![]() Factors associated with non-participation included mistrust, being female being younger than 26 years short stay in the community and belonging to semi-nomadic sub population due to their remote and disperse settlement, discrimination, their non selection as CDD, and language and cultural barriers. This led to a significant prevalence reduction from 35.7% to 12.3% (p 8, not pregnant, not breastfeeding, not severely ill,) participating in the test in each round, increasing to 83% over the two rounds. However, as a response to persistent high infection prevalence in Massangam Health District in Cameroon, two rounds of alternative treatments including biannual CDTi, ground larviciding and test and treat with doxycycline (TTd) were implemented. The main onchocerciasis elimination strategy is annual Community-Directed Treatment with ivermectin (CDTi).
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