All posts by Sophie Mayer

About Sophie Mayer

Sophie graduated with a degree in molecular biology from Reed College in Portland, Oregon. Currently an intern at the Global Network for Neglected Tropical Diseases, Sophie's main interests in public health include stimulating biomedical research and development for neglected diseases and logistical and legal barriers to medicine access.

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.

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.

 

Getting to 100% Coverage: Partners in Treatment

In the face of many obstacles, Nicaragua’s history in ensuring a national deworming program has shed light on the potential for success.  Former Global Network intern, Frankie Lucien, and fellow George Washington University Masters student Cara Janusz, traveled to Nicaragua and investigated the challenges and achievements of the Nicaragua experience and developed a case study with support from Children Without Worms.

This week End the Neglect will be featuring a six-part series of blog posts covering interesting elements of the Nicaragua experience highlighted in the case study, entitled “Worms and WASH(ED)”.

Distribution of mebendazole in Nicaragua.

Running a national public health campaign is a big undertaking and often, multiple partners must work together to bring all the necessary resources and know-how to the table. National programs aim to reach the country’s entire population in need, but often financial and human resources end up clustered around urban centers and specifically targeted populations. Smaller organizations, which often have longstanding relationships with communities and a particular expertise in a given area, fill in program gaps.  In the case of deworming programs, this means ensuring treatments are between campaigns.

In a unique public-private partnership, Johnson & Johnson’s donated deworming treatment mebendazole is distributed to governments through the Children Without Worms program with the support of the nonprofit Task Force for Global Health. Children Without Worms works in eight countries, including Nicaragua, to distribute treatments and address sanitation, water and hygiene challenges that contribute to the prevalence of intestinal worm infections.

With more than 1.3 million children at risk for intestinal worm infections, Nicaragua’s Ministry of Health decided to focus on school-age children in its national deworming program and counts on NGOs to fill in some of the gaps and other community needs. The national program harnesses existing infrastructure – the national school-based Expanded Program for Immunization (EPI) – and takes advantage of a drug donation program, Children Without Worms, to target school-age children.

Nicaragua, with the help of Children Without Worms, has scaled up its deworming program to better control outbreaks. Nicaragua exceeded the WHO coverage target in 2010, reaching 87 percent of all school age children, and treated another 1.5 million in 2011.

Before Children Without Worms’ involvement, other NGOs provided donated treatments and worked at the local level, in line with the country’s earlier system of decentralized health clinics. Now equipped with a strong national healthcare program and large drug donations direct from J&J, these organizations – which include Save the Children, World Vision, CARE and others – have stepped in to reach the niche populations that are not targeted by Nicaragua’s national school-based donation program, such as children younger than five. These smaller NGO-based donations also stock local health clinics for treatment (mebendazole or albendazole) between mass drug campaigns, and can be used by anyone in the community. Reaching the entire population at risk of worms is essential to reduce the likelihood that worms will be transmitted from person to person.

With multiple partners and multiple sources of drugs, Nicaragua has worked hard to coordinate drug donations and mass drug campaigns to make sure that all in need receive appropriate treatment. Still, some medicines reach the country outside of government-coordinated channels, and can cause problems if the donations are not matched with the target populations’ needs. For example, preschool-age children must receive a chewable form of mebendazole, so it is essential that the right formulation is sent to the right partner. Nicaragua’s reliance on NGOs to cover niche populations means that the country is working hard to address these challenges head on, and given its history of adapting to changing resource and distribution systems, the future looks bright.

To read more about the case study “Worms and WASH(ED)” please click here.