2. Onchocerciasis or River blindness is a disease caused a filarial worm know as
Onchocerca volvulus.
The Onchocerciasis Control Program in West Africa (OCP) started operations in 1975.
Its main objectives were to eliminate human onchocerciasis, as a disease of public-
health importance and an obstacle to socio-economic development, from the Program
area.
The African Program for Onchocerciasis Control (APOC) which took over from OCP
was launched in 1995 and ended in 2015, ultimately to eliminate human
onchocerciasis from the African countries in which the disease was endemic.
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3. This goal is being achieved, via a public-private
partnership(WHO,Merck,TDR), using a strategy, of community-directed
treatment (CDT) with ivermectin, that is based on the empowerment of
each target community.
APOC evaluations were carried out in 2000, 2005 and 2010. With the
decision to close APOC at the end of its planned period of operations in
2015, a final evaluation was agreed in December 2014 and terms of
reference developed.
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4. The countries in the West African savanna zone were particularly burdened by the
adverse health and socioeconomic impact of this disease, as exemplified by the
situation in Burkina Faso (then Upper Volta) where out of a total population of 4,5
million, 400,000 people were infected.
Of these, 10 per cent had serious ocular manifestations, including a high rate of
blindness, Furthermore, the epidemiology of onchocerciasis in most of the west
African countries concerned had been thoroughly investigated and national projects
were already under way. 4
5. Its objective was to eliminate onchocerciasis ,as a public health importance and as
an obstacle to socio-economic development from the program area. By the end of
2002, the OCP covered 11 West African countries, and had introduced large-scale
Mectizan(Ivermectin) distribution to about 10million people, through the
community-directed treatment approach, with treatment coverages ranging from 51-
81%.
Infection in humans can lead to skin depigmentation and loss of elasticity, painful
nodules under the skin where the adult parasites are lodged and vision loss and
eventual blindness when the parasites migrates to the eyes. 5
6. Research on large scale Mectizan use, illustrated the importance of evidence-based
results, the power of multicountry studies, the need for social science in community-
driven endeavours and operations research, and the value of empowering communities as
allies in diease control.
The vector control on which the OCP was initially based successfully interrupted the
transmission of the parasite causing human onchocerciasis, Onchocerca volvulus, in
many areas.
The introduction of Mectizan led to the decline in anterior-segement lesions in the eye
and the arrest of posterior-segment lesions. The drug continues to be highly effective in
morbidity
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7. The basic elimination strategy that was used was MDA which took over
vector control which was used at first by OCP.
Data collected from mali and senegal clearly proved that MDA could
eradicate Onchocerciasis.
The following steps were put in place to eliminate Onchocerciasis:
starts with mapping of onchocerciasis and instituting MDA with ivermectin (phase
1), followed by monitoring and evaluation. Stopping-MDA surveys use
entomological evaluation of black flies and epidemiological assessments of children
using serology. 7
8. If successful, Community-Directed Treatment with Ivermectin (CDTI) is
stopped and the onchocerciasis-endemic area moves into Phase 2 (Post-
Treatment Surveillance - PTS) for 35 years.
Entomological surveillance is then used to confirm the elimination of
transmission and progression of the endemic area into Phase 3 (Post-
Elimination Surveillance - PES), with permanent cessation of treatment. There
will be further occasional surveys during phase 3, until regional elimination is
declared to ensure that recrudescence or re-establishment of infections do not
occur.
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9. There two main intervention strategies that were used
Mass drug treatment with Ivermectin (MDTI): Ivermectin which directly killed the
micro filarae of Onchocerca was distributed once a year for free due to a join
collaboration of WHO , OCP, Merk and Co
Vector control: the use of larvicides was first whereby larvicides was sprayed in the
breeding sites of the various species Onchocerca. Recently the slash and clear
method was practiced where bushes along the rivers where black flies had been
identified were cleared. This help reduce the norm of bites per individual.
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10. 1. Conflict and civil war
2. Loa-loa co-endemicity
3. Cross boarder transmission
4. Diagnostic tools for elimination
5. Entomology work force
6. Motivation for community drug distributors
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11. Establishment of sustainable onchocerciasis control programmes in all endemic
African countries was the first objective for these two phases.
. The second objective was the co-implementation of onchocerciasis
control with other disease control activities. This was a stated aim from
the beginning of APOC.
A third objective was to provide assistance to countries in stopping
ivermectin treatment. This is largely still in process at the end of APOC.
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12. . Reduction of the risk of transmission in ex-OCP countries was an objective
that addressed surveillance through 152 surveillance sites in six countries.
. The sixth APOC objective was to cease activities without jeopardizing past
activities. The evaluation team felt this may not be achieved.
An additional two activities were voted by Joint Action Forum (JAF). These
were first, mainstreaming gender in APOC activities and providing adequate
material and human resource support to APOC.
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