Meeting between OCP and national coordinators of the onchocerciasis control programme: Ouagadougou, 29-31 March 1993

J,* t \ WORLD HEALTH ORGANIZATION ORGANISATION MONDIALE DE LA SANTE ONCHOCERCIAISIS CONTROL PROGRAMME IN WEST AFRICA PROGRAMME DE LUTTE CONTRE L'ONCHOCERCOSE EN AFRIQUE DE L'OUEST EXPERT ADYISORY COMMITTEE Fourteenth session Ouaeadousou. 7-l I June 1993 ocP/EACr4.8 (OCP/devo /126/2.17) ORIGINAL: FRENCH MEETING BETWEEN OCP AND NATIONAL COORDINATORS OF THE ONCHOCERCIASIS CONTROL PROGRAMME (Ouagadougou, 29-31 March 1993) TABLE OF CONTENTS INTRODUCTION ADOPTION OF THE AGENDA DEVOLUTION PROCESS tN THE PARTICIPATING COUNTRIES . Priorities accorded by the Governments to the maintenance of OCP's achievements Limits of OCP in its material and financial support to the devolution process . . . . Page ..1 2 3 I I 3. r. 3.2. I I 2 2 2 4 4 3.3. 3.4. 3.5. 3.6. Continuation of donors' financial support to OCP . . . Methodical and rational distribution of ivermectin Better definition of the roles of OCP and WHO/AFRO in devolution Integration of devolution activities into those of the basic health structures of the Participating Countries Current status of the formation and functioning of the National Onchocerciasis Committees (NOCs) and National Devolution Committees (NDCs) Participation of rural communities . . . Priority to be accorded to women as regards training . . Presentation of devolution plans (revised and new) . . . 2 3.7 4 5 3.8. 3.9. 3.r0. ocP/EACl4.8 Page ii I $ 3.1 l. Presentation of devolution plans to be revised (countries in the original area) 5 3.12. Presentation of devolution plans currently being prepared 3.13. List of donors already contacted by the countries for the financing of the devolution plans 5 4. 3.14. Epidemiological surveillance in the context of devolution in 1993 . . . . 8 EPIDEMIOLOGICAL EVALUATION, IVERMECTIN TREATMENT AND PLANNING 8 4.1 Epidemiological evaluation . . . . 8 Objectives4.t.l. 4.r.2. 4.1.3. .....8 Typeof examination... .......8 Delimiting of the zones according to different modes of intervention8 4.1.4. Techniques, equipment and quality control 4.1.5. Human migration studies (annex 7) 4.1.6. Incidencestudies 4.1.7 . Passive screening 4.2. Ivermectin treatment 4.2.t Results and Planning . . . . . 4.2.2. Participation of the Yector Control Unit (VCU) in ivermectin treatment 4.3. Plan of epidemiological activities 4.3.1. Plan of evaluation . . . 4.3.2. Ivermectindistributionplans 5. ANALYSIS AND INTERPRETATION OF DATA AND REPORTING RECOMMENDATIONS ANNEXES : ,... 9 9 9 9 l0 r0 r0 ll ll ll l3 r2 l5 ,1 ocP/EAcr4.8 Page I I. INTRODUCTION A meeting between OCP and the National Coordinators was held from 29 to 3l March 1993 in the OCP headquarters in Ouagadougou. The session was opened by Dr Ebrahim M. Samba, Programme Director, who welcomed participants and expressed his satisfaction at seeing that all the National Coordinators of the eleven Participating Countries were present (see list of participants appended hereto as annex l). He noted that the donors were satisfied with the performance of OCP within the mandate given to it but were asking themselves a number of questions on the chances of success of devolution activities after the cessation of OCP. The week starting on 28 March 1993, which the Director termed'devolution weekn, would be devoted to reflections on the devolution process in the different countries. The Director indicated that, both for OCP and the donor countries, devolution remained the main concern in this fourth Financial Phase. That was why the meeting was aimed, among other things, at finding answers to the questions raised by the Joint Programme Committee on the devolution process during its thirteenth session held in December 1992 in Geneva. 2. ADOPTION OF THE AGENDA The agenda proposed by the Chief of the Devolution Unit was adopted without amendment. 3. DEVOLUTION PROCESS IN THE PARTICIPATING COUNTRIES 3.1. Priorities accorded bv the Governments to the maintenance of OCP's achievements In dealing with this item, the Programme Director pointed out that OCP was one of the rare examples of successful projects and that that was insufficient considering the continent's potentialities. He reaffirmed, however, that by combining their efforts, all those concerned would be able to make the OCP devolution process a success. 3.2. Limits of OCP in its material and financial suooort to the devolution orocess The Programme Director recalled that during its thirteenth session held in Geneva, the Joint Programme Committee stressed the fact that OCP had no mandate to finance devolution activities in the countries. On the other hand, he listed three fields in which OCP could intervene to support the devolution process and give more chance to the countries to carry out devolution successfully, viz.: - Trying to go beyond the first part of its objective by reducing prevalence to the lowest possible level (almost zero) so :rs to prevent or delay significantly the emergence of recrudescence. - Involving as many partners as possible at all levels by means of a sustained public awareness campaign to ensure that onchocerciasis would no longer become a public health problem. To that end, he encouraged the use of personal contacts to pass on the necessary information. - Seeing to it that the tools required for devolution were available, simple, affordable and within the reach of all those concerned. These tools were, among other things, ivermectin, a macrofilaricide, diagnostic methods, and treatment of villagers by themselves (community treatment). As regards the last-mentioned point, the wish was ardently expressed for all necessary efforts to be made to demystify the disease and its treatment. tocP/EACl4.8 Page 2 3.3. Continuation of donors' financial suooort to OCP Donors were making it more and more known that the continuation of their financial support to OCP would now depend on the progress made by the countries with regard to devolution. OCP would therefore have to encourage the Participating Countries to make more efforts in this devolution process. 3.4. Methodical and rational distribution of ivermectin As regards the ivermectin distribution methodology and the presentation of results, it was observed that this activity had been carried out by the national teams according to the established protocol and that the monitoring reports had been provided in time. However, the National Coordinators were asked to continue to maintain the compliance with the strategies adopted for ivermectin distribution by the various actors in the different zones (see document 93/ll0/devo/2.17 presented to the meeting and which will be submitted to JPCI4). 3.5. Better definition of the roles of OCP and WHO/AFRO in devolution (See annex 2: Institutional framework for Devolution and the roles of the main actors (summary table). A complet document reference 93/l15/devo/2.17 was presented to the meeting and will be submitted to JPCI4). 3.6. Intesration of devolution activities into those of the basic health structures of the Particioatine Countries The eleven National Coordinators pointed out the integration efforts made in their respective countries and their future plans. Annex 3 summarizes the diseases combined with onchocerciasis in the countries' devolution plans. In Benin, although the devolution plan had not yet been updated, onchocerciasis monitoring was not vertical. The peripheral health services were involved in the large-scale treatment in the field. Information on onchocerciasis control was regularly given during periodic meetings of the health services as well as those of the country's financial backers. With the exception of Atakora and Borgou, a retraining seminar on onchocerciasis had been organized in each region. In the near future, seminars of the same nature would be organized in these two regions. The devolution plan to be updated would combine onchocerciasis with the target diseases of the expanded programme on immunization, dracunculosis, leprosy, African human trypanosomiasis and schistosomiases. In Burkine Faso, the devolution plan had been finalized and financed. It combined onchocerciasis with dracunculosis and African human trypanosomiasis. The whole health pyramid was concerned with the integration. Thus, health workers at different levels had been retrained. This training covered 60 medical officers, 1,000 nurses and 8,000 community health workers. Active onchocerciasis surveillance was carried out by mobile teams. Health posts undertook passive surveillance. The whole health services personnel was involved in awareness-raising on onchocerciasis. Despite that, the Coordinator did not consider the integration to be complete yet. In C6te d'Ivoire, the devolution plan had been revised and it took into account onchocerciasis, dracunculosis, schistosomiases and African human trypanosomiasis. The national team was composed of health workers employed in the different centres where they were responsible also for other diseases. Besides, each health centre had named a worker to take care of onchocerciasis. The national team had just benefitted from a budget line from the Ministry of Health to cover some activities. Thirty nurses had also been trained in large-scale ivermectin treatment methodology and epidemiological surveillance. (ocP/EACr4.8 Page 3 Ghene had, for the first time, appointed a medical National Coordinator with a view to a better coordination of medical devolution activities. The devolution plan, not yet revised, had combined onchocerciasis with dracunculosis, leprosy and yaws. The integration was being made from the peripheral to the central level. Many Oncho Committees were functioning at regional and district levels. Others would be set up soon. Community workers had received training on onchocerciasis and leprosy. The national team had conducted many large-scale treatments. Community treatments were currently being undertaken in some basins. Many non-governmental and religious organizations were actively involved in ivermectin distribution. ln Guinee, onchocerciasis would be integrated into the primary health care (PHC) programme. A draft had already been prepared in that direction and submitted to the PHC Technical Steering Committee, at the central level. The devolution plan, currently being prepared, should be finalized by the end of 1993. But, already, the community treatment undertaken was based to a large extent on the PHC system. The devolution plan would combine onchocerciasis with African human trypanosomiasis and schistosomiases. ln Guinee-Bisseu, the need for integration had been well perceived at the central level. However, the integration of onchocerciasis control activities into other health activities was not yet a reality. The devolution plan had combined onchocerciasis with malaria and schistosomiases. In Meli, the integration was a preoccupation of the Ministry of Health. All the programmes would be integrated into the primary health care system. With regard to onchocerciasis surveillance, all the activities had been carried out in collaboration with the peripheral structures. The devolution plan had been updated from those prepared by the basic structures, hence the involvement of local structures already at this stage. Because of the unique nature of this step, the Coordinator was asked to send to OCP a copy of the different devolution plans of the districts and regions. The updated national plan had combined onchocerciasis with schistosomiases and African human trypanosomiasis. Passive treatment was carried out by 70 national fixed centres. During large-scale treatments, as maoy field workers (medical officers, nurses) as possible were used. Community treatment started some two years ago. In this connection, all treatment plans were prepared by the health centres (district) themselves. The national team provided training to district trainers, the districts being responsible, themselves, for the training of their workers. The national team participated in all monthly district meetings. Here, the personnel was involved in awareness-raising campaigns. The Ouelessebougou Rural Animators Training Centre had trained 60 people in 30 villages in the fields of onchocerciasis and ivermectin distribution. In Niger, the devolution plan had combined onchocerciasis with schistosomiases and dracunculosis. Training workshops, notably at the peripheral level, were currently being prepared. The gradual integration of devolution activities into those of the basic health structures was a major concern of the authorities. In Senegal, the whole staff was taking care of onchocerciasis and other diseases at the same time. As regards the structures, the major endemic diseases department was responsible for many diseases, including onchocerciasis. Chief nurses of medical posts were systematically involved in large-scale distributions in the field. Other modes of distribution were being used. Community distribution projects would be financed by NGOs to cover Velingara and Kedougou. The devolution plan would combine onchocerciasis with schistosomiases and dracunculosis. In Sierra Leone, health workers at the peripheral level were more and more involved in large-scale treatments. The devolution plan currently being prepared would combine onchocerciasis with schistosomiases. ocP/EACr4.8 Page 4 In Togo, the devolution plan had not yet been revised. At present, it had combined onchocerciasis with leprosy and tuberculosis. The onchocerciasis control programme was under the division of primary health care. Passive treatment was carried out by fixed centres. Large- scale treatment was taken advantage of by chief medical officers and nurses to send supplies to and supervise the other inaccessible areas. Consciousness-raising covered many health problems(expanded programme on immunization, family planning, etc.). On the whole, it emerged from all the presentations and discussions that the integration should concern the following points: structures, resources, activities. 3.7. Current status of the formation and functionine of National Onchocerciasis Committees(NOCs) and National Devolution Committees (NDCs) - NOCs With the exception of Ghana where the NOC had functioned well so far by laying emphasis on socioeconomic development in the onchocerciasis-freed zones, all the other couniriei needed to get the resources required to make their committees operational. These NOCs, if functional, would serve as a support to the devolution committees that would be set up. - NDCs An instrument setting up a national devolution committee had been issued in Senegal. Benin, Burkina Faso, Cote d'Ivoire, Guinea-Bissau, Guinea, Mali, Niger and Togo had identified the different ministries that would compose their respective devolution committees. Steps were being taken to make the setting up of these committees official. Sierra Leone was getting ready to put in place its devolution committee. Annex 4 shows the present state of the composition of the devolution committees in the eleven OCP Participating Countries. 3.8. Particioation of rural communities The different National Coordinators made much mention of the participation of rural communities. This included community treatments, carried out or planned, in the countries, awareness-raising and training undertaken in the villages, and ground larviciding by villagers in some countries to control blackfly nuisance. 3.9. Prioritv to be accorded to women as reeards trainine One of the main tasks of OCP in connection with devolution was training. The programme had made a very appreciable effort in the training of nationals of the participaiing Couniries. In recent years, at the express request of the JPC, a special effort was being made to include more women in the different training programmes. The meeting appealed once more to the countries to continue with their efforts to train as many women as possible. ocP/EACl4.8 Page 5 3.10. Presentation of devolution olans (revised and new) Country Year Diseases combined Cost for 5 years Burkina Fasol April l99l - African human trypanosomiasis - Schistosomiases - Dracunculosis 1,610,884,256 FCFA i.e., US$ 5,712,355 Cote d'Ivoirel February 1993 - African human trypanosomiasis - Schistosomiases - Dracunculosis 976,660,630 FCFA i.e., US$ 3,756,387 Guinea-Bissau2 Malil October 1992 - Malaria - Schistosomiases us$ 4,477,109 February 1993 - African human trypanosomiasis - Schistosomiases 991,404,602 FCFA i.e., US$ 3,965,619 Nigerl t992 - Schistosomiases - Dracunculosis 555,273,073 FCFA i.e., US$ 2,904,896 l. Revised plan 2. New plan 3.1 L Presentation of olans to be revised (countries in the orieinal area) Country Diseases combined Benin Ghana - African human trypanosomiasis - Schistosomiases - Leprosy - Expanded programme on immunization - Dracunculosis - Leprosy - Dracunculosis - Yaws Togo - Leprosy - Tuberculosis 3.12. Presentation of devolution olans currentlv beins nreoared Country Diseases combined Guinea - African human trypanosomiasis - Schistosomiases Senegal - Schistosomiases - Dracunculosis Sierra Leone - Schistosomiases BURKINA FASO ocP/EACr4.8 Page 6 3.13. List of donors alreadv contacted bv the countries for the financine of the devolution olans BENIN (a) List of donors contacted - Benin-Switzerland Medico-health Programme - Dutch Support to Primary Health Care: agreement had already been obtained to finance the purchase of laboratory equipment; funds for the training of medical officers and nurses in Atakora had also been released (about FCFA 350,000) - ADB: there was a promise for FCFA 100 million (b) List of NGOs involved in ivermectin distribution - Hopital Saint-Jean de Dieu, Tanguieta and Boko - Hopital Ordre de Malte, Djougou - Hopital Evangelique, Bembereke - Hopital Soumon Sero, Nikki - Institut Tropical de Hambourg, Cove Donor financing the devolution plan: World Bank Other donors contacted : . WHO: for training and manufacture of water sieves . USAID and UNICEF: for supply of drinking water . Dutch Embassy . Helen Keller International (HKI) COTE D'IVOIRE (a) Donor contacted - UNDP (United Nations Development Programme) (b) NGO involved in oassive ivermectin distribution. - Ferkessedougou Baptist Hospital GHANA (a) The country had not yet contacted donors (b) NGOS involved in ivermectin distribution - ADRA (Adventist Development and Relief Agency) - Sight Savers - Red Cross - Presbyterian Church ffi MALI NIGER GUINEA.BISSAU GUINEA ocP/EACl4.8 Page 7 World Bank : an official request has been made and a reply was expected by the end of March 1993 HKI: This NGO seemed to be prepared to finance the information, education and communication (I.E.C) activities Donors contacted - World Bank - China (a) Donors contacted (even bofore the preparation of the plan) - USAID - lVorld Bank (b) NGOs involved in ivermectin distribution (see also part 4 of the report) - oPc - Sight Savers - Philafricaine Suisse SENEGAL (even before the preparation of the plan) (a) Donors contacted (a) Donors contacted - Belgium - EDF - The Netherlands (b) NGOs financine the communitv treatment (see also part 4 of the report) oPc Sight Savers Save the Children Donors contacted - FAO - UNDP - wHo - USAID ocP/EACr4.8 Page 8 (b) NGOs involved in ivermectin distribution (see also part 4 of this report) - OPC: will finance community ivermectin distribution projects. - APMP (Association for the Promotion of Preventive Medicine) SIrnna LEONE (a) Since the devolution plan had not yet been prepared, the country had not contacted donors. (b) NGOs involved in ivermectin distribution (see also part 4 of the report) - Sight Savers - Baptist Convention - Lunsar Eye Hospital - British Medical Research Council TOGO The country had not yet contacted donors. 3.14. Epidemioloeical surveillance in the context of devolution in 1993 The following emerged from the presentations of the National Coordonators in the original area : The epidemiological evaluation in Ghana and Mali were financed by OCP. The plan for the epidemiological evaluation of sentinel villages in Niger was ready and had been submitted to OCP for funding. The Coordinators of Cote d'Ivoire, Togo and Benin had not yet prepared thely epidemiological evaluation plans. Generally speaking, it was realized that the national teams did not havo tho financlal resources required for these epidemiological evaluations. After discussions, the mesJing urged the Participating Countries to continue with the contacts with donors and NGOr. and wlth WHO/AFRO to use the amount earmaked in the WHO/country budget (AFRO/POC) 3o finance devolution activities, particulary onchocerciasis epidemiological monitoring activitlor, 4. EPIDEMIOLOGICALEVALUATION,IVERMECTINTREATMENTANDPLANNING 4.1. Eoidemioloeicalevaluation 4.1.1. Objectives The main objectives df epidemiological evaluations in the OCP were revlowod. The purpose of these evaluations was to assess the impact of control measures on transmission, decline in parasite reservoir, early detection of renewed transmission (recrudescence) and the detection of the development of resistance to chemotherapy. 4.1.2. Type of examination The various measurements used in epidemiological evaluation, the outcomes of which influenced operational decisions with regard to the control strategy to be adopted, were presented as: point prevalence, trends in prevalence, CMFL and trends, incidence (annex 5), and special surveys in migration studies. IocP/EACl4.8 Page 9 The periodicity of evaluations according to the type of study required was categorized as follows : - every three years (in indicator villages); - time of decision-making for stopping larviciding; - research requirement for base line data (in virgin areas); - after five or more years of ivermectin distribution. 4.1.3. Delimitation of mnes according to different modcs ol interention Another important element to be taken into account in epidemiological evaluation was the diversity of the situations, in terms of different modes of intervention. Accordingly, the whole OCP area had been divided as follows: - Central OCP areas awaiting decision for stopping larviciding: Benin, C6te d'Ivoire, Ghana, Mali and Togo (surveillance for transmission). - Extension areas of combined ivermectin and larviciding: Benin, C6te d'Ivoire, Ghana, Guinea, Mali, Sierra Leone and Togo (surveillance for incidence). - Areas of ivermectin treatment only (these are mainly in the northern part of the western extension): Guinea, Guinea-Bissau, Mali and Senegal (evaluation mainly for morbidity). 4.1.4. Techniques, equipment and qtality control The elements involved in the various diagnostic techniques were parasitological and serological. - Parasitological examination : this tool, the skin snip, had limitations and had been facing problems of resistance from patients due to the trauma inflicted. The period of reading slides after the snip was 30 minutes or 24 hours. - In order to minimise both intra- and inter-observer variation there was stitl a need for quality control (annex 6). - Operational testing of serological diagnosis. In view of the known limitations of the skin- snip methodology and the trauma involved, studies with the objective of obtaining an immunodiagnostic test using a tri-cocktail antigen were currently under way. These studies involve blood letting by lancet and storage on filter papers. Another blood letting procedure for PCR tests was being anticipated. This test would be able to detect the decline in parasite reservoir in the human. - Sterilisation of equipmenfi sterilisation of equipment for snipping was currently being carried out in conformity with WHO guidelines and the present boiling system was being maintained. The modification and improvement of the boiling equipment were being considered. 4.1.5. Humon migration sfitdies (annu 7) It was agreed that the topic of migration in the OCP area needed to be studied in more detail. For this purpose, a committee of four was set up to review the instruction and questionnaire for the migration studies. The outcome of this meeting will be communicated in a separate document. ocP/EACl4.8 Page l0 4.1 .6. Incidence studies It was made clear that for the purpose of the incidence surveys in areas of both larviciding and ivermectin distribution, skin-snip negatives should be given a placebo and if possible nothing at all, and should be followed up and given ivermectin if they became positive at subsequent evaluations. 4.1.7 . Passive screening Parasitological confirmation of onchocerciasis cases detected passively was important only in the onchocerciasis-freed zones (devolution zones). It was agreed that diagnosis for passive treatment was to be made on the basis of presumptive diagnosis. Where the skin snip facility was available and sterilization of equipment assured, the test could be undertaken 4.2. Ivermectintreatment 4.2.1. Results and planning Ivermectin treatment results were presented during the OCP Annual Internal Technical Review meeting. Generally speaking, large-scale treatments would be continued in the same basins in each country and for the same periods. Passive treatments would also be carried on. However, it should be noted that community treatment projects financed by NGOs would soon be operational: - Guinea Organization for the Prevention of Blindness (OPC), in the Sankarani and Fie basins; duration: 5 years. - Mali - Sight Savers, in Bougouni, for 5 years. - Sight Savers, in the Kati area; cost FCFA 17,657,000 for 5 years. - Sight Savers and Save the Children (USA), in the Kolondieba area; Cost about FCFA 3,500,000 for 5 years. - OPC, in Kayes and Bafoulabe; cosfi FCFA 3,263,050 - Senegal - OPC in the Velingara district; cost FCFA 13,441,000 for 5 years 4.2.2. Participation of the Vector Control Unil (VCU) in ivermectin treatment Generally speaking, during their regular catching and dissection missions, VCU teams participated in ivermectin treatment with a view to contributing to the active treatment by reaching those absent at the time of the different missions of the national and EPI teams. The VCU teams also conducted ivermectin treatments in villages close to catching points where infective females had been detected and which were not covered by an ivermectin treatment programme. However, the rationale behind such an action by VCU was deemed questionable in view of the following: (a) uncertainty of where the infective flies might have come from;(b) possibility of animal onchocerciasis;(c) only one ivermectin treatment per year while one particular catching point could reveal infective flies many times during the year. t IocP/EACl4.8 Page I I All these VCU actions were aimed at increasing the treatment coverage rates and were carried out after discussions with and prior agreement of National Coordinators. These treatment efforts did not interfere with the normal vector control activities but would be gradually reduced to enable the national teams to get more involved. They resulted in the treatment of 15,084 persons with 22,595 tablets from August 1992 to February 1993 in Benin, Cote d'Ivoire and Ghana. This work was carried out simultaneously with the sessions for the raising of the populations' awareness of the disease and the different methods for controlling the scourge with a view to a greater participation in the activities for the maintenance of OCP's achievements. In the western extension zone, the same actions were undertaken in Guinea, Sierra Leone and Mali, according to the above-mentioned principles, after a briefing on the methodology by the National Coordinators and leaders of the epidemiological teams. In all, 18,956 persons were treated with 30,815 ivermectin tablets from March 1992 to February 1993. In Mali, the VCU teams, some of the members-of which had received training in the GRAAPI technique for communication and consciousness-raising in rural areas, actively made use of this method in the public awareness and community treatment campaign in 30 villages in the Baoule river basin. Reports on treatments by the various YCU teams were regulary sent to the National Coordinators for follow-up and the updating of data. 4.3. Plan of eoidemioloeical activities 4.3.1. Plan of evaluation The plan for the evaluations depended on the type of evaluation: - studies on prevalence trends, migration studies: these studies could be carried out simultaneously; - incidence studies in the extension areas carried out at the same time as ivermectin distribution ; - ophthalmological evaluations conducted before ivermectin treatment in a zone; - pre-treatment incidencestudies. 4.3.2. Ivermectin disoibution plans For ivermectin distribution, the following should be taken into account: - rainy season; - synchronization of several treatments' - observance of the interval between trlatments; - possibility of using local personnal to reduce the duration of treatments; - proposal by the countries as regards the most appropriate periods for the treatment. After briefly reporting on the implementation of the evaluation and ivermectin distribution plans, the National Coordinators of the different Participating Countries stressed some problems which could be summarized as follows: - delay in the sending of evaluation files during evaluation missions; - coordination of evaluation and treatment plans of Guinea-Bissau and Senegal for a better use of the logistics necessary for covering these activities; GRAAP: Groupe de Recherche et d'Appui pour I'Autopromotion Paysanne et Populaire [Research and Support Group for Farmers'and People's Self-Advancement] IocP/EACr4.8 Page 12 - delay in financing evaluation activities; - need for radio contact for evaluation and treatment teams in remote areas and where means of communication are non-existent (for example: Sierra Leone); - estimation of time for prospection and consciousness-raising in villages located in new treatment zones. Steps would be taken to solve these problems during the next missions. The request by Sierra Leone for the mobile teams to be provided with radios would be discussed with the OCP Chief of Administration and Management in line with the agreements signed with the national authorities on this subject. The National Coordinators were informed that the contents of the medical kits for evaluation and treatment missions would be reduced in future. The new supply would take into account essential drugs required for the smooth conduct of the activities. The Coordinators would have to report on drug stock remaining after the missions. 5. ANALYSIS AND INTERPRETATION OF DATA AND REPORTING On the item dealing with the analysis and interpretation of data and reporting, the meeting stressed the need to see to it that the epidemiologists of the Participating Countries were in a position to analyse data collected from the epidemiological surveillance of onchocerciasis. The resources needed to obtain this objective were: compatible microcomputers, transfer of OCP data(epidemiology, entomology), data utilization and follow-up programmes (EPICROS2 already operational in main OCP bases, and SEPT3, currently on trial). Besides, it was decided that the modes of data collection and analysis should be standardized between OCP and all the Participating Countries and that feedback should be intensified. A manual being prepared on data processing and analysis, a preliminary draft of which was presented to the meeting, would allow the national teams to better understand the data that would be tranferred to them and be in a better position to continue with and go deeper into the analysis and interpret the results for appropriate decision-making. Since the need for the training of epidemiologists was being increasingly felt, it was recommended that a programme be prepared for the National Coordinators for an informal computer training in OCP. In the general context of academic training, the Participating Countries should intensify their requests to OCP for the training of epidemiologists, giving priority to National Coordinators and some of their collaborators and taking the necessary steps for a minimun supply of microcomputers. It was decided to standardize the reports and dummy tables on epidemiological evaluation and ivermectin treatment surveys according to the modes of treatment used. It was recommended that National Coordinators insert the summary tables in the texts of the different reports and the detailed tables in the annexes to these same reports. The types of tables adopted after the discussions are appended hereto as annexes 8 and 9 for reference. , 2 EPICROS: Software for Preview of cross-sectional epidemiological data 3 SEPT: Software for the processing and analysis of epidemiological data per country t2 3 4 5. 7 8 ocP/EAcl4.8 Page 13 RECOMMENDATIONS Considering the diversity of actors and the different modes of ivermectin distribution; thc meeting recommends that National Coordinators make sure that the methodology used conforms with the strategy indicated for the zones concerned. (Net. coord.) The meeting appreciates the efforts of the different countries to integrate devolution activities of OCP into other health activities and recommends the intensification of these efforts especially because of the moderate resources at their disposal. (Net. Coord./Perticipating Countries) The meeting appreciates the efforts made so far in the creation of National Devolution Committees and recommends that the National Authorities take the appropriate steps to concretize the formation of these committees which should be made operational. (Net. Coord./Pertlclpating Countries/AFRO Intercountry Coord./CDEVO) The meeting requests the countries to make their NOCs functional, so as to be supportive to the National Devolution Committees. (Nat. Coord./Participating Countries) Considering the growing interest of the donors in the devolution activities, the meeting recommends that the devolution plans of the various countries be written or updated as soon as possible, to facilitate the contacts with the potential donors. (Partlcipatlng Countries/Nat. Coord.) The meeting recalls that OCP has no mandate to fund devolution activities. The Participating Countries are therefore asked to pursue contacts with funding agencies and donors for the financing of their devolution plans and send copies of such requests to OCP. (Partlcipatlng Countrles/Nat. Coord./CDEVO) The meeting has happily noted the involvement of NGOs in certain devolution activities like ivermectin distribution. It is recommended that the National Coordinators discuss with the NGOs the modalities of their involvement to ensure the sustainability of the funding of priority programmes including epidemiological surveillance. (Nat. Coord.) The meeting has noted the efforts made by WHO/AFRO to support devolution activities. It is recommended that the National Coordinators contact the WHO Representatives in their various countries for a greater utilization of the WHO country budget (AFRO/POC) allocated to devolution activities. (Nat. Coord./AFRO Intercountry Coord./Participatlng Countries) In conformity with the donors' wish, the meeting recommends that the Participating Countries accord priority to women in their training plans. (Participating Countries) Weighing before ivermectin treatment should continue according to MSD recommendations. However, in view of the difficulties encountered in the field, the meeting recommends the continuation of studies under way to assess the dosage of ivermectin using other parameters. (CEPI/CBIS) The meeting recommends that National Coordinators with YCU teams continue to harmonize the distribution of ivermectin in the villages. (Nat. Coord./YCU/EPl) 6. l0 9 ll ocP/EAcl4.8 Page 14 t2. r3 t4 r5. l6 t4 Considering that ivermectin treatment is the sole means of onchocerciasis control in the northern parts of the Western Extension and that some areas, notably in Senegal, were not covered, the meeting recommends that a new ivermectin treatment map be established to incorporate these zones and these should be covered by new letters of agreement to be signed between the countries concerned and OCP. (CEPI/Nat. Coord.) The National Coordinators have expressed the need to be trained in data processing and analysis and the acquisition of a microcomputer. The meeting recommends that the informal training in the OCP already under way be continued and that the Coordinators seek means of acquiring the microcomputer at the national level. (Net. Coord . / CDEY O /CBIS) The need for epidemiologists in the National teams being a pressing problem, the meeting recommends that the Participating Countries take all necessary steps to submit to OCP candidates for training in this field, with priority being given to the National Coordinators and some of their collaborators. (Perticipating Countrles/Nat. Coord./CDEVO) The meeting, recommends that OCP organizes for the benefit of the National Coordinators and some of their collaborators, in-service training on data processing and methodology relating to epidemiological surveillance and ivermectin distribution (CBIS/Nat. Coord./CDEVO) The meeting recommends the updating of the manual of procedure for skin-snip surveys (JPC9.9 (A) - Annex l). (CEPI/CBIS) l5 Annexe I LIST OF PARTICIPANTS OCP I - Dr Ebrahim M. Samba, Programme Director 2 - Dr A. Seketeli, Chief DEYO, Ouaga (Chairman) 3 - Dr B. Boatin, Chief EPI, Ouaga (Co-Chairman) 4 - Mr E. Soumbey, Chief BIS, Ouaga 5 - Mr J. Trudel, CAM, Ouaga 6 - Dr L.K. Akpoboua, Bamako (Rapporteur) 7 - Dr O. Ba, Ouaga E - Dr H. Agoua, Ouaga 9 - Mr M. Kassambara, Parakou l0 - Dr I. Niambele, Bamako (Rapporteur) I I - Dr K. Nimaga, Ouaga l2 - Mr E.J. Senghor, Ouaga 13 - Mr S. Lamine, Niamey 14 - Mr M. Sarr, Bouake l5 - Dr A.K. Diallo, Tamal6 NATIONALS Dr L. Assogba, National Coordinator , Benin Dr K. Aryeetey, National Coordinator , Ghana Dr E. Batchassi, National Coordinator, Togo Dr P. Brika, Deputy National Coordinator, Cote d'Ivoire (Rapporteur) Mr J.K. Fosu, Executive Director, NOS, Ghana Dr R. Kambirr!, National Coordinator, Burkina Faso Dr G. Kadade, National Coordinator, Niger Dr Y. Kass6, National Coordinator, Guinea Dr M.C. N'Dour, National Coordinator, Senegal Dr Tamba Nhaque, National Coordinator, Guinea-Bissau Dr M. Traor6, National Coordinator, Mali Dr A.R. Wurie, National Coordinator, Sierra Leone (Rapporteur) WHO/AFRO 28 - Dr A.W. Tiemtor6, Intercountry Devolution Coordinator, Ouaga 16- t7- r8 - 19- 20- 2t- 22- 23- 24- 25- 26- 27- tr c, (r)i g E s € Eq b EE E A E € ;Q € T .i ,q e fl -E Eo- c, t o (J(! tr d * rH Hg =(.)o'=>E;t =-o<tl rrJc) E€ .E: 6(! =.eEilAH EI H E *15 E tr c,E tr o o t)E oL a o .J C)E o E 1!r €ils EI EEJodtrol E 0CP/EAC14.8 - Page 16 tro E r! o o io ct 0 tr bD .E o (.) c o o C) L o ooo c,o o o (J C) q) ! C) o EGo E {)(J C, i) E 0 (! o bD o o Eo -o a. o ca rI]Q E =oo>>EA r-Ez5 =ioyot J z F z (/) fl OEEO!tF 3V -5 =EJo sl o !! .o .E ; *g h, g € g H[ E € E €gEI fE}:;: '6= -E 9E r X .E IE-a 7.q E; o ? .E &e h oJ=l;J E.E EE .E .E H a iE EE iE ,$ i E gE iq E!HEi ; iAi iE E?$E€:E:EcB,If €I s;gE r iaiiEE* E gilEglEt EHErE€EHs EB E $f si= Bi E xsEsgE7-, eE,:,:gii.Ee Ug ti,.:E ^EFS +Qrrr o o o E (! .2 d a)o oEotr o o oo a(! C)t E hD o EA6 -0) €Hgrs {l E! =ld 6 .o obo c.=bEo= .B'g90 sc!5()o.9 >€F r.r 8E e€ 8o EAE.FtE()c) E: uOoobH'gr sg 2d .,!, I E.c EI {,9 Eut b'E IErt 5b9 EI ;EEUI FOO F 2) o-AOEo: r! a E u E = $E: E= B'i F.g :B: E: E $ *E ETHe .Ei T 3 ts re+; Ee : ; EE H6 siEEEi:gii*ifEs giii:EiE,giisgfis,s* r,,,, oIE .d =oL a0 .g b0 o E Eo HIEzto = sl.6 EzlI o I v0 .-u n"t C'(lr> s.9 9Ht! s2 rfrEX EE9-6 .gF E; rr.]l t -6 zl .nE Hl e.g EI ilg 8,gE --Yavl oro Btr o5i o.rlEx9 zl ol al >tt!l el I! '.lla F c z) U) U'il ,4! z ul F Il. o(h r! ..] o& az z F J rI1 o il q. vil B tJ.l d IL J z o F F FU' z 1 Onchocerciasis Control Programme in t#est Africa: Devolution Diseases combined with onchocerciasis in the devolution plans of the countries (March 1993) l. Diseases to be combined with onchocerciasis in the future revised plan 2. PIan to be revised 3. Diseases to be combined with onchocerciasis in the future new olan OCP/EAC 14.8 Page 1 7 Annexe 3 29 March 1993 EPI target diseases Guinea worm Leprosy Trypano- somiasis Tuber- culosis Yaws Schisto- somiasis Mala- ria Beninr x x x x x Burkina Faso x x Cote d'Ivoire x x x Ghana2 x x x Mali x x Niger x x Togo2 x x Guinea Bissau x x Senegal x x S. Leone3 x Guinea3 x x t aro l..le! "r .9 _ctI r--d -'1 >e. o () 'o \oN ct E.Eo> SXna6F ocP IEACL4 .8 Page 18 ,EI q) o\ Eo E t Eq) E NN E. o tr $ c.l E. o) tr N E. o E F{ do E o\ dq) E \o E o tr \o +. +. q. ri JxElV> X 'hiL- !r. ,:'a . O\J h lrl + J-F) rsW.:?I Zffig X X X .32,? 383fL (,r) o- X X X > vQ-ri.zO .r u.)B6> X a. cldr!lr- \J2u);a X X X X x X z *CF4!z ,t! X X X 6. -i .2. h/z X X X X X X X X X ,i JY<d&>())8.] <do X X X X X X X x FJ fi x x X X* X X X x X &Fz oO &F(n z 2 z z a ca U) Ir z Vd to Qd -o rI.lF oU z o f ilt!() z oF D v)(h catql z J E1 z sl Cn fiz 5 o 14z El -.) dd rI.l U) :l()l cl cl <l EI F IJ" .oe U)dllr l- lJluE< €>4*O c.)UlL 7OC rrt -<t- --'\ 7) :t! >FQZo) rrl (J o- z-)E- os VY <Fr<cl; u) o- 9o.dU ,;c Z a. OCP/EAC14.8 Page 19 q; oC _g 'd )o c', .E =.9 o I?o o CL lo xocc E .9 o) o .9cLobo)pO, o.o rF o(Y) ct,O)co) 'E .E o, o5',cD ,/ -/ E co(, o o o o U' (U o lr) o) @ o) r\ @ o, 1() @ o) (f) @ o) @ o) o,N o, r\N o) r.o o, GootroI-'t 71tV ET o.=N,YFLL I €dII ooNo(r)or,oo(ooo@oo)oo o$ E'EtrCEEFFE'EO(D L()EEodil o ! .E o E o ooc -9 I I o! t,o o 6o .l-.FE GL o CL o c { E o o (s/lur) lJhl3 pue (%) acualenard ! 'J:- tI-p:() :l: .a OCP/EACl4.8 Page 20 (oI o C C os oN oo f ouOtr@_9 o!Oo(oe o + oN o c .E q) d) r() .= o -J trr oE' o (O L{r, la -oo -oL +,F -oo .ts -GIJ o I cn o -o .=o GL o o- oooooooooooooooo P=PS=9o)cor\cotr'$cr)Nr I f I1 It z rnalca-l / rappau n tr I I I r -] IocP/EACl4.8 Page2L Annexe 7 MIGRATION STUDIES Standard Ouestionnaire l. Ask all persons above l5 years old themselves how long they have lived in the village and(if possible) when they first settled in the village. for individuals under l5 years their parents or guardian should be used to give the response' Z. Those that have not lived in the village all their lives should be asked where they lived before coming to settle in the village. 3. Ask each person as above if he or she has ever travelled outside the village for more than 6 months during the Past 15 Years. 4. Indicate the place or places by name or by the nearest known village or town they went to. 5. For each place visited, indicate the year of visit if possible, and the duration of stay. If the person has been to several placei record the stages by order of and by duration. 6. For individuals that are new residents ask for their places of origin, i.e., the places they lived before coming to the village. New residents are of two categories. Those that have come for visit only [indic"t. thisJ and those that have the intention to stay for over 2 years. j. For those that have been out for 6 months or more within the last 15 years, ask for the following: (i) the reason (motive) for their movement; iiil if they are familiar with onchocerciasis, whether there are people with oncho (v) where they went to; are the ptaces visited near any rivers within a radius of l0 km (names if possible); what is ihe o.cupation of these people at their original residence and at where they migrated to; All- persons must be asked whether they have ever received ivermectin, where given, by whom and when. (iii) (iv) a*oo 6q -obtrcg z o (! O. otu o dq) F o U) o0r on, oooECd \./ > tr t)(g ca aX o 980trd z'; (l) d o d oF OCP/EACI4.8 Page 22 : i o.)3ao3Gl3'- q, 9, 'd-E6trOgEH E EE -eE*9>vE'--og !! E 'E'Fo UoEE (l,.r SEE ':i tr t !6ai ,r, .i .gE.E B '8, e'; *E g '=L.gEt go EEE : c(t o) cl o G, :o) :-li>. :O) .=G oE t) a .E6955E9= E;q) o) rJ CElrr(J eoo oo9= c!E =e)q) '1, E'6. =o)(aq) Gt CL9E 89'a .9oEq q) irE|, .- aAtrL(utJI& o) E s! E{ o E G E( 6 ox c) t)q) q) dq) (n ob0 G, o() l<q) 0< Eo -o H az oI q) (n aax* tr o (n O.oA o tt) o o. E(l) E 63x(,) Eo (g L c) E tro L t)d ca O() ar ?P O> oq) oooCcd cd= 7,> q) n (g oF I IOCP/EACl4.8 Page 23 o q) .o E z ano= .zH .; 50 o.tr t) (g L oo (H o Eo -o z t)q) (n(\,() Botr (h q) (n o o. tr t)(€ ca o 99otrcg z'i o.) (g a G, oF ::. :o) .i u) .=> u, Q) '6 1D 9.- 9{ r-Xo) e) u, -oeEh al'I9trEt -E c)t8 - lih(au gE O(r E3Etr 4.5QZ oE j.: 0)-5etr.otr6<F OCP/EACl4.8 Page 24 -tr '5(JFu (DtsoE =l. (D q) -od (d o -o k tn a o c0 o. o 0r Eq) (U oLF s L.(l) .o z q) t) C) Pr o (g o E H E,* $"Eo$ 5.e *a E&o t) cU ca I+{Eoo oE d(dn(t) d oF : tr odLJ cd Q) tr Io EEoo>= oiY(\, >,()r<q)cd OEho;L-E)u) d o c,F o\ q) x(u OCP/EACl4 . B Page 25 a I b6 '5 q)i tr .IE(d E 5!) 5r.9E€E Lon E Es 6.E zts &'E:;E (l) bI) cleb Er E o c0 a.o0. Eq) dq) F Eo ! (J xlll ot) -o tr Q) ano 0r I(l) trE =o) '5E EEr.ad 50 tt)d m e9,trc,cg. =z Z', ts9 (l)i.j Ag (d oF : o C\, o!$ tr6d 3'5Ebbo. .zs oS ()E?9(D'-i oo(g ;i q)JO ; q) .o F oi q) xq) a II OCP/EAC14.8 Page 26 { o (n Eot) o tr Iotr t<o trd o q) -o cd d q) -o H t) a o o(.) oil .o o(B .o65P-Etr50z? o) EP _gg ErzE !-i (J so.Eilo d oF () o EEo o (! o Q) ! cd d q) = -o an a !o (l) aq)il tro cd o.o0. (l) do hF s o .o z q) t)q) H A. !o dl<o t! a! o t',r- (.)|(uhD -o (€- z a,d ca ;aezz (3 oF 2 q) E9doL Io E q) q) ot)(g o. -o (l) (!F ; an o z -o() 'If cda , Ll,(-o9,-H(D €g oir cg 5(d L'rr. (t):9trH LI-o=2,5 .: o F oi (.) Xotr tr OCP/EACl4 .8 Page 27 a I tr o d E(.) t) -oo tr (J q) E o (H o dto o .o CB d E(l) I ! k an a o oIo& ts ,,_ THgEb9 = o.uz .*!o-9 r-Ccdq).lL -o;OEbE) o.=zE E3 €q bOts os LrI ilo.E&o (n oF tro d Eq) th -oo aH ad .= c)oI)5 'trd oa \.2 o9E5b :€ tt) tr o .t) l.< &E ooq) o() z t)(d ca q) troU ,tr (n Q) I l< t) o o a0(l) & o (g oF ii tro E cdq) l< tr Io H l< Q) tr a E E oI o (d d d E (r) Cd Q) to(€F .t) tnd (J Hq) I o I o o C)I d o t) o t) t't cg (J q) F Ot q) X(,) t tI OCP/EAC14 .8 Page 28 I t (J od Hq) o c cd o ,f =ogE I 'o_tsq) -u) e o !(.) t oI c)/, q) €r $ oa tr o C, O. 9r q) dol<F o) (J Xr! tro ah -o o) dli q.) E a E= $ z'5 k a, cd m -tr a) G,Coo) =9 BO.E&o d F t- tro cdobq)-bo trcB c)'re)-Et-F(D5o. .io >.d .=! =Elq) EC€ 5E ; I -o(!F O. oxotr