title: Factors affecting community participation in the CDTI program in Morogoro, Tanzania.
abstract: BACKGROUND
  Up to 4 million people in Tanzania are at risk for the parasitic disease onchocerciasis. A treatment program, Community-Directed Treatment with Ivermectin (CDTI), has made significant gains in prevention and treatment. Understanding factors affecting participation could help boost treatment coverage and sustain gains made in controlling onchocerciasis in endemic areas.
  
  
  OBJECTIVE
  To explore community-perceived factors related to participation in and sustainability of the CDTI program in southwest Tanzania.
  
  
  METHODS
  Multilevel triangulation design using surveys, focus group discussions (FGDs), and semistructured interviews to collect data in two villages in the Morogoro Rural District of Tanzania. In total, 456 villagers participated in the survey and 42 in FDGs. Five community-directed distributors (CDDs) and three community health workers were interviewed.
  
  
  RESULTS
  High levels of awareness of onchocerciasis (90%) and methods of prevention and treatment (95%) were reported. Over 75% of participants knew how ivermectin was distributed and 74% have taken the drug. Over 90% of villagers knew that distribution of the drug was for treatment and prevention. Only 43% knew the cause of onchocerciasis. Through FGDs, villagers reported barriers to participation, including lack of comprehensive understanding of the disease, fears of medication, distrust of the method determining dose, lack of health education materials, insufficient CDD-resident communication, and inflexible drug distribution mechanisms.
  
  
  CONCLUSIONS
  Sustaining programs without supporting growth of CDDs and reinforcing education of communities could lead to a decrease in treatment and an increase in the public health threat. This research uncovered a need for more effective community education and sensitization.
  
  
  CONCLUSIONS
  Understanding barriers to participation in community-based programs can assist public health and community health nurses and key stakeholders including Ministries of Health and local and regional health systems in the development of education and support materials to enhance health literacy and encourage program participation.
authors.affiliation: Nurse Educator, Global Health Service Partnership, Hubert Kairuki Memorial University, Dar es Salaam, Tanzania; Adjunct Assistant Professor, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, USA.
authors.forename: Kate J
authors.initials: KJ
authors.lastname: York
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Kabole
authors.forename: Mwifadhi
authors.initials: M
authors.lastname: Mrisho
authors.forename: Devon M
authors.initials: DM
authors.lastname: Berry
authors.forename: Elena
authors.initials: E
authors.lastname: Schmidt
mesh_terms: D000328:Adult; D000977:Antiparasitic Agents / Q000627:therapeutic use*; D003153:Community Health Services / Q000706:statistics & numerical data*; D005260:Female; D017144:Focus Groups; D019538:Health Care Surveys; D006266:Health Education; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006801:Humans; D007559:Ivermectin / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D009855:Onchocerciasis / Q000188:drug therapy*; D015397:Program Evaluation; D036301:Qualitative Research; D013636:Tanzania; D055815:Young Adult
chemical_list: D000977:Antiparasitic Agents; D007559:Ivermectin
keywords: Community-directed treatment with ivermectin; community-directed distributors; mixed methods research; neglected tropical disease program; onchocerciasis