Audit of the community-directed treatment with ivermectin (CDTI) for onchocerciasis and factors associated with adherence in three regions of Cameroon.
Audit of the community-directed treatment with ivermectin (CDTI) for onchocerciasis and factors associated with adherence in three regions of Cameroon.
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DOI：
10.1186/s13071-018-2944-z
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发表时间：
2018-06-19
影响因子：
3.2
通讯作者：
Robert A
中科院分区：
文献类型：
--
作者：
Kamga GR;Dissak-Delon FN;Nana-Djeunga HC;Biholong BD;Ghogomu SM;Souopgui J;Kamgno J;Robert A
在喀麦隆的伊维菌素社区定向治疗项目1、沿岸的2和西伊维菌素社区定向治疗项目中，经过15年多的治疗后，2011年进行的流行病学评价显示，盘尾丝虫病在一些社区的流行率仍然很高。为了调查解释这种高流行率的潜在原因，2015年4月至5月在三个卫生区（HD）进行了一项集群覆盖率调查，以评估CDTI的实施情况，2014年治疗覆盖率和五年坚持治疗的情况。在分析过程中考虑了两阶段聚类设计，数据与人群中的年龄和性别分布成比例加权。在三个HDs，69个社区领导人，762户主，83个社区药物分销商（CDD）和2942家庭成员进行了访谈。CDTI的组织和户主的参与平均较弱，其中84.0%（95%CI：81.2-86.4%）的人没有参加2014年大规模药物管理（MDA）期间的活动。平均而言，10名社区领导人中有6名宣布治疗时间由卫生人员决定，而社区发展中心的选择是在社区会议上作出的，只有43.4%的社区领导人这样说。2014年加权治疗覆盖率为64.1%（95% CI：56.8-70.9%），三种HD之间无显著差异。调查覆盖率低于报告覆盖率，差异显著，范围为14.1%~ 22.0%。在10岁及以上的受试者中，57.8%（95%CI：50.2-65.1%）的受试者声称在最近5次MDAs中每次都使用过该药物，HD之间无显著差异，而9.8%（95%CI：7.5-12.8%）的受试者声称从未使用过该药物。在多变量分析中，与5年治疗依从性相关的最重要因素是CDTI的高参与度和年龄（40岁以上）。尽管社区发展倡议已经实施了15年多，但社区参与和所有权仍然薄弱，覆盖率低于报告的覆盖率，接受调查的人道主义机构平均坚持五年。公共卫生部官员加强社区的所有权，并应社区的要求及时采购伊维菌素，这些都是应采取的一些措施，以提高治疗覆盖率，坚持治疗，从而实现消除盘尾丝虫病。进一步的人类学和昆虫学研究将为我们理解这三个CDTI项目中疾病的持续性提供更好的见解。
After more than 15 years of community-directed treatment with ivermectin (CDTI) in the Centre 1, Littoral 2 and West CDTI projects in Cameroon, the epidemiological evaluation conducted in 2011 revealed that onchocerciasis endemicity was still high in some communities. To investigate the potential reasons explaining this high endemicity, a cluster coverage survey was conducted in April-May 2015 in three health districts (HD), to assess the implementation of the CDTI, the 2014 therapeutic coverage and the five-year adherence to treatment. A two-stage cluster design was considered during analyses, with data weighted proportionally to age and gender distribution in the population. In the three HDs, 69 community leaders, 762 heads of households, 83 community drug distributors (CDD) and 2942 household members were interviewed. The CDTI organization and the involvement of heads of households were in average weak, with 84.0% (95% CI: 81.2–86.4%) of them who had not participated in activities during the 2014 mass drug administration (MDA). On average, six of ten community leaders declared that the period of treatment was decided by the health personnel while the CDDs selection was made during a community meeting for only 43.4% of them. The 2014 weighted therapeutic coverage was 64.1% (95% CI: 56.8–70.9%), with no significant difference in the three HDs. The survey coverages were lower than the reported coverages with a significant difference varying from 14.1% to 22.0%. Among those aged 10 years and above, 57.8% (95% CI: 50.2–65.1%) declared having taken the treatment each time during the last five MDAs with no significant difference among HDs, while 9.8% (95% CI: 7.5–12.8%) declared that they had never taken the drug. In multivariate analysis, the most important factors associated with the five-year adherence to treatment were high involvement in CDTI and age (40+ years). Despite more than 15 years of CDTI, there was still weak community participation and ownership, a lower coverage than reported and an average five-year adherence in the surveyed HDs. The reinforcement of the community ownership by the Ministry of Public Health officials and the timely procurement of ivermectin as requested by the communities are some measures that should be implemented to improve the therapeutic coverage, adherence to treatment and hence achieve onchocerciasis elimination. Further anthropological and entomological studies would provide better insights into our understanding of the persistence of the disease in these three CDTI projects.
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影响因子：
3.2
作者：
Shuford KV;Turner HC;Anderson RM
通讯作者：
Anderson RM
影响因子：
4
作者：
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通讯作者：
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影响因子：
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作者：
Nuwaha, F;Okware, J;Ndyomugyenyi, R
通讯作者：
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作者：
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作者：
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通讯作者：
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