Category Archives: River blindness

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

 

Picture-of-Mabinty-Koroma-2

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). 

A Minute with NTD expert: Ellen Agler, Chief Executive Officer of the END Fund

END Fund logo

At the recent “Uniting to Combat NTDs: Translating the London Declaration into Action,” we had a chance to catch up with Ellen Agler, Chief Executive Officer of the END Fund. The END Fund is a private philanthropic fund mobilizing resources for neglected tropical diseases in Africa.

Global Network: What does it take for exposed individuals to fight NTDs?

Ellen Agler: When I was in Mali, I also got a chance to see in addition to the mass drug administration other aspects of the program. There is a huge backlog of trichiasis surgery. Blinding trachoma, if it starts advancing, it is incredibly painful… It feels like sand going over your cornea, and you will go blind if you don’t get this surgery in the advanced stages.

And to see how simple of a surgery it was- that it really only took 10 or 15 minutes. [END Fund] do have this incredible message of about 50 cents per person per year can protect you against these seven diseases that cause disability, cause suffering, cause blindness, and really change the trajectory of your life. And that is a simple message, and I think that we’re all rallying to ensure that we can prevent these diseases, we can treat them in the early stage so that no one has to suffer those diseases.

Continue reading

A Test For River Blindness

 

A boy helps Samuel Nicol, (age unknown) who suffers from onchocerciasis, walk through the village of Gbonjeima, Sierra Leone. Olivier Asselin, 2012.

A boy helps Samuel Nicol, (age unknown) who suffers from onchocerciasis, walk through the village of
Gbonjeima, Sierra Leone. Olivier Asselin, 2012.

Re-posted from Greg Laden’s Blog on ScienceBlogs

River blindness, also called Onchocerciasis, is the result of the infection of several different eye tissues by the nematode Onchocerca volvulus. The bacterium Wolbachia pipientis lives symbiotically in the gut of the nematode, and escapes the small roundworm to cause an inflammatory response in human tissues, which results in damage to the tissue. These infections can occur in a number of different human tissues causing a variety of effects, but when the eye tissues are involved, the result can be river blindness. It is endemic and widespread in several areas of Africa, as well as more restricted areas in South America and the Middle East.

Treatment of the disease involves killing the bacterium, which in turn kills the host nematode, using various anti-biotics. However, as we have learned over recent decades, widespread use of antibiotics can be less than ideal because this can cause selection for resistant strains so that treatment can become generally ineffective across an affected population. Ideally, there would be a reliable test for river blindness infection that would allow more targeted use of treatments.

A research team at Scripps has just published a paper in PNAS that may lead to such a treatment. The team examined urine samples from people who are known to be infected with the nematode Onchocerca volvulus and its attending Wolbachia pipientis bacterium with those who were not thought to be so infected. A massive laboratory based hunt for differences in the contents of the urine was carried out, and one molecule was identified as unique to the infected humans. This was N-acetyltyramine-O,β-glucuronide, which started out as a neurotransmitter found in the nematodes while they are young, which is then converted to N-acetyltyramine-O,β-glucuronide in the human body and eventually secreted in the urine.

The nematode has a somewhat complex lifecycle in which the very young worms infect various tissues and reproduce there, causing the damage to the tissue via the bacterium’s release. This neurotransmitter seems to be unique, or nearly unique, to these young worms. This is important because the nematode is probably widespread in humans in the endemic areas, but as relatively dormant adults found here and there throughout the body. It is only the young reproducing worms that cause the river blindness. Therefore, N-acetyltyramine-O,β-glucuronide specifically identifies individuals at risk of tissue damage to the eyes.

The test is not yet ready for prime time. There needs to be a field test that can be administered easily in conditions where there are only minimal or no clinical facilities. The test materials have to be reasonably inexpensive and not require special handling such as refrigeration. Ideally, this would consist of a urine test strip as have been developed in the past to test for blood sugar levels or pregnancy.

Another important outcome of this finding is the method itself, which the researchers have dubbed “Metabolome-mining.” (The term “metabolome” refers to the full set of metabolites to be found in a particular organism or tissue, similar to the term “genome” for the full set of genes.)

More information will be available at the Scripps Research Institution web site.

Globisch, D, Moreno, A, Hixon, M, Nunes, A., Denery, J., Specth, S., HYoerauf, A, & Jand, K (2013). Onchocerca volvulus-Neurotransmitter Tyramine is a Biomarker for River Blindness PNAS