Osue Hudu O
Nigerian Institute for Trypanosomiasis (and Onchocerciasis) Research (NITR), Kaduna, Nigeria.
Ethiop J Health Sci. 2017 Mar;27(2):129-138. doi: 10.4314/ejhs.v27i2.5.
Impact assessment of community-based ivermectin treatment control of onchocerciasis is required to determine its effectiveness. This study was conducted to evaluate geographic coverage and demographic ivermectin treatment compliance.
The number of village dosage were obtained from the community based distributors. Bioclinical data of participants comprising gender, age, number of treatment received from inception and dosage were obtained. Each participant was subjected to physical examination for palpable nodule and other skin clinical signs and symptoms of onchocerciasis. Visual acuity test was done using the Snellen illiterate E-chart. Eye examination was performed using touch loop and handheld ophthalmoscope. Skin snips from both iliac crests were incubated overnight at 28-32°C and emerged micrifilaria enumerated under an inverted microscope. The changes in epidemiological indices at post-decade of mass drug administration were compared with baseline data.
Village annual ivermectin treatment doses averaged 62%, ranging between 10-100%. Individual treatment compliance rate was generally low with an average of 4 treatments and a range between 0-10. Despite variations in treatment compliance, there were significant improvements in some onchocercal morbidities. These include reduced number and severity of itching, visual impairment, papular onchodermatitis, onchocercomata (palpable nodules) and leopard skin. Ivermectin treatment halted development of new blind cases, except the case of a man who had optic nerve disease and became blind 2 years after ivermectin treatment had commenced. There was a significant overall reduction in parasite burden with very low mean skin microfilaria load of 1.7mf per skin snip and 3.7% skin mf prevalence, compared to baseline data of 17.7mf and 37.9% respectively. The palpable nodule was also drastically reduced from 14.5% to 6.4%. Outcome of this study has practically demonstrated that even a single dose ivermectin treatment is capable of clearing skin mf load on a long-term basis. This assertion is exemplified by the result obtained from Bomjock village that had taken treatment only at inception, and the prevalence rate was reduced from 70% to about 9.0% at post-decade of intervention.
It can be inferred that high demographic coverage with annual treatment doses, it is feasible to attain a shorter time (within a decade) contrary to the anticipated longer-term projection.
需要对基于社区的伊维菌素治疗盘尾丝虫病的效果进行评估，以确定其有效性。本研究旨在评估地理覆盖范围和人群对伊维菌素治疗的依从性。
从社区分发商处获取村庄剂量数量。收集参与者的生物临床数据，包括性别、年龄、自开始治疗以来接受治疗的次数和剂量。对每位参与者进行身体检查，以检查是否有可触及的结节以及盘尾丝虫病的其他皮肤临床体征和症状。使用斯内伦文盲E视力表进行视力测试。使用接触环和手持检眼镜进行眼部检查。从双侧髂嵴采集皮肤切片，在28 - 32°C下孵育过夜，然后在倒置显微镜下对出现的微丝蚴进行计数。将大规模药物给药十年后的流行病学指标变化与基线数据进行比较。
村庄伊维菌素年治疗剂量平均为62%，范围在10% - 100%之间。个体治疗依从率普遍较低，平均接受4次治疗，范围在0 - 10次之间。尽管治疗依从性存在差异，但一些盘尾丝虫病发病率有显著改善。这些包括瘙痒的次数和严重程度、视力损害、丘疹性盘尾性皮炎、盘尾丝虫结节（可触及的结节）和豹皮样皮肤的减少。伊维菌素治疗阻止了新的失明病例的出现，除了一名患有视神经疾病的男子，他在伊维菌素治疗开始2年后失明。与基线数据分别为17.7条微丝蚴/皮肤切片和37.9%相比，寄生虫负担总体显著降低，平均皮肤微丝蚴负荷极低，为1.7条微丝蚴/皮肤切片，皮肤微丝蚴患病率为3.7%。可触及的结节也从14.5%大幅降至6.4%。本研究结果实际表明，即使单次剂量的伊维菌素治疗也能够长期清除皮肤微丝蚴负荷。这一论断由仅在开始时接受治疗的邦乔克村的结果得到例证，在干预十年后，患病率从70%降至约9.0%。
可以推断，通过高人口覆盖率的年度治疗剂量，与预期的长期预测相反，在较短时间（十年内）实现这一目标是可行的。
