Perceptions on onchocerciasis and ivermectin treatment in rural communities in Uganda: implications for long-term compliance

Registers of community-directed distributors of ivermectin for onchocerciasis from 2000 to 2005 were reviewed to identify people highly and poorly compliant to ivermectin treatment. Compliance was termed ‘high’ if a person took annual ivermectin ≥4 out of 6 times and ‘poor’ if it was taken <4 times. Individuals (409 and 362 highly and poorly compliant, respectively) were interviewed on knowledge of onchocerciasis, severity of the disease, benefits of ivermectin treatment and its adverse events. Those who believed onchocerciasis to be a serious disease and also believed ivermectin treatment alleviated symptoms (71.9%), were highly compliant compared with (37.7%) who believed that onchocerciasis was not a serious disease and ivermectin did not alleviate symptoms (P<0.001). Those who believed that ivermectin caused itchiness were 6.1% and 39.5% of highly and poorly compliant respectively (P<0.001). Given that people more highly compliant with ivermectin mass drug administration (MDA) appear to better recognize the severity of onchocerciasis and the salutary effects of ivermectin, their enthusiasm to take ivermectin should be maintained through regular health education on the benefits and importance of continued treatment, and proper management of adverse events. The conclusions drawn in this article may equally apply to other MDA programmes.