1. Sight for the Blind Presented by: Walden University MPH Student
Berhane Chiche
MPH Student
Environmental Health-PUBH
Instructor: Dr. Raymond Thron
Summer Qtr. 2014
Walden University

2. Introduction This presentation is mainly focused on:
Educating Ethiopian people about River Blindness, (Onchocerciasis)
Its causes, effects, preventions, controls, and available resources.
The major stakeholders of this presentation include:
Ethiopian Federal Government
Teppi province ministry of health
Community Health Center
 I want to use this opportunity to welcome everyone to this important presentation. My name is Berhane Chiche and I am a graduate student at Walden University. I am currently pursuing a master’s degree in public Health at the university. I am originally from Ethiopia. I choose Teppi one of Ethiopian province for this presentation because during the course of my research, this region ranks highest in the case of River blindness in Ethiopia.

3. Introduction (Cont’d)
Non- Governmental Organization (NGOs)
Charity Organizations through churches
World Health Organization (WHO)
The Carter Center Foundation and River Blindness
The National Onchocerciasis Task Force (NOTF)
Environmental Health Department
Now, after introduction, let us look at why do I want to present this topic and its benefit to this Teppi region community in particular.

4. Map of Ethiopia
Ethiopia is one of the most beautiful and popular country in the continent of East Africa (also known as horn of Africa). Ethiopia a country where welcome still has meanings, whose people has many divers and colorful ethnic backgrounds but are united in their friendliness and pride; a country where recently many changes had taken place but the many ancient customs and traditions remain intact. The traditions of hospitality for instance, for which Ethiopian people have been justly famous for centuries (Ethiopian Truism Commission). Ethiopia has a population of almost 70 million people with an area of 435,000 square miles. In 1939, an Italian researcher was the first to reveal the presence of Onchoceriasis in the south western part of the country (River blindness, (2000)). The study conducted in 1970 in the northwestern region of the country approximates that 7.3 million individuals are endanger of River Blindness. The study shows that 1.4 million individuals are infected by River Blindness (river Blindness (2000)). The intensity of the endemic level in the communities were described by nodule prevalence rates acquired from Rapid Epidemiological Mapping of Onchoceriasis (REMO) activities conducted in 1977.
River Blindness (2000): Carter Center. (WWWwww.cartercenter.org/documents/1175.pdf)

5. The audience of this presentation
Representative from Ministry of Health
Local Health center Workers including doctors, Nurses, and Axillary nurses
Representative from different charity organization
Jimma University Medical School
Carter's foundation representative

6. Objectives of this presentation
Participants should be able to identify possible causes of River Blindness (Onchocerciasis)
How the disease spread among the population
Knowing prevention method at primary, secondary, and tertiary level
Identify barriers to the access of services to those suffering from this disease
The community of Teppi should be able to participate in the discussion to minimize the River blindness

7. Objectives (Cont’d) To Create Awareness in the community
To get non-governmental financial and help for the people who are suffering from Oncosoroasis.
To get the Ethiopian government attention to fight and eradicate River Blindness in Teppi region and other part of the country
To reach other parts of the country who are suffering from the same dilemma of the disease
To know the current diagnosis and treatment available for River blindness

8. Pathophysiology of River Blindness
In 1875, the scientist, John O’neill was the first to observe and document volvulus microfilariae,
with the name craw-craw, the West African name of the disease.
Almost 50 years later, the scientist Blacklock discovered that the true cause of River Blindness is simulium (Hoerauf, 2003).
Hoerauf, A. (2003). Onchocerciasis. Journal of Science, Medicine, and the Future, v.326,p

9. What causes onchoceriasis?
River Blindness is a given nickname to this disease because of it occurrence mostly in rural areas near rapid flowing river.
An infection manifested by onchoceriasis which resides and multiplies at river out flow
It ranks 2nd causing blindness in the world.
River Blindness or Onchocerciasis is a vision hazard manifested by onchocerca volvulus. It is found where river stream is found
World Health Organization (WHO), (2002) and (
The primary cause of this disease is a warm called Onchocerca Volvulus, which enters the human’s body through a bite by a black fly. Once the worm enters human body, it can grow and spreads within the body. Inside the body, the warm continue to multiply millions of offspring called microfilaria. These offspring move around in the body system of infected person and causing itching, skin lesion, muscular pains, weakness, and how it results to blindness and disfiguring human body is the mystery you all need to be attentive to get from this presentation.
Zein, A. Z. (1986): The epidemiology of onchocerciasis in north western Ethiopia. Trop. Geog. Med.; 38(1): (ispub.com/IJPD/1/2/3369)

10. What causes onchoceriasis?(Cont'd)
It is one of the Neglected tropical disease (NTD)
River Blindness (Onchoceriasis) public health concern and is one of the socioeconomic importance in Ethiopia.
There is insufficient information on River Blindness in Ethiopia
Zein, A. Z. (1986): The epidemiology of onchocerciasis in north western Ethiopia. Trop. Geog. Med.; 38(1):33-37

11. Significance of River Blindness in Different countries
Approximately 17.7 million people are affected worldwide by onchoceriasis
Nearly 99% of infected persons live in Africa and the 1% lives in Yemen and six countries in America
Over 500,000 individuals encounter visual damage.
270,000 individuals lost their sight by this disease. (
Udell, D. (2007): Recent Updates on Onchocerciasis: Diagnosis and Treatment. Oxford Journals. Retrieved from, (

12. Significance Cont`d
The southwestern part of Teppi region has high prevalence rate (85.3%)
Kuwara region has the lowest prevalence rate (6.9%)
(ispub.com/IJPD/1/2/3369)
Taticheff, S., Williams, J. F. & Wondimu, W.(1993): Longitudinal study of onchocerciasis in Bebeka, Ethiopia. Ethiopian med. J. 31(3): (ispub.com/IJPD/1/2/3369)

13. Diagnosis of River Blindness
The diagnosis is referred as skin disease
Nodules form around the worms on the skin
Inflammation cause on the skin surface
Skin snip
General antibody test
In Ethiopia, it is more of skin disease and enlargement of the scrotal in male. (
The case of River blindness is not easily identified immediately after the infection. It may take up to about a year for the larvae (also called microfilariae) to develop fully in the human body. The larvae live from years within human body and the person may be asymptomatic, which means there is no signs and symptoms of the illness over the years, until the larvae dies causing skin lesion like rash or if the death larvae is in the eye leading visual impairment then progress to blindness. The most effective diagnosis of Onchocerciasis volvulus infection is by skin snip, and antibody test which could exclude infection. Unfortunately these test materials are not readily available in our health centers and it is not cost effective for our community
(Centers for Disease Control and Prevention (CDC), (2010): Onchocerciasis FAQs: Retrieved on from (

14. Mode of Transmission
The picture shows the cycle of the disease and the mode of transmission. 1) Parasitized: The insect takes a blood meal from a human. A pool of blood is pumped up into the fly, saliva passes into the pool, and infective Onchocerca larvae pass from the fly into the host’s skin. 2) Infection: The larvae enter the host’s skin tissue, where they migrate and form nodules, and slowly mature into adult worms. 3) Proliferation: New worms form new nodules and find existing nodules and cluster together. Smaller male worms migrate between nodules to mate. 4) Reproduction: After mating, eggs form inside the female worm and develop into microfilariae. A female may produce 1,000 microfilariae per day. 5) Transport: When the infected host is bitten by another fly, microfilariae are transferred from the host to the fly.
World Health Organization (WHO), (2002) (

15. Effects of the disease
Effects of the disease includes: lymphadenitis, which results in hanging groins and elephantiasis of the genitals,(which is the common in Ethiopia) visual impairment and blindness. Over time the infected individuals skin begins to sag, patchy depigmentation on the legs becomes visible and leads to a condition known as leopard skin.
Greenberg, Z., Jonas, F., Maayan, S., Marva, E., Strauss, U. & BenEzra, D. (2003): Onchocerciasis among Ethiopian Immigrants in Israel. IMAJ; 5:

16. Eyes of infected person and how the worm is embedded under the skin disfiguring the body.
(World Health Organization, 2010).
This is what happens when the dead larvae logs into the eye and other parts of the body. This presentation gives an idea to help, and be encouraged to support the victims. Although those people who do not get early treatment will lose their sight, they need supportive care and assistance from the government to live an independent life. River Blindness (2000): Retrieved from, (

17. Treatment for River blindness
The drug Ivermectin does not kill the adult parasites in the body, but it does reduce the microfilariae in the skin so that the disease does not progress. This medication is administered orally.
Mectizan is another potent drug that temporarily renders the female worm infertile. This kills the larvae (Center for the Disease Control and Prevention, 2010).
emedicine.medscape.com/article/ overview & (
The drug Mectizan has been effective against the worms that cause Onchocerciasis. When it is given in multiple doses over days or weeks and even years the results can be successful. Mectizan is an effective way to make the adult female worm temporarily infertile. It also kills larvae. If an un-infective simulium fly bites an infected person who has taken the drug, it will not become infected or infectious. Mectizan, though potent against River blindness, has its problems. This is because it needs to be administered regularly. Training staff to serve millions of infected people is in itself a public health challenge. The drug ivermectin, which was previously been used for treatment, does not kill the adult parasites, reduces the number of microfilariae in the skin so the disease does not progress. It is administered orally and cannot be given to pregnant women or to children under the age of five (emedicine.medscape.com/article/ overview & (

18. Intervention, Prevention and control
There are two main actions needed:
The spraying of larvicides in and around the breeding sites of the black fly.
Early treatment with a powerful drug called Ivermectin that kills the young worms in the body (World Health Organization, 2010).
Another way to break the cycle of the disease is by reducing the speed of fast running rivers, thereby making them unattractive as breeding grounds for the black fly. Most humans are bitten during the day, so the best way to avoid being bitten is to wear long garments that cover the whole body. Spraying infested areas with insecticides is an affordable and not long lasting. However, reducing the flow of rivers can be very expensive and impractical. Centers for Disease Control and Prevention (CDC), (2010 (

19. Demographics of River blindness
There are two main actions needed:
The spraying of larvicides in and around the breeding sites of the black fly.
Early treatment with a powerful drug called Ivermectin that kills the young worms in the body (World Health Organization, 2010).
(World Health Organization, 2010).
River blindness generally affects more men than women. This may be due to the occupations that men are involved in like farming and fishing. People from 0-10 years old have the lowest infection rate. The risk increases with age. Most victims are between the ages of years. Currently, there are no studies or research that has data on the frequency of Onchocerciasis in specific races. River Blindness (2000): Retrieved from (

20. Who is at risk to get this disease?
Travelers, missionaries, and Peace Corp volunteers
People who live in villages near rapidly flowing streams/rivers (CDC, 2010): (

21. Conclusion
Ocular onchocerciasis considered as mild or rare in Ethiopia, but ocular manifestations has been reported in some of the studies. This needs more research.
The popularity of the disease is related with the daily occupational work including farming near the river, taking bath in the river, and also swimming which reveals the person to the vector.

22. Conclusion (Cont'd)
River blindness is a serious condition which has been neglected for so long because of inadequate treatment and early diagnosis.
Measures should be taken by individuals, communities, organizations at both State and Federal level to fight this disease.
We can lower the incidence rate of River blindness and make our citizens free from this terrible disease by disseminating information Education on this disease.
Help, teamwork, and corporations are needed from individual in the community, charity organizations like churches and missionaries and the federal government of endemic countries to increase awareness of this disease. Communities at risk by geographical location should be assisted by their government and WHO through environment health agencies on how to control or eliminate black flies from the area. Finally, put yourself in the shoes of those who lost their sight because of this illness. How do you feel?

23. Recommendations
Ethiopian researchers` and nonprofit organizations, and interested individuals need to study more on ocular manifestations in divergent provinces of Ethiopia.
The federal government and NGO’s should continue to work together to elevate consciousness to the communities in endemic area-----etc.
World Health Organization, 2002).
World Health Organization, 2010). (

24. Recourses for Help Local Health Centers Ministry of Health
Sight Savers
Charity Organizations like Churches
Missionary Organizations like Helen International
Carter foundation for the blind
Primary prevention of river blindness should be the responsibility of local health centers. This can be done by educating the community on environmental health such as clearing bushes around the river bands, which will thereby eliminate hosts of black-flies. The Ministry of Health of Ethiopia should conduct research within each province and use the data for global assistance. Sight Savers including Carter Foundation in Ethiopia are a non-governmental organization that has been helping with the supply of free drugs called Ivermenctin, which are donated from pharmaceutical companies. Detailed information about other charity organizations will be available at local health centers and here in USA at Ethiopian Embassy for the confirmed cases of River blindness
Taticheff, S., Williams, J. F. & Wondimu, W.(1993): Longitudinal study of onchocerciasis in Bebeka, Ethiopia. Ethiopian med. J. 31(3): (ispub.com/IJPD/1/2/3369
Thanks for Your Attention.

25. References:
Centers for Disease Control and Prevention (CDC), (2010): Onchocerciasis FAQs: Retrieved on from (
Hoerauf, A. (2003). Onchocerciasis. Journal of Science, Medicine, and the Future, v.326,p
Udell, D. (2007): Recent Updates on Onchocerciasis: Diagnosis and Treatment. Oxford Journals Retrieved from(
River Blindness (2000): Retrieved from(
Jira, C. (1993). Prevalence of onchocerciasis in Blue Nile valley of western Ethiopia. Indian J. Pub. Hlth; 37(4):

26. References (cont'd)
Taticheff, S., Williams, J. F. & Wondimu, W.(1993): Longitudinal study of onchocerciasis in Bebeka, Ethiopia. Ethiopian med. J. 31(3): (ispub.com/IJPD/1/2/3369) Taticheff, S., Abebe, M., Workneh, W. & Hana N.G. (1987): Onchocerciasis: A prevalence study in Bebeka, Ethiopia. Trop. Med. Parasitol.; 38(4): ( River Blindness (2000): Carter Center. Retrieved from (WWWwww.cartercenter.org/documents/1175.pdf) .

27. References (cont'd)
River Blindness (2000): Carter Center. Retrieved from,
(WWWwww.cartercenter.org/documents/1175.pdf)  
World Health Organization (WHO), (2002) (
Zein, A. Z. (1986): The epidemiology of onchocerciasis in north western Ethiopia. Trop. Geog. Med.; 38(1):33-37