Additional health and development activities for community-directed distributors of ivermectin: threat or opportunity for onchocerciasis control? 
We studied the involvement of community-directed distributors (CDDs) of ivermectin for onchocerciasis control in other health and development activities in Nigeria, Togo and Cameroon.  Most CDDs (82%) were involved in additional activities, especially EPI, water and sanitation and community development projects.  These activities did not take up much time and were not considered an important burden.  Ivermectin treatment coverage did not decline with increasing number of additional activities.  Other health programmes are interested in building on the experiences and structures of community-directed treatment with ivermectin and involving CDDs in their health programmes.  Some, such as EPI, provide financial incentives.  Incentives by other programmes may enhance the performance of CDDs when they are selected on the basis of their CDD status.  CDDs, health personnel and community members have very positive attitudes towards greater involvement of CDDs in additional health and development activities.  We conclude that additional activities for CDDs do not pose a threat to but rather provide an opportunity to strengthen sustainability and effectiveness of ivermectin treatment.