By Henry Rosenbloom
In the serene villages of Nkalo and Maone in Southern Malawi, Sheikh Yusuf – an elder in the community – goes door-to-door delivering medication for river blindness, also known as onchocerciasis. He, like many community directed distributors (CDDs), is a volunteer, offering his time so that his community will have a healthier future.
Since 2016, Sheik Yusuf has been a dedicated CDD in the recurrent mass drug administration (MDA) campaigns. Yusuf and his team hold great influence in their communities, advocating for communal acceptance of the treatments and educating the community on safe practices to avoid the parasite that causes river blindness.
“I don’t want to see anyone suffer from this debilitating disease,” he says, as he continues to administer medication year after year. “We must all do our part to protect our community.”
CDDs like Sheik Yusuf are the beating heart of the effort to eliminate river blindness in Malawi. Carrying little more than measuring sticks (used to determine quantity of the medication), treatment registers to record household treatments, and vital medication, teams like Yusuf’s have played a significant role in the progress the country has made toward elimination.
“CDDs were a focal point of the MDA as they hold a lot of trust within these communities,” says Laston Sitima, a Onchocerciasis Control Program Manager at the Malawi Ministry of Health (MoH).
“In addition, CDDs have the ability to reach areas where health workers are not able to reach. CDDs used a house-to-house method when conducting the MDA to ensure that all eligible household members were treated as opposed to central point distribution where some household members cannot come for the drugs.”
The Malawi Ministry of Health oversees coordination of all activities related to the elimination of river blindness such as training health workers and CDDs, as well as MDA management. Vital drugs are also solicited from pharmaceutical donations, which in turn are distributed by CDDs trained by the MoH during MDAs.
During the most recent campaign, Sheikh Yusuf and his team helped distribute over 1.4 million treatments in 6 districts in southern Malawi. River blindness is endemic in ten out of the 29 districts in Malawi, and END Fund, through the Reaching the Last Mile Fund (RLMF) supported treatment in 6 districts. Through consistent efforts of treatment distribution by both the MoH and CDDs, Malawi is on course to assess the extent of disease interruption in endemic areas. Only ten of the country’s 29 districts remain endemic for river blindness. Of the ten, research is ongoing in two to determine the possibility to end future distribution of treatments. The other eight recently conducted an MDA to deliver treatments to more than 1.7 million people living at risk of the disease.
The community driven effort to eliminate river blindness is only made possible by the volunteer CDDs. Sheikh Yusuf’s legacy is one of compassion, determination, and a belief in the strength of a united and healthy community. With every home he visits, every child he helps, Chiradzulu District takes a step closer to a future free from the shadow of river blindness.
His calm and confident demeanor soothes even the youngest residents. He understands the significance of his mission—to bring life-changing medication to those who need it most.
“The Ministry of Health (MOH) is proud of Malawi’s progress toward elimination of river blindness,” says Laston.
“The strategy to eliminate river blindness as a public health problem is to conduct mass drug administrations of ivermectin for consecutive years, so that a large percentage of the population is treated for the disease and thus reducing the overall prevalence. This work has found success in Malawi due to vigilance of our CDDs. In 2023, the Ministry of Health trained over 17,000 CDDs across 6 endemic districts in southern Malawi.
Though beautiful, the lush team estates at the base of the Grand Mulanje mountain in Malawi are endemic to the black flies that carry river blindness. Photo credit: Kondwani Jere
Through community health workers like Sheikh Yusuf, the country is distributing preventative medication to communities in endemic regions, following the lead of countries like Niger that recently announced elimination of transmission of the disease.
The Reaching the Last Mile Fund (RLMF), one of the END Fund’s four core funds, focused on eliminating river blindness and lymphatic filariasis in seven countries. It expanded in 2023 to support elimination efforts in eleven countries including Malawi after partners pledged more resources in the effort to end this debilitating neglected tropical disease (NTD).