The African Programme for Onchocerciasis Control: impact on onchocercal skin disease

Trop Med Int Health. 2011 Jul;16(7):875-83. doi: 10.1111/j.1365-3156.2011.02783.x. Epub 2011 Apr 12.


Objectives: To assess the long-term impact of the African Programme for Onchocerciasis Control on itching and onchocercal skin disease (OSD).

Methods: Seven study sites in Cameroon, Sudan, Nigeria and Uganda participated. Two cross-sectional surveys were conducted of communities meso- and hyper-endemic for onchocerciasis before and after 5 or 6 years of community-directed treatment with ivermectin (CDTI). Individuals were asked about any general health symptoms including itching and underwent full cutaneous examinations. Onchocercal skin lesions were documented according to a standard classification.

Results: Five thousand one hundred and ninety three people were examined in phase I and 5,180 people in phase II. The presence of onchocercal nodules was a strongly significant (P < 0·001) risk factor for all forms of onchocercal skin disease: APOD (OR 1·66); CPOD (OR 2·84); LOD (OR 2·68); reactive skin lesions (OR 2·38) and depigmentation (OR 3·36). The effect of community-directed treatment with ivermectin was profound. At phase II, there were significant (P < 0·001) reductions in the odds of itching (OR 0·32), APOD (OR 0·28); CPOD (OR 0·34); reactive skin lesions (OR 0·33); depigmentation (OR 0·31) and nodules (OR 0·37). Reduction in the odds of LOD was also significant (OR 0.54, P < 0.03).

Conclusions: This first multi-country report of the long-term impact of CDTI reveals a substantial reduction in itching and OSD. APOC operations are having a major effect in improving skin health in poor rural populations in Africa.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Cameroon
  • Cross-Sectional Studies
  • Female
  • Filaricides / therapeutic use*
  • Humans
  • Ivermectin / therapeutic use*
  • Male
  • Middle Aged
  • Nigeria
  • Odds Ratio
  • Onchocerciasis / complications
  • Onchocerciasis / drug therapy*
  • Pruritus / parasitology*
  • Risk Factors
  • Rural Population
  • Skin Diseases, Parasitic / complications
  • Skin Diseases, Parasitic / drug therapy*
  • Sudan
  • Uganda


  • Filaricides
  • Ivermectin