Controlling onchocerciasis by community-directed, ivermectin-treatment programmes in Uganda: why do some communities succeed and others fail?

In Uganda, human onchocerciasis is controlled by annual, mass, community-di rected, ivermectin-treatment programmes (CDITP) in all endemic communities where the prevalence of the disease is greater than or equal to 30%. This i s a practical, long-term and cost-effective strategy. In some communities, this system succeeds in providing treatment at the desired level of coverag e (i.e. 90% of the annual treatment objective, which is itself equivalent t o all those individuals eligible to take ivermectin). Other communities, ho wever, fail to reach this target. The aim of the present study was to deter mine the factors that were significantly associated with success or failure in achieving this target. The data analysed were answers to a questionnair e completed by 10 household heads randomly selected from each of 64 randoml y selected endemic communities (of which 36 succeeded and 28 failed to reac h their coverage target) in the four districts of Kabale, Moyo, Nebbi and R ukungiri. Among the programme-related Factors investigated, success was associated, a t a statistical level of significance (P less than or equal to 0.05), with involvement of community members in: (1) decisions about the execution of t he programme; (2) attendance at health-education sessions; (3) selection of the community-based distributors (CDB); and (4) rewarding CBD in kind. In general, the involvement of community members in the planning and execution of a CDITP (and the resultant sense of pride in community ownership) was m ore likely to produce successful results than when external health workers or even community leaders or local councils Look responsibility.