ArticleBMC public health2026
The pervasive socio-economic and psychological burden of onchocerciasis in endemic communities of Bo District, Sierra Leone: an explanatory sequential mixed-methods study.
Article in BMC public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundOnchocerciasis (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.
methodsWe used an explanatory sequential mixed-methods design (QUAN → qual). 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 0-2) and psychological impact (range 0-3) 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's α = 0.76-0.81), 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 = 40) were analysed thematically to explain the quantitative findings. Ethical approval was granted by the Njala University Institutional Review Board (NUIRB) on 14 April 2024.
resultsThe burden was extensive: 71.7% (95% CI 69.4-74.0) of respondents reported economic hardship and 95.8% (95% CI 94.7-96.7) scored at least one psychological impact. The socio-economic and psychological indices were statistically independent (ρ = .026, p = .311) and did not differ significantly across chiefdoms (F(4,1495) = 1.91, p = .106), sexes (t(1498) = 0.26, p = .796), or age groups (F(2,1497) = 0.80, p = .451). Qualitative themes described a productivity-poverty cycle, stigma experienced as "social death," and an unrecognized gendered caregiving load.
conclusionsOnchocerciasis 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.
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