River blindness in Africa

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River blindness in Africa

• Presented By
• Grace Salako Smith
• Walden University
• Ph.D Public Health Student.

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The Disease and its Cause

• Onchocerciasis or river blindness, is the world's
  second leading infectious cause of blindness. A
  parasitic disease with an insect vector -
  blackfly (Simulium). that breeds in water. The
  blackfly lays its eggs in the water of
  fast-flowing rivers, these mature into adult
  blackflies in 8 to 12 days. The female blackfly
  typically seeks a bloodmeal after mating and,
  upon biting a person who is infected with
  onchocerciasis, may ingest worm larvae, which can
  then be passed on to the next person bitten by
  the blackfly. Eventually, the transmitted worm
  larvae develop into adult worms and settle into
  fibrous nodules in the human body close to the
  surface of the skin or near the joints.
  Onchocerca volvulus, the parasitic worm can live
  for up to 14 years in the human body.
  
• Retrieved from http//www.worldwaterday.org/wwday/
  2001/disease/oncho.html

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29 Symptoms of River Blindness Disease

• Severe itching initially in one section of body
  then spreading to whole body and eyes
• Skin nodules Lymphadenitis
  Lichenified skin Loss of skin
• pigmentation Excessive skin pigmentation
  Photophobia
• Corneal inflammation Iris inflammation
  Retinal inflammation
• Choroid inflammation Optic nerve inflammation
  Eosinophilia
• Urticarial (hives-like) rash Swelling of
  limbs (oedema) Spotty skin Bleeding patches
• From Tough and wrinkled skin Enlarged groin
  lymph nodes Fluid swellings of testes
  (hydrocoele Elephantiasis of scrotum) Itchy
  red eyes Excessive tear formation
• Cataracts Blurred vision Loss of vision
  Nodules under skin Skin rash Itchy skin

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Life cycle of Onchocerca volvulus
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Worldwide Occurence and Distribution
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Faces of the Victims
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An Infected Eye and Victims
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Environmental Epidemiology

• Despite success in West Africa, 109 million
  people remain at risk of contracting river
  blindness in the 19 countries of Central, Eastern
  and Southern Africa.
• This is due to the infestation of fast flowing
  streams and rivers polluted by raw sewage
  untreated solid and liquid waste which provide a
  great breeding place for blackflies.

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Incidence and Morbidity

• In recent decades, onchocerciasis has struck some
  18 million people worldwide, and accounts for
  nearly a tenth of all cases of blindness. The
  vast majority of river blindness cases have been
  in sub-Saharan Africa, where nearly 30 countries
  have been affected.
• Reference.
• Laolu Akande (2003) Victory over river
  blindness.Success of "big dream" is a model for
  other African health campaigns. Africa Recovery,
  Vol.17 1 (May 2003), page 6

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Current Status of Disease in Africa

• The WHO program treats nearly 54 million people
  annually in 15 countries. It has achieved a 30
  percent reduction in the prevalence of infection,
  and a 55 percent reduction in itching. The rates
  of impaired vision and blindness have dropped by
  35 percent.
• The WHO tries to get national government to take
  over funding the programs once they are up and
  running, but that can be difficult because
  Onchocerciasis is not high up on the budget list
  compared to HIV/AIDS and tuberculosis.

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Current treatment

• 30-year campaign against river blindness, known
  as the Onchocerciasis Control Programme (OCP),
  formally concluded in December 2002. free dose of
  the drug Mectizan, donated by the US
  pharmaceutical company Merck, in time to prevent
  the disease from reaching its mature stage, when
  irreversible blindness can occur.. The World
  Health Organization (WHO) estimates that the
  effort has prevented 600,000 new cases of the
  disease.

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Current Treatment challenges

• "Onchocerciasis is a forgotten disease," "It
  needs more attention and it is a disease which we
  can eliminate if more effort is put into it."
• Although Ivermectin, manufactured by Merck is
  effective, it can be difficult to convince people
  to take it.This is because the drug does not kill
  the adult worms, but reduces their breeding rate
  and kills off their belligerent offspring. When
  sufferers first take the drug, it can produce
  severe itching and swelling, as the baby worms
  inside the body die off.
• The drug must be taken annually for the life of
  the adult worm, which is about 15 years.
  Furthermore, everyone in the village must take
  the drug with the exception of small children,
  the very ill and pregnant and nursing women or
  else the worms will continue to breed and can re
  infect the population.
• Additionally, people frequently stop taking the
  drug once the symptoms of the disease subside,
  often after several years of treatment, said
  Tanzanias minister of health and social welfare,
  David Mwakyusa.
• http//www.globalpost.com/

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Intervention Background Information

• In 2005 alone, the river blindness control
  program helped to treat over 35 million people
  against the disease in Central, Eastern and
  Southern Africa.
• Over the last 30 years, CIDA has committed more
  than US25 million to international efforts to
  fight river blindness in Africa. Since 2002,
  Canada has ranked as one of the top five donors
  worldwide.
• CIDA funding is currently providing
  community-based drug treatment programs for
  infected patients.
• Source http//www.acdi-cida.gc.ca/cidaweb/acdicid
  a.nsf/En/FRA-1012103248-K3K

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Current Donors and organizations

• The Carter Center's River Blindness Program
  distributes Ivermectin to control or eliminate
  river blindness, also known as onchocerciasis The
  program aims to eliminate the disease in 13
  endemic areas in the Americas as well as parts of
  Uganda and Sudan. It also aims to control the
  disease in Nigeria, Ethiopia, Cameroon, Uganda,
  and Sudan.
• The Carter Center receives donated ivermectin
  from Merck, and then follows the
  "Community-Directed Treatment with Ivermectin
  Process"

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Other Donors The World Bank.

• APOC is based on Mectizan (ivermectin)
  distribution. This drug was developed by Merck
  Co. in the 1980s and is now donated for
  riverblindness control. Mectizan is distributed
  by communities themselves, trained and supported
  by the riverblindness partners, including
  international agencies, participating country
  governments, NGDOs, donor countries, and of
  course, the communities themselves. APOC was
  tested and validated on a local basis and has
  been scaled up by continually launching more
  projects. From modest beginnings in 1996, it is
  estimated that by 2007, 65 million people will be
  reached annually through this program. The
  distribution network is also being tested to
  deliver other interventions. This enticing
  possibility opens the door to further scaling up
  and presents the opportunity to deliver other
  basic health interventions in the riverblindness
  areas, which are almost exclusively remote,
  rural, and poor. Most are not reached by other
  programs and some are not reached by the national
  governments.
• Source The World Bank Group. Global
  Partnership to Eliminate River blindness
  retrieved from
• http//www.worldbank.org/afr/gper/

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Donor Activity

• Center Partners Increase Program ReachThe Carter
  Center's River Blindness Program works through
  partnerships at all levels. The primary partners
  are the people in the afflicted communities, who
  organize themselves and volunteer their time to
  help distribute Mectizan.  The Lions Clubs
  International Foundation, a longtime partner in
  the fight against river blindness, has provided
  The Carter Center with grants since 1996 to
  prevent the disease in Africa and the Americas.
  The River Blindness Program supports the
  ministries of health and their national
  onchocerciasis control efforts executed within
  and through national primary public and community
  health care systems. The Carter Center also works
  closely with the Centers for Disease Control and
  Prevention and the Mectizan Donation
  Program. The River Blindness Program partners
  in Africa include the ministries of health in the
  five endemic countries, the United Nations and
  affiliated organizations (the World Health
  Organization, the World Bank, and UNICEF), and
  other nongovernmental development organizations.
  Another important partner is the African
  Programme for Onchocerciasis Control, which is
  executed by WHO and funded through a World Bank
  trust fund. In Latin America, OEPA's
  partnerships include the ministries of health in
  the six endemic countries, the Pan American
  Health Organization, the Centers for Disease
  Control and Prevention, academic institutions
  (such as The Scripps Research Institute), and
  independent organizations.
• The Carter Center (2009) Center Partners Increase
  Program ReachRetrieved on July 14, 2009 from
  www.cartercenter.org

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Success Story

• Cameroon is one of the West African countries
  where River Blindness has been wiped out.
• Source Canada Agency for International
  Development (2009) River Blindness In West Africa
  Is Nearly Eradicated, Canada Is Key Donor To
  Expansion Efforts Across Africa

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Possible Solution?Treatment Drug in clinical
trials

• A drug normally used in animals will be tested
  for its ability to control river blindness
  transmission in clinical trials in the Democratic
  Republic of Congo (DRC), Ghana and Liberia.The
  phase III trials, launched (1 July, 2008) at the
  World Conference of Science Journalists in
  London, United Kingdom, will assess the
  effectiveness of moxidectin in preventing
  transmission of the worms which cause river
  blindness, or onchocerciasis one of the leading
  infectious causes of blindness in Africa.
• The trials will last for the next two and a half
  years and will be run by the WHO Special
  Programme for Research and Training in Tropical
  Diseases (WHO/TDR), and Wyeth Pharmaceuticals,
  the company behind the drug. Fifteen hundred
  people at four sites in the three countries will
  be involved.
• Source Voices from Ghana retrieved from
  http//ghanavoices.files.wordpress.com/2009/07/riv
  er-blindness-2.gifimgrefurl

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NEEDS

• More financial support for non governmental and
  other Institutions to increase public health
  education especially in the rural areas.
• Clean and potable water both surface and
  underground (boreholes) for the poor people in
  African countries like Zambia, Tanzania and Mali
  so the people with have little contact with the
  river and the blackflies that transmit the
  disease.