Research Article: The Contributions of Onchocerciasis Control and Elimination Programs toward the Achievement of the Millennium Development Goals

Date Published: May 21, 2015

Publisher: Public Library of Science

Author(s): Caitlin Dunn, Kelly Callahan, Moses Katabarwa, Frank Richards, Donald Hopkins, P. Craig Withers, Lucas E. Buyon, Deborah McFarland, Archie C. A. Clements.

Abstract: In 2000, 189 member states of the United Nations (UN) developed a plan for peace and development, which resulted in eight actionable goals known as the Millennium Development Goals (MDGs). Since their inception, the MDGs have been considered the international standard for measuring development progress and have provided a blueprint for global health policy and programming. However, emphasis upon the achievement of priority benchmarks around the “big three” diseases—namely HIV, tuberculosis (TB), and malaria—has influenced global health entities to disproportionately allocate resources. Meanwhile, several tropical diseases that almost exclusively impact the poorest of the poor continue to be neglected, despite the existence of cost-effective and feasible methods of control or elimination. One such Neglected Tropical Disease (NTD), onchocerciasis, more commonly known as river blindness, is a debilitating and stigmatizing disease primarily affecting individuals living in remote and impoverished areas. Onchocerciasis control is considered to be one of the most successful and cost-effective public health campaigns ever launched. In addition to improving the health and well-being of millions of individuals, these programs also lead to improvements in education, agricultural production, and economic development in affected communities. Perhaps most pertinent to the global health community, though, is the demonstrated effectiveness of facilitating community engagement by allowing communities considerable ownership with regard to drug delivery. This paper reviews the contributions that such concentrated efforts to control and eliminate onchocerciasis make to achieving select MDGs. The authors hope to draw the attention of public policymakers and global health funders to the importance of the struggle against onchocerciasis as a model for community-directed interventions to advance health and development, and to advocate for NTDs inclusion in the post 2015 agenda.

Partial Text: As the 2015 deadline to achieve the Millennium Development Goals (MDGs) nears, it is timely to assess achievements and consider new priorities now being set for the post-2015 agenda. Although data limitations have led to some concerns over their utility in gauging the equity and sustainability of achievements [1–4], the MDGs are considered to be the international standard for measuring development progress. Moreover, since their inception, the MDGs have guided global health policy and programming, as they illustrate the link between population health and development more broadly [4,5]. This association is nowhere more evident than in the impact of Neglected Tropical Diseases (NTDs) on the world’s poorest populations. As both proxies for and promoters of poverty, NTDs act as an impediment to human development; hence, a concerted effort to control and eliminate these diseases would make an indelible mark on the health and well being of the very poor [6].

To determine the impact onchocerciasis control and elimination programs have on the MDGs, the authors conducted a literature search using Pubmed, Web of Science, and Cab Direct. The terms “onchocerciasis AND river blindness” were searched in combination with the following key words: “MDGs,” “poverty,” “economics,” “malnutrition,” “food insecurity,” “education,” “helminth infections,” “children,” “school attendance,” “women,” “gender,” “gender equity,” “stigma,” “maternal health,” “reproductive health,” “mortality,” “loa loa,” “environment,” “HIV,” “partnerships,” “ivermectin,” “Mectizan Donation Program,” and “community directed.” Abstracts and full articles were reviewed if they addressed any of the MDG goals or targets. The reference sections of key sources were used to identify primary studies and other relevant articles. Additionally, publicly available data from APOC and the Mectizan Donation Program and reports from organizations that manage onchocerciasis programs were reviewed to assess the collective reach of current onchocerciasis partners.

A literature and data review found that reducing the burden of onchocerciasis in highly endemic areas through control and elimination programs contributes to the achievement of several MDGs. This impact is explained in detail below and summarized in Table 1.

The MDGs aim to reduce extreme poverty and ensure equity in fundamental rights [55]. As demonstrated in this paper, onchocerciasis programs support these exact aims. By reducing the prevalence of a stigmatizing and disabling disease, onchocerciasis programs improve the overall health of individuals. In turn, this allows for gains in worker productivity, gender equity, and education, thus stimulating the development of affected communities.



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