Progress report of the word health organization for 1999: 1 September 1998- 31 August 1999

Onchocerciasis Control Programrne in West Alrica Programme de lutte contre I'onchocercose en Afrique de I'Ouest JOINT PROGRAMME COMMITTEE ornce orthe chairman JPC - CCP coMIrEBcoNr?lir?tHioGRAMME JOINT PROGRAMME COMMITTEE Twentieth session The Hague.6-8 December 1999 Provisional agenda item 5 JPC2O.2 ORIGINAL : FRENCH September 1999 I i { PROGRESS REPORT OF THE WORLD HEALTH ORGANIZATION FOR 1999 (1 September 1998 - 31 August 1999) CONTENTS Page E)(ECUTryE SUMMARY ...............3 VECTOR CONTROL .......................6 Climatic conditions .....................6 Aircraft fleet and aerial operations. ...............7 Treated areas.......... ......................9 Insecticides and control strategy .................10 Hydrology and teletransmission.... ..............11 Entomological surveillance and evaluation network..... ..................11 Monitoring of the aquatic enüronment .......14 TVERMECTIN (MECTZAN@) DISTRIBUTION AND EPIDEMIOLOGICAL4CTrVrTmS................ ................. 15 Ivermectin treatment ................15 Epidemiological evaluations ......................17 Epidemiological surveillance in the original Programme area........... .......18 Epidemiological evaluations in the western and south-eastern extension areas.......... l9 Ophthalrnological evaluations ....................20 BIOSTATISTICS AND INFORMATION SYSTEMS .....20 TRANSFER OF ACTIVITIES TO THE PARTICIPATING COUNTRIES ........,.................22 Transfer of residual activities .....................22 Training ...................22 V/HO/AFRO SUPPORT TO OCP ACTIVITIES IN THE PARTICIPATING coLNTzuES .........,... ....................23 INTERDISCIPLINARY RESEARCH............ ......,.......... 24 Insecticides ............ 24 Vector identification................ ..................24 Parasite identificatior.l......,......, .................. 25 Special entomological studies ...................26 Diagnostic tests for the surveillance of onchocerciasis .................26 JPCZO.2 Page 2 Epidemiological modelling.......... ...... Z7 Macrofil Chemotherapy Project ....... ......28 ADMINISTRATION AND SIIPPORT SERVICES......... ..................3I Objectives, organization and functioning of services ....................31 Administrative costs... ..............31 Budget and Finance................ ....................12Personnel ................33 Supplies and services............... ..................33 Transport and communications ..................34 LIAISON, INFORMATION AND VALORZATION ACTIVITIES............. .....14 V/ith the V/orld Health Organization............... ............j4 V/ith the Participating Countries................ .................. j5 V/ith the statutory structures of OCP and APOC .........35 With the Donors .....36 V/ith the Evergreen Helicopter Company ....................36 V/ith the scientific community ...................316 Celebration of the 25 years of OCP ...........ÿ7 Valorisation and promotion work......... .....38 Documentary collection ...........38 Internal OCP meetings................ ...............40 FIGURES Fig. I VCU Plan of operations for 1999 ......... ...................p Fig.2 Annual transmission potentials (May 1998-April 1999) Simulium damnosum complex species infected with Onchocerca volwtlus ..............14 Fig. 3 Annual transmission potentials (May 1998-April 1999) Simulium damnosum complex savanna species infected with Onchocerca volwtlus.... ............... lB Fig.4 zones for large-scale ivermectin treatnent in ocP as from 1999...............................16 Fig. 5 Prevalence ofmicrofilariae in villages evaluated between 1997-1999 in OCP.......-...18 JPCaO.2 Page 3 EXECUTIVE SUMMARY a) Decreases in rainfall were recorded during 1998 in most of the basins of the Programme area compared to 1997.In the eastem zone decreases were recorded in the basins of the Oti in Togo and of Lake Volta in Ghana while in the westem zone, the decrease concerned the basins of the N'Zi and lowerBandama in Côte d'Ivoire.In Guinea and Mali however, some excess rainfall was recorded. The months of July, August and September 1998 in the Eastern basins and August, September and October in the Vy'estern basins were the wettest. b) The mrmber of aircrafts used under contract during the period under consideration ranged between seven (from May to July and November to December 1998) and six (from August to October 1998) and between five (from January to February 1999) and three (from March to April 1999). In the'tÿÿestern zorre, aeiallarviciding was virtually totally suspended during the month of April 1999. The same situation occurred in the Eastern zone. These suspensions were made possible because of the satisfactory entomological results and/or the low discharge rates recorded in the different watercourses. c) 1998 was the last year of the three-year aerial spraylng contract between OCP and the 'Evergreen Helicopter International" @HI) company. In close collaboration with the Management and technicians of the Programme, negotiations undertaken by WHO with EHI made it possible for an agreeme,lrt to be reached for a nerù/ contract to cover the last four years of the Programme. From 1999 to zCfl,three helicopters would be made available during March and April and five helicopters for the rest of the year. Due to the reduction of larviciding coverage, only two helicopters would be available to the Programme in March and April of 2002, and three for the rest of the year. d) Larvicide teatne,lrts were stopped in Decernber 1998 on the lower Bandaur4 I.Izi and Comoe in Côte d'Ivoire. At the sarne time, larviciding was also officially stopped in Sierra Leone where virtually no river had been treated since April 1994. e) Compared to the period from May 1997 to April 1998, the cost of the flight hotrs used by the Programme decreased by US$ 768,956 (about 19olo reduction). Insecticide consumption also decreased, which was reflected in a US$ 860,535 reduction of the cost. This decrease was due to i) the decrease in rainfall recorded in May and June 1998, ii) the cessation of larviciding treatrnents in the main basins of Côte d'Ivoire at the end of December 1998 and iii) the optimization of the cost efficiency of aerial operations. 0 As in the previous years, the seven selected operational insecticides (temephos, phoxim, pyraclofos, B.t H-14, permethrin, carbosulfan and etofenprox) were used up to December 1998 according to the insecticide rotation shategy aimed at preventing blackfly resistance and keeping the effects of larviciding on the non-target aquatic fauna to minimum. Since January 1999, with the cessation of aerial larviciding on most of the basins of Côte d'Ivoire, temephos, pyraclofos, permethrin and B.t H-14 were the main insecticides used. However, the three other insecticides are still available for use in the rotation strategy when the blackly susceptibility level and/or hydrological conditions so require. g) At present, the OCP hydrological monitoring network comprises of 71 water-gauges including 56 equipped with hydrological beacons most of which belong to OCP (three belong to the "hydroniger" network and four to hydrology department of Benin). The period under review witnessed a number of acts of vandalism, namely, thefts of solar panels and batteries which are increasingly sought-after for domestic use. To remedy this situation, the Programme had to intensiff the sensitization of the populations and local authorities on the importance of maintaining the network in running condition. h) Overall, the results of the entomological evaluation were satisfactory in all of the basiurs treated during the period under review. Only 6 (six) catching points (out of the 107 monitorBd regularly) showed Annual Transmission Potentials above 100 infective larvae perperson per year during the period of May 1998 to April 1999. If the transmission due to the savanna species alqre were considered, only two catching points had an ATP abovel00, one on the tributaries of the Oti in Togo (Titira), and one on the Tinkisso (Fifa) in Guinea. i) The cessation of larviciding in almost all of the basins in Côte d'Ivoire at the end of 1998 lpd to the closure of the Bouaké sector as well as its two sub-sectors of Bouaké and Odienné. This closure was accompanied by a restructuring marked by a redeployment of entomological afid insecticide research activities between Odienné, Kara and Ouagadougou, Éts well the transferrof the molecularbiology laboratory from Bouaké to Ouagadougou. j) The long term aquatic monitoring results presented by the national hydrobiology teaûs showed that the fish populations in treated water courses in Guinea and untreated water courses in Côte d'Ivoireexhibited an upward trend. The relative downward tends of catches observed on monitoring statlons in Ghana seem to be unrelated to lanriciding treahents which have ceaçd since 1992 on the Oti where this situation persisted. As regards the invertebrate fauna, only fie Ephemeroptera group @actidae, Tricoryttridae, Oügoneuriidae and Epheureridae principalfy) seems to be affected at the monitoring stations on the treated watercourses. On those watercour$es no longer under teatnent, recolonization was partial, with a persistent absence of mainly sofe of the Ephemeroptera k) During 199811999 more than 6.400.000 people from over 17.600 villages were teated \À'lth ivermectin tbrough the Community Directed Treatuent (CDTD method which had now bçn installd in m. ost of the villages and which had eirtirely replaced the method of disüibution by Se mobile tearts in the Participating Counfries. The proportion of üllages covered by CDIII compared to those planned for coverage ranged from 80% to 100% in the eigbt countries of ttre Programme out of the ten concemed with CDTI. No treatue, rt could be made in Sierra Leone qrd Guinea Bissau due to the insecuriÿ in these countries. The mean coverage in terms of üe percentage of individuals treated compared to the total population registered was 77.syo (wlth counby variations rangrng from 52.1%o to 87.4oÂ). No serious side effect was reported. D Four non-governmental organizations (NGOs) as well as various community goüps or associations were involved in ivermectin distribution in four of the OCP Participating Coundes (Ghana, Guinea, Mali and Sénégal) through providing support to mainly training activities and retraining of staff (health staff and CDDs) for the full installation of community directed keatment with ivermectin. m) The results of the epidemiological evaluations conducted between May 1998 and June 1999 in the 348 üllages of the nine countries in which onchocerciasis control activities were carripd out were overall satisfactory. In the western and south-eastem extension areas, the epidemiological trends were good everlrwhere except in the basin of the Mafou in Guinea whdrc a stagnation was observed. In the original Programme area under epidemiological surveillarrce the results remained excellent except in the basin of the Comoe in Burkina Faso where the fifst analyses seem to indicate a relative increase of the number of cases recently detected. n) Ophthalmological evaluations were carried out in the Niger, Mafou,Niandan,sankarani and Dion basins in five villages in Guinea after nine to ten cycles of annual treatment with ivermectln. JPCzO.2 Page 5 The results were satisfactory and continue to show very significant improvements in the lesions of the anterior segment of the eye, and a stabilisation of the posterior segment lesions. The microfilarial load in the eye was virtually nil, thus precluding any risk of onchocercal blindness. o) The Participating Countries were trained in data management and began to exploit the epidemiological and entomological evaluations data collected by the Programme and which had been transferred to them on high performance computers that were provided by the OCP. Such training was carried out in concert with the national onchocerciasis control coordination staff, and, the emphasis was placed principally on the entry of the data collected from the epidemiological evaluations. The integration of these data into the national health information systems remained a priority. To facilitate the analysis of data in collaboration with the nationals, the Geographical Information System Arc View which is used for the analysis of the data was updated with the Coordinators and the epidemiologists during these haining sessions. p) In collaboration with, and under the coordination of the PET Unit, the Countries have carried out communiÿ sensitization activities, epidemiological surveillance and/or evaluation actiüties, as well as ivermectin treahnent. These different activities were reviewed during the National Coordinators' meeting which also included the Secretaries and national or General Directors of health ofthe 11 Participating Countries. The Ministries of Health ofthe Participating Countries have facilitated the integration of CDTI in the national health systems as well as the decentralisation of the epidemiological surveillance of onchocerciasis through on-the-job haining of staffat the peripheral and village levels. C) WHO/AFRO supported the activities of the Programme in the areas of epidemiological surveillance and integrated control of prioriÿ endemic diseases including onchocerciasis by organising a workshop on the evaluation of epidemiological surveillance syste,rns and a consultative meeting which took place at OCP/Ouagadougou from 3 to 7 }.[ray and 31 May to I June 1999 respectively. The WHO Representations in the Participating Countries actively participated in these activities. The most significant event of this period remained the creation by the Regional Office, of the future centre for epidemiological surveillance and control of prioriÿ endemic diseases for which the terms of reference rvere currently being reviewed. r) Most of the insecticide research activities during the period under review focused on improving the cost-effectiveness of bacillus thuringiensis H-14 formulations which were regularly bio-tested with the orbital shaker and through experimental sprayings at discharges above 15m3/s. The only chemical insecticide which underwent field trials, in rivers this year was a new formulation of temephos. s) Current research work was aimed at further refining vector identification techniques, namely, the morphology, morphometry, HDA (heteroduplex), and Cÿotaxonomy methods which remained the reference technique. A new molecular biology technique based the use of DNA microsatellite markers was transferred by IRD/IVlontpellier to OCP. It will be used for making distinctions and comparison of the blackfly populations of certain hydrological basins of Guinea, Mali and possibly northern Sierra Leone. 0 Determining the prevalence of the infection from a pool screening of the blackflies through specific DNA probes of O. volvulzs is now the technique used in close collaboration with the national entomologist teams in those areas of the Programme which are no longer under larviciding, both for the detection of any possible resumption of the transmission of onchocerciasis, and for the study of the impact of ivermectin treatment on the transmission. tPC20.2 Page 6 u) Special entomological studies were continued i) on the tributaries of the Oti (Kara, Keran and Mô) in Togo in an effort to improve entomological results, ii) on the Black Volta, the Mole and Kulpawn in Ghana within the framework of post-treatment type of entomological studies to direct better onchocerciasis control in these basins. v) The Diethylcarbamazine (DEC) patch test as an altemative diagnostic tool to skin snipping was fully introduced in OCP during the year under review. The trials and the training of peripheral health centres staff were carried out during the epidemiological evaluations using üre skin snipping method. The procedure of preparation of the test material was transferred to all {he countries except Guinea Bissau and Sierra Leone. w) The " Macrofil " chemotherapy project supported the Onchocerciasis Chemotherapy Researph Centre (OCRC) in Ghana where clinical studies are ongoing, aimed at determining the macrofilaricidal effect potential of ivermectin used in combination with other therapeutic ageûts when simultaneously administered. During the period under review, Macrofil also piloted sorhe studies on some new products such as Moxidectin and supported research work on new molecutæ targets for the teatment of lymphatic filariasis and on the genetic bases and mechanisms of tloe resistance to ivermectin. All these activities carried out by Macrofil are nov/ the responsibillty of the Drug discovery and research and Product development sub-units within the Prodqa Development and Research Unit (PRD) of the Communicable Diseases cluster of which TDR is part according to the new organisational structure of IVHO. x) The administration Unit continued to support all the units and actiüties of the Programme $y managing in the most rational way possible and to the best interests of the Organization, 4c human, financial and material resources of OCP. The period was marked by the organization sf a nunber of management se,minars and üaining workshops to shengthen the perfonnance of t$c staffin order to reduce costs. y) The Onchocerciasis Control Prograrrrme in West Africa experienced a very important evept in its evolution at the beginning of this year (1999). OCP celebrated the 25th anniversary of its activities from 8 to13 February 1999 at the Programme's headquarters in Ouagadougou and h the Participating Countries. The organization and dates ofthis jubilee were left to the discretiqn of the counhies depending on local circumstances. This was the occasion for the Programme to strengthen the sensitisation of the Donors, of the Participating Countries themselves as well;s the courtries not included in the Programme are4 the scientific and the public at laq$r about its activities. VECTOR CONTROL Climatic Conditions l. During the period under consideration, decreases in rainfall were recorded in most of the basins of the Programme area except in Guinea and Mali where the precipitations exceeded those recorded in 1997.In the Eastern zone, these decreases were noted in the basins of the Oti (Kana and Mô) in Togo and in those of Lake Volta in Ghana. In the Western zone, they were recorded in the basins of the N'Zi and lower Bandama in Côte d'Ivoire. Periods of high flooding were recorded on the Comoe, but they were due to the high rainfall in its upper basin in Burkina Faso. The months of July, August and September 1998 in the eastern basins, and August, Septembdr and October in the westem basins, were the wettest. JPC2O.2 Page 7 2. Furthermore, when comparing the dry periods of 1998 and 1999, that of 1999 was wetter than the previous period in the Eastem zone. In the westem zone, the situation was different, with less rainfall in the basins of Côte d'lvoire in 1999 while those of Guinea were wetter. Aircraft fleet and aerial operations 3. The number of helicopters used under contract during the period under consideration ranged between seven (from May to July and November to December 1998) and six (from August to October 1998) and between five (from January to February 1999) and three (from March to April 1999). In the Western zone, aeial larviciding was virtually totally suspended during the month of April 1999. The same situation occurred in the Eastern zone. These suspensions \ryere made possible because of the satisfactory entomological results obtained and/or the low discharge rates recorded in the different watercourses. 4. 1998 was the last year of a three-year aerial spraylng contract between OCP and the "Evergreen helicopter Intemationaf' (EHI) company. An agreement for a new contract to cover the last four years of the Programme (1999-2002) was reached with that same company. Under the terms of this new contract, from January 1999 to the end of December 2001, three helicopters would be made available to the Programme during the months of March and April while for the rest of the year five helicopters would be available. Under the terms of the same contract, OCP guarantees the company payment for 53.6 flight hours per month for each helicopter contracted. h2002, as a result of the reduction of the laruiciding coverage, only two helicopters will be made available to the Programme in March and April, and three for the rest of the year. The company will then be guaranteed payment for 58.8 flight hours per month for each helicopter contracted. 5. During the period of May 1998 to April 1999, the helicopters used 3,666 flight hours for larviciding (out of which 17.4 hours were for prospecting) as against 4,524 flight hours for larviciding (and none for prospecting) during the same period in the previous year (Tablel), which represents a reduction by 858 hours. This difference (-l9Yo) is mainly due to i) tlre decrease in rainfall recorded in May and June 1998, ii) the cessation of the aerial larviciding on the main river basins of Côte d'Ivoire at the end of December 1998 and iii) the constant search for an optimization of the helicopter treatrnent rounds. 6. Taking into account the cost of one overtime flight hour which until December 1998 was US$.722, fuel included, and which is now US $ 1,126, the amount corresponding to the reduction in the number of flight hours is about US$ 768, 956 (i.e. US$ 1,126 X370 from January to April tege). rIPC}A.2 Page 8 Table l. Consumption of flight hours for treatments from May 1998 to April 1999 afd comparison with the previous period 7. Compared to the preüous perio( the Programme spent US$ 860,535 less for insecticidBs between May 1998 and April 1999, which represents a decrease of about 2l% n larvicidès consumption (Table 2). This decrease is mainly due to i) the cessation of lanriciding on tüe Comoé, Lower Bandama, NZi and the upper course of the Sassandr4 ii) the inhoduction 0f Teknar which contributed to a decrease in the consumption of temephos, Vectobac, phoxins aid etofenprox which is a rather costly insecticide, and iii) hydrological conditions calling for a suspension of lanriciding on manywater courses. Table 2. Larvicides consumption from May 1998 to April 1999 and comparison with tle previous period Months Flight hours M"1" g?Aptil 98 Itvtuv 98-Æria99 Difference Between lgttgg et98t99 May June July August September October November December January February March Aoril 534 526 504 342 255 350 360 380 487 426 251 109 287 355 454 262 262 288 343 512 267 338 225 73 -247 -t7t -0s0 -080 +007 -062 -017 +t32 -220 -088 -026 -036 Total 4524 3666 -858(-19%) Larvicides Quantities used (litres) Differences (litres) Cost Difference (us$)May 97-April 98 May 98-April99 Temephos 34 426 20 553 -13 883 -226 709 Vectobac 21 I 783 111 194 -39 835 -274 86r Teknar 4 247 20 233 +15 986 +132 364 Phoxim 28 409 12 6t7 -15 792 -244 460 Permethrin 14 268 t7 671 +3 404 +035 023 Carbosulfan tt s76 6 906 -4 669 -097 2t7 Pwaclofos 25 915 25 873 -43 -001 132 Etofenprox 20 769 13 169 -7 600 -183 541 Total 351 403 288 970 -62 432 -860 534 Gzlo/"\ JPCZO.2 Page 9 Treated areas (Fig. l) 8. The only aerial operation still going on in the original Programme area is on the tributaries of the Oti in Togo (Keran, Kar4 and Mô) which was added to the basins of the south- eastern extension in 1995. However, ground larviciding continued on the Dienkoa in Burkina Faso during the period concerned, under the supervision of the national team and with financial and technical support from OCP. In the Westem extension, aerial larviciding was definitively suspended in Sierra Leone at the end of December 1998. On the same date, they also ceased on most of the watercourses of the southern extension in Côte d'Ivoire except on the middle course of the Sassandra and its tributaries the Bagbé and Bafing. 9. In 1999, the total length of rivers likely to be teated by both aerial and ground larviciding for the purpose of preventing transmission is 11,698 km. However, no aerial larviciding was carried out in the Eastern zone between 5 to 24 Apt'rl (weeks 14 to 16) and between 5 to 18 April (weeks 14 and l5) in the'Westem zone due to a satisfactory entomological situation and /or very low discharges of the river. Maximum larvicidal coverage was recorded between 14 and2O December 1998, the period during which there was a fall in water level and therefore high larval productivity. Close to 78%o (9,096 km of rivers) of the theoretical coverage was treated. 10. In the basins of the southem extension in Côte d'Ivoire, larviciding on the Comoé, Lower Bandama and N'Zi ceased in December 1998. Post-treatment entomological evaluations started on these basins in February 1999 using the pool screening of blackflies method. FlG. I : VGU PI-AN OF OPERATIONS FOR 1999 / PLÂN D'OPERAflONS DE VCU POUR i999 ,, Luüeaü€t{idbasl S6ord üeetrsrt -3.- ralumrtsisorris - Prsl OcPbqrdry (ùEnC. Éqdtün dlb.rdffid.|§bdrd-ÿ) Liû dr.a. OCP(e tu,.xLrBbBd. ddqrcræeftd) *- OngE RqlalE æâ MryrLHê æ dJ. JPCZO.2 Page 10 1 I . In the basins of the western extension, the continuing insecurity in Sierra Leone led the Joint Programme Committee (JPC) to decide on the definite cessation of larviciding in the northern part of that coun§. It must be recalled that there has been no larviciding in Sierra Leone since April 1994 (except for a few weeks larviciding in 1997). Aerial larviciding continues in ghe basins of Guinea while ground larviciding under the responsibility of the national team of M{li, with financial support and technical supervision from OCP is undertaken in Niger and its tributaries near Bamako. Insecticides and Control strategy 12. The seven operational insecticides selected by OCP (temephos, phoxim, pyraclofos, S.r. H-l4,permethrin, carbosulfan and etofenprox) were used up to December 1998 as in the previous years according to the insecticide rotation strategy aimed at preventing blackfly resistance apd keeping the effects of larviciding on the non-target aquatic fauna to a minimum. Since Januâry 1999, with the cessation of larviciding in most of the river basins in Côte d'Ivoire, temephQs, pyraclofos, permethrin and B.t. H-14 have been the main insecticides used. However, the thrpe other insecticides remain available for use in the rotation shatery when the blackfly susceptibiüÿ situation and/or hydrological conditions so require. 13. Due to the insecticide rotation shategy and the limited use of the organo-phosphorops compounds, especially temephos, it was possible to appropriately manage the resistanse phenomenon so :ls to preserve the efficiency of vector contol which had been the only stratefy used by the Programme over the first 14 years of its existe,nce. No decrease in blackdy susceptibility to B.t. H-14 has yet been observed vrithin the Programme area after 17 years of tpe of the this biological insecticide. Vfith respect to the chemical insecticides, the susceptibiliry tqts were caried. out as in preüous years with the organo-phosphorous compounds in prioriÿ (temephos, phoxim and pyraclofos), especially in the basins where resistance to one or the otffi of these insecticides had been well established. 14. Some improvement ofblackfly susceptibiliÿ to temephos was observed in certain basilrs of the Eastern zone, particularly those of the Mono in Togo and Ouémé in Benin. However, it must be noted that in the basins recently excluded from vector control, the definite cessation pf larviciding was not immediately associated with the extinction of resistant blackfly populatior§, namely those observed at Beriaboukro on the lower Bandama and Amouakoul«o on the Comoé. Even though these populations are decreasing, their involvement in seasonal migration can negatively influence the evolution of blackfly susceptibiliÿ level in the basins still under larviciding. 15. Blackfly susceptibility to phoxim remained satisfactory in all of the basins of the Programme. No sign ofresistance to carbosulfan, permethrin and etofenprox was reported eithef. On the other hand, some resistance of the blackflies to pyraclofos was observed in the foci of the Niger at Tienfala in Mali, and of the Milo at Kerouane in Guinea. 16. Although the blackfly susceptibility situation rü/as relatively satisfactory, vigilanoe continues to be exercised, especially with respect to the number of consecutive cycles of use qf temephos which, given the conditions described above, generally do not exceed three in most of the basins treated. Furthermore, after long periods of suspension of larviciding due to thp satisfactory results obtained or the specific hydrological conditions, some susceptibility test have to be conducted for greater caution in the choice of the insecticide to be used when larviciding has to be resumed on the concemed river stretches. Such treatment decisions are made also taking into account the efficiency of the pyrethrinoids and pseudo-pyrethrinoids - the two categories of insecticides which are used during the periods of rise (permethrin) and spate or fall in water level JPC2O.2 Page I I (etofenprox) respectively - on the blackfly populations resistant to the organo-phosphorous compounds. Etofenprox was used in the same way as in previous years during the periods of rise and fall in water level so as to reduce the use of the organo-phosphorous insecticides at discharges between 15 and 70m3ls. During the period when the water level was high, carbosulfan and permetrhin were used on most of the large rivers within the limits of the six consecutive cycles per year over the same river stretch as recommended by the Ecological Group. 17. A formulation of ,8.r. H-14 (Teknar) proposed by the firm Thermo Trilogy Corporation also gave satisfactory results under operational conditions in 1998 in the western zone in terms of effective carry, at a dose (540m1per m'/s) below the one usually used (720m1per m3ls.) It is currently being used at discharges above 15 m3/s. Greater quantities of this formulation were ordered in 1999 for larger scale use. Hydrology and teletransmission 18. At present, the OCP hydrological network consists of 7l water-gauges including 56 equipped with hydrological beacons most of which belong to OCP (three belong to the "Hydroniger" network and four to the hydrology deparhnent of Benin). The period under review witnessed a number of acts of vandalism, namely thefts of solar panels and batteries which are increasingly sought-after for domestic use. The Prograrnme reacted to the situation by intensiÿing the sensitization of the populations and local authorities to the importance of the network which allows for a real time teletransmission of hydrological data through the three satellite reception stations located at Kara in Togo, Odienné in Côte d'Ivoire, and Ouagadougou in Burkina Faso (back-up station). 19. Following the cessation of larviciding in Sierra Leone, monitoring of the network is now the responsibility of fourhydrological brigades comprising two national brigades in Guine4 and two OCP brigades (one at Odienné and one at Kara). The Coordinator ofhydrological activities who is stationed at OCP's headquarters in Ouagadougou, assists the hydrological brigades i) in detecting any failure in the beacons thanks to a back-up satellite reception staüon that he manages ii) in readjusting the former hydrography chart and iii) in the repair of any defective parts of the beacons, with the support of three electronic technicians from the Programme also stationed in Ouagadougou. Entomological surveillance and evaluation network 20. At present the entomological evaluation network in the treated zone comprises 107 catching points which are visited regularly including 54 monitored each week (point A) and 53 every fortnight (point B). However, catches can be organized on demand in occasional monitoring points for the purpose of finding explanation or solutions to incidental entomological problems raised during the weekly briefings. Such was the case this year for Sikan on Keran, Porga, Panséni, and Oti-Toutionga on the main Oti, Igbomal«o on the Térou, Agolin-Pahou and Azraou on the Ouémé, and Naboulgou on the Koumongou. As in previous years, village captures were used in Guinea at those pointS which are inaccessible during the rainy season so as to get a more complete coverage of the entomological evaluation network. This was the case for Banankoro on the Milo, Bolorosso on the Gbanhala, Kouya Laya on the Kouya, Yalawa on the Mafou, Koundeboum on the Bale, and Koda on the Léléko river. 1PC20.2 Page 12 21. On the whole, the results of the entomological evaluation were satisfactory in all of treated zones of the Programme. However, in some basins transmission of the savanna strain of the parasite by the savanna blackflies remained difficult to contain despite continued larviciding and the distribution of ivermectin, particularly in the case of Fifa on the Tinkisso and Titira on the Keran. These basins were the subject of particular attention and corrective measures were taken in order to bring down the transmission to acceptable levels as soon as possible. 22. After separating the parasites of animal origin from human onchocerca through analysis with specific DNA probes, six catching points (out of 107 monitored regularly) showed Axnpal Transmission Potentials of human onchocerca above 100 infective larvae per person per yEar (frg.z).If the transmission due to the savanna blackflies alone is considered (Fig.3), only two catching points had an ATP above 100, one on the kibutaries of the Oti in Togo (Titira), and qne in the basin of the Tinkisso in Guinea (Fifa). FIG. 2 : Potentiels Annuels de Transmission @AI) en zone haitée (Ioutes espèces) / Annual Transmission Potentials (ATP) in area under larviciding (All species) PAT'ATP o <ioo O loo.l9!, o 200.399 O /(,o -7s9 a >8oo PGqt OCP bowdary (odCtEl. cim, $dtm ad br6l qrrE qtsim boodary) Lffie adJe!ê OCP (arB hiüdê, dtæbG oGl, sud er odE@e de lb.à) Original Prcglæ a@ bqrdey,/ L[üe eæ irtuab POTENNEI§ AilNUEL§ DE IRANSM§SrcN ANNUAL ÏRANSMI!§ION FOTENTI,ALS ,{âmr.y l0g8 -AYrüApril 199e Espèc du mplexe smulium damnGum mfeclées par Onch@ volwlus Simulium damcum mplex sæciæ tnfected with OncfiæE rclwlus ---- W6Ifr ald ærrhem qlæDn æ bouqrary / Um(e d6 exlffiirc oGt d sud. JPC}O.2 Page 13 FIG. 3 : Potentiels Annuels de Transmission (PAT) en zone traitée (Espèces savanicoles) / Annual Transmission Potentials (ATP) in area under larviciding (Savanna species) 23. As in preüous years, transmission was negligible in the dry season, but intense during the periods of high larval productivity and of increased man/vector contact (particularly during the planting or harvesting periods.) Thus from l0 to 16 August 1998, transmission was particularly high vrith a total of 25 infective females carrying 79 infective larvae caught during that week. 24. High quantities of blackflies were caught in February, March and April, namely in the basins of Sankarani in Guinea, and Sassandra in Côte d'Ivoire. The high parturiÿ rate of these populations which proved to be totally uninfected suggests that these blackflies were originating from uninfected zones of the original Programme area and are ca:ried elsewhere by the harmattan winds. However, the ever increasing populations of blackflies these past years and the decline of partiruty rates at some of the catching points also suggest possible larviciding failures related to a lowering of blackfly susceptibiliÿ. This hypothesis is being investigated concurrently with a reinforced monitoring of aerial larviciding and a decreased use of organo-phosphorous compounds on the watercourses of Guinea. 25. The post-treatment entomological studies initiated between July and November 1998 in the basins of the Black Volta, Mole and Kulpawn in Ghana showed infectivity values of 1.79 o/oo at Ankayakrom on the Black Volta; l3}%o at Chiassa on the Mole and 2.96yoo at Bielikpong on the Kulpawn. These values are above the threshold used for decision-making about the cessation of larviciding, which is one infective female for one thousand parous flies. Other studies carried out over a two-year period in 1997 and 1998 on one hand on the Marahoué at Kongasso, on the Black Volta at Tagadi Kohodio in Côte d'Ivoire, and on the other hand on the Kankélaba at Kankéla, on the Bafing IV at Konina Bac and on the Baoule at Madina Diassa and Nzana in Mali showed satisfactory results in all points except at Nzana where a 1.46 % infectivity level was recorded, which is slightly above the acceptability threshold. JPCZO.2 Page 14 26. The cessation of larviciding in almost all of the basins of Côte d'Ivoire at the end of 1998 led to the closure of the Bouaké sector as well as two of its sub-sectors, i.e. Bouaké and Odienné. This closure was accompanied by a restructuring marked by a redeployment of the entomologigal and insecticide research activities between Odienné, Kara and Ouagadougou, as well as ühe transfer of the molecular biology laboratory from Bouaké to Ouagadougou. Monitoring of the aquatic environment 27. The evaluation of the impact of factors other than insecticides (through habitat qualiÿ studies) on the aquatic environment has been one of the main components of this monitorihg prograurme put in place by OCP, the first data of this evaluation will be available at the endrof the year. The study of the long term impact of the anti-blackfly larvicides on the non-tar$et aquatic fauna is continuing, with the sampling being almost exclusively carried out by frre national hydrobiology teams. 28. V/ith the cessation of larviciding on many of the watercourses, emphasis will be put pn the evaluation of their recolonization by the invertebrate fauna primarily, and to a lesser extfirt by fishes. Monitôring actiüties were officially stopped in Sierra Leone. They are continuing in Côte d'Ivoire, Ghana and Guinea through letters of agreement signed with the natio{al hydrobiology teams- The entry and partial processing ofthe data, the coordination ofmonitori[g activities as well as the liaison between the teams in the field and the Ecological Group contirlrc to be ensured by OCP. 29. The results of the aquatic monitoring presented by the national teams indicate an overpll upward trend of the fish populations in the treated water courses in Guinea and the trntreated watercourses in Côte d'Ivoire. The trends related to the decrease of the catches per unit effôrt (CPUEs) observed in the monitoring stations of Ghana appear to be unrelated to the larvicfb heaünents which have been suspended since 1992 on the Oti where this situation is persistept. The best results in catches were recorded with the small and medium size mesh, which corfld mean a satisfactory recruitrnent among the fish populations. Despite this overall improvementlof the catches, some species such as H.pictus, C. auratus, S. filamentosus at Mandiana, P.ansorÿii, H. pictus at Boussoulé, and H. pictus at Baranama continue to be rarer and rarer. On the otËer hand, the coefficients of condition remained stable, which shows that the conditions of the aquafic environment have not deteriorated. 30. As for the invertebrate fauna, only the Ephemeroptera group @actidae, Tricorythidte, Oligoneuriidae and Ephemeride principally) seems to be affected on the treated stations. In terms of entomic biomass, all the monitoring stations showed a relative stabiliÿ except Boussoulé on the Milo. On the watercourses no longer under larviciding, the recolonization is partial, witll a persistent absence of some taxa such as the Heptageniidae, the Ephemeridae, the Oligoneuriidâe, the Ecnomidae and Neoperla sp. 31. The need to publicize the achievements of the aquatic monitoring programme put in place by OCP was also one of the major concerns of the Ecological Group during the period of this report. ln addition to some manuscripts on specific subjects that have been published, in pressor in the process of being finalized with the collaboration of members of the Group, steps are beUrg taken for the publication by the end of next year of a semi-scientific brochure and a book on the different activities carried out under the aegis of the Ecological Group, with the participation of renowned scientists. IVERMECTIN ACTIVITIES JPC2O.7 Page 15 DISTRIBUTION AND EPIDEMIOLOGICAI- Ivermectin treatment 32. Last year, the method of community-directed treatment with ivermectin (CDTI) entirely replaced that of distribution by the mobile teams in all the countries except in Niger which is not concerned with CDTI. The Programme continued to provide financial and technical support to the countries to assist thern in the retaining of all those involved in CDTI. [n the CDTI approach, it is the communities themselves which assume responsibility for the distribution of ivermectin in their respective villages. They are empowered to choose their own distributors and the method they wish to use for the distribution (door to door or at a designated place in the village). The distibutors are tained by the health centres staffwhich itself is trained by the national teams for onchocerciasis control with support from OCP and some non-govemmental organizations §GOs).This year, no treatrnent could be carried out in Sierra Leone and Guinea Bissau due to the social unrest and insecuriÿ which prevailed in these two countries. 33. As in the previous years, the treatrnent was carried out in the areas previously mapped out to be areas of high and medium risk, and more recently of low risk of onchocercal eye disease and/or blindness. For the purpose of extending ivermectin treatment to the forest zones not previously covered by OCP, the rapid epidemiological mapping of onchocerciasis @EMO) was carried out in Guine4 southern Ghana and southern Côte d'Ivoire. The results obtained were finalized to include all the onchocerciasis endemic areas in the national disfribution progfttrnmes. The haining of the health staff concerned was carried out and freaünent activities have already started. 34. Figure 4 shows the areas of the Programme under ivermectin treatrnent. In the north of the westem extension of the Programme in Guinea, Mali and Senegal, CDTI remained the only method used for contolling morbidiÿ and reducing the tansmission of onchocerciasis. Certain parts of the original Programme area also benefited from CDTI. These were the basins of the Dienkoa ofthe Bougouriba and of the Black Volta (Mouhoun) in the Batie area in Burkina Faso, the basins of the Oti-Pendjari, Sota Alibori in Benin, the tibutaries of the Oti in Togo, the basins of the Sissili, of the Kulpawn-Mole and of the lower Black Volta in Ghana as well as the basins of the Comoe, of the N'ZiÆandam4 Sassandra and Marahoue in Cote d'Ivoire. The ûeatments were also carried out in the basin of the Kankelaba, of the Bagoe and of the Baoule East in Mali. 35. This year, the 3mg Mectizan tablets were used in all the countries. The purpose of the introduction of this formulation of the drug was to facilitate its distribution in the field. The use of these 3mg tablets led most of the countries concerned with CDTI to develop plans for the retraining, monitoring and supervision of all the players involved. The main objective of these plans was to establish new bases for making CDTI more effective in all the countries by the year 2002. 36. Training and rehaining sessions aimed at better consolidating CDTI implementation were carried out by members of the national teams in collaboration with OCP and the NGDOs. The first phase consisted in training the trainers made up of doctors and nurses in charge of health centres in the zones concemed by the distribution. The second phase entailed the training of community distributors by the health workers. Last year, all the countries concemed with CDTI except Sierra Leone and Guinea Bissau carried out these training and rekaining sessions. To date, 198 doctors and 21 18 nurses/technicians and other paramedical workers have been trained in these countries, which makes a total o12316 health workers retrained in CDTI out of the 2335 planned for 1998/1999. However, the countries are now at varying degrees in the process of (MECTTZ.TN@) TPCZO.2 Page 16 retraining their health workers for the full installation of the CDTI philosophy for which the fifst training sessions were carried out between 1996 and 1997 . 37. The supervision of the distribution at the peripheral level was ensured by ttre health stiff responsible for those villages under CDTI \Àrithin their catchment area. These workers had the responsibiliÿ of collecting data on the number ofpeople treated in each village under CDTI. The results were then forwarded to the district medical officers who in tum forwarded the data to the national coordinators. These nurseÿtechnicians were also responsible for the management of 4rÿ severe adverse reaction which the üllage distributors might report. However, no such reactiôn was reported during the period under consideration. 38. Several NGOs provided financial support to the CDTI by participating among other things, in such activities as the supervision and training of nurses/technicians and communitty distributors. During the period of 1998/1999, the NGOs involved were mainly Sight Savqrs lnternational in Mali, Ghana and Guine4 the organization forthe prevention of blindness in Mdli, Guinea and Senegal, and the PhilAfricaine Suisse in Guinea. Some local NGOs or communi§r associations such as the "Centre de formation d'Animatrices rurales" (CFAR) in Mali can also be mentioned 39. Helen Keller International (HKI) in collaboration with OCP organized aworkshop at the Programme's headquarters in April 1999, which saw the participation of the officers or representatives in charge of Information, Education and Communication (IEC) activities wittün the Ministries of Health, of the various national coordinations of onchocerciasis contrDl prograürme, and other resource persons of Burkina Faso, Ghana, Benin, Côte d'Ivoire, Mali, Niger and Togo. The purpose of the workshop was to establish a partnership between this NGO and the Participating Countries in the area of ONCHO focused IEC activities; to develop work plans aimed at specific targets within the IEC strategy, to elaborate action plans and to discuss the procedures for the monitoring and evaluation of these plans. FlG.4: ZONES FOR LARGE§CALE IVERMECTIN TREATMENT lN THE OCP AS FROM 1999 DE TRAITEMENT A GRANOE ECHELLE A L'IVERMECTINE OANS L'OCP A PARTIR OE 1999 ffidHôffiErCq)lltæ(àrü,@qdd1tuôH) rf,brÈy/ffi&m* TPCZO.2 Page 17 40. More than 6.400.000 people in about 17 6A0 villages and hamlets were treated with ivermectin through the CDTI approach during 1998-1999. The proportion of villages actually covered by CDTI during 1998-1999 compared to the number of villages identified by the health workers to receive CDTI in their respective health districts varied from one country to another but was more than 80%. This proportion was 80 and 84Yo in two countries (Togo and Benin respectively),90% in Guinea,92oÂin Mali and Côte d'Ivoire,960 in Senegal and 100% in Burkina Faso and Ghana. Clearly significant progress in the installation of CDTI in the villages was made this year in Benin where in 1997-1998 the geographic coverage of the villages was less than 50% due to the late start up of the CDTI training activities in this country. The mean coverage realised in the villages treated, in terms of the percentage of individuals treated compared to the total population registered, was 77.5% with varying rates ranging from 52.1 to 87.4% in the different countries. 41. The objective of extending the CDTI approach in ivermectin distribution to all the areas eligible for treatrnent before the end of the first six months of 1999 was almost achieved except in the forest zones of southern Côte d'Ivoire and Ghana where training of the health staff is ongoing. However, a net increase in the number of villages covered by CDTI as well as the populations treated compared to 1997-1998 treahnent plans was observed. 1997-1998 was the year of the transition from treatment by the mobile teams to the CDTI method during which the Eaining process began with the preparation of the communities for this new approach in ivermectin distribution. 42. Burkina Faso, Guinea (Conaloy) and Sénégal initiated the process of procuring ivermectin from the Mectizan Donation Programme (I!DP) in 1998. The quantities of ivermectin tablets needed for CDTI in these three countries were received directly and integrated into their respective national drug distribution systems in early 1999. This year, Mali, Togo and Ghana started the process of procurement of their ivermectin supply from MDP for their heatrnents in the year 2000. The remaining other countries have started the administrative paperwork for procuring their Mectizan tablets directly from MDP without going through ocp. Epidemiological evaluations 43. Onchocerciasis epidemiological surveys were carried out in the OCP area by the decentalized district, regional or zonal teams, depending on countries, under the guidance of the national teams and with the participation of the OCP technicians with the aim of contolling the qualiÿ of results and proüding the information needed to: a) assess or determine, as part of surveillance, the epidemiological situation in the villages in the original prograûrme area where larviciding was stopped eight to 11 years ago; b) zlssess the impact of control activities through the measurement of incidence in the western and south-eastern extension areas and other specific areas in the original Programme area subjected to both ivermectin distribution and larviciding. 44. The method used during these evaluations was the same as in the previous years, namely the classical parasitological method of skin snipping which allows for an assessment of the prevalence of infection, the intensity of the infection and the presence of any new infections. The latter are defined as infections in children of five years of age or less who have never been treated with ivermectin, or infections in individuals who had been found to be negative during previous evaluations. In addition to the parasitological skin snipping method, the large scale experimentation of the Diethylcarbamazine (DEC) patch test was conducted in some villages in tPC20.2 Page 18 the whole Programme area. The series of epidemiological surveys of the current year should complete the cross-sectional surveys started in 1997 with the aim of obtaining an overall vi6w of the general epidemiological situation in all of the Programme area two years before the end the Programme. The number of villages evaluated between May 1998 and June 1999 was: Benin ([3 villages), Burkina Faso (59 villages), Côte d'Ivoire (24 wllages), Ghana (48 villages), Guinea (94 villages), Mali (54 villages), Niger (21 villages), Senegal (12 villages) and Togo (23 villages). Figure 5 shows the epidemiological results of villages surveyed between 1997 and June 1999. Epidemiological surveillance in the original Programme area 45. Epidemiological surveys, in the context of strengthened epidemiological surveillanqe, were conducted in some basins of the original Programme area with a view to assessing tfie overall epidemiological situation since larvicide treatrnents were stopped eight to 11 years ago. Surveys were undertaken lnl57 sentinel villages in the following basins : Koupeologo, Nakam$é, §a?inon, Léraba" Comoé, Sourou, Upper Mouhoun, Tapoa and Sissili in Burkina Faso; Whlte Bandam4 Lérabu Comoé, UpperBagoé, N'Zi in Côte d'Ivoire; Blach White andRedVolta Oti and Daka in Ghana; UpperBagoé, Banifing VI, Bani-Yamé, Farako-Lotio in Mali and Niger afd its tributaries in Niger. 46. ln the 13 villages of the basins of the Bagoe, Banifing fV, Bani Yame and Farako Lotio evaluated in March 1999 in Mali in the context of routine epidemiological surveillance, tlfe results were excellent with virtually zero prevalence rates ranging from 0.0% to 0.3Yo (Fig.5). 47. The epidemiological results of the 31 villages evaluated in April-May 1999 in the Black, White and Red Volta basins (called Mouhoun, Nakambé and Nazinon respectively), the Koupéologo, Sissili, Tapoa, Léraba, Comoé and part of the Oti in Burkina Faso within the JPC2O.2 Page 19 original Programme area remain excellent more than nine years after the suspension of larviciding. On the whole, prevalence rates are low, but particular attention needs to be given to the two basins of Comoé and OtiÆendjari. In the basin of OtiÆendjari where prevalence rates reach L2.4o in the Nianla village, evaluations were made with the aim of delimiting the part of the basin to be put under ivermectin treatment in Burkina Faso, just like the part of this basin in Bénin which is already under ivermectin treatment. With crude prevalence of 3.5%o and 6.5% in Sakora and Bodiadougou villages respectively in the Comoe basin, further investigations / analysis by the national team are on course to establish the origin of the new cases detected. 48. The epidemiological situation remains equally excellent in the ten villages evaluated in April 1999 in the basins'of the'White Bandama, Leraba-Comoe, Baoulé and Comoé in Côte d'Ivoire. The crude prevalence rates observed ranged from 0.0% to 4.5o and no new case was detected in those villages. 49. The epidemiological results in the basin and tributaries of the Niger in Niger remained excellent more than ten years after the suspension of larviciding without any other intenrention. In the 18 villages evaluated in May-June 1999, the incidence rates were all zero and no indigenous child was found to be positive. 50. In the six villages evaluated in the Kankélaba basin in Mali in November 1998 in the context of posÈlarviciding studies, the situation wils excellent with a zero incide'nce rate and prevalence rate ranging from zero to 1.9%o. 51. The results in the Kulpawn-Mole basins under exclusive treatment with CDTI in Ghana did not sesm satisfactory in all of the ten villages evaluated in 1998 although a significant decline of the epidemiological trend was observed in Kulun village where the prevalence rate dropped to 6.8%o, but the annual incidence rate was above 1.9%.Prevalence rose to 31.5yoat Jabaga and 13 children aged five to ten yeffs were found positive in four villages. In view of this bad epidemiological situation persisting in those Kulpawn and Mole basins, adequate measures are currently being taken in order to improve the geographical coverage of the villages and the therapeutic coverage of the population with ivermectin while enstring a smooth impiementation of the recommended measures through strengthened monitoring of CDTI by the national health staff. Epidemiological evaluations in the western and south-eastern extension areas 52. The routine epidemiological evaluations undertaken from March to May 1999 in Guinea in connection with the monitoring of control activities and the training of the district teams involved 49 villages in the basins of the Kolente, Tinkisso, Niandan, Kony4 Balé, Niger, Mafou, Sankarani and its tributaries where vector contol has been combined with ivermectin distribution since 1989. The epidemiological situation remains satisfactory in all of these basins, with crude prevalence rates below 20o in all the villages evaluated except in the Sérékoroba village in the Mafou basin where prevalence rose from24.20 in 1997 to 2l.20yo in 1999. The trend of parasitological epidemiological indices is declining in all these basins. The trends observed tally with those predicted by the ONCHOSIM model. 53. In the western extension areas in Mali, epidemiological evaluations were conducted in November 1998 in seven villages of the basins of the Niger (and its tributary Dlani) and of the Fié.. The overall epidemiological results were satisfactory with prevalence rates ranging from Oo to 13.20%o. This part of the Niger basin in Mali has been under ground larviciding combined with ivermectin distribution since I 988. TPCzO.2 Page 20 54. In the northem part of the westem extension area of the Programme in Senegal, simple epidemiological evaluations were undertaken in May 1999 in l2 villages of the basins of the Gambia and of the Koulountou rivers where ivermectin distribution is the only control strategy. Ivermectin distribution has been in force in these two basins since 1988. The frequency of distribution was two annual treatments from 1988 to 1995 and one annual treatment in 1996 by the mobile teams, and by CDTI in 1997 and 1998. The overall epidemiological results remained excellent in all of the 12 villages evaluated with crude prevalencè rates below 60Â. Out of 545 children under five years of age who had never been treated with ivermectin, only one was fouhd to be positive in these villages, compared to 39 children who would have been positive if no treatment had been conducted in the area. 55. In the basins of the south-eastem extension areas which have been under larviciding sirtce 1989, and combined with large scale treatrnent with ivermectin as from 1992, qidemiologifal evaluations were undertaken in 13 villages in the basins of the Oueme, Okparq ZouandKouffo in Benin in April 1999, in 23 villages of the basins of the Mono, Amou, Anié, Habo, Ogou td Vy'awa in Togo in May-June 1999 and in 12 villages of the basins of the Asukawkaw, Dayi 4rd Mô in Ghana in October 1998. In the basins of southem Togo, the e,pidemiological results wôre excellent with crude prevalence rates of the infection rangrng from 0.0% to 8.74o/o.In Beniru lhe highest prevalence rate was 17.8%. It was observed in a village of the Zou basin. The epidemiological situation also remains very satisfactory in the basins of the Asukawkaw and Dêy in Ghana The highest prevalence rate was 12.60% in these two basins of Ghana. No child under five years of age not treated with ivermectin was found to be infected. However, in the basinrof the Mô/Oti under lanriciding in Ghana, the epidemiological evaluations conducted in two villages in October 1998 following the poor results obtained in the village of Moala in May 1908 (prevalence rate of 62W, made it possible to confirm these results (Pibila, 20.5% and Kotri, 45.7%) that were on the whole not good along the basins of the Oti and its tibutaries in Ghaha, Togo and Benin. Ophthalmological evaluations 56. In connexion with the longitudinal monitoring of the long term impact of ivermectin treatnent on the evolution of ocular onchocerciasis, ophthalmological evaluaüons were carrled out in Guinea in five villages of the basins of the Niger, Mafou, Niandan, Sankarani and Dlon where larviciding was combined with ivermectin treatrnent. After at least nine cycles of annpal treatrnent with ivermectin, the results were satisfactory and continued to show a signific6nt reduction in the lesions of the anterior segment of the eye. Changes in posterior segment lesions were equivocal and further analysis is on course. Nevertheless, there were virtually no mgre increase in infection or ocular lesions associated with onchocerciasis likely to impair visionror cause a risk of blindness. Overall, the results continued to suggest a beneficial effect of the ivermectin treatment on the eye. BIOSTATISTICS AIID INFORMATION SYSTEMS 57. During the period under review, the prioriÿ activity of the Biostatistics and Information Systems Section (BIS) of the PET Unit was the transfer of data to the Participating Countries of the Programme. BIS also continued to coordinate the processing of the entomological and epidemiological evaluation data, especially the data entry and validation by the staff of the technical units of the Programme, and to play a major role in computer assistance within the Programme with respect to the routine maintenance of the various computer equipment instalfed in OCP, the local network, and associated services (Internet and e-mail). This assistance also concemed training in computer science, management of the diflerent data banks and their backup. JPCZO.2 Page 2l 58. This year, training sessions on epidemiological data management were organized in seven Participating countries of the Programme based on the computer equipment donated and installed mainly in the national onchocerciasis control coordinations. With this donation, the countries also received the epidemiological and entomological data collected to date by the Programme. By conducting these training sessions before the end of the year, the countries should be able to enter, validate and analyse their data as well as exchange them with OCP in order to update the central epidemiological data bank, the checking of which remains still a priority at BIS. 59. The use of the Geographical Information System (GIS) with the ArcView software has facilitated the analysis of the entomological and epidemiological data. The computerised mapping component of the system has also allowed the Programme's cartographer to produce maps which can easily be updated. In the framework of the exploitation of the data tansferred to the countries, an initiation course to the use of ArcView was organized in 1998 for the national onchocerciasis control Coordinators. During these training sessions on ArcView, the longitudinal anaÿsis of the data was introduced, incorporating the data on the incidence of the infection and on the epidemiological and entomological trends, as well as the epidemiological predictions made from the ONCHOSM model. A simple and operational system which fully integrates the analysis of these data is being developed by the HealthMap trnit of the WHO Headquarters in Geneva. This system will be made available to the countries to facilitate data management. 60. The routine analyses were pursued at BIS. Thus, the analyses of the ophthatnological data, those of the epidemiological studies on the effect of ivermectin and those collected during the study on new diagnostic tools were made. The epidemiological evaluation protocol that was developed and applied in May and Nov.enrber 1997 in the basins ofthe southe,m exte,lrsion in Côte d'Ivoire is now applied in epidemiological evaluations based on skin snipping. This protocol makes it possible to collect reliable epidemiological data in a basin under both larviciding and ivermectin distribution, the last treatment of which must date eleven months back. The results are encouraging but this requires further sensitisation of the communities. The analysis ofthe data derived from the DEC patch tests along with the tests based on skin snipping is underway and will help refine the epidemiological evaluation protocol. 61. During the period under review, BIS continued the integrated analysis of epidemiological and entomological evaluation data by supplementing the existing data banks with information collected on the vector and vector control operations. The final objective was to produce a statistical directory of these data for dissemination, first of all in the Programme to facilitate their verification for accuracÿ, and then to the Participating Countries and the scientific community. To this end, the revision of programmes and data banks was again considered as a priority activity during this year. This revision became necessary in order to keep software packages clear of problems related to the transition to the year 2000. A major part of this work has already been done on the data collected as part of the activities of the vector control unit by integrating such data in a single bank, but that for the epidemiological data bank is still under way. 62. Information systems related to control activities are becoming increasingly important within the Programme, strengthening the local network, and installing this year a server devoted to the accounts of the Programme. Efforts were made to hain secretaries and assistants in the use of Word, PowerPoint and Excel. The two Web sites available on the servers in Ouagadougou at the United Nations (www.cenatrin.bflpnud/omsoncho) and in Geneva at IVHO Headquarters (www.who.int/ocp) were reviewed. Major work was carried out on the Ouagadougou Web site in order to incorporate the salient points of the celebration of the 25 years of the Programme. The computer stock was also reviewed and a renovation plan is being implemented in order to solve the problems related to the transition to the year 2000 and to make adequate and performing computers available by the end of the Programme. TPCZO.2 Page 22 TRANSFER OF ACTIVITIES TO THE PARTICIPATING COUNTRIES 63. With respect to the transfer of the residual activities of the Programme to the Participatigrg Countries, the objective is to strengthen the capacities of the countries in order to enable th6m undertake epidemiological evaluation and surveillance for the early detection of recrudesce4ce and its control by CDTI, and to bring any residual entomological activities which might remsin afrer 2002 to a successful conclusion. The activities aimed at conholling morbidiÿ, detecting {rd overcoming recrudescence will then have to be integrated into the national multidise4se epidemiological surveillance systems. One of the major roles of OCP is to ensure a smoqth transfer of the residual activities of the Programme to the Participating Countries. To this eüd, OCP with the support of WHO/AFRO and other development organisations desirous to take pprt in these activities, provided technical, logistic and financial support to the countries during (he period under review. Transfer of residual activities 64. Training, raising of awareness of national authorities and of the general public, as well as support to operational research were the main activities carried out during the period un{cr consideration. For the implementation of this plaru OCP as usual, worked in close collaboradon with the V/HO Regional Office for Africa. Besides, contacts between OCP and the Participa{ng Countries continued; i) on the one hand, through the annual National Coordinators' mee{ng which was held from 2 to 4 Jtrne 1999 in Ouagadougou, and through missions and meetilgs organised in the counties, ii) and on the other hand, between OCP and WHO through fte Regional Office for Africa and the countries by the organisation of a taining workshop on fhe evaluation of epidemiological surveillance systems and the follow-up to the consultative mee{ng on multidisease epide,rniological surveillance held in 1998 in Ouagadougou from 3 to 7 May fod from 31 May to I fune, 1999 respectively. 65. From January to June 1999, some üsits were made on behalf of OCP by a speciali$ in public health to the Participating Counhies of the Programme except Sierra Leone and Gui{rca Bissau. The objective of this mission was to monitor the recommendations and discussions that the specialist in public health had had in1997-1998 with the health authorities of the Ministies of Health on the consolidation of the achievements of the Onchocerciasis control Programme pd other aspects related to multidisease surveillance. These visits were also aimed at stepping uplthe introduction of onchocerciasis in the major concerns of Ministries of Health in the preparadon or revision of national health policies of Participating Countries. Training 66. In order to guarantee the success of the transfer process, the Programme pursued its training policy by awarding fellowships to the nationals of Participating Countries for specialisation in fields related to onchocerciasis control activities. Thus the Programme awarded, between September 1998 and August 1999, 18 fellowships distributed by discipline as follows: health services management (4), Public health (5), Parasitology (4), Molecular biology (1) ana General administration (4). This figure brings to more than 505 the number of people who hpve benefited from OCP fellowships from 1974 to 1999. Most of the countries have submitted and discussed with oCP a training plan for 1998-2002 which is being implemented. 67. As in the past, OCP continues to put emphasis and preference on "on-the-job" and field training centred on the following main aspects of onchocerciasis control: entomology, the methodology of epidemiological evaluation, and ivermectin distribution. Special emphasis continues to be laid on the training of the National Coordinators and other national team workers JPCzO.2 Page 23 in the OCP methodology for the analysis and interpretation of active epidemiological surveillance data and on the initiation of the workers concerned to the use of computers. 68. Except for Guinea Bissau and Sierra Leone, all the other countries have trained and retrained agents on the methodology of epidemiological surveillance/evaluation during epidemiological surveys carried out in the villages during the past period. 278 technicianVnurses, paramedical agents and 16 physicians have undergone taininÿretraining in their respective areas of intervention. This gives a total of 294 agents who have received traininÿrefaining out of the target figure of 308 persons. The effective use of staff trained in the context of decentralized epidemiological surveillance/evaluation integrated into the national multidisease surveillance system is yet to be promoted in all the countries, for the purpose of consolidating the achievements made in each district, region or zone. \ryHO/ATRO SUPPORT TO OCP ACTTYITIES IN TIIE PARTICIPATING COIINTRIES (A contribution from the WHO Regional Office for Africa) 69. Once again, during the present reporting period, epidemiological surveillance and the effective integration of onchocerciasis control activities in the national health systems were the areas in which the WHO Regional Office for Africa centred most of its support to OCP. 70. Following the adoption, by the 48ü session of the regional committee of IVHO/AFRO, of the regional stategy of integrated epidemiological surveillance, the Regional Office dweloped a systematic evaluation protocol. In view of familiarising the national officers in charge of epidemiological surveillance in the OCP counüies and those of the \ü/est African epide,rniological block with the protocol and of determining the steps to be followed in conducting systematic evaluations of the national surveillance systems, a workshop was organized jointly by the Regional Office and the OCP from 3 to 7 May 1999 in Ouagadougou. The Regional Adviser for the control of the'bther topical diseaseÿ' and the Regional Adüser for emergencies and disaster contnol as well :§ some epidemiologists of the Regional Office in collaboration with the PET unit staffand the OCP laboratory officer actively participated in the preparation and the execution of this important workshop. 71. From 31 May to 1 June, the meeting on the follow-up of the 1998 consultative meeting on surveillance and integrated control of prioriÿ endemic diseases including onchocerciasis was held in Ouagadougou. The meeting made it possible to take stock of the progress made regarding the implementation of the recommendations of the meeting of April 1998 and to determine the steps required for integrating the surveillance of onchocerciasis control into the national health systems. The Regional Adviser for the control of the "other tropical diseases" and the Regional Adviser for emergencies and disaster control assisted in preparing and holding this meeting. Mention must be made of the conspicuous and very active participation in this meeting of the interim Director of the infectious diseases control Division of the WHO Regional Office for Africa. The epidemiologists of the West African epidemiological block also participated in this important meeting. 72. As a member of a committee set up during this meeting that took place at OCP on 1 June 1999 between the Director of the infectious diseases control Division of the WHO Regional Office for Africa and the Director of OCP, the Regional Adviser for the control of the "other tropical diseases" participated in the review of the terms of reference of the future centre for support to the surveillance and control of WHO priority endemic diseases that will become fully operational on the OCP premises in Ouagadougou before the end of the Programme in the year 2002. JPCZO.2 Page 24 73. The Offices of the WHO Representations in Africa continue to lend support to the national onchocerciasis control programmes in the OCP countries and contribute largely to the efforts undertaken by the Ministries of Health in order to integrate onchocerciasis contrpl activities in the national health systems. Mention must be made of the active participation of the WHO Representatives and Epidemiologists in the OCP countries in the workshop on the systematic evaluation of the national health systems and in the follow-up to the consultatiÿe meeting on the surveillance and integrated control of priority endemic diseases. 74. It must be emphasizdthatDr E. Samba, WHO Regional Director for A-frica, participatpd personally in the celebration of the 25ü anniversary of OCP during the week of 8 to l3 Februafy 1999, in Ouagadougou. The Regional Adviser for the control for the "other hopical diseases" ulas part of the committee that prepared this event and, he made a presentation on disease surveillarpe during one of the conferences that marked the 25ü anniversary of OCP. INTERDISCIPLINARY RESEARCH Insecticides 75. The major focus of this acüviÿ this year was mainly on improving the cost-effectivenqss of the formulations of bacillus thuren§ensrs H-14 which are regularly bio-tested with the orbifal shaker system as well as field trials in rivers at discharges above 15 m3/s. However, the pte samples of Vectobac@ 12AS continued to be systematically tested with the orbital shaker syst(rn so as to limit the risk of the delivery of defective batches. Three experimental samples of Vectobac@ delivered in Septanber 1998 in dnrms specially equipped with recording tlrermom{u were also evaluated with the orbital shaker. By the end of this year, the results of th$e experiments will be used by the Abbot company for a better determination of the role pf temperature in the process of deterioration of Vectobac l2AS. This could lead to the discovdry of the means to improve the stabiliÿ of the batches intended for use in the vector conüol activities carried out by the Programme under normal conditions. 76. The only chemical insecticide which were tried in rivers during the past three years is a formulation of temephos produced by the PF{YTAGR[ company. The operational performarlce of this formulated in a20%o emulsifiable concentrate (with acarry of 17 krn at the dose of 0.[5 litrdm3/s at a discharge of 905 m3/s and 29lrrîat the dose of 0.3 lite /m3ls at a discharge of 783 m3/s) remained below the performance usually observed with the formulation currently used by the Programme (14 to 28l<rn actual carry at the dose of 0.15 litre/m3ls at a discharge of about 400 m'ls; 77. The research work undertaken since 1998 in collaboration with the Institut Pasteur in Paris aimed at producing some formulation from the five recombinant strains of.B.r. H-14 did rfot meet expectations both in terms of their efficacy against blackfly larvae and the development of a simple, cost-effective technique for evaluating the efficacy of B.t. H-14 batches. The little probability of reaching these objectives by the end of the Programme, the complexity and discontinuity of this work initiated since 1992 do not allow for any confirmation that this work will possibly be pursued beyond its present stage. Vector identification 78. The research work currently in progress is aimed at further fine-tuning vector identification techniques, namely the morphological, morphometric, "HAD" (heteroduplex), and JPC}O.2 Page 25 cÿotaxonomic methods which remain the reference technique. The main objective is the strengthening of the capacity to analyse and interpret the ever increasing and complex entomo- parasitological data, especially those collected from the forest/savanna kansition zones which are characteized by : - The great variability of the entomological parameters (density and specific composition of the blackfly populations) in relation to i) the alternation of the seasons, ii) the greater or smaller magnitude of the blackfly population movements and iii) the generalized intensifi cation of the deforestation phenomenon; - The high incidence of human population movements and of entomological factors on the vectorial role of blacklly species as well as on the dynamics of the transmission of the forest and savanna strains of Onchercerca volvulus. 79. Due to this exkeme complexiÿ resulting from the play of entomological, parasitological, bioclimatic and dernographic factors, a transfer of the microsatellites technology had to be carried out between lRDiIVlontpellier and OCP in 1998 to make it possible to initiate some studies aimed at differentiating and comparing the S. damnosum s.l.populations of certain hydrological basins in Guinea and Mali. These studies will be extended to northern Sierra Leone if the securiÿ situation permits to allow for a confirmation of the data on blackfly population movements of great magnitude. Parasite identilication 80. In 1998, the molecular biology laboratory continued its activities in tbree main areas : i) operational support through the identification (using species and stain specific DNA probes), of the infective larvae of the parasite O. volvrlus in infective blackfly or in the parasite taken from humans, ii) improving cwrent knowledge about the pathogeniciÿ levels of the parasites collectd iii) training nationals in the identification of parasites through the DNA probes and in the identification of vectors through the heteroduplex and microsatellite techniques. This latter component of the activities of the laboratory is expected to have more and more prominence given the many requests being received. 81. In view of the results accumulated by the Programme both from ophthatmological and parasitological evaluations, it is more evident that the same correlation is not found within the Programme area between the parasite identification as O. volvulus of the savanna strain and the eye lesions observed in both the original and extension areas. These findings reinforce the hypothesis of the existence of one or several other strains of parasites within the O. volvulus species. Further studies are ongoing in collaboration with the Universiÿ of Alabama at Birmingham aimed at developing microsatellite markers for a more reliable identification of the populations of the savanna type of the parasite and to determine the different levels of phatogenicity. Six pairs of microsatellite markers are being evaluated and already suggest the possibility that they might allow for the identification of the savanna strain. 82- The technique which is aimed at determining the prevalence of infection from a pool screening of blackflies through the specific DNA probes oî O. volvulus is now operational throughout the Programme area. It is used in collaboration with the national teams and the riverine rural communities for: a) blackfly infectivity studies in post-larviciding areas, b) monitoring the transmission of O volvulus in the oncho-freed zones as well as those under ivermectin treatment. JPC2,O.2 Page 26 83. The molecular biology laboratory has, in collaboration with the PET Unit and the natiortal teams, carried out the training of trainers in the preparation and application of the DEC patch tOst in the Participating Countries of the Programme. The identification of the microfilariae collectod from patients during epidemiological evaluations also constituted a non-negligible part of the activities of the laboratory. Special entomological studies 84. The special measures taken in 1997 in an attempt to improve the entomological results on the tributaries of the Oti in Togo (Kara, Keran and Mô) were continued in 1998 and are stlll going on. These measures which basically consisted in i) intensiônng ground larviciding on the tributaries of the Oti in support to aerial larviciding, ii) extending the larviciding coverage On these tributaries down to their confluence with the Oti, and iii) treating the Oti for folr consecutive weeks shortly prior to the spate period, were reinforced this year. As a matter of fapt, because of the incidence of the harmattan winds on blackfly densities in this area, test-catchps were carried out during the same period on the Alibori, Mekrou and Pendjari in Benin to moniftr the phenomenon. Furthennore, in the framework of the reinforcement of ground larviciditrg during the dry season and before the rise in the water level, there was ground treaûnent of üe main Oti with Teknar@ for eight weeks instead of four. The results were promising and $e treatrnents will continue until the beginning of the spate period. 85. The'post-teatnent" tlpe of studies initiated from July to November 1998 on the Blæk Volt4 Mole and Küpawn in Ghana have shown infectiviÿ levels of 1.79o/æ at Akanyakrom ôn the Black Volta" 1.300/æ at Chiassa on the Mole and 2.96o/oo at Bieli§ong on the Kulpawtr. These relatively high levels, especially for areas under ivermectin teatnent, will be re-evaluatpd periodically in order to assess the trend of the transmission so that the measures take,n to contol onchocerciasis in these areas can be readjusted. On the Marahoué at Kongasso, the Black Volta at Tagadi Kohodio in Côte d'Ivoirg on one han{ and on the Kankélaba at Kankéla, th4 Banifing IV at KoninaBas,the Baoulé at Madina Diassa and at Nzana in Mali, on the other haüd, the results of the studies which were concluded in 1998 were satisfactory at all catching poiüts except Nzana where an infectiüÿ level above one infective female for 1000 parous flies (1.469§l) was recorded. Diagnostic tests for the surveillance of onchocerciasis 86. The classical method of skin snipping for parasitological diagnosis continues to be u§ed for epidemiological surveillance and evaluations. The validation of the Diethylcarbamazine (DEC) patch test as an alternative diagnostic method to the skin snip was continued during ttre period under review. The testing or operational applications of this test are in progress in the fiçld together with the training of peripheral level health staffto its use. These training sessions tdke place during the epidemiological surveys based on skin snipping. Research to improve the DEC patch test is under way to obtain a"prepacked' form of presentation to facilitate its utilisation in the field (see paragraph 104). The DEC patch test appears to be more acceptable to üre population compared to other tests. TPCaO.2 Page 27 Epidemiological modelling 87. A general review of the ONCHOSIM epidemiological model and its application to the integrated analysis of data was carried out early in the year alongside with the annual meeting on operational research strategies. Since 1988, the ONCHOSIM model has been actively used as a tool for analysis and assistance in decision making at OCP. After two other successful modelling attempts, it was decided to develop a complete model for the simulation of transmission that could be used to predict epidemiological trends during and after vector control operations and to predict control efficiency based on chemotherapy. A major part of the quantification and validation of the model was based on epidemiological and entomological data collected during the 1975-1991 period and on existing literature upto 1990. Ever sincà, the model has been used to design guidelines on the required duration of larviciding alone and that of vector control combined with ivermectin treatment. 88. Today, ten years after its development and during this period of gradual disengagement of OCP, there appears to be a need for a critical review of the model in the light of the quantiÿ of data accumulated and of the better knowledge acquired on the disease. A comparison of the predictions of the model with the epidemiological data recently collected would be interesting for two main reasons : a) It will help make the model more reliable as an evaluation and prediction tool that will assist in decision making now and after OCp. b) It will guarantee a more integrated analysis of data : the comparison of observed üends in relation to predictions will make it possible to identiÿ the irregularities in the control and will stimulate the joint analysis of the different types of (epidemiological, entomological, sociological, etc.) data. 89. In practical terms, the review of the ONCHOSIM model had then a two-pronged aim : a) Review ofthe ONCHOSM model : what does it look like ? How is it quantified? What can it predict and how reliable are its predictions in the light of the epidemiological data recently collected ? b) Adjustnent after discussing conclusions and recommendations in view of designing a work plan to improve ONCHOSIM. 90. The recommendations that were formulated during that review focus on three major points, i.e., (i) to analyse the Programme evaluation data in a more integrated and multidisciplinary manner by including the concrete simulation of the control operations on the basis of data provided by the vector control unit with priority given to the study of the impact of the combination of vector control and ivermectin treatrnent in the eastem and western extension areas; (ii) to reconsider the quantification of the parameters of the model related to the development of the parasite and to its dynamics in man and in the vector based on the knowledge of control history in the Programme area including anecdotal information and (iii) to apply ONCHOSIM for the simulation of zones where mixed populations of the vector live together, including forest vectors. These recommendations are being implemented in collaboration with the public health department of the Erasmus University of Rotterdam in The Netherlands. 9l . An application of this review was illustrated by the start of an integrated data analysis for a prediction of epidemiological trends at Bagan on the Mô and Kpesside on the Kara in Togo. On these two rivers, with the collaboration of entomologists of the Programme and based on the ItPC20.2 Page 28 results of Annual biting rates (ABR) and Annual Transmission Potential, it was reckoned that the larvicides had been only 39o efficient from 1977 to 1988 arfi75% efficient from 1989 to 1998 and could be maintained at this efficient level until 2002 onthe Mô. On the Kara, it was estimattd that larviciding was 40Yo efficient from 1977 to 1988 and 60% efficient from 1989 to 1998, aûd could be maintained at this efficient level until 2002. The surveys on migration conducted in 1997-1998 revealed that three out of 17 positive cases were migrants who arrived in the villa$e of Bagan in 1995 and 1996. There were no recent migrants among the positive cases of Kpesside; the five positive cases were considered as migrants who arrived in the village more than twer*y years ago. Assuming that the effect of ivermectin treatment would remain the same during t[re coming years and by maintaining an average coverage rate of at least65Yo, the predictions shqw that the epidemiological situation could be controlled at Bagan on the Mô before tbeyear 2002 but CDTI would be required at least until 2005 at Kpesside on the Kara in order to have $e situation under control. These analyses will be continued togetherwith reliable epidemiologidal surveys in order to determine the correct epidemiological situation at the end of the Programrfie and thus make decision-making guides available to the Participating Countries. Macrofil Chemotherapy Project Clinical studies 92. MacrofilÆilariases Research & Development (R&D) provided funding and ensured tSe haining for the Onchocerciasis Chemotherapy Research Centre (OCRC) in Ghana. New cliniqal biochemis§ equipment has been installed; resulting in higher capacity and faster processing pf clinical sarnples, for clinical trials. Currently at the OCRC several clinical studies are beifg conducted. They address the macrofilaricidal potential of ivermectin combined with oüer therapeutic agents when administered simultaneously. 93. IVhile preliminary evaluation of the results of study 27 (albetdazole * ivermecti{e: safety, efficiency and pharmacokinetic) do not sustain the use of this combination Es macrofilariçidal, the data relative to the blood drug levels is of cardinal relevance to the lymph$ic filariasis elimination Programme which is based on this combination. 94. Study No29 - (levamisolefivennectin and levamisoleralbendazole compared to levamisole alone). This study which started in May 1999 will evaluate the safety and efficacytof this combination on the O.volvulzs microfilaria, the adult parasite and the coincidental parasific infections. The study was initiated in May lggg.ltis conducted under full GCP standa.ds. T[e study 28 (levamisolerivermectin and levamisolql-albendazole) constituted the basis for study ?9. No prohibitive adverse reactions were detected when this combination was used. 95. Studies on Human pharmacokinetic studies of albendazolerivermectin combinations for the treatment of Lymphatic Filariasis (LF) in patients from high onchocerciasis prevalerice regions will expand the information available from Study 27. A similar study addressifrg albendazole and DEC is currently being conducted in India. Due to the fact that the f.F elimination programme could be viewed in some areas as a coordinated programme with ûre Onchocerciasis Control Programmes, it was recognised that additional clinical studies addressing the safety of ivermectin + albendazole be warranted. A study in Ghana and Zanzlbar is beihg implemented with the involvement of about 3000 patients. JPC2O.2 Page 29 Pre-clinical and research activities Moxidectin 96. The filaricidal activity of this registered animal health product was extensively studied by APOC/OCP/TDR sponsored investigators. In a recently conducted informal meeting with the manufacturer (Cyanamid) the following "unique selling points" for moxidectin were recognized: - Longer elimination half life and volume of distribution than ivermectin, offering the possibility of less frequent treatment - Sterilization or death of female wonns - Efficacy in ivermectin resistance 97. These properties together with an extensive pre-clinical (toxicological, technical) documentation support the possibility to develop moxidectin for onchocerciasis and for lymphatic filariasis. WHO approached Cyanamid (the commercial owner of the animal health product) with the purpose of initiating formal discussions aimed towards the clinical development of the product for human use. Development plans were prepared and are under consideration. If approved, clinical studies will be conducted at the OCRC. 98. During the APOC and OCP meeting on "Operational Research and Stategies" in March 1999, the scenarios for the use of new anti oncho drugs or drug combinations \ilere addressed. Future studies will include patients from the areas that have been difficult to conhol. Orytetracycline 99. This antibiotic was exarnined for its filaricidal potential in several animal models. In thejird, rifampicin at high doses caused a reduction in the number of microfilaria with no apparent effect on adult worms. On the other hand in the cattlelO. ochengi model it was observed that after I 3 IM injections (over a period of six months) of l0 mg/k g or 20 mÿkg the microfilaria are no longer detectable 12 months after the start of the teatnent. By nine months all adult lryorms u/ere dead and most nodules had disappeared. It is presumed that these effects are related to the presence in the filarial \ryonns of an endosymbiont (Wolbachia of the Rickexsiales farnily) sensible to the antibiotic. Based on these results antibiotics active against Rickettsia and available for clinical use will be screened in the jird model. If an effective antibiotic compatible with the use in humans (including children and pregnant women) is identified, it should be considered for further evaluation in the cattle model or evaluated in Onchocerca patients. EAC did not endorse the initiation of human clinical trials until such animal data is available. Research leads 100. Over 2000 compounds acquired from different sources (Walter Reed Army Institute of Research, Glaxo Welcome, Research and Consulting Company Ltd. and the Cancer Research Institute at Aizona State University) were tested in the Jird / B. phangi animal model. From these, six "hits" were identified and are currently being evaluated further to determine if they could constitute leads. Previously, PD 105666 as well as other entities were reported as potential leads; however after additional evaluation it was concluded that these compounds did not fulfil the criteria for further testing in cattle. JPC}A.2 Page 30 101. The Macrofil/Filariasis R&D brought up for consideration to the CRDÆRD Drug Discovery Research Steering Committee (26 April 1999) the need to implement in vitro "whole parasite" screening methods within the current flow chart. In vitro O. ochengi or volvulus adglt woûn assay, O. lienalis, volvulus microfilaricidal assay or an in vitro T. colubrifurmls assay were recommended. These assays would be of relevance not only for "connecting " the in vitfo molecular target screens that may become available (see below) with the whole animal screens but they could also shorten the compound evaluation time and associated costs. "New molecular targets for filariases" initiative 102. Under the auspices of APOC, OCP and TDR a meeting addressing the need to identifi new molecular targets for filariasis drug discovery was held in Geneva from 2 to 3 Novemler 1998.20 investigators from different disciplines attempted to define from the numerous targsts that exist in the filaria the ones that could fulfil the objectives of the filariases drug discovefiy programme. This meeting also addressed the support infrastructure that is required to identiÿ drd adapt the new targets to a drug discovery programme. The conclusions of this meeting wdre recently published in the magazine "Parasitology Todaÿ'. As a direct result of this meeting tpn proposals of high qualiÿ were submitted for consideration to the CRDÆRD Drug Discovüy Research Steering Committee (26-30 April 1999). Detection of ivermectin resistance 103. The MacrofilÆilariases R&D-supported work on the genetic basis and mechanismspf ivermectin resistance in parasitic nematodes, resulted in the identification of three resista{ce mechanisms, e.g.: changes in the dynein of amphids, changes in the level ofP-glycoprotein whilch transports drugs across biological membranes and molecular changes in the ivermectin recep(or (a GABA-controlled chloride channel). Progress in this area was recently reviewed by a teamlof basic and applied field research scientists and workers in Ouagadougou (13-L4 June 1999). It qas recommended that clinical researchers §oguchi Memorial krstitute and OCRC) should examfre patients from areas where ivermectin is not providing the expected results, and alongside this, Sre basic science investigators should engage in a concerted./coordinated effort to focus on üÊ development of an ivermectin resistance detection tool based on available genetic infonnatiÇn. Combination of these two teams will constitute a Product Development Team. The OÇP laboratory will be the reference centre for parasite material collection and distribution for ttre above prograûrme. Optimization of the DEC "Patch test" 104. The possibility of developing a standardized DEC "Patch test" by a commerdal manufacturer was explored. Six companies (Alza Pharmaceuticals, Cygnus, Inc., Lohmalrr Therapy-System, Elan, Shwartz Pharma and 3M MEDICA) with expertise in tansdermal delivüry systems for drugs were contacted. The current technology of the DEC "Patch test" (including ltre current costs) was described to these companies. Responses indicating interest from all of thçm were received. Several have been selected for further discussions. Administration and management 105. 'Within the recent "restructuring" of WHO, MacrofiLtrilariases R&D activities fall within the Drug Discovery Research and the Product Development components of the Product Reseaûch and Development (PRD) group. This group is part of the Communicable Disease Research rytd Development (including TDR) department (CRD) which is part of the cluster of Communicable Diseases (CDS). Macrofil/ Filariases R&D activities are coordinated by an expert, through his JPCaO.2 Page 3l direct participation in the Drug Discovery Research Group and the Product Research and Development R&D Committee. Following the recommendations from the EAC.19, an EAC member was nominated a voting member of the CRD/PRD Drug Discovery Research Steering Committee. This nomination provides a direct EAC representation in the decision-making process for the filariases drug discovery and development process. ADMINISTRATION AI\D SUPPORT SERVICES Objectives, organization and operation of services 106. The function of the Administration and Finance unit is to support the activities of the OCP operational, technical and scientific units. It manages the infraskucture of the Programme as well as the human, financial and material resources taking budget constraints into consideration. It is also in charge of managing documentation. It offers services in terms of purchase, finance and staff management, transport and communication as well as general administration. During the period under review, the unit lent support in the following fields : i) Training on the utilization of 'Word, Excel and PowerPoint for all the OCP/APOC secretaries and administrative assistants. ii) Retraining of mechanics at the Toyota Dealer's. iii) Training of radio technicians by a Codan technician. irr) Training seminar for the heads of garage and warehouse managers of the national teams. v) Computer training for managerial officers. vi) Sensitization and retraining campaign on road safeÿ. vii) Organization on 16 and 17 July 1999, in two groups, of a management seminar for the Programme's General Services and SSA staffin order to refine their managerial skills. 107. Other seminars will be organized in the future. A programme will be developed at a later stage to enable the oCP and APOC stafibenefit from these ÿpes of haining. Administrative costs 108. The administrative costs of the Programme are defined as those related to the budget headings conceming the Director's Office, the Administration and support services in Ouagadougou and in Geneva. Table 4 below shows the expenditures made from 1994 to 1998 in the context of this support as well as the percentage that they represent compared to the overall cost of the Programme. JPC2O.2 Page 32 Table 4. Cost of Programme administration fiom 1994 to 1998 ( in US$) (767,161)*: expenditurerelatedtotheDirector'sOffice(US$ 1,411,554)adjustedforcomparisq,n needs after subtracting US$ 529,393 spent for training and US$ 115,000 spent for a seniôr technician of the PET unit, posted for 1996 only. 109. The rate of administration expenditure compared to total expenditure that was 13.221/0 in 1997 increased to l5.03Yo in 1998. This increase, in relative value, is accounted for by a significant 78.49% decrease in the overall expenditure ofthe Programme between 1997 and 1908 and by a 7.37Yo decrease in adminisfiative costs between 1997 and 1998. 110. Small administrative costs could still be incuned from now to the end of the Programrgc but they should not exceed a critical threshold that will jeopardize the smooth running of tte latter. Therefore the relative rates of administrative costs should be expected to increase towarrfls the end of the Programme in relation to its total cost. Arrangements are still being made to f,lI vacant positions only with special short duration job contracts that are less costly than the WIiO contracts. Budget and linance 111. In 1998, the US dollar exchange rate increased from CFA 599 in January to CFA 614 ûn April and dropped to CFA 552 inNovember. The average exchange rate for 1998 was CFA 593. During the first semester of 1999, the average exchange rate was CFA 598, with a maximum of CFA F 626 in June. Therefore, the 1999 budget was prepared on the basis of an exchange rate of US$1:CFA550. ll2. Due to above mentioned fluctuations and trends, the 2000 budget was carefully preparpd based on an exchange rate of US$ 1 : CFA 580. 113. The f,rnance section is managing 14 bank accounts distributed in the 11 participatilrg countries of the Programme and tallies them every month with the statements submitted by the 1l national teams and by the eastern and western zones. The internal auditors' report on the accounts managed by the section is being drafted but, a priori, the standards and good practicss seem to have been respected. Unit 1994 1995 1996 1997 1998 Director's Office 656,831 718,500 767.161* 763.847 879,727 Administration and Support Services Ouagadougou 1,842,485 r.9t0.737 1,842,570 1,715,580 1,345,4i11 Support Services Geneva 451,274 405,480 348,451 311,467 360,068 0verall Administration costs 2,950,590 3rû34r717 2,958,182 2,790,894 2r585,2ffi Total of Programme expendifure 23,150,289 21,614,710 21,792,694 21,110,457 17,206,2?.1 o Administrative costs 12,750 l4ro4o 13,57o t3,22Vo 15,o3oA JPCaO.2 Page 33 114. As in the past, the Budget and Finance Division took care of all the accounting operations of the APOC progralnme. These were payments, transfer of funds for the various projects, data recording and monitoring of budget execution. 115. In November 1998, the Division benefited from the installation of a new RO/AFI computer system in view of harmonizing the accounts with those of the WHO headquarters in Geneva. This called for a three week adequate and accelerated training of all the staff of the Division in order to familiarize them with the new system. This training is currently going on in- house. Personnel I16. During the period underreview, the entomological sectors of Bouaké comprising the sub- sectors of Bouaké and Odienne were closed down. The entomological sub-sectors of Kara, Atakpamé, Bohicon, Parakou and Hohoe were converted into operational bases on 1 June 1999 (see paragraph26). L17. V/ith these closures, the contracts of 28 employees under WHO status and 40 agents under SSA contact were terminated on 31 December 1998. All contract termination emoluments were paid within reasonable time limits. 118. During the period under reüew, the statutes for the National Professional Officer (I.IPO) was introduced in the Programme staff. The ones of Special Service Agreement (SSA) was also used to recruit professionals. The Personnel Diüsion has been increasingly asked to proceed to temporary recruiünent in order to fill the vacancies resulting from contract terminations. 119. The Division continued to provide assistance to APOC staffmanagement in terms of defining positions, recruiting agents as well as classification of positions agreed upon. Supplies and services 120. This division is in charge ofpurchasing goods and services, managing stocks and selling offthe Programme's obsolete or surplus items. Furthermore it is in charge of office management, arranging travel by air and üsas, receiving and distributing mail, fax and telephone. It also supervises the securiÿ and cleaning services provided by extemal enterprises. 121. This year, a large number of meetings were held in the OCP conference room. This Division contributed the logistic and administrative support required for the smooth running of these meetings. 122. The Supplies Division placed, on behalf of the two OCP and APOC progftlrnmes,579 purchase orders for 7 46 items purchased during the period under review, amounting to a total of US$ 1,230,000; this was handled directly with the Participating Countries. Similarly, 245 purchase orders amounting to US$ 4,858,000 were processed by the rù/HO central purchase division in Geneva. tPC20.2 Page 34 Transport and communications 123. On behalf of the whole Programme area, this Division is in charge of managing the vehicle fleet which includes 248 vehicles, the telecommunications network which comprises 40 radio/teleprinter stations, ftve spare parts warehouses as well as five fuel tanks of an overpll capacity of 59,250 litres. Also during this year, the Division was in charge of the ongoifig campaign to raise drivers' awareness which had made it possible to reduce road accident rates [y 72%owithin four years. 124. The vehicle fleet reduction policy is being implemented based on the reduction of veclor control activities and on the take over of onchocerciasis control activities by the countries. 125. Composed of 87%o vehicles suitable for all road conditions, the fleet has been 90olo operational. Three quarters of the vehicles were made available to the national teams for VGU and PET activities. Following the withdrawal of 36 worn-out vehicles from circulation and üle transfer of four vehicles to the Participating Countries, the fleet was reducedby 14% as comparbd to the previous year. 126. During tiie period under reüew, emphasis was laid on the management of the spare p{ts stocks of the central warehouse in Ouagadougou which comprises no less than 5081 differrgnt items. 127. As part of reorganizing the garages and improving the working conditions of workshpp staff, two maintenance workshops v/ere bült at Hohoe in Ghana and Parakou in Benin. 128. With respect to telecommunications, all the capital cities of the counüies covered bV ü* Programme were equipped with radio except Guinea Bissaq thus raising the radio networklb 45 stations 129. Furthermore, in four major bases of the Programme, the Radio communication systçm was modenrised by purchasing five new Codan radios linked to a computer in order to bri{ge with Internet, using the Lotus cc: Mail software. The V/orld Food Programme (WFP) which u$es the same tlpe of system in the sub-region provided assistance in configuration and installatipn at the Programme headquarters in Ouagadougou. Two of these radios are currently being instailed in Odienne and Kara. LIAIS ON, INFORMATION AI\D VALORIZATI ON ACTI\TITIES Introduction 130. At the beginning of this year 1999, the West African Onchocerciasis Conkol Prograrnlne witnessed a very important event in its evolution. The OCP celebrated its 25 years of activitips. Thus, from 8 to 13 February 1999, a whole week was devoted to this celebration. In üre Participating Countries, the organisation and dates of this jubilee \r/ere left at the discretion of lhe couttries and according to opportunities. The long series of celebrations of this silver jubilee Will end in October in Geneva, Switzerland, with the inauguration of the ONCHOCERCIASIS stahlte. With the World Health Organization 131. The Onchocerciasis Control Programme has maintained and developed a regular and dynamic collaboration with WHO : JPC}O.2 Page 35 - From 31 August to 4 September 1998 the Programme Director attended a meeting of the Regional Committee in Harare, Zimbabwe. - The Coordinator of the Director's Office and the Chairperson of the Staff Association attended the Global WHO Staff Management Meeting in early October 1998, in Geneva, Switzerland. - From 25 lanuary to 3 February 1998 the Programme Director attended the 103d session of the Executive Committee in Geneva. - The training on epidemiological surveillance orgarized by WHO-AFRO and WHO Headquarters in collaboration with OCP was held in Ouagadougou from 3 to 7 N,day 1999 at the OCP headquarters. - From 29 IV4.ay to 12 June 1999 the Principal Administration Officer and the interim Chairperson of the Association represented OCP and APOC in Genev4 at meetings held at the headquarters on administrative management, and at the second Global WHO Staff Management Meeting. - From 17 to 26 May 1999, the Programme Management attended the 52od WHO General Assembly and the Symposium on the 25 years of OCP, both held in Genev4 Switzerland. - From3l Mayto I June 1999theOCPheadquartershostedaworkshopjointlyorganisedby \ /HO-AFRO on the surveillance and control of priority diseases including onchocerciasis. - From 22 to 24 June 1999, the Programme Director, Dr Yankum Koffi Dadzre attended the CDS Cluster meeting with partners and the IBC-}2TDR" in Geneva, Switzerland. Due for retirement at the e,nd of the month, he proceeded to his debriefing during this mission at the WHO Headquarters in Geneva. \ilith the Participating Countries 132. From I to 2 March 1999, the hydrobiologists of the Participating Countries held their annual meeting in Lomé, Togo where, ajoint meeting of these hydrobiologists and the Ecological Group was also held on 3 March. From 4 to 5 March, still in Lomé, the Ecological Group held its twentieth session. OCP, represented by a team of the VCU unit, actively participated in all these activities. 133. The National Coordinators of the Onchocerciasis Control Programme and the Epidemiologists at the WHO representations in the eleven Participating Countries held their annual meeting from2 to 4 June 1999 at the OCP headquarters in Ouagadougou. \ilith the statutory structures of OCP and APOC 134. The Committee of Sponsoring Agencies (CSA) for OCP and APOC and other members met at the following dates and venues, with the participation of the Programme Management: - The 81" session of the Committee of Sponsoring Agencies (CSA) of OCP-APOC was held in New York, USA from I to 2 October 1998. - The 82'd session of the CSA was held in Accra, Ghana on 6 December 1998. JPCZO.2 Page 36 - From 7 to 9 December 1998 the Joint Prografilme Committee met also in Accra and, the Joint Action Forum met from 9 to 1l of the same month. - From 4 to 5 March 1999, the Ecological Group held its 20ü session in Lomé, Togo. - The 83'd session of the CSA was held in V/ashington, USA from29 to 30 April 1999. The Programme Management was able to consult with the World Bank Officials. - From 7 to 11 June, the 20ù session of the Experts Advisory Committee (EAC) was held in Ouagadougou, Burkina Faso at the OCP headquarters. - The 84ù session of the CSA was held in London, UK from 15 to 16 July 1999. With the Donors 135. The Programme Director, in view of mobilizing funds for the two OCP and APOC Programmes, üsited Sweden,Italy, Portugal and Germany from 16 to 26 November 1998, Paris from 14 to 17 February, and Geneva, Paris and Brussels from late March to 4 April 1999. \üith the Evergreen Helicopter Company 136. On 14 September 1998 a consultation meeting, between OCP and the EvergreÇn Helicopter Company which is in charge of aerial larviciding, was held in Ouagadougou, Burki4a Faso. A second meeting was held in Ouagadougou again at the OCP headquarters in order to review the contract betwee,n OCP and Evergreen Helicopter. With the Scientilic community 137. The Programme was actively represented at various fora with the scientific communiÿ: - The Programme Director attended the Partners' Forum for the elimination of lyrrphadc filariasis, held in Geneva from 21 October to I November 1999. - The Director attended the meeting of the Mectizan Experts Committee, held in Atlant4 USA fromlto9November. - The Programme Director attended a workshop on effective and efficient dishibution of drugs against lymphatic filariasis, held at Annecy, France, from24 to 26 February 1999- - VCU represented OCP at an intemational workshop on climate and health held in Bamako, Mali, from 27 Marchto 3 April. - The Programme Director and a strong scientific delegation of OCP and APOC attended the 20ü African Congress on Health Sciences, held in Accra, Ghana from 17 to 24 Apnl. - Macrofil scientists, from the WHO Headquarters and from OCP attended the meeting on resistance to ivermectin, held at the OCP in Ouagadougou from 13 to 14 June. JPCZO.2 Page 37 - The PET Unit Head attended a workshop on the development of a manual for programme leaders and on process indicators for the elimination of lymphatic filariasis, held in Atlanta Georgia, USA from 7 to 9 July 1999, at the Centre for Disease Conhol and Prevention (CDC). Celebration of the 25 years of OCP 138. The year 1999 marks the 25 years of the Onchocerciasis Control Programme (OCP) in West Africa. This anniversary ofïered the Programme a golden opportunity to fully communicate with the public at large. Most of the activities, intended to promote the Programme and make it visible in the 11 countries and beyond, mobilized all the sensitization, promotion and information networks- This momentum was at its height from 8 to 13 February 1999 with the celebration of the25 years of OCP at the Programme headquarters. 139. All the Participating Countries, the populations, the representatives of the countries and donor institutions, the WHO-AFRO Regional Director, the Co-sponsoring Agencies,IRD, the V/HO country representatives, the OCP national coordinators and, all those who, close or far, endeavoured and still endeavour to ensure a smooth running of the Programme were informed and invited to participate in this big feast. 140. An awareness campaign was conducted in all the Participating Countries with the major purpose of better defining the activities to be undertaken, by involving a maximum of parbrers. The OCP received from its many guests and partrers proposals and suggestions on how best to celebrate the25 years. Thus the OCP was able to use specific examples to demonsûate that, by involving everyone, and with determination, it is possible to accelerate health developme,nt in the countries. l4l. The celebration of the 25 years v/as an opportuniÿ to mobilize the local communities, the Govenrments and parbrers in favour of continuing surveillance and onchocerciasis contol beyond the year 2002 and ensuring the promotion of OCP achievements. Activities planned within the context of the 25e Anniversary of OCp 142. The following major activities were conducted : - Opendoordays; - Mention of the 25ù Anniversary by the WHO Director-General during the presentation of her report to the Executive Council and to the World Assembly of 1999; - Establishment and inauguration of an Onchocerciasis Statute in Ouagadougou, Burkina Faso; - Drama and music show by Amity Meria, Onyeka, Owenu and Prospère Kompaore in Ouagadougou; - Sports activities; - Photo exhibition and multimedia animation; - Conferences on integrated surveillance of parasitic diseases including onchocerciasis and on the socioeconomic development of the oncho-fieed zones. JPCZO.2 Page 38 143. All the activities were conducted in collaboration with the Ministry of Health, the Ministry of Agriculture, the World Bank, FAO, WHO and UNDP. The 'ü/HO Headquarters provided assistance in terms of media coverage by drafting and editing a press release, designiûg a video trailer that was broadcast on 43 TV stations and, by providing OCP with a commuricatiqn specialist to cover the activities during the celebration week. The United Nations Information Centre GINIC) provided assistance to OCP on this occasion by facilitating contacts wi[h correspondents of the international press and, by programming TV broadcasts for the UN Tttÿ channel and by enlisting the film "Les yeux de l'espoir" (The Eyes of Hope) to be shown at the African international movie and television market during the FESpACO. lM. The organization of the celebration of the 25 years in the western and eastem areas as wgll as in the Participating Countries with the exception of Guinea Bissau and Sierra Leone w{s effective. 145. The following information and promotional supports were used during the celebration: - Articles, stickers, tee-shirts, caps, posters, pi[s, cassettes, leaflets and radio adverts designçd for the anniversary. - A magazine on the history and achievements of the Programme is being finalized. - A poster representing the content of the magazine was prepared. Another poster containi{g the congratulation messages from Heads of State of the Participating Countries and from tüe representatives of the OCP sponsoring agencies was presented during the onchocerciasls memorial day in Ouagadougou. - A CD-ROM of more than 300 images, illustrating the activities of OCP over the 25 years fs also being finalized. 146. The celebration of the OCP 25ü Anniversary at the OCP sites and in the Participatiug Countries provided an opportuniÿ to promote reflection on, and advocacy of OCP achievement§. The information and sensitization aspect was the driüng force of all the events at both OCP headquarters and the sites. Special mention must be made of some outstanding guests who weie present at the oCP headquarters during the celebration of the 25 years: - Several Ministers of Health of the OCCGE member countries, members of Government and of the Diplomatic Corps (Germany, Belgium, Switzerland) and Heads of Agencies of the United Nations System in Burkina Faso; - Mr Bruce BENTON from the World Bank; - Mr Marwan ALGHANEM from the Kuwait Fund; - Mr Pierre THENARD, Technical Adviser to the French Minister with special responsibility for Cooperation and French-speaking communities; - Dr Phillipon from IRD (ex-ORSTOM) who came to Ouagadougou especially for the 25Ë anniversary. 147 . The media largely covered these events. Six joumalists of the Intemational Press (RFI, Africa N"1, BBC, Reuters, Associated Press, TV5) covered the celebration. JPCaO.2 Page 39 Valorization and promotion work 148. The OCP assists in coordinating the agencies of the United Nations System in sub- committees such as Administration, Emergencies, Communication and Programmes. In the sub- committee on Communication, the Administrator in charge of communication organizes and maintains contact with the media, the international press correspondents, the UN Channel and Frequency, the political authorities, the representatives of the UN agencies and of international institutions. 149. On 2l June 1999, Dr Kofi Yankum Dadzie, Director of the Onchocerciasis Control Programme in V/est Africa (OCP), was decorated as Knight of the National Order of Burkina Faso by presidential decree N'99-230-1999. The Minister of Health of Burkina Faso, on behalf of all the OCP Participating Countries awarded this distinction to the Programme Director for the services rendered by OCP and WHO through his person and the whole OCP staff. All the representatives of the UN Agencies and the Ambassador of Ghana in Burkina Faso were present at this decoration ceremony. Before then, on Saturday 19 June, Dr Dadzie had paid a courtesy call to the Emperor of the Mossi in Ouagadougou. This visit enabled the Moro Naba and his Ministers to obtain reliable information on the future activities of OCP with respect to the devolution of OCP activities to the Participating Countries and to the WHO-AFRO projects and, on the establishment of a support centre for integrated epidemiological multidisease surveillance at the OCP headquarters. Documentary collection Periodicals 150. Numbering 126 in 1998, there are presently 136 titles. Subscriptions mainly concern selected periodicals on health in the hopical environment. The titles received are periodically placed in detail in the Summary Bulletin. Scientific books I 5l . Several books were obtained either by order or by donation from partrrer institutions. To date, the collection includes 17933 general documents and books. The collection has seen an increase in the number of its audio-visual documents which now include 4103 slides, 160 video cassettes and 28 audio cassettes. The subscriptions to the CAB Health data banks and other free subscriptions to the CD-ROMs and electronic products of WHO and partner institutions were maintained. The grey literature known as 'OCP technical documents and archives' is currently the subject of an important project. This project aims at proüding electronic support: (CD ROM and CANOFILE System), bibliographic references and plain text. This documentation compiled over the 25 years of OCP's existence constitutes the collective memory of the latter. 152. During the period under review, the Centre was visited by a large number of external users, especially during the memorial week of the 25ù anniversary of OCP (8-13 February 1999). Thus it received 2664 intemal and external users including students from the health institutions, experts and consultants from NGOs and from medical research institutions. It recorded 1772 loans, photocopied94 468 pages, sent out 135 OCP and APOC video cassettes and, distributed about 4800 oCP and APoc leaflets, 6000 brochures and 2200 oCP posters. Institutional relationships JPCZO.2 Page 40 153. The documentation centre maintains good relationships with many documentation units of research institutions in Burkina Faso. Thus, in addition to its interlibrary loaning activiÿ, the Centre participates in projects for the establishment of national documentary networks. Mentiqn can be made of the "Health Network" which comprises WHO documentation centres aûd libraries, the Health Institute, Faculty of Health Sciences, the National Malaria Control Cent{e, the SYFED Centre, the OCCGE of IRD and OCP/APOC. Mention can also be made of tfre "African Index Medicus" project which comprises the members of the Association for Heallh Information and Libraries in Africa (AHILA). The WHO-AFRO and WHO libraries in Geneÿa favourably responded to the many requests for documents (articles from periodicals, books ar[d technical reports). Meetings and seminars 154. From 13 to 19 September 1998, the head of the Documentation Centre attended the 6ü Congress of the Association for Health Information and Libraries in Africa (AHILA), held ln Lusak4 Zar;ùria. During the Congress, whose theme was '?rofessional training of heaüh librarians" she made a presentation on continuing training of health science librarians: tSe example ofmanagement and marketing in the management of information and communicatiQn systems. From lZto 16 October 1998, she attended the meeting of Library Officials of the WIIO Regions, held in Geneva. From 5 to 7 January 1999, she attended the Colloquium on tte Management and Marketing of Services and Information Systems jointly held on the OQP premises in Ouagadougou by the PanAfrican Development Institute in West Africa - Sahpl (IPD/AOS) and by the Library and Information Science School of the Montreal University, Canada. During this colloquium, the results of work on the theme: "Marketing Plan for t$e Documentation Centre of the OCP/APOC Programmes, 1998-2000" were presented. Internal OCP meetings 155. The following major internal meetings were organizedby the Programme : - From 26 to 30 October, meeting of the operational zones of the vector control unit in Bouaké, (Côte d'Ivoire). - From 2to 6 November 1999, the PET Unit organized a workshop in Bouaké on data analysis. From 9 to 11 March 1999, PET and VCU held a meeting on "Operational research strategies" in Ouagadougou, Burkina Faso. From 12 to 15 May, the meeting on entomological research and insecticides was held in Kara, Togo. From 16 to l7 June 1999, a training seminar on management was organized for the OCP staff. a