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Knowledge, Attitude and Practices
Towards Onchocerciasis Prevention and
Control in Bench Maji Zone, South Western
Beteab Getachew1 and Abiyu Tadele2*
1Gebretsadik Shawo General Hospital, Bonga, Ethiopia
2Department of Animal Science, Bonga University, Ethiopia
Submission: September 01, 2019;Published: September 11, 2019
*Corresponding author: Abiyu Tadele, Department of Animal Science, Bonga University, Ethiopia
How to cite this article: Beteab Getachew, Abiyu Tadele. Knowledge, Attitude and Practices Towards Onchocerciasis Prevention and Control in Bench Maji Zone, South Western Ethiopia. JOJ Ophthalmol. 2019; 7(5): 555725. DOI: 10.19080/JOJO.2019.07.555725
Onchocerciasis is one of the most important public health problems over large areas of tropical African countries including Ethiopia. Involvement of individuals and communities are an important component of Onchocerciasis prevention and control methods. The objective of this study was to assess community’s knowledge, attitude and practices towards prevention and control of Onchocerciasis in Kometa Kebele. A cross-sectional study was carried out in Kometa kebele in which 362 respondents who were above 18 years of age were considered in data collection. Data were collected using a pre-tested questioner administered to sample respondents which was then analyzed using SPSS version 20. The results indicated that majority of the respondent were male (55%) & 32.9% of the interviewed respondents attended primary school. The average family size per household was 5.5person. Majority of the respondents (64.4%) knew about the disease Onchocerciasis. About 36.5% of respondents mentioned Onchocerciasis can be transmitted, of which 50.8 % knew that the transmission is related to black fly biting. Majorities (90.3%) of the respondents mentioned that onchocerciasis is treatable disease with drug. In the present study 85.9% of the study respondents perceived that, Onchocerciasis could cause blindness and death. In the present study 79.6% of respondents did not wear protective clothes when they are working around fast flowing water. In the study area more than 82percent of the respondents take ivermectin for Onchocerciasis prevention. About 67, 64 & 60.4% of respondents had good knowledge, attitude and practices, respectively. In conclusion, most of the respondents knew the disease Onchocerciasis, however they majorities lack awareness on the causative agent, mode of transmission and prevention of Onchocerciasis. Thus, it is important to create awareness and implement intervention activities among communities about Onchocerciasis in the area to prevent and control the disease and achieve the desired goal at national level.
Onchocerciasis, commonly known as ‘river blindness’, is a debilitating vector-borne disease which is mainly caused by a parasite, Onchocerca volvulus . It could be transmitted by the bite of black-fly, Simulium damnosum, which can breed in fast flowing streams and rivers . The disease is also termed river blindness because the vector, the blackfly, is commonly found in areas where there is a rapidly flowing streams and rivers. The common manifestation of the infection is blindness. The disease is also characterized by causing skin lesions with severe itching, a serious eye lesion and blindness known as river blindness. It is a chronic and slowly progressive disease. The initial infestation often occurs in childhood, and many of the affected individuals remain asymptomatic for long periods .
Onchocerciasis is among the most important public health problems which is widely distributed over 30 tropical country and in six countries of Latin and Central America and one Arabian Peninsula . Around 125million people in the world are estimated at risk of the infection and majorities of them are found in Africa . In Ethiopia, 3 million people are already infected, whereas 7.3 million are at risk of infection and almost everyone in an endemic village will harbor the disease. Nine regions surveyed for river blindness were shown to be endemic; the endemic areas extend from the northwest part to South West part of the country that borders Sudan . Mass treatment of high-risk communities with ivermectin was adopted in line with the African Program for Onchocerciasis Control (APOC) community directed treatment with ivermectin (CDTI) strategy [5,6]. The Right to Sight global
initiative was launched in 1999 by the World Health Organization
(WHO) and The International Agency for the Prevention of Blindness
(IAPB), with the aim of eliminating avoidable blindness by
the year 2020 and in so doing preventing an estimated 100 million
people from going blind. An indicator of the impact of VISION
2020 is whether the prevalence of avoidable blindness is indeed
declining (FDRE, 2016). The main control strategy for onchocerciasis
in Ethiopia is mass treatment with ivermectin . The
ultimate goal of the APOC is to reduce the public health and socio-
economic problems of onchocerciasis by providing the administration
of the tablet for a period of 12-15 years using the strategy
of yearly CDTI in endemic areas to kill the microfilariae that
invade the eyes and are present in the skin to be transported to
another victim by the black fly. Ivermectin drug is highly effective
in the mass treatment of onchocerciasis, it kills the microfilariae
that invade the eyes and are present in the skin to be transported
to another victim by the black fly.
Onchocerciasis is one of the major causes of morbidity in
South West part of Ethiopia, the result studied by various scholars
in the country indicated that, nearly one and half million cases
of Onchocerciasis are estimated to exist in Ethiopia, especially in
South West in an area of about 300,878 square kilometers; the
population at risk of infection is estimated to be 7.3million. The
disease affects population in habituating the fertile area of the
country and discourages development schemes due to decrease
force and decline individual productivities which result increase
of dependency and poverty . In Sheka Zone, the study carried
out in 1993 indicated that, the existence of Onchocerciasis in this
area and given an opportunity as a beginning of ivermectin drug
distribution for treatment of Onchocerciasis . Due to the existence
of large volume of rivers and streams flowing throughout
the year in Bench Maji Zone and the adjoining Zones, the possibility
of disease occurrence might be high. Since, Bench Maji Zone
is situated adjacent to Sheka Zone, after the identification and
distribution of ivermectin drug for treatment the community’s
knowledge, attitude and practices towards prevention and control
of Onchocerciasis in Bench Maji Zone, Kometa kebele was not
studied and yet known. Therefore, the aim of this study was to
investigate the community’s knowledge, attitude and practice towards
onchocerciasis in Kometa Kebele South Western Ethiopia.
Onchocerciasis is one of the major causes of morbidity in
South West part of Ethiopia including the study area. Therefore,
assessment of KAP of the kebele residents towards prevention
and control of Onchocerciasis could:
a) Help health planners and health educators providing basic
information to focus on its Prevention and control.
b) Provide a baseline data on the awareness and practice of
Onchocerciasis prevention for the study area.
c) Use as base line data for further researches who want to
conduct on prevention and control of Onchocerciasis.
d) Moreover, the finding used directly or indirectly concerned
bodies to plan, control and prevent the critical problems
of Onchocerciasis .
This study was conducted in Aman town Kometa kebele,
B/Maji Zone, SNNPR, Ethiopia. Kometa kebele is found in
South-Western part of Ethiopia, which is 565km away from
the capital city of Ethiopia (AA). The total number of households
found in Kometa kebele were 2,221; Kometa kebele is
situated 3 km away from Mizan Tepi Teaching hospital. The
main ethnic groups are Bench, Kaffa and Amhara. The major
religions are Orthodox, Protestant and Muslim. The official
working language is Amharic (AK, 2017).
b. Study design
Community based cross-sectional study design was used that
employ qualitative and quantitative data collection method.
c. Source population
Representative households from Kometa kebele were source
d. Study population
All respondents aged above 18 years were considered as
e. Sample size determination
Using a single proportion cross sectional formula, the sample
size calculation considers the following assumptions; - Since
there is no research done in study area previously, estimate of proportion --- 50% Degree of accuracy------ 5% Confidence
level --- 95%
Sample was size Calculated ---
n = Z2 p (1− p) / w2 = (1.96)2 (0.5 x0.5) / (0.05)2 = 385
However, the total number of households which are found in
Kometa kebele were (N) 2221; Since it is less than 10,000, adjustment
was made using correction formula
Using Nonresponse rate of 10% (329*10/100 = 33), the sample
size became 362. Thus, a total of 362 respondents were
involved for this study.
f. Sampling Technique
The study participants/respondents were selected by using
systematic sampling technique and the first household was
selected using lottery method. When calculated the interval K
/ or the sampling fraction become which was approximately
equal to 1/6; which is in every 6th house the data collection
process was made until the desired sample size was achieved.
Data collection tools (questioner) was adapted after review
of relevant literatures. The questionnaire and statement were
grouped and arranged according to the objectives that they could
Data was collected face to face interview method within the
household’s house to house visit using structured questionnaire.
Data collectors were enumerated and trained for one day about
objectives, questionnaire and interview techniques before they go
to data collection. The principal investigators were closely supervising
and collected data. Study Variables are Knowledge, Attitude
Good knowledge- Those respondents who are able to score
≥70% of the total knowledge questions on Onchocerciasis prevention
and control; Poor knowledge- Answering < 60% of the
knowledge question on prevention and control of Onchocerciasis;
Positive attitude- Those respondents who are able to score ≥70%
of the total attitude questions on Onchocerciasis prevention and
control; Negative attitude- Those respondents who are able to
score ≤ 60% of the total attitude question on Onchocerciasis prevention
and control; Good practice- Those respondents who are
able to score ≥70% of the total practice questions on Onchocerciasis
prevention and control and Poor practice- Those respondents
who are able to score ≤ 60% of the total practice questions on Onchocerciasis
prevention and control.
Collected data were checked for completeness, missing value
and complied on excel 2007 and analyzed using SPSS version 20.
The result of study was summarized using tables, figures and presented
in frequency and percentage.
In most of the study participants were male (55%) in (Table
1) which the mean age was 32.6 year. Regarding their marital
status, majority (74.9%) were married, (13.8%) were divorced
& (11.3%) were single. The predominant religions of the study
participants were Orthodox and Protestant (43.4 and 36.2) percent,
respectively. The educational status of the study participants
indicates primary school (32.9%), secondary school (26.8%) and
In the present study indicated in (Table 2), most of the respondents
knew about the causes of onchocerciasis by stating
black flies as the main cause (43.4%), however majorities (48.9
%) still did not know the causes of onchocerciasis in the study
area. In the present study, majority of the respondents (64.4%)
knew about the disease Onchocerciasis, about 36.5 % of respondents
mentioned onchocerciasis can be transmitted, of which 50.8
% knew that the transmission is related to black fly biting. The
rest of 49.2% had misconceptions about mode of transmission of
onchocerciasis. Majorities (90.3%) of the respondents mentioned
that onchocerciasis is treatable disease with drug (Table 3). The
result pertaining to the respondent’s response on the sign and
symptoms of onchocerciasis indicated in (Figure 1), majority of
the respondents (56.08%) said body itching could be the main
sign and symptoms followed by body swelling (22.10%).
In the present study majority (85.9%) of the study respondents
perceived that, Onchocerciasis could cause blindness and
death. In addition, 72.7% of respondents think that, treatment with ivermectin drug could bring drug related adverse effects.
However, most of the respondents (61.3%) consider that, Onchocerciasis
is not a health problem of the community (Figure
2). Similarly, 60.5 percent of respondents recognize that, Onchocerciasis
does not transmit from ill person to a healthy person. In
this study, most of the respondents (72.7%), wearing protective
clothes cannot prevent from the bite of female black fly (Table 4).
In the current study the respondent’s attitudes towards prevention
and control of Onchocerciasis were indicated in (Table 5).
Majorities (63.3%) indicated that, extension workers are mainly
involved in providing the drug. In this study respondents indicated
that morning and night (37.6%) are the most suitable time for
the bite of female black fly.
In the current study majority (79.6%) of respondents did not
wear protective clothes/or shoes when they are working around
fast flowing water. In the study area more than 82 percent of the
respondents take ivermectin for Onchocerciasis prevention. About
58.6% did not participate during mass treatment with ivermectin.
In this study 59.1 percent said that, there was no black fly breeding
site in their surroundings. However, more than 72 percent of
the respondents sleep under a treated net (72.9%), use bed net at
nighttime (73.5%) and slept under a treated net during the previous
night (73.2%), respectively (Table 6). In the present study
the respondents who had good knowledge, positive attitude and
practices about onchocerciasis were 67, 64 & 60.4%, respectively.
In the present study the highest percentage of male (55%)
than female (45%) was observed, which was in a good agreement
with the results of various scholars in the country [1,2,7]. The result
on educational level obtained in the current study indicated
majorities (32.9%) were attained primary education, which was
also in line with the findings of . In this study, both male and
female respondents engage in socio-economic activities such as
fetching water which can expose them to black fly biting (Table
7). Formal education appeared to be one of the medium for the
awareness of the disease. As a result of the formal education that
most of the respondents had, the study showed that 32.9% of the
respondents have already acquired primary education are aware
of the disease. Even though more than half of the respondents
know about the disease.
However, a study by Figueroa et al.  & Chen et al. 
showed different results from this present study with the print
media accounting for their major source of information. The
growth of social media over the years might contribute to the
reason why it is the major source of information in this study.
This study revealed that 97.5% of the participants had knowledge
about kidney transplant. According to Alex et al. , kidney
transplant had the highest response (94%) in a study conducted
on medical students from South India with similar response
(88%) among medical students in South Africa . The higher
response on kidney transplant might be attributed to the fact that
the kidney is the most transplanted organ globally.
In the present study majorities (48.9%) of the study participants
did not knew the causative agents of Onchocerciasis. In
line with this, many authorities believe that low knowledge and
practice of the communities in Africa predispose them to infection
. On the other hand, majority (43.4%) of the respondents
associate the causative agent of the disease with the bite of black
flies, which is comparable with the finding of study conducted in
Bebeka, Southwest Ethiopia . Similarly, in this study, majority
of the cause with the bite of mosquito and parasite, which is consistent
with the findings of the study conducted in Bebeka, Southwest
In the present study pertaining to sign and symptoms, body
itching (56.08%) and body swelling (22.10%) were the major sign
and symptoms. This result agreed with the findings of Fitsum et
al.  in which body itching was the main symptom. On the other
hand, this result was also in the same scenario with the findings of
[11,12] who reported itching to have a high percentage, followed
by swelling and itching. In the present study, majorities (79.6%)
of the respondents did not wear protective cloths to prevent from
bite of black fly, even though they work around fast flowing rivers.
This finding is in close agreement with the reports of Fitsum et
al. . In addition, the community’s practices towards prevention
of Onchocerciasis were taking ivermectin drug (82.3%) and using bed net (73.5%), which is in close agreement with the findings of
Fitsum et al. .
In this study, majority of the study participants based on the
operational definition had poor knowledge of onchocerciasis (i.e.
only 67% of the study participants had good knowledge). Similarly,
majority of the study subjects had poor attitude and practice
about onchocerciasis (i.e. only 64 & 60.4% study subjects had
good attitude and good practice about onchocerciasis, respectively).
This finding is also consistent with the findings of the study
conducted in Sequa area, Southwest Ethiopia  the study conducted
in Quara district, Northwest Ethiopia  and the study
conducted in Homa District, Western Ethiopia . This is probably
due to shortage of health education at the community level
and the CDDs may not be properly trained about onchocerciasis
due to negligence of health extension workers to supervise the
CDDs in delivering health education, and/or excluding the community
interventions for onchocerciasis in the health extension
In conclusion, even though most of the respondents knew
the disease Onchocerciasis, majority of them still lack awareness
on the causative agent, mode of transmission and prevention of
Onchocerciasis. In addition, the respondents associate the causative
agent of the disease with the bite of black flies. Some others
associate the cause with the bite of mosquito and parasite.
In relation with the sign and symptoms of Onchocerciasis, body
itching, and body swelling were the main indicatives identified by
the respondents. In prevention and control mechanisms, respondents
did not wear any protective cloths to prevent from bite of
black fly, even though they work around fast flowing rivers. This
could predispose the communities to infection with Onchocerciasis
and interfere with the activities which could be undertaken
to prevent and control the disease. Therefore, it is necessary to
improve communities’ awareness about Onchocerciasis. In addition,
health extension workers should properly deliver adequate
training on prevention and control of Onchocerciasis for the community.
Health service centers should collaborate with concerned
professionals in the area to prevent Onchocerciasis .
The authors would like to acknowledge Mizan Aman office of
health center for their provision of information. Finally, we are
also indebted to thank those households and health extension
workers who participated in this study.
Yesuf A Assessment of KAP of CDTI of onchocerciasis among the communities around Seqa area, southwestern Ethiopia (2006) Addis Ababa, Ethiopia: MSC. Thesis, Addis Ababa University.
Wayuma TA Community-based cross-sectional study of the status of onchocerciasis, and awareness of the Community Drug Distributors (CDDs) about Onchocerciasis and Community Directed Treatment with Ivermectin (CDTI) in Homa District, Western Ethiopia (2015).