Uganda has successfully freed 821,230 people, the largest number to be freed from river blindness globally based on the latest WHO guidelines. This has expedited the process of achieving its goal of eliminating river blindness (onchocerciasis) nationwide by 2020. At its peak, the vector-transmitted parasitic worm caused eye and skin disease in 37 districts in Uganda, with about 6.7 million people at risk.

Map of Uganda/Alvaro1984 18
Map of Uganda/Alvaro1984 18

The Ninth Uganda Onchocerciasis Elimination Expert Advisory Committee (UOEEAC) to the Ministry of Health that met between 2nd and 4th August 2016, confirmed that four blindness transmission zones (foci) have met the World Health Organization (WHO) criteria for elimination.  These are Mpamba-Nkusi (Kibaale district), Mt. Elgon (Bududa, Manafwa, Mbale and Sironko districts), Itwara (Kabalore and Kyenjojo districts) and Imaramagambo (Bushenyi and Mitooma districts). An estimated 821,230 persons living in these districts are no longer at risk of acquiring the onchocerciasis. These four foci now join the Victoria focus in central Uganda (Kamuli, Kayunga, Jinja, Mayuge and Mukono districts) that achieved elimination in the early 1970s; where the disease once threatened a population of 2,550,043 people.  It is therefore safe to say that an estimated 3,371,273 Ugandans are no longer at risk.

The Committee also recommended that the Obongi-Moyo focus in Moyo district begin a three-year post-treatment surveillance monitoring period to determine if it can also be classified as onchocerciasis free.  It joins three other foci (Kashoya-Kitomi, Wambabya-Rwamarongo and Nyamugasani) that may be declared free of this parasitic scourge in the next few years.

UgandaThere are four foci where interruption of transmission of river blindness is suspected to have been achieved: West Nile focus (Yumbe and Koboko districts); Bwindi focus (Kabale, Kanungu and Kisoro districts); Budongo focus (Buliisa, Hoima and Masindi districts), and Nyagak-Bondo focus (Nebbi, Zombo and Arua districts). However, since these foci are on the border with the Democratic Republic of Congo (DRC), the process for documenting elimination is more complicated since assessments must be coordinated with DRC health officials.  A delegation from DRC attended the UOEEAC meeting and reported a recent and successful cooperative joint assessment by Ugandan and DRC health professionals in the West Nile focus in April 2016.

Transmission of River Blindness continues in only two of Uganda’s original 17 focus areas: the large Madi-Mid North focus (Pader, Lamwo, Kitgum, Gulu, Amuru, Nwoya, Oyam, Lira, Adjumani, and Moyo districts), with a population of 1,362,058; and a much smaller Lhubiriha focus in the Kasese district, with a population of 131,113.  The Madi-Mid North focus shares a border with the Republic of South Sudan.  The Lhubiriha focus is on the DRC border.

This success has been made possible through the effort of the Ministry of Health’s River Blindness Elimination Program with the support of partners including; The Carter Center, World Health Organization/African Program for Onchocerciasis Control, GTZ, Sightsavers, the Lions Clubs International Foundation and the Lions of Uganda, Merck, the Mectizan Donation Program, BASF, and USAID’s ENVISION Project led by RTI International.

Uganda’s accomplishment is evidence that total elimination of River Blindness is possible in Africa.