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Dr. Cottenpurg is working with a team of Canadian physicians in a remote region in west Africa. He is particularly interested in the mass dosing campaign that has been undertaken to eradicate onchorcerciasis with a novel formulation of the anti-filarial drug, ivermectin. The villagers have been given the standard oral dose. For three days after dosing a nurse was available in the village to record adverse events and provide treatment if necessary. A preliminary survey of the microfilarial load in the given village had been carried out using skin snips. The mean number of microfilariae per mg of skin varied between 10 to 20.

The team records all adverse events. However the most common appear to be worsening of pruritis, fever and headache (please see Table below).

The Canadian team has its base at Achi Agu and 20 of them who showed positive skin snips were also given the drug. 16 of them reported increased itching and a spreading rash as well as fever.

Dr. Cottenpurg asks his young assistant, Melanie, to sketch out a map of the region and record the number of adverse events in each of the villages. When she hands him the sketch he asks her to explain the distribution of the adverse events.

Village Number treated Number adverse events %
Achi Agu 2300 276 12
Bongo 1015 213 21
Choyo 400 140 35


This problem presents simulated data that allowed students to explore mass dosing campaigns, international health and the problems of managing parasitic infections in the Third World. As the last problem in the series, it returned them to a reconsideration of adverse drug reactions and the variability introduced by diet, genetics etc.

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