02875nas a2200493   4500000000100000008004100001653001000042653000900052653001300061653002800074653001100102653001600113653001100129653001500140653000900155653001600164653001200180653001500192653001900207653001300226653001700239653002100256653002900277653001000306653001100316100001300327700001600340700001500356700001200371700001400383700001300397700001500410700001700425700001300442700001600455700001800471700001600489245009000505856007700595300001100672490000700683520167700690022001402367       2011                            d10aAdult10aAged10aCameroon10aCross-Sectional Studies10aFemale10aFilaricides10aHumans10aIvermectin10aMale10aMiddle Aged10aNigeria10aOdds Ratio10aonchocerciasis10aPruritus10aRisk Factors10aRural Population10aSkin Diseases, Parasitic10aSudan10aUganda1 aOzoh G A1 aMurdoch M E1 aBissek A-C1 aHagan M1 aOgbuagu K1 aShamad M1 aBraide E I1 aBoussinesq M1 aNoma M M1 aMurdoch I E1 aSékétéli A1 aAmazigo U V00aThe African Programme for Onchocerciasis Control: impact on onchocercal skin disease.  uhttp://onlinelibrary.wiley.com/doi/10.1111/j.1365-3156.2011.02783.x/epdf  a875-830 v163 a<p><strong>OBJECTIVES: </strong>To assess the long-term impact of the African Programme for Onchocerciasis Control on itching and onchocercal skin disease (OSD).</p>

<p><strong>METHODS: </strong>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.</p>

<p><strong>RESULTS: </strong>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 &lt; 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 &lt; 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 &lt; 0.03).</p>

<p><strong>CONCLUSIONS: </strong>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.</p>
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