Table 2

Summary table of barriers and motivators for uptake of CDTI

Thematic areasBarriers to CDTI uptakeMotivators/facilitators for CDTI uptake
Awareness Lack of understanding about blackfly vector specific transmission Understanding of transmission, prevention and treatment of onchocerciasis (education in school)
Limited understanding of prevention and treatment Observed reduction in community morbidity
'The benefit of this Mectizan programme is that it has helped the community from blindness. …many people would have been blind and parents in those days and even youths had leopard legs…’ (CDD, man, aged 31–40 years)
Availability Distribution timing of CDTI (community members being absent from community as on the farm) Regular distribution with supplies available from other sources if missed distribution or symptomatic.
They distribute it from house to house. But if you have itches you can go to the pharmacy and pay a 100 FRS to get Mectizan’ (Community member, man, aged 15–20 years)
Demotivation from CDDs due to lack of intrinsic and/or extrinsic motivation Financial and/or non-financial motivational structures in place
Accessibility Seasonality of CDTI (CDDs being unable to access rural communities because of lack of resources such as umbrellas and boots)
‘What I find very difficult in the task is, transportation is difficult especially during the rainy season when we must use materials like)umbrellas, shoes etc.’ (CDD, man, aged 41–50 years)
Medication is free
The benefit to the community is that we benefit the Mectizan for free. So, we do not pay transport and if we were to be paying transport to go and get it, am not sure that even twenty people would go and get the Mectizan’ (Community member, woman, aged 41–50 years)
House to House distribution
Acceptability Side effects(experienced, observed in others or rumoured) (see online supplemental file 12 for more details) Health benefits (experienced or observed in others / preventative and symptom control)
‘Sometimes my eyes cannot really open but when I take the mectizan, my eyes will open. So, it depends as every person has its own benefits just as I just said mine. I have benefits in mectizan and that is why I now trust mectizan’ (Community member, woman, aged 41 to 50 years)
Fears of ‘hidden’ disease or provoking disease
'When Mectizan just came I heard many people say that “you people should not take Mectizan oh… Mectizan will wake up all diseases in your body. Sometimes it can generate a sick in you when you don’t have money and that is how you will die' (Community member, woman aged 41–50 years).
Encouragement from parents (especially mothers) or other members of the community
Association with witchcraft Belief ivermectin will treat multiple diseases '
The benefit is that we should drink it and it should stop any illness that is filarial in anybody’s body.’ (Community member, woman, aged 41 to 50 years)
Perceived exclusion criteria of ineligibility to take Mectizan due to other health conditions (such as pregnancy, epilepsy, hernias, alcohol consumption)
‘We were told not to give epileptic patients mectizan, and equally some men who complained that they have Hernia and that they cannot take mectizan’ (CDD, woman, aged 31–40 years)
Medication to treat side effects is free
Discouragement from others (eg, family or palm wine makers) Being able to receive free treatment for side effects from CDDs or be referred to a health facility
‘Most of them go to the health centre and they are given drugs to cold down all the pains.’ (Community member, man, aged 41–50 years) (see online supplemental file 12) for more details)
Fear of death
‘Some people take the drugs while others do not mainly because of the side effects like swollen bodies, itches and rashes. Some people in the community when you have witchcraft and you take mectizan, you will die. So, some people too refuse taking it because one may have witchcraft and is not aware of it. So, they prefer not to take it at all.’ (Female community member 15–20 years)
‘Some people decide that they will never take Mectizan again· For example, an old man said that he took Mectizan and it almost killed him and concluded that he will never take it again in his lifetime’ (Community member, man, aged 31–40 years)
Costs of treating side effects, especially hernias
Economic costs of missing work or school because of side effects
‘I said no· because I am in a rural area and if I take all at once and it gives me a severe side effect that will disturb me from going to my farm, then I will have to absent from my farm.’ (Community member, man, aged 41–50 years)
  • CDD, community drug distributor; CDTI, community-directed treatment with ivermectin.