Siewe Fodjo Joseph Nelson, Okwii Moses, Jada Stephen Raimon, Hadermann Amber, Rovarini Jacopo, Amaral Luis-Jorge, Nditanchou Rogers, Bol Yak Yak, Logora Makoy Y, Carter Jane Y, Willems Johan, Colebunders Robert
Global Health Institute, University of Antwerp, Antwerp, Belgium.
Kampala University, Juba, Republic of South Sudan.
PLoS Negl Trop Dis. 2025 Sep 8;19(9):e0013493. doi: 10.1371/journal.pntd.0013493. eCollection 2025 Sep.
A high onchocerciasis disease burden and a low coverage of community-directed treatment with ivermectin (CDTI) have been observed in many parts of South Sudan. In the Maridi County, CDTI was re-introduced in 2017 and various interventions implemented to improve coverage.
Through successive community-based surveys, we investigated whether an onchocerciasis awareness campaign and a switch from annual to bi-annual distribution of ivermectin in Maridi County increased CDTI coverage. We also reviewed the evolution of ivermectin distribution in Maridi since 2017 and identified the determinants for ivermectin uptake.
For past years in Maridi, CDTI programme performance has been highly variable due to security concerns, limited funding, misconceptions about ivermectin, and poor organisation of mass treatment campaigns. Community-based surveys conducted between 2018 and 2024 in Maridi found that upon switching from annual CDTI (2017-2019) to bi-annual CDTI (2021 onward), therapeutic coverage significantly increased from 40.8% in 2017 to 70.3% in 2023. Lower age, male gender, more CDTI information sources, and awareness of a link between onchocerciasis and epilepsy were all associated with increased uptake of ivermectin.
This study showed that with reinforced awareness raising accompanying biannual CDTI, a higher ivermectin treatment coverage is achievable. The findings present an opportunity for the health system to advance its onchocerciasis elimination scheme in remote, conflict-stricken communities in South Sudan.
在南苏丹的许多地区，盘尾丝虫病负担较重，而伊维菌素社区定向治疗（CDTI）的覆盖率较低。在马迪县，2017年重新引入了CDTI，并实施了各种干预措施以提高覆盖率。
通过连续的社区调查，我们调查了马迪县开展的盘尾丝虫病宣传活动以及伊维菌素分发从每年一次改为每两年一次是否提高了CDTI覆盖率。我们还回顾了自2017年以来马迪县伊维菌素分发情况的演变，并确定了伊维菌素使用的决定因素。
在过去几年中，由于安全问题、资金有限、对伊维菌素的误解以及大规模治疗活动组织不力，马迪县的CDTI项目执行情况差异很大。2018年至2024年在马迪县进行的社区调查发现，从每年一次的CDTI（2017 - 2019年）改为每两年一次的CDTI（2021年起）后，治疗覆盖率从2017年的40.8%显著提高到2023年的70.3%。年龄较小、男性、更多的CDTI信息来源以及对盘尾丝虫病与癫痫之间联系的认识都与伊维菌素使用的增加有关。
本研究表明，通过加强宣传并配合每两年一次的CDTI，可以实现更高的伊维菌素治疗覆盖率。这些发现为卫生系统在南苏丹偏远、受冲突影响的社区推进盘尾丝虫病消除计划提供了机会。
