CIENCIA Y ARTE DE ENFERMERÍa oriiginal

article

Beliefs of Ivermectin’s preventive capacity for COVID-19

in people from rural areas

Janet Mercedes Arévalo-Ipanaque 1

Creencias de la capacidad preventiva de la Ivermectina Dora Clarisa Muñoz Garay 2
para COVID-19 en personas de una zona rural Fabricio Alonso Lévano Bautista 3
Flavio Paolo Dagnino Guzmán 4

ABSTRACT. Objectives: To address the beliefs of the effect of veterinary Ivermectin 1% orally as a preventive of COVID
-19 in people from a rural area. Methods: A qualitative-phenomenological study was carried out, with a sample obtained
by saturation, composed of ten adult residents of a rural community, accidentally selected when they went to the place
where 1% ivermectin was dispensed for veterinary use. To whom the semi-structured interview was applied. Results: The
information about beliefs was grouped into three categories: anguish and onset of the disease in the area, awareness -
search for prevention and belief - confidence - no discomfort. Conclusions: The belief that the population has about the
preventive effect of veterinary ivermectin for COVI-19 infection, causes them to take it voluntarily and individually on a
monthly basis, referring that with its consumption they do not present discomfort and maintain health.

Keywords: Belief, ivermectin, prevention

RESUMEN. Objetivo: Abordar las creencias del efecto de Ivermectina veterinaria 1% vía oral como preventivo del COVID
-19 en personas de una zona rural. Métodos: Se realizó un estudio cualitativo fenomenológico, con una muestra obtenida
por saturación, compuesta de diez personas adultas residentes de una comunidad rural, seleccionadas de forma accidental
en el momento que acudían al lugar donde expenden ivermectina 1% de uso veterinario, a quienes se aplicó la entrevista
semiestructurada. Resultados: La información en torno a las creencias fue agrupada en tres categorías: angustia e inicio
de la enfermedad en la zona, conciencia - búsqueda de la prevención y creencia - confianza - no molestia. Conclusión:
La creencia que tiene la población sobre el efecto preventivo de la ivermectina veterinaria para la infección por COVI-19,
ocasiona que la tomen mensualmente de forma voluntaria e individual, refiriendo que con su consumo no presentan
molestias y conservan la salud.

Palabras clave: Creencia, ivermectina, prevención

1
Master’s Degree in Higher Education Sciences. Research and Scientific
Management Advisor - Regional Council III from Metropolitan Lima of the College
of Nurses of Peru.

orcid.org/0000-0002-2205-0522. Quote as: Arévalo-Ipanaqué JM, Muñoz DC, Lévano FA, Dagnino
FP. Creencias de la capacidad preventiva de la ivermectina para
2
Ph. D. in Management. Professor at the Private University of the North (Universidad COVID -19 en personas de una zona rural. Rev. Cienc y Arte Enferm.
Privada del Norte), Auditor of health services at Peruvian Central Air Force Hospital 2020; 5(2): 26-30 DOI: 10.24314/rcae. 2020.v5n6.05
(HCFAP).
Correspondence:
orcid.org/0000-0003-3092-0636 janetarevaloi@gmail.com
34
Student of the VIII semester of the Nursing career at the Autonomous University
of Ica (Universidad autónoma de Ica). RECEIVED: 15/11/2020 ACCEPTED: 05/12/2020

26 www.cienciaenfermeria.org Los artículos de la revista se publican bajo licencia de Creative Commons Reconocimiento 4.0 Internacional.
 Rev. Cienc. Arte Enferm. 2020; 5(2). ISSN: 1755-7682
INTRODUCTION
The COVID-19 pandemic is a problem that humanity is facing
in a globalized and unprecedented context. Sharing resources,
experiences and learnings, is the only possibility to overcome
this overwhelming and suffered situation for the living being.1
This pandemic affected the world’s population from the be-
ginning, so that by the end of March 2020 most countries had
directives to stay at home, confining about 85% of the popu-
lation or about 227 million people, with all non-essential busi-
nesses closed; having a dramatic impact on the economy, with
unemployment increasing by 4.4%, a figure that continues to
rise.2
As a result, the emergence of SARS-CoV-2, the cause of CO-
VID-19, challenged health systems worldwide. In Peru, from
the beginning of the pandemic, information from the Ministry
of Health (MINSA) indicated that the lethal coronavirus was in-
creasingly spreading throughout the country. In August 2020,
cases increased dramatically in Ica. The mortality rate for CO-
VID-19 in this southern region of the country reached 13.9%,
the highest in Peruvian territory. Chincha Alta was precisely
one of the districts that reported the highest number of dea-
ths in the country, followed by Callao with 12.9%, Lambaye-
que 11.8%, Lima 10.8%, Tumbes 10.6%, La Libertad 9.6%, Mo-
quegua 9.3%, Ancash 9.2%, Piura 8.5%, Loreto 7.6%, Madre de
Dios 7.2%, San Martin 7.0%, Arequipa 6.6%, Ucayali 4.8%, and
Amazonas 4.4%. The last positions in mortality rate were taken
by Cajamarca 2.4%, Huancavelica 1.6%, Cusco 1.5%, Apurimac
1.2% and Puno 1.2%.3
Only two months after the first case of COVID-19 was registe-
red in Peru, the Ministry of Health ordered the addition of iver-
mectin to the treatment protocol against COVID-19, through
Ministerial Resolution No. 270-2020-MINSA dated May 8, 2020.
The official indication for the use of ivermectin was 1 drop (200
mcg) per Kg of weight with a maximum dose of 50 drops, as a
single dose in mild patients and the same dose for two days
in moderate or severe cases of COVID-19. This resolution led
doctors to start indicating treatment based on case evaluation,
prior informed consent and monitoring of adverse events of
prescribed drugs.4
Ivermectin is a broad-spectrum antiparasitic authorized for hu-
man oral use in the treatment of parasitic infestation of stron-
gyloides stercoralis and onchocerca volvulus.5 It is one of the
most widely used drugs in veterinary medicine. Furthermore,
in human medicine, it is used in the treatment of various pa-
rasitosis.
Beliefs of Ivermectin’s preventive capacity for COVID-19 in people from rural areas
After the indiscriminate use of ivermectin began, controver-
sies arose about its preventive effect. An example of this is
what Lescano and Pinto reported regarding the use of this
drug in Peru without scientific evidence, pointing out the con-
sequences that could have the widespread misinformation re-
garding ivermectin as a treatment against COVID-19, added to
the permissibility of veterinary products to be used in human
patients, as well as the important role of veterinary doctors in
this situation.6
Given the lack of scientific evidence proving the efficacy of
ivermectin, on 12 October, MINSA approved the technical do-
cument Management of persons affected by COVID-19 in hos-
pitalization services, with Ministerial Resolution No. 839-2020/
MINSA, which in its article 2, eliminated the use of this drug in
the protocol of care for COVID-19.7
Despite this amendment, the population has continued to use
ivermectin, especially in rural areas where there is a tendency to
believe in and use traditional preventive medicine on a daily basis.
The belief supposes an expectation of action on the part of
the believing subject, since it disposes him/her to act in a cer-
tain way. The individual beliefs are of special relevance becau-
se they refer to the personal identity and these are stored in
the episodic or autobiographical memory, while the social and
cultural beliefs are stored in the semantic memory.8
Therefore, beliefs denote assumptions linked to the responsi-
bility assumed by the population in the face of the conviction
of preventing the disease. Belief is a relevant phenomenon in
the health of the population. The environment that charac-
terizes the studied behavior is characterized by a situation in
which they feel deprived of their freedom as citizens, compl-
ying with the prevention and health control measures issued
by the central government; however, this compliance limits
them in the exercise of their work activities, reducing their
family economy. It is when people make their decisions and,
aware of the effect this drug could have, decide to take it as a
preventive.
This fact has been clearly observed in the population of a rural
community located in Chincha Alta, Department of Ica, south
of Lima, who have developed the habit of consuming ivermec-
tin on a monthly basis, as a measure to prevent infection by
COVID-19.
For this reason, a study was proposed that aimed to address
the beliefs of the effect of 1% ivermectin veterinary use as a
preventive measure against COVID -19 in people in a rural area.
27
 Arévalo J, Muñoz D, Lévano F, Dagnino F

METHODOLOGY
A qualitative phenomenological study was developed, con-
sidering that the qualitative approach deepens in the phe-
nomena, seeking to understand the meaning of exploring a
phenomenon from the point of view of the other, allowing an
approach with areas of psychosocial knowledge.9
The sample obtained by saturation was composed by 10
adults aged between 20 and 53, who were approached in cir-
cumstances in which they received the veterinary ivermectin
in doses of 1 cm by 50 kilograms of weight, associated to 10
cm of pure milk, in a rural zone of the District of Chincha Alta,
Province of Chincha, Department of Ica, Peru.
The data collection period was from June to November 2020.
It included adults who did not have symptoms of COVID-19.
Data collection was done through semi-structured interviews
that lasted approximately 30 minutes and were recorded with
prior authorization and scientific rigor. Participation was vo-
luntary, maintaining ethical principles. The participants were
identified with the keys P1 to P10.
The audios were transcribed assigning codes to each unit of
meaning, constituting the categories of the study that were
analyzed and interpreted with the support of theories and
philosophy, sustaining that from the interior of the being, the
theoretical value is given to the beliefs that demand the inves-
tigator to continue monitoring the events, in order to value the
effect of the drug as a phenomenon of belief.
RESULTS
In the statements of the ten people who received 1% ivermec-
tin for veterinary use against COVID-19, whose dose was 1 cm
per 50 kilogram of weight, associated with 10 cm of pure milk,
three categories were recognized:
P2: “My son got sick and I thought he had the COVID-19, I visi-
ted a doctor to give him some aggressive treatment, and he is
healthy happily.”
Awareness and search for prevention
The participants, upon learning about the benefits of 1% iver-
mectin for veterinary use to prevent COVID-19, asked how
they could have access to it, in order to avoid this terrible di-
sease that kept them distressed and limited in the develop-
ment of their activities. Several of them live from agriculture,
which is their means of economic and family support. Hence,
their expressions were:
P2: “Ivermectin was a light of hope within this pandemic, why
don’t we take it?”
P3: “I heard from some neighbors about ivermectin.”
P4: “I was told by the neighbors that it prevents the disease.”
P5: “The disease forced me to look for ivermectin.”
P5: “It prevents me, I’m taking it and it has worked for me.”
Belief, confidence, and no discomfort
The inhabitants of these areas began to strengthen their beliefs
and confidence in the 1% ivermectin for veterinary use against
COVID-19, in addition to the fact that there was information in
the media. This belief became more and more entrenched in
them because when they consumed it, they did not present
any adverse effect or discomfort. The residents began to build
confidence with the medication, which is why they continued
to take it every month.
P6: “I have confidence in it, I’m taking it for three or four mon-
ths, I feel good, I have no problems, so I continue to prevent.”

Distress and onset of disease in the area P7: “I have confidence in it, it prevents, I have no discomfort.”

The participants said that at the beginning of the disease, they P8: “I’m taking it monthly and I don’t feel any discomfort.”
did not pay much attention to it because the disease was not
yet present in their area. However, when it spread to the rural P8: “I have no discomfort and it is the sixth dose I take.”
area, they were informed of the deaths of family members and
close neighbors. Then they felt an increase in their emotions
such as distress, fear, desperation, and anxiety, by seeing their
area deserted as people stayed in their homes to protect their
health. In the face of this situation, they express the following:

P2: “I am afraid of what is happening, nobody has ever died

this way before.”

P2: “They are my neighbors. I feel a lot of longing because they

were young.”

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 Rev. Cienc. Arte Enferm. 2020; 5(2). ISSN: 1755-7682
FINAL CONSIDERATION
Ivermectin is one of the most widely used antiparasitic drugs
in veterinary medicine.6 However, no scientific evidence is
found to support its efficacy and safety as a preventive treat-
ment against SARS-CoV-2 in humans. Chirinos et al.10 state
that possible interactions between ivermectin and multiple
drugs used in patients with COVID-19 are unknown.
On the other hand, the pandemic has meant facing an unk-
nown situation characterized by a deadly disease that puts
rural people in a vulnerable position.
It is known that the spectrum of this disease is wide and in-
cludes from mild and self-limited symptoms to severe and
progressive atypical pneumonia, multiorgan failure and even
death.11
The search for health and survival was born among the in-
habitants in the face of the information about the increase
in the number of deaths and COVID-19 infections. In Ica, the
lethal coronavirus presented a mortality rate of 13.9%, the hi-
ghest in Peruvian territory.3
In this context, the population of the rural area shows rest-
lessness, a threat that is more intense every day, which gene-
rates a concern for not knowing what drugs can prevent with
the expected effectiveness and solve the disease that is la-
tent in this geographical area. Being aware that they needed
to have some preventive protection that would allow them
to continue developing their activities; the concern started
the search for preventive drugs. Here comes the news of the
benefits of ivermectin.
We know that distress appears in the man at a moment that
has as a starting point the state of unconsciousness, when
the spirit sleeps and then does not distinguish his self from
the rest of his, when what there is is nothing: empty existen-
ce, and this nothing is at the same time the suggestion of
a possibility that cannot but distress. This possibility, which
becomes present in nothingness, is the distress.12
On the other hand, the consciousness converges, which is a
psychic process that actively participates leading man to un-
derstand the objective world and his personal being.13
Therefore, prevention requires changes at the individual and
social psychological level that are considered in the different
stages of the preventive process, avoiding a risk or unfavo-
rable event that causes damage. It is in this context that the
population values its health and resorts to prevent unwanted
events.
On the other hand, belief is a subjective truth, a conviction,
something that the subject considers to be true and allows
the subject to relate to the (mental) representation.8
Beliefs of Ivermectin’s preventive capacity for COVID-19 in people from rural areas
In the desire to prevent health, the population resorts to their
conviction of certainty that the medicine will benefit them,
they believe in what they cannot see or prove scientifically
and they support it in an act of faith as it happens in religions.
Therefore, it can be stated that the population is informed
about the crisis in which Peru is, becoming aware that they
are exposed to the disease by COVID-19 which, in addition
to being fatal, does not have an effective treatment known.
In this emergency situation, the inhabitants assume the de-
cision to self-medicate with ivermectin as a preventive mea-
sure, an antiparasitic drug that was initially widespread and
even approved by the health authorities. This behavior per-
sists because the threat has not been destroyed and is rein-
forced because those who consume it do not feel any adver-
se effects that would make them distrustful.
It is concluded that the present study allows elucidating the
beliefs expressed by the inhabitants before the administra-
tion of 1% ivermectin for veterinary use, who by their own
will assume the responsibility of the effects that the drug
can cause and that, through an act of faith and religious
approach, decide to consume it on a monthly basis, even
more, with the confidence that they have not presented in-
conveniences that could limit its consumption.
It is important to highlight that the reliability generated by
not having presented discomfort that puts their health at risk
during the months that they are consuming the dose of iver-
mectin, allows them to cling to continue consuming it as a
preventive measure and become multipliers of information,
so that more people participate in the measure chosen, con-
sidering that so far they are doing well.
Conflicts of Interest: The authors state that there are no con-
flicts of interest.
29
 Arévalo J, Muñoz D, Lévano F, Dagnino F

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