Evaluation report 1974-1979: part I

JOINT COORDINATING COMMITTEE Onchocerciasis Control Programme in the Volta River Basin Area Ofice of the Indcpendent Chairman c/o World Health Organization l2ll Geneva 27, Switzcrland Tct, 3rl606l Tctcrtrf,t3 2782L J.C.C..C.C.C. COMITE CONJOINT DE COORDINATION Programme de Lutte Contre I'Onchocercose dans la Rdgion du Bassin de la Volta Bureau dr Prdsident Indlpendant c/o Organisation Mondialc dc la Sant6 1211 Gendve 27, Suisse Tet 3.6061 r6rcr)|iE8 2782L operationa I act tliii;IJOINT COORDINATING COMMITTEEFifth session Lom6, 5-8 December 1978 Part I 30 October L978 Plovisional agenda item 1l The Independent Chairman submits for the consideration of the Joint Coordinating Committee, at its fifth sesslon, part I of the Evaluation Report: Operational activities. This document has been reviewed by the Steering Committee which has made the following comments: "It ts noted that an earlier draft of the first part of the OCP Evaluation Report which refers in most part to the vector control and associated activities, has had the benefit of a critical review by the Scientific and Technical Advisory Committee and the National Onchocerciasis Comrnittees. " ocPf7S.2 ONCIIOCERCIASIS CONTROL PROGRAMME IN TIIE VOLTA RIVER BASIN AREA EVALUATION REPORT L97 4-197 9 PART I presented by the WORLD HEALTI{ ORGANIZATION ocPf78.2 Page 11 SI]MMARY Chapter Chapter Chapter Chapter ChapEer Chapter Chapter ChapEer CONTENTS AND CONCLUSIONS I. History of the Programne . . II. The problem of onchocerciasis III. The control campaign and its results IV. Economic development . V. Research and environmental proEection VI. Training VII. Implementation and costs VIII. Plan of Action and Budget 1980-1985 Page I 7 L7 4L 42 51 58 60 Annex I. Annex II. Annex III. Annex IV. Reinvas ion Epidemiological evaluation data - as of I October 1978 Research EstimaEe of inputs for an extension into Benin, Ghana and Togo SI]MMARY AND CONCLUSIONS This reporE reviews what has been achieved in the Onchocerciasis Control Prograrmre over the last four years. The initial funding was pledged for six years, L974-L979. To form the basis for the second period of financing, 1980-1985, it was recommended by the Steering Comittee in L977, and endorsed by the Joint CoordinaEing Committee in Kuwait, that an assessment should be presenEed Eo the fifth session of the Joint Coordinating CormitEee(JCC). The report which follows incorporaEes comnenEs received from the sponsoring agencies, the Scientific and Technical Advisory CormnitEee (STAC) and the National Onchocerciasis Cormittees. The Programe started in 1974 with the organization of Ehe administrative structure and the recruitment and training of the essential technical personnel. In 1975 control operations got underway in Phase I. In accordance with the timetable established by the PAG Mission, Phase II followed in 1976 spreading inEo Phase III in 1977. ocPf 78.2 Page iii Vector conErol has been highly successful over Ehe whole area and the results obtained so far are in 1ine with those predicted by Ehe PAG Mission. Only at a few siEes, with peculiar hydrological configuration, has larviciding not resulted in total kil1 at cerEain Eimes of the year. These sites are quickly idenEified by the surveillance teams and corrective action taken. lmprovement of application techniques Progressi-ve1y reduces the number of such failures. The second round of surveys for epiderniotogical evaluation is already indicating that the level of vector control esEablished in chose parts where larviciding has been conEinuous for three years is resulting in a noticeable decline in the prevalence of the disease among young children, and a stabilizing of the symptoms a.Eongst those previously affected. The reinvasion phenomenon continues to affect the peripheral zone of the OCP area. Research has shown thaE most reinvading Simulium arrive in key areas in a gravid state. Many of Ehese flies carry infecEive O. volvulus. Although the weekly riverine Ereatments prevent the flies from becoming esEablished, they nevertheless Pose a seasonal threaE to the human population. However, Ehe total reinvaded area represents only 20% of the total OCb area and is of a sLze comparable to that forecast in the PAG Mission rePort, although the actual Pattern of disEribution differs. Reinvading flies emanaEe from sources uP to 300 km away. The extended treatment of rivers in souEhern Ivory Coast in 1978 has had a pronounced renedial effect on some of the worst affected sites. The entomological and epidemiological methodologies ernployed in the Progranme have proved saEisfactory. Ihe application of larvicide Eo the breeding sites from aircraft is stil1 the only effective means of controlling the vector. The entomological evaluation teams have provided useful informaEion on the distribution of Ehe vecEor, the Annual BiEing Rate (ASR) and the Annual Transmission PoEential (ATP). Similarly, daEa has been progressively collected by the Epidemiological Evaularion Unit on Ehe clinical, ophthalmological and epidemiological aspects of the disease in over 3OO sanple areas. This data forms a basi-s for subsequent study of the evolution of the disease following Ehe control of the vector. Research has been planned and carried out according to operational requirements. Notable progress has been made in identifying and plotting the distribuEion of the different species of the S. damnosum complex, and determining the principal vectors in the Programe area. A greater understanding has been achieved of the epidemiology of the disease. Progress has been slower in the development of new insecticides and drugs but steps have been taken in 1978 to accelerate Ehese studies. Ihe imporEance of suiEable chemotheraPy Eo supplement the vector control activities is undeniable insofar as it could ease the plight of those infected, but not blind, and also help Eo shorten the duration of the Prograuune. Research in this field is closely coordinated with TDR. Training of national personnel has been an important activity of the Progra'mne. After training technical staff to meeE its own requirements, Ehe Programe has provided fellowships to docEors, ophthaloologists and entomologists from the participating countries in order to strengthen the national structures. In this respecE 1978 has seen a significant increase in the cooperation between the governments and the Programe. The Programe has also provided in-service training in the methodologies used to scientists from other countries. One of the main purposes of the Programe is to open up river valleys for subsequent economic development, Such developmenE is a national responsibility. Ihe Economic Development Unit has been following the extent of this development, which vari.es from country to country, and has drawn up an inventory of projects being implemented in the OCP area. The complete review of economic potential and develop,ment in the area is the subject of Part II of this Evaluation ReporE. Ihe evaluation of these first years of activity also shows that the results obtained by the Prograrure meeE the objectives defined by STAC. ocPf7y.2 Page iv As defined by STAC, the objective of the progranme is to reduce the impact of onchocercia_sis to a sufficiently low level Ehat it no longer represents either a public health problem oran obstacle to socioeconomic develop,ment, and also to maintain and adjust control activitiesin order to stabilize the disease at a tolerable level. This tolerable level results when the biting densit y of the vector within the controlarea is reduced, if not to zero, at least to a level at wtrich transmission of O. volvulus fallsbelow the threshold at which serious lesions of ocular onchocerciasis occur. In order toquantify the entonological criteria STAC ado pted the recomendation of a Scientific AdvisoryPanel (SAP) Working Group thaE a river vall ey should be considered safe for resettlement whenthe Annual Transmission potential (ATp) Uaa been reduced to below lOO infective larvae ofO. volvulus anafor the Annual BiEing Rate (ABR) was below 1OOO flies. These leve1s have been achieved over approximately 75% of the area and each year isbringing additional improvement as source areas of rei-nvading flies are attacked. STAC concluded that, on PresenEly available knowledge and techniques, there would have Eo be continuous operational activity in the progranrme area for the scheduled 20 years. It is not Possible at this stage to forecast the precise nature or level of these activities, becausethe Progranme has been operational over the whole of the originally designated area for just over one year, a period insufficient to allow the collection of Ehe basic data essential toforecast future developments. The Progrrme has been able to suspend systematic larviciding on some of the perennial rivers of the central part of the controlled zone in the dry season. Ihe degree to whichthis reduction in larviciding can be dxtended in time and space can only be determined by careful experimentation, to avoid jeopardizing levels of ATp and ABR, and will be dependlnt also on the effect of treatment undertaken beyond the present boundaries. STAC considered that it should be possible to m:ke a reasonablg gsfimnfe of the extent of these cuts in the Present area three years after the establishment of ful1 control operations in all threephases of that area, i.e. at the end of 1980. At the end of the 2o-year period, the magnitude of the maintenance operation and itsduration will depend on the success of the presenE carupaign and on the introduction of possible new technology. Also, the duration of the Programe will be influenced by the results ofplanned supporting research. Efforts will continue to determine the longevity of the parasitein the human host, to develop suitable chemotherapy, to reduce the impact of reinvasion and to modify control Ehrough the implementation of possible alternative methods and Ehe develop- ment of other insecticides and formulations. The cost of the Programe for the L974-L979 period is approximately US$ 55 OOO OOO. budgeE esEimates for a continuation of this Programe at the present level of operations The over Ehe next si-x-year period, 1980-1985, including approxi.mately US$ 133 OOO OOO. These figures staff, of which 3.5% is for statutory increase operational costs except for aerial operations total vehicle fleet per year. the extension into southern Ivory Coast, i-s incorporaEe an annual increase of 11.5% for and 8% for inflation, 8% for all other and the cost of replacing one-third of the ocPf 78.2 Page 1 CI{APTER I HISTORY OF THE PROGRAMME Onchocerciasis, or river blindness, is transmitted in West Africa by blackflies, belonging to the Simulium damnosum complex, which breed in rapidly flowing sections of many rivers. This disease, which is particularly severe in the Sudan and Guinea savanna zonest brings viEh iE debilitation and blindness. In parts of the West African savanna onchocerciasis consEitutes an i-mportant deterrent to human settlement and the subsequent economic developmenE of many valleys which lie uninhabiEed and unproductive. ln L974, at the beginning of the Onchocerciasis Control Programme (OCP) covering nearly 7OO OOO square kilometres in the Volta River basin, it was estimated that 1O7. of the population was harbouring 0n ocerca volvulus , the parasite causing onchocerciasi-s, and that about 70 OOO people were blind as a consequence of the disease. It is not possible to assess the exact number of blind in Ehe Programme area, but it is more relevant Eo take inEo consideration the geographical concentration of blindness due to onchocerciasis in cerEain areas, when estimating the impact of the diseas'e. The eprdemiological Pattern of ocular onchocerciasis, with extremely high blindness rates in relatively young age-SrouPs in sma11 rural populations, explains the important socioeconomic consequence of the disease. Awareness of the exE.enE of the problen had been steadily developing since the 194Os. Systeoatic surveys to assess the magnitude of the problem and studies to develop and evaluate potential control measures were carried out in many of the countries concerned since the early 1950s, thus providing improved background information on the epidemiology and socioeconomic importance of the disease. Control operations aiming at the destruction of the vector hTere carried out during the 1960s, beginning on a modest scale and culminating in a campaign involving three countries and 60 OOO square kilometres, under the aegis of the GovernmenE.s of Ivory Coast, Mali and Upper Volta in association with the European Development Fund (EnF), and the grganisation de Coordination et de Coop6ration Pour la lutte contre 1es Grandes End6mies (OCCGE). In 1968 the World Health 0rganizaEion (I.IHO), in joint sponsorship with the UniEed SEates Agency for International Development (USAID), and OCCGE, convened a technical conference in Tunis to consider the problem of onchocerciasis. The conference concluded that control by means of larviciding was technically feasible and chances of success would be greatest if the operations were carried out in ecological zones sufficiently large to obviate Ehe need for continuous conErol of the whole area in order to ProtecE it against reinvasion by Ehe onchocerciasis vectors. It was recoruuended that priority be given to launching a large-sca1e control programme in the Volta River basin area, involving adjoining Parts of Benin, Ghana, Ivory Coast, Mali, Niger, Togo and Upper Volta, to protect populations severely affected by the disease and to constitute the cornerstone of future coordinated action against onchocerciasis, and in favour of associated development, in Africa south of the Sahara- In 1969 a meeEing was organized in BrazzaviLle by the WHO Regional Office for Africa to refine further the approach needed for preparing the proposed campaign. Representatives from the Government of Ghana, OCCGE and USAID, as well as from WHO, attended these discussions. ShorEly thereafter, in 1969 and 1970, several of the interesEed countries submitted formal requests - emanating from the highest auEhorities - to international and bilateral sources of technical cooperation and funding which were thought to be interested in contribuEing to such an ambitious underEaking. Among those organizations r.rere the Food and Agriculture OrganLzatLon of the UniEed Nations (FAO), Ehe InternaEional Bank for Reconstruction and DevelopmenE (IBRD), the USAID and WHO. Simultaneously, the United Nations Development progranme (UllOp) manifested its i-nterest in broadening its existing involvement in onchocerciasis studies and control in the Volter River basin area. ocP/78.2 Page 2 The preparatory phase On Ehe basis of the request.s received and at the suggestion of IBR-D, WHO and UNDP sponsored a meeting of interested parties in Geneva in 1970 to draw up the terus of reference of a mission designed to carry out complementary investigations in the seven countries concerned, as well as Eo plan and cost the proposed 0nchocerciasis Control Programme. This Preparatory Assistance to Governments (PAG) missi-on was funded by UNDP with FAO as Associate Agency. Ileanwhile, in L972, the Director-General of FAO, the President of IBRD, the Adninistrator of UNDP and the Director-General of WHO, in view of the importance and complexity of the scheme envisaged, decided to set up a SEeering Corunittee, comprising a representative of each of the four sponsoring agencies, to ensure Ehe coordination of the action taken by these agencies in the planning and implernentation of the Programne. The findings of the PAG mission and the data originating from other preliminary investigations were combined to form a reportrr which was presented during 1973 to the Governments of Benin, Ghana, Ivory Coast, I'{ali, Niger, Togo and Upper Volta. This report formulated a plan of work for onchocerciasis cont.rol in the Volta River basin area which could lead to the repopulation, settlement and economic development of the endemic zones. The rePort was also presented to various agencies, institutions and governments. The Plan of Operations proposed by the PAG mission report was endorsed during a conference held at Accra in November L973, which brought together the seven governments involved, and the four sponsoring agencies. At the conference the agreement governing the operaEions of the Progreme (Operational Agreement) was formally signed by the participating governments and WHO. This agreement, which seE out the basic arrangements for the management of the Progranme, r.ras supplemented in L974 by individual Country Protocols defining the specific contributions of each government. As Executing Agency, WHO was assigned the task of implementing the Progr:me which was formally established from 1 January 1974 with headquarters in Ouagadougou, Upper Volta. The first year of acE.ivity was devoEed to seEting up the structures, the recruitment and training of staff, the development of infrastrucEure, the purchase of equipment and supplies, complementary surveys and the intensification of research. Actual control operations began in February f975. The machinery established to manage the Prograrme included, at the country leve1, National Cormrittees for Onchocerciasis (NOC), comprising representatives of the main national services concerned. The role of these commiEtees is principally, to coordinate the action of all national services involved in the Programme and the subsequent economic development projects, and to ensure liaison between Ehe government and Progrrme headquarters. At the agency level, a Scientific Advisory Panel (SAP), made up of nearly 2OO technical and scientific workers, was formed by WHO to be called upon, as necessary, for advice on al1 aspecEs of the disease and its conErol. An Ecological Panel (EP), comprising a sma11 group of specialists with wide experience in river basin ecology, the epidemiology of diseases in river basins and the ecological effects of pesticides, was set up by the Steering Committee to guarantee satisfacEory protection of the environment. 1 UNDP, FAO, IBRD and WHO (1973) Onchocerciasis control in the Volta River basin area Coast Mali t To and er Volta , ocP 3.1 + Annexes O-1 Eo VI-5, 24OO pp. IvotoftheP ator Assistance Mission to the Governments of Dahom Ghana ocp/18.2 Page 3 At the Paris meeting of donor and participating governments and sponsoring agencies, in June 1974, it was agreed to amplify the managauent structures of the Progranme. The additional structures included, in particular, a Joint Coordinating Conmittee (.lCC) comPosed of 1 represenEaEives of E.he seven countries, all contributing Parties and the four agencies.' The role of the JCC was to exercise general supervision over the policies to be adopted in the planning and execution of the Programre and to fo1low the develoPment of activities. The Conmittee, which would be presided over by an Independent Chairman and served by a joint Wtto/World Bank secretariat, would meet at least once a year for this PurPose. To provide the JCC with a continuous independent evaluation of the technical aspects of the Progranme, WHO formed a Scientific and Technical Advisory Comnittee (SfeC) composed of L2 members of the Scientific Advisory Panel. This Corcnittee would meet twice a year to review scientific and technical aspects of the Prograrune and would prepare an annual rePort containing its findings and reconr-endations for submission to the JCC through WHO and the Steering Cormittee. Final1y, the SEeering Cormittee established an Economic Development Advisory Panel (EDAP) to assure the continuous review of inforaation relating to the economic development asPects of the Prograrme. This Pane1, composed of economists and specialists in agricultural and rural development would meet Ewice a year and would present an annual report on its findings and recorunendaEions to the JCC through the World Bank and the Steering Conrmittee. These additional structures were described in a Memorandum of Understanding which was approved by the JCC at its first session in Abidjan, Ivory Coast, in February L975. Following the assurances received from contributing parties at this first session of the JCC, an Onchocerciasis Fund Agreement covering the financing of the first six years of operations was signed on 7 May 1975 by ninez donor governments, the African Development Bank, the IBRD, IDA, UNDP and WHO. a In 1976, following the consolidation of the Progreme activities in the field and within the context of the new orientation being given to the functlons of the Organization as a whole, the decision was taken by the Director-General t,o transfer the responsibility for the Prograrure from WHO headquarters to the Regional 0ffice for Africa. This transfer implied both a new approach Eo management and a reorganization of the supporting services. Thus, in December L976, a new Director was appointed and the headquarters in Ouagadougou assumed fu11 responsibility for rhe impleurentaEion of the Progrnnrme under the authority of the WHO Regional DirecEor for Africa. The Office of the Progrsmme Director in Ouagadougou rras enlarged by the transfer of staff fron the support unit in Geneva, and a liaison office was established in BrazzaviLle. Experience so far indicates that the cenEralization of activities in the field has had the effect of creating a closer association with the different levels of structure, in particular with the participating countries, and a greater flexibility for the manageoent. The interagency Steering Cormittee for Onchocerciasis Control in the Volta River basin area, which had been particularly active during the preparatory and launching phases of the Prograrune, has proved to be a valuable tool for concerted action and rapid decision-making. 1 M"*b"." of the JCC as of December 1977: Belgiun, Benin, Canada, France, Federal Republic of Germany, Ghana, Iraq, Ivory Coast, Japan, Kuwai-t, Mali, Netherlands, Niger, Norway, Togo, United Kingdom of Great Britain and Northern Ireland, United States of America, Upper Volta, the Africa DevelopmenE Bank, the United Nations Development Progpme (UttOp), the Food and Agriculture Organization of the United Narions (FAO), the World Bank (IBRD) and the World Health Organization. ? - The Kingdom of Belgium, Canada, the Republic of France, the Federal Republic of Germany, Japan, Kuwait, the Kingdom of the Netherlands, the United Kingdom of Great Britain and Northern Ireland and the United States of America. ocYf ta.z page 4 Nat ional Onchocerciasis Comittees By mid-1974, each of the participating countries had formally established a National onchocerciasis Cornrnittee (Noc). In particular these Comittees played a major role in resolving logistical probleos which arose during the first years of operations. At the first joint meeting of the NOCs which rras convened in Abidjan in June 1977 Lt was unanimously agreed that the Comittees and the Progr:me should meet annually. At the invitation of the Government of Benin a second Deeting took place in Cotonou in June 1978. Advisor bodies During the first four years of activities the Prograune has benefited from the guidance and support of the advisory bodies. In the initial sEages, visits were made by members of the Ecological Panel (EP) and the Scientific and Technical Advisory Conrmittee (SfeC) to the Programre area for discussions with the field staff, and to obtain first-hand knowledge of the environment and of the operations. With the expiry of the mandaEe of mpmbers of STAC at the end of 1976, the composition of the Cormittee was reviewed and slighly modified to xoeet the changing needs. Following the transfer of manag€ment, a joint meeting of both groups took place in Ouagadougou in 1977, followed by a meeting of STAC aE the I{HO Regional Office, BrazzaviLLe, in August 1978. Ihe Ecological Panel has been reviewing the data collected by the hydrobiology research workers under the aquatic monitoring programe and has drawn attention to factors which might be detrimental to Ehe environment. The role of STAC in evaluating the technical aspects of the Progr"mme and, notably, giving guidance in research, has been equally valuable. Although efforts were made to minimize duplication through joint meetings and through cross-representation at meetings, some overlap beEween the roles of the Scientific and Technical Advisory Comittee and the Ecological Panel has not been completely avoided and solutions to this continue to be sought. As Adninistrator of the Onchocerciasis Fund the World Bank is responsible for mobilizing and managing the funds required to carry out the Programe. Advances from the Fund to WHO are made on a quarterly basis on receipt of a written submission of the estimated paynents Eo be made during Ehe following quarter. At. half-yearly intervals, the Bank provides to eaph of the contributing parEies and to the Steering Comittee, a statement of contributions, receipts of and disbursements from the Fund. As of 31 December L977, the amount of advances by the World Bank was $ 30 2OO 0OO of which $ 20 2OO OOO was for the L974-L976 period and $ 10 OOO OOO f.or 1977. r a oII N o6 N ru 8E Ii EI2 o)OEu,tIz I I I E .!z 2 UJoo I z 5 <, E oJ z $ F\ 6 art E 3z t!o tn gI OE lfl = =c(9 od,4 JI - o E @ s2 EE = - .! o E o = c E E r q2 ,(, . c oo n\\)i s o - 0 ,c E J (, IIJ z UJ at, o u.l z JSG!l "e@I 0V I o t 4) 8 z 0 Jo E EAD n c p ! 'i ;: o: .di',.,o. ::6 :',!. :r':,o.@' a .Eg E u, q HH o(J o l.r. rFIG.I-2 MANAGEMENT STRUCTURES 1 ocPf 78.2 page 6 Nat i onal Onchocerci asr s Commrttees Special Fund for Onchocercr asr s ( tBRD ) 1 September 1978 Ecologrcal Panel 1 l- I IL I I I I Economr c Development sory Panelt_ J t- I Il- Scientif ic Advisory Panel Sc ientif ic and Technical I I I I I Advi Com sory mittee t- I J I --l IL T I I wHo 78409 JOINT COORDINATING COMMITTEE STEERI NG COMMI TTEE EXECUTING AGENCY (WHO) External Relations and lnformation Programme Director Onchocerci asi s Eprdemiology & Public Health Administrative Support Servi ces Simulium Control Operatr ons mrc Development Unit -t E---- - ocP/78 2 Page 7 CHAPTER II THE PROBLEM OF ONCHOCERCIASIS The disea se and the parasiEe Onchocerciasis is a parasitic disease caused by a nematode of the filaria grouP, 0nchocerca volvulus. The parasite is strictly associated with man and has no known animal reservoir. It is transmitted by several dipteran flies of the Simuliidae family, which includes the West African vectors, the species complex Simulium damnosum. The Simulium or blackfly is both vector and intermediat.e host: a microfilaria ingested from a human has to complete a development cycle within the blackfly; in about seven days it becomes an infecEive larva, the only form which can infect man. There is no possibility of transmission of the disease except by forms of the parasiEe that have compleEed this obligatory intravectorial cyc 1e. Adult Onchocerca volvulus worms, male and feqale, live i-n human tissues either in the free state or encapsulated in fibrous formations known as onchocercomas, cysts or nodules. The free worms and deep-seated nodules are normally undetectable. The superficial nodules, which are visible and palpable, are mosEly located in the subcutaneous tissues overlying bone: costal margin, iliac crests, trochanters, sacrum, knees, shins, sku11. Each cyst contains one or more pairs of worms. As a rule patients have several cysts or SrouPs of cysts, and in nodulectomy campaigns there have been cases where over 40 cysts have been removed from a single p ati ent. During its lifetime (est.imated at 10-15 years) the fernale Onchocerca produces millions of embryos, microfilariae, which spread throughout the body tissues but with a Particular affinity for the skin and eyes. From Ehe skin they may be ingesced by a blackfly during its blood meal. In man the microfilariae have a life expectancy of one to two years. After this time, unless they have been ingested by a blackfly and are thus able to continue their development cycle, they die in the tissues. The main clinical manifestations of the disease are due to reacEi.ons to the presence of microfilariae, and their severiEy is directly related to Ehe inEensity of parasite infection. The simplest manifestatlons are skin lesions which are caused by scratching, and are followed by pruritic papular eruptions. LaEer on the skin may undergo a varieEy of changes: thickening and sclerosis in the form of pachyderma (elephant skin), localized or exEensive cutaneous atrophy, and depigmentation. Distribution of onchocerciasis Onchocerciasis is essentially a disease of tropical Africa, where it is prevalent to varying extents between latiEudes l5'N and 15'S. However, iE also affecEs cwo oEher continents: America, with foci in Guatemala, Mexico, Venezuela, northern Brazil, and Colombia; and Asia, wiEh the focus in northern Yemen. Broadly speaking, the northern limit of the disease in Africa runs from Ganbia to Ehe south of Lake Chad; it then rises in the Sudan along the Nile as far as the Abu Haned region(19'15rN) and drops again into Ethiopia along the tributaries of the Ni1e. The countries situated between this line and the EquaE.or are the worst affected: Ehe whole of West Africa(except Mauritania), Cameroon, southern Chad, Ehe CenEral African Empire, southern Sudan, western Ethiopia, and northern Zaire. Further south, the disease occurs in Equatorial Guinea, Gabon, Congo, Rwanda, Burundi, the central basin and southern part. of ZaLte, Uganda, western Kenya, Ianzania, Angola, and Malawi, where it reaches its southernmost point, 17"S. oce/n.z page 8 The vector and transmission Vector species The known vectors of human onchocerciasis are flies which belong to the Sinuliidae family. The African vectors are members of the couplexes distribution of the disease) and Sinulium neavei Simuliun dannosum (throughout the area of(in'certain parts of central and east Africa). As regards damnosum s.1. , its area of distribuE,ion extends northwards and southwards beyond t,hat of onchocerciasis. Ihe S. damnosum comp lex It has been known for some years that S dr-nosum , once regarded as a homogenous species, in fact consEitutes a complex of different taxa. As a result of recent studies 24 separate cytological segregates have been identified throughout tropical Africa. For West Africa nine segregaEes have been described, six of which (ttNilet', rrsirbatt, ttBandamatr, ttSoubrett, ttYahtt, "Biller') are of direct concern to the Prograrme because they are found in or closely associaEed with the Progremme area. At a Scientific Advisory Panel meeting on vector complexes the decision was endorsed to consider these as species with the following nElmes already given them in publications, S damnosuu s. s. S. sirbanum S. sanctipauti S. soubrense S. yahense and S. squamosum respectively. Table II-1 and Fig. II-1 show the distribution of these six main species for the whole of West Africa, and for the Programe area and adjacent zones respectively. Each of the species has a characteristic distribution pattern related to the distribution of the bioclimatic zones of hlest Africa. Thus S. sanctipauli has never been demonstrated outside Ehe forest zones; S. squamosr:m and S. yahense are more ubiquitous but mainly confined to certain types of watercourse in well wooded country ; S. soubrense mai-n Iy inhabits the Iarge rivers in the foresE and Guinea savanna zonesl S. dannosr:n s.s. is found mainly in the Guinea savanna zones; S s irbanum has been found in forest areas but it is mainly in the Sudan savanna zone and the northern Guinea savanna that this species is widespread. Differences in transmission potential have been demonsErated between species and as a function of the bioclimaEic zones. TABLE II.1. DISTRIBUTION OF SPECIES OF S DAMNOSUM COMPLEX Sp ec ies Indication of distribution Habitat s quElmosum yahense soubrense sanctipauli damnosum s. s. s irbanum Cameroon, Benin, Togo, Ghana, Ivory Coast, Upper Volta Togo, Ghana, Ivory Coast, Liberia, Gui-nea Benin, Togo, Ghana, Ivory Coast, Liberia, Guinea, Upper Volta Ghana, Ivory Coast, Liberia Cameroon, Nigeria, Benin, Togo, Ghana, Ivory Coast, Liberia, Guinea, Mali, Niger, Upper Volta Cameroon, Nigeri-a, Beni.n, Togo, Ghana, Ivory Coast, Guinea, Gambia, Upper Volta, I,la1i, Niger Humid forest and riverine forest in Guinea savanna Hunid forest and mountain forest; extends into Guinea savanna Humid forest and riverine forest, extends into Guinea savanna Humid forest Humid forest and Guinea savanna; extends into Sudan savanna Sudan savanna; extends into Guinea savanna and even forest ocPf 78.2 Page 9 Bio-ecology of the vector Like all blackflies, S damnosum s.1 running water. Pre-adu1t development (e tropical running-water t€mPerature condit somewhat different requirements with resP of their breeding sites. . develops, during its larval and pupal stages, in ggs, larvae and pupae) lasts about a fortnight under ions. The various species of the complex have ect Eo the physicochemical conditions of the water factors; only reservoir of the Among all the biological peculiarit,ies, two fundamental characteristics stand out because they determine the strategy and tactics Eo be employed against S. daonosum. (i) The demands of the larvae of the complex are relaEively exacting, particularly in regard to their nuErition. This is reflected in limited spatial distribution of the breeding places and is what makes it possible, after a careful survey of Ehose breeding places, t.o implement a campaign aimed at destroying, within a Siven area and by sufficienEly specific action, all the larva1 populations of the species. (ii) This factor, favourable to the execution of a coordinated cempaign, is unfortunately counterbalanced by the flying power of the females; whence, on the one hand, Ehe need to continue larviciding over a very long period lo obtain only a satisfactory reduction in the parasiEe population harboured by man; and, on the other hand, the need Eo apply treaEment Eo a sufficiently extensive protective zone so as to minimize the consequences of possible reinvasions. Transmis sion The microfilariae of 0. vo1vu1us, the pathogenic agenE of human onchocerciasis, have Eo go through a stage in a vector in order to continue their development. These microfilariae, ingested during a blood meal, undergo several moults in the course of a cycle that lasEs an average of seven days. On completion of this cycle, the infective larvae break out of the fly during a subsequent blood mea1. In view of the duration of the reproductive cycle of the female S damnosum , it is unlikely that the parasite would develop to the infective stage between t\ro successive blood meals. Ihus an infected female does not normally become capable of E.ransmitting the disease unEil she Eakes a third blood meal. Ihe dynanics of transmission depend on many factors, the main ones being: the absolute quantity of potential vecEor blackflies; the mean age of Ehe vector populations I che vecEor species concerned (adaptation to the parasite, degree of anthropophilly, eEc. ) ; the transmission season; Ehe degree of contact between human and vector populations, which depends on human activities (linked to age and sex) and on the above-mentioned the level of infection of the human populations, which are the pathogen. Epidemioloey of onchocerciasis Not aII the determining factors in the spontaneous development of onchocerciasis have yet been found, but a number of general rules can be deduced from observations so far. a ocP/78.2 Page 10 Parasite build-up Onchocerciasis is a parasitic infection that progresses slowly as part of a cumulativeprocess. There is a long period of clinical latency after infection (one year on average). Spontaneous cure is belated and is governed by the life-span of the adult worm (10-15 years). Under stable conditions of transmission, the filarial load in the individual steadily increases over the years. The severity of the lesions varies directly with the degree of parasite infection, i.e., with the number of adult wontrs in the body of the host and the number of microfilariae they release. Level of transmission and length of exposure to blackfly bites are the two factors in man-vecEor conEact that govern parasite build-up. In four villages of the Programe area it was possible to determine annual transmission Potentials (atp)t before the start of the campaign, over a sufficiently long period to have agood idea of the effect of annual variation. Medical exrmination has shown that exposure to increasing ATPs leads to increasingly severe onchocerciasis lesions among a population(rable rr-2). Onchocerciasis occurs in foci, each of which is centred on a breeding place, or succession of breeding places, in the inrmediate vicinity of which the disease appears in its most severe form. The disEribution of foci is governed by the hydrogeographical features of the region. Depending on the density of breedlng places, foci may be relatively extensive and continuous, or separate and restricted in area, in a mosaic pattern. Endemicity in any given focus falls off with increasing distance from the centre. This stratification into levels of endemicity (first-1lne, second-line and third-line villages) is governed by the frequency of contact between man and vector, which decreases with distance from the larva1 breeding place and the distance over which the blackfly has to travel. Endenicity levels A study carried ouE in the Progr:mme area in 364 villages has shown that Ehere are thro distinct types of endemic siEuation. (a) A level of severity of the disease, corresponding to what entomologists have called the desertion level and epidemiologists call the intolerability level, at which the I survival of the conrmunity as a group is at stake. This seems to occur whenever the blindness rate rises above 4-5% of. the Eoal population. The population then starts to decline, aE least relatively, as a result of a combinaEion of health factors and social factors. The surface occupati-on density tends to fall,below 5O inhabit^rt"fk-z unt[-1 it reaches a critical threshold value of 35 inhabitants/kn'at which first-line villpges are doing no more than living on borrowed time. A11 such villages also have: - over 60% of. onchocerciasis; - over 20% of persons with ocular onchocerciasis; -. over LO% of persons wi-t.h severe ocular complications; - mean microfilarial density of over 10-15 mf. Not all contmunities with over 60% cases of onchocerciasis are in this situation and they may have different values for the other parameters. However, it_ seems reasonable to consider this rate as a threshold beyond which there is a major risk of the situation becoming intolerable. The existence of this risk is defined as hyperendemicity. 1a Eor an explanaEion of ATPs and annual biting rates (ABRs) see footnote on pages 22 and Geographical disparities a 1 ocdf78.2 page 11 ; o .rl U(! F{)o o E olr o JJ th . .r{ @ oOOtr TJ adtr(! 'F{ tJEO U o rci) ttroOtr .r{o! utH c)(!!ilrd JqlF{O{!J )o(0(JaB d(! 'UE .()tr OE(!r o!H€l,A aciUFl 0) rJU)o>r o.r{ tr 0)! '.{fuv lr(Juo o>,o!@luoo.o .C o o-o t, .J .r{ .ori0JO ..tE!J l. lr! 0J l-'l oa.tO"{t,ooE .tr'!6(,:00, o o ...{rtt o oO tB..{!OO>U -c.r.r o o! O .r.{ a-l .r{ (d (a--\ B lr (!J(0 ''{x o.o trOtr(!6J 0r-c(0OlJtrod9E.o(!'J O O >co)O.r{ O-l@€$Ctro '.i (U t0 lr Flo(H rEHOO0)otr €d..{o (d trquooooE tan .no 0.) o E.r{!o(!H(0C) +JJ do6r|uoEotrlJ O -l ..1r! 0.r tiFltr t)0o.o F{ c{ co .$ vvvv cn -l H tsz rllHo Fl zo t-{a an t'-i a z f, H FI p zz zH ct) fi& C)zH oH zoH H s Ao Ar () zH v)o A{ E fqo F(J frthfr lI] N Il-lH EI Fl FO H a th U) o.. €q G c):v J FA E{N rJH C-.1 NN .$ i{\o F\ Yor c3o .9 P 8^t E'dei s'eYr{f, ..r N c7) co Nr\ $ i N o\ oN ;{ 1r)N o ,F{ o6 oI(Btr ': ..ro'; o^t H b3>-o 9v-3fueo o N @ .f, F{ E.e crt co No t/l R{ ? o\ rn E E tl .d E;EHarr qqr!bb . o.:ooz @N cf) N @ \o N d @N rL) s :'i AO, E o\ rn \o ro J o oN @ \o N o .J oo o(!tr 'F{o o^ E: ESoo lr -EA.o o N @j rn i{(t) o F\ t{N @\o i{o d N t9,>.i oJ ::'.{ $^ :Y O OJ n (E.ivutroo(00 o'o-z @o rn + -)GI o'l F{ N \t r.f1 A PrH oo6l oo c! J oo\o J ooo N o oo(0 F{ F{ .F{ IA lD 6z o .r{t d o tri a @ a oE(0 o oI) tr(! A olrll 0.) 'rJ clb I ocPf78 2 Page 12 (b) On the other hand, when infection is below a certain level, the disease is socially inapparent. In such comunities, however: - onchocerciasis is not a causative factor of blindness, or is an unimportant one, and the blindness rate is generally less than 17. (except in places where there is another major endemic disease, such as trachoma)1 - Iess than 1O7" of the population have ocular onchocerciasis and the number of irreversible ocular lesions is in single figures (always less than 2.5% of the population); - mean microfilarial density for all positive cases is less than IO. This level of perfect tolerance exists in almost all villages in which less than 40% of. cases were found. Above Ehis threshold 1evel of 40%, however, more severe symptoms soon begin to aPPear. Thus, hypoendoicity, the tolerable level of the disease, is defined by the existence of less Ehan 357. of cases in a cormunity. (c) Between these two limits, less than 35% and over 60%, every type of situation may be found. Collective resistance factors (population density per village territory), individual susceptibility factors, and differences in exposure to risk according to sex, occupational or ethnic caEegory, social division of labour or the mode of working the village territory, mean that no general law can be formulated to describe what is usually called mesoendoicity. The definition of mesoendprricity is thus purely a negative one: a situation is mesoendemic when the disease ceases to be socially inapparent but has notyet reached a leve1 that is intolerable for the group affected. Blindness The concentrates of cases of blindness in small rural communities, with extrenely high rates in relatively young age-groups (fig. ff-Z) has serious repercussions on the working capacity of an imPorEant sector of the populatlon. Recent observation of a high mortality aroong blind Persons compared wi-th healthy adults of the sane age range, would seem to imply that the Present estimate of lOO OOO blind in the Progranrme area is not an exact view of thephenomenon. The risk of blindness incurred by populations living in a hyperendemic area canbe two or three times higher than the rate of blindness observed at any given moment. I a6 . f utr o o ! \d O o-, .e BY F Mono lto udfo Br -o g o a- a \. l"' 62U UJ =F a DoY E c L.- E Y I 3 o\ fo(, z F tr z a rt *8 \ 0z F oJ o @ f,o(9 fo @U o 62 !z ouJ a a Jo 6 Io too @ o(J o6 o)zzUF a f oof oo o lo o tr ,N _a soj al* o a UY fo6 * tr s = a o(, o E ov ct ov =6 o o o gigHs i o<!*o< T oo(, 5 fozoFoo N q N € 8 oa 4 xuJe -oo -l =lololzl -l <t :lql ro g ouL g o aI =E e, F E *Ir ocPf78.2 PaSe 14 20 FIG.II-2 AGE DISTRIBUTION OF BLIND MEN IN 15 HYPERENDEMIC VILLAGES Blindness due to onchocerciasis Blindness due to other diseases 10 20 30 40 s0 60 70 l5 c o)o oG 10 5 N N o : / \/ \/ \/ \ \ \ " -- -2? Age I I ocP/78.2 Page 15 ITISI OHfiI ost + l.ct C!; o oo ?.1{he' a oo O a a aa a ! A q@.E,N c € vv/ s a or v r o EO VV V V = co. cqErzool (v) rJ) r\ 99 sltl, 6)g) s '= (l)> O-PetL()go ol P aC S EH r .-L o -oE (, uJ 92- o H' ,. F H',3=trl a EE > >d)aq) -i>occ\:,, ho= tt s= o-v_*- a .E E=PP o sSuJ (DfE 93pO- o) -oe o.P 6Lc(E .9 (u o cr o. Ztl- { a a G -(E(EL s* fr .!?(o(!@zY o- f o cD .o cE IJJ .=(! o o L o) ,o0 .= c o,E c .9 s a o- o CL o aoa o o olr, .t"tio .3ts t a oo a5 o o a Ia o 8az -a{'--i -+ rJ)N a- o IO I I I I I I I Ig$oo o a @{ oo o 3 3.a: eO a a o lJ)@ t L o) A o o{ o5a h O o rr) olo pu!t8 a oocPf 78.2 Page 16 bs Eta & to tooto o ooE o >s o o, o@ oN o|- o No ! a o a a a o IJJt L(J o llJ J-F z =Va o z $cD ,uJFli 9H lIF LL o z F C) UJ IL z J O cr IJJ(J o -Oz o o(o o, o) (D E o:t()e .9 c)(D o<r3 o)() oE(J oO(') a tr tl aO o a o a o oa' a a a tr a oo o a o o a a oN o a a a ooNor\Oo) o 8838 ur>ls aqt lo uollcalul lecJacoqcuo o@ ia a o 5 o o ocP/78.2 paSe 17 CHAPTER III THE CONTROL CAMPAIGN AND IIS RESULTS Basic data - method s of control and Eechniques In default of any Eherapeutic weapon at present utilizable in a mass camPaign, the only feasible method of controlling onchocerciasis is stil1 by control of the vector. Taking into account the genetic, biological and ecological characteristics of S. damnosum s.1 , Ehe control of the vector can be approached, in Eheory, from many angles. Ecological control The elimination of rapids, which are where the vector reProduces and develops, would be a final and, therefore, ideal solution to the problem of onchocerciasis. Thus in Africa the great dams built (Aswan, Akosombo, Kainji, Kossou), being built or planned (Se1ingu6, Manantali, Noumbiel, Jebba, Bui), by eliroinating any possibility of S. damnosum bre eding up- river, have had or will have an exErenely beneficial effect on the onchocerciasis situation. A study undertaken by OCP has esEablished that the constructi.on of just the one hydroelectric dam at Noumbiel, on the Black Volta between Upper Volta and Ghana, will result, aparE from the final elimination of local vecEor populations along considerable reaches (120 km) of this river and its tributaries, in a saving of $ 150 OOO a year in the cost of conventional vector control operations. However, to construct such engineering works for t.he sole purpose of controlling a disease, important Ehough it may be from an economic point of view, is out of the quesE.ion. The topography of the African savanna zones would not penoiE it in all places where it would be desirable, and the cost of such dams is generally very high. On the other hand, Ehe proliferation of smal1 dams to provide reserve water supplies near rural population cenEres has often resulted in an aggravation of Ehe onchocerciasis problem because of the favourable condiEions for the development of S. damnosum created bv their spillways. Genetic control The introduction of sterile males inEo natural vector populations has been the theme of many experimenEs, and has been successfully utilized in campaigns against certain insects. The fact that females of S. damnosum mate only at the sLart of their adult lives and then, having been ferEilized, a.e abTEE-rig.ate over long distances, rules out the application of this method. There are also currently insuperable problems concerning mass colonization of S. damnosum in the laboratory. The flies cannot be mated in captivity and have difficulty in taking blood and ovipositing. Biological control Many parasites infest S. damnosum in nature and research efforts are at. present being concentrated on the possibiliti"" of "tilizing them with a view to reducing or eliminatingvector populations. It is still too early Eo say whether this technique could be applicable in mass campaigns. Chemical control This method can be approached in two ways: conE.rol measures directed against Ehe adult, and control of the aquatic develop,ment st.ages (eggs, larvae and pupae). ocPf 78.2 Page 18 Adult control One of the earliest campaigns against S. damnosum employed this principle, though it insec tic ider^Ias not possible to deEermine the part played by larvicide action (part of the falling directly into the rapids) in the successful results obtained. In fact, because of the possibilities of dispersal of S. damnosum females around their sites of reproduction, particularly during the rainy season, it would not be feasible to conduct an adulticide campaign covering a wide area. However, research is in progress with a view Eo developing a control technique that would a11ow protection of localized sites, part.icularly in reinvaded areas. Control of pre-adu 1t developmenE stages Eggs and puPae of blackflies are securely fixed to their supports and partly protected from their surroundings by the adhesive jelly, in the case of the egg mass, and by the cocoon, in the case of the pupae. As neither of these stages ingests food particles from its surroundings they could only be destroyed by fairlystrong contacE poisons. They are not effectively destroyed by any insecticide currently in operational use. On the other hand the larvae, because of their relative concentration and their mode of obtaining nourishment by filtration of parcicles in suspension in the water, are the forms most susceptible to insecticides that act mainly through ingestion. In default of any alternative, 1arva1 control is therefore Ehe principle upon which most campaigns against blackfly vectors of onchocerciasis have been conducted in Africa. Widely utilized in prior campaigns, and again adopted for the Programme, larval control is governed by the following principles: - the larvicide solution must be released upstream from each breeding site, or set of breeding sites, so as to destroy the larvae of all stages; Ehe range of action of the insecticide \dave transported by the current depends essentially on Ehe hydrologicaL and topographical characteristics of the watercourse treated; - applications must be made periodically, at intervals shorter than the Iarval life- span of the species; the periodicity has been fixed aE seven days, which satisfies both biological and logistical exigencies; - these applications must conEinue, in a given area, for as long as the capacity for reproduction of the residual blackfly population poses a threat from the epideuriological viewpoint (transmission rate too high) or in entomological terms (re-establishment of local blackfly populations too rapid). Technique s Until 1971 the insecticide used was DDT, which is very effective but whose residual properties and effects on the envirorunent krere not aPpropriate to the present ecological requirements. As a result of studles undertaken since 1967, investigators have been able to select several compounds belonging to the organophosphorus group, one of which, temephos(Abate @, OUS 786), combi-nes in a specific formulation the essential properties of high effectiveness aga inst S. damnosum larvae of all sta ges, and, because of its relatively specific action, its low persistence and the very small doses applied, low toxicity for the environment This insecticide has been used since the start of operations by the Prograrnme, but investigations continue with a view to developing new compounds in different formulations. Most of the campaigns prior to the Programme, which were based on the princi-ple of larval control by chemical means, used treatment techniques suited to Ehe sma11 geographical areas covered. Ilowever, the treatment appliances, both static (drums with holes Eo release ocPf 78.2 Page 19 the insecticide over a given period), or mobile (floating cratt of various sizes), very soon proved unsuitable for the treatment, of large areas because of the impossibility of utilizing them in all siEuations. Access to the rivers in all seasons constitutes the major, often insoluble, problem that the Ereatment Eeams have to face when working on the ground, especially during Ehe rainy season which is generally Ehe period of high transmission in most onchocerciasis-infested va1leys. The treatment rounds are Eherefore done incompletely, not always at regular intervals and at the cost of unremitting efforEs. Moreover, for these less than ideal results the resources that have Eo be deployed are considerable. To take one example, the treatment of the Comots-L6raba River in the Banfora region (25 OOO km2) required from 1969 to L972 tine presence, five days a week, of four strong ground teams, each consisting of one qualified technician, two labourers and one driver, with cross-country vehicles and equipment for larviciding (boat, out-board motor, etc.). These teams \^rere able to reach all the Ereatment points only in the dry season, despite the constant maintenance of 300 km of tracks specially built for the purpose. The results showed the effects of these constraints and the level of Eransmission in Ehe largely inaccessible southern parE of this zone remained too high for the maintenance, or return, of human populations. In view of the strategic exigencies, largely deEermined by the biology of the vecEor and necessitating the treatment of extensive areas, Ehese land-based meEhods could no longer be considered, so in 1967 spraying from the air rdas sEarEed on a trial basis. Later, a type of aeroplane used for agricult.ural spraying, then the helicopter, first sma11 and then medium-sized, were Eried out. The aeroplane provedvery efficient for medium-sized and large waEercourses, where gallery forest veget.aEion does not hamper navigation and treatment. IE proved less so for the smaller rivers obscured by forest canopy, where it is replaced with great advantage by the helicopter, whose manoeuvrability is practically unlimited. The first five years of operations Vector control operations After analysis of the various principles, methods and techniques, and in the light of experience with prior campaigns, the Onchocerciasis Control Prograrune was planned and put into operation according to the following criE.eria: - control measures directed against the larvae of the vecEor, which are iEs most concentrated and mosc susceptible development sEages; - uEilization of insecticide with 1itt1e residual action, effective at low concenErations and producing 1ittle pollution under the conditions of application; - treatment from the air, the only method at present applicable which has proved, for practically IOO% effectiveness, the least costly. Aerial operati-ons An invitation to bid for a contract Eo carry ouE aerial operations gave details of che requirements. This included specifications for the development of equipment for the release of accurately measured quantities of insecticides for both helicopter and fixed-wing machines The type of machine considered suitable for the work requested as well as the flying hours required were also specified. It was anticipated that it would be possible to treat the large rivers by fixed-wing aircraft and that the smaller rivers would require helicopters. ocPf 78.2 PaEe 20 At the end of JuLy L974, the contract was awarded to Evergreen Helicopters Inc. from McMinnville, United States of America, who operated Be11 206 helicopters and a Pilatus Porter aircraft. hlork cormrenced in during that season the 75 630 litres of Abate 1975 in Phase I only, operating from one base in Bobo-Dioulasso, and following hours of fixed-wing and helicopter were flown to dispense Phase I 1975 Larviciding Prospection Administration Total hours Abate He 1 icopter Fixed-wing Helicopter Fixed-wing 1 911 366 782 80 89 94 2 782 540 47 369 28 261 ToEal 75 630 In January 1976 Phase II began with the treatment of the lower WhiEe Volta by helicopter while treatment conEinued in Phase I. This machine flew across from Ehe Bobo-Dioulasso base each Tuesday and when the rains began ln May, all the other rivers which started flowing in Phase II were treaEed by the same helicopter, assisted by the fixed-wing on the White Volta once Ehe flow of water was sufficient for fixed-wing treatment. At the end of 1976, with the treatment of Phases I and II, the following hours had been flown: Phases I and II L976 Larviciding 3 011 488 Prospect ion I L92 95 155 4L 4 3s8 624 Administration Total hours Abate 79 862 50 085 ToEal 129 947 During these initial Ewo years of operation a system evolved which is flexible enough to deal with the consEanE adjustments that have to be made. At the end of 1976, the initial aerial contract with Evergreen Helicopters Inc. came to an end. International bidding for the next contract took place in mid-June 1976. The contract was awarded to Viking Helicopters Ltd, an Ottawa based firm, on 6 August 1976. The change of contractor provided an ideal opportunity to improve equipment and Eechniques, based on the knowledge acquired in the first two years of operation. With the helicopter equiPment, the previous contractor had developed a gravity-fed system and although very effective in the wet season, problems had been experienced in distributing insect.icide at difficult breeding sites in the dry season. Consequently, the incoming contracEor was asked to develop a "dual" system where, by operating a switch in the aircrafE, the pilot could elect for the insecticide to be emitted either by the gravity-fed system or through a pressure- fed single nozzle. This newly developed I'restrictorrr system proved highly successful, particularly in the dry season. Modifications were also made to the fixed-wing equipment. The previous contractor used an underslung cylinder into which the required quantity of insecticide was fed and emitted by the action of a floating piston. with the newly developed equipment, all parts are internal within the aircraft and the only external parE is the emission tube. The system is activated by air pressure and has proved accurate and reliable. ocP/78.2 pate 21 In the first year of operation with the new aerial contractor, the whole designated Prograrune area was under treatment for the first time and at the end of L977 the following hours had been flown: Phases I II and IIL L977 Larviciding Prospection Administration Total hours Abate He1 icopter Fixed-wing 4 424 854 5 350 L O25 84 318 7L 297 685 57 249 LL4 Total 155 615 The treaEment flying was done with six helicopters in spraying configuration and two fixed-wing aircraft operating from Tamale and Bobo-Dioulasso. Fifty-four per cent. of insecticide released was by helicopter atd 46% by the two fixed-wing aircraft. The average release of insecticide per hour (80 litres per hour) is four times that of a helicopter(20 litres per hour). A1so, the fixed-wing aircraft can be operated for approximaEely half the cost of a helicopter. As river levels alEer, the breeding sites of S. damnosum change and aircraft circuits have to be modified accordingly. It is unlikely that a river treated with a particular quantity of insecEicide one week would require the same dosage the following week, and as rivers start to flow, or dry up, they are constantly being added to or removed from a circuit. Hence, it is necessary to produce new treatment. maps each week at the two bases of Bobo- Dioulasso and Tamale. Following Ehis the pilots are briefed on the circuit to be flown that Particular week. The pilots carry with Eheu the 1:5OO OOO treatment maps, which indicate the rivers to be treated and the dosages required, and 1:2OO OOO maps which show the release Points of the breeding sites to treat. Circuits normally take three to four days(Figs III-1 and III-2). There are eight major fuel distribution point.s in the programe area frorn where Ehe subsidiary caches are supplied. At six of these points bulk fuel is available from airport PumPs, but at the other two fuel has to be brought in from elsewhere. There are 8O subsidiary caches of fuel and insecticide in the prograrme area (Fig. III-3). Both fuel and insecticide have to be made available in drums. Maintenance of adequate stocks at these caches and the keeping of accurate records are large-scale logistical exercises. Entomological su rveil lance The original plan for entomological evaluation (pAG mission report, Annex V_3) envisaged a network of seven sectors and 24 subsectors, from each of which would operate about two Eeams of vector collectors. Additional teams r^rere to be aEtached to each of the sectors to give a total of 58 Eeams. Each team would consist of three vect.or collectors, adriver and vehicle; 141 regular catching points lrere to be visited at fortnightly intervals.At each visit two consecutive days (11 hours) catching would be undertaken. In addition shorter catches would be made at other less important sites and larva1 searches made at known and suspected breeding places. This basic plan has been modified in several respects: (a) the vector collecting team has been reduced from three to two collecEors; (b) the collections at regular catching points have been made at weekly instead offortnightly intervals ; (c) the number of caEching poinEs has been considerably increased, and almost al1 catches are for the lI-hour period. ocP f78 .2 Page 22 These alterations to the original plan were considered necessary to provide satisfactory operational information. As the control operation is based on a weekly cycle, hydrological data collected by the surveillance teams must be transmitted by radio from the subsectors each week. Most of the hydrological stations are important catching points which must be visited weekly regardless of whether a catch is made. Similarly, each team must return to base each week in order to pass on its vital hydrological information. Thus the utility of operating Ehe surveillance network on a weekly cycle is obvious. In addition, the entomological data concerning both larval searches and adult collections is invaluable in planning the aerial control operations. A fortnightrs delay in acting on this information is too great when dealing with a vector whose immature stages are completed in less than that time. In addition to this operational role the entomological evaluation, at this stage, is designed to provide (i) a measure of the effectiveness of the Prograuune in the period before reliable epidemiological changes can be demonstrated; (ii) statistically valid data to compare biting and transmission rates r^rith the hurnan parasitological and ophthalmological findings; and (iii) aata for use in research into the reinvasion phenomenon. In order to fulfil these requirements 5O vector collecting teams were employed during 1975 and 86 during 1976 and L977, falLing to 78 in 1978. In addition anoEher 20 teams were employed on a temporary basis for an intensi-ve programme designed to study reinvasion problems it 1977 and 1978. In setting up Ehe entomological evaluation network, 525 catching points were studied in varying degrees of detail, and the catching results stored in the headquarterrs computer. These catching points are distribuEed as follows: Phase I Phase II Phase III !il Phase III E 227 108 70 LZO Increasing knowledge has indicated Ehat more intensive catching at fewer sites is 1ike1y to yield the most valuable results, especially when reinvasion problems are being studied. Thus, during 1977, at average of 27O (range 213-302) caEching Points was visited each month, and over 14OO days caEching undertaken per month, to give an average of 5.3 days I catching per site per monEh. Establishment of criteria InterpreEation of the entomological data presents a number of problems. ClearIy, in the complete absence of th vecEor such as S. damnosum e vector no further transmission wiIl take place. However, , which under certain circumstances may migrate (page 24), with a this situation is unlikely Eo be achieved, or mainEained, for long periods over wide areas. It has thus become necessary to determine the level of biting f1y populations and Potential transmission of O. volvulus which is considered acceptable from the medical and economic viewpoints. In order to make a judgement concerning the success or otherwise of the programne, and to provide criteria for assessing the advisability of settling populations in zones of severe onchocerciasis, OCP convened a Scientific Advisory Panel Working Group in June 1977. The group considered the available entomological data concerning the transmission situation before vector control activities, togeEher with the known resultant degrees of the disease. The group decided that an Annual Transmission PotenEial (ATP) I of 1OO was extremely 1 Thi" is the annual total of the estimated individual monthly Eransnission Potentials obtained from the formula: No. of days in month x No. of infective larvae x No. of flies caught No. of days worked No. of flies dissected Calculations for the ATP in Ehe Programme area are based solely on the numbers of infecEive larvae indistingu ishable from O. volvulus in the fliestheads. Where Simuliu:n biting densities are low, as in the Programme area, ATPs calculated in this way are liable to wide fluctuation resulting from the numbers of infective larvae in single f1ies. ocPf78.2 Page 23 unlikely to result in any untoward medical or socioeconomic effects. Available daEa also suggested thag an ATP of 8OO* was likely to be accompanied by severe onchocerciasis. In order to cover the situation where previously uninhabited areas are to be subjected to human settlement, it was also necessary to determine what level of biting fly populations might- give rise to unacceptable levels of ATP. The Panel concluded that an Annual Biting Rate (ABR) r of less than 1OOO was most unlikely to give rise to an ATP of over lOO and this could be considered safe, and that with an ABR of above 8OOO a hyperendemic onchocerciasis situation was 1ikely to develop should a human population conLaining some onchocerciasis carriers be settled. The group clearly appreciated that with knowledge which should become available after the second or third passage of the epidemiological evaluation teams, it might be possible to safely increase Ehe accePtable levels of ATPs and ABRs- An analysis of the results during three years for the Phase I and II area shows a sceadily inproving situation. 7" of ATPs below 100 % of ABRs below 1OOO Phase I Phase II Phase I Phase II L975 L97 6 L977 68 81 86 70 85 92 6T 72 79 50 80 85 In 1975 Phase I was under insecticidal control whilst Phase II was not. However, it seems most likely that the control activities in Phase I influenced the results in Phase II where, at, the few catching points from which several yearsr data were available, the lowest ever ATPs and ABRs were recorded. The superior results of Phase II in subsequent years arises frm the fact that this area is 1ittle subjected t.o reinvasion by epideroiologically significant numbers of flies froo outside the control area, whereas about 40% of Phase I is so reinvaded. In many cases results in the heart of the Progratrme area are excellent. For example, at Wayen (point 0407) situated on the White Volta river just east of Ougadougou, no vector flies have been caught since the start of the control campaign, yet, in the pre-control times rhe ABR exceeded SOOO and the ATP exceeded 2OO. In most of the Black, I{hite and Red VolEa, and Sissili valleys in Upper Volta, transmission of onchocerciasis has almost certainly ceased since the start of the control campaign. Further south, in the Black Volta valley, control has improved oarkedly each year, e. g. at Chache (point 1303)2 the sicuation for the three years of control is as follows: ABR ATP L973-7 4 I97 5 t97 6 L977 34 000 12 015 L 957 657 N.A. 825 80 15 Tt.e L977 data concernlng ABRs and ATPs at 157 well-studied point.s have been analysed and plotted on Figs III-4and III-5. Sinilarly all usable pre-control data have been plotted on Figs III-6 and III-7. The ABR data has been plotted for 114 points and ATP data for 96 poinEs. I ,hr. is the annual total of the estimated individual rnonthly biting rates that have been obtained from the formula: No. of flies caugh t x No. of days in month 2 See Fig. III-8. No. of days worked oct/78.2 Page 24 Control in Phase III l,Iest was implemented only in March L977, and for parts of Phase III East only in August 1977 (not at all in the easternmost valley - the Sota valIey). Therefore, the data for L977 in Figs III-4 and III-5 include three or rnore months of pre-control in these areas. Analysis of Ehe pre-control ar.d 1977 ATPs shows the following breakdown: L977 Pre-control ATP No. of points % pt int s No. of points % of points o- 99 100- 199 200-399 400-7 99 800+ The flies appeared to be a monsoon winds. Each year indicated on Fig. III-9. influx of infective flies. generally in numbers which reinvasion study are shown 9l 20 19 16 11 58 13 L2 10 7 L2 6 19 l2 47 13 6 20 L2 49 L57 100 96 100 The pattern of results when ABRs are considered is very similar with a few more points registering results which do not fal1 below the critical level (IOOO). The reinvasion phenomenon Shortly after the commencement of control in the Phase I area, fly populations dropped sharply and in most cases became zero within three or four weeks. However, with the onset of the rainy season large numbers of flies reappeared at certain sites in the south-\"7est of the Prograrme area. DeEailed investigations showed (a) that there was no active breeding in the area; (b) that virtually all the flies were parous (were in fact several days old and had already taken at least one blood meal before they were caught by the vector collector) ;(c) flies in many cases were carrying infective stages of the parasite Onchocerca volvulus. reinvading population moving in the same direction as the prevailing a similar reinvasion has occurred in the same areas which are These are areas where there is an epidemiologically significant Flies probably penetrate to all parts of the Programe area but are epidemiologically insignificant.. The results of the in Annex I. Sources of reinvading flies are probably located to the south-west of the reinvaded zones. Experimental control in the I'larahou6 and Sassandra valleys in June-July 1977 seemed to greatly curtail the reinvasion of the Upper Bandama and L6raba rivers. Control operations carried out on the Marahou6 and Sassandra rivers in Ivory Coast during 1978 have confirmed this observation. The reinvading flies have proved to be only savanna cyEospecies. Extension activity in Ivory Coast Eo cover all savanna regions should result in an improved situation in the Bandama valley, as already menti-oned, and in Ehe Bui region of the B1ack Volta. A comparison of the reinvasion map (Fig. III-9) with rhe map of ATPs Ln L977 (Fig. III-4) shows that most of the caEching points registering unsatisfactory ATPs fall within Ehe reinvasion zone. The actual zone affected by reinvasion is less than 3O% of the total original Prograune area, and with alEerations to the southern extension of the Prograrune area in Ivory Coast Ehis is likely to be considerably reduced. Epidemiological evaluation Aim and methods The outline in the PAG report follows: for the epidemiological work to be done by the OCP rnras as ocP/78 .2 Page 25 (a) surveillance of O.33% of the population of the Programe area, i.e. 33 OOO personsdistributed in the seven participating countries of which the population concerned is estimated at about 10 million; (b) stratification according to endemicity leve1s of the localities, or regions if these are known, in such a way that two-thirds of the sample are situated in zones of meso- or hyper-endemicity because rrthe primary aim of the surveys is to determine the effects of the control operations in areas with high levels of endemicity't; (c) initial selection, on the basis of data previously collected, of a random sample composed of N clust-ers of 3OO persons until the required number in each country is ob tained ; (d) longitudinal follow-up during the inplementation of the programe, at three-yearintervals, of each of the individuals forring the evaluation clusters; (e) annual deEailed examination of 8-107. of the samplel complete ophthalmological examination, complementary laboratory tests. Sanple design It soon became evident that valuable random selection. the focal distribution of the disease would not allow for a rt r{as considered that in endemic situations which were far from being homogeneous, and where one could see a distinct Pattern of foci in relation to the profile of watercourses, acareful choice ldas necessary, and in L975 it was decided to utilize the following criteria,agreed upon by STAC: (a) The "villages" must be representative of all the ecological, hydrological andgeographical zones of the basins and Idatercourses where breeding i1""". occur. TheThe villages selected must be representative of all the known foci. As a result Eheyare scattered throughout the 14 ooo km of rratercourses covered by the programme. (b) They should be interdependent with the entomological evaluation progranme, i.e.they should be selected close to the permanent collecting points, particularly whenentomological considerations so require. (c) Fu11 attention should be paid to sociological factors, longitudinal studies beingincompatible with a high drop-out rate and presupposing social homogeneity and anadequate leve1 of population stability. Accordingly, administrative and comrnercialcentres (which have too high a proportion of foreigners, tenporary residents and non-residents), agricultural (including processing) businesses and p.oj""t, dependent onmigrant and seasonal labour, and nomadic comnunities were all excluded. (d) The different 1eve1s of prevalence need to be represented in the samples. Bearingin nind the PAG missionrs recommendation that Evro-thirds of the villages in the sampleshould have a prevalence of more than 33%, iE. was found preferable to serect 75% of t,.esample from hyperendemic villages (prevalence >60%) and the other 25% from villages whereprevalence is lower. (e) As a result, of the total of 3oo subjects lss6,-gndsd for the clusters, it wasnecessary someEimes to combine several small villages to form one cluster, sometimes torestrict the survey in excessively large villages to one or more districts. (f) As far as possible, the selection of villages should take into account the economicdevelopment zones. ocPf78.2 Page 26 (g) Random selection was replaced by selection based on the accepted evaluation criEeria. (h) CorrnuniEies from non-endemic regions who come to settle in the reclaimed areas, such as the territory of the Volta Valleys Development Authority (AVV) in Upper Voltat and who form a control population not foreseen in the PAG mission report, had to be included in the evaluation Programe. Current meEhodology Since the beginning of the campaign, baseline data have been collected in the seven countries. On the basis of the criteria mentioned above, the following conclusions can be drawn: Geograph ical dispersal all river basins treated by the vecEor control unit are represented in the samPle. Relation with entomologv whenever possible the villages close to a Permanent Simulium catching point were chosen in order to assess entomological results. In certain cases the request of the enEomologisEs. The different represented in the sample. the degree of correlation with the investigations were conducted upon Ehe levels of transmission (AtP) are Migrants: in the AW where there is a populaEion of non-infected imigrants, 3600 individuals have been registered for a special study aimed at checking the persistence of any residual transmission. Qua ntitative aspect: the basic sample established in the seven countries in the ea toLals 80 OOO people, out of a population of 11 millionoriginal Prograrme ar inhabitants. This represents a sample of O.75% of the population, which is ccnsiderably greater than the nu.'nber originally envisaged (O.337"). This decision was taken in consideration of: - the need to retain a sufficiently large sample in order to obtain significant results in the longitudinal surveys of villages over a period of 10 years or more, in view of the high absentee rate of 20% at each examinaEion; a1so, the larger sample initially chosen now contains a sufficient number of villages from which valid conclusions can be drawn on the transmission resulting from infected flies imported from outside Ehe OCP area; - the need to ensure adequate geographical coverage as required by Ehe entomological control; - the need for mapping of foci and chemotherapeutic trials. For operational reasons, the epidemiological evaluaEion has been carried out aE two different leve1s, simple and detailed. The simple survey consists of a parasitological assessment of prevalence and intensity of onchocerciasis by means of examining two skin snips, plus a screening procedure for visual impairment and blindness. In the detailed survey a careful clinical and ophthalmological examination is also included. Because of the time- consuming technique, the detailed exeminations have been carried out on only approximaEely 15% of the total sample, allowing for certain special studies concerning ocular lesions. Data concerning the activities of the Epidemiological Evaluation UniE is given in Annex II ocP/78.2 page 27 Medical results of entomological operations (a) Results of preliminary campaigns 1962-1974 in the Proqramme area The Sikasso region (Mali) The basin of the Farako, a smal1 secondary tributary of the Banifing in eastern Ma1i, was a large and serious focus of onchocerciasis. Its treatment began in L962. As it covers only 2OOO km2 and has no biological or natural boundaries, the treated area could never be completely protected and was constantly reinvaded by blackflies migrating from nearby basins. In the central area of this focus, the best-protected part, the theoreEical number of bites per man per year (lBn) was kept within the region of 1OO0 during the conErol period (exEreme values 350 and 25OO), whereas during Ehe interruption in 1965 it was 12 OOO. Medical observations in four villages kept under surveillance for 10 years show that this partial control of the vector was enough to reduce the level of endemiciEy fron over 50% to 1O% and less. The maintenance of residual transmission is confirmed by the presence of an infected nine-year-old child; however, the very low level of such transmission is confirmed by the fact that onchocerciasis prevalence in children under 15 years of age feIl fro:n L5% to 0.4% between 1968 and 1976. After 13 years of partial control of the vector in this area, even though the blackfly r^ras not eradicat.ed anyvhere, it was found to be impossible for the disease to Persist in places where Ehe ABR had been reduced to 1OOO or less for 10 years. Ihese villages now contain only residual cases, bearing witness to parasiEe infection that is dying out, and sporadic cases indicating the persistence of low residual transmission. The Banfora region This region in the south-west of Upper Volta along Ehe frontiers with llali and Ivory Coast was subjected to Simuliun control in 1969 because it formed a natural extension of the neighbouring campaigns in l'lali (Farako since 1962) and Ivory Coast (Upper Bandama , L969). Unfortunately, the operations had to be halted for financial reasons from October 1973. During the six years of the campaign protection rdas never complete. The ABR during the interruption of operations is not precisely known, but no doubt fluctuated around 15 OOO bites annually. Compared with the pre-canpaign situation (1967-1969), the surveys carried ouE in 1973 and early 1974 showed that in six years the leveI of endemicity had dropped by l5-2O"L in all the villages, falling fron 7O-8O7" to 55-60% in hyperendemic regions and from 50-657" to 35-40% in mesoendemic regions. Ihe fall in prevalence rras marked in subjects under 30 years of age and almost imperceptible above that age, confirming that the reduction of Eransmission \./as the cause. In late 1975 a further series of surveys showed Ehat endemicity had almost returned to its original leve1. The deterioration was particularly marked in males between the ages of 1O and 30, and the infection rate in children under 10 years had increased slightly instead of continuing its rapid fa11. A one-year break in entomological control, which brought a massive quantity of blackflies inEo contact with a parasit.e reservoir E.hat had not been reduced sufficiently, was enough to wipe out Ehe benefits of six years of work almost completely. (b) Prelininary results of OCP The first check of the results of operations in Phase I began in 1978. Sixteen Upper Volta villages were re-examined and Ehe reliability of survey and diagnostic methods confirmed: the disease was found again in more than 99% of the people where it had been observed three years earlier; the few negative cases can be account,ed for either by an error of identification or by mishandling, oE by carriers with a very 1ow parasitic load thaE randomizes the demonstration of microfilariae (the diagnostic error risk is lower than 17.). ocP/78.2 Page 28 Eight hyperendemic villages were re-examined along the Bougouriba and Black Volta rivers,in an area where vector control was not completely successful in 1975 (ATp = 183 in 1975 in Mabere village), buE where as early as L976 ATPs were below the threshold of year. 1oo larvae /^"/ In the O-4 years age-group, the prevalence of onchocerci-asis had decreased from 5.3% xo 1.67" rrithin three years and among the 140 children born since the beginning of operations, only two were found infected (they were born in early L9l5). A slight decrease even tends to appear in Ehe 5-9 years age-group. Seven other villages were visited again in late 1977 in the Upper ComoE basin where the control is reported to be excellent since January L975, that is for almost three years. Nopositive cases were found among children born during that period. Of the 277 children examined in the under five age-group, none had onchocerciasis whereas three out of 267 (L.IT") were infected before the campaign began. In the meantime, the prevalence had dropped from 9% to 6% in Ehe 5-9 years age-group. Finally, in Dangouadougou, a village located on the rouEe of the reinvasion phenomenon, the ATP is sti1l higher than 1OOO. The disease in Ehe village is becoming more severe: the overall prevalence is increasing slightly, but the individual microfilarial loads aregrowing on an avera8e of one-third (32 mf. instead of 20), two children under four were foundinfected and the prevalence has increased from 3.5% to 7% it this age-group. These medical results clearly confirm the validity of the findings of the entomological evaluation. The tendency to a setback of the disease is still more significant if one considers that the Eransmission has been reduced to a lower level. The ATp values established in 1976 allow an optimistic view of the overall epideroiological results which willbe observed after a five or si-x-year period of control. The aging of adult r{7orms will ther}lead to a significant decrease of the parasitic load to which will be added the effects of the renewal of generations among the population. In terms of ophthalmology, four villages in Upper Volta have been re-examined(Mouvielo, Kimpeo, Pendie and Dangouadougou) after a three-year period. preliminary resulCs do not show any significant difference as regards the prevalence of ocular onchocerciasis or Ehe number of severe cases, butr generally speaking, overall rates have diminished slighqly. However, in three of these villages (Mouvielo, Kimpeo and Pendie) where entomological resulds are satisfactory, there is a tendency to a decrease of ocular microfilarial loads in data for 1978, as compared to 1975 data. Also, Ehe number of patients with aggravated ocular impairment is remarkably low. This might explain why the blindness rate has decreased from L2.3% to 8.2% in one hyperendemic village (Dangouadougou): the number of new cases ofblindness was low and the blind of the village had been subjected to high morrality. A11 these results, and especially the assumption that the interruption of the transmis$ion of onchocerciasis might already have had a favourable stabilizing inpact on the ocular lesiqns, must be checked on a statisEically reliable sample. This will be done in 1979. l, study df the risk factors of blindness among onchocerciasis patients in a protected area will be undertaken. Such a sEudy will be most valuable for the future assessment of the number ofblind people in the OCP area. In order to evaluate the effects of the vector control operations in the programme area, a subsample of 150 to 200 villages was chosen, according to criteria defined by STAC, and will form Ehe reference sample for longitudinal evaluation. These villages will be re-examined at fixed intervals independent of any other possible facE.ors likely to alter their representative characEer. The other villages will form a data bank which can serve either for special evaluations(need for a greater number in certain areasr localresidual transmission, reinvasion, agricultural development, etc.) or for certain specific studies (therapeutic trials, mono_ vectorial transmission) . t ocPf 78.2 Page 29 Finally, oEher villages could be included in the future sample if the boundaries of OCP are modified. As a first approach, the sample selecEed for regular evaluation of Ehe Prograrune will be made up as follows: Upper Volta Mali Ivory Coast Niger Togo Benin Ghana Total 56 villages out of 117 visited 36 65 39 57 817 15 27 23 27 30 54 207 364 { t-a o I I ;o@ U @ FF E} =- P,;ZtrH= CEFa H]EB8i9s-)>,4UJ?Ju '<z 6a22); uiOEoa< >2@EUEocu .@> '<Oa 6uu Ek8F6IN<F 4 c \ atE I I t- I Ii. L ooF@ F -U =<z@ Itt a t,ii I \ ! 1 i g\ l. ) t V \''^ f I ,o i' ,rJ^ t \\.- -")t \ f' I{_ ( E g I +,/?)- .-r' t ; o E t. .t* tI t i* N o(r, o .+ N .o@o N ao 83. U' ts :)o G. o F -zrU rr=FFdsEc(F FL cr() ct i. c o 2 t-- o I -t". ,'l Uo UJ)t.gi <UU!6= !6 ,<E =uu 2>AUEY =oYk=d EE; oluZrz =989:s p .=- ln >OE FdUU -Ucix> g I OGE Z6 ir o l ; o@ U ,oFq zi!U> E?'; <aE-UF9E-z ;s=F.UA>xXJI J<> ujoEQU >J26oQ 49a OU: Fii>g6E .UU <E8uc0<l<J e L ----t o z I I I t I I 1.! / .i-,--i N o .!I-/! I o o '|.r t"---) t ''-)\ f.-i b-/fil + t_\1. '\,_,) ,5 !? \-- f I it/ ( \ ,o( t l \.- E I I ,': J o A c o F o o o I I I I r I I _\_ I \ \ -J I - --q--J ot o o tr) o s o N a N r 6 oUd tJ) F lo G, o F rZrU8=FIFdsEccF Flt tE oE a ) o o t -L, .1 \ IEI IEI Lil Ooe<6OOJ -U<- =E ll o U o., a oIt d) I o a o z c 'E4 u l ( a\ I, I o.i oltI Oi ,i oi(' i, I ., u1- ,a f \ a\ \ 4l.(i, o ji t ! i I , I ,?, I i!1 a'I .\ ( \ * M lsl tEl u F ./'''') _i ;)ir. i- _i '1, I ,t i) o (, L o a \.- o t tr v I E J 6 I o f o o (, l oY I t? .4 -.-/ a-. N .N €6 \_oA@(J6 oa UJ e, u, = = cc(9 o E,GTu EE 9=ru)Fz oL oz JJ ul fL tlJ IE ,' l, E o o o o o t-a \-- o I i i)o I UI ,-) f' il- I .rc l;^ J' t lg \-., z o 'i.( t t l'? pr: I 1 ,l- 't I i Ii; u A.dL I I '7' ._,) I ,l 1. ,^l- - lr ,o ( ( '"'-)I -/\ -t -r N @o N\\o&so(Oa oo)o)6)o)oF(Yrr d)olllf 'OOOO oooO-Nt@ oocoo rr O) I U)J trz UJ e,^ az ,;oi-8 Ez EF J)zz 0 d f U ( (()\)- L o o i I .oo)oro)o)oooo)oF(,NEttr+?8888 'oooooFN+6 @ f ooocoo o o I Io z ( I T t Ii.- ! I io I .:, \ \ ; d.i, q F '-') P ! I) B? 2 J I t- "J). I .i I .o(( ( I t'? ,,_i l"'- -', ,:J -''jll ?,i! 1_._.r! '-, €o N\oa@()6 oo rrI I U' UJ nl:r<Hari,r0z rF 6 J l zz /._.-.-. r.-.-,-.- E i. o II I t'-4.- J (D CD 6) .l)(,)cr)(Yl tsErrl+r8888 oNtco '! -e ,loocoo 9I .! 0 2 I?! i I o o I l.iVi i i. \ a I\ \ a a.Ii, '\._,) .) t o ,t I ( i\ u F I 'i .o t -") 5 LJ I ^t , :.J t'? (o0 N tO 83. J otrFz oI ul .EG I 3 F6ZI tr,l HFo- lto a =a/,z EF J Dz2 o ) \ U' ,l !. z t ta.- o F 4 I io 2 l 1 o E t ai.ti, ,i ! B -ti!' - t i, \ \ \ ,.8 \ -) .5 t U -.- f d tI\ o Et tl \ ,o l. ( I I o E I I' :,J //"7j ._l /I trl\ )'(u.-J' N .a @ots\\o rNQ6oa o, o, o)g) o) d)oo)oFmNErrl+ooooo rOOoO 'ooooOFNsto oocoo J o E,Fz o 9 ulGG nlJoHUHF ES L Iz F 6 J fzz 7 \ o i. J tI t o U FIG. ]II_8 AREAS OF REINVASION, CATCHING STATIONS AND EXPERIMENTALLY TREATED RIVERS. ocP/78.2 page 37 BAMAKO Bogbe. Phase I I Pont Faya Phase I Niompourou Phaselll(W) Kouoro Radier Yanfolila SI KASSO Pan kourou' ,, BOBO-DIOULASSO, I ?i ti Lanviera Pont Diebou gou Madina assa BANFORAFourkou ra Routier Nan ienavogo Folonzo Ngapie I KORHOGO I Badikaha Massadougo Gite ? aka Chach6' II I aBoo :G: l-t ch. Ni I a I I a =o o ) 5o BuG- Marabadiassal \ t SEGUELA \I souare I MAN L. Kossou O Every dayCatching sites Areas of serious reinvasion t Areas of minorreinvasion Tiassale Jg]L 1977 Experimental lnsecticide Treatments - lnternational boundaries Programme boundary ABIDJAN wHo 78100 \ I I I n F z. ocPf78.2 PaSe 38 E U s z .t ( a a a a .l IL!._ a a a a! I I i \ a a o a o \ Utr F I iaJ\ l sa a f, o \.U) UJE or< :zHO e4tr- )z ultt a a a a a .\ a a a a ) oo J l 9 e oo oE ttttaaaaa ......./).. ( (. a a a 7- \ ! :I .o >E -Qo otr 'Aa a= c'- O^ OE oao! doo a :F-CCOoN6 oY = % i ..-")t5 i a ,t I z t. t .e vzz zoootrF F<<A <Jif)o 888 =lo r u 6 !r IO lO ui-o >x >* E QX iE i3 rat;9 Ee ie dE ?* H: Ex XE EE H: H; Eg >U UE >E =iE> =L Iu 6Y L. TNIT E T I '. !' I i I I \ \ \ i, \\ E----__ (\)t 3' I ------: 6d.t N .! 3!t -i t IJ s I f. I t'? 8 z9F EU Lo)oGF z,oo 4o (9 z 2z (9U6 UGoq U @ U G U - =G <9 o&,r U -F =I IGuao ozo q o F 9 =uozU o .i E g L g o z q o l. aI 'I BE :l :+ 'l i8 '1 {trl 8 .l E)"oo@i [,aEEHE ite s e E H EE >fEE EEE ET a a a a a o' a,{'..aa a "t ?p' .!.; at a .'a 'S. a +. a a a a r-\y a: at ."j .a1o. a ,l l a o ,o a a a rl ,a o a a tg -sb8E Ea6q ; i*g I E: E; E 5 E\iliIc o.a a. j' 'a O. ., l'.o a ..'a A. a I a a o a t I a o .o .a. a a a a a. a a. \-, \... aa a o .' i '.? r x a a N o .a '.4 ;.' .+ !i .l,i a a ) :|.- lt , ,,! \'..1 i.;tr .'a a ..aa '"''4r..... t t \o a o FJo EUL f -tizto tlF eetrEE 6 zo F =Goe a ti ., a, a a ! a ii. .t... .' .:. . ' .!" a aa, oa ,a 'aa o o o I t c 'a ?tN'l a o a .a a ,. ocp/78.2 Page 41 CHAPTER IV ECONOMIC DEVELOPMENT Ihe Unit started functioning in February L976. The first few months were spenE on faoiliarization tours within the Progranme area, establishing contacts with the ministries and officials concerned with development activities and projects in the oncho zones of the respective countries, with representatives of the Unit,ed Nations Development Programe, FAO, WHO and other specialized agencies of the United Nations, and with other multinational and bllateral aid agencies. Close association was established with the regional development organizations in the Programe area, in particular those based in Ouagadougou, and also with the Comit6 InEer- Etats pour la lutte contre la S6cheresse (CILSS), and the Inter-African Centre for Hydraulic Studies. During the course of the year the funcEions of the Unit were more to be information and liaison, namely to: specifically defined collect and disseminate basic socioeconomic data which may be useful for planning and development acti.ons by both beneficiary and donor countries; on the basis of the socioeconomic data collected, assist in the establishment of a socioeconomic data bank for the Progranrne area; - aE the request of the countries, study and advise on development projects being executed or planned for the oncho zone; - maintain contacts with all parties to the Programe and interested agencies /1(beneticiaries, sponsoring agencies, bilateral and multinational aid and financing agencies). Following this definition a standard questionnaire for collection and transmission ofinformation to the Programe on a regular basis was devised and circulated to the programe countries. rn 1975 the responsibility for preparing an annual report on socioeconomi.c developmentsin Ehe Programe area, which had hitherto been assuoed by the United Nations Development Prograrme, passed to the unit. with the assumpEion of this responsibility, the st;ffing ofthe uniE was effected on a multidisciplinary basis (sociology, agroeconomics, developmeni econooics and public health) in order Eo ensure the proper integration of the various aspectsof development. By combined use of the questionnaire and personal visits by members of theunit, infotmation was assembled for compilat.ion of the annual socioeconomic reports for L977and 1978. ocPf 78.2 Page 42 CHAPTER V RESEARCH AND ENVIRONMENTAL PROTECTTON Research The greater part of the research carried out by Ehe Onchocerciasis Control Programe fa1ls under the following main headings: (i) vector ecology; (ii) Vector control; (iii) Epidemiological, clinical and parasiEological research; (iv) Chemotherapy. This research has had a strong operational bias. While most of the work has been entrusted to institutions and universities under contractrl toro research scientisEs and nunerous short-term consultanEs, have also been employed directly by the Prograrme. An amount of approximately $ 2 3O0 OOO has been spent on research, equivalent to almost 7"/" of. total expenditure of the Prograrmte. Vector ecology It was appreciated at the beginning of the Programme that the vector, S. damnosum , was not a single species but rather a complex of several very closely related species. Initially the species could only be identified in the larval forn by examination of the giant chromo- somes in the salivary glands; therefore emphasis has been placed on finding morphological characteristics which would enable the field entomologist to classify the adults, pupae and larvae using a light microscope. Keys have been developed for Ehe identification of adults and a working grorrp was convened to consider their field application and adoption by the Programe. Research has also been carried out on the enzyme pollm.orphisms in the adults of the s damnosum comp 1ex. This method has enabled S. squamosuo and S. yahense Eo be different !a ted but it does not have the same field potenEial as morphological keys. Techniques were devised for the rearing of single generations of flies in the laboratory from eggs obtained from wild-caught blood-fed females. Until adult identification became possible, these methods were utilized during the study of the reinvasion phenomenon to obtain larvae for cytotaxonomic ldentification. The rearing technique was passed on to a few technical personnel for field implementation. AtterDpts were made to develop a laboratory colony of S. damnosr-m. Unfortunately, most efforts to Eransport live material, mainly eggs, to laboratories outside West Africa failed, except when the material was handcarried. However, some Progress was made in developing blood-feeding and certain mating procedures which provide a foundation for the continuation of these studies. The variations in behaviour and vectorial capacity of the different species have been studied. lnformation was derived coincidentally from a variety of research experiments and also directly fron the control operations. An X-ray fluorescent sPectroscopy technique was used in an attempt Eo identify the sources from which migrating flies emanated. A prolonged study was undertaken of the movement of adults in relation to major wind Patterns. I o 1i"a of research agreements financed by ocp is given in Annex rrr. tocPfTB.z Page 43 Studies have been carried out to determine the epidemiological iryortance of each of the cyto-species of the S. demnostm co,mplex. This work has tended to confirm the earlier findings that the savanna species of the cooplex, damnosum and S. sirbanum , are unable to transmit effectively the forest variety of O. volvulus, and vice versa. As the Prograrme relies entirely on vector collection to assess the S damnosum s.1. Present in an area and to evaluate the effectiveness of control, research has been aimed at developing an operationally acceptable, alternative method of catching the blackflies, and at finding an artificial substrate as a suitable means of determining the larval population. l\lo adult traps have been successfully tried. The first, a wi-ndow-pane trap, intercepts Ehe insects in flight; though useful as a research tool, it has not caught adults consisEently in numbers in any way couparable with vector collectors. It has shown, however, rhat flies tend t.o move uPstrean along, and just above, the river bed. The second, the aluninir.nn sheet trap, has proved more efficient than vector collectors particularly in reinvasion areas, but its effectiveness is influenced greatly by its location. It has the advantage of catching adults of physiological stages different frm those seeking a blood meal, especially gravid flies. However, such flies are not suitable subjects for an epidemiological evaluation of the control operations. Operationally, this trap would not only give less valuable results but would require as 8reat, if not greaEer, manpower input than at present available in the entomological evaluation netvork. After many trials it was found that clear plastic strips were the most effective artificial substrate for larvae, but they did not prove more attractive than the natural substrate available at any site. Nonetheless, through their use addirional information was obtained on Ehe distribution of the larvae in the water at depths of at least three metres. Vector control In view of the reliance of the Programre on one formulation of the larvicide, viz., Abate emulsifiable concentrate, priority has been given to finding an alternative. This research has been developed in close association with the Division of Vector Biology and Control of WIIO, Geneva. A floating-cage method has been devised for the testing of new insecticides and formula- tions against the larvae of S. damnosum s.1. enabling their effect on non-target organisms to be observed. The results of these small-scale tests are similar to what is obtained in riverine tests. Ttris is a narked advance on all previous methods and enabled the rapid screening of a range of products. However, the nr:mber of coryounds which x0eet the strict specifications laid down for the Programe and give maximust control of the vector, with minim,m effect on the other aquatic organi.sms, is very limited. So far, only Chlorphoxim has reached the stage of a large-scale field test. Results indicate that the fomulation of Chlorphoxim supplied, used at concentrations lower than are used with Abate, i,s more toxic to non-target organisms although effective against S. damnosum larvae. Likewise, other insecticides have proved too toxic to the non-targeE organisms and more selective formulations are being sought. Research has shown that the feeding mechanism of the Sinulitm larvae filters from the rdaEer particles of a size mainly in the range of 5 to 15 qp. Ttrese particles take 18 to 30 minutes to pass through the gut. Accordingly, the effectiveness of particulate formulations of different insecticides, including AbaEe, is being tested. Of special interest are microencapsulated formulations which may enable larvicides to be more target-positive. In this respect MeEhyl-Dursban, which failed in other formula- tions, is under trial as Reldan 10-10 presented within capsules which are intended to rupture when ingested by the larvae. The possibility of using pyrethroids in similar formulations is being explored. Trials are also under hray to determine the usefulness of insect growth regulators, Dimilin and Altozid, in the control of Simulium. S. ocPf7s.2 PaBe 44 Because of the need to monitor the susceptibility of Simulium larvae to Abate and to any other insecticide which might be introduced during the period of control operations, a method was devised to enable susceptibility tests to be carried out in field conditions and give consistent results. Ihis method is now in operational use and to date there is no evidence of the development of resistance to Abate anyrhere in the Progranure area. On the other hand, resistance to DDT has been observed in larvae collected from rivers where that insecticide had not been used previously for Simuliun control; presumably this results from DDT leeching into the rivers after agricultural application. Before an insecticide can be safely accepted for operational use, large-scale riverine tests are necessary. These tests cover a period of one year Eo take into account the variety of riverine and climatic conditions common to the area. A Scientific Advisory Panel meeEing was convened in Geneva in July 1978 to assess the present knowledge on alternative insecEicides. This meeting, attended by representatives of several chemical coryanies, made recormendaEions for future work aimed at finding a standby product to replace Abate, should this become nece s sar y. Ep idemi olog ical, clinical and parasitol ical research On the medical side most of the research has been underEaken in the course of the epidemiol-ogical evaluation activities, producing a greater insight into the implications of the disease. To provide comparative data on the dynanics of onchocerciasis transmission and on the pathogenesis of the disease from a similar, uncont.rolled area, a longitudinal study has been undertaken in Northern Cameroon over a period of three years. The applied research undertaken by the Epidemiological Evaluation Unit has been mainly concerned with operational epidemiological aspects of onchocerciasis in order to improve the field survey techniques used. In Ehe field of parasitology, several different meEhods for the examination of skin snips were coryared to determine a suitable technique both for large- scale field surveys and for the detection of new and light onchocercal infections. I'licrofilaruria, which is an important sign of systemic onchocerci-asis, was investigated and a sirnple field technique based on filtration of urine was developed. Histological examinations of skin snips have been carried out to assist in the identifica- tion of skin lesions due to onchocerciasis. , rhe sta ava Although it o volvulus ges found in ilable to ena has been recognized for some time that there are aPParent differences beitween found in the forest and savanna areas, and that the parasites in infectiJe the vector may be other than O. voIvulus, until recently no techniqrr" ,.{ b1e clarification. RecenE .d.rr.r"u" i. histochemical staining techniqued are now beginning to provide meEhods which could have future operational consequences and possibly lead to a more precise enEomological evaluation of transmission Potentials. Staining techniques have also been devised for the differenEi-ation of the microfilariae of O. volvulus and D. streptocerca. Ihis method has enabled a significant Prevalence of D. streptocerca to be noted in the Volta Region o f Ghana. A study is being undertaken of the digestion of skin snips by Collagenase, a method which enables the total number of microfilaria present in a snip to be counted, as against only a percentage by the standard techniques. In the ophthalmological field, different vision tests were explored to ensure reliable results on impaired vision in the villages examined. It was found that different figures in the shape of a hand were preferable for use in Ehe operational conditions of the Progratmte. Following reports from other onchocerciasis areas indicating a high Prevalence of glaucoma, especially in young age-groups, measurements of intra-ocular tension were taken during two years. This research has shown that severe ocular onchocerciasis is strongly associated with secondary glaucoma which represents a final stage of severe ocular Pathology. ,t ocPf 78.2 Page 4j Another irnportanE operational aspect of onchocerciasis is the definition of cases at high risk of blindness. For this purpose the relationship between the ocular parasite load and severe onchocercal eye lesions was investigated, as well as the iroportance of optic nerve involvement in onchocerciasis and its influence on the visual fields. Following studies on the relationship between the ntmber of microfilariae in the anterior chamber of the eye and the intensity of onchocercal infections, it has been shown that the presence of ntmerous microfilariae in the eye is associated wiEh severe and irreversible lesions. A scoring system for the ocular microfilarial load has been developed. It has also been demonstrated that visual field defects in onchocerciasis constitute an irnportant and conrnon visual handicap, often equivalent to blindness. The epidemiological and ophthalmological data collected by the Prograrrne has served as a basis, in combination with other data particularly geographic and demographic, for the redefinition of endemicity levels. Consequently the idea of t'sporadicrrendemicity has now been abandoned. Chemothe!apy Within Ehe Prograrune area a trial was undertaken to determine the possible advantages which might derive from nodulectomy. Initial results indicate that such practice could be beneficial in certain cases, for exaryle, in children with head nodules. In the absence of a suitable drug for rnass treatroent., a chemotherapeutic research progranme has been progressively inplemented. For obvious ethical reasons trials were under- taken only with drugs Ehat are widely used and whose efficacy, side-effects and toxiciEy are already well-known, but whose activity and ruethod of use vriEh onchocerciasis patients in Ehe Programme area needed Eo be specific. Ihe reference microfilaricide, Diethylcarbamazine (OnC) has been tested both in restric- ted communities and for mass treatment in whole vi1lages. A variety of regimes was tested and the subjecEs followed up medically for at least several months and sometimes for several years. The results may be sumarized as follows: (i) in lighE to moderately infected persons the side-effects can be conErolled by administering gradually increasing doses and adding antiallergic arrdfor anti-inflanmatory drugs ; (ii) in patients with a high parasite count the side-effects are extremely troublesome, but again, the side-effecEs have been reduced by using low initial doses and eroploying antiallergic drugs; (iii) the effects on the ocular parasite count are excellent. The ocular reactions Eo the drug are either not dangerous or can be controlled by corticoids; (iv) the addition of other anthelminthics, such as levamisole, to DEC does not help; (v) DEC eyewashes cause violent ocular reactions and so cannot be recornrnended in prac tice. Suramin, the recognized macrofilaricide, was prescribed with town outpatients and meso- and hyper-endemic village corrmunitiesr up for three years. The following observations were made: the usual precauEions to some of which were followed (i) Ehe toxic and side-effects of suramin are most violent in subjects with highfilaria counts, so strict medical surveillance is necessary; (ii) Ehe parasiticidal activity is more marked in moderately infected Ehan in highlyinfected patients; ocPfts Page 46 (:.ii) the effect on the ocular parasite count is excellent but there is some risk of developing irreversible lesions. A bibliography on suramin L97O-1975 was published. Other drug trials using metrifonate, levamisole and nifurtimox have been carried out in the Progranme area and in Cameroon. Metrifonate has been administered in different regimens to a hlperendemic village but the results will not be available until late 1978. In order to strengthen and accelerate the studies of current and potentially suitable drugs, a Chemotherapeutic Research Centre was established in Tamale in northern Ghana in t97 6. For the future, chemotherapeutic research is directed towards short-, medium- and long- term objectives. The reduction of the risk of blindness among populations infected before the beginning of the Programs is a short-term objective. 2 The target group for possible action is made up of individuals who do not yet suffer irreversible ocular lesions but have a sufficiently high level of infection for the risk persist that such lesions may appear during the months or years to come. from Eo In a few years this initial group will only comprise tq/o types of individual: on the one hand those in whose case it is too late to intervene and on the other those whose condi- tion will never evolve tovrards blindness. lrlhen that moment comes no Preventive measures will any longer be justified. The criteria for identifying the group at risk must not only be technically acceptable(sensitivity, specificity, reproducibility, etc.) but also usable under field conditions and by auxiliary personnel. These two latter factors rePresent, at the moment, a major obstacle to mass diagnosis of a possible target group. In regard to therapy the classical filaricides administered at the usual doses perhals precipitate ocular lesions. To use them in a mass campaign would therefore require Ehel development of new treatment schedules, less toxic and better tolerated by the populations. In the medir:m term the possible topical use of filaricides (eye drops, transcutaneous preparations, etc. ) as well as operations such as cephalic nodulectomy in children under 15 years of age should be given more study. Likewise, control of transmission through measures against the vector has created new epidemiological conditions which may change completely the indications for chemotheraPeutic measures. The evolution of ocular lesions may perhaps be spontaneously slowed down, if not stoPped altogether, once a zorre is protected. The need to treat the groups at risk would in that case be felt much less acutelY. Moreover, the problem of the toxiciEy for the eye of the filaricides used at Ehe moment has not yet been solved. Mass treatment designed to dirninish the risk of blindness in a protected zone may not therefore be clearly indicated. Longitudinal surveys with a view to comparing the risk of blindness (1) in controlled and uncontrolled zones and (2) in the absence of and after treatment, must be carried out before a decision can be taken regarding intervention. These medium-term objectives imply a reduction in the human parasite reservoir. Such a reduction can only be obtained by chemotherapy applied to the whole population. Ttrere is a strict time limit involved, since by definition these objectives will gradually lose theirjustification as the end of the entomological Prograrmte draws near. ocP/78.2 Page 47 Here again, there can scarcely be any quesEion of banking on the discovery of new products since their develo,pment Eay take five to 10 years even when a rrcandidatet? product is available, which does not seen to be the case at the ument. Research should be directed towards the possibility of using, in mass campaigns, filaricides at present available or already undergoing clinical tests. Ttreir action should be studied in relation to the reduction of the hr.man parasite reservoir, which means that it oust be possible to adrninisEer them to all the infected population and not merely to a restricted targeE group, as would be the case in a campaign to prevent blindness. Fina1ly, a Prograume of chemotherapeutic research is in line also with some long-term objectives. The most iryortant of those objectives is the need Eo provide a method of controlling the disease in succession to the vector control caupaign, so as to keep transmis- sion down to an acceptable level once that caupaign is coopleted. Several solutions for this problem of the Progrnmers consolidation phase are being studied. Most of them aim at controlling the vector: biological control, use of encapsulated forms of insecticide, reorganization of the vector control. caryaign on the basis of local resources, new methods of conducting spraying operations, etc. None of these solutions, however, would seem to be as satisfactory either from the scientific or from the financial and logistic point of view as the control of transmission through a chemotherapy campaign affecting the whole population. Such a campaign, aimed at neutralizing or periodically reducing the huoan parasite reservoir (every five years, for exaryle) would only be possible through the use of a macro- filaricide that was effective and could be used in mass campaigns. 0n Ehe other hand, the tirae needed to achieve that objective - 15 or so years - makes itpossible to envisage the development by the pharmaceutical firms of a new macrofilaricide meeting the standards of efficiency and safety required. Co@eration with the phannaceutical industry The ever-increasi.ng cost of developing any new product and uncertainty regarding the profit that may be m:de by producing a medicaoenE against onchocerci.asis discourage Ehe ParticiPation of the phartaceutical industry in research on the chemotherapy of onchocerciasis. Ihe high cost of developing a medicanenE is mainly due to the following factors the need to mFintain on a pemanent footing research facilities designed to Eest products that are potentially valuable for onchocerciasis control; the need to have available in the endemic regions adequate clinical facilities and personnel capable of carrying out clinical research; the existence of national standards in many countries (and standards that are becoming more and more stri.ct) in regard to the effectiveness and safety of drugs; Ehis is ParticuLarly true in the case of a product intended for use in a mass campaign; the possibility that a 'rcandidate'r product of clinical interest may be costly to synthesize at the outset and may remain costly if lt is produced only in smal1 quantities; the time needed t,o discover any product that is altogether new i-n this field. Ihe Potential benefits of a nets product such as a macrofilaricide may seem of a social raEher than an economic nature and it would appear that financial support would be necessary to ensure the participation of industry in Ehis tli?e of research. ocPf 78.2 Page 48 An accelerated progranme of onchocerciasis chemotherapy which would aim at increasing Ehe chances of the discovery of a new macrofilaricide by the pharmaceutical firms by encouraging cerEain decisive sEages in the development of the new product would be justified by the combination of the three factors mentioned below: (i) Ehe iryortance of making provision for the consolidation phase of the present vector control progralme ; (ii) the value of discovering a new macrofilaricide that was safe and effective and could be used as the weapon of choice during that phase; (iii) the need to aid firms financially in order to obtain their cooperation in this type of research. The irnplementation of this research progranme will be carried out in close cooperation with the Special Prograrune for Research and Training in Tropical Diseases (IDR). At the present time TDR activities in respect of onchocerciasis chemotherapy are along three main lines: - encouraging the synthesis of new filaricides by the pharmaceutical firms; encouraging the esEablishstent of screening centres for such products; - encouraging clinical trials in endemic zones of products that have shown filaricidal activity and for the use of which in hr:man medicine permission has been obtained. For its part the medical personnel of OCP is in a unique position to carry out, under the besE possible technical and material conditions, a whole series of studies directly connected with Ehe operational objectives of the Prograrme: therapeutic trials designed to test at village comnunity level on the one hand the the classical filaricides and on the other Ehe various products already used i.n human medicine for diseases other than onchocerciasis but which have already shown filartci- da1 activity; - clinical, morphological and other studies of the llazzotti reaction; an atteryt tol classify this reaction also fits inEo this framework as does the study of methods naking it possible to diminish its intensiEy; - experimental epidemiological studies with the main ai-m of defining various population groups (target groups for certain measures, high-risk groups, etc.) or for determining the relationship between certai.n forms of treatment and the evolution of the disease. Environmental Protection The weekly application of the larvicide used to control the vector, Abate emulsifiable concentrate, could have an adverse effect on non-target organisms. Therefore, in the early stages of the operations, an aquatic monitoring progralme was set in moEion. Unfortunately, no data was available as a basis for future cornparison; thus, studies of the rivers covered by the first phase of operations corunenced almost at the same Eime as the larviciding. Only on two rivers not brought under treatment until the third phase l^ras pre-control data obtained. Despite these problems, the protocol developed for the aquatic monitoring and followed consistently on eight rivers principally in the southern section of the Programme area, has proved adequate and sufficiently sensitive to record any significant alteration in the cornposi- tion of the riverine fauna. Results have indicated, as expected, a certain diminution in the overall quantrty of non-target invertebrate organisms in those rivers under continual control. This generally amounts to approximately 30% but there is no indication of a similar effect on the fish population. ocP/78.2 Page 49 Ttre inltlal iryact of the insecticide on the aquatic fauna appears to be more drastic during the flret treatments of a river but, even without interruption of the weekly schedule, the rtverine fauna is able to recover gradually to a level conparable with other rivers in the area. Studies on the fish population have not revealed the disappearance of any species under the regular appllcation of larvicide, and the ntsrber of young fish remains high' suggesting that breeding is unaffected. Data collected ie recorded on specially designed forms and fed into a conputer for subsequent analysis. Because of the tremendous differences in the rivers, not only seasonal but annual on account of the varying rainfall affecting flow and discharge, several years study will be necessary before firm conclusions can be drawn. However, a certain consistency ln results has already been noted permitting a reduction in monitoring frequency from monthly to quarterly lntervals. In conjunction with these monitoring activities there is a back-uP research progranrne which ls leading to a greater understanding of the natural ecological balance that exisEs in the rivers and the interrelationships of the different organisms. @ o a 9sndtu a a oa ooa r a a a a o T zt =m !. oc I o =ol26) d< ,1. 2o m I >C* or!r;E€€ =Ist I l a99q 9.ooO ,e ,i ,:;5F3i3a_32 <gii oi:fiq o9 o o a N ocP/78.2 page 51 CHAPTER VI TRAINING After adoption of the PAG Mission Report in 1973, the rapid implementation of rhe 0nchocerciasis Control Programme and launching of operations required a large number of personnel of varied disciplines and levels. The min Ehrust of OCP being entomological the SreaEest need was, of course, for entomologists and technicians. The demands of the prograrmre were Sreater than the available supply and a contracE was concluded with Ehe OrganisaE.ion deCoordination et de Coop6ration pour la Lutte contre les Grandes End6mies (OCCGE) for the training of these categories of personnel at the Institut de Recherches sur ltOnchocercose(IRO) at Bouak6. Under this contract four entomologists, one assistant entomologist and 26 technicians were trained between 1974 ar.d 1977, sufficient, in fact, to fill all the posts in OCP authorized in the budgeE. WiEh funds provided for fellowships, one nedical officer received Eraining in ophthalmology and another followed a course in public health. As the Prograrme developed, the need for in-service or more advanced training of itspersonnel became evident.. Training appropriate to the speciaLLzed, needs of the different sections of the Programme was organized, for example, Ewo technicians received specializedinstruction in rearing single generaEions of flies for taxonornic identification, and several entomologists were introduced to the new techniques developed for identifying the different species of the S. damnosum cornplex. The opportunity was given to an assisEant entomologistto receive academic training to qualify as an enEomologist. on the epidemiological side requirements were much smaller and in-service training waspossible: technicians were taught to take skin snips and examine them for mi.crofilariae, and census clerks to collat.e essential information on the population in villages surveyed by the epidemiological teans. In the field of administration, eqhasis was given to providing instruction, either inOuagadougou or in WHO headquarters, Geneva, in stores management, book-keeping, cost accounting, and preparation and execution of Ehe budgeE. Attenti.on was also paid to thetraining of mechanics, on whom much of the success of the operations depends. English andFrench language course vrere arranged and continuous in-service-training in secretarial duties was provided. rhe methods and techniques which oCP has developed to survey, control and evaluate thevector and Ehe disease are models of value to entomologists, parasitologists and ophthalmolo-gists studying onchocerciasis elsewhere. Accordingly, doctors and scientists participate inPrograrme activities for varying periods including, so far, an entomologist from Sudan, trophysicians - from Mali and BrazLL - and an ophthalmologist and health superintendenE fromNigeria. At Ehe request of the Ghana Government, two national entomologists were attachedto the Tamale sector for four months practical training prior to their subsequenE assignmentby the Government to assist with preliminary sEudies in the proposed extension area. TtrePrograrmte has also been included in the reorientatlon training course for wHo entomologists which had 11 participants in 1976 and 10 in 1977. At its fourth session held in December L977 ia Kuwait, the JCC confirmed its specialinterest in Ehe question of training. The participating countries strongly eryhasized thatthey wished to avail Ehemselves of all the possibilities that the progranrme could offer inthis regard. During 1978, the Prograune Director visited each of the countries for an exchangeof views with the authorities. The action Eaken so far was reviewed and the problem oftraining in onchocerciasis was considered withln the context of the overall tr.ini.,g prograrmeof WHO. The specific areas in which oCP can assist in training national personnel are: - parasitology and ophthalmology as applied to the collection of base-Iine data on oncho-cerci'asis and to Ehe epidemiological evaluation of a conErol campaign against thedisease I ocPf 78.2 page 52 - ecology and control of the vectors of onchocerciasi-s as applied to the geographical surveillance of the breeding sites, to the organization of detailed entomological investigations, and to the planning andestablishment of an entomological evaluation ne twork; ecology and control of the vectors of onchocerciasis as applied to the planning, costing and implementation of vector control oPerations (aerial logistics, equipment and ground support networks); cytoEaxonomy of the S. damnosum corrylex in lJest Africa; techniques for the collection, classification and presentation of data on economic development projects in the Prograrme area; planning of the infrastructure, and financial and administrative management for an onchocerci.asis control campaign. As of September 1978 the training support within the framework of OCP was as shown in the following Tab1e VI-1. ocP/l8.2 PaSe 53 TABLB VI-I, ITAINING SUPPORT SINCE INCEPTION OP PROGRA}I}G As8l6tant d rAesalnisgerenE MinlstCre de la Srnt6 Publlque, AnEenne d rHygiene Yrmouasoukro, CAte d rlvoire AIIOTO, I.lr NrGueesen DEH DEH, l,lr Jesn Ivory Corrt Ivory Corrt IRO, Bouak6 lRO, Bourk6 Entonology 4 Eonths Entonology 4 monthsAssiBtant d rAssalnl6Bernt Uinlstere de 1r Sant6 Publique, Secteur de Grgnoa, COte drlvoire A6Elrtant d rAs!ainisseEent Ulnistere de la Sant6 Publique, Grandes End6ules !,tan, COte drlvoire Nare Nrtionality TilIe or posE occupled(at tire of celectron) Training instituEions Fi,e Id o f specializaEion Dura t ron FELI.oI{SItIPS ABOUSSA, Dr Aylt6-Po11y AGOIIA, Dr Hyaclnthe AKOGBEm, Mr Codjo Mrrtln AIAKYE, Mr Joseph Somua ANITI, Mr Iaonrrd A. K BUGRI, Dr Srmuel Z GIJLE, Dr C16rent OUS$, Dr ceruin SAHIIAN, Ur J.rc! SEKE1ELI, Dr Azodogr SOME, ltr Antoine lllISONt Mr Ulchael Davld ASIGRT, rlr BA , Dr OuEr Upper Vo1t. Be nln Ghau ToBo Bcnln Ghane Ghau Benln Benin Ghrna Togo Ghana Ghane Mstl t't6decin Chef Subdivlsion Srnltrire Aneho, Togo Docteur V6t6rintlre Chef de ls R6gion Elevage de lrAtacora, 86nin Profe!aeur de liologie- G6ologie, Lyc6e Behtnzln Porto-Novo, B6nin Rese6rch Officer Council for Sclentlfic and Industrirl Recerrch Accrr, Ghrna Rc!e.rch Officer Councll for Sclentiflc and Indu!trirI Re8eerch Accta, Gh.nr Docteur en H6declne M6decln Chef du Secteur No. 3 des l.lehdles TrrnsDi!sibler, Bauko, Mali lGdical Officer Ulnlstry of Herlth Accre, Ghana M6decin Chef Clrconscrlption U6dicale Djougou, B6nin Chef des Services de lt6decine et de PharMc1e HOpltal de Parrkou, B6nln Research Scienti6t Instltute of Aqustlc Bio logy Achlrcta, Ghsnr Docteur Ing6nieur Entonologic Agricole Profegseur Sciences Nr ture I le I CollAge de Tounouu Bobo-Dlouhsso A!Bistant EntomologisE Mlnlstly of Health Accra, Chana Clinique Ophtrlmologlque Unlversit6 de Dakar Senegr I ORSTOI!, Bondy, Fr&nce OCCGE, Bouak6 ORSIDM, Bondy, Fr.nce University of Mieni Dlilml, Floridr Centre for Disease Control Atlanta, Georgia Ecole Nationale, Slnt6 Publique de Rennes, France OCP ouagadougou C linique Ophtalnologlque Universlt6 de Dakar 56n6ga 1 University of Salford UniEed Kingdom ORSToM, Bondy, Frrnce OCCGE, Bobo-Dioulaseo OCCGE, Bouak6 London SchooI of Hygiene and Tropical Hedicine Unlted Kingdom OCCGE, Bouak6 ophths lmo I ogy EntoEo 1 ogy EnEoEoIogy Hydrob i o logy En tomo I o8y Publlc health Para6 i to logy Ep 1 demlo Iogy ophEha lnoloSy Hydrobio logy Entomo logy Entono logy Paras 1 Eo Iogy Pes t ic ide re s idue anr Iys rs 15 nonEhs 5 months 2 months 3 years 2 years 3 years I monEh 1 year 3 years 3 years 2 years I year llAINING 797 4 GMTO, Mr Bagul J. B Ivory Coaat IRO, Bouak5 EntoEo logy 4 nonths ocPf78.2 Page 54 ADJONOU, Mr Christian AHADZIE, Mr Daniel .A.ITCH.EDJI, ur Cyralle AMPAH, Mr Victor L AVISSEY, Mr Henry S MAH, l,tr Akwasa A TABLE VI-1. ISAINING SUPPORT SINCE INCEPTIoN OF PROGRAISIE (continued) Togo Technicren d rEntonologie IRo, Bouak6 Chef de la section drEntomologie MlnistEre de Ia Sant6 Publrque, Lom6, Togo Ghana LaboraEory Technician National Malarla Service Minrstry of Health Ho, Volta Region, Ghana IRO, Bouak6 Benin Infarmier drEEat Technrcien d rEntomologie Antenne EnEomologrque occcE CoEonou, B6nrn IRO, Bouak6 Ghana IEboratory Technician National Malaria Service MrnisEry of HeaIEh Ho, Volta Reglon, Ghana IRO r Bouak6 Ghana Technrcian Natronal Malaraa Service Mrni6try of HealEh Ho, volta Regron, Ghana lRo, Bouak6 Ghana Te chni c ra n National Malaria Servrce MinisEry of HealEh Ho, volta Region, Ghana IRO, Bouak6 Infirmier AdjoinE 4dme 6chelon MinisEere de la FoncEion Publique eE du Travail Ougadougou, HauEe-Vo1ta Entono logy 4 nonths En t oDo logy L-L/2 En tono Iogy 2 nonths Entomology 2 monEhs En tomology 2 EonEhs EnEono logy 2 months Name Nationality Title or posc occupied(at tire of selection) Field of specialization Dura t ionTraining insEitutions TMINING (continued) t974 Encomo Logy Entonology Entomology Entmology En tono logy EntoEo logy En Eomo logy 4 monEhg 4 nonthe 4 month6 IO months 4 months 3-1/2 nonths 5 monEh! GBOHO, Dr Chri6tophe NION, I.lr Joseph OCRAN, Ur Michael SAWADOGO, Mr Rsogo 0. SoME, Mr Antolne ZERBO, l'1r GasEon IfeE, I,lr Atse Ivory Coast Ivory Coast Upper Volta Upper VolEa Upper Volta Upper VoIta Ghana V6t6rinaire Inspecteur MlnistEre de Ia Production anlmle, Abidjan C0te drlvoire As6istant d rAssainissement Inspection Sanitaire Ministdre de la Sant6 Publique, Daloa Cdte drlvoire Contr0 Leur Phytosanrtaire Inspection des Produits v696 taw l'lini6Eare de 1 rAgrrculture eE de lrElevage oua gadougou, Haute-VoIta Medical Entonologist MinisEry of Health Epidemrology Drvision Infirnier 1er 6chelon Anlenne Onchocercose Banfora, Haute-Vo1ta Professeur Sciences Na ture 1 le s CollEge de Tounouu Bobo-Dioulasso, Haute-Vo1ta Professeur de Biologie MinisEEre de lrEducatlon NaEionale, Ouagadougou Haute-Vo1ta IRO, Bouak6 IRO, Bouk6 IRO, Bouak6 IRO, Bouak6 lRO, Bouak6 IRO, Bouak6 oCP, Bole t97 5 MRRO, Mr T616 Upper Volta IRO, Bouak6 En Eomo logy 3 Eonths ocPfT Page COULIBALY, I'lr Soungrlo DIALIO, Mr Isaac DIARM, ltr Yousaouf GMGIJIDI, Mr Kokou Pierre Beni.n I(ASSAMBAnA, Hr I'trbo Ma Ii OTCHOIIARE, ilr Jous Benln IADIJ W-1. TRAINING SUPPORT SINCE INCEPTIoN 0F PRoGR HME (continued) Ma 1i Conducteur d rAgriculcure 3Ere classe l.tinistere du Travarl et de la Fonctron Publrque BaMko, MaIi IRO, Bouak6 Ha 11 Infirmier drEtaE 2Ere classe Responsable du Poste M6dlcal de ITOICIA Klrr, l,lali IRO, Bou8k6 Ur li Ing6nieur des Trevau Agricoles - 3Ere classe Op6rrtron Riz SEgou, !,hli IRO, Bousk6 lnflrnler SpScialiste en En cono log ie- Paras i to I ogie OCCGE, Cencre lluraz AnEenne EntoEologique Coconou, 86nin Infilnier drEtat 2Ene classe Secteur des Grandes End6ni es Bandtrgara, l.trIi Infimier Sp6ciallste en Entonolog ie-Para s i to logie OCCGE, Centle Muraz Antenne EntonoloSlque cotonou, Bdnin IRO, Bouak6 IRO, Bouak6 IRO, Bouak6 En tono loBy 4 Eonths En tomo logy 4 Eonths Entono I ogy 3-1/2 nonths En totro logy 3 months En tomo 1 ogy 4 nonthg Entomo loBy 3 months N.r Nrtioulity Tltle or poat occupied(rt tim of selection) Irsinrng institutrons Fleld of specr!lizrtlon Dura t i. on IIAINING (conclnued) t97 5 DOFINI, l,lr Jrcques FIASORGBoR, Mr c€or8c K. @NE , M! Urwutosu MAH I,ANE, Mr Abdoulaye TLAHO, Hr Plerre Clrver fOMTE, Mr KaEi Upper Volt. Upper Volta Upper Volta To go Niger Ghana Infiroler Adjoint 4 Ere 6chelon Cenlre Mddlcrl Hound6 MlnisEere du Travall et de la Ponctlon Publrque Bobo-Dloulasso, Hrute-Voltr Technician lllnistry of HesIEh Accra, Gh.na Laboratory Technicirn !hnistry of Health Lore, ToSo lnflrnier 1er 6chelon Centre Mddical de Hound6 tlaute-VolEa Sp6cialis te d rEntoEologle- ParaslEologie de IrOCCGE Service des Grandes End6nies, Nlamey, Niger Inflrnaer 3Ere 6cheloo Dispensalre de Banforr IRO Bourk6 IRO, Bouak6 IRO, Bouak6 IRO, Bouak6 IR0, Bouak6 IRO, Bouak6 Ent omo I ogy En tomo 1 o8y EnEomology En Eomo I ogy Entomology En tomo I ogy 3 months 1-1/2 nonths 4 Donthg 3 oonth! 4 months 3 nonEhs t97 6 Name NaEionality Title or po6t occupied(aE time of selection) Training instiEutions Field of specializaEion Dura tion TRAINING (continued) L977 Entomo logy Ent omology En tomo logy 4 nonths 4 Eonths 6 weeks DIALIO, ltr Arba l. OUEDRAOGO, Mr M. .ldaxlre SIMAGA, Dr Bakary Upper Volta Upper Volta Ma 1i lnfirnier 3Ere 6chelon Centre Muraz Bobo-Dioulasso, Hsute-Vo1ta InfirEier 3Ere 6chelon Centre de Sant6 KoEblssiri, Haute-Vo1Ca OCP sEaf f reBber IRo, Bouak6 IRo, Bouak6 IRo, Bouak6 197 E ocP f78 .2 page 55 ADA}0U, l.lr Haudi Niger AGOLJA, Dr Hyacinthe Benin BALDE , l,lr Mamdou S Guinea CAIARA, Dr Sekou Y, Gu anea DIALLO, !'lr Amdou Guine a DORE, Mr Iah Guinea FASSEM, Mr Ido Upper VolEa GMMOU, Mr Ciba Guinea KAFANDO, Mr Jean ChrisEoPhe Upper Volta KASSE, Dr Yaya Guanea KONE, Ur Koho Raynond Guinea TABLE VI-1. TRAINING SUPPORT SINCE INCEPTIoN OF PROCRAMIIE (continued) Aide-Assistanc de ltAction Socrale, 2dre classe Niarey, Niger Sector Chief, oCP B8uko, Ua I1 Chef drEqui.pe EnEomologre Servace NatlonaI de Prevention, Projet Paludisme, Conakry, Guin6e M6decrn Inspection M6drcale des Ecol.es, Conakry, Guin6e Chef de la Section ParasiEologie Service National de Pr6ven!ion, Laboratoare National, Conakry, Guin6e Chef d'Equi.pe Prolet de Lutte contre I ronchocercose, Conakry Gurn6e Infirmie r oCP, Epidemrological Evaluation Unit Ouagadougou, Upper Volta Parasltologrste, ProJeE de Lucte conEre 1 ronchocercose, Conakry, Guin6e Laboratory AssastanE OCP, Epademiologacal Evaluation Unlt ouagadougou, Upper Volta M6 de can-op hta Ino 1og is te Directeur, Projet de LutEe contre lr0nchocercose Kaokan, Guin6e oCP, LaM-Kara IRO, Bouk6 IRo, Bouak6 IRo, Bouak6 OCP, Eprdeniological Evaluation UniE ocP, Eprdeniological Evaluation Unit Ouagadougou, Upper VolEa IOTA, BaMko Centre Muraz, OCCGE Bobo-DiouIas I o oCP, Epideniological EvaluaEion Unit Ouagadougou, Upper VoIta CenEre Muraz, OCCGE Bobo-DiouIas6o IOIA, BaMko lRO, Bouak6 OCP, Bobo-Dioulasso IRo, Bouak6 cy totaxonomy Entonology Parasitology 2 EonEhs ParasiEology 2 oooths 0phth4 1mo logy 12 monEhs Parasitology 3 nonths Para6 i to logy 2 month! Micro6cop re 1 month ophEha 1mo 1 ogy 12 nonths Eotomo logy 4 monEhs Entomo Iogy Entomology 8 weeks 6 Eonths 2 weeks 4 months KOtnoU\rI , Mr Ketevi Chef drEquipe, ParasiEologre, Servlce National de Pr6venEion Projet PaludrsEe Conakry, Cuin6e Togo AssistanE d rEntonologie Service des Grandes End6mie s Lon6, Togo 3 months 4 Eonths ocPh paSe IABLE vI-I. I?AINING SUPPORT SINCE INCEPTION OF PROGAA!'IHE (continued) A lisE of 16 candadates for traaning was submitted by letEer dated 20 SepEehber 1978 from the MinisEry of Health, MaIi Nare Nrtiouli ty TItlc or port occupicd(rt Eir of cclcctlon) Trrining rn!titutlons PieId of specialization Dula t ion TMINING (continued) 19 78 IABO, l,tr Rahiou IAMA, l,lr Roger MENSAH, Mr Gilbert SAGNO, I'lr Arslne I(ABA, l.lr Kabine CAMARA, Dr Sekou Y KOUROIJIIA, l.lr SouleyMne MASAOE, Hr Nicholas J oUIAR.E, H! Theoua Niger ABBlstant drElevege 2ere chlse Leboratoire drElevage Niary, Niger Guiner Professeur de Blologie Facult6 de6 Sclencea de la Nature Conakry, Gurn6e Cha196 de Recherchee Antenne de Recherchee Entomologlques, Cotonou Benin Gui ne e BiologisEe, EnqueEes Ps1ud. , Service NrEioul de P16vention, Conakry Gui n6e Guine a AsgiBtant de IrEntomologiste OUS Projet de LulEe contre 1 rOnchocercose, Conakry Guin6e Guinea M6decin Inspection M6dicrle deg Ecoles, Conakry cuin6e Guinea Chef drEquipe Section de Parasitologie Prolet de Lutte contre lr0nchocercose Conakry, Guin6e Tanzanra DisEricE Herlth Officer Regional Deve loprent Arusha, Tanz.nia Guinea As6istant de 1 rEnEomologiste Ol,tS ProjeE de Lutte contre I rOnchocercose, Conakry Guin6e oCP, TenkodoSo IRO, Bouak6 IRO, Bouak6 oRSmM, Bouak6 IRo, Bouk6 IRo, Bouak6 ocP IRO, Bouak6 lR0, Bouak6 ocP lRO, Bouak6 IRO, Bouak6 ocP Entomology EnE omo IoSy Hydrobao Iogy En tomo Iogy En toEo loBy Enlomology Enromo 1 ogy Entomology En tono 1 ogy 8 weeks 6 months 4 Eonths 6 nonths 4 months 4 nonths 1 month 4 months 4 month6 1 month 4 Eonths 4 Donths I month ocPf78.2 page 58 CHAPTER VII IMPLEMENTAIION AND COSTS Budget execution L974-L979 Expenditures for the 1974-1979 period are expected to be approximately $ 55 360 OOO,l representing savings of some $ 7 2OO OO0, on original estimates. A comparison between the PAG Mission estimates by activity for expenditure currently estimated as of llay L978 for the same period, breakdovrn: L974-L979 and total gives the following Act iv.!-ty Vect.or control Epidemiologica 1 eva lua t ion Economic development Director rs Office, ADMIN , WHO support, meetings Research/tra in ing JCC Per sonne 1 Aerial contract In sec t ic ide Resear ch/tra ining Opera t ion s /ma i,nt enan c e f trave 1 Capital items Other (JCC, meetings, consu ltant s ) PAG ($) 35 083 000 3 406 000 1 399 000 13 390 000 9 282 000 ($) 35 175 000 2 979 000 827 000 lt 583 000 4 317 000 479 000 Savings ( oyerrun ) ($) 92 000 427 000 572 000 1 807 000 4 965 000(47s OOc)z %of Curren t %of Eota 1 es t imates tota I 56 22 I5 64 5 I 5 2 2L 8 I Total 62 560 OOO 100 55 360 OOO lOO 7 200 000 A comparison between the PAG Mission estimates by category of expenditure for L974-L979 and anticipated expenditure for the same period, is as follows Ca Eegory PAG %of Curren t %of Savings( overruni ) ($) i 467 000 727 000 1 894 000 4 965 000 total estimates total ($) ($) 20 566 000 11 236 000 7 712 000 9 282 000 4 611 000 9 153 000 33 18 L2 15 36 I9 1I 8 15 8 7 15 20 099 000 10 509 000 5 818 000 4 3I7 000 8 067 000 4 616 000 I 934 000 (3 4s6 000) 4 537 000 5 (1 934 000)3 7 200 000Toral 62 560 000 100 55 360 000 100 Actual expenditures for 1974-L977 amount to $ 29 299 147 There was no provision for the JCC in the PAG rePort. No provision was made for this in Ehe PAG rePort. 1 2 3 ocPf78 2 Page 59 By the above comparisons, actual expenditures are expected to be 25% Less on insecEicide, 537" Iess on research/training, and 50% less on capital acquisitions. Over the Lg75-Lg77 perlod, Progranrne total costs per kilometre of river decreased 32% from $ 31.48 in 1975 to$ 2L.52 in L977. Projections through 1979 also suggest decreases in total cost per kilometre beyond the 1977 rate. These reduct.ions have occurred as a result of maintaining administrat.ive overheads relatively consEant and by carefully monitoring the most imporEanE variable items in vect.or control such as insecticides and evaluation teams. From 1975-1977, minimum Buaranteed flighE hours were exceeded by 7.3% for fixed-wing aircrafE and 3.6% for helicopter. L977 insecticide applications in Phase I and phase II represented decreases of 5% and 46% in litres per kilometre of river protected compared to L975 and 1976. As of I'lay 1978, the number of entomological surveillance teams protected in Phases I, II and III had been reduced by L6%,28% and to the first years of operation (L915, L976, L917, respectively). per kilometre of river 11%, respectively, compared Excepting dramatic reversal of the climatic conditions experienced during the last threeyears, the satisfactory cost-effective ratio of our operations should continue during the 1980-1985 period since the optimal use of Programme financial resources reflects better knowledge of field conditions and improved efficiency. ocP/78.2 Page 60 CHAPTER VIII PIAN OF ACTION AND BUDGET 1980- 1985 A. PI.AN OF ACTION During the subject period, the straEegy of the OCP will remain essentially as originally planned. The objective of the Programme will continue to be to reduce the impact of onchocerciasis to a sufficiently low leve1 so that it no longer represents either a public health problem or an obstacle to socioeconomic development and also to maintain and adjust control activities so as to stabilize the disease at a tolerable level. Methods of entomological and epidemiological evaluation of the control operations will continue unchanged. These activities wilI be supported by a programme of applied research. The present administrative infrasEructure of the OCP should remain substantially unchanged with 48 professional postsr 643 general services posts, two aerial bases and about six sectors and 22 subsectors. Vector control operations The plan of action for vector control over the period 1980-1985 calls for the protection of a cumulative total of 3 552 438 km of river compared to 2 095 207 km during the period L974-L979, L,e. an increase of 7O%. This is due to the gradual build-up of activities duri-ng the period L974-L979 (larviciding beginning only in 1975) as compared to the period 1980-1985, during which it is envisaged to maintain an annual 1evel of activities similar to that pro j ected f.or L979 . RIVER DISTANCES PROTECTED BY PHASE BY YEAR IN KILOMETRES1 L974 L97 5 t976 t977 L97 8 L979 Tota I L97 4-t979 Per year 1980- 1985 Tota I 1980- 1985 Phase I Phase II Phase III Ivory Coast extension 191 143 191 143 59 894 191 143 59 894 258 908 19r r43 59 894 258 908 4L 064 191 t43 s9 894 258 908 82 L28 955 7L5 239 576 776 724 L23 192 191 143 59 894 258 908 82 t28 1 146 838 I I3s9 364 r ss3 448 492 768 Tota 1 t9L L43 251 O37 509 945 551 009 592 073 2 095 207 592 073 3 552 438 1 Calculated by multiplying estimaEed wet season river length by 17.5 weekly treaE- menE circuits and estimaEed dry season river lengths by 34.5 weekly treatment circuits. In terms of inputs per kilometre of river protecEed, helicopter hours wiIl decrease from IL2 to 109 per lO OOO km (-37"), and vector collecting teams will decrease from 15 to 13 per lOO OOO km (-13%). See tables on page 61. The rate of fixed-wing hours will, however, i-ncrease from 23 to 27 per 10 O0O km of river protected (L7%) and the amount of insecticide used per 100 km of river treated will increase from 39 to 42 ]-itres (87"). This is due to anticipated higher-than-average rates of consumption for these two inputs in the Ivory Coast extension area, larger rivers in the south necessitating more fixed-wing aircraft use and more insecticide than smaller rivers further north. In brief, the impact of these increases on unit costs for the period l98O-1985 is great since they affect every year. ocPf78.2 PaSe 61 3 H^ XH aH Zd 5qric E3 eE Es A{! o^ ag d^ 'i9 .!!n;e u [r]aA pg =9 r,r *H ef, EoazA< rdXH fq e ;o lFl aH E25orIa,Yrdxi>ii t4 35 al a^ ag &^ sY>& u trl atu ea5-9 r'r F aS Ho ^z-<H FI rd rnco&F{ o\ t!14H{JI v OO HO q o\J -l\o oo (t) o\(aoF{ (n e{ c.l O \OOOo\Nc{o N F{ (f) r\ N @ o\ -t o\ &r^tr cO(dolOJJ >. Io >,@ EQ O\ F{ J\o oo ro O\(7)OJ (r) ^t r'\ O \o\oOr{(r)Nrr F\ N CO @ J Rd o\ ,{(Jl v\t r\q o\ J co\o o@F\ O\ \t cI\ H(7)H O\-tNrc!-t@co.+ dJ C. N cN @ -t d o\35 d F{\o ot/'l o\(')o -tcON F\O\o\oOF{ a') c.t r/t NN c7) co rn J & @r\5o\ rq co\o o @N o\(f)o J(7)N NO\o\OOJ -)c{Ll1 N (O \o cr) &r\ e5 o o\ -1 \.oH(?)J NOto\oO'{ci (rl -t o\J N @ o\ d\o NYo\ Hd co r.\ J(f) e! -frnN c7) c{ (?) c\.1 \o N r) & r^s; d IIo\J \o\o co o\ d \o\o cO _til 4r\ .) o\ _{ o Itlt JJtrooH d..{HHOtt)HHHc)C oo o o xut,.t,otrx6(d(d0(u OrOiOri J(! ! oH rrl il@JoN rd'{HrJt v OO H@6\ F{ o\t J oo o\ \o -to\Oo\-tO F{J o@N o@o\co (Y) -t Orn!n -{J o\o Fa o@ rn @(t) s3 d(so\ o,{E x1vo >.CO d cQ 6;J o -tJ o ra J F{ -to\Oo\-tOJJ o@N oo\cocO€rn F{ (\t o\oJ o(t) -t \o O\& N o\ J()t v\t F\O\vJ (7) \o F{ oJ o c{ 610N oNo\ F{J o\Lr)(n c7) \O (7)@oLrl O\ .f, r'\ c{ il F{ N -t -t (t) N d o\ET q o\t F{ o rr) d F{ \to\Oo\+O -{J o0oNOo\oCO cO tn F{N o\o ,{ o(f) -t \o & cosI q o\o c{ o\o @ \to\Oo\-tO JF{ o@6t oo\@@@tn F{N F{ F{ F{ o -tJ \o & N FHG q I O(7)F{O-to\J i NO\O\orn\oo\@-) JN J J |r1 c7') J rO il \oeI o IF\6NCOJN oo c{J \t .f, Ni c7) rn o @ CN & rn N53 o II oo F{ C!J o\ J o F{ c!J o\ J d .+ .) ot q I ud,oOH (d.r{HHO(,) HHF{(Jtr oc, o o xuOtrOt{Xfd (! (u 00,) tuAAri (d u oH I Lr]cod r{ cN dr{HUI v ooH6 c'\ H o F{ @ -t -tcoNJC{J -t-tN+@or Ji caJ @\o -t tr@ &(!O\ 0rd =E >'tvo x(D66 oJ @ \troNJc{J -t$NNJ-) cOJ @N o\N& o\ r{(Jr .f,Ho F{ -) F{ \o !nNd)Jc{J J\tO +\oO F{: n F{ r{ N c7\ O\&a-N5q o H @ -tcoNJNJ -t$Nc{F.|ca c7') 14 @F\ ox do o\J @ \O ci) NHC\J \t\tN c{JcO -tJ @N Ndah O \O c{ \tJcoJ Jo\\o -) J rf) l I N 14 \o @ &x(Jor o I I \ON F{ C?) ao\ car{ oN o rt1 r6 :N o\ O \o d 14 c.) \od a cO 35 d I JJd oOH (d.r{Hr-{OoHHHCJC (,C) c, 0J >tJth(/)Otix(! $ (d O6) P{AFrF{ i (d t) oH ocPf 78.2 PaBe 62 o o^ H5 = r'I<H HP .QH46 E]E 31AB aoZs<-r &^ fiH >P HJ 2a 3HH^ 3e E1 r'r E:Ioo^2 64oH C) rd e HA Rii a5 HH)p X tI;= 3d -. trrr^ chv3.ii -3 A9 xfrr ils E] I.] 33Ia se U)zH & !n @ Fl ch ttlFl HUI v OOH@ q o\ F{ N o\ ooo o rn\t O\ (n F{(fr (,) d) ooooooooo ooorne{@ -fr-t N -t ooo ooln F{ rriltrO(Uo\ O,lJid >. Ivo >,o d co o\ J c.l o\ ooo Lrlr\ O\('lJ(o co ca ooooooooo rnoo r\N@ N -t oo o rn C! or& t-\ o\J(,l v\t r\q o\ F{ CN o\ ooo CN r{ r{ ONcO .$ (o c{ O-t@O\ cO \OO\ r'{ O\ LAJT\ @ O\ r"{ coN o\(n N Oto @ o@ & o\3Hdd N o\ o o ro N O\(Y.}F{(f) c.l cr) ooooooooo 'nOOl'\ N co (\\t oo 1r1 N & @ss o (7) o\ oo @r) O\COJ c') rn co ooooooooo rnoo N(\CO o\ (t) ooo cO rl C{ & N F\9or do I @O\c{ ci (\ c\ \O-)@HN\oJrno\ NF\NNr{U1 o\ N N o\o N -t r-{ & \o NYo\ d \O .+ -f tn ciJ \t 14N\O co ca @ crl o\$ \t6 co J c{ J & e; o I I o -t H ca\o n N o J c.)\o r) N -t& .) o\dd trl tJC oOH (d.r{ HHO(,HHHOd o0, o 0, >.JdJ|r')(,)!X(d(d(uoG) tuorQ{H H${J oH I I I I I ocP/78.2 Page 63 Progranrme activities during the period 1980-1985 will require, annua1ly, a total of 6430 helicopter flying hours and 1583 fixed-wing flying hours. The grand total will be 38 580 and 9498 hours for helicopter and fixed-wing, respectively. Compared to L979, this rePresents no increase in aircraft or in aircraft hours per kilometre of river protected. These hours are distributed annually as follows: He 1 icopter F ixed-wing exEension Tota 1 1 800 898 2 582 I 150 6 430 Phase I Phase II Phase III Ivory Coast I 583 Approximately 250 ooo Iitres of insecticide will be required annually. Although thetrend for insecticide use in Phase r and Phase II reflects decreasi-ng amounts per kilometre ofriver Protected, uncertainty exists with regard to consumption in phase III. Also, theeffect thaE treatment of the rvory coast ext.ension zones will have on insecticide use in theinterior, northern zones of Phases r and II cannot be determined with precision. Phase I Phase II Phase III 367 200 5L6 500 operating from 22 subsectors collecting teams, sectors, and ared to the sEatus quo as L977 1980 1983 A totaL of.27o capture points will be serviced by 7g teams and six sectors. There is no increase in the number of vector subsectors, respectively, per kilometre of river protected, comp anEicipated at end 1979. Ep idemi o losical evaluation - Field evaluation: The total nurnber of villages included in the first evaluation of theProgramme area was 313, of which 45 were detailed evaluation villages (DE). Not all these3oo villages will be included in future follow-up for reasons such as change of population andvery low endemiciEy of onchocerciasis. About 50% of. the total n,mber of simple evaluationvillages (sE) will be regularly re-examined, whereas nearly all the 45 detailed evaluationvillages will be included in rhe follow_up. The sample for the future longitudinal study will therefore be, approxlmatery,15o villages sE and 45 villages DE, in principle equally distriburea wittrin rhe Ehree phasesof the Programme area. rn some of the SE villages a stratification of the sample may be used to confirm theabsence of transmission in certain areas, for instance, examination only of children bornsince the beginning of the vector control prograflrme. For the same reason non_infectedpopulations resettling oncho-freed areas may also be included. - Follow:Yp intervals: The serected villages will be re-examined every third year. Areasof very stable and successful vector control will be controlled every fifth year by simpreevaluation' to confirm the absence of transmission, whereas it rnay be necessary to make morefrequent passages in areas of doubtful transmission control. Ist passage 2nd passage 3rd passage 4th passage L97 5 197 I 19 81 1984 L97 6 L979 L982 I985 ocP/78.2 Page 64 The criteria for based mainly upon: selection of villages to be included in the future follow-up will be - the duration of vector control; - the level of ongoing transmission, if any. A third factor to take into consideration will be the statistical background, i.e. a sufficient. number of carefully selected villages must be examined to enable reliable c onc Ius ion s . The follow-up villages will therefore be grouped together, according to Ehe above criteria, and Eaking into account geographical and epidemiological characteristics, such as endemicity levels. The research activities undertaken by the Unit are described on page 65. Economic development The experience gained by the Unit during its first three years has highlighted the importance of the following essential components for developmenE of the oncho zone: (a) a basic socioeconomic infrastructure, particularly basic health services, schools and roads, especially in resettlement areas; (b) the need for integration of public health components into development projects; (c) integration of the oncho zone into the national economy of each country through regional development and planning; and (d) the necessity for anticipating development problems and bottlenecks by keeping these under continuing study and review in order to prevent their becoming critical' issues. r The evolution of these different aspects should be closely followed during the period 1980- 1985 . i In this respect the report on the economic aspectsl of the Programme has suggested that the Unit could expand its research and policy analysis activities by undertaking research and analysis and by organizing research to be done by others. It should specialize substantially on socioeconomic subjects directly related to the vector control programme. Resettlement and migration are areas where the need for a progranme and policies are acute in several countries Other possible areas suggested for socioeconomi-c research are health and health care deli.very. Also, on several occasions the participating counEries have suggested that the Uni particular attention to putt.ing in evidence the economic benefits derived by the countr from the vector control activities. .l ib give s Tra in ing The training programme will continue to aim at three objectives: (a) to improve the skills of personnel already employed; (b) to prepare ne\^7 personnel as may be required; (c) to instruct personnel from other African countries in the procedure of survey, control and evaluation of onchocerciasis and its vectors. 1 See Part II of Evaluation Report. ocPf 78.2 Page 65 Research The research activities undertaken or sponsored by the Programme during I98O-1985 will continue to be closely related to its changing requirements. The principal objectives of future entomological research are as follows (i) to find a series of alternat.ive larvicides and formulations to replace Abate; (ii) to locate the resting sites of the adults in order to determine the feasibility of employing adulticides to strengthen control measures; (iii) to prepare suitable keys for the identification of the adult females and males, pupae and larvae of the different species of S. damnosum common to Ehe Prograrmne area; (iv) to study the movement.s of S. damnosum s.l. and the factors influencin g migration; Ehis would enable the Programme to predict when reinvasion would Eake place and from where, and to take approprlate action before, rather than after, the event; (v) to develop appropriate technologies which will facilitate the control of the vector; this wiIl involve seeking alternative methods of conEroI, including environmenEal manipulation, to reduce the sources of the vector. The aquatic monitoring operations wilI be pursued. Trials will be undertaken to determine the efficacy of environmental manipulation, e.g. modification of some breeding sites which should lead to a corresponding reduction in the quantity of insecticide applied to the watercourses. FolIowing these experiments a SAP Working Group will be convened to consider the possible wider application of the technique, especially in those areas where development and intensive settlement is taking place. Medical research will continue to emphasize studies involving the epidemiology of the disease and the search for a safe and efficient therapeutic agent. The role of EPI will include the evaluati.on of drug trials and their eventual application on selected populations, as well as applied research to define cases at risk of blindness and in need of treaEment. Another important aspect of research will be the investigation of more refined evaluation techniques that may become available in the future, and which may improve the diagnosis or treatment of onchocerciasis. Contracts will be established with a certai-n number of specialized insEiEutions or research workers for the execution of studies which have priority for the operaEional objectives of the Programme, and which cannot be undertaken by Programme personnel. Close liaison wilI be maintained with the WHO Special Programme for Research and Training in Tropical Diseases, regarding basic research orienEed towards greater understanding of the disease. ocPf78.2 Page 66 B. BUDGET Budget requirements for the period are estimated at $ 132 646 3OO; this figure was calculated on the basis of estimates for capital requirements, the possible cosE of the aerial contract,l and estimates for the remainder of recurring expenditures using L9l9 as a base. The following assumptions have been made - an annual increase of 11.5% for staff (3 .5% for inflation); statutory increase plus 8% for - an annual increase of 8% for a11 other operational costs (excluding aerial operations); - replacement of one-third of the total vehicle fleet per year. The increase in cost from L974-L979 to 1980-1985 is $ 77 286 7o3, of which $ 49 216(64%) is due to inflation and $ 28 olo 403 (36%) is due ro increased activity. By rheof 1985, however, a sufficiently high level of control will have been achieved to permit a considerable reduction of the level of activiEies required to maintain control. This reduction of activities will almost certainly reflect decreased costs. 300 end I of the The estimated aerial expected number of f bids submirred in 1976 plus plus 307.). The costs for 30% (107. per year increase summarized as follows: llelicopter Fixed-wing Helicopter F ixed-wing contract costs for 1980-i985 have been carculated on the basislight hours and an hourly rate estimated on the basis of "Iosing" 7% LnfLation per year; plus 9% for unknown factors (1976 bids 1983-1985 represenr estima red flight hours ar rggo-19g2 rates plusdue to inflation and contingencies). These calculations are 1980- 1982 No. hours Rate Tota I 19 290 4 749 No. hours 19 290 4 749 ($) 659 594 1983- 1985 Rate ($) 857 772 Toral 15 533 016 ($) L2 7t2 LLO 2 820 906 Tota I ($) 16 53t 530 3 666 228 20 L97 758 35 730 774 Tota 1 Grand total These rates are, of course, tentative. The actual rates will be knovm only after the results of an international call for bids tn L979 for the period lggo-1gg2 and in lgg2 for theperiod 1983-1985. ocPf 78.2 Page 67 The following series of tables are presented: Descript ion I.A I.B r.c II.A II. B III. OCP l98O-1985 by Programme acEivity Comparison between L974-L979 and 1980-1985 by Prograrune activity Pie Chart by Programme activity OCP 1980-1985 by category of expenditure Pie Chart by category of expenditure Vector Control Unit 198O-1985 by category of expenditure Epidemiological Evaluation Unit I98O-1985 by caregory of expenditure Economic Development UniE 1980-1985 by category of expenditure Environmental Protection, Applied Research and Training 1980-1985 by category of expenditure 0ffice of the Programme Director and Administrative Support/Ouagadougou t98O-1985 by category of expenditure Administrative Support Geneva, Rome, expenditure Brazzavi-l-Le 198O-1985 by category of Meetings , 1980- 1985 Joint coordinating corEnittee, 1980-1985 by category of expenditure Total Expenditures 1974-1985 emphasizing transition periods 1979, 1980, 198l IV v VI V II. V III. Ix. x. xI. ocPf 78.2 Page 68 ro @ioN(!d lJt -o c)HO o\ il ooooOF{ \OJ@\.o \:f o\ oooo N N @\.o\tN\OH - ooooN\t \ON Or O\\Ol coHI ooo \t J F\ @ oooooo o\Lrl@ OO\N -t rn rao\ ro (\ O\Oco o\ oo ca \o \o c{ caH r^ @ o\ F{ oooorn o\ \tooodc! ooooF\ \t o11rn (f) c7) ooooNCO o\ o\ F{ (f) o\ 6t (n ooooooOrN r\ o\ ctO6o\ e! d) \O @il d ooN In .f, t\ r{ oo(n $ t/) co \o N -t co o\ J ooooN-t (f) c{ Or@ I ooooJCO \O cli c.) c.) ooooF\O O\N\.o (\ t1lc{ c.) oooooo\O \O d) -to\,n tn c\tJ c\t \o NJ H ooo \o H\o i oo c\] N o rn dt (f) @ o\ F{ ooooF{ r\ -t to@\O il ooooO\ c.) cO -)c{ oooo -t \O \o r^ e{o c{N ar) ooooooF\NF\ O\ cn c! c7) ci \o Ni1/l \OJJ oN \o o\\t J oo ci) o\ N -f C.) N c{ co o\ I oooo _tN Lnol-\ tn J oooo@i \O@LAN c{ oooo(t) \t cooF{ o\O\J N oooooota\ \O \O Jo\F\lnNo@Orn COJ -{ oo\o Ln @ ct) .{ ooo -to\fo c{ il @ o\ J oooo\OO N N \O c.) J oo rno r+ \OCON(\ oooo@ca \t r\\OJ c\ oooooor,t6Jo O\o@Or -l t^Oo\-t C. J ooo -) co c\ J o Ot N$ o\ H o@ o\ J ooooN-f O-t\O c{ oooo N d co-tOc{ al ooooC.) C. O c7) e.l \.o \tH N oo @ @d oooooo\OcOO rno(o OrnF{\t cO .$ N r{ o -t 6 rn O H E](JE(Jttto-oood tr.rr.;ut--\EO!utrOtr .r{$o€o+J<(B JJrcrdo.trrIr(drrJU(sO.oC ! (utrOaO.r(dO>Otrr.aO.tEO. O E ^P{ O , ! trOG.CuOotrl,.AFl o or o > o o 6J $ J f{ (! bO 0,1'Fl O O o Eooqr(drJd!!)>o..r{(uL)tr ..t > o d.-t ,-t d o .ri , $drJ (]0 (u o o tr € lf b0 rJ o .AA !tr O 'O 0J E'.1 u a rd i'J COJt{ddOUJOtrr>O o o o o lr E'-l! o ! (d (d H rd ! .r.rEl]rJEtr$@(,)>o(dNc tr E E O.-l td.-l @ d '-l 0J ..r C N 0.)O O O '-r >.O t{ E d .rr d d tr O <d OtJ € t J F tr bo.trl 5 u ..{ O .d .r.l li 0,}(.) .,.{ o o. o (d o (0 o 0J E g) o @EQ Eojo"oQ!oEo0rt J (d ]J oH HH H H C) rd E fr(J o&A ca rn @ o\J Io@ o\ F{ 0rq) o t; E] F] co H ocPf78.2 Page 69 E{ @NO\(Orntn O\tnJLoJC)F{e{-)LrlO\O F{JvNr{ o\ F{ o F{ 1":i@O\oIANLA F{ J c7) : o\ c?) ...l ooo@d(0oot{!ootrc)H€ CN\o F- o\ c') -t O\ \O \O (\ -t (n\O O F\ rn lr) \tJ@FlO\@F\ O\OCONJJO\\Or\\O\O@F{ \O l'\ Ci $ v o F{ NCON(\JLr) ornF\ -to-tr\@-fF\r)Lo rncnN Lrl (f) o N \o co N r\ F\ ro co o\J Io@ o\ r{ oooooooooooo Gt\tf\F\OJ \OF\@\O\OF{o\o\-tNco\o \O F{ \O r{ \t O\ @F{J r-{ ooo -t F{ F\ @ ooooooo\rn@ @O\N\trnLnO\rON O\O(') o\ oo cf) \o\t\o(\ dtJ o\ N o\J I -tN o\ .-{ F\(o o\ \o i ca -t F{\t\Oco\Or\ ciO\r\$\tu1 O t/r CO F\ t{ cO \OOF{(fi-tO\ OC.NJNF\ rnra\+JA$ @N (f) F\ @ r\@-f@O\O .+ @ (7'lF\F\JJo\N t^ e.t cf) F\ o\ rn o\rl (f) LA n ocr@ =.8l..lU >op(d0,) t{NEON60.Gq)OAt{(J .-l,FAF) JJ(,)or€ooc]J>JJ(dO 'r{ t{t]soG o.dad l{o.EJIJ(d,T{(!U)>ur'r{!.r{0r(dtttro.do..{o>()deE(J'r{ood€!!tr'FlOrslO.dtroul{Etrc) .,rd.r.,rtlrro!€]Ja>6t{&oc(lr4rrtrcdO.r.lot{cotrAjArtrOo>oEo{.r{C}oorE^o)rJE€OO-4lr(,)t{€troooodHJrdrl]60oOA ooo(0trsr>o.t0)L 'r{ > O'.1 'JO 'r{ A d.dJJOocJ(/JtrQoorJ(,)(dutr O € O'.{ , t!OJIT6OOHJF{(Ho o o l{ E€ o +r (0 d O .r{'rlt1:Eti@oOO H E E o, d@ 6 'r{ '.{ 'r{ 0,,O O O '.lO lr (d '.{ t t C OlJ 'O C -l tr oO, rr ..i .d .t .Jo .r.,r o ad oo o E o o tH o.)o.oaHor'ooroH (u t, oH FH HFo rrl = &(, o&A E! rn @ o\ r{ Io@ o\ F{ o o\r\ o\d I .+ F\ o\ - z rrl 14BH rd zoaH& Pr oO 'j E{ Fl ca Er ocPf 78.2 PaSe 70 TABLE I. C ONCHOCERCIASIS CONTROL PFOGRAMME 1980_1985 BY PROGRAMME ACTIVITY Vector control operations 68.6% Epidemiological evaluation 4.97o Economic development 2.5% Applied research, envir. protection and training 6.6% Office of Programme Director and administrative support 1 4.1% lndependent chairman and JCC 0.7% Meetings 0.9% Regional liaison Brazzaville O.4o/o Administrative support Geneva 1.2% FAO/Rome technical support 0.19lo lyHO 7E880 ocPf78.2 Page 7L F{ 6]J oH ooooooooootnO\N$Fl Oca(nNJ -t@No\\o@rnnr{o\ O\trrJ oooooooo -t\O\tO Noo-tN-)O\r(\l-\NF\ or,lN@lr)COJ oo rn (f) F{ J \o c{ r{ oooooooooocoo OONOcn (o (\ rncO r\ <' ro oo @ 6l c7) rr \o o(f) \o -t\o c{ cn r.{ rn O o\ F.{ oooooooooooJocoo\ Hcoroo\o r\.{Oc.tO F{O\-)C{N(\ oooooooo\atn\oN J c! .-l LOJ(a\O\t@r-rtF- O\oN-l - o in rn @!n ro C\t oooooooooooo Otno\torn coN J J ooo o\\o N J oo Ln -trn co \o N -f co OiJ oooooooooo caJLOO-t OONNC.tF{rocoN@ O@NNi C\ oooooooo$'acoO \oNo\\oO\ (n F- '{\oF\N\O O\\ONJ oo L6 F{ N 6 cr) N ooooooooooNo O,J1 O|^Ln \O F\o r{ oo N o o\ F{ J oN N\o o tn e.t CO @ o\ F{ ooooooooooL^OLn\or\ Jt\.{Lr.|rn\O@\OO\O@F\(\c{J r-{ oooooooo$'arnc{ \oNo\oO\ Ci r-{ Ch\OF-i$ @\ONJ oo o\ \o .{ (f) C.l N ooooooooOO\tO OrnNrntn CO F- o\ oo -t NJ r--.t r-{ oo ca o\ N -t C7) N N @ Or r{ ooooooooooF\@N\tF\ cooNoo NN\tO\!f1F\r..NF{J F{ ooooooootnF-N\o o\N-tLn o\F-Ln@ l-- Fl O\ cO F\INJJ o@ e.t ro CO o\J ooooooooooNo QLrldLntn F{N o\ N r{ o J oo \t o\(n e{ F{ @ o\ J oooooooooor{ococoo \o ro \t \o F,-O\ F\ c.l F\ cO rn\oNJr-{ i oooooooo -r..-$o 11 F\ O\ cr)OrF-O@O\ F{ cO c.l \OLnHF{ o o\ (f) F\ o @ r{ oooooooooooo Ot^\tLn(n $F\ @ o N o\ o o\ N$ o\ i o@ o\ J ooooooooooO\O\FrCn+ n- \t I-- cO $NNO\ON\A\ONJ-l J oooooooo\OF-\tO (nF-rn@ NF\NCO NJ\OFl \Ot/)JJ oo o\ (! F{ o\ \o J oooooooooor.)o Arnrn6 ;6 coN F\ oo ro Ln + o\ oo -t co Ln co F\ J c) ,g o€ 'r{ d +1 (d @(dtrt{ tr .F{ c,} 6Co.JEoo.r{ooot{ oc(do>.n oOt^tr(d(! .J.r{ u o (s ti .c>!orcuc)Itd€..{OOtr0,rdJUJO+J oot(uotr(drJC O. .r{ O..-l C C q) -{ o o-d f (! o (s Ulo69.'{otr)E.r{rloOtrtrJrJtfrJJCC)O (d o (d ^€ d J'r{ o.o.r.lOO.lJtrgrr).lJOlr l] (, (,) C (d O C O€o c, c o o o.o o c or<Hodd O()EH a]J o o C) J (u a oU o o(,) r{ (d) I J (d +J oH oolJbol{ o cc5(l)(u .H rrJ E €.-|oo.i tr .r{ ..{ ..{ tr .C J5Jotr'Eqh>tI] o d q) ! .H H(s ]J .r{ o(d o o E o) +J .F{ J (d +J .Fl o(d() I d(! ! oH FI HoH a fl(J E]& E{H azElAXfr] ho d () rdH (J 1r) @ o\J Io @ Ol r{ tu c)o 'jH td FI FA H ocPf 78.2 Page 72 TABLE ]I. B ONCHOCERCIASIS CONTROL PROGRAMME 1980_1985 BY CATEGORY OF EXPENDITURE Aerial operations 26.9% Personal services 37.9% lnsecticides 9.3% Research and training 6.6% Rental, supply anC maintenance 8.2% Build/furniture 0.3% Vehicles 4.3% Joint coordinating committee 0.7% Equipment 0.3% Capital items 4.9o,/o v'Ho 78882Operational travel 3.5% Meetings 0.9% Consultants 1.1% ocP/78.2 Page 73 r{ (d IJ oH tt oooooooooornO\OO@ @ r^ o\ \o F,-\O@.f,\t\O6t cO $ O t1 \o (') ooooooO\\O$ o'OO NC7)O\ -{N(\ F\TAN N(v)J oo co F\ J o\ r^ @ EgEE ^No\od6driA r^ C') _t oo: J(ft o rn oo o\ co\t o\ o o\ rn @ o\ r{ oooooooooo coF{@r{F\ (f)F\F{O(7) l^NO\F{Fa N\OJ oooooo ci r^ \o Ln (\ r{ \t c7) \o@l.-\t t/l\ON oo o\ rn co J r\ F{ ooooooooOO-{O ONorO(r) (") rn o\ oo F{ F{ No F{ oo f.\o e\l @I -t@ o\ r{ oooooooooo cO .J' F{ O\ (n O\J\.c)$r^ .J'NO!\OOltrl-{ I oooooo\tn-) NNO\ -+t-tF- NNE! tn \O 6l N J +N \o I ooooooooOOorO oc.too(.) Cn t^ @ oo o\ c.l F{ o\ o\o -tl/'t J r\ 14 c?) @ o\ I ooooooooood-rLnon \O \O F- d) r\\t\OONOTI t.t A I oooooo|-\ rn rn r{NO O<o-{ F\NF{ \t \O .l oo o\ co(a tn J oooooooooo@o ONNO(Yl F\ rn F\ oo@ \t 6 oo F\ o\(v) N \o J C.l @ o\ J ooooooooooF\N rncOd) c{Fltn\tO .f,\c)c\l@O\o-t J oooooo@Ne.l \oN\tJF\Ln(\ Fl O\ -fLnJ oor\ N ra o (o Fl oooooooooocoo o6r\oo -) Jrnr oo@ @ o\ F\ oo ro J @ (7) r{ J co Or F{ oooooooooo|f,lr\L^rn\o O\\c)O\@Ca cir^.+$@O\ \t ooooooO\ F- .+ J l.- O\@NOF-n@ co1/.)l oo co \o -t(Y) NA ooooooooOOF-O oNro c7) \o ltt\o ooI\ (r) -fN oo t/] o6o (v') J @ o\: tt oooooooooo\ornNN\, \ONc'\tnF\CiI'tNJT\ @$ oooooo@N$ JNTt O\NF\(') -l \O ca Ln -{ o@ Lr1 o N I J oooooooooocoo ONF-O(7) Ft Ln\o oo@ o\o\o oo\o tn o -t N (J o,c) oC}FJ .HOUtrO 'FrddJC,(! 00 .F.t o, C llJ t 'F{atc!tr ''lr Eoo.r{€(0o! ojd(dCE>.r{OOlr(d(!(0 ..{ 'r{ ]J 'o t E >rrdluc)lrd€O(dOtrOtr'r{Ju:r.l ootc!!o(!!c o.'r{ 16 C tr C OrOO&o.OOO(0crro(!.r.{ooo..{'r{ubotr tr-r!t1.-lErruJc0,)odo(6rEd(Ur.;a o.JC,OOOlrHOu0)lr}{ooAOOOCqro oodorqlo.GootrA<Hd@<c)Oc)tr{ oU o o o i (!) oU an o o J (d I I d]J oH oou@t{ u, trdroo .r.{uJE o..{ o o.J E ..{ .F{ '-l t{ 'tr ,,roe lQfr{>ld th E o]J 'r{ (It IJ .r{ a(d q) o E c, IJ ..{ (d .J .i o.(d o I J(, ! Fr Ff Hots oz d() td&5 E{H aztdAX rI] fi & (J rd H o F4 Ln6 o\ il Io co o\ J HH z .1od tszoo &oH(J trl t4 HH F1 EO ts tt I ll F{(! +J H ooooooooooO\NF\tOO J\O(\JF O O\ crl \O (f)JFr\O<-Fl oo\o F{ (7) -t .s oo o\ o\o o\ ooooooO\oO \oNo$ta {' r-{ I oo\o @ o\ LO oo rn o\ tn \o rn co o\ J oooooooooo .$ cO F- \t \t O o\ \o c.l F-N ri 6l O\ c.t H trt oo r-{ COt/) o\ oo(.) o\(\ F{ ooooooocoo F{ c.) r^ F\N oo@ o\ o\ oo F{ o\ n(O J .+ @ o\ F{ ooooooooooOr $ c.) \.o \t @\oNtnrlFr(nJ@N J oo@ -tl/) co oo\t @ co ,+ J oooooo oNo J\otn co c\ ooN Ni F{ oa\o o 'N^ r{ c7) co o\ F{ oooooooooolnN\.oNtn F- -) O O\ c.)J(r)ONNJ ttt o \o \o\o F\ ooJ o\ No H ooooooO\OO J@rl F\ (\ oo\o -to r{ ooF\ CO c.) 14 J c{ @ o\ J tl ooooooooooNN\O\t@ \oe{Or.)J ,{cioNNJ o rn F\ @\o F o -) o\ ooooooOoro iNttl F\N I oo Ol @ o\ o\o o\N O d @ o\ J ooooooooooOO\e{ON r^@co@oiNO\\ON ttt oo\o \o J\o oo o\ J @ ooooooooo -{@6\o o.l ooC. .f o\ O c{ \o c.) o\ o@ o\ I ooooooooooO\NC.O\F\ cO\O\oNcOdN@\.oFl I oo C. 6rl oo J\o F\ ooooooo@o .{N(n\ON oo@ @ co oo cf) rn @ (J C) F) 0,o! (d(d o0tdoc .ri rJ (dCA trJ E60'r{(r'rl0)! o c (B.,r (d > .F{OO !U EG (d .,t .F{ JJ .J H -c >rJ F{ €! (Jtr$'El'Jcjo tr o c u (dJ o rJ oO!cdr(iuF or.,r d d t o,doo.coooo(!U)t16..lOCO'J.r{!b0C6JuH(d.-l!!14tr0.) o<0orUddrdr"{o" o.-lOOtrOlrlrotJC,!trooCGOOCoJO0J o c o cD o.o.o o trAr<F{&&r/)ooc)EH o TJ a o(,) r{ IB oU o o J (d I i (d ]J oH U,O+Jb0g (,) ccroa, .r{!JE E'.1 o o. F{ d ..{ 'J .J tr-d,SJod coh>tI] o E 0,U .r{ J (d JJ .r{ o$o o 0,) IJ .r.{ J (d rJ G(!(J I 14 (d +J oH F-l HoH az fl(J ocPf78.2 PaBe 74 E]& ErH az E]Ax trl tro &o(9 rdH q) rn @ o\ r4 Io@ o\ F{ HH z zoH H Fl E] F] (J H FioH z r! E P{ trl H ,l FO H rtt tl ocP/78.2 page 75 J cd JJ oH I oooo@\O O\ \o F\ LO r{N oo\o c{ -t ttt oo o\ F{ oF\ N oo o\ o@ r{ CO oo o\ \o F\ I oo Ol \o N oo CD F\ 6 N c?) n @ o\ F{ ooooO-t \O Fl(o tn oo LN co trt ooo r-{ @ oo o\ \o F\\o I ooct LnJ oo c7) !n F{ ooN N o\\o .f, @ o\ trt oooo('.} \O -) r\ -t$ I oo o\ N trt oo r-{ r-{ N ttl oo o\ o\o\o o \t\' J I \t i oo(') .$ e.l\o (n @ o\ H ooooO\O o-t(r) -$ o c7) r.- II oo -t F\\o ! oo\o o\ .f, tn I oo -t (f) F{ ooi (7) F{ o N c.l\o 11 e{ co o\ H I oooo\oo cooN$ oo@ \o ooN o\ J\, oo -t r^ o\ -t oN c-lJ I oo e\l NJ oo\o r\o ro I co o\ F{ trt oooorn@ \o F- N C7) o(Y] \o ooo \or\ (7) oo\o \o\t\t oo J F{ oo -t il F{ oo @tn -t o@ o\ J oooorr.|o -ttne{ c'') I o co I oo N N(7) (7) oo r/) No -t oot/l oJ I o od ooo (?) J \:f o8or- .F.t oUOE .JCd 1(ddo0 .r{ trtr +ro C .r{ 5! (! . q trJ El,ch.r€.J(uijotr(0trd>'r{oo!(!E(do .F{ .r{ r, l{ -c>{J c'ou ot{(0'IrOCO ! O C .r{ (I,r o ]J(,,q!(d r, tdrJ to.'.{ td d c c tir o ()-6 O€ O O d (,,€6.F{(JOO..{...t!60CCJuH..lEUrrJCe,) odo(trE(t'(0r.-{O.(a.HCTOo.O!t{ouo, l{ ! o (,, o.o o o tr ot(uc,doroo.o.o0r6A{<r+C@<OOc)>H tt, IJ o o o J (0 t o TJ o o o J(s d tr I J(! U oH d,Ut{(atrJOJO)u-l E .Ft o o.tr .-r .-rt{.c, ,oeh>r4 tl, E 0, .l.J 'r{ J (0 U .J o(!() o q) U .F{ F{ (d .lJ ..{ A o C) F{ dl) o H F] HoH oz e(J E]& FTH azfrlAX td ho &o() 14H C) ca @ o\d Io co o\ J E{H z Hz rdE Oro F-l rd r.l a (J H o v (J rd rc Fl EA H ttt I J (d u o ts oooooo(7,) F{ tn \t c\l tn@O\\Otn F- \1. F{J oo @ @ F{ F{ oo o\ J\tO (') oN o o\o (f) o J o c.l F{ @ oo o\ (t') o\ rn ooo -tJ N @ rn @ o\ J oooooo(') \O tn F'- CO CO -{ rn cI\(") F{ (\ oo o\ N(n N oo -t o\\o N ooo o\ r{\o oo \o N\o J oo o\ @ F{ J oo N Itt -,r\ F{ { @ o\ F{ oooooo cOO\@ co \o Fl O\ .f, F- (\ Fl (\ oo oN(\ oo rn c\tJ F\ oo o.t ('') N ooo \oo rn F{ ooo o r{ J ooo \.o F{\o r{ c.) @ o\ F.l ooooooOO\o cl\oF{F\ Ci rn E{JN ooo -t N oo\o 01 rn\o o \o o co LN o e.l -to\ CO F{ ooo cl o F.t N \o o\\t 6l @ o\ F{ ooooooo\OO -l \O -)rn N d) NFIN oo o\ @ @ ,{ o o\ J\o oo r7) F{ o\ -f ooJ 14 o\ C\ F{ o lr) $ o\ oo\o @ (f) J F{ @ o\ F{ oooooo ci\o@ -) \O t/1(.).{ .{ 6l F{ C\ oo o\ \t F\ F{ o F\ r^\o rn oo o\ \t rn -t LN rn o\ J rf oo tJ) N @ ooo CO co c{ r{ o@ o\ F{ ooooooooco \o co o\roo\ C{JFl ooo N\o F{ oo@ c.) c{ rn oo e.l r{ c\.1 -f ooo r\oJ F{ ooo l{ @ ooo @ co J J Jd(06 UJJood(!(Htrg tHUlJ(dtrtr!ooooo ,{ xJ o 000 trOlf rJJ !trotroooooo l{lrt{oooU{JUooooo0) ..{..{ 'Jv.F{ 'J v .r{ o 'rl TJ o 0) u orr.do,o t{H(0(d() U(,JF{trodOt{Ot ..1Eobou)ooo Hg'r{JLh .'{ r4 Oo>o.E(Jcao 5 zHHrzH -do I{(s o o C) t{ rf (d o '"1 o0 oi o o !J E] I -1(d JJ o JJ ,o a TJ o) oo e o o Fr aZ (,) tr(B o o 0, t{ F{ d o '.{o q) z I co HH (,) t(d o, an o l{ ! q) .r{ Joa I F{ (d ! ou an !Jiq, oo a o (,) Aaz o0 .,.{ .r{ (d trH I H H H HH H t 6 HH H I lI HoH az d ocPf 78.2 Page 76 Hil HH oz rI]AX rd ho &o(J E]H(, Fq rn @ o\ r-{ I @ o\ r{ (J z r-{ zH *H Az o& Id U) E]& o 14 r-{ F] A{ A{ zo l-{ Ho trlHod Pr 'J Hzfr] zo& r-{ z td H ,] ca H ocPf78.2 PaEe 77 FI qt IJ oH ooooooooooo6rO@r\ !n@\tO\F.(,('lrnFl$ .i|' Fa l\ (D \C, J ooo coo \t ooo o @ Fa ooooooOON oe{-tlnd\OFt \O oo6t \o6t @ 86l \o CA\o @J o o\ i ooooooooooil\O.vtNrn 1l\l\-l-t@ t@Nln\O(\l(7t J -a ll oo 6,1 @ Glo oo O! \o @ ! ooooooOOco o6lo 6l F{ oo@ At(n F{ oot\ Or c (r) $@ o\ ooooooooooI\\Od)oO Orrt1^6r(n@61 6trn..(ft ,{ Ft oo c Fl 6t oor'l € .f ooooooOO6l o6t661 6tA oo6l F{ rn J oo Or\o!n @ c Fl I ooooooooooCDl\NCD r.I .cdt-.oor\No$'{(r)JJ oo@ Itt(i .s AI ootn \o @o c'') l ooooooOOot ONr- 6l F{ F{ oo o\ 6(7) F{ oo\t \c, 6l GI (i N @ crr I ooooooooooAIOO\(r)O t o\6r@o6r I\ONr\(''rO6t '{ -a ! 8\o $@a N ooo @ (\ ooooooOOc?) o6rot .l oJ oo A oo(n @ Fa c 6t @ o\ F. oooooooooo '{ .f, 6l l\ !n .tO(DO$ I r\o N lr! 6l o\NJ oo ch rn c oo N J]n 6l ooooooOO\g o616rclo A oo\o -t6t J oo co F{ -t\c, 6t o@ Ch tl oooooooooo\t o\ F. cO rn t Ch@O\-al\6Fl(?)FaO6lF ooN tn oo o\ (7) (\l N ooooooOO\t O6l\t 1rn o\ oo .f, \o .f Fa oo(rt oFI\t N 68 oF,{orjo t1Q, Ed6 q,O+attr !o trr{ au qtQ Q-. eo tD ra 8.,{ O irruc ct trd> -.loo H clEqt (tr{r{ u t .€>tr E'E r, c)Lql ! OcOHOC {alJo utaqr€tllrrqr!rcO'{ q, tr tr C Odo().6o€ooqro)! r! ?aO0rq+{+{rr0OtrE-terti-lEurlF.trauo (lt c, qt-. E (t (t r+{ o"o+l O, O, O.O *. tr orl OLHOoAO0rOrCOto o c o, c, rao o dA.<r{ilt/a<oou=H o ! o o o J 6 a a a o rJ o o o Fa q, a a I F. CIu oH (oo!Ot{ o trcroo) .r{ Un E €."{OO. -{ C{-{ ..1 H.q, ,rordFars.>rtl o Eo r, J q, r, o, tlt() 6 Eo r, +{ '{qt rJ A(d C' I t{ ql rr oH FI HoH oz flo !n @ cr\ Io@ o\ Fa o(j oo(,g o HilI A. (A EIllrd>5l{ FrHH<afrzHET(ItA. H}(281r{ =hoo xatzo<(,EICHo<HC)o rsf >&Ar{ o EI H Eo trr c)r{ h F!.o H EI F] ae H rtl F.l (B ]J oH oooF\(\ \oo\ln c.) (\ J o r\ co -t\o r{ oo N \o F\ F{ ooo \o @\t rn @ o\ F{ oooo ca \t O\ r{O\ Lr1 C{ oo N o|r) c7) oo .+ rn CO o rn -toJ ! @ o\ J oo\o F\$ o rn @ N ooJ \o r{ CN oo@ N rn oo N (Y') o\ (n @o F{ oooo €J o\r\t -tc{ o Oi \t @(\ oo(.) o CN oo Fa -t co (\ @ o\ F{ oooooco \oo F1 .f, e.l oo@ \o rn O.l o J co o.l oo -t rn N Fa @ o\ F{ oo co r\ co oo N c?) o\ r-{ oor) r{(f)(\ ooo \o(\ oo\o N\o o co o\ F{ ooooNC) colr]F\ Cn d ooN @oN oo r{ -tN o F\ o\o o o G 0)!d^@(IJ.-l trO cd --l oEo .rl A >ro c)lrtroo(do(,ll{ tro.do(d.Hd EU!o(d(0(,J tr€lr oivOAAO U)dE]H& Oo orJ rI]OEo Era zdEId J (d U oH o o o .J tl(, U) IJ (d rJJ a IA oo Td o Hcotu Or a o kl ooo&oh 'r{ \- $r r:l OFio FI HF{ NONv) ilc)FqA ocPf 78.2 Page 78 t'1 @ o\ F{ Io@ o\ F{ 14 F] FIH NN s Fq II] EI2ilODdHH -o<z>EIfrl Azxtd EIo EEHO&o>AdO{OD(Jrri rllHEI<>()HH> <FadH aH zH EA H HH rc FI Fq H ocPf78.2 Page 79 J C'{J oH oooooooo(O Lr) F\ \O CON-)\O\O-)Otr1IA JN oo r{ F{\o o\ TA @ o\ F{ ooooooooNr^@\t 6t \o o r-{c.l (\l r/l oo o\ ooN @ o\ il oooooooo\ooe{\o O\\oO\No r<-J oo{ c{ @ J (f) @ o\ F{ ooooooooca\ocoo @ l/1 t- \tO\ F{ .J' oo f.\ rn\o F{ N co o\J ooooooooNNrnCo corn\oQ @ F{.i- oor\ otn J d co o\ r{ ooooooooJ@c7)@ o\ .$ rn F\N r{ cr) ooo r\ (f) J o@ o\ F{ ooooooooO\-tJO O\t\tt^F\ r{ ca oo\t -tNJ J oq)o>o(u 'r{ tl)+r t{0i-l61p o (dtrC '.{iloou(, 0, ..{ otr.r{rJ0,OJ (d E(,) O{t{! O"Arq)0J , oc)P{(nO- o +J o o o J ($ a F J (s ]J oH J(, TJ oH oo\t F\ o\ F{ J n @ o\ J oo@ o\(t) 6t $O o\ F{ ooo NNN c7) co o\ F{ oo\o rn o6l N @ o\ J oo .f, o o\ F{ J @ o\J oo(7) \o F\ oo o\ J oo c7) CN\o d 6 @ 'r{U 0.) oE rd&5 E{H Az tdAX E] [qo &o(J rI1H (J FA t/tO o\J Io@ o\J 14 EIHHH E o(J C,zH ts z r-{ ao o HzH o F) X fr] FI FO H rn @ o\J Io@ o\ J U)() zH H E] E] Xl-l E] FT FO ts u.,t @Hon €F.rrto$Hr\Ol Fl-?\O@\Crh(t! CIl F .f $ u'l(\ac,\r.t-?a-?(\lFoooo OGlhC,rF..+6ll\c)ra\o$ I\ Fa \t Fl6{ at CA o('I o (.tt\@ ,\co€l\-?6('i6o6t('tFF. l,.t (n \O C'r ('lN Ch @ rtl 8 C'G lno(h IFI @ CN 888888r{ aE 1'l| tO t\ ,\ \'F0O\OFCidtrno(\tta(h\O@(\ai{('ltO ('tt oI (rI .c a\a \o oooooocooGo Gl ('l \Ornr\@ .CF(rI !'1€N \E' E o .s r'l6 @ c,l 888888@(tt1,1O\CtO '{ \al r{ \C, I\ t\ .tFdl 6t\Odt\C, Fa 6a a 6t o 8 dto({ Fl ooooootn (\t o O\o@O! avt 1,lO crr .? (7t oo(h so or o@ c Fa oooooooooooo('lilt\dr\-, o('l (o-?o\?(\l\0ON\ON .+FaNFa 6l o 8 (D co oooooo\at ('t o r.t o c.lOu1 Fa .+@-t FI '{ 8 .+ 6 @ o\ c oooooooooooo .t Crl .l (rt -? (ra \crr-a@N$(rlOu'r(f,FarnFa F{AF'F. N ooo 8A oooooo -t (\a ch o(cC,\ C'T \C'O \Et ('l Or oo6l u1 CA@ ca, o\ I$ o\ F{ J€\at@\Ot\(vlC,rF.+-,rn\l, dl \C, -t ,\ d O\ Ch (7l F. (h \C,Cl\dtOr\O\O(v) (r'l cl fl \o 6l ('lt\@ F@\t .+ l\ Fa -? (n t'')6t\-t c,N(Y) \ONN ct cn \ll Fl6t (rr('t .c\o .f .+ o +a Ft!6qlrrH aL)Q'6E-rqrog.A>F.(JO+{OF.C,trl.ElAo-.E tr F. >tr qt -(J O ct EO rl A-. , \.-d N tr -16Otr€Olr-\N(!rJ a 4 trO l- O q, ctdrrGlclcrco<r.6!66C'.Of-h-.Aql o > al ct}l t ! a\.\. Eln o, E Oct a u rr gO Ct .tE u 60 O l. |. r{F. O OE Oq, O O qtF.6FlL6OrOCto..€ o o o ct Lo > o o. q,Lr{>Ortrrarlaarrdo(ooolutoorltr O € Or=l cl 6o H l.rr orr F d il oo o Gl c, Et. 6 rr d d €{ d €o Eo 0o (o o o at E E orr qtct 6 { +{ r{ oOOO-{OLg..JACEAu € tr .. L o0, u { 3 3 tUO +{ O OCL Oo O E O O !OCIOo"LOEOTOC A ql oH ocPf 78.2 Page 80 @(,i o6 Or o\ o\a (h ao r-.1ilfrl A. zoHHl-{ttz flH c,z t-a Nt{ v) s O. =EI ;(D CAJ I -t o\ l{ trld Hr{ oz EI O{xtrl Fl HoH r{x trI Ff rq H ocPf78.2 ANNEX I REINVASION Insecticide treatment of the rivers of Phase I, which began in February L975, was followed within t.hree weeks by a general reduction in S. damnosum s.1. biti .ng densities over the whole area Ereated. At the end of April 1975, however, disturbing nunbers of biting flies began to aPPear along the River Bandama and on the River L6raba at Pont L6raba, At first it was considered that control might be breaking down with the increase in discharge caused by the onset of the wet season, and the supervision of the treatments was intensified. In spite of this, biting rates increased through June, July and August (fig. f) At the same time intensi-ve ground and helicopter prospections on the affected and nearby rivers failed to produce any but the very occasional Iarva. The flies were characEerized by parous rates approaching LOO% and heavy infections with filaria larvae indistinguishable from O. volvulus. This last factor riras believed to indicaE.e that Ehe flies might originate from the forest where such infections are usual In April L976 OCP staff and members of the InstiEut de Recherches sur lrOnchocercose(IRO), Bouak6, met in Bobo-Dioulasso to plan the field research to be undertaken to investigate the naEure and origin of the reinvasion, should it recur. Ihe srudy utilized as many meEhods of catching and observing the flies as rras feasible, and included cytoEaxonomic deteroinat.ions of adults and larvae reared from eggs obtained from biting adults. Other reinvading flies were fed on onchocercal carriers Eo determine whether they could transmit O. volvulus. Adults caugh t in Ehe affected areas were colnpared with larvae and pupae from suspecE source rivers outside the Prograrme area, by fluorescent X-ray spectroscopy to see if they could be traced to specific rivers. FIy caEches were made daily at eight stations and extra vector collectors and chauffeurs \{ere specially recruited for this purpose. The resulEs of the studies underEaken betrdeen April and October can be sumarized as follows: (i) The increase of biting flies recurred in April and continued through September not only along the River Bandama and at Pont L6raba, but also to a much lesser extent at Points in the Black Volta river basin. No local breeding could be found that could accounE for the adult populaEions. (ii) Daily catches at straEegic points revealed that flies were only to be caught close to the river banks, and appeared in successive waves with peaks which were synchronous at well separated points (e.g. Pont L6raba and Niaka), suggesEing the influence of meteorological facE.ors. over 97% of females were parous, of which 5 to 15% carriedinfective larvae similar to O. volvulus. of o. vorvulus. since .or"-.ffiEi.r"1 the infections were obtained some distance Comparatively few flies had developing stages zones were uninhabited this suggested that away and at least seven days prior t.o capE.ure. (iii) Flies from Pont L6raba developed infective O. volvulus larvae after feeding on an infecEed caPEurer. Eggs were obtained from other errgorged tlies and the larvae eventually reared from them were identified as belonging to the savanna cytospeciesS. damnosum s.s. and S. sirbanum. Later in the season the techniques of adult iden-tification had progressed sufficiently for captured adults to be identified directly. These confirmed thaE the great majority were of the tv/o savanna cytospecies named above with the occasional occurrence of a few S. soubrense. (iv) The fluorescent x-ray spectroscopy studies indicated that, in general, there was a reasonable correlation between the "fingerprintstr of larvae and adults from the seme source area. Applied to flies caught in the reinvasion area it indicated that those caught at Pont L6raba along the Bandama river were similar, suggesting a comon origin. They appeared to originate from areas to the southwest of Phase I in April and May with a shift to the west and northwest in June. This last area included the untreated rivers of Phase III W of the OCP area. ocPf 78.2 Annex I page 2 (v) Once it became evident that reinvasion hras occurring, and in the belief that flies might be of forest origin, the Lower-Bandama River was experimentally treated with insecticide from Lake Kossou to Tiassale. Betr^/een 4 June and 7 July 1976 six treatment cycles were carried out, and had the effect of reducing the biting density at Tiassale from about IOOO per day to less than lO per day. There \^ras no equivalent effect on the biting densities along the Bandama or at Pont L6raba although slight reductions were observed on some of the Bandama/Bou stations such as Marabadiassa. The lower Bandama treatments began before results of the cytoE.axonomic studies were available, and confirmed that the reinvading flies were generally not of forest origin. From these results it was concluded that (i) rhe biting S. damnosum were not of local origin and with few exceptions consisted of savanna cytospecies; (ii) they were parous, therefore had taken a blood-meal prior to their arrival, and were imporEing and transmitting O vo 1vu lus (iii) they must have originated from breeding sites of savanna sPecies and therefore may have come from either the south-west, west or north of Phase I; (iv) Ehe exact origin of the flies \^Ias not knotrn. As 1977 was the first year in which Phase III W, part of the susPect source area for reinvasion, hTas routinely treated, studies on the reinvasion problem were extended to include this area. Sixteen daily catching stations were set up and manned with additional vector collectors. Studies on female flies caught in source and invacied areas included cytotaxonomic determination, dissection to determine age, infection rates and morphological characteristics. Specimens were also collected for XFS t'fingerprintingrr. Collecting methods were extended to include Be11ec t'plaquet'traps sited at Pont L6raba to catch arriving adults, and Johnson sucti.on traps located at Korhogo, Banfora, Sikasso and Bougouni to monitor airborne insects. Fig. II compares the techniques used Lt L975-1977. potential source areas on the Marahou6 and Upper Sassandra river systems r^7ere ProsPected by helicopter. Once it became obvious that the routine treatmenEs of Phase III W did not prevent the reinvasion of the Bandama and L6raba rivers, the Upper Marahou6 (22 June to 10 August) and Upper Sassandra systems (5 .luly to lO August) were exPerimentally treated with insecticide. The results of the 1977 studies showed that (i) The reinvasion of the Bandama and L6raba rivers occurred as usual despite the routine treatments of the Phase III W rivers. (if) The 1976 observations on the cytotaxonomic status and physiological conditions of the invading flies were confi-rmed. (iii) Fly collections on Bellec "plaques" at Pont L6raba showed peaks one or before those on vector collectors and most flies were gravid. There was an humidity on the day the "plaques" caught their first S. damnosum. two days increase in (iv) At the beginning of the rainy season savanna cytosPecies were breeding on the Marahou6 and Upper Sassandra systems. (v) Flies caught biting on the L,6raba, Bandama and Bou rivers tended to have longer wings than those biting at the Bago6, Baoule and Ouassoulou rivers, suggesting different origins. t ocPf|8.2 Annex I page 3 (vi) Following the second cycle of experimental treatments on the Marahou6 an inrnediate drop in f1y densities was observed at Pont L6raba and along the Bandama (fig. f). It could noE be decided wtrether the extensj.on Eo the Upper Sassandra river system materially reduced densities any further although local fly densities (e.g. at Massadougou) were drarnatical ly reduced. After consideraEion of the results of three yearsr studies, the Scientific and Technical Advisory CormnitEee, at its sixth meeting in November !977, endorsed the following conclusions: (i) The Programme area is invaded by S. daqqosum s.1. foales from outside sources and this phenomenon can be expected to occur each year. The reinvading populations were composed of savanna cytospecies. Ihesouth-west tonorth-east direction of the rei-nvasion corresponds to the direction of the prevailing winds, confirming that migration is wind- assisted. Large numbers of females travel 2OO-25O km, smaller numbers may travel up to 3OO or 4OO km from source areas. The large majority arrive after a blood meal and oviposit within the OCP area before taking a further blood meal. A high proportion of parous biting flies is therefore indicative of ongoing reinvasion. The studies indicated that the invading flies can carry O. volvulus from the source area The experimental treatment of the Marahou6 significantly reduced the fly population in the invaded areas. It is not yet known vtrether forest cytospecies have Ehe same pattern of migration. (fi) Any area situated 25O klr downwind from major breeding sites is open to reinvasion by, possibly, infective flies. Therefore, successful local vecEor control may not necessarily result in an entirely satisfactory epidemiological situation. Strategy for 1978 With the beginning of the Ivory Coast extension activities a new subsector was opened at Seguela in early March 1978. Ihis becane the centre of the reinvasion sEudies for 1978 Fourteen every-day catching stations were set up in both source and arrival areas. Following the results of the experimental insecticide applicaEion of 1977 it was decided Eo treat the River Marahoud as soon as it began flowing, and to observe the effect on Ehe Bandama and L6raba catches. After a reasonable interval, the River Sassandra would be EreaEed to see if further reductions might fo1low. Observations to date show that flies began to arrive aE Pont L6raba and along the River Bandama before the Marahoud started to flow. Treatments began on 25 April when flow began and have resulEed in lower fly densities in the reinvasion zone than in previous years. It is at present too early to coment on the effect of the Sassandra treatments which corrmenced on 7 June 1978. ( ocPf78.2 Annex I page 4 G! o CL .9 tr r40 r20 rm 80 60 40 20 140 t20 100 80 60 40 20 FIG. I. MEAN DAILY CATCEES OF S DAI'TNOSUM AT STRATEGIC REINVADED SITES AMJJASO AMJJASO AMJJASO AMJJASO AMJJASO 140 120 r00 80 60 10 20 c l Pont L6rrbe r975 r976 1977 Ch. Badikrht Lowar Bandrma Trcatmcnt Trcatments of Marahoue and Sassandra @ st 3,, Ch. Nraka E ?- sl Gite 3 311 No Record % 256 Marabadiassa E= cr17 N , Months ocPf 78.2 Annex I page 5 tt) T{ Ha =H(n zoH tr-) zH E] d tEl E zH z Ir1V H&Irloz (n E1H ts r-.{ H Er(J r-{ H (J H h Bqefg.I eeep TecTSoTo.roafau Iecol r.\J + + + sarPnfs fagfEarl crfdouds \o F{ + + + (caTTag) sdE.rf eleTil rn F{ + + + (uosuqor) sde:3 uo11cn5 -t F{ I + (lrauuagl,(docsor3cads der-y fuecsa.ronld (?) F{ I + + (dauTeU) saTpnfs 1ec1to1o:oafaru pue SuTdde:t fJBJc.rrV N F{ + + ea.rE aPTsfno sacJ,nos 1e11ua1od ]o tuaruf Be.rI F{I I IrrBa.If sr.rrroP BItrePuBg mearl sdn erPuPssBs tsam III es?qd - fuarrrlBerJ, oJ + EA.IB Pefearl ePTsfno (an:ng o\ + + + ea.rE PafeeJf aprsuT (an:ns a1lg @ + + + uoTssTrtrsuPrf TEcoT J:o K1r11q1ssod uo :1caqg N I + + UOTfBUTEJAfAP salcads aT"ur€rg \o +o. + uoTf euTrrrJaf eP salcads Te^re.I r/1 + + ID >\ q)AE .r{ odU o(d o ea.re alco aPrsfno -t I + BerP ilco aPTsuI (7') I + + saqcf?c TeuoN N + + + ,{(d o i n N o\ F.{ \o N o\ F{ t\r\ o\ F{ + 1 I I ocP/78.2 ANNEX II DATA RECORDED UP TO 1 OCTOBER 1978 BY THE OCP EPIDU'{IOIOGICAL EVALUATION I]NIT (EPI) 1. Villages and visits In the OCP area Outside the OCP area Total Villages evaluaEed by EPI Villages evaluated by other teams 307 26 28 335 26 Total 333 28 361 Data not collected by EPI For 26 villages, data from surveys conducted according to the OCP methodology and in Iiaison with EPI were recorded. These are the only data available for these villages. In 24 vil1ages, similar data were recorded and verified during a Visits (to ::S villages evaluared by EPI) A number of villages have been visited once or more by EPI since 1 visir 311 villages 2 visits 21 villages 3 visits 2 villages 4 visits I village of evaluation (in 335 vil Iages evaluated by EPI) Simple evaluation 272 viLlages Detailed evaluation 63 villages 2. Overall evaluation activities, by year later visit by EPI L97 5 L Country Size of sample ( recorded population) Subjects examined at least once by EPI No. of subjects examined in S imp 1e evaluation De tai 1 ed evaluation t97 5 197 6 r97 7 19 78(to 1 Oct. ) Niger Togo Ivory Coast Benin Mali Upper Volta Ghana 3 578 LO 764 14 186 8 931 L6 440 32 s62 L8 972 L 246 7 43L 7 637 5 929 11 480 23 743 13 084 794 L 797 3 168 L 436 I 256 4 L77 3 336 4 t74 LL 260 3 422 s60 3 966 3 480 s 444 9 223 8 I75 I 469 5 L97 2 375 2 681 7 99L 6 268 4 662 4 442 4 885 Tota 1 105 433 70 550 L5 964 18 856 30 848 25 981 l3 989 86 514 89 674 ocP f 7 8.2 Annex II page 2 3. Total smple (recorded population) 4. Situation by country and endemicity leveI, 1 October 1978 No. of villages Population concerned Prograrme area Outside presenE OCP area 333 28 96 625 8 808 Total 361 105 433 Level of endemicity PAG estimates Actual figures No. of people exanined by EPINo. of c 1us ters No. of people No. of vi1 lages Recorded population NIGER Hypoendemic Mesoendeoic Hyperendemic 2 2 2 600 600 600 5 3 6 L 268 563 L 228 581 L79 875 Total 6 1 800 T4 3 059 1 635 TOGO Hypoendemic Mesoendemic Hyperendemic 2 2 2 600 600 600 5 t2 2 9t2 5 049 2 540 4 257 Total 6 1 800 L7 7 96L 6 797 GHANA Hypoendemic Mesoende-mic Hyperendemic 5 5 6 1 500 1 500 1 800 3 8 30 648 2 605 11 084 605 2 3tL 9 458 Total 16 4 800 4L L4 337 t2 374 UPPER VOLTA Hypoendemic l,lesoendemic I{yperendemic t6 L7 L7 4 800 5 100 5 loo 19 28 64 5 480 8 399 15 083 4 326 6 990 13 208 Tnrmigaagisn zones 6 3 600 3 396 Total 50 15 000 LL7 32 562 27 920 , oce/r{oo Annex frhA page 3 Level of endemicity PAG estimates Actual figures No. of people examined by EPINo. of c lus ters No. of people No. of vil lages Recorded population MALI Hypoendemic Mesoendemic Hyperendemic 4 5 5 1 200 I 500 1 500 L4 L4 35 4 26r 4 486 7 693 3 249 3 817 5 670 Total L4 4 200 63 L6 440 t2 736 IVORY COAST Hypoendemic Mesoendemic Hyperendemic 4 4 4 1 200 I 200 1 200 1 5 5l 189 I 725 L2 272 L72 1501 9 L32 Total L2 3 600 57 L4 L86 10 805 Bm.IIN Hypoendemic Mesoendemic Hyperendemic 2 2 2 600 500 600 I 8 15 509 2 502 5 069 444 2 069 4 L35 Total 6 1 800 24 8 080 6 648 Percen tase share of each country in the saople Respective percentaqes of the different endeoicity levels in Ehe OCP area(excluding iuurigration zones) Niger UpperVolta t'Ia1i Ivory Coast Ghana Togo Benin According to PAG Actual EPI figures s.5% 3% 45.s% 33.5% L2.5% L7.s% L7% L5% L4.5% L4% 5.5% 8.s% s.5% 8. s% t Hypoendemic Mesoendeoic Ilyperendemic t2 355 23 t92 57 478 L3% 2s% 62% Total 93 025 100% ocPf 78.2 Annex II page 4 Activities in the planned extension area and outside the Prograume area State No. of villages Recorded population Niger Ghana Togo Benin J l2 10 3 519 4 635 2 803 851 Total 28 8 808 , ocPf 78.2 ANNEX III oooooooo6Jooo +r)-)@tr):f\trn cooo oo 3 ,* c I o) r o o cd Ii cJ oJ .i !o cJ >,.d'u (d.tr,-ci< E ..lAcgA{OJOOUOOq 1qFE..{'Ud!Eo!rJ@tr(HO..rlO ! X C _ O O O.4 a tD A-E ..c C o $:: o ! tr o o o! OH = O O cD (d Oi $! o.Fr w-C ! o ol (6 o c)o o E (! o. .-.r .,.{ lr E .trtr(Ho0Jo!corHoo!qdtH o o tr O o cJ..{ 3qf oo..r(s(uEooocErJ El-d^ -o cn o.d ! O o)JIA- $dd (Joool xodiofoc ..{-C Olde . > 16 o..t.O = oE!tr|.-to!doqr(!trJO El E.-tE..t (s .r !rtrqdl!u!trc.)!O o o!1O,,, b0o(H! O-d tr o.x I! ; c c, < d Lq u o EO C .lu v.J o $ o.;uO(,l OrJ.dC!'U>O..laodOoXO(!oJo{J ! (., O. O f, ! CJ O !.r.{ O S C) >JEBOAJBicUU.-{O.dO-O!CtrqO.O.C'O.-lO .r{oHtTtt;OEOOJMO Xl1tH0JHr..tEO!.du6p. cQ rJ O -o H o rc, ! O O..Ft (, i o anFz rc E d (J & d a ld& r ci-coo-coUE]J(i a.ool.H-d 0J '' O 6 JJ d q{(dEo.rro nt.)dci-o ood E >.Cdt{OOoJU Oi3!.,ttuoouoJo(J 0,r o o'd (dO tr O-O O" ord0J!'oo!o .dtrd0J+J(0c6oH d .- d OOHOo..{o !>dtiOtr0) ..{ li O 0.-t O.'.r o0l.rtrHo!o u o hoq o o ol-o o.rr o.o o.OOH-Oo>a (d 0) ! '.1 o .r.{ x 0.) o. o q0) ! oq U)o -o 0) .rl .r{ !ouc) oo. ...{ oE ]Jcrtr ,i oJ!! G) >q .oqr ]J€ a a) o.cFU |r)\O NN tt\tr)NcO|.\NNNO\ Or O\ Or F{F{F{l o.!G,,O(no o o o (d cJ) JJ o(d o(J l] o H o&H d JJ i o !(.) o o D tdI CJ() o o F-loO trl &oH(J E] I (J o FlI oFz EI H t <J> an ! o E ooooooooNi\tO -tr)oo\O$r]k') r)\o NN tt -rtnN@f\NNNO\ O\ Or O\iiilH O! cJo(,o 1J o 'r{! OJ A (,)() a N N I ra \o rF.O\ O\ iFl o ]J J n o OJ tl 1' (B a) o a)lr bo o trA O(JUJC) oo-to.rJ'oics -dBod.F{ootro(,FO>O!!cd$.J(/) -c.-{ o CdJH ! 6o@>fO.XOOdtrAtrtr!i.c-d0J(0 '-C O .- CJ 16 qr.-l F u 0i Orir g)tsoJJNoOrr-codO.'{Xr-OOOqrq}O-C O o\ O -C 0J u O o O qJOBil!!(.).drJ!i 6C / $ o.O tr-c aJ $ ioJ cLd d Jqr !q @ O b011 oO >s.r{..lrro!ou..r!cO!{OOo..{O!O(0ti'-rE!-o$otf,o!cfu!.Jd oJrJG-o(6a)> o U O lr O O O o '.1 3 O-C LtG O.rl (d >,.r{ C tr -C u (d(dOC>H't,O!CJHd lr-C OAr (d 6 (! O.J o-C €rJa./)L)E-d.r.{!u.f{rJtro) ,''iO C., o o (d'U Cd-Cu E E >,-o.i o ! c . !J 5 O Ci q.ru..{n..{.o! ,.Jtr.J!4..{E(oO0JEt,!CO.iOUo..iO0J!uh0q)O..l 1, O tr O.d.ri d tJ @ a.eEuo!o$.rrrJ>OoOE,O 5 o..r l]E ! o tr tr O OOlr,SHOlrl(itrurJOcB0)C-duF (d E u o E< o.Fl >r rr.r.{ rJ o o) o o o. oti o" o lr(n c.) vl (.) & OlraJ 5 0! 0J -OOUJ]JG ..1 '.1 O ..{!! >-o a ..ltrt(BrdX J (i o.i-d tr o0orrO!trO -o 50$..{o.o0JcorJO.r{!O.r.{OH > (E >'d O q)0JOlilrO!! >'du(J0)G,l o orH 0)! b0-o -o .-Etrro'ErouoO.r{ o C (d !! o. o d > ciO.i ! li O ,$$o(d! .-!.FlUr-d X ! o .^n oql.ilOJ(Jrro) ;!LHG13-C(d-d o.H..{ > (0 ! O ! EJ!!oO! tr (iqfq OqO $ cii O O ! O o0trtH 'F{ O o.@E0)cd boE o(!5 uoqo6o Ele Elo .rt dt -o!!l o($ I u (t (rlo(iEqcdo >'c 'u(!oJ0)UU.i od(,)f 0.) o1, c.F(!o o .r.{ ]J ! 'r{ U o H tr c, aa9l o9lUIU cl o !(dlOJ O O) rrl'o -c orll o o! !,t ^5OOEUEi o.i ooF U O-U)a&d O F-r od H ! o(0 o(J Ir o H OJ .J EIo N fl o c .r{l! .,{ od\oJ fr HlEfu OI calq, 0.) 'dd (B! u oJJ..l O! o.o. .rroo JJ lr \0)otsF-l H ocPf 78.2 Annex III page 2 ,-, i ...,1 F\ O O -d O\ O .r{FIJU OJd,u ..{ tr ..{ ...{! €'U (,o o botr ! J C.F{cd d.n .,{ .r.r .:l orJrJlf.cCdolJoJoB r.O.Eq, rJ!q @ C..{r!6(o8 .r{ ...1 U rc oJ c -oJOx (,).J arllE L)tr.rlO(d(d (J..{i>,o .r{€ q, oEa o .F{u>(a(a (,-o (d !6 'O'Fl(U(,)(Horo otr o)(d60000) tr tr rd-oO(t,..{lJ .r{trooc ootr.o d0J (0 6()(,)k>qJC(il]..1(,j r, (,) (u orJ(,) OF{OA{od5tr(JOO€oo, > (dq{ doo.r{€ E0.)-c d a -crJ-doorJ (,) .d otouc ^trU E(dcdtl(s F{ o.r{t(d(nEE'r (0 oJ .Olr(,O(, rroth(d-o o 0,A.AEOE()FJH+J! F{o(d> o6 'r{ -d r}lEocrU,EOOoo(dO tr'.1!o!E(,l{(00 .r{ oJ g -d r+{ 'F{ t+{r+{ rx €..t o oC€ l{ tr(d o.,{tr '.{ (0o(!Elr .F{ o, uJJd d s,G O.r{Eo >ro d JN O }Jdao)o d-c > .F{ OJODtr Ot.cd> .F{ o oJ oclo5rJ-Oc) o a ..1 ]J o() U) Hz =IEI &() c)d td u) 14d t ! c, ..{ ]J oo (, o Flo(J E] &oH() EI o Ffo oHz td H <J> U) ].J o e oooooo '/) .+LAN ooooF- ral \t c') F{ ! o .J ! o A{ N F\ I rl@ F\ F\ O\ O\ JJ z F-@I\ F\O\ O\ F{J th ]J J (a otl tr o E (! (,) (/) C) t{ o0 o t{A IAtrAi OOC)ort0roocloIr O>Od ,+4 E tr o-d.Jo o b0! u q{116l{0OO t+{ lr O >lr3 .d a.q t+{{J (r) rJ ..{ @O.r1 CFI u d €Balqt-cd..{OE.JuOc, ,.tr€..{u.r{d^O rJ tr o i 3..{O(!o(!oE O.rJF\ O.r{\OO(,,NUON-oo\t)5 o\ 'O J r >r..{Hr O o Or-CA trJiHtr h.o 'n ..lrjji (s .rdo. X.dt]{ 51,r+i .q)o o o o (! 0 (,JNJ d EA E JJO\O'.| B !JJJE's oE o, c 'o or d (! qrt dOtrr+rOlErU.n ID o (! 'U a 0) ! (H o o c) .J oq) A .J) o c, orJ oQlitrJO OC) ouguoooo -c o > (drru lf .r.l lr q{ o o (d..{! ..{ c -c'utrEajo(!.CO tr or-C(aO!(dU d tr Ao(uuE.r{C(l) O O b0'.1EOood d€ no60q)t$ -C ..{d o0 ^ ArJOd!tr, .rl ..{ CJ O Ur)dUE(, o (0 0.q o0 >oEodtr(,Jo.F{ o ooq) o (0 60-0!tr >q d (! o cOO<dll'r{ 'U o o o. o tr o. og (d o o c)il ; (.) IEdd(!o .F{ AJJ()(d oo ...,1 ]J .J .r{ (/) >o(d 'oJoo !(d0) .r{ l. o(dOA(,,o(,)!(do ct) oo .r{ 0)u.F{ x(,,oo ..{ OJ! oo o0JoEEu o!ooo(d_dJl]rrEl 'r{ (B Jl(d-Cq ol +J(JOOIo trl 'rrr o Elc6 0) cBld o 6ot .r.r{(d lo0lJ .l >oo@lrcJJ O-f 0J]J -d Fl .tr(,)o.$u tlO O(H||HEOO @ O '.{ -d otruod rotr O)o>(/, -dOlru! o!0)U(U. -coou>rB (0 qr (dr > >.F{rOlr!(0tr rd El tr o 'dH ?l 9.dE .dI H E!rilo o) o, (d ,lq{ -c!J .n Eltrr OO tr..1l.r{ O 'O(d(/)lt!jJol O'J d O 'r{Frr..l.o.C .r{ ! U .J rJ th H ,; ! lol .I €I SEEI ..{ ,l dlu-()l(i-d EOO!(dU(!EU,o(! >'o! uro! o040 '.{ EA x cl rdl EI olot *l ot a;trO a.A -oJI eDIJ(!J -d :E o.lool o ^dlzu II JJI 'd rJ rdl! ..{ r{l(6 rJ Ol! otltrtroJllr l-.{ rIil o cq ocPf78.2 Annex III page 3 U> a Ud o E ooooLno .+ -{ilF{ oooo rn u1 N6ld ! o .F{ li o) A. \o r\ ILNN r\ F\o\ o\ JFI I C,o \ON F\ F\O\ O\Jd u)U F. J @ o l{ ! o E rtt o(a o ! @ olr A{ @ .JlrrJO"{u.ou ..{ OEolr'i{t, od (dA t+a (! t{tH tr(00(0q{ -tc()ooo..{tr rJ .r{ o(d6()(u5..{ rJr+{ ...1 t..{oo orJ o .ctr6truoo oErJ-dE.,{(drd ootr -c-6(uETUE(a ; o 'Fl o oo art ou dl{qlr o o t,(d o od o r! U) dt o .E 'oTJJOH(a +{oo € oE , Aqlu)a oo0 t,(DoO r.,uv)r{Oo ot+{tro JJO(!! tr '{oX >..{OOrJAO ao!E.JOodo o..{lrg)ooc ,.c.c oIJHO rg o o o .r.l o oo o t{ o rJ o a o t{ rr.l o6 o q, <h E o .r{ OE cu0,(d .,ErJ XF{ r! o .rJil o.F{rJ o El o oO ll Ut !. -o (Dl (! (uolu t+r0, cl 5 '+{> EI E..l6 qllot -dEl oI5 o(,.IJU o cal ooE OOXrJ-C-{N d A.Otr, @"{o! o o(0,c(a 6 00ooo. 0.r .c. @ri.|Jtr6 r+{ .F{ O .,{tr(,)o fq .r{ P.o (,) .r{ E'+ro -6 ..{ .cOO+r(0!J .r{ q, co ,.d o € .t O(dOOl{ -ool(/jBrd(o >rJlfttt{. o=q,Eo€uotooColrurO>C.rrO>-dHO. d O H..{ (t, OF{.r{ r, O +r tr rl r0.F{ O @.r{ .n o.r, o E tr B Fl t{ 0J tr t{! tr lJ O O t+4 r, O'r{oO6'.{.dH@Qg{Jql, .n60@t4(u.noor(!0@a@r+].Goood@h.F{ o o q Jr (t, o,'.t (0Jr+{.F{ d '.{ t{ O EfAtd= F{..{ .!tru-c!.'{q t+{ ti€ H u.J t{t(n0(u(u(uoootr rJ F{ > o0 u b05 tr (,V) c!.Fl g€ trrJ.FlEl O J r. O O .0.r1 r0)XJ€ EUtrJEo>IJ .o.JOotrtr-o(!rJ!O00..1 >.d c, O 'r{ > O -Ctr@.J!>,OlrOtrJtr(u .r{@tOOlJO'.{(.)O}.d,OtrO-cl{dOo(!-Crd5 O..r{ u u or O. O. lJ -o u E 1, o o oA o HA .d o t{(, o c0 oc o EllrE 310, o ol-d t .F{ Ol+r O -c dlo o 0,qEl-do-do LdlBJU-o o€l oE lo >'+.8 x .l d o oiJU)I?a€ aoEooo.o!o!o !o.orO rJrJ)vtE o€E o€ >' t+{ € '-1 td .r{ O)NO5(Jutr€ooo6O o tr O -C O'r{oduo+Jh.,{ 1, tu o x o h(a o ,0, o-c.o, lirJ O.F. +J O O Oo o OO l{+.lt+{EEcrr.'+,loco-co..{ts.r{oq,3>1J I(o rr}]ho F{.r{$l{ ,Otr+J1r-d r o(BIJXO o..@ohU,oE +r.6 'r{ .r{Oo rJ.o>X r0 F{ 0r.intr.Oo(d@oHktr ..{r(u(!E El o o :Jl (,) 6 ^O ol .r{ s)l, ol bo'd t4d dltr *r Ell.r{ >lv o idl't, b0k 'rrlo ! xIo o o.o .ltr c oH col-o o, o o ..{ TJ) +J ''{ti(o aH .+{qi otr +aJ(JO '.{OE -d(uo= an F{J(0ooo+{ooHOO t{V >H5 ..{ FI cdlJ EI(0 (trlo trl .r{ (,l!()l dElrtruo <FI> atJ >rO +J(0() ol{trtrr(dtrx> o) F4 ! o a F .J rl d o() v)Hz E] E ItIil(J C)c fi u, frlil E o a c n{t, oq) () o FIo C) E] co F{o trI I () oFloEoHzEl t-.,1 a ocPf 78.2 Annex III page 4 <.t> <n D TJt a oct ! o d .r{ rJ tr oo tnHz H a El&() !d CJ& s U) rrt& ) t o ..{ IJ d o() oFloo trl &o ET(.) EI I (J o Flo oHz rd H oo -t oo @ H E o ..{ t{ o or \o F\ I rn r\ o\ J b0 \o N I r) N o\ a; (D U F{ th c, I{ H o 'U rU o U) ol{ b0 o! O{ ^oOrJu)trr JJ 't, gJ !JO(0ooEOHEd)boo!j-cJ@ d A tr lr (d o! +JEG.r{HlJ!(! - E-r ! (/r (s5(!a!tr^oo! 'o ot !(! ! O o) O..r.r O OOO t{ O (a ! rJ hoE0, o o..{ tr..r..{ o o -c'| B o (u.r, c lrlJlOf{CpCr(d! o o.!r o tr oO0OrJoOOOtitrotrrt{-c .,{F{oEl o'o!>\> +r-o E 5l o -{#u.f.,lU)l xoocF{O O lr Ol +r b0!, O,@ +J O dlJ r+{AEI J d cd -o o El x ol o.a o (! o6 5lo !l .n .r{ o o.)t6 !l ltH d tr .'{ oOl tr .l H 6q I O(, OI rd (rjl ..{ 'r.l < O Ju o.,lr 'co r{ E UJHtl.n-c cr!j<J lE u (, !, o o .O.l.n.n-c6oq{(d(!U)l oB!E3oB o0 Elc5l .r{ lrll]ol(! (,)l ooJ ol!k'ol lo(d .lbo(/)l 00 -c 0,rJh0 ..{cg B'.{OO. t{(a orfl(,Jd0, 0J Elo > Jlooul , .o rdl oul cul hO ..{ .r{ Id >l ..{glBo.lo -o coldEr 6to-cdFqord kEl>,o !'nl tr(do_c(d(u(drloEo0(d!r3(! -d ?lu (,J tr d 3 > !ElFl O .'.{ d C, tr r . U)t{..{lO(Jri!.-{E(!foo o(/)l u(s|-r$rJJou3! O O U BHrd @ . }'! tr Ct+1 a ebod $ tr ..{ O trE ir) .J.rl(JO(!dJ.(!.(!(d,r{ ulr..{uO.F{CrEd(,)!rtr oc!!O'.|-CrO!oO$ oorr]{(0!-oo..{.rdu_c > tr<(H(Hr{..{Uu E.J OI @ < o (,) .r{.H ac) .J.CU.JOXU)JEOE !d)u!(,jolrocH -r..1 (d (! (,)d O.(! o.rJ O C, h0(dSEIoo(doEoo>d o. 3..i O (,) o.-r o o.r{ .J O d 0J ti tr C, O lr otOOO.r{tElJqJOUCr!d d O O B O-{ (,j o0>o 0., .r{Og)Elrd(utrHqO. tr.JCrrt(sEOC.JnOO.lr.'{ b0 ! O.E,..{..{-d cd€iOotroo!rtEEoEOo ooo.n@>,,aa!,$Ho> -d X O.C, b0O XO-C.-l O Od 0,)Fi O o-o O o (,)(H O 3 tr tr-o! ! q) (/J o o. ol{ o. .d olr(d o6 od l+{ o >\ (+{rJo .r{ rh 'r{ C -oo ..{ r-..1ooo (,t OHG(s a) c, b0 .rc,EU.r{ JEo >UJ Ot.r{dAJEu-o (d o (!€ rJ o(aH o(a (+{ o >\ q{uO .r{ d> 'r{ C -oo .,.{ J oO(ao on o.(d U)0J d0 lJ ..1 5EOx(,)o!'-1 tr)JE +J-O (d o (0.OU o(,) Er 0J@ d o .r.{ ! ]J .r{ ]J U) dH (! o .Fl tl o q.{ o o o (drd U]J dv)(d F{ 'dUq, <U .r{ ^tr(Jp a C) ?l EI oJl o cdlE trlU G,,I(,El .r{ tr ^ Oltr a, lJ r:.ltr ..{ 1, ld oNU .F{ rJ .r{ tr o 'U 5 o O'FlO JJ lr O0 '-JE..{ o tr-otr!r>.-r3Oo.r{-OO addro oF{PHdlrH ocPf78.2 Annex III page 5 oo F{ r{ .o 0, a {J o C) anHzIrI E El&o Id fi(n EI& o ..t ! oO (J o FJo(J rd &oH(J E] I () o F]o oFz rI] H <J> U) U o oo co J io o 'r{tr 0, P{ \o N I rnt\ o\ r--{ b0 \o N I N o\ F{ -oo h oU o c)tl t{ o E (d o th q) ! o0 oti O{ q) ol tr oJl o, rl Bot oJl o -c oJ>-d u! ol tr u J cl(!._t J 'r <l tr ts oo.r{oTHEtrIr c o.r c,)OJ.l.]J .r{ >(,t (d JtJ .O lr rJ _O(0 5 0.! orJ c, o .r{ o o! o)il Ec'eo.ooroo.-c o o 0,(drJOO.> ^li (,)..{@o o o otr +r o B El , .J U 5IHB!..{ o.rloo o f ral ci-tr (r(u:rl or!o.-rEl oO O O t|rl Cf!EE!(/)l.r{ o ll..{OO 'r{ ddooo..ro ElJlruH.r{ rJ q)(! 06E O fC,t trF h0!rrjtr(dtro(d.-ld ..1 c trrSrtroOO O .(0..1 Okg.r{orouOJJdO.(0JO'n lr O AJ (du(d(dN(d0)dE O. lr.Jo0 J (,J qr!trOtrsdotr0) .-l .C ..1 (J .F{ .r{ C, r, > JJ .rl H -d 'r.l! - O.t+i (,, U (du o! o c, Butr!q{rJ!(d!(!!O.JJl,r,tro.oH(drJOOOrf d]J!odo..toOtrtrd.-lH! uEoHor(ddo r{O}r.oJJ(oJ>lrO.r.lti5O! o J-d > 0, urrdEo!ooord de60'oo d!$OO6Utro dE -o oE 6EAOJE@ >(dd$ lr .r{ v)E @oo >q O HFI OlrA(d odc -dcJ(!0O.d 'r{OJJtr!l{oJ@cio-o o .r{ d .r{ootb0! FJ u oor, ..{ > c ..r -oi.J! o >'d oE tr C.dH.r{(!lJ q) ah o o!a o l{(n (u o c,& I o!!oooo-o! (, O'Ei O -Cd>u lrJ.iloorJr+rx -d B.-t o 0)uU)iootroo.Et o o EBoo.JoEOO(ru>c, c od o.El .,{EuoJl Edol rr O O O ol o ..{ ..{ +J trlrJ!o(dEJ o c).,{ ! dl! rlqr (dtl oq o. I o-c:, o .lEi lLo o.hl .orH rl{Oo(dOU oE(H (d c .J+JO.JoE -coo.-roO.-C tr O ti {J !(d B O o) o, o'rll .F{ o-c c)h0Ou$JJlrt ocr(!.ilq) o.-rJ) o 0J1, trooE.-r-o F !OlrtrOq, .riO!drl-Ctr -ou(a(!c+Jtr.0, .r{ O 0, .J 'Uu!! ,rE F{a El ! d o, q,o o d fll (n-o.r{JJ ..{ d)l o (HXolco+r'ug o th dl o o d dtr O o El o tr o, .J(! .r o0 rdl J E BotCtl-CrJt!J O lu (d > o) ou-c.l.doo-cHo(J(/)l 3qE! o .,{ t) U .r{ JJ tt) H trr O ob0(, >' Fl .J 'r{o$olrtrd o(n(d >-d-c .,{ (J (J o(! 0) o^fr -d0, c) >l] o(dvlODI!o ooqrdd oo!!troCuoo dAF] c)() I ocPf 78.2 Annex III page 6 <.t> a rJ o a oooooooorOr^Oci \OO\(n0o(7) C\ C) N oo Ln \o F{ o 1/1(r) F{ @F\ o\ F{ t o .F{ lr o Fi t') \O NF\ll \AL^r\@NNNN O\O\O\6 dF{F{J tiOu(ro(4)o F\r\o J o IJ J U' olr lr o E a r! o tt, olr o0 olrA (,,€r rEug,O.o0ru)I @.r{ O O o) O lJ g, (o O O. lJ(! C rl u tr O € dr dF{r X4} OO.Fl (.) .r{ u ..{ O } tdF{ sr 3 ..{rJO.O(!<Orr.r{O6€(x(dg)OrrE+{Et{OOdO ..lOtrr,.oUri6.'{utJ!! "Or{y{OO.Fr.OOXtr6!rOO'}{ O B ! O O O o O.r{E o0'+r o O d, -o -c -r O lr O O(ddlru(U>trO.rd-oO.U,> t 'Fa Orir.r{.'{ O lr O O O'rld.uO.5-oti >OooHErJ(! E (a @ 6 O 6 -.r r q' OH (sOOtrOlrOll6-d O.CA trOU)uuoli(l.c(!o@(!!rF{ (,) O Au€ o r{ E O-O6 >,1.-O r' g .d tr-d (u OrJ .Ll (, 'J o O 6 O trt O O'{'''l o tr-l-{! 'x B-C o.'{ tr.F{.r{ u o o t!..{u(u OrJ Or.,-dHOE.'{ (! .cldtr orr(,)(0BoE !@> >,rJ o r, l{ 5 J tx l{ o tt c, q,dE(od(!0i+{r6l)ot'{(,0udooEtr't'+{rJroo EUO!lJrJ! li{Od Aa15g X.FlOurOBlJr{trlltrQtr t, o O .r.{ Oq{ O O O O'J EO tr O O E tr.,{ Ft O-d (}{ !U O oo€ o O H l{ o r d O E tr o 'r.r{ t0'.l.d lr 6 O tr O O, O(l.i O lr< JJ (J O Ut+t O (,) qrtr (, :i t, o o (0 rtUJItr6ad o o oJ o q) , tr -dd (J >(o1r! >au.'{ 'r{tro F{ }EuOrrqrJi+4.r{(0o oE q, o o x trO+J (U r, O lir! F{ } @-r -d 0) .r O C J OUrxOJJ(u..{(,)t{J ootroo(d.lr c tr Hr 0,OtrOO'.1-dtrt,OO.rlh0OodGE O l. h O,E -o(0-ooo-otsHo< rJ>01(U6olr'{O'EO .r.lqrO}{-C.rJ!u u,E> r,trOO tl: E{ O OE O O$6 r{.EEar3r!!rljb(u.tr.d o 6.r{ l{ O O O O!"dNrHt+lU,!Jl{.r{rJ_O(!rj! ^z o > o c o .(url..{d.r{.r{Ou tr o tr o.F{ro u, .".1 t!-C O 6 O tr O trB !r u E .o ti.'{ -O .'.1 o dt€OdJ .r{56! !Zo-{letrt{Ooooo.lJ o! o(!t !oEor-c otuqt .r{ O t)>Uo o) @q!..1 tr OQra'r{ .,lulOdriOl{ o.JooorJ3s r!@O NN o >\E.ra O\ €rJ!rF. c, -A (, ,(atrcxtr-{ H .r{ .r{ J orx, o>lJ -E'.1 d!otr(0trC(Z|D!r(0.rt t 0) o oo oliA o! .0 q) o o& J(! (l) ..{ o o !J 'O ..{ O ..{ q{ r}l 9)O ''-'l .r{ rr - Elu rJ g) ,l o (t, tr ol o 0,1 ol oc>dl c .d .r{ El .i lr ('ld,tlBd6 IOJ O.r{ .ltr .,{ (,l!to(!tr60rr-{ (U tr6r'.{)eurr J !JJdooo >r+{ tr t{ottrrJ 'ddco 6E OH(!(J(J I otr 0)tro: .r{ 'r{ q, > u r+{ (,) c(0orJo oEol!!r00(u oOol.@ +{t+{ O G t{r, trt+{ U dd.,{q{ Ed , oodrJ E @10()(un0r.c tr.'{OJ]JOt{ -cr alJ O O E€OU..{x x@OE O O E >Q>EU'lr t! .r{ 4..{ (,) U lr d-l orJ(0o(,rt 6 Fi d @.F{OOO-ClrlrHEtiOOU d o U) TJ ."{ u at, H l) o(! o() lr o H o& H (!p o t{ o o op rI1 ()() o o I c, .{,)ol ol uCl..l (! (r, c,l oo , rdglo o o fr.li EO () o E-ou!o o.Ft oHt.tr>cr:tpF{EX o!d 3'l HI 0rl(Jl F{ o .,{ Vdl(nI +r f{ll+{ o ol o €l xol (J r, hl.n .JJ(,) -.O liJ,oclo >.n o .-/.rl& p € o ad .r{ TJ d o C) U) Eizt{ E fsl&(J Q d rd tn Irt& I F]odFzo() &oHo ttl I oo Flo otsz Irl H H ocPf 75.2 Annex III page 7 <r> cr-) +) a o E oooorO @\O ooo F\ F\ o\ J dlr U t, o€(0(/)c,t{rO , !..tt dAo tr< E < .r{ o.'.1oq{, E o tr .'.lt O ,r O (d > 4,, O O1, OJ!rol'{.ot+rHt{,o-co.n(s oo.dorJoE(dtso.il].JrJ cl O O tU €'F{r{ O Ot OA -{'o€ } o 0,) x > .r{ J lr,OOtr.r{.Fl.oOlrd!UO5 > 6 Oq{ tr,'n.C OE 't{ tr) (t)r{r] o ..r o >, l{ o..c () o -o (d!}]urotilr(,)14atr(0o@Ootr6uiOOdOO'r{d lr o o C arF{ o o |'r o ^60 .-l O .c! o.'{ (u'O E r{.r{ {J A-O O Oo o o tr rJ (J o rJ 6 (H-{ >,-o x.rl o E tr q{ 6 -o d o.J oF{ x d d oE o< (d >r.r{ @q, o o t{ k tB o c€.r{ o o r 3 Etr >-C OrJ .o (d Otr6-.9.n-Cq .D(! d r, -c ,a o 4...t o E -i €.F{ -cOUOEo'TOONO(ad6trtr E O (,) (! Or O -C tr-C d 6OUtr.-l-dJOAtrOOh0i+{ C! }r O 6 l: > o O l.F{ O0o tlo d orH (! g0 o o q{r r, tr o og,..r (u q{ o0 o hE E (! (d.-r rro'd .o ! J x .n.o o_r.o o toO o o >O O! O @lr O..l ) A,A C, -C t{ ! t -C ..1 .C tr O ) .D E F{ !r .Ju 60rd 5!€ o+J.F{u o >'t{ o tr > otr-olJotrooodlo-codd.n t .'.1 < ca E d !. E .o F-{ .r{ o. t+{ .r.{ o. F{ E o .r{ lr o or \or\ I r'l F\F\ F\O\O Fl- ?n TJ r{ a @ o t l{ o $ @ o o t{ @ o tr Ai !Jtao!tr.o€OO..'{AlJlr!.OE 0J O O o'r{ I , €J !DF{ !J u GA . I -d (u.6 d O Oocoo.J(,).ooz .c o o H h, h< o ourJtroxtrxtro ..{ (d8O..{O.c.Aa3li'd -EE,tu !trOlJ+J.JlrO(a(,u(06OrnOSOtrUO tr > E -{ E +r Ar OE O€ t{ ort+.r a.AaEO(0€tr.crr6€t€rEE.{tr.r{rJrCc,tH O (., (!-C.r{ O @(d Or! d El ! B-C d -r r!d JJ !l ,lqr.,l .r{ o Cl >(d o O.dlrJ B ,p tr -C u E t{ .JdEF{lto d, o (d L d orl.o-dOOrdOO,{ .r{-r+{EI<oE(+{urc r+. H o .r{l c0 r, r, o. 60 .r{o cDl.crl(0oo >dUtJ h rJ O OU O!rF{..{H (uut.'{'IrHtrdu.t(, 3.d o 3 rJ o o c oEa.c o 5 o E 0r (d@6(!(.,d(d}{(du!uCOrJ(uO>OO>(!q,!r .r{!t{Utr!U,lit{OOd(,JJOO.JtUt+{(ddtrO.O DoE!EFI(drrFIrJ(Bl] t o o o A. ot{ o. ,c olr(! o o o& .d a(U \rhtrr.g:qro €krJtrO!r16(!rr 6 r{oooU E E.o otr (d-d d cO tr (r-.1 oEdq,..{ +J O.U tr Ud O.'{.io o€ .ol{-c tJ tr+)rJO6OrJoooo EE tr @-C O .J..r E o doE.Jq,..{ .rllrlrrrL >o6uo,)lr uF{ (6 >6 c, (u (u.HJt, lr t{ ! tfi o x rJ IJJtr(0Orl tEl.o .don o Ersd6trtoco .l,rdd Or,t{ttr(!!J (UJ e >\-d E =ro3I (d..{ lJ JJF{arrua(dEO o.'{Ht{(/) o ,EO' rJ .CEIuald .nlO EJI od5l .d-d(,EIO ]J .JIH o(/ll(d -OO O..{(Hd,.r{}JO oolrt{ hO oF{ o.tr rJ(0005 tr t{ .r.{O td Q! o(ro >lrd O!tr (! q, .J ..rlr O Orx O td 'r.l .F.l .r{ .F{oEoo>O >\O !o-c.dac,H O Aod o rJ) JJ .r.l rJ o dH o !J oc t+{ tOEI tro .dtr d o l{tt{Oqt o-o d>n (u .,r < q)d rdooo, tl.Jrd ^ Ol rrO^ulc)(,Jo.nl E ..i a trl<a()pl vq{lr ^OO-l r!qot,(,) !tr0)!. +J (B t, o CF{ (drrorrudC)<qJoq) € o a6 .r{ +J d o() v, Frzfrl E EId C) ()d !d ald& t o) .r{ rJd o() FIo&Hzoo &o Ei()t{ I () o FIo oHztd H H ocPf 78.2 Annex III page 8 <J> c/) ! oci ooo r) ooo LN 6t ooo \t .o o .,{ ti o or \o F\ I F\ o\I @ N I\t N o\ J Ur o rl) rn N I\t N o\ J x J a F, (,) +J r-l 5 o o ,r ! o € a(! u) o o tr o0 olr Ar t@OrO(,or.lfl{tr€(0 €rotrBU) o-c a!JCTUrJCO!(!EU,Oo.CJ t{lJr{fr-dEB -COBOro -d! o-c o drJ d orJ!, (d .r{(B(u(JU)3 u-coJo0, <a Bt+{ f{-CrrlJtrt+.tOH5 c0Y{ O O-do-o 6 tr o. < @.F{ @ tatdEtro.O0rk.r{-C! .r{€t O lJ O.C.llr.r{Ou(!O--c!oo0r.r{trurd.F{rtutSqr o > tr bohol{ ^O O I Oo (d orJ!J oJJlid !, Oo (0 -Aot80.rtr@Bo0) -d o..t >,! (,) >(,,rJq{U,CJ.J F{.ndcdoud-ct{.r1(Dod .F{{J!Eoolrb0 k'{oo(u-do0,HIE(,)BrJlC E o! t+{ @tr o (B€ ..{uoo rrr, (!€JJ(,lr{ o B o ooo6 Eo +J .r.,1 > r+{ o, +J F{tH ! O lr OF{lr rd ,EOO dFl @ O Or+{.JcEU)b0o .-rcld 'u(Dtr.no.cooOJ...{JJO+JOtr -CO(ardt{PdrJ > O rr-d @ooo.rrrJdU,aE-'lXC '.{6q)O O tr (,,.CO>,>, oopl]!>,trtH(d(uo..r-o o u.dIJJ(JO(d+JO.Flr,€.cd6.oCJJ.r{!tt!'.{OtrOOrx.r{ r/) JJ .r{ (, .r{ O. O ..{ Au ! {J O OrJ (u.r{ o on o H6 ().dq{ o, Gt 00(u .n @ d t}{ g) > tr >JO'.lCOrd.Fr <(,,OOr{€gtl o]J tl{ O F{oo,OrJ(,OrJo)t0C'Ut r ! l{-d o.d 0r .o o01,uo>oo5tr(dAOu.dOo .{OrtrH-Cor ,-{ o JJ OE o 0J > a,r .r{ > O C ^!do, O C.r{ .t tr O)t6(,)oo.r{ 'U ! E o.c o'Hdo)o(d€u($6rO.r{OUC B o lr o E o.r.l3 uu.r{ d ooJ(a>o1'J, (J tr.r{E 0)t+{ or..{ 0J qt -C ..{ > ..{ O >F{ u ! li .tod(l.r{qrrDJE-ouEl >,.a,tr oo6rl-orr^oo ,O-CJr..lldO.'{duodF{ltO!J .r{ ..{ o Jlo g o 6rJ Er U) El tr (,).r{ od ttt -O O ..{ld .J 'Jo o 6 lr <Dlo to rJ rO t{tJ O. u d ($ O.rJ o o o.o o.d a <(,)OlruOOBd 1, o,) ID o o. lro o !(0 0) tt) q, & tr o 'r{]J JJ .r{ U o H ota F{ tl ,ooE U.d .r{ O. o d) ct)t!-{ Ooo6,E -c Eo. rJ O .r.,1 Otrtrtrord(! rJ(,)b0td OFI lrooa.60 .J XrJuoc+J(,)(a o 6tO(,JEAJtr > J.'{ E Jdokoo ..{ o oq{ o.tr o|I E o r0 X'.1 OF JJ O! O xrrJ .C .d ..{ oo on , -c.F{ EoJJ-O C L{0r.no6-dErr!!Jo.o(dqrooo(!0, F{O(!ErJ'{ -o(,>..{(i6(! f ! o'o +J <,, q, 'r1 0,, .F.lJrJOEJOOtrE@ .C El o.'l 6rJ Jlor k(d olc o @b0 Ol.r{ dJ O o.dcl (dl] o ..{ El! -o p{r !r 6l trootlorJJc, > c, l,{ o-CO, JJ .lO O rJ € calq{ r li IHJ tJ o o+{..r o JHrro'uoo El.qrtrU) >,o Exoc(, rJ F{ .r{ .F{ r o.tr c oq,Eo(d .F{!l{obo Xo) ^t{odrroc!0JJ.F{r-O O6, lro oo0o!r(Uu rJ 6 .Ft -c rdJ ,r o0O t{ o o oo..r E -o(0o$EE0) .o CIUC, ...{ 'U .d f. ll .cOdO@C' rr..{d.Jo> r,-dLtr xo ElSO{".{ 'UOJI50.J| -d)urJ 6,4l olAo.-,/.alu+Jb0Alr, H o(H.Jl o d (dF O (nl O.Fl u qr vloDl !b0 .Ad(D .r{!'u o(!>o .Ad 6 ..{ (0 H o o( a -oo tr o06N o lf(! o) li(,) o q,,(Hd (, -{+J c0JO ! .r{ ..{ €!o@z H U d)ol6ol otrlo(dt rr I >.Jhl trl ol ->1E I-{l H@o&dO r-l 1,(l, .r{ r, o C) v)Hzf:l E trId(J Ed fia td& o o 'r'lU o(-) FlodHzo(, &oHq) frl I x oFlo oHz 14 H H ocPf78.2 Annex III page 9 oooooo CO \t$$ \o F\ I rn F\ t-\ F\O\ O\td oz t oJ d .r{ TJ a o() u)FEzor{& =4l.l r,:EilU)&rI1(Jd J C)()&H EloV) F1HOdH H ah fr Or Az J (J Halrl ;(J Flo H EaHpr IEI Fl fl tr]z EI() HH H <t> V) +J a o d € o 'F{lr(u A o]J J o ot t{ o id- d(! o @ o lr @ o tr Ar ! o o oa o tr o. (,) tiq, c) o o& t o .r{ rJ aU .r{ U od H oEtru tr d .oo O..l OE..{ Q d () € 0,, E u)trd..{} ..too Qot.J 0, El qJ; 0 d .r{ o o.r{ o) E! O io O +J.-{ +J t.Ht-\ -0rrd q,Eo.E!r!('J Oo Od.r.t .d OE;_(d rl ! 9 9, H o >\..i .r{ o (0 o rr.; o -C tr t ti c.r u i i'o, - F O q > {.| I E 6 d u tril.'.| o 6rra .u.; o- hrr; ou:E o 6 o 0r O (! q (a .F.l Or r{ A o..t E j C:'jJ O i o9l-r0r >,-rdE0l ? o'flgoo!..rlEoo.,r nE i+{lr o (,1 (! o o o..{ (!}J d tr O 6 Et- C o - iUn cl > o ol - c.r Oq -q.1 q q ..c... F E rr.r-r.,_{ o r{ o o E j o u ! -o o o U (d o . H q, tr u H l. .r{ U ,.ii..{ 6 d .C O O d O O tr O Uj O !.9.'Jr tr O oFr (t(a rJ tr ! or o .,+i o n € ol oi rJ o 0r-C trot(!0q{ (Joo c! o F{rJo. io -nt-o6'tr6 > o o o F-l.c 9+r o-o'+{ 5 G J tr aJ ol ou iru c; id-q,rJo (J o!r.lPE..t oto Oannor.coE!,-c 0Joo!ol{tr rJ.!-l ..,ral >, o.F{rdoorJ .o-5ot - ir r.C o o . ^..t B ! E - d x tr !r or -o E tr - o E o b >\ . Ero u.qrO(!d .'{bo(!E! cdB od.Jd)(B O(0!c 9-q E !0 oou 'q (D.ir o -.r{.d rL6 o E 0- E.J;r o - H..,.,o 69E q q > (! A q 9l a + L, o q E F{ (d o o 6 r. tr p u - 0 d _ (d rr..r,.c srr€ u !r o._o $..{ c qtrnr-c -,o i c iu 3 a = uG --dd o !-r $ Q. a -c oIdL^ o- d- a.:J o o O..rq.rt9ld E a, cl..d-{ o.r{'+i rJIr - G ol.,l o6 8..r,+i.J-E o. o q.)o.r{ocdrr >(d.rJoo q E o t--6q .jEE--'63 > Ft o o ot o o! bO 6 oOo C fo xil o c (B.r dH r . xk..{-c.o.n E q o lFr d tr . t tr o O-c-o, i 0 i:.=J oJ9 rH lJ rd t{ rJ tr 60.,{ (,? q e o 6.J d qr; ch E- - ,5 U 6 <i <.r>o.r{r0.r (do (ddo.{ JJO O..1Eot .i5to ;Ed O'r.l rJ o F{ o _. O tr -. e -t tr'O -o .O 6 !, O, tr E - OJ frf O 5 -CtJ.'JqC(!oOUo-.1(0otr-o(,O OtrBO-oUh .;5 -989d ooEd-o!! Er ->-ro O6-cr.6o tr!tr € q H r (U o ? _ ? t ! S .c .d q d > X.r{; r, o.q a, .d o (0 o){ Eg 9qn r.|9dod >!EE."li. rrur qrrr-qeE >.;rr$ 5 tr..1.tr O >ttr O d !.c tr 6.=t (d O U O o d O.d'r{ r, 6..t b..l a,,Q tr o, E u B.o o t{ o o.r.J g) B ol i o i SA{,jjE,s r-{.: t 5,ij E tr .,! ,E .5| - O O tr o 6 >'1, J trillO.r{6tJ.OrdoO(0 t{ f{! Ot C, O t+{dE0JO=-{l.Cd.ArU_C,otduOE!(do!oEoao tr.C > (d o o-tr o o (d r+{_c Ir .-l CI-C O C) ..{ O A ! O O u O!o.'JodtrOOr!rdrr a trEdJ.io6rJo)o6(Jut,.r{ O tr trF{ J f O ri 'F{ tr ! qr.r{ o C E € .^: r+lh06g)dEU..rE.-truj6ktrOOuCO.r{o(rOO>OtOFr.'{ I tr O-C o h0 i7 u u,d (0 1, O O O t, bo-C C () lr O J.r{o, o.d d u.,{t{'o.-t o }{rJ.r{r, >| o o.,{.nEo ! ,booEr+rUrrtBtrBordo,OOOOtr...ldoOtrrddd.o J..{ (,)rfl o tr E (! @hO (! tr (,J.^CrrH.r{ 60 a} olr lJ (J (s O (d lr od o tr O o O O)H..|.-l- 00tr tr tr (0 6 O..{ ti Or,-t tr$ (a O0 ! (d tr O 6.r{ O r{ 6 O.: o €OqtOOF{dOrO..{ErJJfdlrJ (/)d > , r{ b0J tr O'u O.; _o E Q 01..1 (u O o q, o u oE O.i-tF.o"EE>ouoo;ooIE-o-o d .coo!str(s0 oFl o0Jnda .r{ d (.)(!C o, '.loV €c)5 o ocPf78.2 Annex III page 1O <l> U) rJ tr a o oooo\O \O @(o@(n ooo LA oooo\tO rrl 1, o .r{ l{ oA Nr\ I\O@ r\ F\O\ O\ Fll lr(! E cOF\ Ir\r\ o\ J \O F- F\ F\O\ O\ F{ F{ o]J F{ @ otl I{ o rd d CU d) tt) o) tr bI) o L{A sibo ddlt/)r)l. O ..1 0, q,(D (d .r{ tr.,{ €O (,j O t+{UF.l€@'+{O€h0rJJO'r{d=O J O F{ r0 (l) rJ O tr t{ c0 0.r{F{ +J Gt+{ tr '-{F1 O O u +J.FrtrOulOO6OOAOa >.r{.id.F{ u.r{ > o@ OO+JtrorHrdrJOO^ONOO Or 6.0 Or E-r.c O.do\ o .t.o,orOu'r{HF{E!J O0.r{ - 't O !l JJ rJ Otr trE O tr-r O tr O r! -C og.r{rraJtrOtdAOuE.@ 6-C (,)rJ.F{ O }r .n l{ r- oo.Fltrrlcrccr!F{6o()h rJdoa,coorHoool{tl(d F{ O ]J rJ 'r{ +r r, >'.c (0rJ O O O.r{ (a'.1 l!! ll (U o.CrrOtadFltrrrhlr ^rJ o (d<d.r{ O q, d @ .r{E O .o E.d l{ -C tr Otl{ O ^U 6 .F{ (,) !J Fa rJ.Fl Olr€.r{ O o C.r{ .(! , toooo .U,r0B>,outr.d .dq,.d €tolr u..{r.'{uri J (,) 00 o o o.u o.F{ oo o +Jo.r{d}r+r(uoo.ctro, @ o d.r{ O O o Fl b0'.{ r O0 O 'lJtr -o€ O O t0 (l tB E O J o'.{ tr t{ !l Od U, 6-{E'O tr O OJ O o l{ O..l r, tr -l tr >'.d t{ t{ABO-oo€'r{6>O-CUtdO. c ot{trdrH.r{ tr o@O'r{ €otr.r{u oo.r{rJ(d > 600) (d,O cr-o !F{Er o(,OF{(,,A>ll .r{ .r{ O lt:>oo hoF{lr tr€ (0qr.n, tr oB tJ .r{ .r{oU)@d)u@oO C r,)F\FlF{ O.'{O\ O a.A-4a.A €rJH Eo6 trod O. r{! . .r{ or+{(,o.o .cOUrEtl lJd t{ O'o ONo>o-dr\-o 3rr6Et{O.droJ-critr Qd rJ..{tr AO'-l trH(B=rr3= ol{r!o d @(! .(}{aa trE,J "{ O .r{ dtE O @O O(!\o<-o tr E r{XF- .r{.l{ OOO\OOOEOJ t{ .o O .r.l .F{J .O o.o.c(!trA{(o,,CA o'.{c)oo o(s ..{Otrl{lJ(JI{ oo rJ o a d @O J >t'.{ u q, O Odo-olJoo.otrO 6'r{"{ OU'O TO tr o.tH J E O O C, .r{ .r{ F{ .r{.r{rrEl{tr..{(0 -clrs(uJ603lr.r{XO.r{dOrdEOiU)o.r{o o.o 0 r,rnJOourtr o (Dc) u,, otrt{tn-COo.'{(dOJ!JEO!JtJ ! 3 t! t{.'{ Ir d tru.r{OBOOO ut !-d .C-r'.{ EotraJ+rorJ6Aagout.trc.oo O'.{OJOtH'r'{rOE u E 'x t o h ao Ic(l, th oA olra E(.) lrd o o 0,c 'ttrq, orgoroo, 06lrTETOOCOF.T cd o }] e.t o.o rB6r:O6lJE.-lOO .ndo.oq) duF{tr.'{ €O>".1 rJOO-{ 6t, udotroo.BtrE .'{trdrdOEC)EOO@q,f.r c-d t,E o 6-.{-dtrOUJEOUU!JO-{ (a I t{ O (0 O q, -r (, o o o E o 0r€ J Eo.r{o.tro-d-d l{u.Jt>OUE{r+{rJ6 ,00r-cH o trooJJooqol+{F{ s)co !J o g) o o >,O6o).rJ!uF{6q)(0rnaO0@t{.r{6@trOOoEtr.6 o O l6 tr'Fl > u'.'l-{u 6.J o-1 rd€ O,E !r (Ul{@(,r{>rJcU}.U,€O r! O O.r{ O JJ (d O O O OH o.J d ) o ov.o q e E o(,L .r{ q, I o-d lr(!3q) .r{ }Jootrt{ 6 ..1rro0) OOrrCo6(u rJ.d Oo o tr-oo tr..tr.I{ou) rs @(!o tr c.c ..{ .r{ o >d -d >.J orJ E-{..{ooxrJ o tDt o rJ.'{ , o tr El'JJ-{ O' O O uta.AQu €U(UAOOt!tiSts tr o.tJ t{ (t,U'I o(oco .J ! .r{ ..{ thQcnJaorlo(0O.r{oa O 'Fl IJ 'r{ ..{-o !d ot Q@ Ao d.F{ olOCdq,ja'.1J.'{€l,<tt ojiootr $ .l.J (/) tJ !J O l+{ .r{ oO'r{OO .'{t+{OdUt{ EO-{odcoqrHooo lJr,d)qt.r{.F.lO ac qrJ-C o o EA.r.r 6 o .r{O()u(.)C}ru trO C..l Olr (, tli o t+lt{ tr O!'r{ Ot0.r{tr.C.r{t,lrrO E OrJ th6ri o (, c, o x (d Q.cJ. aHOlt.r{!OO o .J U) ri .F.l rJ tt, dH Fl EI ol(,l o F{l o (6l -d ,rl(J 0rl aj€l .r{ ! -oltr O !J Erlt+t ...,r o tt oN{J ..{ JJ ..{ tr OlrJOo.r.rO u lr h0F{E..{Otr-od!r>'nJO q)..{-o Otudta0)OF{DHEl]H d(B Et{ o() rfl o a;IrOJ ..{ -O F{I E-ou(d5 .C!E Ao0) o ^dzu I Jd 'drr(!tr .r{ t{qrrJo 5 araccc, !Hfq o EO .tc od o(d .r{ (!() ! (0 .i..r .F{ bo oooEoo u OF4Fi }J ,.JOOJlUCdJJU(dI .r{CUrtdlrlU<F{A{HI th H id o€ ,ot) .'{ trJ .,{ crJo6()o vc) U)HIEzc)tddEfird qt&El(J& J(Jc)&H r{o ru1FI 140 Ha fl tu z F] (J Ho rt] E (J o F1oH EaH A{ EI Fl a tdzld(, HH H ocPf 78.2 Annex III page 11 ooo o H th .r{ t{Jd(!A{ oo .r.l ! O .Lr .F{ F{ r! O-{tr!oo(a!OE.n J trJ-C+r(Ut0)- $ lr(a.o trhHH H €ooao)t) .ia rJ .r{duotr()o C) U'H1zorild =4frl !dl{ vt& trl()il Fl C)c)&H frl O(r) Filrt O& t-rH(n fi * az FI c) Hofrl j(J o FIoH EaH A.l{ FI a ETzfr](J a <t> U) rJ a I{ oo F\ r\(a ! o .F{ l{ o A{ Nr\ I\o r\ o\ J X H) - N t-\ I\o r\ o\ J -oo h <n$ F{ a th ok I{ o Ed6 CA(r, o,l{ ot) ot F{ t(u @ oA olra E ot d o o o& I th .r{ oao 0,(d+J .r'lOJElrrroa) EgErJ (t .r{ r, trBtrOOqro @rJ!N.{ArO\5d(,,od-dtroU 'F'l O >'@(s-od ..{ r+{ x , O-rC,u .F{ C, OuootrtrHO <0'r{ OIJ€ (t, 'r{ ii tr o B o) .r{ H ; o) ..{ o o o. ta d oI. o (,) o o o oo(0> o €!o(0 r,(d0, a,c .r{ U e ..{ q{go otr> 'r{ tr(! a O) r+roo -o t{rJo or,tro o,(,>(, .c(0 +JO 'F{ (d l T' ,o!>' tda.A 6 -oJ OiOtrt{(t,rJoo-c o o o .r.r u > H.d .Irdou tr @r'O ...,1 O C .C > 0, 'r{rro$>(dE o) !.Fl FllJt].c(d+rO6O.r..un+{Uo tr..r.d d o3q B 0) oolJd)tr tr! O OJi O O O.!d ."{ .J .r{J E'O tH -o ,ooorJ e!-c o c 5(B+JOg, u0..1 oor+{ tr u tr11 O.-t t0 Eo orod rlC-o.r{OootO.,{ o tr . > u .,{ .r{ u) :ts 's't 6l €I :l !t(! 'r{oJ a € o '(, o N ]J .A o^(d(utr ri(d(i Q-{ o ..1 '.{ Elr od00l o.iHOI tr- .n tBl6l301 ol]l "gl(drjl -o JlE0dolC).lolo -c >'H.o Co >.ut($r,U) od o c!oxoo .J lfO\ O.r{ J IFr oro d lJ tr oq{ N > (,) OtH rJ hjiOlt'r{'r{OOr{ oHo(6l]rJo(d orF{ o 6 (u (, -{ B.o !J > (UF{ t{ -o 6 O O ..{ .r.,1 -o Ori..{</jc!lJlrdJJ trF{ > O t -l (u.r{t+{ 'r{ rd -d rd rF{ > tdE-rH,tr o.,{o or 'o ']{ tr olC0 rJ ..1 lr O .r{ trl >(!rJrtrIr(BrJl!Jo.tdOoE'.ll <s(J b0E r..{ o >lF{ t 6 l] UE lr I .(,,l.n i! N C (,) (/)l.ill oJl o -o Jl .J -{ltto€J..{l UJu ,lo, o, ! o (D olJl.c 6 >lu > r{ rr t{l >lrJ >F{l O l. .r{ O0+Jlild lf olo, o, lr -o c..llolo o, >l; o o..{'.| >l >l E (,Jl-{orJ-dl{llcJ .l o l{H x 5 dl .lN tr ol o o.cd ot.nlolr o. o; d .r.l l{(U d .r.{ q{ olr u .F{ E o!)U d) c) (D ol ,!ln +JI J .,{l > > l-{lotrl > .F.r I (! oo -Ckrio (,) >,O 'o -d ,o+Jtroo oHHO t!.trtr(0 (!qro r. Elo (0 5l-{d .r{ (,)1(6r! (dlr, A{ Ol Ool o (J o dl..{ oo l]l o o rr El 00-c! Ol E (! rdlo rJ(B (Jlo o 'rrlraol€-c-d lo'Ho-cl U O .1-6 0tr ol c .r.r col o. u,o. trl'J tr -d tr o c,OI '.r B Xo o @O .d p E._t tB{.Jq{tr(,)orrrJo rr tr€ >o (, +J O 6.r{ Otr-{..{o. hf+i e e Lt.rt t{ oE!'r{trlJlrCr>qrOg)CO..{drJ.r{ uJJol(!+JEoorJ!r tr..r O o! (0 o <dOO!!tr.r.{lrO > od (s (!(HO C G.r.| O lr O -d dH.r{(,,}!rUUO.Ft c o .r{ IJ t, .r{ U o H col (d ol oq) rrl.J c ..{l lr .F{ dl ot ^=r€OX.E JJ (, r+{ .JfrO ocood!Eo! c, ...{ o o>rr!,F)..1 '{ (0tr(!rJ oDEoCA H ) : 8.2ocPfT Annex III page 12 <J> cJ-) ti tr I oooooo F{O(nFi on @ o rrl o\ (i E o 'r{t{ o o{ ltl \o NN tt -f, r) l'\ NO\ OrHJ TJ oo \o F\ o\ d -oo h \o F\ o\ F.t -do!(0 E o}J d @ o l{ l] o tr$ o o olr @ ol]A E€otr o '61...1 6-d @ ! I o oq, tr rj .r{ O O li .r{lr tr ..r{ 5 O O td drn BrJ oFr-nrD O'r,QoF-orJ-oE>C o\qlO9.Jd € or-{-{H O (,J d tr O0d ! 6'x B ' o'.{ d(dCrt.r.lOUrrC>OO B tr lr d..{ O o0.o..tJ6JJU){JOOJul(0d)9(oErr--\d.'{ O C\A tr?.1 t{ lJ tr ! b0(! > ...,1 OF.H '{ 6 O O E O tlboil o\ lJ q{ o E rJ 0JOUH(!lfOt+{rn60O.F{6-dorr>(d.3)Odd.+r-dONd)E.r{.'{tn !r H ! <rl-lOF{ E r-t o o.E <'rdd.F{O\trUUEOq{6 -d x lrF,r J ott-{.r{u o o o+J (U.r{ O O c0 o. !J.r{ -d o trr+.l tr !o E o to.; bo..r = o o >, o o..J o 6 tr o o.ri,ri rl, o r-{oor6trogsoo €.,{N608OO(!c)(a>O00 ..{ tr}E>\Buu.r{ro!!rJoooo=u .r{F{ (0 3..r O d r O o o rJU!rC)otroJ>O-ouq{O.FlSrJlI]OEd.n.crdq{ aoo6aErilrJus)Bo rn F\ o\J Io F\ o\ F{ tr .r{ (d lr) u-) tr o x. -C 1,&o($-d lrd,@"{O-{ .F{ -O F{, ,or .r{ -a0:6<B .€(,lN F{,FTO Oor >-dF{og, F{ l+lo >,o! BEO O J€BrlJc ooJU,o €rJ(,)olr ..{ -Cr{ O-C rl .-olJ ooo.c cE -luOg6(!EqUBOtrOJ OrJrGro.troo,)h.J ! Jdc-otrr{6 O -q,F{ .o CFI 0,, -{ (0urr]{ > .o (! +J O.O5X-C0.)o0rH-o o60E rdo]JJ ol] ocoB U)lrE..{ o0, -d t{F{U O -oBo@l{troO. +{ .r{otrd5C(ut oooo .r{ lr .Fttr o.n ,.dl{ o-dq,Otr>U .r.,1B.qro -dtuotrIJ 'r'lr+{ (! o..{ oo(ixo >tr(a!(dU)6 E 6-'{ E o o oo o tr o. .c o t{(u o c) o& >'rrr lr tr-C t .F{ OFI d) O d) O .rlF{ .r{ OCOo.-{(d>\urJc, -d o-o o-o (d c) € o o0(!?.1 i Ero d (! ! tr o 5 .^QO-d OF{ r,,'.{ r,) O.(,) -ClJr{OH(!Oqr-d+J r+{.,{ O O O. @!' 'do>oor0+{ddlrE.r{odBO c0 <r) d dE-C-{E 'J rs {r'Fi o(d o O (d.^ o >:urrrJ!6c)_cqfd6.r{O.}rdOrJOO.Fl .ooEO(ddtrlr(d >'O-C OtH C.'{riu lr d) o,{ o or(,)(dtr(d.FlllJO f J ...{ tr > >\ U !J 5F{(!lrOUcdg)OF{0JO(,)Ol{..ltrlrO -C ..1 .'{ -d O k .r{ 'r{ >OUEo!rOEtHlr .r1cdlr(l)>(Et{ Or+l-l .r{ O-C O XtlJ 6Hoootr{Jd)Ooo +J o .r{ o o d CJ tr G'q{ o lr (u o.Ntr ..{ r{JEd6trtl .A) t+{ (r) o6HO o(! lr rd I o 'r{ IJ o o(H .r{ t+{ o (.) otl ola oJl otl(,) .rl ol(!OI .Jl odl td5l(.)l o ..{ ooc dd ..{ o(,Q J ..{ 'r{ol!5ldlrl > I(d J a(.) 'n I 5 6(l, d o .J tl oE t lr .r{ '- o U .,{ oo.rJoo !J F{ ! .r{ q,t@>cr6(ulJ tr!x6O OHd O O.r{ .dcB]J .J a@1 oJ d."{lC orl .r{ ttltEool! -c ..rlou> rJlf c)_d o €oo .J o-cF EO d o 'F{U a ! ..{ U ch H +JOF{ -c(dU oBl]doO'HVI Exor,o c,E .r{ dJ O.J d O'-r >, CD EQ o& >J EI EI 0rl C)l dldl -!l oJ ol .n dl oo Oltt{l] okl o ,ArH O -Ou 6.-{U..{ OF{ 5 d} (,)-o rJ(0o, .r{gool u d.r{ o@tuttd H !l oldJJI O ..{ I .Jdl ! >l o) E (U tJ r+{cod14(,)UC) <lJ (d C) U)o C) a ! o.d ,ota -r{ aU.AdL)otrC)o v(J aHidz()EId =4l{ r{EI C')&l{()& F] oc)dH frl O(r, FItrl 0dH H ct) fl A{ Az Fl q) Ha rdE () o 'JoH EaHA fr] Fl fl EIz rll() HH H ocPf78.2 Annex III page 13 <J> a t, tr a o e oooo oLn O\Orr rl oooooo NOrilF\ oooooo oo FIJ 't, o dt oA F\@ F\ F\o\ o\ FIJ F-@F\ F\O\ O\ F{ F{ \O I.r F\ F\ O\ O\ JF{ >\ J aFl ol r, F{ o o ! t{ o d6 IA d) olr o0 ol] o{ ooB EF{OOdrJ(! r{-d d..l I ..t-c U,o E Elfti+{O.rJ tr Oco o trt tr OY{F\ O Otr }rr{ O ! O\ d U.'{d tr .o d-lF{ !ldoroo!trug,dc'o€(B o..{66q{.r{c(do ,cedEo dEHU).r{o!o .r{F{q{ U O J >|o).r{d O ..{ l-.1 r.{ d I +J ,lJ ,o rr ti Ed O O.r, .! Q.U U U E O!r(uoc6(uNtr)OE.>OlrJN oEo..r(.)(drJ(! o50ruo.(dE(,) d) +JF{ O C) O)qt d r 0J.4 o'U C)B.dBO'r{rdt.ctr Ot+l+{ r,) rd !JO d tr-C O li tog o o H 5 -0lr€JitotrlrtrU tro.t6'do6o o. rJ (u .r{ .r{()rl{60(u.!rJ> n O td-o @O rS C, o 5cu <D a .c tr-t5 ed O O trrJ'1 F{HOJ!+rrdo-o(d q; o ,o(d IA 'r{ OUqttqflro E t{ O o hod)o.odotr'rr(/JE..r.c .,{c-{5!!J50trl]tr o o'1,o0ro<oGl!rrod@(BOOrdNu B r{ oo\l{ A.'OFIHootooEFrqrouotrtrd.c.lJ(!o.r{3.Fl!OO!J!Ot{OO.@rJqrtrJ!,d t d o. .r{ o.F.t o ! oEEo!+J(U .oOtr,oOCB(,oBoo(t, f) o ,{J .r.lF\OUOOT{ F-ErJq{OJor u trtHrgli -{ O tr O, .'.1ouo.r{E,c}Bd ErJ .o .r{trrJ6Od) O (d O"OH .r{!,ri O kJ .Ctr(!t{rr-C..{H(!+r!orJ3 1, o tt) oo o}]o E otld o dJ o,& ra{Ettotr6U,otro(sdO-6.'{-CO.Jr.,{oEu!1J-odrjtcr0c,orHEli (6, O lr O E-o O OO lJ ao O EOot{{c/Jdt{dtfJJ g O O'.{F{ C, trOIJ(UttO+{-d.'{ed-vhtro-c3!ooq,a6crJotl .dOUd'.{g)OO tr r{(.) rxJ-C -cooEIoo6+Jq.)6o€..6Qrr.J.,-{C!trrJoolrlO -CdJO!truro o E ot.a rJ $ .Jq}EO.(r).l,.c,:, -{otr.cr,)atrcod) -oH60..{rdqroodoolr€J! O O O d-o o, tr O lr(,).r{d-C.r{ ,{ O.Fl!O !, rU ! OF{ 0rr{ lr daEt{rtr, lrSOO O $ d O..{ tr o 6 O.r{F o.Er o o E J (0 (J tr,lJ ot -c o.)UI ]J$o o.r{ J u ord! otrtr O O.O o^rdOoO'-lq,d!>i(dt{0rrO$!o-ocJp o (,)tH o.$ .r.l .r{ O t! -trurrirJ! .c(,doo) o(dO(a.dlrO,Etr!Urr.-t d o q c(d ti..{ E O otrorJc)(Jto>(d! .,'r ..r o o0 (J .c >o(J.,{ OO(a U Ot{ r.Odo.C([Oq C O ri 0)O(n>o otr-trdu0)F O(J'r{ t!E !O(aoo+JUJd .r{ rJ (J tr O.otroOOOOO (tu,loqEtriqf..{ >oi (dqf.r{ c, o o -o ! (i o o0.r{ q,Jg>OOlrtlO O ! >'tr o >'tilJ do o or o lr .r{ oo.dji+r(,J(do)o)uE+r(utrdt>-o>, OO.r{O.r{Od.r{-HtroB.nO'rO..{ aOoJ!o!>do.doo(0(dq.'{-drrOo.-uO) OEU'-oOtrEodbodofoOrr!h06..t-dtrEOr{ C 5 C.H rJt, !J rJ oO oui'.{ b0tr 6 u> E >'tr o o o o E trO tJ oot+{ O 0, O -C tr J 0)cO 6 tr ..r H B:, {J !J .F{ .,.to.J'uOU.o.<r!o g u, o lr o crq{q o (0ts +J J E A-o lr O O E O a o .r{ U !, ..{ {-, o H -og 'rltJ +J O)dJtr(d a,l]J o(dl o.d rE dl d o(6I l{ (J 'r .cl o)o ()lE .dlJ o^ >,^o!ot.dEOrUTOOG@o,coE .r{oood tr<vodH .r{ q{ 0;otr ..{ 14O O 'r{o'd -coOEa H F{tBooO '.{OAlroqrt{v >HD 'F{ F-l I UOdE(,)^o EootoOE OFIHF{ d ot (d arr4O0lr O.d.J .r{OU.rlOO, o -c o o..J (,)oooEr{troorr(sOt{trrJF{> -'r{$0) .(,oo\o!^o tOU.r{xtr\o€do.>$ rJu\o(do10)! ..iOEo,IEF-It! a '1, o , r{U d oq) U)Hz EI E frlil(, q) & fi tt) tllfr E * EI FioEfr] :tr() H ocPf78.2 Annex III page 14 t <J> U) u a o e oo(n cf) r-.t € .J lr oA \o l'- o\ J -oo h o +J J (a q) ! ! o t (! oq q) l] @ o l' Pi .. tr F{ tr t0 F{ d d I (a I! 6 td.r.l tr.J oE -o E B rlO ..{ O.'{ lr . E O 1..{ O u O (!B () t{-o'+r d'O u tr O rJ O r0-d u O ot{Jrro6..{Ho(,JtrtrF{aur.c.F{cr(0oo<orriF{ a.r{ toO g tr E.'{ O -{ O OoE-co SrOuo,tE! ooo-rs+JrJvU)O-OOITOOF{@ .r{..{ o-C td le O Q ..'{ G'-1 Xb0 B B'O O rr F{ C o XE u E rB dd d llF{'J O +r rt l, 1, tr cB O'.1! .rlt o td @t$ (s..{r.1.{.r{ C) O > d) tl otrr o >rJ(t,(,JooEqro(Ur -O(ddli^(d(!EF{SlrJEJN .Fl..A{-o , (,) O O't, (! .r{ o(r r{ ti v orJ:! o o oE'lrrH (0t{ldr]o-o(srJ.'{lit{troo(dO .d 'O > CJ E +r d-o tr l] ^u.d!OOtd6>,'r{(JOoE9 O X (0 O E'r{ > ! t{C) lr'r'{rrJrrvhoo co t o.r{oEIoEr+{O.r.{OE^.dXd'4orrAco(0O B JJ.;{ (d F{ !r 'r{J dtt O trO .^ rJvil o.Al O 6rr tr.'{ >'U UJ q, O ! .r{t+{ tH rrt O O JOrHJ r-d B O -O..'l .C tr O)tr (0OOt!!()trBAudooUQ.r{ gJ o..{.r{ (,'d fll O (0 C O -d'.{ (dtr'.{ .r.{ Z > u tr O'.{'.1 O'Fl l: t:'r{ oJrrEE F{c} E l-lEr.t Oto (d(!-doa.C.d(!rsrOt,lra)>u€(ao!joSrotrn.dEd -d td 0, O..l rU o-C..1-d O'.1 6'r{ t! O E 0JF--{r B E lr+JBun'+{ O-o-C lili E 'u o o oA o t{A ot o 6) o c)& o 'r{Utr ,'.1 ()o EIXo.oao€d'.{ E o,tr O -C .r"l Eo)6rJu(,) -d.r{il lr'.{U CI 3 5JOtrtH-oEoo.F{cdaouzu -dotru,o-c oE oo..{ trUtrUdO50qlu o GO .tr r hoo >,OU O d-{ll q, o..{ ogorl..lldO 6F{ U E lr O o(!orBop .r{r+t > o oOrrtrOOl]HU..{J(!A ..{ u u ..{ I, o H I o , o EA N60l{(aaoE(d H()5 1.O !J .r.lda o C) (d .: o tl c, o,1 o.1 tri(,() C)o a E oJ a .rl !t o(, v) tszfrl a lrl& c)il E] a rI]& E o) .r{ r, o(J A{4d rlt Ho =ld (J H ocPf 78.2 Annex III page 15 <J> U'p r, d) o 5 oooooooo(7) fl Lr1 r\(a-.-tnO\O6@ F{ ooooooooo u1\o\t(n-tra ooN r{ @ F\ o\ d € odk op{ \O f\NT\tt rn\Of\@ NNI\T\cI\o\o\o\ FIF{dJ trH(d(! h= \o N I rnNco I.\ N F\o\ o\ or r{F{l ! oE GD rJ F{ a o o l{ t' o !tqt o o o t{ @ olr A. t+,t I h --; r, .9 €O O'-{ O O q, ,o ootr o+JE o E (d (U tr rd d .ot{uOUriOlfC.'{.r{trotrutr,xcoakHouo>ooEtrrr...r ! GoqtorJ .r{ d E I{ rJ O.r{ (! O.F{ Oq }r 0J (,) Orr.r{ o. -r E ! (,,.d ..{ >O l]Cr(U-turrrOdtru!]trOO+r!6Or!OOO(!Olr .r{ O tr O O (, d -C(J d 0, E r{ On o0 c) > > o. d (,, .A o (a o.rxOtr O 0,t E O tr.-r trl.lr (Uoqr! lr tr.;1.d rr}{ o..{ O E ot6rJOfrrd.tl.J-Ca)6 .r{ O'o tr t+r t, E (0 O >\ rJ ri }r >Ot t0 O (U - C o E-C o oA C a t, lJtri d rJ rJ tr f{ C O 'ri l, 6 <J 6 tr o o tr 0r r.r.,tF{O€ o) (0 o q, O r o o'+{ f o oO C '{ -C E 21 O tr O O g.ta1 o (/,B6@Oond!>tH-oooOCOOO..{Oqrtrr.OUrdrH .d B'r{ c} lJ li !J r tr o, 6 tr rJ ..{ o.t .O (D B ttt..{ C , >.r{ o tr O .raqrot{-o>(d-dc0uoE(0o u rH tr F{ 6 < E ' 00 >t.c 6 E o r aO 5 F{ t+{ O d.r{ J O U O tU tr tdoCq,O..c-drJo..{ftrOrr+l Or+lrH O 60O 0, tr Otll@'O O.'{Jr+{ Ul r.r{-C >rO O.'{F\ O.r{ (o.JO O O (o OrJ!J lr t{ C u,o\ trrJ tr O)!u+{d.Ct0OOd(,,r.r.lO>O t0cl orl! AA > O.> $ o!rr tl!c ! t{ q, q, F{ (, C o.! d tr (d t X 3H{-o.oQ qt (0 (d (d (' (B oH B 6 o u, JltdOuOEtrH(oc! $F{ CJ O t0d 0J.o!J..{ B! a)ca g <d O tr . trEEO+JTJOA+r@(!O!, o > o.i d d q -d t0 >Or ta (U.'{ ! O tru E n o o .c E ti (! 4..{lioorJuoooEOot$tr(U!>'trEo.rl o (,, o o.r{ o.o ,{rtl}tr6Etrtrt{r.t '+rQdSlJooqr(do @ E q-c t] . >\€ -C lJ (! F{ r+{ U O OF{tr4J(!+JOt+{oAE .C(,OlrOOtrtrEuq{o!orJE..ro(! tr 6 O -o r+t d >'.1 (J l-touooouU)trb0E-{]JOdr.Etr!r..{OOOU..{OOOtrdtr!>Or>o5J'r{OA o r+{ o o.rt tr do o ouor+ruU)l{oorHA!0,) ouo(u(dE!Go o..{ -oro...{ Eq or trE0J<riOrr(dtr(\, -fBEOoOtrO-rOUq-d'do'nF{O^O.OOrrO.r{o.r{$F'+.d-COtrdO(0u3!Jo!Jlcor.,{o> unOd>F-.c,qd+Jtr(dO-dOOCOo\O!X, A>oE-rO+rr!{(dOo | .tt,trrJo(uo ooB O O'F{F{k u, o.!(60roEc)B co t!!,>luro!(/,o 0)rd JJ OJ +r tr .dAJ,OUO otfluo J r.l-{ €-lJJOc! o d..r ! .F{d+JlJo r. O (a J€L''.1 6 O6 !r..{ F{@ O.r{ @J F- €0Jcoo\ou-d..r i(sdurJ-CBlrutr! o o.J.r{ >,drroB €(, ! ,touo!.1 t, O -d t{ !.1o Qt +J o rJ(d .,{ 4..{(,r.r>.coE ..{JOUl{-O 5J!.naHoo.3<o ! o o o o. oI{o o t{(! o ctt oc I!ooOJ!rJoo tr tlarj q, o U)o=r.>t.4 d, o >rd orr O a't, rr.rl ) .6 ].r tr.,{ il€5 O (,, rF{€ l{ OeE t0 (, tr u6Eo€rr!odrr,()trd-coOtqr-Crrl{ .C @>\ O o rrrrOk.F{-d..{trtrl{ OF{ ur+{..{,u o.> q,5F{=tri+{6'Uoo000cdtr tr! , d >r .'{ 'F{ tr -C >\ (dlrlr(,OrJt+{'(,p o (a lt"{ o(,!H('6rrO9O"{OrJOd+Jr!d >r d, d (, oO O.F{ O O, tr gH E l{ > H E.o U tl o rH ql .nc rJO(0 ,oEEdE(0 ol{ .c b06rrotrt{t0rJ asJ(Jooodd >r .r{ .r{lr! lrO(,j(0U lrO .r{ Cjtr>O O'.1tsEl{ ..{ d drJ50(utr t+{ (\,q) ootr .F{tdOU(dUE(! JEfP{Or!dC) lr t(uo 60oo(u rDE g -d.c u r).rJt, c@O 6.F{ CF{ ..{ .J oEl{E(ooo(dl{trrJ(noo.r{ >>trO'Fl O OHt{oE o 'F{!l au U otH Ol (d .0) oloJ udl.n 6 u,6lo0 , (!HIO O OF{lJ ra c) o E-out{O O'.{ OHr{tr>cat!f,HE>\o!d i ,ot oo dlo 6lH -dlo(9ll+a .J oEo (n o or,!, ...1 OJrJE rJ rd.r{ ."i J -du uoUJ<< dH o .'{ }] d!J rto o- hotJO .-rJ (sd) t{tlr Cr(dqJ+Jtr >c!6 '-1 3()d a J t o d .r{ rJ a o() r!) Hzt{ E EIil(J c)& fi(n trIc zo t-{H() trtHod A. FI4Hz EIEzo& H z EI l ocPf78.2 Annex III page 16 t <J> (n D U d aI ooo oooooo Ln \o J ooo J E o .r{ l{ o) O{ F\ F\ o\ r{ \o N I LA F\ F\No\ o\ JJ >, i a - rn r\ o\ F{ (! F) o rJI UJ o l] tr o € a(n th @ a) t{ b0 o tr Pr F{Er6re .,{.dOOlrrrG)O O'.{ J C)O > d r.5 -CO''{..{6lr!OtrE u O tr-trJUO-Csr.r{O(d..r-cH6 !E U B XUt-o t{ 6 oadrJOO uoO.tr>OO F{qrOd!rEoEoo)O. li O trU O 6Eo.'rrJdHO ArJ d O rJ oo60l]odfr, O rJF{ O(a{Jl-OIr r!(u.,{rrOd(! B o o)-d r{ a!ou50.htr o o o (! 'd (!5 tH 6 d, =t rJE O O (,) OlJNCE..lJ o)N00(d!dO\dOd(s.'{uJJ.r{ r $ tr+J .r{ fr O o.rJ J C .C'r-l (! t{ E 5 6 OH O A 4...{ -o t+l o tH oqr] o(!U€ .dotrO +r o(dqtrEOooXxz o o F{u-C-oOUJ(!rJ-tr(dr0 .dJOJJOE o-c c0!E o >-d,0,-cdddo .r{ (u .r{E >,qf o @o!JJOOGO rr U 60.r.l o > o Uj d d'o!Jtr-O.JO(0 d tr q,<.{ 0,t 'rJOOOOo.,.t ao > oo > rJ o.-c -r l]U(I(d(0JJCdO -CJo ) (a >,tH o +J UJ OO-o O.F{F{ lt O.rl , o ao'd o @o>o0roGo.JtrrJtr.r{l] tr O (,) O (u1, r.{OU,OO Ol L OtH O O -d-d6Et+{trl.lF ]J > U (u A.O .cu(oJ.r{od]JEdUdo tr'r"lO @G J O '.ltrotdu o.,{rH b0t{E! tr o (0t+{ o.r{a <.d'o ou!q,ltrcrrq,O.OU,Olr ooJJ-O o oB .cu'oEI! o.d o 5l .n tr olt(d(u01OrXotrdlB cd tr o Elouoq{(6l .c > oElO r+l .r{ $r I o! .l >, t{(alOd+r(65 O tr-l d +J.r.| O J.Fl orJl{od O''l!(a.Flr+{ U C .r{ ti t+{ lr 5 -c (!.r{ 6 Ots > ! Or+{ 1, o th o o. olr o. o}](d o(,) c,& tH o(!o xu .d OiFlUUilO rB(d>O'q-o 6 EO<O!r,ooo >,(! O @rrJ-o o ac oo @ >.n oOriBOtrtr(dtrou q O .r{F{ OOE^Jt +J(d!or o(!+Jor]{ -C qrJ > 'UU ! O'-l ^O].>f4(!.d >,cd)E !.U Oo(d'.1 , cd O d.t-lfJ -1 d .,{ (J -Ooa B (0ooooEu oo-caQgJHHU'H(6C' d€otr .F{llt! rJ C)(drj oF{rx (! 0) ,(n'r{o.crooE,ll 0., .ocr00uC!E(,,trEOoooo(a .r{l{!-co(HOrJ! rx.o o0,) q, trrH -d-o (d 0 drJOO !J (U .r{ >.frCJlJIJ O O b0.'{5>EOo, IJ.r{tJJOqlHr0rdo. OrJEOtrtrtdOE{ .r{ iJ (J O (!o dH ,c)ru>tl{ 'r{q{! oo 'r{ J!tJ(! d(ddoro(d E q(,, .o(drdlJ o(,od .]iOOo)O(!(,)rJE Eo,(0q{rJ(0t{Old €-ootroou,{(!>UOU .J lr -O >ru o E ot(d>r! auddU ..1 ..{ lr(,H 6 0(i0).r{ oa.cduF rtu..{ o. o 'r{U IJ 'r{ TJ U) H .j. d6!(,) h0H =ro(U 0>i=t 6tr . bo(uFardoJO.oo5 lr io -or,C @r6JOE o>OE04 cd ti00(u .(da mro. tia ,{r vloDl rJT .r{ l{ oo li (HOJ >(d .A U) , 'u o .r{ IJ a o() U)Hztr] Eldd() :d(J & fi rJ) trl& t o .F{ ]Jt o L) zoHFo E] FTod A{ Fl Hz rd o&H z rd aocPf 78.2 ANNEX IV ESTIMATE OF INPUTS FOR AN EXTENSION INIO BENIN, GHANA AND TOGO An extension gf full operations into Benin, Ghana and Togo covering those areas described in documenE JCC4.4I will depend upon the outcome of studies currenEly i.n progress and the decision of the Joint Coordinating Conrrnittee. Initial calculations indicate that such an extension would result in an additional 97 935 km of river to protect annually, represenEing L7% of the total Progr:mme area as of December 1979. Preliminary estimates for extending operations in Benin, Ghana and Togo are currently as follows: (1) A total of 5760 helicopter hours and 30OO fixed-wing hours would be required (2) During the period 1980-1981, two extra helicopters representing an estimated additional 1440 guaranteed flying hours per year. It is estimated that 500 fixed-wing hours would be required using aircraft currently engaged by the Programre. (3) A reduction in treatment may be possible after two years, which would mean that one of the additional helicopters could be dispensed with in the period 1982-1985. During Ehis period 960 helicopter and 500 fixed-wing hours per year would be required The proposed extension would result in considerably more flying ln the south-eastern corner of the Progranme area. The use of the Tamale base would involve a two-hour return ferry-fIight, i.e. two helicopters would use four hours ferry-flying each week to reach the treatrnent area. Ihis would represent 2O8 (52 x 4) hours per year, or 4L6 hours for the initial Ewo years. At the present cost of flight hours ($ 394) this represents a total of US$ 163 904 in ferry-flying alone. Iherefore, the transfer of the Tamale base to another, more centrally located, site may have to be envisaged. Ihe annual insecticide requirement for the extension areas of Benin, Ghana and Togo would be 11O OOO litres. However, it is estimated Ehat these operations will decrease insecticide needs in Ptrase I, II and III by 30 OOO litres. Thus Ehe total annual insecticide requireoent would be 8O OOO litres or 480 OOO for the six-year period. The enEomological surveillance would be conducted by 21 teams operating fron certain of the original subsecEors as well as from three new subsectors. A total of 88 general service staff and two professional staff would be required as follows: ITOCe,TION Vector Control Unit GENERAL SERVICE PROFESSIONAL vcuflqfouaga Tamale sector Bole S. sector Lama-kara sector Porga S. sector Parakou sector(fornerly Natitingou) Parakou S. sector Atakpame S. secEor Hohoe S. sector Adminis Erat.ive services TOTAL Study of the geographical exEension of the Programe area requested by the Governments of Benin, Ghana, Ivory Coast, Mali and Togo. 2 Aerial operations, entomological surveillance. 4 7 3 5 3 6 18 20 20 2 I 22 1 a ocPf 78.2 Annex IV page 2 Projected helicopter hours, fixed-wing hours, insecEicide, and vect.or collection teans for the period 1980-1985 are in the order of 157., 32%, 32%, ar.d 27% of those required for the regular Prograrrme. These estimat.es are largely based on the experience acquired during start-uP years in the other areas of the Programe and will be used until the results of the extension studies denonstrate that changed inputs would be appropriate. Simple and detailed medical evaluation would be conducted by the Epideniological Evaluation Unit but at this ti.me additional cosEs are not anticipated. Budget An extension of Progr:nrme activities into Benin, Ghana and Togo for the period 1980-1985 would cost about $ 16 239 80O. Ihis projecti.on is based almost entirely upon requirements for the vector control programrne; i.e. 5760 helicopter hours, 3OOO fixed-wing hours, 48O OOO litres of insecEi.cide, two additional professional posts,88 general service posts and the replacement of 18 vehicles in 1981 and in 1984.I The following series of tables is presented: Description a Table I. II. III. rv. 1980-1985 by Programe acEivity 1980-1985 by category of expenditure Vector Control Unit 1980-1985 by category of expenditure Office of the Programe Director and administrative support 1980-1985 by category of expenditure. I These inputs have been costed as for the regular budget 1980-1985. ocPf78.2 Annex IV page 3 ra cOiO\ rt'rUIootscO o\ J oo F\ rr) oJ o d -?(f) Fr \o H oo @ o\(r) N \o r-{ ltl @ Or I ooN o.l c{tt oo CN r\ N @ c! o o o r^ @ 6l -t@ o\ @ o\ rrttt oo\a o(\ oo\o C! i o\ N oo rn o\ ct rrttt oo cn @JI oot\ oo c.l ooo o\ F{ rr1 N N @ o\ oo -? \o J o Or F{(.) N o (r) co c\.1 J @ o\ i lrttt o N -fd I oo(a at @ @ al ooo F\ o\ @ N o @ o\ d ttttt oo C! cn J I o J c{ o\\o e.l oo(n r/) oN N Fl ri c000(!+r(0>oc)daOrC,COO6OTTF) oEoo--\oE.r.t 'r{trCu(Jo>Eu O.'{ f. \\ & O d ,d t',6 'E| O u--.\ N G5 .H.r{ d O. tr O- Nu>(B(6QO<GCd tr c}{ f o. ri lr d > O O+J t{ U, O" I cO FoEorurEo. -ct u o o ! G .r.{roodo>oo(!t$dt{(!ot.F{0,o,ct)EOO0rdtr!>O..H_o!.r1>0JC.i{G.Hi(Uu@o(,)oaHU(,..{u tr O ! 0r..{ u (! r AoHl{loo!ro ooooE.norJ(drE .d.r{!o}Edo0(,jo(0tr H E E O!' 6..{ tr .r{ .F{ d Ajooo.roLE.rtc6o.u '(, tr i ! bod JJ .H E .r.{ Oo 'J o oo o (! o E o o0 €OOoO. lrO€AI(u- Fl HoH a Er H H F{(J trI a *(J o& A{ rr) @ o\ F{ Io @ o\ H O{(J I zoHaz E] E{XEl H H F-l m Fr I i I I l t I t [, t I I i !d 6U oH ttt oooo e{ F\ 1r)0 1r1 c{Fi \+ J oooooo$\o\+ F{ Cl \O O\F{Otr]co\O ri \o (f) oo ca \' o\ rn i ooooOr\ o\ r]rn c.)$ oo @ o il oo Lr\ -,\o o @ o\ c.) N \o d rn @ o\ il oooo\ON \O F{\, o\ N oooooocrt { \o sl c') F{F\O(\ r\Ol.\ oo @ \,(o @ N oo\o N o\o F\ o N J oo rn co N .s @ o\ H ttt oooo F{ OJ:co c! ooooooNF{CO 6] (n @o\O\o\oo\o d oo @ (n \o\o N oooo\O@ Ln \o r)N o @ \o o c{ o\\o N o o ca c.) N CN @ o\ d oo cnn NJO\ F\I ooooooCidN rcno\e{oJ\oo\o r-.t oo$ N o rn (\ oo @ tfllt oo6 rn o \o d d o o Or rn dt N @ o\ J ooOO@\o \O rnN\O J I ooooooN(^\O F\ F{ Ct)1r1 rt F\tn O\ tn N \+N c7) o.J oo -t ro o rn o co o r) ca C. N @ o\ ttt oo J Cr) \O \OJ ooooooNO\(\ O\rnJ O\ C{ c7)\t -, rr J oo c\] -) co\o N oooo\+N ci rn o c{ o(\ oo@ -) N o N o\ co N o @ o\ H I oo(.) o \O@ rn L^d ooooooNO\O (D|r1c{ .JNo\ .+.f$ - oo -t o @ rf\ c{ oo o\ -tlt o o o C\ H o o\ N o(n oN c.l C)() @r- o'o '.{ tJJ(!o0(dtrlrd ..1 O c!tro.rEoo.r{oo0J! otr6o>.r{O O lr ^d Cs 6 .r{.JrJo(dtr'.c >!C,trlJC;)tr(d!.JO)OL{OdHUJq,u(a O ! (! o.tr (s ri do .r{ o....{ d d qJdoo.qJ(do(d/l'lJtd '.{ <) o E ...,1 ! b0 ddJrJlfliCOO (d o cd -! (d , .F{ O.@.AO0rud,tr(a!ro!trocad(dOtrO! oocooaoot o IJ d) o o i (0 F tn Fi a o(J F] 5zz Fl EToH oouO0lroc]d)oo .r{!dE 'U .F.l (.) O.d tr ..{ .r{ .r{tr.ca aaoy o 6! ..1 t 6U .r{ o(d(J al) E EiH F] tsH tu (J ll H o Er FJ FioH Az fr c) ocPf78.2 Annex IV Page 4 trld P t-{oz fsl P{xH fr{o )i&o(J FTHI EA rn @ o\ F{ II Oril P{oo I zoHaz rI] Eix rd t-.1 H E] .r € H l l I I I I l I I I I i I I I l I I Irl l -1 I ttt lt ocPf 78.2 Annex IV page 5 I dU oH ooooN t-\ tn@ r) e\tH\t ooooooN\o\t 4Sl\ocoro -t@\O(') \o ca oo\o @ @ -t r) J ooooOF\ O\ rn r^ co$ o @ r/) d o rn r) -t\o oo -tcn J \o rn @ Or trt oooo\.oN \OJ\+ o\ GI oooooo\Oil\O O\COJ\tOc{NOI\ oi N Fl co N o\o llN oo\o N oo6t LA o C.) F\ N co c'l .f, o o\ i oooo J J codFr@N I ooooooc')r@ N-)@NO\o\oo\o t oo -t (7)\t\o G] oooo\O@ ro \o tr)(\I o @ \o oosl o\\o N oo\o a.l d o\ N c.) @ o\ il rtt oo -)rl Nr{O\Nil ooooooOiN cl ci o\ OOFr\oo\o d oJ o\ @ -t N oo @ ntl o co r) oo\o i H o F\ oo N N @ o\ ooooco \o \o rn N\O oooooo@r)\O or(.)\trtNr1O\tn o cf) @ c?) N o -t LNlt o .J- r) o co o d oo Fl o\ J c.) C\ @ o\ J I oooo Fl Cf) rnJ\.o \O ooooooOo\N ra r.6 i o (\ cfl -t-trr d oo LA @\o \o N oooo -f c{ cn rn o e\] o N rn o O c?) I N oo cr) N @ @ N o @ o\ oo cao \.o CO6rn ooooooOo\O rtl 6 c{ca e{ o\ -t \+ \t il oo c{ r\o rn N oo o\ -tI o oN o o\ .s Ni o d N o\\o c{ (J() o- OE ..{ du(d o0$Clr". ...{ o EtrfrE60.JOOoJ!(u6(!(J>.F{ O O tr -C (d (d .F{.JuOG!E >u(ud!()l-tr!!.r{C)OtrOtrHUdo!J o o I, (i o.tr $ rJ dO .r{ o..H d d q,roo.cJ(sc)(!o)ttU.r{OoE..{rJb0ttrillirJJCOO (0 O (! .! (u , ...{ O.o.ACrOJJtrtrOuA)titrtAr,tr$Otro}1, oocooJo.ocrc o .J o o H(d dd t/) H th o C) J zz Fl Eio E{ UJO!Ootrotrdao0, .r.luHE !.rroo. i d '.{ 'r{ '.{lrE)alqre oc G,U ...1 (u ]J o(d() U) E HH Fl H F{ Pr () F] Ho Fi Fl Ho Er az fl a rd& HHazf:I o{XH fqo &o rI]F (J tfl @ o\J Io @ o\ J ErH zD lJodHzo() doH(J Id I z H cJ) zfrlFX E] H H H bl F] FA H ( ocPf 78.2 Annex IV page 6 TABLE IV. EXTENSION - OFFICE OF TIiE PROGRA}.IME DIRECTOR AND ADMINISTRATIVE SUPPORT 198O-1985 BY Cd,TEGORY OF EKPENDITURE 1980 1981 L982 198 3 1984 1985 Total AnnuaI costs Personal services Operational travel Consul tants Accomodation and utilities Suppl i es Operations and maintenance 13 200 14 700 16 400 18 300 20 400 22 700 105 700 TOTAL ANNUAL COSTS 13 200 L4 700 16 400 18 300 20 400 22 700 105 700 Capital itens Buildings Furniture Vehicles Equipment TOTAL CAPITAL ITEMS TOTAL 13 200 L4 700 16 400 18 300 20 400 22 700 105 700 f