{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T01:36:13Z","timestamp":1787016973758,"version":"build-2736575974"},"reference-count":47,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2021,9,1]],"date-time":"2021-09-01T00:00:00Z","timestamp":1630454400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100010663","name":"H2020 European Research Council","doi-asserted-by":"publisher","award":["ERC 671055"],"award-info":[{"award-number":["ERC 671055"]}],"id":[{"id":"10.13039\/100010663","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001713","name":"European and Developing Countries Clinical Trials Partnership","doi-asserted-by":"publisher","award":["TMA2020CDF-3152"],"award-info":[{"award-number":["TMA2020CDF-3152"]}],"id":[{"id":"10.13039\/501100001713","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000683","name":"Royal Society of Tropical Medicine and Hygiene","doi-asserted-by":"publisher","award":["Small Grants 2020"],"award-info":[{"award-number":["Small Grants 2020"]}],"id":[{"id":"10.13039\/501100000683","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"published-print":{"date-parts":[[2021,9]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>\n                      Onchocerciasis, caused by the filarial nematode\n                      <jats:italic>Onchocerca volvulus<\/jats:italic>\n                      , remains endemic in Cameroon despite decades of community-directed treatment with ivermectin (CDTI). CDTI is often hampered by coendemicity with loiasis (another filariasis caused by\n                      <jats:italic>Loa loa<\/jats:italic>\n                      ) in some areas. Strong epidemiological evidence suggests that\n                      <jats:italic>O. volvulus<\/jats:italic>\n                      infection increases the risk for onchocerciasis-associated epilepsy (OAE) among Cameroonian children. This highlights the urgent need to strengthen onchocerciasis elimination programmes in mesoendemic\/hyperendemic areas. Novel alternative strategies, such as the \u2018slash and clear\u2019 (S&amp;C) vector control method, may be required to complement ongoing CDTI to accelerate elimination of transmission. The short-term impact of S&amp;C on the biting rates of the blackfly vectors has been demonstrated in other settings. However, its long-term effectiveness and impact on parasitological and serological markers of onchocerciasis transmission as well as on OAE are still unknown.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>We aim to assess the effectiveness of annual S&amp;C interventions combined with CDTI in reducing onchocerciasis transmission and epilepsy incidence. Eight onchocerciasis-endemic villages located &lt;5\u2009km from the Mbam or Sanaga rivers will be randomised to two arms: four villages will receive yearly CDTI only for two consecutive years (Arm 1), while the other four villages will receive CDTI plus annual S&amp;C for 2\u2009years (Arm 2). Study outcomes (blackfly biting rates, infectivity rates and seroprevalence of onchocerciasis antibodies (Ov16 antibodies) in children, prevalence of microfilaridermia and epilepsy incidence) will be monitored prospectively and compared across study arms. We expect that S&amp;C will have an added benefit over CDTI alone.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>The protocol has received ethical approval from the institutional review board of the Cameroon Baptist Convention Health Board (reference number: IRB2021-03) and has been registered with the Pan African Clinical Trials Registry. Findings will be disseminated at national and international levels via meetings and peer-reviewed publications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>PACTR202101751275357.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2021-050341","type":"journal-article","created":{"date-parts":[[2022,2,14]],"date-time":"2022-02-14T03:13:32Z","timestamp":1644808412000},"page":"e050341","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":15,"title":["\u2018Slash and clear\u2019 vector control for onchocerciasis elimination and epilepsy prevention: a protocol of a cluster randomised trial in Cameroonian villages"],"prefix":"10.1136","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3544-1239","authenticated-orcid":false,"given":"Joseph Nelson","family":"Siewe Fodjo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melissa Krizia","family":"Vieri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonard","family":"Ngarka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wepnyu Y","family":"Njamnshi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonard N","family":"Nfor","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michel Karngong","family":"Mengnjo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam","family":"Hendy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter A","family":"Enyong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dennis","family":"Palmer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria-Gloria","family":"Basanez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1919-1340","authenticated-orcid":false,"given":"Robert","family":"Colebunders","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0052-1511","authenticated-orcid":false,"given":"Alfred K","family":"Njamnshi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,9,2]]},"reference":[{"key":"2022021323325984000_11.9.e050341.1","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1186\/s13071-016-1868-8","article-title":"Still mesoendemic onchocerciasis in two Cameroonian community-directed treatment with ivermectin projects despite more than 15 years of mass treatment","volume":"9","author":"Kamga","year":"2016","journal-title":"Parasit Vectors"},{"key":"2022021323325984000_11.9.e050341.2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(96)11094-1"},{"key":"2022021323325984000_11.9.e050341.3","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pntd.0000461"},{"key":"2022021323325984000_11.9.e050341.4","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0008965","article-title":"Onchocerca volvulus and epilepsy: a comprehensive review using the Bradford Hill criteria for causation","volume":"15","author":"Colebunders","year":"2021","journal-title":"PLoS Negl Trop Dis"},{"key":"2022021323325984000_11.9.e050341.5","doi-asserted-by":"crossref","first-page":"1278","DOI":"10.1016\/S1473-3099(18)30425-0","article-title":"The temporal relationship between onchocerciasis and epilepsy: a population-based cohort study","volume":"18","author":"Chesnais","year":"2018","journal-title":"Lancet Infect Dis"},{"key":"2022021323325984000_11.9.e050341.6","doi-asserted-by":"crossref","first-page":"ofaa206","DOI":"10.1093\/ofid\/ofaa206","article-title":"A second population-based cohort study in Cameroon confirms the temporal relationship between onchocerciasis and epilepsy","volume":"7","author":"Chesnais","year":"2020","journal-title":"Open Forum Infect Dis"},{"key":"2022021323325984000_11.9.e050341.7","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1684\/epd.2020.1164","article-title":"Persons with onchocerciasis-associated epilepsy and nodding seizures have a more severe form of epilepsy with more cognitive impairment and higher levels of Onchocerca volvulus infection","volume":"22","author":"Abd-Elfarag","year":"2020","journal-title":"Epileptic Disord"},{"key":"2022021323325984000_11.9.e050341.8","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0007300","article-title":"Onchocerciasis-associated epilepsy in the Democratic Republic of Congo: clinical description and relationship with microfilarial density","volume":"13","author":"Siewe Fodjo","year":"2019","journal-title":"PLoS Negl Trop Dis"},{"key":"2022021323325984000_11.9.e050341.9","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1093\/inthealth\/ihaa012","article-title":"Meta-Analysis of epilepsy prevalence in West Africa and its relationship with onchocerciasis endemicity and control","volume":"12","author":"Siewe Fodjo","year":"2020","journal-title":"Int Health"},{"key":"2022021323325984000_11.9.e050341.10","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0007407","article-title":"From river blindness to river epilepsy: implications for onchocerciasis elimination programmes","volume":"13","author":"Colebunders","year":"2019","journal-title":"PLoS Negl Trop Dis"},{"key":"2022021323325984000_11.9.e050341.11","doi-asserted-by":"publisher","DOI":"10.1093\/inthealth\/ihx054"},{"key":"2022021323325984000_11.9.e050341.12","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1093\/trstmh\/traa193","article-title":"What does the COVID-19 pandemic mean for the next decade of onchocerciasis control and elimination?","volume":"115","author":"Hamley","year":"2021","journal-title":"Trans R Soc Trop Med Hyg"},{"key":"2022021323325984000_11.9.e050341.13","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0006702","article-title":"Community-directed vector control to supplement mass drug distribution for onchocerciasis elimination in the Madi mid-North focus of northern Uganda","volume":"12","author":"Jacob","year":"2018","journal-title":"PLoS Negl Trop Dis"},{"key":"2022021323325984000_11.9.e050341.14","doi-asserted-by":"crossref","DOI":"10.1038\/s41598-019-51835-0","article-title":"Accelerating river blindness elimination by supplementing MDA with a vegetation \"slash and clear\" vector control strategy: a data-driven modeling analysis","volume":"9","author":"Smith","year":"2019","journal-title":"Sci Rep"},{"key":"2022021323325984000_11.9.e050341.15","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1186\/s40249-018-0497-1","article-title":"Epidemiology of onchocerciasis-associated epilepsy in the Mbam and Sanaga river valleys of Cameroon: impact of more than 13 years of ivermectin","volume":"7","author":"Siewe Fodjo","year":"2018","journal-title":"Infect Dis Poverty"},{"key":"2022021323325984000_11.9.e050341.16","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1186\/s40249-020-0628-3","article-title":"Prevalence and incidence of nodding syndrome and other forms of epilepsy in onchocerciasis-endemic areas in northern Uganda after the implementation of onchocerciasis control measures","volume":"9","author":"Gumisiriza","year":"2020","journal-title":"Infect Dis Poverty"},{"key":"2022021323325984000_11.9.e050341.17","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1186\/s40249-019-0517-9","article-title":"Low prevalence of epilepsy and onchocerciasis after more than 20\u2009years of ivermectin treatment in the Imo River Basin in Nigeria","volume":"8","author":"Siewe","year":"2019","journal-title":"Infect Dis Poverty"},{"key":"2022021323325984000_11.9.e050341.18","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1186\/s40249-018-0496-2","article-title":"The effect of bi-annual community-directed treatment with ivermectin on the incidence of epilepsy in onchocerciasis endemic villages in South Sudan: a study protocol","volume":"7","author":"Abd-Elfarag","year":"2018","journal-title":"Infect Dis Poverty"},{"key":"2022021323325984000_11.9.e050341.19","doi-asserted-by":"crossref","DOI":"10.3390\/pathogens9040315","article-title":"The role of the Maridi dam in causing an onchocerciasis-associated epilepsy epidemic in Maridi, South Sudan: an epidemiological, sociological, and entomological study","volume":"9","author":"Lakwo","year":"2020","journal-title":"Pathogens"},{"key":"2022021323325984000_11.9.e050341.20","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1186\/s13071-019-3345-7","article-title":"Impact of 19 years of mass drug administration with ivermectin on epilepsy burden in a hyperendemic onchocerciasis area in Cameroon","volume":"12","author":"Boull\u00e9","year":"2019","journal-title":"Parasit Vectors"},{"key":"2022021323325984000_11.9.e050341.21","unstructured":"Hendy A . Blackfly ecology and Onchocerca volvulus transmission in three formerly hyperendemic foci in Uganda, Tanzania and Cameroon. [PhD Thesis] 2018; University of Antwerp. Available: https:\/\/repository.uantwerpen.be\/docman\/irua\/7a3e67\/13135.pdf"},{"key":"2022021323325984000_11.9.e050341.22","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0008926","article-title":"The Mbam drainage system and onchocerciasis transmission post ivermectin mass drug administration (MDA) campaign, Cameroon","volume":"15","author":"Abong","year":"2021","journal-title":"PLoS Negl Trop Dis"},{"key":"2022021323325984000_11.9.e050341.23","doi-asserted-by":"publisher","DOI":"10.1046\/j.0269-283x.2001.00300.x"},{"key":"2022021323325984000_11.9.e050341.24","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1093\/inthealth\/ihz044","article-title":"Low ivermectin use among 5- to 6-year-old children: observations from door-to-door surveys in onchocerciasis-endemic regions in Africa","volume":"12","author":"Siewe Fodjo","year":"2020","journal-title":"Int Health"},{"key":"2022021323325984000_11.9.e050341.25","first-page":"519","article-title":"Le diagnostic parasitologique de l\u2019onchocercose: revue critique des m\u00e9thodes en usage","volume":"38","author":"Prost","year":"1978","journal-title":"M\u00e9decine Trop"},{"key":"2022021323325984000_11.9.e050341.26","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1016\/j.actatropica.2018.01.009","article-title":"The blackfly vectors and transmission of Onchocerca volvulus in Mahenge, south eastern Tanzania","volume":"181","author":"Hendy","year":"2018","journal-title":"Acta Trop"},{"key":"2022021323325984000_11.9.e050341.27","unstructured":"Iliffe S , Wilcock J , Drennan V . Chapter 5: five main stages in framework analysis. NIHR Journals Library, 2015. https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK286110\/"},{"key":"2022021323325984000_11.9.e050341.28","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1179\/136485911X12987676649700","article-title":"A guide to the Simulium damnosum complex (Diptera: Simuliidae) in Nigeria, with a cytotaxonomic key for the identification of the sibling species","volume":"105","author":"Post","year":"2011","journal-title":"Ann Trop Med Parasitol"},{"key":"2022021323325984000_11.9.e050341.29","doi-asserted-by":"publisher","DOI":"10.1016\/0035-9203(78)90039-1"},{"key":"2022021323325984000_11.9.e050341.30","first-page":"88","article-title":"The differential dispersal of nulliparous and parous Simulium damnosum","volume":"26","author":"Duke","year":"1975","journal-title":"Tropenmed Parasitol"},{"key":"2022021323325984000_11.9.e050341.31","doi-asserted-by":"crossref","unstructured":"Jacob B , Loum D , Munu D , et al . Optimization of slash and clear community-directed control of Simulium damnosum sensu stricto in Northern Uganda. Am J Trop Med Hyg;104:1394\u2013403.doi:10.4269\/ajtmh.20-1104","DOI":"10.4269\/ajtmh.20-1104"},{"key":"2022021323325984000_11.9.e050341.32","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/172.5.1414"},{"key":"2022021323325984000_11.9.e050341.33","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1186\/s13071-016-1623-1","article-title":"Analysis of age-dependent trends in Ov16 IgG4 seroprevalence to onchocerciasis","volume":"9","author":"Golden","year":"2016","journal-title":"Parasit Vectors"},{"key":"2022021323325984000_11.9.e050341.34","doi-asserted-by":"crossref","unstructured":"Niamsi-Emalio Y , Nana-Djeunga HC , Chesnais CB . Unusual localization of blood-borne Loa loa microfilariae in the skin depends on microfilarial density in the blood: Implications for onchocerciasis diagnosis in co-endemic areas. Clin Infect Dis 2021:ciab255.","DOI":"10.1093\/cid\/ciab255"},{"key":"2022021323325984000_11.9.e050341.35","first-page":"667","article-title":"A force-of-infection model for onchocerciasis and its applications in the epidemiological evaluation of the onchocerciasis control programme in the Volta River Basin area","volume":"64","author":"Remme","year":"1986","journal-title":"Bull World Health Organ"},{"key":"2022021323325984000_11.9.e050341.36","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1159\/000355921","article-title":"Methodological difficulties in the conduct of neuroepidemiological studies in low- and middle-income countries","volume":"42","author":"Bharucha","year":"2014","journal-title":"Neuroepidemiology"},{"key":"2022021323325984000_11.9.e050341.37","first-page":"103","article-title":"D\u00e9pistage de l\u2019\u00e9pilepsie en zones tropicales: validation d\u2019un questionnaire en Mauritanie","volume":"1990","author":"Diagana","year":"2006","journal-title":"Bull Soc Pathol Exot"},{"key":"2022021323325984000_11.9.e050341.38","doi-asserted-by":"publisher","DOI":"10.1111\/epi.12550"},{"key":"2022021323325984000_11.9.e050341.39","doi-asserted-by":"publisher","DOI":"10.1016\/S0035-9203(02)90433-5"},{"key":"2022021323325984000_11.9.e050341.40","doi-asserted-by":"publisher","DOI":"10.1370\/afm.141"},{"key":"2022021323325984000_11.9.e050341.41","unstructured":"Kleinman K , Sakrejda A , Moyer J . clusterPower: power calculations for cluster-randomized and cluster-randomized crossover trials, 2021. Available: https:\/\/CRAN.R-project.org\/package=clusterPower [Accessed 9 Feb 2021]."},{"key":"2022021323325984000_11.9.e050341.42","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyx169"},{"key":"2022021323325984000_11.9.e050341.43","doi-asserted-by":"crossref","first-page":"2044","DOI":"10.1056\/NEJMoa1705026","article-title":"A Test-and-Not-Treat strategy for onchocerciasis in Loa loa-Endemic areas","volume":"377","author":"Kamgno","year":"2017","journal-title":"N Engl J Med"},{"key":"2022021323325984000_11.9.e050341.44","first-page":"923","article-title":"[Latency period in onchocerciasis]","volume":"58","author":"Prost","year":"1980","journal-title":"Bull World Health Organ"},{"key":"2022021323325984000_11.9.e050341.45","doi-asserted-by":"crossref","first-page":"316","DOI":"10.1186\/s13071-018-2864-y","article-title":"Modelling the impact of larviciding on the population dynamics and biting rates of Simulium damnosum (s.l.): implications for vector control as a complementary strategy for onchocerciasis elimination in Africa","volume":"11","author":"Routledge","year":"2018","journal-title":"Parasit Vectors"},{"key":"2022021323325984000_11.9.e050341.46","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0007557","article-title":"Modelling exposure heterogeneity and density dependence in onchocerciasis using a novel individual-based transmission model, EPIONCHO-IBM: implications for elimination and data needs","volume":"13","author":"Hamley","year":"2019","journal-title":"PLoS Negl Trop Dis"},{"key":"2022021323325984000_11.9.e050341.47","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1186\/s13071-018-2944-z","article-title":"Audit of the community-directed treatment with ivermectin (CDTI) for onchocerciasis and factors associated with adherence in three regions of Cameroon","volume":"11","author":"Kamga","year":"2018","journal-title":"Parasit Vectors"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2021-050341","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,2,14]],"date-time":"2022-02-14T03:13:52Z","timestamp":1644808432000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2021-050341"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,9]]},"references-count":47,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2021,9,2]]},"published-print":{"date-parts":[[2021,9]]}},"alternative-id":["10.1136\/bmjopen-2021-050341"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2021-050341","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,9]]}}}