MAIDUGURI, 18 May 2010 (IRIN) - A 15-year river blindness immunization programme in the fertile bread-basket of otherwise-arid Borno State in northeastern Nigeria, now in its 11th year, hangs in the balance for lack of funds.

The disease, also known as onchocerciasis, reduced agricultural activities in the past two decades as farmers fled riverine areas, but this flight abated when aid agencies started the immunization programme. Now, two-thirds of the way through, it could flounder.

With up to 36 percent of inhabitants of southern Borno contracting river blindness, the state has the country's highest prevalence levels, and is considered "hyper-endemic", according to the Health Ministry's National Onchocerciasis Control Programme.

"The flowing waters and good vegetation have endowed the southern part of Borno State with a paradoxical curse because these streams and vegetation which are good for cultivation have become breeding grounds for the black flies responsible for high cases of onchocerciasis in the region," Abubakar Galadima, World Health Organization's African Programme on Onchocerciasis Control (APOC) coordinator in Borno State, told IRIN.

"River blindness has an adverse effect on food security in Borno State in that people in food-producing areas continue to move northwards, leaving behind their fertile land," he added.

At least 30,000 people have deserted their farms and villages to escape the disease over the past 20 years, while some 40,000 have been infected, according to statistics from the state's onchocerciasis control programme.

The many rivers and fast-flowing streams provide an ideal breeding ground for the black fly, according to NGO Helen Keller International (HKI), which has been trying to treat the disease in Borno State for the past 11 years. The fly bites human skin then lays eggs which turn into tiny worms, which can cause discomfort and impaired vision in the sufferer, and ultimately lead to blindness.

Just under half of the population of Borno State farm in riverine areas - mainly planting maize, sorghum, millet, cow peas, tubers and groundnuts.

Prevention and treatment

The best way to prevent and treat river blindness is to take an annual dose of ivermectin, known as `Mectezan' which kills the fly larvae, according to the World Health Organization (WHO). If taken consistently for 15 years, the patient can gain life-time immunity, said HKI parasitologist and programme manager, Peter Aimankhu.

But treatment is expensive, costing US$18 per dose - and Borno is the poorest state in the country, according to the Nigerian Central Bank. Most inhabitants live on under US$1 per day.

HKI has provided free treatment and training for 11 years with help from WHO, the Nippon Foundation and Chevron, as part of its corporate responsibility programme. In 2004 WHO reduced its funding to US$5,700 a year, which it channels through its African Programme on Onchocerciasis Control [APOC].

The government was supposed to provide counterpart funds to run the river blindness programme, but it has not done so, said Borno State's onchocerciasis coordinator Galadima, leaving APOC and HKI worried they will not be able to complete the immunity programme.

HKI funding has been hit by the global recession, says Aimankhu. "Since the recession our donors have turned their attention elsewhere with little consideration for Africa and this affects the volume of funds for intervention projects like the onchocerciasis."

Over 3,000 volunteers trained

So far, HKI has trained 3,100 community volunteers across the state to administer the drugs house-to-house. Each family pays a token fee of just over one US cent. In return for his or her efforts, villagers must tend to the volunteer's crops free-of-charge. Agencies have treated 87 percent of residents in the state's 12 endemic districts over the past 11 years, estimates Galadima - but the exact degree to which prevalence has dropped is unknown as no one can afford to do a study, he said.

In the sleepy village of Yimirshika, 200km south of the state capital Maiduguri, 40 percent of residents had river blindness 17 years ago, but now only a few people show visible signs of the disease, according to village chief Lawan Daniel Malgwi. But there are only enough pills for 4,000 of the 7,500 residents this year, says community volunteer Musa Ilya. Population growth is high here and the treatment estimates have not taken this into account, complains the chief.

HKI is now using funds for its Borno State nutrition programme to fund gaps in its river blindness fight.

APOC's Galadima told IRIN: "Things are not moving the way they were; we have been crippled financially due to lack of state counterpart funding... We sometimes find it hard to fuel our vehicles and go for supervision in the affected communities."

The drug shortage is made worse by community volunteers setting aside some pills to sell to Fulani cattle-herders at "handsome prices", said HKI's Aimankhu. `Mectezan', which is not available in Nigerian drug markets, can be used to de-worm livestock, he explained.

Achieving state-wide immunity requires four more years of treatment. "If the project stops at this stage, the effects will be devastating. It will turn the tide of the success we have achieved which will be quite disastrous," Aimankhu said.