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In: Simpson TW, Strickland GT, Mercer MA, ed. New developments in tropical medicine, II. Washington, D.C., National Council for International Health [NCIH], 1983. 111-18.Onchocerciasis, a disease caused by the parasite onchocerca volvulus, is now recognized by the World Health Organization as one of the world's major public health problems. Until recently, few western physicians had heard of the disease and many thought of it as rare and unimportant, characterized by benign "parasite tumors" of the skin. Transmission of the parasite by the vector blackfly is limited by climate and habits of the fly to defined endemic regions in tropical Africa, North Yemen, southern Mexico, Venezuela, Brazil, Columbia, and Ecuador. An estimated 40 million people are infected with the parasite and all but 1 million fo these live in tropical Africa. The economic impact of the disease has been devastating. It can force communities away from adjacent fertile land, which reduces agricultural production. To confirm diagnosis of the disease, either microfilariae or adult worms must be detected and/or recovered from the patient and identified by their specific morphologic features. During the 1970s, a long-range program to control the transmission of O. volvulus was developed and is being implemented by the WHO, supported by the International Bank for Reconstruction and Development and other agencies, known as the Onchocerciasis Control Program (OCP). The program's purpose is to reduce or arrest transmission by killing the vector blackfly. Breeding places along rivers and streams of savanna regions are being systematically sprayed. It is hoped that onchocerciasis will be reduced to a sufficiently low level so that it no longer is a public health problem or an obstacle to socioeconomic development. The adult worm lives an estimated 11-16 years and the gravid females continue to generate millions of microfilariae that live about 2 years. Without a long-term (e.g., 20 year) program, blackflies could reinvade the OCP area from other regions whici would resume the cycle from the reservoir of adults and microfilariae of O.volvulus still harbored by older people in the area.
Global distribution of schistosomiasis: CEGET/WHO Atlas. Distribution Mondiale de la schistosomiase: Atlas CEGET/OMS.
World Health Statistics Quarterly. Rapport Trimestriel de Statistiques Sanitaires Mondiales. 1984; 37(2):186-99.Schistosomiasis, the most prevalent of the water-borne diseases, is endemic in 74 tropical developing countries and infects over 200 million persons in rural and agricultural areas. However, recent advances in diagnostic techniques, new antischistosomal drugs, and accumulated understanding of the epidemiology of the infection offer improved prospects for schistosomiasis control. Morever, adaptation of quantotative parasitologic techniques for the diagnosis of schistosomiasis will make more data available for use in national control programs. The World Health Organization (WHO) has been instrumental in providing reliable reference material on the geographic distribution of schistosomiasis and, on the basis of a survey of Member States, collaborated with Centre d'etudes de geographic tropicale (CEGET), in the development of an Atlas. This volume consists of topographic relief maps that identify the presence of absence of schistosomiasis by village or locality. There are wide variations in the prevalence, intensity of infection, ans species of parasite according to ecologic differences, snail intermediate hosts, and occupational and cultural norms. The Atlas also highlights the relationship of water resource development projects to schistosomiasis endemicity. Attention to such data may lead to the selection of project areas known not to be endemic. More sophisticated geographic analyses based on land form, soil and geologic characteristics, ground water level, and agricultural land use have been used predictively in Japan. The Atlas is expected to serve as a reference point to evaluate the global progress in schistosomiasis control.
[Unpublished] . 27 p. (USAID Contract No. DPE-5927-C-00-5068-00)Health personnel in Niger report that malaria is the leading diagnosis in health facilities (1980-1984), about 380,000 cases/year), but just 19% of the population live within a 5 km radius of a health facility. A 1985 household survey reveals that 31.4% of children had a febrile illness (presumptive malaria) within the last 2 weeks and 22.1% of all child deaths were presumptive malaria related. The Government of Niger began developing a national malaria program in 1985 to reduce malaria-related deaths rather than morbidity reduction, because available data indicated that morbidity reduction was not feasible. There is no standard treatment regimen for presumptive malaria, however. Some studies indicate that an effective dose regimen is 10 mg chloroquine/kg body weight in a single dose. Some health workers use other antimalarial arbitrarily. Lack of uniformity can increase the risk of chloroquine and Fansidar resistant falciparum. Government officials are thinking about having only chloroquine available at first level facilities. It plans to set up national surveillance for chloroquine resistance. Niger has just 1 trained malariologist, indicating a need for training of more staff. To keep government costs to a minimum, it wants to set chloroquine at all points in the distribution network. The program's plan of action also includes chemoprophylaxis for pregnant women, limited vector control in Niamey, and health education stressing reducing breeding sites. A REACH consultant believes that it is possible for the program to reach its coverage targets within 5 years. Obstacles include limited access to health care, unavailable chloroquine in warehouses, and lack of untrained personnel (the main obstacle). The consultant suggests various interventions to help Niger meet its targets, e.g., periodic coverage surveys. The World Bank, WHO, the Belgian Cooperation, and USAID are either providing or planning to provide support to the malaria control programs.