{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T04:39:04Z","timestamp":1792557544137,"version":"4.5.0"},"reference-count":24,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T00:00:00Z","timestamp":1785110400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T00:00:00Z","timestamp":1792540800000},"content-version":"vor","delay-in-days":86,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Public Health"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Onchocerciasis (river blindness) persists in Bo District, Sierra Leone, despite decades of ivermectin-based mass drug administration (MDA). Programmatic efforts have prioritized parasitological and ocular outcomes, so the socio-economic and psychological burden of the disease within affected communities remains poorly quantified. We aimed to determine the magnitude, structure and distribution of this non-clinical burden.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We used an explanatory sequential mixed-methods design (QUAN\u2009\u2192\u2009qual). In the quantitative phase, 1,500 adults across five endemic chiefdoms of Bo District (Bagbwe, Baoma, Gbo, Selenga, Tikonko) were surveyed using multistage cluster sampling. Socio-economic impact (range 0\u20132) and psychological impact (range 0\u20133) were each measured with a formative composite index summing binary items on economic hardship, education\/employment obstacles, emotional well-being, social stigma, and self-esteem. Instruments were forward- and back-translated into Mende, pilot-tested (Cronbach\u2019s \u03b1\u2009=\u20090.76\u20130.81), and administered on Android tablets using ODK Collect. We used chi-square tests, one-way ANOVA, independent-samples t-tests and Spearman correlation in JASP (v0.18). Eleven key informant interviews and eight focus group discussions (five participants each,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200940) were analysed thematically to explain the quantitative findings. Ethical approval was granted by the Njala University Institutional Review Board (NUIRB) on 14 April 2024.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The burden was extensive: 71.7% (95% CI 69.4\u201374.0) of respondents reported economic hardship and 95.8% (95% CI 94.7\u201396.7) scored at least one psychological impact. The socio-economic and psychological indices were statistically independent (\u03c1\u2009=\u2009.026,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.311) and did not differ significantly across chiefdoms (\n                      <jats:italic>F<\/jats:italic>\n                      (4,1495)\u2009=\u20091.91,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.106), sexes (t(1498)\u2009=\u20090.26,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.796), or age groups (\n                      <jats:italic>F<\/jats:italic>\n                      (2,1497)\u2009=\u20090.80,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.451). Qualitative themes described a productivity-poverty cycle, stigma experienced as \u201csocial death,\u201d and an unrecognized gendered caregiving load.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Onchocerciasis imposes a pervasive, uniformly distributed dual burden in Bo District that is invisible to parasitological surveillance. Morbidity-management, stigma-reduction and psychosocial support should be delivered population-wide and integrated into primary healthcare and MDA delivery rather than targeted narrowly at demographic risk groups.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12889-026-28720-3","type":"journal-article","created":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T01:45:14Z","timestamp":1785116714000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The pervasive socio-economic and psychological burden of onchocerciasis in endemic communities of Bo District, Sierra Leone: an explanatory sequential mixed-methods study"],"prefix":"10.1186","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-2145-1327","authenticated-orcid":false,"given":"Augustine Bob","family":"Moseray","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alhaji Brima","family":"Gogra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rashid","family":"Ansumana","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,27]]},"reference":[{"key":"28720_CR1","doi-asserted-by":"publisher","unstructured":"Adjorlolo S, Adimado EE, Setordzi M, Akorli VV. 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All participants gave voluntary informed consent; for non-literate participants, consent was documented by thumbprint witnessed by an independent community member, an oral-consent procedure approved by the review board.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable; no individually identifying data are presented.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"3029"}}