Presented by
Ijedinma Abanobi, M.P.H Student
PUBH 6165-3 Environmental Health
Walden University
Instructor: Dr. Patrick Tschida
Fall, 2011
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 communities 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.
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 programs
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 Public
Etiology of Onchocerciasis
(River Blindness)
 Onchocerciasis is a vector-borne disease caused by the
filarial worm parasite Onchocerca volvulus.
 Transmitted 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)
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)
Mode of Transmission
Source: River Blindness: A forgotten Disease, The Carter Center. Retrieved
from http://www.cartercenter.org/news/documents/doc2217.html
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)
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)
Morbidity Patterns
 Skin inflammatory response to motile microfilaria
causes itching and rashes.
 Debilitating and disfiguring skin conditions including
skin, nodules, hanging groin, leopard skin, thinning of
the skin and more.
 Severe cases impair vision and causes blindness.
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/symptom
s.html
Morbidity Patterns (contd.)
• Hanging 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 Image source: The Filarial Genome
Network (2011). Onchocerca volvulus: The
than women
Causative Agent of River Blindness.
Morbidity Patterns (contd)
 Leopard 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/onchocerci
asis/disease/en/index.html
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.htm
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
- Stigmatization
Social Consequences of
Onchocerciasis (contd)
 Impact 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.htm
Economic Consequences of
Onchocerciasis
 Direct Costs
- include health care costs of rehabilitation
 Indirect Costs
- include costs stemming from the loss of
productivity
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 slums
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.htm
Control of Onchocerciasis: Strategies, Techniques
and Challenges (contd.)
 Ivermectin (Mectizan®)
- Potent and costeffective
- 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.html
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)
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)
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
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.jpg
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)
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 plans
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 programs
Conclusion
 Successful 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
REFERENCES
1.
2.
3.
4.
5.
6.
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). CommunityPerceived Benefits of Ivermectin Treatment in North-Eastern
Nigeria. Social Science & Medicine 50: 1451-1456
CDC, (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)
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), 494504
7 WHO, (2011). Onchocerciasis Control Programme in West
Africa (OCP). Retrieved from
http://www.who.int/apoc/onchocerciasis/ocp/en/index.html
8 WHO, (2011a). Afican Programme for Onchocerciasis Control
(APOC) Nigeria: Onchocerciasis status. Retrieved from
http://www.who.int/apoc/countries/nga/en/index.html
9 WHO, (2011b). APOC: Life Cycle of Onchocerca volvulus.
Retrieved from
http://www.who.int/apoc/onchocerciasis/lifecycle/en/index.ht
ml
10 WHO, (2011c). APOC: Ivermectin. Retrieved from
http://www.who.int/apoc/cdti/ivermectin/en/
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