# Onchocerciasis and non-communicable diseases in the Bafut Health District, Cameroon: Knowledge, attitudes, and practices towards community-directed treatment with ivermectin

## TL;DR

This study in Cameroon finds that while knowledge about river blindness is high, concerns about side effects and the coexistence of chronic diseases like arthritis and hypertension may hinder treatment success.

## Contribution

The study highlights the intersection of onchocerciasis and non-communicable diseases in Cameroon, advocating for integrated health strategies.

## Key findings

- Most participants showed good knowledge and practices regarding onchocerciasis and ivermectin treatment.
- Over 75% reported symptoms of onchocerciasis, with nearly a quarter also having a non-communicable disease diagnosis.
- Arthritis was the most common self-reported NCD, and hypertension was the most frequent family history of NCDs.

## Abstract

Onchocerciasis remains a public health problem in Cameroon despite years of community-directed treatment with ivermectin (CDTI). Its persistence increasingly overlaps with the rising burden of non-communicable diseases (NCDs). Community knowledge, attitudes, and practices (KAP) toward onchocerciasis and CDTI, as well as the coexistence of chronic NCDs, may influence the success of elimination programs.

A community-based cross-sectional study was conducted between April and June 2022 in Bafut Health District, Northwest Cameroon. Using a structured, interviewer-administered questionnaire, information was collected on sociodemographic characteristics, knowledge, attitudes, and practices related to onchocerciasis and CDTI, as well as symptoms and comorbidities associated with NCDs. Descriptive statistics were used to summarize responses, while the association between quantitative variables was determined using the Chi-square test and logistic regression analysis. Statistical significance was set at p < 0.05.

Of the 250 respondents (mean age 40.9 ± 13.6 years), 96.8% had heard of onchocerciasis, though only 46.0% correctly identified the filarial worm as the cause. Good knowledge, a positive attitude, and good practices regarding onchocerciasis and CDTI were observed in 78.0%, 61.3%, and 90.4% of the respondents, respectively. Symptoms of onchocerciasis were reported by 188 participants (75.2%), with itching being the most common (50.4%). Of these, 46 (24.5%) also reported a diagnosis of NCD, while 84 (44.7%) reported a family history of NCDs. Arthritis (32.4%) was the most common self-reported NCD, and hypertension (14.0%) was the most frequent family history.

This study revealed high levels of knowledge and good practices regarding onchocerciasis and CDTI; however, knowledge gaps and concerns about side effects continue to hinder the uptake of ivermectin. The coexistence of onchocerciasis with chronic NCDs highlights the need for integrated disease management and reinforced health education to support elimination goals.

Onchocerciasis, or river blindness, remains a significant public health concern in Cameroon despite decades of community-directed treatment with ivermectin (CDTI). Although CDTI has reduced transmission, the disease continues to affect communities where non-communicable diseases (NCDs) such as arthritis, hypertension, diabetes, stroke, and epilepsy are also on the rise. The coexistence of onchocerciasis and chronic conditions may complicate treatment decisions, affect adherence, and undermine elimination goals. This study was conducted among 250 residents of Bafut Health District, where onchocerciasis is endemic. Using a structured questionnaire, knowledge, attitudes, and practices (KAP) toward onchocerciasis and CDTI were assessed while documenting the occurrence of NCDs. Most respondents demonstrated good knowledge of the disease and reported taking ivermectin. Over 75.2% of participants reported symptoms suggestive of onchocerciasis, and nearly one in four of these also had an NCD diagnosis, while close to half reported a family history of NCDs. Arthritis was the most common condition reported, and hypertension was the most frequent family history. The findings highlight the need for integrated approaches that link onchocerciasis elimination with NCD prevention and management, supported by strengthened community health education.