Community-directed treatment with ivermectin in Maridi, South Sudan: Impact of an onchocerciasis awareness campaign and bi-annual treatment on therapeutic coverage
Ivermectin coverage significantly improved in Maridi district in 2023 after biennial treatment (70.3%).
A high onchocerciasis disease burden and a low coverage of community-directed treatment with ivermectin (CDTi) have been observed in many parts of South Sudan. In Maridi County, CDTi was re-introduced in 2017 and various interventions implemented to improve coverage.
Through successive community-based surveys, this study investigated whether an onchocerciasis awareness campaign and a switch from annual to bi-annual distribution of ivermectin in Maridi County increased CDTi coverage, and reviewed the evolution of ivermectin distribution in Maridi since 2017 to identify determinants for ivermectin uptake.
For past years in Maridi, CDTi programme performance has been highly variable due to security concerns, limited funding, misconceptions about ivermectin, and poor organisation of mass treatment campaigns. Community-based surveys conducted between 2018 and 2024 in Maridi found that upon switching from annual CDTi (2017–2019) to bi-annual CDTi (2021 onward), therapeutic coverage significantly increased from 40.8% in 2017 to 70.3% in 2023. Lower age, male gender, more CDTi information sources, and awareness of a link between onchocerciasis and epilepsy were all associated with increased uptake of ivermectin.
This study showed that with reinforced awareness raising accompanying biannual CDTi, higher ivermectin treatment coverage is achievable. The findings present an opportunity for the health system to advance its onchocerciasis elimination scheme in remote, conflict-stricken communities in South Sudan.
This publication relates to R2HC funded study: Innovative approaches to reduce the burden of disease caused by onchocerciasis