and 1991 reduced the overall MF prevalence by 68.1% from 43.5% to 13.9%
Extensive data collected over many years document the very significant impact of interventions conducted by the National Onchocerciasis and other Eyes Diseases Control Programme during challenging times with periods of civil unrest
Summary
Onchocerciasis ( known as “river blindness”) is a serious public health problem that has hindered socioeconomic development in endemic areas in sub-Saharan Africa [1]. The disease is caused by the filarial parasite Onchocerca volvulus that is transmitted by Simulium black flies. The initial efforts of the Onchocerciasis Control Programme in West Africa (OCP) focused on vector control through aerial application of larvicides in black fly breeding sites from 1974 to 1992 in 11 West African countries [4]. Since 1987 the recommended control strategy for onchocerciasis in Africa has been annual or semi-annual mass treatment with ivermectin, which kills the microfilarial progeny that cause skin disease and blindness. From 2002, when OCP was taken over by the African Programme for Onchocerciasis Control (APOC) through 2015 when APOC closed, more than 1 billion ivermectin treatments were administered, and more than 2 million cases of blindness were prevented [5]. This paper aims to review the impact of past interventions on onchocerciasis in Cote d’Ivoire between 1975 and 2013, and review plans for disease elimination
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