title: Community-directed treatment with ivermectin in two Nigerian communities: an analysis of first year start-up processes, costs and consequences.
abstract: OBJECTIVE
  To determine the start-up processes, costs and consequences of community-directed treatment with ivermectin (CDTI) in two onchocerciasis endemic rural towns of Southeast Nigeria; namely Achi and Nike. The other objectives were to discover the community-financing mechanisms, local ivermectin distribution strategies and communities' organisational capacity to handle the programme.
  
  
  METHODS
  Structured questionnaires, informal interviews, observations, discussions with community members at general village assemblies and community outreach lectures were used at different stages of the study.
  
  
  RESULTS
  The towns had the organisational capacity to implement the programme. Coverage with ivermectin was between 31-73% in Achi (mean = 58.6%), and 36.6-72% in Nike (mean = 61.95%). The unit financial costs were $0.17 in Nike and $0.13 in Achi, but the unit aggregate cost was $0.37 in Nike and $0.39 in Achi. When research costs were removed, the unit aggregate cost was $0.22 in Achi and $0.20 in Nike. Provider's financial costs and communities' non-financial costs were the biggest contributors to the aggregate cost. The cost would decrease in subsequent years since the research cost and parts of the mobilisation and training costs would not be incurred after the first year.
  
  
  CONCLUSIONS
  Governments and sponsors of CDTI should find means of continuously strengthening the programme and providing technical support to the communities. As both CDTI and communities are dynamic entities, continuous health education campaigns are needed to keep reminding the people of the benefit of long-term ivermectin distribution, together with the need for community ownership of the programme.
authors.affiliation: Health Policy Research Unit, Department of Pharmacology and Therapeutics, College of Medicine, University of Nigeria, P.M.B. 01129, Enugu, Nigeria. obinna.onwujekwe@lshtm.ac.uk
authors.forename: Obinna
authors.initials: O
authors.lastname: Onwujekwe
authors.forename: Reginald
authors.initials: R
authors.lastname: Chima
authors.forename: Elvis
authors.initials: E
authors.lastname: Shu
authors.forename: Paul
authors.initials: P
authors.lastname: Okonkwo
mesh_terms: D000871:Anthelmintics / Q000191:economics / Q000627:therapeutic use*; D003153:Community Health Services / Q000191:economics / Q000458:organization & administration*; D003365:Costs and Cost Analysis; D019353:Endemic Diseases / Q000517:prevention & control*; D006266:Health Education; D006302:Health Services Research; D006801:Humans; D007559:Ivermectin / Q000191:economics / Q000627:therapeutic use*; D009549:Nigeria; D009855:Onchocerciasis / Q000188:drug therapy* / Q000191:economics; D016730:Program Development; D012424:Rural Population
chemical_list: D000871:Anthelmintics; D007559:Ivermectin