Tag Archives: onchocerciasis

South-South Cooperation Moves Forward to Free the Indigenous Yanomami People from Neglected Tropical Diseases

 

Photo by Shaan Hurley

Today marks the United Nations (UN) Day for South-South Cooperation — an opportunity for the global development community to examine how developing and emerging countries can share knowledge, exchange best practices and pursue joint projects to generate tangible solutions to development challenges.

As a young officer in the Ministry of Health of Argentina, I attended the first UN Conference on Technical Cooperation among Developing Countries (TCDC) where I had the opportunity to witness the launching of the Buenos Aires Plan of Action, a blueprint adopted in 1978 that offered guidance and new energy to the concept of south-south cooperation. At the same time, the International Conference on Primary Health Care concluded with the Alma Ata Declaration — a public health milestone that recognized health as a fundamental human right.

It was an exciting time to be a part of these landmarks in public health and see how these principles are being carried out today. A closer look at Brazil and Venezuela’s joint commitment to controlling and eliminating neglected tropical diseases (NTDs) within the Yanomami community —a nomadic indigenous tribe made up of approximately 35,000 people — spotlights the key role of south-south cooperation in reaching all populations in need of key health interventions. Equally important, this successful model can be replicated within the Latin American and Caribbean (LAC) region and across the globe.

The Yanomami territory is a remote stretch of tropical rainforests and mountains on the northern border of Brazil and southern part of Venezuela (approximately 19,000[1] people live on the Brazilian side and 16,000 on the Venezuelan side). The combined border area is over 9.6 million hectares — about twice the size of Switzerland — and represents the largest forested indigenous territory in the world. The entire community is affected or at risk for onchocerciasis, also known as river blindness.

The high prevalence of onchocerciasis  within the Yanomami community represents the last stronghold of this disease in the LAC region, which has made significant strides towards its elimination, in addition to controlling many other NTDs. Several countries across the region have either launched or implemented national plans to control and eliminate NTDs within their borders. In 2014, Colombia became the first country in the world to eliminate onchocerciasis. These successes underscore the strong political commitments made by regional leaders including the Organization of American States (OAS), the Pan American Health Organization (PAHO) and the Council of Ministers of Health of Central America and the Dominican Republic (COMISCA).

While these are impressive milestones, more work needs to be done to address NTDs within the Yanomami community —  as the area occupied by the Yanomami is regarded as the greatest challenge for interrupting the transmission and making LAC an oncho- free region. Because of their nomadic habits plus their isolated and forested environment, health workers must travel by helicopter or boat to reach them. Many logistical and financial challenges need to be overcome to deliver the required series of treatments.

Here is how south-south cooperation can help address these challenges:

Brazil and Venezuela formalized and agreed to join efforts to tackle this problem in May 2014 during the 67th World Health Assembly. Through this commitment, these two countries will coordinate efficiently the provision of continuous integrated healthcare for affected communities in both Brazil and Venezuela. They will work together to train local community health workers and form bi-national humanitarian teams that will also include local residents to treat the last focus of onchocerciasis in the Americas through the development of integral  healthcare to affected communities on both sides of the border.

Furthermore, these teams will support the creation of a bi-national health model to provide work assistance for Brazil and Venezuela. A technical team of the Brazilian Ministry of Health is working with the Venezuelan Ministry of Health team in order to strengthen and integrate public policy to eliminate onchocerciasis in the Yanomami area.

By harnessing their collective experiences and expertise, I am confident that these countries can successfully work together to end the unnecessary suffering of the Yanomami population — and ultimately help the LAC region see the end of onchocerciasis.

Looking ahead, the post-2015 development agenda dialogue, the BRICS Ministers of Health meeting and the UN South-South Cooperation EXPO offer exceptional opportunities for government officials and development partners to showcase south-south cooperation as a critical, sustainable and successful model to address NTDs and other pressing global health and development challenges.


[1] According to Health Ministry of Brazil, in 2012, the Yanomami territory had 293 small villages that contain 4,550 families from five different ethnic groups, most of them Yanomami. There were 21 thousand of indigenous people living in this region, which 11,600 were located in endemic area.

¡Felicidades, Colombia! Colombia Eliminates Onchocerciasis

 

Credit: Flickr user Char R/ CC

Credit: Flickr user Char R/ CC

The Global Network for Neglected Tropical Diseases would like to congratulate Colombia on becoming the first country in the Americas to eliminate onchocerciasis. This Monday, July 29, Colombia received verification of the elimination of onchocerciasis from the World Health Organization (WHO). This is a great achievement in the field of neglected tropical diseases (NTDs) and global health!

Onchocerciasis, also known as river blindness, is an NTD caused by a parasitic worm and is transmitted by the bite of Simulium black flies. This NTD causes disfiguring and painful skin infections and eye lesions, and is the second leading infectious cause of blindness globally. Control and elimination efforts began in the region of the Americas in the early 1990s, primarily with the formation of the Onchocerciasis Elimination Program for the Americas (OEPA). OEPA, which is sponsored by the Carter Center, was launched in 1993 in response to the Pan American Health Organization’s (PAHO) resolution CD35.R14, which calls for the elimination of onchocerciasis from the Americas. At the time of the resolution, 500,000 people were at risk for onchocerciasis in the region and the NTD was endemic in 13 foci found in 6 countries: Brazil, Colombia, Ecuador, Guatemala, Mexico and Venezuela.

The recent success in Colombia is a result of close collaboration between Colombia’s Ministry of Health and Social Protection, Colombia’s National Institute of Health and its partners, which include The Carter Center and OEPA, PAHO, Merck and many others. In countries endemic for onchocerciasis, people were treated with ivermectin (Mectizan) through mass drug administration campaigns two to four times a year. The hard work and dedication demonstrated by the local health workers and community leaders in distributing the treatment and educational information was essential for achieving the goal to eliminate transmission of the disease. Ivermectin is donated by Merck & Co through the Mectizan Donation Program.

Ecuador may be the next country in the region to apply for verification of elimination, following the 3-year post-treatment surveillance phase established by the World Health Organization (WHO). Guatemala and Mexico will complete the 3-year post-treatment surveillance phase in 2014 and could then request verification from the WHO. The remaining two foci in the region are in southern Venezuela and northern Brazil, among the Yanomami indigenous community. A key to the elimination of onchocerciasis in the Yanomami area is an integration of activities to address other determinants of health and NTDs, such as strengthening primary care services, access to clean water and improved sanitation.

On the same day, energized by the announcement that Colombia received certification for the elimination of this NTD, the Colombian President Juan Manuel Santos and Minister of Health and Social Protection Alejandro Gaviria demonstrated once more their government’s commitment to the people of Colombia by launching its 5-year integrated national plan of action to address trachoma and soil-transmitted helminthes.

Colombia’s experience can help guide the efforts of other Latin American and African countries working towards elimination of this and other NTDs. Thanks to these great achievements, we are closer to seeing the end of the seven most common NTDs by 2020!

How a Nigerian General Became an Advocate for Stopping River Blindness

Lieutenant General (Ret.) Theophilus Yakubu (TY) Danjuma knows river blindness firsthand. As a Nigerian who grew up in a country with one of the highest rates of river blindness (also known as onchocerciasis) infection in the world, he has not only witnessed the devastation this disease can bring to families and communities, but has also suffered from the disease himself.

River blindness produces rashes, skin lesions and severe skin inflammation that can make the skin change color and lose elasticity. People suffering from the disease often face daily social humiliation and isolation, and infected children struggle to pay attention in school because of intense itching. River blindness, however, is aptly named. Its most debilitating symptoms are severe visual impairment and irreversible blindness.

General Danjuma’s experience with this disease began in the 1960s. While leading a company of soldiers in Nigeria, he was bitten by the Simulium black fly that transmits the worm larvae that cause river blindness. For two years, the larvae spread throughout his body, maturing into adult worms and releasing bacteria that eventually trigger an immune system response. He awoke one morning with swollen eyes and itchy, inflamed skin. General Danjuma successfully underwent two weeks of treatment and experienced no lasting symptoms, but says he has never forgotten the sight of his own skin sample under the microscope at the local clinic. He still shivers at the memory of tiny worms swimming in and out of view under the lens.

General Danjuma is the Grand Patron of an important NGO based in Jos, in Northern Nigeria. The NGO, The Mission to Save the Helpless, better known by its acronym MITOSATH” is well known to the health team in the Africa Region as an important partner of African Programme for Onchocerciasis Control (APOC). MITOSATH is also among the most active NGOs in Nigeria contributing to the control of river blindness other neglected tropical diseases.

Controlling River Blindness in Africa: Setting an Example

A young boy leads a man impacted by river blindness. Photo by Olivier Asselin.

 

 

 

 

 

 

 

 

 

 

 

 

 

When river blindness control programs were first implemented in the 1970s, up to half of all adults in some hard-hit communities had gone blind from the disease. This tragedy caused many Africans to abandon their ancestral homes and livelihoods; the economic losses were estimated at US$30 million. The first Onchocerciasis Control Programme focused primarily on spraying insecticide over infected areas in order to minimize the prevalence of the black fly, preventing transmission of the parasitic worms from person to person, and eventually incorporated treatment with Ivermectin, the drug that treats river blindness, when it became available.

With the help of the World Health Organization and the World Bank in 1995, this program was expanded and renamed the African Programme for Onchocerciasis Control (APOC). Rather than attempting to control the black fly population, APOC sought to control the parasitic worms in humans through community-directed treatment with Ivermectin in 19 countries. Treatment with Ivermectin successfully kills the worms in the people who have them, thereby disrupting transmission of the disease.

Merck & Co. donates Ivermectin to Nigeria (and other countries in need), and APOC trains volunteers to distribute the drug in communities. Today, APOC provides Ivermectin to more than 96 percent of endemic communities in Nigeria, reaching more than 23 million people. Until everyone is treated, however, the risks of re-infection and new outbreaks remain. River blindness is still present in most Nigerian states, including Taraba state where General Danjuma was born. The disease continues to deeply impact communities and the lifetime productivity of the 31 million Nigerians at risk.

Now a successful businessman and politician, General Danjuma’s personal experience with river blindness and the success of MITOSATH and APOC motivated him to donate US$1 million to the program in 2010. With his donation, he hopes to invigorate interest in public health challenges in rural Africa. General Danjuma noted that, “these are not the neglected diseases of tropical Africa, but rather the diseases of neglected people.”

General Danjuma’s crusade to raise the profile of rural health issues has already gained momentum. Following his example, in 2011, the government of Nigeria pledged an additional US$5 million to APOC to assist with its control efforts. General Danjuma hopes that other countries and the private sector will join the movement to eliminate this debilitating disease once and for all.

 

In March 2012, General Danjuma participated in a panel discussion at the Center for Strategic and International Studies. Read our blog post on that event here.

 

UK NGO sets their sights on river blindness

Sightsavers, a UK-based NGO that addresses preventable blindness in the developing world and contributors to End the Neglect, is this year’s Financial Times (FT) seasonal appeal recipient. Sgithsavers will receive donations from British readers who contribute to the FT appeal, which will run from November 21 – mid-January. The UK government has also agreed to match individual donations made to the appeal. 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.” Click here to read the full article. Also, check Jeremiah Norris’ (Director, Center for Science in Public Policy, Hudson Institute) Letter to the Editor in response to this piece.