PET contribution to DDC 2001 annual report

PET CONTRIBUTION TO DDC 2OO1 ANNUAL REPORT 1- Control activities and results - Since 1974, the Onchocerciasis Control Programme in West Africa (OCP) had set as its objective to reduce the disease to a point where it would no longer represent a problem of public health importance and an obstacle to the socio-economic development of the endemic countries. - After more than 28 years of control operations , onchocerciasis is no longer a problem of public health importance. Its endemicity was drastically reduced in all the basins but some points on the Oti in Togo, the Pru in Ghan4 the Tinkisso and Mafou in Guinea still have unsatisfactory prevalences (fig2 ). - In 2001, as in the past years, several activities were carried out in the countries by the national teams which are now taking over from OCP. 1-l Community Directed Treatment with Ivermectin (CDTI) - This method of treatment is now installed in all of the countries concerned with the distribution. The treatment which had been stopped in Sierra Leone and Guinea Bissau because of the socio- political situation has resumed. Everywhere the treatment is carried out by community distributors (CDDs) trained by the district and regional teams which themselves receive capacity building training with the financial and technical support of the OCP Programme. - In general, the treatment with ivermectin is administered once a yeal. in almost all of the basins except in the Bouguiriba basin in Burkina Faso, in the basins of the Oti in Togo and of the Fal6me and Gambia in Senegal where it is administered twice ayear. - In 2001, 250 doctors, 2500 technicianVnurses and other paramedical workers, more than 55 000 community distributors benefited from training / retraining on the CDTI approach in the countries. - More than 7 million people in 20 000 villages and hamlets were treated during the past year. The geographic coverage in the countries varies from 72.4 Yo to 100 oh with an average of 83 Yo. The therapeutic coverage varies between 5l % and 82 %. Nl the countries now order their ivermectin supply directly from the Mectizan Donation Programme The supervision and monitoring of CDTI are ensured by the staff of the peripheral health centres with sometimes logistical or financial support from the Programme and NGOs. 1-2 Epidemiological / ophthalmological surveillance / evaluation - Thanks to the efforts of OCP and the countries, decentralized and trained teams (regional and district), regularly undertake epidemiological evaluations in the various basins. In 2001, 590 villages were evaluated in the OCP countries, both in the original Programme area and in the Extension areas. In general, these epidemiological evaluations are conducted using the method of the skin snip , however, the diethyl carbamazine (DEC) patch test was also used in some villages. The results obtained were excellent (prevalence: 0 %)in most of the villages (FigZ), except in some like Titira in Togo (217 %\ Hiampenika in Ghana (14.3 %) and Mouvielo in Burkina Faso (06.6 %o) ; however, downward trends were observed on these specific points. The community microfilarial load (CMFL) was almost nil everywhere). - The ophthalmological evaluations carried out in Ghana in 2000 had shown a regression of ocular lesions. No ocular microfilariae had been detected. I 1-3 Biostatistics and Information system support In connection with the maintenance of the achievements of OCP, the transfer of data-processing tools (equipment, programmes and data) and of the appropriate skills to the countries continued. Emphasis was placed on the updating of the data and the simplification of the programmes to allow for easy consultation of the epidemiological and CDTI data. Training modules and guides for users were developed for the national staff. A databank was developed for the OCP Documentation Centre and a Web site is in the process of being installed. L-4 Transfer and Training OCP continued to support the countries in their efforts to integrate the control of the morbidity and recrudescence of onchocerciasis into their national multidisease surveillance systems. For the period under review, 30 fellowships in various fields were granted to nationals of the OCP countries. Several training sessions were organized on a continuous basis by the Programme for the national teams. 2- Challenges Now at the end of its mandate, OCP has succeeded in making onchocerciasis no longer a problem of public health importance. The skills necessary for the continuation of the control activities have been transferred to the countries. Today these control activities, especially surveillance, are carried out by the national teams who were trained and involved with a view to maintaining the achievements of the Programme. It is now pressing for the countries to find the necessilry resources (equipment, logistics) to continue the integrated epidemiological and entomological surveillance of the disease. Morbidity must be controlled by an effrcient distribution of ivermectin with a geographic coverage of 100 Yo in each basin and a therapeutic coverage of at least 65 ohin each eligible village. The motivation of community distributors and health workers will have to find solutions adapted to each situation. 3- Prospects The activities of ivermectin distribution and epidemiological surveillance will continue. Emphasis will be placed on strengthening the skills of the national teams and advocacy for the integration of the residual activities of onchocerciasis control into the national health systems of the countries. 2 LFigure 1 Prccontrol prcvalence of onchocerciasis in the OCP area MEV{ErcE c 0-5 /I| 5l{s () 151-30 ra 30l-80 O 'oo @P boundq (qrgnd w.Et rn sosern md lnc@tu et ftron etfuy) Lrmte OCP (arr€ rnrbde d.nnonr @€sl M €lorchocercose de IorA) --- ongdPrqam.r..b@y/Lrmt .rsrn0d6 d @sern d sffirn .{.nsm aaa DMuy ongmd OCP ffi e7o) W.d.m -rd Sodham .xtssEm (19E7 - lgm) Figure 2 Prevalence of microfilariae in the villages evaluated between 1999-2001 MIEEOFxgOELIEIIfuGNALUEEEMEXTS-2OOIiO@ muEEHrc&NtE WTAGSW,rcArE lm 201 t l0@ c o o oa - OCp bDund.ry (@n.t s.t.m. souhm ild6raon.ho.r.neron Umft ocP (.Lr l6d.r!, densron. .l o6cn...rcor. d.tolAt _---- Aillo?l Prcgtrrun6 -.a Mdary/hl..tre hildr onq[al and wrsah.nd $uhem &n.lm aEa bouhdrry umil?.ur dal. ildensrons ou.detsud 590 villagcs eveluated in 2001 J - Nfrma bou.oaa.s, Fronfiares /'