title: Onchocerciasis control in the Democratic Republic of Congo (DRC): challenges in a post-war environment.
abstract: OBJECTIVE
  To evaluate onchocerciasis control activities in the Democratic Republic of Congo (DRC) in the first 12 years of community-directed treatment with ivermectin (CDTI).
  
  
  METHODS
  Data from the National Programme for Onchocerciasis (NPO) provided by the National Onchocerciasis Task Force (NOTF) through the annual reports of the 21 CDTI projects for the years 2001-2012 were reviewed retrospectively. A hypothetical-inputs-process-outputs-outcomes table was constructed.
  
  
  RESULTS
  Community-directed treatment with ivermectin expanded from 1968 communities in 2001 to 39 100 communities by 2012 while the number of community-directed distributors (CDD) and health workers (HW) multiplied. By 2012, there were ratios of 1 CDD per 262 persons and 1 HW per 2318 persons at risk. More than 80% of the funding came from the fiduciary funds of the African Programme for Onchocerciasis Control. The cost of treatment per person treated fell from US$ 1.1 in 2001 to US$ 0.1 in 2012. The therapeutic coverage increased from 2.7% (2001) to 74.2% (2012); the geographical coverage, from 4.7% (2001) to 93.9% (2012). Geographical coverage fell in 2005 due to deaths in loiasis co-endemic areas, and the therapeutic coverage fell in 2008 due to insecurity.
  
  
  CONCLUSIONS
  Challenges to CDTI in DRC have been serious adverse reactions to ivermectin in loiasis co-endemic areas and political conflict. Targets for personnel or therapeutic and geographical coverages were not met. Longer term funding and renewed efforts are required to achieve control and elimination of onchocerciasis in DRC.
authors.affiliation: Faculty of Public Health, Université Catholique de Louvain, Brussels, Belgium.
authors.forename: J-C
authors.initials: JC
authors.lastname: Makenga Bof
authors.forename: V
authors.initials: V
authors.lastname: Maketa
authors.forename: D K
authors.initials: DK
authors.lastname: Bakajika
authors.forename: F
authors.initials: F
authors.lastname: Ntumba
authors.forename: D
authors.initials: D
authors.lastname: Mpunga
authors.forename: M E
authors.initials: ME
authors.lastname: Murdoch
authors.forename: A
authors.initials: A
authors.lastname: Hopkins
authors.forename: M M
authors.initials: MM
authors.lastname: Noma
authors.forename: H
authors.initials: H
authors.lastname: Zouré
authors.forename: A H
authors.initials: AH
authors.lastname: Tekle
authors.forename: M N
authors.initials: MN
authors.lastname: Katabarwa
authors.forename: P
authors.initials: P
authors.lastname: Lutumba
mesh_terms: D000977:Antiparasitic Agents / Q000191:economics / Q000600:supply & distribution / Q000627:therapeutic use*; D003153:Community Health Services / Q000191:economics; D015023:Democratic Republic of the Congo; D006282:Health Personnel / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007559:Ivermectin / Q000191:economics / Q000600:supply & distribution / Q000627:therapeutic use*; D009855:Onchocerciasis / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000977:Antiparasitic Agents; D007559:Ivermectin
keywords: Democratic Republic of Congo; Oncocercosis; República Democrática del Congo (RDC); République Démocratique du Congo (RDC); community-directed treatment with ivermectin; onchocerciasis; onchocercose; traitement communautaire par l'ivermectine (TCI); tratamiento con ivermectina dirigido por la comunidad (TIDC)