River Blindness ( Onchocerciasis - PowerPoint Presentation

Slide1

River Blindness(Onchocerciasis)

Presented by

Ijedinma

Abanobi

, M.P.H Student

PUBH 6165-3 Environmental Health

Walden University

Instructor: Dr. Patrick

Tschida

Fall, 2011Slide2

Topic Presentation Outline

This presentation is aimed at educating community leaders and the Nigerian government of the impact of

onchocerciasis

, while addressing the social and economic burden of the disease in endemic

c

ommunities in Nigeria.

This includes a review of the etiology, mode of transmission, social and economic consequences

,

control strategies, techniques & challenges.

This also includes the role of Non-governmental Organizations, as well as Federal, State and Local Government of Nigeria.Slide3

Objectives:

Educate and inform community leaders of endemic regions and the Nigerian government of

onchcerciasis

.

Address the social and economic consequences of

onchocerciasis

.

Emphasize on community empowerment, and advocate for social mobilization.

Promote partnerships with international NGOs, Foundations, WHO and ministries of health.

Promote self-reliance, self-efficacy, sustainability and local control of programsSlide4

Target Audience

Nigerian

government, Policy makers and

Stakeholders/NGOs including

World Health Organization (WHO), The African

Programme

for

Onchcerciasis

Control (APOC) and The Carter Center.

Ministries of Health/Department of Public Health

Community leaders of affected communities

Interested PublicSlide5

Etiology of Onchocerciasis (River Blindness)

Onchocerciasis

is

a

vector-borne disease caused

by the filarial worm parasite

Onchocerca

volvulus.

T

ransmitted by blackflies

(

Simulum

demnosum

) which

breed in fertile fast flowing

rivers.

Also known as River Blindness due to its

most extreme

manifestation and the breeding site of the blackfly.

(WHO, 2011; CDC, 2011)Slide6

Host and Mode of Transmission

Female blackflies bites an infected human host and sucks up larvae of O.

volulus

Larvae become infective as it develops within

the

blackfly

Infects another human during blood meal

Infective larvae migrate and form nodules as they mature

Female worm reproduces generating ~1000 microfilariae per day

Causes debilitating skin and eye lesions as they migrate and die (WHO, 2011c)Slide7

Mode of Transmission

Source: River Blindness: A forgotten Disease, The Carter Center. Retrieved

from http://www.cartercenter.org/news/documents/doc2217.htmlSlide8

Magnitude of Onchocerciasis

Globally:

- second leading cause of blindness

- approximately 90 million are at risk of infection

- 37 million are infected with the parasite

- 500,000 are blind & 1.5 million visually impaired

- endemic regions include Africa, Latin America and Yemen

In Africa:

- 99% of cases present in 27

sub-saharan

African countries

(WHO, 2011)Slide9

Magnitude of Onchocerciasis (Contd)

In Nigeria :

-

Majority are infected with

onchocerciasis

- 35, 014 hyper-endemic communities

-

Approximately 28 million individuals reside in these communities

(WHO, 2011a: CDC, 2011)Slide10

Morbidity Patterns

Skin inflammatory response to motile microfilaria causes itching and rashes.

D

ebilitating

and disfiguring

skin conditions

including

skin, nodules, hanging

groin, leopard skin, thinning of the skin

and more.

Severe cases impair vision and causes blindness.Slide11

Morbidity Patterns (contd.)

Skin Nodules

- appear when microfilariae forms clusters under the skin

- as microfilariae die off, it causes itching within the upper layer of the skin

(WHO, 2011c)

Image Source:

FiLARiA

-EU

Onchocerciasis

Symptoms

.

Retrieved

from

http://www.filaria.eu/treat/treat/oncho/symptoms.htmlSlide12

Morbidity Patterns (contd.)

H

anging groin

- results when microfilariae invades the lymph nodes

-

destroys skin elasticity as worms migrate to the groin area

- this causes loose & hanging folds

-more common in men than women

Image source: The Filarial Genome Network (2011).

Onchocerca

volvulus: The Causative Agent of River Blindness. Slide13

Morbidity Patterns (contd)

L

eopard skin

- prominent in the lower limbs

-intense itching

- skin loses elasticity and pigmentation

(WHO, 2011)

Image Source:

APOC. Retrieved

from http://

www.who.int/apoc/onchocerciasis/disease/en/index.htmlSlide14

Morbidity Patterns (contd)

Impaired vision and blindness

- occurs in severe cases when lesions develop in the eye

- determined by microfilariae worm load near the eye

(WHO, 2011)

Image Source: OCP: African

Programme

for

Onchocerciasis

Control. Retrieved from https://apps.who.int/ocp/slides/index.htmSlide15

Social Consequences of Onchocerciasis

Disruption of family life and relationships

- Desertion of from rural to urban parts

- affects sexual life of affected couples

Limited social interaction

- Onset of symptoms reduces self-esteem, reputation

- StigmatizationSlide16

Social Consequences of Onchocerciasis (contd)

I

mpact on women and children

- affects the age of marriage in young women

- their choice of their partners

- lessens bonding between new mother and child

Educational impact on children - children drop out from school to lead blind family members

(

Ubachukwu

, 2006)

Image Source: OCP: African

Programme

for

Onchocerciasis

Control.

Retrieved

from https://apps.who.int/ocp/slides/index.htmSlide17

Economic Consequences of Onchocerciasis

Direct Costs

- include health care costs of rehabilitation

Indirect Costs

-

include costs stemming from the loss of productivity

Slide18

Economic Consequences of Onchocerciasis

Reduces work productivity

- individuals afflicted with disabling skin conditions are unable to work

- work activities in these communities include farming, fishing, handicraft, trading etc.

Urban migration and slum development

- unable to access and secure employment

- experience extreme poverty and become beggars on the streets

- settle in shanty towns and resort to living in slumsSlide19

Control of Onchocerciasis: Strategies, Techniques and Challenges

Vector Control:

- ground application or aerial spraying of

larvicide

in breeding waters of the blackflies

Limitations

-expensive

- concern of the effect of chemicals on the environment including vegetation, aquatic life and the air.

Image Source: OCP: African

Programme

for

Onchocerciasis

Control.

Retrirved

from https://apps.who.int/ocp/slides/index.htmSlide20

Control of Onchocerciasis: Strategies, Techniques and Challenges (contd.)

Ivermectin

(

Mectizan

®)

- Potent and cost- effective

- one oral dose annually for 16 – 18 years

- gradually destroys and inactivates microfilariae

- suppresses reproduction of adult worms (WHO, 2011c)

Image Source: WHO, (2011)

Ivermectin

. Retrieved from http://www.who.int/apoc/cdti/ivermectin/en/index.htmlSlide21

Control of Onchocerciasis: Strategies, Techniques and Challenges (contd.)

Ivermectin

benefits

-

effective against other intestinal

parasites

-

relieves itching, improves

skin

texture

and

less

ill

health

-

increase physical vitality

and

performance

(

Abanobi

et al., 1993;

Akogun

et al., 2000) Slide22

Status of Onchocerciasis Control in Nigeria

Initial launch of

community-directed treatment with

ivermectin

(CDTI) project was

in 1997

As of 2007, 27 active CDTI projects present

Only a single

national

onchocerciasis

task force (NOTF)-secretariat supported

projects

No

vector elimination

projects

(WHO, 2011a)Slide23

Status of Onchocerciasis Control in Nigeria (contd)

Ivermectin

distribution (as of 2007)

- treatment target was 35 339, and so far 33 924 communities have been treated

with

ivermectin

.

- covering 96% of endemic communities in 2006

Therapeutic coverage

(as of 2007

)

- treatment target was 29 509 353 people, so far 23 464 448 people have been treated

with

ivermectin

- covering 79.5% of the infected population

Training (as of 2007)

- 91 278 are

trained or retrained community-directed

distributors

- 323

people per community-directed

distributor

-22982 trained

or retrained health

workers Slide24

Profile of Onchocerciasis in Nigeria

Image source: WHO, (2011) African

Programme

for

Onchocerciasis

Control (APOC). Retrieved

from

http

://www.who.int/apoc/countries/ng_web.jpgSlide25

Role of International NGOs

APOC and OCP by the WHO

- Promote control strategies via aerial spraying and donation of

Mectizan

- Empowering communities in delivery of

ivermectin

in endemic regions

- Work with the government and community leaders in educating and training health workers

(WHO, 2011)Slide26

Role of Nigerian Federal and State Governments

Federal and State Government

- Commit, allocate, and manage resources including financial and human resources

- Form collaborations and partnerships with

NGOs to achieve success

-

Educate and train health workers in the

distribution of

ivermectin

- Inform local government and community leaders of goals and plansSlide27

Role of Local Government and Community Leaders

Mobilize community members and health workers in the mass distribution of

ivermectin

Organize training workshops managed by NGOs and ministries of health

Inform community members when

ivermectin

distribution will take place.

Develop

self-reliance and self-efficacy

of implementing the program

Ensure sustainability and local control of programsSlide28

ConclusionSuccessful control of

Onchocerciasis

possible due to:

- the use of a comprehensive regional approach

- community participation and empowerment

-sustained long-term partnerships (Levine, 2006)

More efforts needed:

- sustainability of control programs

- improvement in the county’s health care system Slide29

REFERENCES

Abanobi

, O.C.,

Anosike

, J.C.,

Edungbola

, L.D., (1993). Observation on the

Deworming Effect

of

Mectizan

on

Gastro-intestinal

Helminths

during

Onchocerciasis

Mass Treatment

in Imo State Nigeria. Nig. J. Parasitology 14, 11-16.

Akogun

, O. B.,

Akogun

, M. K., Audu, Z., (2000). Community-Perceived Benefits of Ivermectin Treatment in North-Eastern Nigeria. Social Science & Medicine 50: 1451-1456CDC, (2011) Parasites – Onchocerciasis

.

Retrieved from http://www.cdc.gov/parasites/onchocerciasis/epi.html

Levine, R., (2007). Case Studies in Global Health: Millions Saved

. Sudbury, MA: Jones and

Bartlett

Opara

, K. N.,

Fagbemi

O. B.,

Ekwe

, A.,

Okenu

D.M.N., (2005). Status of Forest

nchocerciasis

in the Lower Cross River Basin, Nigeria: Entomologic Profile after Five Years of

Ivermectin

Intervention. Am. J. Trop. Med.

Hyg

., 73(2), 371–37.

Ubachukwu

, P. O., (2006). Socio-Economic

Impact Of

Onchocerciasis

With Particular Reference To Females And Children: A

Review. Animal

Research International; 3(2

)Slide30

REFERENCES (contd)

Ubachukwu

, P. O., (2006). Socio-Economic Impact Of

Onchocerciasis

With Particular Reference To Females And Children: A Review. Animal Research International; 3(2), 494-504

WHO, (2011).

Onchocerciasis

Control

Programme

in West Africa (OCP). Retrieved from http://www.who.int/apoc/onchocerciasis/ocp/en/index.html

WHO, (2011a).

Afican

Programme

for

Onchocerciasis

Control (APOC) Nigeria:

Onchocerciasis

status. Retrieved from http://www.who.int/apoc/countries/nga/en/index.html

WHO, (2011b). APOC: Life Cycle of

Onchocerca

volvulus. Retrieved from http://www.who.int/apoc/onchocerciasis/lifecycle/en/index.html

WHO, (2011c). APOC:

Ivermectin

. Retrieved from http

://www.who.int/apoc/cdti/ivermectin/en/