River Blindness Program - Articles By Carter Center Experts
May 24, 2013
Progress Toward Elimination of Onchocerciasis in the Americas — 19932012
Published by Centers for Disease Control and Prevention, Morbidity and Mortality Weekly Report,
Vol. 62, No. 20.
Onchocerciasis (river blindness) is caused by the parasitic worm Onchocerca volvulus, transmitted to humans by the bite of infected black flies of the genus Simulium, and is characterized by chronic skin disease, severe itching, and eye lesions that can progress to complete blindness. Currently, among approximately 123 million persons at risk for infection in 38 endemic countries, at least 25.7 million are infected, and 1 million are blinded or have severe visual impairment.
Jan. 3, 2013
New England Journal of Medicine, Vol 368 No. 1.pp. 53-64. Doi:10.1056/NEJMra1200391
Author: Donald R. Hopkins. Since the last case of naturally-occurring smallpox in 1977, there have been three major international conferences devoted to the concept of disease eradication. Several other diseases have been considered as potential candidates for eradication, but the World Health Organization (WHO) has targeted only two other diseases for global eradication after smallpox. In 1986, WHO's policy-making body, the World Health Assembly, adopted the elimination of dracunculiasis (Guinea worm disease) as a global goal, and it declared eradication of poliomyelitis a global goal in 1988. Although both diseases now appear to be close to eradication, the fact that neither goal has been achieved after more than two decades, and several years beyond the initial target dates for their eradication, underscores the daunting challenge of such efforts, as does the failure of previous attempts to eradicate malaria, hookworm, yaws and other diseases. "Disease Eradication" was published as part one of "A Global View of Health An Unfolding Series." Read the overview of the series >
Aug. 17, 2012
Progress Towards Eliminating Onchocerciasis in the WHO Region of the Americas in 2011: Interruption of Transmission in Guatemala and Mexico (PDF)
Published in the Aug. 17, 2012, edition of the World Health Organization's Weekly Epidemiological Record. It is reprinted with permission.
More than 100 participants attended the 21st IACO held in Bogota, Colombia in November 2011; the meeting was organized by the Ministry of Social Protection of Colombia and OEPA/Carter Center staff. Data presented during IACO 2011 led to the conclusion that onchocerciasis transmission had been interrupted in the Southern Chiapas focus of Mexico and the Central focus of Guatemala, and that MDA could be stopped in these locations in 2012.
July 6, 2012
Transmission of Onchocerciasis in Wadelai Focus of Northwestern Uganda Has Been Interrupted and the Disease Eliminated (PDF)
Published in the Journal of Parasitology Research,volume 2012 (2012), article ID 748540, 7 pages. It is reprinted with permission.
Authors: Moses N. Katabarwa, Frank Walsh, Peace Habomugisha, Thomson L. Lakwo, Stella Agunyo, David W. Oguttu, Thomas R. Unnasch, Dickson Unoba, Edson Byamukama, Ephraim Tukesiga, Richard Ndyomugyenyi, and Frank O. Richards. Wadelai, an isolated focus for onchocerciasis in northwest Uganda, was selected for piloting an onchocerciasis elimination strategy that was ultimately the precursor for countrywide onchocerciasis elimination policy.
Dec. 1, 2011
Cost-Effectiveness of Triple Drug Administration (TDA) With Praziquantel, Ivermectin and Albendazole For the Prevention of Neglected Tropical Diseases in Nigeria
This article was published in the December 2011 issue of Annals of Tropical Medicine and Parasitology, 105(8). Online signup is required to read the full article.
Authors: Evans, D; Mcfarland, D; Adamani, W; Eigege, A; Miri, E; Schulz, J; Pede, E; Umbugadu, C; Ogbu-Pearse, P; Richards, F O. Onchocerciasis, lymphatic filariasis (LF), schistosomiasis and soil transmitted, helminthiasis (STH) are all co-endemic in Nigeria. Annual mass drug administration (MDA) with ivermectin (for onchocerciasis), albendazole (for STH and with ivermectin for LF) and praziquantel (for schistosomiasis) is the WHO-recommended treatment strategy for preventive chemotherapy. Separate delivery rounds for distribution of these drugs have been the usual approach to MDA. All three drugs, however, have now been shown to be clinically and programmatically safe for co-administration with what has come to be known as triple drug administration (TDA). We examined the cost savings of converting from separate delivery rounds to TDA in two states in Nigeria.
Dec. 6, 2011
Seventeen Years of Annual Distribution of Ivermectin Has Not Interrupted Onchocerciasis Transmission in North Region, Cameroon (Login required.)
American Journal of Tropical Medicine and Hygiene, 2011 vol. 85 no. 6 1041-1049. doi: 10.4269/ajtmh.2011.11-0333.
Authors: Moses N. Katabarwa, Albert Eyamba, Philippe Nwane, Peter Enyong, Souleymanou Yaya, Jean Baldiagaï, Théodore Kambaba Madi, Abdoulaye Yougouda, Gervais Ondobo Andze, and Frank O. Richards. Since 1996, The Carter Center has provided ongoing assistance to Cameroon Ministry of Health (MOH) for distribution of ivermectin for onchocerciasis control in endemic areas of North Region, taking over a project that was launched by the MOH and the River Blindness Foundation in 1992. The African Program for Onchocerciasis Control (APOC) joined The Carter Center in supporting North Cameroon from 1998 to 2003. APOC was designed to substantially financially support delivery of an annual dose of ivermectin through community-directed treatment with ivermectin (CDTI) for 5 years. The objective was to establish a mechanism for sustained delivery of an annual dose of ivermectin, thereby achieving reduction of prevalence and transmission to a point where onchocerciasis would no longer be of public health or socioeconomic concern.
Oct. 25, 2011
Onchocerciasis in the Americas: From Arrival to (Near) Elimination (PDF)
Parasites & Vectors, 2011, 4:205. doi:10.1186/1756-3305-4-205. This article is reprinted with permission.
Authors: Ken Gustavsen, Adrian Hopkins, and Mauricio Sauerbrey.
Once endemic to six countries in the Americas (Brazil, Colombia, Ecuador, Guatemala, Mexico and Venezuela), onchocerciasis is on track for interruption of transmission in the Americas by 2012, in line with Pan American Health Organization resolution CD48.R12. The success of this public health program is due to a robust public-private partnership involving national governments, local communities, donor organizations, intergovernmental bodies, academic institutions, non-profit organizations and the pharmaceutical industry. The lessons learned through the efforts in the Americas are in turn informing the program to control and eliminate onchocerciasis in Africa.
Nov. 1, 2010
Emergence of Onchocerca Volvulus From Skin Mimicking Dracunculiasis Medinensis (PDF)
Reprinted with permission from the American Journal of Tropical Medicine and Hygiene, 83(6), 2010, pp. 1348-1351.
Authors: Mark L. Eberhard, Ernesto Ruiz-Tiben, Andrew S. Korkor, Sharon L. Roy, and Philip Downs. We describe 11 cases of suspected Dracunculus medinensis infection in which the worm recovered was identified as Onchocerca volvulus. Identification was based on morphology of the examined specimen.
May 5, 2010
Effects of Annual Mass Treatment with Ivermectin for Onchocerciasis on the Prevalence of Intestinal Helminths (PDF)
Am. J. Trop. Med. Hyg., 83(3), 2010, pp. 534-541. doi:10.4269/ajtmh.2010.10-0033; Copyright © 2010 by The American Society of Tropical Medicine and Hygiene. Reprinted with permission.
Authors: Julie Gutman, Emmanuel Emukah, Njideka Okpala, Chinyere Okoro, Andrew Obasi, Emmanuel S. Miri, and Frank O. Richards, Jr. We evaluated the effect of annual ivermectin (IV) distribution for onchocerciasis on the prevalence of soil transmitted helminth (STH) infections in school-aged (SAC) and preschool-aged (PAC) children by comparing children in villages that had received treatment for 13 years to those from socioeconomically similar villages in untreated areas.
May 4, 2010
Does Onchocerciasis Transmission Take Place in Hypoendemic Areas? A Study in North Region of Cameroon (PDF)
Published in The Journal of Tropical Medicine and International Health, volume 15 no 5 pp 645652 May 2010. This peer reviewed version is reprinted with permission.
Authors: Moses N Katabarwa, Albert Eyamba, Mouhamadou Chouaibou, Peter Enyong, Thomas Kuété, Souleymanou Yaya, Abdoulaye Yougouda, Jean Baldiagaï, Kambaba Madi, Gervais Ondobo Andze, and Frank Richards. Objective: Community-directed treatment with ivermectin (CDTI) for onchocerciasis control is targeted to meso and hyperendemic areas in Africa. Below the threshold, communities are considered hypoendemic and mass treatment is not recommended. As policy begins to shift from control to elimination, hypoendemic areas' role in maintaining Onchocerca volvulus needs re-examination. The study determined whether independent transmission occurs in a hypoendemic area in the north region of Cameroon.
April 1, 2010
Traditional Kinship System Enhanced Classic Community-Directed Treatment With Ivermectin (CDTI) for Onchocerciasis Control in Uganda (PDF)
Transactions of the Royal Society of Tropical Medicine and Hygiene 104 (2010) 265272.
Authors: Moses N. Katabarwa, Peace Habomugisha, Stella Agunyo, Alanna C. McKelvey, Nicholas Ogweng, Solomon Kwebiiha, Fredrick Byenume, Ben Male and Deborah McFarland. Summary: The challenges of community-directed treatment with ivermectin (CDTI) for onchocerciasis control in Africa have been: maintaining a desired treatment coverage, demand for monetary incentives, high attrition of community distributors and low involvement of women. This study assessed how challenges could be minimised and performance improved using existing traditional kinship structures.
Jan. 15, 2010
Lack of Active Onchocerca volvulus Transmission in the Northern Chiapas Focus of Mexico (PDF)
Am. J. Trop. Med. Hyg., 83(1), 2010, pp. 1520 doi:10.4269/ajtmh.2010.09-0626; Copyright © 2010 by The American Society of Tropical Medicine and Hygiene. Reprinted with permission.
Authors: Mario A. Rodríguez-Pérez , Thomas R. Unnasch , Alfredo Domínguez Vázquez , Alba L. Morales-Castro ,Frank Richards Jr. , Graciela P. Peña-Flores , María Eugenia Orozco-Algarra , and Gibert Prado-Velasco. The northern Chiapas onchocerciasis focus has undergone 11 years of ivermectin mass treatment. No evidence of microfilariae in the cornea and/or anterior chamber of the eye or in skin snips was seen in residents examined in 2006 in two sentinel communities (upper limit of the 95% confidence interval [UL 95% CI] = 0.5% and 0.3%, respectively).
Dec. 1, 2009
Monitoring Ivermectin Distributors Involved in Integrated Health Care Services Through Community-Directed Interventions a Comparison of Cameroon and Uganda Experiences Over a Period of Three Years, 2004-2006, (PDF)
Published in December 2009 edition of The Journal of Tropical Medicine and International Health, volume 15 no 2 pp 216-223. This peer reviewed version is reprinted with permission.
Authors: Moses Katabarwa, Peace Habomugisha, Albert Eyamba, Stella Agunyo, and Catherine Mentou. Summary: Community-directed interventions (CDI) is an approach where the community is given adequate information to get involved in decision-making, organization and mobilization of resources to tackle any challenges that affect its health. This study assesses and compares the effectiveness of ivermectin distributors in attaining 90 percent treatment coverage of the eligible population with each additional health activity they take up.
Nov. 22, 2009
Interruption of Transmission of Onchocerca volvulus in the Oaxaca Focus, Mexico (PDF)
Am. J. Trop. Med. Hyg., 83(1), 2010, pp. 21-27, doi:10.4269/ajtmh. 2010.09-0544; Copyright © 2010 by The American Society of Tropical Medicine and Hygiene. Reprinted with permission.
Authors: Mario A. Rodríguez-Pérez, Thomas R. Unnasch, Alfredo Domínguez-Vázquez, Alba L. Morales-Castro, Graciela P. Peña-Flores, María E. Orozco-Algarra, Juan I. Arredondo-Jiménez, Frank Richards, Jr., Miguel A. Vásquez-Rodríguez, and Vidal García Rendón. All endemic communities of the Oaxaca focus of onchocerciasis in southern Mexico have been treated annually or semi-annually with ivermectin since 1994. In-depth epidemiologic assessments were performed in communities during 2007 and 2008. None of the 52,632 Simulium ochraceum s.l. collected in four sentinel communities was found to contain parasite DNA when tested by polymerase chain reaction-enzyme-linked immunosorbent assay (PCR-ELISA), resulting in an upper bound of the infection rate in the vectors of 0.07/2,000.
Sept. 5, 2009
Sustainability of Ivermectin Distribution Programmes
This article was published in the Sept. 5, 2009 issue of The Lancet, Volume 374, Issue 9692,and is reprinted with permission.
Lindsay J Rakers, Emmanuel Emukah, Jude Onyenama d, Grace Amah, Nnenna Ukairo, Uche Enyinnaya, Emmanuel Miri, Frank Richards, Sustainability of ivermectin distribution programmes, pgs. 785 - 786.
March 31, 2009
Successful Interruption of Transmission of Onchocerca volvulus in the Escuintla-Guatemala Focus, Guatemala (PDF)
This article was published in the March 2009 issue of PLoS Journal of Neglected Tropical Diseases and is reprinted with permission. PLoS Negl Trop Dis 3(3): e404. doi:10.1371/journal.pntd.0000404.
Authors: Rodrigo J. Gonzalez, Nancy Cruz-Ortiz, Nidia Rizzo, Jane Richards, Guillermo Zea-Flores, Alfredo Domı´nguez, Mauricio Sauerbrey, Eduardo Catu´, Orlando Oliva, Frank O. Richards Jr, Kim A. Lindblade. Elimination of onchocerciasis (river blindness) through mass administration of ivermectin in the six countries in Latin America where it is endemic is considered feasible due to the relatively small size and geographic isolation of endemic foci. We evaluated whether transmission of onchocerciasis has been interrupted in the endemic focus of Escuintla- Guatemala in Guatemala, based on World Health Organization criteria for the certification of elimination of onchocerciasis. Read the press release>
Sept. 1, 2008
The Onchocerciasis Elimination Program for the Americas (OEPA) (PDF)
This article written by M. Sauerbrey was published in the Annals of Tropical Medicine & Parasitology, Vol. 102, Supplement No. 1, pp 2529(5) (2008) and is reprinted with permission. Human onchocerciasis (river blindness) occurs in 13 foci distributed among six countries in Latin America (Brazil, Colombia, Ecuador, Guatemala, Mexico and Venezuela), where about 500,000 people are considered at risk.
Sept. 1, 2008
After a Decade of Annual Dose of Mass Ivermectin Treatment in Cameroon and Uganda, Onchocerciasis Transmission Continues (PDF)
Tropical Medicine and International Health, Volume 13, no. 9, pp 18. © 2008 Blackwell Publishing Ltd. Authors: Moses Katabarwa, Albert Eyamba, Peace Habomugisha, Tom Lakwo, Same Ekobo, Joseph Kamgno, Thomas Kuete, Richard Ndyomugyenyi, Ambrose Onapa, Mkpouwoueiko Salifou, Marcelline Ntep and Frank O. Richards. Objective: To evaluate the effectiveness of 10 years' annual single dose ivermectin treatment on onchocerciasis transmission in hyperendemic areas of Cameroon and Uganda.
June 1, 2008
Dracunculiasis, Onchocerciasis, Schistosomiasis, and Trachoma (PDF)
Annals of the New York Academy of Sciences, 1136: 45-52 (2008), Issue - Reducing the Impact of Poverty on Health and Human Development: Scientific Approaches.
Authors: Donald R. Hopkins, Frank O. Richards, Jr, Ernesto Ruiz-Tiben, Paul Emerson, P. Craig Withers, Jr. Published Online: 25 Jul 2008. The definitive version is available at wiley.com.
March 1, 2008
Short Report: Could Neurocysticercosis Be the Cause of "Onchocerciasis-Associated" Epileptic
Am. J. Trop. Med. Hyg., 78(3), 2008, pp. 400401. Copyright © 2008 by The American Society of Tropical Medicine and Hygiene.
Moses Katabarwa,* Tom Lakwo, Peace Habumogisha, Frank Richards, and Mark Eberhard. Abstract. We conducted a nodule prevalence survey in four onchocerciasis sentinel communities in Moyo and two in Kanungu districts of Uganda. Seven (33.3%) out of 21 excised "onchocercomas" (nodules) in Moyo District and excised onchocercomas from four of six persons in Kanungu District turned out to be cysts of Taenia solium.
Jan. 1, 2008
Evidence for Suppression of Onchocerca volvulus Transmission in the Oaxaca Focus in Mexico (PDF)
Am. J. Trop. Med. Hyg., 78(1), 2008, pp. 147152, Copyright © 2008 by The American Society of Tropical Medicine and Hygiene. Authors: Mario A. Rodríguez-Pérez,* Cristian Lizarazo-Ortega, Hassan K. Hassan, Alfredo Domínguez-Vásquez, Jorge Méndez-Galván, Patricia Lugo-Moreno, Mauricio Sauerbrey, Frank Richards Jr., and Thomas R. Unnasch.
Oct. 1, 2006
Successful integration of insecticide-treated bed net distribution with mass drug administration in Central Nigeria (PDF)
Am J Trop Med Hyg; 75: 4: 650-5. Copyright © 2006 by The American Society of Tropical Medicine and Hygiene Blackburn BG, Eigege A, Gotau H, Gerlong G, Miri E, Hawley WA, Mathieu E, Richards F.
Jan. 1, 2005
Significant Decrease in the Prevalence of Wuchereria Bancrofti Infection in Anopheline Mosquitoes Following the Addition of Albendazole to Annual, Ivermectin-Based, Mass Treatments in Nigeria (PDF)
Annals of Tropical Medicine and Parasitology; 99: 155-64. Richards, F., Pam, D., Kal, A., Gerlong, G., Oneyka, J., Sambo, Y., Danboyi, J., Ibrahim, B., Terranella, A., Kumbak, D., Dakul, A., Lenhart, A., Rakers, L., Umaru, J., Mafuyai, H., Jinadu, M., Miri, E., and Eigege, A.
April 1, 2005
Community-directed interventions strategy enhances efficient and effective integration of health care delivery and development activities in rural disadvantaged communities of Uganda
Tropical Medicine & International Health Volume 10 Issue 4 Page 312 - April 2005 By M. N. Katabarwa, P. Habomugisha, F. O. Richards Jr and D. Hopkins, The Carter Center, Atlanta GA, USA.
Jan. 1, 2005
Editorial: Whither Onchocerciasis Control in Africa? (PDF)
Editorial: Whither Onchocerciasis Control in Africa? By D. R. Hopkins, F.O. Richards, and M. Katabarwa, The Carter Center, Atlanta, Georgia; Centers for Disease Control and Prevention, Atlanta, Georgia. (Am. J. Trop. Med. Hyg., 2005 Jan;72(1):1-2. No abstract available.) PMID: 15728857
June 26, 2004
Kinship Structure and Health-Care Improvement in Sub-Saharan Africa
The following was originally published in The Lancet, Volume 363, Number 9427, as a letter to the editor.
Jan. 1, 2004
A Longitudinal Study of Impact of Repeated Mass Ivermectin Treatment on Clinical Manifestations of Onchocerciasis in Imo State, Nigeria (PDF)
Authors: E.C. Emukah, E. Osuoha, E.S. Miri, J. Onyenama, U. Amazigo, C. Obijuru, N. Osuji, J. Ekeanyanwu, S. Amadiegwu, K. Korve, F. Richards. Published in American Journal of Tropical Medicine and Hygiene 2004; 70:556-61. Abstract: We conducted a cohort study on impact of effects of eight years of annual ivermectin mass treatment administered in eight villages in Imo State, Nigeria. Physical and visual acuity examinations carried out in 462 persons in 1995, prior to the launching of mass drug administration with ivermectin, were compared with re-examinations of 411 (89%) of these same individuals in 2002. We found that gross visual impairment decreased from 16% to 1%, nodult prevalence decreased from 59% to 18%, and papular dermatitis was reduced from 15% to 2%. No change was seen in leopard skin rates (14%). the only incident lesions were three subjects from a single community having the appearance of new nodules (e.g., nodules not identified in the 1995 examinations). Differences in community coverage did not appear to influence the benefit from treatment of individual residents.
Jan. 1, 2002
Involvement and Performance of Women in Community-Directed Treatment With Ivermectin for Onchocerciasis Control in Rukungiri District, Uganda (PDF)
Authors: Katabarwa, M.N., Habomugisha, P., Ndyomugyenyi, R., and Agunyo, S. Published in Annals of Tropical Medicine & Parasitology, Vol. 95, No. 5, 485-494 (2001).
Jan. 1, 2002
Lymphatic Filariasis Elimination and Schistosomiasis Control in Combination with Onchocerciasis Control in Nigeria (PDF)
Authors: Hopkins D.R., Eigege A., Miri E.S., Gontor, I., Ogah, G., Umaru, J., Gwomkudu, C.C., Mathai, W., Jinadu, M.Y., Amadiegwu, S., Oyenekan, O.K., Korve, K., Richards, F.O. Published in American Journal of Tropical Medicine and Hygiene. 2002; 67(3):266-72. Abstract: This paper describes a pilot initiative to incorporate lymphatic filariasis (LF) elimination and urinary schistosomiasis (SH) control into a mature onchocerciasis control program bsed on community-directed ivermectin treatment in central Nigeria. In the same districts having onchocerciasis we found LF (as determined by blood antigen testing in adult males) in 90% of 149 villages with a mean prevalence of 22.4% (range 0-67%). Similarly, SH, as a mean prevalence in school age children of 24.4% (range 0-87%). Health education and treatment interventions for SH resulted in 52,480 cumulative praziquantel treatments, and 159,555 combined onchocerciasis and LF treatments (with ivermectin and albendazole) as of the end of 2000. Treatments for onchocerciasis and LF were separated by at least 1 week from treatments for SH. There was no negative impact on the coverage of the onchocerciasis program by the addition of LF and SH activities.
Dec. 1, 2001
The Carter Center's Assistance to River Blindness Control Programs: Establishing Treatment Objectives and Goals for Monitoring Ivermectin Delivery Systems on Two Continents (PDF)
Authors: F. Richards, E. Miri, M. Katabarwa, A. Eyamba, M. Sauerbrey, G. Zea-Flores, K. Korve, W. Mathai, M. Homeida, I. Mueller, E. Hilyer, and D. Hopkins. Published in the American Journal of Tropical Medicine and Hygiene 2001; 65:108-14. Abstract: Periodic mass treatment with ivermectin in endemic communities prevents eye and dermal disease due to onchocerciasis. As part of an international global partnership to control onchocerciasis, The Carter Center's Global 2000 River Blindness Program (GRBP) assists the ministries of health in ten countries to distribute ivermectin (Mectizan®, donated by Merck & Co.). The GRBP priorities are to maximize ivermectin treatment coverage and related health education and training efforts, and to monitor progress through regular reporting of ivermectin treatments measured against annual treatment objectives and ultimate treatment goals (e.g., full coverage, which is defined as reaching all persons residing in at risk villages who are eligible for treatment). Since the GRBP began in 1996, more than 21.2 million ivermectin treatment encounters have been reported by assisted programs. In 1999, more than 6.6 million eligible persons at risk for onchocerciasis received treatment, which represented 96% of the 1999 annual treatment objective of 6.9 million, and 78% of the ultimate treatment goal in assisted areas.
Nov. 1, 2001
On the Road with President Carter: Targeting River Blindness
During November 2001, former President Jimmy Carter attended the 11th annual InterAmerican Conference on Onchocerciasis in Mexico City, which brought together high-level representatives from the six onchocerciasis- or river blindness-endemic countries in the Americas to discuss recent findings that, under certain conditions, it is feasible to eliminate river blindness in the Americas. Occurring mostly in Africa, the disease also threatens about 540,000 people in Mexico, Guatemala, Venezuela, Colombia, Ecuador, and Brazil.
May 1, 2001
Involvement of Women in Community-Directed Treatment With Ivermectin for the Control of Onchocerciasis in Rukungiri district, Uganda: a knowledge, attitude and practice study (PDF)
Tropical Medicine & Parasitology, Vol. 95, No. 5, 485-494 (2001).
Authors: Katabarwa, M.N., Habomugisha, P., Ndyomugyenyi, R., and Agunyo, S. Published in Annals of Abstract: A study of knowledge, attitudes and practice was carried out in the Rukungiri district of Uganda, in order to investigate the involvement of women in community-directed treatment with ivermectin (CDTI), for the control of onchocerciasis. The data analysed came from interviews with 260 adult women (one from each of 260 randomly-selected households in 20 onchocerciasis-endemic communities), community informants, and participatory evaluation meetings (PEM) in eight communities. The women who had been treated with ivermectin in 1999 generally had more knowledge of the benefits of taking ivermectin, were more likely to have attended the elevant health-education sessions and were more involved in community decisions on the method of ivermectin distribution than the women who had not received ivermectin in that year. There were fewer female community-directed health workers (CDHW) than male CDHW in the communities investigated. The reasons for not attending health-education sessions, not participating in community meetings concerning the CDTI, and the reluctance of some women to serve as CDHW were investigated.
Feb. 1, 2001
Community-Directed Health (CDH) Workers Enhance the Performance and Sustainability of CDH Programmes: experience from ivermectin distribution in Uganda (PDF)
Authors: M.N. Katabarwa, F.O. Richards Jr. Published in Annals of Tropical Medicine & Parasitology, Vol. 95, No. 3, 275-286 (2001).
Jan. 1, 2000
Authors: Katabarwa, N. M.; Richards, F.O. Jr.; and Ndyomugyenyi, R. Published in Annals of Tropical Medicine and Parasitology 94, 485-495 Abstract: In rural Ugandan communities where onchocerciasis is meso- or hyper-endemic, conrol of the disease is now being carried out using a strategy of community-directed programmes for the annual distribution of ivermectin to all persons eligible to take the drug. For these programmes to achieve their annual target coverage of at least 90% of the population eligible to take ivermectin, and to continue to sustain themselves for 10-15 years or more, even after external donor funding ceases, it has been found essential to replace the initial community-based strategy, imposed from outside, by a community-directed strategy developed by the community members themselves. Furthermore, it is essential for success that full use be made of the traditional social system, which is very strong in all rural communities in Uganda. This system is based on patrilineal kinships and clans, governed by traditional law, and in it women play an important role. If this system is ignored or by-passed by governmnet health personnel or by the sponsors and promoters of the programme, the communities are likely to fail to reach their targets.
June 1, 1998
The Onchocerciasis Elimination Program for the Americas: A History of Partnership (PDF)
This article was published in the Pan American Journal of Public Health 3(6), 1998 and is reprinted with permission.
The decision in 1987 by the pharmaceutical firm Merck & Co. to provide Mectizan® (ivermectin) free of charge to river blindness control programs has challenged the international public health community to find effective ways to distribute the drug to rural populations most affected by onchocerciasis. In the Americas, PAHO responded to that challenge by calling for the elimination of all morbidity from onchocerciasis from the Region by the year 2007 through mass distribution of ivermectin. Since 1991, a multinational, multiagency partnership (consisting of PAHO, the endemic countries, nongovernmental development organizations, the Centers for Disease Control and Prevention in Atlanta, Georgia, as well as academic institutions and funding agencies) has developed the political, financial, and technical support needed to move toward the realization of that goal.
Jan. 1, 1996
Community-Based Ivermectin Distributors: Onchocerciasis Control at the Village Level in Plateau State, Nigeria (PDF)
Authors: F. Richards, C. Gonzales-Peralta, E. Jallah, E. Miri. Published in Acta Tropica 1996; 61:137-44. Abstract: The use of community residents as agents for distributing mass ivermectin therapy for onchocerciasis provides a component of community participation absent from mobile team delivery methods. Community-based distribution, however, presupposes preexisting human resources in the endemic villages capable of fulfilling the essential functions of an ivermectin distribution process: mobilizing and educating the population, dispensing the drug, maintaining records, and monitoring and treating adverse reactions Even when such human resources exist, the comunity workers must continue to receive tangible support from both external (government and donor agencies) and internal (community) sources. Donor and government agencies must accept that their data collection demands will be limited by the literacy standards of the communities being served. Community leaders must agree to set and use their own local standards of payment (including food stuffs or exchange in kind) to compensate the distributors for their time and efforts. The use of locally available human and remunerative resources is a prerequisite for true community ownership of a program.