Knowledge, Attitude and Practice (KAP) among adults above 18 years of age towards Onchocerciasis elimination in focus that have Completed Post Treatment Surveillance (PTS) Period in Uganda Open Access

Abstract

Abstract

Knowledge, Attitudes and Practices (KAP) among adults above 18 years of age towards onchocerciasis elimination in foci that have completed Post Treatment Surveillance (PTS) in Uganda

By: Oumer Shafi Abdurahman

Purpose: Since the launch of the onchocerciasis elimination policy by the government in 2007, Uganda had successfully achieved elimination in 11 of the 17 disease transmission zones, also known as foci. Based on historical and scientific evidence, annual and bi-annual treatment strategies sometimes complimented by vector control have been implemented. Available data points to the successful elimination of onchocerciasis after the three-year post treatment surveillance period. However, do communities believe that onchocerciasis has been eliminated? This study assesses community beliefs towards the elimination of the disease and examines whether the different intervention strategies in different foci have affected community beliefs towards elimination differently.

Methods: Data was collected between May - July 2016 in three foci of Uganda: namely, Imaramagambo, Mt. Elgon, and Kashoya-kitomi foci where elimination is achieved. Districts from each focus, sub-counties, and perishes were selected purposively based on their proximity to former vector breeding sites and river systems. Households were randomly selected after updating the list of households in the community. confidence in elimination was compared between foci and districts using chi-square tests. Multivariate logistic regression was used to identify variables associated with community belief in elimination.

Results: Forty-eight percent (48%) of the respondents knew that mass drug administration had been stopped because the disease was no longer in their community. However, when pressed about their belief about elimination ("Do you believe river blindness is eliminated from your community?"), 43.8% of the respondents were skeptical. Mt. Elgon focus (in which vector elimination and 13 years of annual treatment followed by 5-years of bi-annual treatment had been implemented), exhibited the highest confidence in elimination at 68% (p<0.0001). The likelihood of believing that elimination had been achieved was 8.269 times higher for community members who were informed about what to do next when treatment was stopped when compared to those who were not informed, after controlling for treatment place, having ever seeing someone with the disease, and sources of knowledge about the disease.

Discussion: Despite the successes of elimination efforts, communities are still asking for the continuation of treatment with Ivermectin. Co-endemicity of soil transmitted diseases and fear of recurrence of onchocerciasis has contributed to the continued demand for the drug.

Recommendation: A proper exit strategy is needed before halting treatment as we approach elimination. The end game for one disease should consider other diseases that are co-endemic in the area. WHO, in collaboration with onchocerciasis-endemic countries, should come up with guidelines that focus on strengthening public health interventions to help cut the transmission cycle of soil transmitted diseases and which incorporate treatment with Albendazole or Mebendazole in places where onchocerciasis and lymphatic filariasis are eliminated.

Table of Contents

Table of Contents

CHAPTER ONE: INTRODUCTION ................................................................................................ 1

OVERVIEW OF ONCHOCERCIASIS PROGRAM ........................................................................................ 1

THE UGANDAN NATIONAL GUIDELINE FOR ONCHOCERCIASIS ELIMINATION .................................... 4

OVERVIEW OF THE THREE FOCI OF OUR STUDY SITES ......................................................................... 5

STEPS TAKEN TO STOP ONCHOCERCIASIS TREATMENT IN UGANDA ................................................... 8

STUDY QUESTIONS/OBJECTIVES/HYPOTHESES .................................................................................... 9

General Objective: .............................................................................................................................. 9

Specific Objectives: ......................................................................................................................................................... 9

SIGNIFICANCE OF THE STUDY .............................................................................................................. 11

ACRONYMS ............................................................................................................................................ 12

IMPORTANT TERMS .............................................................................................................................. 12

CHAPTER TWO: LITERATURE REVIEW ................................................................................... 13

NEGLECTED TROPICAL DISEASES ........................................................................................................ 13

ONCHOCERCIASIS ................................................................................................................................. 15

Onchocerciasis and poverty: ............................................................................................................ 16

Onchocerciasis and stigma ............................................................................................................... 17

Onchocerciasis Control/elimination programs: .............................................................................. 18

Success stories in onchocerciasis elimination: ................................................................................ 20

Exit strategy of onchocerciasis programs after elimination: .......................................................... 23

CHAPTER THREE: METHODS ..................................................................................................... 24

QUESTIONNAIRE FORMULATION ......................................................................................................... 24

PRE-TESTING THE QUESTIONNAIRE ..................................................................................................... 25

STUDY AREAS ....................................................................................................................................... 25

SAMPLING ............................................................................................................................................. 25

Multi-stage, random and purposive sampling ................................................................................. 25

Sample size calculation, Confidence level and Minimizing error ................................................... 27

Avoiding gender bias ........................................................................................................................ 28

Selection of interviewees ................................................................................................................... 29

Community Meetings ........................................................................................................................ 32

Composition, selection and training of data collectors .................................................................... 32

How the interview was conducted? .................................................................................................. 34

Special situations during data collection and how we dealt with them ........................................... 34

Polygamous Families ..................................................................................................................................................... 34

Absent Household .......................................................................................................................................................... 34

Abandoned Household .................................................................................................................................................. 35

Non- Respondent reasons ................................................................................................................. 35

Special occasion: people with disability ........................................................................................... 35

Data management ............................................................................................................................. 35

Data analysis ..................................................................................................................................... 36

Planning and execution of activities ................................................................................................ 37

Logistic plan ................................................................................................................................................................... 37

Government Procedures ............................................................................................................................................... 37

Ethical approval ................................................................................................................................ 38

Limitations of the study ................................................................................................................................................ 39

CHAPTER FOUR: RESULTS ......................................................................................................... 40

DEMOGRAPHIC INFORMATION ............................................................................................................ 40

KNOWLEDGE ABOUT ONCHOCERCIASIS .............................................................................................. 40

FACTORS ASSOCIATED WITH BELIEF IN ELIMINATION ....................................................................... 42

IMPACT OF ELIMINATION STRATEGIES IN THE SIX DISTRICTS ON BELIEF IN ELIMINATION ............ 43

Analysis of maximum likelihood towards the belief of onchocerciasis elimination ....................... 46

The overall model equation .......................................................................................................................................... 47

Fitness of the model ....................................................................................................................................................... 47

Odds ratio estimates and their interpretations ........................................................................................................... 48

CHAPTER FIVE: DISCUSSION ..................................................................................................... 50

CONCLUSION AND RECOMMENDATIONS ............................................................................................. 53

REFERENCES: ................................................................................................................................ 55

ANNEX A. UGANDA ONCHOCERCIASIS ELIMINATION FLAG ............................................. 59

ANNEX B. SURVEY QUESTIONNAIRE ........................................................................................ 61

ANNEX C. COMMUNITY MEETING GUIDE ............................................................................... 69

ANNEX D. PHOTO TAKEN DURING THE DISCUSSION WITH THE COMMUNITY ..................................... 72

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, General Health Sciences, Epidemiology
Keyword	health education Belief KAP post treatment surveillance Confidence Mectizan Ivermectin Disease transmission zone community drug distributors or CDDs
Committee Chair / Thesis Advisor	McFarland, Deborah A, Emory University
Committee Members	Katabarwa, Moses, The Carter Center
Partnering Agencies	Non-US governmental agency (e.g., Minister of Health in Haiti) International Non-governmental organization (e.g., CARE, Inc.)

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