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  1. RIVER BLINDNESS(ONCHOCERCIASIS)IN CAMEROONPresented byAhone NgujedePhD StudentPUBLIC HEALTHWalden UniversityJuly 28, 2012

  2. 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. PRESENTATION OUTLINE

  3. 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. OBJECTIVE OF PRESENTATION

  4. 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. TARGET AUDIENCE

  5. 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. SELECTED STAKEHOLDERS

  6. Other names: Onchocerciasis Robles’ disease A 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.htm Pennisi, E. (2002). New culprit emerges in river blindness. Science. 295(5561): 1809-1810. doi: 10.1126/science.295.5561.1809 RIVER BLINDNESS ETIOLOGY

  7. 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. RIVER BLINDNESS ETIOLOGYContinued…

  8. 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.81692 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 EXTENT OF RIVER BLINDNESS

  9. 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.html Moeller, D. W. (2011). Environmental health (4th ed.). Cambridge, MA: Harvard University Press. EXTENT OF RIVER BLINDNESSContinued..

  10. 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 MODE OF TRANSMISSION AND HOST

  11. CLYCLE OF RIVER BLINDNESS TRANSMISSION Life cycle of the black fly. Photo: CDC, http://www.dpd.cdc.gov/dpdx/HTML/Filariasis.htm

  12. 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 MODE OF TRANSMISSION AND HOSTContinued…

  13. SYMPTOMS OF RIVER BLINDNESS Adult worms live up to 15years in humans Lifespan of nematode larvae is 2years On 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

  14. SYMPTOMS OF RIVER BLINDNESSContinued… Source: neglecteddisease.gov Source: APOC

  15. 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.html Nettleman, M. D. (2011). Onchocerciasis. Medscape. Retrieved from http://emedicine.medscape.com/article/224309-overview Source: nhm.ac.uk

  16. 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.htm Sightsavers International (2010). River blindness. Preventing Blindness. Retrieved from http://www.sightsaversusa.org/our_work/how_we_help/prevention_and_cure/preventing_blindness/16890.html 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 TREATING FOR RIVER BLINDNESS

  17. Mectizan/Ivermectin treatment Source: Adrian Arbib / Sightsavers http://www.sightsaversusa.org/our_work/how_we_help/prevention_and_cure/preventing_blindness/16890.html

  18. 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 TREATING RIVER BLINDNESSContinued…

  19. 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.html 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 CONTROL AND PREVENTION OF RIVER BLINDNESS

  20. 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. Source: WHO, Sierra Leone.http://www.neglecteddiseases.gov/target_diseases/onchocerciasis/index.html#symptoms

  21. 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: African Programme for Onchocerciasis Control (APOC)-created in 1995. Mectizan Donation program, created in 1987. Onchocerciasis Elimination Programme for the Americas (OEPA)-created in 1992. Onchocerciasis Control Programme (OCP)-created in 1974. CONTROL AND PREVENTION OF RIVER BLINDNESS Continued…

  22. Source: OCP: African Programme for Onchocerciasis Control. Retrirved from https://apps.who.int/ocp/slides/index.htm Helicopter spraying insecticide in flowing waters.

  23. 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.html World Health Organization, (2011). Ivermectin. African Programme for Onchocerciasis Control (APOC). Retrieved from http://www.who.int/apoc/cdti/ivermectin/en CONTROL AND PREVENTION OF RIVER BLINDNESS Continued…

  24. 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

  25. 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: 10.4103/0974-9233.71594 Center 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…

  26. 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: 10.4103/0974-9233.71594 Center 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…

  27. 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. MAIN FOCUS OF PRESENTATION(CONCLUSION)

  28. 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 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 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 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 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 Moeller, D. W. (2011). Environmental health (4th ed.). Cambridge, MA: Harvard University Press. Nettleman, M. D. (2011). Onchocerciasis. Medscape. Retrieved from http://emedicine.medscape.com/article/224309-overview Pennisi, E. (2002). New culprit emerges in river blindness. Science. 295(5561): 1809-1810. doi: 10.1126/science.295.5561.1809 Sightsavers International (2010). River blindness. Preventing Blindness. Retrieved from http://www.sightsaversusa.org/our_work/how_we_help/prevention_and_cure/preventing_blindness/16890.html 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 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 World Health Organization-WHO (2011). Ivermectin. African Programme for Onchocerciasis Control (APOC). Retrieved from http://www.who.int/apoc/cdti/ivermectin/en REFERENCES

  29. 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 SOURCES FOR FURTHER READING