Progress and concerns in the World Health Organization onchocerciasis control program in West Africa

Onchocerciasis or river blindness is a filarial disease that leads to skin atrophy, impaired lymphatics, eye lesions and blindness. In hyperendemic zones it produces the highest known community rates of blindness in the world, collapse of settlement and desertion of the valleys. At the request of seven West African Governments, the World Health Organization in 1975 commenced a 20-year larviciding program to control the disease and permit economic rehabilitation of the abandoned lowlands. This has so far met with substantial success but further progress is thwarted by annual invasions of infective flies on the WSW monsoon from source regions beyond the perimeter of the control area. This phenomenon, together with questions of possible insecticide resistance, the survival of non-target life forms, inflation and financial support, polyparasitism, appropriate technology, training and national and international program structures, calls for a reconsideration of purpose and strategy.