River Blindness: an emerging success story and the Nigerian lady that drove it…


Those that went to medical school in the University of Nigeria in 90s will remember an articulate, passionate and scholarly teacher we had in first year. Her course “Parasitology” was the first brand new, medical topic we would be exposed to. In retrospect we were incredibly lucky to have Dr Uche Amazigo as our teacher. This year, Dr Amazigo retires after steering for five years a programme widely acknowledged as a success story within the international health community – the African Programme for Onchocerciasis Control (APOC).

When my friend Paul Ejime sent me this story from a recent meeting in Abuja, I thought that it would good to start the year with this immensely positive story to remind ourselves of calibre of people we have in senior management positions in the health sector around the world….

River Blindness: Taking control success to focal elimination

By Paul Ejime*

The international health community – health ministers, donors, non-governmental development partners, UN agencies, health experts and the media – converged recently at the Transcorp Hilton, Abuja, the Nigerian capital, united in one purpose – how to rid Africa of the River blindness scourge.

River blindness, a vicious parasitic worm disease transmitted by the bite of black flies causes intense itching, skin disfiguration, vision loss, and blindness. The adverse impact of the disease on Africa, which bears the greatest burden of Neglected Tropical Diseases (NTDs) include reduced agricultural productivity, recycling of poverty and an impediment to development. The urgency in tackling river blindness and other NTDs cannot be over-emphasized with just five years to 2015, the date set by world leaders for the attainment of the Millennium Development Goals (MDGs) including halving extreme poverty worldwide.

In spite of the lingering effects of the global economic crisis, international donors gathered in Abuja did not disappoint. They committed US$31 million to support WHO/APOC’s efforts to control and embark upon focal elimination of river blindness from Africa.  APOC partners are determined to significantly shrink the regional map of river blindness by 2015. Among the new commitments was a first-ever individual donation of US$1 million announced by a Nigerian philanthropist and survivor of river blindness General T.Y. Danjuma.

General Danjuma, a special guest at the meeting and grand patron of local NGDO MITOSATH, which supports Nigerian government in the fight against river blindness and other NTDs, recounted his experience as a young military officer, who battled and survived river blindness.

“I have had a personal experience with this disease and live with relatives and friends who are victims,” he said, and urged the Nigerian government to also contribute more toward eliminating the disease.  More than 120 million people worldwide are at risk of River blindness with about 90 percent or more than 102 million of the at-risk population in Africa. Nigeria accounts for an estimated 30 million of the population at risk scattered in 31 of the country’s 36 states and in the Federal Capital Territory.

In an apparent response to General Danjuma’s plea, Prof Chukwu reiterated Nigeria’s commitment to step up support and contributions toward the elimination of the disease in line with the theme of the Abuja meeting: “Join forces to make River Blindness history.”

The success of the efforts to eliminate of river blindness from Africa is based largely on APOC’s cost-effective and innovative Community-Directed Treatment with Ivermectin (CDTI) strategy. This strategy also known as the Community-Directed Intervention (CDI) is a bottom-up approach to public health care delivery whereby communities play a leading role in the management of their own health.

As the longest running public-private partnership for public health in Africa, some of the major achievements of the WHO Onchocerciasis control programme in the past 15 years include (86% reduction in severe itching, 33% reduction in prevalence of the disease, prevention of more than 500,000 cases of blindness and an estimated Economic Rate of Return of 17% on invested funds).  The programme has also created a network of close to one million trained community-directed drug distributors majority of whom supporting the Ministries of Health in the delivery of other health interventions.

Despite these achievements, more work is required to expand the programme’s reach, conduct needed research and to secure additional funding to facilitate transfer of ownership to countries and to carry control activities through until elimination of the disease as a public health and socio-economic problem in Africa.

There is good news from recent studies showing that for the first time in Africa there is possibility of eliminating transmission of the disease in some foci (in Guinea-Bissau, Mali, Senegal and Kaduna, Nigeria), using existing tools – the CDI. In response to intensified advocacy by WHO/APOC and partners, 34 African universities, medical and nursing schools have undertaken to incorporate the CDI strategy in their curricula.  No doubt this will lead to an exponential increase in the number of health professionals with requisite expertise in CDI and the engagement of communities in public health delivery with trickle down effects for health system and Primary Health Care strengthening, and contributing to the attainment of health-related MDGs by countries.

“We have reached the stage that Africa can get rid of river blindness, and the APOC partnership, with the support pledged by donors and governments in Abuja can make this happen,” said Dr Uche Amazigo, WHO/APOC Director.

It was also a home-coming of sort for the programme’s first female director, Dr Amazigo, who is retiring early next year after steering for five years a programme widely acknowledged as a success story within the international health community. Dr Amazigo was commended for her outstanding dedication, commitment, strong leadership and effective public health management. The JAF16 meeting in Abuja was a crowning of an illustrious career for the Nigerian scientist, former senior lecturer and parasitologist with specialization in tropical diseases and reproductive health. Her research in 1990 formed the basis for the establishment of APOC with headquarters in Burkina Faso, a former epicentre of river blindness in West Africa.  

Many speakers paid glowing tributes to Dr Amazigo as an advocate for the poor and their needs.  At a dinner given in her honour, WHO/APOC donors and partners under the aegis of the Committee of Sponsoring Agencies presented the out-going director with a special bronze statue of African women gathered under a tree, apparently discussing solutions to their myriad problems.

*Ejime is a Communication/Media Consultant to the WHO African Programme for River
  Blindness Control


Never doubt that a small group of thoughtful committed people can change the world; indeed it is the only thing that ever has…Margaret Mead

Chikwe Ihekweazu is an epidemiologist and consultant public health physician. He is the Editor of Nigeria Health Watch, and the Managing Partner of EpiAfric (www.epiafric.com), which provides expertise in public health research and advisory services, health communication and professional development. He previously held leadership roles at the South African National Institute for Communicable Diseases and the UK's Health Protection Agency. Chikwe has undertaken several short term consultancies for the World Health Organisation, mainly in response to major outbreaks. He is a TED Fellow and co-curator of TEDxEuston.

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