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Progress Toward Eliminating Mother to Child Transmission of HIV in Kenya: Review of Treatment Guideline Uptake and Pediatric Transmission at Four Government Hospitals Between 2010 and 2012.
AIDS and Behavior. 2016 Nov; 20(11):2602-2611.We analyzed prevention of mother-to-child transmission (PMTCT) data from a retrospective cohort of n = 1365 HIV+ mothers who enrolled their HIV-exposed infants in early infant diagnosis services in four Kenyan government hospitals from 2010 to 2012. Less than 15 and 20 % of mother-infant pairs were provided with regimens that met WHO Option A and B/B+ guidelines, respectively. Annually, the gestational age at treatment initiation decreased, while uptake of Option B/B+ increased (all p's < 0.001). Pediatric HIV infection was halved (8.6-4.3 %), yet varied significantly by hospital. In multivariable analyses, HIV-exposed infants who received no PMTCT (AOR 4.6 [2.49, 8.62], p < 0.001), mixed foods (AOR 5.0 [2.77, 9.02], p < 0.001), and care at one of the four hospitals (AOR 3.0 [1.51, 5.92], p = 0.002) were more likely to be HIV-infected. While the administration and uptake of WHO PMTCT guidelines is improving, an expanded focus on retention and medication adherence will further reduce pediatric HIV transmission.
Advocacy, communication, and partnerships: Mobilizing for effective, widespread cervical cancer prevention.
International Journal of Gynaecology and Obstetrics. 2017 Jul; 138 Suppl 1:57-62.Both human papillomavirus (HPV) vaccination and screening/treatment are relatively simple and inexpensive to implement at all resource levels, and cervical cancer screening has been acknowledged as a "best buy" by the WHO. However, coverage with these interventions is low where they are needed most. Failure to launch or expand cervical cancer prevention programs is by and large due to the absence of dedicated funding, along with a lack of recognition of the urgent need to update policies that can hinder access to services. Clear and sustained communication, robust advocacy, and strategic partnerships are needed to inspire national governments and international bodies to action, including identifying and allocating sustainable program resources. There is significant momentum for expanding coverage of HPV vaccination and screening/preventive treatment in low-resource settings as evidenced by new global partnerships espousing this goal, and the participation of groups that previously had not focused on this critical health issue. (c) 2017 The Authors. International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.
Global Health Action. 2015 Sep 18; 8:29034.Background: Health equity is a priority in the post-2015 sustainable development agenda and other major health initiatives. The World Health Organization (WHO) has a history of promoting actions to achieve equity in health, including efforts to encourage the practice of health inequality monitoring. Health inequality monitoring systems use disaggregated data to identify disadvantaged subgroups within populations and inform equity-oriented health policies, programs, and practices. Objective: This paper provides an overview of a number of recent and current WHO initiatives related to health inequality monitoring at the global and/or national level. Design: We outline the scope, content, and intended uses / application of the following: Health Equity Monitor database and theme page; State of inequality: reproductive, maternal, newborn, and child health report; Handbook on health inequality monitoring: with a focus on low- and middle-income countries; Health inequality monitoring eLearning module; Monitoring health inequality: an essential step for achieving health equity advocacy booklet and accompanying video series; and capacity building workshops conducted in WHO Member States and Regions. Conclusions: The paper concludes by considering how the work of the WHO can be expanded upon to promote the establishment of sustainable and robust inequality monitoring systems across a variety of health topics among Member States and at the global level. Copyright: 2015 World Health Organization. Open Access.
Geneva, Switzerland, WHO, 2011.  p.This tool, developed in collaboration between WHO, the Office of the High Commissioner for Human Rights (OHCHR) and the Swedish International Development Cooperation Agency (Sida) is designed to support countries to strengthen national health strategies by applying human rights and gender equality commitments and obligations. The tool poses critical questions to identify gaps and opportunities in the review or reform of health sector strategies.
Strong ministries for strong health systems. An overview of the study report: Supporting Ministerial Health Leadership: A Strategy for Health Systems Strengthening.
[Kampala], Uganda, African Centre for Global Health and Social Transformation [ACHEST], 2010 Jan.  p.This overview is adapted from the report Supporting Ministerial Health Leadership: A Strategy for Health Systems Strengthening by Dr. Francis Omaswa, executive director and founder of The African Center for Global Health and Social Transformation (ACHEST) and Dr. Jo Ivey Boufford, president of The New York Academy of Medicine (NYAM). The study and report were commissioned by the Rockefeller Foundation to explore the feasibility of establishing a support mechanism for ministers and ministries of health especially in the poorest countries, as part of the Foundation’s Transforming Health Systems initiative, The study was initially designed to assess the potential value of three proposed programs to strengthen the leadership capabilities of ministers of health: a global executive leadership program for new ministers; an ongoing, regional, in-person and virtual leadership support program for sitting ministers; and a virtual global resource center for ministers and high level ministerial officials providing real-time access to information. During the course of the study, it became clear that it was essential to expand the inquiry to better understand the challenges and needs of ministries as a whole, as they and their ministers provide the stewardship function for country health systems.The content of the report was derived from six major activities:a comprehensive literature review of the theory and practice of effective leadership development and organizational capacity building, and an environmental scan to identify any existing or planned leadership development programs for ministers of health or any that have occurred in the recent past globally; a survey of the turnover of ministers of health; targeted interviews with ministers, former ministers, and key stakeholders who interact with them, conducted between October 2008 and September 2009, to better understand the roles of ministers and ministries, the challenges they face, resources at their disposal, and their thoughts on what additional resources might enhance their personal effectiveness and that of their ministries; a consultative meeting of experts and stakeholders held in Bellagio, Italy part way through the project; participation of the project leaders (Omaswa and Boufford) in relevant global and regional meetings, as well as individual meetings about the project with critical leaders in international and donor organizations and potential champions of this effort; and a consultation with African regional health leaders to discuss the final report, held in Kampala, Uganda. (Excerpt).
Monitoring and evaluating actions implemented to confront AIDS in Brazil: civil society's participation.
Revista de Saude Publica / Journal of Public Health. 2006 Apr; 40 Suppl:88-93.The United Nations Declaration of Commitment on HIV/AIDS recommends that governments conduct periodic analysis of actions undertaken in confronting the HIV/ AIDS epidemic that involve civil society's participation. Specific instruments and mechanisms should be created towards this end. This paper examines some of the responses of the Brazilian government to this recommendation. Analysis contemplates the Declaration's proposals as to civil society's participation in monitoring and evaluating such actions and their adequacy with respect to Brazilian reality. The limitations and potentials of MONITORAIDS, the matrix of indicators created by Brazil's Programa Nacional de DST/AIDS [National Program for STD/AIDS] to monitor the epidemic are discussed. Results indicate that MONITORAIDS's complexity hampers its use by the conjunction of actors involved in the struggle against AIDS. The establishment of mechanisms that facilitate the appropriation of this system by all those committed to confronting the epidemic in Brazil is suggested. (author's)
New York, New York, UNDP, Bureau for Development Policy, HIV / AIDS Group, 2004. 32 p.HIV/AIDS multi-sectoral strategic planning has been promoted and successfully undertaken in a number of countries. In most cases, the planning process results in the design and completion of national strategic frameworks (NSF) or plans. While such frameworks continue to provide valuable strategic orientation, they have often not served the intended purpose of guiding successful and well-coordinated implementation at national, provincial, regional, district, constituency and community levels. To date, the transformation of strategic frameworks into effective and coordinated action remains a major concern for most governments and their partners. The broad diversity of actors, the numerous sectors involved and the variety of components of the response illustrate the complexity of implementation and coordination. To achieve a strategic multi-sectoral response, it is important to develop a strategic framework and management approach consistent with national policies, priorities and local experiences. (excerpt)
Journal of Family Welfare. 2004; 50 Spec No:26-30.Nearly half a million women are in the child-bearing age and more than 10 million children die each year; most from preventable causes. There is very high clustering of these deaths in just a few countries. The South Asia region contributes almost 50 percent of the total maternal deaths. In this context, child survival and safe motherhood components of the programme has been a direct intervention to reduce infant and child mortality and maternal mortality. The intervention was evidence-based and was supposed to help population stabilization efforts of the government of India, which was another genuine concern of economic planners. Under this programme, Government of India in the early 1990s set a goal of achieving maternal mortality rate of two per 1000 births and infant mortality rate of around 30 by the year 2000. The National Population Policy 2000, The Tenth Five Year Plan (2002-2007) and The National Health Policy 2003 strongly reiterated the government's commitment to achieve the goals to improve the status of human development at the earliest. Such commitments are reflected and highlighted again in the Rural Health Mission approved by the Government of India very recently with additional financial allocation. (excerpt)
The World Health Organization European Health in Prisons project after 10 years: persistent barriers and achievements.
American Journal of Public Health. 2005 Oct; 95(10):1696-1700.The recognition that good prison health is important to general public health has led 28 countries in the European Region of the World Health Organization (WHO) to join a WHO network dedicated to improving health within prisons. Within the 10 years since that time, vital actions have been taken and important policy documents have been produced. A key factor in making progress is breaking down the isolation of prison health services and bringing them into closer collaboration with the country’s public health services. However, barriers to progress remain. A continuing challenge is how best to move from policy recommendations to implementation, so that the network’s fundamental aim of noticeable improvements in the health and care of prisoners is further achieved. (author's)
Geneva, Switzerland, Joint United Nations Programme on HIV/AIDS [UNAIDS], 2002 Aug. 24 p. (UNAIDS/02.45E; WHO/HIV/2002.17)The purpose of the guidelines is to assist National AIDS Programmes (NAPs) and Ministries of Health in implementing second generation HIV surveillance systems through a logical and standardized process. More specifically, the guidelines are primarily addressed to programme managers, epidemiologists, social scientists and other experts working in or with national programmes on surveillance issues. The practical steps and recommendations place particular emphasis on the initial steps involved in the implementation of second generation surveillance systems. They include the following: assessment, consensus, plan and protocol development, implementation and, finally, monitoring and evaluation. (excerpt)
Bulletin of the World Health Organization. 2004 Oct; 82(10):746-749.The rationale for providing antenatal care is to screen predominantly healthy pregnant women to detect early signs of, or risk factors for, abnormal conditions or diseases and to follow this detection with effective and timely intervention. The recommended antenatal care programme in most developing countries is often the same as the programmes used in developed countries. However, in developing countries there is wide variation in the proportion of women who receive antenatal care. The WHO randomized trial of antenatal care and the WHO systematic review indicated that a model of care that provided fewer antenatal visits could be introduced into clinical practice without causing adverse consequences to the woman or the fetus. This new model of antenatal care is being implemented in Thailand. Action has been required at all levels of the health-care systems from consumers through to health professionals, the Ministry of Public Health and international organizations. The Thai experience is a good example of moving research findings into practice, and it should be replicated elsewhere to effectively manage other health problems. (author's)
From Bangkok to Mexico: towards a framework for turning knowledge into action to improve health systems [editorial]
Bulletin of the World Health Organization. 2004 Oct; 82(10):720-721.As a follow-up to the International Conference on Health Research for Development that took place in Bangkok, Thailand, in 2000, WHO convened a Ministerial Summit on Health Research to be held in Mexico City in November 2004, to review progress to date and reflect on emerging opportunities in the global field of health research. In 1990, the Commission on Health Research for Development recommended that all countries should undertake essential national health research; it stipulated that international partnerships are the foundations for progress and that financing for these efforts should be mobilized from both international and national sources. In 1996, WHO'S Ad Hoc Committee on Health Research Relating to Future Intervention Options outlined a five-step priority-setting approach to decide how health research funds should be allocated. It identified "best buys" for the development of products and procedures in several key areas, including childhood infections, malnutrition, microbial threats, noncommunicable diseases and health systems. Overall, progress has been slow and there is much more to be done to deal with major health challenges. (excerpt)
American Journal of Public Health. 2005 Jan; 95(1):8.The term global as applied to human development emerged in the 1960s at the time of the green revolution, when the World Bank advocated the need to “think globally, act locally.” The terms global, international, and intergovernmental have different roots and translate differently in policy; institutional functions; and level of analysis, action, and accountability. They are not mutually exclusive. While the term international has framed much of the work in health across countries over the past decades, the term global has become more politically viable in that it elevates the vision of health to the whole planet, moving beyond geopolitical boundaries and including not only governments but nongovernmental stakeholders and actors. The World Health Organization (WHO), created shortly after World War II as a specialized, intergovernmental agency, is intended to lead and coordinate the health actions of governments worldwide. The work of WHO is facilitated when consensus is reached among countries on global priorities, as was the case for malaria and smallpox eradication in the 1960s, primary health care and immunization in the 1970s, and the Global Program on HIV/AIDS in the 1980s. (excerpt)
Indian Journal of Community Medicine. 2002 Jul-Sep; 27(3): p..Health systems have undergone overlapping generations of reforms in the past 100 years, including the founding of national health care systems and extension of social insurance schemes. Subsequently to realize the goal of "Health for all" the system of primary health care was adopted the world over. The system of primary health care paid too little attention to the people's demand for health care and it concentrated exclusively on the perceived needs. In the past decade or so there has been gradual shift of vision towards what WHO calls the "New Universalism" high quality delivery of essential care, defined mostly by criterion of cost-effectiveness, for everyone, rather than all possible care for the whole population or only the simplest and most basic care for the poor. (excerpt)
The level of effort in the national response to HIV / AIDS: the AIDS Program Effort Index (API), 2003 round.
Washington, D.C., USAID, 2003 Dec.  p.The success of HIV/AIDS programs can be affected by many factors, including political commitment, program effort, socio-cultural context, political systems, economic development, extent and duration of the epidemic , and resources available. Many programs track low-level inputs (e.g., training workshops conducted, condoms distributed) or outcomes (e.g., percentage of acts protected by condom use). Measures of program effort are generally confined to the existence or lack of major program elements (e.g., condom social marketing, counseling and testing). To assist countries in such evaluation efforts, several guides have been developed by the Joint United Nations Program on HIV/AIDS (UNAIDS), the World Health Organization (WHO), the United States Agency for International Development (USAID) and other organizations (see, for example, “Meeting the Behavioural Data Collection Needs of National HIV/AIDS and STD Programmes” and “National AIDS Programs: A Guide to Monitoring and Evaluation of HIV/AIDS Programs”). However, information about the policy environment, level of political support, and other contextual issues affecting the success and failure of national AIDS programs has not been addressed previously. (excerpt)
Geneva, Switzerland, WHO, 2003. xvi, 140 p. (USAID Cooperative Agreement No. HRN-A-00-97-00007-00)This Tool is designed to assist users in assessing the status of infant and young child feeding practices, policies, and programmes in their country. The purpose of such an assessment is to identify strengths and possible weaknesses, with a view to improving the protection, promotion, and support of optimal infant and young child feeding. The Tool is designed to be a flexible instrument. It can be used in its entirety, which is preferred, or in part, and can be employed by a range of users for various purposes. The approach taken may depend on: - the stage of policy and programme development in the country concerned; - the commitment of key decision-makers to undertake the assessment and to use the results; and - the human and financial resources available. The Tool can be used as a companion piece to the Global Strategy for Infant and Young Child Feeding as an assessment tool to help determine where improvements might be needed to meet the Global Strategy targets. Consideration should be given to using the Tool periodically, every several years, to track trends on the various indicators, report on progress, identify areas still needing improvement, and assist in the planning process. (excerpt)
Lancet. 2003 Nov 29; 362(9398):1773.December 1 is the 16th World AIDS Day. The major theme of the past year has been on strengthening the campaign for cheap antiretroviral drugs. This thrust, some critics maintain, has been to the detriment of HIV prevention efforts. Perhaps the most ambitious HIV/AIDS development in the past year has been WHO’s focus on the “3 by 5” target—a commitment to provide antiretroviral drugs to 3 million people in developing countries by the end of 2005. For many the “3 by 5” initiative, if successfully implemented, will bring a longer life. But how useful is this and other antiretroviral-based initiatives to those people with AIDS in the developing world who will die today, tomorrow, or in the very near future? For these people, the stark reality is that it is too late for antiretroviral treatment; what they need, yet rarely receive, is palliative care. (excerpt)
Epidemiology of measles in the central region of Ghana: a five-year case review in three district hospitals.
East African Medical Journal. 2003 Jun; 80(6):312-317.Objective: As part of a national accelerated campaign to eliminate measles, we conducted a study, to define the epidemiology of measles in the Central Region. Design: A descriptive survey was carried out on retrospective cases of measles. Setting: Patients were drawn from the three district hospitals (Assin, Asikuma and Winneba Hospitals) with the highest number of reported cases in the region. Subjects: Records of outpatient and inpatient measles patients attending the selected health facilities between 1996 and 2000. Data on reported measles eases in all health facilities in the three study, districts were also analysed. Main outcome measures: The distribution of measles eases in person (age and sex), time (weekly, or monthly, trends) anti place (residence), the relative frequency, of eases, and the outcome of treatment. Results: There was an overall decline in reported eases of measles between 1996 and 2000 both in absolute terms and relative to other diseases. Females constituted 48%- 52% of the reported 1508 eases in the hospitals. The median age of patients was 36 months. Eleven percent of eases were aged under nine months; 66% under five years and 96% under 15 years. With some minor variations between districts, the highest and lowest transmission occurred in March and September respectively. Within hospitals, there were sporadic outbreaks with up to 34 weekly eases. Conclusion: In Ghana, children aged nine months to 14 years could be appropriately targeted for supplementary, measles immunization campaigns. The best period for the campaigns is during the low transmission months of August to October. Retrospective surveillance can expediently inform decisions about the timing and target age groups for such campaigns. (author's)
East African Medical Journal. 2003 Jun; 80(6 Suppl):S1-S20.Health sector reform is 'a sustained process of fundamental changes in national health policy, institutional arrangements, etc. guided by government and designed to improve the functioning and performance of the health sector and, ultimately, the health status of the population'. All the forty six countries in the African Region of the World Health Organisation have embarked on one form of health sector reform or the other. The contexts and contents of their health reform programmes have varied from one country to another. Health reforms in the region have been influenced largely by the poor performance of the health systems, particularly with regard to the quality of health services. Most countries have taken due congnizance of the deficiencies on their health systems in the design of their health reform programmes and they have made some progress in the implementation of such programmes. Indeed, some countries have adopted sector-wide approaches (SWAps) in developing and implementing their health reform programmes. Since countries are at various stages of implementing their health reform programmes, there is a lot of potential for countries to learn from one another. This paper is a synthesis of the experiences of the countries of the Region in the development and implementation of their health sector reform programmes, it also highlights the future perspectives in this important area. (author's)
In: Population studies (lectures on population education), [compiled by] Sri Venkateswara University. Population Studies Centre. Tirupati, India, Sri Venkateswara University, Population Studies Centre, 1979. 41-50.This paper highlights the importance of health education in population education. Definition of health, as well as, the objectives of health education in the prospects of the WHO is presented in this paper. Furthermore, it focuses on the different aspects of health education, namely: personal hygiene and environmental sanitation; maternal and child health; nutrition education; applied nutrition program; school health education; transmission of diseases and cultural practices; national health programs; age at marriage of women and health; and population explosion and health hazards.
WORLD HEALTH ORGANIZATION TECHNICAL REPORT SERIES. 1994; (845):i-iv, 1-31.This World Health Organization expert committee report presents chapters on new public health action towards health for all; current issues in health information; health information needs at the district level; methods for collecting and processing information; the analysis, presentation, and reporting of health information; facilitating the use of health information; and resources and management support to district health information development. Many countries in recent years have developed national health information systems to supply a range of essential health information for national policy making and health planning. National health systems at the district level are closely involved in data collection and reporting. These systems face the challenges of how to continue supporting district-level managers in implementing primary health care and how to decide what new information will be required at the local level, especially for monitoring the equity, coverage, quality, and efficiency of health interventions, as a country undergoes major health system reforms. Health information systems suffer from a number of well-known problems, with further improvements still required in data collection processes, methods of analysis, use of microcomputers and informatics, and the presentation and communication of health information. These new challenges emphasize the critical need that all countries have for reliable, relevant, timely, and useful health information. Recommendations are made for member states and the World Health Organization.
Eradication of indigenous transmission of wild poliovirus in the Americas. Plan of action, July 1985.
[Washington, D.C.], PAHO, 1985 Jul. 26 p. (EPI-85-102; CD31/7 Annex II)The Pan American Health Organization (PAHO) appointed a Technical Advisory Group (TAG) which met in July 1985 to plan eradication of wild poliovirus in the Americas by 1990 by immunization and surveillance. The strategies to be adopted are mobilization of national resources; vaccine coverage of 80% or more of the target population; surveillance to detect all cases; laboratory diagnosis; information dissemination; identification and funding of research needs; development of a certification protocol; and evaluation of ongoing program activities. The expanded immunization program (EPI) will be organized at the country level by setting up National Work Plans, with inventories of resources and identification of participating agencies and donors, under the guidance of national EPI offices. The TAG will be composed of a core of 5 experts on immunization, with additional consultants as needed, meeting quarterly, semi-annually or annually to review progress and publish recommendations. Regional EPI offices will coordinate eradication activities between the Ministries of Health, the 10-11 epidemiologists/technical advisors in each country and all agencies affiliated with the PAHO. Support personnel will be available at the sub-regional and regional level, including support virologists to assist the laboratory network. Appendices are attached showing estimated costs for regional and regional personnel, vaccines, laboratories, and program activities, predicting that the effort will pay for itself 2.3 times over by 2000.
Clinical management of acute diarrhoea: report of a Scientific Working Group, New Delhi, October 30-November 2, 1978.
[Unpublished] 1979. 21 p.This is a discussion of the clinical management of acute diarrhea, which was covered by a Scientific Working Group at the Southeast Asian Regional meeting of WHO in 1978. Current knowledge on the use of oral rehydration therapy for diarrhea was reviewed at the meeting. The mixture, which works for all age groups and for diarrhea of any etiology, is aimed at restoring normal fluid and electrolyte balances. The chemical means whereby these balances are restored are discussed in detail. There is evidence that the therapy reduces mortality caused by diarrhea to nearly zero and reduces the cost of hospitalization and intravenous therapy. Its great advantage is that it can be administered at home early in the course of the disease. Use of the oral rehydration technique with the complete and the incomplete formulae and by home reconstitution are discussed. Supply has not always kept pace with demand. Other aspects of the clinical management of diarrhea, e.g., with drugs, diet, or intravenous fluids, are covered. Recommendations for future research both on the clinical and the program sides of the issue are proposed. The UNICEF activities connected with national oral rehydration programs are listed.
Epidemiology and control of schistosomiasis: report of a WHO Expert Committee, Geneva, 6-10 November, 1978.
Geneva, Switzerland, WHO, 1980. (WHO Technical Report Series No. 643)The World Health Organization (WHO) Expert Committee on Epidemiology and Control of Schistosomiasis met in Switzerland in November 1978 and dealt with epidemiology (the parasite, the snail intermediate host, human infection), control (review of progress in selected national control programs, control tools and techniques, factors influencing the choice of control methods in schistosomiasis, and evaluation of control), training courses in parasitology and in epidemiology, the feasibility of control, the strategy of control, and control policies in the future. Although reliable and effective schistosomiasis control measures have become available, the most appropriate combinations of these measures still need to be worked out. Both disease control in the human population and transmission control of the biological cycle are essential to the concept of total control of schistosomiasis. Drug treatment will have an increasingly significant role in disease and transmission control, but there is also a need for operational research in order to define the best ways of using the available drugs. The cost of control at this time will make it difficult for the poorer endemic countries to have effective programs within the constraints of their health budgets, meaning that less expensive methods of control are necessary. Programs that have depended exclusively on chemotherapy experienced problems after some years, and it is important to encourage the use of other methods in programs using chemotherapy on a large scale.
Geneva, Switzerland, WHO, 1977. 28 p. (OCP/STAC/77.2)The STAC (Scientific and Technical Advisory Committee) is evaluating the feasibility for economic development in the Volta River Basin. The main obstacle is the danger of onchocerciasis which could lead to blindness. The onchocerciasis control program hopes to reduce the disease to a low enough level that it no longer poses a major health problem or an obstacle to socio-economic development as well as to maintain the disease at a tolerable level. Therefore, studies, plans, and recommendations on insecticides are being made. The program is treating waterways with Abate, a biodegradable larvicide, in addition to undertaking parasitological surveillance. Blackflys are captured and their larvae are analyzed; data is recorded; and tests are conducted to detect any insecticide resistance. The STAC also examined villagers to diagnose human microfilariae in their skin and determine if eye lesions were present. Treatment currently used to combat the disease is either by nodulectomy and/or chemotherapy, but neither is fully effective and mass treatment is difficult. Metrifonate is a promising drug which affects the microfilariae in the cornea without irritating the anterior segment of the eye. Although there are some difficulties in overcoming onchocerciasis, reclamation of the valleys will benefit the population.