Onchocerciasis (River Blindness)

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Onchocerciasis (River Blindness)

• Presented by
• Elizabeth Ndubisi-Ukandu, Ph.D Student
• In partial fulfillment of PUBH-8165-3-Environmenta
  l Health
• Walden University
• Instructor Dr. Jeff Wu
• Summer Term, 2009

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Outline of topic presentation

• This presentation is aimed at indirect education
  primary victims of River Blindness through
  primary healthcare providers, volunteers, local
  health agencies in the endemic areas.
• There is review of the etiology, mode of
  transmission of this disease, as well as
  examining why the situation persists, cultural
  barriers and prevention measures.
• There is a look at the successes of prevention
  strategies and continuing efforts in other
  areas. Lastly there is a provision of a list of
  resources for further reading.

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Presentation Topic

• Onchocerciasis (River Blindness)
• Health education campaign for primary care
  providers and health agencies in endemic regions.
• Self-prevention measures by primary victims
  through health education by public health
  educators.

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Presentation Objective

• Educate rural inhabitants of endemic regions,
  travelers in the region on River Blindness.
• Educate on Cultural, ethnic and religious values
• Campaign for the elimination and eradication of
  River Blindness.
• Encourage victims to seek professional healthcare
  services.

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Who are the target audience?

• Healthcare providers for the targeted community
• Rural inhabitants of endemic regions particularly
  in Africas remote villages, the traveler in
  these regions.
• Departments of Public Health
• Policy makers and interested public
• (WHO, 2001 CDC, 2008)

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Why are they the target audience?

• The healthcare providers because they are the
  primary providers of care for the victims
• The rural village inhabitants who are the primary
  victims of the disease
• Health care agencies who are responsible for the
  public health of the community
• Global agencies interested in eradicating the
  disease.
• (Levine, 2007 WHO, 2007)

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Etiology of Onchocerciasis (River Blindness)

• Onchocerciasis is caused by a parasitic worm and
  is spread by the bite of an infected blackfly
• It is also called River Blindness because
  infections are most intense in remote African
  rural agricultural villages, located near rapidly
  flowing streams.
• (WHO,2001 CDC, 2008 Levine, 2007)

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Host and Mode of Transmission

• The parasitic worm lives in the Blackfly where it
  develops
• Once a blackfly is infected, it infects the human
  victim by bites. The severity of the resulting
  disease depends on the intensity of the bites
  (CDC, Fact sheet2008)

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Cycle of Onchocerciasis Transmission
Source Basáñez M-G et al River Blindness, A
Success story under threat?
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Significance of Onchocerciasis (River Blindness)

• Global Onchocerciasis prevalence is 17.7 million
• 270,000 are blind and another 500,000 have visual
  impairment
• 99 of infected persons are in Africa the
  remainder is in Yemen and six countries in the
  Americas
• world's second leading infectious cause of
  blindness (CDC, 2008 WHO, 2001).

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Chart of Onchocerciasis Infection
Source Basáñez M-G et al River Blindness, A
Success story under threat?
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How enduring is it?

• It is the world's second leading infectious cause
  of blindness
• Millions of people are being handicapped from a
  preventable disease.
• (CDC, 2008 WHO, 2001).

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Why does it continue to persist?

• Lack of education on the dangers of fast flowing
  rivers.
• Rural communities and their cultural and
  spiritual connections and interpretations of
  water, its natural source and the correct way
  of using it (WHO, 2001 Rinne, 2006).
  
  
  
  
  
  
  

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Where are the endemic regions?

• The endemic regions are primarily the rural
  villages of Africa, which are close to bodies of
  flowing waters.
• Yemen
• 6 other countries in the Americas
• (CDC, 2008 WHO, 2001).

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Endemic Areas for Onchocerciasis Disease
Source Basáñez M-G et al River Blindness, A
Success story under threat?
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Is the disease treatable?

• Disease is highly preventable
• Once a victim has been infected, there is no cure
  for the disease, its progress can be delayed with
  oral medication (CDC River Blindness fact sheet,
  2008).

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Prevention measures - Personal

• Oral dose of 150 micrograms per kilogram (maximum
  12 mg) every 6-12 months of the highly effective
  Mectizan (invermectin) (WHO, 2008).
• This medication will not cure the disease but it
  will slow down its progress, killing off almost
  95 of the tiny worms (Levin, 2007).

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Prevention measures health agencies

• Controlling insect breeding sites in rivers is
  one of the pillars of prevention by spraying the
  aerial spaces and rivers (WHO, 2001).
• Free distribution of the highly effective
  medicine Mectizan (ivermectin), this medication
  provides a yearly protection from a single dose
  (Levine, 2007).
• Sustaining a comprehensive regional prevention
  effort and collaborations (Levine, 2007).

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Prevention measures Global efforts

• Onchocerciasis Control Program in West Africa
  (OCP), which is being sponsored by the WHO, World
  Bank, UNDP and UN Food and Agriculture
  Organization
• In 1992, the Onchocerciasis Elimination Program
  in the Americas (OEPA) was launched in 6
  countries

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Barriers to prevention

• Cultural, spiritual and religious symbolism of
  water in endemic regions
• Lack of education on the health issues and risks
  associated with the transmission of River
  Blindness disease
• Lack of adequate funding to implement a sustained
  intervening campaign.
• (Rinne, 2006 Gary-Felder et al 1999 Parker et
  al, 2003).

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Communication goals

• Intimate knowledge of the etiology and mode of
  transmission of River Blindness and of the
  cultural and ethnic values of its victims in
  this instance the rural inhabitants of African
  villages and possible travelers through the
  region (Schiavo, 2007 cancer.gov/pinkbook)
• A sustained education campaign developed to be
  sensitive to the cultural, religious, ethnic
  values of the target groups (Katzen, et al 2005)

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Message of this presentation

• River Blindness is a health risk with reported
  and documented incidences of mortality
• River Blindness is preventable and controllable.
• River Blindness can be eradicated through a
  concerted effort by all stakeholders.

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Message strategy

• Use of the Theory of Reasoned Action (TRA) model
  (Schiavo, 2007).
• Use of the Communication for Social Change (CFSC)
  model (Gary-Felder and Dean, 1999, p.15)
• Interpersonal channels such as a) peer-to-peer
  discussions b) theater presentations c) use
  community role models with positive influence on
  the audience (www.campaignstrategy.org).

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Successes of Prevention measures

• The Onchocerciasis Control Program (OCP) launched
  in 1974 and African Programme for Onchocerciasis
  Control (APOC) in 11 Countries have
• Prevented over 600,000 cases of River Blindness
• 22 million children in endemic areas born free of
  risk of river blindness
• Annual cost of treatment under 0.60 per person
• Non-interrupted commitment from 4 original
  sponsors and 27 donors over 28 years of program

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Conclusions

• Although Controlling Onchocerciasis (River
  Blindness) has been lauded as one of the global
  public health successes, there are still endemic
  areas where it still accounts for the leading
  cause of blindness (Levine, 2007).
• WHO has just collaborated with a pharmaceutical
  company to launch the testing of a new promising
  drug in Africa for River Blindness (WHO, 2009).

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References

• Campaign Strategy Tools
• http//www.campaignstrategy.org/
• CDC River Blindness fact Sheet (2008)
• http//www.cdc.gov/ncidod/dpd/parasites/onchocerci
  asis/factsht_onchocerciasis.htm
• Making Health Communication Programs Work
• http//www.cancer.gov/pinkbook
• Gray-Felder, D., and Dean, J. Communication for
  Social Change A Position Paper and
• Conference Report. 1999
• Culled from Renata Schiavo Health Communication
  From Theory to Practice
• Katzen, C., Solan, M., Dicker, A. (2005).
  E-mail and oncology A survey of radiation
• oncology patience and their attitudes to a new
  generation of health communication.
• Levin, Ruth., (2007). Case Studies in Global
  Health Millions Saved.
• Making Health Communication Programs Work
• http//www.cancer.gov/pinkbook

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References

• Parker, M., Gazmararian, J. (2003). Health
  Literacy Essentials for Health
• Communication.
• Rinne, E. M Seeing is Believing' Perceptions of
  Safe Water in Rural Yoruba
• A History of Water, 2006
• Schiavo, Renata Health Communication From
  Theory to Practice (2007)
• Schiavo, R., Freimuth, Vicki "Evaluation of a
  Public Health Campaign"
• WHO Global Plan to combat Neglected Tropical
  Diseases 2008-2015
• http//whqlibdoc.who.int/hq/2007/WHO_CDS_NTD_2007.
  3_eng.pdf
• WHO Water-related Diseases (2001)
• http//www.who.int/water_sanitation_health/disease
  s/oncho/en/
• WHO New Drug being tested in Africa for River
  Blindness
• http//www.who.int/mediacentre/news/releases/2009/
  river_blindness_20090701/en/

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List of Sources for further reading

• Basáñez M-G, Pion SDS, Churcher TS, Breitling LP,
  Little MP, et al River Blindness
• A Success Story under Threat?. PLoS Med 3(9)
  e371. doi10.1371/journal.pmed.0030371
• Basáñez, María-Gloria Pion, Sébastien DS
  Boakes, Eve Filipe, João AN Churcher, Thomas
  S Boussinesq, Michel, Effect of single-dose
  ivermectin on Onchocerca volvulus a systematic
  review and meta-analysis. Lancet Infectious
  Diseases, May2008, Vol. 8 Issue 5 DOI
  10.1016/S1473-3 Retrieved from Academic Search
  Premier
• Duke, B.O. Onchocerciasis (river blindness)-can
  it be eradicated?
• Parasitology today, 1990 - ncbi.nlm.nih.gov

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List of Sources for further reading cont.

• Otubanjo, O. A. Adeoye, G. O. Ibidapo, C. A.
  Akinsanya, B. Okeke, P. Atalabi, T. Adverse
  reactions from community directed treatment with
  ivermectin (CDTI ) for onchocerciasis and
  loiasis in Ondo State, Nigeria. Revista de
  Biologia Tropical, dic2008, Vol. 56 Issue 4.
  Retrieved from Academic Search Premier
• Stingl, Peter. Onchocerciasis developments in
  diagnosis, treatment and control. International
  Journal of Dermatology, Apr2009, Vol. 48 Issue 4
  DOI 10.1111. Retrieved from Academic Search
  Premier
• Thylefors, B. Alleman, M. M. Twum-Danso, N. A.
  Y. Operational lessons from 20 years of the
  Mectizan Donation Program for the control of
  onchocerciasis. Tropical Medicine
  International Health, May2008, Vol. 13 Issue 5
  DOI 10.1111 AN 31678526 Retrieved from
  Academic Search Premier