title: Community-directed interventions are practical and effective in low-resource communities: experience of ivermectin treatment for onchocerciasis control in Cameroon and Uganda, 2004-2010.
abstract: BACKGROUND
  The community-directed intervention (CDI) approach has improved treatment coverage in onchocerciasis-affected communities. However, there is still a lot to learn. This study assessed its performance and highlighted the lessons learnt so far.
  
  
  METHODS
  Representative samples of households were selected from Cameroon and Uganda program areas through multi-stage random sampling. An adult male and female from every selected household were interviewed separately on their involvement in CDI activities every year between 2004 and 2010. Community health workers (CHWs) were interviewed and treatment records reviewed to determine whether 90% treatment coverage was attained within 2 weeks. Records related to training of CHWs and their supervisors were analyzed.
  
  
  RESULTS
  Decision making decreased for community leaders and health workers, while it increased for community members. The proportion of CHWs attaining 90% treatment coverage within 2 weeks improved as their demand for monetary incentives, and number of persons they served, reduced. The number of CHWs supervised by a community supervisor remained low, but increased for the health workers. The cost of training a CHW and a community supervisor reduced to about US$1 and US$4.8, respectively.
  
  
  CONCLUSIONS
  The CDI approach was effective, culturally appropriate and probably less costly in delivering health services in low-resource communities.
authors.affiliation: The Carter Center, Atlanta Georgia, USA mkataba@emory.edu.
authors.forename: Moses N
authors.initials: MN
authors.lastname: Katabarwa
authors.affiliation: The Carter Center, Kampala, Uganda.
authors.forename: Peace
authors.initials: P
authors.lastname: Habomugisha
authors.affiliation: The Carter Center, Yaoundé Cameroon.
authors.forename: Albert
authors.initials: A
authors.lastname: Eyamba
authors.affiliation: The Carter Center, Kampala, Uganda.
authors.forename: Edson
authors.initials: E
authors.lastname: Byamukama
authors.affiliation: The Carter Center, Yaoundé Cameroon.
authors.forename: Philippe
authors.initials: P
authors.lastname: Nwane
authors.affiliation: Uganda Management Institute, P.O. Box 20131, Kampala, Uganda.
authors.forename: Alex
authors.initials: A
authors.lastname: Arinaitwe
authors.affiliation: Action for Youth and Women Network, PO Box 16144, Kampala, Uganda.
authors.forename: Julius
authors.initials: J
authors.lastname: Musigire
authors.affiliation: Makerere University, School of Social Sciences, P.O Box 7062, Kampala, Uganda.
authors.forename: Ruth
authors.initials: R
authors.lastname: Tushemereirwe
authors.affiliation: The Carter Center, Kampala, Uganda.
authors.forename: Annet
authors.initials: A
authors.lastname: Khainza
mesh_terms: D002163:Cameroon / Q000453:epidemiology; D003153:Community Health Services / Q000191:economics / Q000458:organization & administration*; D003150:Community Health Workers / Q000193:education / Q000458:organization & administration*; D003256:Community Participation / Q000379:methods*; D003657:Decision Making; D005191:Family Characteristics; D005369:Filaricides; D006801:Humans; D007559:Ivermectin / Q000627:therapeutic use; D009855:Onchocerciasis / Q000188:drug therapy*; D014454:Uganda / Q000453:epidemiology
chemical_list: D005369:Filaricides; D007559:Ivermectin
keywords: Cameroon; Community-directed interventions; Ivermectin; Low-resource communities; Onchocerciasis; Uganda