title: Non-adherence to community directed treatment with ivermectin for onchocerciasis control in Rungwe district, southwest Tanzania.
abstract: BACKGROUND
  Community directed treatment with ivermectin (CDTI) for onchocerciasis control was developed as a strategy for achieving sustained high coverage in endemic communities. This strategy for over a short period of time has radically altered the consequences of infection with Onchocerca volvulus. The present challenge is maintaining the high therapeutic coverage especially in some of the impoverished endemic countries. One of these challenges is non-adherence to ivermectin treatment and this provides compelling reason for data collection at community level.
  
  
  OBJECTIVE
  To describe the factors associated with non-adherence to CDTI.
  
  
  METHODS
  Cross-sectional descriptive study.
  
  
  METHODS
  Communities participating in CDTI activities in Ndubi village, Rungwe district, southwest Tanzania.
  
  
  RESULTS
  A high proportion (66%) of respondents were aware of onchocerciasis, and this was more significant in males than females (X2 = 9.17; p< 0.002). Knowledge on causes of the disease was low, only 29.3% associated it with the bite of Simulium fly, 17% associated it with mosquitoes, 17.1% to houseflies, and 30% had completely no idea. Knowledge on signs and symptoms of onchocerciasis was also observed to be equally low (20.4%) among the respondents. Similarly, only 35.4% of the respondents knew itching, swelling of the body, diarrhoea and vomiting as associated side effects of ivermectin. There was, however, no sex difference in knowledge levels (X2 = 0.01; p>0.939). Low knowledge levels on causes of the disease, signs and symptoms and side effects of ivermectin were attributed to inadequate health education in the communities. However, some other factors associated with non-adherence were local beliefs and the lifestyle of alcoholism.
  
  
  CONCLUSIONS
  Factors identified to affect programme implementation and associated with non-adherence were inadequate knowledge on causes of the disease and sign/symptoms, side effects of ivermectin, local beliefs and lifestyle of alcoholism in the communities.
authors.affiliation: Vector Control Division, Ministry of Health, P.O. Box 1661, Kampala, Uganda.
authors.forename: T L
authors.initials: TL
authors.lastname: Lakwo
authors.forename: D B
authors.initials: DB
authors.lastname: Gasarasi
mesh_terms: D000328:Adult; D000368:Aged; D000977:Antiparasitic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D003153:Community Health Services / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007407:Interviews as Topic; D007559:Ivermectin / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009855:Onchocerciasis / Q000188:drug therapy*; D010349:Patient Compliance; D010353:Patient Education as Topic; D018570:Risk Assessment; D012307:Risk Factors; D013636:Tanzania
chemical_list: D000977:Antiparasitic Agents; D007559:Ivermectin