Research

Community-directed delivery of doxycycline for the treatment of onchocerciasis in areas of co-endemicity with loiasis in Cameroon

Samuel Wanji^1,2 , Nicholas Tendongfor^1,2 , Theolbald Nji² , Mathias Esum² , Julious N Che² , Armand Nkwescheu³ , Fifen Alassa⁴ , Geremy Kamnang⁵ , Peter A Enyong^6,2 , Mark J Taylor⁷ , Achim Hoerauf⁸ and David W Taylor⁹

¹  Department of Biochemistry and Microbiology, University of Buea, P.O. Box 63, Buea Cameroon

²  Research Foundation for Tropical Diseases and Environment, P.O. Box 474, Buea, Cameroon

³  Ministry of Public Health, Division of Operational Research, Yaoundé, Cameroon

⁴  Melong Health District Services, P.O. Box 68 Melong, Cameroon

⁵  Mbanga Health District Services, P.O. Box 29 Mbanga, Cameroon

⁶  Tropical Medicine Research Station, P.O. Box 55, Kumba Cameroon

⁷  Filariasis Research Laboratory, Molecular and Biochemical Parasitology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK

⁸  Institute of Medical Microbiology, Immunology and Parasitology (IMMIP), University Hospital Bonn, Sigmund-Freud Str.25, 53105 Bonn, Germany

⁹  Centre for Infectious Diseases, College of Medicine and Veterinary Medicine, University of Edinburgh, Summerhall, Edinburgh EH9 1QH, UK

author email corresponding author email

Parasites & Vectors 2009, 2:39doi:10.1186/1756-3305-2-39

Published:	27 August 2009

Abstract

Background

Severe side effects following ivermectin treatment of onchocerciasis in areas of co-endemicity with loaisis have been an impediment for the work of the African Programme for Onchocerciasis Control (APOC) in forested regions of several countries. Doxycycline has been shown to be effective in the treatment of onchocerciasis and has the added advantages of killing adult Onchocerca volvulus but neither adult Loa loa nor their microfilariae. This drug therefore offers great potential for the treatment of onchocerciasis in areas of co-endemicity with loiasis. The limitation of use of this drug is the duration of treatment that may pose a potential problem with therapeutic coverage and compliance with treatment. To benefit from the advantages that doxycycline offers in the treatment of onchocerciasis, it will be necessary to establish an effective distribution system that can access remote communities. This study assessed the feasibility of a large-scale distribution of doxycycline for the treatment of onchocerciasis in areas of co-endemicity with loiasis using a community-directed approach.

Methods

The study was carried out in 5 health areas co-endemic for Onchocerca volvulus and Loa loa which had no prior experience of the Community Directed Treatment with Ivermectin (CDTI). The community-directed delivery process was introduced using a cascade mechanism from the central health system that passed through the regional health delegation, health district and the health areas. Community health implementers (CHIs) were trained to deliver doxycycline to community members and, under the supervision of the health system, to monitor and document drug intake and side effects.

Results

The community members adhered massively to the process. Of the 21355 individuals counted, 17519 were eligible for treatment and 12936 were treated with doxycycline; giving a therapeutic coverage of eligible population of 73.8%. Of the 12936 who started the treatment, 97.5% complied by the end of six weeks. No serious side effect was registered during the six week treatment.

Conclusion

This study indicates that when empowered the community health implementers can successfully deliver doxycycline for six weeks for the treatment of onchocerciasis in areas of co-endemicity with loiasis. The therapeutic coverage and the compliance treatment rate achieved in this study coupled to the known efficacy of doxycycline on O. volvulus, are indicators that the strategy involving the mass administration of doxycycline can be used to control onchocerciasis in those areas of co-endemicity with loiasis where ivermectin may be contraindicated.