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Significant progress has been made in onchocerciasis control through mass distribution of ivermectin among affected human populations, fostering optimism for disease elimination. However, despite these considerable advances, the elimination of the disease remains a major challenge in many African foci. This paper describes the current situation of onchocerciasis in Adamaoua Region of Cameroon after 20 consecutive years of ivermectin mass treatment. The study was conducted between August and September 2020 in Adamaoua Region of Cameroon. Onchocerciasis endemicity was assessed through parasitological and clinical diagnosis. Microfilarodermia and nodule prevalences assessed in 2020 were compared to those of 1998-2002 and 2010-2013 surveys using the Chi-square (X 2) statistic test. A total of 4,814 participants aged between 5 and 108 years, including 50.4% men and 49.6% women were enrolled in the study. The nodule and microfilaria prevalences reported from this sub-sample were 0.87 [0.64 - 1.19] % and 0.77 [0.54 - 1.07] %, respectively. At the community level, the mf prevalences ranged from 0.5% to 4.5%. Globally, the community microfilarial loads (CMFL) were < 0.5 mf/ss. The survey therapeutic coverage rates were between 40% and 78%, lower than those reported (79% - 83%) by the NOCP. The coverage rates in ivermectin treatment in all age groups of the population were below 65%, except for the 40-50 age group where it was ≈70%. The results of this study show a drastic decline in onchocerciasis prevalences after 20 consecutive years of CDTI, indicating a significant progress towards stopping O. volvulus transmission in Adamaoua Region. However, additional efforts are needed to increase the population coverage in ivermectin treatment in order to stop the parasite transmission in this region.

Effective mass drug administration (MDA) is the cornerstone in the elimination of lymphatic filariasis (LF) and a critical component in combatting all neglected tropical diseases for which preventative chemotherapy is recommended (PC-NTDs). Despite its importance, MDA coverage, however defined, is rarely investigated systematically across time and geography. Most commonly, investigations into coverage react to unsatisfactory outcomes and tend to focus on a single year and health district. Such investigations omit more macro-level influences including sociological, environmental, and programmatic factors. The USAID NTD database contains measures of performance from thousands of district-level LF MDA campaigns across 14 years and 10 West African countries. Specifically, performance was measured as an MDA's epidemiological coverage, calculated as persons treated divided by persons at risk. This analysis aims to explain MDA coverage across time and geography in West Africa using sociological, environmental, and programmatic factors. The analysis links epidemiological coverage data from 3,880 LF MDAs with contextual, non-NTD data via location (each MDA was specific to a health district) and time (MDA month, year). Contextual data included rainfall, temperature, violence or social unrest, COVID-19, the 2014 Ebola outbreak, road access/isolation, population density, observance of Ramadan, and the number of previously completed MDAs. We fit a hierarchical linear regression model with coverage as the dependent variable and performed sensitivity analyses to confirm the selection of the explanatory factors. Above average rainfall, COVID-19, Ebola, violence and social unrest were all significantly associated with lower coverage. Years of prior experience in a district and above average temperature were significantly associated with higher coverage. These generalized and context-focused findings supplement current literature on coverage dynamics and MDA performance. Findings may be used to quantify typically anecdotal considerations in MDA planning. The model and methodology are offered as a tool for further investigation.