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What to do to eliminate onchocerciasis

By Ijeoma UKAZU

To achieve complete elimination of Onchocerciasis, also known as River Blindness, one of the Neglected Tropical Diseases, NTDs in Nigeria, the federal government needs to release funds as well as improve support in order to sustain progress.

The disease, which is caused by a parasitic worm Onchocerca volvulus, is transmittable to humans through exposure to repeated bites from infected black flies of the genus Simulium. It is most common in those who live in remote African villages.

Currently, Nigeria implementation and impact project on Onchocerciasis have seen some level of progress which expert states that, “the transmission of the disease has been interrupted in Plateau, Nasarawa, Kaduna, Kebbi and Zamfara States. More than 2.0 million persons are no longer in need of Mass Drug Administration, MDA, for Onchocerciasis in the endemic local government Areas of Kaduna state.

“More than 2.7 million persons are no longer in need of MDA for Onchocerciasis in the 15 endemic local government Areas of Kebbi and Zamfara States. In Delta, Ekiti, Yobe, Oyo and Bauchi states are suspected to have interrupted Onchocerciasis transmission.

“While 10 states, Kano, Adamawa, Taraba, Niger, Kwara, Kogi, Osun, Ekiti are on track for elimination by 2030,” says the focal person, United Nations Children’s Fund, UNICEF, supported NTDs Programme, Federal Ministry of Health, Dr. Chukwuemeka Makata.

Despite progress, Dr. Makata revealed that the programmme needs improved support and release of funds for NTDs as it plans to intensify and carry out high-level advocacy to policy makers as part of its immediate plans.

He added that there would be scale up interventions to cover all eligible endemic Local Government Areas, LGAs and all at-risk populations following Onchocerciasis elimination mapping.

However, the UNICEF focal person said that the project is faced with some challenges such as; insecurity in some LGAs, poor funding support by government for Onchocerciasis interventions and poor incentives for community implementers.

Makata at a two-day media dialogue on NTDs Control in Nigeria, organized by UNICEF in collaboration with the Child Rights Information Bureau, CRIB of the Federal Ministry of Information and Culture, recently in Port Harcourt said that, “while carrying out the survey on Onchocerciasis, we catch the black fly that picks the parasite to find out if it still carries this parasite. The implication is that, if the parasite is found in the insect, it means it is still in the population and transmissible.

“These blackflies breed along fast-flowing rivers and streams, close to remote villages located near fertile land where people rely on agriculture. They can travel from where they are to somewhere 10 to 20 kilometres away, if the fly is with the parasite, they easily transmit to another person. While carrying out the survey, we give a distance of about 20km from the river until we get to a place they might not be able to reach.”

Contributing, Dr. Nse Akpan, National Coordinator, Neglected Tropical Diseases Elimination Programme, Federal Ministry of Health, said that all states in the country are endemic for one or more of these NTDs and only four LGAs out of the 774 LGAs are not endemic for any of the NTDs.

Today, Nigeria is battling with the management of 15 out of the 20 NTDs identified by the World Health Organisation, WHO amid poor awareness that has remained a barrier to early treatment. Unfortunately, more than half of Nigerians, an estimated two out of every three persons, are at risk of one or more NTDs, according to statistics.

These include trachoma, (Granular Conjunctivitis), Onchocerciasis, (River blindness) Lymphatic Filariasis, (Elephantiasis) helminthiasis, soil-transmitted, schistosomiasis, (parasitic worms) and leprosy, snakebites Yaws Rabies, Buruli ulcer, Leishmaniasis, Human African Trypanosomiasis, HAT, among others.

Akpan further said that most Nigerians affected by any of the 15 NTDs, ravaging many communities have continued to display poor health-seeking behaviour. Many are also reluctant to speak about their condition.

Quoting figures from Neglected Tropical Diseases Elimination Programme, Akpan said, Nigeria has an estimated 119.5 million people suffering from Lymphatic Filariasis; 51.4 million have Onchocerciasis.

Contributing, Dr. Obiageli Nebe, Deputy Director, Programme Manager, National Schistosomiasis/ Soil-Transmitted Helminthiasis Elimination Programme called on the federal government to invest in NTDs as partners (WHO and UNICEF) are doing enough.

She said, “The medicines running into millions come into Nigeria every year as Nigeria is one of the largest beneficiaries of NTDs commodities globally. There is no country in the world that benefits the amount of medicine that comes into Nigeria.

“We appreciate the partners and appeal to journalists to do more reports on NTDs to put the issue always on the front burner. So that at the course of the elimination campaign, we will all gather to celebrate. But this is a very critical stage, from 2021 to 2030 we want to keep track of whatever is happening in NTDs to ensure total elimination.

According to the World Health Organization, WHO, symptoms of Onchocerciasis often don’t appear for up to one to two years after infection. Skin nodules and itching may develop. Eye infections can lead to vision changes and blindness.

According to a 2017 report by the Federal Ministry of Health, more than 99 percent of all cases on Onchocerciasis and Onchocercal related blindness are found in Africa, with Nigeria having the greatest burden of the disease, and has about 40 percent of the global population at risk. Nigeria has about 50 million persons in over 40,000 communities at risk. Blindness and severe skin manifestation are two major effects of the disease on affected populations.

The report also states that Onchocercal blindness is the world’s fourth leading cause of preventable blindness after cataract, glaucoma and trachoma. The disease is significantly a disease of the poor with economic implications resulting in further impoverishment of affected communities, a challenge to the SDGs 2 and 3 and national developmental goals.

WHO recommends Ivermectin as treatment for Onchocerciasis at least once yearly for 10 to 15 year period. Symptoms include: severe itching, disfiguring skin conditions, and visual impairment, including permanent blindness.

The Global Burden of disease study estimated in 2017 that there were 20.9 million prevalent Onchocerciasis volvulus infections worldwide: 14.6 million of the infected people had skin disease and 1.15 million had vision loss.

Community-directed treatment with Ivermectin is the core strategy to eliminate onchocerciasis in Africa. In the Americas the strategy is biannual large-scale treatment with the drug.

Four countries have been verified by WHO as free of Onchocerciasis after successfully implementing elimination activities for decades: Colombia, Ecuador, Mexico, and Guatemala.

By the end of 2017, three additional countries had stopped mass drug administration and completed three years of post-treatment surveillance in at least one transmission area: Bolivarian Republic of Venezuela, Uganda, and Sudan. 1.8 million people live in areas that no longer require mass drug administration for Onchocerciasis.

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