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Abstract：
BACKGROUND: Globally, there are an estimated 20.9 million cases of onchocerciasis, with Africa bearing the greatest burden. The World Health Organization (WHO) has targeted the disease for elimination by 2030. As of August 2023, there were 15 foci in 37/48 (76%) districts and one city in Uganda that had reached the elimination phase. However, there is a paucity of data on community involvement in post-elimination surveillance (PES) activities. The communities in the post-elimination phase are expected to maintain surveillance, provide health education, refer cases for treatment, and participate in surveillance. However, it is not clear whether this is being done. In this study, we assessed the feasibility of community involvement in post-elimination surveillance activities in Bududa District, Eastern Uganda, to draw key generalisable lessons for similar settings.
METHODS: This was a cross-sectional study employing rigorous mixed methods of data collection. We used a semi-structured questionnaire to collect quantitative data on randomly sampled study participants in two sub-countries in the district. Community involvement in post-elimination surveillance (PES) was our dependent variable, measured using Yes or No questions, and our independent variables were measured on different scales. Computations of proportions and associations were done using Stata 15 software. Conversely, qualitative data were collected via focus group discussions (FGDs) for community participants and key informant interviews (KIIs) for local leaders. For the qualitative component, we had 2 FGDs, each consisting of 8 gender-balanced participants per group and 8 KIIs. Qualitative data analyses were done using a robust thematic framework approach, ensuring the reliability and validity of our findings.
RESULTS: A total of 422 participants with a mean age of 51.4 years (SD = 15.8) participated in the study. Community involvement in post-elimination surveillance was low (14%). Factors associated with involvements were district support [Adjusted odd ratio AOR 14, 95 CI = (2.5, 81.7)], seeing black flies in the environment in a week preceding the survey [AOR 8, 95% CI = (1.5, 42.5)], in one month [AOR 3.8, 95% CI = (1.1, 13.2)], and being a community volunteer in the Ivermectin treatment program [AOR 4.3, 95% CI = (1.03, 17.9)]. Lack of funding, poor motivation, poor program sustainability planning, and a lack of drugs at health facilities were key challenges affecting community involvement in post-elimination surveillance.
CONCLUSIONS: Community involvement in onchocerciasis post-elimination surveillance activities in Bududa District in Eastern Uganda was low but could be improved by increased district support, funding, community motivation and sensitisation.
METHODS: This was a cross-sectional study employing rigorous mixed methods of data collection. We used a semi-structured questionnaire to collect quantitative data on randomly sampled study participants in two sub-countries in the district. Community involvement in post-elimination surveillance (PES) was our dependent variable, measured using Yes or No questions, and our independent variables were measured on different scales. Computations of proportions and associations were done using Stata 15 software. Conversely, qualitative data were collected via focus group discussions (FGDs) for community participants and key informant interviews (KIIs) for local leaders. For the qualitative component, we had 2 FGDs, each consisting of 8 gender-balanced participants per group and 8 KIIs. Qualitative data analyses were done using a robust thematic framework approach, ensuring the reliability and validity of our findings.
RESULTS: A total of 422 participants with a mean age of 51.4 years (SD = 15.8) participated in the study. Community involvement in post-elimination surveillance was low (14%). Factors associated with involvements were district support [Adjusted odd ratio AOR 14, 95 CI = (2.5, 81.7)], seeing black flies in the environment in a week preceding the survey [AOR 8, 95% CI = (1.5, 42.5)], in one month [AOR 3.8, 95% CI = (1.1, 13.2)], and being a community volunteer in the Ivermectin treatment program [AOR 4.3, 95% CI = (1.03, 17.9)]. Lack of funding, poor motivation, poor program sustainability planning, and a lack of drugs at health facilities were key challenges affecting community involvement in post-elimination surveillance.
CONCLUSIONS: Community involvement in onchocerciasis post-elimination surveillance activities in Bududa District in Eastern Uganda was low but could be improved by increased district support, funding, community motivation and sensitisation.
摘要：
背景：在全球范围内，估计有2090万例盘尾丝虫病，非洲承担着最大的负担。世界卫生组织（WHO）的目标是到2030年消除这种疾病。截至2023年8月，乌干达37/48（76％）地区和一个城市有15个病灶已达到消除阶段。然而,关于社区参与消除后监测(PES)活动的数据很少.预计处于消除后阶段的社区将保持监测，提供健康教育，转诊病例进行治疗，并参与监视。然而,目前尚不清楚是否正在这样做。在这项研究中,我们评估了社区参与布杜达区消除后监测活动的可行性，乌干达东部,为类似的设置绘制关键的可概括的经验教训。
方法：这是一项横断面研究，采用严格的混合数据收集方法。我们使用半结构化问卷收集了该地区两个分国家随机抽样的研究参与者的定量数据。社区参与消除后监测(PES)是我们的因变量，使用“是”或“否”问题进行测量，我们的自变量是在不同的尺度上测量的。使用Stata15软件进行比例和关联的计算。相反，通过针对社区参与者的焦点小组讨论(FGDs)和针对当地领导人的关键线人访谈(KIIs)收集定性数据.对于定性组件，我们有两个FGD，每个小组由8名性别平衡的参与者和8名KIIs组成。定性数据分析使用稳健的主题框架方法进行，确保我们研究结果的可靠性和有效性。
结果：共有422名平均年龄为51.4岁（SD=15.8）的参与者参与了这项研究。社区参与消除后监测的比例较低（14%）。与参与相关的因素是地区支持[调整后的奇数比率AOR14，95CI=（2.5，81.7）]，在调查前一周在环境中看到黑蝇[AOR8，95％CI=（1.5，42.5）]，在一个月内[AOR3.8，95%CI=（1.1，13.2）]，并成为伊维菌素治疗计划的社区志愿者[AOR4.3,95%CI=(1.03,17.9)]。缺乏资金,动力不足,糟糕的项目可持续发展规划，医疗机构缺乏药物是影响社区参与消除后监测的主要挑战。
结论：乌干达东部布杜达区社区对盘尾丝虫病消除后监测活动的参与程度较低，但可以通过增加地区支持来改善。资金,社区动机和敏感性。
方法：这是一项横断面研究，采用严格的混合数据收集方法。我们使用半结构化问卷收集了该地区两个分国家随机抽样的研究参与者的定量数据。社区参与消除后监测(PES)是我们的因变量，使用“是”或“否”问题进行测量，我们的自变量是在不同的尺度上测量的。使用Stata15软件进行比例和关联的计算。相反，通过针对社区参与者的焦点小组讨论(FGDs)和针对当地领导人的关键线人访谈(KIIs)收集定性数据.对于定性组件，我们有两个FGD，每个小组由8名性别平衡的参与者和8名KIIs组成。定性数据分析使用稳健的主题框架方法进行，确保我们研究结果的可靠性和有效性。
结果：共有422名平均年龄为51.4岁（SD=15.8）的参与者参与了这项研究。社区参与消除后监测的比例较低（14%）。与参与相关的因素是地区支持[调整后的奇数比率AOR14，95CI=（2.5，81.7）]，在调查前一周在环境中看到黑蝇[AOR8，95％CI=（1.5，42.5）]，在一个月内[AOR3.8，95%CI=（1.1，13.2）]，并成为伊维菌素治疗计划的社区志愿者[AOR4.3,95%CI=(1.03,17.9)]。缺乏资金,动力不足,糟糕的项目可持续发展规划，医疗机构缺乏药物是影响社区参与消除后监测的主要挑战。
结论：乌干达东部布杜达区社区对盘尾丝虫病消除后监测活动的参与程度较低，但可以通过增加地区支持来改善。资金,社区动机和敏感性。
