Sight for the Blind

1. Sight for the Blind Presented by: Berhane Chiche MPH Student Environmental Health-PUBH 6165 - 5 Instructor: Dr. Raymond Thron Summer Qtr. 2014 Walden University

2. Introduction This presentation is mainly focused on: • Educating Ethiopian people about River Blindness, (Onchocerciasis) • Its causes, effects, preventions, controls, and available resources. The major stakeholders of this presentation include: • Ethiopian Federal Government • Teppi province ministry of health • Community Health Center

3. Introduction (Cont’d) • Non- Governmental Organization (NGOs) • Charity Organizations through churches • World Health Organization (WHO) • The Carter Center Foundation and River Blindness • The National Onchocerciasis Task Force (NOTF) • Environmental Health Department

4. Map of Ethiopia

5. The audience of this presentation • Representative from Ministry of Health • Local Health center Workers including doctors, Nurses, and Axillary nurses • Representative from different charity organization • Jimma University Medical School • Carter's foundation representative

6. Objectives of this presentation • Participants should be able to identify possible causes of River Blindness (Onchocerciasis) • How the disease spread among the population • Knowing prevention method at primary, secondary, and tertiary level • Identify barriers to the access of services to those suffering from this disease • The community of Teppi should be able to participate in the discussion to minimize the River blindness

7. Objectives (Cont’d) • To Create Awareness in the community • To get non-governmental financial and help for the people who are suffering from Oncosoroasis. • To get the Ethiopian government attention to fight and eradicate River Blindness in Teppi region and other part of the country • To reach other parts of the country who are suffering from the same dilemma of the disease • To know the current diagnosis and treatment available for River blindness

8. Pathophysiology of River Blindness • In 1875, the scientist, John O’neill was the first to observe and document volvulus microfilariae, • with the name craw-craw, the West African name of the disease. • Almost 50 years later, the scientist Blacklock discovered that the true cause of River Blindness is simulium (Hoerauf, 2003). • Hoerauf, A. (2003). Onchocerciasis. Journal of Science, Medicine, and the Future, v.326,p.207-210.

9. What causes onchoceriasis? • River Blindness is a given nickname to this disease because of it occurrence mostly in rural areas near rapid flowing river. • An infection manifested by onchoceriasis which resides and multiplies at river out flow • It ranks 2nd causing blindness in the world. • River Blindness or Onchocerciasis is a vision hazard manifested by onchocerca volvulus. It is found where river stream is found World Health Organization (WHO), (2002) and (www.sightsavers.org/in)

10. What causes onchoceriasis?(Cont'd) • It is one of the Neglected tropical disease (NTD) • River Blindness (Onchoceriasis) public health concern and is one of the socioeconomic importance in Ethiopia. • There is insufficient information on River Blindness in Ethiopia Zein, A. Z. (1986): The epidemiology of onchocerciasis in north western Ethiopia. Trop. Geog. Med.; 38(1):33-37

11. Significance of River Blindness in Different countries • Approximately 17.7 million people are affected worldwide by onchoceriasis • Nearly 99% of infected persons live in Africa and the 1% lives in Yemen and six countries in America • Over 500,000 individuals encounter visual damage. • 270,000 individuals lost their sight by this disease. http://cid.oxfordjournals.org/content/44/1/53.long) • (http://cid.oxfordjournals.org/content/44/1/53.long)

12. Significance Cont`d • The southwestern part of Teppi region has high prevalence rate (85.3%) • Kuwara region has the lowest prevalence rate (6.9%) (ispub.com/IJPD/1/2/3369)

13. Diagnosis of River Blindness • The diagnosis is referred as skin disease • Nodules form around the worms on the skin • Inflammation cause on the skin surface • Skin snip • General antibody test • In Ethiopia, it is more of skin disease and enlargement of the scrotal in male. (www.cdc.gov/parasites/onchocerciasis/add)

14. Mode of Transmission

15. Effects of the disease

16. Eyes of infected person and how the worm is embedded under the skin disfiguring the body. (World Health Organization, 2010).

17. Treatment for River blindness • The drug Ivermectin does not kill the adult parasites in the body, but it does reduce the microfilariae in the skin so that the disease does not progress. This medication is administered orally. • Mectizan is another potent drug that temporarily renders the female worm infertile. This kills the larvae (Center for the Disease Control and Prevention, 2010). • emedicine.medscape.com/article/224309-overview & (www.cdc.gov/parasites/onchocerciasis/add)

18. Intervention, Prevention and control • There are two main actions needed: • The spraying of larvicides in and around the breeding sites of the black fly. • Early treatment with a powerful drug called Ivermectin that kills the young worms in the body (World Health Organization, 2010).

19. Demographics of River blindness • There are two main actions needed: • The spraying of larvicides in and around the breeding sites of the black fly. • Early treatment with a powerful drug called Ivermectin that kills the young worms in the body (World Health Organization, 2010). • (World Health Organization, 2010).

20. Who is at risk to get this disease? • Travelers, missionaries, and Peace Corp volunteers • People who live in villages near rapidly flowing streams/rivers (CDC, 2010): (www.cdc.gov/parasites/onchocerciasis/add)

21. Conclusion • Ocular onchocerciasis considered as mild or rare in Ethiopia, but ocular manifestations has been reported in some of the studies. This needs more research. • The popularity of the disease is related with the daily occupational work including farming near the river, taking bath in the river, and also swimming which reveals the person to the vector.

22. Conclusion (Cont'd) • River blindness is a serious condition which has been neglected for so long because of inadequate treatment and early diagnosis. • Measures should be taken by individuals, communities, organizations at both State and Federal level to fight this disease. • We can lower the incidence rate of River blindness and make our citizens free from this terrible disease by disseminating information Education on this disease.

23. Recommendations • Ethiopian researchers` and nonprofit organizations, and interested individuals need to study more on ocular manifestations in divergent provinces of Ethiopia. • The federal government and NGO’s should continue to work together to elevate consciousness to the communities in endemic area-----etc. World Health Organization, 2002).

24. Recourses for Help • Local Health Centers • Ministry of Health • Sight Savers • Charity Organizations like Churches • Missionary Organizations like Helen International • Carter foundation for the blind

25. References: Centers for Disease Control and Prevention (CDC), (2010): Onchocerciasis FAQs: Retrieved on from (www.cdc.gov/parasites/onchocerciasis/add) Hoerauf, A. (2003). Onchocerciasis. Journal of Science, Medicine, and the Future, v.326,p.207-210. Udell, D. (2007): Recent Updates on Onchocerciasis: Diagnosis and Treatment. Oxford Journals Retrieved from(http://cid.oxfordjournals.org/content/44/1/53.long) River Blindness (2000): Retrieved from(http://www.cartercenter.org/countries/ethiopia.html Jira, C. (1993). Prevalence of onchocerciasis in Blue Nile valley of western Ethiopia. Indian J. Pub. Hlth; 37(4):135-7 .

26. References (cont'd) Taticheff, S., Williams, J. F. & Wondimu, W.(1993): Longitudinal study of onchocerciasis in Bebeka, Ethiopia. Ethiopian med. J. 31(3): 191-200 (ispub.com/IJPD/1/2/3369) Taticheff, S., Abebe, M., Workneh, W. & Hana N.G. (1987): Onchocerciasis: A prevalence study in Bebeka, Ethiopia. Trop. Med. Parasitol.; 38(4):279-82 (www.ncbi.nlm.nih.gov/pub) River Blindness (2000): Carter Center. Retrieved from (WWWwww.cartercenter.org/documents/1175.pdf) .

27. References (cont'd) River Blindness (2000): Carter Center. Retrieved from, (WWWwww.cartercenter.org/documents/1175.pdf)   World Health Organization (WHO), (2002) (www.who.int/apoc/onchocerciasis/status/en/) Zein, A. Z. (1986): The epidemiology of onchocerciasis in north western Ethiopia. Trop. Geog. Med.; 38(1):33-37