Consequently, the transmission is most intense in the river valleys and the disease most severe in communities located near the rivers. The severity of onchocerciasis is closely related to the prevalence and intensity of infection in the community. With such high blindness rates, the burden of disease is overwhelming and threatens the economic survival of the villages. The disastrous effects of ocular damage caused by onchocerciasis are well known but the sheer misery of onchocerciasis skin lesions and their attendant itch has been largely overlooked in the past. However, a large multi-country study has recently shown that onchocercal skin disease imposes a grave burden and that its symptoms have important personal and psychosocial effects not only on the affected individuals, but also on their families and communities.
Symptoms make it difficult for affected persons to concentrate, work and interact socially.
Onchocercal skin lesions are an important cause of stigma and seriously affect people's self-esteem. In some areas, oncho-infected individuals are ostracized by the local community. TDR's psychosocial research suggests that, in the countries under study, many people with Reactive Skin Disease fear that having this infection may hamper their designs for marriage or even negatively influence their prospects for leadership positions. For the affected people, the most serious consequence of onchocercal skin disease is itching, which is often very severe, and the cause of sleeplessness, fatigue and weakness. Troublesome itching also leads to scratching, often with stones, twigs or knives, and results in bleeding wounds, sores and pain in the affected parts of the body.