CHAPTER ONE

INTRODUCTION

1.0 BACKGROUND OF THE STUDY 

 Onchocerciasis is an infection caused by the Onchocerca volvulus worm which is spread to humans through the bite of an infected blackfly. It is a leading cause of blindness in some countries and is believed to infect over 17 million people worldwide (World Health Organization, 2008). Infection can cause dermatitis with severe itching, eye disease including blindness, and the formation of nodules in the skin.

 In recent decades, Onchocerciasis has struck 18 million people worldwide, and accounts for nearly a tenth of all cases of blindness (World Health Organization, 2008). The vast majority of cases of river blindness are in Sub-Sahara Africa, where nearly

30 countries have been affected (World Health Organization, 2008). Onchocerciasis is a major public health problem in many parts of the world. All reported cases result from emigration of individuals from endemic areas. (Crosskey,  1998)

            The presence of Onchocerciasis has been reported in Africa.

These observations were confirmed in 1917 and 1920 by  researchers. Then in 1995 an estimated 270,000 people were blind and another 500,000 had severe visual impairment as a result of the disease (World Health Organization, 2007). The disease is found in east central and West Africa. In West Africa

regions     where     the     disease     has     reached     hyperendemic

proportions, over 100,000 persons were blind or had their eye sight seriously impared (World Health Organization, 2006). In Nigeria alone over 50% of identified hospital cases of filarial infection were cases of Onchocerciasis is endemic in Oji River Local Government Area. 

 In Achi, a town in Oji River Local Government Area of Enugu state, 68% prevalence rate with a density of 24.9% microfilaria per mg of skin was reported (Nwoke, 1990).

 This study emphasizes the implications of Onchocerciasis on the health conditions and socio-economic life in Oji River Local Government Area of Enugu State.  

1.1 Statement of Problem

 The high incidence of serious visual impairment and blindness, skin rashes, lesions and intense itching and  depigmentation of the skin of many inhabitants of Oji River L.G.A attracted the  interest of the researcher. In Oji Local Government

Area of Enugu State, there is a high incidence of serious visual impairment and blindness. In severe cases the patients are infected with Onchocerca volvolus which manifest under skin as nodules (Ochocercoma) hanging and enlarged groins. This condition has affected most of the indigenes, particularly farmers, who have to abandon their fertile farmlands due to severe illness or visual impairment, which in very extreme cases lead to blindness. The socio-economic fabric of the area is affected as many of the inhabitants, including youths, and adults, resort to begging.

 In Oji River, onchocerciasis can be considered as an occupational disease. Most of the risk areas are Achi and Ugwuoba who are exposed to the bites of black flies while going about their daily chores where black flies breed, or are common. The occupational group includes farmers, fishermen, cattle herdsmen or people who live near rivers, which are the breeding sites. The majority are aware of the disease which they recognized once their  body starts itching or muscular skeletal pains develops, while some attributed chronic itching, nodules, bad  vision and leopard skin to blakfly bite. In the southern part of Nigeria, ochocerciasis occurs in areas where savannah and forest regions merge. Therefore, in view of these, the researcher decided to embark on this study. The implications of onchocerciasis on the health conditions and socio-economic activities in Oji River L.G.A of Enugu State, Nigeria.

1.2 Research Questions

1.          What percentage of the population are affected by  

onchocerciasis? 

2.          What is the impact of the incidence of onchocerciasis on the health of the inhabitants? 

3.          What is the relationship between the incidence of

onchocerciasis and sex, age, and education? 

4.          How does the incidence of onchocerciasis affect the income level of household? 

5.          How does the incidence of onchocerciasis related to the type of occupation in the study area? 

1.3 Aims and Objectives

 The aim of the study is to investigate the implications of onchocerciasis on the Health conditions and Socio-economic activities in Oji River L.G.A of Enugu State. In doing this, the following form the objectives of the study which are to: 

1.          determine the percentage of the inhabitants affected by incidence of the onchocerciasis in the study area.

2.          determine the health impact of the incidence of

onchocerciasis in the two communities of the study area. 

3.          determine the relationship between income, occupation,  education and the infected population.

4.          identify how the incidence of onchocerciasis affect the income levels (earnings) of people in Oji River L.G.A.

5.          establish the relation to type of occupation of the

inhabitants. 

1.4 Research Hypotheses 

The study tested the following hypotheses 

1.           Ho: There is no significant difference in the incidence of           onchocerciasis infection between Achi and Ugwuoba.    

2.           Ho: The incidence of onchocerciasis is not related to (1)  Gender (2) Age (3) Level of education (4) Income levels of   household and occupation.

1.5 Conceptual Framework 

                               This work is based on the concept of sustainable

livelihoods. In the 80s and 90s the concept of “sustainability” found their way into all discussions concerning the present and future exploitation of our resource, economic development in general and many other topics. As Wolf (1995) said that the word “sustainability” does not mean very much and its meaning is very vague and uncertain until it is attached to an object. As such sustainability is defined in different ways depending on the origin, point of view etc of the person using the concept. The concept begins to take shape only when it is used in connection with an object or something concrete. He therefore argues that the first thing to do is to establish in what area or for what object sustainability is to be achieved. This is because the concept is used increasingly in conjunction with a specific object, e.g. sustainable resource use, sustainable agriculture, sustainable growth rates or sustainable development among others etc.

 Kuhmen (1992) argues that sustainability means fundamental survival, keeping the community alive. To achieve this, the main requirement is sufficient food through agriculture with the help of increased means of production and greater efficiency in production. Attempts are made to meet the demand e.g. O.F.N, Green Revolution etc. in Nigeria. Conservation of the productive basis is seldom or at best considered second. He then argues that sustainability means ecologically acceptable production whereby everything removed is then replaced so as not to harm the ecological system. 

 The implication of this is that both the life of man and the resources he depend on must be adequately sustained. This means sustainable livelihood. 

 For the large number of people resident in the developing world, their basic needs. In terms of both development and conservation are immediate and local.  Survival in the short term is their primary concern and for this they depend largely on the resources of the surrounding area. For approximately 65 percent of the people living in the developing world, these needs are rural based (United Nations Development Programme, 1993). Providing sustainable rural livelihoods, not just for the present population but for many billions more, is therefore an urgent need, as the populations will have to be supported by what is often a very fragile and difficult environment. For adequate and decent livelihoods that are sustainable, much depends on policies which affect agriculture (Chambers et al., 1989). Within rural areas agriculture plays roles in securing livelihoods at the household level. As Rigg (1997) has suggested, there is more to rural life than agriculture. Farming is only one option for securing basic needs for food and cash in rural areas. 

 The people of Oji River Local Government Area is faced with the problem of the blackfly. The blackfly is causing them the disease  known as onchocerciasis.

Onchocerciasis is an eye and skin disease causing skin rashes, swelling, inflammation, lesions and intense itching. The skin wastes away and loses its elasticity giving the appearance early ageing (Vagima, 2008). People with onchocerciasis have several  hundred nodules on their skin. They cause discomfort that are usually painful. Effect of onchocerciasis  include the inability of young children to grow and yet  they look old. Affected  individuals look ugly and miserable, sickly and always suffer from  repeated chest infection (Reyment, 2001). He opined that onchocerciasis is an important factor for eplilepsy and dwarfism  in certain areas. According to Ubachukwu (2006), onchocerciasis is usually a serous threat to public health. He noted that mortality among the blind may be four times as high as among on-blind persons of the same age in the same community. As a result of debilitation and blindness, the infected person is unable to maintain any type of productive activity males sterility can be caused by an invasion of reproductive organs of microfilariae. Onchocerciasis disability impacts subsistence farming communities causing them to switch to less productive, but lessintensive, crop and livestock activities. The incidence of acute onchocerciasis reaches its peak during the rainy season, the time of peak agricultural cultivation thus compounding productivity loss. Women with onchocerciasis are unable to participate in market trading the major form of economic activity available to women. Onchocerciasis is one of the reasons for desertion. This has far-reaching effects on the agricultural production and economy of the people by forcing them to desert rich fertile and production lands in favour of upland, watershed areas,

consequently resulting in overpopulation of less productive areas, with the attendant over cropping. The pattern of village aboundment in Oji River correlates strongly with the geographic pattern of onchocerciasis and blindness. These call for a need for sustainable management. It is to this effect that this work is based on the concept of livelihood. 

1.6 Significance of the Study 

 This study is both theoretically and practically significant. On the practical aspect, it will go a long way in guiding all stakeholders, particularly the joint planning committee and the community members. It will help to promote the adoption of sage hygienic practices within the communities in order to limit the occurrence and effect of insect vector and to assist in empowering the communities for behaviour changes through participatory approaches and also analyzing the health need of the population. 

On the theoretical level, the researcher makes a significant contribution to the existing knowledge which include, (NGOS,

WHO/APOC, Joint monitoring programmes and community members for the control) and preventions of the insect vector causing the disease in the area and for the promotion of environmental hygiene and health.

1.7 Limitations of the Study

1.          Inferences were drawn using only the sample size.

2.          The study lasted for only four months. There is need to  extend this type of research for at least one year to get full  effect of the disease on the people.

3.          The inferences drawn in this work were based only on questionnaire. Medical and laboratory analyses were not included. 

1.8 Scope of the Study 

 This study is limited to two communities in Oji River Local Government Area in Enugu State. They are Achi and Ugwuoba. It is strictly aimed at investigating the implications of onchocerciasis on the health conditions and socio-economic activities in Oji River L.G.A of Enugu State, the impact of onchocerciasis on health, social, income, to investigate the incidence of onchocerciasis infection in relation to gender, age, level of education, income of households and occupation types. The methodology adopted in collecting data include research questionnaire, field observation and oral interviews with selected households heads. The time frame for the work is four months (it is horizontal). 

1.9 Study area 

1.9.1  Location 

 The study area is located at the Oji River Local Government Area (L.G.A). It is located that about longitude  60⁰E and latitude 60⁰W bounded by the River Mamu which forms the boundary between Enugu State and Anambra State to the west. It is bounded by Udi and Awgu areas. (Fig 1)

1.9.2Physical Characteristics 

1.9.3 Climate 

 The study area falls within the humid tropical rainforest belt of southeastern Nigeria. It has two seasons: the rainy season and dry season. The rainy season which is characterized by heavy thunderstorms lasts from April to October. The dry season lasts from November to March, and is characterized by chilly harmattan. The rainy season is marked by double maxima of rainfall.  The first peak occurs in July and the second in September. The mean annual rainfall is about 2000mm. In 3 months. The heavy rainfall and storm result in flooding. The turbulent run-off results in leaching, sheet erosion and eventually to gully erosion (Ogbukagu, 1984).

 During the dry season, humidity is low and clouds are absent. Temperature is high during the day and low during the night. This causes high evapotranspiration rate, which contributes minimally to the lowering of water table. Harmattan occurs between the months of November and February. During its prevalence, visibility is poor mostly at nights and early in the morning. This is as a result of suspended dust particle in the atmosphere. There is noticeable drop in rainfall during the month of August. This is popularly known as “August break”. It is caused mainly by deflection of the moisture laden westerly trade wind by the cold canary current. However, due to changes in weather, the August break sometimes occurs in July or early September. 

 The climatic conditions of this area which are characterized by heavy rainfall, high temperature, strong wind and relative humidity, all combine to bring about physio-chemical weathering (Egoboka, 1983). From all indication it is climate of this area that favour the breeding of blackflies that cause onchocerciasis. 

1.9.4 Vegetation 

Removal of natural vegetation cover from a forest area during construction work can lower the infiltration capacity to a point where rain intensity becomes higher.  In Oji River Area, most of the vegetation have been replaced by buildings, roads, and compounds with bare and paved surfaces due to urbanization there by thereby making the infiltration capacity to be decrease. The high annual mean temperature and high relative humidity favours luxuriant plant re-growth, which ideally produce climax vegetation of the rainforest zone and the vegetation is guinea. These favour the breeding of black flies that cause the onchocerciasis.

1.9.5 Geology 

 The study area falls within the Anambra Basin of southeastern Nigeria. The sediments found in the basin are mainly sandstone, shale, mudstone siltstone and sometimes limestone sequences.

 In the study area, the sediments cut across two geologic ages and periods, from upper Maestritehtian to Palacocene. 

 Three geological formation outcrop in the study area. They are Ajali Sandstone, Nsukka Formation and Imo Shale. Ajali

Sandstone and Nsukka Formations are of upper Cretaceous (Reyment, 1980) while the Imo Shale Formation is Tertiary.

Ajali sandstone covers the entire Achi town. It is well exposed around Ozom River near Oji River police station. The formation is poorly sorted, friable, massive, cross-bedded and white in colour. 

Nsukka Formation lies on top of Ajali Sandstone and covers a considerable extent in the study area. The places covered by Nsukka formation are Oji River urban, Inyi, Awlaw and part of

Akpugoeze. A good exposure of the formation was observed in Obune-Inyi. The outcrop in this place is almost entirely sandstone. Siltstone is also present, outcrop of coal exists in places where the sandstone has been removed by erosion, especially in the stream valleys. The sandstone is massive medium to very coarse grained, pebby, gravely and indurate. The upper part of the sandstone has been affected. By weathering and erosion, it is brown to rustic brown and sometimes reddish colour which shows ferruginization (Egboka, 1983) 

 Imo shale (Palaeocene) is the youngest of the formation and lies conformably on top of Nsukka formation. It covers the entire southern part of the study area. The towns within the area are

Ugwuoba, Obinofia Ndiuno, Ndikelionwu, Ufuma and part of Akpugoeze. The formation has shale and sandstone (Ebenebe sandstone) units. The shale number is laminated, friable dark and grey in colour with the Ebenebe sandstone lying on top of the shale units. The top of the sandstone has been greatly weathered and ferruginized. It is loose unconsolidated and massive. It is unsorted fine to coarse-grained sandstone. The colour is light brown, dull and sometime dirty white. The study area is endowed with a number of resources of economic importance. These resources are coal deposit, hydrocarbon, clay deposit, sandstone deposit and forest vegetable. Some of the resources are exploited locally by the villagers. The study area is mostly rocky bedded with rapid and falls supporting breeding of

Simulium damnosum. 

1.9.6 Topography 

                        The topography of the study area emanates from the

undulating area of Udi Hills and falling to the west to join the lower Anambra system near it’s junction with the Niger (Egboka and Orajiaka, 1988).

The study area is generally marketed by low lands. The highest elevation above mean sea level in the area measure 1000ft (above 300m) and it is located at Nachi. The prominent features in the area are the Enugu Escarpment and the Ebenebe Sandstone Ridge. The Ebenebe Sandstone which trends NW-SE passes through Ugwuoba in the study area (Egboka and Orajiaka, 1988). Erosion is active in the area, and this has combined to modify the landscape. Gully erosion is common in the area covered by Ajali Sandstone and Ebenebe sandstone. And this has continuous effect on residential and agricultural land. The evolution of the entire landscape in the study area corresponds with two geologic cycles, namely, the transgression in the Turonian stage (upper Cretaceous) and the transgression in the early stage of the Tertiary. The topography of the study area supports breeding of simulium damnosum. (Simpson, 2006). Oji River is located on a depressed   environment. A critical study of the topographical map of Oji River shows that due to blocked absence of drainage and soil type, the flood water accumulates. This favours the breeding of black flies that causes

onchocerciasis.

1.9.7        Drainage 

 Oji River Local Government Area has poor drainage system. The study area has aboundant surface water and groundwater resources. Several rivers, streams and springs served the inhabitants all their needs.  Almost the whole place in the study area are characterized by effluent seepages originating at sandstone and shale boundaries and where the water table is exposed by erosion. In the rainy season infiltration, and run-off are high, water table is shallower. As a result, there are quite a number of seepages during the wet season and most of the driedup channels now contain water thus increasing the water supply in the area. The surface water divide coincides with the AwkaOrlu upland which falls steeply eastward into the Mamu plains.  Groundwater divide exists in the study area. This feature is responsible for most of the numerous seepages running out from road units and erosional features in the area under study. Achi area is covered by a thick body of highly porous, friable and unconsolidated Ajali sandstone. Because of the character of the formation, infilteration and perculation are very high with the result that only very few surface water exist. Poor drainage favour the breeding of black flies that cause the onchocerciasis.

1.9.8       Human Characteristics 

1.9.9         Population and Health 

 The population of the study area is 136, 587, which was estimated in 2007 census counting, total number of female is 80,000, which was estimated in the national population census in 2007. Total number of male is 56, 587 (National population Commission, 2007).  They have poor health condition. There is no pipe borne water. Some of the households have no latrine.  There is absence of storm sewers and as such, the road surface serves as a means of run off consequence. In the few places where the drains are in existence, they are open and are being used for refuse disposal.  At other places they are poorly managed. They wash and dump their refuse everywhere. These favour the breeding  of black flies that cause the onchocerciasis.

1.10 Occupation 

 The inhabitants of Oji River Local Government Area environs are mainly farmers, which is the major traditional occupation in the area. The typical agricultural produce includes:  cassava, yam, maize, vegetables, mangoes, oranges, plantain, palm oil and ground nuts. Farming as an occupation plays a predominat role in the exposure of people to the infection of the disease. Farmers were said to have experienced the vector bite during farming time.

1.11   Settlement Patterns 

 It is not well planned as people put up their buildings indiscriminately. Urban floods results when towns and cities are planned without due consideration to the hydrology and topography of the area. The cause of flooding is as a result of thoughtlessness and carelessness of the contractors to erect building on flood courses. These favour the breeding of black flies that cause the onchocerciasis.