Expert Advisory Committee: report of the nineteenth session, Ouagadougou, 1-5 June 1998

ONCIIOCERCIASIS CONTROL PROGRAMNIE TN \YEST AFRICA EXPERT ADVISORY COMMITTEE Report of the nineteenth session Ouagadougou. l-5 June 1998 CONTENTS -ll II Page List of participants Executive Summary and Recommendations 2 5 8 8 A. B. C. D. E. F. G. H. I. J. K. L. Opening of the session Adoption of the agenda Follow-up to the recommendations of the eighteenth session of the Expert Advisory Committee Matters arising from the eighteenth session of the Joint Prograrrune Committee . . . . Review of the report of the nineteenth session of the Ecological Group Review of scientific, operational and technical issues relating to the implementation of the EAC strategy recommendations Measurement of progress against the EAC conceptual framework on integration andtransfer ... Report on progress of APOC Other matters Date and venue of the trventieth session of EAC Adoption of the draft report Closure of the session Annexe I : Report of the nineteenth session of the Ecological Group Annexe 2: Conceptual framervork on integration and transfer . . . . Annexe 3: Statement by professor Ofosu-Amaah Annexe 4: List of recommendations 8 9 11 aI t2 25 26 26 27 27 27 28 47 52 53 \ 10 07.98 tEACI9 Page 2 LIST OF PARTICIPANTS EAC Members/Membres CCE Professor Adenike Abiose, Medical Director, The National Eye Centre, P'M'B' 2267 ' Kaduna' Nigeria' Tet: 234-62 239373 (Home; - Fax: 234-62 238360 c/o Sight Savers - E.Mail: abiose@infoweb.abs.net Dr. P.F. Guillet, Directeur de Recherche ORSTOM, LIN BGP, 9ll Avenue d'Agropolis,34032 Montpellierc6dexl,France-T6l:3346704 1924-Fax:334675420M-E-mail:guillet@ mpl.orstom.fr Dr Christian lfv€que, D6l6gu6 i I'Environnement, ORSTOM, 213 rue La Fayene 75480 Paris,-Cddex 10, France -T61. (3i.il +g oi 77 i4 - Fax : (33.1) 48 03 7526 - E-mail leveque@ paris orstom.fr Dr Lindiwe Elizaberh Makubalo, Director, Health Systems Research and Epidemiologiy, Department of Health, C1VITAS Building, Struben Street, Private Bag x 828, Pretoria 0001, South Africa, Tel: (012) 3|2-0774 - Fax: (o|2) 328 6299 - E.Mail:makubl@hltrsa2.pwv.gov.za professor David H. Molyneux, Director, School of Tropical Medicine, Pembroke Place, Liverpool L3 5eA, United Kingdom, iet: 44-151 7OB 9393 - Fax: 44-l5l707 0155 - E-mail:fahy@liv.uk.ac professor Detlef R. Prozesky, Faculty of Medicine, Universiry of Pretoria, P.O. Box 667, Pretoria 00o1, South Africa - Tel : ('il) tzzsqtl4g - Fax : (27) 123294524 - E-mail : prozeskT@medic.up-ac.za professor M. Tanner, Director Swiss Tropical Instirute, Socinstrasse 57, P.O. Box CH- 4002 Bas6l, Switzerland - Tel. 41 61 284 8287 - Fax: 4l 61 2'71 7951 - E.Mail: tannerml@msn.com Docteur Mamadou S. Traor6, Chef du D6partement Sant6 corrrmunautaire, Institut National de Recherche en Sanr6 pubtique (INRSP), B.P.1771, Bimako, Mali, Tel: 223 22 60 45 or 22 42 3l - Fax: 223 22 60 45 - E.Mail: mstraore@malinet.ml Dr J. Frank Walsh, 80, Arundel Road, Lytham St Annes, l-ancashire FY8 lBN, Angleterre Telifax: 44 - 1253 -7 96080 - E. Mail : walshoncho@wavenet. co. uk Dr yoichi Yamagata, Development Specialist, Instirute for International Cooperation (IFIC), Japan International Coopiration Rgeniy (nCAi, 1G5 Honmura-cho, Ichigaya, Schinjuku-ku, Tokyo, 162 Japan - Tel +81-3-3269-3851 - Fax +81-3-3269-6992' E-mail: yoiti@ jica'go'jp Dr Faru Yumkella, Regional Research and Evaluation Olficer, The Programme for International Training in Health (INTRAH), p.O. go* 44958, Nairobi, Kenya, Tel'.254-2-229610123 03 8l/ 2t tg20t}l lg2l/21 70 93 - Fax: 254-2226824 -E N{ail: intrahro@users africaonline.co.ke Nrrtional Coordinators/Coordonnateurs Natiorlaux Ortcho I)r Brinra Kargbo, Nattonal Coordinator, Makenr. Stctr.t Leone I)r [-arnrne I)rawara, Coordonnateur natronal, I] I) 58'), Dakar Fanll, Senegal-Fax (221) 824 3532 I)r Souleynrape Sanou. Coordonnateur national, Mrrtrstire de la Sant6, Ouagadougou. Burkina Faso J.. EAC I9 Page 3 World Bank/Banque mondiale Dr Philip Coyne, Consultant, Onchocerciasis Coordinating Unit, The World Bank Group, Washington, D.C., USA FAO Mr Moukoko Ndoumbe, FAO, Rome - Tel (396) 57053010 (direct) I (396) 57055667 - Fax (396) 5225 3152 - E-mail : ( Felix. Moukoko Ndoumbe@fao.org) WHO-OCP/OMS-OCP Dr K. Yankum Dadzie, Programme Director, Onchocerciasis Control Programme, Ouagadougou Dr H. Agoua, Vector Control Unit, Onchocerciasis Control programme, Kara Mr A. Ak6, vector control Unit, onchocerciasis control programme, odienn6 : Dr L.K.B. Akpoboua, Vector Control Unit, Onchocerciasis Control Programme, Odienn6 Dr U. Amazigo, Social Scientist, African Programme for Onchocerciasis Control, Ouagadougou Dr Y. Bissan, vector Control unit, onchocerciasis control programme, Bouake Dr B.A. Boatin, Chief, Planning Evaluation and Transfer Unit, Onchocerciasis Control Programme, Ouagadougou Dr o.w. christensen, consultant, onchocerciasis control programme, Geneva Dr N. Demb6l6, Planning Evaluation and Transfer Unit, Onchocerciasis Control Programme, Ouagadougou Mrs B. Elom, Conference Officer, Onchocerciasis Control Programme, Ouagadougou Dr J.M. Hougard, Chief, Vector Control Unit, Onchocerciasis Control Programme, Ouagadougou Dr A.H. Itondo, Information Officer, Onchocerciasis Control Programme, Ouagadougou Mr V. K6re, Vector Control Unit, Onchocerciasis Control Programme, Ouagadougou Dr J. Lazdins, Manager, Macrofil Project, Onchocerciasis Control Programme, Geneva Mr D.E Miller, Chief, Administration and Management, Onchocerciasis Control Programme, Ouagadougou Mr S. N'Gadjaga. Planning Evaluation and Transfer Unit, Ouagadougou Dr lvl Noma, I:prdemiologist Biostatistician, African Programnre for Onchocerciasis Control, Ouagadougou Mtss L- llavelonanosy, Programme Officer, Onchocerciasis Control Programnre, Ouagadougou Mr M Sarr, Vcctor Control Unit, Onchocerciasis Control Progranune, Ouagadougou t L EACI9 Page 4 Dr K.E.M. Siam6vi, planning Evaluation and Transfer Unit, Onchocerciasis ControI Programme, Ouagadougou Dr A. soumbey, Planning Evaluation and Transfer Unit, ouagadougou Dr L. To6, Vector Control Unit, Onchocerciasis Control Programme, Bouake Dr L. yam6ogo, A.g. Coordinator, Director's Office and Coordinator of the Aquatic Monitoring, Onchocerciasis Control Programme, Ouagadougou O bservers/ Observateurs prof. Samuel Ofosu-Amaah, Director, Ghana School of Public Health, University of Ghana, P'O' Box 13 [-egon, Ghana , Tel. (233) 21 500 199 - Fax: (223)21500388 - E.Mail: gsph@ghana.com Dr B. Philippon, Responsable de I'UR, Sant6 et Politiques de D6veloPpement-, ORSTOM' 2L3' rue La Fayene, paiis ZS+S0, France - T6l : 33 148 03 77 09 - Fax : 33 I 48 03 78 06 EACI9 Page 5 EXECUTIVE SUMMARY AND RECOMMENDATIONS I . The nineteenth session of the Expert Advisory Committee (EAC) was held at the OCp Hqs in Ouagadougou from I to 4 June 1998 with Professor David Molyneux in the Chair. Members of the Committee were briefed on the progress of the Programme and the challenges it faced during the Saturday preceding the session. The Director-General of WHO, Dr Hiroshi Nakajima, visited the OCP/APOC Hqs. and addressed EAC Members and OCP staff on Thursday 4 June. 2. The Progralrune Director summarized the action taken by OCP in response to the recommendations made by the 1997 session of EAC. He referred to the extension of the aerial contract with Evergreen up to the end ofProgramme operations n20}2and informed the Committee that national entomologists had been appointed in all eleven countries to assume responsibility for post-OCP entomological activities in addition to other duties incumbent on them. Unfortunatity it had not been possible to resume vector conhol in the northem part of Sierra Leone. The strengthened activities recommended by EAC for the Oti river basin had been implemented; vector control in the Karkelaba area had ceased; and a comparison between pre-OCP and current entomological data in Guinea Bissau showed a drastic reduction of fly infectivity in an area of low endemicity and sparse population. 3. Dr Dadzie informed the Committee that all OCP countries had now adopted a policy of Multidisease Surveillance and Control and some had made budgetary provision for implementaton. Training was increasingly focusing on middle-level, district staff; epidemiological and other data had been transferred to national authorities. He made a plea to EAC Members tJidentiff candidates with skills in behavioural and social sciences to assist OCP in the transfer process. The programme Director ended by reassuring the Committee that performance indicattrs were now in use for monitoring activities in OCP and at the national level. 4. Professor Molyneux informed EAC Members about his attendance at, and report to, the December 1997 session of the Joint Programme Committee (JPC) held in Liverpool. The Committee reconfirmed its confidence in the Programme ability to solve any problems th;t might arise and to arrive at a successful conclusion of its operations. JPC approved the reports and recommendations of the 1997 External Evaluation Team and of the Macrofil Review Group. Dr Ebrahim M. Samba, wHO Regional Director for Africa, committed AFRO to support OCP's efforts to integrate onchocerciasis surveillance in national Multidisease Surveillance and Control systems. JPC also considered the question of support to socioeconomic development in onchocerciasis-freed zones and requested the Committee of Sponsoring Agencies (CSA) to propose mechanism(s) for that purpose. 5- The JPC session was addressed by the Secreiary of State for International Development, Government of the United Kingdom of Great Britain and Northern lreland, the Rt. Honourable Clare Short, M.P., who pledged her country's full support to OCP r.vhich was an outstanding example of true partnership and inspired optimism in the field of international cooperation.The session r.vas also honoured by the anendance at one of its meetings by President and Mrs Carter. The President expressed his confidence in the Programme to reach its objectivc within the coming five years. 6. Infbrnration was provided to EAC Menibers regarding the acrivities of the ivlanagemcnt and Administratiorr Unit in support to OCP and the African Proqranrrnc lor Onchocerciasis Control(APOC) .l EACI9 Page 6 H.vdrobiology 7. EAC, in referring to the statement in the 1997 External Evaluation report that Iarviciding would not cease before 2002 in several parts of the Extension areas endorsed the need for post- control environmental surveillance implying a need for post-OCP funding.The Committee recommended to CSA that the mandate of the Ecological Group remain unchanged and that FAO as the lead agency for support to socioeconomic development take the necessary initiative in this respect. Also, EAC recommended that UNEP be approached in this context. The Committee welcomed the progress towards publication of the results of ecological monitoring. Progress in the implementation of the EAC strategy recommendations 8. The Committee endorsed the recommendations of OCP with the exception of the proposal to cease vector control in the Sassandra basin in Cote d'lvoire where a significant human reservoir was still present. 9. In the Sassandra basin, EAC recommended that seasonal aerial larviciding be maintained for another two to three years, including control on the Bagbe, Bafing tributaries. In the Oti river basin, the Committee recommended the reintroduction of vector control in the viciniry of the Keran and Kara confluences and twice-yearly ivermectin treatment throughout the basin. EAC also recolnmended biannual distribution of ivermectin in the lower Comoe basin situated outside the OCP area. 10. Given the short time remaining to the Programme and the current security situation in Sierra Leone, the Committee recommended that the control strategy be modified to one of ivermectin treatment only, with APOC support as from 2003. Vector control ll. The Comminee l. expressed its satisfaction with the continuation of the contract with "Evergreen Helicopters" until the end of aerial operations in2002;2. concurred with the criterion for detection of recrudescence as two (2) infective flies per 1000 parous flies; 3. noted the appointment of medical entomologists in all OCP countries and approved their training for integrating onchocerciasis surveillance in the control of vector-borne diseases; and 4. recommended that in addiion to the use of only four larvicides (8.r. H-14, temephos, pennethrin and pyraclofos), etofenprox be kept in readiness to controlresistance to any of the four compounds, should it occur. Planning. evaluation and transfer 12. After consideration of this activity the Committee recommended that ONCHOSIM should assess the importance oI systematic non-compliance in ivermectin treatn]cnt altd of inadequate vcctor control. EAC also recommended to discontinue the practice of rvithdrarval ol ivermectin trcatment for the purposc ot-allorving epidemiological evaluation. Other recommcndations rverc to establish partnership r.vrth Iocal governments ancl schools in support ol Conrmunitr,-directed -l-reatment rvith Ivermectrn; that Participating Countrics be encouraged to prcpare operational plans tilr their ivlultidisease Survcillance systerns and deflnc the competences required and the rcsources and training nceded lbr efl-cctivc inrplementation; that the methodology oldetectrnq the causcs of recrudcscetlcc be developed; artd tltat the constraints tn carrying out lleld *ork anrl horv to ntanage such constraints be includcd in trainiug programmcs. EAC I9 Page 7 Macrofil 13. In respect to Macrofil, the Committee recommended that EAC representatives be directly involved in the TDR Drug Development Programme whenever Macrofil mafters are considered; that the combinations of ivermectin/albendazole and ivermectin/levamisole be given priority in the current research; that new "lead components" be pursued through appropriate screens; that the possibility of moxidectin development be vigourously pursued; and that the the scenarios for the use of macrofilaricide(s) be defined. Progress against the EAC conceptional framework on integration and transfer 14. The Committee agreed on a revision of the framework adopted at its 1997 session and that this new framework be accepted by OCP and the Participating Countries. EAC also approved a format for an activity checklist and recommended that country-specific solutions to OCP residual activities be more fi.rnly developed. The Committee finally recommended that systems analysts pay particular attention to prevailing health policy/strategy/trealth sector reform ani legislation; to thl structuraUfunctional composition of health services; level of donor support; nature and level of decentral ization; and experience with comparable integration processes. Other matters 15. EAC had the benefit of additional information on the progress of ApOC, the OCp Molecular Biology Laboratory and the West and Central Africa Hydrological Observatory. The complete list of recommendations can be found in Annex 4. .t EACI9 Page 8 A. OPENING OF THE SESSION l. The Director of OCP, Dr K. Yanlium Dadzie in welcoming the participants to the headquarters of the nvo African onchocerciasis control prograrrrmes stressed the importance of this session of the Expert Advisory Comminee (EAC) which took place during the first year of the Phasing-out Period. He referred to the recent meeting of the OCP on Strategy and Operational Research which had focused its discussions on the approaches for the last five years of operations and he now looked forward to the EAC reaction to the recommendations made by that meeting. Two major issues were at play: the need to reduce the residual human reservoir of infection to a minimum before handing over to national authorities and the need to maximize capaciry-building to empower national authorities to undertake post-OCP activities. 2. Dr Dadzie referred to the close collaboration established with WHO-AFRO in the field of capacity-building in terms of strengthening national epidemiological and control systems, culminating in a recent WHO/AFRO-WHO/I{Q-OCP meeting in Ouagadougou at which the ground was laid for establishing a regional Multidisease Surveillance support centre within the OCP compound. An ad hoc committee had been set up to make detailed recommendations concerning the activities to be undertaken by this centre and its organization. EAC comments on the report of the Ouagadougou meeting would be communicated to Dr Samba and the Committee of Sponsoring Agencies (CSA) before the final report were submined to the Joint Programme Committee (JPC) in Accra. 3. Next year would be the twenty-fifth year of OCP operations and would be celebrated within the Programme area and, probably at the i999 World Health Assembly. Suggestions from EAC for these celebrations rvould be welcome. 4. Professor David H. Molyneux, Chair of EAC expressed his own satisfaction, and that of his Committee, to meet again in Ouagadougou. He particularly welcomed the new Members as well as the representatives of the Commiftee of Sponsoring Agencies (FAO and the World Bank), the observers (ORSTOM and the Ghana School of Public Health, Legon) and the new Manager of Macrofil. B. ADOPTION OF THE AGENDA 5. The Committee adopted the agenda which is reflected in the list of contents of the present report. C. FOLLOW-UP TO THE RECOMMENDATIONS OF THE EIGHTEENTH SESSTON OF THE EXPERT ADVISOIIY COMIVIITTEE 6. Dr Dadzie summarized the actions taken by OCP in response to thc recommendations of I:u\C.18 as lollorvs: the contract rvith the cLrn'ent aerial opcrator (Evergreen) had bccn extended to covcr thc 1999-2002 period at a cost sliehtly exceeding the budget provrsions fbr the l)trasins-olrt Period: entomologists had been appointed rn all ll countries to bc trarnecl bv OCP rn gror,rncl- lar"'iciding and ilr the prirrcrples blackt)y pool screcning in aildrrron to thcir zrssrgncci clr-rties as sovcrnnte nt publrc health cntomologists; in Siena Leotte it had not, apart from a f'ew weeks larviciding in 1997. been possible to resume vecLor control (sec also paragraphs 36 to 4l bclow'); EACI9 Page 9 special efforts had been made in the Kara area (Oti river and its tributaries) to define more precisely the conditions of operations in that area (see paragraphs 25 to 29 below and Annexe 2 of EAC. 18); a proposal for an "Ecological Panel" had been prepared by the Ecological Group for consideration by CSA (see paragraph l8 below); the downward epidemiological trend in the Kankelaba area had allowed for cessation of vector control; comparison between recent and pre-control entomological data showed a 100% reduction in fly infectivity in Rio Geba and an 89%o reduction in Rio Corubal (Guinea- Bissau), both areas where endemicity was low and the population spa$e; a consultant had visited seven Participating Countries to review progress in instituting integrated Multidisease Surveillance systems; he reported that all countries had adopted a policy in that respect and that four of them had made budgetary provision for the application of this policy; implementation of policy remained to be optimized; training was no'w being carried out at various levels - high level, medium and at the peripheral level with increasing emphasis on the latter two levels; the process of data transfer to national authorities was well under way and plans were being developed for the transfer of OCP data to Ministries of health, universities and research institutes; increasing use was being made of social and behavioural science field studies; individuals with such skills were scarce and EAC members were invited to propose candidates for work in the field within OCP; performance indicators were being applied systematically within the Programme; the targets set by the 1996 national workshops had been fully met; nationaUOCP targets now applied to the training prograrnme in Community-directed Treatment with lvermectin (CDTI) and to the ivermectin coverage of population and villages. D. MATTERS ARISING FROM THE EIGHTEENTH SESSION OF THE JOINT PROGRAMME COMMITTEE (including recommendations of the 1997 External Evaluation Team and of the Macrofil Review Group) 7 . In reporting on his attendance at JPC. 18, held in Liverpool, Professor Molyneux emphasized the following: thc overalI impression 'uvas that of a successful and constructive meeting; the Committee welcomed and approved the reports and recommendations of thc 1997 Extemal Evaluation Team and of the Macrofil Revier.v Group; JPC expressed its confidence in the Prograrrune to solve any problems that rnight arise, to ensure integration within national health systems oI post-OCP activities and to eff-ectively involve communities in such activities; Donor funding of the Programme seemed to be assured until the end of its operations in 2002; EAC I9 Page l0 the Regional Director of WHO-AFRO committed his office to support the efforts of OCp to-ensure integration of surveillance of onchocerciasis and its control into national Multidisease Surveillance Systems as confirmed by the holding of the WHO-HQ/WHO- AFRO/OCP workshop on this issue held in Ouagadougou in April this year; the question of a mechanism for support to socioeconomic development in oncho-freed zones had been considered by CSA, which had made a reconunendation in that respect, and a regional workshop on the same issue was held at OCP HQ during the week preceding the current EAC session; the JpC session was addressed by the Secretary of State for International Development, Government of the United Kingdom, the Rt. Honourable Clare Short, M'P', who reconfirmed the commitment of hir country to the support of oCP and stressed the nr:e partnership within the Programme whose success "should give rise to optimism in the ireld of iniernational cooperation where it was often sadly lacking". ++* Administrative briefi n g g. In addition to the substantive workload of the unit, the Administration and Management Unit had since EAC.18: - obtained Govemment signatures of all l l countries on the Memoranda of Agreement covering the Phasing-out Period (1998-2002); - provided services to the African Programme for Onchocerciasis Control (APOC) in such areas as preparation of post descriptions/classification; budget allocations; training of project acc-ountanS in thqcountries; purchase of capital equipmenq and making funds uriil.ble to projects via the WR offices to projects, as well as providing logistic support to APOC meetings; - taken delivery of 30 vehicles, the last big purchase of vehicles up to the end of OCP operations; hlnceforth only replacement of approximately four vehicles per year was envisaged; - organized seminars for OCP drivers to reduce accidents, with encouraging results. 9. With the closure of the Bouake office and the conversion of the Parakou, Atakpame and Hohoe sectors into national bases, the personnel section of the Unit had made the arrangenlents connected r.vith the staff members' end-of-contract or reassignment and informed goverrlments about their nationals leaving OCP service. 10. \Vithrespecttothebuclget,theProgramme[)irectorpointedoutthatalthoughEAC.the 1997 Ilxtemal Ilvaluatiorr Tcam and the JPC h; all wamed against turther staflreduction, such reduction r,vas incr,,itable as the approved budget provisions did not allorv tor nlaintairring the 1997 staff level' EACl9 Page I I E. REVIEW OF THE REPORT OF THE NINETEENTH SESSION OF THE ECOLOGICAL GROUP 1 l. In the absence of Professor Davide Calamari, Chair of the Ecological Group, Dr Christian L6v6que presented the report of the nineteenth session of the Group which met in Odienn6, C6te d'Ivoire on 4-6 February 1998. 12. Most of the recommendations of EGl8 had been implemented, though the environmental pilot study in the Sassandra basin had not been undertaken. 13. The Group received a thorough briefing on the activities of the Vector Control Unit with emphasis on the surveillance of the aquatic environment and on the use of larvicides, their effectiveness and the ongoing search for improved formulations, in particular of Baeittus thurengiensis (8.t.) H-14. 14. The Ecological Group made a series of specific recommendations regarding the institution or discontinuation of ichthyological and entomological surveillance at specified river sites and a request was made to ensure that the hydrobiologists receive complete hydrological data to allow for a more thorough analysis of the aquatic surveiiiance information. I 5. Hydrobiological studies had shown that after 20 years of larviciding the biodiversity of aquatic invertebrates was still good and generally stable. Monitoring of rivers where larviciding had ceased has shown some increase in diversity towards pre-control levels. Though some of the most sensitive non-target groups had not yet reappeared. 16. The Group fi.rther recommended the publication of the impact of larviciding with permethrin in Guinea and the impact of etofenprox. The analysis of twenty years of aquatic surveillance with respect to fish populations and insects would also be published in international joumals. Moreover, the publication of a scientific synthesis on the activities of OCP and national teams in regards to the aquatic monitoring prograrnme was strongly recommended. 17. In response to a request of the Joint Progriurrme Committee to consider measures to protect the environment in relation to socioeconomic development, the Ecological Group prepared Terms of Reference (TOR) for an "Ecological Panel". In reality, the Ecological Group devoted part of its time to environmental issues and there was no requirement to establish another Panel. However, the composition of the Group might need to be reconsidered. Moreover, the Group being consultative, it was important that relevant information about environmental issues be submitted to it for discussion and recommendation. I 8. EAC was informed in this connection that the Committee of Sponsoring Agencies (CSA) at its recent session had discussed the draft TOR and concluded that the Ecological Group should continue its activities under its current mandate. Any environmental issues concerning resettlement in oncho-freed zones rvould be addressed in the context of socioeconomic development follow-up, referred to OCP/CSA and subsequently brought to the artention of FAO which already had a mandate in this respect. CSA would then consider ways and means of addressing likely financing issues. One way would be to refer the matter to JPC. If FAO was in need of additional expertise, rr should address the Ecological Group'"vhich would provide such expertise or identify the appropriatc resources. t EACI9 Page 12 EAC comments and recommendations 19. The EAC welcomed the increasing rate of report preparation and felt that scientific publication of the hydrobiological data with the full involvement of the national teams in authorship would be a valuable aid to their recognition helping to ensure their continued professional activity in the post- OCp period something which had been emphasized by the Ecological Group and EAC for some time. ZO- The Committee endorsed the Ecological Group's alterations to the monitoring regime but suggested that OCp should inform the Group of the recent changed status of control in the Oti basin where monitoring had been suspended- Zl. The mandate of OCP with regard to environmental issues was clearly restricted to the aquatic environment. [t was proposed that FAO take the leadership for environmental problems arising with the settlement and development of oncho-freed valleys. The Group would continue under is current mandate to cover relevani environmental aspects, at least until 2002. FAO might play a similar role as OCP with regard to the activities of the Group, e.g. provide data and any information that could help the Group to properly advise the Programme on environmental protection. EAC strongly ,eiom*ended that OCP and FAO invite UNEP and other relevant institutions to associate themselves with future environmental developments in the oncho-freed zones. In this context, projects might be submitted to the Global Environment Fund- 22. Finally, attention was drawn to the Extemal Evaluation Report (1997), approved by CSA and JPC, which stated (section 2-4,last para) "lt is noted that in many parts of the extension zones larviciding will not cease before 2002. Post-control surveillance to confirm the environmental recovery is essential and Participating Countries have the trained manpower to do it". This implied that post-OCP funding would need to be earmarked for this activity. F. REVIEW OF SCIENTIFIC, OPERATIONAL AND TECHNICAL ISSTIES RELATING TO THE IMPLEMENTATION OF THE EAC STRATEGY RECOMMENDATIONS (Arurexe 3 to the EAC.l8 report) Programme report 23. The following table illustrates the actions taken by the Programme since the 1997 session of EAC in the fields of larviciding, cessation of vector control, ivermectin treatment and epidemiological surveillance related to the EAC.18 Strategy Recommendations: Geographical area (basins) Action recommended by EACI8 EACl9 commcnts Guinea- Bissau, Sene gal, ll/estern L'lal t - exclusive ivcrmectin treatment until end- 2002 -APOC/TDR/OCP rrrl lroc group to determine duration ot' rverntectin treatment beyond 2002 - iverrnectrn treatrne nt rn Rio Geba (Guinea-Bissau ) restnctcd to fbrrner posrtive rndividuals - evaluation of cortr rtt Lrrt tty-d irected ivermectin treatrnent considering also APOC 3 y,ears expencncc EAC conrplimented the National Teams and the Progranrme on the ercellent results achicved by'the trertntent of ivernrcctin ilr the rcgiorr EACI9 Page 13 Guinea. Northern Sierra Leone - larviciding/ivermectin treatment until end- 2002 In Guinea the situation is generally satisfactory and the Committee approved the current strategy with some intensification of ivermectin coverage in the Mafou basin. As to Northern Sierra Leone: see paragraphs 36 to4l below. Soulhern Extension (Togo, Benin, Ghana) - larviciding/ivermectin treatment until end- 2002 - incidence studies in Benin and Togo using the protocol for areas under ivermectin treatment EAC supported the Programme.strategy. Concern with the Oti tributaries was again registered (see paragraphs 25 to 29 below). Sassandra/Lower Nzi- Bandama./Lower Comoe(Cote d'lvoire) : cessation of larviciding (before 2002\ determined by epidemiological evaluation (end-97/early 98) Bandama, Nzi area results were excellent confirming cessation of Iarviciding. However, EAC did not recommend that larviciding should cease completely in the Sassandra basin. Kankdlaba(Mali) and fularahoue(Cote d'lv.) - cessation of larviciding end-May 1997 - post-treatment studies from June 1997 EAC supported decision to cease larviciding. Niger/Bamako(Mali) - cessation of ground-larviciding end- I 998 i f ep idem iology satisfactory Ground-larviciding to continue till 2001 Baoule-Bagoe(Mali) - epidemiological evaluation to derermine appropriateness of cessation of ivermectin treatment Bui & Kulpawn-Mole (Ghana1. Bougouriba, Dienkoa (Burkina Faso). Sota- Alibori(Benin) Oti- Pendjari (Togo-Benin) - control strategy unchanged until 2002 - intensification of ivermectin treatment - ivermectin treatment beyond 2002 EAC approved current strategies and would review situation in 1999 after a further round of cvaluations. Results of the 1998/1999 entonrological su rvey of Kulparvn area lvere arvaited rvith interest (for tribut:rries of Oti: see llar:rs 25 to 29 belorv) ,St t tr ! ha r tr .S r c r rtt - Le on c Shoulrl sccuritv irnprovc: OCP should assist rcsu nrption of ivcrntectin (rcatnrent via CDTI EACI9 Page l4 EAC comments and recommendations 24. The EAC in reviewing the documents relating to vector control and the overall entomo- epidemiological situation considered in detail each river basin. In discussing these issues, the Committee was conscious that in recent years several residual foci had emerged for a variety of reasons, specifically premature cessation of larviciding and incomplete vector control. The Extemal Evaluation Team had also expressed its concem on this issue. The decisions and recommendations made by EAC were therefore consonant with the overriding consideration to ensure optimization of control through the well defined strategies of vector control and ivermectin treatment. In this regard, the Committee recommended that if the epidemiological situation gave cause for doubt, vector control should be continued and epidemiological surveillance intensified. EAC was concerned that although in some areas the Annual Transmission Potbntial (ATP) was satisfactory there still remained a significant human reservoir. Oti basin 25. The Committee paid particular aftention to the situation in the Kara-Keran-Md tributaries following the concern expressed at its 1997 session (EAC. 18 report, paragraph 35 and Annexe 2). EAC received a very detailed and comprehensive account of this problem area prepared by the Programme. 26. EAC commended the Programme's approach and supported vector conhol of the entire Keran, Kara and M6 rivers with the reiqtroduction of conEol of the Oti river in the vicinity of the Keran and Kara confluences at the period'immediately prior to the start'of the rainy season. Pilots should, whenever possible, be accompanied by OCP staffin the area. Coincident with the reinhoduction of aerial larviciding in the main channel of the Oti, the entomological results in April-May 1998 proved much better than at the same time in 1997, and no more blacklly "outbreaks" were recorded. 27. An additional reason to maintain vector contol was the risk of reinvasion of the upper Mono and Oueme basins (reverse migration at the beginning of the dry season). In order to reduce transmission to the acceptable threshold heatment should be maintained in these basins until 2002, particularly the lower part of the three rivers; coverage of entire stretches would be improved and seasonal larviciding implemented on Oti river during the critical periods of the year (transmission peak, movement of flies). 28. The Committee recommended that ivermectin should be distributed twice yearly with one treatment being given just before the main transmission season (i.e. in early April). Afteireviewing the model prediction of the impact of ivermectin trearment in TitirE bab connrmed that the ivermectin treatment should continue after 2002. EAC furthe r recommended that OCP review the validity of the simulation in terms of the quality and coverage of both Iarviciding and ivermectin treatment as well as the human migration lactor (see also paragraph 68 below). 29. Given the importance of the area, its targe population and mountainous terrain, itwas clear that good ivermectin coverage would be diftlcutt io maintain. AIso, given the difticulty referred ro above in carrying out larviciding would bc less than perfect. Horvever, rvith improvcd performance and the maintenance of both methods of control until the end oI the Programnl.. o satisfactory situation could be handed over to the national authorities (sec also paragrupf, ++ bclorv). (lonro basi n 30 Larvicide treatments in Comoe had bcen highly successlul in controlling transmission along this rivcr and epiderniological trcnds in thc area were satislactory. Downstreanr, a long stretch of EACI9 Page l5 river, located outside OCP limits, remained untreated. Originally colonised exclusively by forest fly species, this area presented a typical pattern of foresUnon blinding onchocerciasis. However, migrants, mainly from Burkina Faso, had colonized this area during the last decades, a-nd brought with them the savanna form of the parasite which was now present in the area but at much lower frequency than the forest type, an epidemiological situation exacerbated by deforestation. 3 l. Because of deforestation, an area was colonized by savanna blackfly species along the lower Como6 to the coast. These flies were transmitting locally both savanna and forest forms of the parasite. It was not clear whether the savanna form had maintained its pathogenicity since eye lesions were not observed in the area. 32. The presence of these savanna flies, with migration potential, infested by savanna parasites was of concern and should be regarded as a possible source of recrudescence of_infection in the adjacent oncho freed areas. Although there was no reason to continue larviciding in the protected area, the Committee recommendedthat trvice-yearly ivermectin treatment be carried out in the lower Como6 (outside the OCP area) in order to reduce transmission. 33. EAC also recommendedthe use of microsatellite population markers to compare blackfly and residual worrn populations from the OCP area (intermediate Comoe) with the populations of the lower part of the river to determine the epidemiologicaUentomological situation Sassandra basin 34. Although treatrnent of the $assandra basin started in 1979, transmission was not successfully controlled until 1985 when treatments were extended to the upper part of the Sassandra tributaries (Boa, Bagbe and Bafing). Epidemiological situation in this basin was among the worst of the rihole OCP areas before control operations commenced. 35. The OCP plan was to suspend vector control in most of the basin and to maintain larviciding only in the upper part of the three main tributaries in Guinea (part of the Western Extension). EAC, because of the epidemiological situation in some villages, expressed serious concem about the proposed suspension in 1998 with the possible risk of recrudescence due to premature cessation of larviciding. This basin was a potential source of reinvasion and it could have serious implications for other oncho-freed areas. EAC therefore recommended that vector control in this basin be maintained for two to three yearc. This could be achieved by treating not only the upper part but the main tributaries @agbe, Bafing) with seasonal larviciding of the Sassandra river during the most critical transmission periods of the year. This would incur some significant additional cost. Sierra Leone 36. EAC noted that no control activity had taken place in Sierra Leonc during the year under revierv. 37. The Committee was informed that OCP's infrastructure in Sierra I-eone had been destroyed and that at present the security situation precluded any onchocerciasis control activity. 38. Given that northern Sierra Lcone was an area ollorv oncho blindncss rates (forest type foci) and that migration of flies into southem Guinea norv appeared to be lintrtccl, tltere was not a strong case to resume vector control. With the security situation being problcrnattc, at the least for the foreseeable future, the short time remaining to the Programme and the scrious consequences to the ( EACI9 Page l6 Programme of the loss of staff and helicopters to rebel activity, the EAC recommended that the Programme strategy for that area be changed to one of ivermectin delivery only. 39. At present, conditions did not exist for Community-directed Treatment with ivermectin (CDTI) and it was anticipated that this may remain the case for some time after fully peaceful conditions have been restored. Many villagers from oncho endemic areas were cunently staying in the bigger towns under the protection of security forces and EAC recommendedthat thought should be given to whether ivermectin could be delivered in these limited secured areas. 40. It was also recommended that the Programme consider what alternative means might be employed and what help provided for the delivery of ivermectin once peaceful conditions existed widely but while social structures might still be fragile. 41. [t was clear that from 2003 Sierra Leone would require a country-wide iver-mectin delivery prograrnme for many years and this programme might be starting again from scratch. The EAC, therefore, recommended that at the end of 2002 Sierra Leone be eligible for support from APOC. Vector control Programme report 42. The new contract with "Evergreen Helicopters" to cover aerial larviciding from 1999 until the end of OCP operations in2OO}was based essentially on the complete cessation of vector control in Cdte d'Ivoire as from January 1999; continuation without change from 1999 to 2001; and a steep 43. The long-established rotation scheme of larvicides continued is application during the period under review resulting in further improvement of the cost/efficiency of aerial operations. An improved formulation of Bacillus thuringiensrs H-14 allowed for its experimental utilization at higher discharge rate and reduced dosage together with a better carry. 44. The results of entomological evaluation were satisfactory throughout the area under vector control. Of a total of 126 capture points, 1 l9 presented Annual Transmission Potentials (ATPs) below 100, considered to be below the risk of development of serious onchocercal eye manifestations, while five showed ATPs below 200 up to which the risk is minimal. At the remaining two points, located at the tributaries to the Oti river,'transmission was high with ATPs between 200 and 400 and special efforts had been made to understand the reasons for this unsatisfactory situation. On the Kdran and Kara tributaries of the Otiriver, where the transmission rvas particularly high, ground larviciding had been intensified, fly captures undertaken in neighbouring rivers, aerial prospection reinforced, ivermectin treatment intensified and sociological investigations carried out (see also paragraphs 25 to 29 above). 15. Furthermore, experinrental aerial larviciding was carried out on the Oti river to determine rvhether this watercoursc might be ttre source of reinvasion of Kdrarl, Kalt and lvlo rivers. 46. During the period undcr revierv, a methodology for screening poolecl blackflies to assess the quantity of L3 larvae using DNA had been developed as had the identification of Sizulium by DNA rnicrosatellite methods. TIie statf of the Boualie nrolecular biology laboratorl' had been trained in the tcchnique rvhich rvould bc applied rvhcnever there rvcre a need to understarttl trarlsmission dynamics. 41. J'he Molecular Biology Laboratory rvould be moved in the ncxt 12 months to OCP hcadquarters to function as a reference laboratory within the context of the intercountry Multidisease Surveillance Support facility soon to be estabtished there. EACIg Page 17 EAC comments and recommendations 48. EAC noted and approved the training proposed for medical entomologists to be organized by OCP to ensure dissemination of the Blackfly Head Poo[ method for determining the number of infective flies per 1000 flies as a tool for recrudescence detection. The Committee reiterated its recommendation of last year that these entomologists should be polyvalent in their skills and have national responsibilities in the context of the needs of other vector-bome diseases. 49- EAC recalled that a criterion for detection of recrudescence had so far been changes in incidence. The question was asked whether the number infective flies (2) per 1000 parous flies had now been accepted as a criterion and the Committee was informed that this was so. Incidence detection occurred late in the recrudescence cycle while entomological detection allowed for early detection. 50. The Committee had recommended in 1994 that as from 1999 only four larvicides (8.r. H-14, temephos, permethrin and pyraclofos) be used in the vector control prograrnme at a time when etofenprox was not yet available on the market. EAC now recommendedthat etofenprox should still be stored where appropriate until it was known whether improved formulations of B.r. H-14 could allow cost-effective treatment of rivers up to 70 mr/s under operational conditions. Relying only on temephos and pyraclofos at intermediate discharge (40-70 m3/s) might be risky from the resistance point of view. 51. T.he Committee was informed about the distinction between "residual foci" (present in the Original Programme area) and'"potential foci"'(at risk of deVeloping). The causes of such foci emerging could be reinvasion,. operational difliculties (prdblems of access), migration or insufficienUinadequate control (see paragr aph 24 above). - 'Planning, evaluation and transfer Programme reDort 52. During 1997 over three million people were treated with ivermectin in more than 10 000 villages within the Programme area. The distribution was increasingly being carried out tfuough Community-directed Treatment with a population coverage of about 7 60/o in I 0 000 communities. The proportion of treated villages was only slightly above 50-%"of the villages targeted for this method of treatment. 53. In September 1997 and in January-February 1998 evaluations were carried out in C6te d'lvoire, Guinea and Mali to ascertain the extent to which villages hitherto treated by mobile teams were covered by the Community-directed Treatment with Ivermectin (CDTI) and to assess the process of installing CDTI. More than 80% of the villages in Guinea and Cote d'Ivoire had introduced CDTI, less than 40% in Mali. 54 Epidemiological evaluation carried out in the Marahoue and Nzi Bandama basins in Cote d'lvoire showed zero prevalence in most of the villages while out of I9 villages in the Sassandra basin, nine had prevalence of Iess that 3% rvith the others ranging up to 21.5%. Although prevalence rates were high in the lorest zone of the Lorver Como6, the levelof blindness rvas less than l%. 55. Within the Original Programme arca, cpidemiological surveillance rvas carricd out in Burkina iraso, C6te d'lvoire, Ghana, Mali, Nigerand Togo. In all, l2l sentinel villages located near river basins where larviciding ceased 7 to l0 years ago rvere examined with overall satisfactory results, .l EACI9 Pagc I 8 yyo to 4.4yo prevalence, except for the Daka (Ghana) and Oti-Pendjari (Togo) basins where prevalences up to 24.6%o were found' 56. Ophthalmological evaluations carried out in the Pru basin in Ghana after nine rounds of ivermectin treatment showed continued improvement in anterior segment Iesions but no significant improvement in the posterior segment which remained stable. Ocular microfilariae were now rare. Aft". s".r..al treatments with ivermectin ocular lesions showed a shift towards the higher age groups. 57. Specificity trials of the DEC patch test carried out in Z,arrbia.where there is no onchocerciasis, and in the Cameroon, demonstrated lack of reaction to M. perstans. Tests in Ghana were equivocal with respectto M. perstans while there was positive reaction to M. streptocerca..An increase of 10%o to2OYoof OpC in ttre Nivea crearn improved the skin response without any adverse reactions (see also paragraph 83 below). 58. ONCHOSIM predictions of the epidemiological trends in river basins in C6te d'Ivoire supported decision-making on cessation of larviciding and simulations were carried out to verify do^wnward prevalence tr"ndr in Guinea in basins under combined vector controUivermectin treatrnent. Analysis was also made of data from the Asubende focus to determine the effect of nine rounds of ivermectin treatment. 59. During the year, 27 fellowships were granted for post-graduate training in epidemiology and public health and "on-the-job" training of medical offtcers and technicians was carried out at the iistri"t level in onchocerciasis epidemiological surveillance and evaluation. In collaboration with WHO-AFRO training in Multidisease Surveillance and Control, including onchocerciasis, was carried out in Benin, Burkina Faso, Cdte d'lvoire, Guine4 Serlggal and Togo. 60. 193 medical officers and 1754 nurses/technicians in the.areas where Community-directed Treatment with Ivermectin was being implemented, or planned, had been trained as trainers for community distributors. So far more than l0 000 distributors had been trained and were carrying out the treatnent. Furthermore, OCP and national staffhad been trained in the use of the Geographic Information System and the use of the ArcView software, for comparative analysis of epidemiological and entomological data. 61. The Programme was norv mobilizing all possible efforts to generalize Community-directed Treatment with Ivermectin (CDTI) as the sole method of distribution. Motivation was an important factor and use of incentives was being made to induce National Coordinators and district health staff to reach a high level of coverage. EAC comments and recommendations Nl,,qlelling support to s c 't 62. E,AC considered the p.rrameters of the ONCHOSIM modcl as regards the efficacy of ivermectin after nine rounds,,f annual treatments. An impo(artt qt:cstion in vier.v of the routine application of iverntectin in C)(lP was whether, in addition to elintinairng microfilariac, iverlnectin aiso has an impact on the nticrpfilarial(ml) output of adult lemale pursites and rvhether this irtrpact was temporary or pennanent. 'l'his question hacl been addressed by arrllysing data from tlve annual rrcatmenrs collected in Asubcnde rvith the help of ONCHOSIM. 'l'aking into account the vector control activities irr that area, attempts to fit the simulation results t,'otained with the model to the trial data rvere carried or-rt. EACI9 Page 19 63. After testing several hypotheses, it was found that the data could only be explained by assuming that after each treatment female worrns recovered during a period of l0 months after which mf-production stabilized at a level which was 35o/o (confidence interval 25Yo to 40%) lower than before treatment. The analysis of data collected after the nine annual treatments in Asubende did not invalidate the original assumptions about the efficacy of ivermectin. 64. The implications of this findings were tested by investigating the impact of control based on a combination of larviciding and ivermectin treatment. This strategy was currently applied in the Extension areas'of OCP. For a number of combinations of duration of larviciding, number of annual treatnents and coverage, the risk of recrudescence after stopping control was calculated for different levels of endemicity. 65- It was found that, compared to the original requirement of 14 years of exclusive larviciding, a saving of at least two years could be realized by adding annual ivermectin treatnieh! provided that a sufficiently high coverage (65Yr) could be guaranteed during the entire period, and provided that during control there would be no importation of infection Hence, a period of 12 years of combined contol should be suflicient to prevent recrudescence even if there were a 2 to 4 years delay between the two control measures. 66. Two predictions were shown for two different scenarios for the Asubende complex on the Pru river in Ghana. If it were assumed that vector contol and ivermectin treatment continued and ceased together at the end of 20U2,the prediction showed that this would most likely lead to recrudescence. However, annual ivermectin teatrnent at a mean coverage level of 70% continued until 2005, would most likely suffice to eliminate onchocerciasis from this focus. 67- The need to prolong ivermectin treatment beyond 2002lul^ the Asubende area could be explained by the fact that significant transmission occurred during the contol period and that ivermectin coverage was inadequate during three treatrnent rounds. 68. The Commitlee recommendedthat mathematical models of control scenarios should include parameters of systematic incomplete coverage of ivermectin treatment and missing periods of larviciding to assess situations where ivermectin control was required to continue beyond 2002 (see also paragraph 28 above). 69. The Programme Director informed the Committee that he would call a meeting of epidemiological modelling experts in the near future to make recommendations for ho* to further improve the reliability of ONCHOSIM predictions. Evaluation strategy 70. EAC addressed the complex issue of OCP evaluation strategy befween now and the end of the Programme. 71. The Conrmittee noted the cessation of ivermectin treatment in some basins to provide the Programme with tme prevalence figures for evaluation purposes. The cessation of iverrnectin over a l-2 year period had been demonstrated in the model to push out the time frame fbr combined control by at least the same number of years, thus requiring additional years of ivermectin control beyond Programme operations. EAC recontnrended - mindful of the difficulties this rvould cause to the Programme - that for the purpose of providing reliable prevalence data, the interruption of ivermectin treatment for evaluation purposes be stopped. The Programme had the responsibility to limit the residual activities which countries had to undertake beyond 2002. EACI9 Page 20 72. The alternatives available for evaluation were limited as historically the Programme had used AnnualTransmission Potential/Biting Rates (ABRs) and Community Microfilarial Loads (CMFLs) (derived from skin snips) to demonstrate prevalence and incidence but the masking of the prevalence by ivermectin and thJ sensitivity of the data at the lower levels of prevalence an! incidence gave cause for concern regarding the validity of the data for operational decision-making. 73. Alternative approaches were considered and EAC recommended that the use of the DEC patch test to measurJincidence in three to five-year old children should be standardized while the Programme would continue to use skin snips for a further year. 7 4. EAC recalled that the Extemal Evaluation Team recommended that there was a need for a two- year period post-control evaluation to validate the impact of the 12 yeat combined strategy. The bommittee iecognized that at the end of the Programme the advice which could be provided to govemments *o,rld have to be base4 as mentioned above, on data which were lpss sensitive than hith"rto provided by the Programme. The need for a post-OCP evaluation activity, within the context of national multidisease surveillance systems, was underlined as a three to four-year period of monitoring of the post-OCP situation would provide countries with advice as to where and for how Iong ivermectin ihould be distributed. These activities, EAC emphasized, were distinct from recrudescence surveillance. 75. The Committee also noted, with satisfaction, that epidemiological surveyVsurveillance in the Original Programme area had shown absence of transmission in most of that area more than seven years after the cessation of larviciding. 76. Given that entomological'evaluation might form part o(surveillancealso after 2002, EAC recommendedthat the system within, or by means of which, this,activig would be implemented, be defined as soon us posibl.. This would include decisions regarding which health workers would make up the teami responsible for implementation; arranging-the availability of containers and preservitives; and declding upon methods and funding for sending specimens to the DNA iaboratory. Training needs would also have to be addressed, e.g. for the capturers and the managers who would use the data to make operational decisions. Ivermectin treatment 77. EAC noted with appreciation the achievements of the local health authorities and communities'in the Bougouriba valley (an area visited by the Committee in 1997) who had achieved four times a year distrilution of ivermectin. EAC therefore wished their congrahrlations to be conveyed to the authorities. 78. Given that the CDl'l approach had only been introduced in the OCP area less than two years ago, EAC considered the piogress made in substituting CDTI for mobile team distribution sitisfactory. One factor rvhich had delayed the process was a tencie ncy for some health staff to "hold on" to information, thus rrnpeding progress. 1g. EAC stressed the inrportance of a well-functioning national health system for the success of CDTI. This applied to such functions as ordering of ivemrectin .rnd its distribution to the points of rutilization and w,as an asl)ect over which OCP would have littlc control (see Section G.). 80. In respect to the ordering of ivermectin, which rvas to become the responsibility of. the Participating Countries, the Conrmittee was infornted that strch ordering, rvhich '"vas bascd on rcporting of-returns fionr the field should eventually become inte grated with the management of the "c.ssentiildrugs" packag.'rvithin the context of thenational Multidisease Surveillance and Control systems. EACIg Page 2 I 81. It was noted that OCP had been cooperating fruitfully with NGOs for many years - for instance in ivermectin distribution. other possible partnerships were mentioned: local government: since they represent the communities that directly benefiU suffer if the service delivers/ fails to deliver, their co-option is likely to be a positive force supporting Community Directed Treatment with Ivermectin schools: school children can be informed and motivated through the provision of classroom materials; they can be of help in assisting illiterate adult distributors. 82. EAC also noted the serious potential bottlenecks in CDTI identified by the three-country research of Dr T Diarra as well as by the 1997 External Evaluation Team. They included transport for health centre level nurses to get to the villages for training and supervision; and the motivation of this level of staff, as well as of staff at the district and regional levels, to do-non-curative (and therefore non-remunerative) work. It was likely additional issues would be,iilentified at the forthcoming workshop on the sustainability of CDTI. It was recommended that these issues be researched in multi-country studies, so that the necessary focused action could be taken. 84. The Committee noted that there had been steady progress towards empowering the pharrnacy divisions of national health services to order ivermectin independently. In view of the fact that the DEC patch test was due to be operationalised, and would continue to be used after 2002, EAC recommended that similar arrangements be set in motion for the acquisition by countries of the materials that will be required for its production and standardization. Training 85. EAC noted that considerable progress had been made with preparing training modules rhar dealt with the skills country teams needed at all levels concerned with onchocerciasis control. This was an example of a targeted intervention, where OCP could expect to make a difference to the effective functioning of a relevant aspect of the national health services of the Participating Countries. 86. The need had been identified by the 1997 External Evaluation Team for specifically targeted training for Multidisease Surveillance/onchocerciasis control managers. For that purpose, the[ollowing steps were required: a training necds analysis, involving the HRD sections of the Ministries otHealth; the identification o[institutions in the region (one lrancophone and one anglophone) ',villing and able to ot-[er a training module to meet these necds; an alternative rvould be to locate a group able to design the training as an interactive, computcr based packagc. Diagnostic tools 83. EAC noted that the evaluation of the DEC patch test has given encouraging rcsults as rcgaiCs its sensitivity, greater positivity after ivermectin treatment as compared to skin snip, and its specificity vis i vis M. perstans.'The Committee supported the plan of the Programme to undertake the training of national staff in-the use of the DEC patch test, continue the evaluation of the test parallel with skin snipping especially the2}Yo concentration in'Nivea cream read after 24 hours in hypoendemic areas. EAC recommendedtJrutthe Programme develop with national teams, protocols for field application, specific for.pach Participating Country. This would include the definition of sampling procedures, study areas and villages and the practical implementation of the test. tEACI9 Page 22 87 . It was recommended that 1999 be set as the target date for the introduction of such training; that OCP work closely with the Ministries in identifying candidates for this training; and that the OCP bursary scheme strongly support it. 88. In order to ensure that newly qualified health workers in the region were well informed and motivated with respect to onchocerciasis, it had been suggested for several years that OCP make an input into their under-graduate training. EAC recommended that material be prepared on onchocerciasis and its control for medical, nursing and health inspector training, bearing in mind the limited time likely to be allocated to the subject. This should be done in cooperation with the academic community from all Participating Countries. Upon completion the material should be distributed to training institutions in the region using, for example, the OCP network of National Coordinators. 89- The 1997 External Evaluation Team recommended that Directors of Information Education and Communication (IEC) programrnes in the national health services should be contacted to discuss the integration of onchocerciasis messages in national IEC plans, as well as the development and use of materials. For the reasons stated in the report of the Evaluation Team, EAC recommendedthat this activity receive attention during the coming year. 90. In respect to training and preparedness for recrudescence, the Committee recommended that an element of how to detect the cause(s) of reappearance of the disease be included in training progammes. Furthermore, such progftlmmes should include a description of constaints in carrying out field work and of how such'constraints were overcome. 91. The OCP training prograrnme had in the past laid much emphasis on high-level training. The Commiuee was assured that the hend was now towards training,at the district level and taining.of peripheral health workers. 92. At the end of the consideration of this agenda item, Professor Samuel Ofosu-Amaah, Director, Ghana School of Public Health, was invited by the Chair to make a statemen! the text of which can be found in Annex 3' Macrofir Prosramme reDort 93. Following recent clinical studies showing that the combinations of ivermectin with albendazole or DEC (diethylcarbamazine) had a marked synergistic effect on microfilaraemia in Iymphatic filariasis and hence on transmission, combination trials had been initiated in Hohoe on onchocerciasis patients with results expected in early 1999. 94. A draft report correlating the pharmacokinetic, toxicological and efficacy data on the benzimidazole UMF 078 had been prepared by an independent toxicologist. UMF 078 had produced severe, acute CNS toxicity following oral administration in test animals; this was not observed following intramuscular administation. Furthermore, genotoxicity was also observed. These results would be assessed by the TDR Product Development Team and a final recommendation would be made in the near future. 95. Studies rvere being canied out to determine rvhethcr moxrdectin had the alleged sterilizing, or even macrofilaricidal cflect and if these results so warranted, clinical studies in humans rvould be considered. As nroxidcctin rvas given priority in the cattle scrcen, a decision regarding promotion of another promising conrpound (PD 105666) rvould be carefully examined. EACIg Page23 96. Following the rationalisation of the in vivo screening system, I100 compounds had been evaluated and 16 potentially new research leads had been identified. 97 - In order to implement the high throughput screen (JPC.l8 recommendation), actions regarding identification of new molecular targets and supply of chemical struchres were being impterienteal 98- Work continued on the detection of the genetic basis for ivermectin resistance in parasitic nematodes including Onchocerca volvulus. The current work focused on changes in the dynein of amphids; on changes in the level of P-glycoprotein; and on molecular changes in the ivirmectin receptor. EAC comments and recommendations 99. The Committee welcomgd the appointnent of the new Manager of Macrofil;the incorporation of Macrofil within ft: 9ryg development process of TDR; and the continuing partnership withindustry, academia and NGDOs, which should lead to faster and more cosreffective execuiion ofprojects. 100- EAC strongly recommended that in view of the specific operational requirements of a macrofilaricide within the framework of OCP, EAC representatives should be more a-irecUy involved in the decision-making process for the Macrofil Drug Development Programme within TDR. The Committee should be represented when discussions related to Macrofil took place as the Programme interests could only be served by a view of the field imperatives which wlre the determinants of OCP's interests. l0l - EAC endorsed the termination of firther work on amocarzine for onchocerciasis contol and was gratified that an early decision would be made on whether or not to continue research on UMF 078 after a meeting scheduled for June 1998. This early deci5ion was important as the narrow therapeutic index of UMF 078, when given orally, as well as its mutagenicity continued to be of serious concern. It was stressed that administration by the intramuscular rouie was not a feasible alternative under field conditions. 192. As initial experimental studies suggested that moxidectin might either permanently sterilize adult female worms, or even kill them, the Committee reaflirmed iis earlie. i""om-endation that Macrofil pursue this compound as the alternative drug most likely to be of practical use in onchocerciasis control. 103. EAC noted current research on drug combinations of ivermectin and albendazole and ivermectin and levamisole and recommended that results be evaluated as soon as possible to review operational implications. I04- The EAC further recommended that OCP define the scenarios under which a macrofilaricide(s) might be used; identifu priority areas and, in the hope that a macrofilaricide might become available, undertake modelling to provide the Progranrme/countries with information on which they could plan the introduction of a drug for control. As critical parameters the following rvere identified: si ngle dose/multiple doses combination therapy e ffi cacy - macro fi I aricidal and rnicrofi laricidat population nuntbcrs to be treated mass treatment or targeted treatment EACI9 'a'.re 24 - requirement for medical supervision - justification for vertical/mobile distribution in the context of impact on transmission and time frame of delivery - justification for limited vector control to support macrofilaricidal treatment. 105. With regard to the prophylactic use of ivermectin, the Committee noted that further studies in caftle were ongoing and reaffirmed that careful attention be paid to the possibility of producing resistance to both Onchocerca and co-existing gastrointestinal nematodes. 106. The possible future availability of generic ivermectin for routine use in diseases other than onchocerciasis might increase the possibility of producing ivermectin resistance and could also create difficulty with evaluation and impact assessment in the field. While WHO/OCP should continue to use Mectizan@ for iS control prograrnmes, the Committee recommended that plans be madeinadvanceforovercomingsuchanticipatedproblems. 107. EAC recognized the need to develop a tool to detect and monitor possible emergence of ivermectin resistance in the field. It was emphasized that this tool would be of importance to study if combininations of larviciding with ivermectin treatnent on reducing the ernergence of resistance had a synergitic effect. EAC recommended that the methodology to be developed should also be applicable for the evaluation of parasites from vectors. 108. The Programme should ensure that well defined Onchocerca volvulus material be preserved by a variety of methods to ensure retrospective assessment of ivermectin resistance genes when appropriate probes became available. The material should be representative of different O. volvulus life cycle stages, parasite strains'from areas where ivermectin lrad not been deployed and where it had. Since resistance mechanilms may be identified using biochemical methods, it wbs recommended, in addition to storage of dry material for DNA studies, to store in liquid nitrogen or at - 80'C. 109. The possibility of optimizing (via industial partners) the DEC patch test and the PCR methodology used for vector identification should be explored. Publications 1 10. EAC noted the preparation of the reports on the Bougouriba and on the Oti tributaries and recommended that these studies merit publication in scientific journals. I I l. The Committee firrther commented on the publication of "20 Year of Onchocerciasis Control" which provided a detailed account of the Programme together with an extensive bibliography. EAC congratulated OCP on this achievement and noted that several other important publications relative to OCP w,ork had been published during the year under review or would be published shortly. The Committee re-emphasized the importance of the Programme disseminating its results both in the scientiflc and rvider public domain, as was done through video and television accounts of the Programrne. I 12. EAC finally encouraged the publication in scientific journals of hydrobiological data with full authorshrp of the national teants. GEACIg Page25 IVTEASURENIENT OF PROGRESS AGAINST THE EAC CONCEPTUAL FRAMEWORK ON INTEGRATION AND TRANSFER (Annexe 4 to the EAC.l8 report) ll3. EACreviewedAnnex4of its l99Treportandmadeanumberof modificationstoit(see Annexe 2 of the present report). I 14. In Annexe 2 a series of activities is listed that need to be undertaken to empower each country to take over onchocerciasis surveillance and control by 2003. EAC recommended that these be accepted by OCP and the Participating Countries as an overall strategy to be followed. EAC also recommended that these activities constitute a checklist, using the following format: 1 15. EAC requested that this format be used to report progress in empowerment/transfer, for each country at its next session in June 1999. 116. The progress during the pgst year showed that the Programme recognized the importance of the integration of OCP activities at the national level. 117. There was full awareness dmong OCP staffof the need to develop country-specific solutions for the OCP residual activities. Substantial efforts were already.made to develop country-specific solutions at all levels, particularly with regard to monitoring and surveillance, training and CDTI. 1 18. A number of studies and surveys were addressing key issues with regard to the efficiency and quality of the Programme particularly with regard to CDTI, health management information systems, training and staff performance. I 19. While recognizing the efforts made by the Programme, EAC recommended that country- specific solutions to OCP residual activities should be more firmly developed on the basis of a comprehensive systems analysis in each of the countries concemed. 120. The EAC, and the 1997 Extemal Evaluation Team, felt that the systems analysis should provide the basis and framework for the detailed planning of the integration and transfer process in each country and recommended that particular attention be paid to (l) the prevailing health policy and strategy in view of the health sector reform processes and also in relation to the prevailing legislation, (2) the structural and functional composition of the health service on offer [including public-private mix], (3) the level of extemal donor assistance, (4) the nature and level of decentralization of the health system and (5) previous or ongoing experience with comparable integration processes. l2l. The system analysis should further allorv identillcation ol the distribution/assignment of responsibilities and authority among the key players and decisions-rnakers for the integration and transfer process at central and peripheral level. 122. The Comntittee was of the opinion that the systems analysis, rt'donc contprehensively, rvould also lead to the most effective organisational stnrcture oi the residual OCP activities. Particular attention shoutd be paid to the role of Ministries oIHealth in relation to other ministries/directorates Activity Indicator 1998 r999 2000 2001 2002 report summarizing policies donereview of policy documents rc. MDSC no EACI9 Page26 that could be crucial in assuring sustained integration and transfer such as Ministries/directorates of Local Governments and Community Affairs. Besides the govemmental bodies and institutions, attention should be paid to local organisationVassociationVgroupings that could be involved in OCP residual activities. 123. EAC recommended that these systems analyses should be undertaken in each country by OCP country teams in collaboration with the national schools of public health and"/or related insti tutions/networks. 124. The Committee paid particular attention to the research that should more closely accompany the integration and transfer process. It was felt that future research should move from descriptive studies to intervention and operational research in order to inform progralnme staff who would also generate the basis for the formulation of the key research questions. 125. EAC strongly recommended that the Programme should appoint a health systems research specialist - despite filnding constraints - as this speciality was crucial for assessing the transfer and integration process. iZO. .[-tre Committee felt that the health systems researcher could play the key role in formulating the research questions and developing core protocols in close collaboration with the country teams and their associated network of health systems and public health researchers (see para I l9 above). The health systems specialist would also assist country teams and their collaborators in design and analysis issues. 127. Finally, the health systems specialist should create the platform for the interactions of research teams and disciplines and should particularly emphasize [he association of the social aird behavioural scientists. 128. EAC recognized the role Donors could play in assisting the integration process by harmonizing the policies and strategies at country and regional level; particular emphasis was placed on the health sector reform process in relation to the position of the Programme and the integration of post-OCP needs into health systems. H. REPORT ON PROGRESS OF APOC 129. A progiress report on the African Programme for Onchocerciasis Control (APOC) was presented by Dr Amazigo on behalf of the Programme M'anagement of APOC. 130. EAC was informed that the Technical Consultative Committee (TCC) of APOC at its recent session approved eight projects making a total of 37 projects in nine countries currently being fimded by APOC. These consisted of 30 ivermectin distributions, three vector elimination and four headquarters support projects. The Committee was also informed about the status of the impact assessment study initiated by the TCC and the Management of APOC. The study would be conducted in I5 sites in nine of the APOC countries. The challenges faced by APOC rvith regard to sustainability of CDTI were highlighted. I. OTHEII NIATTERS l3l. n prescntation rvas rnade ot'the activities of the molecular biology' laboratory during which particularattentionwaspaidtothc appticationofthemicrosatelliteteclrniquefortheidenti{'ication of parasites and vcctors. EAC I9 Page 27 112. OCP maintained five sets of primers used in the identification of the Simulium damnosum s.s. populations and one set for the characterization of Onchocerca volvulus. The OCpfuniversity of Alabama collaborative research was close to finalizing the development of primers designei to identifu parasite strains. Staff of the laboratory had been trained in the application of this t..h1iqu.. 133. OCP could use this technique in the following areas: - identification of blacklly populations migrating from the river basins in northern Sierra Leone to the Baoule and Bagoe basins in Mali to clariff the transmission between Sierra Leone and the Upper Niger basin in Guinea; identification of the different O. volvulus strains in the context of research on hybrid parasites to explain the apparent differences in pathogenicity found in different zones of the Programme (Lower Comoe, Baoule and Sota-Alibori). the search for ivermectin resistance markers. 134. The Committee was also informed about the activities of the ORSTOM West and Central Africa Hydrological Observatory. J. DATE AND VENUE OF THE TWENTIETII SESSION OF EAC 135. The Committee decided to hold its twentieth session at OCP headquarters in Ouagadougou from Monday 7 to Friday I I June 1999, the briefrng session to be held on the Monday. K. ADOPTION OF THE DRAFT REPORT 136. A draft of the report was approved by the Commiftee with the understanding that modifications agreed upon during its consideration would be incorporated and that the final draft would be approved by the Chair on behalf of the Committee. L. CLOSURE OF THE SESSION 137. Having expressed his gratitude to all those who had facilitated the work of the Committee, Professor Molyneux declared the session closed. 138. Following the closure of the session, Members of CSA and OCP/APOC staff were addressed by the Director-General of WHO on official visit to Burkina Faso in connection with the OAU summit. Dr Nakajima referred to the accomplishments of the two Programmes and thanked the partners and the staff for their contributions to OCP and APOC. Professor Molyneux pledged the continuing support of EAC to OCP during the final years of the Programme during which the emphasis would be to ensure that the achievements of OCP be maintained. EACI9 Page 28 ANNEXE I REPORT OF THE NINETEENTH SESSTON OF THE ECOLOGICAL GROUP Odienne. 4 - 6 February 1998 CONTENTS SUMMARY OF RECOMMENDATIONS A. INTRODUCTION B. ADOPTION OF THE AGENDA C. FOLLOW-UP OF EG 18 RECOMMENDATIONS . . . . D. REPORT ON VECTOR CONTROL ACTIVITIES E. AQUATIC MONITORING ACTIVITIES F. TI{E ECOLOGICAL PAI.IEL OF ONCHO-FREED ZONES PROGRAMME OF WORK FOR 1998/1999 ARRANGEMENTS FOR THE NEXT MEETING I. READING AND APPROVAL OF THE REPORT J. CLOSURE OF THE SESSION Appendix l: List of participants Appendix 2: List of documents Appendix 3: Work prograrrune for 1998 Pages ..43 G H 29 30 3l 32 33 34 39 42 43 43 44 45 46 2EACIg Page29 Annexe I SUMNlARY OF RECOMMANDATIONS The summary of the Ecological Group's recommendations is presented below Setting-up of a national team for the monitoring of non-target invertebrates in C6te d'lvoire (para 5l). Continuation of the aquatic monitoring of the entomofauna on the Marahoue and spot sampling of the entomofauna on the L6raba and the Red Volta to assess the recolonization potential of these two watercourses no longer under larviciding (para- 52). Selection of some watercourses for spot studies of the quality of the non-target entomic fauna (para. 53). Implementation of the habitat assessment technique after preliminary training of the hydrobiologists Gara. 54). Suspension of hydrobiological monitoring in Sierra Leone given that the data collected are fragmentary and insecurity persisting (para. 56). Impact study of the use of permethrin in Guinea and publication of the results in a scientific journal (para. 57). Publication of two docunients (concerning invertebratds and fish) on 20 years of aquatic monitoring and of one document on the effects of eto'fenprox on the non-target aquatic fauna (para. 58). Making available to the hydrobiologists all hy&ological data for a more comprehensive analysis of the aquatic monitoring data (para. 59h). Considering the possibility of making available the necessary resources for the production of a consolidated report (in book form) on the surveillance and larvicide evaluation activities carried out under the aegis of the Ecological Group (para 6l) . 10. Participdtion of the ichthyologists in the international conference on "African fishes and fisheries: Diversity and utilisation" to be held in September 1998 in South Africa (para. 6e). ll Participation of an OCP staff member in the Symposium on environmental information systems to be held in Cotonou, Benirt (para. 69). 3 4. 5 6. 7 8 9 EACl9 Page 30 Annexe I A. INTRODUCTION l. The Ecological Group held its nineteenth session from 4 to 6 February 1998 in Odienne, Cote d'lvoire under the chairmanship of Professor Davide Calamari and with full attendance by all is members. Dr (Mrs) A. Reenberg, a guest expert, was also present. The list of participants and of working documents are appended hereto as appendices I and 2 respectively. Opening session Z- In the absence of the Prefect of the Odiennd Region, the opening ceremony was presided over by the Secretary General of the prefecture, Mr Z,arnll€, Kouassi Jean-Baptiste and the regional Director of Health, Dr. Idrissa Diomand6 who honoured with their presence the opening of the joint meeting between the Ecologicai Group and the Hydrobiologists on 4 February l'998. 3. As the first speaker, Dr J.M. Hougard, Chief Vector Control Unit (VCU) excused the Programme Director who, although unable to be presen! had very much wanted to attend these deliberations of the Ecological Group as in 1997. Dr Hougard then went on to stress the main reasons behind the choice of Odienn6 for this session of the Ecological Group (headquaters of the Western Zone of the Programme ; proximity of the treated watercourses which had been visited by the Group in 1980. Before expressing on behalf of the Programme Director, on his own behalf and on behalf of all his collaborators his best wishes for 1998 to the national authorities present, to the members of the Ecological Group and to the hydrobiologists,. Dr Hougard summarized the main conclusions of the Joint Programme Committee (JPC) meeting held in Liverpool (United Kingdom of Great Britain and Northem Ireland) from 1 to 3 December 1997. 4. On behalf of the Prefect of the region, lvlr Z,an€l|particularly thanked all the players involved in the Programme for the successes achieved in the contol of river blindness. He acknowledged the delicate nature of the mission of the Programme which had to restore the health of the populations through the use of larvicides against the aquatic stages of the vector while preserving the aquatic environment. According to Mr Jean-BaptisteZan6l6,,the Programme deserved congratulation and recognition by the populations and the authorities for the attention given to these two important aspects for sustainable and harmonious development- 5. Lastly, Professor Calamari, Chairman of the Ecological Group, highlighted the successive missions assigned to his Group since it was set up even before the start-up of the Programme (designing of monitoring policies, protocols and structues ; selection of insecticides and toxicological evaluation of these ; greater. emphasis on "environmental impact" type studies). He then declared open the nineteenth session of the Ecological Group. 6. The film "Eyes of Hope", "Les yeux de l'espoir", an ORSTOM-WHO/OCP Coproduction in its finalization stage rvas then shown as a preview to the great satisfaction of allthe participants. .Ioint meeting behveen the Ecological Group and hydrobiologists I . The main conclusions and recommendations of the hydrobiologists' meeting' (cf item E of the rcport) were surnmed up for thc menrbers of the Ecological Group. lssues such as the recolonization potential of the watercourses alter the cessation of larviciding, the caLISes of certain fluctuations in fish catches (catch per rrnit c{'tort) while the toxonomic ricl'mess and coefficient of condition of the principal species remained stable were discussed. EACI9 Page 3 I Annexe I 8. Drs G. Crosa and E.K. Abban briefed participants on the on going analysis of the 20 years aquatic monitoring data undertaken since 1996. The notion of the impact of some insecticides on rhe entomic launa as well as the significance of certain factors suchas hydrology (especially the duration and magnitude of the spate) on fish recruitment and populations were discussed. 9. Afterward, informative presentations were made by some members of the Ecological Group for the benefit of the hydrobiologists. In this connexion, Professor V.H. Resh introduced the notion of habitat quality assessrnent at the monitoring sites. Given that the biological condition of the watercourses was dependent upon the quality of the water and of the aquatic habitat, an evaluation thereof should be a component part of the study of the long-term changes which occurred, this was particularly important when the biological condition remained poor despite a cessation of larviciding. 10. Professor D. Colman explained the principles of cost-benefit evaluation based on hypothetical analyses of the economic spin-offs of the decisions made by the Ecological Group from 1974to 1998. The costs of monitoring, meetings, research, as well as the additional cost involved in the use bf certain insecticides were all taken into account. The benefits were expected to increase, particularly through additional fish catches resulting form the improved strategy in insecticide utilisation. The data used in the analyses showed an international rate of return (IRR) of 13 %. The study will be continued and consolidated in collaboration with the other members of the Ecological Group and the hydrobiologists with a view to producing a document which will be discussed at the next session of the Ecological G.,.oup. I 1. In her presentation on changes in land use and occupation'and the impact of these changes on the environment, Dr (Mrs) A. Reenberg stressed the importance of proper management of the land, forests and watercoursqs made available again for agricultural production as a result of the success of onchocerciasis control. She also demonstrated the significant role that remote sensing and the application of the GIS techniques (Geographical Infomration Systems) can play in improving the understanding and management of natural resources. The cultural and socio-economic aspects were also to be taken seriously into consideration. 12. As for Dr (Mrs) S. Leloup, she presented the list of environmental projects planned in the participating countries and being finalized by the World Bank. She also informed the participants about the existence of specialized African reviews on environrriental data bases. 13. Finally, Dr J.M. Hougard made a presentation on blackfly nuisance, the control methods available, the main contexts in which such control can be implemented as well as the main and potential players rvho would be involved. Reflexion is continuing on how to best address the issue of the control of blackfly nuisance rvith increasing involvement of the national players. 14. The hydrobiologists and the members of the Ecological Group highly appreciated these informative presentations which are always an excellent oppo(unity offered to the hydrobiologists to update and broaden their knowledge on these issues. Exchanges of views also took place between the anglophone hydrobiologists (who attended the seminar in Maroua (Cameroon) on enviromrental impact studies) and the members of the Ecologicat Group on hor.v to apply the knorvledge gained lrom the seminar in their daily activities. B. ADOPTION OF THE AGE,NDA 15. The agenda, as presented in the Table of contents of this rcport. rvas adopted- EACI9 Page 32 Anle=xsl C. FOLLOW-UP OF EG I8 RECOMMENDATIONS 16. Most o[the recommendations of the Ecological Group had been actioned. However, the recommendation made to the Committee of Sponsoring Agencies regarding the environmental pilot study to be carried out on the Sassandra had remained unansrvered. D. REPORT ON VECTOR CONTROL ACTIVITIES 17. The Chief of the Vector Control Unit (VCU) first took stock of the situation of Phase IV in its main components (larvicides, flight hours, personnel) before reviewing the unit's activities and main results during the past year which was essentially marked by: The development of a seemingly more effective formulation of B-t- It-14 by the "Thermo Trilogy Company". The cessation of larviciding on the lower Black Volta (January 1997), the Kank6laba and the Marahoud (June 1997); the continued suspension of larviciding in Sierra Leone except for a few weeks during the first half of 1997 (March and April). The end of the exclusivity contract with Abbott (the current supplier of B.t. H-14) The use the technique of pool screening of black{lies for the early detection of the infection in the blackfly instead of man. It is a cheap and simple technique, therefore fit for use by the participating countries for the surveillance of recrudescence. The continuation of the insecticide rotation strategy based on their effectiveness, cost or toxicity. The intensification of efforts aimed at better understanding and controlling the problem of "trouble spots" as well as of the potential foci of onchocercal infection. 18. The results of vector control operations on transmission of the parasite could be said to be satisfactory on the whole. Out of 126 catching points visited regularly, 119 presented an Annual Transmissioh Potential (ATP) below 100 infective larvae/person/year. Of the remaining seven points, five had an ATP below 200 infective larvae/person/year, while the other trvo (Titira and Tapound6) had an ATP between 200 and 400 infective larvae/person/year. 19. To achieve these results, the watercourses had regularly been treated with the operational insecticides the method of utilization of which was explained by the chiefs of Administration and Technical Services of the Programme's two operational zones. 20. In the Eastem Zone for instance, river discharges had on the whole been lorver in 1997 than in 1996 due to poor rainfall. Aerial operations had to be suspcnded for six weeks, from week l0 to rveek 15, i.e. from J March to l3 April. 21. Larviciding rvas carried out on the basins of the Ouemc and Mono, of Kouffo l, Sio, the tributaries of Lake Volta (Pru, Bonakye, Chacl-Wulubong, Asukar.v karv, Dayi), the tributaries of the Oti (Keran, Kara and Vlo). EACI9 Page 33 Annexe 1 22. It is worth noting that on one hand larviciding was suspended on the Iower Black Volta (in Ghana) on 3 I December 1996 and on the other hand, that the basin of the Dienkoa (upper Mouhoun in Burkina Faso) was under ground larviciding. 2J. Because of the resistance to temephos observed in some of the watercourses, a strategy likely to promote a return to a normal susceptibility level (through a maximum use of permethrin during the flood period, of etofenprox during the spate and low discharge periods as well as maximum use of temephos) was instituted. In such a czrse, the use of temephos should not exceed three consecutive cycles on the same river stretch. 24. In the Western Zone, basically three insecticides were used in rotation on the Niger in Mali, that is carbosulfan, permethrin and etofenprox. Pyraclofos was used sparingly for four cycles because of intermediate blackfly resistance.to this product. On the tributaries of the Niger (Fii-Faya, Dylamba) temephos was used very little because of the known blackfly resistance to it. B.r. H-I4 and especially etofenprox were used depending on the discharge rates. 25. In C6te d'lvoire, temephos was not used in all of the basins because of the resistance to this product observed on the Sassandra and its tributaries. The six other available insecticides were used according to the usual rotation system. Phoxim was not used to avoid the occurrence of any cross resistance on the Bandama. Temephos and pyraclofos were not used on the Comoe because of resistance problems. 26. In Guinea, carbosulfan was not used on the Sankarani, Milo and Niandan in order to allow monotoring of the long term efiect of permethrin on the non-target aquatic fauna. Temephos and pyraclofos were not used on the Milo as of week I I because of loW,ered blackfly susceptibility to these products. 27. In Sierra Leone, after the resumption of aerial larviciding on the upper Rockel (RK 100, 200, 300 and is tributaries) and the upper Mongo during week l0 in I997, operations had to be suspended again at week 14. As for the Kaba and Kolent6, they have not been treated since April 199.4. 28. krviciding was stopped on the Kank6laba at the end of March 1997 after 20 years of aerial treatments. Similarly, they were stopped on the Marahou6 and its tributaries, the Banoroni and 8616 after 18 years of aerial treatments. Improvement of larvicide formulations 29. The attempt made at developing improved formulatiors of the insecticides used were carried out in the framework of operational research activities in VCU. They essentially centered on Bacillus thurengiensis H-14, the only biological insecticide used by the Programme. The concerned two basic aspects: selection of the most effective commercial formulations and development of recombined strains of B.r. H-14. 30. The differenr corrrmercial formulations propose to OCP (essentrally pre-samples of Vectobac l2AS) rvere being systematically tested with the orbital shaker to determine their efficiency levels on the larvae of S. tlanmosurn s.l. These tests which make it possiblc to reduce the risk of being delivered defective batches are planned in collaboration rvith Abbott Co. rvhich remains the main supplier of B.r. II-i4 to the Programrne. 31. The analysis of the results obtained from I996 to 1998 shorvs a dehnite improvement of the quality of the formulations tested rvhich are increasingly meeting the efficiency standards required for the Programme's Vector Control Operations (CL50>90 mg/l/s). EACI9 Page 34 Annexe I 32. In addition to the tests with orbital shaker, commercial formulations of Vectobac l2AS and Teknar were river tested on the Marahou6 and White Bandama in July and August 1997. The experimental treatments were carried out at the dose of 0.54 l/nf/s (0.75% of the operational doie). They showed rhat at discharge between 30 and 110 nfls, Teknar had a more efficient carry (the distance beyond which the detachment of older larvae is below 95%) which is twice that of Vectobac 12AS. 33. Treatrnent carried out under real operational conditions (aerial treatments) will make it possible in the very near future to confirm the validity of the results thus obtained. In connection with the same treatrnents, the efficacy of Teknar IIP-D at discharges above 15 rrf/s could be adequately evaluated. 34. It must be noted that ongoing r€sear.ch to improve formulations of the operational insecticides also concerns ttre recombineO srains of B.t. H-14 produced by ttre'Pasteur Tnstitute- Some formulations developed from these recombined sEains will be tested with the orbital shaker in order to assess the respective roles of each of the four toxins' of Bacillus thuingtensts H-14 active on the larvae of Simutium danuoscua s.l. These formulations will also be used for the development of a simple and cheap technique allowing for the testing of the efficacy of the operatironal batches of-B.t. H-14 based on the hemolytic characteristics of the "Cytl Aa" toxin which seefiN to be the most active larvicide ot S- dannosum s-l- 35. Among the many advantages deriving from the availability of this technique must be mentioned the possibility it offers for improved commercial formulations of B-t. H-14 and cbnsequently, the strengthening of the operational capacity of the teams involved in the use of 36. After asking for complementary inforrnation about onchocerciasis in Sierra lrone, the risk that this country may constitute for the rest of the Programme, the other potential biological insecticides which might become available on the market in the near funre, the Ecological Group congratulated the Programme on the work achieved and on the quality of the presentations. It encouraged VCU to carry on with the tests on the Teknar formulation. E. AQUATIC MOMTORING ACTTSITIES Monitbring of the entomofauna 37. In C6te d'Ivoire, monitoring of the aquatic fauna was carried out at Danangoro and Entomokro on the Marahou6 which has been under larviciding since March 1979. From Jamraly 1996 to April 1997, only four of the operational insecticides were use in rotation (B-t. H-L4, phoxim, pyraclofos and permetrin). At Danangoro, the densities of the overall saxicolous fauna increased from 180 to 4551 individuals/Surber. The Ephemeroptera (which are more susceEible to larvicides) showed an increase in their densities which were higher than the densities recorded in 1994/95 and 1995/96. The taxonomic richness of the fauna collecred in the night drift ad the Surbers was marked by the absence of the Ephemeridae, Oligoneuriidae and Neoperln s-p- The relative composition of the saxicolous communities was still dominated by the Trichoptera followed by the Ephemeroptera and Chironomidae. These observatiom were similar to those made at Entomokro. 38. In Guinea, the activities of the invertebrate Biology section were essentially centered on the Niandan, the Milo and the Dion. At Sassambaya on the Niandan, rtre densities of the overall fauna showed an upward trend starting in 1996. In the longer term, a relative sabiliry of the densities of the EACI9 Page 35 Annexe I Baetidae and Orthocladiinae was observed while those of the Hydropsychidae improve and those of the Tricorythidae remained almost null on the rock slabs. The taxonomic richness of the fauna colected in the Surber before larviciding was carried out on the Niandan was comparable to the richness observed during the larvicide treatrnents (33 compared to 32 taxa during the larvicide rrearmenr period). At Boussoul6 on the Milo, a gradual decrease of the total faunal densities on the rocks was observed berween 1987 (beginning of larvicide treatments) and 1997. The Chironomidae and Hydropsychidae were dominant in the Surber samples while the Baetidae, Caenidae and Tricorythidie became rare. The uxonomic richness of the rock fauna showed a decrease (35 compared to 30 today) but some rare taxa were the cause of this situation- ln sort, the larvicide treatrnents on the Milo alone or in conjunction with other factors seem to affect the benthic fauna at Boussoul6. At T616 on the Dion, the absence of pre-treatrnent data makes it difficult to interpret the results recorded. However, a slight upward trend of the densities of the total fauna is observable from 1991 to 1997- It is mainly dominated by the non-target Diptera whose flucnrations are about the same as those of the overall fauna. The Hydropsychiade, Caenidae and Baetidae show density fluctuatio;ns which on the whole remain stable. 39. In Ghana, the Pnr and Oti were sampled from November 1996 to April 1997- The drift and rock slab fauna was found to be unstable on the whole during the monitoring period. The drift indices and the mean numbers of taxa on the Pru at Asubende were low between September and November 1996 when the river was treated with pyraclofos, etofenprox, phoxim and permetbrin only. An improvement of these different index values was noted from December 1996 to May 1997 when the watercourse was treated with B.r. H-14 alone. The number of Hydropsychidae collected on the rock.slabs in January 1997 was higher than the index values recorded in 1980 and 1981, which was during the pre.larviciding period. The night'drift indices of the Ephemeroptera were close to those recorded during the pre-larviciding pdriod. Contrary to the other taxa, Neoperla s.p. continued to be absent in the night drift and on the rock slabs. On the Oti where larviciding began in tg77 and ended rn Lgy2, an improvement of some taxa in the night drift was noticeable fir. y.r6 after the cessation of the treatrnents. A full recolonization by Irptophlebiidae was noted in 1996t97 as opposed to the Oligoneuriidae and Heptageniidae whose recovery was only partial. 40. Larviciding on the watercourses of Sierra kone has been carried out since 1989 with temephos, B.t. H-14, phoxim and pyraclofos. Among the watercourses treated, three hadbeen undei regular monitoring since March 1989. They were the Kaba, The RokeVSeli and the Mongo. Larvicidlng on the Rokel has been suspended since March 1994, on the Kaba and Mongo since March 1995. Monitoring of the non-target entomofauna showed a drop in the density of the total fauna and principal taxa, and a notable scarciry of Neoperla s.p., Oligoneuriidae and Aethaloptera in all the stations during the larviciding suspension period. 41. The night drift samples collected during the larviciding suspension period showed a decrease in their taxonomic richness. All the taxonomic groups were affected and the suspension of the larvicide r.reaunents brought non improvement. The notable observation at the time of the review was thar the Ephemeroptera rveie dominant again. Factors other than the larvicide treatments may have influenced these results- i\tonitoring of the ichthYofauna 42. In C6te d'lvoire, monitoring was continued at the stations of Ganse on the Comoe, Niaka on rhe White Bandama and pont Frontiere on the L6raba. With regard to the global species richness, the number of species caught was on the increase in all the stations- At Pont FrontiEre' Barbus trispilos and Barbus sublineatus reappeared in the catches after having disappeared since 1985, and Pollenula leonensis was noted for the frrst time. EACI9 Page 36 Annexe I 43. An improvement was also observed in total CPUEs, per mesh-size artd per principal species especially at the pont Frontiere station where larviciding was ftrst stopped in C6te d'Ivoire' These increases being attributable to the catches with the small-mesh nets, this meant that the juveniles and/or the small size fishes were on the increase in this environment during the period yld:' review' Changes leading to better well-being of the fish communities were therefore noticeable in these stations. 44. Monitoring in Guinea was carried out at the stations of Mandiana on the Sankarani, Baranama and Dion, and at the station of Boussoul6 on the Milo. Overall, the CPUEs were on the decrease this year cbmpared to those recorded in previous years- This was noticeable in the total CpUEs, the types of mlsh nets and the CPUEs of th" principal species. The species richness was on the increase and had remained fairly high since 19i3/t994 atthose three monitoring stations' Compared to previous years, no total oiaroUt" disappearance of any species was observed despite permethrin orrfy. e" iroprovement of these differeni index values was noted fromDecember 1996 the gradual a""..*" Jsome species in-the catches, pa(icularly at Boussould. The mean condition coeflicients of most oitrr" p.in"ipal species showed arilative stability compared to previous years' This was the case for instance if A. i*rotrpidotus, B. nurse at Mandiana, B. leucicus, schilbe intermedius and B. macrolepidofzs at Baran"*". Ho*"vei, certain species such as Synodontis eupterus, "-nd f' . nurse atBaranama *a a. macrolepidotus, C. aurarzs ai Boussoul6 showed a slight decline in their condition. On the other hand, P. bovei, petrocephalus soudanensls and B' nurse at Boussoul6 showed a clear upward trend of their condition' 45. In Ghana, monitoring of the ichtyofauna in the context of the assessment of the long term effect of the larvicide teatmeins canied out by the Programme on the non-target aquatic fauna was continued on the oti and pru rivers. The CPUbs and coefficient.of condition of the fishes were the basic parameters studied- 46. The monitoring data showed that the CPUEs were on the decrease in all the watercourses treated or not. If the decrease could not be aftributed to any particular events on the Oti (a watercourse not under larviciding) the situation on the Pru could partially be due to the illegal use of certain agro-chemical p.oau"ti whichpoisoned the fishes. This was observed in February 1997 when a massive mortality of fishes was recorded' 47. The evaluation of the condition of the fishes showed that their o.r"rull well-being had been preserved during the larviciding years. In conclusion, the stability of the condition of fishes was considered as evidence that the decrease observed in the catches could not be linked to a degradation of their aquatic environment; such degradation would have affected their condition. The Oti had been monitored for 5 years after the lasitreatment on that river. The ecology of the station, however had undergone some changes as a result of the constmction of a dam upstream. It is therefore reconrmended that the regular monitoring of fishes in the Oti be discontinued' 4g. Because of the persistent socialun-rest in Sierra Leone, monitoring of the ichtyofaune could not bc carried out as regutarly as recorrrmended by the programme olrvork established by OCP' Two stations were monitored: Bumbuna on the RokeVSeli and Matotoka on the Pampana' Based ?n:l' f-erv data collected, the CPUEs of the lorv-rvater period rvere higher this year than those recorded in previous years since 1992. As regards the eftrciency of the catihes per net size, the trend appeared to be similar to that observed since 1992. The medium and srnall-mesh nets appeared to have been more cflflcient in terms of the number of fishes caught rvhile the medium and larBe-13sh nets were morc cfficient in tenns of the weight of the catches. overall, the parameters studied (CPUEs, specles rich.css and coefficient of condition) shorved a relative stability this year and a trend toward recruitment rvould have probably been dernonstrated if compleie data had been collected' No disappearance of any species was recorded' EACI9 Page 37 Annexe I 49. Some data were also presented by the national teams of C6te d'lvoire, Ghana and Sierra Leone on the use of ichtyotoxins by some of the populations in their respective countries. List of the different plants and chemical products used were provided with information on the directions for use of each as well as the fishes most affected by the product. Despite the use of these products in some of the watercourses monitored, the results of catches seem to be affected only in the short term. 50. On the whole, the monitoring results presented by the national teams show a satisfactory situation of the fish community struch-lre with stable coefficierits of condition and species richnesi. The CPUEs show some fluctuations which, nonetheless, remain within acceptable limis and which could be related to the hydrological conditions of the past years. As regards the invertebrate fauna, the scarcity or near total disappearance of certain taxa (Iricorythidae, Oligoneuriidae, Neoperla s.p., Ephermeridae) noted a few years ago is persisting. The total faunal densities were not affected evin though the stock structure sho*ed some fluctuations which, however, were not-plOjudicial to the functions of energy transfer among the different invertebrate communities. The retum of the Leptophlebiidae on the Oti which has not been treated since 1992 is worth noting. 51. The Ecological Group then addressed a number of pertinent issues relating to the monitoring activities carried out by the national teams. In this connection, it noted the absence of any team in COte d'Ivoire for monitoring the entomofauna and expressed the wish that this situation be rapidiy corrected in order to facilitate the assessment of the recolonizadon potential of those watercourses which are no longer under larviciding in the country. 52. Another issue of importdnce was the maintenance of the existing monitoring stations on the watercourses which were no longer treated in order 16 allow for the assessment of their recolonization potential. It is to be noted that zuch assessment is'underway with respect to fishes in C6te d'Ivoire and Ghana. Concerning the invertebrates, however, the only monitoring station is in Ghana on the Oti which is under the influence of the Kompienga dam in Burkina Faso. Ye! in accordance with the recommendation made by the l2th session of the Ecological Group, it is necessary to evaluate the situation of the entomofauna of some of the rivers no longer under larviciding. Therefore, the Group recommended that: i) monitoring of the entomofauna be continued on the Marahou6 (C6te d'lvoire), ii) a spot assessment of the situation be conducted on the Red Volta at Nangodi (Ghana) and on the L6raba at Pont-FrontiEre @urkina Faso) at the end of the rainy season, a period of maximum taxonomic richness. 53. In addition to the aforementioned watercourses, the Group recommended the selection of other watercourses and stations at the discretion of the national coordinator of the hydrobiological monitoring for spot studies to be carried out. Such studies should include identification of the different types of substrates and habitat for a comprehensive assessment of the situation of the non- target entomofauna. 54. Given the role played by the habitat in the global quality of the biological environment of watercourses, the Group recontmended the implementation of the method of habitat quality assessment presented by Professor Resh (cf. Item 3 of the report) after initial training of the teams. The rationale for such training is discussed in item G of the present report. 55. The increase noted in the catches of small size fishes or juveniles has also caught the attention of the Ecological Group which wishes for an in-depth analysis of the data for a better understanding of the phenomenon. 56. The difflculty encountcrcd in interpreting the data collected by the team fiom Sierra Leone with periods of intemrption due to the prevailing insecurity, as well as the scientific and/or EACI9 Page 38 Annexe I operational interest of the data were discussed by members of the Ecological Group. They deemed of no use to continue monitoring activities in this country. 57. The Ecological Group also reviewed the data collected by the team from Guinea. Contrary to the impression suggested by the results in the fish monitoring report, catches during these past years were in fact comparable to those recorded at the beginning of the 1990's and slightly higher than those noted at the beginning of the monitoring programme. With respect to the use of permethrin in rotation with the other insecticides except carbosulfan needed to be adequately assessed. Therefore, the Group recofilmended the Programme undertake such assessment without delay in collaboration, if necessary, with the members of the team and a consultant. Analysis of 20 years aquatic monitoring data 58. In accordance with a recommendation made during the previous session of the.Ecological Group, Drs G. Crosa and Y. Fermon carried out with some of the hydrobiologists a more indepth review of the analyses which had been made in 1996. They also put beforc the Group two draft documents for publication (one on ichtyofauna and the other on invertebrates). These two documents will be revised to be-submined for publication if possible before the end of this year. Professor Resh will be responsible for the revision of the document on invertebrates. The one on fishes will first have to be rewritten by the consultant and submitted to OCP within 2 months. The complete report which was considered interesting will be cited in reference in the publications indicating that it can be obtained from OCP upon request. Consequently, the Programme should take the appropriate steps to ensure accessibility ofthe documents to the scientific community in hn appropriate format. It is worth noting that a document on the methodology of anaiysis ofthe data on iong term monitoring of the non-targ;t aquatic fauna is already in press in Chemosphere- Professor Calamari has for his part, directed the preparation of an article on environmental monitoring and assessment of the risk involved in the use of larvicides by OCP; the articte has been accepted for publication in "Parasitology today". The Ecological Group's response to the hydrobiologists' recommendations 59. Overall, the Ecological Group appreciated the quality of the presentations and the relevance of the observations made by the Programme stafl and the hydrobiologists of the national teams, which facilitated the groups discussions. The Ecological Group once more congratulated all the hydrobiologists and encouraged them to persevere in that direction. It then examined the recommendations made by the hydrobiologists and made the following suggestions: a) The studies to be carried out upstream and downstream of the monitoring stations should be the responsibility of the national teams. However, this could be done in conjunction with their normal monitoring activities and therefore should not entail any additional expenses. b) The study of the recolonization by non-target invertebrates on the Red Volta at Nangodi was considered to be important and therefore rvas endorsed by the Group. c) The exploitation of the data about the long term use of permethrin on the non-target aquatic fauna in the rvatercourses of Guinea was also approved. d) The Group noted that the pollution of the Sassandra by the nearby agro-industrial plant which caused the aquatic monitoring activities to be suspended was continuing. Therefore it did not think it rvas advisable to resumc rnonitoring of this watercourse. c) The decision to stop monitoring of the ichtyof,auna on the Oti five years after the cessation of larviciding was endorsed. So was the sarnpling of inve(ebrates in this watercourse t'uvice a year during the dry season for an assessnrent of the recolonization potential. EACI9 Page 39 Annexe I f) The Ecological Group maintained its position in respect to the advisability of establishing monitoring stations in the basins of the Mongo, Kaba and Kolent6 in Guinea. g) The resumption of fish monitoring on treated but no longer monitored rivers was not endorsed by the Group; the reasons for the suspension were maintained. h) The Ecological Group encouraged collaboration between the hydrobiologists and the Programme staff toward publication of their studies' results. For a better exploitation of the data" it recommended that the discharge rates and water levels of the watercourses concemed be made available by the Programme to the hydrobiologists. The list of the monitoring stations should also be communicated to the officerin charge of hydrology so that priority may be given to those. Aquatic monitoring during the fifth financial phase 60. The last phase of the Programme will be characterized by the continuation of the monitoring of the invertebrate and ichtyofauna consolidated by the assessment of the quality of the aquatic habitat (bergeset lit) at the sampling sites. During this phase when phasing out of larviciding activities allows for a study of the recolonization of the treated watercourses, the resettlement of the valleys and intensification of human activities, however, do not always make it easy to adequately interpret the recolonization data'collected. Given that the changes occurring on river bar*s and beds are factors of significance in their biological soundness, any assessment of the recolonization potential of these water course's should, from now on, be coirsolidated with inforrration on the quality ofthe habitat. Monitoring of the aquatic environment will therefore be essentially focused on the assessment of the recolonization of the watercourses cohcemed. 61 . In addition, a process should be initiated for the publication of a document in book form, with the participation of renowned scientists on the different activities carried out under the aegis of the Ecological Group. The document which will comprise several parts will cover the following areas: insecticide selection, long term monitoring, the research protocols and their evolution in time, the main'decisions made by the Ecological Group and their economic significance, the policy governing monitoring and the role played by the Ecological Group in the activities launching of the Programme and in raising environmental awareness in West Africa. Consequently, the Ecological Group recommended that the Programme consider the feasibility of this important project for its own renown and for the valorization of its achievements in aquatic monitoring, a rare model in Africa. THE ECOLOGICAL PANEL FOR ONCHOCERCIASIS-LIBERATED ZONES IN T TE AREA OF THE ONCHOCERCTASIS CONTROL PROGRAMME IN WEST AFRTCA Preamble 62. The Ecological Group of the Onchocerciasis Control Programme in West Africa (OCP) has been charged rvith drarving up suggestions for thc activities of a proposed "Ecological Panel" for onchocerciasis-liberated zones in the area of the OCP, lor review by the OCP Joint Programme Committee (JPC). Giving that such tremendous efforts ,.vere made to avoid envirorunental danrage in the OCP larviciding operations, it could bc undone in a sho( period if environmental conccrrt is not incorporated into rcsettlement projects. Sustainable development in the oncho-free areas is a collective duty and a moral responsibility. F EACI9 Page 40 Annexe I 63. The overall objective o[ the proposed Panel is TO BE AN ADVISORY BODY AND to assist OCP-Participating Governments and external development assistance authorities to formulate and implement agricultural development prograrrrrnes/projects, in accordance with the strategies and guidelines that the JPC considers will promote the aspirations of participating goverrlments for assuring sustainable settlement and development in onchocerciasis-liberated zones. Proposed terms of reference 64- In accordance with the overall objective of the proposed Ecological Panel, the philosophies which orientate the Panel's Terms of reference are: The necessity to identiff the type and potential magnitude of the most critical environmental dsks that may be associated with settlement and with the exploitation of natural resources. The desirability of developing homogeneous technical guidelines which will help development planners to reduce those risks and thereby increase the prospects for attaining sustainable development objectives. The need to advise the Agencies on the environmental aspects of any development project submitted to them in the framework of sustainable development of the oncho- freed zones. The necessity to help in revitalizing the national structuresin charge of environmental related issues and in their real involvement in the follow-up of the guidelines developed by the Panel. : The necessity to help structures involved in the development of the oncho-freed zones to have a reflex to consider the protection of the environment. The need to assist in an effective involvement of nationals in impact studies in relation to development projects in their countries. 65. The proposed Terms of Reference fall under four broad headings, each of which is elaborated below. (1). To provide "guiding principles" which will assist settlement and development planners and investors to formulate development programmes/projects that are founded on standardized "state-of-the-art" technical approaches rvhich take full account of the need to protect and conserve significant proportions of the natural environment. Assessment of the health impact of development project should also be incorporated. The guiding principles will cover such fi.rndamental subjects as: - The choice of the most appropriate application procedures for agriculrural chemicals and biologicaI control agents. - The choice of most appropriate land use paractices (eg crop composition, cultivation intensity, rotation principles, anti-erosion measures etc.) . l'he extent to rvhich savanna resources can be exploited, rvithout resulting in sertolts rvoodland depletion, which can othenvise lead to reduced soil condition and productivity, and ro the encroachment of soil erosion. In this context, guidelines on tree planting options need to be developed and publicized. rt-l_ EACIg Page 4l Annexe I - The options for.managing those riveside fringing forests that play key roles in thestabilization of river banks and in the protectiol oiaquati" ..oryrt#s; which laner isessential for the sustainable management of fishery resources. Here also, guidelines needto be dev-eloped for the planting.of non-indigenous trees as substitutes for the ,,wild,, species of riverside trees and:[bt that may i-nevitably be destroyed during settlement and./or the implementation of a develop.n.nt prograrnme. (2)' To take the lead role in initiating and-coordinating environmental and agricultural statusreviews of onchocerciasis-liberated areas, giving special aialytical aftention to the following: - In the'domain of agricultural development,'to review land-use patterns and evolvingpatterns of agriculturar pressure and crop/rivestock preferences. ' . Here, it will be necessary to make a complete review of these parameters over the lastquarter of a century, drawing upon national deve-lopment reports, -ountry reviews byintemational orgeniz^1isns and $! nryleeaings ofthe Ministerial Mleting on sustainablesettlement and Development ofthJ ocP ArJa (Paris, lgg4).gy "o*puri"g the variousnational sihrations and tends T th"y present themselves today, *rritr, ti" predictions thatwere made.in the Report of the Preparatory Assistance Mission to Govemments(published in 1973-before the Iaunching oitl," ocp), it sh;;ld;; possible to assessthe validity of making long-term prediclions and to identiff thos'e settlement andagricultural procedures and practiCes that have been most iuccessful, in terms ofsustainabilq,Td appropriate invironmental manageme;i.A; fi"i"ing, to* such anexercise will have dirict bearing on the formulition of the guiaing principles, asdescribed above. - In the aquatic environment contexl to review the enormous data on river biota collected lll{l"otologists of the OCP and their collaborators and to assess the potential fortrsheries exploitation. Needless to say, the compilatioy"{yr,.r and interpretation of those data will require thefullest collabbration of the oCP's Ecological Group and of national hydrobiological authorities, whose role will take on added significance when the OCp comes to an end and when the Ecological Group is dissolved. - - (3)' To promote special srudies (case-studies) of selected areas of on-going development activity,to obtain "learn-by-experience" information on the most significant positive and negativecontributing factors, and to assess the extent to which the lessons learnt .outa afply to other areasand to different ecological situations. one such study (an environmental imfact assessment ofsettlement and development in the Uppel Ldbara Basin; i^ ru....sfully conducted in 1993, andthe experience gained in its planning and implementationcould form the basis of a model for fruthercase-studies and pilot projects, e-g. in the Sassandra Basin of C6te d'lvoire. Such additional studieswould provide information that could facilitate the formulation of thc guiding principles, as outlinedabove. (4) To provide an advisory service to any development authoriry, irrespective of whether it bea national ministry concemed rvith development or an assistance agency desirous of investing indevelgnlent in a particular country and./or region. Such a service would not constitute acoordinative mechanism, but the advice it could provide rvould go a long way towards ensuring that :::*:t]^S g.Ylgi"g principles were taken into consideration and apptied whenever possible, andwltnout conf ltcting with national development and conservation policies and preferences. EACl9 Page 42 Annexe I 66. ForefficiencytheEcotogical Panel shouldbeof asmall sizeandthecompositionof the group should include, for example, a land use and management specialist, a landscape ecologist, a pollution specialist, an agronomist and a rural sociologist. Others could be conservation biologist, health specialist, economist, water management specialist. They might be coopted "vhen needed- G. PROGRAIVIIVIE OF WORK FOR 199811999 67. In addition to the routine monitoring of the long term effects of the least selective larvicides (permethrin, carbosulfan and etofenprox) on the non-target aquatic fauna, the programme of work will include major activities aimed at valorizing and promoting OCP achievements in the ecological monitoring of the rivers treated. 68. Thus, different publications should come out during the year and will concern: - etofenprox (the draft has already been submitted to the chairman of the Ecological Group for revision) - permethrin use in Guinea (cf item E of this report); - the consolidated report on the results of 20 years aquatic monitoring (tro publications) - environmental monitoring and risk assessment of the larvicides used by the Programme of Onchocerciasis Control in West Africa (already accepted for publication in "Parasitology Today") 69. With the view to further making the OCP monitoring prograrnme better known, the Ecological Group recommended the participation of some iihthyologists .in the international conference organized by the PARADI association and the Soci6t6 des Pgches d'Afrique (Afric'an Fisheries Co.) to be held in September 1998 in South Africd. The theme of the conference is "African fish and fisheries: Diversity and utilisation". The Group firther recommended that the Programme be represented at the symposium on environmental information systems to be held in Cotonou at a date which will be communicated by Dr (Mrs) S. Leloup. 70. The aquatic sampling prograrnme proposed by the hydrobiologists was revised by the Ecological Group to take into account the observations made in item E of this report (Annex 3). 7l. Lastly, a prograrnme of training of the hydrobiologists in habitat assessment was proposed as follows: - ' Professor Resh would travel to Ouagadougou 34 days before the departure of the OCP team for the meeting of the hydrobiologists. He would train the Programme's hydrobiologist then, together, they would leave for the hydrobiologists' meeting during which they would train the hydrobioliogists of the national teams. 72. Dr Levpque would prepare a presentation on fish habitat which he would deliver at the joint nreeting betrveen the hydrobiologists and the Ecological Group. 13. Rationale for the training programme The aquatic launa of the watercourses located rvithin the Programme area has been affected by rhe changei in both the qualiry of the rvater (resulting from the spraying of the larvicides) and in the habitat (desertion an resettlement of former villages, changes in the vegetation cover, etc). To date, the focus has solety been on the analysis of thc reaction of the faunal communities to the changes in the quality of the rvater. The EcologicalGroup proposes the implementation of a training progi.nrrn. involving the OCP hydrobiology i.u* and the national hydrobiologists to i) evaluate all EACI9 Page 43 Annexe I the monitoring stations both in terms of water quality (results of larviciding) and habitat, ii) allow for a differentiation between the delays in the process of recolonization which are due to the decrease in the quality of the water and those related to the degradation of the habitat, iii) take the necessary steps to enable the national teams to carry out these studies on their own after 2002. H. ARRANGEMENTS FOR THE NEXT MEETING a) Data and Venue 74. The twentieth session of the Ecological Group would be held in the Eastern Zone on 4 and 5 March 1999, preceded by that of the hydrobiologists on I and 2 March 1999. The venue would be chosen so that it is easily accessible and would allow a field visit to the Oti and./or its tributaries. b) Chair 15. The Ecological Group announced the choice of Professor V.H. Resh as Chairman of the twentieth session (1999) and Professor D. Calamari (current Chairman) to represent the Group at the nineteenth session of the Expert Advisory Committee (EAC) in Ouagadougou, Burkina Faso, and of the Joint Programme Committee (JPC) in Accra, Ghana. The Group expressed its sincere thanks to the outgoing Chairman for the work accomplished and wished the incoming Chair full success in the performance of his duties. I. READING AND APPROVAL OF TIIE REPORT 76. The French version of the report was read and approved by the participants after some minor amendments- The complete draft will be submitted to the Chairrnan of the Group for approval before its finalization for presentation to the Expert Advisory Committee. J. CLOSURE OF THE SESSION 77. The Chairman of the Ecological Group thanked his colleagues for their active participation in the discussions. He also thanked the OCP staffstationed at Odienn6 for the practical organization of the meeting and for the attention paid to the Group. Lastly, the Programme was congratulated by the Group forthe lively and clear presentations which contributed to the success of the deliberations and for the efficient support received from the secretariat. Professor Calamari then declared the session closed and said he looked forward to meeting the members of the Group again in March l 999. EACI9 Page 44 r\nnexe I Appendix I LIST OF PARTICIPANTS lvlembers of the Ecolo-eical Group Professor Davide Calamari, University of Milan, 3rd Faculty of Sciences, Environmental Research Group, Via Ravasi 2, 2l 100 Varese, ltalY Tel : 0039-3 32-250217 - Fax: 003 9-332-281 3 08 - E-mail@imiucca.csi.unim i. it Professor David Colman, Schoolof Economic Studies, University of Manchester, Manchester Ml3 9PL, United Kindom Fax: 0l6l 275 4929 - Tel.0l6l 275 4804 Dr S. I-eloup,2723 Ontario road, NW # 3, Washington DC, USA Tel-/Fax: | 202 667 1342 Dr Christian L6vdque, D6l6gud ir l'Environnement, ORSTOM, 213 rue La Fayeffe, 75480 Paris C6dex 10, France Tel. (33.1) 480377 74-Fax(33.1) 48037526 Professor Vincent H. Resh, Department of Environmental Science, Policy and Managemen! Entomology Program, University of Californi4 201 Wellman Hall, Berkeley, California 94720, USA Tel. (510) 642-3327 - Fa-r (510) 642-7428 - E-mail: vresh@nature.berkeley.cda Associate member . Dr Anette Reenberg, Instirute of Geography, Oster Voldgade 10, DK-1350 Copenhagen K, Denmark Tel. + 45 35322562 - Fax: * 45 35 322501 - E.mail: ar@geogr.lcrudk Other DarticiDants Dr Giuseppe Crosa, University of Milan, Via Emmanueli 15, 20L26 Milan, Italy Tel. 392 64474203 - Fax: 392 64474200 - E-mail: crosa@field.fao.org - FAO - World Bank OCP Secretariat Dr H. Agoua, VCU/OCP, B.P. 36 Kara, Togo Dr L.K.B. Akpoboua, VCU/OCP, B.P. 5M Odienn6, Cote d'lvoire M. i.R. Bakon6, VCU/OCP, B.P. 549 Ouagadougou, Burkina Faso Dr Y. Bissan, VCUiOCP, B.P. 1474 Bouak6, Cote d'lvoire Dr J.M. I{ougard, VCU/OCP, B.P. 549 Ouagadougou, Burkina Faso M. J.M. Tapsoba, VCU/OCP, B.P. 549 Ouagadougou, Burkina Faso Dr L. Yam6ogo, VCU/OCP, B.P. 549 Ouagadougou, Burkina Faso .I EACIg Page 45 Annexe I Appendix 2 LIST OF DOCUMENTS OCP/VCU/HYBIO/98.I OCP/VCU/HYBIO/98.2 OCP/VCU/I]YBIO/98.3 OCP/VCU/HYBIO/98.4 OCP/VCU/HYBIO/g8.5 OCP/VCU/HYBIO/98.6 OCP/VCU/HYBIO/98.7 ocP/vcu/HYBIO/98.8 OCP/VCU/I{YBIO/98.9 Results of the monitoring of the aquatic environment corsoridated reporr1985-1997. By M.E. Diop Ichtyotoxins and their use in some of the watercourses under environmental surveillance - By M.E. Diop Monitoring of the aquatic environment in Guinea in relation to the antiblacldly larvicides (l9u-1997) - Fanfonde Konde. & Keletigui ttaue Summary of the annual report of OCp's Hydrobiology Section Summary annual report of C6te d,Ivoire (Ichthyofauna l99G 1997 season). By Kouassi N,Gouan Cyrille Fis_h monitoring in relation to ocp lawiciding in Gharn annual report for L996197 monitoring year - By E.K. Abban Ghana invertebrate monitoring report for r996t9i - By J. samman lummary report of the annual fiih monitoring of the onchocercia'sis control Programme treated water courses in Siena kone - lgg6figg7 - By ZacBah fguatic monitoring non-target entomofauna of rivers larvicided by the onchocerciasis control programme in Sierra lrone - By Daniel rtrbttey - Habitant Assessmenr - By V.H. Resh - An overview of twenry years monitoring of fish populations in West Africa by the Onchocerciasis Conrrol progiamme _ By Fermon et al, 1998 - Long term assessment of insecticides trearments in west Africa: Aquatic entomofauna - By Crosa er al, l99g aa EACI9 Page 46 Annexe 1 Appendix 3 PROGRAMME OF }VORK FOR 1998 Drift sampling is only collected for monitoring the taxonomic richness of rvatercourses Therefore, the drift wilt be sampled only twice a yez:, during the period of, highest raxonomic richness. Sampl ing period/Frequency IchryofaunaInvertebrates January to DecemberJanuary to April November to December Country/River Once (2 nigh| every 2 months Qnce (2 nighQ every 2 months Once (2 night) every 2 months Once (2 nigh0 every 2 months t,4 tt D n 4 aa Danangoro/Marahou6 Entomokro/Marahou6 -Pont Frontidre/I-6raba Niaka/Bandama Gans6/Como6 Sabari/Oti Asubende/Pru NangodiiRed Volta Sassambaya/Niandan Baranama/Dion T616lDion Boussoul6/Milo Mandiana/Sankarani Monitoring suspended (data too fragmentary and persistent insecurity) Ghana Guinea Sierra Leone C6te d'lvoire Once (1 day)/month Twicb I day, only in dry season Once (1 day)/month Once (1 day)/monttr, end of rainy season/begirning of dry season Once (1 day)/month Once (l day)/month Once (l day)/month 4 NI] 4 g 4 EACIg Page 47 ANNEXE 2 tr 'a 0-) eq -Z EGcJ(gr: .^oU 0Je ficJo.:c 0';cd aO^^o d= L 0i .- -dLPC? sai3 *a oi E'O -C -;,o q .* =1O cdE' E 90 € E e'EdJ= -- 0)() *:{ (, cEE.> .- _ L.r -(g(Dku g =_.9t_ U L ^-b'= g 3h{ r E;HCv-o)g(do;OO5q€€ I sE:;E(J 9'I o'- < 6 -6.9 10i! -o t.F.;b hE.E€ .c9yth"d Igg.r;E o E PH9€ !'E ."v)edr- -i- o trO\ o o rr'=o 5.8 ar 'l;8 8F.E .ioo.(g <-t.e 9t 3 +4< 3 ft'r 5 Bxg : E ," o k Q!E€-3 sp.d UBE;C 3. s.E'i q E .e .q'I * 'Es74* ._!Hg)e!jd)ar (( o'-nE-c d ' -(J*<_ q_; eEPUF : d E;-: , a 7.- -iU.< vH a^o-<Jorts' -t6H.<frV nt .- Cg P XHEEsEEn d e:=):-io o 92 > C- '<f,U.rJ^v^s-vXaYoro !.-!dJ9€ ts; S Ha,(! o c - ; s ic;f Eq 9 oo-= F - =<Y c= 6;or at H # >, t-r,oE i:6'-;-9rboc=.=Xo->q)oi>^ v-Pe.= 3 X y 'tt-fEC6.Eqj c,a,r, @ o\3 ,^LooOO\qO\(l) _Lg()6< *rI1(1)-!r cl= Etg ^(go\ o. 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So6.O NE -Lo o-So33 *cO o o e E d c .9 6 ;o 6 o o L.= O ^^ d.=Eo oC -Eo C= :]C ..S 0.)o o C) ru cl ! c € C) oO 'o a -o E .9 (g L() o- o '- .o -o !6d 3s +6 C .- o =l 6ol cn a= -"J o 6 EI .. ca i E -a E.9.e Ed, 6 --.Y .}4: > tr cd'E b E =doo-dd .flE 7.= B C EE -9. '{ C oAo., 3'E .z '1.: EH6 S .EE,s o o o o .l L 6l -d.9Olo ', c(r6dc. drr- EACI9 Page 50 Annexe 2 E =O o CqOoC- sH d:FT, OO >L oc -O6 OO o o a =-o O o o- 5 oo_ o€oc 6.- .24 --o *O =o o0 o o F =q oU LO .9= ooo->o= *q E .9 bo o -o Po o-:oU 9oLOOc '5d OOo.>o= -oI 3.0 o; q= 3"4dO 't& .{: d cl co: '5!> :1; :do-o(gl \o o\ EJo\ r) uEE: ! ,g* E 3 at o= 'o Ei oo -ocGl '6c -ooq* !ooE.E69 o5 .2'A9'5 -=.rD ^(g-o E =-d c'-co + (r(J o (! o a!q) oo o. o oo oE .r O o .!3 '= -o)<n IO ! 6 -o I =. d6 oC ';D Io; ocEc9.eqoq)o EoS ,=Eooq)c>Co ='a+ d! ! c, -o o a d.- .94 o0Es3 .9-EEOO =9O.()ruo h0 i: oo()c>E() :'a * -oE rul( c, €e u'6 .) ';l- >,ab o';L!oco.GI , ()L od a=don .9 o 'o o ! cl c e 'oc GI a) GI CL(,r o. a) a T () sq b3 -6 -t* o- .' SEo. =.=E 'ie6 --1r-6E 3E: '85ii_ 5€HT 3g *F 6.-e E !-Cl .3€ 3i r.=+d o2 (J z I o.o o Fo z() z * F o z (J z t F o z (J z + FF oo odzz l* F z o() z + (J z T G = =o o q) Eo oO 6 6 E lC co)6O CCooo '=q oj?O9 oC 'oo -o d-o ^C d_!a)st ae +d q) o (g ac c (l co 6 oO =.9 ;E o L o0 0) 6 olJ oo (g =q) = .9 hO o o E o o .9:o o .I a o- O 6tr o -o C = + o(J c d ru (€ .9 oO o .9 EoP o-o .9 'o o .C o o- o :/, o -o q €!2 't d'=o-oU.5C'toir e3-.I o-X -o3;a ocotr-o60cq=>d o.J 6oi= '-dL2 >o-oo o!=4LL^ =o-od *+I* a: .9E 6-O .-u-O L4gEo;f Eg $Ed..- o\ E 43E::E Ei E5u E 5E E :ldl cl c{ '=:-. olF =lo,j1 O I a - at EACI9 Page 5 I Annexe 2 L o o-o L o d a d o '(, oO o! .= 0) c! o'= LO rO. € !O 6,!g 6bOF.I3P'E -oLLo'o -odEo FO 6 *c) OE rl]; :;Ec -G, do co96h>^ od-(f7-O<€ ;eoo *E L .o -o o o. o o o 'o O^ oo= oO Eoo;3 ooc .:6 c: '=- :o *o o () = '5 d'o ._ c) ootE .=oct! LOOL .= oo(o-c!H + qjl 0)tE oe'o ()4E!ruiYq=9d dcJ EI3E eeE ctr '6€ so rO. o(! O o .9o .=o -a.2 bs ii qr 9J o- -= 'Oo CE(g oI) q Q,)oo L6 +! oo '= L L € O oO coo d= *co 'oo -o(, q 6J o. a o oO C)o I o .Y6tro -o a .9 o bo '= '= L -o C6o _bf >. oc.l:a:=o:o8= o o oil bD4 6C-V O H:.-5oP9.-AI P- u: edoE;BE +do o 2 oz ,; o .E F * o.() ri o z ";O .E LF + O z .; o '6 LF (J': o€z. *v O '= F o z -a\(_) t\ -o *v :E o O z A(J o * J o 2. (J z o. o 2 (J z (J o * o. o F z (-) * FoZ O z a o z() z * -ol cldi C6do o9coY -o o- :OO '.'= L.-v6 -oo6 .-- 9 '=o)> ei 6O =6 =€l9g c -f:Y- C0 roC- o o U o aO ootJ =a ? :o := - = oO .; 'iz O6 .E.o 'b .r 6 =6C o.Ya =coaS 'e C^- -- o i: .=dd -.Y o- !o- co o- o- qu\U- " . - '= ') :9o c n) .- l q- ) :, o O-O .) UC -oO €: .= -U -o6 -:JoFU- ^^ 9E3 H q --oq)::ocEs s q= o:6 q^6oc -* !.1Etb 3-O6 coJ .9CaL 'E= o !.d -o64I€" aE =i 6.9Yo!, t :l * -= 6 6 Oq od bo-;c-oE*'.= Ec-o Ldq 6; 61Y g =? !! o LLOco ,^ >\ -o o^ I- 2 o6:^ r)_ dL=- .-!cQo o>\ ,^'= ; L -€itro rF..:'q .- = .) J O *or!)- o 6 6 c) o oO o.9 '=2 OO -OL .roO-ooo -o -o =o o- c= €L- -o -c 2 J a--(n -- ;L a .g .: C o c C c EACI9 Page 52 ANNEXE 3 STATEMENT BY PROFESSOR OFOSU-AMAAH The Committee was concemed that the impressive achievements of the Programme be sustained. The issue of integration in the health field was critical but the prospects were not too bright. One reason was that goverrunents depended increasingly on foreign assistance which in some cases led to independent donor-driven programmes. Furthermore, donor assistance would need to take into consideration the specificities of individual countries. There could be no standard approach common for all. One problem of the "vertical" success of OCP was that until recently the Participating Countries had relatively less responsibility for the Programme. However, full country participation was now required which meant ensuring that health prograrnmes including onchocerciasis control were accorded their proper place within overall development programmes. Perhaps the success of OCP could be used as a lever in this respect at a timb when countries were in the process of instituting health sector reform. It was important to impress on political leadership of OCP achievements. He pointed out that Ministries of Health were only one group interested in health development and support should also come from such bodies as local governments. It was necessary to create "alliances". Close contact and collaboration with staff of other health programmes would ensure easier acceptance. To achieve sustainability, target populations should accept ownership with the support of local organizations. On the issue of capacity-building, it was emphasized that there was the critical issue of the selection of appropriate target grouiis. At the university level, special degree courses, including other diseases, could be envisaged while at the community level, country particularity needed to be taken into account while drawing on the experience of such community-based activities as the family planning programmes, which provided alternative distribution models. -l EAC 19 Page 53 ANNEXE 4 LIST OF EAC.19 RECOMiVIENDATIONS The commiltee reconrntended that: Ecological Group - OCP invite UNEP and other relevant institutions to be associated with environmental developments in oncho-freed zones (para.2l); Implementation of EAC strategy recommendations - if the epidemiological situation in basins planned for cessation of larviciding give cause for doubt, vector control should continue with intensified epidemiological surveillance (para.24); - ivermectin be given twice yearly'in the Oti basin (para. 28); - OCP review the validity of the simulation for Oti in terms of the quality and coverage of larviciding and ivermectin treatment as well as the human migration factor (para. 28); - wice-yearly ivermectin treatment be instituted in the lower Comoe area (para. 32); - microsatellite population markers be implemented (para. 33); - larviciding be maintained in the Sassandra basin (para. 35); - the strategy in northern Sierra Leone be modified to ivennectin treatrrrent only (para. 38); - thought be given to ivermectin treatment of exposed populations refugees in Siena Leone towns (para 3e); - thought be given to possible alternative mearx of eventual ivermectin teatment in Sierra Leone where social structures will be fragile (para. a0); - Sierra Leone be eligible for APOG support after2002 (para. 4l); Vector control - Etofenprox be stored for use in emergency situations (para. 50); Modelling support to strategy development - models of control scenarios include systematic incomplete coverage of ivermectin treatment and incomplete larviciding (pa.a. 68 - see also para. 28 above); Evaluation strategy - the intemrption of ivermectin treatment for evaluation purposes be discontinued (para.71); - the use of DEC patch test in three to five-year old children be standardized (para.73); Diagnostic tools - OCP develop with national teams country-specific protocols for application of DE,C patch testing (para.83); - arrangements be made for Participating Countries to acquire material for DEC patch tests (para. 84); Training - 1999 become the target date lor specifically targeted training (para. 87); - onchocerciasis material bc prepared for undergraduate training (para. 88); - discussion take place in I 999 rvith IEC prograrrunes for integration of onchoccrciasis in national IEC plans (para. 89); I a .l a- EACI9 Page 54 Annexe 4 - elements of how to detect the causes of'recrudescence and description of field constraints - and how to overcome such constraints - be included in training prograrnmes (para. 90); Macrofil - EAC representative(s) be directly involved in the TDR Drug Development Programme when Macrofil is under consideration (para. 100); - ivermectin/levamisole ivermectin/albendazole receive priority in the search for drug combinations(para.103); - OCP develop scenarios for field use of macrofilaricides (para. 104); - plans be made for solving anticipated problems caused by the use of generic ivermectin in other diseases than onchocerciasis with the potential of producing ivermeciin resistance (para. 106); - material for DNA studies be storbd in liquid nitrogen or at -80o C (para. l0g); - the possibility of optimizing the DEC patch test and the PCR methodology for vector identification be explored with industrial partners (para. 109); . Progress against the EAC conceptual framework on integration and transfer - OCP and Participating Countries adopt a proposed (EAC.l9) list of activities as a basis for an overall strategy and a corresponding checklist (para. I I 4); - comprehensive systems analysis'be carried out in OCP countries in collaboration with schools ofpublic health or other national institutions (paras. ll9,l2O,123); - OCP appoint a health systems specialist (para. lZ7); Miscellaneous - the local health authorities and communities in the Bougouriba valley be congratulated at the successful implementation of a four times a year ivermectin treatment (ytara.77). {$ : I a