Download ENVIRONMENTAL HEALTH PUBH 8135 * 8 WALDEN UNIVERSITY

Augustina Ugo R. N., M. S. N.
Walden University, Ph.D. Student
ID# Walden A00131751
PUBH 8165 – 8
Professor: Dr. Jean Johnson
Term: Winter 2009
This Presentation is to educate the general
public(especially travelers to African Countries
where this disease is endemic) on Onchoceriasis or
River Blindness.
Onchocerciasis
 Onchoceriasis or River Blindness : is a common, chronic
multisystemic disease , and the world’s third leading infectious
cause of blindness. It is called riverblindness because the vector
survives in aquatic areas such as streams, rivers.
 Causation: Nematode called Onchocerca Volvulus, can survive
up to fifteen years in the human body
 Mode of Transmission: By bite of a black fly, a female specie,
requires blood meal for ovulation, from insect bite, or human to
human.
 Host: Human beings are the only host
Incubation Period & Life cycle
 Initial bite goes unnoticed
 1 to 2 years after exposure clinical symptoms manifest
as lava has grown into adult worm.
 Life Cycle: Human and Black fly stages
 Human stages : Infected black fly introduce stage
three lava unto human skin penetrating into the
wound. Develops into adult filariae in 6 – 12 months.
Adults resides in in connective tissues for 14 years.
Black fly stage
 A fly ingests microfilaria at blood meal, which
migrates from the fly gut to its thoracic muscles.
Develops into first stage larvae after 28 hours,
develops into stage two after 96 hours; 6 to 10 days
second molting occurs and develops into stage three
infective stage. This infective larva can infest another
when the fly takes its next blood meal.
Distribution
35 countries of the world are affected and 28 countries
and 90% of infected population are from Africa. In
Africa 10% of a village may be blind, including up to
50% of those aged 40 years and older. 85.5 million
people live in endemic areas and half of them are
found in Nigeria (WHO, 2004).
Endemic to Central and South America affecting 70,000
people in Guatemala and Mexico, small isolated area
in Venezuela, Colombia, Brazil, Euador, Yemen and
Saudi Arabian Peninsula.
Distribution
 More than 123 million people live in endemic areas
 18 million people are currently infected.
 270,000 people are blind
 Additional 500,000 have severe visual impairment
 Onchocerciasis is seen among the low socio economy
population living near rivers, stream s where the vector
breeds
Symptoms or Onchoceriasis
 Initial stage without symptoms,
 Later stage :
 Skin Manifestation with itching and rashes, and
subcutaneous bumps under the skin, skin may thicken
and roughen, and wrinkles
 Ocular Manifestation :eye lesions ,blindness
 Lymphatic Manifestation: Lymph nodes swollen,
genitals organs inflamed and swollen; organs
containing adult worms may be seen and felt under
the skin.
Prevention
Avoid fly infested area
Wearing protective clothing such as long sleeves and
pants
Use of insect repellent such as DDT may help
Clean surrounding with no stagnant water or dirty
gutters close to environment
Most effective measure is annual single dose of
treatment of the affected population with the
medication called Ivermectrin
FUTURE CONTROL OF
ONCHOCERIASIS FOR AFRICA
 Royal Taylor Institute Amsterdam, The Netherlands’
 Sightcare International, Ibadan, Oyo /state, Ibadan,
Nigeria.
 Harvard School of Public Health, Boston, MA, U. S. A.
 Institute Nation ale d de Recherchi en Publique ,
Bamako, Mali
Treatment For Onchocerasis
 Ivermectin is said to be safe and effective drug for the mass treatment
of onchocerciasis and when used on an individual basis, it reduces the
ability of the treated person to transmit Onchocerca volvulus
infection. The effect of community-based ivermectin treatment on
the degree of transmission within the community was assessed by
determining the incidence of new infection in children Ivermectin was
distributed annually on three occasions to the eligible members of a
population of approximately 14,000 people living on a rubber
plantation in a forest area endemic for onchocerciasis. After 2 years, the
prevalence of infection in 5-year-old children decreased by 21%. The
annual incidence in an uninfected cohort of children decreased by 35%
and, after age-specific adjustment, the reduction in incidence in 7- to
12-year-old children was 45%. Thus, community-based distribution of
ivermectin led to a significant reduction in incidence of new infection.
These findings suggest that ivermectin can be important in reducing
the transmission of onchocerciasis
Barriers encountered by Public
Health Workers
 Poor road or no roads at all in the remote areas making
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transportation difficult to get to these remote area
No effective communication system, and language barrier
is encountered at last.
No access to health care
Some areas has no doctor, nurses,
Some districts are not known to be inexistence by their
local ministry of health
Sometimes there is no fuel or gad
The workers are poorly paid
Risk Factors
 People who live close to gushing rivers and streams
where the vector black fly breeds.
 Poor and low socio economic villagers
 Travelers visiting these endemic remote countries
 Onchoceriasis proven risk factor for
Glaucoma(Egbert, 2005) There is a scientific evidence
that glaucoma is strongly associated with
Onchoceriasis.
Public Health Intervention Program
 Health Education to the community
 Medication supplied free of charge to African
Countries called Mectizan, made by Merck & Co.
Inc., could effectively and safely treat and prevent river
blindness, this is on going.
 The organization program, the World bank, WHO and
others formed partnership, using the villagers
volunteer in distributing the mediation as required
 The federal ministries of health of each countries
predicates in the eradication effort by public education
Public Health Intervention Strategy
 Enhance community participation between health care
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workers, and the villagers.
Train villager to plan and execute maximun action for their
benefits and for their children.
Community based treatment Intervention. Under
supervision use community to collect medication from the
Ministry of health and distribute to the villagers.
Public health workers also need to train villagers, supervise
and procure their allocated share from the Ministry of
health regularly
Provide bicycle to natives to get to the remote areas.
Eradication of diseases in African
communities
 Just as President Jimmy Carter said at the eradication
of guinea worm in Africa; He made it clear to the
villagers that they are the ones to get themselves out of
this disease outbreak by adhering to public health
education and advise on the disease prevention.
Websites
 Association Management Professionals at
www.ampmanagement.org
 The Nigerians Peoples Club New York Branch The
Big Apple [email protected]
 Dr. Victoria Ukachukwu V.P. Rutgers University,
Dept of Biochemistry vkachukwu@gm
 Childrens Hospital at Montefiore, V.P.,
[email protected]