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ONCHOCERCIASIS: THE PUBLIC HEALTH IMPACT IN AFRICA

ONCHOCERCIASIS: THE PUBLIC HEALTH IMPACT IN AFRICA. ENVIRONMENTAL HEALTH (PUBH 8165-1) INSTRUCTOR: DR. SHANA MORRELL FAITH MBANUGO PHD PUBLIC HEALTH WALDEN UNIVERSITY MAY 02, 2009. TARGET AUDIENCE. Environmental Health workers Residents of endemic areas

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ONCHOCERCIASIS: THE PUBLIC HEALTH IMPACT IN AFRICA

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  1. ONCHOCERCIASIS: THE PUBLIC HEALTH IMPACT IN AFRICA ENVIRONMENTAL HEALTH (PUBH 8165-1) INSTRUCTOR: DR. SHANA MORRELL FAITH MBANUGO PHD PUBLIC HEALTH WALDEN UNIVERSITY MAY 02, 2009

  2. TARGET AUDIENCE • Environmental Health workers • Residents of endemic areas • Travelers from the US to endemic areas • Representatives of WHO and other agencies involved in Onchocerciasis control • Health Ministries in Africa

  3. Learning objectives • What is Onchocerciasis • What are the symptoms • How is it transmitted • How is it diagnosed • WHO control programs • Challenges faced

  4. ONCHOCERCIASIS: THE DISEASE • ENDEMIC IN 28 SUB-SAHARAN AFRICAN NATIONS (WHO, 1995) • APPROXIMATELY 42 MILLION PEOPLE WORLDWIDE AFFLICTED (LEVINE,2007) • THE DISEASE IS CAUSED BY THE PARASITIC WORM ONCHOCERA VOLVUS TRANSMITTED TO HUMANS BY BLACKFLIES (THYLEFORS &ALLEMAN,2006) References Levine,R. (2007). Case Studies in Global Health: Millions Saved. Sudbury, MA: Jones and Bartlett Publishers. Thylefors, B. & Alleman, M. (2006). Towards the elimination of Onchocerciasis. Annals of Tropical Medicine & Parasitology, 100(8), pp. 733-746. WHO (1995). Onchocerciasis and its Control. Report of a WHO Expert Committee. Technical report Series No. 852. Geneva: WHO

  5. MODE OF TRANSMISSION • The Vector -THE SIMULIUM BLACKFLY TRANSMITS ONCHOCERCIASISBY BITING INFECTED PERSON -THE BLACK FLY INGESTS MICROFILARIAE OF O. VOLVUS, THEN BITES ANOTHER PERSON -THE BLACKFLIES BREED IN RIVERINE AREAS AND RESIDENTS IN THIS AREA ARE BITTEN OFTEN (LEVINE, 2007) Reference Levine, R. (2007). Case Studies in Global Health: Millions Saved, Sudbury, MA: Jones and Bartlett Publishers.

  6. THE ONCHOCERCIASIS CYCLE • Retrieved from http://www.cartercenter.org/health/river_blindness/index.html

  7. Transmission Continued • The Victim -INSIDE THEHUMAN BODY O. VOLVUSLARVAE GROWS INTO ADULT WORMS -AFTER MATING THE ADULT FEMALE PRODUCES MILLIONS OF MICROSCOPIC MICROFILARIA -THE MICROFILARIA CONSTANTLY MOVE THROUGH THE SKIN AND EYES CAUSING SYMPTOMS (LEVINE, 2007) References Levine, R. (2007). Case Studies in Global Health: Millions Saved. Sudbury, MA: Jones and Bartlett Publishers.

  8. THE ONCHOCERA VOLVUS WORMS Retrieved from http://www.studenttravel.about.com/b/2005/08/02/2005-2006-cdc-yellow-book-dastardly-disease-and-evil-animals.htm

  9. SYMPTOMS • SKIN (WHO, 2009) -Rashes -Swelling -Inflammation -Lesions -Intense itching -Nodules on skin References WHO (2009). Onchocerciasis – the disease and its impact. Retrieved from http://www.who.int/apoc/onchocerciasis/disease/en/index.html

  10. ONCHOCERCIASIS NODULES Retrieved from http://www.asnom.org/en/442_onchocerciasis.htm

  11. SYMPTOMS CONTD. • EYES (WHO, 2009) -WHEN MICROFILARIAE MIGRATE TO THE EYES AND DIE, IT CAUSES AN INFLAMMATORY RESPONSE WHICH LEADS TO; -IMPAIRED VISION DUE TO KERATITIS -BLINDNESS -SECONDARY GLAUCOMA Reference WHO (2009). Onchocerciasis – the disease and its impact. Retrieved from http://www.who.int/apoc/onchocerciasis/disease/en/index.html

  12. EYE LESIONS FROM ONCHOCERCIASIS Retrieved from http://www.cehjournal.org

  13. DIAGNOSTIC METHODS • Skin snip • Antigen - based Immunological assay • The Mazzotti test • Diethyl – Carbamazine Patch test • PCR –based technique • Slit lamp exam • Nodule palpation(Thylefors & Alleman, 2006) References Thylefors, B. & Alleman, M. (2006). Towards the elimination of onchocerciasis. Annals of Tropical Medicine & Parasitology, 100(8), pp. 733-746.

  14. SKIN SNIP Retrieved from http://www.stanford.edu/class/humbio103/ParaSites2006/Onchocerciasis/Diagnosis.html

  15. Combating Onchocerciasis • EARLY CONTROL EFFORTS • -DRUGS USED INCLUDED SURAMIN AND DIETHYLCARBAMAZINE CITRATE (Thylefors & Alleman, 2006) • -NODULECTOMY • -VECTOR CONTROL THROUGH SPRAYING BREEDING SITES WITH DDT (Levine, 2007) References Levine, R. (2007). Case Studies in Global Health: Millions Saved. Sudbury, MA: Jones and Bartlett Publishers. Thylefors, B. & Alleman, M. (2006). Towards the elimination of onchocerciasis. Annals of Tropical Medicine & Parasitology, 100(8), pp. 733-746.

  16. THE ONCHOCERCIASIS CONTROL PROGRAM (OCP)- 1974 to 2002 • -LAUNCHED IN 1974 UNDER WHO • -PARTNERS INCLUDED WORLD BANK, FOOD AND AGRICULTURE ORGANIZATION, THE UNITED NATIONS DEVELOPMENT FUND (WHO, 2009) • -COVERED 11 AFRICAN COUNTRIES (WHO, 2009) • -INITIAL STRATEGY WAS VECTOR CONTROL • -TREATMENT WITH IVERMECTIN ADDED 1988 (WHO) Reference WHO (2009). Onchocerciasis Control Programme (OCP). Retrieved from http://www.who.int/blindness/partnerships/onchocerciasis_OCP/en/

  17. The African Program for Onchocerciasis Control (APOC) • -ESTABLISHED IN 1995 • -INCLUDES 19 PARTICIPATING AFRICAN COUNTRIES • -PARTNERS WITH HEALTH MINISTERIES, NON-GOVERNMENTAL DEVELOPMENT ORGANIZATIONS • -UTILIZES COMMUNITY DIRECTED TREATMENT WITH IVERMECTINE (CDTI) (WHO, 2009) • Reference • WHO (2009). African Programme for Onchocerciasis Control (APOC). Retrieved from http://www.who.int/blindness/partnerships/APOC/en/

  18. IMPACT OF INTERVENTIONS • CDTI ACHIEVED ESTIMATED TREATMENT COVERAGE RATE OF 74% • -80% REDUCTION IN OPTIC NERVE DISEASE • -50% REDUCTION IN ITCHING (Levine, 2007) • ECONOMIC BENEFITS AS PEOPLE RETURNED TO FERTILE LANDS TO FARM (Hodgkin et al., 2007) Reference Hodgkin, C., Molyneuux, D. H., Abiose, A., Phillipon, B., Reich, M. R., Remme, J. H., Thylefors, B., Traore, M. & Grepin, K. (2007). The future of Onchocerciasis control in Africa. PLoS Neglected Tropical Diseases, 1(1).

  19. IMPACT Contd. • -OTHER INCIDENTAL BENEFITS FROM IVERMECTINE TREATMENT INCLUDE EXPULSION OF INTESTINAL WORMS, REVERSASL OF SECONDARY AMENNORRHEA, IMPROVED LIBIDO IN MEN, CLEARANCE OF HEAD LICE (Anosike et al., 2007) Reference Anosike, J. C., Dozie, I. N. S., Ameh, G. I., Ukaga, C. N., Nwoke, B. E. B., Nzechukwu, C. T., Udujih, O. S. & Nwosu, D. C. (2007). The varied beneficial effects of ivermectin (Mectizan) treatment, as observed within onchocerciasis foci in south-eastern Nigeria. Annals of tropical Medicine & Parasitology, 101(7), pp. 593-600.

  20. CHALLENGES • -120 MILLION PEOPLE STILL FACE THREAT OF RIVER BLINDNESS IN AFRICA (WHO, 2007). • -CONFLICTS IN AFRICA INHIBIT PROGRAM • -LONG RANGE FLIGHT OF BLACK-FLIES POSES RISK OF RE-INTRODUCTION OF DISEASE TO DISEASE FREE AREAS • -INSUFFICIENT AFRICAN HEALTH WORKERS AND FACILITIES

  21. CHALLENGES Contd. • -CONCERNS THAT FINANCING MIGHT DRY UP • DETERMINATION OF WHEN TO STOP THE IVERMECTIN TREATMENT SAFELY • REFUSAL OF SOME PEOPLE IN ENDEMIC AREAS TO TAKE IVERMECTIN (Semiyaga et al., 2005) Reference Semiyaga, N. B., Lalobo, O. & Ndyomugyenyi, R. (2005). Refusal to take Ivermectin: the associated “risk” factors in Hoima district, Uganda. Annals of Tropical Medicine & Parasitology, 99(2), pp. 165-172.

  22. RECOMMENDATIONS • THE AFRICAN NATIONS, THE WHO AND THEIR PARTNERS SHOULD SUPPORT RESEARCH EFFORTS TO DETERMINE WHEN IVERMECTIN TREATMENT CAN BE STOPPED SAFELY • AFRICAN NATIONS SHOULD GIVE PRIORITY TO FUNDING OF ONCHOCERCIASIS CONTROL PROGRAMS IN THE NATIONAL BUDGET

  23. RECOMMENDATIONS Contd. • -INTEGRATE CONTROL PROGRAMS INTO THE HEALTH SYSTEM • -INTENSIFY CONTROL ACTIVITIES IN POST-CONFLICT COUNTRIES • -GRASSROOT EDUCATIONAL PROGRAMS TO EXPLAIN THE GOAL OF TREATMENT WITH IVERMECTIN • -CONTINUE SURVEILLANCE AND TREATMENT

  24. QUESTIONS ???

  25. References Anosike, J. C., Dozie, I. N. S., Ameh, G. I., Ukaga, C. N., Nwoke, B. E. B., Nzechukwu, C. T., Udujih, O. S. & Nwosu, D. C. (2007). The varied beneficial effects of ivermectin (Mectizan) treatment, as observed within onchocerciasis foci in south-eastern Nigeria. Annals of Tropical Medicine & Parasitology, 101(7), pp. 593-600. Hodgkin, C., Molyneux, D. H., Abiose, A., Philippon, B., Reich, M. R., Remme, H. J., Thylefors, B., Traore, M. & Grepin, K. (2007). The future of onchocerciasis control in Africa. PLoS Neglected Tropical Diseases, 1(1).

  26. Semiyaga, N. B., Lalobo, O. & Ndyomugyenyi, R. (2005). Refusal to take Ivermectin: the associated “risk” factors in Hoima district, Uganda. Annals of Tropical Medicine & Parasitology, 99(2), pp. 165-172. Thylefors, B. & Alleman, M. (2006). Towards the elimination of onchocerciasis. Annals of Tropical Medicine & Parasitology, 100(8), pp. 733-746. WHO (2009). African Programme for Onchocerciasis Control (APOC). Retrieved from, http://www.who.int/blindness/partnerships/APOC/en/

  27. WHO (2009). Onchocerciasis Control Programme (OCP). Retrieved from, http://www.who.int/blindness/partnerships/onchocerciasis_OCP/en/ • WHO (2009). Onchocerciasis – the disease and its impact. Retrieved from, http://www.who.int/apoc/onchocerciasis/disease/en/index.html • WHO (2007). Onchocerciasis control in the WHO African region: Current situation and a way forward. Report of Regional Committee for Africa. 57th session, Brazzaville, Congo.

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