Operational Assessment of the Community-Directed Treatment with Ivermectin Programme for Onchocerciasis Control in Enugu State, South East Nigeria

Community-directed treatment with ivermectin has served as the primary strategy for onchocerciasis control across Nigeria since the 1990s, yet programme fidelity and community distributor performance remain variable across states. This study conducts an operational assessment of the community-directed treatment with ivermectin programme in Enugu State, South East Nigeria. A cross-sectional programme evaluation design was used, covering 30 implementation communities in Igbo-Eze North, Udi, and Aninri Local Government Areas. Data collection tools included structured interviews with community-directed distributors, focus group discussions with community leaders, facility register reviews, and direct observation of drug distribution practices. Key performance indicators assessed included therapeutic coverage rate, community distributor training frequency, drug supply reliability, and adverse event reporting. Evidence from 2020 to 2024 identifies persistent programme gaps including inadequate supervision of community distributors, low coverage in migrant and forest communities, and missed annual distribution rounds due to drug stockouts. This study produces a performance gap analysis and community-level coverage maps to guide remedial action. Recommendations will be submitted to the Enugu State NTD Control Programme and the Federal Ministry of Health Neglected Tropical Diseases Division. Findings will support Nigeria's reporting commitments under the WHO NTD roadmap for 2030. Keywords: community-directed treatment, ivermectin, onchocerciasis, programme assessment, Enugu State.