Augustina Ugo R. N., M. S. N. Walden University, Ph.D. Student ID# Walden A PUBH 8165 – 8 Professor: Dr. Jean Johnson Term: Winter 2009

This Presentation is to educate the general public(especially travelers to African Countries where this disease is endemic) on Onchoceriasis or River Blindness.

Onchocerciasis Onchoceriasis or River Blindness : is a common, chronic multisystemic disease, and the world’s third leading infectious cause of blindness. It is called riverblindness because the vector survives in aquatic areas such as streams, rivers. Causation: Nematode called Onchocerca Volvulus, can survive up to fifteen years in the human body Mode of Transmission: By bite of a black fly, a female specie, requires blood meal for ovulation, from insect bite, or human to human. Host: Human beings are the only host

Incubation Period & Life cycle Initial bite goes unnoticed 1 to 2 years after exposure clinical symptoms manifest as lava has grown into adult worm. Life Cycle: Human and Black fly stages Human stages : Infected black fly introduce stage three lava unto human skin penetrating into the wound. Develops into adult filariae in 6 – 12 months. Adults resides in in connective tissues for 14 years.

Black fly stage A fly ingests microfilaria at blood meal, which migrates from the fly gut to its thoracic muscles. Develops into first stage larvae after 28 hours, develops into stage two after 96 hours; 6 to 10 days second molting occurs and develops into stage three infective stage. This infective larva can infest another when the fly takes its next blood meal.

Distribution 35 countries of the world are affected and 28 countries and 90% of infected population are from Africa. In Africa 10% of a village may be blind, including up to 50% of those aged 40 years and older million people live in endemic areas and half of them are found in Nigeria (WHO, 2004). Endemic to Central and South America affecting 70,000 people in Guatemala and Mexico, small isolated area in Venezuela, Colombia, Brazil, Euador, Yemen and Saudi Arabian Peninsula.

Distribution More than 123 million people live in endemic areas 18 million people are currently infected. 270,000 people are blind Additional 500,000 have severe visual impairment Onchocerciasis is seen among the low socio economy population living near rivers, stream s where the vector breeds

Symptoms or Onchoceriasis Initial stage without symptoms, Later stage : Skin Manifestation with itching and rashes, and subcutaneous bumps under the skin, skin may thicken and roughen, and wrinkles Ocular Manifestation :eye lesions,blindness Lymphatic Manifestation: Lymph nodes swollen, genitals organs inflamed and swollen; organs containing adult worms may be seen and felt under the skin.

Prevention Avoid fly infested area Wearing protective clothing such as long sleeves and pants Use of insect repellent such as DDT may help Clean surrounding with no stagnant water or dirty gutters close to environment Most effective measure is annual single dose of treatment of the affected population with the medication called Ivermectrin

PARTNERSHIP WHO (technical assistance) UNICEF (albendazol distribution) NGOs (Ivermectin distribution) Ministry of Education (school level) Ministry of Social Reinsertion (community level) PRESIDENTIAL INITIATIVE (?) OPORTUNITIES Political and Social Stability Economical Country Growth Poverty Government Reduction Program Increase of School Enrollment Health Municipality Government Revitalizing Program Onchocerciasis CDT Program, on- going PMI and Global Fund Grants for Malaria PMI-MSH partnership for logistics capacity building CHALLENGES Activities Integration Financial Gap Human Resources Health Information System Strategies for Community Involvement Co-Infection (Oncho+LF) Disability Management Social Integration SUGGESTION Creation of NTD country laboratories:Profile Stage of implementation Best practices FUTURE CONTROL OF ONCHOCERIASIS FOR AFRICA Royal Taylor Institute Amsterdam, The Netherlands’ Sightcare International, Ibadan, Oyo /state, Ibadan, Nigeria. Harvard School of Public Health, Boston, MA, U. S. A. Institute Nation ale d de Recherchi en Publique, Bamako, Mali

Treatment For Onchocerasis Ivermectin is said to be safe and effective drug for the mass treatment of onchocerciasis and when used on an individual basis, it reduces the ability of the treated person to transmit Onchocerca volvulus infection. The effect of community-based ivermectin treatment on the degree of transmission within the community was assessed by determining the incidence of new infection in children Ivermectin was distributed annually on three occasions to the eligible members of a population of approximately 14,000 people living on a rubber plantation in a forest area endemic for onchocerciasis. After 2 years, the prevalence of infection in 5-year-old children decreased by 21%. The annual incidence in an uninfected cohort of children decreased by 35% and, after age-specific adjustment, the reduction in incidence in 7- to 12-year-old children was 45%. Thus, community-based distribution of ivermectin led to a significant reduction in incidence of new infection. These findings suggest that ivermectin can be important in reducing the transmission of onchocerciasis

Barriers encountered by Public Health Workers Poor road or no roads at all in the remote areas making transportation difficult to get to these remote area No effective communication system, and language barrier is encountered at last. No access to health care Some areas has no doctor, nurses, Some districts are not known to be inexistence by their local ministry of health Sometimes there is no fuel or gad The workers are poorly paid

Risk Factors People who live close to gushing rivers and streams where the vector black fly breeds. Poor and low socio economic villagers Travelers visiting these endemic remote countries Onchoceriasis proven risk factor for Glaucoma(Egbert, 2005) There is a scientific evidence that glaucoma is strongly associated with Onchoceriasis.

Public Health Intervention Program Health Education to the community Medication supplied free of charge to African Countries called Mectizan, made by Merck & Co. Inc., could effectively and safely treat and prevent river blindness, this is on going. The organization program, the World bank, WHO and others formed partnership, using the villagers volunteer in distributing the mediation as required The federal ministries of health of each countries predicates in the eradication effort by public education

Public Health Intervention Strategy Enhance community participation between health care workers, and the villagers. Train villager to plan and execute maximun action for their benefits and for their children. Community based treatment Intervention. Under supervision use community to collect medication from the Ministry of health and distribute to the villagers. Public health workers also need to train villagers, supervise and procure their allocated share from the Ministry of health regularly Provide bicycle to natives to get to the remote areas.

Eradication of diseases in African communities Just as President Jimmy Carter said at the eradication of guinea worm in Africa; He made it clear to the villagers that they are the ones to get themselves out of this disease outbreak by adhering to public health education and advise on the disease prevention.

Websites Association Management Professionals at The Nigerians Peoples Club New York Branch The Big Apple Dr. Victoria Ukachukwu V.P. Rutgers University, Dept of Biochemistry Childrens Hospital at Montefiore, V.P.,