Community-directed treatment with ivermectin in two Nigerian communities: an analysis of first year start-up processes, costs and consequences

Onwujekwe, O; Chima, R; Shu, E; Okonkwo, P; (2002) Community-directed treatment with ivermectin in two Nigerian communities: an analysis of first year start-up processes, costs and consequences. Health policy (Amsterdam, Netherlands), 62 (1). pp. 31-51. ISSN 0168-8510 DOI:

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OBJECTIVES: To determine the start-up processes, costs and consequences of community-directed treatment with ivermectin (CDTI) in two onchocerciasis endemic rural towns of Southeast Nigeria; namely Achi and Nike. The other objectives were to discover the community-financing mechanisms, local ivermectin distribution strategies and communities' organisational capacity to handle the programme. METHODS: Structured questionnaires, informal interviews, observations, discussions with community members at general village assemblies and community outreach lectures were used at different stages of the study. RESULT: The towns had the organisational capacity to implement the programme. Coverage with ivermectin was between 31-73% in Achi (mean = 58.6%), and 36.6-72% in Nike (mean = 61.95%). The unit financial costs were $0.17 in Nike and $0.13 in Achi, but the unit aggregate cost was $0.37 in Nike and $0.39 in Achi. When research costs were removed, the unit aggregate cost was $0.22 in Achi and $0.20 in Nike. Provider's financial costs and communities' non-financial costs were the biggest contributors to the aggregate cost. The cost would decrease in subsequent years since the research cost and parts of the mobilisation and training costs would not be incurred after the first year. CONCLUSION: Governments and sponsors of CDTI should find means of continuously strengthening the programme and providing technical support to the communities. As both CDTI and communities are dynamic entities, continuous health education campaigns are needed to keep reminding the people of the benefit of long-term ivermectin distribution, together with the need for community ownership of the programme.

Item Type: Article
Keywords: CDTI, CDDs, community-directed treatment, ivermectin, onchocerciasis, Willingness-to-pay, onchocerciasis control, mass-distribution, uganda, recovery, river, Anthelmintics, economics, therapeutic use, Community Health Services, economics, organization & administration, Costs and Cost Analysis, Endemic Diseases, prevention & control, Health Education, Health Services Research, Human, Ivermectin, economics, therapeutic use, Nigeria, Onchocerciasis, drug therapy, economics, Program Development, Rural Population, Support, Non-U.S. Gov't
Faculty and Department: Faculty of Public Health and Policy > Dept of Global Health and Development
PubMed ID: 12151133
Web of Science ID: 178297900003


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