Dissak-Delon Fanny Nadia, Kamga Guy-Roger, Humblet Perrine Claire, Robert Annie, Souopgui Jacob, Kamgno Joseph, Essi Marie José, Ghogomu Stephen Mbigha, Godin Isabelle
Ministry of Public Health, Yaoundé, Cameroon.
Université Libre de Bruxelles, Brussels, Belgium.
PLoS Negl Trop Dis. 2017 Aug 14;11(8):e0005849. doi: 10.1371/journal.pntd.0005849. eCollection 2017 Aug.
The fight against onchocerciasis in Africa has boomed thanks to the Community Directed Treatment with Ivermectin (CDTI) program. However, in Cameroon, after more than 15 years of mass treatment, onchocerciasis prevalence is still above the non-transmission threshold. This study aimed to explore a possible association between people's beliefs/perceptions of onchocerciasis and of CDTI program, and their adherence to ivermectin in three regions of Cameroon.
METHODOLOGY/PRINCIPAL FINDINGS: A cross sectional survey was carried out in three health districts with persistent high onchocerciasis prevalence. Participants were randomly selected in 30 clusters per district. Adherence to ivermectin was comparable between Bafang and Bafia (55.0% and 48.8%, respectively, p>0.05) and lower in Yabassi (40.7%). Among all factors related to program perceptions and disease representations that were studied, perceptions of the program are the ones that were most determinant in adherence to ivermectin. People who had a "not positive" opinion of ivermectin distribution campaigns were less compliant than those who had a positive opinion about the campaigns (40% vs 55% in Bafang, and 48% vs 62% in Bafia, p<0.01), as well as those who had a negative appreciation of community drug distributors' commitment (22% vs 53% in Bafang, 33% vs 59% in Bafia, 27% vs 47% in Yabassi; p<0.01). The most common misconception about onchocerciasis transmission was the lack of hygiene, especially in Bafia and Yabassi. In Bafang, high proportions of people believed that onchocerciasis was due to high consumption of sugar (31% vs less than 5% in Bafia and Yabassi, p<0.001).
CONCLUSION/SIGNIFICANCE: There are still frequent misconceptions about onchocerciasis transmission in Cameroon. Perceptions of ivermectin distribution campaigns are more strongly associated to adherence. In addition to education/sensitisation on onchocerciasis during the implementation of the CDTI program, local health authorities should strive to better involve communities and more encourage community distributors' work.
由于伊维菌素社区导向治疗（CDTI）项目，非洲抗击盘尾丝虫病的行动蓬勃发展。然而，在喀麦隆，经过15年多的大规模治疗后，盘尾丝虫病患病率仍高于非传播阈值。本研究旨在探讨喀麦隆三个地区的人们对盘尾丝虫病和CDTI项目的信念/认知与他们对伊维菌素的依从性之间可能存在的关联。
方法/主要发现：在盘尾丝虫病患病率持续较高的三个卫生区开展了一项横断面调查。每个区从30个群组中随机选取参与者。巴方和巴菲亚对伊维菌素的依从性相当（分别为55.0%和48.8%，p>0.05），而雅巴西的依从性较低（40.7%）。在研究的所有与项目认知和疾病认知相关的因素中，对项目的认知是伊维菌素依从性的最主要决定因素。对伊维菌素分发活动持“不积极”看法的人比持积极看法的人依从性更低（巴方为40%对55%，巴菲亚为48%对62%，p<0.01），对社区药品分发人员的工作持负面评价的人也是如此（巴方为22%对53%，巴菲亚为33%对59%，雅巴西为27%对47%；p<0.01）。关于盘尾丝虫病传播最常见的误解是缺乏卫生，特别是在巴菲亚和雅巴西。在巴方，很大一部分人认为盘尾丝虫病是由于糖分摄入过多（31%，而巴菲亚和雅巴西不到5%，p<0.001）。
结论/意义：喀麦隆对盘尾丝虫病传播仍存在常见误解。对伊维菌素分发活动的认知与依从性关联更强。除了在实施CDTI项目期间对盘尾丝虫病进行教育/宣传外，地方卫生当局应努力让社区更好地参与进来，并更多地鼓励社区分发人员的工作。
