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Programmatic and Communication Issues in Relation to Serious Adverse Events Following Ivermectin Treatment in areas Co-endemic for Onchocerciasis and Loiasis.

Haselow NJ, Akame J, Evini C, Akongo S - Filaria J (2003)

Bottom Line: Program implementers do not as of yet fully understand the psychological impact of serious adverse events on communities and therefore have not designed communication strategies that adequately address the real concerns of community members.It is clear, however, that along with an effective case detection and management strategy, a reinforced communication strategy will be required to motivate at least 65% of the total population in onchocerciasis and loiasis co-endemic areas to participate in the treatment program and to take ivermectin over an extended period.This strategy must be based on research undertaken at the community level in order to address the concerns, fears and issues associated with adverse events due to ivermectin - to ensure that communities believe that the benefits of taking ivermectin outweigh the risks.

View Article: PubMed Central - HTML - PubMed

Affiliation: Helen Keller International, B,P, 14227, Yaoundé, Cameroon. nhaselow@hotmail.com

ABSTRACT
In areas co-endemic for loiasis and onchocerciasis, the classic Community-Directed Treatment using ivermectin (Mectizan(R)) must be adapted as additional program activities, better communication and tighter control of ivermectin stocks are required to minimize risk and manage serious adverse events following ivermectin treatment in patients co-infected with Loa loa. The importance of these serious adverse events on community participation in onchocerciasis control efforts has not been adequately studied. Program implementers do not as of yet fully understand the psychological impact of serious adverse events on communities and therefore have not designed communication strategies that adequately address the real concerns of community members. It is clear, however, that along with an effective case detection and management strategy, a reinforced communication strategy will be required to motivate at least 65% of the total population in onchocerciasis and loiasis co-endemic areas to participate in the treatment program and to take ivermectin over an extended period. This strategy must be based on research undertaken at the community level in order to address the concerns, fears and issues associated with adverse events due to ivermectin - to ensure that communities believe that the benefits of taking ivermectin outweigh the risks. In addition to an overall increase in the time required to sustain onchocerciasis control programs in co-endemic areas, each aspect of the reinforced program and communication strategy - rapid epidemiological assessments, materials development, training, advocacy, community sensitization and mobilization, case management and counselling, supervision, monitoring and evaluation will require additional resources and support from all stakeholders concerned.

No MeSH data available.


Related in: MedlinePlus

Vicious cycle of SAEs and low coverage caused by increased fear of taking ivermectin.
© Copyright Policy - open-access
Related In: Results  -  Collection


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Figure 1: Vicious cycle of SAEs and low coverage caused by increased fear of taking ivermectin.

Mentions: With better surveillance, other provinces of Cameroon and other countries (e.g. Sudan) are also reporting more SAE cases in areas co-endemic with loiasis and onchocerciasis. These co-endemic areas operate their programs with a unique challenge to manage all adverse side effects adequately, to maintain the cost per treatment at an acceptable level and to achieve and maintain a treatment coverage rate of at least 65% of the total population in order to adequately diminish transmission among the population and eliminate onchocerciasis as a public health problem and socio-economic importance [5-9]. This is not an easy undertaking. Because of the fear caused by serious adverse events [3,10-12], a reinforced strategy is required to motivate communities to participate in community-directed treatment with ivermectin (CDTI) and to take ivermectin. A review of several of the independent African Programme for Onchocerciasis Control (APOC) monitoring reports from 1999–2001 documented that mild and serious side effects were neither recorded nor reported in many projects, and in Cameroon, health education was not adequate to allay fears and misconceptions of community members about side effects. In the report of one of the CDTI Projects in the South West of Cameroon [12], the high rate of refusals (27.7%) among those eligible for treatment was closely linked to a high level of scepticism, doubt and pessimism among community members and the absence of a strong sensitization and mobilization effort. Likewise, an evaluation of the implementation of TCC9/Mectizan® Expert Committee guidelines in areas of Cameroon co-endemic for onchocerciasis and loiasis undertaken by APOC and the TCC in October 2000 [11] found that, in general, communities did not have enough information on side effects to allay their fears. In the presence of SAEs, rumours and incomplete information, some community members acknowledged fear associated with even minor side effects and were understandably reticent to take ivermectin (Figure 1).


Programmatic and Communication Issues in Relation to Serious Adverse Events Following Ivermectin Treatment in areas Co-endemic for Onchocerciasis and Loiasis.

Haselow NJ, Akame J, Evini C, Akongo S - Filaria J (2003)

Vicious cycle of SAEs and low coverage caused by increased fear of taking ivermectin.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2147071&req=5

Figure 1: Vicious cycle of SAEs and low coverage caused by increased fear of taking ivermectin.
Mentions: With better surveillance, other provinces of Cameroon and other countries (e.g. Sudan) are also reporting more SAE cases in areas co-endemic with loiasis and onchocerciasis. These co-endemic areas operate their programs with a unique challenge to manage all adverse side effects adequately, to maintain the cost per treatment at an acceptable level and to achieve and maintain a treatment coverage rate of at least 65% of the total population in order to adequately diminish transmission among the population and eliminate onchocerciasis as a public health problem and socio-economic importance [5-9]. This is not an easy undertaking. Because of the fear caused by serious adverse events [3,10-12], a reinforced strategy is required to motivate communities to participate in community-directed treatment with ivermectin (CDTI) and to take ivermectin. A review of several of the independent African Programme for Onchocerciasis Control (APOC) monitoring reports from 1999–2001 documented that mild and serious side effects were neither recorded nor reported in many projects, and in Cameroon, health education was not adequate to allay fears and misconceptions of community members about side effects. In the report of one of the CDTI Projects in the South West of Cameroon [12], the high rate of refusals (27.7%) among those eligible for treatment was closely linked to a high level of scepticism, doubt and pessimism among community members and the absence of a strong sensitization and mobilization effort. Likewise, an evaluation of the implementation of TCC9/Mectizan® Expert Committee guidelines in areas of Cameroon co-endemic for onchocerciasis and loiasis undertaken by APOC and the TCC in October 2000 [11] found that, in general, communities did not have enough information on side effects to allay their fears. In the presence of SAEs, rumours and incomplete information, some community members acknowledged fear associated with even minor side effects and were understandably reticent to take ivermectin (Figure 1).

Bottom Line: Program implementers do not as of yet fully understand the psychological impact of serious adverse events on communities and therefore have not designed communication strategies that adequately address the real concerns of community members.It is clear, however, that along with an effective case detection and management strategy, a reinforced communication strategy will be required to motivate at least 65% of the total population in onchocerciasis and loiasis co-endemic areas to participate in the treatment program and to take ivermectin over an extended period.This strategy must be based on research undertaken at the community level in order to address the concerns, fears and issues associated with adverse events due to ivermectin - to ensure that communities believe that the benefits of taking ivermectin outweigh the risks.

View Article: PubMed Central - HTML - PubMed

Affiliation: Helen Keller International, B,P, 14227, Yaoundé, Cameroon. nhaselow@hotmail.com

ABSTRACT
In areas co-endemic for loiasis and onchocerciasis, the classic Community-Directed Treatment using ivermectin (Mectizan(R)) must be adapted as additional program activities, better communication and tighter control of ivermectin stocks are required to minimize risk and manage serious adverse events following ivermectin treatment in patients co-infected with Loa loa. The importance of these serious adverse events on community participation in onchocerciasis control efforts has not been adequately studied. Program implementers do not as of yet fully understand the psychological impact of serious adverse events on communities and therefore have not designed communication strategies that adequately address the real concerns of community members. It is clear, however, that along with an effective case detection and management strategy, a reinforced communication strategy will be required to motivate at least 65% of the total population in onchocerciasis and loiasis co-endemic areas to participate in the treatment program and to take ivermectin over an extended period. This strategy must be based on research undertaken at the community level in order to address the concerns, fears and issues associated with adverse events due to ivermectin - to ensure that communities believe that the benefits of taking ivermectin outweigh the risks. In addition to an overall increase in the time required to sustain onchocerciasis control programs in co-endemic areas, each aspect of the reinforced program and communication strategy - rapid epidemiological assessments, materials development, training, advocacy, community sensitization and mobilization, case management and counselling, supervision, monitoring and evaluation will require additional resources and support from all stakeholders concerned.

No MeSH data available.


Related in: MedlinePlus