Statistical Analysis Of The Reported Cases Of Onchocerciasis (River Blindness) Disease From 2000-2011

Project and Seminar Material for Statistics

Statistical Analysis Of The Reported Cases Of Onchocerciasis (River Blindness) Disease From 2000-2011


Abstract


Onchocerciasis is increasingly recognized as one of the major diseases of public health importance in endemic parts of the world, especially in Sub-Saharan, Africa. (WHO 1995).

The main purpose of this study is to carry out a statistical analysis of the reported cases of onchocerciasis disease, from 2000-2011. A case study of federal Medical Center Abalkaliki,Ebonyi State. This research project looked into the distribution of ochocerciasis patients by sex from 2000-2011, prediction of the possible number of onchocerciasis patients for the years 2012-2014. How a person can get infected. This research work tested whether the rate of occurrence of onchocerciasis is the same among the age groups. It also tested if there is any difference in the number of male and female reported cases.

Among the major findings were:-

  1. Within this 12 years a grand total of 1686 cases were reported out of which 895 are men. This represents 53.08% of the total population while the remaining 791 cases representing 46.93% are female.
  2. Results also showed that the rate of occurrence of the reported cases is not the same among the age groups.
  3. Both; male and female have equal chances of being infected with onchocerciasis.

Chapter One


1.0 Introduction

Onchocercias is increasingly recognized as one of the major diseases of public health importance in endemic parts of the word, especially in sub-Saharan, Africa. West Africa includes the most endemic areas in the world; Nigeria being one of the largest countries in West Africa has been reported to have a high incidence of onchocerciasis infection with 7 million people with the disease and 40 million at risk. Onchocerciasis is the world’s second leading infectious cause of blindness. It is not the nematode, but its endosymbiont, Wolbachia pipientis that causes the severe inflammatory response that leaves many blind. An estimated 18 million people suffer from Onchocerciasis, world wide.

Onchocerciasis is a chronic parasitic infection caused by the filarial nematode, onchocerca volvulus. This disease is transmitted from one individual to another through the bites of black fly simulium damnosum of the family simulidae (Nwoke et al, 1991) normally found near streams and rivers (giving disease its common name River Blindness).Sometimes, the bite transmits parasitic worms into the body. As they spread, they cause terrible itching, muscle pains and weakness. Eventually when the worms reach the adult stage, they attack the eyes leading to permanent blindness. The entire process may take up to 30 years from the first bite.

One can ask, how common is Onchocercasis (River Blindness)? Currently 35 countries around the world are affected by Onchocerciasis. It is an ancient disease of Africa and accordingly, 28 of the affected countries and over 90% of all infected people are in Africa. With the rest occurring in 6 countries in Latin America at in Yemen and the Arabian Peninsula. In some communities in Africa, 50% of the men over age 40 have been blinded by Onchocerciasis. It is found in rural often poor populations living near fast flowing rivers, rapid and other turbulent waters where the black fly vector breeds. While the women draw water from village wells the men often fish and farm near the fast flowing rivers.

Onchocerciasis has become endemic in central and South America as well, affecting 70,000 people in Guatemala and Mexico alone. Other small isolated endemic foci occur in Venezuela, Colombia, and Brazil, Ecuador. The prevalence of infection is nearly zero at birth, since Onchocercasis can but seldom does; undergo intrauterine transmission and increases with age to a high plateau later in life reaching 100% in hyperedemic areas. Similarly, intensity of infection increases with age to a plateau between age 30 and 50 years.

Geographical differences in the disease manifestation may result from variations in;

  1. Different forms of species of the vector with different life cycle and habits.
  2. Different parasite strains with varying pathology and antigenic make up.
  3. The degree of the host(s) susceptibility

1.1 Statement of Problems

The last two decades have seen a re-emergence of river blindness in Nigeria due to increasing poverty and insufficient social amenities in the rural areas. Nigeria is made up of 36 states plus F.C.T, 18 out of this number representing 49 percent of the states are river blindness prone states. They include Abia, Anambra, Benue, Cross-River, Ebonyi, Enugu, Ekiti, Edo, F.C.T, Imo, Kano, Kwara, Niger, Ogun, Osun, Oyo, Taraba and Zamfara. Out of these affected states, Ebonyi State has the highest case in the South-East zone.

The presence of Onchcercal skin lesions is unsightly and has a psychosocial effect on the affected. Onchocerciasis is among the five neglected disease in Nigeria (i.e. Guinea worm, River Blindness, Elephantiasis, Bilharzias and leprosy).

From 1969-1970 several African countries including Nigeria applied for aid from, World Bank, UNDP, WHO and USAID in launching control programs. July 1970 a meeting in Geneva set up an international study mission to collect and access epidemiological economic and other data in preparation for a multinational control program on river-blindness. They found out that about 90% of onchocerciasis cases occur in Africa. Onchocercasis is endemic in 28 African countries including Nigeria.

Of recent Ebonyi state government enacted a program that in every year there must be a workshop in the state in general in which citizens shall be educated particular on the issue of Onchocerciasis as one of its strategies for mass mobilization cause. But then the disease seems to be stubborn and obstinate. The Federal Government in conjunction with the state government and the NGO’s established the primary health care program the disease proved the program null and void. The number of Onchocerciasis cases in Ebonyi state keeps on increasing by the day.

The improvement in the health status of the citizens is a significant co-factor in the poverty reduction efforts. Nevertheless, with all these failure, anxieties of the incessant increase of Onchocerciasis cases in our society today were the bases of this study. This study is also designed to find out the causes, control activities and solutions to eradicate onchocerciasis within the shorted period.


1.2 Aims and Objectives

The general objectives of this research are to carry out a statistical analysis on the reported case of River Blindness (Onchocerciasis from 2000-2011 using).

The specific objectives are to;

  1. Determine the distribution of Onchocerciasis patients by sex and age from 2000-2011.
  2. Determine if there is any difference between the male and female reported cases.
  3. Know if the number of River blindness cases is the same among the age groups.
  4. Predict the possible number of Onchocerciasis patients in the year 2012-2014.
  5. Find out how people can get Onchocerciasis, risk factors, symptoms and control activities.
  6. Make appropriate recommendation based on the findings made.

1.3 Significance of the Study

There is urgency for this type of research to be carried out for the following reasons;

  1. There is a big hope that the information which this study will enumerate will then help the government and NGO’s to know the predictable cases in the nearer future.
  2. It will help to address one of the great challenges of Ebonyi state Ministry of health which is accurate data on Onchocerciasis.
  3. As a statisticians, to help the government far analysis of the present nature and statues of Onchocerciasis in Ebonyi state.
  4. This research will come out with findings on the intervention strategies at present and provide invaluable perspective to the present generation which would serve as a guide to planners and managers in the health sector.
  5. This project will suggest ways to conquer River Blindness projection despite all its construction efforts to get rid of us (Man) before the next generation.

1.4 Research Questions and Hypothesis

Research Question 1:

What is the distribution of Onchocerciasis patients by sex and age from 2000-2011.

Research Question 2:

What is the possible number of Onchocerciasis patients from 2012-2014.


1.5 Statement of Hypothesis

HO: The rate of occurrence of river blindness is the same among the age groups

HA: The rate of occurrence is not the same among the age groups


1.6 Scope of the Study

The study will limit it analysis with Ebonyi state based on the targeted objectives of the River Blindness disease. The data collected for this study may or may not indicates the total number of Onchocerciasis patients but the number of its occurrences within a given locality on a specified period as they have been recorded in the hospitals record.

Coming to the materials like chemicals, apparatus, specimen plus other laboratory agents and catalyst, that are involved in the River blindness test or diagnosis is some how beyond the scope of this research work. Although it is necessary, but is was limited due to the statistical approach. For more information, the bibliography in chapter five of this work highlights you more in the stated field.


1.7 Limitation of the Study

The problems associated with the data collection are as follows

  1. The data was not originally collected and kept for the purpose of this study. This made the researcher to spend a lot of time arranging the data in order to suit his work.
  2. The data was only released on request, after the researcher must have gone through series of interrogations. it was difficult to collect this data due to what the officials termed confidentiality.
  3. The transportation fare associated with the collection of the data cannot be overemphasized, plus the unbearable altitude of the primary users
  4. The reliability of the data is yet another problem associated with the data. However, most onchocerciasis patients at times do not report or complain to the public so that any person who hears it can forward its solution or control techniques. Thus their cases might not be recorded. Secondly ,those who made known their cases to the public sometimes may not get an answer , rather they take their cases to the native doctors, who may not brig an answer to their problems or keep record of such cases
  5. With all these therefore this research is based on reported cases of river blindness in Ebonyi State

1.8 Definition of Terms

Blindness:

The condition of lacking visual perception due to physiological or neurological factors.

Epidemiology:

The scientific study of the spread and control of diseases.


Chapter Five


5.0 Summary Conclusion and Recommendation

This chapter deals with the summary, conclusion and recommendation for the study.


5.1 Summary

The main concern of this study was to carry out a statistical analysis on the reported cases of (onchocerciasis) river blindness. Using Federal Medical Centre Abakaliki from 2000-2011.

To guide the study, two research questions and two hypotheses were established in relation with the stated objective. The population of study comprise of all male and female Onchocerciasis patients as reported in F.M C, Abakaliki aged 0-51+.

From the findings made, it was discovered that a total of 1686 patients of onchocerciasis reported their cases to F.M.C. Abakaliki from 2000-2011. Out of this number 895 were men and 791 were female. From this data it can be seen that onchocerciasis is more in men than female.

It was also seen that those between the ages 0-10 has the lowest reported cases. The disease becomes more as the age group increases.

From the predictions made, if the present rate of mass awareness is maintained or even improved on. The disease onchocerciasis will soon be eliminated.


5.2 Conclusion

Onchocerciasis (river blindness) is a serious public health problem with important social-economic consequences. The presence of onchocercal skin lesions is unsightly and has a psychosocial effect on the affected. It is transmitted by a bite of a certain female simulium (black flies).

The rate of occurrence of onchocerciasis diseases is not the same among the age groups. The cases were seen to be increasing from 2000-2007, but stated going down from 2008-2011. The slope of the trend line also gave a positive. Slope (+2.32)

Thus, the above case was as a result that people have started reporting their cases to the appropriate quarters. There is now awareness among the communities especially the leadership of the communities and the citizen.

Furthermore, the project went on to test whether the number of reported cases is the same among the male and female patients. The test concluded that the male and female reported cases of onchocerciasis are equal.

Onchercerca volvulus were more present among subjects from 30-50 years and above showing long time exposure to bites of the vectors as they are old in their farming profession the main working population is from 30 years and above and the research showed a progressive increase in infection with increase in age. A similar observation was made in Ibarapa L.G.A of Oyo state Nigeria (Akinboye et al 2008).

The main control methods include treatment with the drug invermectin, surgical removal of the worms, and by larvicide spraying in endemic foci. Experts conclude that the disease can be eliminated by controlling the vector and simultaneously killing the microfilaria in humans via invermectin treatment for 14 years, the lifetime of the adult worm in the human body.


5.3 Recommendation

Based on the findings from this research work the following are out for recommendation.

  1. The current public health initiatives need to be strengthened, sustained and expanded to continue being effective.
  2. The government should provide support for a solid and lasting infrastructure, with adequate human resources, in each of the endemic areas. This will ensure that the infected and those at risk of being infected with onchocerciasis are able to avoid the burden of the disease.
  3. There is a need to improve people’s altitude towards the disease and improve disease awareness through appropriate health education. This will encourage the acceptance of invermectin as adequate treatment and compliance to the treatment regimen to reduce morbidity and promote self-esteem.
  4. There is need to improve on the implementation of onchocerciasis control programme in West Africa and in Ebonyi state to prevent continuous spread and disease morbidity related to this infection. This can be done through effective monitoring by the Ebonyi state ministry of Health.
  5. The success of any technical aid programmes especially in health depends on the political will of the recipient government to provide its counterpart funds. The health sub-sector of Ebonyi state should always pay their required counterpart funds in time. With adequate funds the donor agencies would be encouraged to participate very effectively in any well designed programme be it health agriculture, education, etc.
  6. Finally, the researcher wishes to notify the general public that onchocerciasis situation is a challenge to all our health condition. The researcher implores that the above recommendations should be taken care of, so that Ebonyi state and Nigeria in general will be free from this dangerous disease so as to increase our productivity and optimal enjoyment of life.

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