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;
a.  Different forms of species of the vector with different life cycle and habits.
b.  Different parasite strains with varying pathology and antigenic make up.
c.   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.