Onchocerciasis in Anambra State, Southeast Nigeria: clinical and psychological aspects and sustainability of community directed treatment with ivermectin (CDTI).
BACKGROUND
A cross-sectional study was performed to determine the psychological impact of onchocerciasis, and assess sustainability of the decade-old community directed treatment with ivermectin (CDTI) in Ayamelum Local Council, Anambra State, Southeast Nigeria.


METHODS
Skin manifestations assessed using the rapid assessment method (RAM) in 894 subjects from 13 communities selected by multi-stage sampling were classified based on the anatomical sites affected. Focus group discussions and in-depth interviews were used to obtain information on the psychological impacts and sustainability of the CDTI programme. Qualitative data were summarised while quantitative data generated were analysed using charts and tables.


RESULTS
Anatomical distribution showed a preponderance of onchodermatitis on the limbs (the most exposed parts of the body) and buttocks (an area considered 'private'), thus revealing some reasons for the psychological impacts of the skin disease and the psychosocial inclination of the victims. Itching (40%) and onchocercal skin manifestations (OSDs) (34.3%) were identified as the most troublesome signs and symptoms, while the most worrisome consequence of onchocerciasis was social seclusion (or stigmatisation) (34.3%). Focus group responses revealed the persistence of psychological impacts on the victims, affecting almost all facets of their lives. The CDTI programme has performed creditably well when assessed using the sustainability indicators, yet there are still challenges in the areas of coverage, monitoring, resources, and participation. A 'quick-win' was identified whereby the CDTI chain could be utilised to deliver other health interventions.


CONCLUSIONS
It is recommended that onchocerciasis control programmes should include aspects that would address its psychosocial impacts and threats to the sustainability of the CDTI programme.
Public Health Parasitology Unit, Department of Parasitology and Entomology, Nnamdi Azikiwe University, Awka, Nigeria. evari4u@yahoo.com
Evaristus C
EC
Mbanefo
Christine I
CI
Eneanya
Obioma C
OC
Nwaorgu
Victor M
VM
Oguoma
Moses O
MO
Otiji
Bernice A
BA
Ogolo
D000328:Adult; D001294:Attitude to Health; D003153:Community Health Services; D003430:Cross-Sectional Studies; D005239:Fear; D005260:Female; D005369:Filaricides / Q000627:therapeutic use*; D006801:Humans; D007559:Ivermectin / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009549:Nigeria / Q000453:epidemiology; D009855:Onchocerciasis / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology; D010465:Perception; D011537:Pruritus; D019035:Rural Health Services; D012649:Self Concept; D013240:Stereotyping
D005369:Filaricides; D007559:Ivermectin