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Slide of blind man led by child

Slide of blind man led by child - California State Water ......public health importance • 25 million onchocerciasis-free hectares (67.5 million acres) are now being resettled •

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Page 1: Slide of blind man led by child - California State Water ......public health importance • 25 million onchocerciasis-free hectares (67.5 million acres) are now being resettled •

Slide of blind man led by child

Page 2: Slide of blind man led by child - California State Water ......public health importance • 25 million onchocerciasis-free hectares (67.5 million acres) are now being resettled •

Onchocerciasis = river blindness

• caused by the parasitic roundwormOnchocerca volvulus

• transmitted by female black flies of the Simulium damnosum complex

• Solution: control the vector (the black fly)

• Solution: control the parasite through chemotherapy with ivermectin

Page 3: Slide of blind man led by child - California State Water ......public health importance • 25 million onchocerciasis-free hectares (67.5 million acres) are now being resettled •

Slide of parasite

Page 4: Slide of blind man led by child - California State Water ......public health importance • 25 million onchocerciasis-free hectares (67.5 million acres) are now being resettled •

Slide of abandoned villages

Page 5: Slide of blind man led by child - California State Water ......public health importance • 25 million onchocerciasis-free hectares (67.5 million acres) are now being resettled •

Control of Onchocerciasis

• United Nations Development Program, World Bank, and World Health Organization funded theOnchocerciasis Control Program in 11 West African countries, 1974-2002 (extended to 2007)

• Goal: Control river blindness, resettle abandoned valleys, increase food and crop production, raise GNP, and reduce severity of future droughts

• African Program for Onchocerciasis Control in 19 central African countries, 2000-2010

• Goal: Disease elimination through drug therapy

Page 6: Slide of blind man led by child - California State Water ......public health importance • 25 million onchocerciasis-free hectares (67.5 million acres) are now being resettled •

Onchocerciasis Control Onchocerciasis Control Programme Programme (OCP)(OCP)

African Programme for African Programme for Onchocerciasis Control Onchocerciasis Control (APOC)(APOC)

MOROCCO

Former Spanish Sahara

MAURITANIA

MALISENEGAL

THE GAMBIA

GUINEA BISSAU GUINEA

SIERRA LEONE

LIBERIA

CÔTE D’IVOIRE

BURKINA FASO

GH

ANA

TOGO

BEN

IN

NIGERIA

NIGER

ALGERIA

TUNISIA

LIBYAARAB REP. OF EGYPT

CHAD SUDAN

CAM

EROO

N

CENTRAL AFRICAN REPUBLIC

ERITREA

ETHIOPIA

DJIBOUTI

SOMALIA

KENYAUGANDA

RWANDA

BURUNDICO

NG

O

GABON

EQUATORIAL GUINEA

SAO TOME AND PRINCIPE

ANGOLA

NAMIBIABOTSWANA

ZAMBIA

TANZANIA

MALAWI

ZIMBABWE

MOZA

MBI

QUE

SOUTH AFRICA

SWAZILAND

LESOTHO

MAD

AGAS

CAR

MAURITIUS

COMOROSMAYOTTE (Fr.)

SEYCHELLES

CAPE VERDE

DEM. REP.OF CONGO

Page 7: Slide of blind man led by child - California State Water ......public health importance • 25 million onchocerciasis-free hectares (67.5 million acres) are now being resettled •

Strategy of Vector Control:The First Approach

• stop black fly transmission of parasite to humans

• over time, the human “reservoir” of parasites decreases

• 9-11 year parasite life cycle, 14-20 years of insecticide applications needed

• 30,000 miles of river sprayed weekly

Page 8: Slide of blind man led by child - California State Water ......public health importance • 25 million onchocerciasis-free hectares (67.5 million acres) are now being resettled •

Helicopter spraying

Page 9: Slide of blind man led by child - California State Water ......public health importance • 25 million onchocerciasis-free hectares (67.5 million acres) are now being resettled •

Slide of insecticides used

Page 10: Slide of blind man led by child - California State Water ......public health importance • 25 million onchocerciasis-free hectares (67.5 million acres) are now being resettled •

Fish are the Essential Protein Source in this Region

Page 11: Slide of blind man led by child - California State Water ......public health importance • 25 million onchocerciasis-free hectares (67.5 million acres) are now being resettled •

Slide of monitoring stations

Page 12: Slide of blind man led by child - California State Water ......public health importance • 25 million onchocerciasis-free hectares (67.5 million acres) are now being resettled •

Evaluation of Fish

• species richness and composition• catch per unit effort• size distribution• population densities• condition factor (length-weight relationship)

Page 13: Slide of blind man led by child - California State Water ......public health importance • 25 million onchocerciasis-free hectares (67.5 million acres) are now being resettled •

Evaluation of Benthic Macroinvertebrates

• species richness and composition• densities• night-time invertebrate drift patterns• recovery of sensitive species• toxicity tests (black flies and non-target

organisms)

Page 14: Slide of blind man led by child - California State Water ......public health importance • 25 million onchocerciasis-free hectares (67.5 million acres) are now being resettled •

Slide of gutters

Page 15: Slide of blind man led by child - California State Water ......public health importance • 25 million onchocerciasis-free hectares (67.5 million acres) are now being resettled •

Slide of stream gutters

Page 16: Slide of blind man led by child - California State Water ......public health importance • 25 million onchocerciasis-free hectares (67.5 million acres) are now being resettled •

Socio-Economic Impact of Controlling River Blindness

• onchocerciasis is no longer a disease of public health importance

• 25 million onchocerciasis-free hectares (67.5 million acres) are now being resettled

• food production has increased to support 17 million additional people

Page 17: Slide of blind man led by child - California State Water ......public health importance • 25 million onchocerciasis-free hectares (67.5 million acres) are now being resettled •

Slide of Leraba

Page 18: Slide of blind man led by child - California State Water ......public health importance • 25 million onchocerciasis-free hectares (67.5 million acres) are now being resettled •

What is the environmental sustainability of resettlement in

onchocerciasis-free areas?• resettlement is spontaneous, little

infrastructure such as schools or roads exist• settlers try to occupy largest possible areas• few sustainable soil, water, fisheries, or

crop-management techniques are practiced

Page 19: Slide of blind man led by child - California State Water ......public health importance • 25 million onchocerciasis-free hectares (67.5 million acres) are now being resettled •

Habitat Assessments

• conducted at all sites where fish and benthic macroinvertebrates are collected

• existing habitat is compared to descriptions that describe optimal, suboptimal, marginal, or poor conditions

• within each category, a high, medium, or low score is applied

Page 20: Slide of blind man led by child - California State Water ......public health importance • 25 million onchocerciasis-free hectares (67.5 million acres) are now being resettled •
Page 21: Slide of blind man led by child - California State Water ......public health importance • 25 million onchocerciasis-free hectares (67.5 million acres) are now being resettled •

At the program’s inception an “environmental catastrophe”

resulting from the large-scale, long-term applications of

insecticides to West African Rivers was feared

Were the fears justified?

Page 22: Slide of blind man led by child - California State Water ......public health importance • 25 million onchocerciasis-free hectares (67.5 million acres) are now being resettled •

Concepts of River Zonation

• Fish and invertebrate communities occur in different river zones

• Therefore, application of insecticides could eliminate taxa and change ecological status

• However, in African rivers, there are no species replacements; species richness increases downstream

• Species are distributed over large areas; recolonization potential is high

Page 23: Slide of blind man led by child - California State Water ......public health importance • 25 million onchocerciasis-free hectares (67.5 million acres) are now being resettled •

Insect life cycles in tropical Africa were unknown

• 4-12 weeks for hydropsychidcaddisflies and dragonflies

• Adult life of aquatic insects is longer

• Recolonization occurs more rapidly than expected

Page 24: Slide of blind man led by child - California State Water ......public health importance • 25 million onchocerciasis-free hectares (67.5 million acres) are now being resettled •

Boundary Layer Concept

• Boundary layer is 1-3 mm thick; affects contact and uptake of insecticides

• Non-target benthos should have higher uptake than black fly larvae

• Flow is complicated; boundary layer is transient and very thin

• Insecticide contact should be higher for black flies than for non-target organisms

Page 25: Slide of blind man led by child - California State Water ......public health importance • 25 million onchocerciasis-free hectares (67.5 million acres) are now being resettled •
Page 26: Slide of blind man led by child - California State Water ......public health importance • 25 million onchocerciasis-free hectares (67.5 million acres) are now being resettled •

Rivers are in an equilibrium condition

Rivers are driven by disturbance, no steady state or equilibrium

Page 27: Slide of blind man led by child - California State Water ......public health importance • 25 million onchocerciasis-free hectares (67.5 million acres) are now being resettled •

Monitoring was based entirely on on fish and macroinvertebrates

• Dynamic aspects of river discharge, metapopulations, and biota should be studied as part of an overall assessment

• Today, a systems approach would be used(Mekong River Commission)

Page 28: Slide of blind man led by child - California State Water ......public health importance • 25 million onchocerciasis-free hectares (67.5 million acres) are now being resettled •

Water flow downstream (quantity, quality)

Water flow upstream (quantity, quality)

Industrial & urban waste

diversion

Flooding

transportation Dam

Fisheries

irrigation

agricultural runoff

Forests

Mekong River

Basin EcosystemL. Bêche

Page 29: Slide of blind man led by child - California State Water ......public health importance • 25 million onchocerciasis-free hectares (67.5 million acres) are now being resettled •

Mekong River: Evaluating Effects of Large Dams

• Biological Assessment• In-stream flows• Ecological risk assessment• Water quality• Sediment toxicity

Page 30: Slide of blind man led by child - California State Water ......public health importance • 25 million onchocerciasis-free hectares (67.5 million acres) are now being resettled •

Bioassessment

• Fish• Benthos• Zooplankton• Algae• Macrophytes• Primary Production• Respiration

Page 31: Slide of blind man led by child - California State Water ......public health importance • 25 million onchocerciasis-free hectares (67.5 million acres) are now being resettled •

Lessons Learned from West African Biomonitoring

• Large-scale programs start from political decisions, not necessarily with a scientific basis

• Programs hindered by what cannot be done (higher-level identifications) and tradition (sampling devices)

• Monitoring can only tell us so much; a complementary research program reveals underlying effects

Page 32: Slide of blind man led by child - California State Water ......public health importance • 25 million onchocerciasis-free hectares (67.5 million acres) are now being resettled •

Slide of end of road

Page 33: Slide of blind man led by child - California State Water ......public health importance • 25 million onchocerciasis-free hectares (67.5 million acres) are now being resettled •

Outcomes of OnchocerciasisControl

• African Program for Onchocerciasis Control now in 19 more countries (ivermectin only, Merck donation)

• coordinate distribution of drugs for lymphatic filariasis (SKB donation)

• potential distribution of anti-malaria nets• reductions in parasitic-induced anemia

Page 34: Slide of blind man led by child - California State Water ......public health importance • 25 million onchocerciasis-free hectares (67.5 million acres) are now being resettled •