River blindness leaves scars amid successes

“I started getting treatment in 1996. My health was not okay. When they started treating me, the condition improved but I lost my eyesight because of filarial. One eye is completely blind but the other side is seeing partially –it has blurred vision,” he narrates 47 years later.

Before the year 1990, Dr Stephen Kalyegira, the district health officer (DHO) of Kabarole, says there was no clear plan for addressing the disease and so sufferers couldn’t get treatment.

The disease, Kentama, now 85 years old said, caused a lot of itchiness and the aggressive scratching left him with “scars that are still visible to date.” “The itchiness disappeared after treatment but the scars remained. My wife also got the disease and she was treated,” he adds. 

Mr Clouds Philbert, a senior vector control officer in Kabarole District, says they gave Kentama 20 rounds of treatment. “That is 20 years of treatment because we were giving the medicine once a year.

This was given to the whole community, we don’t segregate,” he says. 

Dr Kalyegira says in the Itwala focus, which consists of Kabarole and Kyenjojo districts, more than 100,000 people were suffering from the disease in the 1990s but the disease was eliminated in the area in 2016. 

Symptoms
Dr Edrida Muheki, the country representative of the Carter Center, a non-governmental organisation that works with the Health ministry in fighting river blindness, says the disease has many symptoms, key among them is “going blind.”

“But this happens much later in life. But the first symptom is itching skin because the worms live underneath the skin, so they cause some reaction that makes the person feel uneasy and start itching,” she explains.

Dr Muheki also says because of the itching, people feel so uncomfortable that scratching with their hands is ineffective.

“Another sign is fatigue –feeling very tired. A person can harbour this disease for even 30 years, so when it becomes too much and those worms enter the eyes, it eventually leads to blindness,” he says.

The DHO says the districts share River Sogahi, which is the breeding area for black flies, the insect that transmits the filarial worm –the cause of river blindness (Onchocerciasis).

“In the life cycle of the black fly, a crab is very important. The black fly lays its eggs on this crab. The crab inhabits fast-flowing rivers, which in this case is Sogahi,” Dr Kalyegira explains.

The microfilaria are the young ones of the adult filarial worm that the black fly injects into the body after biting a person. The worm inhabits the body.

In the early 1990s, people in the tea plantations were failing to work because of the bites of the black flies.

“The then district administrators contacted a German organisation called GTZ. GTZ team to come and see what was causing the disease –that was in 1991. They [the team from GTZ] did a preliminary survey along with the Tropical School of Medicine in the United Kingdom,” the DHO says.

Elimination efforts
He adds: “The school seconded two professors who came here to do the study. With that support from GTZ and Carter Center [of the United States] later, we note that a lot of milestones have been made. The districts had training of village health teams in order to identify who is affected, dosing, looking at the river lines in order to kill the crabs.”

Dr Muheki says: “This intervention of community treatment using ivermectin [to kill the worms in the human body] was scaled up and was also coupled with river dosing. River dosing is an intervention where a safe chemical is applied in the river where the black flies which transmit river blindness breed. And with that over years, the transmission of the disease was eliminated in this focus in 2016.”

Other affected areas
In Uganda, there are many other areas that had the disease, some of them have also been eliminated like this Itwala focus but some of them have not yet eliminated the disease.

“That means the whole country cannot be certified or verified by the World Health Organisation (WHO) to have eliminated river blindness as a country. That is why this area has to continue monitoring to ensure that the disease does not come back until we are verified by WHO that we have eliminated the disease,” Dr Muheki says.

She says Uganda has made great strides in the elimination of the disease using a similar intervention of mass administration of drugs to affected populations and river dosing. 

Dr Jane Ruth Aceng, the health minister, says they are cooperating with neighbouring countries (DR Congo and South Sudan) to stop the cross-border spread so as to eliminate the disease in the country.

Background
Initially endemic in 39 districts, river blindness, a Neglected Tropical Diseases, affected 3 million people and 7.2 million people were at risk of infection, according to Mr David Oguttu, the programme manager for river blindness elimination at the Health ministry.