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Dr
Joseph Nelson Siewe Fodjo

Cameroon

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Project Title

"Slash and Clear" for ONchocerciasis control and Epilepsy prevention (SCONE)

Project Objectives

Aims and specific objectives Our project has the following objectives: Investigate the feasibility and acceptability of S&C in selected Cameroonian villages which are meso/hyperendemic for onchocerciasis Evaluate the impact of sustained annual S&C on the transmission and infection burden of onchocerciasis in the study villages Use transmission dynamics models to predict the long-term impact of S&C on the burden of onchocerciasis in general and OAE in particular

Host Organisation

Department Institution Country
Brain Research Africa Initiative (BRAIN) CM

EDCTP Project

TMA2020CDF-3152

EDCTP Program

EDCTP2

EDCTP Project Call

Career Development Fellowship (CDF)

Study Design

Prospective, community-based trial

Project Summary

Onchocerciasis is a parasitic disease caused by Onchocerca volvulus and transmitted to humans via blackfly bites. Besides the usual skin and eye symptoms reported in persons with onchocerciasis, it is becoming obvious that the parasite also causes epileptic disorders. Despite years of annual mass treatment with ivermectin, onchocerciasis transmission persists in Cameroon especially in villages with loasis co-endemicity. Moreover, with the preventive measures instituted to limit COVID-19 transmission, the usual door-to-door distribution of ivermectin for onchocerciasis control may be implausible until the pandemic has been fully contained. Alternative elimination strategies are urgently needed to curtail onchocerciasis transmission and reduce its disease burden without violating the health safety guidelines in place. The effectiveness of the “slash and clear” (S&C) method in reducing blackfly biting rates has been demonstrated in hypoendemic onchocerciasis foci in Uganda. However S&C has not been evaluated in meso/hyperendemic settings, and there are no empirical data showing that this intervention is able to reduce onchocerciasis transmission and epilepsy incidence in the short term. This project seeks to follow-up on the transmission of onchocerciasis when annual S&C is implemented in affected Cameroonian villages, and the consequences on new cases of epilepsy after three consecutive years of intervention. Study villages with similar onchocerciasis endemicity levels at baseline will be randomised to annual S&C and no S&C. Outcome parameters such as Ov16 seroprevalence in children < 10 years, O. volvulus microfilarial load in the general population, and entomological measures (blackfly biting rates, blackfly infectivity rates) will be investigated prospectively to monitor onchocerciasis transmission patterns. The collected data will be used to construct mathematical models to predict onchocerciasis transmission and assess the added benefits of annual S&C interventions. By the end of the third year, an epilepsy survey will be conducted in all study sites. Based on the reported year of seizure onset among the identified persons with epilepsy, year-by-year epilepsy incidence will be established retrospectively and compared across studies villages with and without S&C. The scope of this project fits within the purpose of this call as it assesses a community-based, cost-effective approach to eradicate onchocerciasis (a poverty-related disease). Immediate spill-overs from this project will include important field-based data that can be used for onchocerciasis modelling, and eventual follow-up projects to investigate the impact of the S&C intervention on the epidemiology of epilepsy, which is considered by many as a disease of poverty (80% of cases reside in resource-limited settings).