aRAPID EPIDEMIOLOGICAL ASSESSMENT (REA) MISSION REPORT WORLD HEALTH ORGANISATION AFRCAI\ PROGRAMME FOR ONCHOCERCIASIS CONTROL (APOC) BY DR. PETER ENYONG (T e mp o r ary A dv is e r/WH O) Dr. Peter Enyong Tropical Medicine Research Station P.O Box 55 Kumba Cameroon Tel. (237) 3s 42 3l e-mail. penyong@camnet.cm t -Introduction: Onchocerciasis has been recognized as a disease of public health importance with serious socio- economic consequences. lt is for this reason that the world Health Orgnisation (WHO) decided to create the Onchocerciasis Control Programme (APOC) in West Africa. The control activities were geared towards the elimination of the vector Simulium funosium and so control the disease The strategy could not be put in place in the other regions of Africa, for various reasons, the most outstanding being the high cost of the programme. Recently the discovery and the registration of ivermectin (Mectir"n') a microfilaricide which could be used for mass treatment of onchocerciasis and the pledge of Merck and Co.Inc to donate this drug has raised great hopes for the control of this disease in the human population. This new development led to the creation by WHO of the African Onchocerciasis Control Programme (APOC) in 19 onchocerciasis endemic countries outside OCP. (WHO.1995, Molyneaux and Daries 1997). The APOC strategy is base on a partnership agreement between the governments of the endemic countries and NGDO's @oatin et al, 1997) to assure a sustainable community directed treatment with ivermectin (CDTI). The general philosophy was to build up an intensive community participation with a view to make the communities to become the owners of the programme and eventually continue the distribution after APOC activities shall came to an end. With this in mind, ivermectin had to be distributed in communities that had a very high risk of getting serious ocular and dermal disease (Taylor et al, 1992, WHO, 1992). The degree of risk of a community is directly linked to the intensity of the infection of the population. (Remme et al, 1998). The risk factor can be determined by a rapid epidemiological assessment (REA) and the data used for the rapid epidemiological mapping of Onchocerciasis (REMO). APOC, therefore, strongly recommends the utilization of the REMO data for the delineation of CDTI areas. For this to be of any use, all REA data must be accompanied by geographical coordinates which can be gathered from various sources including maps (ruler reading from geographical maps) or by the Global Positioning System (GPS). REA data collected recently by the NGDO's (SSI, HKl, BASED), which was intended to refrne the REMO maps, did not have the coordinates. Since this data was not collected using the GPS, ait could not be integrated into the GIS. The aim of this assignment is to use existing geographic maps, to provide coordinates for each village. General Objectives: To help the GTNO secretariat to complete the REA data already collected Specific Objectives l. Read offand note the geographic coordinates (longitude, latitude in degree, minute and seconds) of the study villages from existing topographic maps. 2. Train members of the REA teams on how to read out the coordinates from topographic maps. Materials and Methods: A large table, maps, long rulers are the main materials needed for this work. Training the REA tearn members. Cameroon lies betwecn 9o to 16o West and 2" to 13 o North and has been divided into 44 topographic maps. Each topographic map covers an area delineated by two degrees East and North (example, 9o E to l0o E, 3 o N to 4 " N). Each degree is divided into 60minutes and each minute is divided into 60 seconds. These features, which are on the map, were shown to the trainees. A typical village was identified on the map and with a ruler, the coordinates (latitude/longitude) were read out and entered into the column reserved for this purpose on the data sheet. Also two coordinates were read out and the village located on the map. In locating the coordinates it is important that the ruler is very straight (example 3 o 53' 00"/10" 30' 00" taken on the right and left top and bottom side of the map gives us the village Log Sambo) or parallel to an adjacent line. ii. Execution oi !s;L The exercise was to complete the REA data using l:200.000 maps of the Center, Littoral and East provinces. These three provinces are found on 9 maps (Muatko, Edea, Yaounde, Akonolinga, Abang, Bertoua, Nanga Eboko, Bafia, Ndikinimeki, Linte, Yoko). A member of each REA team identified and marked out the health areas and all the villages under it were underlined or circled with a suitable marker. Any villages not existing on the map Mme. Essame Josette-NOTF Yaounde Mme. Ntsama Susan - Ministry of Health Yaounde References: MOLYNEAUX, DH and Davies, JB 91997). Onchocerciasis control: Moving towards the Millennium. Parasitol. Today. 13 (13 (11): 418-423. REMME, RII. DADZIE, KY; Rolland, A and Thyleforc, B (1998). Ocular onchocerciasis and intensity of infection in the community. [. West African Savanna. Trop. Med. Parasitol. 40.340-347. TAYLOR, HB DIJI(E BOL and Munoz, B (1992). The selection of communities for treatment of onchocerciasis with ivermectin. Trop. Med. Parasitol. 43.267-270 Summary REA data was collected from Littoral II and Centre III provinces in order to fine tune the REMO maps. Unfortunately this data did not include the coordinates of the villages and other localities. This data could not be collected by GPS since this will entail revisiting the l5l8 villages. It was therefore decided that the coordinates be read offfrom topographical maps of the provinces concerned. 1033 of the l5l8 villages were located and the coordinates (longitude, Iatitude) recorded in degrees, minutes and seconds. Some of the villages could not be located on the maps because they are new or are part of the towns. To complete the dat4 it may be necessary to revisit these villages and use the GPS on the spot.
aRAPID EPIDEMIOLOGICAL ASSESSMENT (REA) MISSION REPORT WORLD HEALTH ORGANISATION AFRCAI\ PROGRAMME FOR ONCHOCERCIASIS CONTROL (APOC) BY DR. PETER ENYONG (T e mp o r ary A dv is e r/WH O) Dr. Peter Enyong Tropical Medicine Research Station P.O Box 55 Kumba Cameroon Tel. (237) 3s 42 3l e-mail. penyong@camnet.cm t -Introduction: Onchocerciasis has been recognized as a disease of public health importance with serious socio- economic consequences. lt is for this reason that the world Health Orgnisation (WHO) decided to create the Onchocerciasis Control Programme (APOC) in West Africa. The control activities were geared towards the elimination of the vector Simulium funosium and so control the disease The strategy could not be put in place in the other regions of Africa, for various reasons, the most outstanding being the high cost of the programme. Recently the discovery and the registration of ivermectin (Mectir"n') a microfilaricide which could be used for mass treatment of onchocerciasis and the pledge of Merck and Co.Inc to donate this drug has raised great hopes for the control of this disease in the human population. This new development led to the creation by WHO of the African Onchocerciasis Control Programme (APOC) in 19 onchocerciasis endemic countries outside OCP. (WHO.1995, Molyneaux and Daries 1997). The APOC strategy is base on a partnership agreement between the governments of the endemic countries and NGDO's @oatin et al, 1997) to assure a sustainable community directed treatment with ivermectin (CDTI). The general philosophy was to build up an intensive community participation with a view to make the communities to become the owners of the programme and eventually continue the distribution after APOC activities shall came to an end. With this in mind, ivermectin had to be distributed in communities that had a very high risk of getting serious ocular and dermal disease (Taylor et al, 1992, WHO, 1992). The degree of risk of a community is directly linked to the intensity of the infection of the population. (Remme et al, 1998). The risk factor can be determined by a rapid epidemiological assessment (REA) and the data used for the rapid epidemiological mapping of Onchocerciasis (REMO). APOC, therefore, strongly recommends the utilization of the REMO data for the delineation of CDTI areas. For this to be of any use, all REA data must be accompanied by geographical coordinates which can be gathered from various sources including maps (ruler reading from geographical maps) or by the Global Positioning System (GPS). REA data collected recently by the NGDO's (SSI, HKl, BASED), which was intended to refrne the REMO maps, did not have the coordinates. Since this data was not collected using the GPS, ait could not be integrated into the GIS. The aim of this assignment is to use existing geographic maps, to provide coordinates for each village. General Objectives: To help the GTNO secretariat to complete the REA data already collected Specific Objectives l. Read offand note the geographic coordinates (longitude, latitude in degree, minute and seconds) of the study villages from existing topographic maps. 2. Train members of the REA teams on how to read out the coordinates from topographic maps. Materials and Methods: A large table, maps, long rulers are the main materials needed for this work. Training the REA tearn members. Cameroon lies betwecn 9o to 16o West and 2" to 13 o North and has been divided into 44 topographic maps. Each topographic map covers an area delineated by two degrees East and North (example, 9o E to l0o E, 3 o N to 4 " N). Each degree is divided into 60minutes and each minute is divided into 60 seconds. These features, which are on the map, were shown to the trainees. A typical village was identified on the map and with a ruler, the coordinates (latitude/longitude) were read out and entered into the column reserved for this purpose on the data sheet. Also two coordinates were read out and the village located on the map. In locating the coordinates it is important that the ruler is very straight (example 3 o 53' 00"/10" 30' 00" taken on the right and left top and bottom side of the map gives us the village Log Sambo) or parallel to an adjacent line. ii. Execution oi !s;L The exercise was to complete the REA data using l:200.000 maps of the Center, Littoral and East provinces. These three provinces are found on 9 maps (Muatko, Edea, Yaounde, Akonolinga, Abang, Bertoua, Nanga Eboko, Bafia, Ndikinimeki, Linte, Yoko). A member of each REA team identified and marked out the health areas and all the villages under it were underlined or circled with a suitable marker. Any villages not existing on the map Mme. Essame Josette-NOTF Yaounde Mme. Ntsama Susan - Ministry of Health Yaounde References: MOLYNEAUX, DH and Davies, JB 91997). Onchocerciasis control: Moving towards the Millennium. Parasitol. Today. 13 (13 (11): 418-423. REMME, RII. DADZIE, KY; Rolland, A and Thyleforc, B (1998). Ocular onchocerciasis and intensity of infection in the community. [. West African Savanna. Trop. Med. Parasitol. 40.340-347. TAYLOR, HB DIJI(E BOL and Munoz, B (1992). The selection of communities for treatment of onchocerciasis with ivermectin. Trop. Med. Parasitol. 43.267-270 Summary REA data was collected from Littoral II and Centre III provinces in order to fine tune the REMO maps. Unfortunately this data did not include the coordinates of the villages and other localities. This data could not be collected by GPS since this will entail revisiting the l5l8 villages. It was therefore decided that the coordinates be read offfrom topographical maps of the provinces concerned. 1033 of the l5l8 villages were located and the coordinates (longitude, Iatitude) recorded in degrees, minutes and seconds. Some of the villages could not be located on the maps because they are new or are part of the towns. To complete the dat4 it may be necessary to revisit these villages and use the GPS on the spot.