Ivermectin dosing based on physical appearance

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Abstract
Ivermectin is a safe and effective microfilaricide which has been shown to have a beneficial impact on some onchocercal eye lesions. Current requirements for the distribution of ivermectin are that patients be weighed, and that their dose be determined according to their weight. This requirement increases the cost of distributing the drug to communities in need of treatment and, when scales breakdown, may lead to the suspension of distribution. Data are presented on a simple, alternative method of dose assessment based on the physical appearance of the patient. Fifteen assessors achieved an overall level of agreement with the weight-based schedule of 86% on a sample of 6420 patients. The level of agreement varied between assessors, from 73% to 95%. About 6% of the population would have received doses outside the range of the current weight-based schedule. We believe that the current insistence that each individual's dose of ivermectin be determined by weighing will hamper efforts to distribute the drug to those most in need of it and that our data indicate that workers can be trained to distribute ivermectin safely without weighing every individual. We would welcome confirmation of our findings from other populations.