Treatment with ivermectin: what works in one community may not work in another.

Nigeria is highly endemic for onchocerciasis, and seven million people are infected, 40 million at risk of infection and 0.2 million blind from the disease. Disease control is through mass distribution of ivermectin (Mectizan) “ a drug that has revolutionized the treatment of onchocerciasis and other nematode diseases of man”. What is needed therefore, is to put in place an eVective system of drug delivery and distribution that can be sustained by the endemic countries themselves. An approach for ivermectin distribution is through community self treatment, where the communities themselves are actively involved in planning, designing and executing the ivermectin delivery system. This has been termed community directed treatment with ivermectin (CDTI) by the African Programme for Onchocerciasis Control, APOC. CDTI schemes are currently being tested in Africa to decide on the best approach. However, the danger lies in extrapolating results generated from some communities to all onchocerciasis endemic communities. Every community has its unique characteristics and priorities, and what works in one community may not work in another. Therefore, the preferences of individual communities must be a priori determined, and the results used to model and implement appropriate community specific sustainable CDTI schemes. This pilot study investigated the preferences for community financing and self distributing ivermectin in three Nigerian communities. This study should be of help to APOC and programme managers involved in establishing sustainable community based and controlled systems for endemic disease(s) control. Study design Achi, Nike and Toro communities were the study sites with an estimated total population size of 125 000. Interviewer administered structured questionnaires were used to interview the respondents who were randomnly selected household heads. Based on a table for sample sizes, 404, 393 and 214 household heads in Achi, Nike and Toro communities were interviewed respectively.