Abstract
This study evaluated the Onchocerciasis Control Programme in Igboeze North Local Government Area of Enugu State. It evaluated the availability of Onchocerciasis control services, the availability and adequacy of qualified services providers and materials, the level of utilization of Onchocerciasis control services and the level of sustainability of these services in the LGA. The factors evaluated in relation to the utilization of the services included, the distance of people to the nearest health facility, age and gender influences. To achieve the purpose of the study, seven research questions were formulated and three null hypotheses postulated. The study adopted the descriptive survey research design. It covered the 49 villages/communities in Igboeze North LGA, of whom 662 community-directed distributors, 245 community/opinion leaders, 35 Front-line health facility staff and the three team members of the local Onchocerciasis control team were studied. There was no sampling as the entire population was studied through the use of three sets of questionnaires and programme data stored in the local government headquarters and the health facilities. For the purpose of reaching valid conclusions, data collected were analyzed quantitatively using frequency distribution and percentages in respect of research questions one through five and mean and standard deviation for research questions six and seven. The Student t-test and ANOVA statistics were used to verify the three hypotheses at .05 level of significance. Data generated from programme records were used to confirm information got from respondents. The study revealed that Mectizan™ distribution, annual training and retraining of community-directed distributors and community self-monitors were available to a good extent, while health education and mobilization and monitoring of community self-monitors were available to a lesser extent. It also revealed that all the services personnel and materials were available but the adequacy remained a problem. The study further revealed that the distance of the people to the nearest health facility affected the utilization level of the services, while age did not. Further on, gender affected the utilization of community self-monitoring services, while it did not affect Mectizan distribution and health education and mobilization. Based on the major findings and conclusions, it was recommended that the state government and the local government should ensure the availability and adequacy of programme personnel and materials, and improve on the funding of the programme. The community was recommended to fully assume the ownership of the programme by meeting frequently to discuss programme strategies, select and compensate CDDs and also monitor the activities of such CDDs.
CHAPTER ONE
Introduction
Background to the Study
Despite the several control efforts put in place regarding Onchocerciasis, it is still classified as a neglected tropical disease due to extreme fluid political and donor situations. Due to the epidemiological characteristics of the disease, governments in endemic areas, owing to one political reason or the other (poverty, war, conflicts), do not pay attention to the disease (Remme, 2004). Donor agencies owing to lack of certain dedicated infrastructure that will enable committed control efforts merely adopt remedial control measures.
Before the Onchocerciasis Control Programme (OCP) got under way in 1974, Onchocerciasis was the second cause of infection-induced blindness in the world (Wikipedia, 2010). It affected thirty-six countries in Africa, the Yemen and, very locally, Latin America. But the most severely hit was Africa, where it was a debilitating obstacle to settlement and economic and social development.
Today, about forty million people are afflicted worldwide with two million blind (Njepuome, Ogbu-Pearce, Okoronkwo & Igbe, 2009). They further stated that eighty-five and half million people in thirty-five countries live in endemic areas where the disease ravages. Further breakdown of the figure shows that twenty-eight countries are in Africa, six in Latin America and the other is Yemen. Some eighteen million are estimated to be infected, and of this, about ninety-nine percent live in Africa.
Onchocerciasis, also known as river blindness and Robles’ disease, is a parasitic disease caused by infestation by Onchocerca volvolus, a nematode (roundworm) (WHO, 2010). It is got through the bite of a vector, the blackfly or Simulium species, through which its lifecycle may be traced.
Gaffar (2010) and Willey, Sherwood, Woolverton & Prescott, (2009) stated that a gravid female blackfly takes a blood meal meant for the maturation of its ova from an infested human host, ingesting the infective microfilariae of the nematode. The microfilariae enter the gut and thoracic flight muscles of the blackfly progressing into the first larval stage and move to the proboscis and into the saliva in their third larval stage. These take about seven days.
During another blood meal, the blackfly passes the larvae into the next human host. The larvae migrate to the subcutaneous tissues and undergo two more moults. They form nodules as they mature into adult worms over six to twelve months.
After maturing, adult male worms mate with the female worms in the subcutaneous tissues to produce between 700 and 1,500 microfilariae per day, according to Trattle and Gladwin (2007). The microfilariae migrate to the skin during the day, and blackfly only feed in the day, so the parasite is in a prime position for the female fly to ingest it. Blackfly takes blood meal to ingest these microfilariae to restart the cycle.
According to Willey et al. (2009), it is not the nematode but its endosymbiont, Wolbachia pipientis, which causes the severe inflammatory response that leaves many blind. When the worms die, their Wolbachia symbionts are released, triggering a host immune system response that causes intense itching and can destroy nearby tissues, such as the eye (Sightsavers International, 2007).
Rodolfo Robles’ study on patients in Guatemala in 1915 led to the discovery that the disease is caused by the filarial, Onchocerca volvolus and sheds light on the lifecycle and transmission of the parasite. According to Okulicz (2008), Robles, using case studies of coffee plantation workers in Guatemala hypothesized that the vector of the disease was a day-biting insect, and more specifically, two anthropophilic species of Simulium flies were found in the endemic areas. James, Berger, Elston and Odom (2006) described the disease, Onchocerciasis, in the following phases or types:
