Reduction in Onchocerca volvulus infection prevalence and intensity in Logo Health Zone in Ituri, Democratic Republic of the Congo, in the absence of interventions: Results of screening for clinical trials of moxidectin vs. ivermectin in 2010 and 2021-2023

Reduction in Onchocerca volvulus infection prevalence and intensity in Logo Health Zone in Ituri, Democratic Republic of the Congo, in the absence of interventions: Results of screening for clinical trials of moxidectin vs. ivermectin in 2010 and 2021-2023 | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Reduction in Onchocerca volvulus infection prevalence and intensity in Logo Health Zone in Ituri, Democratic Republic of the Congo, in the absence of interventions: Results of screening for clinical trials of moxidectin vs. ivermectin in 2010 and 2021-2023 Françoise N. Ngave, Deogratias U. Wonyarossi, Germain M. Abhafule, and 23 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7151190/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 16 Mar, 2026 Read the published version in Parasites & Vectors → Version 1 posted 8 You are reading this latest preprint version Abstract Background: In Ituri province, 7576 and 1056 volunteers living in the Health Zone (ZdS) Logo and Nyarambe, respectively, were screened in 2021-2023 for two studies comparing efficacy and/or safety of moxidectin and ivermectin in individuals with or without detectable Onchocerca volvulus skin microfilariae densities (SmfD, microfilariae/mg skin). Site selection was based on the clinical trial capacity established for the Phase 3 study of moxidectin and SmfD measured among 1373 and 36 individuals screened in ZdS Logo and Nyarambe, respectively, in 2010. We are comparing the SmfD measured in 2010 and 2021-2023 in ZdS Logo where ivermectin mass administration was never implemented. Methods: Four skin snips from each consenting/assenting individual ≥12 years old were weighed and incubated in isotonic saline for ≥8 hours. Emerged microfilariae were counted and SmfD calculated as the mean of the number of microfilariae/mg skin of each snip. Other data collected included age, gender, village of residence and history of ivermectin treatment. Results: In 2010 and 2021-2023, respectively, adults (18-93 years old) represented 92.1% and 73.2%, and women 36.9% and 46.6% of the 1373 and 7547 volunteers from ZdS Logo without reported prior ivermectin treatment. Among these adults and adolescents (12-17 years), no microfilariae were detected in snips from 23.3% and 26.9% in 2010 and 89.8% and 96.8% in 2021-2023, respectively, with mean SmfD (± standard deviation) being 24.30±35.52 and 11.8±18.37 in 2010 and 1.1±6.44 and 0.3±2.62 in 2021-2023, respectively. Conclusions: Given that the reduction in infection prevalence and intensity cannot be attributed to ivermectin distribution, it has to be due to reduction in infective vector biting rates, possibly linked to a recently proposed change in vector species triggered by land-use changes. Because SmfD reflect transmission events approximately 2-15 years earlier, infective vector biting rate assessment is needed to determine current transmission rates. Reduced transmission shifts macrofilariae age distribution towards older macrofilariae with lower reproductive capacity. Comparison of the results from the Phase 3 and the ongoing efficacy study might help determine whether macrofilariae drug-susceptibility changes significantly with macrofilariae age. Should that be the case, transmission models evaluating the impact of mass drug administrations could be adjusted. Onchocerciasis skin microfilariae prevalence moxidectin ivermectin Northern Ituri DRC Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Background Onchocerciasis, a Simulium -borne parasitic disease caused by Onchocerca volvulus is targeted for elimination (interruption of parasite transmission). Current World Health Organization (WHO) 2030 targets are WHO verified elimination in 12 countries, stop of Mass Drug Administration of ivermectin (MDAi), the principal intervention strategy, in at least one focus in 34 countries and >16 countries having stopped MDA for ≥50% and >12 countries having stopped MDA for 100% of the population by 2030 [1]. In Colombia, Ecuador, Guatemala and Mexico, WHO verified elimination following ≥ 23 rounds of biannual MDAi, complemented in around 300 communities by quarterly MDAi. This reduced the number of people requiring interventions in the Americas from 0.538 million to around 0.039 million people living in the endemic area spanning the Brazil and Venezuela border in 2023 [2-7]. More than 90% of people infected or at risk of infection live in sub-Saharan Africa (SSA) where many endemic areas are very large and hyperendemic [8-11]. For these and other reasons, elimination across SSA is most challenging [12]. The initial objective of the African Programme for Onchocerciasis Control (APOC, 1995-2015 [13]) was to eliminate onchocerciasis as a public health problem in Central, Eastern, Southern SSA and Liberia through MDAi via community-directed treatment with ivermectin (CDTI) [14, 15] in meso- and hyperendemic areas, i.e. where rapid epidemiological assessment (REA) [16, 17] estimated that >20% or >40% of adults ≥20 years, respectively, had subcutaneous onchocercal nodules (nodule prevalence) [10, 11, 18]. After research [19, 20] and APOC-funded parasitological assessments [21, 22] suggested that interruption of parasite transmission may have or could soon be achieved in many areas under long-term annual CDTI, APOC’s objective expanded to include all endemic SSA countries and Sudan and to eliminate parasite transmission in some countries by 2020 and in 80% of countries by 2025 [23]. Following devolution of APOC responsibilities to countries or the WHO Expanded Special Project for Elimination of Neglected Tropical Diseases (WHO/ESPEN), WHO revised these targets [1]. As of 2023, MDAi had been stopped for 17.8 million people across Equatorial Guinea, Ethiopia, Mali, Nigeria, Senegal, Togo, and Uganda, while MDAi continues for 247.8 million people in the WHO African Region. Across Sudan and Yemen in the WHO Eastern Mediterranean Region, ivermectin distribution has been discontinued for 0.51 million and continues for 1.7 million people [24]. APOC data reviews and expert consultations on the needs for interrupting parasite transmission across the countries within its mandate concluded that alternative treatment strategies are required in many areas [23, 25]. One strategy identified is use of moxidectin rather than ivermectin in selected areas. Moxidectin development was initiated by the UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (WHO/TDR) in the late 1990s in consultation and with support of the Onchocerciasis Control Programme in West Africa (OCP, 1974-2002) and APOC [26-37]. In 2014, WHO licensed all data at its disposal to the Australian not-for-profit health charity Medicines Development for Global Health (MDGH) to register moxidectin with a stringent regulatory authority and make moxidectin available to countries. In 2018, moxidectin was approved by the United States of America Food and Drug Administration (US-FDA) [38]. The pharmacokinetic and safety data from a paediatric study in Ghana [39] supported approval of moxidectin for ages ≥4 years by the Ghana Food and Drugs Authority (G-FDA) [40-42] and the US-FDA [43]. To provide WHO and countries with additional data to decide on moxidectin’s inclusion in guidelines and policies, a randomized, double-blind, single dose study (MDGH-MOX-3002) in individuals ≥ 4 years old with ≥ 0 skin microfilariae (mf) density (SmfD, mf/mg skin) obtained safety data in 5550 adults, 2289 adolescents (12-17 years) and 187 children (4-11 years) in the Democratic Republic of the Congo (DRC) randomized 4:1 to moxidectin:ivermectin and in 3240 adults, 890 adolescents and 840 children in Côte d’Ivoire randomized 4:1 to moxidectin:ivermectin with concomitant administration of 400 mg albendazole. A randomized, double-blind, ivermectin-controlled study (MDGH-MOX-3001) including 323 participants ≥ 12 years old with ≥10 SmfD assessing the efficacy and safety of three annual and five biannual treatments is ongoing in DRC (protocols: https://mox4oncho-multimox.net/resources). The majority of the efficacy and safety data supporting the regulatory approvals came from a Phase 3 (P3) study in Liberia, Ghana and DRC [27, 35, 36]. One of the DRC study areas was in Northern Ituri (Figure 1) where participants for studies MDGH-MOX-3002 and MDGH-MOX-3001 were recruited. We are here comparing the SmfD obtained during screening for these studies in 2021-2023 and the P3 study in 2010 in ≥ 12 years old individuals in the Aires de Santé (AdS) belonging to the Zone de Santé (ZdS) Logo and reporting the SmfD obtained in the AdS belonging to the ZdS Nyarambe. Methods Trial registration All studies were registered in Clinicaltrials.gov: the P3 study on 14 November 2008 (ID: NCT00790998), MDGH-MOX-3001 on 15 March 2019 (ID NCT03876262), MDGH-MOX-3002 on 17 March 2020 (ID NCT04311671). Studies MDGH-MOX-3001 and MDGH-MOX-3002 are also registered in the Pan African Clinical Trials Registry (IDs PACTR202004639229710 and PACTR202003567524647). Regulatory Agency and Ethics Committee approval MDGH-MOX-3001 and MDGH-MOX-3002 protocols, information documents for potential participants, consent and assent forms and study conduct were approved by the DRC National Ethics Committee (Comité National d’Ethique de la Santé) and the National Regulatory Agency (Direction de la Pharmacie et du Médicament/Autorité Congolaise de Règlementation Pharmaceutique, Ministère de la Santé Publique, Hygiène et Prevention (MoH)). Approvals for the P3 study were obtained from the Ethics Committee of the Ecole de la Santé Publique Université de Kinshasa and the MoH [27, 35, 36]. All documents were also approved by the WHO Ethics Review Committee. Recruitment and informed consent/assent with parental consent Informed consent or assent with parental consent (IC/IA) was obtained in or close to the villages where volunteers lived and documented through signature or thumbprint in the presence of an independent literate witness. Screening of volunteers ≥12 years old for the P3 Study in Northern Ituri took place between January 2010 and January 2011 (referred to as ‘2010’ since only 14/1409 volunteers were screened in 2011). ‘Nested recruitment’ of volunteers ≥12 years old for MDGH-MOX-3001 and MDGH-MOX-3002 occurred from May 2021 to July 2023 (Figure 2): (1) Volunteers provided IC/IA to be screened based on information about screening procedures and their possible choice(s) based on the screening results. (2) During the discussion of these results, additional details about the studies were provided as indicated by each individual’s eligibility to inform IC/IA to study participation. 3001 Study MDGH-MOX-3001, 3002 Study MDGH-MOX-3002, HC Health Center, IC/IA Informed Consent or Assent with parental/guardian consent, IVM ivermectin, Tx treatment. Eligibility for MDGH-MOX-3001 required a skin microfilariae density of ≥10 mf/mg skin. Quantitation of skin microfilariae densities Four skin snips (one from each iliac crest and calf) were taken with a 2 mm corneoscleral punch. Each snip was weighed and individually incubated in a well of a flat-bottom 96-well plate for ≥8 hours in isotonic saline. The emerged microfilariae in each well were counted with an inverted microscope [26, 35]. Given that around 97% of adolescents screened in 2021-2023 had undetectable SmfD, the MDGH-MOX-3002 protocol amendment to include 4–11-year-old children excluded SmfD measurement in children. SmfD was calculated as the mean of the unrounded mf/mg skin of each snip. Thus, each individual with ≥1 mf detected across all snips is considered mf-positive. This is a more stringent criterion for mf-positivity than we used in our previous overview of the P3 study screening data [27]. Demographic characteristics, village names and GPS coordinates For studies MDGH-MOX-3001 and MDGH-MOX-3002, age, gender, village and AdS of residence (as per the ‘Division Provinciale de la Santé Ituri’ names and delineations introduced in 2014) were entered into the database for all screened. The P3 study database included only study participants. The data for screen failures were extracted from the source documents. For this analysis, the village names reported in 2010 [27] were mapped to those introduced in 2014. The village GPS coordinates are provided in Additional File 1 Table S1. Maps Maps were generated with QGIS version 3.40.3. Shapefiles for DRC (ADM0) and Ituri Province (ADM1) were those available at WHO. While WHO has shapefiles for ZdS (ADM2, not used in the maps), WHO does not have shapefiles for Mahagi Territory and the AdS. These were obtained from the DRC MoH (COD2 and COD4, respectively). The AdS shapes were corrected as necessary using QUICKOSM background by DUW in collaboration with local health care staff. Study area Location Volunteers lived in 9/26 AdS comprising the ZdS Logo and 2/22 AdS comprising the ZdS Nyarambe in the Mahagi Territory in the Ituri province of DRC (Figure 1) close to Lake Albert. While these AdS represent only a fraction of the AdS in each ZdS, for convenience the ZdS name will be used here when referring to data across these nine and two AdS. Additional File 1 Fig S1 shows Figure 1 C with 2021-2023 dwellings indicated. Additional File 1 Fig S2 provides an overview of the study area, including the location of the Centre de Recherche en Maladies Tropicales de l’Ituri (CRMT) at the Hôpital Général de Réference Rethy and of villages included in 2002 and 2015 evaluations of O. volvulus infection prevalence. The area is mountainous with people living primarily on the slopes or tops of lower hills and cultivating fields in the valleys close to rivers and streams (Additional File 1 Fig S2 and Fig S4). River basins and villages Based on the topographical characteristics, the rivers and their affluents, villages were assigned to three river basins: Awo in the North, Kuda in the center and Lebu in the south (Figure 3, Additional File 1 Fig S2). Villages where volunteers were screened in 2010 and 2021-2023 (black), only in 2021-2023 (orange), only in 2010 (brown). Note the village of Ucudo is so close to Thedeja 2 and Drayi that its name could not be displayed. Results of 2002 Rapid Epidemiological Assessment In 2002, APOC-funded REA, conducted by co-authors Tony O. Ukety and Deogratias U. Wonyarossi at the ‘Projet Ophtalmologie à Nyankunde’ identified meso- and hyperendemic villages (Additional File 1 Table S2 and Fig S4) which led to the area being designated as a ‘high risk’/priority area for CDTI implementation [10, 11]. The 2007 WHO/TDR decision to include this area in the P3 study was based on the REA results, the fact that CDTI had not been implemented and consultation with APOC as well as the MoH. WHO/TDR investments into the necessary personnel capacity and infrastructure resulted in establishment of the CRMT (Additional File 1 Fig S2). The CRMT capacity, the P3 screening data and the fact that CDTI had not yet been implemented in the ZdS Logo led to selection of this area for studies MDGH-MOX-3001 and MDGH-MOX-3002. Additional File 1 Table S3 provides an overview of CRMT capacities, research experience and diseases prevalent in the area (Additional File 1 Fig S2). Vectors The vectors obtained through collection of aquatic stages and human landing catches in 2015-2018 were identified as Simulium dentulosum and Simulium vorax [44]. Socioeconomic characteristics The majority of the population is poor with agricultural livelihoods, including subsistence farming. Production of coffee, mostly sold in Uganda, constitutes the main source of income and employment. The fields people cultivate may not be close to or in the same river basin as their village of residence and people from different villages may have fields close to each other. Men and women have different roles: men clear the fields and prepare water courses for watering and drainage, as required, while both men and women plough, sow, weed and harvest. Field work occurs throughout the year given that the fertility of the area allows several harvests per year. Ivermectin treatment history The ZdS Logo, Nyarambe and Rethy were included in the agreement between WHO and the MoH that established the APOC CDTI-Project Ituri Nord, initiated in 2007 [45-47]. The 2007-2012 CDTI-Project Ituri Nord reports to APOC characterize the ZdS Logo and Nyarambe as not requiring CDTI and did not cover the ZdS Rethy [48, 49]. The ZdS Rethy was included in the APOC CDTI Project Ituri Sud, initiated in 2012 [50]. As per the ESPEN Implementation Unit level onchocerciasis database (accessed 16 February 2025) CDTI was not implemented in the ZdS Logo. For control of lymphatic filariasis in the ZdS Nyarambe, between 181,468 and 225,278 people received ivermectin+albendazole annually in 2016-2019 and 2021-2022 (treatment coverage 80% to 84%) and in 2023, 197,640 people received ivermectin alone (treatment coverage 84%). ZdS is an area delineated by the health system administration, not based on criteria delineating an O. volvulus transmission zone [51-53]. The different ivermectin treatment history of the ZdS Logo and Nyarambe and its possible impact on SmfD of those screened in 2021-2023 and parasite transmission is one of the reasons for data presentation by ZdS. Ivermectin treatment history of individuals screened None of the volunteers screened in 2010 had received ivermectin previously. In the P3 study, 472 volunteers (SmfD 10-299) received a single dose of 8 mg moxidectin (n=315, geometric mean SmfD: pre-treatment 37.4, 12 months post-treatment 0.7) or 150 µg/kg ivermectin (n=157, geometric mean SmfD: pre-treatment 40.7, 12 months post-treatment 8.0) in 2010 to January 2011 [27]. In 2021-2023, ivermectin treatment between 2 and 1800 days before screening was reported by 29/7576 (0.4%) volunteers from the ZdS Logo and 9/1056 (0.9%) volunteers from the ZdS Nyarambe, respectively. Volunteers were not asked about participation in the P3 study. Reliable post-hoc identification of P3 participants was not possible. Our best estimate suggests that around 48 moxidectin- and 26 ivermectin-treated P3 participants were screened in 2021-2023. The treatment of any P3 participants with moxidectin or ivermectin cannot be considered as ‘prior ivermectin treatment’ affecting SmfD measured in 2021-2023 because: (1) Given the O. volvulus reproductive life of 10±3 years [54-57], very few of the macrofilariae present in P3 study participants at the time of their treatment can have been alive/reproductively active during screening 2021-2023; (2) the duration of the embryostatic effect of a single ivermectin or moxidectin dose on SmfD shows considerable inter-individual variability [27, 35, 58, 59]. While its maximum is unknown it is extremely unlikely to be ≥10 years in even a small percentage of those treated which would be tantamount to a single dose being permanently sterilizing (or life-span shortening/cidal). While there are no data to support or refute such a hypothesis for moxidectin, available data for ivermectin do not support such an effect [60]. For individuals without prior ivermectin treatment, the SmfD reflects the individual’s intensity of infection and across individuals the prevalence of infection among those evaluated (as detectable based on the number of skin snips, incubation medium and duration [61]). In contrast, and given the variable long-term effect of a single ivermectin (or moxidectin) dose on an individual’s SmfD [27, 35, 58, 59], this is not necessarily the case for people who have taken ivermectin relatively recently. Consequently, our analysis focuses on individuals who did not report prior ivermectin treatment during screening. Data analysis For some analyses, SmfD were categorized either as 0 vs >0 or as follows: 0, >0-<5, ≥5-<10, ≥10-<20, ≥20-<30, ≥30-<40, ≥40-<50, ≥50-<60, ≥60-<80, ≥80. Logistic regression with prevalence of infection (yes/no) as the dependent binary variable and age and gender as independent variables were used to analyse the data from 2010 and from 2021-2023 separately to identify the extent to which age and gender impacted the risk of being infected in each period. For 2021-2023, prior ivermectin treatment was included as an additional independent variable. The data obtained from the 10 villages in the ZdS Logo where at least 20 individuals had been screened in both 2010 and 2021-2023 were analysed by logistic regression as described above and also using the period (2010 and 2021-2023) as interaction effect for age, gender, and village. Inferential Analyses were conducted with R (R Foundation for Statistical Computing, Vienna, Austria). All Confidence Intervals (CI) are 95%. Descriptive analysis and Figures were generated in Excel 365. Results Demographic characteristics Most volunteers screened in 2010 (1373/1409, 97.4%) and in 2021-2023 (7574/8594 (87.8%) without prior ivermectin treatment, 29/38 (76.3%) of those with prior ivermectin treatment) lived in the ZdS Logo with adults representing 92.1% and 73.2% and women 36.9% and 46.6% of volunteers screened in 2010 and 2021-2023, respectively. The mean age of both adults and adolescents without prior IVM treatment was somewhat higher in 2010 than 2021-2023 (Table 1). In 2021-2023, the age distribution among adolescents was shifted towards younger ages compared to 2010, while in 2010 the percentage of adults between approximately 45 and 65 years of age was higher than in 2021-2023 (Additional File 1 Fig S5). Table 1: Demographic characteristics No prior IVM treatment Prior IVM treatment 2010 2010 2010 2010 2010 2021-2023 2021-2023 2021-2023 2021-2023 2021-2023 2021-2023 2021-2023 2021-2023 2021-2023 2021-2023 Zone de Santé Age category Gender N Mean Age SD Age Min Age Max Age N Mean Age SD Age Min Age Max Age N Mean Age SD Age Min Age Max Age Logo 1373 40.1 16.92 12 93 7547 32.0 17.59 12 93 29 38.1 20.57 14 84 Adults 1265 42.2 15.91 18 93 5517 38.4 16.44 18 93 25 41.7 19.88 18 84 Adults F 471 48.9 14.33 18 85 2519 41.1 16.62 18 87 6 50.5 15.32 21 62 Adults M 794 38.3 15.48 18 93 2998 36.2 15.96 18 93 19 38.9 20.68 18 84 Ado 108 15.2 1.55 12 17 2030 14.6 1.39 12 17 4 15.5 1.29 14 17 Ado F 35 14.8 1.50 12 17 1006 14.5 1.37 12 17 2 16.5 0.71 16 17 Ado M 73 15.4 1.54 12 17 1024 14.7 1.40 12 17 2 14.5 0.71 14 15 Nyarambe 36 45.6 16.09 18 70 1047 30.3 18.14 12 91 9 45.6 19.05 19 79 Adults 36 45.6 16.09 18 70 690 38.4 17.50 18 91 9 45.6 19.05 19 79 Adults F 18 55.1 10.77 32 70 270 43.9 17.20 18 91 4 60.5 15.33 46 79 Adults M 18 36.0 14.95 18 66 420 34.8 16.77 18 86 5 33.6 12.16 19 48 Ado 357 14.6 1.21 12 17 0 Ado F 173 14.6 1.12 13 17 Ado M 184 14.7 1.28 12 17 Abbreviations: Ado Adolescents, IVM ivermectin, SD standard deviation Zone de Santé Nyarambe Only 36 individuals were screened in 2010 making comparison with the 2021-2023 data not meaningful (Table 2). Additional File 1 Fig S6 and Tables S4, S5 and S6 , provide the data. Zone de Santé Logo Skin microfilariae density across all AdS Figure 4 shows the SmfD in each individual screened in 2010 and 2021-2023 by age and gender. Mean (± standard deviations) SmfD across all and all mf-positive individuals without ivermectin treatment history was 24±35.5 and 32±37.6 in 2010 and 1±6.4 and 13±18.5 in 2021-2023, respectively (Table 2). In 2010, only 23.3% and 26.9% of adults and adolescents had undetectable SmfD while these percentages were 89.8% and 96.8% in 2021-2023, respectively (Figure 5). Additional File 1 Tables S4, S5 and S6 provide further details. The odds ratio (OR) for infection (mf positivity) was 3.101 (CI [2.053, 4.713], p<0.001) and 0.024 (CI [0.019, 0.030], p<0.001) in 2010 and 2021-2023, respectively. In 2021-2023 males were statistically significantly more likely to be infected then women (OR 1.643, CI [1.386, 1.952], p<0.001) and the odds of being infected increased with age (OR 1.030, CI [1.025, 1.034], p0.1). In contrast, in 2010, the ORs for males vs females and increase with age were not statistically significant (OR 0.836, CI [0.634, 1.099] p>0.1 and OR 1.004, CI [0.996, 1.012] p>0.1, respectively). Table 2: Skin microfilariae density across all and across mf-positive individuals without prior ivermectin treatment in Zone de Santé Logo and Nyarambe Zone de Santé ALL individuals mf-positive individuals Period N Mean SmfD SD SmfD Min SmfD Max SmfD N Mean SmfD SD SmfD Min SmfD Max SmfD Logo 2010 1373 24.3 35.52 0 299.4 1049 31.8 37.59 0.1 299.4 Adults 1265 25.4 36.42 0 299.4 970 33.1 38.40 0.1 299.4 Adolescents 108 11.8 18.37 0 73.5 79 16.1 19.80 0.1 73.5 2021-2023 7547 1.1 6.44 0 177.8 625 13.1 18.54 0.1 177.8 Adults 5517 1.4 7.33 0 177.8 561 13.7 19.02 0.1 177.8 Adolescents 2030 0.3 2.62 0 66.6 64 7.9 12.62 0.1 66.6 Nyarambe 2010 Adults 36 10.6 24.39 0 135.6 26 14.6 27.77 0.1 135.6 2021-2023 1047 0.4 2.89 0 53.8 30 13.2 11.21 0.2 53.8 Adults 690 0.6 3.54 0 53.8 30 13.2 11.21 0.2 53.8 Adolescents 357 0.0 0.00 0 0.0 0 Prevalence and intensity of infection by AdS of residence Volunteers living in the AdS Draju and Kanga represented 84% and 12% of those screened in 2010 and 53% and 35% of those screened without prior ivermectin treatment in 2021-2023, respectively. Across these adults and adolescents, infection prevalence dropped from 79% to 9% in Draju and from 69% to 9% in Kanga and mean SmfD from 26.2 to 1.2 in Draju and from 17.1 to 1.1 in Kanga (Table 3). Table 3: Skin microfilariae density across all and all mf-positive individuals without prior ivermectin treatment in AdS Draju and Kanga Aire de Santé ALL mf-positive Period N Mean SmfD SD SmfD Min SmfD Max SmfD N Mean SmfD SD SmfD Min SmfD Max SmfD Draju 2010 1149 26.2 36.71 0 299.4 908 33.1 38.41 0.1 299.4 Adults 1057 27.3 37.65 0 299.4 838 34.4 39.27 0.1 299.4 Adolescents 92 13.4 19.40 0 73.5 70 17.6 20.53 0.1 73.5 2021-2023 4015 1.2 6.70 0 177.8 362 13.0 18.61 0.1 177.8 Adults 2803 1.6 7.80 0 177.8 324 13.5 19.13 0.1 177.8 Adolescents 1212 0.3 2.64 0 66.6 38 8.2 12.70 0.1 66.6 Kanga 2010 161 17.1 29.21 0 200.8 111 24.8 32.38 0.1 200.8 Adults 151 18.1 29.88 0 200.8 107 25.5 32.75 0.1 200.8 Adolescents 10 2.3 5.43 0 16.9 4 5.9 7.81 0.3 16.9 2021-2023 2673 1.1 6.20 0 99.2 231 13.2 16.90 0.1 99.2 Adults 1967 1.5 7.00 0 99.2 205 13.9 17.24 0.1 99.2 Adolescents 706 0.3 2.79 0 64.1 26 7.5 12.75 0.1 64.1 Prevalence and intensity of infection by village of residence In 18 villages screening occurred in both 2010 and 2021-2023. Participants from these villages represented 95% (1302/1373) and 76% (5738/7547) of participants without prior ivermectin treatment (Additional File 1 Table S5). In 10 villages more than 20 volunteers were screened in 2010 (range 25‑324, total 1241) and 2021‑2023 (range individuals without prior ivermectin treatment 106‑682, total 3518). Figure 6 A illustrates the drop in prevalence of mf-positive individuals from 2010 to 2021‑2023. Figure 6 B and Additional File 1 Fig S7 show for Umulo and the other nine villages, respectively, that infection prevalence and intensity dropped across genders and age. In these 10 villages, the odds ratio (OR) for infection (mf-positivity) was 3.274 (CI [2.111, 5.116], p<0.001) and 0.019 (CI [0.014, 0.026], p<0.001) in 2010 and 2021-2023, respectively. In 2021-2023 males were statistically significantly more likely to be infected then women (OR 1.678, CI [1.321, 2.138], p<0.001) and the odds of being infected increased with age (OR 1.040, CI [1.034, 1.047], p0.1, respectively). These ORs are similar to those obtained across all individuals screened in ZdS Logo. The OR for being infected in these 10 villages in 2021-2023 compared to in 2010 was 0.003 (CI [0.001, 0.007], p<0.001). In 2021-2023, males had a relatively higher risk of being infected than in 2010 (OR 1.966, CI [1.333, 2.911], p<0.001) and the odds of being infected increased more with age than in 2010 (OR:1.036, CI [1.025, 1.047], p<0.001). B: N = 324 in both 2010 and 2021-2023. Prevalence and intensity of infection by river basin Figure 7 shows the drop in infection prevalence and intensity from 2010 to 2021‑2023 across all individuals screened living in the Kuda and Lebu river basin. No conclusions are possible for the Awo basin because no individual screened in 2010 lived in a village in the ZdS Logo in that basin. Discussion The SmfD of individuals living in the ZdS Logo, whether analyzed overall, by age-group or by AdS, village or river basin when numbers screened allowed, shows a substantial drop in the prevalence and intensity of infection from 2010 to 2021-2023. No conclusions can be drawn for the ZdS Nyarambe because only 36 individuals were screened in 2010. Given that people living in ZdS Logo can move freely into the ZdS Nyarambe and might actually move regularly into that ZdS for field work close to breeding sites, it would be surprising if prevalence and intensity of infection had not changed in the ZdS Nyarambe independent of the ivermectin treatments for LF control in that ZdS. Neither dataset was obtained to sample age- and gender-representative sections of the population to assess infection levels (Table 1, Additional File 1 Fig S5). Sample size and area covered are, however, large and the method used is precise compared to other evaluations (Additional File 1 Table S7). Our analysis could not account for (1) a ‘participant self-selection bias’ due to potential participants being told that people with ‘too few worms in their skin’ cannot participate in the study in 2010 (the P3 study inclusion criteria required ≥10 SmfD [27, 35, 36]) but not in 2021-2023 (Figure 2) which might have discouraged those considering themselves uninfected from participating in screening in 2010 and (2) that where people live is not where they work the fields and might get infected. These limitations are, however, unlikely to explain the decrease in infection prevalence and intensity the SmfD data show. Given that ivermectin was not distributed in the ZdS Logo between 2010 and 2021‑2023, ivermectin distribution cannot explain this decrease (nor can the single dose of moxidectin or ivermectin 472 infected individuals across 17 villages received in the P3 study in 2010 to January 2011). The 2010 data show that the ZdS Logo met the criteria for hyperendemicity [11, 62, 63]. Considering the data and modelling showing that long-term CDTI with high treatment coverage in hyperendemic areas themselves is needed to significantly reduce infection prevalence and intensity [23, 57, 64], ivermectin distribution in the ZdS Nyarambe in 2016‑2019 and 2021‑2022 is also very unlikely to have driven the decrease in infection prevalence and intensity in the ZdS Logo. Consequently, the most likely cause is decreasing infective vector biting rates. This leads to decreasing numbers of young macrofilariae, i.e. a shift in the macrofilariae population towards older macrofilariae approaching or beyond the end of their reproductive life-span and thus decreasing numbers of mf producing macrofilariae. The OCP showed these effects when comparing the macrofilariae from volunteers in villages after 7-10 years of vector control and villages without vector control. This research also found lower reproductive capacity in older compared to younger macrofilariae [65] which further contributes to lowering host SmfD [55, 57]. While following up MDGH-MOX-3001 and MDGH-MOX-3002 participants in seven villages (Kpana, Ndroy, Rudju, Mbesi, Yau, Ngungbu, Jabi) whose inhabitants work the fields in the Kuda river basin, village leaders told FNN and the nurses: (1) that blackfly nuisance had declined and blackfly bites decreased from several/day to several/week over the past approximately 10 years, (2) blackfly nuisance, previously present throughout the year is now restricted to the two rainy seasons. The authorization provided by one of the ‘grands chefs’ to clear forests in the Kuda basin valleys for agricultural use and to reduce blackfly nuisance has left little shade cover for blackflies (Additional File 1 Fig S3). We are not aware of any larviciding or other vector control interventions by national or provincial authorities. In their report of entomological evaluations in the area, Post et al. point out that: (1) S. neavai may have been the main or only anthropophilic vector in the past and disappeared following land use changes that reduced shade cover that species needs; (2) the main species identified between 2015 and 2018 was S. dentulosum , a species with unarmed cibarium, (3) S. dentulosum does not regularly feed on humans and had never been implicated in O. volvulus transmission; (4) Given that 30% and 11% of 155 S. dentulosum caught via human landing catches were O. volvulus infected and infective, respectively, S. dentulosum is a probable vector. Its efficiency as a vector is unknown; (5) Further investigation is needed into the role of S. vorax in O. volvulus transmission given that only 4 specimens were available to assess O. volvulus infection and infectivity [44]. Publicly available results of other evaluations in and around our study area (Additional File 1 Table S7) include those of the 2002 REA (Additional File 1 Table S1, Fig S2, Fig S4), the 2015 DRC MoH parasitological or serological evaluations and research studies conducted from 2016 to 2018 on onchocerciasis-associated epilepsy [66-68]. Comparison of these data with ours cannot provide further insight into trends in parasite transmission for methodological reasons. The correlation between REA-based nodule prevalence and prevalence of mf-positive individuals in the general population is not very tight and the skin mf prevalence data used to establish this correlation were obtained with two snips [63]. Two snips, typically used in prevalence surveys and studies not aimed at assessing the efficacy of anti-onchocercal drugs (including in the studies on onchocerciasis-associated epilepsy [66-69], provide less sensitivity for detecting mf-positive individuals than four snips [61, 70]. Two of the studies by Mandro et al. [67, 68] included persons with epilepsy. The long-postulated association between O. volvulus infection and risk of epilepsy has been confirmed [71-82]. Consequently, infection prevalence in persons with epilepsy cannot be compared with our data. Assays for the presence of immunoglobulin G4 against the O. volvulus antigen Ov16 (Ov16 IgG4) detect both current and past infections. The time to seroconversion in both directions is unknown and not everybody infected might seroconvert. A WHO advisory committee review of large-scale evaluations of Ov16 IgG4 prevalence identified discrepancies between results with different assays and concerns about false-positive and false-negative results. Thus, both methodological and biological factors can contribute to discordance between mf-positivity and Ov16 IgG4 positivity in the same individual and differences in infection prevalence estimated parasitologically or serologically [83-92]. When considering what the reduction in infection prevalence and intensity we identified indicates about current transmission levels and prospects for elimination of transmission without interventions, it needs to be taken into account that the SmfD measured reflect past transmissions. These transmissions occurred approximately 2-15 years earlier because (1) the pre-patent period is estimated at 12-18 months [56, 57, 93, 94] and it may take up to 3 years from an infective bite to the resulting macrofilaria(e) producing detectable mf levels [56, 57, 95], (2) the estimated reproductive life span of the macrofilariae is 10±3 years [54-57] and (3) the estimated microfilariae life span is around 12-15 months [56, 57, 96]. To assess current transmission, extensive collection of anthropophilic vectors and determination of their infectivity is required. While our data provide no information on current transmission levels, they show that transmission decreased significantly resulting in the macrofilariae age distribution among those screened in 2021-2023 vs in 2010 being shifted towards older and less reproductively capable macrofilariae. It is unknown whether older macrofilariae approaching the end of their reproductive life span have a different susceptibility to anti-onchocercal drugs (whether ivermectin, moxidectin or drugs currently in development [37]) than younger macrofilariae. The transmission models ONCHOSIM and EpiOncho, used to estimate time to elimination with different strategies, consider macrofilaria age-dependent reproductive capacity (additional files to [57]), but to our knowledge not age-dependent drug-susceptibility. Comparative analysis of the 12- and 18-months efficacy data from the P3 study in this area [27] and study MDGH-MOX-3001 may provide an opportunity to evaluate age-dependency of macrofilariae susceptibility to ivermectin and moxidectin. This may be a unique opportunity given that evaluations in areas under CDTI [97] do not allow to differentiate the CDTI-driven reduction in transmission and macrofilariae age distribution and the cumulative effect of ivermectin treatment on macrofilariae reproductive capacity [57]. Estimates of macrofilariae-age-dependent drug-susceptibility could improve model predictions. Conclusion In the ZdS Logo, O. volvulus infection prevalence and intensity dropped substantially over around 11-13 years without health system-directed interventions. Given that SmfD, nodule prevalence and Ov16 IgG4 reflect past transmissions, large-scale entomological evaluations are needed to assess current transmission levels and thus the extent to which the change in the vector species proposed by Post and coworkers [44] may result in elimination or in keeping transmission at very low levels. Given that reduction in transmission, whether due to ‘natural causes’ (e.g. land-use or climate change), vector control or large-scale treatment with current anti-onchocercal drugs, shifts macrofilariae age distribution, comparing ivermectin and moxidectin efficacy in the ongoing and the P3 study might help determine whether macrofilariae drug-susceptibility changes with age. If it does, inclusion of relevant parameters in the transmission models could improve the accuracy of the modelled time to elimination. Abbreviations AdS Aire de Santé (Health area, lowest health system administrative unit) APOC African Programme for Onchocerciasis Control CDTI Community directed treatment with ivermectin CI 95% Confidence interval DRC Democratic Republic of the Congo G-FDA Food and Drugs Authority of Ghana MDAi Mass drug administration of ivermectin MDGH Medicines Development for Global Health mf Microfilaria MoH Ministère de la Santé Publique, Hygiène et Prevention of the Democratic Republic of the Congo OR Odds ratio REA Rapid Epidemiological Assessment SmfD Skin microfilariae density (mf/mg skin) SSA Sub-Saharan Africa US-FDA Food and Drug Administration of the United States of America WHO World Health Organization WHO/ESPEN WHO Expanded Special Project for Elimination of Neglected Tropical Diseases WHO/TDR UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases ZdS Zone(s) de Santé (Health zone) Declarations Ethics approval and consent to participate MDGH-MOX-3001 and MDGH-MOX-3002 protocols, information documents for potential participants, consent and assent forms and study conduct were approved by the DRC National Ethics Committee (Comité National d’Ethique de la Santé) and the National Regulatory Agency (Direction de la Pharmacie et du Médicament/Autorité Congolaise de Règlementation Pharmaceutique, Ministère de la Santé Publique, Hygiène et Prevention (MoH)). Approvals for the P3 study were obtained from the Ethics Committee of the Ecole de la Santé Publique Université de Kinshasa and the MoH [27, 35, 36]. All documents were also approved by the WHO Ethics Review Committee. Participants documented their consent or assent with parental consent to study participation through signature or thumbprint in the presence of a literate witness in or near their villages. Availability of data and materials Consent to participation in screening for studies MDGH-MOX-3001 and/or MDGH-MOX-3002 or the P3 study did not include consent to publication of individual participant data. Consequently, the study sponsors (MDGH and WHO/TDR) and the authors cannot make individual participant data publicly available. Individuals wanting to analyse the data should request the data from the Sponsors (WHO/TDR, [email protected] , and Medicines Development for Global Health, [email protected] or https://www.medicinesdevelopment.com/contact). Requests should include the objectives, data analysis plan and plans to obtain applicable approvals and involve the investigators (co-authors on this manuscript) and commitment to not share the data with anybody else. Competing interests BM was and MuMu and SK are staff of MDGH, Australia. In 2014, WHO licensed all data on moxidectin at its disposal to MDGH to prepare the New Drug Application for moxidectin to the US FDA and make moxidectin available at an affordable cost. MDGH remains the regulatory sponsor of moxidectin. MDGH co-funded studies MDGH-MOX-3001 and MDGH-MOX-3002. ACK and CMH work for WHO which funded the work of all co-authors on the P3 study through its department UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (WHO/TDR). ACK retired from WHO in March 2023 and is continuing to work for TDR as a consultant, including on studies MDGH-MOX-3001 and MDGH-MOX-3002. Funding Studies MDGH-MOX-3001 and MDGH-MOX-3002 in DRC were funded by a grant from the European & Developing Countries Clinical Trials Partnership (EDCTP, grant # RIA2017NCT-1843 MoxiMultiDoseMod), by MDGH and a grant from the Luxembourg National Research Fund (FNR n°INTER/ EDCTP/ 17/12331087/ MoxiMultiDoseMod/ Michel Vaillant). WHO/TDR funded the P3 study, utilizing contributions from the WHO African Programme for Onchocerciasis Control (APOC), 6.3 million $US from Wyeth (and Pfizer following Pfizer acquisition of Wyeth) and WHO/TDR donor countries. Pfizer was not involved in this publication. Authors’ contributions FNN, DUW, AN were co-investigators in the P3, MDGH-MOX 3001 and MDGH-MOX-3002 studies responsible for recruitment. GMA and JLM conducted parasitological evaluations for the three studies. MDGH-MOX-3001 and MDGH-MOX-3002: TOU was the principal investigator. MiMa and PTA were co-principal investigators. CBU, AAR, IAM, GLA, JUU, CMA and JdDNU were co-investigators responsible for recruiting. SK and BM co-designed the studies and collaborated on the protocols. BM collaborated on study preparation, staff training and study initiation. BM and MuMu managed the conduct of the studies at MDGH. P3 study: DKB was the principal investigator for the P3 study in Ituri. MMN conducted parasitological evaluations. J-P UU and GLM were co-investigators responsible for recruitment. CMH participated in P3 study site training and initiation, managed study conduct, supervised study monitoring and close-out, supported investigators. DUW generated all maps with the exception of the map of the 2002 REA results in Additional File 1 Fig S4. MV was responsible for P3 study data management after WHO became sole study sponsor and co-designed and conducted the statistical analyses for this publication. ACK co-designed the P3, MDGH-MOX-3001 and MDGH-MOX-3002 studies, collaborated on the protocols and managed or co-managed study preparation and set up, did staff training and study initiation. ACK conducted the descriptive analyses, co-designed the statistical analysis, created the figures, drafted the manuscript, and finalized it based on co-author feedback. All authors reviewed the manuscript and approved the submitted version. Acknowledgements We are particularly grateful to all those who agreed to be screened for their co-operation. We acknowledge the contribution of Jean-Pierre Lotsima who passed away in March 2023. Dr. JHF Remme, at the time staff of WHO/TDR, generated the map of the 2002 REA results in Additional File 1 Fig S4 in ARCGIS 10.3 for the 2010 TDR internal discussions on study areas for the moxidectin community effectiveness studies and discussions with APOC and the Ministry of Health/ National Onchocerciasis Control Programme in DRC. The authors alone are responsible for the views expressed which do not necessarily represent the views, decisions or policies of the institutions with which the authors are affiliated. Copyright World Health Organization 2025. This article is licensed under the terms of the Creative Commons Attribution 3.0 IGO License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the World Health Organization, provide a link to the Creative Commons licence and indicate if changes were made. The use of the World Health Organization’s name, except in reference to the article, the use of the World Health Organization’s logo, is not authorized as part of this licence. The link provided below includes additional terms and conditions of the licence. 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Bull World Health Organ. 1980;58(6):923-5. Duke BO. The population dynamics of Onchocerca volvulus in the human host. Trop Med Parasitol. 1993;44(2):61-8. Pion SD, Nana-Djeunga HC, Kamgno J, Tendongfor N, Wanji S, Njiokou F, et al. Dynamics of Onchocerca volvulus Microfilarial Densities after Ivermectin Treatment in an Ivermectin-naive and a Multiply Treated Population from Cameroon. PLoS Negl Trop Dis. 2013;7(2):e2084. doi: 10.1371/journal.pntd.0002084 [doi];PNTD-D-11-01182 [pii]. Additional Declarations Competing interest reported. BM was and MuMu and SK are staff of MDGH, Australia. In 2014, WHO licensed all data on moxidectin at its disposal to MDGH to prepare the New Drug Application for moxidectin to the US FDA and make moxidectin available at an affordable cost. MDGH remains the regulatory sponsor of moxidectin. MDGH co-funded studies MDGH-MOX-3001 and MDGH-MOX-3002. ACK and CMH work for WHO which funded the work of all co-authors on the P3 study through its department UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (WHO/TDR). ACK retired from WHO in March 2023 and is continuing to work for TDR as a consultant, including on studies MDGH-MOX-3001 and MDGH-MOX-3002. 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Halleux","email":"","orcid":"","institution":"World Health Organization Special Programme for Research and Training in Tropical Diseases (TDR)","correspondingAuthor":false,"prefix":"","firstName":"Christine","middleName":"M.","lastName":"Halleux","suffix":""},{"id":489376940,"identity":"f26fdb85-e993-4e27-9539-af788811ab4f","order_by":20,"name":"Michel Vaillant","email":"","orcid":"","institution":"Luxembourg Institute of Health","correspondingAuthor":false,"prefix":"","firstName":"Michel","middleName":"","lastName":"Vaillant","suffix":""},{"id":489376941,"identity":"21d994ff-d647-494f-95e2-d89ea64faa61","order_by":21,"name":"Anna Schritz","email":"","orcid":"","institution":"Luxembourg Institute of Health","correspondingAuthor":false,"prefix":"","firstName":"Anna","middleName":"","lastName":"Schritz","suffix":""},{"id":489376942,"identity":"52fc3b07-02e5-4bbe-bc26-1caf19a60e06","order_by":22,"name":"Beatriz Mosqueira","email":"","orcid":"","institution":"Medicines Development for Global Health","correspondingAuthor":false,"prefix":"","firstName":"Beatriz","middleName":"","lastName":"Mosqueira","suffix":""},{"id":489376945,"identity":"2c456908-03ce-40c4-b554-7d855cf0d936","order_by":23,"name":"Mupenzi Mumbere","email":"","orcid":"","institution":"Medicines Development for Global Health","correspondingAuthor":false,"prefix":"","firstName":"Mupenzi","middleName":"","lastName":"Mumbere","suffix":""},{"id":489376946,"identity":"cbfafeaf-0f37-4a6b-a579-b760d26dbe0e","order_by":24,"name":"Sally Kinrade","email":"","orcid":"","institution":"Medicines Development for Global Health","correspondingAuthor":false,"prefix":"","firstName":"Sally","middleName":"","lastName":"Kinrade","suffix":""},{"id":489376949,"identity":"3e4c4bcb-6dd8-44a6-83ca-50f380d4571c","order_by":25,"name":"Annette C. Kuesel","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAArklEQVRIiWNgGAWjYBACCTBZwCAHZiUQr8WAwRiqxYB4LYkNMBZBIDkj+fCHDwZ26RtuNx9geLjjD2Et0hJpaZIzDJJzN9w5lsCQeIYIW+QkcsyYeQyYc7fdyAE6r40oLfmfP/8xqE83I1qLtEQOgzSDweEE4rVI9jwzk+wxOG64/0ZawoHENmPCWiSOJz/+8KOiWh4YdAcf/myTI6wFBRwgUf0oGAWjYBSMAlwAADb8N0xVSSfEAAAAAElFTkSuQmCC","orcid":"","institution":"World Health Organization Special Programme for Research and Training in Tropical Diseases (TDR)","correspondingAuthor":true,"prefix":"","firstName":"Annette","middleName":"C.","lastName":"Kuesel","suffix":""}],"badges":[],"createdAt":"2025-07-17 16:53:22","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7151190/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7151190/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s13071-025-07199-8","type":"published","date":"2026-03-16T15:58:53+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":87574297,"identity":"06840990-11ce-4aa4-8237-4200fdd2699e","added_by":"auto","created_at":"2025-07-25 11:24:43","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":691355,"visible":true,"origin":"","legend":"\u003cp\u003eLocation of study area within DRC\u003c/p\u003e\n\u003cp\u003eA: Ituri Province (black) in the North East of DRC, B: Mahagi territory (white) bordering Lake Albert (blue) within Ituri Province, C: Aires de Santé where individuals were screened. Lelo and Kpanyi are in the Zone de Santé (ZdS) Nyarambe, all others in the ZdS Logo. Red circles show places where villagers screened in 2021-2023 indicated blackfly nuisance.\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7151190/v1/4add88ff5cf6143125112b19.jpeg"},{"id":87574740,"identity":"8f3bafb2-eb1d-44ad-b9eb-2495af9131e9","added_by":"auto","created_at":"2025-07-25 11:32:43","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":86820,"visible":true,"origin":"","legend":"\u003cp\u003eSchematics of nested recruitment for studies MDGH-MOX-3001 and MDGH-3002 in DRC\u003c/p\u003e\n\u003cp\u003e3001 Study MDGH-MOX-3001, 3002 Study MDGH-MOX-3002, HC Health Center, IC/IA Informed Consent or Assent with parental/guardian consent, IVM ivermectin, Tx treatment.\u003c/p\u003e\n\u003cp\u003eEligibility for MDGH-MOX-3001 required a skin microfilariae density of ≥10 mf/mg skin.\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7151190/v1/1ba4c4592ccebf81c769a6dd.jpeg"},{"id":87574299,"identity":"1856b27b-017e-45a6-8b7d-b425a9f1d0bd","added_by":"auto","created_at":"2025-07-25 11:24:43","extension":"jpeg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":1287041,"visible":true,"origin":"","legend":"\u003cp\u003eVillages of residence of individuals screened in 2010 and in 2021-2023\u003c/p\u003e\n\u003cp\u003eVillages where volunteers were screened in 2010 and 2021-2023 (black), only in 2021-2023 (orange), only in 2010 (brown).\u003c/p\u003e\n\u003cp\u003eNote the village of Ucudo is so close to Thedeja 2 and Drayi that its name could not be displayed.\u003c/p\u003e","description":"","filename":"floatimage3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7151190/v1/fe93a64aa52674c959743ab9.jpeg"},{"id":87574304,"identity":"6fdb1e97-b8d6-4906-8778-3c37284f452f","added_by":"auto","created_at":"2025-07-25 11:24:43","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":157307,"visible":true,"origin":"","legend":"\u003cp\u003eSkin microfilariae density among all women (A) and men (B) screened in 2010, and women (C) and men (D) screened in 2021-2023 who had no prior ivermectin treatment and (E) women and men screened in 2021-2023 who reported ivermectin treatment between 2 and 1800 days before screening in ZdS Logo\u003c/p\u003e\n\u003cp\u003eSmfD skin microfilariae density, mf microfilariae, A n=506, B n=867, C n=3525, D n= 4022, E women n=8, men= 21\u003c/p\u003e","description":"","filename":"floatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-7151190/v1/f738ab209bde7df4a773823a.png"},{"id":87574743,"identity":"043485db-c07d-4ad4-8624-4c30320dd2de","added_by":"auto","created_at":"2025-07-25 11:32:43","extension":"jpeg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":757915,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of skin microfilariae density in 2010 and 2021-2023 in the Zone de Santé Logo among adults and adolescents without prior ivermectin treatment\u003c/p\u003e\n\u003cp\u003eA: Adults N=1265 in 2010, N=5517 in 2021-2023, B: Adolescents N=108 in 2010, N=2030 in 2021-2023.\u003c/p\u003e","description":"","filename":"floatimage5.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7151190/v1/c7cc57656eec113f3bcfb2a7.jpeg"},{"id":87574744,"identity":"b768260b-957a-4263-b3c3-72b63ae56313","added_by":"auto","created_at":"2025-07-25 11:32:43","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":144194,"visible":true,"origin":"","legend":"\u003cp\u003eA: Percentage of mf-positive adults and adolescents in 2010 and 2021‑2023 in the 10 villages in the ZdS Logo where at least 20 individuals without prior ivermectin treatment were screened in both periods, \u003cbr\u003e\nB: Skin microfilariae density in each individual without prior ivermectin treatment screened in 2010 and 2021-2023 in Umulo by age and gender\u003c/p\u003e\n\u003cp\u003e_F women, _M men.\u003c/p\u003e\n\u003cp\u003eA: In 2010, the number of adults screened in each village ranged from 24 to 314, the number of adolescents ranged from 0 (Jupadrogo) to 44 with less than 10 adolescents screened in Yau, Draju, Jupadrogo, Ndroy, Ngbungbu, Juparima and Kanga. In 2021-2023, the number of adults ranged from 64 to 462 and that of adolescents from 25 to 244.\u003c/p\u003e\n\u003cp\u003eB: N = 324 in both 2010 and 2021-2023.\u003c/p\u003e","description":"","filename":"floatimage6.png","url":"https://assets-eu.researchsquare.com/files/rs-7151190/v1/82538243a6d1d8d7aea40f82.png"},{"id":87574303,"identity":"bfee5f73-9057-4168-a141-170506100664","added_by":"auto","created_at":"2025-07-25 11:24:43","extension":"png","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":47881,"visible":true,"origin":"","legend":"\u003cp\u003ePrevalence and mean skin microfilariae density in 2010 and in 2021-2023 by river basin among individuals without prior ivermectin treatment living in the ZdS Logo\u003c/p\u003e\n\u003cp\u003eA: Percentage of volunteers who did not report prior ivermectin treatment screened with ≥ 1 microfilaria detected, B: Arithmetic mean skin microfilariae density across all who did not report prior ivermectin treatment. Number screened in 2010 (brown) and 2021-2023 (green), respectively: Awo 0 and 858, Kuda 1245 and 5671, Lebu 128 and 1017.\u003c/p\u003e","description":"","filename":"floatimage7.png","url":"https://assets-eu.researchsquare.com/files/rs-7151190/v1/9c99323be8e7ec0422eaf27c.png"},{"id":105223438,"identity":"f7f75e1e-1ef9-4bb9-82f9-981ef1e840ae","added_by":"auto","created_at":"2026-03-23 16:06:33","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":4882871,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7151190/v1/ba5f5a12-db72-4e45-abe0-b04b258726a8.pdf"},{"id":87574316,"identity":"aa7104d8-01ef-4250-93b6-a1410202c544","added_by":"auto","created_at":"2025-07-25 11:24:43","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":10760038,"visible":true,"origin":"","legend":"","description":"","filename":"NgaveetalIturiOnchoPrevAdditionalFile1.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7151190/v1/5eddc8337864884624f1cf4a.pdf"},{"id":87574302,"identity":"6b3c7dc7-fa4e-4ac5-9262-5bc7a82209bb","added_by":"auto","created_at":"2025-07-25 11:24:43","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":207861,"visible":true,"origin":"","legend":"","description":"","filename":"NgaveetalIturiOnchoPrevGraphicalAbstract.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7151190/v1/22da8c008961a2d963fb0d4f.pdf"}],"financialInterests":"Competing interest reported. BM was and MuMu and SK are staff of MDGH, Australia. In 2014, WHO licensed all data on moxidectin at its disposal to MDGH to prepare the New Drug Application for moxidectin to the US FDA and make moxidectin available at an affordable cost. MDGH remains the regulatory sponsor of moxidectin. MDGH co-funded studies MDGH-MOX-3001 and MDGH-MOX-3002.\nACK and CMH work for WHO which funded the work of all co-authors on the P3 study through its department UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (WHO/TDR). ACK retired from WHO in March 2023 and is continuing to work for TDR as a consultant, including on studies MDGH-MOX-3001 and MDGH-MOX-3002.","formattedTitle":"Reduction in Onchocerca volvulus infection prevalence and intensity in Logo Health Zone in Ituri, Democratic Republic of the Congo, in the absence of interventions: Results of screening for clinical trials of moxidectin vs. ivermectin in 2010 and 2021-2023","fulltext":[{"header":"Background","content":"\u003cp\u003eOnchocerciasis, a \u003cem\u003eSimulium\u003c/em\u003e-borne parasitic disease caused by \u003cem\u003eOnchocerca volvulus\u003c/em\u003e is targeted for elimination (interruption of parasite transmission). Current World Health Organization (WHO) 2030 targets are WHO verified elimination in 12 countries, stop of Mass Drug Administration of ivermectin (MDAi), the principal intervention strategy, in at least one focus in 34 countries and \u0026gt;16 countries having stopped MDA for \u0026ge;50% and \u0026gt;12 countries having stopped MDA for 100% of the population by 2030 [1].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn Colombia, Ecuador, Guatemala and Mexico, WHO verified elimination following\u0026nbsp;\u0026ge;\u0026nbsp;23 rounds of biannual MDAi, complemented in around 300 communities by quarterly MDAi. This reduced the number of people requiring interventions in the Americas from 0.538 million to around 0.039 million people living in the endemic area spanning the Brazil and Venezuela border in 2023 [2-7].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMore than 90% of people infected or at risk of infection live in sub-Saharan Africa (SSA) where many endemic areas are very large and hyperendemic [8-11]. For these and other reasons, elimination across SSA is most challenging [12]. The initial objective of the African Programme for Onchocerciasis Control (APOC, 1995-2015 [13]) was to eliminate onchocerciasis as a public health problem in Central, Eastern, Southern SSA and Liberia through MDAi via community-directed treatment with ivermectin (CDTI) [14, 15] in meso- and hyperendemic areas, i.e. where rapid epidemiological assessment (REA) [16, 17] estimated that\u0026nbsp;\u0026gt;20% or \u0026gt;40% of adults\u0026nbsp;\u0026ge;20 years, respectively, had\u0026nbsp;subcutaneous onchocercal nodules (nodule prevalence)\u0026nbsp;[10, 11, 18].\u0026nbsp;After research\u0026nbsp;[19, 20]\u0026nbsp;and APOC-funded parasitological assessments\u0026nbsp;[21, 22]\u0026nbsp;suggested that interruption of parasite transmission may have or could soon be achieved in many areas under long-term annual CDTI, APOC\u0026rsquo;s objective expanded to include all endemic SSA countries and Sudan and to eliminate parasite\u003cem\u003e\u0026nbsp;\u003c/em\u003etransmission in some countries by 2020 and in 80% of countries by 2025\u0026nbsp;[23]. Following devolution of APOC responsibilities to countries or the WHO Expanded Special Project for Elimination of Neglected Tropical Diseases (WHO/ESPEN), WHO revised these targets\u0026nbsp;[1]. As of 2023, MDAi had been stopped for 17.8 million people across Equatorial Guinea, Ethiopia, Mali, Nigeria, Senegal, Togo, and Uganda, while MDAi continues for 247.8 million people in the WHO African Region. Across Sudan and Yemen in the WHO Eastern Mediterranean Region, ivermectin distribution has been discontinued for 0.51 million and continues for 1.7 million people\u0026nbsp;[24].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAPOC data reviews and expert consultations on the needs for interrupting parasite transmission across the countries within its mandate concluded that alternative treatment strategies are required in many areas [23, 25]. One strategy identified is use of moxidectin rather than ivermectin in selected areas. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMoxidectin development was initiated by the UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (WHO/TDR) in the late 1990s in consultation and with support of the Onchocerciasis Control Programme in West Africa (OCP, 1974-2002) and APOC [26-37]. In 2014, WHO licensed all data at its disposal to the Australian not-for-profit health charity Medicines Development for Global Health (MDGH) to register moxidectin with a stringent regulatory authority and make moxidectin available to countries. In 2018, moxidectin was approved by the United States of America Food and Drug Administration (US-FDA) [38]. The pharmacokinetic and safety data from a paediatric study in Ghana [39] supported approval of moxidectin for ages \u0026ge;4 years by the Ghana Food and Drugs Authority (G-FDA) [40-42] and the US-FDA [43].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTo provide WHO and countries with additional data to decide on moxidectin\u0026rsquo;s inclusion in guidelines and policies, a randomized, double-blind, single dose study (MDGH-MOX-3002) in individuals \u0026ge; 4 years old with \u0026ge; 0 skin microfilariae (mf) density (SmfD, mf/mg skin) obtained safety data in 5550 adults, 2289 adolescents (12-17 years) and 187 children (4-11 years) in the Democratic Republic of the Congo (DRC) randomized 4:1 to moxidectin:ivermectin and in 3240 adults, 890 adolescents and 840 children in C\u0026ocirc;te d\u0026rsquo;Ivoire randomized 4:1 to moxidectin:ivermectin with concomitant administration of 400 mg albendazole. A randomized, double-blind, ivermectin-controlled study (MDGH-MOX-3001) including 323 participants \u0026ge; 12 years old with \u0026ge;10 SmfD assessing the efficacy and safety of three annual and five biannual treatments is ongoing in DRC (protocols: https://mox4oncho-multimox.net/resources).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe majority of the efficacy and safety data supporting the regulatory approvals came from a Phase 3 (P3) study in Liberia, Ghana and DRC [27, 35, 36]. One of the DRC study areas was in Northern Ituri (Figure 1) where participants for studies MDGH-MOX-3002 and MDGH-MOX-3001 were recruited.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWe are here comparing the SmfD obtained during screening for these studies in 2021-2023 and the P3 study in 2010 in \u0026ge; 12 years old individuals in the Aires de Sant\u0026eacute; (AdS) belonging to the Zone de Sant\u0026eacute; (ZdS) Logo and reporting the SmfD obtained in the AdS belonging to the ZdS Nyarambe.\u0026nbsp;\u003c/p\u003e"},{"header":"Methods","content":"\u003ch2\u003eTrial registration\u003c/h2\u003e\n\u003cp\u003eAll studies were registered in Clinicaltrials.gov: the P3 study on 14 November 2008 (ID: NCT00790998), MDGH-MOX-3001 on 15 March 2019 (ID NCT03876262),\u0026nbsp;MDGH-MOX-3002 on 17 March 2020 (ID NCT04311671). Studies MDGH-MOX-3001 and MDGH-MOX-3002 are also registered in the Pan African Clinical Trials Registry (IDs PACTR202004639229710 and PACTR202003567524647).\u003c/p\u003e\n\u003ch2 id=\"_Toc203408055\"\u003eRegulatory Agency and Ethics Committee approval\u0026nbsp;\u003c/h2\u003e\n\u003cp\u003eMDGH-MOX-3001 and MDGH-MOX-3002 protocols, information documents for potential participants, consent and assent forms and study conduct were approved by the DRC National Ethics Committee (Comit\u0026eacute; National d\u0026rsquo;Ethique de la Sant\u0026eacute;) and the National Regulatory Agency (Direction de la Pharmacie et du M\u0026eacute;dicament/Autorit\u0026eacute; Congolaise de R\u0026egrave;glementation Pharmaceutique, Minist\u0026egrave;re de la Sant\u0026eacute; Publique, Hygi\u0026egrave;ne et Prevention (MoH)). Approvals for the P3 study were obtained from the Ethics Committee of the Ecole de la Sant\u0026eacute; Publique Universit\u0026eacute; de Kinshasa and the MoH [27, 35, 36]. All documents were also approved by the WHO Ethics Review Committee.\u0026nbsp;\u003c/p\u003e\n\u003ch2 id=\"_Toc203408056\"\u003eRecruitment and informed consent/assent with parental consent\u003c/h2\u003e\n\u003cp\u003eInformed consent or assent with parental consent (IC/IA) was obtained in or close to the villages where volunteers lived and documented through signature or thumbprint in the presence of an independent literate witness.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eScreening of volunteers \u0026ge;12 years old for the P3 Study in Northern Ituri took place between January 2010 and January 2011 (referred to as \u0026lsquo;2010\u0026rsquo; since only 14/1409 volunteers were screened in 2011).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026lsquo;Nested recruitment\u0026rsquo; of volunteers \u0026ge;12 years old for MDGH-MOX-3001 and MDGH-MOX-3002 occurred from May 2021 to July 2023 (Figure 2): (1) Volunteers provided IC/IA to be screened based on information about screening procedures and their possible choice(s) based on the screening results. (2) During the discussion of these results, additional details about the studies were provided as indicated by each individual\u0026rsquo;s eligibility to inform IC/IA to study participation.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e3001 Study MDGH-MOX-3001, 3002 Study MDGH-MOX-3002, HC Health Center, IC/IA Informed Consent or Assent with parental/guardian consent, IVM ivermectin, Tx treatment.\u003c/p\u003e\n\u003cp\u003eEligibility for MDGH-MOX-3001 required a skin microfilariae density of \u0026ge;10 mf/mg skin.\u0026nbsp;\u003c/p\u003e\n\u003ch2 id=\"_Toc203408058\"\u003eQuantitation of skin microfilariae densities\u003c/h2\u003e\n\u003cp\u003eFour skin snips (one from each iliac crest and calf) were taken with a 2 mm corneoscleral punch. Each snip was weighed and individually incubated in a well of a flat-bottom 96-well plate for \u0026ge;8 hours in isotonic saline. The emerged microfilariae in each well were counted with an inverted microscope [26, 35]. Given that around 97% of adolescents screened in 2021-2023 had undetectable SmfD, the MDGH-MOX-3002 protocol amendment to include 4\u0026ndash;11-year-old children excluded SmfD measurement in children.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSmfD was calculated as the mean of the unrounded mf/mg skin of each snip. Thus, each individual with \u0026ge;1 mf detected across all snips is considered mf-positive. This is a more stringent criterion for mf-positivity than we used in our previous overview of the P3 study screening data [27].\u0026nbsp;\u003c/p\u003e\n\u003ch2 id=\"_Toc203408059\"\u003eDemographic characteristics, village names and GPS coordinates\u003c/h2\u003e\n\u003cp\u003eFor studies MDGH-MOX-3001 and MDGH-MOX-3002, age, gender, village and AdS of residence (as per the \u0026lsquo;Division Provinciale de la Sant\u0026eacute; Ituri\u0026rsquo; names and delineations introduced in 2014) were entered into the database for all screened.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe P3 study database included only study participants. The data for screen failures were extracted from the source documents. For this analysis, the village names reported in 2010 [27] were mapped to those introduced in 2014.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe village GPS coordinates are provided in Additional File 1 Table S1.\u003c/p\u003e\n\u003ch2\u003e\u003cspan id=\"_Toc203408060\"\u003eMaps\u003c/span\u003e\u003c/h2\u003e\n\u003cp\u003eMaps were generated with QGIS version 3.40.3. Shapefiles for DRC (ADM0) and Ituri Province (ADM1) were those available at WHO. While WHO has shapefiles for ZdS (ADM2, not used in the maps), WHO does not have shapefiles for Mahagi Territory and the AdS. These were obtained from the DRC MoH (COD2 and COD4, respectively). The AdS shapes were corrected as necessary using QUICKOSM background by DUW in collaboration with local health care staff.\u0026nbsp;\u003c/p\u003e\n\u003ch2 id=\"_Toc203408061\"\u003eStudy area\u003c/h2\u003e\n\u003ch3 id=\"_Toc203408062\"\u003eLocation\u0026nbsp;\u003c/h3\u003e\n\u003cp\u003eVolunteers lived in 9/26 AdS comprising the ZdS Logo and 2/22 AdS comprising the ZdS Nyarambe in the Mahagi Territory in the Ituri province of DRC (Figure 1) close to Lake Albert. While these AdS represent only a fraction of the AdS in each ZdS, for convenience the ZdS name will be used here when referring to data across these nine and two AdS.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAdditional File 1 Fig S1 shows Figure 1 C with 2021-2023 dwellings indicated. Additional File 1 Fig S2 provides an overview of the study area, including the location of the Centre de Recherche en Maladies Tropicales de l\u0026rsquo;Ituri (CRMT) at the H\u0026ocirc;pital G\u0026eacute;n\u0026eacute;ral de R\u0026eacute;ference Rethy and of villages included in 2002 and 2015 evaluations of \u003cem\u003eO. volvulus\u003c/em\u003e infection prevalence. The area is mountainous with people living primarily on the slopes or tops of lower hills and cultivating fields in the valleys close to rivers and streams (Additional File 1 Fig S2 and Fig S4).\u0026nbsp;\u003c/p\u003e\n\u003ch3 id=\"_Toc203408063\"\u003eRiver basins and villages\u003c/h3\u003e\n\u003cp\u003eBased on the topographical characteristics, the rivers and their affluents, villages were assigned to three river basins: Awo in the North, Kuda in the center and Lebu in the south (Figure 3, Additional File 1 Fig S2).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eVillages where volunteers were screened in 2010 and 2021-2023 (black), only in 2021-2023 (orange), only in 2010 (brown).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNote the village of Ucudo is so close to Thedeja 2 and Drayi that its name could not be displayed.\u003c/p\u003e\n\u003ch3\u003e\u003cspan id=\"_Toc203408065\"\u003eResults of 2002 Rapid Epidemiological Assessment\u0026nbsp;\u003c/span\u003e\u003c/h3\u003e\n\u003cp\u003eIn 2002, APOC-funded REA, conducted by co-authors Tony O. Ukety and Deogratias U. Wonyarossi at the \u0026lsquo;Projet Ophtalmologie \u0026agrave; Nyankunde\u0026rsquo; identified meso- and hyperendemic villages (Additional File 1 Table S2 and Fig S4) which led to the area being designated as a \u0026lsquo;high risk\u0026rsquo;/priority area for CDTI implementation [10, 11].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe 2007 WHO/TDR decision to include this area in the P3 study was based on the REA results, the fact that CDTI had not been implemented and consultation with APOC as well as the MoH. WHO/TDR investments into the necessary personnel capacity and infrastructure resulted in establishment of the CRMT (Additional File 1 Fig S2). The CRMT capacity, the P3 screening data and the fact that CDTI had not yet been implemented in the ZdS Logo led to selection of this area for studies MDGH-MOX-3001 and MDGH-MOX-3002. Additional File 1 Table S3 provides an overview of CRMT capacities, research experience and diseases prevalent in the area (Additional File 1 Fig S2).\u0026nbsp;\u003c/p\u003e\n\u003ch3 id=\"_Toc203408066\"\u003eVectors\u0026nbsp;\u003c/h3\u003e\n\u003cp\u003eThe vectors obtained through collection of aquatic stages and human landing catches in 2015-2018 were identified as \u003cem\u003eSimulium dentulosum\u003c/em\u003e and \u003cem\u003eSimulium vorax\u003c/em\u003e [44].\u0026nbsp;\u003c/p\u003e\n\u003ch3 id=\"_Toc203408067\"\u003eSocioeconomic characteristics\u003c/h3\u003e\n\u003cp\u003eThe majority of the population is poor with agricultural livelihoods, including subsistence farming. Production of coffee, mostly sold in Uganda, constitutes the main source of income and employment. The fields people cultivate may not be close to or in the same river basin as their village of residence and people from different villages may have fields close to each other. Men and women have different roles: men clear the fields and prepare water courses for watering and drainage, as required, while both men and women plough, sow, weed and harvest. Field work occurs throughout the year given that the fertility of the area allows several harvests per year. \u0026nbsp;\u003c/p\u003e\n\u003ch3 id=\"_Toc203408068\"\u003eIvermectin treatment history\u0026nbsp;\u003c/h3\u003e\n\u003cp\u003eThe ZdS Logo, Nyarambe and Rethy were included in the agreement between WHO and the MoH that established the APOC CDTI-Project Ituri Nord, initiated in 2007 [45-47]. The 2007-2012 CDTI-Project Ituri Nord reports to APOC characterize the ZdS Logo and Nyarambe as not requiring CDTI and did not cover the ZdS Rethy [48, 49]. The ZdS Rethy was included in the APOC CDTI Project Ituri Sud, initiated in 2012 [50]. As per the ESPEN Implementation Unit level onchocerciasis database (accessed 16 February 2025) CDTI was not implemented in the ZdS Logo. For control of lymphatic filariasis in the ZdS Nyarambe, between 181,468 and 225,278 people received ivermectin+albendazole annually in 2016-2019 and 2021-2022 (treatment coverage 80% to 84%) and in 2023, 197,640 people received ivermectin alone (treatment coverage 84%).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eZdS is an area delineated by the health system administration, not based on criteria delineating an \u003cem\u003eO. volvulus\u003c/em\u003e transmission zone [51-53]. The different ivermectin treatment history of the ZdS Logo and Nyarambe and its possible impact on SmfD of those screened in 2021-2023 and parasite transmission is one of the reasons for data presentation by ZdS. \u0026nbsp;\u003c/p\u003e\n\u003ch2 id=\"_Toc203408069\"\u003eIvermectin treatment history of individuals screened\u003c/h2\u003e\n\u003cp\u003eNone of the volunteers screened in 2010 had received ivermectin previously. In the P3 study, 472 volunteers (SmfD 10-299) received a single dose of 8 mg moxidectin (n=315, geometric mean SmfD: pre-treatment 37.4, 12 months post-treatment 0.7) or 150 \u0026micro;g/kg ivermectin (n=157, geometric mean SmfD: pre-treatment 40.7, 12 months post-treatment 8.0) in 2010 to January 2011 [27].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn 2021-2023, ivermectin treatment between 2 and 1800 days before screening was reported by 29/7576 (0.4%) volunteers from the ZdS Logo and 9/1056 (0.9%) volunteers from the ZdS Nyarambe, respectively. Volunteers were not asked about participation in the P3 study. Reliable post-hoc identification of P3 participants was not possible. Our best estimate suggests that around 48 moxidectin- and 26 ivermectin-treated P3 participants were screened in 2021-2023. The treatment of any P3 participants with moxidectin or ivermectin cannot be considered as \u0026lsquo;prior ivermectin treatment\u0026rsquo; affecting SmfD measured in 2021-2023 because: (1) Given the \u003cem\u003eO. volvulus\u003c/em\u003e reproductive life of 10\u0026plusmn;3 years [54-57], very few of the macrofilariae present in P3 study participants at the time of their treatment can have been alive/reproductively active during screening 2021-2023; (2) the duration of the embryostatic effect of a single ivermectin or moxidectin dose on SmfD shows considerable inter-individual variability [27, 35, 58, 59]. While its maximum is unknown it is extremely unlikely to be \u0026ge;10 years in even a small percentage of those treated which would be tantamount to a single dose being permanently sterilizing (or life-span shortening/cidal). While there are no data to support or refute such a hypothesis for moxidectin, available data for ivermectin do not support such an effect [60]. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFor individuals without prior ivermectin treatment, the SmfD reflects the individual\u0026rsquo;s intensity of infection and across individuals the prevalence of infection among those evaluated (as detectable based on the number of skin snips, incubation medium and duration [61]). In contrast, and given the variable long-term effect of a single ivermectin (or moxidectin) dose on an individual\u0026rsquo;s SmfD [27, 35, 58, 59], this is not necessarily the case for people who have taken ivermectin relatively recently. Consequently, our analysis focuses on individuals who did not report prior ivermectin treatment during screening.\u0026nbsp;\u003c/p\u003e\n\u003ch2 id=\"_Toc203408070\"\u003eData analysis\u003c/h2\u003e\n\u003cp\u003eFor some analyses, SmfD were categorized either as 0 vs \u0026gt;0 or as follows: 0, \u0026gt;0-\u0026lt;5, \u0026ge;5-\u0026lt;10, \u0026ge;10-\u0026lt;20, \u0026ge;20-\u0026lt;30, \u0026ge;30-\u0026lt;40, \u0026ge;40-\u0026lt;50, \u0026ge;50-\u0026lt;60, \u0026ge;60-\u0026lt;80, \u0026ge;80.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eLogistic regression with prevalence of infection (yes/no) as the dependent binary variable and age and gender as independent variables were used to analyse the data from 2010 and from 2021-2023 separately to identify the extent to which age and gender impacted the risk of being infected in each period. For 2021-2023, prior ivermectin treatment was included as an additional independent variable. The data obtained from the 10 villages in the ZdS Logo where at least 20 individuals had been screened in both 2010 and 2021-2023 were analysed by logistic regression as described above and also using the period (2010 and 2021-2023) as interaction effect for age, gender, and village.\u003c/p\u003e\n\u003cp\u003eInferential Analyses were conducted with R (R Foundation for Statistical Computing, Vienna, Austria). All Confidence Intervals (CI) are 95%. Descriptive analysis and Figures were generated in Excel 365.\u0026nbsp;\u003c/p\u003e"},{"header":"Results","content":"\u003ch2\u003eDemographic characteristics\u003c/h2\u003e\n\u003cp\u003eMost volunteers screened in 2010 (1373/1409, 97.4%) and in 2021-2023 (7574/8594 (87.8%) without prior ivermectin treatment, 29/38 (76.3%) of those with prior ivermectin treatment) lived in the ZdS Logo with adults representing 92.1% and 73.2% and women 36.9% and 46.6% of volunteers screened in 2010 and 2021-2023, respectively. The mean age of both adults and adolescents without prior IVM treatment was somewhat higher in 2010 than 2021-2023 (Table 1). In 2021-2023, the age distribution among adolescents was shifted towards younger ages compared to 2010, while in 2010 the percentage of adults between approximately 45 and 65 years of age was higher than in 2021-2023 (Additional File 1 Fig S5). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 1: \u0026nbsp; \u0026nbsp; Demographic characteristics\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"937\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"10\" valign=\"bottom\" style=\"width: 481px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo prior IVM treatment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 244px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePrior IVM treatment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 47px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2010\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2010\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2010\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2010\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2010\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2021-2023\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2021-2023\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2021-2023\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2021-2023\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2021-2023\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2021-2023\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2021-2023\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2021-2023\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2021-2023\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2021-2023\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eZone de Sant\u0026eacute;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge category\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 47px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean Age\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSD Age\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMin Age\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMax Age\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean Age\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSD Age\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMin Age\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMax Age\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean Age\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSD Age\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMin Age\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMax Age\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLogo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 47px;\"\u003e\n \u003cp\u003e1373\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp\u003e40.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e16.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\n \u003cp\u003e93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e7547\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp\u003e32.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e17.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp\u003e38.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e20.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e84\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdults\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 47px;\"\u003e\n \u003cp\u003e1265\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp\u003e42.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e15.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\n \u003cp\u003e93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e5517\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp\u003e38.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e16.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp\u003e41.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e19.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e84\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdults\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eF\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 47px;\"\u003e\n \u003cp\u003e471\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp\u003e48.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e14.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\n \u003cp\u003e85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e2519\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp\u003e41.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e16.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp\u003e50.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e15.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdults\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eM\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 47px;\"\u003e\n \u003cp\u003e794\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp\u003e38.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e15.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\n \u003cp\u003e93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e2998\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp\u003e36.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e15.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp\u003e38.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e20.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e84\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 47px;\"\u003e\n \u003cp\u003e108\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp\u003e15.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e1.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e2030\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp\u003e14.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e1.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp\u003e15.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e1.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eF\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 47px;\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp\u003e14.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e1.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e1006\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp\u003e14.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e1.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp\u003e16.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e0.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eM\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 47px;\"\u003e\n \u003cp\u003e73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp\u003e15.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e1.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e1024\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp\u003e14.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e1.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp\u003e14.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e0.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNyarambe\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 47px;\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp\u003e45.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e16.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\n \u003cp\u003e70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e1047\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp\u003e30.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e18.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp\u003e45.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e19.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e79\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdults\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 47px;\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp\u003e45.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e16.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\n \u003cp\u003e70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e690\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp\u003e38.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e17.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp\u003e45.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e19.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e79\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdults\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eF\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 47px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp\u003e55.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e10.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\n \u003cp\u003e70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e270\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp\u003e43.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e17.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp\u003e60.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e15.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e79\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdults\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eM\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 47px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp\u003e36.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e14.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\n \u003cp\u003e66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e420\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp\u003e34.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e16.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp\u003e33.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e12.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 47px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e357\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp\u003e14.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e1.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eF\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 47px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e173\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp\u003e14.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e1.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eM\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 47px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e184\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp\u003e14.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e1.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAbbreviations: Ado Adolescents, IVM ivermectin, SD standard deviation \u0026nbsp;\u003c/p\u003e\n\u003ch2 id=\"_Toc203408074\"\u003eZone de Sant\u0026eacute; Nyarambe\u003c/h2\u003e\n\u003cp\u003eOnly 36 individuals were screened in 2010 making comparison with the 2021-2023 data not meaningful (Table 2). Additional File 1 Fig S6 and Tables S4, S5 and S6 , provide the data.\u003c/p\u003e\n\u003ch2 id=\"_Toc203408075\"\u003eZone de Sant\u0026eacute; Logo\u003c/h2\u003e\n\u003ch3\u003e\u003cspan id=\"_Toc203408076\"\u003eSkin microfilariae density across all AdS\u003c/span\u003e\u003c/h3\u003e\n\u003cp\u003eFigure 4 shows the SmfD in each individual screened in 2010 and 2021-2023 by age and gender. Mean (\u0026plusmn; standard deviations) SmfD across all and all mf-positive individuals without ivermectin treatment history was 24\u0026plusmn;35.5 and 32\u0026plusmn;37.6 in 2010 and 1\u0026plusmn;6.4 and 13\u0026plusmn;18.5 in 2021-2023, respectively (Table 2). In 2010, only 23.3% and 26.9% of adults and adolescents had undetectable SmfD while these percentages were 89.8% and 96.8% in 2021-2023, respectively (Figure 5). Additional File 1 Tables S4, S5 and S6 provide further details.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe odds ratio (OR) for infection (mf positivity) was 3.101 (CI [2.053, 4.713], p\u0026lt;0.001) and 0.024 (CI [0.019, 0.030], p\u0026lt;0.001) in 2010 and 2021-2023, respectively. In 2021-2023 males were statistically significantly more likely to be infected then women (OR 1.643, CI [1.386, 1.952], p\u0026lt;0.001) and the odds of being infected increased with age (OR 1.030, CI [1.025, 1.034], p\u0026lt;0.001). Prior ivermectin treatment did not significantly impact the odds of being mf-positive (OR 1.348, CI [0.388, 3.602, p\u0026gt;0.1). In contrast, in 2010, the ORs for males vs females and increase with age were not statistically significant (OR 0.836, CI [0.634, 1.099] p\u0026gt;0.1 and OR 1.004, CI [0.996, 1.012] p\u0026gt;0.1, respectively).\u003c/p\u003e\n\u003cp\u003eTable 2: \u0026nbsp; \u0026nbsp; Skin microfilariae density across all and across mf-positive individuals without prior ivermectin treatment in Zone de Sant\u0026eacute; Logo and Nyarambe\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"620\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eZone de Sant\u0026eacute;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"5\" valign=\"bottom\" style=\"width: 240px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eALL individuals\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"5\" valign=\"bottom\" style=\"width: 257px;\"\u003e\n \u003cp\u003e\u003cstrong\u003emf-positive individuals\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePeriod\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean SmfD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSD SmfD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 47px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMin SmfD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMax SmfD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean SmfD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSD SmfD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 47px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMin SmfD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMax SmfD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLogo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 47px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 47px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2010\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\n \u003cp\u003e1373\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp\u003e24.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e35.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e299.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\n \u003cp\u003e1049\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e31.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e37.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e299.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdults\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\n \u003cp\u003e1265\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp\u003e25.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e36.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e299.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\n \u003cp\u003e970\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e33.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e38.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e299.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdolescents\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\n \u003cp\u003e108\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp\u003e11.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e18.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e73.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\n \u003cp\u003e79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e16.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e19.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e73.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2021-2023\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\n \u003cp\u003e7547\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp\u003e1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e6.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e177.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\n \u003cp\u003e625\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e13.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e18.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e177.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdults\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\n \u003cp\u003e5517\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp\u003e1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e7.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e177.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\n \u003cp\u003e561\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e13.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e19.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e177.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdolescents\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\n \u003cp\u003e2030\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e2.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e66.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e7.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e12.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e66.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNyarambe\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 47px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 47px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2010 Adults\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp\u003e10.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e24.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e135.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e14.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e27.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e135.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2021-2023\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\n \u003cp\u003e1047\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e2.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e53.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e13.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e11.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e53.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdults\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\n \u003cp\u003e690\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e3.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e53.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e13.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e11.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e53.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdolescents\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\n \u003cp\u003e357\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 47px;\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003ch3\u003ePrevalence and intensity of infection by AdS of residence\u003c/h3\u003e\n\u003cp\u003eVolunteers living in the AdS Draju and Kanga represented 84% and 12% of those screened in 2010 and 53% and 35% of those screened without prior ivermectin treatment in 2021-2023, respectively. Across these adults and adolescents, infection prevalence dropped from 79% to 9% in Draju and from 69% to 9% in Kanga and mean SmfD from 26.2 to 1.2 in Draju and from 17.1 to 1.1 in Kanga (Table 3).\u003c/p\u003e\n\u003cp\u003eTable 3:\u0026nbsp; \u0026nbsp; \u0026nbsp;Skin microfilariae density across all and all mf-positive individuals without prior ivermectin treatment in AdS Draju and Kanga\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"622\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAire de Sant\u0026eacute;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"5\" valign=\"bottom\" style=\"width: 242px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eALL\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"5\" valign=\"bottom\" style=\"width: 257px;\"\u003e\n \u003cp\u003e\u003cstrong\u003emf-positive\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePeriod\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 47px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean SmfD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSD SmfD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 47px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMin SmfD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMax SmfD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean SmfD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSD SmfD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 47px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMin SmfD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMax SmfD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDraju\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 47px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 47px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 47px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2010\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 47px;\"\u003e\n \u003cp\u003e1149\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp\u003e26.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e36.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e299.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\n \u003cp\u003e908\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e33.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e38.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e299.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdults\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 47px;\"\u003e\n \u003cp\u003e1057\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp\u003e27.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e37.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e299.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\n \u003cp\u003e838\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e34.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e39.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e299.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdolescents\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 47px;\"\u003e\n \u003cp\u003e92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp\u003e13.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e19.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e73.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\n \u003cp\u003e70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e17.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e20.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e73.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2021-2023\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 47px;\"\u003e\n \u003cp\u003e4015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp\u003e1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e6.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e177.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\n \u003cp\u003e362\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e13.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e18.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e177.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdults\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 47px;\"\u003e\n \u003cp\u003e2803\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp\u003e1.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e7.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e177.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\n \u003cp\u003e324\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e13.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e19.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e177.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdolescents\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 47px;\"\u003e\n \u003cp\u003e1212\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e2.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e66.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e8.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e12.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e66.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eKanga\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2010\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 47px;\"\u003e\n \u003cp\u003e161\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp\u003e17.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e29.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e200.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\n \u003cp\u003e111\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e24.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e32.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e200.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdults\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 47px;\"\u003e\n \u003cp\u003e151\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp\u003e18.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e29.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e200.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\n \u003cp\u003e107\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e25.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e32.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e200.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdolescents\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 47px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp\u003e2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e5.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e16.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e5.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e7.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e16.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2021-2023\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 47px;\"\u003e\n \u003cp\u003e2673\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp\u003e1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e6.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e99.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\n \u003cp\u003e231\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e13.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e16.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e99.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdults\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 47px;\"\u003e\n \u003cp\u003e1967\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp\u003e1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e7.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e99.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\n \u003cp\u003e205\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e13.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e17.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e99.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdolescents\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 47px;\"\u003e\n \u003cp\u003e706\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e2.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e64.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e7.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e12.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e64.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003ch3 id=\"_Toc203408082\"\u003ePrevalence and intensity of infection by village of residence\u003c/h3\u003e\n\u003cp\u003eIn 18 villages screening occurred in both 2010 and 2021-2023. Participants from these villages represented 95% (1302/1373) and 76% (5738/7547) of participants without prior ivermectin treatment (Additional File 1 Table S5).\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn 10 villages more than 20 volunteers were screened in 2010 (range 25‑324, total 1241) and 2021‑2023 (range individuals without prior ivermectin treatment 106‑682, total 3518). Figure 6 A illustrates the drop in prevalence of mf-positive individuals from 2010 to 2021‑2023. Figure 6 B and Additional File 1 Fig S7 show for Umulo and the other nine villages, respectively, that infection prevalence and intensity dropped across genders and age.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn these 10 villages, the odds ratio (OR) for infection (mf-positivity) was 3.274 (CI [2.111, 5.116], p\u0026lt;0.001) and 0.019 (CI [0.014, 0.026], p\u0026lt;0.001) in 2010 and 2021-2023, respectively. In 2021-2023 males were statistically significantly more likely to be infected then women (OR 1.678, CI [1.321, 2.138], p\u0026lt;0.001) and the odds of being infected increased with age (OR 1.040, CI [1.034, 1.047], p\u0026lt;0.001). In contrast, in 2010, the ORs for males vs females and increase with age were not statistically significant (OR 0.773, CI [0.574, 1.035], p=0.1 and OR 1.005, CI [0.997, 1.013], p\u0026gt;0.1, respectively). These ORs are similar to those obtained across all individuals screened in ZdS Logo. The OR for being infected in these 10 villages in 2021-2023 compared to in 2010 was 0.003 (CI [0.001, 0.007], p\u0026lt;0.001). In 2021-2023, males had a relatively higher risk of being infected than in 2010 (OR 1.966, CI [1.333, 2.911], p\u0026lt;0.001) and the odds of being infected increased more with age than in 2010 (OR:1.036, CI [1.025, 1.047], p\u0026lt;0.001).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eB: N = 324 in both 2010 and 2021-2023.\u003c/p\u003e\n\u003ch3 id=\"_Toc203408084\"\u003ePrevalence and intensity of infection by river basin\u003c/h3\u003e\n\u003cp\u003eFigure 7 shows the drop in infection prevalence and intensity from 2010 to 2021‑2023 across all individuals screened living in the Kuda and Lebu river basin. No conclusions are possible for the Awo basin because no individual screened in 2010 lived in a village in the ZdS Logo in that basin. \u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe SmfD of individuals living in the ZdS Logo, whether analyzed overall, by age-group or by AdS, village or river basin when numbers screened allowed, shows a substantial drop in the prevalence and intensity of infection from 2010 to 2021-2023. No conclusions can be drawn for the ZdS Nyarambe because only 36 individuals were screened in 2010. Given that people living in ZdS Logo can move freely into the ZdS Nyarambe and might actually move regularly into that ZdS for field work close to breeding sites, it would be surprising if prevalence and intensity of infection had not changed in the ZdS Nyarambe independent of the ivermectin treatments for LF control in that ZdS. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNeither dataset was obtained to sample age- and gender-representative sections of the population to assess infection levels (Table 1, Additional File 1 Fig S5). Sample size and area covered are, however, large and the method used is precise compared to other evaluations (Additional File 1 Table S7). Our analysis could not account for (1) a \u0026lsquo;participant self-selection bias\u0026rsquo; due to potential participants being told that people with \u0026lsquo;too few worms in their skin\u0026rsquo; cannot participate in the study in 2010 (the P3 study inclusion criteria required \u0026ge;10 SmfD [27, 35, 36]) but not in 2021-2023 (Figure 2) which might have discouraged those considering themselves uninfected from participating in screening in 2010 and (2) that where people live is not where they work the fields and might get infected. These limitations are, however, unlikely to explain the decrease in infection prevalence and intensity the SmfD data show.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eGiven that ivermectin was not distributed in the ZdS Logo between 2010 and 2021‑2023, ivermectin distribution cannot explain this decrease (nor can the single dose of moxidectin or ivermectin 472 infected individuals across 17 villages received in the P3 study in 2010 to January 2011). The 2010 data show that the ZdS Logo met the criteria for hyperendemicity [11, 62, 63]. Considering the data and modelling showing that long-term CDTI with high treatment coverage in hyperendemic areas themselves is needed to significantly reduce infection prevalence and intensity [23, 57, 64], ivermectin distribution in the ZdS Nyarambe in 2016‑2019 and 2021‑2022 is also very unlikely to have driven the decrease in infection prevalence and intensity in the ZdS Logo. Consequently, the most likely cause is decreasing infective vector biting rates. This leads to decreasing numbers of young macrofilariae, i.e. a shift in the macrofilariae population towards older macrofilariae approaching or beyond the end of their reproductive life-span and thus decreasing numbers of mf producing macrofilariae. The OCP showed these effects when comparing the macrofilariae from volunteers in villages after 7-10 years of vector control and villages without vector control. This research also found lower reproductive capacity in older compared to younger macrofilariae [65] which further contributes to lowering host SmfD [55, 57]. While following up MDGH-MOX-3001 and MDGH-MOX-3002 participants in seven villages (Kpana, Ndroy, Rudju, Mbesi, Yau, Ngungbu, Jabi) whose inhabitants work the fields in the Kuda river basin, village leaders told FNN and the nurses: (1) that blackfly nuisance had declined and blackfly bites decreased from several/day to several/week over the past approximately 10 years, (2) blackfly nuisance, previously present throughout the year is now restricted to the two rainy seasons. The authorization provided by one of the \u0026lsquo;grands chefs\u0026rsquo; to clear forests in the Kuda basin valleys for agricultural use and to reduce blackfly nuisance has left little shade cover for blackflies (Additional File 1 Fig S3). We are not aware of any larviciding or other vector control interventions by national or provincial authorities. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn their report of entomological evaluations in the area, Post et al. point out that: (1) \u003cem\u003eS. neavai\u003c/em\u003e may have been the main or only anthropophilic vector in the past and disappeared following land use changes that reduced shade cover that species needs; (2) the main species identified between 2015 and 2018 was \u003cem\u003eS. dentulosum\u003c/em\u003e, a species with unarmed cibarium, (3) \u003cem\u003eS. dentulosum\u003c/em\u003e does not regularly feed on humans and had never been implicated in \u003cem\u003eO. volvulus\u003c/em\u003e transmission; (4) Given that 30% and 11% of 155 \u003cem\u003eS. dentulosum\u003c/em\u003e caught via human landing catches were \u003cem\u003eO. volvulus\u003c/em\u003e infected and infective, respectively, \u003cem\u003eS. dentulosum\u003c/em\u003e is a probable vector. Its efficiency as a vector is unknown; (5) Further investigation is needed into the role of \u003cem\u003eS. vorax\u003c/em\u003e in \u003cem\u003eO. volvulus\u003c/em\u003e transmission given that only 4 specimens were available to assess \u003cem\u003eO. volvulus\u003c/em\u003e infection and infectivity [44]. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePublicly available results of other evaluations in and around our study area (Additional File 1 Table S7) include those of the 2002 REA (Additional File 1 Table S1, Fig S2, Fig S4), the 2015 DRC MoH parasitological or serological evaluations and research studies conducted from 2016 to 2018 on onchocerciasis-associated epilepsy [66-68]. Comparison of these data with ours cannot provide further insight into trends in parasite transmission for methodological reasons. The correlation between REA-based nodule prevalence and prevalence of mf-positive individuals in the general population is not very tight and the skin mf prevalence data used to establish this correlation were obtained with two snips [63]. Two snips, typically used in prevalence surveys and studies not aimed at assessing the efficacy of anti-onchocercal drugs (including in the studies on onchocerciasis-associated epilepsy [66-69], provide less sensitivity for detecting mf-positive individuals than four snips [61, 70]. Two of the studies by Mandro et al. [67, 68] included persons with epilepsy. The long-postulated association between \u003cem\u003eO. volvulus\u003c/em\u003e infection and risk of epilepsy has been confirmed [71-82]. Consequently, infection prevalence in persons with epilepsy cannot be compared with our data. Assays for the presence of immunoglobulin G4 against the\u003cem\u003e\u0026nbsp;O. volvulus\u003c/em\u003e antigen Ov16 (Ov16 IgG4) detect both current and past infections. The time to seroconversion in both directions is unknown and not everybody infected might seroconvert. A\u0026nbsp;WHO advisory committee review of large-scale evaluations of Ov16 IgG4 prevalence identified discrepancies between results with different assays and concerns about false-positive and false-negative results. Thus, both methodological and biological factors can contribute to discordance between mf-positivity and Ov16 IgG4 positivity in the same individual and differences in infection prevalence estimated parasitologically or serologically\u0026nbsp;[83-92].\u003c/p\u003e\n\u003cp\u003eWhen considering what the reduction in infection prevalence and intensity we identified indicates about current transmission levels and prospects for elimination of transmission without interventions, it needs to be taken into account that the SmfD measured reflect past transmissions. These transmissions occurred approximately 2-15 years earlier because (1) the pre-patent period is estimated at 12-18 months [56, 57, 93, 94] and it may take up to 3 years from an infective bite to the resulting macrofilaria(e) producing detectable mf \u0026nbsp;levels [56, 57, 95], (2) the estimated reproductive life span of the macrofilariae is 10\u0026plusmn;3 years [54-57] and (3) the estimated microfilariae life span is around 12-15 months [56, 57, 96]. To assess current transmission, extensive collection of anthropophilic vectors and determination of their infectivity is required.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWhile our data provide no information on current transmission levels, they show that transmission decreased significantly resulting in the macrofilariae age distribution among those screened in 2021-2023 vs in 2010 being shifted towards older and less reproductively capable macrofilariae. It is unknown whether older macrofilariae approaching the end of their reproductive life span have a different susceptibility to anti-onchocercal drugs (whether ivermectin, moxidectin or drugs currently in development [37]) than younger macrofilariae. The transmission models ONCHOSIM and EpiOncho, used to estimate time to elimination with different strategies, consider macrofilaria age-dependent reproductive capacity (additional files to [57]), but to our knowledge not age-dependent drug-susceptibility. Comparative analysis of the 12- and 18-months efficacy data from the P3 study in this area [27] and study MDGH-MOX-3001 may provide an opportunity to evaluate age-dependency of macrofilariae susceptibility to ivermectin and moxidectin. This may be a unique opportunity given that evaluations in areas under CDTI [97] do not allow to differentiate the CDTI-driven reduction in transmission and macrofilariae age distribution and the cumulative effect of ivermectin treatment on macrofilariae reproductive capacity [57]. Estimates of macrofilariae-age-dependent drug-susceptibility could improve model predictions.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn the ZdS Logo, \u003cem\u003eO. volvulus\u003c/em\u003e infection prevalence and intensity dropped substantially over around 11-13 years without health system-directed interventions. Given that SmfD, nodule prevalence and Ov16 IgG4 reflect past transmissions, large-scale entomological evaluations are needed to assess current transmission levels and thus the extent to which the change in the vector species proposed by Post and coworkers [44] may result in elimination or in keeping transmission at very low levels. Given that reduction in transmission, whether due to \u0026lsquo;natural causes\u0026rsquo; (e.g. land-use or climate change), vector control or large-scale treatment with current anti-onchocercal drugs, shifts macrofilariae age distribution, comparing ivermectin and moxidectin efficacy in the ongoing and the P3 study might help determine whether macrofilariae drug-susceptibility changes with age. If it does, inclusion of relevant parameters in the transmission models could improve the accuracy of the modelled time to elimination.\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"604\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003eAdS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 529px;\"\u003e\n \u003cp\u003eAire de Sant\u0026eacute; (Health area, lowest health system administrative unit)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003eAPOC\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 529px;\"\u003e\n \u003cp\u003eAfrican Programme for Onchocerciasis Control\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003eCDTI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 529px;\"\u003e\n \u003cp\u003eCommunity directed treatment with ivermectin\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003eCI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 529px;\"\u003e\n \u003cp\u003e95% Confidence interval\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003eDRC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 529px;\"\u003e\n \u003cp\u003eDemocratic Republic of the Congo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003eG-FDA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 529px;\"\u003e\n \u003cp\u003eFood and Drugs Authority of Ghana\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003eMDAi\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 529px;\"\u003e\n \u003cp\u003eMass drug administration of ivermectin\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003eMDGH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 529px;\"\u003e\n \u003cp\u003eMedicines Development for Global Health\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003emf\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 529px;\"\u003e\n \u003cp\u003eMicrofilaria\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003eMoH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 529px;\"\u003e\n \u003cp\u003eMinist\u0026egrave;re de la Sant\u0026eacute; Publique, Hygi\u0026egrave;ne et Prevention of the Democratic Republic of the Congo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003eOR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 529px;\"\u003e\n \u003cp\u003eOdds ratio\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003eREA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 529px;\"\u003e\n \u003cp\u003eRapid Epidemiological Assessment\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003eSmfD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 529px;\"\u003e\n \u003cp\u003eSkin microfilariae density (mf/mg skin)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003eSSA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 529px;\"\u003e\n \u003cp\u003eSub-Saharan Africa\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003eUS-FDA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 529px;\"\u003e\n \u003cp\u003eFood and Drug Administration of the United States of America\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003eWHO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 529px;\"\u003e\n \u003cp\u003eWorld Health Organization\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003eWHO/ESPEN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 529px;\"\u003e\n \u003cp\u003eWHO Expanded Special Project for Elimination of Neglected Tropical Diseases\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003eWHO/TDR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 529px;\"\u003e\n \u003cp\u003eUNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003eZdS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 529px;\"\u003e\n \u003cp\u003eZone(s) de Sant\u0026eacute; (Health zone)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Declarations","content":"\u003ch2\u003eEthics approval and consent to participate\u003c/h2\u003e\n\u003cp\u003eMDGH-MOX-3001 and MDGH-MOX-3002 protocols, information documents for potential participants, consent and assent forms and study conduct were approved by the DRC National Ethics Committee (Comit\u0026eacute; National d\u0026rsquo;Ethique de la Sant\u0026eacute;) and the National Regulatory Agency (Direction de la Pharmacie et du M\u0026eacute;dicament/Autorit\u0026eacute; Congolaise de R\u0026egrave;glementation Pharmaceutique, Minist\u0026egrave;re de la Sant\u0026eacute; Publique, Hygi\u0026egrave;ne et Prevention (MoH)). Approvals for the P3 study were obtained from the Ethics Committee of the Ecole de la Sant\u0026eacute; Publique Universit\u0026eacute; de Kinshasa and the MoH [27, 35, 36]. All documents were also approved by the WHO Ethics Review Committee. Participants documented their consent or assent with parental consent to study participation through signature or thumbprint in the presence of a literate witness in or near their villages.\u0026nbsp;\u003c/p\u003e\n\u003ch2 id=\"_Toc203408091\"\u003eAvailability of data and materials\u003c/h2\u003e\n\u003cp\u003eConsent to participation in screening for studies MDGH-MOX-3001 and/or MDGH-MOX-3002 or the P3 study did not include consent to publication of individual participant data. Consequently, the study sponsors (MDGH and WHO/TDR) and the authors cannot make individual participant data publicly available. Individuals wanting to analyse the data should request the data from the Sponsors (WHO/TDR, [email protected], and Medicines Development for Global Health, [email protected] or https://www.medicinesdevelopment.com/contact). Requests should include the objectives, data analysis plan and plans to obtain applicable approvals and involve the investigators (co-authors on this manuscript) and commitment to not share the data with anybody else.\u0026nbsp;\u003c/p\u003e\n\u003ch2 id=\"_Toc203408092\"\u003eCompeting interests\u003c/h2\u003e\n\u003cp\u003eBM was and MuMu and SK are staff of MDGH, Australia. In 2014, WHO licensed all data on moxidectin at its disposal to MDGH to prepare the New Drug Application for moxidectin to the US FDA and make moxidectin available at an affordable cost. MDGH remains the regulatory sponsor of moxidectin. MDGH co-funded studies MDGH-MOX-3001 and MDGH-MOX-3002.\u003c/p\u003e\n\u003cp\u003eACK and CMH work for WHO which funded the work of all co-authors on the P3 study through its department UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (WHO/TDR). ACK retired from WHO in March 2023 and is continuing to work for TDR as a consultant, including on studies MDGH-MOX-3001 and MDGH-MOX-3002.\u003c/p\u003e\n\u003ch2 id=\"_Toc203408093\"\u003eFunding\u003c/h2\u003e\n\u003cp\u003eStudies MDGH-MOX-3001 and MDGH-MOX-3002 in DRC were funded by a grant from the European \u0026amp; Developing Countries Clinical Trials Partnership (EDCTP, grant # RIA2017NCT-1843 MoxiMultiDoseMod), by MDGH and a grant from the Luxembourg National Research Fund (FNR n\u0026deg;INTER/ EDCTP/ 17/12331087/ MoxiMultiDoseMod/ Michel Vaillant).\u003c/p\u003e\n\u003cp\u003eWHO/TDR funded the P3 study, utilizing contributions from the WHO African Programme for Onchocerciasis Control (APOC), 6.3 million $US from Wyeth (and Pfizer following Pfizer acquisition of Wyeth) and WHO/TDR donor countries. Pfizer was not involved in this publication.\u003c/p\u003e\n\u003ch2 id=\"_Toc203408094\"\u003eAuthors\u0026rsquo; contributions\u003c/h2\u003e\n\u003cp\u003eFNN, DUW, AN were co-investigators in the P3, MDGH-MOX 3001 and MDGH-MOX-3002 studies responsible for recruitment. GMA and JLM conducted parasitological evaluations for the three studies.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMDGH-MOX-3001 and MDGH-MOX-3002: TOU was the principal investigator. MiMa and PTA were co-principal investigators. CBU, AAR, IAM, GLA, JUU, CMA and JdDNU were co-investigators responsible for recruiting. SK and BM co-designed the studies and collaborated on the protocols. BM collaborated on study preparation, staff training and study initiation. BM and MuMu managed the conduct of the studies at MDGH.\u003c/p\u003e\n\u003cp\u003eP3 study: DKB was the principal investigator for the P3 study in Ituri. MMN conducted parasitological evaluations. J-P UU and GLM were co-investigators responsible for recruitment. CMH participated in P3 study site training and initiation, managed study conduct, supervised study monitoring and close-out, supported investigators.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDUW generated all maps with the exception of the map of the 2002 REA results in Additional File 1 Fig S4.\u003c/p\u003e\n\u003cp\u003eMV was responsible for P3 study data management after WHO became sole study sponsor and co-designed and conducted the statistical analyses for this publication.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eACK co-designed the P3, MDGH-MOX-3001 and MDGH-MOX-3002 studies, collaborated on the protocols and managed or co-managed study preparation and set up, did staff training and study initiation. ACK conducted the descriptive analyses, co-designed the statistical analysis, created the figures, drafted the manuscript, and finalized it based on co-author feedback.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll authors reviewed the manuscript and approved the submitted version.\u0026nbsp;\u003c/p\u003e\n\u003ch2 id=\"_Toc203408095\"\u003eAcknowledgements\u003c/h2\u003e\n\u003cp\u003eWe are particularly grateful to all those who agreed to be screened for their co-operation.\u003c/p\u003e\n\u003cp\u003eWe acknowledge the contribution of Jean-Pierre Lotsima who passed away in March 2023.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDr. JHF Remme, at the time staff of WHO/TDR, generated the map of the 2002 REA results in Additional File 1 Fig S4 in ARCGIS 10.3 for the 2010 TDR internal discussions on study areas for the moxidectin community effectiveness studies and discussions with APOC and the Ministry of Health/ National Onchocerciasis Control Programme in DRC.\u003c/p\u003e\n\u003cp\u003eThe authors alone are responsible for the views expressed which do not necessarily represent the views, decisions or policies of the institutions with which the authors are affiliated.\u0026nbsp;\u003c/p\u003e\n\u003ch2 id=\"_Toc203408096\"\u003eCopyright\u003c/h2\u003e\n\u003cp\u003eWorld Health Organization 2025.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eThis article is licensed under the terms of the Creative Commons Attribution 3.0 IGO License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the World Health Organization, provide a link to the Creative Commons licence and indicate if changes were made. The use of the World Health Organization\u0026rsquo;s name, except in reference to the article, the use of the World Health Organization\u0026rsquo;s logo, is not authorized as part of this licence. The link provided below includes additional terms and conditions of the licence. The images or other third party material in this article are included in the article\u0026apos;s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article\u0026apos;s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWorld Health Organization. Ending the neglect to attain the sustainable development goals: a road map for neglected tropical diseases 2021\u0026ndash;2030. 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PLoS Negl Trop Dis. 2013;7(2):e2084. doi: 10.1371/journal.pntd.0002084 [doi];PNTD-D-11-01182 [pii].\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":true,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"parasites-and-vectors","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"parv","sideBox":"Learn more about [Parasites \u0026 Vectors](http://parasitesandvectors.biomedcentral.com/)","snPcode":"13071","submissionUrl":"https://submission.nature.com/new-submission/13071/3","title":"Parasites \u0026 Vectors","twitterHandle":"@bugbittentweets","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Onchocerciasis, skin microfilariae prevalence, moxidectin, ivermectin, Northern Ituri, DRC","lastPublishedDoi":"10.21203/rs.3.rs-7151190/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7151190/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e In Ituri province, 7576 and 1056 volunteers living in the Health Zone (ZdS) Logo and Nyarambe, respectively, were screened in 2021-2023 for two studies comparing efficacy and/or safety of moxidectin and ivermectin in individuals with or without detectable \u003cem\u003eOnchocerca volvulus\u003c/em\u003e skin microfilariae densities (SmfD, microfilariae/mg skin). Site selection was based on the clinical trial capacity established for the Phase 3 study of moxidectin and SmfD measured among 1373 and 36 individuals screened in ZdS Logo and Nyarambe, respectively, in 2010. We are comparing the SmfD measured in 2010 and 2021-2023 in ZdS Logo where ivermectin mass administration was never implemented.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eFour skin snips from each consenting/assenting individual ≥12 years old were weighed and incubated in isotonic saline for ≥8 hours. Emerged microfilariae were counted and SmfD calculated as the mean of the number of microfilariae/mg skin of each snip. Other data collected included age, gender, village of residence and history of ivermectin treatment.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eIn 2010 and 2021-2023, respectively, adults (18-93 years old) represented 92.1% and 73.2%, and women 36.9% and 46.6% of the 1373 and 7547 volunteers from ZdS Logo without reported prior ivermectin treatment. Among these adults and adolescents (12-17 years), no microfilariae were detected in snips from 23.3% and 26.9% in 2010 and 89.8% and 96.8% in 2021-2023, respectively, with mean SmfD (± standard deviation) being 24.30±35.52 and 11.8±18.37 in 2010 and 1.1±6.44 and 0.3±2.62 in 2021-2023, respectively.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eGiven that the reduction in infection prevalence and intensity cannot be attributed to ivermectin distribution, it has to be due to reduction in infective vector biting rates, possibly linked to a recently proposed change in vector species triggered by land-use changes. Because SmfD reflect transmission events approximately 2-15 years earlier, infective vector biting rate assessment is needed to determine current transmission rates. Reduced transmission shifts macrofilariae age distribution towards older macrofilariae with lower reproductive capacity. Comparison of the results from the Phase 3 and the ongoing efficacy study might help determine whether macrofilariae drug-susceptibility changes significantly with macrofilariae age. Should that be the case, transmission models evaluating the impact of mass drug administrations could be adjusted.\u003c/p\u003e","manuscriptTitle":"Reduction in Onchocerca volvulus infection prevalence and intensity in Logo Health Zone in Ituri, Democratic Republic of the Congo, in the absence of interventions: Results of screening for clinical trials of moxidectin vs. ivermectin in 2010 and 2021-2023","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-25 11:24:38","doi":"10.21203/rs.3.rs-7151190/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-09-16T13:35:57+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"289757624882154047276658747766526176516","date":"2025-07-25T09:13:25+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-22T20:29:07+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"276556649790863709541271531855477021186","date":"2025-07-19T00:06:43+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-07-18T19:21:26+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-07-18T07:54:45+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-07-18T06:53:44+00:00","index":"","fulltext":""},{"type":"submitted","content":"Parasites \u0026 Vectors","date":"2025-07-17T16:51:55+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"parasites-and-vectors","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"parv","sideBox":"Learn more about [Parasites \u0026 Vectors](http://parasitesandvectors.biomedcentral.com/)","snPcode":"13071","submissionUrl":"https://submission.nature.com/new-submission/13071/3","title":"Parasites \u0026 Vectors","twitterHandle":"@bugbittentweets","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b99cb9a1-2df4-439e-b222-fb2d5a59200b","owner":[],"postedDate":"July 25th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-03-23T16:03:14+00:00","versionOfRecord":{"articleIdentity":"rs-7151190","link":"https://doi.org/10.1186/s13071-025-07199-8","journal":{"identity":"parasites-and-vectors","isVorOnly":false,"title":"Parasites \u0026 Vectors"},"publishedOn":"2026-03-16 15:58:53","publishedOnDateReadable":"March 16th, 2026"},"versionCreatedAt":"2025-07-25 11:24:38","video":"","vorDoi":"10.1186/s13071-025-07199-8","vorDoiUrl":"https://doi.org/10.1186/s13071-025-07199-8","workflowStages":[]},"version":"v1","identity":"rs-7151190","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7151190","identity":"rs-7151190","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}