Perception and treatment <strong>of</strong> onchocerciasis29To encourage them to take the drug,emphasis should not be laid on the apparentlyinsidious manifestations <strong>of</strong> the disease but onthe ultimate effect, which is blindness and onthe fatal effect <strong>of</strong> blindness on their futuregenerations.To implement this enlightenmentprogramme, use will be made <strong>of</strong> the alreadyexisting Community Directed Distributors(CDDs) who are selected members <strong>of</strong> theindividual communities, mostly teachers, trainedby World Health Organization (WHO) under theAfrican Programme for Onchocerciasis Control(APOC) for the distribution <strong>of</strong> ivermectin (WHO,1996). These people will work hand in handwith the primary health care units in the variouscommunities. It is recommended that WHO, incollaboration with the Ministry <strong>of</strong> Health andnon-governmental Development Organizations(NGDO) remunerate these CDDs who have,hitherto, been left to be remunerated by theirindividual communities. It was found out duringthe study that most communities do not givethem even transport money to go to theheadquarters and collect drugs. As a result,most <strong>of</strong> them, though willing to work, arefrustrated, and may <strong>of</strong>ten skip the opportunityto continue the service. Cost recovery assuggested by Amazigo et al (1998) and Hopkins(1998) may also be a way <strong>of</strong> helping to sponsorthese CDDs. This involves payment <strong>of</strong> a tokenamount by each treated family.It is also recommended that in additionto the distribution <strong>of</strong> ivermectin and theenlightenment campaign, WHO shouldencourage and sponsor nodulectomy astreatment method for the Onchocerca nodule inthis local government area. The only knownhindrance is the cost <strong>of</strong> removal. When theresearchers sponsored the excision <strong>of</strong> nodules inUkpata community, most infected people werewilling to submit themselves for the exercise(Ubachukwu, 2001).ACKNOWLEDGEMENTSThe author wishes to thank CODESRIA forsponsoring the study and A. O. Anya forsupervising the work. The people <strong>of</strong> Uzo-UwaniLocal Government Area are gratefullyacknowledged for their co-operation. Thereferee is highly appreciated for helpfulsuggestions.REFERENCESAMAZIGO, U. O., EZIGBO, J. C. and EZEASOR,P. O. 1993. Onchocerciasis in Nigeria:The Prevalence among Residents inForest- and Guinea-Savanna VillagesAround the <strong>Anambra</strong> River Area.Journal <strong>of</strong> Communicable Diseases, 25(3): 89-95AMAZIGO, U., NOMA, M., BOATIN, B. A.,ETYA’ALE, D. E., SEKETELI, A andDADZIE, K. Y. 1998: Delivery systemsand cost recovery in Mectizan treatmentfor onchocerciasis. Annals <strong>of</strong> TropicalMedicine and Parasitology 92,Supplementary Number 1, S23-S31.AMAZIGO, U. and OBIKEZE, D. S. 1991. Socio-Cultural Factors Associated withPrevalence and Intensity <strong>of</strong>Onchocerciasis and Onchodermatitisamong Adolescent Girls in Rural Nigeria.World Health Organization, Geneva.CROSSKEY, R. W. 1981. A Review <strong>of</strong> Simuliumdamnosum s. l. and HumanOncochocerciasis in Nigeria with SpecialReference to Geographical Distributionand Development <strong>of</strong> a Nigerian NationalControl Campaign Tropenmedizin undParasitologie 32 (1): 2-16CROSSKEY, R. W. (1990): The Natural History<strong>of</strong> Blackflies. John Wiley and Sons Ltd.,England, 711pp.EBOH, E. C. 1998. Social and EconomicResearch: Principles and Methods.Academic Publications and DevelopmentResources Ltd. Lagos, 206 pp.EDUNGBOLA, L. D. (1982): Prevalence <strong>of</strong>onchocerciasis in Ile-Ire District(Ifelodum), Kwara State, Nigeria.Tropical and Geographical Medicine34:231-239.EDUNGBOLA L.D. and ASAOLU, S. O. (1984):Parasitologic Survey <strong>of</strong> Onchocerciasis(River blindness) in Babana District,Kwara State, Nigeria. American Journal<strong>of</strong> Tropical Medicine and Hygiene33(6): 1147-1154.EDUNGBOLA, L. D., ONI, G.A. and AIYEDUN, B.A. (1983): Babana Parasitic Diseasesproject. 1. The study area and apreliminary assessment <strong>of</strong> onchocercalendemicity based on the prevalence <strong>of</strong>“leopard skin”. Transactions <strong>of</strong> theRoyal Society for Tropical Medicine andHygiene, 77: 303-309.HOPKINS, A. D. (1998): Mectizan deliverysystems and cost recovery in the
UBACHUKWU, Patience Obiageli 30Central African Republic. Annals <strong>of</strong>Tropical Medicine and Parasitology, 92Supp. No. 1: S97-S100.NWOKE, B.E.B. (1990): The Socio-EconomicAspects <strong>of</strong> Human Onchocerciasis inAfrica: Present Appraisal. Journal <strong>of</strong>Hygiene Epidemiology Microbiology andImmunology, 34(1): 37-44.NWOKE, B. E. B. ONWULIRI, C. O. E. andUFOMADU G.O. (1992): Onchocerciasisin Plateau State Nigeria. EcologicalBackground, Local Disease Perceptionand Treatment and Vector ParasiteDynamics. Journal o f HygieneEpidemiologyMicrobiologyImmunology, 36(2): 153-160.UBACHUKWU, P. O. (2001): Studies onEpidemiology and Effects <strong>of</strong> HumanOnchocerciasis on Productivity andSocial Lives o f Rural Communities inUzo-Uwani Local Government Area <strong>of</strong>Enugu State, Nigeria. Ph. D. Thesis,University <strong>of</strong> Nigeria, Nsukka, 268pp.WHO (1995): The Importance <strong>of</strong> OnchocercalSkin Disease. Report <strong>of</strong> a Multi-Country Study by The Pan-African StudyGroup on Onchocercal Skin Disease.TDR/AFR/RP/95.1WHO (1996): Community Directed Treatmentwith Ivermectin. Report <strong>of</strong> a multicountrystudy. TDR/AFR/RP/96.1, 80pp.WHO (1997): The World Health Report 1997.Conquering Suffering. Enrichinghumanity. World Health Organization,Geneva, pp. 89-122.
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