TY - JOUR
T1 - Non-adherence to ivermectin in onchocerciasis-endemic communities with persistent infection in the Bono Region of Ghana
T2 - a mixed-methods study
AU - Otabil, Kenneth Bentum
AU - Basáñez, María-Gloria
AU - Ankrah, Blessing
AU - Bart-Plange, Emmanuel John
AU - Babae, Theophilus Nti
AU - Kudzordzi, Prince-Charles
AU - Darko, Vera Achiaa
AU - Raji, Abdul Sakibu
AU - Datsa, Lydia
AU - Boakye, Andrews Agyapong
AU - Yeboah, Michael Tawiah
AU - Fodjo, Joseph Nelson Siewe
AU - Schallig, Henk D. F. H.
AU - Colebunders, Robert
N1 - Funding Information: This work was supported by a grant from the United States Agency for International Development (USAID) and UK FCDO from the British people (UK FCDO) through the Coalition for Operational Research on Neglected Tropical Diseases (COR-NTD) and administered by the African Research Network for Neglected Tropical Diseases (ARNTD). Its contents are solely the responsibility of the authors and do not necessarily represent the views of USAID, UK FCDO, COR-NTD, or ARNTD. M‑GB also acknowledges funding from the MRC Centre for Global Infectious Disease Analysis (MR/R015600/1), jointly funded by the UK Medical Research Council (MRC) and the UK Foreign, Commonwealth & Development Office (FCDO), under the MRC/FCDO Concordat agreement and is also part of the EDCTP2 programme supported by the European Union. Funding Information: We thank all the staff and students of the Consortium for Neglected Tropical Diseases and One Health, the Department of Biological Science, and the Centre for Research in Applied Biology who provided support in one way or another to ensure the successful implementation of this research. We also appreciate the efforts of the directors and staff of the Tain District, the Wenchi Municipal Health Directorate, and the Subinso Health Centre for their invaluable contributions to the study. Our appreciation also goes to the chiefs and people of the study communities who partnered with us in this study. Publisher Copyright: © 2023, The Author(s).
PY - 2023/12/1
Y1 - 2023/12/1
N2 - Background: The World Health Organization has proposed that onchocerciasis elimination (interruption) of transmission be verified in 12 (approximately a third) endemic countries by 2030. The strategy to reach this goal is based on ivermectin Mass Drug Administration (MDA) with high geographical and therapeutic coverage. In addition to coverage, high levels of treatment adherence are paramount. We investigated factors associated with ivermectin intake in an area of Ghana with persistent Onchocerca volvulus infection. Methods: In August 2021, a cross-sectional mixed-methods study was conducted in 13 onchocerciasis-endemic communities in the Bono Region of Ghana. Individuals aged ≥ 10 years were invited to participate in a questionnaire survey. A total of 48 focus group discussions and in-depth interviews with 10 community drug distributors and 13 community leaders were conducted. Results: A total of 510 people participated in the study [median age: 32, interquartile range 30 (20‒50) years]; 274 (53.7%) were females. Of the total, 320 (62.7%) declared that they adhered to each treatment round and 190 (37.3%) admitted they had not taken ivermectin during at least one MDA round, since becoming eligible for treatment. Of 483 participants with complete information, 139 (28.8%) did not take ivermectin during the last round (March 2021), and 24 (5.0%) had never taken ivermectin (systematic non-adherers). Reasons for not taking ivermectin included previous experience/fear of side-effects, being absent during MDA, pregnancy, the desire to drink alcohol, and drug distribution challenges. Being male, having good knowledge and perception of the disease, and not having secondary or higher level of formal education were significantly associated with higher odds of ivermectin intake. Conclusions: A relatively high level of non-adherence to ivermectin treatment was documented. There is a need for targeted educational and behavioural change campaigns to reverse these trends and ensure a steady course toward meeting onchocerciasis elimination targets in Ghana.
AB - Background: The World Health Organization has proposed that onchocerciasis elimination (interruption) of transmission be verified in 12 (approximately a third) endemic countries by 2030. The strategy to reach this goal is based on ivermectin Mass Drug Administration (MDA) with high geographical and therapeutic coverage. In addition to coverage, high levels of treatment adherence are paramount. We investigated factors associated with ivermectin intake in an area of Ghana with persistent Onchocerca volvulus infection. Methods: In August 2021, a cross-sectional mixed-methods study was conducted in 13 onchocerciasis-endemic communities in the Bono Region of Ghana. Individuals aged ≥ 10 years were invited to participate in a questionnaire survey. A total of 48 focus group discussions and in-depth interviews with 10 community drug distributors and 13 community leaders were conducted. Results: A total of 510 people participated in the study [median age: 32, interquartile range 30 (20‒50) years]; 274 (53.7%) were females. Of the total, 320 (62.7%) declared that they adhered to each treatment round and 190 (37.3%) admitted they had not taken ivermectin during at least one MDA round, since becoming eligible for treatment. Of 483 participants with complete information, 139 (28.8%) did not take ivermectin during the last round (March 2021), and 24 (5.0%) had never taken ivermectin (systematic non-adherers). Reasons for not taking ivermectin included previous experience/fear of side-effects, being absent during MDA, pregnancy, the desire to drink alcohol, and drug distribution challenges. Being male, having good knowledge and perception of the disease, and not having secondary or higher level of formal education were significantly associated with higher odds of ivermectin intake. Conclusions: A relatively high level of non-adherence to ivermectin treatment was documented. There is a need for targeted educational and behavioural change campaigns to reverse these trends and ensure a steady course toward meeting onchocerciasis elimination targets in Ghana.
KW - Ghana
KW - Ivermectin
KW - Mass drug administration
KW - Mixed-methods
KW - Non-adherence
KW - Onchocerciasis
UR - http://www.scopus.com/inward/record.url?scp=85177035170&partnerID=8YFLogxK
U2 - https://doi.org/10.1186/s12879-023-08806-8
DO - https://doi.org/10.1186/s12879-023-08806-8
M3 - Article
C2 - 37974087
SN - 1471-2334
VL - 23
JO - BMC Infectious Diseases
JF - BMC Infectious Diseases
IS - 1
M1 - 805
ER -