Awareness gaps of onchocerciasis in endemic Health district of Kéniéba, Séféto, Dioila, Kati and Selingué in 2021: cross - sectional study in Mali

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Background Onchocerciasis is still endemic and requiring Mass drug administration (MDA). In Mali, despite more than 15 rounds of treatment, community perception and adherence depend critically on awareness of the disease. This study aimed to assess awareness and knowledge gaps in the context of long-term MDA exposure assess in endemic communities receiving ivermectin MDA. Methods A cross-sectional survey was conducted in the health districts (HD) of Dioila, Kati, Kéniéba, Séféto and Sélingué in Mali after 2020 ivermectin MDA distribution. The survey involved 12,663 individuals from 2,357 households. Data on knowledge, attitudes, and reasons for drug acceptance were collected using the ODK platform and analyzed with SPSS. Results Among those who swallowed ivermectin, the primary reasons were to avoid contracting the disease 45.2% (2,689/5952) or to stay healthy 44.0% (2,619/5952), with significant differences across districts ( p < 0.001). Awareness of onchocerciasis was high overall (95.6%), ranging from 89% in Kéniéba to 99.6% in Sélingué ( p < 0.001). However, knowledge of the mode of transmission was poor: only 32.1% (724/2254) knew it was transmitted by black flies, with the lowest rates in Kati (19.6%) and Sélingué (20.9%). Knowledge of the existence of treatment varied from 45.3% in Kati to 96.2% in Sélingué ( p < 0.001), but among those who aware, correct identification of ivermectin as the treatment was high (96.9%). Conclusion While awareness of onchocerciasis as a disease is high in most districts after 15 + MDA rounds, critical knowledge gaps persist regarding transmission and treatment purpose. Many individuals take ivermectin for general health or due to instruction rather than specific prevention. Targeted health education to explain transmission and the rationale for MDA is needed to sustain adherence and progress toward elimination.

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