River blindness in Africa Presented By Grace Salako Smith Walden University Ph.D Public Health Student.

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 Most people in rural Africa lack potable drinking water and depend on fresh flowing streams and rivers for water for daily needs. Most of these streams are polluted with sewage, solid and liquid wastes. They are therefore fertile breeding places for blackflies which are the vectors for human infection with river blindness disease.

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

Life cycle of Onchocerca volvulus A black fly bite sucks up the larvae of the parasitic worm from the blood of the human victim and transmits this to the next victim of the blackfly depositing these in their blood. The larvae grow into a thin worm and these multiply twisting around muscles and blood vessels. If these worms are carried in the blood to the tissue of the eyes, they result in blindness.

Worldwide Occurence and Distribution

River Blindness in Africa Data Sheet Source

Faces of the Victims Women

An Infected Eye and Victims Example of the blindness in the eye of a victim. Figure 2 : Blind Men

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.

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

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.

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.

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 Tanzania’s minister of health and social welfare, David Mwakyusa. http://www.globalpost.com/

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 US$25 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/acdicida.nsf/En/FRA-1012103248-K3K

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"

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/

Donor Activity Center Partners Increase Program Reach The 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 Reach Retrieved on July 14, 2009 from www.cartercenter.org

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

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/river-blindness-2.gif&imgrefurl=

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.