Comparison of three strategies for mass distribution of ivermectin in Achi, Nigeria

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Abstract
The Nigerian Ministry of Health has estimated that there are 40 million people in Nigeria at risk of onchocerciasis, and has asked for supplies of free ivermectin (Mectizan) to be donated by Merck, Sharpe and Dohme. In anticipation, three methods of distribution—door-to-door, clinic-based and centralized—were compared for cost-effectiveness. Costs were based on market values, and included salaries of and per diem payments to staff, cost of transportation, and subsistence during field activities. Effectiveness was measured by the total number of subjects successfully dosed. The local cost of dosing was N3.7 per person for the centralized system, N5.8 for the clinic-based system, and N9.2 for the door-to-door system (N10 = U.S.$1).