By Simon Bush,
“The neglected tropical disease (NTD) agenda would not have been feasible without the Community Directed Treatment with Ivermectin (CDTI) framework.
This is the conclusion of a recent paper commissioned by Sightsavers on combating onchocerciasis – or river blindness. What it means in less formal terms is that involving communities in the distribution of river blindness treatments has proven to be effective, sustainable and a method that can be used to combat other diseases. What it also means is the role played by non-governmental development organisations (NGDOs), such as Sightsavers, is fundamental to tackling, and ultimately eliminating, NTDs.
The river blindness tale has been told many times before, and readers of this blog may well be familiar with its treatment, Mectizan® (ivermectin*), which is donated for mass distribution by global pharmaceutical company Merck & Co. Inc. (known as MSD in the UK). But at Sightsavers we wanted to show another side of the story. After nearly 60 years of working in Africa to alleviate river blindness, we felt it was time to take stock of how NGDOs have performed, and ensure that by looking back, we are heading in the right direction in the future – especially as the scientific evidence shows that we have moved from the control of the disease to the elimination of its transmission.
The paper, ’Empowering communities in combating blindness and the role of NGOs’, reviews published literature and previously unpublished documents relating to approaches to river blindness in Africa during the early 1990s. Through four case studies, it describes the challenges organisations have faced when trying to encourage affected communities to manage their own treatment programmes. This was the only way those trying to tackle river blindness felt ongoing action could be sustained for 20 years or more – eventually leading to elimination. Read more: Success in combating NTDs means community ownership
The Government of Uganda has recently launched a health program to eliminate river blindness in the country. The implementation of a mass-drug administration initiative to combat this neglected tropical disease (NTD) is currently the work of President Yoweri Museveni.
Onchocerciasis, or river blindness is the world’s fourth leading cause of preventable blindness, infecting at least 37 million people living near the rivers and fast-moving streams of sub-Saharan Africa. It is spread through the bites of a small black fly that breeds in rapidly flowing waters along fertile riverbanks. This disease leads to visual impairment or blindness, skin disease, and debilitating itching. River blindness has devastating socioeconomic consequences, because it debilitates its victim and stunts economic capacity and development.
The health program to eliminate river blindness is being undertaken by the Ugandan Ministry of Health. It targets river blindness amongst children over five years of age in of Acholi, a region that for decades has been burdened by the disease. With this initiative there is a wave of new hope as the introduction of the new drug, Ivermectin has already begun to re-energize the government’s commitment to eliminate this deadly disease. President Museveni has also urged Acholi residents to “mercilessly” take the drugs, saying Uganda can, “wipe out this river blindness disease because it is not like HIV/Aids.” The river blindness initiative is tied to other health projects in the country, such as nodding disease, mass measles, and immunization programs.
Click here to learn more about river blindness.
Click here to learn how you can help fight NTDs
Eliminating a disease is no small task. It helps to have a detailed plan. Partners working to eliminate blinding trachoma, one of the seven neglected tropical diseases targeted by 2020 INSight: The End in Sight.
Produced by the International Coalition for Trachoma Control (ICTC), 2020 INSight is a global strategic plan with crucial next steps toward trachoma elimination by 2020.More than 2 million people are either blind or suffer excruciating pain because of trachoma. It makes one person experience severe sight loss every four minutes and blinds four people every hour. Over 4.6 million are in the final, painful stages of this eye disease and require surgery to prevent them from going blind. It is endemic in at least 59 countries, in areas with limited access to water and sanitation.
A coordinated effort by governments, nongovernmental organizations, donors and other stakeholders is urgently needed to achieve the goal. Crucial next steps include the following:
- Survey districts where trachoma is suspected to be endemic, so intervention can begin;
- Dramatically improve access to clean water and latrines;
- Increase global funding for trachoma control, including implementation of the SAFE strategy (Surgery, Antibiotics, Facial cleanliness, Environmental improvement);
- Train teachers and other community leaders about facial cleanliness and better hygiene so they can spread the message in their communities;
- Quickly address the backlog of 4.6 million people who need surgery to prevent blindness;
- Identify support for more mass drug administration (MDA) programs to provide about 380 million more antibiotic treatments.
More than 80 percent of the burden of active trachoma is concentrated in 14 countries, where immediate action is needed. Eliminating the disease in Africa alone would boost the continent’s gross domestic product (GDP) 20-30 percentage points based on conservative annual productivity loss estimates.
Since 1998, Pfizer Inc has donated more than 225 million doses of the antibiotic Zithromax® to treat and prevent blinding trachoma. The International Trachoma Initiative (ITI) manages the distribution of the medicine.
Get your copy of 2020 INSight
Click here for more information on the appeal. Below an excerpt on the current state of river blindness published in FT:
The river in Nigeria’s poor, remote northern state of Zamfara has always played a central part in the 70-year-old’s life. He and his friends swam in it as boys “until our eyes were red”. It is a vital source of water for homes, livestock and crops in Mr Adamu’s village of Birninwaje, a fishing and farming community of 3,000 people, where he was for many years the traditional leader. It is also the source of his blindness. River blindness is endemic in these parts. The parasitical disease is named after the black flies that live near flowing waterways such as the Zamfara – and across sub-Saharan Africa, Latin America and parts of the Arabian peninsula – and transmit one of the world’s leading causes of blindness.