Can Togo meet the 2020 target for elimination of onchocerciasis as a public health problem?

June 6th, 2016

Togo's Mo River.  Fast flowing rivers are good breeding sites for the black flies that spread onchocerciasis.

Togo’s Mo River. Fast flowing rivers are good breeding sites for the black flies that spread onchocerciasis.

About five years ago, the World Health Organization (WHO) laid out an ambitious set of global goals around the elimination or control of 17 neglected tropical diseases (NTD), among them the elimination of onchocerciasis, or river blindness, in selected African countries by 2020.[1] In 2012, the neglected tropical diseases (NTDs) community of pharmaceutical companies, donors, endemic countries and non-governmental organizations (including the US Agency for International Development (USAID) and FHI 360, which respectively fund and manage the END in Africa project), embraced the WHO NTD goals and committed to work toward achieving them.

Today, we have evidence that it is, indeed possible, to stop the local transmission of onchocerciasis in some African countries. In fact, the WHO estimates that with sustained progress, 12 countries in Africa can eliminate this disease by 2020, including Benin, Burundi, Chad, Kenya, Mali, Guinea-Bissau, Guinea, Malawi, Niger, Senegal, Sierra Leone and Togo.[2]

River Blindness in Togo: Then and Now

About 20 years ago, Togo was heavily infected with river blindness, according to baseline data from surveys supported by the WHO’s now-defunct Onchocerciasis Control Program (OCP), which closed in 2002. Those surveys found that millions of people in 32 Togolese districts, spread across 5 of the country’s 8 regions, were suffering from or at risk for onchocerciasis.

After over 16 years of mass drug administration (MDA) with ivermectin, the drug of choice for preventing and treating river blindness, there are indications that 5 of those districts, all in Togo’s Maritime region, can now move toward stopping MDA.[3] Nevertheless, the other 4 affected regions still need a few more years of MDA before the onchocerciasis situation is expected to drop to a level that permits them to stop treatment.

Steps and Challenges on the Path to Disease Elimination

Leaders of a community in Togo meet with END in Africa staff on onchocercaisis prevention.

Leaders of a community in Togo meet with END in Africa staff on onchocercaisis prevention.

In response to recommendations from the END in Africa project, which were based on a review of Togo’s National Onchocerciasis Control Program (NOCP) that the country had requested, Togo developed a 5-year onchocerciasis elimination plan (2015-2019) and created a technical committee for onchocerciasis elimination. Comprised of national and international epidemiologists, entomologists, and other experts from organizations such as WHO, FHI360, Sightsavers, and Health and Development International (HDI), this committee, which met for the first time in April 2016, will help Togo’s NTD program to review the country’s onchocerciasis data and make decisions on where and when to stop MDA. It will also help the country to adhere to the WHO’s new guidelines, released in early 2016, for stopping onchocerciasis MDA and confirming disease elimination.

Although Togo has made significant progress toward ending onchocerciasis, END in Africa’s 2013 review of the NOCP identified several challenges that still stand in the way of disease elimination. Among these are: ensuring proper MDA implementation, addressing cross border issues, motivating community drug distributors and other key actors in the elimination program, and securing adequate funding for the NOCP.

So, while Togo’s NOCP can still meet its target of eliminating onchocerciasis as a public health problem by 2020, it will need a lot of financial and technical support from NTD partners to address the above challenges. Especially those relating to MDA implementation in the 4 regions that still harbor the disease, as well as conducting evaluations to determine when it’s safe to stop MDA.

 

[1] World Health Organization. 2012. World Health Organization’s 2020 Roadmap on NTDs. Geneva: World Health Organization. Available at http://www.who.int/neglected_diseases/NTD_RoadMap_2012_Fullversion.pdf

[2] World Health Organization. 2016. “WHO revises onchocerciasis guidelines as countries approach elimination target.” Available at: http://www.who.int/neglected_diseases/news/WHO_revises_guidelines_for_river_blindness/en/

[3] Togo’s NTD Program is currently arranging to conduct evaluations to determine whether it is safe to stop MDA in the Maritime region.

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