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Epidemiological studies were carried out among 180 randomly chosen settler and 180 non-settler households in the three resettlement schemes of Kishe, Gera and Didessa located in river valleys and highland areas of Illubabor Administrative Region in western Ethiopia. Up to 49% of the indigenous populations (in Kishe) and 0.9% of the settlers had onchocerciasis, with a mean density of 13.6 filariae per slide/skin snip for indigenous people and 9.4 for settlers. Onchocerciasis prevalence rates were higher in males than females and were highest in the 20-59 age group. In the Kishe scheme, rates were inversely related to distance between residences and probable forest/stream habitat of Simulium damnosum. No onchocerciasis transmission appears to occur in the Gera scheme at 1,950 meters altitude, apparently due to the absence of suitable vectors. Eight of 622 (1.2%) persons had malaria (P. vivax and P. falciparum). The most common man-biting anophelines were A. gambiae and A. funestus. No human trypanosomiasis cases were found but high livestock mortality was reported by local populations in the lowland schemes of Kishe and Didessa.
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PMID:Onchocerciasis, malaria and trypanosomiasis in three resettlement schemes in western Ethiopia. 184 11

A survey was carried out in 4 different locales of the Sanaga River basin of Central Cameroon in mid-1989 to evaluate the felt needs of the population for health care and their reasons for choosing among the health resources available to them. The 4 locales were Edea, an urban industrial complex with 33,000 inhabitants; Mbebe-Kikot, a small village in the tropical forest with 350 inhabitants, Mbandjock, an urban agroindustrial center in the savannah zone with an estimated population of 17,000; and Ntui, a rural agglomeration of around 5000 at the border between the savannah and forest. Mbebe-Kikot had only a health center and the others all had hospitals and a network dispensaries and pharmaceutical depots. Each quarter and village had community health agents trained to provide primary health care. Traditional practitioners were omnipresent in both urban and rural areas. Representative samples of at least 300 persons in 3 of the locales and the entire population of Mbebe-Kikot were interviewed about their illnesses, use of health services, and reasons for their choices. Records of the health facilities serving the survey populations were also examined, but were too incomplete to be of use. The samples included 330 persons in Mbebe-Kikot, 327 in Ntui, and 328 each in Edea and Mbandjock. Nearly 1/3 of respondents reported they had had some sickness in the past month. 70% of all the conditions reported in Ntui and Mbebe-Kikot and 80% in the 2 urban sites led to demands for assistance at a health facility. Malaria was the most common pathology reported, followed by rheumatologic conditions, abdominal pain, cutaneous infections, and bronchopneumopathies. Malaria accounted for 18% of diagnoses with constant rates in all 4 sites. Onchocerciasis is hyperendemic in Mbebe-Kikot, which had a high rate of possibly related diagnoses: 7.3% ocular pathology, 7.0% cutaneous infections, and onchocerciasis in the strict sense 10.3%. 50-60% of those surveyed made a decision about treatment as soon as they became aware of a pathology. The study resulted in 3 major findings. Prevalence rates are high, with acute infections predominating. The demand for care is strong, and almost all individuals seek care. Rates of self-treatment are high, but recourse to community health agents is very rare. The preferred source of care is the official health system, chosen by 50% of the surveyed populations. Rural populations visited traditional practitioners more than did their urban counterparts. Geographical and financial considerations both played major roles in decisions regarding care. The strong preference of the population for the official, curative health system has implications for the government's primary health care program.
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PMID:[Health care accessibility and adequacy of health care system in the Sanaga basin (Central Cameroon)]. 194 44

Environmental impact of pesticides used in vector control programmes against Onchocerciasis, Trypanosomiasis, Malaria and Bilharziasis, depends on chemicals used and control strategies. Dealing with the experience of the Onchocerciasis control Programme in West Africa, we introduce in what perspective, it is possible to establish an environmental monitoring programme in order to minimize the impact of treatments. In tropical Africa, vector control chemicals pressure, decreased in the years 1980.
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PMID:[Impact of vector control on the aquatic environment]. 226 73

The vector and soil transmitted parasitic infections produce a highly diverse group of diseases in terms of the importance of their impact upon human populations and in terms of the control methods that might limit that impact. In Ghana a method was developed for quantitatively assessing the relative importance of different disease problems by estimating the amount of healthy life lost through illness, disability and death as a result of each disease. The quantitative assessment is derived from information on incidence rate, case fatality rate and the extent and duration of disability produced by the disease. The method may be used to help decide the priorities for the allocation of resources to alternative procedures or programmes by calculating the amount of healthy days of life which may be saved by different approaches and then relating these savings to the costs of the approaches. Each of the vector and soil transmitted parasitic diseases in Ghana had special characteristics that influenced the estimates of their relative importance. Attribution of death due to malaria posed special problems, but even with the most conservative estimate malaria was the single most important cause of loss of healthy life of all diseases in Ghana. For schistosomiasis there is such great uncertainty concerning how much disability or mortality that results from infection that the relative importance of schistosomiasis could not be usefully estimated; thus research into the extent of disability and death caused by schistosomiasis should have a very high priority if rational allocation of resources for its control is to be achieved. Onchocerciasis, though not generally considered an important cause of mortality, is an important cause of chronic severe disability. The importance of ascariasis and hookworm remain uncertain both because of the lack of information as to the extent of disability and mortality that they produce and the lack of data in Ghana as to their prevalence and intensity of infection. Guinea worm was of little importance from the national point of view, but was highly important in focal areas. Trypanosomiasis would appear to be of minor importance because its incidence was quite low, but for an epidemic disease such as trypanosomiasis the importance must be estimated based on what would occur if there were not effective surveillance and control methods. Diverse though this group of parasitic diseases is a common thesis is that each has been relatively neglected in relation to its importance and for each a considerable reduction in loss of healthy life should be achievable at reasonable cost.
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PMID:The application of a quantitative approach to the assessment of the relative importance of vector and soil transmitted diseases in Ghana. 652 50

Onchocerciasis is commonly known as River Blindness and affects about 18 million people around the world. It is transmitted by black flies that breed in river and stream rapids and transmit the parasitic microfilariae, Onchocerca volvulus, to people who live and work near such rivers. Infection with the microfilariae results in blindness or visual impairment for 1 or 2 million people. The microfilariae migrate to superficial tissues and may invade any part of the eye and ocular structure. Living worms cause little damage, however, their death triggers a localized inflammation which can lead to blindness. Sclerosing keratitis, a severe corneal involvement, is the major cause of blindness from the disease. The World Health Organization (WHO) Expert Committee on Onchocerciasis has estimated that 9% of the disease is found in Africa, the rest occur in Yemen and Latin America. Treatment with ivermectin is contraindicated for pregnant and lactating women, children under 5 years of age, asthmatics, and people with other diseases. The WHO Onchocerciasis Control Program in 11 countries of West Africa has eliminated the risk of onchocerciasis by aerial spraying of black fly breeding sites only from 1 country. A single annual oral dose (150 mg/kg) of ivermectin can reverse early lesions in the cornea. Ivermectin must be taken annually to sustain protection against blindness, thus its incorporation into primary health care along with malaria, AIDS, trachoma, xerophthalmia, and cataract is most cost effective. Nigeria and Tanzania have optometry schools, and optometrists can play a significant role in onchocerciasis control and blindness prevention programs by training local health care workers to distribute invermectin in vision screening programs.
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PMID:Onchocerciasis and other eye problems in developing countries: a challenge for optometrists. 824 90

This review addresses changes in the ecology of vectors and epidemiology of vector-borne diseases which result from deforestation. Selected examples are considered from viral and parasitic infections (arboviruses, malaria, the leishmaniases, filariases, Chagas Disease and schistosomiasis) where disease patterns have been directly or indirectly influenced by loss of natural tropical forests. A wide range of activities have resulted in deforestation. These include colonisation and settlement, transmigrant programmes, logging, agricultural activities to provide for cash crops, mining, hydropower development and fuelwood collection. Each activity influences the prevalence, incidence and distribution of vector-borne disease. Three main regions are considered--South America, West & Central Africa and South-East Asia. In each, documented changes in vector ecology and behaviour and disease pattern have occurred. Such changes result from human activity at the forest interface and within the forest. They include both deforestation and reafforestation programmes. Deforestation, or activities associated with it, have produced new habitats for Anopheles darlingi mosquitoes and have caused malaria epidemics in South America. The different species complexes in South-East Asia (A. dirus, A. minimus, A. balabacensis) have been affected in different ways by forest clearance with different impacts on malaria incidence. The ability of zoophilic vectors to adapt to human blood as an alternative source of food and to become associated with human dwellings (peridomestic behaviour) have influenced the distribution of the leishmaniases in South America. Certain species of sandflies (Lutzomyia intermedia, Lu. longipalpis, Lu. whitmani), which were originally zoophilic and sylvatic, have adapted to feeding on humans in peridomestic and even periurban situations. The changes in behaviour of reservoir hosts and the ability of pathogens to adapt to new reservoir hosts in the newly-created habitats also influence the patterns of disease. In anthroponotic infections, such as Plasmodium, Onchocerca and Wuchereria, changes in disease patterns and vector ecology may be more difficult to detect. Detailed knowledge of vector species and species complexes is needed in relation to changing climate associated with deforestation. The distributions of the Anopheles gambiae and Simulium damnosum species complexes in West Africa are examples. There have been detailed longitudinal studies of Anopheles gambiae populations in different ecological zones of West Africa. Studies on Simulium damnosum cytoforms (using chromosome identification methods) in the Onchocerciasis Control Programme were necessary to detect changes in distribution of species in relation to changed habitats. These examples underline the need for studies on the taxonomy of medically-important insects in parallel with long-term observations on changing habitats.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Deforestation: effects on vector-borne disease. 848 73

Epileptic seizures are frequent in neurocysticercosis and may occur during cerebral malaria. Findings are reported from a matched case-control study conducted in March 1996 in the savannah woodland region of northwest Central African Republic to determine whether any relation exists between Onchocerca volvulus infestation and epilepsy. About 70% of the study region's inhabitants are infested with O. volvulus. Each epileptic case was matched against 2 nonepileptic controls on the criteria of sex, age, residence, treatment with ivermectin, date of last ivermectin dose, and the number of ivermectin doses. Onchocerciasis was defined as at least 1 microfilaria observed in iliac crest skin snip biopsy. 187 cases and 374 controls were included in the study. 39.6% of the epileptics and 35.8% of the controls had onchocerciasis. The mean dermal microfilarial load was 26 microfilariae per mg of skin in the epileptics and 24 microfilariae per mg of skin in the controls. The relation between O. volvulus infestation and epilepsy was statistically nonsignificant.
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PMID:Onchocerciasis and epilepsy: a matched case-control study in the Central African Republic. 1008 46

Drug development offers potential solutions to a number of tropical health diseases, although the expense of pharmaceutical research and lack of return on investment has limited the production of new agents. The greatest successes have been through the development of single dose therapy and mass treatment control programmes for a number of diseases. We review some of the current treatment regimens for malaria, intestinal helminth infection, onchocerciasis, filariasis and schistosomiasis, and their use in clinical practice. Geographical spread and emergence of drug resistant parasites have hindered the control of malaria, the most important global parasitic infection. Artemisinin compounds have proved effective antimalarial agents producing rapid reduction of parasite load and can be used in combination treatment regimens to combat multidrug resistance. Intestinal helminth infections are widespread, giving rise to nutritional deficiencies and impaired childhood cognitive development. Pregnant women in developing countries are at increased risk of morbidity. Treatment with a single dose benzimidazole such as albendazole or mebendazole has beneficial effects on morbidity and rates of transmission. Diethylcarbamazine has been used in the treatment of onchocerciasis and human filariasis. A complicated escalating dose regimen over several weeks is associated with systemic and allergic reactions and may require corticosteroid cover. Simplified regimens for mass population treatment with ivermectin have proved useful and been used in combination with single dose albendazole and diethylcarbamazine. The African Programme for Onchocerciasis Control in West and Central Africa has been one of the most successful mass control programmes virtually eliminating new infections by a combination of chemotherapy, education and vector control. Schistosomiasis is of increasing importance as a result of the creation of new snail habitats by agricultural and economic development. Praziquantel has become the most widely available and effective chemotherapy for schistosomiasis. There have been a number of reports of persistent schistosome egg shedding after treatment posing concerns about the emergence of drug resistance. Eflornithine has been successfully used in patients with human trypanosomiasis failing melarsoprol therapy however expense and availability have limited its potential. Mass control treatment programmes have targeted schoolchildren, adolescents and pregnant women. The integration of schistosomiasis, onchocerciasis, filariasis and helminth control programmes has been considered as a cost-effective method of delivering treatment. It is likely that future control will be based on this optimisation and integration of existing regimens, rather than the development of new agents.
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PMID:Drug treatment of tropical parasitic infections: recent achievements and developments. 1112 30

Since its inauguration in 1995, the African Programme for Onchocerciasis Control (APOC) has made significant progress towards achieving its main objective: to establish sustainable community-directed treatment with ivermectin (CDTI) in onchocerciasis-endemic areas outside of the remit of the Onchocerciasis Control Programme in West Africa (OCP). In the year 2000, the programme, in partnership with governments, non-governmental organizations and the endemic communities themselves, succeeded in treating 20,298,138 individuals in 49,654 communities in 63 projects in 14 countries. Besides the distribution of ivermectin, the programme has strengthened primary healthcare (PHC) through capacity-building, mobilization of resources and empowerment of communities. The community-directed-treatment approach is a model that can be adopted in developing other community-based health programmes. The approach has also made it possible to bring to the poor some measure of intervention in some other healthcare programmes, such as those for malaria control, eye care, maternal and child health, nutrition and immunization. CDTI presents, at all stages of its implementation, a unique window of opportunity for promoting the functional integration of healthcare activities. For this to be done successfully and in a co-ordinated manner, adequate funding of CDTI within PHC is as important as an effective sensitization of the relevant policy-makers, healthworkers and communities on the value of integration (accompanied by appropriate training at all levels). Evaluation of the experiences in integration of health services, particularly at community level, is crucial to the success of the integration.
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PMID:APOC's strategy of community-directed treatment with ivermectin (CDTI) and its potential for providing additional health services to the poorest populations. African Programme for Onchocerciasis Control. 1208 Dec 54

In recent years, associations of particular factors of the human leukocyte antigen (HLA) system with two major infectious diseases of tropical countries have been recognized: common West African HLA antigens are associated with protection from severe Plasmodium falciparum malaria, and HLA-D alleles are associated with generalized disease, localized disease and putative immunity in Onchocerca volvulus infection. Here, Christian Meyer and Peter Kremsner summarize current information on the involvement of HLA factors in P. falciparum malaria and O. volvulus infection, and briefly report on HLA-related immunological characteristics of various conditions in these infectious diseases.
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PMID:Malaria and onchocerciasis: On HLA and related matters. 1527 11


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