Uche Amazigo receives major recognition

Tributes on making the elimination of onchocerciasis
(river blindness) possible

TDR news item
20 February 2013

Uche Amazigo
Provided courtesy of Uche Amazigo

Dr Uche Amazigo, the former Director of the African Programme for Onchocerciasis Control (APOC) recently received the 2012 Prince Mahidol Award in Public Health. She is also scheduled to receive an honorary Doctor of Science (honoris causa) degree from the University of Kwazulu-Natal in South Africa on 17 April. The awards recognize major contributions to global public health from this Nigerian who made an impact far beyond her roots.

Dr Amazigo began her career with pioneering research on the social consequences of onchocerciasis (river blindness) for adolescent girls and women. Her early work, which was supported by TDR, identified the impact of severe skin disfigurement and itching from river blindness.

When the Mahidol prize was given to Dr Amazigo earlier this year, she talked about a chance encounter with a 19 year-old pregnant girl, Agnes, which became a turning point for her. Agnes helped her see the desperation and horrors of unrelenting itching from the severe skin lesions of onchocerciasis that she and so many others endure. TDR produced a documentary of Dr Amazigo’s research project, which included Agnes’ story, and this film was shown at WHO’s World Health Assembly. It was this exposure to how Agnes had to cope with the disease on a daily basis which helped create the broad commitments to control, and now eliminate, the disease.

Dr Amazigo is a long-time collaborator with TDR, receiving her first fellowship in 1978. She was first brought to notice by former director Adetokunbo Lucas, and was later invited to become a member of a TDR task force by another former director, Tore Godal, who became a mentor to her. “TDR transformed my life into something more than I could have imagined,” she said from her home in Enugu, Nigeria.

Dr Amazigo went on to help set up APOC, which was created to mass distribute an annual drug treatment, eventually becoming its director. While there, she worked with TDR on research to improve the distribution of ivermectin, the drug to manage the disease. As a scientist at APOC and later Chief of Sustainable Drug Distribution Unit, she was instrumental in the scaling up of the community-directed treatment approach in countries. This system is now a model of community-based care that in 2011 alone provided treatment to 98 million people in 24 sub Saharan African countries. The simple concept, which was radical in the 1990s when it began, was to ask communities if they wanted to join in an intervention with ivermectin to control onchocerciasis, and if so, would they be willing to manage its delivery? It was an early bottom-up empowerment model, where the distributors are individuals chosen by their peers in the communities. That system is now so successful that TDR went on to support research to examine whether other diseases and conditions could be managed this way. That led to a 2008 publication that showed that the model could also increase malaria diagnosis and treatment coverage, as well as vitamin A supplementation to infants.

In Dr Amazigo’s 31 January acceptance speech in Bangkok, she said, “The community-directed approach works well in remote villages in sub Saharan African but not necessarily in peri-urban or urban areas. And it doesn’t work in the Indian culture. When it comes to public health interventions, one phrase leaps to mind – one size does not fit all. And why should it?”

She went on to call for “a profound rethinking of our policies and how we create them. Why,” she asked, “despite the enormous progress made over the last 30 years, does Africa not have sustainable delivery methods for health interventions? I strongly believe that global health providers and countries will be walking in circles forever unless there is a serious rethinking of delivery systems.”

The Prince Mahidol award provides US $100 000, and Dr Amazigo will be using this to further develop a community-directed school health and nutrition programme she founded for resource poor communities in Nigeria. She uses community volunteers like the model she helped to develop and upscale for onchocerciasis. The goal is to increase children’s attendance and retention in schools, as well as improve their health, cognition and overall academic performance,

For those wanting to send congratulations and messages to Dr Amazigo: