Ivermectin distribution and the cultural context of forest onchocerciasis in South Province, Cameroon.

This investigation examined the cultural context of forest onchocerciasis in several communities in the Dja-Lobo Division of southern Cameroon. The study sought to elucidate behaviors that would enhance or diminish health status relative to forest onchocerciasis and other filarial infections, and to make culturally sensitive and appropriate recommendations regarding the development of health education materials and the long-term sustainability of the ivermectin distribution program in Dja-Lobo. The study consisted of two sequential components; the first was a qualitative study of a few severely affected villages and the second was a quantitative study of 212 randomly selected heads of households from eight villages. The Boulou and Baka peoples in these communities defined general filariasis (minak) as small worms under the skin, identified flies as important transmitters of the illness, and indicated that blindness and other skin and ocular problems were a consequence of the illness. Illness of the Dja (referring to an illness found near the Dja River) was another illness that was closely linked to onchocerciasis; local people indicated it was transmitted by the black flies found near the Dja River, resulting in severe itching and leopard skin. These and other cultural-behavioral data on filariasis were used to implement a health education and distribution program.