Onchocerciasis Onchocerciasis (River Blindness)(River Blindness)

Presented by Presented by Elizabeth Ndubisi-Ukandu, Ph.D StudentElizabeth Ndubisi-Ukandu, Ph.D Student

In partial fulfillment of PUBH-8165-3-Environmental HealthIn partial fulfillment of PUBH-8165-3-Environmental HealthWalden UniversityWalden University

Instructor: Dr. Jeff WuInstructor: Dr. Jeff WuSummer Term, 2009Summer Term, 2009

Outline of topic presentationOutline of topic presentation

This presentation is aimed at indirect education primary This presentation is aimed at indirect education primary victims of River Blindness through primary victims of River Blindness through primary healthcare providers, volunteers, local health agencies healthcare providers, volunteers, local health agencies in the endemic areas.in the endemic areas.

There is review of the etiology, mode of transmission of There is review of the etiology, mode of transmission of this disease, as well as examining why the situation this disease, as well as examining why the situation persists, cultural barriers and prevention measures.persists, cultural barriers and prevention measures.

There is a look at the successes of prevention strategies; There is a look at the successes of prevention strategies; and continuing efforts in other areas. Lastly there is a and continuing efforts in other areas. Lastly there is a provision of a list of resources for further reading. provision of a list of resources for further reading.

Presentation TopicPresentation Topic

Onchocerciasis (River Blindness)Onchocerciasis (River Blindness)

Health education campaign for primary care Health education campaign for primary care providers and health agencies in endemic providers and health agencies in endemic

regions.regions.

Self-prevention measures by primary victims Self-prevention measures by primary victims through health education by public health through health education by public health

educators.educators.

Presentation ObjectivePresentation Objective

Educate rural inhabitants of endemic regions, Educate rural inhabitants of endemic regions, travelers in the region on River Blindness.travelers in the region on River Blindness.

Educate on Cultural, ethnic and religious Educate on Cultural, ethnic and religious valuesvalues

Campaign for the elimination and eradication Campaign for the elimination and eradication of River Blindness.of River Blindness.

Encourage victims to seek professional Encourage victims to seek professional healthcare services.healthcare services.

Who are the target audience?Who are the target audience?

Healthcare providers for the targeted Healthcare providers for the targeted communitycommunity

Rural inhabitants of endemic regions Rural inhabitants of endemic regions particularly in Africa’s remote villages, the particularly in Africa’s remote villages, the traveler in these regions.traveler in these regions.

Departments of Public HealthDepartments of Public Health Policy makers and interested public Policy makers and interested public

(WHO, 2001; CDC, 2008)(WHO, 2001; CDC, 2008)

Why are they the target audience?Why are they the target audience?

The healthcare providers because they are the The healthcare providers because they are the primary providers of care for the victims primary providers of care for the victims

The rural village inhabitants who are the The rural village inhabitants who are the primary victims of the disease primary victims of the disease

Health care agencies who are responsible for Health care agencies who are responsible for the public health of the communitythe public health of the community

Global agencies interested in eradicating the Global agencies interested in eradicating the disease.disease.

(Levine, 2007; WHO, 2007)(Levine, 2007; WHO, 2007)

Etiology of Onchocerciasis Etiology of Onchocerciasis (River Blindness)(River Blindness)

Onchocerciasis is caused by a parasitic worm Onchocerciasis is caused by a parasitic worm and is spread by the bite of an infected and is spread by the bite of an infected blackfly blackfly

It is also called River Blindness because It is also called River Blindness because infections are most intense in remote African infections are most intense in remote African rural agricultural villages, located near rapidly rural agricultural villages, located near rapidly flowing streams.flowing streams.

(WHO,2001; CDC, 2008; Levine, 2007)(WHO,2001; CDC, 2008; Levine, 2007)

Host and Mode of TransmissionHost and Mode of Transmission

The parasitic worm lives in the Blackfly where The parasitic worm lives in the Blackfly where it developsit develops

Once a blackfly is infected, it infects the Once a blackfly is infected, it infects the human victim by bites. The severity of the human victim by bites. The severity of the resulting disease depends on the intensity of resulting disease depends on the intensity of the bites (CDC, Fact sheet:2008)the bites (CDC, Fact sheet:2008)

Cycle of Onchocerciasis TransmissionCycle of Onchocerciasis Transmission

Source: Basáñez M-G et al: River Blindness, A Success story under threat?

Significance of Onchocerciasis Significance of Onchocerciasis (River Blindness)(River Blindness)

Global Onchocerciasis prevalence is 17.7 Global Onchocerciasis prevalence is 17.7 million million

270,000 are blind and another 500,000 have 270,000 are blind and another 500,000 have visual impairment visual impairment

99% of infected persons are in Africa; the 99% of infected persons are in Africa; the remainder is in Yemen and six countries in the remainder is in Yemen and six countries in the Americas Americas

world's second leading infectious cause of world's second leading infectious cause of blindness (CDC, 2008; WHO, 2001). blindness (CDC, 2008; WHO, 2001).

Chart of Onchocerciasis InfectionChart of Onchocerciasis Infection

Source: Basáñez M-G et al: River Blindness, A Success story under threat?

How enduring is it?How enduring is it?

It is the world's second leading infectious It is the world's second leading infectious cause of blindness cause of blindness

Millions of people are being handicapped from Millions of people are being handicapped from a preventable disease. a preventable disease.

(CDC, 2008; WHO, 2001).(CDC, 2008; WHO, 2001).

Why does it continue to persist?Why does it continue to persist?

Lack of education on the dangers of fast flowing rivers.Lack of education on the dangers of fast flowing rivers.

Rural communities and their cultural and spiritual Rural communities and their cultural and spiritual connections and interpretations of water, its natural connections and interpretations of water, its natural source and the “correct way” of using it (WHO, 2001; source and the “correct way” of using it (WHO, 2001; Rinne, 2006). Rinne, 2006).

Where are the endemic regions?Where are the endemic regions?

The endemic regions are primarily the rural The endemic regions are primarily the rural villages of Africa, which are close to bodies of villages of Africa, which are close to bodies of flowing waters.flowing waters.

YemenYemen

6 other countries in the Americas6 other countries in the Americas

(CDC, 2008; WHO, 2001).(CDC, 2008; WHO, 2001).

Endemic Areas for Onchocerciasis Endemic Areas for Onchocerciasis DiseaseDisease

Source: Basáñez M-G et al: River Blindness, A Success story under threat?

Is the disease treatable?Is the disease treatable?

Disease is highly preventableDisease is highly preventable

Once a victim has been infected, there is no Once a victim has been infected, there is no cure for the disease, its progress can be cure for the disease, its progress can be delayed with oral medication (CDC: River delayed with oral medication (CDC: River Blindness fact sheet, 2008).Blindness fact sheet, 2008).

Prevention measures - PersonalPrevention measures - Personal

Oral dose of 150 micrograms per kilogram Oral dose of 150 micrograms per kilogram (maximum 12 mg) every 6-12 months of the (maximum 12 mg) every 6-12 months of the highly effective Mectizan (invermectin) – highly effective Mectizan (invermectin) – (WHO, 2008). (WHO, 2008).

This medication will not cure the disease but it This medication will not cure the disease but it will slow down its progress, killing off almost will slow down its progress, killing off almost 95% of the tiny worms (Levin, 2007).95% of the tiny worms (Levin, 2007).

Prevention measures – health Prevention measures – health agenciesagencies

Controlling insect breeding sites in rivers is one of Controlling insect breeding sites in rivers is one of the pillars of prevention– by spraying the aerial the pillars of prevention– by spraying the aerial spaces and rivers (WHO, 2001). spaces and rivers (WHO, 2001).

Free distribution of the highly effective medicine – Free distribution of the highly effective medicine – Mectizan (ivermectin), this medication provides a Mectizan (ivermectin), this medication provides a yearly protection from a single dose (Levine, 2007).yearly protection from a single dose (Levine, 2007).

Sustaining a comprehensive regional prevention Sustaining a comprehensive regional prevention effort and collaborations (Levine, 2007).effort and collaborations (Levine, 2007).

Prevention measures – Global effortsPrevention measures – Global efforts

Onchocerciasis Control ProgramOnchocerciasis Control Program in West in West Africa (OCP), which is being sponsored by the Africa (OCP), which is being sponsored by the WHO, World Bank, UNDP and UN Food and WHO, World Bank, UNDP and UN Food and Agriculture Organization Agriculture Organization

In 1992, the Onchocerciasis Elimination In 1992, the Onchocerciasis Elimination Program in the Americas (OEPA) was Program in the Americas (OEPA) was launched in 6 countries launched in 6 countries

Barriers to preventionBarriers to prevention

Cultural, spiritual and religious symbolism of Cultural, spiritual and religious symbolism of water in endemic regionswater in endemic regions

Lack of education on the health issues and Lack of education on the health issues and risks associated with the transmission of River risks associated with the transmission of River Blindness disease Blindness disease

Lack of adequate funding to implement a Lack of adequate funding to implement a sustained intervening campaign.sustained intervening campaign.

(Rinne, 2006; Gary-Felder et al: 1999; Parker et (Rinne, 2006; Gary-Felder et al: 1999; Parker et al, 2003).al, 2003).

Communication goalsCommunication goals

Intimate knowledge of the etiology and mode Intimate knowledge of the etiology and mode of transmission of River Blindness and of the of transmission of River Blindness and of the cultural and ethnic values of its victims; in this cultural and ethnic values of its victims; in this instance – the rural inhabitants of African instance – the rural inhabitants of African villages and possible travelers through the villages and possible travelers through the region (Schiavo, 2007; cancer.gov/pinkbook) region (Schiavo, 2007; cancer.gov/pinkbook)

A sustained education campaign; developed to A sustained education campaign; developed to be sensitive to the cultural, religious, ethnic be sensitive to the cultural, religious, ethnic values of the target groups (Katzen, et al; values of the target groups (Katzen, et al; 2005)2005)

Message of this presentationMessage of this presentation

River Blindness is a health risk with reported River Blindness is a health risk with reported and documented incidences of mortalityand documented incidences of mortality

River Blindness is preventable and River Blindness is preventable and controllable.controllable.

River Blindness can be eradicated through a River Blindness can be eradicated through a concerted effort by all stakeholders.concerted effort by all stakeholders.

Message strategyMessage strategy

Use of the Theory of Reasoned Action (TRAUse of the Theory of Reasoned Action (TRA) ) model (Schiavo, 2007).model (Schiavo, 2007).

Use of the Communication for Social Change Use of the Communication for Social Change (CFSC(CFSC) model (Gary-Felder and Dean, 1999, ) model (Gary-Felder and Dean, 1999, p.15) p.15)

Interpersonal channels such as a) peer-to-peer Interpersonal channels such as a) peer-to-peer discussions b) theater presentations c) use discussions b) theater presentations c) use community role models with positive community role models with positive influence on the audience influence on the audience (www.campaignstrategy.org).(www.campaignstrategy.org).

Successes of Prevention measuresSuccesses of Prevention measures

The Onchocerciasis Control Program (OCP) launched The Onchocerciasis Control Program (OCP) launched in 1974 and African Programme for Onchocerciasis in 1974 and African Programme for Onchocerciasis Control (APOC) in 11 Countries have:Control (APOC) in 11 Countries have:

- Prevented over 600,000 cases of River BlindnessPrevented over 600,000 cases of River Blindness- 22 million children in endemic areas born free of risk 22 million children in endemic areas born free of risk

of river blindnessof river blindness- Annual cost of treatment under $0.60 per personAnnual cost of treatment under $0.60 per person- Non-interrupted commitment from 4 original Non-interrupted commitment from 4 original

sponsors and 27 donors over 28 years of programsponsors and 27 donors over 28 years of program

ConclusionsConclusions Although Controlling Onchocerciasis (River Although Controlling Onchocerciasis (River

Blindness) has been lauded as one of the Blindness) has been lauded as one of the global public health successes, there are still global public health successes, there are still endemic areas where it still accounts for the endemic areas where it still accounts for the leading cause of blindness (Levine, 2007).leading cause of blindness (Levine, 2007).

WHO has just collaborated with a WHO has just collaborated with a pharmaceutical company to launch the testing pharmaceutical company to launch the testing of a new promising drug in Africa for River of a new promising drug in Africa for River Blindness (WHO, 2009).Blindness (WHO, 2009).

References:References:

Campaign Strategy ToolsCampaign Strategy Tools http://www.campaignstrategy.org/http://www.campaignstrategy.org/CDC: River Blindness – fact Sheet (2008)CDC: River Blindness – fact Sheet (2008) http://www.cdc.gov/ncidod/dpd/parasites/onchocerciasis/http://www.cdc.gov/ncidod/dpd/parasites/onchocerciasis/

factsht_onchocerciasis.htmfactsht_onchocerciasis.htmMaking Health Communication Programs WorkMaking Health Communication Programs Work http://www.cancer.gov/pinkbookhttp://www.cancer.gov/pinkbookGray-Felder, D., and Dean, J. Communication for Social Change: A Position Paper and Gray-Felder, D., and Dean, J. Communication for Social Change: A Position Paper and Conference Report. 1999Conference Report. 1999 Culled from Renata Schiavo: Health Communication: From Theory to PracticeCulled from Renata Schiavo: Health Communication: From Theory to PracticeKatzen, C., Solan, M., & Dicker, A. (2005). E-mail and oncology: A survey of Katzen, C., Solan, M., & Dicker, A. (2005). E-mail and oncology: A survey of

radiation radiation oncology patience and their attitudes to a new generation of health communication.oncology patience and their attitudes to a new generation of health communication.Levin, Ruth., (2007). Case Studies in Global Health: Millions Saved.Levin, Ruth., (2007). Case Studies in Global Health: Millions Saved.Making Health Communication Programs WorkMaking Health Communication Programs Work http://www.cancer.gov/pinkbookhttp://www.cancer.gov/pinkbook

References:References:

Parker, M., & Gazmararian, J. (2003). Health Literacy: Essentials Parker, M., & Gazmararian, J. (2003). Health Literacy: Essentials for Health for Health

Communication.Communication.Rinne, E. M:Rinne, E. M:

Seeing is Believing': Perceptions of Safe Water in Rural YorubaSeeing is Believing': Perceptions of Safe Water in Rural Yoruba A History of Water, 2006A History of Water, 2006Schiavo, Renata: Health Communication: From Theory to Practice (2007)Schiavo, Renata: Health Communication: From Theory to Practice (2007)Schiavo, R., & Freimuth, Vicki: "Evaluation of a Public Health Campaign"Schiavo, R., & Freimuth, Vicki: "Evaluation of a Public Health Campaign"WHO: Global Plan to combat Neglected Tropical Diseases 2008-2015WHO: Global Plan to combat Neglected Tropical Diseases 2008-2015 http://whqlibdoc.who.int/hq/2007/WHO_CDS_NTD_2007.3_eng.pdfhttp://whqlibdoc.who.int/hq/2007/WHO_CDS_NTD_2007.3_eng.pdfWHO: Water-related Diseases (2001)WHO: Water-related Diseases (2001) http://www.who.int/water_sanitation_health/diseases/oncho/en/http://www.who.int/water_sanitation_health/diseases/oncho/en/WHO: New Drug being tested in Africa for River BlindnessWHO: New Drug being tested in Africa for River Blindness http://www.who.int/mediacentre/news/releases/2009/http://www.who.int/mediacentre/news/releases/2009/

river_blindness_20090701/en/river_blindness_20090701/en/

List of Sources for further reading:List of Sources for further reading: Basáñez M-G, Pion SDS, Churcher TS, Breitling LP, Little Basáñez M-G, Pion SDS, Churcher TS, Breitling LP, Little

MP, et al: River Blindness – MP, et al: River Blindness – A Success Story under Threat?. PLoS Med 3(9): e371. A Success Story under Threat?. PLoS Med 3(9): e371. doi:10.1371/journal.pmed.0030371doi:10.1371/journal.pmed.0030371

Basáñez, María-Gloria; Pion, Sébastien DS; Boakes, Eve; Basáñez, María-Gloria; Pion, Sébastien DS; Boakes, Eve; Filipe, João AN; Churcher, Thomas S; Boussinesq, Filipe, João AN; Churcher, Thomas S; Boussinesq, Michel, : Michel, : Effect of single-dose ivermectin on Onchocerca Effect of single-dose ivermectin on Onchocerca volvulus: volvulus: a systematic review and meta-analysis. Lancet a systematic review and meta-analysis. Lancet Infectious Infectious Diseases, Diseases, May2008, Vol. 8 Issue 5 DOI: May2008, Vol. 8 Issue 5 DOI: 10.1016/S1473-3 Retrieved from Academic Search 10.1016/S1473-3 Retrieved from Academic Search PremierPremier

Duke, B.O.: Duke, B.O.: Onchocerciasis (river blindness)-can it be Onchocerciasis (river blindness)-can it be eradicated?eradicated?

Parasitology today, 1990 - ncbi.nlm.nih.govParasitology today, 1990 - ncbi.nlm.nih.gov

List of Sources for further reading: List of Sources for further reading: cont.cont.

Otubanjo, O. A.; Adeoye, G. O.; Ibidapo, C. A.; Akinsanya, B.; Okeke, P.; Otubanjo, O. A.; Adeoye, G. O.; Ibidapo, C. A.; Akinsanya, B.; Okeke, P.; Atalabi, T.; Adverse reactions from community directed treatment with Atalabi, T.; Adverse reactions from community directed treatment with

ivermectin (CDTI ) for ivermectin (CDTI ) for onchocerciasisonchocerciasis and loiasis in Ondo and loiasis in Ondo State, State, Nigeria. Revista de Biologia Tropical, Nigeria. Revista de Biologia Tropical, dic2008, Vol. 56 dic2008, Vol. 56 Issue 4. Issue 4. Retrieved from Academic Search PremierRetrieved from Academic Search Premier

Stingl, Peter.: OnchocerciasisStingl, Peter.: Onchocerciasis:: developments in diagnosis, treatment and developments in diagnosis, treatment and control. International Journal of Dermatology, Apr2009, Vol. 48 control. International Journal of Dermatology, Apr2009, Vol. 48

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Thylefors, B.; Alleman, M. M.; Twum-Danso, N. A. Y.: Operational Thylefors, B.; Alleman, M. M.; Twum-Danso, N. A. Y.: Operational lessons from 20 years of the Mectizan Donation Program for the lessons from 20 years of the Mectizan Donation Program for the control of onchocerciasis. Tropical Medicine & International Health, control of onchocerciasis. Tropical Medicine & International Health, May2008, Vol. 13 Issue 5 DOI: 10.1111 May2008, Vol. 13 Issue 5 DOI: 10.1111 AN AN 3167852631678526 Retrieved Retrieved

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