RIVER BLINDNESS(ONCHOCERCIASIS)

IN CAMEROON

PRESENTED BY

AHONE NGUJEDE

PHD STUDENTPUBLIC HEALTH

WALDEN UNIVERSITYJULY 28, 2012

PRESENTATION OUTLINE

This PowerPoint presentation reviewed River Blindness; considered the mode of transmission, etiology, extent of disease infection, symptoms, control, prevention measures, economic and cultural barriers of the disease.

The presentation focused on the Cameroonian community. These will include communities, especially those hardest hit by the disease, public health officials, stakeholders, volunteers, and healthcare providers.

OBJECTIVE OF PRESENTATION

Educate Public health officials, volunteers, and the community in particular about river blindness and how to prevent the disease.

Encourage those affected by the disease to seek medical help in order to slow down blindness.

Help to eradicate the disease, if possible. Encourage stakeholders to help in funding. Promote self-efficacy, sustainability, self-reliance,

and local program control.

TARGET AUDIENCE

The target audience is the Northern region of Cameroon. This area is most hit by the disease in Cameroon - a lot is not known about river blindness despite its susceptibility. After this presentation, Cameroonians will be able to identify symptoms, control transmission and progression and also see measures in which to prevent the disease.They will protect their families and hopefully some day live in a community free from river blindness.

SELECTED STAKEHOLDERS The Ministry of Public Health in Cameroon. The Fomunyoh Foundation (TFF). Community Agriculture and Environmental

protection Association (CAEPA). Breaking Ground Charity in Ngaoundere,

Cameroon. Life and Water Development Group (LWDG). Cameroon Association for the Protection and

Education of the child. Cameroon Mass media.

RIVER BLINDNESS ETIOLOGY

Other names: Onchocerciasis Robles’ diseaseA roundworm-like parasite called Onchocerca volvulus. Caused by a bite from female blackflies of the genus Simulium. Found near flowing streams and rivers.Center Disease Control and Prevention (2011). Onchocerciasis (River Blindness). Traveler’s Health. Retrieved from http://wwwnc.cdc.gov/travel/yellowbook/2012/chapter-3-infectious-diseases-related-to-travel/onchocerciasis-river-blindness.htmPennisi, E. (2002). New culprit emerges in river blindness. Science. 295(5561): 1809-1810. doi: 10.1126/science.295.5561.1809

RIVER BLINDNESS ETIOLOGY

CONTINUED…• Found mostly in

Africa in inter-tropical zones.

• Considered a vector-borne disease.

• Attacks the skin and eye.

World Health Organization (2012). Onchocerciasis (river blindness)- disease information. Prevention of Blindness and Visual Impairment. Retrieved from http://www.who.int/blindness/partnerships/onchocerciasis_disease_information/en/index.html

A blackfly feeding on the skin of a human host. Photo: WHO/TDR/Stammers.

EXTENT OF RIVER BLINDNESS

Worldwide: 2nd main cause of blindness in the world. 90 million estimated to be exposed to Onchocerciasis. About 37 million have been infected. Over 1.5million visually impaired and about 500,000 blind. About 99% of disease found in Africa. Yemen and Latin America are also endangered regions-

Mexico, Venezuela, Guatemala, Colombia, Brazil, and Ecuador

Winthrop, K. L., Furtado, J. M., Silva, J. C., Resnikoff, S., & Lansingh, V.C. (2011). River Blindness: an old disease on the brink of elimination and control. Journal of Global Infectious Diseases. 3(2): 151-155. . doi: 10.4103/0974-777X.81692World Health Organization (2012). Onchocerciasis (river blindness)- disease information. Prevention of Blindness and Visual Impairment. Retrieved from http://www.who.int/blindness/partnerships/onchocerciasis_disease_information/en/index.html

EXTENT OF RIVER BLINDNESSCONTINUED..

Cameroon: An estimated 5.1 million people infected About 62% of the population is at risk Almost 60,000 people suffer some degree of visual impairment

from Onchocerciasis

The Carter Center (2010). Making Inventions Out of Necessity to Fight River Blindness. Retrieved from http://www.cartercenter.org/news/features/h/river_blindness/philippe-nwane-aspirator.htmlMoeller, D. W. (2011). Environmental health (4th ed.). Cambridge, MA: Harvard University Press.

MODE OF TRANSMISSION AND HOST

Female blackflies bite infected human host and draws up nematode larvae

Blackflies become infected with nematode larvae of Onchocerca volvulus.

Blackflies infect other humans while feeding on them.

Infected person develops nodules that look like worms

Winthrop, K. L., Furtado, J. M., Silva, J. C., Resnikoff, S., & Lansingh, V.C. (2011). River Blindness: an old disease on the brink of elimination and control. Journal of Global Infectious Diseases. 3(2): 151-155. . doi: 10.4103/0974-777X.81692

Click icon to add picture

CLYCLE OF RIVER BLINDNESS TRANSMISSION

Life cycle of the black fly. Photo: CDC, http://www.dpd.cdc.gov/dpdx/HTML/Filariasis.htm

MODE OF TRANSMISSION AND HOSTCONTINUED…

Female worms reproduces over 1000 microfilariae (MF) a day.

Symptoms start showing over a long period of time. Cause skin lacerations (discoloration or ‘Leopard

skin’) as they reproduce and mate, and subsequently aim for the eye.

Winthrop, K. L., Furtado, J. M., Silva, J. C., Resnikoff, S., & Lansingh, V.C. (2011). River Blindness: an old disease on the brink of elimination and control. Journal of Global Infectious Diseases. 3(2): 151-155. doi: 10.4103/0974-777X.81692

SYMPTOMS OF RIVER BLINDNESSAdult worms live up to 15years in humansLifespan of nematode larvae is 2yearsOn the skin: Nodules under the

skin, causing itchy skin rashes.

Thinning of the skin and discoloration or “leopard skin;” tough and wrinkled.

Elephantiasis of scrotum

Swollen limbs (edema) Bleeding patches from

scratching

SYMPTOMS OF RIVER BLINDNESSCONTINUED…

Source: neglecteddisease.gov Source: APOC

SYMPTOMS OF RIVER BLINDNESSCONTINUED…

In the eyes: Reversible clouding or

cornea Excessive tear formation

in eyes Itchy, reddish eyes and

blurred vision If not treated, permanent

clouding, resulting in blindness

Center for Disease Control and prevention, (2010). Disease. Parasites-Onchocerciasis (also known as River Blindness). Retrieved from http://www.cdc.gov/parasites/onchocerciasis/disease.htmlNettleman, M. D. (2011). Onchocerciasis. Medscape. Retrieved from http://emedicine.medscape.com/article/224309-overview

Source: nhm.ac.uk

TREATING FOR RIVER BLINDNESS Onchocerciasis disease has no cure. Treatment is available called Ivermectin Brand name is Mectizan First introduced in 1987 by Merck & Co., Inc. Taken orally with a single dose of 150-200ug/kg Very effective and safe treatment with very little

side effects.Center for Disease Control and prevention (2011). Onchocerciasis (River Blindness). Traveler’s Health. Retrieved from http://wwwnc.cdc.gov/travel/yellowbook/2012/chapter-3-infectious-diseases-related-to-travel/onchocerciasis-river-blindness.htmSightsavers International (2010). River blindness. Preventing Blindness. Retrieved from http://www.sightsaversusa.org/our_work/how_we_help/prevention_and_cure/preventing_blindness/16890.htmlWorld Health Organization (2012). Onchocerciasis (river blindness)- disease information. Prevention of Blindness and Visual Impairment. Retrieved from http://www.who.int/blindness/partnerships/onchocerciasis_disease_information/en/index.html

MECTIZAN/IVERMECTIN TREATMENTSource: Adrian Arbib / Sightsavershttp://www.sightsaversusa.org/our_work/how_we_help/prevention_and_cure/preventing_blindness/16890.html

TREATING RIVER BLINDNESSCONTINUED…

Ivermectin kills up to 95% of larvae of O. volvulus worms.

Does not kill adult female worms but suppresses production of microfilariae, which reduces transmission.

Relieves extreme skin irritation and itching. Halts disease progression towards blindness. Ivermectin is taken once a year for 16-18 years to

break transmission; prevents transmission, morbidity and mortality rate.

Basanez, M-G., Pion, S. D., Churcher, T. S., Breitling, L. P., Little, M. P., & Boussinesq, M. (2006). River blindness: a success story under threat? PLoS Medicine. 3(9):1454-1460. doi:10.1371/journal.pmed.0030371

CONTROL AND PREVENTION OF RIVER BLINDNESS

No vaccine is available to prevent Onchocerciasis. Most effective measure is to stay away from

blackfly infested river areas. Affected areas could also be sprayed with

insecticide, thus, controlling the breeding areas Free distribution of Mectizan especially to highly

endangered zones

The Carter Center (2010). Making Inventions Out of Necessity to Fight River Blindness. Retrieved from http://www.cartercenter.org/news/features/h/river_blindness/philippe-nwane-aspirator.htmlWorld Health Organization (2012). Onchocerciasis (river blindness)- disease information. Prevention of Blindness and Visual Impairment. Retrieved from http://www.who.int/blindness/partnerships/onchocerciasis_disease_information/en/index.html

SOURCE: WHO, SIERRA LEONE.HTTP://WWW.NEGLECTEDDISEASES.GOV/TARGET_DISEASES/ONCHOCERCIASIS/INDEX.HTML#SYMPTOMS

Drug distributors working with some of the programs mentioned are seen standing with poles used to measure heights of patients during a mass drug administration.

CONTROL AND PREVENTION OF RIVER BLINDNESS CONTINUED…

In order not for River blindness to become a serious public health issue several organizations especially globally are helping to suppress the disease. Some of the widely recognized are:1. African Programme for Onchocerciasis Control (APOC)-

created in 1995.2. Mectizan Donation program, created in 1987.3. Onchocerciasis Elimination Programme for the Americas

(OEPA)-created in 1992. 4. Onchocerciasis Control Programme (OCP)-created in

1974.

SOURCE: OCP: AFRICAN PROGRAMME FOR ONCHOCERCIASIS CONTROL. RETRIRVED FROM HTTPS://APPS.WHO.INT/OCP/SLIDES/INDEX.HTM

Helicopter spraying insecticide in flowing waters.

CONTROL AND PREVENTION OF RIVER BLINDNESS CONTINUED…

Sponsors of these programs include: World Bank, World Health Organization, (WHO), Center for Disease Control and Prevention, (CDC), United Nations, (UN), European/Western, African and Latin American countries.

They help educate both victims and non-victims of the disease and also encourage those with the disease to seek help.

Moeller, D. W. (2011). Environmental health (4th ed.). Cambridge, MA: Harvard University Press.Sightsavers International (2010). River blindness. Preventing Blindness. Retrieved from http://www.sightsaversusa.org/our_work/how_we_help/prevention_and_cure/preventing_blindness/16890.htmlWorld Health Organization, (2011). Ivermectin. African Programme for Onchocerciasis Control (APOC). Retrieved from http://www.who.int/apoc/cdti/ivermectin/en

BARRIERS IN TREATING RIVER BLINDNESS

Socioeconomic barriers The fear of being beaten by the flies caused

people to migrate to less fertile lands. It is expensive to spray infected areas; insecticides

are not only expensive but short term. Reduces lifespan of victims by 4-10 years, thus

making them less capable of taking care of their families. Most of the men contracted the disease while they were fishing.

Adeoye, A. O., Ashaye, A. O., & Onakpoya, O. A. (2010). Perception and attitude of people toward Onchocerciasis (river blindness) in South Western Nigeria. Middle East African Journal of Ophthalmology. 17(4): 310-314. doi: 10.4103/0974-9233.71594

BARRIERS IN TREATING RIVER BLINDNESS CONTINUED…

Medical barriers Travelling to extremely remote areas for medication

distribution and education is difficult because of the bad roads and weather conditions. Most areas are inaccessible.

Adult worms can be removed by surgery, but surgeries are expensive, especially in developing countries. Many can barely afford a daily meal.

Adeoye, A. O., Ashaye, A. O., & Onakpoya, O. A. (2010). Perception and attitude of people toward Onchocerciasis (river blindness) in South Western Nigeria. Middle East African Journal of Ophthalmology. 17(4): 310-314. doi: 10.4103/0974-9233.71594Center for Disease Control and Prevention, (2010). Disease. Parasites-Onchocerciasis (also known as River Blindness). Retrieved from http://www.cdc.gov/parasites/onchocerciasis/disease.html

BARRIERS IN TREATING RIVER BLINDNESS CONTINUED…

Cultural/Religious barriers Lack of knowledge about river blindness. Many victims usually believe magic and witchcraft

cause the blindness. They usually call it a curse Many seek treatment from traditional healers or

herbalists Several communities would rather visit witch doctors

than seek medical attention, not only for river blindness but for every other disease.

Adeoye, A. O., Ashaye, A. O., & Onakpoya, O. A. (2010). Perception and attitude of people toward Onchocerciasis (river blindness) in South Western Nigeria. Middle East African Journal of Ophthalmology. 17(4): 310-314.. doi: 10.4103/0974-9233.71594Center for Disease Control and Prevention, (2010). Disease. Parasites-Onchocerciasis (also known as River Blindness). Retrieved from http://www.cdc.gov/parasites/onchocerciasis/disease.html

MAIN FOCUS OF PRESENTATION(CONCLUSION)

River blindness should not become a serious public health issue.

It is controllable and preventable. Stakeholders need to join efforts to help eradicate

this disease. Eradicating river blindness in Cameroon will be a

successful story of public health improvement in the nation.

REFERENCES1. Adeoye, A. O., Ashaye, A. O., & Onakpoya, O. A. (2010). Perception and attitude of people toward Onchocerciasis (river

blindness) in South Western Nigeria. Middle East African Journal of Ophthalmology. 17(4): 310-314. doi: 10.4103/0974-9233.71594

2. Basanez, M-G., Pion, S. D., Churcher, T. S., Breitling, L. P., Little, M. P., & Boussinesq, M. (2006). River blindness: a success story under threat? PLoS Medicine. 3(9):1454-1460. doi:10.1371/journal.pmed.0030371

3. Carter Center (2010). Making Inventions Out of Necessity to Fight River Blindness. Retrieved from http://www.cartercenter.org/news/features/h/river_blindness/philippe-nwane-aspirator.html

4. Center for Disease Control and Prevention-CDC, (2010). Disease. Parasites-Onchocerciasis (also known as River Blindness). Retrieved from http://www.cdc.gov/parasites/onchocerciasis/disease.html

5. Center for Disease Control and Prevention-CDC (2011). Onchocerciasis (River Blindness). Traveler’s Health. Retrieved from http://wwwnc.cdc.gov/travel/yellowbook/2012/chapter-3-infectious-diseases-related-to-travel/onchocerciasis-river-blindness.htm

6. Moeller, D. W. (2011). Environmental health (4th ed.). Cambridge, MA: Harvard University Press.7. Nettleman, M. D. (2011). Onchocerciasis. Medscape. Retrieved from

http://emedicine.medscape.com/article/224309-overview8. Pennisi, E. (2002). New culprit emerges in river blindness. Science. 295(5561): 1809-1810. doi:

10.1126/science.295.5561.18099. Sightsavers International (2010). River blindness. Preventing Blindness. Retrieved from

http://www.sightsaversusa.org/our_work/how_we_help/prevention_and_cure/preventing_blindness/16890.html10. Winthrop, K. L., Furtado, J. M., Silva, J. C., Resnikoff, S., & Lansingh, V.C. (2011). River Blindness: an old disease on the

brink of elimination and control. Journal of Global Infectious Diseases. 3(2): 151-155. doi: 10.4103/0974-777X.8169211. World Health Organization-WHO (2012). Onchocerciasis (river blindness)- disease information. Prevention of Blindness and

Visual Impairment. Retrieved from http://www.who.int/blindness/partnerships/onchocerciasis_disease_information/en/index.html

12. World Health Organization-WHO (2011). Ivermectin. African Programme for Onchocerciasis Control (APOC). Retrieved from http://www.who.int/apoc/cdti/ivermectin/en

SOURCES FOR FURTHER READING

Ubachukwu, P. O., (2006). Socioeconomic impact of Onchocerciasis with particular reference to females and children: a review. Animal Research International; 3(2), 494-504. Retrieved from http://www.zoo-unn.org/ARI%20vols/vol3/vol3-2/Ubachukwu.pdf

Hunter, J. M. (2010). River blindness revisited. Geographical Review. 100(4): 559-582. Retrieve from http://www.highbeam.com/doc/1G1-240107733.html

Benton, B., Bump, J., Sékétéli, A., & Liese, B. (2002). Partnership and promise: evolution of the African river-blindness campaigns. Annals of Tropical Medicine & Parasitology. 96(1): 5-14. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/12081251

Center for Disease Control and Prevention (2010). Resources for health professionals. Parasites - Onchocerciasis (also known as River Blindness). Retrieved from http://www.cdc.gov/parasites/onchocerciasis/health_professionals/index.html