Comorbidities of onchocerciasis and non-communicable diseases, and determinants of continued transmission in Bafut Health District, Cameroon

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Ajonina-Ekoti, Promise A. Aghaeze, Marcelus U. Ajonina, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7530544/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 02 May, 2026 Read the published version in BMC Infectious Diseases → Version 1 posted 14 You are reading this latest preprint version Abstract Background: Despite decades of mass Ivermectin distribution, onchocerciasis transmission in Cameroon still persists. Comorbidities with non-communicable diseases (NCDs) and gaps in treatment uptake may contribute to sustained transmission. This study assessed the prevalence of onchocerciasis, its comorbidity with selected NCDs, and determinants of continued transmission in Bafut Health District, Cameroon. Methods: A hospital-based cross-sectional study was conducted from June to July 2024 among 282 adults aged ≥30 years residing in Bafut for ≥5 years. Data on sociodemographics, NCD history, onchocerciasis knowledge, and ivermectin uptake were collected using a structured questionnaire. Laboratory investigations included skin snip microscopy, nodule palpation, blood pressure measurement, and venous blood tests for diabetes and rheumatoid arthritis. The relationship between categorical variables was analysed using the chi-square test and logistic regression at a significance level of 5%. Results: The overall prevalence of onchocerciasis was 21.3%. Females (aOR = 6.58, 95% CI: 2.30–18.87, p < 0.001), age ≥60 years (aOR = 4.30, 95% CI: 1.42–13.02, p = 0.01), and lack of formal education (aOR = 4.58, 95% CI: 1.24–16.91, p = 0.02) were significantly associated with infection. The prevalence of NCDs was 8.5% in the population but 40.0% among onchocerciasis patients, with hypertension (25.0%) and rheumatoid arthritis (21.7%) most common. Refusal of ivermectin, mainly due to side effects, was significantly associated with infection (p = 0.01). Nearly half of the participants (48.9%) demonstrated poor knowledge of onchocerciasis. Conclusion: Onchocerciasis remains endemic in Bafut, with continuous transmission driven by female sex, older age, low education, NCD comorbidities, poor knowledge, and ivermectin refusal. Integrated NCD management, health education, and improved ivermectin compliance are critical to interrupt transmission. Onchocerciasis non-communicable diseases Hypertension Rheumatoid arthritis Diabetes Comorbidity Continuous transmission Ivermectin uptake Cameroon Figures Figure 1 Figure 2 Figure 3 Background Onchocerciasis, also known as river blindness, is a parasitic Neglected Tropical Disease (NTD) caused by the filarial nematode worm Onchocerca volvulus and transmitted through the bite of infected blackflies of the genus Simulium spp, which breed in fast-flowing rivers [1] . The disease remains a significant problem in most parts of sub-Saharan Africa, including Cameroon[2]. Despite Mass Drug Administration (MDA) with ivermectin for over two decades in Cameroon, onchocerciasis persists in many foci, including the Bafut District. In Cameroon, onchocerciasis is endemic mainly in the Southwest, Northwest, North and Adamawa regions [3]. According to studies carried out in the Tombel Health District of Cameroon, the prevalence of onchocerciasis was 21.6% [4]. However, recent studies have shown a drastic reduction in prevalence in Adamaoua [5]. Apart from skin, ocular and neurological manifestations, the disease has impaired productivity and has led to other socio-economic consequences in endemic communities. It is the leading cause of preventable blindness and a severe pruritic skin condition in endemic areas. This infection is chronic, rarely causes death, but imposes suffering, stigmatization and hardship on affected individuals [6]. People who travel and volunteer in companies or hospitals in endemic areas are also at high risk of having onchocerciasis. In advanced cases, the skin becomes thickened and wrinkled, showing a lizard or leopard skin appearance. In the past, the stigma of onchocerciasis has always been associated with blindness caused by this disease, but it is now clear that onchocercal skin disease has affected both mental health and social acceptability, leading to a negative impact on the quality of life[7]. Ignorance of the cause and mode of transmission of onchocerciasis has hampered the control of the disease in endemic communities. In recent years, non-communicable diseases (NCDs) such as hypertension, diabetes, rheumatoid arthritis, cancers and cardiovascular diseases have been on the rise in sub-Saharan Africa due to lifestyle changes. Globally, 41 million people die every year from NCDs; 17 million of these persons die before the age of 70years, and the majority (77%) reside in low and middle-income countries (LMIC). The most common risk factors contributing to NCDs are unhealthy diets, physical inactivity, exposure to tobacco, smoke, harmful use of alcohol, overweight, raised blood pressure, raised cholesterol and increased blood sugar [8]. Every year, among the number of deaths that occur as a result of NCDs, 8 million is associated with tobacco intake, 7.5 million from high blood pressure, 2.8 million from being overweight, 2.6 million attributed to high cholesterol intake, 1.8 million are attributed to excess salt/sodium intake, 3 million to alcohol use and 830000 attributed to insufficient physical activity [9]. Detection and management of NCDs at an early stage can prevent complications and premature deaths. Non-communicable diseases are common in patients living in onchocerciasis endemic areas, and the risk of developing these NCDs increases with Onchocerca volvulus parasite load or the adverse effects of the drug ivermectin[7]. According to the 2014 NCD profile report for Cameroon, 239000 deaths were NCD-related and NCDs accounted for an estimated 31% of total deaths that year [10, 11]. A preliminary study carried out in Bafut in 2022 reported a high prevalence of NCDs co-existing with onchocercal ocular and skin disease [12]. Blindness, which is a major complication of onchocerciasis, is also one of the complications of diabetes and hypertension[13]. Such comorbidities with onchocerciasis could cause a problem in the management of onchocerciasis. The co-existence of onchocerciasis with these chronic conditions may complicate the management of the disease. Community Health Workers (CHWs) have reported that during CDTI, people with arthritis have often refused to adhere to treatment because of adverse effects they experienced after taking ivermectin. Again, knowledge of onchocerciasis may be another reason why transmission is still a problem. This, and other factors, could be hindrances to the management, control and eventual elimination of onchocerciasis. However, there exists little or no data on comorbidities of onchocerciasis and NCDs, especially in rural endemic communities like Bafut. The results may have been noted in health centers but not documented for the public. Apart from the refusal to take ivermectin because of adverse effects, other factors, such as current knowledge of onchocerciasis, need to be assessed. In order to establish whether there is a relationship between onchocerciasis and NCDs, this study is designed to determine the prevalence of onchocerciasis and NCDs in Bafut Health District and to identify factors associated with continued transmission of onchocerciasis. Understanding these comorbidities is crucial for the management of both onchocerciasis and NCDs in affected individuals. Data obtained in this study will provide useful baseline information for appropriate interventions and improve public health policy on the management of patients living with both onchocerciasis and NCDs. Methods Study setting and population This was a hospital-based, cross-sectional study conducted from June to July 2024 at the Bafut Health District (BHD) to assess the impact of comorbidity of onchocerciasis and non-communicable diseases such as hypertension, diabetes, and rheumatoid arthritis. The BHD is one of the twenty-one health districts in the northwest region [14], with fourteen health areas, classified either as hypo-endemic, meso-endemic or hyper-endemic for onchocerciasis by the Bafut District Health Service during the REA of oncho endemicity in 2004 [15]. The Bafut Health District, with an estimated population of over 70,000 inhabitants [16], is situated between Latitude 6°10′N and Longitude 10°06′E, North West Region of Cameroon. Administratively, Bafut Sub-Division is one of the five sub-divisions in the Mezam Division, and covers an area of roughly 340 km 2 . It is located in the western grass field geographic region, which includes Cameroon's Northwest Region and surrounding grassland areas. Bafut sub-division is drained by River Mezam (main collector) and its tributaries (Fig. 1). The main collector and its tributaries form a sparse and more or less rectangular drainage pattern. The presence of forested areas with fast-flowing rivers, high temperatures, rainfall and human activities favours the development of Onchocerca vectors and is a key determinant of onchocerciasis occurrence. The study population comprised randomly selected males and females aged 30 years and above who visited the health facilities following community sensitization through church announcements made by the respective Chiefs of Centres (COCs). Any participants aged 30 years or older who had resided in Bafut for at least five years prior to the study, and who provided written informed consent. Individuals were excluded if they were critically ill at the time of recruitment. Sample size and sampling method The minimum sample size was calculated using Lorentz’s formula as follows: Where, Where z 2 = (1.96)2, p = previous malaria prevalence and q = 1-p, d 2 = (0.05) 2 . Siewe-Fodjo et al.[17] reported a 14.6% prevalence (p) of onchocerciasis in Cameroon in 2022. To compensate for the non-response rate, 10% of the determined sample size was added. Therefore, the minimum sample size was estimated at 282 participants who visited the Bafut Health District during the study period. A multistage sampling approach was employed. In the first stage, health areas within the Bafut Health District were stratified by endemicity level, and twelve health areas were randomly selected. These comprised four hypo-endemic communities (Mambu, Nsem, Nchum, and Nsoh), three hyper-endemic areas (Mbakong, Mankwi, and Buwe), and five meso-endemic areas (Mforya, Mankanikong, Manji, Belingyie, and Atulah). In the second stage, participants were recruited consecutively at designated health facilities on scheduled data collection days following community sensitisation. Eligibility criteria included being aged ≥30 years, residing in Bafut for at least five years, and providing informed consent. Exclusion criteria included critical illness, refusal to participate, or being a non-resident. Data collection Physical and clinical examination Skin snip collection (test for onchocerciasis) Skin snips were collected from all participants by the laboratory technicians. Before the procedure, all wells in a micro-titration tray were labelled, and normal saline was placed in each well. Each participant took two skin snips from the shoulder and waist (iliac crest) with a new sterile razor blade, cut into small pieces and placed in a well according to participant number. The tray was then covered and incubated for 24 hours to allow the microfilariae to emerge from the tissue. Each well was then examined microscopically (10x) for emerging Onchocerca volvulus mf, and their number was counted. After this first examination, the snip was transferred into another micro-titration tray containing saline solution, and after 24 hours of incubation, it was re-examined as before. The use of two incubation steps for skin snips is a standard procedure applied by the National Programme for Onchocerciasis Control (PNLO/APOC), and this approach makes it possible to detect Onchocerca volvulus mf, which may emerge slowly from the tissue. Participants were considered positive when Onchocerca volvulus mf was present in their skin sample. The positive samples were then preserved in a cryogenic vial containing 70% alcohol. Blood pressure measurement A blood pressure (BP) machine (Lovia. Shenzhen Noto-Tech Electronics Co., Ltd, China) was used to measure the systolic and diastolic pressure of each participant as follows: The participant was asked to sit on a chair and the blood pressure cuff was snuggled around the upper arm (I inch above the bend of the elbow). The hand was placed on the table at rest, and the “start” button was pressed to begin the measurement. If the results were abnormal, the participants were advised to drink more water, eat more vegetables and fruits, reduce their salt intake, and avoid alcohol and exercise often. A regular blood pressure reading is 120/80mmHg or lower. High blood pressure was defined as 140/90mmHg or higher. Detection of Diabetes and Rheumatoid Arthritis Using Point-of-Care Diagnostic Tests Venous blood samples (2 ml) were collected from participants under aseptic conditions through standard venipuncture into dry tubes, labelled with unique identifiers. Blood glucose levels were measured immediately using the SD Codefree Blood Glucose Monitoring System (SD Biosensor, India) with manufacturer-supplied test strips, following standard operating procedures. Results were classified as fasting or random blood sugar depending on the participant’s meal status. Reference values were defined as 74–106 mg/dl for fasting glucose and <140 mg/dl for random glucose. For rheumatoid arthritis, blood samples were centrifuged and serum analyzed using the Rheumatoid Factor (RF) Latex Agglutination Test (Fortress Diagnostics, UK). Each assay run included positive and negative controls to verify reagent performance. A 50 µl serum sample was mixed with the latex reagent on a test card and gently rotated for two minutes. The presence of visible agglutination indicated an RF concentration ≥8 IU/ml, consistent with a positive rheumatoid arthritis result. Survey instrument A pre-tested, structured, interviewer-administered questionnaire (Supplementary File 1) was used to collect data on participants’ sociodemographic characteristics, history of non-communicable disease (NCD) diagnosis, knowledge of onchocerciasis, and factors associated with onchocerciasis transmission. The instrument comprised 25 items. Ten items captured sociodemographic information, including health area, endemicity level, age, sex, occupation, religion, marital status, education, and duration of residence in Bafut. Six items assessed participants’ knowledge of onchocerciasis, focusing on its cause, transmission, prevention, and treatment. Four items assessed knowledge and self-reported status of NCDs, three items captured signs and symptoms of onchocerciasis, and two items assessed ivermectin uptake and associated side effects. The prevalence of NCDs was determined based on participants’ prior medical diagnosis, current use of prescribed medications, and confirmation through laboratory examination Statistical analysis All data were double-entered into Excel and analysed using SPSS Statistics 26 (SPSS Inc., Chicago, USA). Descriptive statistics were used to summarise sociodemographic characteristics, onchocerciasis knowledge, prevalence of non-communicable diseases (NCDs), ivermectin uptake, and clinical manifestations. Associations between categorical variables and onchocerciasis prevalence were assessed using the Pearson Chi-square (χ²) test. Statistical significance was set at p < 0.05. To determine factors associated with continued onchocerciasis transmission, multivariate logistic regression was performed on variables with p<0.1, and the results were reported as odds ratios (ORs) and 95% confidence intervals (CIs) after adjusting for confounders. Statistical significance for all inferential statistics was set at p<0.01. Results A total of 282 respondents participated in the study. The majority of participants were females (73.4%), above 60 years old (37.6%), had attended primary education (56%) and were farmers 219(77.7%) who had lived in the study area for a duration of 20-40yrs (45.7%) (Table 1). Table 1 Socio-demographic characteristics of the study population (n´=282) Variable Category Number examined Per cent (%) Sex Male 75 26.6 Female 207 73.4 Age group 60 106 37.6 Level of education None 65 23 Primary 158 56 Secondary 34 12.1 Tertiary 25 8.9 Occupation None 9 3.2 Farming 219 77.7 Salaried worker 33 11.7 Business 21 7.4 Marital status Single 28 9.9 Married 246 87.2 Others 8 2.8 Religion Christianity 282 100 Duration lived in the area 40 117 41.5 Prevalence of onchocerciasis The prevalence of onchocerciasis was determined based on the presence of observable palpable nodules/or a positive skin snip. Among the 282 participants, 43(15.2%) had palpable nodules, 17(6.0%) were positive for skin snip, and 6(10.0%) presented with both palpable nodules and a positive skin snip (Fig.2). Thus, the overall prevalence of onchocerciasis in this study was 21.3% (Fig. 3). The prevalence of onchocerciasis was significantly associated with sex, age, education, and marital status (P<0.05). Onchocerciasis prevalence was associated with gender (p<0.001). It was observed that females were 6.7 times (aOR=6.58, 95% CI:2.30–18.87, p = 0.001) more likely to be infected than males. Participants aged ≥60 years had the highest prevalence (31.1%) and were over four times more likely to be infected compared to those aged 30–39 years (AOR = 4.30, 95% CI: 1.42–13.02, p=0.01). Moreover, participants with no formal education were over 5 times (aOR= 4.58, 95% CI: 1.24–16.91, p=0.02) more likely to be infected compared to those with tertiary education. Married participants (23.6%) had higher infection rates (aOR= 4.01 (95% CI: 0.92–17.41, p=0.06) (Table 2). Table 2 Relationship between sociodemographic characteristics and prevalence of onchocerciasis Variable Category Examined (n) Positive n (%) Negative n (%) Crude P-value OR (95% CI) Adjusted P-value Sex Male 75 4 (5.3) 71 (94.7) <0.001 1 Female 207 56 (27.1) 151 (72.9) 6.58 (2.30–18.87) 0.001* Age group 30–39 42 4 (9.5) 38 (90.5) 0.007 1 40–49 61 13 (21.3) 48 (78.7) 2.57 (0.78–8.53) 0.12 50–59 73 10 (13.7) 63 (86.3) 1.51 (0.44–5.12) 0.49 ≥60 106 33 (31.1) 73 (68.9) 4.30 (1.42–13.02) 0.01* Education Tertiary 25 3 (12.0) 22 (88.0) <0.001 1 Primary 158 30 (19.0) 128 (81.0) 1.72 (0.49–6.12) 0.39 Secondary 34 2 (5.9) 32 (94.1) 0.46 (0.07–2.97) 0.42 None 65 25 (38.5) 40 (61.5) 4.58 (1.24–16.91) 0.02* Marital status Single 28 2 (7.1) 26 (92.9) 0.04 1 Married 246 58 (23.6) 188 (76.4) 4.01 (0.92–17.41) 0.06 Occupation Business 21 1 (4.8) 20 (95.2) 0.172 NA Farmers 219 52 (23.7) 167 (76.3) NA Salaried worker 33 5 (15.2) 28 (84.8) NA None 9 2 (22.2) 7 (77.8) NA Duration of stay 5–20 yrs 53 10 (18.9) 43 (81.1) 0.801 NA 21–40 yrs 112 23 (20.5) 89 (79.5) NA >40 yrs 117 27 (23.1) 90 (76.9) NA Endemicity Hypo 78 18 (23.1) 60 (76.9) 0.641 NA Meso 104 19 (18.3) 85 (81.7) NA Hyper 100 23 (23.0) 77 (77.0) NA 1= reference category NA=not applicable Prevalence of non-communicable diseases and onchocerciasis comorbidities Only 24 of 282 participants had at least one of the NCDs; hence, the prevalence of NCDs in the study population was 8.5%. Of the 60 patients with onchocerciasis, 24 had at least one of the NCDs; hence, the prevalence of NCDs in onchocerciasis patients was 40.0%. The prevalences of rheumatoid arthritis and hypertension in the study population were both 18.8% and the prevalence of diabetes was 2.1% and that of hypertension + rheumatoid arthritis was 2.8%. In onchocerciasis patients, the prevalences of rheumatoid arthritis, hypertension, diabetes and Rheumatoid arthritis + hypertension were 21.7 %, 25.0%, 3.3% and 10.0%, respectively. A high prevalence of NCDs was observed in onchocerciasis patients. Our results revealed a great significant association between NCDs and onchocerciasis (p0.05), there was a great significant association between participants who had both hypertension and rheumatoid arthritis and onchocerciasis (p<0.001) (Table 3). Table 3 Prevalence of non-communicable diseases and onchocerciasis comorbidities Disease Study population n=282 Oncho prevalence P-value Oncho Positive Oncho Negative NCDs 24(8.5) 24(40.0) 0 (0.0) <0.001 Rheumatoid Arthritis 53(18.8%) 13(21.7%) 40(88.3%) 0.52 Hypertension 53(18.8%) 15(25.0%) 38(75.0%) 0.17 Diabetes 6(2.1%) 2(3.3%) 4(96.7%) 0.47 Hypertension + Arthritis 8(2.8%) 6(10.0) 54(90.0%) <0.001 Clinical manifestations associated with onchocerciasis versus onchocerciasis comorbidities Clinical manifestations that were associated with onchocerciasis and comorbidities were itching skin/eyes (19, 31.7%) and blindness/blurred vision (15, 62.5%). Neither skin change nor oedema was found in any comorbidity with onchocerciasis. Although there was no significant association between clinical manifestations and onchocerciasis comorbidities, interestingly, all the clinical manifestations were generally higher in onchocerciasis patients than in patients who had comorbidities with NCDs (Table 4). Table 4 Clinical manifestations associated with onchocerciasis versus onchocerciasis comorbidities Manifestation No. of participants (%) Oncho Positive n (%) Oncho + comorbidity P-value Itching skin/eyes 98(34.8) 46(46.9) 19(31.7) 0.70 Skin change 7(2.5) 5(71.4) 0(0.0) 0.06 Edema 2(0.7) 2(100.0) 0(0.0) 0.68 Blindness/blurred vision 41(14.0) 32(78.0) 15(62.5) 0.24 Factors associated with continued transmission of onchocerciasis Knowledge of onchocerciasis More than half of the study population (51.1%) were aware of onchocerciasis. Although only 53.2% of them chose parasite as the cause and identified the blackfly as a vector transmission of onchocerciasis, 95.5% agreed that onchocerciasis was preventable and could be treated with Mectizan. However, very few (3.2%) said it could also be treated by herbs (Table 5). Table 5 Knowledge of onchocerciasis Characteristics Category No. of participants (%) Causes mosquito bites 90(31.9) Parasite 150(53.2) I don’t know 42(14.9) ⃰ 1 Right Knowledge 150(53.2) Mode of transmission sharing clothes 12(4.3) mosquito bites 90(31.9) Blackfly 150(53.2) I don’t know 30(10.6) ⃰ 2 Right Knowledge 150(53.2) Do you think oncho is preventable? No 13(4.6) Yes 269(95.4) ⃰ 3 Right Knowledge 269(95.4) How is oncho treated? Mectizan 269(95.4) Herbs 9(3.2) I don’t know 9(3.2) ⃰ 4 Right Knowledge 269(95.4) ⃰ 5 Right Knowledge 9(3.2) Knowledge score Good knowledge 144(51.1) Poor knowledge 138(48.9) *Right knowledge: ⃰ 1 and ⃰ 2 if response is blackfly, ⃰ 3 if response is yes, ⃰ 4 and 5, if response is either Mectizan or Herbs. Good knowledge: right knowledge of at least 3 knowledge characteristics; otherwise, poor knowledge Ivermectin uptake among the study participants Ivermectin has been distributed in the Bafut Health District for nearly two decades. Acceptance to take ivermectin was one of the factors that was assessed among participants. A total of 266 participants (94.3%) agreed to have been taking ivermectin, whereas only 16(5.7%) refused to take it for reasons such as sickness, blurred vision. A larger proportion of those who refused to take ivermectin were females (13, 81.3%) and in the age group 40-49 years (6, 37.5%) and above 59 years (5, 31.25%) Although there was no significant difference in the acceptance to take ivermectin and onchocerciasis infection status according to sex and age (p>0.05), our results revealed a significant association between onchocerciasis infection status and reasons advanced for refusal which included blindness/blurred vision, other sicknesses and hypertension (p=0.01) (Table 6). Interestingly, when other factors such as sex, age and level of education were associated with onchocerciasis infection status, there was a highly significant association (p<0.001). Being female had 6.58 times higher odds of infection (aOR = 6.58, 95% CI 2.30-18.87, p<0.001). Being in the age group above 59 years had 4.3 higher odds of infection (aOR = 4.3, 95%Cl 1.42-13.02, p=0.01) and having no formal education had 4.58 higher odds of having infection (aOR=4.58, 95%Cl 1.24-16.9, p=0.02). Also, being married had 4.01 higher odds of having an infection (aOR=4.01, 95%Cl 0.92-17.91, p=0.06) (Table 7). Table 6 Ivermectin uptake among the study participants Variable Total Infection status P-value Positive Negative Takes ivermectin Yes 266 57(21.4) 209(78.6) 0.8 No 16 3(18.8) 13(81.3) Reasons for not taking IVM None 3 2(66.7) 1(33.3) 0.01 Sickness 5 5(100.0) 0(0.0) blurred vision 6 6(100.0) 0(0.0) hypertension 2 0(0.0) 2(100.0) Sex male Yes 72 4(5.6) 68(94.4) 0.68 No 3 0(0.0) 3(100.0) Female Yes 194 53(27.3) 141(72.7) 0.74 No 13(81.3%) 3(23.1) 10(76.9) Age group 59 Yes 101 32(31.7) 69(68.3) 0.58 No 5(31.5%) 1(20.0) 4(80.0) Table 7 Bivariate analysis of sex, age, educational level and infection status Variable Category oncho+ p-value OR 95%CI Adjusted p-value Sex Male 4(5.3) <0.001 1 Female 56(27.1) 6.58 2.30-18.87 <0.001 Age group 59 33(31.1) 4.3 1.42-13.02 0.01 Level of education None 30(19.0) <0.001 4.58 1.24-16.91 0.02 Primary 2(5.9) 1.72 0.49-6.12 0.4 Secondary 3(12.0) 0.46 0.07-2.97 0.41 Tertiary 25(38.5) 1 Marital status Single 2(7.1) 0.04 1 Married 58(23.6) 4.01 0.92-17.41 0.06 Others 0(0.0) 0.05 0.02-09.2 0.99 1= reference category Discussion This study describes the current situation of comorbidity of onchocerciasis with hypertension, rheumatoid arthritis and diabetes and determinants of continued transmission of onchocerciasis in Bafut Health District after more than 20 years of continuous administration of ivermectin. Two hundred and eighty-two participants took part in the study, the majority of whom were females (73.4%) in the age group > 59 years (37.6%). Most of them had a primary level of education (56.0%), and the main occupation of participants was farming (77.7%). The overall prevalence of onchocerciasis in the study population was 21.3% indicating that onchocerciasis is still a public health problem in Bafut Health District. This prevalence is more than 200 times higher compared to the prevalence of 0.1% that the WHO considers for elimination [ 10 ]. While the over 2 decades of MDA in Cameroon are reducing transmission in some regions like the Adamaoua [ 5 ], onchocerciasis persists in the Bafut Health District, as confirmed by our findings. Our results are comparable to previous studies in the Tombel Health District, where a prevalence of 21.6% was obtained [ 4 ]. However, our results were more than two times lower than the prevalence of 55.8% reported in Yaounde, Cameroon in 2017 [ 18 ]. This can be explained by the fact that our results were based only on skin snip diagnosis and observable palpable nodules, which can be faulty given the fact that, at the time of collection of the snips, microfilariae might migrate to other parts of the body and may not be captured and the fact that some nodules may not be seen. The actual prevalence of onchocerciasis in Bafut Health District may actually be higher if more sensitive techniques like OV16 IgG4 antibodies were used in diagnosis. When onchocerciasis prevalence was correlated with demographic characteristics, we found a significant association with sex, age, educational level, marital status and per health area (p < 0.005). A higher prevalence was recorded in females (27.1%) than in males (5.3%). This may be explained by the fact that most females in Bafut who have not had any level of education and are married are mostly farmers who work to feed their families, especially in hyperendemic areas. It has been suggested that females work longer on the farm and with exposed bodies than the males, thereby making them more prone to the bites of blackflies [ 19 , 20 ]. Our study recorded a higher onchocerciasis among farmers (23.7%). This is different from studies carried out in Yabassi Health District by Kamga et al. [ 19 ], who recorded a higher prevalence in males than females. The differences in infection rate with regard to sex could be due to occupational exposure and susceptibility of individuals [ 21 ]. The high prevalence recorded in our study among participants above 40 years may be due to the fact that individuals within this age group are usually most active in outdoor activities (like farming, sand mining, tapping and fishing) as confirmed by other studies [ 6 ]. This is also in line with another study that reported a higher prevalence in older age group [ 21 , 22 ]. Non-communicable diseases have been on the rise in most societies because of life-style and behavioural changes. Our study recorded an overall prevalence of 8.5% of NCDs (rheumatoid arthritis, hypertension and diabetes). Comorbidity of these NCDs with onchocerciasis was 40% and this was statistically significant (p < 0.001). When these NCDs were considered individually, there was no significant difference between people with onchocerciasis and those without onchocerciasis. However, the prevalence increased with the presence of onchocerciasis compared to participants without onchocerciasis. Hypertension was the NCD with the highest prevalence of 25% among onchocerciasis patients in our study. It is postulated that prolonged inflammation that may result from host responses to Onchocerca larvae and adult worms can contribute to vascular changes and endothelial dysfunction, which can increase blood pressure and contribute to hypertension [ 23 , 24 ]. Surprisingly, only 2 (3.3%) participants with onchocerciasis in our study were diagnosed with diabetes. This corroborates with the results of Rajamanickam and Babu[ 25 ] that stated that helminthe infections lower the occurrence of diabetes in infected persons and can be explained by the fact that onchocerciasis is chronic and can enhance sensitivity to insulin, hence reducing sugar levels, possibly due to the modulation of inflammatory pathways [ 26 ]. The presence of onchocerciasis was significantly correlated with patients having both hypertension and rheumatoid arthritis (p < 0.05). This is probably due to alterations in cytokine profiles, promoting pro-inflammatory cytokines that can exacerbate both hypertension and arthritic conditions [ 23 ]. Also, immune complexes formed when microfilariae die can cause deposition at joints, leading to swelling and pain, which are typical of arthritis. Interestingly, inflammatory cytokines Th17 and Th2 were implicated in rheumatoid arthritis and hyperreactive sowda form of onchocerciasis[ 27 ]. Amongst factors assessed for continued transmission were knowledge of the disease, presence of NCDs, demographic characteristics and uptake of ivermectin. Our analysis of knowledge of onchocerciasis among the participants showed that 51.1% of them had a good knowledge of onchocerciasis, and 53.2% correctly identified the blackfly as a vector of transmission, including the signs and symptoms associated with it, because of the endemicity of the infection in the study area and continuous sensitisation by health care providers in the area. This result is consistent with the findings of other studies[ 28 , 29 ]. However, these results contradict the results of a study carried out by Wogu and Okaka[ 20 ] that reported that 57% of participants had no knowledge of transmission. Awareness of available treatments is crucial, as a lack of knowledge could lead to non-compliance and ongoing transmission. More than 90% of participants agreed that ivermectin was a way to prevent and treat onchocerciasis apart from using herbs. This is because they had been witnessing the annual distribution of the drug and willingly took it for treatment, as confirmed in our results. A similar study carried out by Adeoye and colleagues in Southwest Nigeria reported that 92% of participants viewed ivermectin as a drug of choice for prevention and treatment of onchocerciasis [ 30 ]. Also, another study carried out in Southwest Ethiopia showed that 93.3% of respondents perceived onchocerciasis as preventable [ 31 ]. It was commendable to observe in our study that > 90% of participants knew the importance of taking ivermectin for a significant reduction in morbidity, an observation that is consistent with studies conducted in other hyper-endemic communities of Edo and Imo States, Nigeria, and Ethiopia[ 30 ]. In spite of this, we still recorded a prevalence of 21.3% which is well above the WHO elimination prevalence of 0.1%. Of the 266 participants who usually took ivermectin, a number of them (21.4%) were positive for onchocerciasis. This could be explained by the fact that they might not have been adhering to treatment, or been constantly exposed to blackfly bites, or this could also be due to ivermectin resistance. It could also be due to poor compliance, as suggested by other studies, which reported that poor compliance with ivermectin treatment was identified as a practice associated with onchocerciasis transmission [ 17 , 32 ]. Low ivermectin coverage and uptake have also been associated with continued onchocerciasis transmission. In our study, refusal to take ivermectin for various reasons was significantly correlated with onchocerciasis infection status and most of those who refused to take ivermectin advanced various reasons for not taking the drug. Some reasons advanced for refusal were fear of drug-related adverse reactions like blurred vision, palpitation associated with hypertension and sickness. This is supported by similar results obtained in an endemic area of Guatemala and in Okpuje, an endemic community in Edo State, Nigeria [ 30 ]. Apart from the above factors, an interruption in ivermectin distribution because of the ongoing sociopolitical unrest in the study could also be a factor for continued transmission of onchocerciasis, as confirmed by previous studies [ 17 , 32 ]. Limitations Some older participants faced challenges understanding certain questions due to language barriers, potentially affecting responses. Moreover, the use of convenient random sampling may have excluded individuals with severe morbidity. In addition, information on ivermectin uptake relied on self-reporting, introducing recall and reporting bias. Laboratory confirmation was limited by the unavailability of the OV16 IgG ELISA, restricting the detection of active and past infections. Likewise, our study was limited to 12 health areas within the district due to socio-political unrest. Conclusions Onchocerciasis remains a significant public health problem in the Bafut Health District, with a prevalence of 21.3% despite nearly two decades of continuous ivermectin distribution. Non-communicable diseases (NCDs) were present in 8.5% of the general study population but in 40% of individuals with onchocerciasis, most commonly hypertension and arthritis. Clinical manifestations such as itching and visual impairment were frequent, and symptoms were often exacerbated in participants with comorbid NCDs. Continued transmission was associated with demographic factors (age, sex, education), social and behavioral factors (knowledge of onchocerciasis, ivermectin uptake), and environmental determinants (presence of rivers and forests). Strengthening community knowledge, improving adherence to community-directed treatment with ivermectin (CDTI), and integrating NCD management into onchocerciasis control efforts will be essential for progress toward elimination. Abbreviations APOC African Programme for Onchocerciasis Control BHD Bafut Health District BP Blood Pressure CDTI Community-Directed Treatment with Ivermectin CHWs Community Health Workers COC(s) Chief(s) of Centre DMO District Medical Officer ELISA Enzyme-Linked Immunosorbent Assay IgG Immunoglobulin G IVM Ivermectin LMIC Low- and Middle-Income Countries MDA Mass Drug Administration mf Microfilariae NCD(s) Non-Communicable Disease(s) NTD(s) Neglected Tropical Disease(s) OV16 Onchocerca volvulus 16 kDa antigen PNLO Programme National de Lutte contre l’Onchocercose RA Rheumatoid Arthritis REA Rapid Epidemiological Assessment RF Rheumatoid Factor WHO World Health Organization Declarations Ethics approval and consent to participate Ethical clearance for the study was obtained from the Institutional Review Board of the University of Bamenda (Appendix I). Administrative authorisation was also granted by the Regional Delegation of Public Health and the District Medical Officer (DMO) of Bafut Health District (Appendix II). Before data collection, these approvals were presented to the selected health facilities' Chiefs of Centres (COCs). Before recruitment, study procedures were explained to participants in both English and the Bafut dialect by laboratory technicians or other trained staff fluent in the local language. Written informed consent was obtained from all respondents, either by signature or thumbprint, after a detailed explanation of the study’s nature and objectives. Participation was entirely voluntary. Data collected was treated with strict confidentiality and stored on password-protected computers. All participants were handled per the principles of the Declaration of Helsinki on the ethical use of humans in biomedical research. Consent for publication Not Applicable. Funding This study received no external funding. Author Contributions IUA, PAA, MUA conceived and designed the experiments. IUA and PAA conducted the study. IUA and MUA performed the analysis. IUA, PAA, MUA, TNA drafted the manuscript. All authors contributed to the revision of the manuscript prior to submission. Availability of data and materials The dataset used in the present study is available from the corresponding author upon reasonable request. Competing interests The authors declare no competing interests. Acknowledgments We would like to thank the study participants who made this study realistic, and the Chief of Centers for the permission granted to conduct the study in the health facility. 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15:26:10","extension":"html","order_by":14,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":152040,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7530544/v1/f6da9f6cd3f85dd3ff6f7332.html"},{"id":92007827,"identity":"d34f8df0-b845-48aa-9ec9-ad918c897b82","added_by":"auto","created_at":"2025-09-23 15:26:10","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":150674,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eBafut health areas and rivers [16]\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Fig.1Bafuthealthareasandrivers.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7530544/v1/b02fae36c0d2cd23d9decd8b.jpg"},{"id":92009164,"identity":"06536d1a-b8fd-4df3-b155-33b30078808e","added_by":"auto","created_at":"2025-09-23 15:34:10","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":29052,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePrevalence of onchocerciasis in the study population based on palpable nodules, skin snip positivity, and combined diagnosis\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Fig.2Prevalenceofonchocerciasisinthestudypopulationbasedonpalpablenodulesskinsnippositivityandcombineddiagnosis.png","url":"https://assets-eu.researchsquare.com/files/rs-7530544/v1/95d15d3822bd4cd62838e02d.png"},{"id":92009167,"identity":"3491d2af-2a0e-4cf8-876d-c30dc14400e3","added_by":"auto","created_at":"2025-09-23 15:34:10","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":61869,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eOverall prevalence of onchocerciasis\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Fig.3overallprevalenceofonchocerciasis.png","url":"https://assets-eu.researchsquare.com/files/rs-7530544/v1/ccabb200b652c43b093d4ea5.png"},{"id":108804584,"identity":"6b13622c-e7b5-414e-a720-731f03cc7b08","added_by":"auto","created_at":"2026-05-08 15:21:48","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":810149,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7530544/v1/6526b3f4-2937-4b27-b016-8a760b0a3d77.pdf"},{"id":92011890,"identity":"fad55708-3256-43e3-b135-a85b35440ae5","added_by":"auto","created_at":"2025-09-23 15:50:10","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":225504,"visible":true,"origin":"","legend":"","description":"","filename":"SupplimentaryFile1Questionnaire.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7530544/v1/b59e02fb72c01d63a3ab2513.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Comorbidities of onchocerciasis and non-communicable diseases, and determinants of continued transmission in Bafut Health District, Cameroon","fulltext":[{"header":"Background","content":"\u003cp\u003eOnchocerciasis, also known as river blindness, is a parasitic Neglected Tropical Disease (NTD) caused by the filarial nematode worm \u003cem\u003eOnchocerca volvulus\u003c/em\u003e and transmitted through the bite of infected blackflies of the genus \u003cem\u003eSimulium spp,\u003c/em\u003e which breed in fast-flowing rivers [1] . The disease remains a significant problem in most parts of sub-Saharan Africa, including Cameroon[2]. Despite Mass Drug Administration (MDA) with ivermectin for over two decades in Cameroon, onchocerciasis persists in many foci, including the Bafut District. In Cameroon, onchocerciasis is endemic mainly in the Southwest, Northwest, North and Adamawa regions [3]. According to studies carried out in the Tombel Health District of Cameroon, the prevalence of onchocerciasis was 21.6% [4]. However, recent studies have shown a drastic reduction in prevalence in Adamaoua [5]. Apart from skin, ocular and neurological manifestations, the disease has impaired productivity and has led to other socio-economic consequences in endemic communities. It is the leading cause of preventable blindness and a severe pruritic skin condition in endemic areas. This infection is chronic, rarely causes death, but imposes suffering, stigmatization and hardship on affected individuals [6]. People who travel and volunteer in companies or hospitals in endemic areas are also at high risk of having onchocerciasis. In advanced cases, the skin becomes thickened and wrinkled, showing a lizard or leopard skin appearance. In the past, the stigma of onchocerciasis has always been associated with blindness caused by this disease, but it is now clear that onchocercal skin disease has affected both mental health and social acceptability, leading to a negative impact on the quality of life[7]. Ignorance of the cause and mode of transmission of onchocerciasis has hampered the control of the disease in endemic communities.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn recent years, non-communicable diseases (NCDs) such as hypertension, diabetes, rheumatoid arthritis, cancers and cardiovascular diseases have been on the rise in sub-Saharan Africa due to lifestyle changes. Globally, 41 million people die every year from NCDs; 17 million of these persons die before the age of 70years, and the majority (77%) reside in low and middle-income countries (LMIC). The most common risk factors contributing to NCDs are unhealthy diets, physical inactivity, exposure to tobacco, smoke, harmful use of alcohol, overweight, raised blood pressure, raised cholesterol and increased blood sugar [8]. Every year, among the number of deaths that occur as a result of NCDs, 8 million is associated with tobacco intake, 7.5 million from high blood pressure, 2.8 million from being overweight, 2.6 million attributed to high cholesterol intake, 1.8 million are attributed to excess salt/sodium intake, 3 million to alcohol use and 830000\u0026nbsp;attributed to insufficient physical activity [9]. Detection and management of NCDs at an early stage can prevent complications and premature deaths. Non-communicable diseases are common in patients living in onchocerciasis endemic areas, and the risk of developing these NCDs increases with \u003cem\u003eOnchocerca volvulus\u0026nbsp;\u003c/em\u003eparasite load or the adverse effects of the drug ivermectin[7]. According to the 2014 NCD profile report for Cameroon, 239000 deaths were NCD-related and NCDs accounted for an estimated 31% of total deaths that year [10, 11]. A preliminary study carried out in Bafut in 2022 reported a high prevalence of NCDs co-existing with onchocercal ocular and skin disease [12]. Blindness, which is a major complication of onchocerciasis, is also one of the complications of diabetes and hypertension[13].\u0026nbsp;Such comorbidities with onchocerciasis could cause a problem in the management of onchocerciasis. The co-existence of onchocerciasis with these chronic conditions may complicate the management of the disease. Community Health Workers (CHWs) have reported that during CDTI, people with arthritis have often refused to adhere to treatment because of adverse effects they experienced after taking ivermectin. Again, knowledge of onchocerciasis may be another reason why transmission is still a problem. This, and other factors, could be hindrances to the management, control and eventual elimination of onchocerciasis.\u003c/p\u003e\n\u003cp\u003eHowever, there exists little or no data on comorbidities of onchocerciasis and NCDs, especially in rural endemic communities like Bafut. The results may have been noted in health centers but not documented for the public. Apart from the refusal to take ivermectin because of adverse effects, other factors, such as current knowledge of onchocerciasis, need to be assessed. In order to establish whether there is a relationship between onchocerciasis and NCDs, this study is designed to determine the prevalence of onchocerciasis and NCDs in Bafut Health District and to identify factors associated with continued transmission of onchocerciasis. Understanding these comorbidities is crucial for the management of both onchocerciasis and NCDs in affected individuals. Data obtained in this study will provide useful baseline information for appropriate interventions and improve public health policy on the management of patients living with both onchocerciasis and NCDs.\u0026nbsp;\u003c/p\u003e"},{"header":"Methods","content":"\u003ch2\u003eStudy setting and population\u0026nbsp;\u003c/h2\u003e\n\u003cp\u003eThis was a hospital-based, cross-sectional study conducted from June to July 2024 at the Bafut Health District (BHD) to assess the impact of comorbidity of onchocerciasis and non-communicable diseases such as hypertension, diabetes, and rheumatoid arthritis. The BHD is one of the twenty-one health districts in the northwest region [14], with fourteen health areas, classified either as hypo-endemic, meso-endemic or hyper-endemic for onchocerciasis by the Bafut District Health Service during the REA of oncho endemicity in 2004 [15]. The Bafut Health District, with an estimated population of over 70,000 inhabitants [16], is situated between Latitude 6\u0026deg;10\u0026prime;N and Longitude 10\u0026deg;06\u0026prime;E, North West Region of Cameroon. Administratively, Bafut Sub-Division is one of the five sub-divisions in the Mezam Division, and covers an area of roughly 340 km\u003csup\u003e2\u003c/sup\u003e. It is located in the western grass field geographic region, which includes Cameroon\u0026apos;s Northwest Region and surrounding grassland areas. Bafut sub-division is drained by River Mezam (main collector) and its tributaries (Fig. 1). The main collector and its tributaries form a sparse and more or less rectangular drainage pattern. The presence of forested areas with fast-flowing rivers, high temperatures, rainfall and human activities favours the development of \u003cem\u003eOnchocerca\u003c/em\u003e vectors and is a key determinant of onchocerciasis occurrence.\u003c/p\u003e\n\u003cp\u003eThe study population comprised randomly selected males and females aged 30 years and above who visited the health facilities following community sensitization through church announcements made by the respective Chiefs of Centres (COCs). Any participants aged 30 years or older who had resided in Bafut for at least five years prior to the study, and who provided written informed consent. Individuals were excluded if they were critically ill at the time of recruitment.\u003c/p\u003e\n\u003ch2 id=\"_Toc177274649\"\u003e\u003cem\u003eSample size and sampling method\u003c/em\u003e\u003c/h2\u003e\n\u003cp\u003eThe minimum sample size was calculated using Lorentz\u0026rsquo;s formula as follows:\u003c/p\u003e\n\u003cp\u003e\u003cimg src=\"https://myfiles.space/user_files/58895_8739fc6c57c1c19a/58895_custom_files/img1758630108.png\" width=\"165\" height=\"97\"\u003e\u003c/p\u003e\n\u003cp\u003eWhere,\u003c/p\u003e\n\u003cp\u003eWhere z\u003csup\u003e2\u003c/sup\u003e = (1.96)2, p\u0026thinsp;=\u0026thinsp;previous malaria prevalence and q\u0026thinsp;=\u0026thinsp;1-p, d\u003csup\u003e2\u003c/sup\u003e = (0.05)\u003csup\u003e2\u003c/sup\u003e. Siewe-Fodjo et al.[17] reported a 14.6% prevalence (p) of onchocerciasis in Cameroon in 2022. To compensate for the non-response rate, 10% of the determined sample size was added. Therefore, the minimum sample size was estimated at 282 participants who visited the Bafut Health District during the study period.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA multistage sampling approach was employed. In the first stage, health areas within the Bafut Health District were stratified by endemicity level, and twelve health areas were randomly selected. These comprised four hypo-endemic communities (Mambu, Nsem, Nchum, and Nsoh), three hyper-endemic areas (Mbakong, Mankwi, and Buwe), and five meso-endemic areas (Mforya, Mankanikong, Manji, Belingyie, and Atulah). In the second stage, participants were recruited consecutively at designated health facilities on scheduled data collection days following community sensitisation. Eligibility criteria included being aged \u0026ge;30 years, residing in Bafut for at least five years, and providing informed consent. Exclusion criteria included critical illness, refusal to participate, or being a non-resident.\u003c/p\u003e\n\u003ch2\u003eData collection\u0026nbsp;\u003c/h2\u003e\n\u003cp\u003e\u003cstrong\u003ePhysical and clinical examination\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSkin snip collection (test for onchocerciasis)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSkin snips were collected from all participants by the laboratory technicians. Before the procedure, all wells in a micro-titration tray were labelled, and normal saline was placed in each well. Each participant took two skin snips from the shoulder and waist (iliac crest) with a new sterile razor blade, cut into small pieces and placed in a well according to participant number. The tray was then covered and incubated for 24 hours to allow the microfilariae to emerge from the tissue. Each well was then examined microscopically (10x) for emerging \u003cem\u003eOnchocerca volvulus\u003c/em\u003e mf, and their number was counted. After this first examination, the snip was transferred into another micro-titration tray containing saline solution, and after 24 hours of incubation, it was re-examined as before. The use of two incubation steps for skin snips is a standard procedure applied by the National Programme for Onchocerciasis Control (PNLO/APOC), and this approach makes it possible to detect Onchocerca volvulus mf, which may emerge slowly from the tissue. Participants were considered positive when \u003cem\u003eOnchocerca volvulus\u0026nbsp;\u003c/em\u003emf was present in their skin sample. The positive samples were then preserved in a cryogenic vial containing 70% alcohol.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBlood pressure measurement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA blood pressure (BP) machine (Lovia. Shenzhen Noto-Tech Electronics Co., Ltd, China) was used to measure the systolic and diastolic pressure of each participant as follows: The participant was asked to sit on a chair and the blood pressure cuff was snuggled around the upper arm (I inch above the bend of the elbow). The hand was placed on the table at rest, and the \u0026ldquo;start\u0026rdquo; button was pressed to begin the measurement. If the results were abnormal, the participants were advised to drink more water, eat more vegetables and fruits, reduce their salt intake, and avoid alcohol and exercise often. A regular blood pressure reading is 120/80mmHg or lower. High blood pressure was defined as 140/90mmHg or higher.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDetection of Diabetes and Rheumatoid Arthritis Using Point-of-Care Diagnostic Tests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eVenous blood samples (2 ml) were collected from participants under aseptic conditions through standard venipuncture into dry tubes, labelled with unique identifiers. Blood glucose levels were measured immediately using the SD Codefree Blood Glucose Monitoring System (SD Biosensor, India) with manufacturer-supplied test strips, following standard operating procedures. Results were classified as fasting or random blood sugar depending on the participant\u0026rsquo;s meal status. Reference values were defined as 74\u0026ndash;106 mg/dl for fasting glucose and \u0026lt;140 mg/dl for random glucose.\u003c/p\u003e\n\u003cp\u003eFor rheumatoid arthritis, blood samples were centrifuged and serum analyzed using the Rheumatoid Factor (RF) Latex Agglutination Test (Fortress Diagnostics, UK). Each assay run included positive and negative controls to verify reagent performance. A 50 \u0026micro;l serum sample was mixed with the latex reagent on a test card and gently rotated for two minutes. The presence of visible agglutination indicated an RF concentration \u0026ge;8 IU/ml, consistent with a positive rheumatoid arthritis result.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSurvey instrument\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA pre-tested, structured, interviewer-administered questionnaire (Supplementary File 1) was used to collect data on participants\u0026rsquo; sociodemographic characteristics, history of non-communicable disease (NCD) diagnosis, knowledge of onchocerciasis, and factors associated with onchocerciasis transmission. The instrument comprised 25 items. Ten items captured sociodemographic information, including health area, endemicity level, age, sex, occupation, religion, marital status, education, and duration of residence in Bafut. Six items assessed participants\u0026rsquo; knowledge of onchocerciasis, focusing on its cause, transmission, prevention, and treatment. Four items assessed knowledge and self-reported status of NCDs, three items captured signs and symptoms of onchocerciasis, and two items assessed ivermectin uptake and associated side effects.\u003c/p\u003e\n\u003cp\u003eThe prevalence of NCDs was determined based on participants\u0026rsquo; prior medical diagnosis, current use of prescribed medications, and confirmation through laboratory examination\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data were double-entered into Excel and analysed using SPSS Statistics 26 (SPSS Inc., Chicago, USA). Descriptive statistics were used to summarise sociodemographic characteristics, onchocerciasis knowledge, prevalence of non-communicable diseases (NCDs), ivermectin uptake, and clinical manifestations. Associations between categorical variables and onchocerciasis prevalence were assessed using the Pearson Chi-square (\u0026chi;\u0026sup2;) test. Statistical significance was set at p \u0026lt; 0.05. To determine factors associated with continued onchocerciasis transmission, multivariate logistic regression was performed on variables with p\u0026lt;0.1, and the results were reported as odds ratios (ORs) and 95% confidence intervals (CIs) after adjusting for confounders. Statistical significance for all inferential statistics was set at p\u0026lt;0.01.\u0026nbsp;\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 282 respondents participated in the study. The majority of participants were females (73.4%), above 60 years old (37.6%), had attended primary education (56%) and were farmers 219(77.7%) who had lived in the study area for a duration of 20-40yrs (45.7%) (Table 1).\u003c/p\u003e\n\u003cp id=\"_Toc175463210\"\u003eTable 1\u0026nbsp;Socio-demographic characteristics of the study population (n\u0026acute;=282)\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"584\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 174px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategory\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber examined\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePer cent (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 151px;\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 174px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 156px;\"\u003e\n \u003cp\u003e75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 103px;\"\u003e\n \u003cp\u003e26.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 151px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 174px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 156px;\"\u003e\n \u003cp\u003e207\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 103px;\"\u003e\n \u003cp\u003e73.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"bottom\" style=\"width: 151px;\"\u003e\n \u003cp\u003eAge group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 174px;\"\u003e\n \u003cp\u003e\u0026lt; 39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 156px;\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 103px;\"\u003e\n \u003cp\u003e14.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 174px;\"\u003e\n \u003cp\u003e40-49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 156px;\"\u003e\n \u003cp\u003e61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 103px;\"\u003e\n \u003cp\u003e21.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 174px;\"\u003e\n \u003cp\u003e50-59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 156px;\"\u003e\n \u003cp\u003e73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 103px;\"\u003e\n \u003cp\u003e25.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 151px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 174px;\"\u003e\n \u003cp\u003e\u0026gt;60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 156px;\"\u003e\n \u003cp\u003e106\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 103px;\"\u003e\n \u003cp\u003e37.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 151px;\"\u003e\n \u003cp\u003eLevel of education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 174px;\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 156px;\"\u003e\n \u003cp\u003e65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 103px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 151px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 174px;\"\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 156px;\"\u003e\n \u003cp\u003e158\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 103px;\"\u003e\n \u003cp\u003e56\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 151px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 174px;\"\u003e\n \u003cp\u003eSecondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 156px;\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 103px;\"\u003e\n \u003cp\u003e12.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 151px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 174px;\"\u003e\n \u003cp\u003eTertiary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 156px;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 103px;\"\u003e\n \u003cp\u003e8.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 151px;\"\u003e\n \u003cp\u003eOccupation\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 174px;\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 156px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 103px;\"\u003e\n \u003cp\u003e3.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 151px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 174px;\"\u003e\n \u003cp\u003eFarming\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 156px;\"\u003e\n \u003cp\u003e219\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 103px;\"\u003e\n \u003cp\u003e77.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 151px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 174px;\"\u003e\n \u003cp\u003eSalaried worker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 156px;\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 103px;\"\u003e\n \u003cp\u003e11.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 151px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 174px;\"\u003e\n \u003cp\u003eBusiness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 156px;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 103px;\"\u003e\n \u003cp\u003e7.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 151px;\"\u003e\n \u003cp\u003eMarital status\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 174px;\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 156px;\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 103px;\"\u003e\n \u003cp\u003e9.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 151px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 174px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 156px;\"\u003e\n \u003cp\u003e246\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 103px;\"\u003e\n \u003cp\u003e87.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 151px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 174px;\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 156px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 103px;\"\u003e\n \u003cp\u003e2.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 151px;\"\u003e\n \u003cp\u003eReligion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 174px;\"\u003e\n \u003cp\u003eChristianity\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 156px;\"\u003e\n \u003cp\u003e282\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 103px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 151px;\"\u003e\n \u003cp\u003eDuration lived in the area\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 174px;\"\u003e\n \u003cp\u003e\u0026lt;20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 156px;\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 103px;\"\u003e\n \u003cp\u003e12.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 151px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 174px;\"\u003e\n \u003cp\u003e20-40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 156px;\"\u003e\n \u003cp\u003e129\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 103px;\"\u003e\n \u003cp\u003e45.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 174px;\"\u003e\n \u003cp\u003e\u0026gt;40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 156px;\"\u003e\n \u003cp\u003e117\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 103px;\"\u003e\n \u003cp\u003e41.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003ePrevalence of onchocerciasis\u0026nbsp;\u003c/h2\u003e\n\u003cp\u003eThe prevalence of onchocerciasis was determined based on the presence of observable palpable nodules/or a positive skin snip. Among the 282 participants, 43(15.2%) had palpable nodules, 17(6.0%) were positive for skin snip, and 6(10.0%) presented with both palpable nodules and a positive skin snip (Fig.2). Thus, the overall prevalence of onchocerciasis in this study was 21.3% (Fig. 3).\u003c/p\u003e\n\u003cp\u003eThe prevalence of onchocerciasis was significantly associated with sex, age, education, and marital status (P\u0026lt;0.05). Onchocerciasis prevalence was associated with gender (p\u0026lt;0.001). It was observed that females were 6.7 times (aOR=6.58, 95% CI:2.30\u0026ndash;18.87, p = 0.001) more likely to be infected than males. Participants aged \u0026ge;60 years had the highest prevalence (31.1%) and were over four times more likely to be infected compared to those aged 30\u0026ndash;39 years (AOR = 4.30, 95% CI: 1.42\u0026ndash;13.02, p=0.01). Moreover, participants with no formal education were over 5 times (aOR= 4.58, 95% CI: 1.24\u0026ndash;16.91, p=0.02) more likely to be infected compared to those with tertiary education. Married participants (23.6%) had higher infection rates (aOR= 4.01 (95% CI: 0.92\u0026ndash;17.41, p=0.06) (Table 2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2\u0026nbsp;\u003c/strong\u003eRelationship between sociodemographic characteristics and prevalence of onchocerciasis\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"653\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategory\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eExamined (n)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePositive\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNegative n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCrude P-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOR (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdjusted P-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\" style=\"width: 82px;\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 72px;\"\u003e\n \u003cp\u003e4 (5.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e71 (94.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\" style=\"width: 68px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 124px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\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: 80px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e207\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 72px;\"\u003e\n \u003cp\u003e56 (27.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e151 (72.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 124px;\"\u003e\n \u003cp\u003e6.58 (2.30\u0026ndash;18.87)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"bottom\" style=\"width: 82px;\"\u003e\n \u003cp\u003eAge group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e30\u0026ndash;39\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 72px;\"\u003e\n \u003cp\u003e4 (9.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e38 (90.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" valign=\"bottom\" style=\"width: 68px;\"\u003e\n \u003cp\u003e0.007\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 124px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\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: 80px;\"\u003e\n \u003cp\u003e40\u0026ndash;49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 72px;\"\u003e\n \u003cp\u003e13 (21.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e48 (78.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 124px;\"\u003e\n \u003cp\u003e2.57 (0.78\u0026ndash;8.53)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e50\u0026ndash;59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 72px;\"\u003e\n \u003cp\u003e10 (13.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e63 (86.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 124px;\"\u003e\n \u003cp\u003e1.51 (0.44\u0026ndash;5.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e0.49\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u0026ge;60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e106\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 72px;\"\u003e\n \u003cp\u003e33 (31.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e73 (68.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 124px;\"\u003e\n \u003cp\u003e4.30 (1.42\u0026ndash;13.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e0.01*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"bottom\" style=\"width: 82px;\"\u003e\n \u003cp\u003eEducation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003eTertiary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 72px;\"\u003e\n \u003cp\u003e3 (12.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e22 (88.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" valign=\"bottom\" style=\"width: 68px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 124px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\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: 80px;\"\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e158\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 72px;\"\u003e\n \u003cp\u003e30 (19.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e128 (81.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 124px;\"\u003e\n \u003cp\u003e1.72 (0.49\u0026ndash;6.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e0.39\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003eSecondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 72px;\"\u003e\n \u003cp\u003e2 (5.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e32 (94.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 124px;\"\u003e\n \u003cp\u003e0.46 (0.07\u0026ndash;2.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e0.42\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 72px;\"\u003e\n \u003cp\u003e25 (38.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e40 (61.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 124px;\"\u003e\n \u003cp\u003e4.58 (1.24\u0026ndash;16.91)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e0.02*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\" style=\"width: 82px;\"\u003e\n \u003cp\u003eMarital status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003eSingle\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 72px;\"\u003e\n \u003cp\u003e2 (7.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e26 (92.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\" style=\"width: 68px;\"\u003e\n \u003cp\u003e0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 124px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\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: 80px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e246\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 72px;\"\u003e\n \u003cp\u003e58 (23.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e188 (76.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 124px;\"\u003e\n \u003cp\u003e4.01 (0.92\u0026ndash;17.41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"bottom\" style=\"width: 82px;\"\u003e\n \u003cp\u003eOccupation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003eBusiness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 72px;\"\u003e\n \u003cp\u003e1 (4.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e20 (95.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" valign=\"bottom\" style=\"width: 68px;\"\u003e\n \u003cp\u003e0.172\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 195px;\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003eFarmers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e219\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 72px;\"\u003e\n \u003cp\u003e52 (23.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e167 (76.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 195px;\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003eSalaried worker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 72px;\"\u003e\n \u003cp\u003e5 (15.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e28 (84.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 195px;\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 72px;\"\u003e\n \u003cp\u003e2 (22.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e7 (77.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 195px;\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"bottom\" style=\"width: 82px;\"\u003e\n \u003cp\u003eDuration of stay\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e5\u0026ndash;20 yrs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 72px;\"\u003e\n \u003cp\u003e10 (18.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e43 (81.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"bottom\" style=\"width: 68px;\"\u003e\n \u003cp\u003e0.801\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 195px;\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e21\u0026ndash;40 yrs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e112\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 72px;\"\u003e\n \u003cp\u003e23 (20.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e89 (79.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 195px;\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u0026gt;40 yrs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e117\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 72px;\"\u003e\n \u003cp\u003e27 (23.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e90 (76.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 195px;\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"bottom\" style=\"width: 82px;\"\u003e\n \u003cp\u003eEndemicity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003eHypo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 72px;\"\u003e\n \u003cp\u003e18 (23.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e60 (76.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"bottom\" style=\"width: 68px;\"\u003e\n \u003cp\u003e0.641\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 195px;\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003eMeso\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e104\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 72px;\"\u003e\n \u003cp\u003e19 (18.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e85 (81.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 195px;\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003eHyper\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 72px;\"\u003e\n \u003cp\u003e23 (23.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e77 (77.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 195px;\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e1= reference category\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNA=not applicable\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ch2\u003ePrevalence of non-communicable diseases and onchocerciasis comorbidities\u003c/h2\u003e\n\u003cp\u003eOnly 24 of 282 participants had at least one of the NCDs; hence, the prevalence of NCDs in the study population was 8.5%. Of the 60 patients with onchocerciasis, 24 had at least one of the NCDs; hence, the prevalence of NCDs in onchocerciasis patients was 40.0%. The prevalences of rheumatoid arthritis and hypertension in the study population were both 18.8% and the prevalence of diabetes was 2.1% and that of hypertension + rheumatoid arthritis was 2.8%. In onchocerciasis patients, the prevalences of rheumatoid arthritis, hypertension, diabetes and Rheumatoid arthritis + hypertension were 21.7 %, 25.0%, 3.3% and 10.0%, respectively. A high prevalence of NCDs was observed in onchocerciasis patients. Our results revealed a great significant association between NCDs and onchocerciasis (p\u0026lt;0.001). Although no significant association was found between onchocerciasis and individual NCDs (p\u0026gt;0.05), there was a great significant association between participants who had both hypertension and rheumatoid arthritis and onchocerciasis (p\u0026lt;0.001) (Table 3).\u0026nbsp;\u003c/p\u003e\n\u003cp id=\"_Toc175463213\"\u003eTable 3\u0026nbsp;Prevalence of non-communicable diseases and onchocerciasis comorbidities\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"600\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eDisease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eStudy population \u0026nbsp; \u0026nbsp; \u0026nbsp;n=282\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003eOncho \u0026nbsp; prevalence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003eOncho Positive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003eOncho Negative\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eNCDs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e24(8.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e24(40.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eRheumatoid Arthritis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e53(18.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e13(21.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e40(88.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eHypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e53(18.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e15(25.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e38(75.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.17\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eDiabetes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e6(2.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e2(3.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e4(96.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.47\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eHypertension + Arthritis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e8(2.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e6(10.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e54(90.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003ch2\u003eClinical manifestations associated with onchocerciasis versus onchocerciasis comorbidities\u0026nbsp;\u003c/h2\u003e\n\u003cp\u003eClinical manifestations that were associated with onchocerciasis and comorbidities were itching skin/eyes (19, 31.7%) and blindness/blurred vision (15, 62.5%). Neither skin change nor oedema was found in any comorbidity with onchocerciasis. Although there was no significant association between clinical manifestations and onchocerciasis comorbidities, interestingly, all the clinical manifestations were generally higher in onchocerciasis patients than in patients who had comorbidities with NCDs (Table 4). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4\u0026nbsp;\u003c/strong\u003eClinical manifestations associated with onchocerciasis versus onchocerciasis comorbidities\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"624\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eManifestation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo. of participants (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOncho Positive\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOncho + comorbidity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eItching skin/eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e98(34.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e46(46.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e19(31.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.70\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eSkin change\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e7(2.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e5(71.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.06\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eEdema\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e2(0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e2(100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.68\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eBlindness/blurred vision\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e41(14.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e32(78.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e15(62.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.24\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003ch2\u003eFactors associated with continued transmission of onchocerciasis\u003c/h2\u003e\n\u003cp\u003e\u003cstrong\u003eKnowledge of onchocerciasis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMore than half of the study population (51.1%) were aware of onchocerciasis. Although only 53.2% of them chose parasite as the cause and identified the blackfly as a vector transmission of onchocerciasis, 95.5% agreed that onchocerciasis was preventable and could be treated with Mectizan. However, very few (3.2%) said it could also be treated by herbs (Table 5).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5\u0026nbsp;\u003c/strong\u003eKnowledge of onchocerciasis\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"637\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategory\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 323px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo. of participants (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eCauses\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003emosquito bites\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 323px;\"\u003e\n \u003cp\u003e90(31.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eParasite\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 323px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e150(53.2)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eI don\u0026rsquo;t know\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 323px;\"\u003e\n \u003cp\u003e42(14.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e⃰\u0026nbsp;\u003c/strong\u003e\u003csup\u003e1\u003c/sup\u003e\u003cstrong\u003eRight Knowledge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 323px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e150(53.2)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eMode of transmission\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003esharing clothes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 323px;\"\u003e\n \u003cp\u003e12(4.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003emosquito bites\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 323px;\"\u003e\n \u003cp\u003e90(31.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBlackfly\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 323px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e150(53.2)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eI don\u0026rsquo;t know\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 323px;\"\u003e\n \u003cp\u003e30(10.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e\u003csup\u003e⃰ 2\u003c/sup\u003e\u003cstrong\u003eRight Knowledge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 323px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e150(53.2)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eDo you think oncho is preventable?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 323px;\"\u003e\n \u003cp\u003e13(4.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 323px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e269(95.4)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e\u003csup\u003e⃰ 3\u003c/sup\u003e\u003cstrong\u003eRight Knowledge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 323px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e269(95.4)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eHow is oncho treated?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMectizan\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 323px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e269(95.4)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHerbs\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 323px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e9(3.2)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eI don\u0026rsquo;t know\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 323px;\"\u003e\n \u003cp\u003e9(3.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e\u003csup\u003e⃰ 4\u003c/sup\u003e\u003cstrong\u003eRight Knowledge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 323px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e269(95.4)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e\u003csup\u003e⃰ 5\u003c/sup\u003e\u003cstrong\u003eRight Knowledge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 323px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e9(3.2)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eKnowledge score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eGood knowledge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 323px;\"\u003e\n \u003cp\u003e144(51.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003ePoor knowledge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 323px;\"\u003e\n \u003cp\u003e138(48.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e*Right knowledge: \u0026nbsp;⃰ 1 and ⃰ 2 if response is blackfly, ⃰ 3 if response is yes, ⃰ 4 and 5, if response is either Mectizan or Herbs. Good knowledge: right knowledge of at least 3 knowledge characteristics; otherwise, poor knowledge\u003c/strong\u003e\u003c/p\u003e\n\u003ch2\u003eIvermectin uptake among the study participants\u003c/h2\u003e\n\u003cp\u003eIvermectin has been distributed in the Bafut Health District for nearly two decades. Acceptance to take ivermectin was one of the factors that was assessed among participants. A total of 266 participants (94.3%) agreed to have been taking ivermectin, whereas only 16(5.7%) refused to take it for reasons such as sickness, blurred vision. A larger proportion of those who refused to take ivermectin were females (13, 81.3%) and in the age group 40-49 years (6, 37.5%) and above 59 years (5, 31.25%) Although there was no significant difference in the acceptance to take ivermectin and onchocerciasis infection status according to sex and age (p\u0026gt;0.05), our results revealed a significant association between onchocerciasis infection status and reasons advanced for refusal which included blindness/blurred vision, other sicknesses and hypertension (p=0.01) (Table 6). Interestingly, when other factors such as sex, age and level of education were associated with onchocerciasis infection status, there was a highly significant association (p\u0026lt;0.001). Being female had 6.58 times higher odds of infection (aOR = 6.58, 95% CI 2.30-18.87, p\u0026lt;0.001). Being in the age group above 59 years had 4.3 higher odds of infection (aOR = 4.3, 95%Cl 1.42-13.02, p=0.01) and having no formal education had 4.58 higher odds of having infection (aOR=4.58, 95%Cl 1.24-16.9, p=0.02). Also, being married had 4.01 higher odds of having an infection (aOR=4.01, 95%Cl 0.92-17.91, p=0.06) (Table 7).\u003c/p\u003e\n\u003cp id=\"_Toc175463220\"\u003eTable 6\u0026nbsp;Ivermectin uptake among the study participants\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"636\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" valign=\"top\" style=\"width: 300px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInfection status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePositive\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNegative\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eTakes ivermectin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e266\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e57(21.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e209(78.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e3(18.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e13(81.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eReasons for not taking IVM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e2(66.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e1(33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003eSickness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e5(100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003eblurred vision\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e6(100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003ehypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e2(100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003emale\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e4(5.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e68(94.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.68\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e3(100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e194\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e53(27.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e141(72.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.74\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e13(81.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e3(23.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e10(76.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eAge group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026lt;39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e4(9.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e37(90.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.74\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e1(100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e40-49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e11(20.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e44(80.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.45\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e6(37.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e2(33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e4(66.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e50-59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e10(14.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e59(85.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.41\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e4(100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026gt;59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e101\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e32(31.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e69(68.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.58\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e5(31.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e1(20.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e4(80.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp id=\"_Toc175463221\"\u003eTable 7\u0026nbsp;Bivariate analysis of sex, age, educational level and infection status\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"697\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 8.0531%;\"\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 6.6372%;\"\u003e\u003cstrong\u003eCategory\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 5.4867%;\"\u003e\u003cstrong\u003eoncho+\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 7.2566%;\"\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 6.2832%;\"\u003e\u003cstrong\u003eOR\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 8.7611%;\"\u003e\u003cstrong\u003e95%CI\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 25.3945%;\"\u003e\u003cstrong\u003eAdjusted p-value\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 8.0531%;\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.6372%;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.4867%;\"\u003e\n \u003cp\u003e4(5.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 7.2566%;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.2832%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.7611%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.3186%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 6.6372%;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.4867%;\"\u003e\n \u003cp\u003e56(27.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.2832%;\"\u003e\n \u003cp\u003e6.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.7611%;\"\u003e\n \u003cp\u003e2.30-18.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.3186%;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 8.0531%;\"\u003e\n \u003cp\u003eAge group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.6372%;\"\u003e\n \u003cp\u003e\u0026lt; 39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.4867%;\"\u003e\n \u003cp\u003e4(9.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 7.2566%;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.2832%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.7611%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.3186%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 6.6372%;\"\u003e\n \u003cp\u003e40-49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.4867%;\"\u003e\n \u003cp\u003e13(21.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.2832%;\"\u003e\n \u003cp\u003e2.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.7611%;\"\u003e\n \u003cp\u003e0.78-8.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.3186%;\"\u003e\n \u003cp\u003e0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 6.6372%;\"\u003e\n \u003cp\u003e50-59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.4867%;\"\u003e\n \u003cp\u003e10(13.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.2832%;\"\u003e\n \u003cp\u003e1.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.7611%;\"\u003e\n \u003cp\u003e0.44-5.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.3186%;\"\u003e\n \u003cp\u003e0.51\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 6.6372%;\"\u003e\n \u003cp\u003e\u0026gt;59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.4867%;\"\u003e\n \u003cp\u003e33(31.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.2832%;\"\u003e\n \u003cp\u003e4.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.7611%;\"\u003e\n \u003cp\u003e1.42-13.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.3186%;\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 8.0531%;\"\u003e\n \u003cp\u003eLevel of education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.6372%;\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.4867%;\"\u003e\n \u003cp\u003e30(19.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 7.2566%;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.2832%;\"\u003e\n \u003cp\u003e4.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.7611%;\"\u003e\n \u003cp\u003e1.24-16.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.3186%;\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 6.6372%;\"\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.4867%;\"\u003e\n \u003cp\u003e2(5.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.2832%;\"\u003e\n \u003cp\u003e1.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.7611%;\"\u003e\n \u003cp\u003e0.49-6.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.3186%;\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 6.6372%;\"\u003e\n \u003cp\u003eSecondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.4867%;\"\u003e\n \u003cp\u003e3(12.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.2832%;\"\u003e\n \u003cp\u003e0.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.7611%;\"\u003e\n \u003cp\u003e0.07-2.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.3186%;\"\u003e\n \u003cp\u003e0.41\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 6.6372%;\"\u003e\n \u003cp\u003eTertiary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.4867%;\"\u003e\n \u003cp\u003e25(38.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.2832%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.7611%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.3186%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 8.0531%;\"\u003e\n \u003cp\u003eMarital status\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.6372%;\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.4867%;\"\u003e\n \u003cp\u003e2(7.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 7.2566%;\"\u003e\n \u003cp\u003e0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.2832%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.7611%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.3186%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 6.6372%;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.4867%;\"\u003e\n \u003cp\u003e58(23.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.2832%;\"\u003e\n \u003cp\u003e4.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.7611%;\"\u003e\n \u003cp\u003e0.92-17.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.3186%;\"\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 6.6372%;\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.4867%;\"\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.2832%;\"\u003e\n \u003cp\u003e0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.7611%;\"\u003e\n \u003cp\u003e0.02-09.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.3186%;\"\u003e\n \u003cp\u003e0.99\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e1= reference category\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study describes the current situation of comorbidity of onchocerciasis with hypertension, rheumatoid arthritis and diabetes and determinants of continued transmission of onchocerciasis in Bafut Health District after more than 20 years of continuous administration of ivermectin. Two hundred and eighty-two participants took part in the study, the majority of whom were females (73.4%) in the age group\u0026thinsp;\u0026gt;\u0026thinsp;59 years (37.6%). Most of them had a primary level of education (56.0%), and the main occupation of participants was farming (77.7%).\u003c/p\u003e\u003cp\u003eThe overall prevalence of onchocerciasis in the study population was 21.3% indicating that onchocerciasis is still a public health problem in Bafut Health District. This prevalence is more than 200 times higher compared to the prevalence of 0.1% that the WHO considers for elimination [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. While the over 2 decades of MDA in Cameroon are reducing transmission in some regions like the Adamaoua [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], onchocerciasis persists in the Bafut Health District, as confirmed by our findings. Our results are comparable to previous studies in the Tombel Health District, where a prevalence of 21.6% was obtained [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. However, our results were more than two times lower than the prevalence of 55.8% reported in Yaounde, Cameroon in 2017 [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. This can be explained by the fact that our results were based only on skin snip diagnosis and observable palpable nodules, which can be faulty given the fact that, at the time of collection of the snips, microfilariae might migrate to other parts of the body and may not be captured and the fact that some nodules may not be seen. The actual prevalence of onchocerciasis in Bafut Health District may actually be higher if more sensitive techniques like OV16 IgG4 antibodies were used in diagnosis.\u003c/p\u003e\u003cp\u003eWhen onchocerciasis prevalence was correlated with demographic characteristics, we found a significant association with sex, age, educational level, marital status and per health area (p\u0026thinsp;\u0026lt;\u0026thinsp;0.005). A higher prevalence was recorded in females (27.1%) than in males (5.3%). This may be explained by the fact that most females in Bafut who have not had any level of education and are married are mostly farmers who work to feed their families, especially in hyperendemic areas. It has been suggested that females work longer on the farm and with exposed bodies than the males, thereby making them more prone to the bites of blackflies [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Our study recorded a higher onchocerciasis among farmers (23.7%). This is different from studies carried out in Yabassi Health District by Kamga \u003cem\u003eet al.\u003c/em\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], who recorded a higher prevalence in males than females. The differences in infection rate with regard to sex could be due to occupational exposure and susceptibility of individuals [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. The high prevalence recorded in our study among participants above 40 years may be due to the fact that individuals within this age group are usually most active in outdoor activities (like farming, sand mining, tapping and fishing) as confirmed by other studies [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. This is also in line with another study that reported a higher prevalence in older age group [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eNon-communicable diseases have been on the rise in most societies because of life-style and behavioural changes. Our study recorded an overall prevalence of 8.5% of NCDs (rheumatoid arthritis, hypertension and diabetes). Comorbidity of these NCDs with onchocerciasis was 40% and this was statistically significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). When these NCDs were considered individually, there was no significant difference between people with onchocerciasis and those without onchocerciasis. However, the prevalence increased with the presence of onchocerciasis compared to participants without onchocerciasis. Hypertension was the NCD with the highest prevalence of 25% among onchocerciasis patients in our study. It is postulated that prolonged inflammation that may result from host responses to \u003cem\u003eOnchocerca\u003c/em\u003e larvae and adult worms can contribute to vascular changes and endothelial dysfunction, which can increase blood pressure and contribute to hypertension [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Surprisingly, only 2 (3.3%) participants with onchocerciasis in our study were diagnosed with diabetes. This corroborates with the results of Rajamanickam and Babu[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] that stated that helminthe infections lower the occurrence of diabetes in infected persons and can be explained by the fact that onchocerciasis is chronic and can enhance sensitivity to insulin, hence reducing sugar levels, possibly due to the modulation of inflammatory pathways [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. The presence of onchocerciasis was significantly correlated with patients having both hypertension and rheumatoid arthritis (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). This is probably due to alterations in cytokine profiles, promoting pro-inflammatory cytokines that can exacerbate both hypertension and arthritic conditions [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Also, immune complexes formed when microfilariae die can cause deposition at joints, leading to swelling and pain, which are typical of arthritis. Interestingly, inflammatory cytokines Th17 and Th2 were implicated in rheumatoid arthritis and hyperreactive sowda form of onchocerciasis[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAmongst factors assessed for continued transmission were knowledge of the disease, presence of NCDs, demographic characteristics and uptake of ivermectin. Our analysis of knowledge of onchocerciasis among the participants showed that 51.1% of them had a good knowledge of onchocerciasis, and 53.2% correctly identified the blackfly as a vector of transmission, including the signs and symptoms associated with it, because of the endemicity of the infection in the study area and continuous sensitisation by health care providers in the area. This result is consistent with the findings of other studies[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. However, these results contradict the results of a study carried out by Wogu and Okaka[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] that reported that 57% of participants had no knowledge of transmission. Awareness of available treatments is crucial, as a lack of knowledge could lead to non-compliance and ongoing transmission. More than 90% of participants agreed that ivermectin was a way to prevent and treat onchocerciasis apart from using herbs. This is because they had been witnessing the annual distribution of the drug and willingly took it for treatment, as confirmed in our results. A similar study carried out by Adeoye and colleagues in Southwest Nigeria reported that 92% of participants viewed ivermectin as a drug of choice for prevention and treatment of onchocerciasis [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Also, another study carried out in Southwest Ethiopia showed that 93.3% of respondents perceived onchocerciasis as preventable [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIt was commendable to observe in our study that \u0026gt;\u0026thinsp;90% of participants knew the importance of taking ivermectin for a significant reduction in morbidity, an observation that is consistent with studies conducted in other hyper-endemic communities of Edo and Imo States, Nigeria, and Ethiopia[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. In spite of this, we still recorded a prevalence of 21.3% which is well above the WHO elimination prevalence of 0.1%. Of the 266 participants who usually took ivermectin, a number of them (21.4%) were positive for onchocerciasis. This could be explained by the fact that they might not have been adhering to treatment, or been constantly exposed to blackfly bites, or this could also be due to ivermectin resistance. It could also be due to poor compliance, as suggested by other studies, which reported that poor compliance with ivermectin treatment was identified as a practice associated with onchocerciasis transmission [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Low ivermectin coverage and uptake have also been associated with continued onchocerciasis transmission. In our study, refusal to take ivermectin for various reasons was significantly correlated with onchocerciasis infection status and most of those who refused to take ivermectin advanced various reasons for not taking the drug. Some reasons advanced for refusal were fear of drug-related adverse reactions like blurred vision, palpitation associated with hypertension and sickness. This is supported by similar results obtained in an endemic area of Guatemala and in Okpuje, an endemic community in Edo State, Nigeria [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Apart from the above factors, an interruption in ivermectin distribution because of the ongoing sociopolitical unrest in the study could also be a factor for continued transmission of onchocerciasis, as confirmed by previous studies [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eLimitations\u003c/p\u003e\u003cp\u003e Some older participants faced challenges understanding certain questions due to language barriers, potentially affecting responses. Moreover, the use of convenient random sampling may have excluded individuals with severe morbidity. In addition, information on ivermectin uptake relied on self-reporting, introducing recall and reporting bias. Laboratory confirmation was limited by the unavailability of the OV16 IgG ELISA, restricting the detection of active and past infections. Likewise, our study was limited to 12 health areas within the district due to socio-political unrest.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eOnchocerciasis remains a significant public health problem in the Bafut Health District, with a prevalence of 21.3% despite nearly two decades of continuous ivermectin distribution. Non-communicable diseases (NCDs) were present in 8.5% of the general study population but in 40% of individuals with onchocerciasis, most commonly hypertension and arthritis. Clinical manifestations such as itching and visual impairment were frequent, and symptoms were often exacerbated in participants with comorbid NCDs. Continued transmission was associated with demographic factors (age, sex, education), social and behavioral factors (knowledge of onchocerciasis, ivermectin uptake), and environmental determinants (presence of rivers and forests). Strengthening community knowledge, improving adherence to community-directed treatment with ivermectin (CDTI), and integrating NCD management into onchocerciasis control efforts will be essential for progress toward elimination.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAPOC African Programme for Onchocerciasis Control\u003c/p\u003e\n\u003cp\u003eBHD Bafut Health District\u003c/p\u003e\n\u003cp\u003eBP Blood Pressure\u003c/p\u003e\n\u003cp\u003eCDTI Community-Directed Treatment with Ivermectin\u003c/p\u003e\n\u003cp\u003eCHWs Community Health Workers\u003c/p\u003e\n\u003cp\u003eCOC(s) Chief(s) of Centre\u003c/p\u003e\n\u003cp\u003eDMO District Medical Officer\u003c/p\u003e\n\u003cp\u003eELISA Enzyme-Linked Immunosorbent Assay\u003c/p\u003e\n\u003cp\u003eIgG Immunoglobulin G\u003c/p\u003e\n\u003cp\u003eIVM Ivermectin\u003c/p\u003e\n\u003cp\u003eLMIC Low- and Middle-Income Countries\u003c/p\u003e\n\u003cp\u003eMDA Mass Drug Administration\u003c/p\u003e\n\u003cp\u003emf Microfilariae\u003c/p\u003e\n\u003cp\u003eNCD(s) Non-Communicable Disease(s)\u003c/p\u003e\n\u003cp\u003eNTD(s) Neglected Tropical Disease(s)\u003c/p\u003e\n\u003cp\u003eOV16 Onchocerca volvulus 16 kDa antigen\u003c/p\u003e\n\u003cp\u003ePNLO Programme National de Lutte contre l\u0026rsquo;Onchocercose\u003c/p\u003e\n\u003cp\u003eRA Rheumatoid Arthritis\u003c/p\u003e\n\u003cp\u003eREA Rapid Epidemiological Assessment\u003c/p\u003e\n\u003cp\u003eRF Rheumatoid Factor\u003c/p\u003e\n\u003cp\u003eWHO World Health Organization\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate\u003c/p\u003e\n\u003cp\u003eEthical clearance for the study was obtained from the Institutional Review Board of the University of Bamenda (Appendix I). Administrative authorisation was also granted by the Regional Delegation of Public Health and the District Medical Officer (DMO) of Bafut Health District (Appendix II). Before data collection, these approvals were presented to the selected health facilities\u0026apos; Chiefs of Centres (COCs). Before recruitment, study procedures were explained to participants in both English and the Bafut dialect by laboratory technicians or other trained staff fluent in the local language. Written informed consent was obtained from all respondents, either by signature or thumbprint, after a detailed explanation of the study\u0026rsquo;s nature and objectives. Participation was entirely voluntary. Data collected was treated with strict confidentiality and stored on password-protected computers. All participants were handled per the principles of the Declaration of Helsinki on the ethical use of humans in biomedical research.\u003c/p\u003e\n\u003cp\u003eConsent for publication\u003c/p\u003e\n\u003cp\u003eNot Applicable.\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eThis study received no external funding.\u003c/p\u003e\n\u003cp\u003eAuthor Contributions\u003c/p\u003e\n\u003cp\u003eIUA, PAA, MUA conceived and designed the experiments. IUA and PAA conducted the study. IUA and MUA performed the analysis. IUA, PAA, MUA, TNA drafted the manuscript. All authors contributed to the revision of the manuscript prior to submission.\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials\u003c/p\u003e\n\u003cp\u003eThe dataset used in the present study is available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003eCompeting interests\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003eAcknowledgments\u003c/p\u003e\n\u003cp\u003eWe would like to thank the study participants who made this study realistic, and the Chief of Centers for the permission granted to conduct the study in the health facility.\u003c/p\u003e\n\u003cp\u003eAuthors\u0026apos; information\u003c/p\u003e\n\u003cp\u003e1Department of Microbiology and Parasitology, The University of Bamenda, Bambili, Cameroon\u003c/p\u003e\n\u003cp\u003e2Department of Public Health, The University of Bamenda, Bambili, Bamenda, Cameroon\u003c/p\u003e\n\u003cp\u003e3School of Health Sciences, Charisma University, Billings, MT, USA\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eOnchocerciasis (river blindness). https://www.who.int/news-room/fact-sheets/detail/onchocerciasis. 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Pathogenesis and host responses in human onchocerciasis: impact of \u003cem\u003eOnchocerca\u003c/em\u003e filariae and \u003cem\u003eWolbachia\u003c/em\u003e endobacteria. Microbes Infect. 2004;6:113\u0026ndash;28. https://doi.org/10.1016/j.micinf.2003.11.003.\u003c/li\u003e\n \u003cli\u003eKatawa G, Layland LE, Debrah AY, von Horn C, Batsa L, Kwarteng A, et al. Hyperreactive Onchocerciasis is Characterized by a Combination of Th17-Th2 Immune Responses and Reduced Regulatory T Cells. PLoS Negl Trop Dis. 2015;9:e3414. https://doi.org/10.1371/journal.pntd.0003414.\u003c/li\u003e\n \u003cli\u003eYirga D, Woldemichael K, Wondafrash M, Kassahun W, Deribe K. KNOWLEDGE AND BELIEF ABOUT CAUSE AND PREVENTION OF ONCHOCERCIASIS IN BEBEKA, SOUTHWEST ETHIOPIA. Ethiop J Health Sci. 2008;18.\u003c/li\u003e\n \u003cli\u003eGilano G, Mulugeta Shegaze \u0026nbsp;null, Dubale A. Knowledge, Attitude, and Preventive Practice Related to Onchocerciasis and Associated Factors among Resource-Limited Selamogo Woreda Residents, South West Ethiopia, 2021. J Trop Med. 2022;2022:2481841. https://doi.org/10.1155/2022/2481841.\u003c/li\u003e\n \u003cli\u003eAdeoye A, Ashaye A, Onakpoya O. Perception and attitude of people towards Onchocerciasis in southwestern Nigeria. Middle East Afr J Ophthalmol. 2010.\u003c/li\u003e\n \u003cli\u003eWeldegebreal F, Medhin G, Weldegebriel Z, Legesse M. Assessment of community\u0026rsquo;s knowledge, attitude and practice about onchocerciasis and community directed treatment with Ivermectin in Quara District, north western Ethiopia. Parasit Vectors. 2014;7:98. https://doi.org/10.1186/1756-3305-7-98.\u003c/li\u003e\n \u003cli\u003eNjamnshi AK, Njamnshi WY, Siewe Fodjo JN. Onchocerciasis elimination in sub-Saharan Africa requires alternative strategies. Lancet Glob Health. 2024;12:e715\u0026ndash;6. https://doi.org/10.1016/S2214-109X(24)00089-5.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"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":"bmc-infectious-diseases","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"infd","sideBox":"Learn more about [BMC Infectious Diseases](http://bmcinfectdis.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/infd","title":"BMC Infectious Diseases","twitterHandle":"#bmcinfectdis","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Onchocerciasis, non-communicable diseases, Hypertension, Rheumatoid arthritis, Diabetes, Comorbidity, Continuous transmission, Ivermectin uptake, Cameroon","lastPublishedDoi":"10.21203/rs.3.rs-7530544/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7530544/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eDespite decades of mass Ivermectin distribution, onchocerciasis transmission in Cameroon still persists. Comorbidities with non-communicable diseases (NCDs) and gaps in treatment uptake may contribute to sustained transmission. This study assessed the prevalence of onchocerciasis, its comorbidity with selected NCDs, and determinants of continued transmission in Bafut Health District, Cameroon.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003eA hospital-based cross-sectional study was conducted from June to July 2024 among 282 adults aged ≥30 years residing in Bafut for ≥5 years. Data on sociodemographics, NCD history, onchocerciasis knowledge, and ivermectin uptake were collected using a structured questionnaire. Laboratory investigations included skin snip microscopy, nodule palpation, blood pressure measurement, and venous blood tests for diabetes and rheumatoid arthritis. The relationship between categorical variables was analysed using the chi-square test and logistic regression at a significance level of 5%.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003eThe overall prevalence of onchocerciasis was 21.3%. Females (aOR = 6.58, 95% CI: 2.30–18.87, p \u0026lt; 0.001), age ≥60 years (aOR = 4.30, 95% CI: 1.42–13.02, p = 0.01), and lack of formal education (aOR = 4.58, 95% CI: 1.24–16.91, p = 0.02) were significantly associated with infection. The prevalence of NCDs was 8.5% in the population but 40.0% among onchocerciasis patients, with hypertension (25.0%) and rheumatoid arthritis (21.7%) most common. Refusal of ivermectin, mainly due to side effects, was significantly associated with infection (p = 0.01). Nearly half of the participants (48.9%) demonstrated poor knowledge of onchocerciasis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eOnchocerciasis remains endemic in Bafut, with continuous transmission driven by female sex, older age, low education, NCD comorbidities, poor knowledge, and ivermectin refusal. Integrated NCD management, health education, and improved ivermectin compliance are critical to interrupt transmission.\u003c/p\u003e","manuscriptTitle":"Comorbidities of onchocerciasis and non-communicable diseases, and determinants of continued transmission in Bafut Health District, Cameroon","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-23 15:26:05","doi":"10.21203/rs.3.rs-7530544/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-09-22T07:42:52+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-21T10:29:54+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-18T11:49:40+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-17T17:45:12+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"1456803544388847129423653433094184556","date":"2025-09-17T06:45:59+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"45749203069182653332850206298530506795","date":"2025-09-16T05:12:40+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"124205761335132098566421083564926158030","date":"2025-09-15T09:06:16+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"335693075965421671076757882047351994334","date":"2025-09-15T07:35:01+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"52190571555614394847239805661320080680","date":"2025-09-15T07:03:40+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-15T06:21:58+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-15T06:19:43+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-09-09T17:55:44+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-09T05:07:32+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Infectious Diseases","date":"2025-09-08T21:25:25+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-infectious-diseases","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"infd","sideBox":"Learn more about [BMC Infectious Diseases](http://bmcinfectdis.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/infd","title":"BMC Infectious Diseases","twitterHandle":"#bmcinfectdis","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"96daf8cc-ae8c-474e-9cd4-ce6efee8a4c8","owner":[],"postedDate":"September 23rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-05-05T10:02:19+00:00","versionOfRecord":{"articleIdentity":"rs-7530544","link":"https://doi.org/10.1186/s12879-026-13505-1","journal":{"identity":"bmc-infectious-diseases","isVorOnly":false,"title":"BMC Infectious Diseases"},"publishedOn":"2026-05-02 15:57:58","publishedOnDateReadable":"May 2nd, 2026"},"versionCreatedAt":"2025-09-23 15:26:05","video":"","vorDoi":"10.1186/s12879-026-13505-1","vorDoiUrl":"https://doi.org/10.1186/s12879-026-13505-1","workflowStages":[]},"version":"v1","identity":"rs-7530544","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7530544","identity":"rs-7530544","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}