Report of participating countries on the implementation of transfered activities: Bénin, Burkina Faso, Ghana, Guinea, Mali, Niger, Sierra Leone and Togo

Onchocerciasis Control Programme in West Africa Programme de Lutte contre I'onchocercose en Afrique de I'ouest JOINT PROGRAMME COMMITTEE Office of the Chairman JOINT PROGRAMME COMMITTEE Twenfy-third session Ouagadougou. 4-6 December 2002 JPC . CCP COMITE CONJOINT DU PROGRAMME Bureau du Pr6sident JPC23.8 ORIGINAL: FRENCH November 2002 Item l0 of the Provisional Aeenda REPORTS OF PARTICIPATING COUNTRIES ON THE IMPLEMENTATION OF ACTIVITIES TRANSFERRED - BENIN - BURKINA FASO - GHANA - GUINEA - MALI - NIGER - SIERRA LEONE - TOGO I I I IBENIN The Community-directed treatment with ivermectin (CDTI) continued in eligible villages. The partial results show a total of 2578 vlllages treated out of 3184 planned, that is an average coverage of 80.520/". The geographic coverage varies from 75 to 85o/o in the concemed areas. The average therapeutic coverage rs75o/o (or I 116 422 people treated out of 1 485 414 registered); it varies from 72 to 82%o. The monitoring and supervision of ivetmectin distribution activities were ensured primarily by the nurses of the communal health facilities. This year, 60 villages were evaluated in 11 basins. Out of 10 849 people examined, only 272 were positive. Prevalence varied from 0 to 39.3Yo and community microfilarial load(CMFL) from 0 to 4.78 mfls. The highest prevalences were recorded at Agonlin-Pahou (26%) on the Ou6m6; Koupongou (39.3%) and Tchafarga (30.5%) on the Oti/Pendjari. A Committee in charge of Multidisease Surveillance and Control was created within the Ministry of Health. The frequent reassignment of nurses from their current posts to others outside the areas under treatment, the delay in transmission of reports to the national coordination and the absence of payment of premiums to community distributors by the boards of management of the health centres still constitute some problems to be solved in some communes. BURIflNA FASO Onchocerciasis control activities are carried out along with activities related to other diseases within the framework of the National Programme of Devolution under the Directorate of Preventive Medicine in charge of multidisease surveillance and control of all epidemo-endemic diseases. [n2002,21 sentinel villages were evaluated. Prevalences varied from 0.30 to 6.70o/o in 20 villages. Only the village of Sakora showed a prevalence of 39.60/o with a microfilarial load of 2.07mf/s and a null incidence. Most of the positive individuals were migrants. The CDTI carried out in 8 districts made it possible to cover l0O % of the villages (i.e. 319 out of 319). Therapeutic coverage varied from72 to 88% with an average of 78% (136 214 people treated out of 17 4 203 registered). More than 500 000 tablets were used out of the 971 500 ordered directly from the Mectizan Donation Programme (MDp). A population of 561 362 people in four of the 8 districts benefited during the 2''d round of treatment from the supplement of albendazole distributed within the framework of the Lymphatic Filariasis Elimination Programme. Post-larviciding studies on the Dienkoa and studies on the impact of ivermectin treatment on transmission in the Bougouriba basin were carried out by the national team. The NGO HKI supported the implementation of IEC activities in the enden-ric areas. The govemnlent, OCP, the WHO Representation in Burkina Faso and HKI remain the principal sources of funding of activities. 2GHANA The efforts of integration of onchocerciasis control activities advocated by the health system reform continued in the districts. Ivermectin was ordered directly frorn the Mectizan Donation Programme and taken delivery by the central store of the Ministry of Health with the assistance of UNICEF. From tlie partial results received from 2 regions out of 9 implementing CDTI, 335 villages were covered out of 455 planned. Overall , ZOG 7gB people out of I 970 502 registered were treated, that is 10.5% average coverage. The number of tablets used amounted to 466 388. The epidemiological evaluation that was planned in 13 river basins could not be carried out owing to the fact that some communities had been treated with ivermectin in connectiou with the Lymphatic Filariasis (LF) Elimination Programme, to the implementation of other health activities and to the absence of logistical means proper to the country. Some entomological surveillance activities were undertaken in the Pru and Asukawkaw basins. Support from the NGO HKI also made it possible to undertake some IEC activities among the endemic communities. The lack of coordination of onchocerciasis control activities with those of the LF Elirnination Programme, the delay in the transmission of CDTI data, inadequate monitoring/supen ision, the absence of motivation of community distributors constitute the major problems to be solved. GUINEA The transfer and integration of onchocerciasis control residual activities in the national health system coutinued. From January to September 2002, out of 7742 villages planned for treatment, 7623 were covered (that is 98%) with 2 075 953 people treated out of 2 548 423 registered (i.e. 8l%). The geographic coverage varied from 95 to IOO% whereas the tlrerapeutic coverage fluctuated between 74 and 85%. Overall, 5 608 080 tablets were used. The delay in the supply of ivemrectin and the rather difficult accessibility of some villages somewhat disturbed the schedule of the distribution. The supervision and monitoring of CDTI carried out on a stream in 122 health centres and 366 villages made it possible to correct some of the shortcomings. With the financial support of the government of Guinea, OCP and the NGO OpC, 212 health technicians and 60 doctors were trained in the use of the training module for community distributors. During this year, 114 villages in 7 basins were evaluated. Out of lO 2l I people examined, 397 were positive, tliat is 03.8%. Prevalences varied from 0 to 12o/o. Six points identified in 5 basins were the subject of entomological surveillance. The nou involvetuent of some of the authorities, the inadequate supervision and monitoriug of CDTI by the districts, blackfly nuisance in the basins where larviciding has stopped constitute some cortstraints to tlie implementation of activities to rvhiclt the national Jteam is striving to find solutions tluough IEC, staff retraining and the intitution of more frequent supervisions. CDTI, epidemiological and entomological surveillance, as well as ground larviciding will be the main activities in 2003. MALI This year a total of 106 villages were evaluated in 12 basins. Prevalence was almost nil in most of the basins. It varied from 0 to 8.4oh with a community microfilarial load ranging between 0 and 0.54. The trained regional teams received a supply of epidemiological evaluation material and equipment. Regarding the entomological situation, 4 monitoring points on the Niger showed furnual Transmission Potentials (ATPs) below 100. CDTI activities continued in the eligible villages. Overall, 3468 villages out of 3508 planned for treatment were covered, that is 98.85%. The geographic coverage varied from 8l to 100%. The therapeutic coverage varied from 73 to 84o/o with an average of 82yo (1 508 575 people treated out of 1 834 411 registered). Out of 5 157 500 tablets ordered, 4 083 751 were used. The periodic meetings at district and regional levels, as well as the national review meeting made it possible to correct and reinforce the implementation of CDTI. Onchocerciasis control activities were financed by the government of Mali, OCp, WHO/AFRO and some NGOs, especially SSI, OPC and HKI. The instability of community distributors, the delay in the transmission of reports, the insufficiency of supervision by the regions and districts, the refusal of some comrnunities to submit to skin snipping, and blackfly nuisance are some of the constraints the programme is faced with. A Plan of action for the year 2003 which has already been elaborated will make it possible to ensure the continuity of activities during the post-oCp period. NIGER Monitoring of the disease is the main activity carried out in Niger in order to ensure an early detection of any possible recrudescence. In2OO2,12 villages were evaluated. Out of a total of 1517 people examined,2were found positive. Prevalences ranged frorn 0 to 1.5%o. Community microfilarial loads were practically nil. Absenteeism is especially n-rarked in the old villages (53.94 o%) where the population is becoming increasingly reticent to submitting to skin snipping. With regard to treatment of the detected cases, 87 onchocercal patients are regularly treated in 26 villages. With the support of HKI, IEC meetirlgs were organized in the endernic villages with the active participation of the teachers, village healtli workers (ASV), health comrnunicators and the mass media. Monitoring and supervision activities were also carriecl out by the national tearn, the districts and the NGo HKI in tlie endemic areas. 4Currently the financing of these activities is ensured by the govemnleut of Niger, OCP, WHO/AFRO and HKI. The reticer.rce of the population towards skin snipping, the mobility of health workers, the motivation of village volunteers are the difficulties which have to be surmounted. SIERRA LEONE Onchocerciasis control activities were marked by the resumption of CDTI in the southern and part of the eastern parts of the country in 2000. The good coverages obtained at the end of this resumption testify to the willingness of the communities to get involved in this strategy. This year, the objective was to extend CDTI to the northem part of the country with the support of OCP and Sight Savers International (SS!. Thus, 239 health workers were trained in 5 districts to ensure in their turn the training of community distributors. The results of the 2''d round of treatment in 5 districts show that I2l0 villages out of 1837 were covered, that is 660/o. The geographic coverage varied from 34 to 91o/o. On the whole, 176 289 people out of 277 697 registered were treated, that is an average therapeutic coverage of 640/o.The latter varied from 46 to 72o/r. With the technical and financial support of OCP, an epidemiological evaluation carried out in July 2002 in 55 villages in the basins of the North of the country revealed liigh prevalences. These varied from 10 to 77oh. A rise of the trends in most of the villages rvas noted. Overall, 49 villages or 89o/o had a raw prevalence above3Oo/o. Entomological surveillance which had been intemrpted in l99l has resumed since December 2001. From December 2001 to June 2002, the national team has caught and dissected a total of 6375 blackflies in the basins of the North. Among the flies caught, 172 were of the savanna type. All the larvae were sent to the DNA laboratory in Ouagadougou for identification. In addition, 8 villages volunteers trained and supervised by the national team have caught flies in connection with the study of blackfly movements in collaboration with the DNA laboratory in Ouagadougou. Sensitization and mobilization activities are continuing through the mass media as well as during community meetings. Supervision and nronitoring activities were caried out by the various levels. TOGO As in the past, the national coordination and the regional and district teams carried out an epidemiological evaluation of 83 villages out of 83 planned in 15 river basins distributed throughout the country. Among the evaluated villages, 69 or 84%o had a prevalence Iorver or equal to 05%. Overall, 669 or 03.52oh of the 18979 (73%) people examined rvere positive witlr O. volvulus. Prevalences varied from 0 to 43%o and the CMFLs rvere practically nil everywhere. The migration history of the positive individuals revealed that 571 or 86oh are residents. in addition, in order to find out about the epidemiological status of some specific groups in the Kara and Keran basins which could be a source of the translnissiotl, all investigatioll was couducted among the gold diggers, fishermen, sand diggers and gardeners. Out of 417 people recorded, 358 rvere examined and 79, that is 22o/o, were carriers of microfilariae. During their stay in tlre villages, the evaluation teams seized the opportunity to 5underlake integrated activities of reinforcernent of otlier health programnles such as the irnmunization of children, the detection of cases of dracunculosis, schistosomiasis, etc... Tlris year, 4474 vlllages out of 4533 planned, that is 99o/o, were covered by CDTI. The geographic coverage varied from 94 to 100 o/ointhe districts. Overall, l748 668 people out of 2 286 738 registered, or 760/o, were treated with 4 716 939 ivermectin tablets at ihe dose of 3mg. The therapeutic coverage varied from 69 to 82o/o in the districts. Financial support from OCP and SSI allowed the training/retraining of a total of 8 643 community distributors in the 5 endemic regions of the country. Within the framework of the post-treatment study in the basin of the Mono and its tributaries where vector control was stopped in 2001, the national team introduced health workers to entomological surveillance and trained 20 villages fly catchers. Overall, 1474 blackflies were caught and sent to the DNA laboratory in Ouagadougou. In order to better become farniliar with entomological surveillance activities in the field, the three technicians recently trained in Odienne benefited from a practical training course at the OCp operational base of Kara. With a view to reinforcing control strategies in the Specific Intervention Zones (SIZ), a cross-border meeting between Benin and Togo was held in Kara from 25 to 26 July 2OOZ. At the end of the meeting, a schedule ofjoint activities was worked out. In addition, IEC, supervision and monitoring activities continued in the endernic villages. An annual review of the activities carried out in January 2OOZ, which brought together all the players made it possible to identify the problems encountered and to make proposals for corrective solutions. The reticence of some populations to submit to skin snipping, the lack of epidemiological evaluation material at the level of the decentralized teams, the clelay in sending reports, the motivation of community distributors were constraints to be lifted. I