title: Predictors of compliance with community-directed treatment with ivermectin for onchocerciasis control in Kabo area, southwestern Ethiopia.
abstract: BACKGROUND
  Compliance with annual ivermectin treatment is a major challenge in community-directed treatment with ivermectin (CDTI) implementation. There are individuals who do not comply with the annual mass treatment, which contributes to the continuity for disease transmission. Hence, ensuring high treatment coverage and sustained compliance should be given due emphasis in the control of onchocerciasis. The aim of this study was to determine CDTI compliance rate and predictors of compliance where the CDTI was in its 9(th) round in Kabo area, southwestern Ethiopia.
  
  
  METHODS
  Community-based cross-sectional study was conducted in Kabo area, three weeks after the 9th round of annual ivermectin distribution. Systematic random sampling was used to select head of households and structured, pre-tested questionnaire was used to interview the study participants. Data was analyzed using SPSS version 16. Descriptive statistics was used to compute mean and standard deviation of continuous variables and frequency for categorical variables, while bivariate and multivariate logistic regressions were used to assess the effects of independent variables on the outcome variable. Variables which showed association in multivariate analysis were considered as final predictors of compliance and strength of association was measured through adjusted odds ratio (AOR).
  
  
  RESULTS
  A total of 308 respondents (age range 18-70, mean age ± SD, 32.21 ± 9.64) participated in the study. Of these, 249 (80.8%) reported that they took ivermectin during the 9th round annual treatment. Significantly higher rate of treatment compliance was reported by participants age ≥35 years (AOR = 5.48, 95% CI; 1.97 - 15.23), participants who stayed in the area for more than ten years (AOR = 3.86, 95% CI; 1.83- 8.11), participants who perceive that they are at risk of contracting the disease(AOR = 7.05, 2.70- 18.43), participants who perceive community drug distributors (CDDs) are doing their work well (AOR = 2.35 95% CI; 1.15- 4.83) and participants who know at least one CDD in their village (AOR = 2.83, 95% CI; 1.26- 6.40).
  
  
  CONCLUSIONS
  The majority of the study participants in the present study area complied with ivermectin treatment. Nevertheless, intervention packages should consider factors such as age, residence duration and community's perception of the disease to improve compliance and make drug distribution sustainable.
authors.affiliation: DireDawa University, School of Medicine, P. O. Box 1362, Dire Dawa, Ethiopia. adugnaendale73@gmail.com.
authors.forename: Adugna
authors.initials: A
authors.lastname: Endale
authors.affiliation: Aklilu Lemma Institute of Pathobiology, Addis Ababa University, P. O. Box 1176, Addis Ababa, Ethiopia. berhanue@yahoo.com.
authors.forename: Berhanu
authors.initials: B
authors.lastname: Erko
authors.affiliation: Haramaya University, College of Health and Medical Sciences, Department of Medical Laboratory Science, P. O. Box 235, Harar, Ethiopia. fwmlab2000@gmail.com.
authors.forename: Fitsum
authors.initials: F
authors.lastname: Weldegebreal
authors.affiliation: Aklilu Lemma Institute of Pathobiology, Addis Ababa University, P. O. Box 1176, Addis Ababa, Ethiopia. dlegessem@yahoo.com.
authors.forename: Mengistu
authors.initials: M
authors.lastname: Legesse
mesh_terms: D000871:Anthelmintics / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D005002:Ethiopia; D007559:Ivermectin / Q000627:therapeutic use*; D055118:Medication Adherence; D009855:Onchocerciasis / Q000188:drug therapy* / Q000517:prevention & control*; D010342:Patient Acceptance of Health Care; D011897:Random Allocation; D011795:Surveys and Questionnaires
chemical_list: D000871:Anthelmintics; D007559:Ivermectin