Prevalence of Onchocerca volvulus nodules in the Sankuru River Valley, Democratic Republic of the Congo, and reliability of verbal assessment as a method for determining prevalence

The epidemiology of onchocerciasis in much of the Democratic Republic of the Congo (formerly Zaire) is not well established. We report the results of an onchocerciasis rapid assessment survey carried out in 18 villages of the Sankuru River Valley in the central part of this country in preparation for mass distribution of ivermectin. Thirty men from each village were randomly selected and examined for subcutaneous nodules. The prevalence of nodules among these men in each village ranged from 82.5% to 100% with a mean prevalence of 95.0%. This study also assessed the validity of using verbal assessment instead of physical examination to determine prevalence of nodules. This verbal method had a sensitivity of 93.5% and a specificity of 83.3%. High sensitivity and specificity for this method suggest that it might be a cost-effective approach to determine the prevalence of onchocerciasis over large areas without using physical examinations requiring medical personal. This approach could be particularly useful when the coverage of health services is poor. The use of the Global Positioning System made it possible to send coordinates and survey data electronically to World Health Organization personnel in Geneva for computer generation of prevalence maps. The use of river boats to conduct surveys and support ivermectin distribution in the Congo is discussed.