Transcript river blindness in Cameroon

RIVER BLINDNESS
(ONCHOCERCIASIS)
IN CAMEROON
PRESENTED BY
AHONE NGUJEDE
PHD STUDENT
PUBLIC HEALTH
WALDEN UNIVERSITY
JULY 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’ 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
CONTINUED…
• Found mostly in
Africa in intertropical zones.
• Considered a
vector-borne
disease.
• Attacks the skin
and eye.
A blackfly feeding on the skin of a human host. Photo: WHO/TDR/Stammers.
World Health Organization (2012). Onchocerciasis
(river blindness)- disease information. Prevention of
Blindness and Visual Impairment. Retrieved from
http://www.who.int/blindness/partnerships/onchocercia
sis_disease_information/en/index.html
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.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
CONTINUED..
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.
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
Life cycleOF
of the
blackBLINDNESS
fly. Photo: CDC,
http://www.dpd.cdc.gov/dpdx/HTML/Filariasis.htm
CLYCLE
RIVER
TRANSMISSION
MODE OF TRANSMISSION AND HOST
CONTINUED…
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 BLINDNESS
Adult worms live up to
 Elephantiasis of
15years in humans
scrotum
Lifespan of nematode
 Swollen limbs (edema)
larvae is 2years
 Bleeding patches from
On the skin:
scratching
 Nodules under the
skin, causing itchy
skin rashes.
 Thinning of the skin
and discoloration or
“leopard skin;” tough
and wrinkled.
SYMPTOMS OF RIVER BLINDNESS
CONTINUED…
Source: neglecteddisease.gov
Source: APOC
SYMPTOMS OF RIVER BLINDNESS
CONTINUED…
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. ParasitesOnchocerciasis (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
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.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
MECTIZAN/IVERMECTIN
TREATMENT
Source: Adrian Arbib / Sightsavers
http://www.sightsaversusa.org/our_work/how_we_help/prevention_and_cure/preventing_blindness/168
90.html
TREATING RIVER BLINDNESS
CONTINUED…
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.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
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
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.html
World 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: 10.4103/0974-9233.71594
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…
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
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.

REFERENCES
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
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: 10.4103/09749233.71594
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-riverblindness.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/224309overview
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
SOURCES FOR FURTHER READING
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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