PREVALENCE OF Onchocerca volvulus WITHIN HONG LOCAL GOVERNMENT

AREA

BY

TIZHE HABSON ABANYI

ST/BST/M/HND/19/045

A PROJECT REPORT SUMMITED TO THE DEPARTMENT OF BIOLOGICAL

SCIENCE TECHNOLOGY FEDERAL POLYTECHNIC MUBI,

ADAMAWA STATE.

IN PARTIAL FULLFILMENT OF THE REQUIREMENTS FOR THE AWARD OF

HIGHER NATIONAL DIPLOMA IN SCIENCE LABORATORY TECHNOLOGY

(BIOLOGY/MICROBIOLOGY OPTION).

MARCH, 2022

i
 DECLARATION

I (Tizhe Habson Abanyi ) with the registration number (ST/BST/M/HND/19/045) hereby

declare that this work is the product of my own research effort, undertaken under the

supervision of (Demshemino P. H. Moses) and has not been presented elsewhere for the award

of any certificate. All sources of information have been duly distinguished and appropriately

acknowledged.

……………………………….. ………………………..

Tizhe Habson Abanyi Date

ST/BST/M/HND/19/045

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 CERTIFICATION

This is to certify that this project: (prevalence of Onchocerca volvulus in Hong Local

Government Area of Adamawa State) was done by Tizhe Habson Abanyi with Registration

Number ST/BST/M/HND/19/045) and defend during the 2020/2021 academic season in the

department of Biological Science and Technology Federal Polytechnic Mubi. The work was

examined and found to meet the requirement governing the award of Higher National Diploma

(HND) of the Federal polytechnic Mubi and it’s approved for its contribution to knowledge and

literacy presentation.

……………………………….. …………………………….

Mr. Demshemino P. H. Moses Date

(Supervisor)

……………………………….. …………………………….

Dr. Okpara A. N Date

(HOD)

……………………………….. …………………………….

External Examiner’s Name

(External Supervisor) Date

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 DEDICATION

I dedicate this project report to God almighty the author and finisher of all, and to Mr. Habson

Abanyi

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 ACKNOWLEDGEMENT

My greatest gratitude goes to God Almighty, the infinity of goodness, from whom every good

gift comes, for the gifts of life and knowledge and who permitted the success and completion of

this project report.

And to my project supervisors in person of Mr. Demshemino P. H. Moses whose

encouragement and support.

I also express my profound gratitude to my parents Mr. and Mrs. Habson Abanyi, who Stood as

a pillar of courage to make me and outstanding child, and to my Husband Mr. Abiodun

Christian Bakare.

I also want to express my gratitude to my head of department Dr. Okpara A. N and all

lecturers and staff in the department of Biological Science, Federal Polytechnic, Mubi, whose

effort in producing great and efficient leaders will never be in vain.

My gratitude also goes to my Siblings, friends and course mates for their support and

encouragement during this research project work, may Almighty God bless and protect every one

of them in all that they do, Amen.

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 TABLE OF CONTENT

TITLE PAGE...................................................................................................................................1

DECLARATION.............................................................................................................................2

CERTIFICATION...........................................................................................................................3

DEDICATION.................................................................................................................................4

ACKNOWLEDGEMENT...............................................................................................................5

CHAPTER ONE..............................................................................................................................9

INTRODUCTION...........................................................................................................................9

1.1 BACKGROUND OF THE STUDY..........................................................................................9

1.2 STATEMENT OF RESEARCH PROBLEM..........................................................................10

1.3 AIM OF THE STUDY.............................................................................................................11

1.4 SPECIFIC OBJECTIVES........................................................................................................11

1.5 SCOPE AND LIMITATION OF THE STUDY......................................................................11

1.5 SIGNIFICANCE OF THE STUDY........................................................................................11

2.1 ONCHOCERCIASIS...............................................................................................................12

2.2 EPIDEMIOLOGY OF ONCHOCERCIASIS IN NIGERIA...................................................13

3 CLINICAL FEATURES OF ONCHOCERCIASIS 2................................................................15

2.4 DIAGNOSIS OF ONCHOCERCIASIS..................................................................................16

2.5 OTHER TEST..........................................................................................................................17

2.6 TREATMENT OF ONCHOCERCIASIS...............................................................................17

2.7 CONTROL AND ELIMINATION PROGRAMMES.............................................................18

2.8 NATIONAL POLICY ON ONCHOCERCIASIS CONTROL...............................................20

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2.9 WORLD HEALTH ORGANISATION (WHO) POLICY ON ONCHOCERCIASIS

CONTROL....................................................................................................................................22

CHAPTER THREE.......................................................................................................................24

MATERIALS AND METHODS...................................................................................................24

3.1. STUDY AREA AND PERIOD..............................................................................................24

3.2. STUDY DESIGN AND POPULATION................................................................................24

3.3. SAMPLE SIZE AND SAMPLING TECHNIQUES..............................................................25

3.4. SAMPLE COLLECTION.......................................................................................................25

3.5. DATA COLLECTION TECHNIQUES AND MEASUREMENTS......................................25

3.6. LABORATORY ANALYSIS................................................................................................25

3.7. DATA PROCESSING AND ANALYSIS.............................................................................26

CHAPTER FOUR..........................................................................................................................27

RESULT........................................................................................................................................27

CHAPTER FIVE...........................................................................................................................30

DISCUSION, CONCLUSION AND RECOMMENDATIONS...................................................30

5.1 DISCUSSION..........................................................................................................................30

5.2 CONCLUSION........................................................................................................................30

5.3 RECOMMENDATION...........................................................................................................30

REFERENCES..............................................................................................................................32

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 Abstract
Onchocerciasis is a parasitic infection caused by the filarial nematode Onchocerca volvulus and

transmitted through the bites of black flies of the genus Similium that breed in rivers and

streams. There has been reported progress made in elimination of onchocerciasis in central and

southern American countries and in some localities in Africa. The target for elimination in the

Americas has been set at 2022 while for 12 countries in Africa this is expected in 2030. This

review was conducted to examine the current status of onchocerciasis elimination at the global

level and report on progress made. Literature searches were made through PubMed, articles in

English or English abstracts, reports and any other relevant articles related to the subject. The

global burden of onchocerciasis is progressively reducing and is no longer a public health

problem in some regions. However, programs are challenged with a range of issues: cross-

border transmission, diagnostic tools, Loa loa co-endemicity, limited workforce in entomology

and maintaining enthusiasm among community drug distributors. More concerted effort using

appropriate tools is required to overcome the challenges.

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 CHAPTER ONE

INTRODUCTION

1.1 BACKGROUND OF THE STUDY

Onchocerca volvulus is a filarial (arthropod-borne) nematode (roundworm) that

causes onchocerciasis (river blindness), and is the second-leading cause of blindness worldwide

after trachoma. It is one of the 20 neglected tropical diseases listed by the World Health

Organization (WHO), with elimination from certain countries expected by 2020. (WHO, 2010).

Onchocerciasis or “river blindness” is a vector borne disease caused by the bite of infected

blackfly (Simulium species) with filarial parasitic worm Onchocerca volvulus. The transmission

from person to person is due to the biting of infected black fly with filarial worm stage three

larvae. The adult filarial worms reproduce and live in Blood nodules of human body for long

period of time, even for more than fifteen years (Mitra A.K, 2017). Black flies of Simulium

species, especially, Simulium damnosum, is the vector and reservoir for onchocercal microfilaria

(WHO, 2016).

Infection with this nematode filarial worm leads to Blood disease and anatomical

impairment, which are dermatitis, pruritus or itching, depigmentation of the Blood or leopard

Blood, onchocercomata, hanging groin, and temporary vision loss to blindness (Ranganathan, B

2012).

The major strategy to eliminate onchocerciasis from endemic areas was ivermectin

(Mectizan) mass drug administration (MDA). Continuous treatment with highly therapeutic

drug covering large geographic area is the main strategy to interrupt onchocerciasis transmission

(Tee C, 2013).

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 According to Global Burden of Disease Study estimate, there were 20.9 million prevalent

O. volvulus infections worldwide in 2017: 14.6 million of the infected people had Blood disease

and 1.15 million had vision loss. More than 99% of infected people live in 31 African countries

(Ikpo, 2016). The disease also exists in some foci in Latin America and Yemen. In 2017, more

than 142 million people were treated in Africa where the strategy implemented, representing

approximately 69.6% coverage of the number of people who require treatment globally (WHO,

2018).

Evidence showed that more than 120 million people were at risk of onchocerciasis

infection in Africa region, of whom 26 million people were infected and over 265,000 people

were blind. People who live in fertile land, extensive agricultural farming area, and people who

live and settle near to river banks were more vulnerable for onchocerciasis infection (Lagatic O.,

2016).

1.2 STATEMENT OF RESEARCH PROBLEM

Onchocerciasis is endemic in coffee growing and large cotton farming areas of southwest

and northwest parts of Ethiopia with different prevalence and epidemiological distribution. More

than 16.3 million people living in different onchocerciasis endemic areas were estimated to be at

risk of contracting the disease (Meribo K, 2017).

The disease has impacts on socioeconomic and mental health of infected individuals.

Prolonged itching of the Blood leads to low productivity and absence from work. Chronic Blood

illness also needs high medical costs. Stigmas and discriminations related to onchocerciasis

affect sexual health of infected individuals and hinder social relation and personal confidence

( Ibe O., 2015).

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 Studies showed that age, sex, educational status, occupation, residence distance from the

river, and residence at river banks were predictors of onchocerciasis infection (Dana D., 2015)

Federal Ministry of Health of Nigeria (FMHN) had set a goal to eliminate onchocerciasis and to

stop community directed treatment with ivermectin by 2020 (Moh, 2016). Onchocerciasis

control and elimination through community directed treatment with ivermectin had been

conducted in the study area for the last fifteen years. However, prevalence of the disease and its

risk factors are not well studied in this study area.

1.3 AIM OF THE STUDY

The major aim of the current study is to determine the prevalence of onchocerca and to

identify factors independently associated with it in Hong and Michika LGA of Adamawa State.

1.4 SPECIFIC OBJECTIVES

The following are the specific objectives:

i. To determine the prevalence of Onchorcerca volvulus in Hong and Michika Local

Government Areas, Adamawa State.

ii. To access if infection is related age and sex in Hong and Michika Local Government

Area, Adamawa State.

iii. To ascertain if infection is related to location.

iv. To identify the potential black fly intermediate hosts in water bodies in the area.

1.5 SCOPE AND LIMITATION OF THE STUDY

This study will be limited to prevalence of onchorcerca volvulus in Hong and Michika LGA of

Adamawa State.

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1.5 SIGNIFICANCE OF THE STUDY

The study will be of great benefit to Ministry of Health, people in Hong and Michika

LGA cliarea as this will be useful for data banks, study on the subject matter.

The finding of the current study are very crucial to decide whether there will be need for

government interventions to institution control programmes.

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 CHAPTER TWO

INTRODUCTION

2.1 ONCHOCERCIASIS

Onchocerciasis is a serious neglected tropical disease caused by the filarial nematode

Onchocerca volvulus, transmitted by black fly which can lead to blindness and chronic

disability.1 The filaria are group of tissue dwelling nematodes of vertebrate that are spread by

blood feeding arthropods, Onchocerca volvulus (Cotton J.A. 2016) With estimated infection rate

of about 37 million people in tropical Africa and in isolated foci in Yemen and Latin America

(Choi Y., 2016), causing a debilitating eye and skin disease in more than 5 million people

(Crump A. 2012) and about 1.2 million visual impairment or blindness (Cotton J.A. 2016). It is

estimated that over 85 million people are leaving in endemic areas with 99% of the cases

resulting from Africa and half of this population residing in Nigeria.

Also, estimate of about 120 million people are at a risk of contracting the disease due to

the breeding habit of the vector (Doyle R.S. 2016). It is more severe along the major rivers in the

northern and central of the continent with the major rivers in the northern and central of the

continent with severity declining in villages farther from the river (Doyle R.S. 2016).

Onchocerciasis has been the second leading infectious cause of blindness in the world (Darvin

S.S., 2018). Long-term onchodematitis may also cause scarring, depigmentation, loss of skin

elasticity and disfiguration (Devin S.S., 2018) Hence, Onchocerciasis related blindness alone

have been estimated to reduce life expectancy by 4-10 years, as well as having an effect on the

host ability to assimilate into their society with other skin related diseases.

Since 1970’s, the World Health Organisation (WHO), International foundation, Non-

Governmental Organisation and Government Organisations have worked co-operatively to

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reduce the burden of Onchocerciasis ((Doyle R.S. 2016). through the use of insecticide sprays as

well as biannual administration of Ivermectin; which has had positive effect in the fight against

the disease in several parts of the world. 1 In Africa alone, an estimated 600,000 cases of

blindness had been prevented by 2002 and as at 2007, over 69 million doses of Ivermectin were

supplied through Mectizan Donation Program. However, in much central part of Africa,

concomitant infection with loa loa has shown precipitate toxic encephalopathy in patients on

treatment with Ivermectin1,7 and irreversible severe neurological events and health effect (Kelly

Hope L.A 2014). Therefore, there is limitation on the use of Ivermectin in much central part of

Africa as well as reliance on a single drug also increasing the potential for the emergence of

Ivermectin-resistant Onchocerca volvulus (Turner H.C., 2013), making development of new

drugs or novel therapies imperative1 and the need for annual review to extrapolate the progress

of it elimination.

2.2 EPIDEMIOLOGY OF ONCHOCERCIASIS IN NIGERIA

Nigeria is the most populous nation in Africa which lie between latitude 4°N and 14°N

and longitude 2° and 15°E (Geographical Aliance of Lowa, 2009), characterised by location of

the largest mangrove in Africa, largest river deltas, tropical rainforest climate, forest zone in the

southern portion (GAL, 2019), with approximately 200 million people. It is estimated that 17

million people (Adesina F.P., 2017) are at risk of the disease while 7-10million people are

infected. Consequently, Nigeria has been estimated to account for nearly 40% of the world’s

prevalence of onchocerciasis (WHO, 2018).

A survey carried out by Noma 2014 on 20 countries participating in African Programme

for Onchocerciasis Control (APOC) showed that Nigeria fall among the high risk countries with

about 26 million after the Democratic Republic of Congo. Also, a research carried out by

6
Adesina in the village of Idoani in Ondo state, Nigeria showed that a total of 24 (75%) from his

32 subjects examined were positive for onchocerciasis infection, with a >30 years old woman

totally blinded and several individual with lizard skin features as a result of onchocerciasis

infection (Adesina F. P., 2017). More so, in the community of Kuhe and Gube of Benue state of

Nigeria, a research on 546 persons showed a high prevalence of onchocerciasis at 61% and 71%

respectively (Onekutu A. 2018), as well as an epidemiological study carried out in fourteen

communities of Bakundi districts of Taraba state which showed that out of 1366 adults males

involved in the study, 45.2% were infected with ten communities having an infection rate in

excess of 30%, lizard skin and leopard skin were seen in 3.5% and 2.0% respectively (Akogun

B. O.1999), hanging groin 2.6% and scrotal enlargement at 8.6%. 21 Furthermore, Opera K.N

2006 shows that certain patients were blind due to onchocerciasis and were positive to

onchocerciasis test. However, it is believed that there was a significant decrease in

onchocerciasis in lower cross river basin due to repeated administration of Ivermectin (Opera

K.N 2006). This is in accordance with the various data from different part of Nigeria by various

researchers (Rebecca S.N., 2008). with its rate of occurrences as reported by these researchers

varying from one geographical area to another with highest endemicity of 83% recorded in Oria

North Local Government Area of Edo state (Akinbo F.O., 2005) 79.5% in Oyo state (159

patients test positive for onchocerciasis out of 200 patients), 94.5 % in Kaduna state, (189

patients tested positive for onchocerciasis out of 200 patients)30 and 54.2% in Ibarapa Local

Government Area of Oyo state.25 These data and lots more shows that Nigeria fall among the

high risk countries on the list of 20 African Programme for Onchocerciasis Control (APOC)

countries with about 26 million after the Democratic Republic of Congo (Noma M., 2014). In

view of the efforts by the World Health Organisation (WHO), International foundation, Non-

7
Governmental Organisation and Government Organisations who have worked co-operatively

toward the elimination of this disease through the establishment of the Africa Programme for

Onchocerciasis Control (APOC) and it transition into the Expanded Special Project for the

Elimination of Neglected Tropical Disease in Africa (ESPEN) with the main strategy been the

establishment of sustainable community-directed treatment with Ivermectin (CDTI) and vector

control with environmentally safe method where appropriate (WHO 2018),. An annual review is

imperative to ensure the availability of updated data on areas which need more Ivermectin

administration as this will aid in achieving the goal of world free onchocerciasis by 2025.

3 CLINICAL FEATURES OF ONCHOCERCIASIS 2.

The microfilaria; onchocerca vulvolus mature into larvae in the gut of black fly of the

genus Simulium. These leaves to the proboscis of the black fly and are introduced to the human

bloodstream when fly take blood meals. 31 In humans, the larvae migrate to various parts of the

body but most often the skin and eyes and form nodules referred to as onchoceroma, typically

seen in the skin, around joints and other bony prominence (Enk C.D., 2006).

Onchocerca volvulus larvae mature into their sexually competent adult forms in these

nodules (Devin S.S., 2018). Male worms may move between nodules to fertilize female worms.

Fertilized female worms then produce microfilaria which are released into the blood stream and

picked up when new Simulium black flies feed from infected humans. The production of

microfilaria by female adult worms depend on their associated Wolbachia endosymbiont,

Developed adult worms cluster in the subcutaneous nodules (onchocercomata) with generalized

pruritus in early infection (Devin S.S., 2018). and if the infection becomes severe, symptoms

may include; Skin rashes, Extreme itching, Change of the skin pigmentation, Loss of skin

elasticity which can make skin appear thin and brittle (leopard skin), Bumps under the skin

8
called onchoceroma, Itching of the eyes, Cataracts, Light sensitivity, Loss of vision with

swollen lymph nodes in rare cases, , Enlarged groin (stewart D. 2008).

Symptom of onchocerciasis reflects the developmental stage of the parasites and the degree of

immune response by the host. Clinical manifestation are highly variable, however, symptoms do

not appear until after the L3 larvae mature into adult worm. On average, symptoms appear

between 9 moths and 2 years after initial acquisition of the parasite and onset of symptoms is

sometimes referred to as the prepatent phase (Devin S.S., 2008)

2.4 DIAGNOSIS OF ONCHOCERCIASIS

There are several test used to diagnose onchocerciasis, usually the first is for clinicians to

feel the skin to try and identify nodules followed by laboratory studies which traditionally

involves demonstration of microfilaria in a skin-snips biopsy sample (Devin S.S., 2018). In this

technique, a razor blade is used to remove tiny skin samples (3-5mg) from multiple sites, (iliac

crest and shoulder). They are placed in saline to observe microfilaria emerging from the sample.

Alternatively, for the purpose of quantification of microfilariae burden, sclerocorneal punch

samples can be used to obtain a specific amount of skin (usually 5 micrograms) for each

samples. The sensitivity is low in the prepatent disease stage, in geographic area of low

prevalence and in areas of mass Ivermectin administration. Skin-snips biopsy spacemen can also

be used to detect microfilaria using nucleic acid amplification (Udall D.N., 2007) This technique

yield high specificity (100%) in experienced hands but low specificity (30-50%) in early stage of

infection.

The diagnosis may also be made by direct examination of surgical specimens obtained by

excision of nodules.7 Other methods entail the use of

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 • ov16 card test: an immunochromatographic card test is used to detect the presence of of

immunoglobulin G4 (IgG4) antibodies to recombinant Ov16 antigen.34

• Recombinant hydride protein (ovh2 and ovh3): based on hybrid proteins of two separate

onchocerca species (Ov₂₀ and Ov₃₀). An enzyme-linked immunoassay (ELISA) based antibody

detection test (Ndu P.N., 2002)

• An ELISA-based test using a cocktail of 3antigen (Ov₇, Ov₁₁, Ov₁₆) have been used to

detect antibodies (Rodriguez 2004).

• Test for low-molecular weight antigen fraction of formal Onchocerca volvulus parasites

(Guzman, 2002).

• Oncho-27 antigens test; in the diagnosis of Onchocerca infection. The advantage of this

test is the use of urine or tears for studying (Ayong, 2005).

• Nucleic acid amplification test: Polymerase chain reaction (PCR) using materials from

skin-snips or skin scratches provided high sensitivity and specificity superior to older

methods (Boatin, 1998). With the invention of Nucleic acid amplification test, Polymerase

chain reaction (PCR), this has aid in early diagnosis of the disease as well as expression of

the parasite genome.1

2.5 OTHER TEST

An oldertechniques that is more of historical interest is the test dosing with Dierhylcarbamazine

(DEC) in oral form to observe the reaction that suggest the presence of onchocerciasis. More

recently, a patch testing using Diethylcarbamazine which decrease risk have been used. 7 This

testing is based on the principle of the Mazzotti Reaction and involves the topical application of

diethylcarbamazine in a cream base (DEC patch). It elicits localized cutaneous reaction

(pruritis), maculopapular eruptions, etc (Devine S.S., 2018).

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2.6 TREATMENT OF ONCHOCERCIASIS

With the pathogenesis of onchocerciasis which is secondary to microfilaria, the goal of therapy

is to eliminate the microfilaria stage of the disease to improve symptoms, prevent progression to

eye lesions and to enhance disease elimination (WHO, 2018),

Therefore, World Health Organisation (WHO) recommends treating onchocerciasis with

Ivermectin and Moxidectin as the drugs of choice due to it microfilaricidal property (Reggy,

2007), Ivermectin is administered at least once yearly for dosing interval of 3-12 month for a

period of 10-12 years (WHO, 2017). Where Onchocerca volvulus co-exist with loa loa, World

Health Organisation recommends that treatment strategies be adjusted, since treatment of

individuals with having high level of loa loa in the blood with Ivermectin can sometimes result

in severe adverse events.7,8,42 Recently, the approval of Moxidectin in June 2018 has also shown a

promising progress toward combating onchocerciasis(Opoqu, 2018). Also, nodulectomy can

result in cure if excision eliminates all adult worms. However, this is not a practical choice in

patients with multiple nodules or in patients with whom nodules are not clinically evident (Devin

S.S., 2018)

2.7 CONTROL AND ELIMINATION PROGRAMMES

Due to significant human health and socioeconomic burdens associated with

onchocerciasis, Onchocerciasis was identified by the World Health Organisation (WHO) as a

potential candidate for disease elimination through annual or biannual mass administration of

Ivermectin since 1970’s; an approach that has eliminated Onchocerciasis from all but four

countries in America (CBC, 2013), reducing or eliminating the disease in many areas (WHO,

2014). With plans in place to gear-up for worldwide elimination by 2025 (Mackenzie, 2012).

This has led to the establishment of several control programmes to enhance effective elimination

11
of the disease ranging from; Onchocerciasis Control Programme (OCP); Following the dramatic

consequences of onchocerciasis in West Africa, WHO launched in 1974 the OCP in

collaboration with three other United Nations agencies including the World Bank, the United

Nations Development Programme (UNDP) and Food and Agriculture Organization (FAO). 8

These UN agencies constitute the sponsoring agencies of OCP. The programme stretched over 1

200 000 Km² to protect 30 million people in 11 countries, from the debilitating effects of river

blindness. For years, OCP operations were exclusively based on the spray of insecticides by

helicopters and aircrafts over the breading sites of the black flies in order to kill their larvae

(aerial larviciding). With the donation of Mectizan (ivermectin) by Merck and Co., Inc. in 1987,

control operations changed from exclusive vector control to larviciding combined with

ivermectin treatment or, in some areas, to ivermectin treatment alone.8 OCP was officially closed

in December 2002 after virtually stopping the transmission of the disease in all the Participating

Countries except Sierra Leone where operations were interrupted by a decade-long civil war.

Between 1974 and 2012, in West Africa using mainly the spraying of insecticides

against black fly larvae (vector control) by airplane and helicopters. The Onchocerciasis

Control Program (OCP) relieved over 40million people from the infection, prevented

blindness in 600,000 people and ensured that 18 million children were born free from the

threat of the disease and blindness. In addition, 25 million hectares of abandoned arable land

were reclaimed for settlement and agricultural production capable of feeding 17 million people

(WHO, 2018).

However, in 1995 experienced the lunched of the Africa Programme for

Onchocerciasis Control (APOC), with the objective of controlling onchocerciasis in the

remaining endemic countries in Africa and closed at the end of 2015 (WHO, 2018). The

12
APOC is a bigger partnership programme than OCP including 19 Participating Countries with

effective and active involvement of the Ministries of Health and their affected communities,

several international and local NGDOs, the private sector (Merck and Co., Inc.), donor

countries and UN agencies. The World Bank is the Fiscal Agent of the Programme and WHO

is the Executing Agency of the Programme. The Community-Directed Treatment with

Ivermectin (CDTI) is the delivery strategy of APOC. It empowers local communities to fight

river blindness in their own villages, relieving suffering and slowing transmission (WHO,

2017). In Africa Programme for Onchocerciasis Control’s final year, more than 119 million

people were treated with Ivermectin and many countries had greatly decreased morbidity

associated with onchocerciasis. More than 800,000 people in Uganda and 120,000 people in

Sudan no longer required Ivermectin by the end of 2015 (WHO, 2018). Then, begins the

transition into the Expanded Special Project for the Elimination of Neglected Tropical Disease

in Africa (ESPEN) (WHO, 2018). The establishment of the Expanded Special Project for the

Elimination of Neglected Tropical Disease in Africa; with sustainable community-directed

treatment with Ivermectin showed that as at 2016 to 2017, more than 132 million people were

treated in Africa where the strategy of community-directed treatment with Ivermectin, (CDTI)

was implemented, representing approximately 67.1% coverage of the number of people

require treatment globally (Devine, 2018).

The Expanded Special Project for the Elimination of Neglected Tropical Disease in Africa

(ESPEN) like Onchocerciasis Control Program (OCP) and African Programmes for

Onchocerciasis Control (APOC), is housed in the World Health Organisation (WHO) regional

office for Africa and relies on support from priority countries for their neglected tropical disease

programme (WHO, 2018). Also, in American, a similar program for the Americas known as the

13
Onchocerciasis Elimination Program for the Americas, (OEPA) began in 1992 with it objectives

of eliminating ocular morbidity and interruption of transmission throughout the America by

2015 through biannual large-scale treatment with Ivermectin. All 13 foci in this region achieved

coverage of more than 85% in 2006, and transmission was interrupted in 11 of the 13 foci so far

in 2017 with elimination effort now focused on the Yunomani people living in Brazil and

Venezuela. Hence, several countries such as Colombia have been certified onchocerciasis free

as at April, 2013 by WHO followed by Ecaudor in September 2014, Mexico in July 2015 and

Guatamela in July 2016 with more than 500,000 people no longer needing Ivermectin in the

America (WHO, 2018).

2.8 NATIONAL POLICY ON ONCHOCERCIASIS CONTROL

The national health policy was introduced in 1988 to promote health for all Nigerians while a

document containing the onchocerciasis policy as a national health intervention for the control

of onchocerciasis as a priority disease was put forward in 2004. The ultimate goal is to

eliminate onchocerciasis as a public health problem throughout Nigeria through strengthening

of self-sustainable prevention and control programmes in endemic communities (Ogbolla,

1988). The global target for the elimination of NTDs is 2025. The policy framework marked

another milestone in the prevention and control of a disease that has greatly affected and

incapacitated the productive and economically viable work force especially those that are

predominantly farmers in the rural areas, remote villages and hinterlands. This informed the

need for review of the progress made so far in order to transit from control to elimination and

prevention to massive ivermectin (Mectizan) and Albendazole administration to eligible

individuals in endemic communities was introduced (Ogbolla, 1988). In 1988, the Federal

Republic of Nigeria put up a National Health Policy, a strategy towards actualizing health for

14
 all Nigerians that represents the government and people collective will. However,

implementing the framework has been more challenging. Health summit was organized in

Nigeria in 1995 with the view for an urgent change in the health systems and status of the

country (Ogbolla, 1988) The Federal Ministry of Health (FMOH) responded to this and

organized a review of the policy in 1996- 1997. The document was not endorsed officially

then. It was endorsed and released as a policy blue print in September, 2004. The entire policy

objective was, “To strengthen the national health system such that it will be able to provide

effective, efficient quality, accessible and affordable health services that will improve the

health status of Nigerians through the achievement of the health-related sustainable

Development Goals(Ogbolla, 1988).

The ministry of justice and other relevant ministries review priorities for health service and

biomedical research, content of activities, promotion and financing of research activities and

assessment of health technologies. They encourage private sectors collaboration in their

activities that promote health and disease control.51 Research activities are predominantly

targeted towards: biomedical and health services, operational research, developmental

research, basic biomedical research which seeks to broaden basic knowledge relevant to

biology and health; and research on socio-cultural factors which directly or indirectly affect

health and health services. Special considerations are given to epidemiological, operational

and developmental research activities (Ogbolla, 1988).

2.9 WORLD HEALTH ORGANISATION (WHO) POLICY ON ONCHOCERCIASIS

CONTROL

In 1974, the World Health Organization (WHO) launched the Onchocerciasis Control

Programme in Africa to combat the menace of river blindness in the region predominantly

15
inhabited by farmers who are easily incapacitated by the scourge. The initial programme was

predominantly via vector control by spreading insecticides along riverbanks to kill the larvae of

Simulium. Merck and Co. Inc. further modified it in 1987 following ivermectin discovery. A

combination of vector control and mass treatment using ivermectin was adopted (WHO, 2018).

The control drive was enhanced to cover 19 countries of Africa from the previous 11 following

the birth of The African Programme on Onchocerciasis Control (APOC) Ogbolla, 1988). Their

target was to treat 50 million people infested with fillariasis annually by 2010 using free

Ivermectin by Merck and Co. Inc. This was complimented by other programmes on training,

research and development in tropical diseases by specialized United Nations Agencies, World

Bank and World Health Organization (WHO) (Ogbolla, 1988). The African programme for

onchocerciasis control was launched in 1995 to ensure wider coverage. It was targeted towards

ivermectin distribution through Community Sustainable Distribution (CSD) approach.

Following the elimination of micro filaricides, its use should be continued for 13–20 more years

to ensure complete elimination in meso-endemic and hyperendemic areas.

16
 CHAPTER THREE

MATERIALS AND METHODS

3.1. STUDY AREA AND PERIOD.

The study will be carried out in Hong Local Government Area of Adamawa State. It is

located in the northern part of the State. It is divided into thirteen (13) districts, and has an area

of 411.5Km2 and an estimated population of 146,019 (Census, 2006). The local government lies

geographically between latitude 10°11'14.64" N and longitude 13°23'44.74" E. The inhabitants

are predominantly farmers, traders and civil servants. Their sources of water include wells,

rivers, streams, pipe-borne water and dams. The supply of tap water is periodically. The major

languages spoken are Kilba, Hausa, Fulfulde. The people are predominantly famers and civil

servants. Meanwhile Hong local government area is divided into 14 districts and has an area of

411.6Km2 with an estimated population of 179.254 (census 2006). The local government lies

geographically between latitude 10°11'14.64" N and longitude 13°23'44.74" E. The inhabitants

are predominantly farmers, traders and civil servants. Their sources of water include wells,

rivers, streams, pipe-borne water and dams. The supply of tap water is periodically

There are many rivers and streams used for agriculture and home consumption. The

livelihoods of the residents mainly depend on cultivating crops and breeding livestock. There

are 28,277 estimated households. More than 85 % of the populations live in rural areas.

3.2. STUDY DESIGN AND POPULATION.

Community based cross sectional study will be conducted. Selected people aged ≥15 years and

having stayed in Hong for at least one year and above will be enrolled in the study.

17
3.3. SAMPLE SIZE AND SAMPLING TECHNIQUES.

A total of 100 health seekers will be screened from each of the four (4) health centers in

each local government areas. Twenty-five (25) persons each will be examined in each of the four

(4) health center.

3.4. SAMPLE COLLECTION.

Clinical presentations of onchocercal blood disease will be observed from study participants in

separate room with adequate natural illumination. After observing clinical presentations.

Blood samples were obtained from each participant, immediately placed in a cold flask with ice,

and transferred to a refrigerator upon returning to the laboratory on same day. All procedure

were performed following rigorous aseptic conditions.

3.5. DATA COLLECTION TECHNIQUES AND MEASUREMENTS.

The independent variables included in this study include age, sex, educational status,

occupation, duration of stay in the residency area, compliance with ivermectin treatment,

distance from the nearby river, residing at river banks, and accessibility of ivermectin treatment

by mass drug administration Nonbiological data will be collected by face-to-face interview using

structured questionnaire adapted from different literature (Logatie 2016). After face-to-face

interview,

3.6. LABORATORY ANALYSIS.

Membrane filter procedure (adapted from references 1 and 7):

Collect fresh blood in sodium citrate or EDTA. Add 1 ml of the blood to 10 ml of 10%

Teepol-saline solution (50 g Teepol concentrate to 450 ml saline). Place a 25-mm Nuclepore

filter of 5-μm porosity over a 25-mm supporting filter paper moistened with water securely into

a filter holder. Remove plunger from the barrel of a 20-ml syringe and connect the barrel of the

18
syringe to the filter holder. Pour the blood-Teepol mixture into the barrel of syringe, replace the

plunger in the syringe, and gently force the solution through the filter. Remove the syringe from

the filter holder, draw up 10 ml of water into syringe, reattach the filter holder, and gently wash

the filter by flushing the water through it. Do this three times total. Pass 3 ml of methanol

through the filter to fix the microfilariae. Remove the filter from the holder and place on a glass

slide; allow to dry thoroughly. Stain with Giemsa or preferred stain per the normal procedure.

Dip the slide in toluene to avoid air bubble formation. Add a drop of mounting medium and a

coverslip. Examine the slide when dry.

Microscopy. Because microfilariae are large, they can be detected by screening at a lower

magnification (e.g., ×10) and then examined at a higher magnification (×40, ×50 with oil, or

×100 with oil) for species-level identification. Because of the large size of microfilariae and

rarity in clinical specimens, it is imperative that the entire blood film should be scanned with a

10× objective before reporting as negative; higher power, including oil immersion, should then

be used to screen for malaria and other blood pathogens.

3.7. DATA PROCESSING AND ANALYSIS.

Data will be entered using EpiData version 3.1 and exported to SPSS version 20 for

statistical analysis. Descriptive statistics like frequency count, measures of central tendency, and

measures of dispersion will be done to determine the prevalence of onchocerciasis and to

summarize other predictor variables. Adjusted odds ratio with its 95% CI will be calculated to

measure strength of association and its statistical significance, respectively. 95% CI will be used

to declare statistical significance.

19
 CHAPTER FOUR

RESULT

Table 1: prevalence of (MF-Positive) in the four health centers.

Health centers No. Examined No. of positive Percentage Positive

(%)
Hong general hospital 25 3 (12%)

Clinic A. P.H.C 25 2 (8%)

Woman P.H.C 25 0 (0%)

Dzumah P.H.C 25 0 (0%)

Total 100 5 (5%)

The table shows that Hong General hospital had the highest prevalence of microfilaria

3(12%).this followed by clinic A primary health care 2(8%). Both Dzumah and Women in

health primary health care had no infection.

20
Table 2: prevalence of (MF-Positive) by age in the four health centers.

Age group No. Examined No. of positive Percentage posive

%
15-20 20 0 (0.0%)

21-26 31 4 (12.9%)

27-32 7 1 (14.3%)

33-38 9 0 (0%)

39-44 6 0 (0%)

45-50 5 0 (0%)

51-56 1 0 (0%)

57-61 4 0 (0%)

62-above 17 0 (0%)

Total 100 5 (5%)

From the table above, participants within the age range from 27-32 had the highest prevalence

14.3%. this followed by subjected within the age range of 21-26 had (12.9%)

21
Table 2: prevalence of (MF-Positive) by sex in the four health centers.

Sex No Examined No. of positive Percentage positive

(%)
Male 42 2 (4.8%)

Female 58 3 (5.2%)

Total 100 5 (5%)

The table above which shows the prevalence of onchocerciasis by sex within Hong, high

prevalence was recorded in Male with 3(23%) followed by Female 2(4.8%)

22
 CHAPTER FIVE

DISCUSION, CONCLUSION AND RECOMMENDATIONS

5.1 DISCUSSION

The research revealed an overall perveance of 5% micro filaria infection in the four study

areas. The result. Obtained in this in this study is higher than the one recorded by Basamez et al

(2006). Who reported on overall increment impact of 5.7% in a study carried out in Otikeran

and Mere River basin in central and norther Togo, the findings however lower than the one

obtained by Katholi et al (1995) overall prevalence of 1% in a study carried out at Bagahn in

northern Central Congo. The result is similarly to the one obtained by Basanez et al (2006).

Who recoded and overall prevalence of 4.9% in a record carried out at Mo town in North and

central Togo.

From the result obtained, participant within the age range of 27 to 32 had the highest prevalence

of 14.3%. however, compered to the report given by Bagahn in 2015 in Keren Central Africa,

age group 21-35 had the highest prevalence with 22.3%.

Meanwhile, these research shows that in the four health center examined in Hong Local

Government Area of Adamawa State. The highest prevalence was recorded in male with (23%)

than in female (4.8%), these is why because, male are mostly exposed to the environmental

activities like fishing, haunting, cattle rearing, Agricultural activities (farming) e.t.c.

5.2 CONCLUSION

Great strides have been made Nationwide in the elimination of onchocerciasis. In Nigeria,

although no country has been verified free of onchocerciasis, progress has been made to

eliminate the disease in some limited localities with optimism that the Nation will be able to

achieve complete elimination in 12 state by 2030. In the Americas, elimination of all

onchocerciasis foci has been achieved, except a single focus (Yanomami) along the border of

23
Brazil and Venezuela. Yemen has made some progress in elimination despite the civil strife. The

global outlook in onchocerciasis elimination is promising; however, the need to address key

challenges remains a priority to programs.

5.3 RECOMMENDATION

1. Health department and other stakeholders should evaluate therapeutic coverage and

community directed treatment with ivermectin in the study area.

2. Zonal health department and other stakeholders should provide behavioral change

communication (BCC) for adults aged 35 and above and for all adult males to wear

preventive cloth during outdoor activities.

3. Zonal health department and other stakeholders should conduct vector control activities

especially for indwellers residing nearby the river.

4. Federal Ministry of Health, Ethiopian Public Health Institute, and other stakeholders should

strengthen periodic entomological surveillance.

5. Further studies using diagnostic test like immunological Ov-16 should be done for the 2020

onchocerciasis disease elimination. Community based study should also be done to identify

factors hindering the community compliance with the treatment.

24
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