Category Archives: River blindness

Adiós! Goodbye, oncho! Mexico joins two other countries in ending onchocerciasis in LAC

Mission to verify the elimination of onchocerciasis in Ecuador. PAHO/WHO, 2014

Mission to verify the elimination of onchocerciasis in Ecuador. PAHO/WHO, 2014

I can’t wait to spread the news. The Latin American and the Caribbean (LAC) region is one step closer to seeing the end of onchocerciasis (also referred to as river blindness): Mexico has become the third country in the world to officially wipe out this disease!

The drive for progress is much of what motivated me during my time as the Director of the Pan American Health Organization, the WHO Regional Office for the Americas. I am excited to continue celebrating these milestones as Neglected Tropical Disease (NTD) Special Envoy, and a life-long advocate for public health.

Earlier this year, I wrote about 7 achievable victories in the fight against NTDs that I hope to see accomplished in 2015. Many of these wishes are coming true.

This week, I am filled with the joyful sense of pride in the accomplishment of Mexico and its partners as I check off Mexico’s certification of onchocerciasis elimination from my wish list. Mexico’s success builds off of Colombia and Ecuador’s certification in 2013 and 2014, respectively, and gives me even more confidence that we will soon see news of a LAC region completely free of onchocerciasis.

Onchocerciasis is a devastatingly debilitating parasitic disease that causes itchiness, rashes, and eye problems, eventually leading to permanent blindness. The parasite is transmitted to humans by the bite of a black fly, which breeds in fast moving rivers, increasing the risk of blindness in nearby communities. What’s more, the disease causes a terrible ripple effect by pulling kids out of school to care for their blind elders, reducing economic productivity, and causing families to move out of fertile river valleys, decreasing agricultural outputs in already impoverished areas.

This momentous occasion moves the LAC region one step closer to eliminating the disease entirely—Guatemala has already submitted a request to WHO to verify elimination, and I hope to soon see more results from the enormous, highly coordinated, south-south cooperative effort between Brazil and Venezuela to stop transmission in the Yanomami communities along their borders.

We should all celebrate this official announcement, and we must particularly congratulate Mexico and the many partners that have been working to control this problem for decades and moved toward accomplishing elimination with new tools and new partners for the last fifteen years. 

Eliminating this disease requires unwavering determination. The first step in the elimination process is at least two years of mass drug administration, in which entire communities who are at risk of onchocerciasis are administered Mectizan (ivermectin) every six months. Merck has made an unprecedented pledge to donate Mectizan to everyone in need, for as long as needed. President Jimmy Carter and the Carter´s Center program (OEPA – Onchocerciasis Elimination Program for the Americas) have been instrumental, joining PAHO/WHO as well as the communities and health workers in a successful dream team. You can see President Carter’s video message here, congratulating partners for their hard-earned accomplishments.

Once large-scale programs are complete, treatments are delivered to individuals on an as-needed basis. Communities are monitored for an additional twelve years to make sure that transmission of this disease has been interrupted. Finally, after treatment and monitoring, countries stop the treatment intervention and watch for three years to ensure that there is no resurgence in transmission, and then apply for WHO certification that elimination has been achieved.

I was thrilled to be able to celebrate the long-term dedication and resulting accomplishment of all partners contributing to this milestone at an event at PAHO Headquarters last week. Health Ministers from the countries that have eliminated or will soon eliminate river blindness, technical advisors, and global policy leaders were specially recognized for the recent successes and spur motivation to run the race through the last mile all around the world. I was particularly moved when Dr. Etienne, Director of PAHO/WHO, invited me to share the frontline when she received the award. The outstanding accomplishment of the countries in the Americas comes at an excellent time, now that NTDs are officially identified in the recently adopted Sustainable Development Goals. The LAC region has hit the ground running.

Dr. Mirta Roses Periago is the Director Emeritus of PAHO/WHO and a Special Envoy for the Global Network for Neglected Tropical Diseases

Al Jazeera’s Documentary Series Highlights Neglected Tropical Diseases


In a fight between the world’s worst diseases and the human population, there are those that dream of a world free of diseases and poverty. Lifelines, a global health television series produced by Al Jazeera with support from the Bill & Melinda Gates Foundation, highlights the efforts of global health workers and professionals who are vigorously working to end neglected tropical diseases (NTDs).

Lifelines’ “River of Hope” documentary highlights the devastating effects of schistosomiasis on poor, rural communities in Senegal. The health crisis started when the Diama dam was built across the Senegal River in 1986. Construction of the dam stopped the river’s flow and created a growing population of infected snails, which left 90 percent of the population living near the river basin infected with schistosomiasis. Schisosomiasis is a water-borne parasite that affects 240 million people in mostly Sub-Saharan Africa and is linked to deadly chronic diseases such as cancer and organ failure.

Lifelines also covered the innovative work of Alassane Ndiaye and Elizabeth Huttinger who are working together on “Project Crevette,” a novel experiment to restore prawns — natural predators of the disease carrying snails — in the lower Senegal River basin to control the spread of schistosomiasis. They plan on convincing political leaders responsible for the Diama dam to build a fish ladder in the dam to allow prawns to maintain their migration upstream where the snails harboring schistosomiasis are heavily populated.

Lifelines also highlighted blinding trachoma and river blindness (onchocerciasis) in the “The End is in Sight” documentary. In Part One of “The End is in Sight,” Lifelines takes us into the Amhara province in Ethiopia, a region that has the highest prevalence of trachoma in the world. Trachoma is an infectious bacterial disease of the eye that blinds approximately half a million people annually. The documentary follows Aba Wolde, an 85-year old citizen of the Amhara region, and his daughter, Amalda. They both have advanced trachoma and must walk over 20 kilometers to a health clinic to receive surgical treatment.

Part Two of “The End is in Sight” takes place in the rural areas of Uganda with a high prevalence of river blindness. River blindness is transmitted by infected black flies and causes severe itching and visual impairment. In 1987, Merck declared that they would donate a medication called Mectizan to treat river blindness for as long as needed through the Mectizan Donation Program (MDP). In Uganda, where about 3.5 million people are infected with river blindness, Dr. Moses Katabarwa introduced an innovative administrative system of mobilizing, educating and providing communities in endemic areas with Mectizan. This approach of mass drug administration (MDA), along with environmental control measures for controlling fly larvae, has produced successful results for eliminating river blindness in multiple regions in Uganda.

Whether you’re an expert in the field of NTDs or someone who is curious to learn more about diseases that keep communities in poverty, we highly recommend that you watch these impactful stories from Aljazeera’s ‘Lifelines’ series.

What Can the Experiences of Sierra Leone and Cambodia Tell Us about How to Fight NTDs?


By Romina Rodríguez Pose, independent consultant on international development and lead author for the Health Dimension case studies, Development Progress Project.

Image from Sierra Leone 15

Neglected tropical diseases (NTDs) affect the poorest billion people in the world. They cause number of chronic health conditions that largely limit people’s ability to study and work and consequently have a healthy and productive life. The stigma attached to them can also lead to isolation and fear for those who suffer.

Although they have been long ignored within international and national agendas, in the last decades, there has been an increasing awareness of how NTDs can impede endemic countries from achieving broader development goals. This led to the emergence of global public-private partnerships involving major drug donations from key pharmaceutical companies, the development of inexpensive control strategies and a growing number of donors earmarking funding for integrated NTD control.

These readily available solutions have enabled some endemic countries to fight the five NTDs that bear 90 percent of the global burden: onchocerciasis, also known as river blindness; schistosomiasis, also known as snail fever; lymphatic filariasis, also known as elephantiasis; soil transmitted helminths, also known as intestinal worms; and trachoma.

Image from Cambodia 8To better understand the drivers of progress, ODI’s Development Progress project has taken a closer look at two of the leading performers: Sierra Leone in Africa and Cambodia in Asia. In spite of their different contexts and epidemiological profiles, three drivers have emerged in both case studies:

1. Advances in the fight against NTDs have been driven by the availability of earmarked funds and donated drugs. These have been crucial for both resource-constrained countries, since most endemic countries are faced with several competing, and perhaps more urgent, health issues (such as high mortality rates for mothers and children in Sierra Leone and dengue outbreaks in Cambodia). As a counterpart, political will and local engagement to take advantage of global initiatives have been crucial in bringing NTDs within the national agenda. Both governments, through their Ministries of Health, have proactively looked for partners, secured funds and drugs donations and made important efforts to develop local capacity.

2. There is an important transitional role for development partners in providing access to strategies and guidelines on how to deal with NTDs until local capacity is fully developed. In both countries, this was achieved through bilateral, regional and global partnerships that helped build the local knowledge base for endemic countries to find their own solutions and to implement strategies according to the particular context. These dynamics between development partners and NTD programme managers have gradually led to a ‘transfer of ownership’ of the NTD programmes.

3. The integration of NTD activities within an existing government structure has been vital to set up cost-effective NTD programmes. Both countries have integrated the distribution of drugs within health and education systems. In Cambodia, given the main threat is from intestinal worms which particularly affect school-aged children, progress has been achieved by integrating the distribution of drugs into the school system and turning teachers into twice-yearly doctors/pharmacists. In Sierra Leone, given that the entire population is at risk from at least three NTDs, the main strategy involved the engagement and training of community members as drug distributors. Elected by their communities, their work is divided into catchment areas for which they are responsible, reaching the most remote corners of the country.

Image from Sierra Leone 14

Despite the increasing awareness of their importance, NTDs still loom large in the cycles of poverty, ill-health and under-development that afflict too many developing countries. Yes, as Sierra Leone and Cambodia show, progress can be achieved in the most difficult contexts and with minimal resources, stressing the importance of including NTD control and elimination targets within the post-2015 sustainable development goals.

All photos by Romina Rodríguez Pose. 

Curing River Blindness with Just One Dose



Mabinty Koroma. Photo courtesy of Helen Keller International.

Reposted with permission from END in Africa

In June 2011, fourteen-year-old Mabinty Koroma was about to take the year-end exam in her middle school. One afternoon whilst in class, Mabinty noticed that she could barely see the writing on the blackboard. She went home that day thinking it was just temporary; but the following morning Mabinty was unable to read her notes and her vision was getting worse. “It became obvious that I couldn’t see well enough to take my exam and would have to drop out of school. My elder brother took me to various traditional healers in many villages in Moyamba district. We went to so many places that I can’t even remember all their names,” said Mabinty.

After a 15-month search for a traditional healer to restore Mabinty’s sight proved fruitless, her family was advised to take her to the eye hospital at Serabu, 40 kilometers from Bo, where Mabinty was attending school. In Serabu, there was no doctor to attend to Mabinty. However, the family decided to stay in Serabu rather than return to Bo.

Shortly thereafter, Sierra Leone’s Ministry of Health and Sanitation (MoHS), with support from Helen Keller International (HKI) and funding from USAID through the END in Africa project, started advocacy and social mobilization efforts to raise awareness about neglected tropical disease (NTD) control activities in the 12 provincial health districts, including Bo.

Using radio discussion programs and promotional jingles on mass drug administration and the use of preventive chemotherapy against NTDs such as lymphatic filariasis, onchocerciasis (“river blindness”) and soil-transmitted helminthes, the MoHS and HKI were working to spread the word that community residents could protect themselves and their children from such diseases just by taking medicine once a year.  With support from its partners, the MoHS distributes millions of doses of ivermectin and albendazole annually in all 14 health districts in Sierra Leone to combat those NTDs.

In addition to the radio promotions, local health workers held a series of community meetings prior to the treatment campaign to further sensitize the public about the benefits of taking treatment, and to encourage community leaders to get the word out to their respective communities.

Over the years, Mabinty and her family had heard some of the radio broadcasts about local NTD control efforts and the national treatment campaign. However, they’d always believed that only people living in the country’s rural areas got NTDs. Since they themselves had always lived in the city, they’d never imagined that they’d be at risk of getting any of those diseases. And so in the past, they’d simply ignored the messages about NTD control efforts, which had started several years earlier in all urban and rural districts of Sierra Leone, and had not gotten any of the annual treatments for lymphatic filariasis and soil transmitted helminthiasis that had been distributed in their community for the past five years.

Now as they tried to cope with her devastating vision loss, however, their attitudes were quickly changing and Mabinty’s family began to open their minds to the possibility that she may indeed be suffering from onchocerciasis, one of the NTDs found in Sierra Leone.  And so, when Mabinty and her father heard that annual NTD control efforts were about to begin again in Serabu, this time they were ready to listen.

“One evening, I was with my father when we heard a town crier saying the drugs for “oncho” and “Bigfut” (as it’s commonly called in the villages) had arrived at the health centre and that distribution would soon start,” she recalled.

After hearing the news, they decided that taking the medicine was worth a shot. Later that week, the community drug distributor visited Mabinty’s house and administered two drug regimens (ivermectin and albendazole) to her.

At first, Mabinty regretted having taken the drugs. “Twenty-four hours after taking the treatment, I felt sick and my eyes began to itch. I started scratching my body and kept on scratching for 3 days,” she said. Fortunately, the peripheral health unit staff in the village health center gave her a medication called Piriton and penicillin eye ointment to stop the itching.

After the initial discomfort from the treatment subsided, however, Mabinty discovered that what seemed to be a miracle had occurred. Her vision had improved and she was able to see clearly again.  So clearly that she was even able to return to her formal school in Bo, St. Andrews Junior Secondary School!

“If I hadn’t gotten my eyesight back, I would never have been able to sit for my Basic Education Certificate Examination,” said Mabinty with a smile. “I say thanks to the CDD and those who made the drugs available to me free of charge, even though I don’t know them personally or their organizations.”

Mabinty’s family is very happy to see her back in school. Her father is now a member of the village health committee and a very strong community organizer. Grateful for the recovery of her eyesight, he now wants to make sure that girls like Mabinty continue to receive annual treatments until the disease has been completely eliminated from the community.

More about END in Africa: Through the work of its END in Africa and END in Asia programs, FHI 360 is advancing USAID’s goal of contributing to the global elimination of NTD by reducing prevalence of seven diseases—lymphatic filariasis (elephantiasis), onchocerciasis (river blindness), schistosomiasis (snail fever), trachoma (blinding eye infection) and three soil-transmitted helminths (hookworm, roundworm, and whipworm).