Loiasis--a neglected and under-estimated affliction: endemicity, morbidity and perceptions in eastern Cameroon.

Loiasis is a neglected disease that may have great social and economic impact in some endemic areas. This study was designed to update the geographical distribution of loiasis and assess the frequency and perceptions of the clinical signs of the disease in the Eastern province of Cameroon. The investigation covered 32 villages and involved 4146 respondents. Human infection with Loa loa was endemic in all the study villages but the prevalence of microfilaraemia generally decreased from south to north. All of the study villages had local names for eye worm and Calabar swellings that varied in meaning and among the various ethnic groups. The most common traditional treatment for eye worm was garlic or onion juice, which is dripped into the affected eye. The body sites that were most affected by Calabar swellings were the upper (30%) or lower (32%) limbs. The swellings were very painful (46%), mildly painful (28%) or painless (26%). Most respondents (94%) reported that the swellings itched. The prevalence of L. loa microfilaraemia in most of the study villages was >20%. These villages are clearly at risk of severe adverse events, with encephalopathy, following mass distribution of ivermectin. The prevalence of the main clinical manifestations of loiasis (i.e. eye worm and/or Calabar swellings) was twice that of detectable microfilaraemia.

The challenges of community-directed treatment with ivermectin (CDTI) within the African Programme for Onchocerciasis Control (APOC).

The principal strategy adopted by the African Programme for Onchocerciasis Control (APOC), for the control of onchocerciasis in the 19 countries of Africa that now fall within the programme's remit, is that of community-directed treatment with ivermectin (CDTI). Halfway through its 12-year mandate, APOC has gathered enough information on the main challenges to guide its activities in Phase 2. An analysis of reports and other documents, emanating from consultants, scientists, monitors and national and project-level implementers, indicates that there are three broad categories of challenge: managerial; technical; and socio-political. Under these three categories, this review identifies the most pertinent concerns that APOC must address, during Phase 2, to enhance the prospects of establishing sustainable systems for ivermectin distribution. The major challenges include: (1) maintaining timely drug-collection mechanisms; (2) integrating CDTI with existing primary-healthcare services; (3) strengthening local health infrastructure; (4) achieving and maintaining an optimal treatment coverage; (5) establishing and up-scaling community self-monitoring; (6) designing and implementing operations research locally; (7) ensuring the adequacy of community-directed distributors; (8) increasing the involvement of local non-govemmental develop organizations in the programme; (9) achieving financial sustainability; (10) implementing equitable cost-recovery systems; and (11) engaging in effective advocacy. The implications of the challenges and suggestions about how they are being (or could be) addressed are also highlighted in this brief review, which should be of value to other programmes and agencies that may be contemplating the adoption of this unique strategy.