Neglected tropical diseases

Despite civil unrest, almost half a million Yemenis treated for onchocerciasis

14 February 2019 | Geneva |Cairo | Sana’a −− Health-care workers in Yemen have defied the odds and distributed medicines to people at risk of onchocerciasis through a large-scale treatment campaign in 33 districts of the country’s eight governorates.1

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The three-day campaign, on 28–31 January 2019, was led by the Yemen Ministry of Public Health and the World Health Organization (WHO), with the support of the Expanded Special Project for Elimination of Neglected Tropical Diseases (ESPEN) and financial assistance from various sources.

We mobilized 970 teams led by 225 team leaders and more than 1935 health workers to assist in the distribution of ivermectin tablets,” said Dr Sami Al-Haidari, Director, National Neglected Tropical Diseases Programme, Yemen. “Preparatory works started in December last year and training workshops were decisive in achieving maximum compliance during the campaign.

Out of a total of 528 420 people targeted in all eight governorates, 474 027 people were reached and treated, achieving 90% treatment coverage.

A total of 1 177 524 ivermectin tablets from the Mectizan Donation Programme were used during the campaign.

Onchocerciasis in Yemen

Unlike in Africa, Yemen has no records of eye complications or blindness due to onchocerciasis.

The disease manifests in a localized form, mainly of the lower legs, as “onchodermatitis” or “reactive onchodermatitis”. Intense itching and skin irritation associated with severe manifestations lead to skin abrasions and other dermal infections.

Onchocerciasis (locally known as “Sowda” or “Sowdah” from the black pigmentation of affected skin) is endemic in 33 districts of the eight governorates of Yemen, posing a risk to a total population of 3 million people.

In Yemen, the prevalence of the disease is confined to the valleys west of the Red Sea, where more than 60% of clinical cases occur in the worst affected areas. During the rainy season (April–September), rapidly flowing water abounds, prompting the breeding of flies and of the blackfly Simulium rasyani, the vector of Onchocerca volvulus.

Prospects for elimination

The national onchocerciasis control programme was launched in 1992 as part of the national leprosy programme, but its approach to onchocerciasis was restructured in 2012 to target all people at risk of carrying microfilariae and susceptible to maintaining transmission even at low levels. Control of the disease has been achieved nationally.

The target now is to achieve elimination as a public health problem in line with the roadmap of the WHO Eastern Mediterranean Region. However, the current political and financial situation, including civil unrest, pose real challenges.

Thanks to the technical support of WHO and the dedicated work of local health workers and volunteers, treatment campaigns targeting everyone at risk are being sustained.

1Saan’a, Hajja, Ibb, Al-Mahweet, Dhamar, Raima, Al-Hodeiedah and Taiz.

Ashok Moloo
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