Life cycle of Onchocerca volvulus

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Transmission Cycle

• Life cycle of Onchocerca volvulus

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Villages near Riverblindness-infested River
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• A young boy leading 2 blind men

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Distribution of Onchocerciasis
99 in Africa 1 in Latin America and Yemen
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Control/Interventions
Kill the microfil.
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Two-Phase Approach to Defeating Riverblindness
in Africa

• Onchocerciasis Control Program (OCP) 1974-2002
  (11 west African countries)
• Vector (blackfly) control (1974-2002)
• Parasite (O. volvolus) control (1988-2002)
• African Program for Onchocerciasis Control
  (APOC) 1996-2010 (19 counties)
• Parasite (O. volvolus) control

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Vector control
Vector control
PHASE 1 OCP 1974 2002 1988 - 2002
11 Countries Up to 7 insecticides
700,000,000
OCP Onchocerciasis Control Program
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Mectizan/Ivermectin

• Microfilaricide

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Mectizan (Ivermectin)

• History Discovered by Merck in 1970s and
  developed for human use in 1980s
• Activity Rapidly kills microfilariae but not
  adult worms
• Clinical application Established as the first
  extremely safe and highly effective drug for
  treatment of onchocerciasis

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Mectizan (Ivermectin)

• Availability In 1987 Merck announced the
  decision to provide Mectizan free of charge for
  as long as needed to control and eliminate
  onchocerciasis as a public health problem
  worldwide

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Benefits of MectizanTreatment

• Prevents worsening of vision and blindness
• Prevents itching and disabling skin lesions
• Improves skin condition and self- esteem
  especially for women
• Promotes resettlement back into previously
  deserted farm land

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Benefits of MectizanTreatment

• Improves school attendance and literacy for
  children and labour productivity for adults
• Effective against scabies, mites, lymphatic
  filariasis and intestinal worms, i.e. Ascaris
  lumbricoides

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Mectizan Distribution Strategies

• Passive distribution
• - Health centers or clinics
• - Mobile clinics
• Community-directed treatment with ivermectin
  (CDTI)
• - Communities are empowered to manage their
  own health through a partnership between
  community health care workers, NGOs, national
  government and WHO/APOC.

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CDTI Strategy

• Project Defined by the National Government
• Funding WHO/APOC (75 of budget), NGDO (20)
  and National Government (5 first year, with
  increasing amounts subsequently)
• NGDO and the Government are responsible for
  technical and administrative management of the
  project
• Sensitize village chiefs and community leaders

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CDTI Strategy

• 5. Train local medical staff (doctors nurses)
• 6. Select and train village-based community
  distributors (CDs)
• 7. Implementation of the CDTI program by CDs, in
  partnership with APOC, NGDO and the Government
• 8. Sustainability of the project and integration
  with other healthcare interventions

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AFRICAN PROGRAM FOR ONCHOCERCIASIS CONTROL
PHASE 2 APOC (19 countries)CDTI Strategy1996
- 2015
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Distribution of Onchocerciasis in DRC JAF-10
12/2003, Kinshasa
Total Population 60 Millions 23.7 million
people at risk 7 million people infected
70,000 blinded
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23 CDTI PROJECTS (At various stages)
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CDTI Kasongo
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CDTI KASONGO

• Area West Virginia or 3x size of NJ
• Population 914,155
• (3 Territories, 8 Health Zones 112 Health
  Centers)
• Prevalence of onchocerciasis
• 40-59
• Projected CDTI Manpower Needs
• 8 doctors
• 8 nurses 58 assistant nurses
• 10,755 Community Distributors

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Basic Demographics on CDTI Kasongo
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Proposed Projects for CDTI Kasongo

• Riverblindness control eradication
• Integration of riverblindness control with
  other healthcare interventions
• Prevent childhood blindness (vitamin A)
• Control of intestinal worms
• Provision of clean water (wells)
• Malaria control (mosquito nets)

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Riverblindness Proposed 2007 Budget 169,303

• Contributions by Partners
• WHO/APOC 75 or 126,978
• UFAR (NGDO) 20 or 33,860
• Government 5 or 8,465

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Distribution of 2007 Budget 169,303

• Itemized Expenses
• Personnel 15,924
• Capital Equipment 73,120
• Supplies 5,917
• Training 14,887
• Travel 17,800
• Communication 5,650
• Operation Consultants 25,005
• Field Office 11,000

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Fundraising strategies

• Individual donors
• Youth concert 6,500
• Religious organizations
• PUMC 7,417
• NPC 2,330
• Academic institutions
• Foundations and Corporations
• Merck 41,000
• Private clubs
• Lawrenceville Rotary 2,500
• Princeton Rotary Club 2,000
• Trenton Rotary Club 1,165
• Hamilton-Washington 500

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Composition of Coordination Team CDIT Kasongo

• Project coordinator (MD)
• 2 Administrative assistants
• Driver
• Sentry

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Progress Report

• Local chiefs, leaders people have been informed
  and sensitized August 2005
• Local project coordinating group has been
  established Dr. Arthur Nondo associates
  February 2006
• Local doctors nurses have been trained October
  2006
• Community workers/distributors have been selected
  and trained February 2007
• Launch of Mectizan distribution June 2007

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Plans for Mectizan Distribution(Number of people
to be treated)

• 2007 200,000 people
• 2008 200,000 200,000 400,000 people
• 2009 200,000 200,000 200,000
  600,000 people
• 2010 200,000 200,000 200,000
  200,000 800,000 people
• 2011 200,000 200,000 200,000 200,000
  200,0001,000,000 people
• 2012-2022 Similar to year 2011

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Accessibility to Kasongo

• Extremely difficult by road, railway or
  waterway
• Best options by air
• ECHO Flight (EU), free once a week
• MONUC/UN, free once a week
• Air Serv International (US), charged twice a
  week

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Poor bridges (driving through water)
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• Poor roads

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Crossing Congo River on Canoe Drs. Shungu
Ntumba
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Vehicle for CDTI KasongoKinshasa, June 2007
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Motorcycles Bicycles for CDTI KasongoKinshasa,
June 2007
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Air servicesECHO Flight (EU), Goma airport
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Hotel IhusiGoma, June 2007
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Hotel IhusiGoma, June 2007
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Hotel Ihusi Lake KivuGoma, June 2007
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Kasongo AirfieldJune 2007
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Kasongo AirfieldUnloading motorcycles, June 2007
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Kasongo AirfieldUnloaded motorbicycles Bikes
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CDTI Kasongo OfficeKasongo, June 2007
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Aerial view of a section of Kasongo
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Community Meeting Chiefs, village leaders
local NGOs (7/2005)
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Community Sensitization MotivationOctober 2006
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Training Doctors NursesOctober 2006
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Training Doctors Nurses Drs. Temor Ntumba
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Trained Doctors NursesOctober 2006
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Training of Community WorkersFebruary 2007
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Training of Community Distributors (CDs)
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Launch Ceremony of CDTI KasongoPublicity 25
June 2007
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Launch Ceremony of CDTI KasongoHotel Palace,
Kasongo 25 June 2007
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Launch Ceremony of CDTI KasongoOpening remarks
by Provincial Administrator25 June 2007
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Launch Ceremony of CDTI KasongoOpening remarks
by the Governors representative25 June 2007
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Launch Ceremony of CDTI KasongoHotel Palace,
Kasongo25 June 2007
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Launch Ceremony of CDTI Kasongo25 June 2007
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Launch Ceremony of CDTI KasongoDose
determination by height25 June 2007
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Launch Ceremony of CDTI KasongoTaking the annual
dose of Mectizan 25 June 2007
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Launch Ceremony of CDTI KasongoDose
determination, Mayor of Kasongo25 June 2007
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Launch Ceremony of CDTI KasongoMayor of Kasongo
25 June 2007
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Launch Ceremony of CDTI KasongoPublicity by a
community worker25 June 2007
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Support of CDTI Kasongo by other NGOsConcerns
Staff, Kasongo
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Support of CDTI Kasongo by other NGOsConcerns
Staff, Kasongo
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Proposed Partnership

• Rotary Clubs of Kinshasa, Kingabwa and Binza
  have expressed strong interest
• A Volunteer Service Grant Application from RI for
  an exproratory field trip by between DRC and US
  members is being completed

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Suggested Areas of Potential Rotary Involvement

• I. Riverblindness
• Immediate Support of CDTI Kasongo
• Promotional items T-shirts, hats, pencils, pins
• Computer printer for UFARs Kinshasa office
• Contribution toward purchase of vehicle for use
  in Kinshasa
• Long term involvement
• Sole support of Tunda Kibombo project
• Provide small scholarships for student wishing to
  intern with UFAR
• II. Provision of potable water

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With President of Rotary Club of KinshasaGrand
Hotel
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Rotary Club of KinshasaJuly 2005
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Mr. Ntumba of Rotary Club of Kinshasa Visiting
Princeton Rotary ClubJuly 2005
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Paul Harris FellowsRotary Club of Kinshasa
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Rotary Club of Kinshasa-KingabwaExchange of
pennants, June 2007
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Rotary Club of Kinshasa-BinzaJune 2007
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Existing semi-private wellKasongo, October 2006
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Dirty Water from Existing WellKasongo, October
2006
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Conditions of existing wellsKasongo, October 2006
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Very few public wells existKasongo, June 2007
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Private wellKasongo, June 2007
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Private wellKasongo, June 2007
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Children fetching water2 miles from the
villageKasongo, June 2007
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Fetching waterSource 2 miles awayKasongo,
June 2007
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Fetching waterSource 0.5 miles downKasongo,
June 2007
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Fetching waterSource 0.3 miles downKasongo,
June 2007
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Broken water pipeSource 0.2 miles
downKasongo, June 2007
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Water source2 miles from villageKasongo, June
2007
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Fetching waterSource 2 miles from
villageKasongo, June 2007
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UFARs OfficeKinshasa
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Front of UFARs OfficeKinshasa
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UFARs OfficeKinshasa
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UFARs OfficeKinshasa
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Official NGDO Group MEMBERSfor Onchocercaisis
Control (12/2005)

• Christoffel-Blindenmission (CBM, Germany)
• Helen Keller International (HKI, US)
• Interchurch Medical Assistance (IMA, US)
• Lions Clubs International Foundation (LCIF, US)
• Light for the World (LW, Austria)
• Mectizan Donation Program (MDP, US)
• Mission to Save the Helpless (MITOSATH, Nigeria)
• Organisation pour la Prévention de la Cécité
  (OPC, Fce)
• The Carter Center (CC, US)
• Sight Savers International (SSI, UK)
• United Front Against Riverblindness (UFAR, US)
• US Fund for UNICEF (US)

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UFAR

• Created as a result of discussions with health
  authorities in DRC and field trips to
  onchocerciasis-endemic villages
• Registered as a tax-exempt charitable
  organization
• both in US (September 2004) and DRC (August
  2005)
• Goal Control and eradicate oncho in CDTI
  Kasongo, in partnership with other players

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UFARs Administrative Body

• UFAR is managed by a multidisciplinary 12-member
  Board of Directors and a 3-member Executive
  Committee.
• Board members are unpaid volunteers, all blessed
  with a strong sense of stewardship and a
  commitment to improve the lives of the less
  fortunate.

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Snacking following UFAR Board Meeting
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UFAR Board MeetingLawrenceville, NJ
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Lets all join hands and defeat this dreadful
disease! www.riverblindness.org
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MECTIZAN WORLDWIDE DISTRIBUTION
Update, April 2005
411 million treatments of Mectizan have now been
distributed for oncho. ------- Donation program
has been expanded to include LF
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THANK YOU
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Suggested Rotary Involvementin Kasongo

• Riverblindness control
• Support UFARs Current Efforts
• Pick up Support another Program, i.e
  Kindu/Kibombo
• Integration of Riverblindness Control with
  other Healthcare Interventions
• Provision of Clean Water (wells)
• Malaria Control (mosquito nets)
• Prevent childhood blindness (vitamin A)