RESUMO
OBJECTIVE: To investigate the impact of health education on community participation in the rapid assessment of onchocerciasis prior to distribution of ivermectin in Nigeria. DESIGN: There was health education with use of pictorial monographs to an adult population and school children in Umulumgbe and Okpatu communities, respectively. The school children in turn transferred the knowledge acquired to their parents through a health club, and a third community (Awhum) had no health education. Randomly selected subjects in each community were then assessed for their ability to recognise clinical manifestations of disease. SETTING: The study took place in three onchocerciasis-endemic, autonomous communities in Udi local government area of Enugu state in eastern Nigeria. SUBJECTS: Fifty, thirty seven, and thirty three male subjects, aged 20 years and above in Umulumgbe, Okpatu and Awhum respectively were involved in the study. RESULTS: 89.3%, 100% and 25.6% of the total number of onchocercal nodules were rightly indicated by the subjects in Umulumgbe, Okpatu and Awhum respectively. 100% of skin depigmentation was also reported in Umulumgbe and Okpatu each, and 50% in Awhum. Although some of the clinical manifestations (onchocercal nodules and skin depigmentation) were wrongly indicated, others (hanging groin and enlarged scrotum) were not reported by the subjects at all. CONCLUSION: This study clearly shows that health education is necessary for control programmes that are meant to be sustainable, especially the WHO-supported community-directed treatment with ivermectin (CDTI).
PIP: This article examines the impact of health education on community participation in the rapid assessment of onchocerciasis before distributing ivermectin in Nigeria. The study was conducted in three onchocerciasis-endemic areas of Nigeria--Awhum, Umulumgbe, and Okpatu--involving 33, 50, and 37 male subjects, respectively, in each community. A health education activity on onchocerciasis was conducted among the adult population and school children of Umulumgbe and Okpatu communities, after which, a rapid assessment of onchocerciasis was carried out. On the other hand, a rapid assessment was also conducted in Awhum in March 1995 before ivermectin distribution without prior health education. The study found that onchocercal nodules were more frequent in the lower part of the subject's body, especially around the pelvic region. Onchocercal nodules were indicated by 89.3% of the subjects in Umulumgbe, by 100% of the subjects in Okpatu, and by 25.6% of the subjects in Awhum. Skin pigmentation was also reported by 100% of the subjects in Umulumgbe and Okpatu and by 50% of the subjects in Awhum. The investigation discovered that some onchocercal nodules were incorrectly identified by the three communities, resulting in failure of reporting other clinical manifestations of the disease. Despite these limitations, researchers still feel that health education greatly influenced their knowledge on the parasitic disease.