title: The African Programme for Onchocerciasis Control: impact on onchocercal skin disease.
abstract: OBJECTIVE
  To assess the long-term impact of the African Programme for Onchocerciasis Control on itching and onchocercal skin disease (OSD).
  
  
  METHODS
  Seven study sites in Cameroon, Sudan, Nigeria and Uganda participated. Two cross-sectional surveys were conducted of communities meso- and hyper-endemic for onchocerciasis before and after 5 or 6 years of community-directed treatment with ivermectin (CDTI). Individuals were asked about any general health symptoms including itching and underwent full cutaneous examinations. Onchocercal skin lesions were documented according to a standard classification.
  
  
  RESULTS
  Five thousand one hundred and ninety three people were examined in phase I and 5,180 people in phase II. The presence of onchocercal nodules was a strongly significant (P < 0·001) risk factor for all forms of onchocercal skin disease: APOD (OR 1·66); CPOD (OR 2·84); LOD (OR 2·68); reactive skin lesions (OR 2·38) and depigmentation (OR 3·36). The effect of community-directed treatment with ivermectin was profound. At phase II, there were significant (P < 0·001) reductions in the odds of itching (OR 0·32), APOD (OR 0·28); CPOD (OR 0·34); reactive skin lesions (OR 0·33); depigmentation (OR 0·31) and nodules (OR 0·37). Reduction in the odds of LOD was also significant (OR 0.54, P < 0.03).
  
  
  CONCLUSIONS
  This first multi-country report of the long-term impact of CDTI reveals a substantial reduction in itching and OSD. APOC operations are having a major effect in improving skin health in poor rural populations in Africa.
authors.affiliation: Department of Dermatology, University of Nigeria Teaching Hospital, Ituku Ozala, Nigeria.
authors.forename: G A
authors.initials: GA
authors.lastname: Ozoh
authors.forename: M E
authors.initials: ME
authors.lastname: Murdoch
authors.forename: A-C
authors.initials: AC
authors.lastname: Bissek
authors.forename: M
authors.initials: M
authors.lastname: Hagan
authors.forename: K
authors.initials: K
authors.lastname: Ogbuagu
authors.forename: M
authors.initials: M
authors.lastname: Shamad
authors.forename: E I
authors.initials: EI
authors.lastname: Braide
authors.forename: M
authors.initials: M
authors.lastname: Boussinesq
authors.forename: M M
authors.initials: MM
authors.lastname: Noma
authors.forename: I E
authors.initials: IE
authors.lastname: Murdoch
authors.forename: A
authors.initials: A
authors.lastname: Sékétéli
authors.forename: U V
authors.initials: UV
authors.lastname: Amazigo
mesh_terms: D000328:Adult; D000368:Aged; D002163:Cameroon; D003430:Cross-Sectional Studies; D005260:Female; D005369:Filaricides / Q000627:therapeutic use*; D006801:Humans; D007559:Ivermectin / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009549:Nigeria; D016017:Odds Ratio; D009855:Onchocerciasis / Q000150:complications / Q000188:drug therapy*; D011537:Pruritus / Q000469:parasitology*; D012307:Risk Factors; D012424:Rural Population; D012876:Skin Diseases, Parasitic / Q000150:complications / Q000188:drug therapy*; D013397:Sudan; D014454:Uganda
chemical_list: D005369:Filaricides; D007559:Ivermectin