Onchocerciasis (River Blindness) in Africa

This paper highlights how poverty affects health care causing epidemic outbreaks of Onchocerciasis, also known as River Blindness in Africa. Although the disease does not directly cause death, it stands as a socio-economic issue due to its effect on families, communities, and countries as a whole. River Blindness is the second leading cause of preventable blindness, after trachoma in Africa (World Health Organization, 2019). Health care, education, resources, and proper funding must be managed to achieve socio-economic satisfaction. In order to highlight this, we discuss the need for funding, available education, and improved healthcare systems.

By simply providing the country with competent ophthalmologists, it would decrease the risk of patients developing total blindness. African communities face an issue with overcrowding due to the poor living conditions created by the Simulium blackfly. They lack abundant food sources, fertile land, clean water, job opportunities, and proper sanitation methods. If there were constant vector control and medical supplies readily available to Africa it would prevent these issues from arising, the work done by the APOC and OCP is evidence of this. Although these actions cannot be done in a blink of an eye there is enough research to support that with the right financial and political support, the elimination of River Blindness in Africa is possible.

River Blindness causes an infection through the transmission of a parasitic worm Onchocerca volvulus. The exact dose of O. volvulus required to cause infection remains unknown, but it often takes multiple bites from the Simulium blackfly in order to contract the disease. The incubation time varies from host to host and by the number of bites. There are many different stages that River Blindness can develop into, even taking as long as a year before they show. Since the parasite is able to mature and live inside our tissues, symptoms mainly arise in the skin or eyes. A patient might experience skin issues that include itching, acute and chronic papular onchodermatitis, fibrosis, atrophy and depigmentation of the skin (Lazdins-Helds et al., 2010). One of the more serious symptoms includes blindness or swollen lymph glands.

Since parasitic diseases are harder to cure there is only one widely used treatment for River Blindness which is Ivermectin. Ivermectin works by stimulating a release of neurotransmitters into the blackfly’s peripheral nervous system (Smith, 2004). The excessive amount causes the gut to paralyze. With their guts paralyzed it prevents the female blackflies from releasing their

microfilariae into our tissue. It is safe for the human brain due to our body’s protective blood-brain barrier (Smith, 2004). The drug only has to be taken once or twice a year in order to be effective because if a patient is given about 150 mg/per kg of body weight, it can inhibit microfilariae production for several months (Basáñez et al., 2006).

About 25 million people are infected worldwide, out of those people 300,000 are blind, 800,000 have an impairment, and 123 million people are at risk (World Health Organization, 2019). As of 2017, there is no available vaccine to prevent the spread of infection. For most of the population, the risk of contracting is low, those with the highest risk live in certain regions of Africa and Latin America. The best preventive actions are by avoiding being bitten by wearing long sleeves and pants, use insect repellent, and wear permethrin-treated clothing (Stewart, 2017). Permethrin is a pesticide used to kill or repel insects such as mosquitoes and ticks.

There is an indistinguishable link between poverty and poor health. Infectious and overlooked tropical diseases such as River Blindness can kill and weaken millions of poverty-stricken people each year. For some countries, like Africa, poverty becomes both a cause and a consequence of poor health. In a study, Naidoo discovered that to devote efforts in to poverty issues an additional aid of $10 billion per year for 10 years is required (Naidoo, 2007). More than 99% of people infected by River Blindness live in the 31 countries in sub-Saharan Africa (World Health Organization, 2018). This happens because poverty can increase the chance of poor health thus making the communities vulnerable to disease. People need to receive health education, a source of income, be provided clean water, have sources of nutrition, and more in order to orient themselves into a healthy lifestyle. Otherwise, it affects these communities politically, socially, and economically.

River Blindness occurs in 30 countries of tropical Africa south of the Sahara (Kale, 1998). It is predominant in rural areas that are often near a body of water like a river or stream. In studies done in 1970, it was revealed that there were many socio-economic consequences due to its high infection rates. As the number of blindness cases increased to epidemic proportions, it left too few healthy people to tend to crop fields (Amazigo, 2006). The blackfly forms a biological vector that covers acres of land on either side of the water. This vector is where they are able to breed, multiply, and develop making it uninhabitable. Because of this, those whose occupations bring them into close contact with the vectors, such as fishermen and farmers, are at relatively high risk for contracting River Blindness.

This prevents these rural communities from using the land and rivers as a source of income and nutrition, causing an economic collapse. This forced many villagers to surrender their homes and to move away to less fertile highlands and forested areas which then affected farmers due to the poor soil and water shortages on the overcrowded lands. Due to River Blindness, it caused a flourishing community into poverty. Living in a third world country like Africa, one has limited resources to have a sustainable lifestyle, federal and state governments can’t provide every community with health facilities (Onwujekwe et al., 1998).

It is estimated that 314 million people that suffer from blindness live in developing countries (Du Toit et al., 2010). Due to the lack of eye care, 19% of the world’s blind population belongs to Africa (Naidoo, 2007). There is an insufficient number of practitioners, adequate facilities, and poor funding of educational programs that focus on eye care. Out of the 53 African countries, only 7 of them run optometric training programs and per one million of the population in the Sub-Saharan African Region, there is an average of one Ophthalmologist (Naidoo, 2007). Practicing practitioners aren’t easy to access either, they are usually located privately or in urban areas.

In order to successfully provide eye care, there is a need for ophthalmic nurses, ophthalmic clinical officers, and other health care staff. Although optometric training programs do occur, the management and program itself are inadequate to support its participants. There is not enough time to learn and be able to administer what is expected from the course and employment. This leads many to feel incapable of performing their job.