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Community register used to record data from a mass drug administration programme to treat river blindness, or onchocerciasis. River blindness is caused by the larvae of the parasitic roundworm Onchocerca volvulus, which is transmitted to humans via the bites of Simulium sp. black flies. After transmission the parasite larvae develop into adults in the skin, causing nodules. The adults breed and produce many larvae that spread throughout the body, including to the eyes. When the larvae die they produce a strong immune reaction that causes inflammation. It is this inflammation that causes blindness.. If an infected person is bitten by a black fly, that fly becomes infected and can spread the disease. Treatment with ivermectin kills the larvae and prevents females from releasing new larvae, therefore breaking the infection cycle. The larvae absorb vitamin A from their host, potentially leading to deficiency. Photographed in Garbabi, Nigeria.

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