- 1 -isr.tiili;r'!&'r-E ia-qL.r -. I WORLD HEALTH ORGANIZATION ORGANISATION MONDTALE DE LA SANTE ONCHOCERCIASTS AND rTS CONIAOL TN THE IIEDERATTON OF NIOENIA NIGERTAN ONCHOCERCIASIS CO}TIROL CAMPATGN World Health Onganlzatlon t97B WORLD IIEALTII O[T(;ANIZATION ONCIIOCETTCIASIS AND ITS CON'I'IIOI, I^\ 'I'IID I.'EDI.]IUTION OI.' NiGEIIIA NIGI.:RINN ONCIIOCIiITCIASIS CONTROI, O{I\IPAIGN I. ISackgrout.td in-[ormation Olchoccrciasis ltas bccn cvidcnt j.n Nigcria for many ycars and some of tlrc first attcmpts to organiz.c onchoccrc:.asis e,ontrol schcmcs in Africa were made in tlrc ALluja and Kainji at'cas. Thc Fcderal authority in Nigcria consldcrsithat onchoccrciasis threatens, ancl constitutes_ an impcdiment to, thc. harmonious socio-cconomic det'clopmcnt of thc country as wclI as being a primary cause o1'suffcring for many people. IIi-gh rates o-[ onclroccrciasis-causcd b]indncss havc br:on rccordcd from certain zones of thc cndcmic arca. Thc I.'cdcral authority lra.s dccidc.d to organize a nationwj.de onchoccrciasis control campaign, cithcr as part o-t thc IVIIO Onchoccrcrasis ConLrol Programmc (OCl'I or as a sr-.paratc national undcrterl<rng in co]laboration rvith IVIIO and othcr intercstcd partics, making full usc of OCI) expcric.ncr:. It is this latter approaclr that rvi I I bc organizccl ancl implcmcnt<-.d by tlrc I.'cdcra I autlrori ty as a national campaign with the activc involvcmcnt of thc State and local au thori t i os . I t is planr)c(l to dcvote no morc than trvo ycars to the prcl iminary plrasc and to st:irt actual control opcrations from early I!i8O onwards. To protect tho si te of tlrc .futurc Ircdcral capital, the f j-rst trcatcd zone should bc. focusscd on thc Abu3a arca. 'fhe treated area would bc subsequently cxtcndc.d by stcps until it includcs alI important zones of cndcrnic onchocerciasis in tlrc country. It is dj.-tficult to detcrminc thc duration of thc campaign at thc present timc, but it is hopcd that thc discasc will bc reduccd to a vcry 1ow leve} by thc campaign, which may wcll cover at lcast 20 yc'ars. 2. A tonLiltlv() <-.valuation oI tho I<norvlcdgc atr<l IacilrLrcs zrr':rilable 2.L DrstribuLiotr of tlro parasLtc ;tn<l tho <.liscasc A numbcr of survoys w(-'r'c cirrrir-'ri out 15 Lo 25 ycar-s ago as a lirst stcp to ass(-,ssi.ng tho nr:rgni tu<lo of tl'r<-. ;>roblcm or i.rs intcnsivc stuciics on limrted aroas. Somo additj.onaL invcstigations wore (:at'ried out morc rcccntly to study Llrc socio-cconomic importirnco o-[ onchoccrciasis. 'Ihesc investigations slrorvcrl Lhat onclroccrciasis is vory rvrdr-'spt'cad tn Nigcria, someLimcs cxtrcmcly sovore in Ioca I j-t lcs o-[ tlrc sa vann:rlr zonc and wi th usua 11y morc bctr j.gn f orms in tlrc forest l-lclt. I\lorc rcccnt rnve.stigati.ons h:rvc involvcd nrorc tllan 2tt5, OOO people (about O.3(# oI tlrr. population of thc l.crlcration basocl on thc t$77 cstimafe, and probably al.rotr L O.4S% oj thc population o1' thc cntlr.'mic at'oas ). 'lho lcvcl of saml>ling varricrl oxLcnsivcly Irom Stato to Stato rvrtlt front O.OO5% to 3.'1i; oI thc populrrL j.on survcl,cd. I t is tlrus dif f icult Lo asccrtarn Lhc accuratc distribuLion oI'tlrc parasitc ar.rd tlrt: dj.sc.aso, an<l it can bc cstimatcd roughly that somo scvcrirl million pcoplo irI'c in-[octccl . ScvcrtLccn of Lhc ninetoen Statc's oI tl)o l.'or.lcration arc involvo<I, ancl thc cntit:nric ar-car covcrs at Ieast 7OO, OOO s(luarc l<ilometrcs. Thc Iuturc Ircdoral capital, Abuja, is situatcd in thc mrcldlc o-[ the enclemic aroa. Tltc cpidorniological data availirble to datc arc not firr Irom homogeneous and vcry tlifl'icuIt to translatc into socio-cconomic implications, populations at risk o-[ l.llinrllross or scvorc occular Icsions, etc. Such <]ata rvi1l 1>rovide I imi tc.d guirtanct: in thc scarch lor vcctor brccding pl irccs an<j rvould probably not bc irclc.rluato as a basis -[or a control programnlc. 2.2 Socio-cconomr<; aspc.cLs A fcrv studics on tl'lc socio-cconomic aspccts of onclroccrciasrs in Nigeria arLr avai. IabIc. 'fhcy dcal mostly witl'r thc imp;rct of onchoccrciasis on thc working ability oI affcctcd pcoptc and clo not considcr associatccl problems of underpopulation of fertilc Ianrls adjaccnt to ovcrpopulatcd impovcrislrccl soils; thus thc. ilctual cxtcnt oI the cconomic probl(-'m is inacio<1uatc}1, docuntonted. A m:rjor study o-[ this phcnomenon is inclicatccl in prcparati.otr for an approach to oxtcrnal f urrrling agencies. 3Nrgcri;r has <lrarvn up pIans, fol Llro progressivo tlcvcLol)mcltt of its hyclr-ocl r:c tri (i rcsour'(:(-.s, ancl a nunrbcr o-t dams arc bc j,ng bui 1t or p).atrncd . Thc c'stallIislurclrL of tlroso (lams rviII contribute to tho climin:rtion of many vcctor brccding placcs but at tlrr: slmc timc prob;rbly crcatc ncw brecding placcs. I t rviII irlso rcsult in Llrr-' f Jooding of consirlcrable arcas o.t land and <lrrstically modi-[y rvatcr availabi).ity lor agrj-clrlLurrrl purposes. These aspects rviII havc to bc tal<on j.nto account rvhen sLu<tying tlrc socio-economic aspccts of thc- discasc- and j.ts control. 2.3 I)r-str-ibutior.r irn<l abunriancc of thc voctors In Nigcria all onchocorciasis vcctors bclong to thc S . rtamnosum com pIex. Somc dotar Icd studios on thc biononric.s, distrit-rution ;rn<l abundance of thc complcx damnosunr as a rvltol"c wcrc mldc 15 to 25 years ago but, cxcopt in tbc Abu3ir arciil , tlrcy rvorc not carricr.l orrt. in th<: systcmaLtc martnr:r- re<luircd to pIan, cost arr<l i.nrplomont a vc(:Lor conLroI ciimpaj.gn. i\lor<.. rcr:r)nt sLuclics aiming irL <:onLrol rvorc'carricrl orrt in thc I:rtc I96Os in tlr<-'Kirinji at'oa and in 1!t77 in thc proposcd l.'cdclal c:rlriLa1 tcrritory, Abu..;a. Adrlitionirl rcports on thc disLributron errrd abrrndancc lravc bcon stry>plrcd by thc Natronal Comnrittce on Onclroccrciasis Control in Nigcrra. 2 .4 Ilytlrologica I data 'l'hc cxrstcncc of a comprchcnsive nctrvorl< of calibratcd rivcr gulrgcs and (:orrcsl)onding rc-asonably accuratc hydrological data Ior all, or most, of tl'tc watercourscs consLituting tl)c vcctor brco<ling placcs arc esscntial -[or thc dctailorl plannLng anrl costing oI thc vcctor corltrol campaign. Tlrc watcrflow, Lhc rivcr profi.Ic and thc nirturc an<l distribution of thc brecding places are thc thrc'c componcrrts uscd for dot<-'r'mining thc amount o-[ insecticide to app].y at cacll closirrg I)or.nt and the clistance bctwccn dosing poj"nts. 'l'hesc data, in turn, arc c.sscntial for tlro l)r'(-rp.rrlrtj,on o-t fLight pIans, Lhc dc.tcrmination of most suitablc t),p(rs of aircIaIt, thc appropriatc r)L-trYork of relatcd ground facilit j,os, cLc., .rr)d thcsc. consLrtutc one of thc marn rtcms of exl)encliture of S rmulium control actrvi ties. 4Irr Nrgcria Lhr: cornlrilation'/ol Irydlological rlata is donc by the I;r.dct'al Watcr Itcsource i\lini.stry, tlrc Ilrvcr llasin Authorities, thc Nlgeria Dlcctrical l)otvor Au.tlrority and thc Statc lvatcr I-loarcis. 'Ihc data arc not contral.izcd but scattorcd Lrctrvccn thc various authoritics. Onc of tltc f irst tasks slrould bc to merp thc location oI cxt sting calibratc(l rivcr garrges., witlt inclrcations on thc pcriod <luring rvl.rich dctailcd reaclings are available, so that a<lditional water gaugcs could bc cstablishcd and calibratcd to fiII the gaps of tlt<-. nctrvork. Thc sccorrrl tasl< should bc'to collate and summarizc thc readings for c;rcl'r gauging sLatron as a basis for schcdulcd planning anrl costing. 2.5 tly,!t'obioIoSj,,:, 1 data 'l'lrc Iarvicirlr-'s st-.1cctc<l -[or Lll() control o.t oncl)oco]'ciasis vcctol's at'c roason:rllIy sa-fo -[t'om arn cnvironmcntrrl'viorvpoint, as sltorvn by tl'rc- cnvironmenta] monitor.ing carricrl out unrlor OCI). I t rviII bc ncvcrtholcss miitldator'1' to proviclc from tho vcr.y bcginning for tho cnvirotrmcntal nronj.torrng of a carc.[uI1y sclcctod scrics o-[ rvatcr' ooul'scs in Nrgcrra. This constitutes a uscIuI mcans o-[ cvaluarting thc accLu'acy oI farvicidc. arpplications, as it woulcl dctcct gross ovcr-dosj.ngs. It may also contributc to thc identification of othc.r causcs oI pollution and ev.rluate thc j.r impact. I"inaIIy, this monitoring woulcl bccomc cssential sl-rould ncrv Iarvicido formulations be used rn Nigcria rvithouL havj.ng been uscci hitherto elsewhere. IclcarlIy, hyclroLliological c.tata should lncludc the monitortng of rclevant biological indicators as rvcl1 as of chemical resiclues of thc cltemical uscd and rclatcd potluLants. In vicrv of sharp differcnccs oftcn obscrvcd from ycar to ycar arrd aJ.rvays found lrom scason to scason, thc monitoritrg should bc ini tiated ils carly as possiblc irncl not Iater thitn otrc -[uI1 ycar bcfore insecticidc trcatmcnts bogrn. 52 .6 Opr,'r'a t iona trlappl icd rcsca rcl.r llroad cxpr:r' cncc o-[ Simulium control and rcla tc<l lrroblorns has bcen actluirccl in thc OCP arca, but is proLraLrly not trans-[or;rbIe to Nrgcrian <:onditions; rvhcrc it is applicablr', lrrl.;usLmonts rvill bc rc<lr,rirccl . It is thus oss<:ntia1, -from a vcry carLy sLagc, to consiclcr thc strengthoning of rnstitrrtions rvhich alc al-rc;rdy rvorkrng on Srnrulium bj"ology arrcl control (such as NI'IIt) or arc wcII-Io('a Lotl ar.rd rvilling to un(lcrtaltc such rvorli. In a numbcr o-[ irr-stanccs i t might rc(lrr]r'o a complcmcntary training of the staf I and an institutronal strongtlrcning irr Lcrms 01 c(luipmcnt, inllirstl'ucture, ctc. ; 'l'hc mai-n topi "s that would bt: involvccl , rn thc light oI Lhc inf ormation analyz,cd abovo, arc: S. <lanrrtosum conrplcx cy LoLaxonorny and nrorpliologicit I,/nunrcr':.ca L taxononry; S. <liimtro-sum com plcx biononrics anrl in parti.<:uLar rclcvant studrcs Ior caclr spcci<;s on brccding plirct-.s, cI-[cct:.vo -[ligltt range, re].ation to onchocolcrilsr.s transmission, populatiorr dynanric.s, ctc. ; Chcmotherapoutic trials; Itcsr-.arch on cnvironmcntal marripulation; Opcrational rcscarch on trapprng dcviccs; Opcration:rI nronitoring of susccptibility to insecticides and espccially Lo thosc. uscd or considcrcd for }arviciding; llytlrobiological rcscarch to irlonti-ty suitaLlle biological indicators for ctrvironnlc-ntaI monitoring and (lctcl'nrinc thc-ir population dynamics, plrcnoJ.crgy, Iimiting -[acLors, c\tc. ; Clromica I morri toring; So<:i<,r-cconomic rc.scarcl'r on aIl asllocts Iinked rvitlr cost-bcnc-[it stuclics rr.'Ia tcd Lo thc campaign; lnfluoncc of animal Onr:hocr.r'<'ir on tl)o clotcrm:-nation o-[ thc annual potcnti:rI 01' transmission. u2 .7 'l'ra i ni ng Nigc.ria is J ortunatc in l-raving a numbcr of Univc'r'sitics and rcsearch inst j.trrt j.ons rvhi<-lr rvi II lropclully plovidc suitablc candi(la tcs -[or staf -[ing thc pro-[ossional posts roquircd for tho campaign. Ilorvcvcr, at prcsorlt tittlc sl.lcci.fic n;rtional cxpcrtrso c.:xists in tr)c ficl<l of blackfly biology and control, arnd provisions shoul<l be macle -[or thc training of staff at all lcvcIs. Sonror oI'.licors might rcrluiro spccia). ly dcsignod training outsi(io Nigcria, proballly in the OCP arc-a. l\loro ..;urtior staf f should i-rc trained in Nigoria. 'llrc nun.bcr of spccj.alisLs o-[ vectol control cnrploy<.d in Ni.gerra is alrcatly Iarlgc ald rviII j.ncrcasc rvitlr thc inr;llonlc.ntation oI the onchoccrciasis control campaign. IL might thus bc aplrropriatc to establish adccluatc tr;rining -[acilitics at tllc I\l .Sc. 1cvcl in onc oI the national Univcrsitros. Jos Univcrsity has pli:nncd.[or thj-s training ancl , altltough not as sui tal.lIc. .[r'om Lhc vicrvpoint o.[ cxisting cxportisc, rvou]-d bc closc cnough to cxistirtg tr':rining an<.1 rt's<.irrch faciliries to constitutc a good Iocation for trarning mcclical cntomologists. 'fhc spociirlizcd training in blackfly biology and contlol sl^ouIrt bc provid<.'rl subsorlucntly, after candidatcs havc obtalncd thc i\l .Sc. 'l't-'chnical offi<:crs, laboratory and field assistaints will also bc ncedcd rn considcrablc numllcrs, and it would be uscful to plan for their training tund relrcshor trarning at an carly stage of prcparation of thc campaign. 3. l.: 7 ld('nlrolo ar)d cll(,nrotlrcra t' 3.1 Data on tlto prcvalcncc and rntt.nsity o.C ortcltoccrclasis in Nrgcria are scarc() ald most:rrc rlot of l'L,c('r'rt t>r'rgirr. It is altnost coI'talnIy safe'to say that thc mort' tiro dist.as<. is loolic'd for thc' ntort-' i t will bc Iound, and tlrat o<rrrlar {anragc rrl thc postorior scllmcnt, iI Iookod for carcfully try opSthtrlmologrcal tc'cl)nrqu(:s, wj. Il lrc found to lro mucll ntoro prt'valont than rs gen(-,raI Iy lrclrt-'vt-'d. Orr t-.t5i<:aI grorrnds. tto fornr ol nlass or Iargc-scalr: cht'lnotl'rerapy llascd on tho drugs at prosc,nt availalrlc for tlro troatmc'nt of onchocorciasis (DEC andfor surarnrn)- can l>t-, rc,conuilendc'c.l as a nlcalls oI t:ottLroIIing tt'ansmissron lty rt-,du<:Lron oI tlrt.'mlcrotilarial r(-'scrvoi.r rrt man. 'fltcrt-'rs no l'(-'gJ.InL'n tltat would lrt-, accr.pLaltlo or fc,asiti tt,to a<lminrst(-'r safcly ir.r tlils way. Nor i.s tltcrr: yc't any oLr)rll' dr'ug wh tclt cittt llr: usod f or tlr rs pr.lI'posL'. 'fltc Lhr.,r.a.py o1' onchoc(-lrcras i.s in Ni.goria slrould lrr.' cottf tncd: (r ) to pL.rsor)s at high risk of blindnr.ss, rn whorn trt: atnr()11 L ts tlstlalfy dif f rcult and sont(-'Limcs dang<:rous on a(ico\lnt ot' Iriglr rntc'nsity of inlcctron: and (tr ) to pL'rsot)s wiLh acut(-, prurLtro I(-'srons, rvho trsually ltavc ItglrL infr-'ctions and support tr('aLment rv(' II. [UosL oI tlrosr.' in tlto f rrst !lroup would havc'to l)(j idr.nti.fir.d lry srrrvcy LL'anls on tlr(-'llasis o-[ c(']'Laln critir:aI srgns and symptoms wltich s(rll n<..r-'d to bc rcl'itrt-,d lly t'csoarch. I)aLrcnLs in Llrr.s()cond group arc IrkcIy to pros(.,nt Lll,-'msclvos lor Lrc'atmont I)rovisron for troatm()nt, using DLiC and suramin. slrould Itc se't up at sp(.(:raI clirtrcs in hosprtal or drspcnsarrcs, I)ut only wller(' thcrc ts an I\l .O. in attondanct.r. Such c()ntros should [re. cstal>lished first rn those places wllcr-t-. ocular onclrocorciasis rs particularly sr:v<-:r'e and rvhore v(,ctor control lras b<..on cstal).1. ishod so tlrat ro infoctrons wiII not supcrvonc a1'tcr trcatmcnt. 3.2 Vcr:tor c<ttrtrol I t is noL possiblc at thrs stag(-' to dr.tc'r-nrrn(-' wlth any dogrt't-' of accura(:y tllc prol)alrIe cost of voctor corrtI.ol.,rpcrations covering thc' 7OO OOO s11 . km. constitutr.ng tlrr: proposr-'d targot aroa. ti Souncl tcclrnical and scrcnL r l'r.t: planning and r)lanag(,,mont ol' the control op(iratrons could contlil)ut(' to a nct rcductiort of costs, whrlo inappropriaLt., tochnical docisions or nlanagemcnt mrglrt rncroaso thcm nlany t inrc's. Thr-. sclection and con)l)os1t ion oI thc' vt:ctor conLrol t<:am r(,sponsible. Ior Llrc' planning of .lr<-, opol'aLions f ronr Lhc prcparatory phasc onwarcls has tlrus a crucial i.nrpor Lal)t;r: l\lost of' tht., insccLi,cide al)l)Ir(:ations wr. lI bc madc. wr- th aircraf t wlrr-,rcvcr Lhc canopy pr-.rmits tllrs. Idt.aI Iy, ,l',.-. (.'rrtonrologi<-'aI ()vaIu:rLion tcams should work scparatoly tronr tlrrr tc'anls carryir-rg orrt Lht'Iarvic:iding tr'(!atm(r11 t so that trclatmcnt and t'valrraLion r:;rrt lrc dono indr-'pt,irdcntIy. In practice tlrrs u'or,rld rcsult in an rnIIatror) ol profcssiona]. sLalling and prove' \'ory costly. The nctwork of c.valtraLion tcail)s. as .l or O.CP. wrII thus p).ay arl rmportant rolc in thc day-to-day planning and ad.lustrgenL of thc insccticr"dr: applrcations. Althouglr tho zonal aroas covcrod lry thcsr. cvaluation L(.arns corrld llo tailorcd to coincid<-, with Statc-, I>oundarios and LIr() (.vaItration itsr-, II' bccont<-' a StatL' rc'sponsrll: lity, Lhrs nlrgllt not alrvays l>t-, a sur tal)lL. solution in vi<:w of tho main opL.r'aLronal consLrarnts srrclr as a(:ce'ss illrlity to tho lrr-cc,dr ng placr:s and sur.-(-) [ [ Iancc plans wh ich ale srrll..;cct to tlr(-' road nr-'Lrvork. l,'urtlrr-.r, thr,' t:losr.sL ()o-ol'dination must cxist bctweon tlrt' <:l'rrr-'l ol tl'rc v(.ctor conLrol op('r'aLions, hrs dcputios and thc cntonrologr,sts rn r;ltargc oI tlrt.,cntornoJ.<.rgicaI surv(]].llanco notwork. 'Ihey should llt'alllr-.to rc'placc r.aclr oLlror durrng pcriods of alts<:nct, and coI)c(.ntratc tltt.ir forcos on crltrcal areas dr,rr'ing roinvasion pcri.ods, and for spt.<:i f ic strrdic.s. TI.ro hydlological moni torrng is essontial Lo thc daily planning oI op(.'rations , as Lhr-. dosing ol rnst-.cticidt-' aL c'aclt applic:rt j on point ts dr,pr,ndont on tlrr: rvater lIou,and rivor rc'grm<:. Altlrough wat(-.r'gauges ()an sorn('Lilnos lro r<'ad Irom Iho aircraf t, rnost readIr)gs arc rotrtrnc'Iy donc Iry tlrr: stafl'of tlle ('ntonlologrcal strrvoiLlancc r)ctwork and radro('d to thc' r'oIcvatrL a<-.r'ia1 op<-.r'ations lras<: or di roctly to tlr() of I rco ol' tlro clticf of thc veotor control op()rations, as appropriaL(,. Thrs activity consti LuLc's an intt,gIaI part of tlr<-' drrtics of Ll'ro c.nLomologrcal t,valua ! Lon r)(.. twork. ITlrr.. hydrc.rtriologrcal monitorirl,{ rs frorn tl'rc teclrnical sLandpoint r,ntit'cIy indcpr-,rrdt-lnt of Llrc'vcctor control operations and ovaluati.on and rs basr-,d on p(,r'r.rdi. surv(-,ys o1 r'<,1,lrt.s(..ntativt-' aroas of sclt-:ctod u'atershcds, with random clrcck-ups oI ottror wat(:r'slrt: ds. A closc lraison wr Llt thc vrrctor control opr-, l'ations is nr-'vc'r'Ll)(.'Ic'ss "tt1.:lrraI so that any hydro- iliologir:aI olrst:r'vatlon rovc.aling r.r'r'ors of troatmc'nt can l.lo rntmedrately rcrporLr:d and fulty invostrgatc'd by Lll(r voctor corltrol ttnit ' In vicw ol tho srmrlar'rLy ol' Lhr-. sL?.a, clrmatr.' and gcography l)(,two(,n f.hc OCb aroa and Iargc zon<,s of Lho onchocer<:j asis c-ndomic are'as oI Nigr.ria. thc' gonc'r'aI approa('lr('s and stalIrrl!l rc(luirc'ntt-rrtts of the Nrgcrian canrpaigr) wrll prolrallly t.rt'ol Lhc sanrc,Lypc'artd orcler of nragni tude. as I'or Lrrr: cLrl'r-oI1 L OCI) ol)(-'I'atron. 3 ,3 Socio-oconomic aspccts Onchoccrciasis is a discasc' rvl'rich, esp<.cialIy in aroas c-rf hrgh cndcmrcity, has very markod socio-,:conomlc cor)soqLlc'nc('s. Suf lurcrs are gc'ncra). Iy delrrf r tatod and thc rclatrvoly lrrglt pe.r'ccI)tagu ol' bIi.nd pooplc lrccomt-'a lrurdon on tlre conrnrrrnity. O1 grcaL(-'r'signr.frcar)cc national Iy is tho onf orccd movnnr(-'r)L ol poptrlati ons arvay I'r'om tlrc' f(-'rL1Ic river vallc:ys wlrich romain rrndorpoprrlatod or dt:st.lr-tr:d and tvl'tosc potc'ntra.L prodr.rctivity rs IargcLy Ie1't untappc'd. 'l'ht: <'ontrol oI'tl'rc voctor Ioading Lo tlro Jrlogr'r-,ssivt-'control of the discasc gradrral ly rclicvcs thc irnpact on Lhosc al'I'<.t'tr.d atrd dcsorted tracLs oI Iarrd w]rrr:lr arc clcar<>d I'or safe rcsr-'ttIc.,rncnL and cxtc.nsivo oxplor tation. 'I'lris slrorrld rt:sul L ln a positivo r;corromic lrr:nrlf :.t f or tlre c:ountry and sLrrdics should bo urtdortaken during tllc proparatory pltasc to asscss i ts lr'vr.. I . l''trll usr,will lrc madr.'ol'avarIatrIr.'daLa as it is Lo bo Iorrnd in the f rLes ol' thr-. r't,'I('r,,ant govc)rnm(-'nt ol l t c<.s and dopartm(-.nts , rnt('rnatiOnal and lrr latr.ral agcncic.s and oLhc.r sotrr'(:()s. llowt-'vc'r' , as onchocercias j.s af fr:ctcd arcas al'c oI ton givon sonrt,rvlrat Iorvor inrportancc by thc. Plannrng Authoritics, rnuch lrasic groundrvorl< wiIl lravr: Lo lrc dono witl'r spccral <'nrplrasis on soil potcntial , waLt.'r availalrrlrty, social and cultural troli<-..[s wlriclr could Iacilrtato, or lri-ndor', tho caasy scLtlcment of pooplc in tlrt' re.clzrintcd ar(-'as (sponLanL.ousIy or tl'rrough organrzcd scLtlonrent), Lo socro-('(:onom j.c r(.quiremLints of tlrc potential sottlcrs , ctc. Strrious <:onsidt-.ratiol) ruust also l-lc givcn to thc: I'act tlrat undcrpopuJ.aLc.d areas oI'tc,n s i tuatr.d <: Iosrr to waLor coursc.s rnight have heavy Glossina populaLions, as woll as a great alrundancc- of aquatic snails artd anopholine nroscluitoes, and sorneLillcs also dcnsc poprrlations o.[ sylvatic yc.lIow fovcr vc-ctors. Thc lrrII rt:clamation o.l tho onchocL'r'ciasis arr-.as rL'(luiI'cs thus not only tho conLrol of malaria l)uL also spocj,fic mcasures to protect tll() sc'ttlers against outllrr.,aks ol othcr dartgcrous vector-borne diseascs and tlrc provision Ior adc.quato facrLitics regarding watcr supply and pcriphoric hcalLlr car(-' faciIitiL.s. I1 I . I,,'!,.para lq rJ__P]le!l As indicatt.d carl.r.or cluring tlro Pr<..paI'atory Phasc: tl'tc following acLivrtrc.s rviII oc. porIormcd: - scIrtct ancl train a national progralllnl() coordinator; - carry out onc5oc<:rciasis strrvr:ys itr sc. Icctod rndrcaLor vil'Iagos, in ordcr Lo obtain tlasr-'-L irrc daLa on Lh(-. pt'ovalonce and intonsl ty of Llto tnI'cction and on tll(.' amount of blindnoss assocrated therewith; - initiat() studr(is as noc()ssary into tl)c'socro-t-'conomic importance of ol-r<.5ot:r-.rciasis and pro.j<'ctions as to thc cconomrc dovelopmcnt which ml ght loIIow rts conLrol ; - soloct a pilot m<-'dic4] cr-ntrt-. rvhclc tr'oatmot)L of onchoct'rciasis can l)(. r:arpicd out undor acloquaLcl modicaL sttpt'rvisron. atrd pr'ovidc tllls witl) tlrt., stal'1', drugs and lacilitie's n(r c(-'ssaI'y lor its propc'r I'unc t ionn r ng : - car.ry out complt-'nrL.r)tary suIV(..ys in or.dor to nlap v('cLor br't.'udlng P I at:r's : - <l()Lr-'r.rninr. tlto gCncI.al ou1 lirrt-'s of Llro dlstrrl)tlLroll ol tlrc various mcm[lt:rs of S. dattttrostrm corrtlllox; - co I-Icct aI I r.r:Ievant h1'drological data and rd('trt rfy gaps requrring establi,slrrncnt and calil>raIron of additional rivcr gatlg()s; - prL,par-e monthly maps oI distribution of thL, v('(:Lor bt'ocding placcs rvith tltc' cltarat:toristics oI S. dantnosttm cytoLyp('s; - dr:t3rnri pr. thc sus<:cpt i lli li ty oI S, dantnosttnt ()onlpl('x to insc'cticides , and s\tl)s(.(lu(.ntly carly out conrplcmc'ntary studiL's wrtl) known cytotypcs; - collcct llastl inc lrydrolliological daLa on l'()plLrs(.'ntaLivL' rvatr:rsheds; - <.lrarv uJ) Lon"aLivo co-stilrg ol a !i()r'reral plan Ior vc'cLot'<:ontroL opcrat rons cov()r'rng thc Pltasc 1 arca (At>u.1 a), taking rnto accour)t aI I krrowrr gr:ogx'aplrical , physrcal ar)d brologrcal data so as to nlipinr iz<. tlrc' r'oinvasir->r'r risks ; tlris might involvc' a zonc' of IOO OOO Lo I50 OOO sr1 . krrr. irr vit,w ol'tlro c('rrtral position of Abu3a and tlrc allscncr. of natural lrerrrrL'r's rrnpondirlg tltc Iong-distancc' I'liglrL ol' tlto vc<:tors; t2 plan and cost thc Proparatory Plrasc activitics rclatcd to tl'Io prclraration o-[ thc troatnl(-'I)t in tho Pltastt 2 arca; carry out'dL.taiIcd studi()s in thc' Phasr-' I aroa to collcct rel.evant lrasoline data on vcctor alrrrndance and distrilruti<.ln at thc adult s Lag() , r'c-[ino thr-. nrappi rtg o-[ tltr-' Iarval ltrr'cdrng s j' t,cs , otc. ; train aII thc nrcdium Iovt'l and .;ultior'staf-t rt'qurrod lor carryrng the Pl)asL. L operations and l.ryinB tht: basos foI tlro preparatory activ.i tics in th<-. Plrasc 2 araa i carry-out any addrLional dutios rc'Iatc'cl Lo thL- goltoraL plannrng, cosLrng and inlplomentatiort of tl)o progranm() as may ltt-' rcquired, e. g. prr paration o-[ acrial conLI'acts ; propa]'atron of ordc'rs for j nsoctici'lc's , cquipmctrt , srrpplirrs ; instal laLiort oI' radi.o n<'trvork; draf t ing rr.'scarclr and trarnrng contracts ; organizing tho trainrrrg outsidL, Nrg('ria, ctc. out 4.1 l')1.rrdr',nioIogi c:rl Uni t 'I'lrc Iipidcnrr.ologicrrl Unit durrng thrs pl)asL,, wrII nct'd in partrcular: - I cpr clt.mrologrs t - L-2 pul;J. r c lrr.aI th oricntcd ophtalrnologis Ls wllo wr Il ne e,d to actluit'c r.'_x;lr:ricncc ol oncltocct-ciasrs - 2 mr,dical parasitologists - I sot:ro-cconomi.st -.1 -(i IaboraLory or fic'Id t<'chnicians - 2 ogrh Lhalmic nurscs - 4-6 Iaboratory attondants - 4 drrvc'r'mcchanics - 2-6 driv<-'rs - I or 2 Iorr'.r.os wi Lh opl-rthulrnic dark roorn rnountcd on tl)cm - ,1 -tt Iour-wlxrc. I drivc vohrclc's. 'I'lris will zrIIow for soLtirtg rrp 2-.1 frold tcilnsr ul) to 2 of wlrrclr would llt. crlutppcd fot' diagnost ic o;lhthalrnologl, in Llrt' f i.oId as rvell as for parasitologrcal diagnosrs. 'Ilrt.ir'Iunctions wr. I] bc'tb coIIc'ct c'prdcmiological lrast-'-1. lnt. data and to i.dc,ntily onclroccrciasis yraticnts in spocial noed o-[ trr-.aLnlcnt. Tlrr. ophthalnric tc'anrs shorrld also i)c t-,rltrrppc'd to undcrtake fiold troatm(.11 t ol'othc.r sinrplc'c.yt' conrditions. r3 cl trarnr ng I..,rl t1,... Ioadt'rs of thosc' t('ams rniglr't bo ltrovi<.tt:d in OCP, or lty lVllO consul tants , ol lry Dr O. I(aIr:'s tcarn at Ibadan wltich wrll lry tll(.Ir l)avL..Lltomsclvos r'()c()rvcd suclt trainirtg, lracilr tles for providrng lrospital troatnrL.nt to paticnts wLth onclroccrciasrs who arc. at higlr rr.sk o-[ l>Iindnoss is ]ikcly to dcmand Jtrovisron of bc,<i spacc, nursj.ng Iar:rIitics, a'n<] a proporti.on o-[ prolosslona] modical tinrr-. for sLlp(-'rvrsion. In tlro pr(-,pal'atory phaso , consrdoration might bo grvun to ostablishrng onu such tre.aLnlcnt cor)trc i.n a heavily infot:tr:d art-'a- in ot'dcr to dotormrno tho logrstics and fcasil>rIrty o.[ such a sL'r'vrco lroloro aLtcnrptrng to provido it nloro rvidt:).y. This would rcquire initral. ly: l I fUt'dicaI ot'ficor I Lalroratory Toclrnician .1 Nurst's I)rovision would lravc'to lrt.'rnadc I'c.rl supply o1 r)c'c('ssary drugs lor troaLnr()nt and for adr-'rluatt-. diagnosLrc erlttilrment. ,1 .2 V('ctor OorrLroI Unrt 'fhc Vt..<:tor Contlol Ur)rt, during thrs Proparatory Phasc, u'iIl roquire in lrar'Licular orto scrti.<-lr and cxpct'iotrc(,d ('t1 tonlologist as cliic.f and gt'ncr'al manag('r of thc vector contro-I opcrat].ons; on(.' oxp('r'r t'nccd L.ntornoLogrs t (poss rl;Iy an agricul tural entomologist ) to <icaI wi tlr aII problt.lns rclaLcd to the' at'riaI application of ins<:cti.crdos, f light pIans, ground Iacilrtit.:s, equipment cvaluation and dr-.vr'Ioprnc:nt, suscc'ptj. ltrlity tests, etc. ; onc ()xpc.rionced entonologrst for th<-. collcction of l>asclino data on tho PItase I arc.a and to collallorate wi tlr Llrc' goncral survey of tht.: otlrcr r.ndomic aroas o1' Nigcrra; at lc'as L oIrL. and pro [crallly two cxp(]rie ncod gc'ographcrs , nlt l r tary oi.rsc.r'vor.s , or Llntoy'roLog j.s ts to carry out acrial survt_rys and conrplcnrcntary ground survoys ovcr thc wlrolo o f tlto cndomic aroas of Nrgc'r-ia .tor m:ipping potontial breoding plact's, conf irmj.ng tlrc mapping I'rom tlrt.' grotrnd , and coI lecting maturral fot' taxonomic :rnd cyLoLaxononrrc idr.nti.f ications; ontomologists would Itc morc' advantagous as thoy would subs<-'qu<-'ntIy scrvo thc canrl;zrrgn tl)rough othe.r dutics and be availalrlt for complcmentar)' survc'ys u'hcnever approprr.at(J: t4 - ono spocially trainrng 1'ull-tinrr-' cytoLaxonomist; this task could lrc sub-contractL-d to an appropriatc rcscarch ct-'ntro or Universi ty within Nigoria; - during the Iirst yc'ar oI the Prcparatory Phasc, onc of the expertenr, ()ntomoloBists shotrl-cl dovotc- most of his timc to train four or five lic'Ld o1 [icers, l'icld and laboratory tt-'r:hnicians, insoct collectors. and othc'r staf f I tlrt' r,ntonrologist should also plan thc dc'tailed activj-ties of the cvaluation nctrvork and thc recording of all blological data rclatcd to this monitorinB (som() of ttrcsc training activj.tics miglrt also llo sub-contracLcu); - duri.ng the sccond year o-f thc Prc'paratory Phasc, the cntomologist in clrargc of thc opc.rations should train st,voral opcration of.[icers rc'sponsible f or thc actual application o I tllL. insccticides , the dai.] and rvc-okly updating of the -f Iight and treatmcnt plans, the recording ol tl)o treatmc.nt and f Iight data, ctC. About 5 f ic.ld o [f icc.rs ,2 lo 3 operation of l iccrs , L2 to 15 lalloratory and fiold tc.chnicians,20 to 30 vcctor coll()ctors and auxiliairies should t-lc- envi.sagod. Onc' Iight I'Lxt d-wing aircraf t ( two to Iotrr seats in passcnger con-[iguration ) or prc'ferably onr. I ight lrcl icopt.cr (2-3 soa'ts) rvrth pilot and mc'clranic rviIl lre ner.dcd frrLl timc'Ior thc two-ve.ar Preparatot', Phaso. Vct'riclc and drivor r<rqlrirorncnts mi.ght lr<' ostal;Irshc.d at tl to IO four'-rvhcel drivc vclricl<'s and 7 to 8 drivc.t's for tho Iirst year - and at lO to 12 vehicles and 9 to IO drivc.rs .[or thc sccond y()ar. At least one of tho vchicles should bc a Lorry to transport luol, -rnsccticides and otller lreavy itoms to tho ground stations of th(-. Plraso I aroa. Light aluminiurn lroats or inflatal>Io dinghics wiII probably bc ncodcd but thcir nulnl>cr and typc. should bc'dt-'cidcd locally according to thc. atrticipated rr-'rlui r('nr(]nts and tho advicc. o I l.rydrologists and lrydrolriologis ts ' accustomcd to ct^iploying l-)oats on such typt-,s of rvatercoursc.s. li) - ,1 .3 Soc:io-cconomi<: Uni. t 'ilte Soci.o-c,:ottomic Unit rvilI rcquirc tllc follorving pcrsonncl to collect thc rangc of data ncccssary to mal<r-' rclcvant assessmcnt: - one fu1I-timc oconomist as hcad of thc Unit to pl;rn;rnd dircct the s tud i cs; - onc sociologist to revicw probJ.cms confronting tlrc population; - ollc humatt gcographcr to study thc migratory bchaviour irnd constraints of thc diflerent groups; - ot'tc agronomist to cxamitrc,Llrc agricultural 1;otcntial of thr: clcared il I'()a s; - - consult'ants, ils nccclssaI.y, lo}' poriocls to be spocifrcd to c€lrry out spccific: str.rdics. 'l'ltc'ncc<l -[or socrctarial assi.stancc and probably er cartographer sltould bc forcsccn. 'I'ltc UniL will rvork in cIosr.'rrssociation rvith tlrc l.'odoral and Statc planning authorj.tics to cnsur'('tlrrrt any asscssmcnts ancl projccLions maclc arc it't lino with govcrnmcnt polic.y. Attontion should bc given in cach area to thc possibility o-[ planno<l vorsus .spontancous scttlc:nront; thc sui tability o-[ any arca -[or intcnsivc crop pro<luc t,ion; thc <Ievelopmcnt of agro-industries; thc rolc of irri.gation; tho provi.sion of hcalth, educational arncl otlrcr social scrviccsl thc construction oI roac[ rrctrvorks, etc. It is impcrativc that cach mt-'mbcr of thc Unit bc Lnclopcnclcnt regarding mobility and lrence bc provid<'<l rvith a suitablc vclliclL- rvith drivcr. Irour vchiclcs altogcther may bc adccluatc, of whiclt at loast half shoulci bc multi-purposc four-whccl dri ve . 1G i 4.4 ArlminisLrirLivc Scrviccs Unit I'5c campaig'r rviII rcquirc a stI'ong admrnistrativo unit c'-hargcd with ovcrall plannir)g ancl Iogistics support to ensurc cffcctivo rccruitmcnt, procuromcnt of supplic's and cquipmc.r)t, rnaintcnancc, ctc. l\luclt rvi1l dcpcnd upon thc propc\r mirnagomcnt, fucllj.ltg, arrci maitrtcnancc o-f vchicles and a strong infrarsLructurc lor this should bc cnsurcd fronr tlle outsct. Additional f aci Ii t j.cs must trlso bc assurccl , suclr as Iandrng pads f or lrcl icopters, airsLrips .for plancs, ra<Iio communications, small ficLd dcpots rvith u'atchmcn apd casu:rI labourcrs -[or -[uc1 and insccticidcs, laborirtory space, garages, Irangars, ctc., wrth aIl the supcrvision, managcmcnt and maintcnancc associa tr:d rvith suclt a nctworl( of gl'ound facilitics. 5. Sr,rb-sc<1uont phascs 'l'lrc l)hasc l arca wiIl cor.rstitute a training ground for a]1 the staff involvcd in tlro')rcparatory Plraso lrnd l)lrase I activitrcs. It will also constituto an idcal training grounrl Ior thc staf.[ suLlscclucntly to bc assi.gnod to I)hasc 2, l)lrasc 3, ancl othcr arcas. To implement the campaign in a Iogical nranncr and ona[rIc it to bcno-[it,l;rom initia] cxpcrietrcc, i,t might l-rc appropriatc to rvork on tl)o I)lrasc I arca -[or tlo ycars beforc cxpanding to l)lraso 2. Tlrc insccticidc :rpplicatior) opcrations rvould lcquire prob:.rbIy trvo mc<lium-sizcd aircra-[t. 'l'hc first ycar of Phase l opcrations rvould thus havc an cxpcrimcntal and training cha rerctcr, and rvould Lrc uscd in parti.cular to train scnior and mcdium-lcvol slaff for thc Phasc 2 <:omplcmcntary survcy. Durj.ng thc - sccond ycar of tlrc I)hasc l opcratron-s, Llrc neu,ly tralncd staff rvould thus carry out this complcmcntury survoy ovcr thc Plrase 2 area whj. Ie t)re staff of tho l>lrasc 1arc.a rvould contributc to training staff for th<-. complcmcntary survcy and opcrations in thc I)hasc 3 arc.;r. 'l'lris pa Ltcrn could bc rcpcated as ncccssary. 'l'o avoicl cxtcnding thc carnpargn ovcr too long a pcriocl , <>ach phasc follorvj.ng Phase I could lnvolvo alrout 2OO, OOO s<g.km., r'c<luiring thus trvo additional cntonlologists, tcn -Iiol<l offi<:crs, 15 fielcl arrd l"aboratory tt-'clrnicrans, 1O to 12 <lr|vcrs, 20 Lo 30 inscct collcctors, 12 to 1-4 vehiclcs (rnclr.r<lj.ng two lorrics), trvo opcrational oI.[iccrs, and probably onc to two a<lditional aircraf t. Tlris mcthod of arpproaclr woul<l corrcspond to: - imJ>lcmontatlon of Phasc I (Abuja alca) i.n l:tUO and 1981; - implcn<-'ntation oI I)hasc 2 (rvcst of Abuja to connc.ct rvith thc OCP arca); - inrplcmr-'ntation of I)lrasc 3 (conLraI castcrn Nigclia) in 1:t83; - implcnrcntat ion o-[ Phasc ,t ( Lhc .tina I arca - castcrn Ni.gorLa ) in 1984 . 'l'ltus by I:)84 opcrations woulrl covc\r most of tlrc. cn<lcmic arcas of thc country. 'I'he subsc<1ucnL ycars rvotrld ccrtainly rnvolvc minor adSustments callcd for in tltc Iight of expcrioncc gaincd, but, for aIl practical purposes, tlrc camyraign rvould bc. in full olreration -from 1!t84 onrvards itnd should bc pJ.anncd along Lllc samL. broad linr:s f or futurc yeal's. l l8 I t would bc implacticat ati tlrrs stergc to attcmpt to dcal rv,i.th the plannrng and staffing in furthcr <l<:tai1, sinco tlro r.rcccssary basis is Iacking. 'lhc ouLlinc providcd abovc should thcrcforc bc considcreci as an orclr-.r of magn r turlc . It rvotrlrl be logical to cnvisagc' thc .subcontracting of ir1,d.oU' orogical sLudics to suitablc j.nstrtutions rvitlrin Nigcria, and tlrc samc. could apply to parL oI thr.'t'cscarclr, tllc rcst o-[ thc rcscarch bcrng carricd out by the campargn staI1. l'lrr-. typc of rcs(-'.lrclr sharing ancl m.rnagcmcnt dccidcd upon shoulrl bc sanctionccl by appropriaLc stalfing provisions. Spccial considcration sl.roul<l ;r1so l.rc givcn to thc analys j"s and cornputcriza Lion of cntomological, ol)erational, hyrl rological and lryri:'obiological rlaLa rrrrd thc dcvolopment of a rclovant and cffcctivc rctricval systcm, an<l to thc corrcsponding staffing rc<1ui rcmcnts . I)ossibLc sourc(-'s o.[ tcclrnica] :rn<l sciontifrc oxportisc I lVi.thin Nigcr':.a A numbcr o-t Nigcrian Univcrsitics l'ravc zool.ogical/cntomological departmcnts and co.uld suggcst nam()s oI promlsing graduatcs {or training as cntomologists. Can<.lidatc ficld o-[ficcrs nriglrt bo provj.dcd by cxisting hcalth structurcs as ficld cxpcricnce and rcliarbility rvill bc morc j.mportant than univcrsity <1ualj.frcations. 'l'hc Univcrsity of .Ios is pl;rnning to organrzc Lho tra inrng of medical cntomologists at thc I\l .Sc. Icvo1, but may not bc frrlIy opcrational in time; altcrnaLivcs shoulcl thcrcforc bc forcsccn, proLlably by lccrui ting zooilogyf cntomology graduatcs .rnd provi<ting them witlr an accc. Ir-.r'a Lod training in Srmulium biology and control. 'l'lrls might lccluirc' cxtornal coopcra tion. NI'tlt lras alrcad.y somc cxpcrionccd sta.tf nombr-.r's rvitlr many years of scrvicc in Nj-gcrra, and onc of tlrom has rvorkc<l extcnsivcly on oncl'roccrciasis and its vcctor-s arrd could ccrtait'tIy contributc to c:itr-r'ying out part oI thc prcliminary survoys, training oI sta-[f , cf c. 6 6 l.) Thc-. WllO Voctor I3iology and )Control Ilesearch Unlt, iiaduna, ltas h'itherto .focussod its activity on Anopl'rcIos bj.oI ogy and corrtrol", but i t is expcctcd that, lrom 1!)7!) onlards, .in apl)rcciirblc part of its rc'sourccs coulci bc dcvoLcd to Simulrum ancl Clos-sina biology and control, and priority would be givcn to onchocc.r'ciasrs voctors. 'l'ho projcct Icadcr is an expcl'ienccd cytotaxonomist hav.i.ng rvorkcd on Anophcles and rvith sonrc cxpcrLctrcc oI Simulium. lYith brrcf rc.frcslrcr training, lrc c:ouId contrlbutc to carrying out dutics for thc f utur<-' c.tmpaign ancl in turn train Nigcrian scicntrsts. 'l'rvo of the staff mr:mbcrs arc cxpcrienccd vcctor control spccialists ltaving somc cxperieuce of Simulium Lliology and control rvhiclr coulcI also bc rmprovcd through short refreshcr training. Such coopcration might provide timc to clcvclop additional Nigcrian cxportise. in thcsc ficlds. Somo Niget'ian Univcrsj.tics aro carrying out resoarch progt'ammcs rvhich, althouglr r)ot strictly oricntcd towar(ls thc otrclroccrciasis fieId, could be r.lircctcd torvarcls thc noorls o-[ tho I"crleratron. IVIIO cou]d play a role by suggcsting suclr a rcoricntation to tlrosc submitting roscarch proposals to t[c Spccral Programmc lor Ilcscarclr irncl'l'r'aining rn'l'r'opical Discascs (TDR) in thc frlaria-sis, vcctor biology irnrl control, lnsLrtutron stI'ongthening fields. 6.2 Orrtsi<lc Nigcriet 'I'hc Onchoccrciasis Control I)r'ogrrrmmc has subcontractc(l tltc training o-[ its own profcssional staff to providc cntomologlsts witlr spccial cxportise on onchocerci:rsis vcctors and Sirnulium control . 'lhcsc training -tacilities could bc uscd, un<lcr contract, on a ncr capita basis as the Institut de Rcchcrctres sur I'Onr:hoccrcosc, llou:tl<ri, Ivory Coast, ltas already provided training to Iinglish-spr.'aking scicntists. I'hc bcst tra:.ning on ol)crationirl aspocts rvould bc providcd by OCP itsclf. Although OCI) has no spocilic provisions for that purposc, Nigcriarn tr-ainecs could bc acccptccl at tl'rc Subscctor, Scctor and Vcctor ContIoI Unit (llQs) Ievels and collaborertc rn thc main drrties Lhcy rvil1 havc to carry out subsequently rvj.thin thc Nigcrian Onchocerciasis Control Carnpaign. OCP has also a small rcscarclt unit (loaling rvith cytoLaxonomy (Dr C. Vajimc) ztnd Srntulitrm bj.onomics and roaring (Dr' .1 . Itaybould) rvhich coulcl rcccivc trarnocs in these f iclds. ?o 'l'ltc cnv:.ronmcntal nronitori;tg rs carricd out uncl'cr contract. by thc Instituto oI A<luatic I3iology, Achinrota, Clrana, anrl a spccially-establishcd OItS'l'O:\t Ilydrobioiogical 'loam, Iloual<r':, I vory Coast. Ilotlr could recei'vc Nigerian trainces if ncccssary. tVltile p;rrt o-C thc training rvor.rld lravc to bc funclcd eitlrcr by Nigcria or by other instr tutions anrl agcncit.'s, thc lVIIO'. Spccia 1 Progrlrmmc f or Researclt and Training in Tropical Discascis ('l'DIt) through its Institutior: Strcngthcning and Training comlloncnt, coulci bc usod for dcvcloping Nigcrian cxpel'tise and training facilitic.s should appropriatc rcqucsts be made.rnd acccptcd by tlrc rclovant Spccj.al Programmc Scicntific lVorking Croups and Stcering Commi t tccs . 'l'hc IVIIO llcgio'raI Officc for Africa has scveral intcr-country tcarus dcaling rvith Itlalaria and Othcr Paras j..tic Discascs. 'llicir cxpcrtisc and -taciliLics coul(l ccrtainly bc u.sccl rvithin the Iimits rosulting from former commitmcnts in other priority arca.s. MlO/VllC at Gcncva, with its snralt group o-t pcoplo ()xpcrrcncL'cl 1r) acrral opcratrons, planning, acrtal application o-[ insccticidcs, sa-[c usc of insecticiclcs, c.tc. , might contribuL() to tlrc planning and costing of the Nigorian campaign,. rvithin tho sco[)() oI its possibilitics. A spc-ciaI cffort rvj. II bc nrade to s(-.curc\ a spccialisL on Sinrulium biology and colttrol in the noar futurc, so as to bc ablc to o-[-[<-'r bcttcr cooperation rvith Nigcria. 2) 7. I"un<ling asllccts 'I'hc follorving financing llossil;ilitics nray Lle consiclorcd (a) thc I)rcparilt(,r-y l)lrasc, and (tl) tlrc opcrirtional plrascs of for thc I)rogramme: (1) (2) Nigcria provi<Jing aII furrt.ls rvith ac.lvicc- -[r'om WllO (in this case tlrcrc may bo tol<on WIIO -[rnancraI ass]stanco). lruntls-in-trust plarc<:rl Lry Nrgcria at thc drsposal o.f \!llO to cover 1;1c. provision of scrvrcc.s, purch[rsc o-[ inscctrciclcs, cquipmcnt and vchiclcs, ctc. (3) UNDP, in responsc to a roqucst lrom thc Nigcrj.an Co',,ornmcntrunder tl-rc country programmc, an<l indj.cativc plernning figurc (IPF), coulrlr-.rl with a cost-slraring arrangomc.nt. (,1 ) Crca,tiort o-[ a smal1 corrsort.ium, possibly rvith LiNDP participati.on, througlr rvhicl'r, on tho Llasis o.[ a l)rogrammc proposal, donors are ;rpproacho<l .[or -[inanr:irrl- an<l technical sulrport. 'i'lrc intorcst of Llrc A-[rrcan Dcvc.Iopnrcnt I]alrk cor-rlcl bc oxplorcti. I t must bo r:mplrasizr:<l tltat an.1, <:ontribuLol is particularly intclested in thc cconomic potcntial of tlrc arc.a subsc(luorrtly clcarcd of thc risk o-[ ortchocorciasis and. any prolrosal must bc supportod by a rvcI l-do<:umcntc.d cconomic dcvclopmcnt prcsentation. 8. Initial stolls I.'ollorvirrg tlro <:onsultations tl)at tool( plarce in Gcnova bcLrvocn rcprcrs('nLaLivcs o-[ tho Nigcrian Covornnrcnt and IVIIO in oarly I"cbruary 1978, tlrc nra L tcr wr I I br: Lhc sub;cct oI Iurthcr discussions b<.'trveon Nigcria and tlro lVllO llr:gional OfIicc -[or A-[r'ic:r. 'I'lr<-'llcgional l)irc:ctor has proposcd that a plarrnj.ng mission Jrom WIIO to Nigc'r'ia shoul<l consLituto tlrc ncxt stcp. 1'his lrlanning mission .ts cnvisagcd Ior l\larch 1:)78, and rvi I1 holcl consul.tations in aLI intc.rcstcd partics in Nigor-j,a rvho wiII bc involr,cd in thc prcparation f or an subso<1ut:nt inrplcmcntation o.[ tlrc. campaign at l.-cricral and Statc lcve]. 'flrc nrission rviII also contact mcml;crs of thc Nigcrian National Committec for Onchoccrciasis (lontrol as rvclI as pcr-sons rvorking on onchoccrciasis, and institutions. '['ltc plannin[i mission rviIl assist thc Nigcrran Govcrnment in prcJrarirrg a dra-[t project documctrt for thc l)r'eparatol'y Pltasc.
- 1 -isr.tiili;r'!&'r-E ia-qL.r -. I WORLD HEALTH ORGANIZATION ORGANISATION MONDTALE DE LA SANTE ONCHOCERCIASTS AND rTS CONIAOL TN THE IIEDERATTON OF NIOENIA NIGERTAN ONCHOCERCIASIS CO}TIROL CAMPATGN World Health Onganlzatlon t97B WORLD IIEALTII O[T(;ANIZATION ONCIIOCETTCIASIS AND ITS CON'I'IIOI, I^\ 'I'IID I.'EDI.]IUTION OI.' NiGEIIIA NIGI.:RINN ONCIIOCIiITCIASIS CONTROI, O{I\IPAIGN I. ISackgrout.td in-[ormation Olchoccrciasis ltas bccn cvidcnt j.n Nigcria for many ycars and some of tlrc first attcmpts to organiz.c onchoccrc:.asis e,ontrol schcmcs in Africa were made in tlrc ALluja and Kainji at'cas. Thc Fcderal authority in Nigcria consldcrsithat onchoccrciasis threatens, ancl constitutes_ an impcdiment to, thc. harmonious socio-cconomic det'clopmcnt of thc country as wclI as being a primary cause o1'suffcring for many people. IIi-gh rates o-[ onclroccrciasis-causcd b]indncss havc br:on rccordcd from certain zones of thc cndcmic arca. Thc I.'cdcral authority lra.s dccidc.d to organize a nationwj.de onchoccrciasis control campaign, cithcr as part o-t thc IVIIO Onchoccrcrasis ConLrol Programmc (OCl'I or as a sr-.paratc national undcrterl<rng in co]laboration rvith IVIIO and othcr intercstcd partics, making full usc of OCI) expcric.ncr:. It is this latter approaclr that rvi I I bc organizccl ancl implcmcnt<-.d by tlrc I.'cdcra I autlrori ty as a national campaign with the activc involvcmcnt of thc State and local au thori t i os . I t is planr)c(l to dcvote no morc than trvo ycars to the prcl iminary plrasc and to st:irt actual control opcrations from early I!i8O onwards. To protect tho si te of tlrc .futurc Ircdcral capital, the f j-rst trcatcd zone should bc. focusscd on thc Abu3a arca. 'fhe treated area would bc subsequently cxtcndc.d by stcps until it includcs alI important zones of cndcrnic onchocerciasis in tlrc country. It is dj.-tficult to detcrminc thc duration of thc campaign at thc present timc, but it is hopcd that thc discasc will bc reduccd to a vcry 1ow leve} by thc campaign, which may wcll cover at lcast 20 yc'ars. 2. A tonLiltlv() <-.valuation oI tho I<norvlcdgc atr<l IacilrLrcs zrr':rilable 2.L DrstribuLiotr of tlro parasLtc ;tn<l tho <.liscasc A numbcr of survoys w(-'r'c cirrrir-'ri out 15 Lo 25 ycar-s ago as a lirst stcp to ass(-,ssi.ng tho nr:rgni tu<lo of tl'r<-. ;>roblcm or i.rs intcnsivc stuciics on limrted aroas. Somo additj.onaL invcstigations wore (:at'ried out morc rcccntly to study Llrc socio-cconomic importirnco o-[ onchoccrciasis. 'Ihesc investigations slrorvcrl Lhat onclroccrciasis is vory rvrdr-'spt'cad tn Nigcria, someLimcs cxtrcmcly sovore in Ioca I j-t lcs o-[ tlrc sa vann:rlr zonc and wi th usua 11y morc bctr j.gn f orms in tlrc forest l-lclt. I\lorc rcccnt rnve.stigati.ons h:rvc involvcd nrorc tllan 2tt5, OOO people (about O.3(# oI tlrr. population of thc l.crlcration basocl on thc t$77 cstimafe, and probably al.rotr L O.4S% oj thc population o1' thc cntlr.'mic at'oas ). 'lho lcvcl of saml>ling varricrl oxLcnsivcly Irom Stato to Stato rvrtlt front O.OO5% to 3.'1i; oI thc populrrL j.on survcl,cd. I t is tlrus dif f icult Lo asccrtarn Lhc accuratc distribuLion oI'tlrc parasitc ar.rd tlrt: dj.sc.aso, an<l it can bc cstimatcd roughly that somo scvcrirl million pcoplo irI'c in-[octccl . ScvcrtLccn of Lhc ninetoen Statc's oI tl)o l.'or.lcration arc involvo<I, ancl thc cntit:nric ar-car covcrs at Ieast 7OO, OOO s(luarc l<ilometrcs. Thc Iuturc Ircdoral capital, Abuja, is situatcd in thc mrcldlc o-[ the enclemic aroa. Tltc cpidorniological data availirble to datc arc not firr Irom homogeneous and vcry tlifl'icuIt to translatc into socio-cconomic implications, populations at risk o-[ l.llinrllross or scvorc occular Icsions, etc. Such <]ata rvi1l 1>rovide I imi tc.d guirtanct: in thc scarch lor vcctor brccding pl irccs an<j rvould probably not bc irclc.rluato as a basis -[or a control programnlc. 2.2 Socio-cconomr<; aspc.cLs A fcrv studics on tl'lc socio-cconomic aspccts of onclroccrciasrs in Nigeria arLr avai. IabIc. 'fhcy dcal mostly witl'r thc imp;rct of onchoccrciasis on thc working ability oI affcctcd pcoptc and clo not considcr associatccl problems of underpopulation of fertilc Ianrls adjaccnt to ovcrpopulatcd impovcrislrccl soils; thus thc. ilctual cxtcnt oI the cconomic probl(-'m is inacio<1uatc}1, docuntonted. A m:rjor study o-[ this phcnomenon is inclicatccl in prcparati.otr for an approach to oxtcrnal f urrrling agencies. 3Nrgcri;r has <lrarvn up pIans, fol Llro progressivo tlcvcLol)mcltt of its hyclr-ocl r:c tri (i rcsour'(:(-.s, ancl a nunrbcr o-t dams arc bc j,ng bui 1t or p).atrncd . Thc c'stallIislurclrL of tlroso (lams rviII contribute to tho climin:rtion of many vcctor brccding placcs but at tlrr: slmc timc prob;rbly crcatc ncw brecding placcs. I t rviII irlso rcsult in Llrr-' f Jooding of consirlcrable arcas o.t land and <lrrstically modi-[y rvatcr availabi).ity lor agrj-clrlLurrrl purposes. These aspects rviII havc to bc tal<on j.nto account rvhen sLu<tying tlrc socio-economic aspccts of thc- discasc- and j.ts control. 2.3 I)r-str-ibutior.r irn<l abunriancc of thc voctors In Nigcria all onchocorciasis vcctors bclong to thc S . rtamnosum com pIex. Somc dotar Icd studios on thc biononric.s, distrit-rution ;rn<l abundance of thc complcx damnosunr as a rvltol"c wcrc mldc 15 to 25 years ago but, cxcopt in tbc Abu3ir arciil , tlrcy rvorc not carricr.l orrt. in th<: systcmaLtc martnr:r- re<luircd to pIan, cost arr<l i.nrplomont a vc(:Lor conLroI ciimpaj.gn. i\lor<.. rcr:r)nt sLuclics aiming irL <:onLrol rvorc'carricrl orrt in thc I:rtc I96Os in tlr<-'Kirinji at'oa and in 1!t77 in thc proposcd l.'cdclal c:rlriLa1 tcrritory, Abu..;a. Adrlitionirl rcports on thc disLributron errrd abrrndancc lravc bcon stry>plrcd by thc Natronal Comnrittce on Onclroccrciasis Control in Nigcrra. 2 .4 Ilytlrologica I data 'l'hc cxrstcncc of a comprchcnsive nctrvorl< of calibratcd rivcr gulrgcs and (:orrcsl)onding rc-asonably accuratc hydrological data Ior all, or most, of tl'tc watercourscs consLituting tl)c vcctor brco<ling placcs arc esscntial -[or thc dctailorl plannLng anrl costing oI thc vcctor corltrol campaign. Tlrc watcrflow, Lhc rivcr profi.Ic and thc nirturc an<l distribution of thc brecding places are thc thrc'c componcrrts uscd for dot<-'r'mining thc amount o-[ insecticide to app].y at cacll closirrg I)or.nt and the clistance bctwccn dosing poj"nts. 'l'hesc data, in turn, arc c.sscntial for tlro l)r'(-rp.rrlrtj,on o-t fLight pIans, Lhc dc.tcrmination of most suitablc t),p(rs of aircIaIt, thc appropriatc r)L-trYork of relatcd ground facilit j,os, cLc., .rr)d thcsc. consLrtutc one of thc marn rtcms of exl)encliture of S rmulium control actrvi ties. 4Irr Nrgcria Lhr: cornlrilation'/ol Irydlological rlata is donc by the I;r.dct'al Watcr Itcsource i\lini.stry, tlrc Ilrvcr llasin Authorities, thc Nlgeria Dlcctrical l)otvor Au.tlrority and thc Statc lvatcr I-loarcis. 'Ihc data arc not contral.izcd but scattorcd Lrctrvccn thc various authoritics. Onc of tltc f irst tasks slrould bc to merp thc location oI cxt sting calibratc(l rivcr garrges., witlt inclrcations on thc pcriod <luring rvl.rich dctailcd reaclings are available, so that a<lditional water gaugcs could bc cstablishcd and calibratcd to fiII the gaps of tlt<-. nctrvork. Thc sccorrrl tasl< should bc'to collate and summarizc thc readings for c;rcl'r gauging sLatron as a basis for schcdulcd planning anrl costing. 2.5 tly,!t'obioIoSj,,:, 1 data 'l'lrc Iarvicirlr-'s st-.1cctc<l -[or Lll() control o.t oncl)oco]'ciasis vcctol's at'c roason:rllIy sa-fo -[t'om arn cnvironmcntrrl'viorvpoint, as sltorvn by tl'rc- cnvironmenta] monitor.ing carricrl out unrlor OCI). I t rviII bc ncvcrtholcss miitldator'1' to proviclc from tho vcr.y bcginning for tho cnvirotrmcntal nronj.torrng of a carc.[uI1y sclcctod scrics o-[ rvatcr' ooul'scs in Nrgcrra. This constitutes a uscIuI mcans o-[ cvaluarting thc accLu'acy oI farvicidc. arpplications, as it woulcl dctcct gross ovcr-dosj.ngs. It may also contributc to thc identification of othc.r causcs oI pollution and ev.rluate thc j.r impact. I"inaIIy, this monitoring woulcl bccomc cssential sl-rould ncrv Iarvicido formulations be used rn Nigcria rvithouL havj.ng been uscci hitherto elsewhere. IclcarlIy, hyclroLliological c.tata should lncludc the monitortng of rclevant biological indicators as rvcl1 as of chemical resiclues of thc cltemical uscd and rclatcd potluLants. In vicrv of sharp differcnccs oftcn obscrvcd from ycar to ycar arrd aJ.rvays found lrom scason to scason, thc monitoritrg should bc ini tiated ils carly as possiblc irncl not Iater thitn otrc -[uI1 ycar bcfore insecticidc trcatmcnts bogrn. 52 .6 Opr,'r'a t iona trlappl icd rcsca rcl.r llroad cxpr:r' cncc o-[ Simulium control and rcla tc<l lrroblorns has bcen actluirccl in thc OCP arca, but is proLraLrly not trans-[or;rbIe to Nrgcrian <:onditions; rvhcrc it is applicablr', lrrl.;usLmonts rvill bc rc<lr,rirccl . It is thus oss<:ntia1, -from a vcry carLy sLagc, to consiclcr thc strengthoning of rnstitrrtions rvhich alc al-rc;rdy rvorkrng on Srnrulium bj"ology arrcl control (such as NI'IIt) or arc wcII-Io('a Lotl ar.rd rvilling to un(lcrtaltc such rvorli. In a numbcr o-[ irr-stanccs i t might rc(lrr]r'o a complcmcntary training of the staf I and an institutronal strongtlrcning irr Lcrms 01 c(luipmcnt, inllirstl'ucture, ctc. ; 'l'hc mai-n topi "s that would bt: involvccl , rn thc light oI Lhc inf ormation analyz,cd abovo, arc: S. <lanrrtosum conrplcx cy LoLaxonorny and nrorpliologicit I,/nunrcr':.ca L taxononry; S. <liimtro-sum com plcx biononrics anrl in parti.<:uLar rclcvant studrcs Ior caclr spcci<;s on brccding plirct-.s, cI-[cct:.vo -[ligltt range, re].ation to onchocolcrilsr.s transmission, populatiorr dynanric.s, ctc. ; Chcmotherapoutic trials; Itcsr-.arch on cnvironmcntal marripulation; Opcrational rcscarch on trapprng dcviccs; Opcration:rI nronitoring of susccptibility to insecticides and espccially Lo thosc. uscd or considcrcd for }arviciding; llytlrobiological rcscarch to irlonti-ty suitaLlle biological indicators for ctrvironnlc-ntaI monitoring and (lctcl'nrinc thc-ir population dynamics, plrcnoJ.crgy, Iimiting -[acLors, c\tc. ; Clromica I morri toring; So<:i<,r-cconomic rc.scarcl'r on aIl asllocts Iinked rvitlr cost-bcnc-[it stuclics rr.'Ia tcd Lo thc campaign; lnfluoncc of animal Onr:hocr.r'<'ir on tl)o clotcrm:-nation o-[ thc annual potcnti:rI 01' transmission. u2 .7 'l'ra i ni ng Nigc.ria is J ortunatc in l-raving a numbcr of Univc'r'sitics and rcsearch inst j.trrt j.ons rvhi<-lr rvi II lropclully plovidc suitablc candi(la tcs -[or staf -[ing thc pro-[ossional posts roquircd for tho campaign. Ilorvcvcr, at prcsorlt tittlc sl.lcci.fic n;rtional cxpcrtrso c.:xists in tr)c ficl<l of blackfly biology and control, arnd provisions shoul<l be macle -[or thc training of staff at all lcvcIs. Sonror oI'.licors might rcrluiro spccia). ly dcsignod training outsi(io Nigcria, proballly in the OCP arc-a. l\loro ..;urtior staf f should i-rc trained in Nigoria. 'llrc nun.bcr of spccj.alisLs o-[ vectol control cnrploy<.d in Ni.gerra is alrcatly Iarlgc ald rviII j.ncrcasc rvitlr thc inr;llonlc.ntation oI the onchoccrciasis control campaign. IL might thus bc aplrropriatc to establish adccluatc tr;rining -[acilitics at tllc I\l .Sc. 1cvcl in onc oI the national Univcrsitros. Jos Univcrsity has pli:nncd.[or thj-s training ancl , altltough not as sui tal.lIc. .[r'om Lhc vicrvpoint o.[ cxisting cxportisc, rvou]-d bc closc cnough to cxistirtg tr':rining an<.1 rt's<.irrch faciliries to constitutc a good Iocation for trarning mcclical cntomologists. 'fhc spociirlizcd training in blackfly biology and contlol sl^ouIrt bc provid<.'rl subsorlucntly, after candidatcs havc obtalncd thc i\l .Sc. 'l't-'chnical offi<:crs, laboratory and field assistaints will also bc ncedcd rn considcrablc numllcrs, and it would be uscful to plan for their training tund relrcshor trarning at an carly stage of prcparation of thc campaign. 3. l.: 7 ld('nlrolo ar)d cll(,nrotlrcra t' 3.1 Data on tlto prcvalcncc and rntt.nsity o.C ortcltoccrclasis in Nrgcria are scarc() ald most:rrc rlot of l'L,c('r'rt t>r'rgirr. It is altnost coI'talnIy safe'to say that thc mort' tiro dist.as<. is loolic'd for thc' ntort-' i t will bc Iound, and tlrat o<rrrlar {anragc rrl thc postorior scllmcnt, iI Iookod for carcfully try opSthtrlmologrcal tc'cl)nrqu(:s, wj. Il lrc found to lro mucll ntoro prt'valont than rs gen(-,raI Iy lrclrt-'vt-'d. Orr t-.t5i<:aI grorrnds. tto fornr ol nlass or Iargc-scalr: cht'lnotl'rerapy llascd on tho drugs at prosc,nt availalrlc for tlro troatmc'nt of onchocorciasis (DEC andfor surarnrn)- can l>t-, rc,conuilendc'c.l as a nlcalls oI t:ottLroIIing tt'ansmissron lty rt-,du<:Lron oI tlrt.'mlcrotilarial r(-'scrvoi.r rrt man. 'fltcrt-'rs no l'(-'gJ.InL'n tltat would lrt-, accr.pLaltlo or fc,asiti tt,to a<lminrst(-'r safcly ir.r tlils way. Nor i.s tltcrr: yc't any oLr)rll' dr'ug wh tclt cittt llr: usod f or tlr rs pr.lI'posL'. 'fltc Lhr.,r.a.py o1' onchoc(-lrcras i.s in Ni.goria slrould lrr.' cottf tncd: (r ) to pL.rsor)s at high risk of blindnr.ss, rn whorn trt: atnr()11 L ts tlstlalfy dif f rcult and sont(-'Limcs dang<:rous on a(ico\lnt ot' Iriglr rntc'nsity of inlcctron: and (tr ) to pL'rsot)s wiLh acut(-, prurLtro I(-'srons, rvho trsually ltavc ItglrL infr-'ctions and support tr('aLment rv(' II. [UosL oI tlrosr.' in tlto f rrst !lroup would havc'to l)(j idr.nti.fir.d lry srrrvcy LL'anls on tlr(-'llasis o-[ c(']'Laln critir:aI srgns and symptoms wltich s(rll n<..r-'d to bc rcl'itrt-,d lly t'csoarch. I)aLrcnLs in Llrr.s()cond group arc IrkcIy to pros(.,nt Lll,-'msclvos lor Lrc'atmont I)rovisron for troatm()nt, using DLiC and suramin. slrould Itc se't up at sp(.(:raI clirtrcs in hosprtal or drspcnsarrcs, I)ut only wller(' thcrc ts an I\l .O. in attondanct.r. Such c()ntros should [re. cstal>lished first rn those places wllcr-t-. ocular onclrocorciasis rs particularly sr:v<-:r'e and rvhore v(,ctor control lras b<..on cstal).1. ishod so tlrat ro infoctrons wiII not supcrvonc a1'tcr trcatmcnt. 3.2 Vcr:tor c<ttrtrol I t is noL possiblc at thrs stag(-' to dr.tc'r-nrrn(-' wlth any dogrt't-' of accura(:y tllc prol)alrIe cost of voctor corrtI.ol.,rpcrations covering thc' 7OO OOO s11 . km. constitutr.ng tlrr: proposr-'d targot aroa. ti Souncl tcclrnical and scrcnL r l'r.t: planning and r)lanag(,,mont ol' the control op(iratrons could contlil)ut(' to a nct rcductiort of costs, whrlo inappropriaLt., tochnical docisions or nlanagemcnt mrglrt rncroaso thcm nlany t inrc's. Thr-. sclection and con)l)os1t ion oI thc' vt:ctor conLrol t<:am r(,sponsible. Ior Llrc' planning of .lr<-, opol'aLions f ronr Lhc prcparatory phasc onwarcls has tlrus a crucial i.nrpor Lal)t;r: l\lost of' tht., insccLi,cide al)l)Ir(:ations wr. lI bc madc. wr- th aircraf t wlrr-,rcvcr Lhc canopy pr-.rmits tllrs. Idt.aI Iy, ,l',.-. (.'rrtonrologi<-'aI ()vaIu:rLion tcams should work scparatoly tronr tlrrr tc'anls carryir-rg orrt Lht'Iarvic:iding tr'(!atm(r11 t so that trclatmcnt and t'valrraLion r:;rrt lrc dono indr-'pt,irdcntIy. In practice tlrrs u'or,rld rcsult in an rnIIatror) ol profcssiona]. sLalling and prove' \'ory costly. The nctwork of c.valtraLion tcail)s. as .l or O.CP. wrII thus p).ay arl rmportant rolc in thc day-to-day planning and ad.lustrgenL of thc insccticr"dr: applrcations. Althouglr tho zonal aroas covcrod lry thcsr. cvaluation L(.arns corrld llo tailorcd to coincid<-, with Statc-, I>oundarios and LIr() (.vaItration itsr-, II' bccont<-' a StatL' rc'sponsrll: lity, Lhrs nlrgllt not alrvays l>t-, a sur tal)lL. solution in vi<:w of tho main opL.r'aLronal consLrarnts srrclr as a(:ce'ss illrlity to tho lrr-cc,dr ng placr:s and sur.-(-) [ [ Iancc plans wh ich ale srrll..;cct to tlr(-' road nr-'Lrvork. l,'urtlrr-.r, thr,' t:losr.sL ()o-ol'dination must cxist bctweon tlrt' <:l'rrr-'l ol tl'rc v(.ctor conLrol op('r'aLions, hrs dcputios and thc cntonrologr,sts rn r;ltargc oI tlrt.,cntornoJ.<.rgicaI surv(]].llanco notwork. 'Ihey should llt'alllr-.to rc'placc r.aclr oLlror durrng pcriods of alts<:nct, and coI)c(.ntratc tltt.ir forcos on crltrcal areas dr,rr'ing roinvasion pcri.ods, and for spt.<:i f ic strrdic.s. TI.ro hydlological moni torrng is essontial Lo thc daily planning oI op(.'rations , as Lhr-. dosing ol rnst-.cticidt-' aL c'aclt applic:rt j on point ts dr,pr,ndont on tlrr: rvater lIou,and rivor rc'grm<:. Altlrough wat(-.r'gauges ()an sorn('Lilnos lro r<'ad Irom Iho aircraf t, rnost readIr)gs arc rotrtrnc'Iy donc Iry tlrr: stafl'of tlle ('ntonlologrcal strrvoiLlancc r)ctwork and radro('d to thc' r'oIcvatrL a<-.r'ia1 op<-.r'ations lras<: or di roctly to tlr() of I rco ol' tlro clticf of thc veotor control op()rations, as appropriaL(,. Thrs activity consti LuLc's an intt,gIaI part of tlr<-' drrtics of Ll'ro c.nLomologrcal t,valua ! Lon r)(.. twork. ITlrr.. hydrc.rtriologrcal monitorirl,{ rs frorn tl'rc teclrnical sLandpoint r,ntit'cIy indcpr-,rrdt-lnt of Llrc'vcctor control operations and ovaluati.on and rs basr-,d on p(,r'r.rdi. surv(-,ys o1 r'<,1,lrt.s(..ntativt-' aroas of sclt-:ctod u'atershcds, with random clrcck-ups oI ottror wat(:r'slrt: ds. A closc lraison wr Llt thc vrrctor control opr-, l'ations is nr-'vc'r'Ll)(.'Ic'ss "tt1.:lrraI so that any hydro- iliologir:aI olrst:r'vatlon rovc.aling r.r'r'ors of troatmc'nt can l.lo rntmedrately rcrporLr:d and fulty invostrgatc'd by Lll(r voctor corltrol ttnit ' In vicw ol tho srmrlar'rLy ol' Lhr-. sL?.a, clrmatr.' and gcography l)(,two(,n f.hc OCb aroa and Iargc zon<,s of Lho onchocer<:j asis c-ndomic are'as oI Nigr.ria. thc' gonc'r'aI approa('lr('s and stalIrrl!l rc(luirc'ntt-rrtts of the Nrgcrian canrpaigr) wrll prolrallly t.rt'ol Lhc sanrc,Lypc'artd orcler of nragni tude. as I'or Lrrr: cLrl'r-oI1 L OCI) ol)(-'I'atron. 3 ,3 Socio-oconomic aspccts Onchoccrciasis is a discasc' rvl'rich, esp<.cialIy in aroas c-rf hrgh cndcmrcity, has very markod socio-,:conomlc cor)soqLlc'nc('s. Suf lurcrs are gc'ncra). Iy delrrf r tatod and thc rclatrvoly lrrglt pe.r'ccI)tagu ol' bIi.nd pooplc lrccomt-'a lrurdon on tlre conrnrrrnity. O1 grcaL(-'r'signr.frcar)cc national Iy is tho onf orccd movnnr(-'r)L ol poptrlati ons arvay I'r'om tlrc' f(-'rL1Ic river vallc:ys wlrich romain rrndorpoprrlatod or dt:st.lr-tr:d and tvl'tosc potc'ntra.L prodr.rctivity rs IargcLy Ie1't untappc'd. 'l'ht: <'ontrol oI'tl'rc voctor Ioading Lo tlro Jrlogr'r-,ssivt-'control of the discasc gradrral ly rclicvcs thc irnpact on Lhosc al'I'<.t'tr.d atrd dcsorted tracLs oI Iarrd w]rrr:lr arc clcar<>d I'or safe rcsr-'ttIc.,rncnL and cxtc.nsivo oxplor tation. 'I'lris slrorrld rt:sul L ln a positivo r;corromic lrr:nrlf :.t f or tlre c:ountry and sLrrdics should bo urtdortaken during tllc proparatory pltasc to asscss i ts lr'vr.. I . l''trll usr,will lrc madr.'ol'avarIatrIr.'daLa as it is Lo bo Iorrnd in the f rLes ol' thr-. r't,'I('r,,ant govc)rnm(-'nt ol l t c<.s and dopartm(-.nts , rnt('rnatiOnal and lrr latr.ral agcncic.s and oLhc.r sotrr'(:()s. llowt-'vc'r' , as onchocercias j.s af fr:ctcd arcas al'c oI ton givon sonrt,rvlrat Iorvor inrportancc by thc. Plannrng Authoritics, rnuch lrasic groundrvorl< wiIl lravr: Lo lrc dono witl'r spccral <'nrplrasis on soil potcntial , waLt.'r availalrrlrty, social and cultural troli<-..[s wlriclr could Iacilrtato, or lri-ndor', tho caasy scLtlcment of pooplc in tlrt' re.clzrintcd ar(-'as (sponLanL.ousIy or tl'rrough organrzcd scLtlonrent), Lo socro-('(:onom j.c r(.quiremLints of tlrc potential sottlcrs , ctc. Strrious <:onsidt-.ratiol) ruust also l-lc givcn to thc: I'act tlrat undcrpopuJ.aLc.d areas oI'tc,n s i tuatr.d <: Iosrr to waLor coursc.s rnight have heavy Glossina populaLions, as woll as a great alrundancc- of aquatic snails artd anopholine nroscluitoes, and sorneLillcs also dcnsc poprrlations o.[ sylvatic yc.lIow fovcr vc-ctors. Thc lrrII rt:clamation o.l tho onchocL'r'ciasis arr-.as rL'(luiI'cs thus not only tho conLrol of malaria l)uL also spocj,fic mcasures to protect tll() sc'ttlers against outllrr.,aks ol othcr dartgcrous vector-borne diseascs and tlrc provision Ior adc.quato facrLitics regarding watcr supply and pcriphoric hcalLlr car(-' faciIitiL.s. I1 I . I,,'!,.para lq rJ__P]le!l As indicatt.d carl.r.or cluring tlro Pr<..paI'atory Phasc: tl'tc following acLivrtrc.s rviII oc. porIormcd: - scIrtct ancl train a national progralllnl() coordinator; - carry out onc5oc<:rciasis strrvr:ys itr sc. Icctod rndrcaLor vil'Iagos, in ordcr Lo obtain tlasr-'-L irrc daLa on Lh(-. pt'ovalonce and intonsl ty of Llto tnI'cction and on tll(.' amount of blindnoss assocrated therewith; - initiat() studr(is as noc()ssary into tl)c'socro-t-'conomic importance of ol-r<.5ot:r-.rciasis and pro.j<'ctions as to thc cconomrc dovelopmcnt which ml ght loIIow rts conLrol ; - soloct a pilot m<-'dic4] cr-ntrt-. rvhclc tr'oatmot)L of onchoct'rciasis can l)(. r:arpicd out undor acloquaLcl modicaL sttpt'rvisron. atrd pr'ovidc tllls witl) tlrt., stal'1', drugs and lacilitie's n(r c(-'ssaI'y lor its propc'r I'unc t ionn r ng : - car.ry out complt-'nrL.r)tary suIV(..ys in or.dor to nlap v('cLor br't.'udlng P I at:r's : - <l()Lr-'r.rninr. tlto gCncI.al ou1 lirrt-'s of Llro dlstrrl)tlLroll ol tlrc various mcm[lt:rs of S. dattttrostrm corrtlllox; - co I-Icct aI I r.r:Ievant h1'drological data and rd('trt rfy gaps requrring establi,slrrncnt and calil>raIron of additional rivcr gatlg()s; - prL,par-e monthly maps oI distribution of thL, v('(:Lor bt'ocding placcs rvith tltc' cltarat:toristics oI S. dantnosttm cytoLyp('s; - dr:t3rnri pr. thc sus<:cpt i lli li ty oI S, dantnosttnt ()onlpl('x to insc'cticides , and s\tl)s(.(lu(.ntly carly out conrplcmc'ntary studiL's wrtl) known cytotypcs; - collcct llastl inc lrydrolliological daLa on l'()plLrs(.'ntaLivL' rvatr:rsheds; - <.lrarv uJ) Lon"aLivo co-stilrg ol a !i()r'reral plan Ior vc'cLot'<:ontroL opcrat rons cov()r'rng thc Pltasc 1 arca (At>u.1 a), taking rnto accour)t aI I krrowrr gr:ogx'aplrical , physrcal ar)d brologrcal data so as to nlipinr iz<. tlrc' r'oinvasir->r'r risks ; tlris might involvc' a zonc' of IOO OOO Lo I50 OOO sr1 . krrr. irr vit,w ol'tlro c('rrtral position of Abu3a and tlrc allscncr. of natural lrerrrrL'r's rrnpondirlg tltc Iong-distancc' I'liglrL ol' tlto vc<:tors; t2 plan and cost thc Proparatory Plrasc activitics rclatcd to tl'Io prclraration o-[ thc troatnl(-'I)t in tho Pltastt 2 arca; carry out'dL.taiIcd studi()s in thc' Phasr-' I aroa to collcct rel.evant lrasoline data on vcctor alrrrndance and distrilruti<.ln at thc adult s Lag() , r'c-[ino thr-. nrappi rtg o-[ tltr-' Iarval ltrr'cdrng s j' t,cs , otc. ; train aII thc nrcdium Iovt'l and .;ultior'staf-t rt'qurrod lor carryrng the Pl)asL. L operations and l.ryinB tht: basos foI tlro preparatory activ.i tics in th<-. Plrasc 2 araa i carry-out any addrLional dutios rc'Iatc'cl Lo thL- goltoraL plannrng, cosLrng and inlplomentatiort of tl)o progranm() as may ltt-' rcquired, e. g. prr paration o-[ acrial conLI'acts ; propa]'atron of ordc'rs for j nsoctici'lc's , cquipmctrt , srrpplirrs ; instal laLiort oI' radi.o n<'trvork; draf t ing rr.'scarclr and trarnrng contracts ; organizing tho trainrrrg outsidL, Nrg('ria, ctc. out 4.1 l')1.rrdr',nioIogi c:rl Uni t 'I'lrc Iipidcnrr.ologicrrl Unit durrng thrs pl)asL,, wrII nct'd in partrcular: - I cpr clt.mrologrs t - L-2 pul;J. r c lrr.aI th oricntcd ophtalrnologis Ls wllo wr Il ne e,d to actluit'c r.'_x;lr:ricncc ol oncltocct-ciasrs - 2 mr,dical parasitologists - I sot:ro-cconomi.st -.1 -(i IaboraLory or fic'Id t<'chnicians - 2 ogrh Lhalmic nurscs - 4-6 Iaboratory attondants - 4 drrvc'r'mcchanics - 2-6 driv<-'rs - I or 2 Iorr'.r.os wi Lh opl-rthulrnic dark roorn rnountcd on tl)cm - ,1 -tt Iour-wlxrc. I drivc vohrclc's. 'I'lris will zrIIow for soLtirtg rrp 2-.1 frold tcilnsr ul) to 2 of wlrrclr would llt. crlutppcd fot' diagnost ic o;lhthalrnologl, in Llrt' f i.oId as rvell as for parasitologrcal diagnosrs. 'Ilrt.ir'Iunctions wr. I] bc'tb coIIc'ct c'prdcmiological lrast-'-1. lnt. data and to i.dc,ntily onclroccrciasis yraticnts in spocial noed o-[ trr-.aLnlcnt. Tlrr. ophthalnric tc'anrs shorrld also i)c t-,rltrrppc'd to undcrtake fiold troatm(.11 t ol'othc.r sinrplc'c.yt' conrditions. r3 cl trarnr ng I..,rl t1,... Ioadt'rs of thosc' t('ams rniglr't bo ltrovi<.tt:d in OCP, or lty lVllO consul tants , ol lry Dr O. I(aIr:'s tcarn at Ibadan wltich wrll lry tll(.Ir l)avL..Lltomsclvos r'()c()rvcd suclt trainirtg, lracilr tles for providrng lrospital troatnrL.nt to paticnts wLth onclroccrciasrs who arc. at higlr rr.sk o-[ l>Iindnoss is ]ikcly to dcmand Jtrovisron of bc,<i spacc, nursj.ng Iar:rIitics, a'n<] a proporti.on o-[ prolosslona] modical tinrr-. for sLlp(-'rvrsion. In tlro pr(-,pal'atory phaso , consrdoration might bo grvun to ostablishrng onu such tre.aLnlcnt cor)trc i.n a heavily infot:tr:d art-'a- in ot'dcr to dotormrno tho logrstics and fcasil>rIrty o.[ such a sL'r'vrco lroloro aLtcnrptrng to provido it nloro rvidt:).y. This would rcquire initral. ly: l I fUt'dicaI ot'ficor I Lalroratory Toclrnician .1 Nurst's I)rovision would lravc'to lrt.'rnadc I'c.rl supply o1 r)c'c('ssary drugs lor troaLnr()nt and for adr-'rluatt-. diagnosLrc erlttilrment. ,1 .2 V('ctor OorrLroI Unrt 'fhc Vt..<:tor Contlol Ur)rt, during thrs Proparatory Phasc, u'iIl roquire in lrar'Licular orto scrti.<-lr and cxpct'iotrc(,d ('t1 tonlologist as cliic.f and gt'ncr'al manag('r of thc vector contro-I opcrat].ons; on(.' oxp('r'r t'nccd L.ntornoLogrs t (poss rl;Iy an agricul tural entomologist ) to <icaI wi tlr aII problt.lns rclaLcd to the' at'riaI application of ins<:cti.crdos, f light pIans, ground Iacilrtit.:s, equipment cvaluation and dr-.vr'Ioprnc:nt, suscc'ptj. ltrlity tests, etc. ; onc ()xpc.rionced entonologrst for th<-. collcction of l>asclino data on tho PItase I arc.a and to collallorate wi tlr Llrc' goncral survey of tht.: otlrcr r.ndomic aroas o1' Nigcrra; at lc'as L oIrL. and pro [crallly two cxp(]rie ncod gc'ographcrs , nlt l r tary oi.rsc.r'vor.s , or Llntoy'roLog j.s ts to carry out acrial survt_rys and conrplcnrcntary ground survoys ovcr thc wlrolo o f tlto cndomic aroas of Nrgc'r-ia .tor m:ipping potontial breoding plact's, conf irmj.ng tlrc mapping I'rom tlrt.' grotrnd , and coI lecting maturral fot' taxonomic :rnd cyLoLaxononrrc idr.nti.f ications; ontomologists would Itc morc' advantagous as thoy would subs<-'qu<-'ntIy scrvo thc canrl;zrrgn tl)rough othe.r dutics and be availalrlt for complcmentar)' survc'ys u'hcnever approprr.at(J: t4 - ono spocially trainrng 1'ull-tinrr-' cytoLaxonomist; this task could lrc sub-contractL-d to an appropriatc rcscarch ct-'ntro or Universi ty within Nigoria; - during the Iirst yc'ar oI the Prcparatory Phasc, onc of the expertenr, ()ntomoloBists shotrl-cl dovotc- most of his timc to train four or five lic'Ld o1 [icers, l'icld and laboratory tt-'r:hnicians, insoct collectors. and othc'r staf f I tlrt' r,ntonrologist should also plan thc dc'tailed activj-ties of the cvaluation nctrvork and thc recording of all blological data rclatcd to this monitorinB (som() of ttrcsc training activj.tics miglrt also llo sub-contracLcu); - duri.ng the sccond year o-f thc Prc'paratory Phasc, the cntomologist in clrargc of thc opc.rations should train st,voral opcration of.[icers rc'sponsible f or thc actual application o I tllL. insccticides , the dai.] and rvc-okly updating of the -f Iight and treatmcnt plans, the recording ol tl)o treatmc.nt and f Iight data, ctC. About 5 f ic.ld o [f icc.rs ,2 lo 3 operation of l iccrs , L2 to 15 lalloratory and fiold tc.chnicians,20 to 30 vcctor coll()ctors and auxiliairies should t-lc- envi.sagod. Onc' Iight I'Lxt d-wing aircraf t ( two to Iotrr seats in passcnger con-[iguration ) or prc'ferably onr. I ight lrcl icopt.cr (2-3 soa'ts) rvrth pilot and mc'clranic rviIl lre ner.dcd frrLl timc'Ior thc two-ve.ar Preparatot', Phaso. Vct'riclc and drivor r<rqlrirorncnts mi.ght lr<' ostal;Irshc.d at tl to IO four'-rvhcel drivc vclricl<'s and 7 to 8 drivc.t's for tho Iirst year - and at lO to 12 vehicles and 9 to IO drivc.rs .[or thc sccond y()ar. At least one of tho vchicles should bc a Lorry to transport luol, -rnsccticides and otller lreavy itoms to tho ground stations of th(-. Plraso I aroa. Light aluminiurn lroats or inflatal>Io dinghics wiII probably bc ncodcd but thcir nulnl>cr and typc. should bc'dt-'cidcd locally according to thc. atrticipated rr-'rlui r('nr(]nts and tho advicc. o I l.rydrologists and lrydrolriologis ts ' accustomcd to ct^iploying l-)oats on such typt-,s of rvatercoursc.s. li) - ,1 .3 Soc:io-cconomi<: Uni. t 'ilte Soci.o-c,:ottomic Unit rvilI rcquirc tllc follorving pcrsonncl to collect thc rangc of data ncccssary to mal<r-' rclcvant assessmcnt: - one fu1I-timc oconomist as hcad of thc Unit to pl;rn;rnd dircct the s tud i cs; - onc sociologist to revicw probJ.cms confronting tlrc population; - ollc humatt gcographcr to study thc migratory bchaviour irnd constraints of thc diflerent groups; - ot'tc agronomist to cxamitrc,Llrc agricultural 1;otcntial of thr: clcared il I'()a s; - - consult'ants, ils nccclssaI.y, lo}' poriocls to be spocifrcd to c€lrry out spccific: str.rdics. 'l'ltc'ncc<l -[or socrctarial assi.stancc and probably er cartographer sltould bc forcsccn. 'I'ltc UniL will rvork in cIosr.'rrssociation rvith tlrc l.'odoral and Statc planning authorj.tics to cnsur'('tlrrrt any asscssmcnts ancl projccLions maclc arc it't lino with govcrnmcnt polic.y. Attontion should bc given in cach area to thc possibility o-[ planno<l vorsus .spontancous scttlc:nront; thc sui tability o-[ any arca -[or intcnsivc crop pro<luc t,ion; thc <Ievelopmcnt of agro-industries; thc rolc of irri.gation; tho provi.sion of hcalth, educational arncl otlrcr social scrviccsl thc construction oI roac[ rrctrvorks, etc. It is impcrativc that cach mt-'mbcr of thc Unit bc Lnclopcnclcnt regarding mobility and lrence bc provid<'<l rvith a suitablc vclliclL- rvith drivcr. Irour vchiclcs altogcther may bc adccluatc, of whiclt at loast half shoulci bc multi-purposc four-whccl dri ve . 1G i 4.4 ArlminisLrirLivc Scrviccs Unit I'5c campaig'r rviII rcquirc a stI'ong admrnistrativo unit c'-hargcd with ovcrall plannir)g ancl Iogistics support to ensurc cffcctivo rccruitmcnt, procuromcnt of supplic's and cquipmc.r)t, rnaintcnancc, ctc. l\luclt rvi1l dcpcnd upon thc propc\r mirnagomcnt, fucllj.ltg, arrci maitrtcnancc o-f vchicles and a strong infrarsLructurc lor this should bc cnsurcd fronr tlle outsct. Additional f aci Ii t j.cs must trlso bc assurccl , suclr as Iandrng pads f or lrcl icopters, airsLrips .for plancs, ra<Iio communications, small ficLd dcpots rvith u'atchmcn apd casu:rI labourcrs -[or -[uc1 and insccticidcs, laborirtory space, garages, Irangars, ctc., wrth aIl the supcrvision, managcmcnt and maintcnancc associa tr:d rvith suclt a nctworl( of gl'ound facilitics. 5. Sr,rb-sc<1uont phascs 'l'lrc l)hasc l arca wiIl cor.rstitute a training ground for a]1 the staff involvcd in tlro')rcparatory Plraso lrnd l)lrase I activitrcs. It will also constituto an idcal training grounrl Ior thc staf.[ suLlscclucntly to bc assi.gnod to I)hasc 2, l)lrasc 3, ancl othcr arcas. To implement the campaign in a Iogical nranncr and ona[rIc it to bcno-[it,l;rom initia] cxpcrietrcc, i,t might l-rc appropriatc to rvork on tl)o I)lrasc I arca -[or tlo ycars beforc cxpanding to l)lraso 2. Tlrc insccticidc :rpplicatior) opcrations rvould lcquire prob:.rbIy trvo mc<lium-sizcd aircra-[t. 'l'hc first ycar of Phase l opcrations rvould thus havc an cxpcrimcntal and training cha rerctcr, and rvould Lrc uscd in parti.cular to train scnior and mcdium-lcvol slaff for thc Phasc 2 <:omplcmcntary survcy. Durj.ng thc - sccond ycar of tlrc I)hasc l opcratron-s, Llrc neu,ly tralncd staff rvould thus carry out this complcmcntury survoy ovcr thc Plrase 2 area whj. Ie t)re staff of tho l>lrasc 1arc.a rvould contributc to training staff for th<-. complcmcntary survcy and opcrations in thc I)hasc 3 arc.;r. 'l'lris pa Ltcrn could bc rcpcated as ncccssary. 'l'o avoicl cxtcnding thc carnpargn ovcr too long a pcriocl , <>ach phasc follorvj.ng Phase I could lnvolvo alrout 2OO, OOO s<g.km., r'c<luiring thus trvo additional cntonlologists, tcn -Iiol<l offi<:crs, 15 fielcl arrd l"aboratory tt-'clrnicrans, 1O to 12 <lr|vcrs, 20 Lo 30 inscct collcctors, 12 to 1-4 vehiclcs (rnclr.r<lj.ng two lorrics), trvo opcrational oI.[iccrs, and probably onc to two a<lditional aircraf t. Tlris mcthod of arpproaclr woul<l corrcspond to: - imJ>lcmontatlon of Phasc I (Abuja alca) i.n l:tUO and 1981; - implcn<-'ntation oI I)hasc 2 (rvcst of Abuja to connc.ct rvith thc OCP arca); - inrplcmr-'ntation of I)lrasc 3 (conLraI castcrn Nigclia) in 1:t83; - implcnrcntat ion o-[ Phasc ,t ( Lhc .tina I arca - castcrn Ni.gorLa ) in 1984 . 'l'ltus by I:)84 opcrations woulrl covc\r most of tlrc. cn<lcmic arcas of thc country. 'I'he subsc<1ucnL ycars rvotrld ccrtainly rnvolvc minor adSustments callcd for in tltc Iight of expcrioncc gaincd, but, for aIl practical purposes, tlrc camyraign rvould bc. in full olreration -from 1!t84 onrvards itnd should bc pJ.anncd along Lllc samL. broad linr:s f or futurc yeal's. l l8 I t would bc implacticat ati tlrrs stergc to attcmpt to dcal rv,i.th the plannrng and staffing in furthcr <l<:tai1, sinco tlro r.rcccssary basis is Iacking. 'lhc ouLlinc providcd abovc should thcrcforc bc considcreci as an orclr-.r of magn r turlc . It rvotrlrl be logical to cnvisagc' thc .subcontracting of ir1,d.oU' orogical sLudics to suitablc j.nstrtutions rvitlrin Nigcria, and tlrc samc. could apply to parL oI thr.'t'cscarclr, tllc rcst o-[ thc rcscarch bcrng carricd out by the campargn staI1. l'lrr-. typc of rcs(-'.lrclr sharing ancl m.rnagcmcnt dccidcd upon shoulrl bc sanctionccl by appropriaLc stalfing provisions. Spccial considcration sl.roul<l ;r1so l.rc givcn to thc analys j"s and cornputcriza Lion of cntomological, ol)erational, hyrl rological and lryri:'obiological rlaLa rrrrd thc dcvolopment of a rclovant and cffcctivc rctricval systcm, an<l to thc corrcsponding staffing rc<1ui rcmcnts . I)ossibLc sourc(-'s o.[ tcclrnica] :rn<l sciontifrc oxportisc I lVi.thin Nigcr':.a A numbcr o-t Nigcrian Univcrsitics l'ravc zool.ogical/cntomological departmcnts and co.uld suggcst nam()s oI promlsing graduatcs {or training as cntomologists. Can<.lidatc ficld o-[ficcrs nriglrt bo provj.dcd by cxisting hcalth structurcs as ficld cxpcricnce and rcliarbility rvill bc morc j.mportant than univcrsity <1ualj.frcations. 'l'hc Univcrsity of .Ios is pl;rnning to organrzc Lho tra inrng of medical cntomologists at thc I\l .Sc. Icvo1, but may not bc frrlIy opcrational in time; altcrnaLivcs shoulcl thcrcforc bc forcsccn, proLlably by lccrui ting zooilogyf cntomology graduatcs .rnd provi<ting them witlr an accc. Ir-.r'a Lod training in Srmulium biology and control. 'l'lrls might lccluirc' cxtornal coopcra tion. NI'tlt lras alrcad.y somc cxpcrionccd sta.tf nombr-.r's rvitlr many years of scrvicc in Nj-gcrra, and onc of tlrom has rvorkc<l extcnsivcly on oncl'roccrciasis and its vcctor-s arrd could ccrtait'tIy contributc to c:itr-r'ying out part oI thc prcliminary survoys, training oI sta-[f , cf c. 6 6 l.) Thc-. WllO Voctor I3iology and )Control Ilesearch Unlt, iiaduna, ltas h'itherto .focussod its activity on Anopl'rcIos bj.oI ogy and corrtrol", but i t is expcctcd that, lrom 1!)7!) onlards, .in apl)rcciirblc part of its rc'sourccs coulci bc dcvoLcd to Simulrum ancl Clos-sina biology and control, and priority would be givcn to onchocc.r'ciasrs voctors. 'l'ho projcct Icadcr is an expcl'ienccd cytotaxonomist hav.i.ng rvorkcd on Anophcles and rvith sonrc cxpcrLctrcc oI Simulium. lYith brrcf rc.frcslrcr training, lrc c:ouId contrlbutc to carrying out dutics for thc f utur<-' c.tmpaign ancl in turn train Nigcrian scicntrsts. 'l'rvo of the staff mr:mbcrs arc cxpcrienccd vcctor control spccialists ltaving somc cxperieuce of Simulium Lliology and control rvhiclr coulcI also bc rmprovcd through short refreshcr training. Such coopcration might provide timc to clcvclop additional Nigcrian cxportise. in thcsc ficlds. Somo Niget'ian Univcrsj.tics aro carrying out resoarch progt'ammcs rvhich, althouglr r)ot strictly oricntcd towar(ls thc otrclroccrciasis fieId, could be r.lircctcd torvarcls thc noorls o-[ tho I"crleratron. IVIIO cou]d play a role by suggcsting suclr a rcoricntation to tlrosc submitting roscarch proposals to t[c Spccral Programmc lor Ilcscarclr irncl'l'r'aining rn'l'r'opical Discascs (TDR) in thc frlaria-sis, vcctor biology irnrl control, lnsLrtutron stI'ongthening fields. 6.2 Orrtsi<lc Nigcriet 'I'hc Onchoccrciasis Control I)r'ogrrrmmc has subcontractc(l tltc training o-[ its own profcssional staff to providc cntomologlsts witlr spccial cxportise on onchocerci:rsis vcctors and Sirnulium control . 'lhcsc training -tacilities could bc uscd, un<lcr contract, on a ncr capita basis as the Institut de Rcchcrctres sur I'Onr:hoccrcosc, llou:tl<ri, Ivory Coast, ltas already provided training to Iinglish-spr.'aking scicntists. I'hc bcst tra:.ning on ol)crationirl aspocts rvould bc providcd by OCP itsclf. Although OCI) has no spocilic provisions for that purposc, Nigcriarn tr-ainecs could bc acccptccl at tl'rc Subscctor, Scctor and Vcctor ContIoI Unit (llQs) Ievels and collaborertc rn thc main drrties Lhcy rvil1 havc to carry out subsequently rvj.thin thc Nigcrian Onchocerciasis Control Carnpaign. OCP has also a small rcscarclt unit (loaling rvith cytoLaxonomy (Dr C. Vajimc) ztnd Srntulitrm bj.onomics and roaring (Dr' .1 . Itaybould) rvhich coulcl rcccivc trarnocs in these f iclds. ?o 'l'ltc cnv:.ronmcntal nronitori;tg rs carricd out uncl'cr contract. by thc Instituto oI A<luatic I3iology, Achinrota, Clrana, anrl a spccially-establishcd OItS'l'O:\t Ilydrobioiogical 'loam, Iloual<r':, I vory Coast. Ilotlr could recei'vc Nigerian trainces if ncccssary. tVltile p;rrt o-C thc training rvor.rld lravc to bc funclcd eitlrcr by Nigcria or by other instr tutions anrl agcncit.'s, thc lVIIO'. Spccia 1 Progrlrmmc f or Researclt and Training in Tropical Discascis ('l'DIt) through its Institutior: Strcngthcning and Training comlloncnt, coulci bc usod for dcvcloping Nigcrian cxpel'tise and training facilitic.s should appropriatc rcqucsts be made.rnd acccptcd by tlrc rclovant Spccj.al Programmc Scicntific lVorking Croups and Stcering Commi t tccs . 'l'hc IVIIO llcgio'raI Officc for Africa has scveral intcr-country tcarus dcaling rvith Itlalaria and Othcr Paras j..tic Discascs. 'llicir cxpcrtisc and -taciliLics coul(l ccrtainly bc u.sccl rvithin the Iimits rosulting from former commitmcnts in other priority arca.s. MlO/VllC at Gcncva, with its snralt group o-t pcoplo ()xpcrrcncL'cl 1r) acrral opcratrons, planning, acrtal application o-[ insccticidcs, sa-[c usc of insecticiclcs, c.tc. , might contribuL() to tlrc planning and costing of the Nigorian campaign,. rvithin tho sco[)() oI its possibilitics. A spc-ciaI cffort rvj. II bc nrade to s(-.curc\ a spccialisL on Sinrulium biology and colttrol in the noar futurc, so as to bc ablc to o-[-[<-'r bcttcr cooperation rvith Nigcria. 2) 7. I"un<ling asllccts 'I'hc follorving financing llossil;ilitics nray Lle consiclorcd (a) thc I)rcparilt(,r-y l)lrasc, and (tl) tlrc opcrirtional plrascs of for thc I)rogramme: (1) (2) Nigcria provi<Jing aII furrt.ls rvith ac.lvicc- -[r'om WllO (in this case tlrcrc may bo tol<on WIIO -[rnancraI ass]stanco). lruntls-in-trust plarc<:rl Lry Nrgcria at thc drsposal o.f \!llO to cover 1;1c. provision of scrvrcc.s, purch[rsc o-[ inscctrciclcs, cquipmcnt and vchiclcs, ctc. (3) UNDP, in responsc to a roqucst lrom thc Nigcrj.an Co',,ornmcntrunder tl-rc country programmc, an<l indj.cativc plernning figurc (IPF), coulrlr-.rl with a cost-slraring arrangomc.nt. (,1 ) Crca,tiort o-[ a smal1 corrsort.ium, possibly rvith LiNDP participati.on, througlr rvhicl'r, on tho Llasis o.[ a l)rogrammc proposal, donors are ;rpproacho<l .[or -[inanr:irrl- an<l technical sulrport. 'i'lrc intorcst of Llrc A-[rrcan Dcvc.Iopnrcnt I]alrk cor-rlcl bc oxplorcti. I t must bo r:mplrasizr:<l tltat an.1, <:ontribuLol is particularly intclested in thc cconomic potcntial of tlrc arc.a subsc(luorrtly clcarcd of thc risk o-[ ortchocorciasis and. any prolrosal must bc supportod by a rvcI l-do<:umcntc.d cconomic dcvclopmcnt prcsentation. 8. Initial stolls I.'ollorvirrg tlro <:onsultations tl)at tool( plarce in Gcnova bcLrvocn rcprcrs('nLaLivcs o-[ tho Nigcrian Covornnrcnt and IVIIO in oarly I"cbruary 1978, tlrc nra L tcr wr I I br: Lhc sub;cct oI Iurthcr discussions b<.'trveon Nigcria and tlro lVllO llr:gional OfIicc -[or A-[r'ic:r. 'I'lr<-'llcgional l)irc:ctor has proposcd that a plarrnj.ng mission Jrom WIIO to Nigc'r'ia shoul<l consLituto tlrc ncxt stcp. 1'his lrlanning mission .ts cnvisagcd Ior l\larch 1:)78, and rvi I1 holcl consul.tations in aLI intc.rcstcd partics in Nigor-j,a rvho wiII bc involr,cd in thc prcparation f or an subso<1ut:nt inrplcmcntation o.[ tlrc. campaign at l.-cricral and Statc lcve]. 'flrc nrission rviII also contact mcml;crs of thc Nigcrian National Committec for Onchoccrciasis (lontrol as rvclI as pcr-sons rvorking on onchoccrciasis, and institutions. '['ltc plannin[i mission rviIl assist thc Nigcrran Govcrnment in prcJrarirrg a dra-[t project documctrt for thc l)r'eparatol'y Pltasc.