Impact of long-term treatment of onchocerciasis with ivermectin in Kaduna State, Nigeria: first evidence of the potential for elimination in the operational area of the African Programme for Onchocerciasis Control.

BACKGROUND: Onchocerciasis can be effectively controlled as a public health problem by annual mass drug administration of ivermectin, but it was not known if ivermectin treatment in the long term would be able to achieve elimination of onchocerciasis infection and interruption of transmission in endemic areas in Africa. A recent study in Mali and Senegal has provided the first evidence of elimination after 15-17 years of treatment. Following this finding, the African Programme for Onchocerciasis Control (APOC) has started a systematic evaluation of the long-term impact of ivermectin treatment projects and the feasibility of elimination in APOC supported countries. This paper reports the first results for two onchocerciasis foci in Kaduna, Nigeria. METHODS: In 2008, an epidemiological evaluation using skin snip parasitological diagnostic method was carried out in two onchocerciasis foci, in Birnin Gwari Local Government Area (LGA), and in the Kauru and Lere LGAs of Kaduna State, Nigeria. The survey was undertaken in 26 villages and examined 3,703 people above the age of one year. The result was compared with the baseline survey undertaken in 1987. RESULTS: The communities had received 15 to 17 years of ivermectin treatment with more than 75% reported coverage. For each surveyed community, comparable baseline data were available. Before treatment, the community prevalence of O. volvulus microfilaria in the skin ranged from 23.1% to 84.9%, with a median prevalence of 52.0%. After 15 to 17 years of treatment, the prevalence had fallen to 0% in all communities and all 3,703 examined individuals were skin snip negative. CONCLUSIONS: The results of the surveys confirm the finding in Senegal and Mali that ivermectin treatment alone can eliminate onchocerciasis infection and probably disease transmission in endemic foci in Africa. It is the first of such evidence for the APOC operational area

Lacerated Lips and Lush Landscapes: Constructing This-Worldly Theological Identities in the Otherworld

When Irenaeus juxtaposed tradition and heresy, he moved away from the Pauline usage, which centered primarily upon incorrect behavior (See 1 Cor 11: 19, Gal 5 :20). lrenaeus\u27 definition of heresy, however, does not indicate that all early Christians prioritized belief over behavior, or even maintained orthodoxy and orthopraxis as separate categories. In the otherworldly spaces of the apocryphal apocalypses doxa and praxis seem to be intertwined, and little or no distinction is made between belief and behavior. Instead, in the Otherworld the categories of primary importance are righteous/unrighteous, good/evil, Christian/Other. The Otherworld is a place in which sins can be sorted and the identity markers which might have been overlooked or are difficult to see in this world can be seen more clearly. And yet, we are left to wonder how that otherworldly clarity maps onto the lived experience of the ancient audiences of these apocalypses. Thus, we will begin by reflecting upon the ability of these apocalyptic texts to create (and recreate) Christian identity by either describing real categories of people, or by creating the categories themselves, and so prescribing reality. In each of the apocalypses that we will discuss the reader learns that his or her identity is determined for all of eternity by the choices that are made in this world. In this regard, each depiction of the otherworld establishes its own identity markers, isolating certain beliefs and behaviors as distinctively Christian. What is startling about the definitions of Christian belief and practice that emerge from each text is that they are rather expansive, covering far more territory than any creed or council. Our discussion will demonstrate that while creedal definitions of orthodoxy ( as well as the apocalyptic definitions of correct belief that mirror them) were often aimed at labeling specific groups as other, the apocalyptic depictions of the otherworld were attempting to be either exhaustive or open-ended, imagining a host of practices that could be used to frame Christian identity. In these imaginary spaces, the theological identities that were crafted could not simply be summarized by simple binaries like orthodoxy/heterodoxy, oppressed/oppressor, or even sinner/sinless. Instead, the apocalyptic visions, which on the surface seem to deal in dichotomies, paradoxically proliferate a range of Christian practices

Lymphatic filariasis in the Democratic Republic of Congo; micro-stratification overlap mapping (MOM) as a prerequisite for control and surveillance

<p>Abstract</p> <p>Background</p> <p>The Democratic Republic of Congo (DRC) has a significant burden of lymphatic filariasis (LF) caused by the parasite <it>Wuchereria bancrofti</it>. A major impediment to the expansion of the LF elimination programme is the risk of serious adverse events (SAEs) associated with the use of ivermectin in areas co-endemic for onchocerciasis and loiasis. It is important to analyse these and other factors, such as soil transmitted helminths (STH) and malaria co-endemicity, which will impact on LF elimination.</p> <p>Results</p> <p>We analysed maps of onchocerciasis community-directed treatment with ivermectin (CDTi) from the African Programme for Onchocerciasis Control (APOC); maps of predicted prevalence of <it>Loa loa</it>; planned STH control maps of albendazole (and mebendazole) from the Global Atlas of Helminth Infections (GAHI); and bed nets and insecticide treated nets (ITNs) distribution from Demographic and Health Surveys (DHS) as well as published historic data which were incorporated into overlay maps. We developed an approach we designate as micro-stratification overlap mapping (MOM) to identify areas that will assist the implementation of LF elimination in the DRC. The historic data on LF was found through an extensive review of the literature as no recently published information was available.</p> <p>Conclusions</p> <p>This paper identifies an approach that takes account of the various factors that will influence not only country strategies, but suggests that country plans will require a finer resolution mapping than usual, before implementation of LF activities can be efficiently deployed. This is because 1) distribution of ivermectin through APOC projects will already have had an impact of LF intensity and prevalence 2) DRC has been up scaling bed net distribution which will impact over time on transmission of <it>W. bancrofti </it>and 3) recently available predictive maps of <it>L. loa </it>allow higher risk areas to be identified, which allow LF implementation to be initiated with reduced risk where <it>L. loa </it>is considered non-endemic. We believe that using the proposed MOM approach is essential for planning the expanded distribution of drugs for LF programmes in countries co-endemic for filarial infections.</p

Relationship between oral declaration on adherence to ivermectin treatment and parasitological indicators of onchocerciasis in an area of persistent transmission despite a decade of mass drug administration in Cameroon

BACKGROUND: Onchocerciasis control for years has been based on mass drug administration (MDA) with ivermectin (IVM). Adherence to IVM repeated treatment has recently been shown to be a confounding factor for onchocerciasis elimination precisely in rain forest areas where transmission continues and Loa loa co-exists with Onchocerca volvulus. In this study, participants’ oral declarations were used as proxy to determine the relationship between adherence to IVM treatment and parasitological indicators of onchocerciasis in the rain forest area of Cameroon with more than a decade of MDA. METHODS: Participants were recruited based on their IVM intake profile with the aid of a semi-structured questionnaire. Parasitological examinations (skin sniping and nodule palpation) were done on eligible candidates. Parasitological indicators were calculated and correlated to IVM intake profile. RESULTS: Of 2,364 people examined, 15.5 % had never taken IVM. The majority (40.4 %) had taken the drug 1–3 times while only 18 % had taken ≥ 7 times. Mf and nodule prevalence rates were still high at 47 %, 95 % CI [44.9–49.0 %] and 36.4 %, 95 % CI [34.4–38.3 %] respectively. There was a treatment-dependent reduction in microfilaria prevalence (r(s) =−0.986, P = 0.01) and intensity (r(s) =−0.96, P = 0.01). The highest mf prevalence (59.7 %) was found in the zero treatment group and the lowest (33.9 %) in the ≥ 7 times treatment group (OR = 2.8; 95 % CI [2.09–3.74]; P < 0.001). Adults with ≥ 7 times IVM intake were 2.99 times more likely to have individuals with no microfilaria compared to the zero treatment group (OR = 2.99; 95 % CI [2.19–4.08], P < 0.0001). There was no clear correlation between treatment and nodule prevalence and intensity. CONCLUSION: Adherence to ivermectin treatment is not adequate in this rain forest area where L. loa co-exists with O. volvulus. The prevalence and intensity of onchocerciasis remained high in individuals with zero IVM intake after more than a decade of MDA. Our findings show that using parasitological indicators, reduction in prevalence is IVM intake-dependent and that participants’ oral declaration of treatment adherence could be relied upon for impact studies. The findings are discussed in the context of challenges for the elimination of onchocerciasis in this rain forest area

Situation analysis of parasitological and entomological indices of onchocerciasis transmission in three drainage basins of the rain forest of South West Cameroon after a decade of ivermectin treatment

BACKGROUND: Community-Directed Treatment with Ivermectin (CDTI) is the main strategy adopted by the African Programme for Onchocerciasis control (APOC). Recent reports from onchocerciasis endemic areas of savannah zones have demonstrated the feasibility of disease elimination through CDTI. Such information is lacking in rain forest zones. In this study, we investigated the parasitological and entomological indices of onchocerciasis transmission in three drainage basins in the rain forest area of Cameroon [after over a decade of CDTI]. River basins differed in terms of river number and their flow rates; and were characterized by high pre-control prevalence rates (60-98%). METHODS: Nodule palpation and skin snipping were carried out in the study communities to determine the nodule rates, microfilarial prevalences and intensity. Simulium flies were caught at capture points and dissected to determine the biting, parous, infection and infective rates and the transmission potential. RESULTS: The highest mean microfilaria (mf) prevalence was recorded in the Meme (52.7%), followed by Mungo (41.0%) and Manyu drainage basin (33.0%). The same trend was seen with nodule prevalence between the drainage basins. Twenty-three (23/39) communities (among which 13 in the Meme) still had mf prevalence above 40%. All the communities surveyed had community microfilarial loads (CMFL) below 10 mf/skin snip (ss). The infection was more intense in the Mungo and Meme. The intensity of infection was still high in younger individuals and children less than 10 years of age. Transmission potentials as high as 1211.7 infective larvae/person/month were found in some of the study communities. Entomological indices followed the same trend as the parasitological indices in the three river basins with the Meme having the highest values. CONCLUSION: When compared with pre-control data, results of the present study show that after over a decade of CDTI, the burden of onchocerciasis has reduced. However, transmission is still going on in this study site where loiasis and onchocerciasis are co-endemic and where ecological factors strongly favour the onchocerciasis transmission. The possible reasons for this persistent and differential transmission despite over a decade of control efforts using ivermectin are discussed. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13071-015-0817-2) contains supplementary material, which is available to authorized users

Prevalencia de caídas en ancianos que viven en la comunidad

Objetivos. Estimar la prevalencia de caídas, los factores asociados y sus consecuencias en ancianos >= 70 años en 2 comunidades, previo a un estudio de intervención. Diseño. Estudio descriptivo transversal. Emplazamiento. Dos comunidades mixtas urbanas-rurales. Participantes. Muestra de personas >= 70 años, 329 para el grupo de intervención (GI) y 372 para el grupo control (GC). Muestreo aleatorio o sistemático. Mediciones y resultados principales. Con un intervalo de confianza (IC) del 95% observamos en los que serán, respectivamente, GI y GC: varones, 38,9% (33,6-44,4) y 41,6% (36,6-46,9); media de edad de 80,11 (79,49-80,73) y 78,42 años (77,77-79,07); mayores de 80 años, 41,9% (37,4-46,4) y 32,8% (29,5-36); nivel de dependencia elevado según el índice de Katz, 10,3% (9,2-11,4) y 13,2% (11,9-14,5); personas que se han caído en el último año, 28,9% (25,8-31,9) y 32% (28,8-35,2); caídas recurrentes en personas que se han caído 34,7% (25,2-45,2) y 37% (28,3-46,3); número total de caídas, 166 y 218. Del total de caídas precisan asistencia médica el 45,4% (37,1-54) y el 30,3% (24,3-36,8); ingresos hospitalarios, 7,3% (3,8-12,3) y 5% (2,5-8,8); presentan fracturas el 10,4% (6-16,3) y el 6,9% (3,9-11,2). Las caídas ocurren principalmente en casa (61 y 56,5%); por causas ambientales (40 y 54%) y problemas de movilidad (37,5 y 36%); las lesiones más frecuentes son las inciso-contusas (86,1 y 77,9%). Conclusión. En ambos grupos la prevalencia de personas que se han caído coincide con la de la mayoría de los estudios. Tampoco existen diferencias relevantes respecto a las características principales de las caídas y sus lesiones derivadas