Progress report by the programme Director

WORLD HEALTH ORGANIZATION ORGANISATION MONDIALE DE LA SANTE III\ lI0i[ "],, 0d.i;rocilt,.iI.:sr;i coti lftTEES Seventh meeting rqqd- l:9_ !_W.*\9a1- u:f CIiOC-,RC,t_r-SIS CC.i'II1OI, l lO(:lL- .i.il :I-i'I IIIE VOI?A RIVER BASIJI ,i ]NA PROG}IESS REPORT By TJ.IE P]IOGRA]/[M DIRECTOR Mr Chairnen Your Excellencies, Distinguiohed del-egr-rtes, ladies and Gcntlemen, I i-ntend presenting to you the recent activities of the ProgreJlme, but before then I lro,.rld, lil<e to thanlc our broti:.ers of iloSo i'or all the efforts tirey have uade to receive us vrith traditj-onal i'logolese hospitality and kindness, I rro,-rld also like to express our gratitude to the Goverrtment of logo for having 1i-nd1;. in"rited us to hold the iireeting of the llational Onchocerciasis Corr:mttees here this year and. for sparing no effort to make us feel at home. T have pleasure also ii: welco+L;ig afl those who are taklng part in our meeting for the first tirrle. you v,rould recaU- tirat during our last meetl-ng v/e agreed, tha,t there was the treeC to travc a fresl: iook at ihe role of the LiCC in tkre light of tvro major iurpos:rng problems, nanely tlevolution of activities and. socio-"g64em'ic develOpment. Since tircn t-le Cornrni ttees krave bcen very active with the preparatory t,v,or}:s for tj:e Programme entrustecl- to tilen, and On this basis we can proceed. towards further development. The response fron the Particlpating Countries on the socio-econoi'ni c repolts has been most encouraging but as the ultimate transfer of the responsibilities of th-e PrograrLrne to the }iLrticipating Countries is now one of the priorities of OCP and as the llOCs develop their sr-r.pportin6 activi'uies it is clear tl:a.t tite reinforcement of their structures is beconing of pararnormt i iaportance. In my report to you on the activities of tl,e Progretmne since the beginning of l-931, I tri11 treat successively the following subjects: Vector Control, Epicierdolo5ical Evaluatlon, Socio-Econoidc Developnent, long-terrt Strategl,, Devolution, other activities and In1'ormation. . ,./ l ZVECTON. CCNTiiOL Ertomo loEical evaluatioq The first senester of l9B1 has .een remarkably dr}, only at the end' of April arrcl ttre begl:rning of May were sporadic rains record.ed rnainly in the South but afso in the Sud.a,n a;1d- Saheliart regions' This differs from 1!82 when there wele hcawy xains in Februa:ry, l{arch and Apri} in almost the whol-e Programme aTea, which influencedr the levels of the watercor:rses very early a,rrd were equally responsible for a very early reinvasion' These t9B1 W season rains have had. littte influence on the ]evels of the watercou-rses which are far below the average. Certain perennial water- courses have been ceased to flow. Qverall- the river flow has been greatly d.ecreased. cornpared. with previous years and. this situation has infl-uenced the control strategy aclopted. during this d.ry period'' This strategy was markcd- by a series of suspensions of aerial treatmentst much rnore frequent anC ext:lsive tliari in previous yeals; an intensive study of thc recololizatior, of savanna breerling sites by tire forest vectors of onchocerciasis ancl much more recourse to gror:nd trcatmentsr wherever necessarXr' Every year duiing the sarie season, Sfound treatments have been carried out by the entonological evaluation teans. This yearts treatments were, however, nore j:,rportant both in tine arri Space because of the voluntary suspensions cf treatrnents" Al-1 the accessible breecling sites with premaginal stages of clJ d.amlosun s.l. were so treated. These includ.ed- lmportant low-water breecling sites in savaruia r,l-vers in Phase III-West in Ma1i, ttrose of the Oti in Togo and Ghana, some of the Sota in Benj-n and. of the White Volta in Ghana' 1'he volgretary suspensions of aerial treatments although facilitated. by the hy6rological conditions resulted principally fron the exceflent entonologi- cal si-tuation at the encl- of the A)82 rainy se3son. Drrring this period' the f1y d.ensities were extrenely 1ow. Ilowever, treatraents were also deliberately suspend.cd in order to complemont infofination on chlorphoxim susceptibility in the Sassarrd-ra and certain other river basins. Ad.varrtage was taken of these treatrnent suspensions to study the recoloni- zation of the breecling sites in th.e savanna by the resistant forest species: S. soubrense/sanctipaull. This stud.;rr was carried out on the White Band-a,ma i-n Ivory Coast and. on the B1ack Volta in Ghana through weekly monltoring of the key breed-i1g sites Iron where sa,aples of farirae ol? pupae of the vectors "'/1 1were taken for cytotaxonor,Iic or norphologicaf id.entification. 1'he results have shown that S. soubrense not only disappearecl by itself from the breeding sites of the Bl-ack Volta in the l)eJ dry season, confirrnjng L)82 observations, but al-so that the treatnents with Telcrar have efirrinated it ',,cnporari1y from the 11'hite Bancl-a,;:ra besin d,uring the sane perioi.. Also the breecling sites of Tienfala o1 thc Niger, close to the zones of agricul-tural projects near Ba.rnako were treated. regulariy by boat rluring almost the whole dry season with excellent resul-ts. !,Ihile these ground. treatl,:ants have demonstrated the possibility of controlling fly populations ct, inportant stretches of watercourses d.uring this tine of the yc;,r i t nust be pointec] out that in t98l the hyclrological cond-itions have been particularly conclucive to this action. An operation terrneC etwi-pe-out" startecJ. during the 12th week of the year, tovrard.s the enci of l,Iarch. Its ain vras to recluce to a mininum before the rainy season the f1;r rLensities on the l-ower ccurses cf the big Atlantic flor^ring rivors consicierecl as source rivers. The objective of this strategy has been to d.eIay as rnuch possible the conta,rnination of the northern rivers, especially those capable of being colonizecl by S. soubrense. Telqlar was the insecticid-e util-ized for this operation ?twipe-out?? durirtg which exceffent results were obtained.. At tjoes because of the complexity of certain breed.ing sites to be treatecl and. afso because TelcaarR is only seni-operationaf in its currently avaj-l-able fcrnulation, it was necessaaTr to use d,ouble concentrations of this larvicid.e for this o.oeration J.2 ppn/lO mn insteaC of 1.5 ppn. consider- ing that B.t: H-1{ has no ad.verse effect at all on non-target faur-:.a. ftrtornologi.cal- monitoring through fly catches per rnan continued as usual ar:d- involved- sone 2OC catching points in the Progran'nc area artd 55 in the Southern Drtension zorre. Frorn January to March 198] only BJO S.. d.a,mnosim s.1. fernales were captured. in 769 catching days in the original kograrrure area coverJ.ng 554 OOO 1fi2. No jrrcrease in f1y populatj-ons was observed in tiris area, clespite the fact that 1n certain cases the suspension of treatrnents exceedecl four months. The entornological situation was satisfactory and. the tra.nsmi-ssion of the d.isease completely interrupted in all the basins concerned. up ti11 end May 1981. .../4 The only productive foci r.iere in the Southe::n river basins of the Programme, where selectj-ve -breatmerts with Abate isolated forest f1y populatj-ons. These foci were on thc lower 3anclana. tr.e Sassartdra basin and. that of the lower Cornoc. Ilowever, with 'rope::ation viipe-outti even thesc populations r^iere ,l,isappearing from thcsc !,'atercourses. In the Southern extension zorree only the nc r-treated. Asukawkaw basin in Ghana ancl fogo was st1l1 colonized. by the vec'ior by the end of the d.ry season. The f1y populations on the Oueme ancl thc lvlono climinished. progressively reaching nil January/lefruary when the rivers stopped flowing. The 19Bl rej-nvasion is ,C.ifferent fron that of the previous years. Whereas in 1982 it appcared at the beginning of April- there was still no evid.ence of it bn the end of April 1985 anC it really started end May. In April-May, trials i-rr the use wf traps in the entomological evafuation netvrork wcre urrirertaker in southern part of the Bobo sub-sector ancl will be extend.ed. to the s.nb^-scctors of Ouagaclougou, Solgatanga arrd Dapaon in July and. August. Thc usc of traps is not intenclccl tc replace the catches on man which will rerlain, fc: OCP, the onJ-y means of eval-uating the campaign quantitatively, Hcvrever it coulcl i e a support to the present basio entomological evaluation nctwo::k ?.r,d for wid-er use as sentinelles dr:ring the reduction of thc cntoaolcgica.l cvaiu-ar,ion network and reinvasion study. After a four-r.reek experimcnt, bhe firs'L sinuliur were caught on the plaques at Pcnt Leraba riuring the iast r.^reek of April. At the sane time Iarval stages of the verctol:' were fcund. at thc brec-ding site at Pont Leraba and a week l-ater simuliun were ca.ptureC on man. These first results suggest that the plaques ca.n be used- as indicators of vector populaticns in specif-i-c areas anC as sucir could probablJr help jn supporting the entcuological evaLuartj-oa nctwork. It may al-so be rnent:-oned that -in thc lTia.rney sub-sector entomologicai activities had been suspcndecl for two months, i.e. fi'<;bruary-March, as rivers d:lied- up. .. ./, 4eri+l_gI9""!ro"g. In March and April as a resul'; of ti:e gooC hydrologica.l and entornological situation ib becarne possible to su, _rend. aerj.al treatr, nt in a nurnber of r.reas of the hogramme area. During four consecutive weelcs, from 24, Ifiardn to 12 lLpril inclusive, aeri.al treatnrents were limited to only 600 hr of water- cot,Ll'ser al-I in Ivory Coast as against 6 000 forrirally covered in this season of low river flow. [he resunption of aerial tre.atments was done progressively as the watL'r level-s started ::ising and a-s d.ictated by the entomological- situation. In the East, al-l- acrial treatnents stcpped. for an B-vreek pericd. Similarly, in the !/est, temephos treatnicnt in Pl:ases I and III(I\I) vras sr-1spend.ed. for five weeks. During this period the aircraft fleet was usecl solery fo= &L}! application j-n appropria-Le areas. Consequently, fiigtrt hours were red.uced. to nearly half the fig'ure shor^Tr for the same period,for 1!82 and. quantities of insecticid.e usecr r,rere also cor.sid.ei:abi-y lower tha.n the same period. in previ-ous ycars. On the lst of May the a-ircraft fleet was increased. in readiness for the vret season. 1\'ro extra Hughes !00 helicopters joined the fleet of 5 and of the present fleet cf B, two have been fitted. with a Bt. II-14 applica- tion system. The rcl ease system h:Ls; given good- results in the short period. of operation. 0n the lst of May a---so, a larger helicopter, a Be1I 20{ jcined the fl-eet ancl will be on contra.ct-ior an B-month periocl. An appropriate B.t. H-14 e"pplicat_ioir system for: t; i s hel-icopter has reen constructed. an,,l has been used. operatlcnally in its first two weeks of operation. 0n the lst of Ji;nc, th: fixeC wing part of tlre fleet was increased. to 2 aitctaft - a Tur:bo Thmsh and. Pilatirs Porter. Both aircraft wil1 be used for treating the big rivers ot' the Progra.mme area once the discharges are large enough. Aerial spraying stalis,,ics for most of Phases I and. III west zones from the period- l97B to preser:t have been analysecl aricl recorcLed on fo:rrs which wi-II eventually be uscd. fo:: the conputer storage of d.ata. .../5 oAquatic monitor ing Routine moniLoring oi' selectecl river systems continues more or less regularly in the five countries concerned. (tvory' Coast, Ghana, Upper Volta, Togo and Benin). A new contractual agreer:ient has been signeC with the Office of Animal Production in Lom6 which will- r:nd.ertake the monitoring of fish popuiations in Togo. Research Thc main research activity has been in the cievelopment of alternative larvicicles. Five new products have been tested, to d.etermine their short-term effect on non-target benthic fauna: OMS )OO2 (pyrethroid), methiocarb (carbamate), azametiphos (organophosphate). Apart from the two organophosphates, the three other forrnulations testeC proved. a priorj- to be quite toxlc b the non-target fauna. In certain cases a traumatisn of fishes (cypothrin at O.18 ppm/fO mn) and shrimps (cypothrjl at O.1B ppm/10 me) and OMS TOO2 at O.Z ppnfJ:O m was even obser:vetL. Aza"uretiphos seems the least toxic at the concentration tested. (o.te ppm/tO mn). The ncw formufation of chlorphoxir\ (206 C) seerls, in the short term, to have the same effect on the non-target organisms as that util-izec1 so far in control activitics ancl its utilizat/-.on has no preference over the o1cl formulation. However, it has now been a.greed. that no pesticide w111 be rej :cteC after only the first bials carried. oi,t in the sirort ter::: except if the prod.uct 1s toxic to fishes and. macrocrustaceans. A protocol will be establ-ishecl to r-rrclertake a parallel test of any new insecticid.e with temephos. Telet ission of hvd.rol- d.ata A new system based. orr the teletransmission of data has been consid.ered. and. field trials wilt be conclucted. in OCP in L984. This system should enabfe a pilot to treat a breeding site with a more acctrate quantity of larvicid.e calcul-atec1 on ctata recorded. earlier the sarne d.ay. 7AdulticidinE I,,iork ha; started. on aLiul-ticicing trials. The objective is, first, to ievel-op effectivc neans of combatting rcinvasion where tiris phencmenon has seri<-lus epid-emiologicar consequences ancI, second., to d.evelop .1i1 alterrrative control technique against savanna speci-es of S. d..:nnosum. The areas Ie. Taya, the R. Baoule near Mad,ina Di-assa and. the River i(ankelaba near Kankela located" in I'IaIi have been sel-cctecr for these small scal-e tri-afs. Discussions have been held regarcling the sercening of different compouncls ancl fornulations, the analysis of vegetation d.eposits of aclulticid.cs to clete:rrrine their persistance under wet season concliti-ons, the procurement of other cand-idatc compound.s ancl the proccd.ures for conCuctlng the first series of trials which will- be carried. out using ground. spraying techniques. The aerial spraying contractor has al-so been contacted. vrith a view to iclentifying appropriate hel-icopter-mounted equipment for 1ater appJ-ication of adulticides to gaI1ery forest vcgetation. EPIDE\TIOIOGICAL EIALUAT]ON From October 1!82 to iviarch 1985, the Elid.emiological- Eval-uation Unit examj-nec a total of 91585 indivicluals in 45 villagcs of which IO were in Mali, 15 in Upper Vo1ta, lJ in Ghana and 6 in Togo. Five villages, including Sanrondji .farrn, were also exa.nined for the second. timc in the southcrrr extension zone in Beni_n. Basecl on thu- overall analysis of the d.ata collected in the {) longitud.inal- evaluation villages, the rj-ver basins can be divided. into four rnain groups:(a) river basins where onchocerciasis has armost d,isappeared., only occasional cases being found: this is essentially, the situation in the Lotio basin which bencfitted from the EDF-oCCGE ca;apaign; (u) river basins where the d.isease is not found unrler the age of 1): these are the Banifing IV, the Koni-Fawara and the Koulpeologo; (c) river basins where the prevalence is ,il r:nder the age of 10, i.e. the Black Volta and its main tributary, the Bougouriba, the White Vol-ta and its tributaries l-ike the Sissili and the Biankouri, the Red. volta, the oti-Pend.jari, and some of its tributarics like the Ko,mongoui(a) speci-fic points vrhere it was cietected. chil-d.ren of less than J years had onchocerciasis arici its epid.emiological significance has yet to be determined. /o ...1O BThey are as fo]l-ows: Landa-Pozand.a on the Kara (one case), Kemin on the Mo (one case), Pend.i5 on the Black Volta (one case). The ocular situation is remarkably good.. The prevalence of ocular onchoccrciasis in the hyperenrlemj-c vil-lages has fallen from'l!.5ot6 in t975 to 2).5?6 as at now. In the mesoenrJ.emic vi1lages, ocular onchocerciasis iras fallen from tl-.y,/o in l9l5 to 8.96. Other evaluations are presently going on in fvory Coast, Upper Yo1ta, Niger and. Ghana. S O C IO - ]!C ONOi].,1i C DUTEI,OF}T]iIT The Econonic Development Unit has had several contacts with the national officers in orcler to help in the preparation of the socio-economic report - this consisted. nainJ.y j.n send.ing the report model to the services concernecl - and in the definition of thc priority fields of cooper-,.tion for the d.evelopment of the oncho-freed. aroas. The Unit is now wor)<ing cn the establishment of an information and socio-economic docunentation service ancl the execution of specific socio- econonic stud.ies which wouId. rnake it possible to evaluate the evolution of resettl-emcnt arrd" the utilization of the oncho-controLled. territori-es. IOI{G TMJVi STBI,T]GY As you are all- a\rare the Prog:^amme is in its tenth year and. almost half way through its originally previe,.^red. life-span of tlrenty 'rears. The Ind.ependcnt Con:rnission which lookecl lnto the 1or:g-termpospects of the Prograr,rme cahie up inrith sorce very clear rcconnendations on what path should. be fol-lowed if the success already registered. wouId. be maintained. in future. Approaching the third. flnancial- phase, with the need for the Programme to have ad.clitional insecticid,cs, the request to extend into surround-ing areas ancl incorporate othcr cor.intries, the desirabil-ity to d.evelop suitable macrofilaricid,al drugs arrd. the ultjmate transfer of responsibility to the Participating countries, it is obli6ptori-r as caIIed for at the third. session of the Jcint Programme Committee, that a long-te:rr strategy be prepared, so that all- concerned. with the Programrne are fulIy aware of their future commitment, finarici-al, technical anC political. "'/9 9This long- te:ra stratery r:rr.st be ::cady for presentation to the fifth JPC ir-r December I!8,{ and. because of tiris tight tite-constraint the Programme has had to talce imned'iate steps thi- year to proceed- i"ith its preparation' Ihc ternis of reference hav., been drawn up in consultation with the Committee of Sponsoring Agencies. ;\ction has beerr taken towarcls preparing a d'etailed. scientlfic report on the prcsent sj-tuation in the Progfa":nme. A strategy Coordinator has been appointed- and a plan of actiorr prepareC. Rrerything is so far on coulrse and. a first progress report will be presentecl to the next session of the J?C in Paris in December. DE'YOLUTIOI.[ Devolution i.s a concept j-ntroduced. by the Ind-epend.ent Comnission which recognized- it as being the ultimate objective of the Prograrnme, i.e. the assu-mption of responsj-bility for maintenance of the onchocerciasis control by the countries conceznett, This must be seen as the end. point of the Iong-term stratcgy arrd., so, perhaps something for the futr:re. You wiLl recall that it r,r,rs clecided at the last meeting of the National Oncirocerciasj-s Corru:rittees j-n riccra that, becausc of its frrture importance, devolution should feature prominently in the ciiscussions of subsequent NOCs. Accordingly it is Lt thc agend-a of the present session so as to enabfe us to define morc clcarly the steps to be taken to ensure an effective take-over of some OCP activities by the l'lational Goverrrnents at the appropriate time. Alread._v the Prograrnme has recej-ved. fuI1 support from both 'WHO Head.quarters and the WiiO Regional- Office for Africa in helping the Participating Corurtries i.mprove their heal-th st:rrctures, especially ';irrough the prima.rTr health care prografi,ncs. In turn each of the Participating Countries has been requested to d.esignatc two national officers charged. with the fol1ow-up of all devolution matters and. to participate, at the appropriate time, in the implementation of activities to be transferred. This wil-l be dea1t r,'rith in greater Cetail d.r-rring our meeting. ...10 10 OTI{M. ACTIVITIES Training The trainlng programme is continuing at approxirnately the same f evel as in previous years. QCP reilains read.y either to provid.e training within the Prograntme or to awarc- fell-owships enabling candid.ates to go elsewhere for training in specific rJ.isciplines. Training will become even more inportant to the Participat:-ng Co,.rttiies in relation to the cventual assunption of responsibility for kogranine activities. Wcstern Extensicn The'destern,'irtensiorr having bcen approrrecL in principle by the JPC, the p1a1 of work for l)8J is being implemented and attention is being focused. on coll-ection of eritomological d.ata in Senegal an.J. Western lvlali. Some insecticid.e su-sceptibility testirrg has been undertaken in Guir:ea and a sunrey of hyd.rological sta'bions carrieC out tlroughout the u/estem Extension area. An aquatic monitoring prograrame will be established. based. on the recommend.ation of the Icological Group. INFOl]}1AT]ON The use of infcrnation n:ust be emphasizecL and. ful1y explored in order to clevelop a rneaningful dialogue arnong all sectors involved in OCP. This information shoul-r,'r be two way anrl should pernit also a feedback process which i-s verX'necessary at this stage of the Programme. The Progra;nme has participaterj in infor;;rltion sessions at al-f levels to teachers, nainly in primary schools, at tsobo; to students in therrP.r:ral Health Trainingsr school at I{intanpc; to two Ambassadors of Donor Cor:retries in Ouagad.ougou; to nenbers of the Ecological Group ancl to visitors from relevant institutj-ons. There have also been journalists arrcl reporters fron Canarla, France, Britaln, C:ernany anrl other parts of the world. who h;.ve cone to be infcri:ecl s;2ecifica1Iy about the kograillme. These have pio..luced articlcs on Rad.io and in the press provid.in6,; good. publicity for OCP. Inforrnaticn on the IYogranne in the Farticipating Countries, which for our purposes may be bctter ternecl as a public Ed.ucation Campaign, is a subject which will- be addressed by this neeting en bloc. .../rl 11 Health Eclucation i-s arr inportant cornponent of Information a.nd especially of the Primary Hea}th Care systen. lnfo:sned. opinion and active cooper:ation on the part of the publ-ic are of the utmost lnportance in the improvement of thc health of the people. Comnnrnity participation is essential for lasting success in any hea1th pro€farune. Ilealth Education must iirvolve special-ized- staff a,nd- the mass nerLia and. all aspects of irealth rnust be covered. in this respect, Onchocerciasis witl be recognizeC as one of the health problems in the Prograiime area and shoufd be incorporatec in the national str.lctures alroiriiy established for mul-ti-d.isease controL and for lleal-th Education. Accortingly OCP nust col-laborate with those scrviccs in Participating States in proi,toting Hcalth trducation. This is ny report on the Onchocerciasis Control kogra.mrne to date, Ivlr Chairman. I{y col-leagucs and f are avai}abIe now to answer any questions you nay r.rish to put.