Progress report for onchocerciasis control in Ghana

o/0 pRocREss REpoRT FOB ONCHOCERCTASIS CONTROL IN GHANA o u Introduction The Onchocerciasis Control Programme has been merged with the Lymphatic Filariasis Elimination Programme since its devolution in Ghana. This brought into being a new programme management made up of a National Programme manager who is also the Director of the Health Research Unit and has direct ovenight of the programme, an Assistant Programme Manager who works as the Field Coordinator and is responsible for the day-to-day running of the prograrnme, a Principal Technical Officer and Biologist, who work from the National level. At the regional and districts levels of programme implementation are Regional and Disrict Disease Control Off,rcers who run the programme at that level. At the national level, the Lymphatic Filariasis Elimination Programme's taskforce was expanded to include 5 nelv members with expertise in Onchocerciasis Control to form a Joint Taskforce for the two programme's. The taskforce was co-chaired by the Deputy Minister of Health and the Director of public Health. The taskforce is working closely with the national programme management in seeking closer collaboration rvith various stakeholders such as Non-governmental Organisations such as the World Visions International. Ghana and Sight Savers Intemational, Ghana and also the Research Institutions in Ghana. The only taskforce meeting for the year was held in 5 May z0o4 inAccra. () 0 Epidemiolo gical Surveillance Most of the Onchocerciasis Control activities for the year 2004 were concentrated in the areas designated as the Special Intervention Zone, which is located along the Pru River Basin in the Brong Ahafo Region. However, some other Oncho endemic areas located outside the SIZ also undertook some CDTI activities O and entomological surveillance activities. Epidemiological surveillance rvas undertaken in l5 out of the 17 selected communities along the Pru River Basin within the Brong Ahafo and Ashanti Regions. The other 2 communities were inaccessible. Results of the epiderniological surveillance carried out in 17 r"illages along the Pru River Basin in the Brong showed that out of a total number of 2452 people registered in the communities surveyed,2232 participated in the survey and?l7 people were found to be positive for the Onchocerciasis w-orms giwing a prevalence of 9.7o/o. Prevalence by community however ranged from 0 to 21.9o/o. Prevalence among the males was higher at s.Oyo as compared to the prevalence among the females, which was 3.9o/o among the total population sun'eyed, Visual acuity testing also showed that out of the toral population of 2400 surveyed 18 w-ere totally blind, 19 had severe visual impairment and 3l had some visual impairment+ The age efoup with the highest percentage among totally blind was I I - 20 years, I 2004 IThe crude prevalence for the communities surveyed ranged from 0 - 25%. The community with the I higlest crude prevalence rate was Asubende followed by Akrakuka with 2l S% and then Nyamebckyere with 21.4%. The only community, which had a crude prevalence of 0%o, was Adaa. The community with the next lowest prevalence was Asempaneye with 1.9 and then Ayerede with 2.2%. The rest of the commrmities had crude prevalence rates that fell within the range glven. The Community Microfilarial Load (CMFL) also ranged from 0 in Adaa to 1.15 in Nyamebekyere. The next lowest to Adaa is Ayerede with 0.06 and then Asempaneye with 0.07, The second highest to Nyamebe$'ere was Pruso Buipe with a CMFL of 1.05. Results of the 2004 Epidemiological Survey in the River Pru Basin No. CommuniW Village Code No, Examined Positive Crude Prevalence Standardized Prevalence GTIJ|FL 1 Adaa 553 102 0 0 0 0 2 Asempaneye 551 5 105 2 1.9 1.7 0.07 3 Ayerede 428 139 3 2.2 1.3 0.06 4 Asubende Beposo 424 92 23 25 24.5 0.59 5 Fawomanq Konkomba 5775 49 5 10.2 11.4 0.34 6 Hiampe 527 298 13 4.4 5.1 0.09 7 Nsuta Derma 5512 75 5 6.7 5 0.19 I Mantukwa 5772 192 38 19.8 21.9 0.49 I Pruso Buipe s540 80 12 15 16.7 1.05 10 Akrakuka 525 130 28 21.5 26.6 1.3 11 Bavaa 424 204 19 9.3 9.3 0.26 12 Brehima 5514 142 7 4.9 5.2 0.26 13 Fawomanq 526 159 I 5.7 6.8 0.13 14 Mimpeasem 424 87 7 9.3 11.2 0.09 15 Nyamebekyere 5544 140 30 21.4 23.6 1.15 16 Pruso Abease (Ahodio) 5541 113 7 9.7 11.9 0.34 17 Seneso 424 125 I 7.2 7.5 0.14 Community-Directcd Treatment with Ivermectin (CDTI) Community-Directed Treated with Ivermectin was conducted (CDTD u'as conducted in communities known to be co-endemic for Lymphatic Filariasis and Onchocerciasis, and then in comrnunities which are only endemic for Onchocerciasis. [n the areas known to be only endemic for Onchocerciasis is found the special intervention areas within the Brong-Ahafo and the Ashanti Regions. The special intervention zone is found in areas known to be only Onchocerciasis endemic rvithin the Brong Ahafo and Ashanti Regions. o o I 2 ,The Special Intervention Zone communities are found in Atebubu and Nkoranza disticts in the Brong Ahafo Region and then in the Offinso district in the Ashanti Region where distribution is being done. [n Atebubu disrict, out of a total of 28552 registered in the endemic communities,22649 people were treated in 52 communities, which form the Special Intervention communities in that distict giving total populuion coverage of 79.3o/o.ln Nkoranza district, 58663 people were registered in 73 communities. Out of the total population registered 44155 people were treated giving a total coverage 75.3%. Treatment also occurred in other Onchocerciasis endemic communities outside the special intervention areas within the Brong Ahafo Region as shown in the table. In Brong Ahafo region therefore a total of 274219 people were registered from 414 communities within 8 endemic districts for treatment butl94428 people were treated with a therapeutic coverage of 70.9% for the whole region. A table of the Brong Ahafo treatment coverage is attached, Entomological Surveillance Activities Entomological Surveillance activities have been initiated. Selection of Blackfly catching sites was in the second quarter of the year 2004. This was followed by sensitization of health workers at the regional, district and sub-district levels. Community members at the chosen sites were also sensitized. The outstanding activities under this activity were identification, selection and training of focal persons at each level. Vector collectors also have to be selected and trained for fly collection. The programme also needs to establish a system of collecting and transporting preserved blackflies from the communities through the national level to Ouagadougou. In the Brong Ahafo Region, the last entomological survey done in the year 2003 in Bui along the Black O Volta Basin in the Wenchi district, Asubende in the Pru River Basin n Atebubu dishict and then in Tanfim also in the Pru River basin but in Nkoranza district. In these areas the team did 8-hourly catches but 6-day catches in Tanfim and 7-day catches in Bui and Asubende. The results of this sunrey showed that in Bui out of a total of 4382 flies caught 2 were infected with 83% being nulliparous. In Asubende, l95l flies were caught and out of this 14 were infected vvith 8 being L3 forms. About 52.5%owerc nulliparous. In Tanfim, 650 flies were caught, none nas infected andT6Yo were nulliparous. During the implementation year under review, a blackfly outbreak lvas reported in Aowin-Suaman district in the Western Region. A team including the National entomologist rvas sent to investigate this outbreak and found that the outbreak resulted from healy rains in July causing swelling of some major rivers and their tributaries. Actions taken were Ivermectin distribution in these areas and health education on the need to rvear protective clothing to prevent bites. 3 a oChallenges The Onchocerciasis Control Programme is faced with many challenges. Significant among these challenges are financial and human resoutre constraints especially at the national level. Transportation is also another problem because there is only one old programme vehicle at the national which makes effective supervision and monitoring from the national level difficult. Ownership of the programme at lower levels of programme implementation have also not been the best and also endemic districts put the prognunme low down on the disease priority list and devote very little or none of their district resources in implementing this programme. Community drug distributors also tend to demand for incentives or financial compensation for the work done. Also lacking has been a feedback for all programme activities. The programme also experienced a delay in the release of the limited funds for Onchocerciasis Control forrn the APOC/SZ. On the local front those communities, which have conducted CDTI, also delay in compilation and reporting on the disease. Other issues of great concem to the programme are the health staff and volunteer fatigue and attrition. The programme is also competing with apparently "rich disease control prograrnmes". Some communities do not have well-defined boundaries and there is also the regular emergence of nerv communities. During drug disuibution previous experience with drug reactions also prevent many people frorn taking the drugs. Misinformation on the purpose of CDTI has also been reported in many commuties and has had a negative impact on drug distribution. Recommendations The programme management is being encouriged id glt fnv'olvea in tocal resource mobilisation in order O to improve on programme funding. APOC/SZ is also encouraged to improve on funding provided for the . activities of the programme in order help step up programme implementation. 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I aa Results of the 2004 Epidemiorogical survey in the Rlver pru Basin a o No. Village Gode No. Examlned Positlve Crude Prcvalence Standardized Prevalence CMFL,l s53 102 0 0 0 02 5515 10 2 1,9 1.7 0,073 428 139 3 2,2 1,i 0.064 Asubende Beposo 424 92 23 25 24,5 0,595 Fawomang Konkomba 5771 49 5 10,2 0,346 527 298 13 4,4 5,1 0,09 5512 75 5 6. 5 0,19 5772 192 38 19,8 21,1 0,49I Pruso 5540 80 12 15 16,7 1.05 10 Akrakuka 525 130 28 21,5 1 11 Bayaa 424 204 19 9,3 9,3 0,26 12 5514 142 7 4,9 0,26 13 Fawomang 526 159 I 5,7 6,8 0, 13 14 424 87 7 9,3 11.2 0,09 15 5544 140 30 21,4 23,6 1,15 16 Pruso Abease (Ahodjo) 5541 113 7 9.7 11.9 0.34 17 Seneso 424 125 I 7,2 7,5 0,14