title: Traditional kinship system enhanced classic community-directed treatment with ivermectin (CDTI) for onchocerciasis control in Uganda.
abstract: The challenges of community-directed treatment with ivermectin (CDTI) for onchocerciasis control in Africa have been: maintaining a desired treatment coverage, demand for monetary incentives, high attrition of community distributors and low involvement of women. This study assessed how challenges could be minimised and performance improved using existing traditional kinship structures. In classic CDTI areas, community members decide upon selection criteria for community distributors, centers for health education and training, and methods of distributing ivermectin. In kinship enhanced CDTI, similar procedures were followed at the kinship level. We compared 14 randomly selected kinship enhanced CDTI communities with 25 classic CDTI communities through interviews of 447 and 750 household members and 127 and 64 community distributors respectively. Household respondents from kinship enhanced CDTI reported better performance (P<0.001) than classic CDTI on the following measures of program effectiveness: (a) treatment coverage (b) decision on treatment location and (c) mobilization for CDTI activities. There were more female distributors in kinship enhanced CDTI than in classic CDTI. Attrition was not a problem. Kinship enhanced CDTI had a higher number of community distributors per population working among relatives, and were more likely to be involved in additional health care activities. The results suggest that kinship enhanced CDTI was more effective than classic CDTI.
authors.affiliation: The Emory University/Carter Center, 1149 Ponce de Leon Avenue, Atlanta GA 30306, USA. mkataba@emory.edu
authors.forename: Moses N
authors.initials: MN
authors.lastname: Katabarwa
authors.forename: Peace
authors.initials: P
authors.lastname: Habomugisha
authors.forename: Stella
authors.initials: S
authors.lastname: Agunyo
authors.forename: Alanna C
authors.initials: AC
authors.lastname: McKelvey
authors.forename: Nicholas
authors.initials: N
authors.lastname: Ogweng
authors.forename: Solomon
authors.initials: S
authors.lastname: Kwebiiha
authors.forename: Fredrick
authors.initials: F
authors.lastname: Byenume
authors.forename: Ben
authors.initials: B
authors.lastname: Male
authors.forename: Deborah
authors.initials: D
authors.lastname: McFarland
mesh_terms: D000328:Adult; D000977:Antiparasitic Agents / Q000627:therapeutic use*; D003153:Community Health Services / Q000458:organization & administration* / Q000592:standards; D003657:Decision Making; D003695:Delivery of Health Care / Q000458:organization & administration; D005191:Family Characteristics; D005260:Female; D006266:Health Education; D006801:Humans; D007398:Interpersonal Relations; D007559:Ivermectin / Q000627:therapeutic use*; D008297:Male; D009855:Onchocerciasis / Q000188:drug therapy* / Q000517:prevention & control; D015397:Program Evaluation; D019035:Rural Health Services / Q000458:organization & administration*; D011795:Surveys and Questionnaires; D014454:Uganda
chemical_list: D000977:Antiparasitic Agents; D007559:Ivermectin