Knowledge, attitudes, perceptions and acceptability of onchocerciasis control through community-directed treatment with ivermectin: Implications for persistent transmission in Ulanga District, Tanzania

Abstract

Background: Ulanga, an onchocerciasis-endemic district in Tanzania, has received preventive chemotherapy for onchocerciasis by community-directed  treatment with ivermectin (CDTI). With CDTI, interruption of transmission could occur after 14-17 years, yet transmission persists even after 20 years. This  may be due to high baseline endemicity and other factors that can lower coverage of CDTI, including poor knowledge of the disease and negative  attitudes and perceptions towards CDTI. This study examined community knowledge, attitudes and perceptions towards onchocerciasis control and  acceptability of the CDTI program in Ulanga.

Methods: A mixed methods cross-sectional study was carried out from June to July 2018. A quantitative questionnaire was administered to 422  household members in the community. This was complemented with qualitative in-depth interviews and focus group discussions.

Results: A majority (94.1%) of community members had heard of onchocerciasis. Only 15.4% had a high level of knowledge about onchocerciasis; about  half (49.2%) had a low level of knowledge on the disease and CDTI. Negative attitudes and perceptions towards CDTI prevailed in nearly half of  participants (46.2% and 44%, respectively). A majority (83.4%) of respondents agreed that they will take ivermectin, and 74.4% were willing to comply with  treatment for 12 to 15 years to eliminate onchocerciasis. In focus group discussions, participants reported mistrust of the method of dose  calculation, that affects the acceptability and use of ivermectin treatment.

Conclusion: Inadequate levels of knowledge, negative attitudes and  perceptions have the potential to affect participation in CDTI. This may result in continual transmission of onchocerciasis.