Home PARASITOLOGY AND ENTOMOLOGY PROJECT TOPICS AND MATERIALS CLINICAL MANIFESTATIONS OF ONCHOCERCIASIS IN SELECTED COMMUNITIES AND ONGOING CONTROL IN ANIOCHA NORTH LOCAL GOVERNMENT AREA OF DELTA STATE

CLINICAL MANIFESTATIONS OF ONCHOCERCIASIS IN SELECTED COMMUNITIES AND ONGOING CONTROL IN ANIOCHA NORTH LOCAL GOVERNMENT AREA OF DELTA STATE

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    ABSTRACT

    A cross-sectional study was carried out in four farming
    communities in Aniocha North Local Government Area of Delta State of
    Nigeria, Idumuogo, Ogodor, Anioma and Ubulubu – between November
    2008 and March 2009.
    The study was carried out to determine the current status of
    Onchocerciasis in the communities, through the study of the clinical
    manifestations of the disease and socio-economic effects on the
    sufferers, and to connect on the ongoing control measures with
    ivermectin in the area.
    A total of 450 subjects were selected for examination for clinical
    manifestation of Onchocerciasis. 140 (31.1%) males, and 104 (23.1%)
    females were found to be infected with one or two clinical
    manifestations. Although infections were found in all age groups, it
    occurred mostly in older groups. Various rates of clinical manifestation
    were recorded thus: leopard skin 106 (24%), Onchocercal nodules 32
    (7.1%), Onchodermatitis 51 (11.3%), itching 50 (11.1%) and impaired
    vision 18 (4.0%) with Idumuogo and Ubulubu, having the highest
    infections rates of 114 (25.3%) and 76 (16.9%) respectively. Males were significantly more infected than females (X2 = 176.4, df = 24, P<0.01).
    From the result of the study, the communities surveyed can be said to be
    hypoendermic for Onchocerciasis with a nodular rate of 32 (7.1%).

    TABLE OF CONTENTS

    Title page – – – – – – – – – – i
    Approval Page – – – – – – – – – ii
    Dedication Page – – – – – – – – – iii
    Acknowledgement – – – – – – – – iv
    List of Figures – – – – – – – – – v
    List of Tables – – – – – – – – – vi
    List of Plates – – – – – – – – – vii
    Table of Contents – – – – – – – – viii
    Abstract – – – – – – – – – – xi

    CHAPTER ONE
    1.0 Introduction – – – – – – – – 1

    CHAPTER TWO
    2.0 Literature Review – – – – – – – 5
    2.1 Epidemiology of Onchocerciasis – – – – – 5
    2.2 Distribution of Onchocerciasis – – – – – 6
    2.3 Clinical Manifestations of Onchocerciasis – – – 7
    2.4 Prevalence of Onchocerciasis in Nigeria – – – – 8
    2.5 Factors influencing the Epidemiology of the Disease – – 11
    2.5.1 Host Factors – – – – – – – – 11
    ix
    2.5.2 The Vector – – – – – – – – – 12
    2.5.3 The Parasite – – – – – – – – 14
    2.5.4 Occupation Factor – – – – – – – 14
    2.5.5 Community Factor – – – – – – – 15
    2.5.6 Cultural Factor – – – – – – – – 15
    2.5.7 Proximity of Population to Breeding Sites – – – 15
    2.6 Nature of the Disease (Clinical/Signs and Symptoms) – 16
    2.7 Diagnosis – – – – – – – – – 19
    2.8 Parameter for measuring Endermicity – – – – 21
    2.9 Socio Economic Importance of Onchocerciasis – – 21
    2.10 Control – – – – – – – – – 24

    CHAPTER THREE
    3.0 Materials and Methods – – – – – – – 28
    3.1 Study Area – – – – – – – – – 28
    3.2 Methodology – – – – – – – – 31
    3.2.1 Ethnical clearance and mobilization – – – – 31
    3.2.2 Subject Examination – – – – – – – 31
    3.2.3 Palpation for presence of Onchocercal nodules – – 32
    3.2.4 Physical Examination of skin for Onchodermatitis,
    Leopard Skin, Handing groin, Scrotal Enlargement
    and Clitoral Enlargement – – – – – – 33
    x
    3.2.5 Visual Equity or Impaired Vision Screening – – – 33
    3.3 Data Analysis – – – – – – – – 33

    CHAPTER 4
    Results – – – – – – – – – – 35

    CHAPTER FIVE
    Discussion – – – – – – – – – – 45
    References – – – – – – – – – 50
    Appendix I – Individual Examination Form – – – – 59
    Appendix II – Chi-Square Test for Significance – – – – 60

    CHAPTER ONE

    INTRODUCTION
    Onchocerciasis, also known as “river blindness” is a disease
    caused by a nematode filarial worm. Onchocerca volvulus, and is
    transmitted through the bites of an infected female blackfly (Similium
    species). The manifestations of onchocerciasis are predominantly
    dermal, lymphatic and ocular in character. Dermal, manifestation include
    pruritis, lesions (papules, macules, urticaria, oedema, excoriatia
    pustules, crusts, scaling ulceration, lichenification, pachydermia,
    Atrophy, pigmentary change leopard skin and others) Nodules, lymphatic
    manifestations are in form of lymphadenopathy, lyphoedema and
    Hanging groin.
    Ocular damages affect the conjunctiva, cornea, lens in form of
    cataract, Retina in form of pigment epithelial atrophy, cotton wool spots
    and Haemorrhages choroid and optic nerves in form of optic neuritis and
    optic atrophy (WHO, 1995).
    Worldwide onchocerciasis is second to trachoma as a leading
    cause of blindness of infectious origin (Thylefors et al 1995). More than
    100 million people worldwide are at risk of infection, 18 million people
    are infected, 800,000 people are visually impaired, 270,000 people are
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    already blind, 3.3 million of the people reside in Nigeria, where it is still
    regarded as a public health problem (WHO, 1995). Blindness which is
    the ultimate consequence of onchocerciasis renders the productive
    segment of the community unproductive, and dependent on others. Also
    most fertile lands have been abandoned because of this disease, (Okolo
    et al, 2004).
    Onchocerciasis in Nigeria is transmitted solely by members of the
    Similium damnosum complex. They are widespread in the savanna
    forest, savanna mosaic and rainforest areas of Nigeria. S. damnosum,
    which breeds in large streams and rivers in the woody and open country
    side, has been known to be common in the rocky sections of the river
    Niger and its tributaries (Eneanya and Nwaorgu, 2001). Maikaje et al
    (2008) also found S. damnosum breeding along River Muvur and Uba, to
    habour infective Onchocerca volvulus microfilarae. In Mubi North and
    Hong Local Government Areas of Adamawa State. Okonkwo et al (1991)
    found
    S. damonsum breeding along the Oji River of Enugu State. Nwoke et al
    (1998) also carried out epidemiological studies of human onchocerciasis
    in rivers of Katsina Ala (tributary of Benue) Anambra and Oji Rivers
    (tributaries of River Niger), the Cross River and Imo River, the costal
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    areas of Rivers, Akwa-Ibom and Cross River States. The exposure of
    those rocks in the beds or side margins of these fast flowing rivers as
    well as numerous trailing vegetation create favourable breeding sites for
    Similium damnosum complex. All these reports indicate that fast flowing
    river, rivulets and streams, favours the breeding of blackfly.
    A Rapid Epidemiological Mapping of Onchocerciasis carried out in
    nine sentinel villages in Edo/Delta (Okhoromi, Ugbokogbe, Oke, Ovao,
    Ekilor, Eko-Ibadan, Idumuogo, Agbor Alidinma and Igbogili) recorded a
    prevalence of 40.4% of microfilaria infection, 18.9% of nodules and 7.7%
    of leopard skin, led to choosing Delta State as an endemic state with
    sufficiently important public health problem to warrant community wide
    ivermectin treatment, where the prevalence of microfilaria is greater than
    40%, (WHO, 1991). Offor et al (1998) trapped blackflies exposed on
    human legs between 0600 hours and 18 hours local time in Okpanam
    (River Awai) and Ogwashuku (River Mgbiligba) of Delta State and
    blackflies were likely forest S. yahense.
    The aim of the present study is to determine the current status of
    onchocerciasis in selected communities in Aniocha North Local
    Government Area of Delta State.

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    The specific objectives include:
    1. To define the prevalence of onchocercal nodules in the
    communities
    2. To define the prevalence of dermatitis in the communities.
    3. To define prevalence of leopard skin in the communities and other
    clinical manifestations in the communities. It is hoped that the
    result will provide useful information on the success of the ongoing
    control programme with ivermectin in these areas.

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