OCP evaluation report : revised version, July 1978

'T- I oucnocpRcrAsrs colrrRor, pRoGRAMME IN TTIE VOLTA RIVER BASIN AREA SCTE}MIFIC A}TD TECHNICAL ADVISORY COMMITTEE Seventh meeting Brazzaville, 21-25 Aueust 1978 ocPlsTAc7.2 ORTGINAL: ENGI.,ISH OCP EVALUATION REPORT Revlsed version (,lury rgZB) a o 4vJ -i2-an- Chapter I Chapter II : Chapter V Chapter III : Ihe Control Campaign and lts Results Chapter IV EVALUATION REPORT COI{TENIS History of the Programme and Management Structures The Problem of Onchocerciasis and the Objectlves of the OCP Research, DrvLronmental Protection and Tralning Implementatlon and costs PIan of Actlon and Budget 1980-1985 IJST OF ILTUSTRATIONS Programme area as of I January, L97B Management structures Chapter II : Dlstribution of species of S.damnosum complex Age dlstributlon of bllnd in 15 villages Chapter IfI : Aircraft treatment circuits Refuelllng points in the Progranrne area Annual Transmlssion Potentials - L977 Annual Bitlng Rates - L977 Annual Transmisslon Potentials - Pre-cont,rol Annual Biting Rates - Pre-control Areas of relnvaslon, catchlng statlons and experlmentally treated rivers Mean dally catches'of S.damnosum at relnvaded sltes Technlques of relnvaslon study Reinvasion areas ftrdemicity of onchocerclasis in the Programme area Geographical distrlbution of blindness Ln Upper Volta Population dlstrlbutlon - Upper Vofta 1975 Chapter IV : Aquatic monitoring sltes Chapt,er f E\TAUIATTON REPORT Provlsional List of Arurexes Annex I Annex II Annex III Annex fV Annex V Annex Vl lNot "r""ently included in this version I Chemotherapy Aerlal Contract Reinvaslon Epidemlological Evaluation data Research Training CEÀPIE| I EISIORT OF ffiE ItsOGBATT..IE AI'ID MANÂGEmJT §mUCîUnXS 1. Oachocerclasle, or rtver bllndness, ls transrnttteit ln Wgsl Africa by blaclÉIles, belonging to the SlEgùirrn ttannosun complex, whieh breed, in rapid§ flowtng Eectlons of xoany rlvens. tIriE dleeaae, rhlch ls partlcularly aeÿere in the Srrdan and Gui^nea savalra zones, 61rngB wlth it itebilitatlon and bIt:dnesa. In parts of the l[eet African sarranna onchocerclasls constitutee an i-nportant detement to hrrnan settlement amd, the subsequent eeonontc d,evelopment of rany valleys which Ile nnhhabited, and rrnproductlve. 2. In 1974, at the begtnning of the Olehocerciasie Control P1:ograme (OCf) corertrtg nearly 7001000 squ€Be kilorneters lr the Volta Rlver basinl lt was est{mated thât LO3 of the populatton was barbourlng Grchocerca volvrrlus. the paraelte causlng onchocerciasis, and that about 70r0OO people were bIlntt as a consequence of the disease. It is not possible to asBess the exaot nunber of bllnd, tn the hograme atrea, but lt 1s more reLerant to take irrto coasideratlon the geographical oonceatratlon of bLlndness due to onchocerclaElE ia certaln atreas, when estlmaltng ttæ rrnFact of the dlsease. the epldenlological pattern of ocular onchocercS.aslsl w'ith extreme§ hrgh bllndnese rates Ln relatlvely young age-groups ln emall nral populatLonal explalns the {nportant soelo-econonie consequenee of the diaease. 3. Awareaess of the extent of the problern had been steadlly d.eveLoplng sfuce the L94Os. Systenatlc srrmeys to aesess the rcagaitutle of the trnoblen and studles to ilevelop and evalute potentlal control measures were careied out ln nanÿ of the corrntrles concerned. since the ear§ 195Osr ttlrs providing I pa€e 2 I-q»rovetl background, lnfornatlon on the epld.enlology and, eoclo-economlc lnportance of the d,i§ease. Control operatlons sfm{ng at the d,estructlon of the vector were camietl out durlng the 1960s, begir:nlng on a mod,est scale and ctrLnlnatlng la a samFalgn lnvolvlng three cor.mtæles ard 6010O0 squar.g klLoneters, under the aegls of the Governnents of lvory Coastr I'lqll and llpper ÿolta 1n associatlon wlth tJre E\ropean Developroent hrnd (nof), and, the Organlsatloa de Coordrnation et d,e coopération pour la lutte contre res Grand,es Ebaénies (occoE). 4. In I96e the Yor1d Health Organiaatfon (WnO), ln jolnt sponsonshlp with the Unlted States Agency for Intærnatlonal Development (USAfp), *d OCCGE, convened a technlcal conference in t\mis to conslcter the problem of onchocerclasls. llhe conferenee concluded tirat control by rteans of larnlcidlng nas teclrnically feasLble and chances of success would be greatest lf the operati.ons were car.rled out in ecologicaL zones Eufflclent§ large to obvlate the aeed, for contLnuous eontrol of the whole area in ord,er to protect it against reinvasion by the onchocerclasls vectore. It wae recomended, that prlorlty be glven to larrnchlng a large-scale control programe ln the ÿoIta RLver basla atrea, lmrolvlng adjohrng parts of Benin, Ghana, Ivory Coaetl Uallr tri6er1 logo and. Uppe:r Volta; to protect populattona Eerere§ affected by the ilisease and to coastltute tÀe cornen-stona of future coordinated action against onohocero!.asLs, andt ln favour of assoclated. d,evelopnent, in Africa eoutb of the Sahara. 5. In 1969 a meeting was organizect j.n BrazzavlLle by the ï?H0 Reg5.onal Office for Africa to refiae fr.rrtir.er the approach need.ed for preparing the proposed carnpaign. n?erts fron üre Governnent of Ghana, OCCGE and IISAID, Ln addition to IrHO representativesl attended these d,lscussionso Shortly thereafter, 1n 1969 and 1970r several of the lnterestecl cor:ntrles subnltted formaL requests - Cbapter I page , eaanattng frm the highest authorltles - to lnternatlonal and. blLateral source§ of technlcal cooperatlon and trnd.in8 which were thor.rght to be lnterested, ln contæibuting to sueh an a;abitious untl.ertaklng. Aroorrg those organlzattons were, the trrootl an(t Agrlcultr:re OrganizatLon of the Uuited NatlonE (nAO), the Interna- tLonal Bank for Reconstruction ancl Development (maO), the USAID and wI{O. Si-m.rltaneouely, the United l{atùons Developroent hogra':me (U,mp) rnanlfest6d lte interest ln broadeptng i-ts oclsting lrnrolvenent in onchocerclasls stutlles and control ln the ÿolta Rlver basin âtrêâo llheJrreparatorv phase 6. 0a the baEis of the requests recelved. antl. at the srr6gestion of I3RD, l[80 and UNDP sponsored, a neetlng of lnterestecL partles in Geneva ln 19?O to draw up the tellms of reference of a mlsslon d.esigned to camy out complementary inveetlgatlons ln the seven countries concerned, as weIJ. as to plan and cost the proposed Onchocerciasis Control hogra:mre. Ihls heparatory Assistance to Governnents (pÂe) nisslon was funded by t7liDP with FAO as ÀEsociate Agency. 7. li[eaurhile, in 19?2, the Direetor-General of FAO, the Presldent of BD, the Adnlntstrator of IINDP and the Dlrector-GeneraL of IïII0, ln vien of the tmFortance and coryLerity of the seheme emrisagecl, decldetl to set up a Sf,ssrrng Comolttee, comprlslng a representative of eaeh of the forrr sponsorirng agenclesl to ensure the coord{nation of the action taken by these ageacles i.re the p].annJng andl Lnplenentation of the hograrrme. qhepterl page 4 8. $re finilings of the PAG L&ssioa and, the ilata or§lnat{ng fton other prelrn{nat'y investlgatlons were conblned to form a reportl, whlch wae presented ilurlng 1973 to the Gorernrnents of Beninr Ghana, Ivory Coaetr ltrall, llIger, [ogo antl Upper Volta. thls report fomtrLatett a plan of work for onchocerclaslE eontrol ln the ÿolta Rlver basir area whlch could lead to the repopulatlon, settlenent ancl economic d,evelopment of the end,enlc zones. Ihe report was also presented to various agenclesl instiürtlons and gorernnent. 9. [he Plan of Operatlons proposect by the PAG }lJ.selon report vag endorEed d,uring the conference heLd at Accra 1n l{ovenber L975 wtrlch brought together the Eeven GovernnentE involved,, and. tÀe forrr sponsorlng agencles. At tbe conference the Agreenent governlng the operations of the Prq3rasme (Operationel Agreenent) wa§ f612g11y signed. by the partlclpatrng Governments artl t7I{0. [h1s Agreement, which set out the baslc arrangenents for the nanagement of the hogra"me, waE supplemented ln 1974 by lndivlctual Corntry hotoeoLs deflning the speclflc eontrlbutions of each Governnent.. 10. As &ecutrng Agency, ffiO was assigned the task of lmplementing the hogra[me whlch rvas fortrâI1y establishett fron ]. January 19?4 with fieadquarters ln Ouagadougou, Upper ÿolta. Ihe flrst year of acttvity was devoted to settirg up the etrrrctures, the recrultment and tralnlng of staff, the dernelopnent of lnfrastructtuer the purchase of equlpnent and, supplles, compLenentary sur"v'eys and the lntenslficati.on or resea,rcb. Actt:a1 control operatlons began i-a February L97j. 1 ' UI,IDP, FAO, IBRD and ttEO (19?r) Onchocerclasis controL ln the Vo1ta River basln area. ReElrt of ttre heuaratorv Assistance ld1ssion to the Goverrurcnts of Dahomev. Ivory Coast. Mali. + Ànnexes 0-1 to -fI-5. 24OO co. iÂer. lloeo and llooer Volta æPhr.L - Gtrapter I PE€E 5 IL. îhe nachlnery establlshed to'oanage the Progracme lnclualed, at the corrntry leveI, Natlonal Coroalttees for Qlchocerclasls (ttOC), conprlslng representatlYes of the maln national se:rrices concerned,. The roLe of these eor,mi tteea ie prlnclpallyr to coord,lnate the actlon of all national gersrlces involved ln the Progrnrrne and. the subsequent econolalc developnent proJects, and to enaure Liaison betrveen the Goverrurent and, Progrerims f,64dqr:alters. L2. At the a€ency leveI, a Scientiflc Advlsory PaneL (Snp), arnile up of nearJ.y 2O0 technical and sclentific workers, was forrued by tIHO to be called upon, as necessary, for advice on all aspects of the dlsease and. its control. Lr. An Ecologlcal Panef (æ), conprising a small group of experts wlth wlde experlenee ln river basin ecology, the epidemiology of dlseases 1n river basins and tire ecolo.;icaI effects of pestiei.d.es, rzas set up by the Steerrng Comlttee to guarantee satlsfactory protection of the enrrlronnent. 14. At tne Parls neeting of donor and partlcipating Governments and eponsorlng agencles, in June L974, it was agreed to anpllfy the managenent shuctures of the hogran:ne. îhe atldltional stæuctr.rres lneludect, ln partlcularr a Jolnt coortlinating Comai.ttee (lCC ) composed of representatlves of ttre seven corrntrles, all contrlbuttng partles and. üre four agerrcleel. lhe role of the JCC was to exercice general supe::vielon over the policies to be ad.opted 1n the planning and executloa of the Progranme anil to follow the development of activitles. fhe Comlttee, wh:tch nould, be presld,ed other by an Independent Chalrsran and served by a jolnt vHo/r?orrd Bank secretariat, would meet once a year for thlE purpose. 15. [o provitle the JCC with a continuous independeat evaluation of the teehnlcal aspects of the Programne, ïIEO formed a Sclentlfic and Sechnlcal Advisory Cormrtttee (SÎAC) composed of 12 menbers of the Sclentiflc Advisory Panel. îiris Cor"m'lttee would neet tnice a year to revlew seientific and tecbnleal aspects of the hogranme' and. to prepare an annuaL report contalnlng lts findings and reco:orendattons for subnisslon to the JCC through ViiO and, the Sf,qsr.ing Comittee. Belglum, Beninr Canad.a, trhance, Fecleral Republic of GernanJr, Ghana, Ivory Coast; Japan, Kuwalt, l/lalir lüetherlands, I{iger, Ilonvay, logo, Unlted Kingdon of Great Britaln ànd Ilorthern lreland, United StateE of Anerlca, Upper lolta, the Aftica Developaevll Ban$ the Un1ted i{ations Developnent Programs (Umf), the Food and Agricultr.rre hganlzatlon of the United. Natlons (U,o), the rÿor14 ganrr (IBRD) ana the iT6316 Eealth Organization. L CbaPter I page 6 L6. Flnallyl the Steertng Comittee eetablished aa Econonic Developaent A(lvlsory Pane1 (fOÂP) to assure the contlnuous revlew of lnfornatlon relating to the economic developraent aspects of the hograme. this Panel, composed, of economlsts and spe- ciallsts la agricultrlral and, n:ra1 cleveloproent would meet twice a year and would present an annual report on its flndings and recormendatlons to the JCC through the Sank and the Steerlng Comdttee. 17. [hese addltlonal EEtrctrrres were êescribed in a ldenorandum of Understanttlng whlch was approred by the JCC at lts first session 1n AbidJan, Ivory Coastl 1n Febnrar;r L9?r. I8. Followlng the assurances recelved, from contributlng partles at thle first session of the JCC, an 0nchocerciasiE hrnit A$eement coverlng the flnanclng of the first si* years of operations rvas slgned, on ? Lxay 1975 by ni.nel donor Governments, the Aftlean Dgys]epnent Baxk, the IBRD, IDA, IIUDP and [rHO. 19. In 1976r following the consolldation of the hogranme activlties in the field, and wlthin the context of tire new orientatlon belng glven to the firnctlons of the Organixation as a whole, the decision was taken by the Djrector-General to hansfer the responsibillty for tbe Progra,nme fuom lÿHO Headquarters to the Regional Offlce for Afr ica. llhis transfer lnpJ.led both a new approach to Tnâna€ement and a reorganiaation of the supporting seryices. îhusl 1n Decerober L976, a new DL:rector was apolnted and the Headqr.urters in Oragailougou assrrmed fuII responsibillty for the lmplernentatlon of the hogramme under the authority of the lfEO Regional Director for Afri.ca. îhe Offlce of the hogra"-e Director ln Otragadougou was enlarged. by tlre transfer of staff from the support unlt ln Genena, and a llalson office wae estabLlshed 1n BrazzaviLle. lllre Kingtlom of Belglun, Canadar tire Republlc of trhance, the FederaL Bepublic of Germany, Japan, Kuwait, the rirrgdom of the Netherlands, the llnl.ted Klngdon of Great Brltaia and l[orthern Ireland and the United States of Anerica. lhese contributgrs were Later joined by Norrray. 1 Chapter I page 7 20. lhe tæansltlon was smooth. ktr»erience so far lnd,lcates that the centrallzatlon of actlvities in tJre flelê h,as hatl, the effect of creatlng a closer associatlon wlth the cl,lfferent leveLs of akuctnre lncluding rrlth the participating corrntries, and. a greater flexibillty for the nanâger:ent. 2J-. îhe lnter-a€ency Steering Comlttee for Onchocerciasis Control 1n the Volta Riner basln area, which bad been particularly aetlve durrn€ the preparatory and lar.mching phases of the Erogranrm€, has proved to be a valuable tool for coneerted action and rapld decislon-naklng. NationaL Onchocerclasls Co@Ltttees 22. By nlit-1974; each of üre Participating eorrntries had fornally establisheô a lfatlonal Onchocerciasls Conrnrittee (iiOC). [hese Comittees played a najor role ln resoLving logistical problens during the fj:rst years of operatlons. 2r. [he flrst jolnt meetlng of the I[OCts which was convened ln AUid;an in June 1977 wae extrenely construetive. It was unaninously agreed. that such meetihgs should become a regrrlar feature and at the lnvltatlon of the Government of Ben'ln a second meet{ht took place 1n Cotonou in June 1978. Advlsor.ri bodl"" 24. Dring the flrst forrr years of activlties the P3og3ame bas benefittetl ^ron the guid.ance and sunport of tire ad,visory bodles. 25. In the lnitiaL stages, visits were roade by nerabers of the Eeological Panel (nf) ana Scientlfic and [echnical A(lvisory Comlttee (Sni.C) to the Prograrnrae area for dtscussions w:lth tle fieltl staff, and to obtain first irand. haowledge of the enrironrnent and of the operations. Iÿith the etçpiry of the Chaoter I page I nantlate of members of SîAC at the end of J.97q the eonpositlon of the Commr11g. was reviewefl antl sllghtly roodified to neet the changing neede. Fol1ou1ng the hansfer of management, a joint meetlng of both groups took place ln Oragadougou ln L977r followed bJ, a meeting of SîAC at f,hs TfrIO Regtonal Office; Brazzaville, in 1978. 26. lhe Ecologlcal Pane1 has been revlewing the data collected by the hydrobLology research workers rrniler the aquatlc nonltorlng progr4rme and be's drawn attentlon to factors which miglrt be detrimental to the environment. 27. Of equal vaLue has been the role of STAC in evaluatlr:g tire tecirnlcal aspects of the Progra"tme and, notablyl giving guidance in research. 28. Altbough efforts were rnad.e to otninize d,uplication thror:gir jolnt neetlngs and. tiirough cross-representotion at rneetings, sone overlap between the roles of the Sclentlflc and Technlcal Advisory Comnittee and the Ecological panel has not been completely avoid.ed, and solutions to tiris contlnue to be sor.rght. One possLbility mlght be to malce joint raeeti-ngs a pemnnent feature or to merge EP lnto STAC. 29. As Àd.m.lnistrator of the Orchoeerciasle Fnnd the Ïÿorld Bank is responsible for nobillalry and, uanaging tJre fr:nds required to camy out the hogranme. Advances from the tr\rnd, to 'i?HO are nade on a quarterly basls on recetpt of a rrltten submisslon of the estlmated. pa;rrnents to be uaile dr.uing tire following quarter. At iialf-yearly i.nterwals, ti:.e tsanl< provldeo to each of the contrlbuting partles and to the Steerlng Comrnfttee, a statement of contrlbutlons, recelpts of and disbursements from the tr\rnal. 30. Ae of Decenber 3]-,, L9T7? the anount of advances by the t'Ior1d Bank was §3OI2OO?O00 of whlch *zOr2oOeOOO for the 19?4-1976 perlod and $IOTOOOrOOO for t9??. ît o o)r o, @ o,)c I ! z o 3o ! I\ no {, ag'fr h\§c 2.\-(.) ) It \\ ls 2 m m EU,U,Do j !ôsz m 2 m! :ED 'Tl (D(D o €f àoo -3 !=DC - Dz D -) J I I I i I I ! I 1r, m z môô 3 @t o o :, Olr C)§lÈ =of o À, q, Ol 3 o,ro -Dtr ! *to6) *t .-.- = =m D m U' o 'Tt z,C *t (t) æ Àoô \ a z ! I i I ! I o 3(D. D -{ E = C) oô mD = 2 6) m - a- o)(a o =6) m =D I o\6 I F (D m! D x o J s o- o,) 6) -D =D ô C) o, § &.-? \. c!t! oF{D z ol ./ \'-.2'- -'-'a. r'\.-.-.-'-.-. E m = ='-'4.r'J''J'\'''s. o 6)o \ \\ I I I MANAGEMENT STRUCTURES r Specral Fund for 0nchocercr asr s ( IBRD ) Ecologr cal Panel Scientif ic Advisory Panel I Economr c Development Advrsory Panel I I II I L J L -J r Scientific and Techn Advisory Committee ical |- I -l NatronalOnchocercr asr s Commrttees wHo 76409 -t J IL JOINT COORDINATING COMMITTEE SÏEERII{G COMMITTEE E)(ECUTING AGENCY(wHo) External Relatrons and lnformatton Programme Director 0nchocercrasr s Eprdemrology & Publrc Health Adminrstratrve Support Servr ces Sr mul r um Control Operatr ons Economr c Development Unt t I I I CHÀPîER II rre PROBTEM 03 O.TCHOCERCIASIS A1TD $TE OBIECTIITES OF fiTD OCP Â. CEICHOCb:RCIASIS lhe dlsease the paraelte 1. Onchocercla.sts ls a parasttlc dlsease canrcett by a neroatode of the fllaria grourpr Onchocerca vohnrlus. Ehe pars.slte ls str{.ct1y assoclated wlth nan and has no krown anlna-I resernolr. It ls transuttted, by several illpteran flLes of the srnrullidae fanitÿr whtch lneludes the tlest Afr{.can vectorsl the speeles conplex @. [he Si-utr].tun or blac]dly ls both vector and. lntemedlate host : a mierofilaria lngestetl fron a ÿtunan her,s to corplete a deveJ.opment cycle rrlthln the blactcffy; 1n about seven days lt becmes an infectlve Iarvs, the only fo:m whtch can infect man. there ls no posslbility of propagation of the ùisease except by fo:mrs of the paraslte that have completecl tlÉs obligatory intraveetorial eJ'cle. 2. Aalult Onehocerca voLrnrlus vrorrIrs rnals and fsrnals, l1ve ln tuxnan tissues either in the free state or encapsrrlated ln fLbrotrs formatlons lorown as onchocercorus, eysts or nod,trles. Ehe free wortff and deep-seated nodules are nornally undetectable. îhe superflclal nodtrles; which are rrlsible and. pa1pabLel are mostly located in the subcutaneous tLssues overl;rlng bone: eostal marg:in, iLLae crestsr trochanters, sacr:Lrm, loaees, shlns, slorll. Each cyst contalns one or more patrs of tzo:us. As a rrrle patlents have several cysts or groups of cysts, an6 in nodulectmy carFal6ns there have been ca.ses where over 40 eysts bave been renoved fron a single pati.ent. 3. Drring lts lifetfuae (estinated at LO-15 years) the female Orchocerca produeesmj-Lllons of enbryos, nierofilarlae, rzhich spread ttrroughort tbe bo4y tissrres but rvith a particular aJfinit;' for the sicln end eyes. Fron the skln they nay be lngested by a Dlacldly during lts blooct meal. In man the nicrofilarlae have a life expectancy of L-2 years. After thls time, unLess they have been ingested by a blackfly and are thus able to coatlnue thelr deveJ-opmemt c;rc1s, they dle tn the tisstres. Chaoter Page 2 4' îhe naln clinleal naÂifestati-ons of the disease are due to reactions to the presence of nLcrofila.r:lae' ancl t4eir severity is directly rela.ted, to the lntenslty of paraslte infectlon. 15" srnplest nanlfestations are skln 1esj-ons vrhlch are caused by scratchj-ng, and are folLowetl by pnrritlc papular enrp11onsl rater on the slÉ-n m4r r-uadergo a var{.ety of changes: thlclrening ancl sclerosLs tn the forn of pac§dema (erephant skia) I localLzed or extenslve cutaneous atrop6y, and depignentatlor. DLs tri butl on of onctlogercla.sis 5' Onchoeerclasis ts essenttally a disease of tropical Afr{.ca, where 1t ls prevalent to varying extents betrveen latihrdes IIoN anct 15os. Eowever, lt also affeets tvro other continents: aroer^i.ca, r,rith focl in Guatenarar L,Iex[cor venezrelal northem Brazill and' coloanbla; and Asla, vrlth the foeus in northem yenen. 6' Broadly spealclnÊ, the northern lirni t of the disease in Africa nrns fron Ganbia to the soutl: of Iah Chad; lt then rj.ses in the Sudan along the Nile as far as the Abu Haned reSion (rgofltN) and drops agaln into Ethiopla along the tr''hrtaries of the Nile. îhe cor:ntries sLhrated between this line antl the Equator are the urorst affected: the rvhole of lïest Afriea (except tfanrLtarria), carneroon, southern chad, the centnal Âfrican Ernpire, southern sudanl rvester:r Ethtopial and northern Zal::e. 7' Purtber south, the dlsease ocsurs 1n Equatorial Gulneal Gabon, Congo, Rvranda, Brrnrndlr the eecxtrar basin antl southern part of zairel uganttal western I(enyar Tanzanta, AnSoIa, ancl ldalarrl, where it reaches lts eouthenrmost pointr l?os. Chapter II Peae 3 îhe vector and transrJssion ÿector speeies 8. llhe l.raorwr vectors of ht'man onchocerelasis are fllles which belong to the Si4ü.11tlaefertl1yo[heAfrc.canvectorsaremerrbersofthecomp1exeS@ dannosum (tfrroughort tbe area of distrihrtion of the cllsease) and @eavgL (in certql" parts of centrral and, east Africa). As rega:stls S. d,agrostm s.1., lts area of dlstrihrtion extends northrvarrls and souttnvards beyontl tbat of onchocerclasis. fhe S. dar:no sum complex 9. It has been lmorr for some years that S. damrosrm,. once reganled as a homogeneans speciesl tn faet constitutes a conplex of d.lfferent taxa. As a result of studles pursued 24 separate cytoJ.oAca1 segregates b.a.ve been ld-entified, throughort lroplcal Africa. 8or ÏIest Affi-ca nlne segregates have been describetl.r slx of which (rrllll"rrr trsirbattt ttBandamatr, rrsotrbrert, rrYahrr, ttBillerr) are of direct concern to the Prog3arme because the;r are found in or closely assoclateê wj.th the pr"ogrernme area, At a Scientific Aduisozy PaneL meeting on veetor complexes the d.ecision vras endorsed, to consiiler these as specles with the follotring nanes alreaily glven then in publlcatimsr llgggg soso, S.slrbanumr S.salctlpaulir S.soubrensel S.yahense and So soüanosün respective3.yo 10. îab1e I æd FL6. shotr the dlstribution of these six nsln species for the whole of ïfest Africa and for the Programe ar€a and adJacesrt zones respectively. 11. Each of the specles has a eharacterLsttc dlstribution pattern reLated. to the d.lstrlblrtj-on of the bioclinnatlc zones of lTest Africa. [hrs Ë.sanctlpau].i has never been demonstrated ortsltte the forest zones; SoseuanosLm and S.yalrense are more ublqultotts but nainly ccmfined to certain t;pes of natereourse in vell nooded couoetry; Srsoubrense rns-iu].ÿ lnhablts the lerrge r{.vers ln the forest and Gui-nea [able 1. DISîRIHJEICN- OF SP-:,CIIIS OF S.DAI'NOSIM COHPITEX §PECIDS Bquamo§utr - Chapter II Page 4 TIÀBITAT hrllid forest and riverine forest in Gui.nea saÿanJra llrrLld forest and mourtain forest; erüectd.s into savanna in Guinea lxrntd forest and. rtveni-ne forest, extend.s lnto savanna ln Guinea hurttd forest hüttd forest and Guinea saÿannai extemdE into Sutlan savtrlna Sutlan savanna.; extends into Grdnea saÿanna and even forest .ÿahense Eoubrense sanctloauli - daxnnosum s.g. slrbanum ITTDICATIOÏ OF DISîRIH,IIO}I Canerom, Beninl [ogol Ghana, Ivory Coastl Upper ÿolta îogo, Ghana, Ivory Coast, I5.berial Guinea Benlnr îogo, Ghana, Ivory Coa.st, Ltberia, Guineal Upper Vo1ta Ghana, Ivory Coastl Ltberia Cameroon, Ifigerial 3entn, llogo; Ghanal Ivory Coast, Iiber{.a1 Gulnea, tr[a].l, Nlgerl Upper Yo1ta Cameroon, NlgerC.a, Benlnr llogo, Ghana, Ivory Coastl Guinea, Ga.nbiae Upper Voltal lrÎallr Nlger tr, U' 7) @c o z, o1t a/,! mI m an o 'lt t? lo IDt<lz.lolqtlcl= c)o =! mx o o c @ = o^ a\) tr o D » Eê F 2ËfrËâE .\J c o() D t o § c t-o =m N) () o -{ozoc t- ooltt :.' È cr N \o\§\. oC >.-_.. 6, ooCO 6) oC tr » » D _.tJ , -{ mz o^0o 6ro @o @o II oC|- UI aho D o l- rn o a » a » x zI 9 m @oCaoC q, ot- 6) -{ zôa §T §-'a @ z 'Tt ot .l J o z I{ z 6)oC § € D tr 0ut 1\ xo ,T ooo a a -{ 3 m mz o e/ { t ! xoc a o^ S o tr 4 Ohpora EDê È q ê § oê lê Otr ouow o * @oC x m a { x!1.Èa tr o aC^ =I >o § g oL * nqso z =m D \ Chao rII Page 5 savarurs' zonesi §.d'amnosun s.Eg ls for.rnd nalnly in the Grrlnea savanna zones; S. st rbanr:m has been fourtl in forest areas hrt it is meinly ln the Sudan savanna zone and the Northern Guinea savanna that this species ts w!.despread. L2' Dlfferences ln transd-ssion potentiaL have been rlenonstrated between specles and. as a fr.urction of the bioe]lnatlc zones. Bio-ecolosÿ of the vector L3' trike all brackflLiesl §.d,amostr.n s.1. deverops, duxing its larral and pupal st€esl ln nrnning rvater- Pre-ad,ult deveropment (eggs, rarvae and pupae) trsts about a fortnight uncler troplcal nrnningdyater teraperattEe cotditicnrs. The various specles of the complex have sonevrhat different requlrements urith respect to the p[yslcoched-cal conditions of the water of their breedlng sLteso 14' Among all the biol-ogical peeuliaritles, trzo fun6anental eharacterâ.stics stand out because thel' deter-nine the strategy and tactics to be eraproyed against S.da.urostm, (i) lhe demands of the rarvae of the comprex are relatlvely exactlng, partlcularlly ln regard to their nutrition. [hi.s ls reflected in Ii'nrted spatlal dlstributlon of the breeding places and is what makes lt possible, after a careful surxrey of those breeding praces, to lnplenent a eaq>atgn arued at destroying, wlthln a glven area and by sn'rfflcient§ spectfic actionr +1l the larval popurations of the specles. Chaoter II Page 6 (ff) thts factor, favourabLe to the execution of a coordlnated ca4ral€1rr is unfortunately cor.mteiUatanced by the ftyine power of the femalee; whencel on the one banrd, the neetl to contlnue larvlclding over a very long peri-od to obtain only a satlsfaetorlr reduction ln the paraslte populatlon harboured by man; and, on the other hantl, the need, to a _DIy treatment to a snffieiently extenslve protectlve zone Eo a,s f,o mln{mfze the consequencee of posslble reinvasions. Transmlssion 15. llhe ulcroflLartae of $.-Wlg4ggl the patirogenic agent of hrnan onchocer- claslsr have to go tbrough a stage ln a vector in orrler to conti.nue thelr development. îhese d.cnofllariae, tngested drrrin5 a blootl meall r:ndergo severaL moults ln the course of a cycle that lasts an average of seven d.ays. On conpletion of thts cycle, the infectlve la":rae break out of the fly during a subsequent blootl mer]. In rlew of the duration of the gonotropbic eyele of the femal e S. dannosmr Lt is rmFossible for the parasite to go through a coupLete cycle between two srccesslve blooil meaLs and an infectetl feuaLe w:tL1 not become epldeniologieally clangerous r:ntiI she talces a thirrt blood meal. 16. llhe dlmapics of transnLssion tlepend on nany factors, the main ones being: the absolute quantity of potentlaL vector bllaclcflles; the mean age of the vector populationsi the veetor specles coneersred. (adaptation to the parasitel degree of anthzropoplû}Iy, etc.) ; the transrission season; Chaoter II Page ? the degree of contact between tnuuan and vector populatlons, ç,hlch depends on h,man aetiv:itlel (tintea to age and sex) and on the above- menttoned factors; the Level of infection of f,[s ]nrrnan popurationa, nh.ich are the only regenrolr of the pathogen. Epidenlologtr of onchoeerciasls 17' I[ot a]l the tleter:ninin.g faetors Ln the spontaneous develooment of onchocerclasis have yet been foturd, hrt a number of general nrles can be deduced from obse:rrations so far. te bulld-uo 18' orchocerciasls i-s a parasltic infection that pro,gresses slor.ày as part of a cumulatlve process. îhere ls a long period of cllnl.car ratency after infeetion (one year on a"era6e). §pontaneous cure is belated antt is S0verned by the life- span of the adurt vorm (1o-L5 years). Und.er stable conditions of transrulssion, the fllariar load ln ttre indlvidual steadlly increases orer the ÿêêrso The severity of the Lesions varies cllrectLy with the {egree of paraslte infectionl 1oê'r rrith the nunber of adtrlt r/ol"ttrs in the body of the host and the number of mierofllariae they release. trevel of transnlsston and. J.ength of exposure to braclcly bltes are the üzo factors in nân-vector eontact that govern parasite hrild-up. L9' rn fotE viLlages of the Programe area, it rras posslb].e to d.etermtne annual trangntssion potentials (em)l, before the start of the comPatgrr over a sufficlentLy rong periotl to have a good ldea of the effect of annua-l var{.atton. Medical examination ha.s sho'ne that c.cposure to increasing Arp Leads to increasingly severe onchocerciasi-s r.eslons anong a popu-lation. 1 For an expranation of Aîps and. ÂrJRs see footnote on pages r.o-rr, cha!,ter rrr. Chaoter IIPagé-8- 20. [his crlJtrrrlatlve effeet also sirorzs ltself in the connerion between inereasing leveLs of preva-1enee and increasin6 paraslte load. îhe greater the proportion of affected persons ln a rillage, the greater thelr para"site 1oad, and rri.ce versa. Geograptr.l ca1 illspar{.fi. es 2L. Onchocerclasis occurs in foei, each of whlch is ceatred on a breectlng p1acel or succession of breeding places, ln the lnmedlate vlctnrf,y of lvi:ich the dlsease appears in lts nost severe fotrt. îhe d.istrtbution of foet is governed by the §drogeographical features of the reglon. Depending on the denslty of bree6ing places, foel nay be relatively extersive and, contlnuotrs, or separa.te and restr:-eted in area i.:r a nosaic patternl 22. Eaderoieit;' in any 5'iven focus falls o1!1f rrith increa.sing distance from the centre. This stra,tiflcatlon into leve1s of endeulclty (tirst-L1ne, second-Lj.ne end third-Ilne viLlages) is go'.'erned. by the frequeney of contact between nan and veetor, vl:ich decreases rvi.th distance fron the 1anral breed,ing pJ.ace and the dlstance over *rirtch tire blaclcfLy ha.s to travel. Role of sex 23' In zones of lorz or moci-erate end.e'.ni cit;r psp are nearly always affected more frequentry than tvotllêrlo îhls dlfference leveLs out ln sperenir-erclc zones, rhere the prevalence of onchocerciersls is the sene for both sexes, althorrgh rolcrofiLarial 1oa.ds are sti1l generally higher for men than for rvonu,,. 24' îhese dlfferences are aLso euident in the fi.gures for the prevalence of eye lesions anil bllndness, rvhich are a-lvrays ht$aer for men. Che.oter II Page 9 25. lhe roost valitl explanation would seen to be a soclologiea.L one. Because of the dlstrihrtion of ta.sks and the social tltrision of Labour, tvom,en are less exposed to cortqct vrith the vector. §rmilsr'ly, ln two villages ln the north of the Ivory Coast tn whlch women are signiflcantly more affeeted t?ran nen, it has been shovn that they alone are concernetl in the cultlvation of rice along the r{-ver benks nhile the men grovr cereal crops further away fron the breeding sites. 26. Thisl horvever, does not exelude the possibility that o';her factorsl such as horaonal ones, nay be involved. 2'1. Studles conducted. in the OC? zone in just over 300 vilLages hane shorvn that there are trvo distlnct tytrles of entleqic situatlon one at each extrerne: (i) a level of disease that roay be eonsidered "tolerablerrl in vtÉch the prevalence of onehocerclasls in the cmunlttes considered does not exceed lÇl; posltLve cases have less than 1O nicroflLar{.ae on average per skln blopsy; there ls llttle or no severe eye tnvolvement; the frequeercy of bllndness is belovr lfi *ra r.esults frcno diseases other than onehocerciasls; (rf) a leveL of infection at rvÏr-leh the tllsease ls octremely severe; aIL v:lJ.J.ages ln rzirleh over 5/o of the regtstered population ls blind have beesr found to have more tban 6@ of their lnhabd.tants lnfected; posltlves have orer 20-25 rd.crofiLar{.ae per blopsy; over 1@ of octrlar onchocereia.slE leslons are severe anÿor lrreversible. Chapter II Page 1O 28. Althoueh there are v:L11a6es in which the prevalence of onehocerclasls ls wer 6$ while the frequency of blLnduess 1s less tttæt 5/q tb^at }gÿel urst be consldened as a threshoLd beyontl rvbich a co@rnlty is at high risk. It would therefore seen Io5:ical to redefine the fotr conventional leveLs of endemr clty as follovs: (i) (ii) Sporadlc cnrchocerciasls : fewer tinan Lÿfr infected, natnly etront adults. H:moenderd.clty I betlveen 10 and 29.ÿ/o lnfected. îhese genera1ly have less tban Io uicrofilarï.a per blopsy and eye ccnapllcations âr€ râipêo I'fesoendenlclty : betrrreen 30 antt 59.# infected. îhls is an lnte:medla,te sitLlatlox in rrhich the population may show varying clegrees of paraslte lnfectlon and j-n wtrich the rlsk of eye comp]Lcations i.ncreases with ulcrofilari.al loed. Hÿlerenderieitv 3 over 6@ infected,. There ls a high rislc of eye conplicatiors and posltlves have more than 20 ntcrofilar{.ae per blopsry On glrera€e. (ur) (r") Chapter II Page IL 3. OBIECîMS 03 îre oCP 29. In nany African cotm.trLes, parasltlc diseases are enderulc. Ho.rorerl during the 196Os, seven Flest Afrtcar go\rernments decltled. to put enphasls on the fight agalnst onchoeerei.asi.s. In fact, nost troptcaL diseases can be 6ealt with efflciently only vithin the frarnewor.k of a global pollc;. of heatth lmpzovement, wi:ich involves a slov process of instlttrtional and beharrloural change. Oa the other handl oneirocer.ciasLs, whlch is also hrovrn to have serc-oua social and econouic repereussions, apart fron being a particurarly sad h]ItralIitarian problernr can be taclcled by vector control cecrFat6ns, uslng speclfle mocl.err teclmolory. 30. îhe Vo1ta Rlver Basi.:r area \za.s hrouae to be one of the rzorst focl of oncho- cercla.sls in the lvoi.ldo [hl.s has been further eonffuued. by t]re epideraiolog.ical sur\r'eys ea:ried out by OCp since L975. îhere are sever"al lgperendenr5-c areasl where more ttran æfr of the population bave onchocercLa.sis, which v:trtuatly inpLies tlut eve4'body fron the age of 10-15 years is infected. I{o,*e than LZfi of the total populati-on uay be brind in such viIIages. 3L. Ellndness constiürtes the best homa and most inportant roedical consequence of onehocerclasls. Also the concentratlon of bllndness in smalL nrru-I comunltlea, rvith extrenely htgh bltndnesE rates in relattvely young age-groups (see Flg. ) severeLy affeets the working capacity of an i-uportant parü of the popqlatton. Ia §perentlerÉ.c areas, onchocerciasls cornpletely d.oroinates as a capse of 20 AGE DISTRIBUTION OF BLIND MEN IN I5 HYPERENDEMIC VILLAGES Blindness due to onchocerciasis Blindness due to other diseases 10 20 30 10 50 60 ?o r5 co(, o o- r0 5 No €N o , \/ \/ \/ \/----/ \ \ \ .a --22 a Age Chapter IIEEBeE- blindness. Iligher bllndness rates are found ln rc.ver basins where onehocer.clasis is hrown to be preva-lent and severè. ,2. Apart froa total bllndness, sevene visual handi.cap due to the tllsease nay constihrte a tlisabiJ.ity eqtrlvalent to bllndness. Also, there ts nov some eridence that the life expectancy for the blind in Africa nagr be shortened. 33. Another social consequence of orchocerciasis ts ilenographic inconsistency wiÉch affeets the very stmcture of the populations oqrosed to the d.i.sease. îhe departure of yol.lng nen (beüneen the ages of 15 and 30) tron an infected village ls part of a n.ch more rid.eqpread tendency to emJ grate torzards the torars of coastal regions that bave bet'i;er resources than the s&ÿ?nnâo llhen thls happens the d,emographtc imba-lance can be seen fron the age pyramlds, whj.cb to varylng extents d.iffer in shape fron the nomal, rerrealJng a nald.j.strihrtion of population by a€e and sexo In the tSrperandemtc zone of norühem Ghana, for examloLe, before the Progra:uae started there were 65 men for every LOO women in the 15-44 year age group; ln sme vLI.lages the proportion vras even as low as 60 or 551 whereas the natlonal average was 9J men per l0o vromen. 34. criterta for the selectlor of the area for the canpatgn lncructect the acti.ve lnterest of the various govenrments concerned, avatlabiLity of d,ata concern-ing the naürre and sever:Lty of the ttiseasel the presenee 6f rn*rrortant areas of severe ffirerend.euiclty trrith hlgh rates of bLindnessl the e:clstence of a borl,o of information concerrring tire cTistrihrtion and beharriour of the vector, the avalIabillt;r of adequate roaps ancl §rdrolog'ical lnfonaation. It was consirlered,. that any vector controL somsalgn would have to be on a large scale if success wae to be achleved as lt nas already heovn that S. dannosum va.s capable of Chaoter II Paee 13 travelling long distances in sananna country. Experlenee of ÉEaIl cortrol canpatgns ln ÏVest Africa had shorm that 1n nany areas durt-ng the wet season, there was a contj.nuous influx of flies fron outslcle the eontrolled. zone. thls had been the e:çerietrce of the EDF carpalgn tn the Banfora region and in control schenes operated in l'ILgerlac 35. An area of ?0OI0OO 1# was ehosen. The northern lirn'i! was deteræinett by the northern linit of the vector itself. The southsm ]Jmlt rzas designed to take atlvantage of the eristence of the Vo1ta and Kossou nar:nade lakes as tt na.s assr.med that the forest fonns of the vector night not reinvatie the sayanna zor€êo 36. there ls no tln.g rvhleh coultl be utillzed for safe and efficlent large scaLe treatment of onchocerciaslsl. ïfithin the tecimlcal resotrces availablel the puraose of the 0C? ls to lnternrpt transntssion through control of the vector and reduce the impact of onchocereiasis to a sufficlently lol level that 1t no longer represents a mqjor public health problen or an obstacle to d.eveLopment. OcrlnS to tbe fact that the llfe-span of the parasite o volrnüus in the hunan host rd6ht be as nuch as 15 years, clunges in the prevalence and lntensity of the dlsease coultl not be expectetl rapldlyl and the Programe was schedulecl to last 15 to 20 years. For additiona1 inforrnation on the chemotherapy of onchocerciasis, see Anne:c. I CHAPTAR IIÏ TI{E COI.ITNOTJ CA]IPAIGI.I A]TD I'TS RESUT'TS A) BAsrc DAî-q. - uerrioDs oF cCImRor atiD TECIIITTQTIEs 1. In default of any therapeutle treapon at present utillzabLe tn a nass canpa.j.gnl the only feaslble methocl of controlllng onchocerelasis ls stlll by control of the vector so that the rate of traulsd-sslon of the paraslte can be reduced to a leveL tolerable for the hunan populatlon. 2. îalclng lnto accorrnt the genetic, biological and ecolodcal chs.racteristlca of S. damrosum sol.1 the eontrol of the vector can be approached, Ln theory, from nany angles. Ecoloical control 7. the ellnlaatlon of raptds, which are vrhere the vector reproâuces and develops, rvorrld be a final and therefore itleal solution to the problen of oncho- cercla.sts. îhus in Afr{.ca the great d.ams bulIt (.a.swan, Àkosombo, KatnJL, Kossotr) or nolr being bullt or plannea (SetinSué, lfianantali, Noumbiel, Jebba, Brrt), Uy elfuntnatjng any posslbiLity of S. tlar.mosg breeding upriver, have had or uiLL have an extrenely beneficial effect on the onchocerciasis sitrration. A stud;r un«lertalcen b7 OCP has established that the constmctlon of Just the one hydro- eLectrLc dam at Noumblell on the Blaclc Volta betrveen Upper Vo1ta and Gbana, raLL resultl apart from the ftnal eLinlnation of loeal vector populations along consi«lerable reaches (tZO !m) of ttrts rtver and its trihrtaries, ln a saving of $L50r00O a year ln the cost of conventlonal lnsecticltllng tecirnlques. 4. However, to constmct such engineering works for the soLe purpose of controlling a disease, irrporbant though tt nay be from an econo:ric point o1 vi.ervl ls out of the questi.on. The topograpÏ\y of the Afrlcan savanna zoaes vrould not permlt lt ln alL p1aces vhere lt would be desirable, antl the cost of such d,arn.q is generalLy very high. Chapter III Page 2 5. Ol the other harlcl, the prollferation of srnalL dams to provide reser:\re water suppliee near mral popuLation centres has often resulted in an a8gravatj.on of the onchocereiasis problen beeause of the favourable cond.itlons for the development of S. damosurn created by their spillvays. Genetic ccntrol 6. llhe tntroductloa of sterC-Le males i:rto natural vector poptùations tras been the thene of nany extrlerirnents, and. has been successfirl§ utiLized in sarï'atgns against cerbaln lnsects. 7. llhe fact that females of S. d,anrnosrln nate o'n§ at the start o:î their adtùt llves and. thenl having been ferüiDzeti, are abLe to nlgrate æer Long distanees nües out the appllcation of this method. îhere are also cur.rentl.;r insuperable probLeros conce:.rlng mass colonization of S. darrrosrrm ln the laboratory. The flles cannot be natecl in capti'rity and have dlfficrrlty ln taii-ng blood and o'ripositing. Btological qqntrpl 8. Àfany parasites infest S. in nature and research efforts are at present being concentratetl on the possibiLities of utilizing then with a yiew to reducing or sliminaf,ing vector populations. îhe lnJ.tla.L results are not very pronlsi.ng and lt is stlII too early to say whether thls technique could be applicable in nass carpaigns. Chentcal eontroL 9. îhis method. can be approached ln two vrqys : control measures dlreeted. agai-:rst the adultr artd control of the aquatic developnent stages ("gg", Larvae and pupae). Adult eontrol L0. One of the earliest campalgns against S. d,arrrosum emPlo;rsfl thls PrinciPlel tbough lt was not possible to deter:nine the part played b;' Iarv'ieide aetionr (pd Chapter fII Page J of the lnsectlclde falllng dlrectly into the raplds) in the successful results cbtained. I1. In fact, because of the posslbllities of dispersal of S.damnosum females around their sltes of reproductlon. partlcularly during the ralny season, lt would not be feaslble to conduct an adulticlde campaign covering a wlde area. However, research is in progress wlth a view to developing a control technique that would allow protection of localized sites, partlcularly ln reinvaded areas. L2. Eggs and pupae of blactcfLles are secureLy flxed to thelr supports an6 partly pmtected fron their surrounttings by the adhesive jelly in the case of the egg nass and' by the eocoon ln the case of the pupae. As neither of these stages ingests food partieles frorn lts surrotr:rdings the'r could onlSr be destroyed by fairly strong contact poisons. îhey are not effectively destroyed b,, arry insecticide cumently i.n use. ].3' Or the other hand the larvae, because of their relative coneentration and their nod'e of obtatnlng nounlshnent by flltratlon of partieles in srspenslor in the waterl are tbe foms rnost suseeptible to lnsectlcldes that act rnarnlÿ through lngestion. rn default of aqy aLternative, rarrar control is therefore the principle upon whlch nost canrpaigrs a€alnst blac!ɧ vectors of oneho- cerciasis have been ccmducted in Africa. 14' lrltlely utll1zed in pr:lor canpalgrsr and agata adopted for the progranrme, lan'al control is governed by the foLlorying principles : the la'rricid'e solutj-on roust be released upstreara from each breed.ing slte or set of breed'ing sltes, so as to destroy ilre la:srae of all stages. îhe range of action of the insecticld.e rvave transported by the cugent depends essentially on the lyd.ro}ogicar and topograplr-ica-l characteristics of the lzatercourse treated; Chapter IIf Page 4 appllcations nrst be rnade.leriodieallyl at intenrals shor,üer than the larual life-span of the species. îhe periodicity has been fixed at seven tlaysr lv?rich satlsfles both bioloSical and, Log:Lstica1 od.6encles; these apprications rnrst continue, in a given area, for as J.org as the capacity for reproduction of the residual bLackfly population poses a threat frora the epiderliolo:ieal vieirpoLnt (transrcisslon rate too trigh) or ln eutonologlce.L te:mrs (re-estaurislr.uent of local blactcp§ populatlons too rapid). lechnaqUes L5. Until 1971 the insecticide trsed was DDî, vir.ich is very effeetive but whose resiclual properties errd effects on the en.rirorulent nere not appropriate to the present ecologlcal req:r-trements. As a result of sttrd.ies trndertaken slnce 196?; investlgators have been able to seLect several compor.mds beJ-onging to the organophosphorus group, one of viriehl tem.ephos (.o.uate @, ot,.s 7æ), comblnes in a speclfic formuLation the esseutial propertles of high effectlveness agalnst S..-qry larvae of all stages, and, beeause of its reLatively specific action, its lov persistenee ancL the very snall doses ap.-)lied, Ior., toxj.city for the environment. 16. It is tirts insectj.clde whicir has been used since the sta,rt of the opera,tions by the Programne, ht investi,3ations are continuing rritrr a vlelz to deveLoping neç, compound.s in «iifferent fo:rouletions. L7. l'Iost of the cerrpai.lns prior to the Programe which were based on the pr:i-nci-o1e of l=.nraI coartrol by cheuical neans, had usecl treatnent teclmiqttes suited to the 6rnaL1 geograroiÉceJ- areas covered. Ilo,vreverr the treahent appliances, botir statle (at-" r,'lth hoLes to release the inseeticide over a given pertod) or mobil-e (floatin8 craft of variotrs si.zes) verîr soon oroved. r.msuitable for the treatment of large a.rea.s beeau'-:e of the j-mpossibilit;r 61 utilizing ttren in aII situatlons. Chapter III ?a6e 5 18. Access to the rivers in all sea.sons i-s rzhe.t constihrtes the rcajor, often lnsolub1e, problen that the treatnent teams haye to face rzhen working on the groturd, especlally d.uring the rainy season vririch ls generalll,r the period of hiSh transmlssion in nost onchocerciasis-lnfested valle;rs. îhe treatnent round.s are therefore d.one incompletely, not alvagts at regu]-a: intenraLs and a.t the cost of unrenltting efforts. I,ioreorer, for these less than iêeal resuf-ts the resotrrces that have to be deployed are considerable. To talce one e::acple, the trea.tnent of the Conoë-Iéraba River in the Banfora region (gl ooo lm2) requireô frcm 1969 to 1972 the presence, five days a rveek, of four strong grotued teans, each consisting of one quallfietl technicianl t.vo labourers and. one dr{ver, r','i1;h eross-cou:ctry veirj.cles and eo^rrlpment for lanrlciding (boat, out-boa.rd. motor, etc.). 19. [hese teaus tzere able to reach a^L]. the treatrrent points only ln the d.ry season, tlesplte the constant roainterrance of 3OO kor of tra.cks speciaLly built for the purpose. 20. [he restrlts shoved the effects of these constraints and the level of trans- ntsslon in the large§ inaccessible southern part of this zone remalned too htgh for the maintenanee or retun: of hr.rman poptrla.tioas. 21. In ,riew of the strateg:ic exigencies, largeLy detenmi.ned by the blolory of the vector and necessitating the treat:nent of extensi-ve areas, these land- based methocl.s could no longer be considered, so ia 1967 spr4ving fron the air vas startetl on a trial basis. trater, J-n turn, the type of aeroplane used for agriculüral spra;ring, then the helicopter, flrst sraall and then mcdium-sized, were tried out. 22. The aero;:lane pro'red ve4r efficient for nediLrm-sized ancl 1a.r5e lvatereourses, lvhere 8allezXr forest ve.Setation does no'c hanper narrigation and treatnent. It proved less so for the maLler rivers obscured by i'orest canopÿ, rvhere it is replaced rrith great ad.vanta6e by the hellcopter, whose manoeuvrability ls practically unlirrited. Chaoter IIf Pas-6 3) ;onr( prLAi,I roî, tl.n Fr3sr'6 Tf-qps .rirD ri,pI;lmirltroi,I Vector Control ooerations 23, After analysis of the various principles, methods ancl. tecbniques, and in the li8ht of experlence r'rith prior caryrai6rrs, the OnchocereLasis Control Progra",rme rvas planned, and then put i.:ato operatlon according to the folloring crtteria : control measures directed agalnst the La:rae of the vector, whtch are its most concentrated. and most susceptible developnrent stages; utiLizatlon of insecticLde irith üttle resldual action, effectlve at low concentrations and producing ltttle pollution trnder the cotrditions of application; treatnent frcm the alr, the on1Ï ns16od at present applicable lvhlch ha,s proved, for practica-lly LOCiS effectiveness, the least coetly. Aerial onerations-l 24. .An Inrritation to Bid for a contract to ea:rXr otrt aerial operations was dravrn up beüneen 10 ar14 12 July L974, glnine details of the requlreunents. [his included specificatlons for the d.evelopment of equiprnent for the relea,se of accurately measured. quantities of insectlcLdes for both helieopter and fixed wing machines. îhe tytrle of rnachine considered, srÉta.bIe for the work requested as well as the flying hours requtretl were also specifled. It wa.s enü.cipated that lt wou1d be possible to treat the Large rlvers by fixed rring ulreraft and that the smalLer rivers wotùd requlre helicopters. fhe contract was arvarded, on ,1 July 1974 to Evergreen lIeLi-eopters Inc. frorir l,ictIinnville, IISA, rvho operated BelI 206 helicoptcrs and a ?ilattrs ?orter aircraft. tAdditional information regarding tire aerial contract is provlded in Annex fI unaDter ILI Fage-7 25. Ilork comenced in 19?5 ln Phase I onlyl operatlng from one base in Bobo-DlouLasso, srd d.uring that serÀon the follovring horrs of fixed. wing anal helicopter were f1oçrn to dlspense 751630 rltres of Abate : Pbase T L9?5 Ï,arrrictiling Prospection Ad.uiulstration fotal ïIrs Hell.eopter Fl..ced rring Helicopter Flxed wing 1r911 366 782 80 89 94 21782 540 Abate 47 1369 28r26L rotal yf22 26. rn 19761 treatnent continued ln phase r and 1n Jaruary 19?z phas";-;;-, czith the treatrnent of the lor.ier tlhlte VoLta by hellcopter. This rnaclrlne flevr acrosa frm the Bobo-ûtoula.sso base each luesttay and rzhen the ralns starüeci in lfqy, all the other r:Lvers whicir started flLovz-ing in Phase II urere treated, by the sane hellcopter, asslsted by the flxed wing on the lïhite rloLta once tlre florv of r,ater was strffieient for filced ving treatment. 27' At the end' of 1976, rzith the treatment of Phases I and II, the fo1lovlng hours hatl been flovzn: ?hases I & II t976 Abatg 791862 50r085 L29 ê47 ,ro11 4eB 11192 95 L55 41 41358 624 Total 2B' hrring these lnltlal 2 yeazs of operation, a system evolved srhtcS ls fleldble enough to tleaL lrith the constant adjustments that have to be nade. trarricidirte Prospeetion Adnlnlstration [otaL EIÊ Chapter III+ Page I 29' At the end of ]r976t the init:Lal aerial contract rulth LrVergreen Helicopters Inc. came to an end. Icteneatioiral bLdding for the next contract took place on 22 Jrrne 1975. [he contract was arzarded to Vl]d.ng llelicqrters 116., an Ottavra ba'sed fi:m, on 6 Arrgust 19?6. llhe ctrange of contractor prunlde6 an id,eal opporümity to tmprorre equtpment and techrlques, based on the lorowledge acquired in the first 2 years of operatlon. ïTith the hericopter equlpment, the prerrious contractor hatt ttevel-oped a gravlly-fed system and although very effective ln the wet season, problens had been extr»eri.enced in distr.i.butlng lnsecttcide at dlfficutt breeding sltes ln the d'rxr season. corsequentry, the lncoulng contractor rvas ast<ed to develoB a r!(luailr system vrhereby, by operating a srritch in the aj.rcraft, the pilot could' elect for tbe lnsecticide to be enltted either by the grarrlty-fed system or through a pressure-fed single nozzle. This nerzs developed rrrestrictorrt systen has proved higlüy successftrll particularly in the dry sea,son. 3o' I"'bdlfieations were a-1so rnad,e to the fixed vrring equlpment. the prerrious contractor used an r-mdersh.urg cyltnder lnto vririch the requi.red quantity of insecticide rvas fed and ercltted by the actloa of a floating plston. iÿLth the newly deveLoped equipnent, at1 parts are lnternal ryitttia the atr^craft and the on\r extema-l part is the erd.ssion tube. îhe s,uotem ls activated by alr pressure eurd has proved, acqurate and reliabJ.e. 1L' rn the first year of operatlon vith the aew aerial contractor, the whore designated Programe area was under treatraent for the ftrst tlme and at the end or' 1977 the follorzing hotrs had. been flonn: Phases Ï, II & IIT L977 Helicopter Fixetl wing tranricidina 41424 854 Prospection - 6ü 57 5 r35O 1'025 îotaL Abate 84rrL8 7Lr2g7 L55 r6L5 nistratlon îota-l IIrs 249 ï14 Chapter fII Page -9 i2. fhe treatrnent flytng was done vrlth six hellcopters ln sprayiag confi8uration and' tno fixed vring alrcraft operatlng from îarna,Ie and Bobo- Dioulasso- Flfty-four pereent of lnsectLcide released was by helicopter and 46 percent by the two fixed w'ing atrcraft. [he average release of inseetlci.d.e per hour (eo r per ho,r) is fot* tirnes that of a heHcqrter (eo I per rro'). Alsol the fixed w'ing can be operated for approrinately ÿ2 the cost of a helleopter. 35. Clearly, as river levels alter, the breeding sltes of S. damrosrrrn change and alr^craft circults have to be nottifletl accordingly. It is unlike3.y that a r{'ver treated rlth a particuJ-ar quantity of lnsecticide one week rri].l requlre the same dosage the folJ-ourtng rveek, and as rivers start to flow, or drÿ up, they are constantl}' belng add.ed to or talcer:. avray frora a elrcu].t. Eence, it is necessersr to produce nev treatnent roeps eaeh weerc and this is d.oee evezy ihnday in the aerial operati-ons seetion of the Vector CmtroL Unit at the trzo bases of Bobo- DiouLasso and îamaLe. Follo'ring this, the pilots are brlefed. on the circtrit to be fronn that partlcuLar lreek and aircrraft then leave these tro bases earry on îuesday norning to f1y the pLaruaed. clrcults. îhe pilots carrIr rvith then the 1 : !0or0Oo treatment naps whleh indlcate the rT.vers to be treated and the d,osages required and 1 : 200r0oo maps rzhich shovr the release points of the breeding sltes to treat. Clrcu5.ts norually take three to four aqys (ntgs. ). 34' There are elght nqior flrel dlstrj-bution points ln the programre area frm tuhere the su-hsicliary caches are supplled. At slx of these polnts brrlk fueL is available from airport punps but at the other tvo, fueL ha.s to be brought i.n from elservhere. Ihere a=.e 8O strbsidla.4' caches of fuel anrl lnsectlcide in the Programre area (Fts. ). Both fueL and lnsecticicle have to be made avallable in dn:rns. i'falnteneurce of ad'equate stocks at these caches and the lceeping of a.ccurate records are large-scaJ-e log.istical e)cencices. .! F F E \ ! II a 0 N *r o !I o o I*j' ., !) t m o: 2 »  ._!_ â o Ct o ^('-r' è./ i-t l.-r)^ ^)i= f--. I 11. , t o. m t. ia ai \a » { m ,aa.aaatt' /"""' a.a aaaaaa I ao ! '1 -{T m { =mz aEoCf 1J' a a a a i s'(.- \ \ o 3 rl ? rË È t a \ \ !I a E a F. a a a a :!9. f. a o a \ \ \ \ ; , aa \ 1 c -J -.-.-.-.-.-.-.-'/ I , I a!; :.. o I i a a I pr a\j I I F Ei' t » ( t ltt p z o m ( I I! ir , i. t â.-.a.-.-.a. o \ I* {>N -o- E3-- mni o!aD -=<5€d ,E!urz< >ffi; ,tr,tîm_D _! chu u, t-rOc-z>:Ml.À eiE 3âgûc#u{! ÉH= ="#z<Éqmz -rJ v, m U'oz cD2àam- ah o! ai I 3 .) \. \ E I I : î r'1. \ * l.\. t? l[' a .1.^. t.gè.t I \; ü' Da.-.., it o' a { m t. \ l I 1. a ô I D !1 : P IoE 'Tt{ a m { =mz{ e aoC{(n t c ..... /o.........^ / -tt.. t;.- -.4 I C a a \ \ \ \ \ \ ,it- - lE-rmt: E a. I 0 G) \ \ \ -1 I ! IÀ .l /I 1 c\ a a o a3. i \l? I 0 N !I o o a a a a a -_a ! I -.ii \ ir- ! ----!-__ , rl -- ---lj I !a ./' ''u\'u., I to o 0!lli p ! o I( » I I Li\Èo\ô§6o -1 I I ! z o m 0 § o o o N 'l ! !I 0 E t\ L 1- r » I J § z r- >èD@n BT> att aTl \ = 9ÈÉ ÉH;d=-9 l-mCrl;iooZ-2mü- esF -l_ô;lkg :si zt-nô{m -r> =fiin!zn{ n U'o 7 :DÎq, =iemm>Eo<@ ittx=j Hâ6 86=z-t2mcôifr; I-FPzi =o=l.llmi<= .{-oaa mm=D>2, 9E âqrtnm>z8 1" u m r* cDzàamT üt{o! !r 6 E I I '-.-.^f '-f 'i. I I I I I I I I I I I I I I 3 d 6 ! I I I I I I I I I I I I I ^f'*f' o I ^r i .j(. .)(.-.n' { o (.{è.t ,i- ''t .i'-/" ü' o \ !t o I :'o o oo o o a o t a m t. a @oC m^ * a Iil. \ -'\.-.j-' \ l t ,._r, ,!o\;6o I p o ./'\ ..t ttrd t ttt t t' '.. a. .aa t .ÿ._.\./) r\./ ,. o * ataaaaaaa aa a o ttaaaaaaa \ T 1r .iO a m 'nC mt- trzo EIz{a z{ :E m !aooT = =m u m \ \ \ \ \ \ D c a a a a a a a Iu m a !!,, \ E ,È ê a m a a a I I ! I t rF ;oa a o a a O a a a a o a :!t.â.5. a a a a i o a o E ) o 3. rid a a .OIl î/ E o aE. a a a a a a i i a a a a a o I n E \j I ''o -{ o o o I(tj o o t Itlt p D a o\ o Cr =3 m ! o oI I3hPr-o o, 99Ëz1î, d a a a * I 3 I 3 m * » @ = xo . !1 Ê @o @o II oc 6) 0oCooC ! a x oC z o m â.-.=.1.-.a. o o 2 o É. é \. \. \ 3 Ia t in'l E Cha.oter ifIGffi'- Entomolo.iieal Sunrei llance 35. lhe orig:lnal- plan for entgnologicaL evaluation (f-+c lllssion Reportl Annex V-3) entrisaged a netvork of 7 sectors and 24 sub-seetors from eaeh of whlclt rzoultl operate approxi-nately 2 f,snrns of vector collectors. AdditionaL teems were to be attachetl to each of tite Sectors to g.ive a totaL of 5g teannso Each tearn vas ex!,ected to consist of 3 vector coLlectors, a driver and velÉc1e; l4L reguli,r catchlnE points çrere to be visltecl at fortnigirtly inte:sra1s. At each rlsit tno consecutlve dqrs (lt irours) catcirtng lzould be undertaken. In addition shorter catches çrould be r:rade at other lsss inportant sltes and larral sea.rches nade at l-aotrn and suspected breeùing praces. 36. îi:is basic plan has been rood.ified i.n several respeets: a) the vector collectin5 tearn has been reduced fron j to 2 collectors. b) the collections at regular catching points lr.rve been made at veeii-y i.:rstead of fo::tnt$hfl-;, intersrals. c) the ntrmber of catching points has been coesld.erably lncreased, and aLmost a'r'r catches are for the 11 hour period. 3'1. îhese alteratlons to the orig:inal plan lvere consld.ered to be necessarîr to provitle satisfactor.'operationaL lnformati-on. As the control operation ts based on a wee1"17 cyclel §drologlcat data collected, by the gurveillanee tearns m.rst be transmLtted by radio from the sub-aectors each weelc. Most of the hydroLogieal stations are imFortant eatching points uhi.ch nust be vislted vreelcly regard.less of tnrhetlier a catch is mad.e. Slmilarlyl each team m.rst reürrn to base eaeh rveek ln orrler to pass on its v:i-taI hyd.rolog:ical lnforratl-on. Iltrs the utlllty of operatin.l; the sunreilLence nehvorlc on a r.ree-Jy c;'cle is otnrlous. In addition the entonologlca-l tlata concerninp; both lanra] searehes antl aclult collectlous is lnvalu.al:Ie Ln planning the aeria.L control operations. A fortnightls deLa.'r in acting on thls infoma.tlon ls too great rzhea dealln;, vrith a vector whose irmature stages are ccnnoleted in less than that time. Chapter III ?age 11 38. In attdition to this operational role the entoroolog:ical enaluation, at tiris stage, is clesiSgeed to provlde (f ) " neasure of ilre effectlveness of the Programe ln the period before reliable epitted.ologtcal ehanges ean be demonstrated; (ii) statlstically varltt data to compare bitry'g and transüLtssion rates with the hunan parasltologtcal and ophthalmoJ.oglcal findings; eurd (rii) data for use in researeh into the relnvasion phenmenono 39. In ozder to fu-LfiLL these :reo-uirements flfty vector collecting tearns vere enployetl during 1975 and 86 tluring 19?6 and L977, falling to Zg ln 19?8. In adtl.ition another 2O teens were errployed on a têq\orary basj.s for an intenslve pro8ralme tleslgpecl to stnd;r reinvasj-on problems 1n 19?7 and I9Zg. 40. In settlng up the entonologieal evaluation netvrorkl 525 catching points bave been stutl'ied ln va:ying tlegrees of ttetalL and the eatchinB resultE stored in the HQ computer. îhese are dlstributed as follows: Ptrese I 227 Phase II IOe Phase IrI iY 70 Phase fII E 120 41. Increasing haowledge has lntlicated that more intenslve catcir:ing at fewer sites i-s 11ke1;' to ;rleld the nost valuable results, especially when relnvaslon probLems are being shrdled. 42. [hrs, durtng 1977, an average of 2?o (range 2ll3-3oz) catcling points was rlsited each nontlr and over L 4oo days eatchlng rrnttertaken per month to glve an average of 5.3 days catching per slte per month. Chaoter IIï Page 12 t of Criterta 43' Interpretatlon of the entonorogical data presents a nu.mber of probLerns. cLear1yl ln the complete absence of the vector no further transd.ssion wi.lL tal<e place. Ilovrever, w-ith a vector such a,s S. damrosum whose srrrr:ival as a bio1oSlca1 entlty ls dependent on lts status as a d.gratory anlmal, tirls slhratlon is unl:lkely to be acirleved o:: natntained for long periods over l.rid.e areas. It has tlnrs become necessar-i' to dete:mj.ne the leve1 of btting flLy populations and potentiaL transutsslon of o. volrnalus which Ls considered acceptabre from the nedical and econontc vier.rooints. In ond.er to nake a judgeraent concerning the success or othenvise of the Prorrarme and to prornlde criteria for assessing the advlsability of settling poptrlattons ln zones of severe onchocerciasls, OCp convened a scientific AdvisorJr Paner 'l'/orii-ng Group in June Lg77. îhe panel carefully considered the availairre entomologicar data eoncerning tire trensnission situation before veetor control acttrritles, together writh the heorvn resultant degrees of the disease. the Panel ilecid,ed that an AnnuaL îransnlsslon potentiaf (arp)l L îhis ls the annual total of the estimated indlrldual nontirly transmission potentials obtained fron the for.rnrla : mon N, 'ectiveof x o. of daTs norked caLeulations for the ÂflP in the Progra:r;re area are based solely on the numbers of infeetive larvae indlstj-ngulsira.ble from 0. volvulus ln the f}[es head,s. iThere Sim.rlium blting densitles are lovr, as in the prq6r.a4ne area, Afprs ca-1eulatedj'n this way are liai:le to rritte fluctuations resulting fron the nr:mbers of infective lanrae in single flles. [. ". "{ ttt"" ""qO.tI,lo. of flles d,issected Chanter III ?age 13 of 100 was extremely unJ.ikely to resrrlt in any rrntowarri nedical or soeio-eeonorulc effects. ÀvalIabIe data also srggested. that an AIP of 8OO+ was llke§ to be accqlanled by severe onehocerclasis. In order to correr the sltrratioa vhere prevlous§ uninhabited areas are to be subJected, to hunan settLeroent, it was also necessarlr to detenuine wha.t Ie:reI of bitlng fly populati-ons ulght give rise to unacceptable leve1s of ASP. îhe PaneL concluded that an Ànnual Bltlng nate (-+ln)I of less tbân I O00 was nost urlllceIy to give r{.se to an AllP of over 1.OO and this could be consldered safer and that vdth an ABR of above I OO0, a t5perende,ric onchocercLasis situation rva.s like§ to deveLopl should a hrlnan populatlon containing some onchocerciasls carriers be settled. [he Panel clearly appreelated that wi.th Imorleclge wldch should become avatlable after the second or thirril passage of the Epideniologicar Erraruation tea.ns, it nlght be possible to safer;r increase the acceptable levels of 3,SPrs and y',3Rrs. 44. An analysis of tire restrLts during three years for the Shase I and II area shor.vs a steadily inrprorrlng situation. % of AIPts belou 100 % of ASnrs below 1 OOO Phase I Phase II L975 L976 L977 7O 85 92 6B EL B6 Phase I 61 72 79 Phase II 50 80 B5 t îhts is the annual totaL of the estinatçd individual nontirJ.y biting rates that have been obtained fron the fonnrLa: 1[o. of f1i es eaught x I[o. of d in month 1[o. of days lvorlred Chapter IiI Pa6e 14 +5. In 1975 r ?hase I was r:nder insecticid.al control wtrilst phase II r.ra.s not. llovrever, it seems most 1ikeL.;' that the control actirities in ?hase I influeneed, the results in Phase II, where at the fev catcirlng points, fron which several yearst data were avallable, the lovest ever AîPts and. ÂBRts were record.ed.. îhe superior results of Phase II in subsequent years arlses fron the fact ttrat this area is little subjected to reinvasion by epid,einlologice.11-.',- significant nr.mbers of flles fr"on outside the eontrol area, whereas about 4al of phase I is so reinvaded. 46. In rnarry eases results in the heart of the Progra:rne aree are excellent, For e:campLe at i7ayen (point O4O7) slted on the l7i:ite Vo1ta rlver just east of ouagatlougour no veetor fiie;: have been caught since the start of th.e control snrnpaign yet ln the Pre-control tfuoes the :lBR exceeded Brooo and the Aîp exeeedetl 20O. In most of t]:e tsIeclc, ÿhite anê Red VoLta and Slssili val-Ie;,s ln Upper Volta tra:lsnlssion of onchocercia.sis hss qlnsst certainl;, ceased since the start of the control campalgn. Further south, in the Elaclc ÿorta vatLe1,1 contro} has inprorred n€rrkedly each yearl êogo at Chache (point L}Cf) the situation for tire three jrears of controL is as follows : A3R ATP L9714 i4rooo N.A. t975 12rO15 825 L976 tr957 BO L977 657 L5 4'1. îhe 1977 d'ata concenaing A3Rts antt AfPts at 15? rvelL studied points have been analysed. and pLotted on Ftg. . Similarly n.t] useable ?re_controL data have been plotted on Figs. . îhe ABR data has been plotted for 114 points ancl Aî? cla.ta for 96 points. -.^f'*'t o o r: è a a t. .{ê.t \i'- b' t .\ i a' a o. a .-/'1. \m t. \ I 0 / ,r. oaaaaælo o aS. a a zzC {a z U' =U,I oz !o{ mz{ t-o I ! , m ôoz{Iot- \ \ \ !I m I .oooo / o cot coa .a. a a.ao t '€,-.-.rl tttt.... Q..... D c o a at a a o , i §'(.-.\. \ \ \. \ \ a o a a a ! ,ll a a a a a  » a a a : , 1 c\ t! â,ll o 2 o a a a o a O a a !I G q \ \II a o a a a a O a a; ? I i,/1 :'I I I n Ei' \j '! z o m ˧HÊ? +tttE{(.rd(o(o(É'(C, (o G' i. \ a. aa .i e: § l/ - !-- ! I a a a a I( a a !rI i i a a o » ooeoo ! T C, @ i. \ I ( ^.-.-.-.-.-.\. \ -Èo\6 6§ ! é t I I I rt It FI !I o EI ^f'-f'r'r I , ),- ./'^.ir .t. i)!'{ ! '' ;r i^))(-.n./' o ''u!.-.r't a D .î o. a a a â a m a t. \ ) o \i / t.. ':.+./'. t - !T ao1616lo aoaaa I zzC @{ z 6) I { m cn I !a m ooz{a ot- t \ \ \ .o oo o/. o ooo oo. .aa at t » c 'ÿ.-'4.4 I ( \ \. \ \ \ a ! a a a a a a a o a aI )^ a , ,i !.iamo o a a a a a o a a :!î.Âa5. o a a a .e I n E \ \aI a a a a i i a. ! I I iÀ a' I aa af è\ at a:. ! I .i i \ ao tt §rI a a a a a a a a a a I n E lj \ â' t{ \ z ( I t ta ! ooeoo c @ § o ! 6 66 ËÈËBr +rrtE{(^)r «) (r, (c)(o (o (ô(o (o ((, î. t ,ll p o- !I n EI o D 2 I a ! \ I ^f'-f'r'' I -tè.t'i t. ,. :! a a \ io. m \.-.i-'l' .i -.a'l'\r. t{ ! J \?a É è T!a n ,,.' ....r/............. t a oa oaaaaaaaa a zzC {T z U' =aU, ôz !o{ mz{ r v, I (o a a at ;.-'\.4 Iq(.-.\aa a , c E t at a a a a a a I ! ,ll I \ a o a a a a a a a a a \. lll lr I ! I I I Irli.t \. \ \ a a!. a @5?\)rcloooo.ooool +rttE{G)r «) (o (cr(o«)(o I 2 I ç a:o ll. T » û E \ \ \IIrâ !I fr E \ \ \ a a o a a ti Il o I ÿ ! ! I i I\ o a o a a a a a a a a a I i Ii , F- a tI e '''u!.-.r'l I({ j » ooeoo ! llt ! o t§ o\6 6 ,l a C, c @ T' \ I i,. i \ ! z c, !I n E ^.-.a.1.-.-. ê a E ts I ê!i B Iè.,1 î-i .J r) {t n' i-' (-.o .\ \e a o' \.-.j\'/' l? a! i 6 I t a 0 l.^ r1./ /.. '\-.-./'. l.\ IP / a.oooo /o oooo.a.a. aa a t Ê è I (a 2 , !I ! a a t t D zzC t- @ _=zo I { m U, I @\ \ \ \ a a a a a a a a \ o a a a o a a a o o :tt. 5. a a a a oa a aaaaaaaa \ ! m ;.-'4.4 I sc.-.\ c E o o a a a a a Ia , ) \. .m a ,i p ; rË ? I rÈ § o \ÿ !I a E ! ,. 3 i E \ \ \ à. a2I tàl 'o I aa8. to D ooe oo I i i I \i t pr I I n E o '''u'.u.r''l I( ! o § E o ! 6\6 @§l§rooooo;8888à +tttE{(rrG) ((r (o(o(oG)(E, (o (o2 T o a t,a t i i. \ i u m p . !1 F E ! 2 o â.-.a.-.-.-. -.^f'-t ''' ... t: I I I u : t atI Cha.oter IiI ?a6e 15 44. Control in ?hase iII rTest vas lmpJ.enented onI)' in i:Iarcir 1977 srd for parts of Phase III East only in Âugrst lgi? (not at a-II in the eastemnost valle;r - the Sota VaLIe;'). Anal;'sis of the Pre-controL and 197? AII?ts shorrs the fo11-oring breakdoln: L97Z I[o. of ooirts Pre-control |â of Lolnts I[o. of points 7,1 of pointsATP o-99 L00-199 2oo-399 4oo-799 800+ 91 20 r.9 16 L1 5B L3 L2 10 7 12 6 19 L2 47 L7 6 20 L2 49 t57 100 49. îhe pattern of results rzhen A3ilts are consldered. is ve4'siuilar witl: a few more points registering resu-Lts r:ri:j.ch clo not fa].L below the erlticaL Level (r ooo1" îhe reinvasion ohgngpeno} 50. Shortl.v after the comenccment of eontrol in the Phase I area, f].y populations dro-oped sharply and in most ca.ses beceme zero rrithin 3 or { neel-;s. However, lvith the onset of the raj.n;r season large nurabers of fLies reappeared at certain sltes tn the soutlpwest of the Progra.r:rne area. DetaiLett investlgations shorred. (") tf,.t there vas no actlve breed.lng in the areai (u) that vlrtqalJ-y a1L the fLies were parou.§, (r'rere Ln fact severaL ilays old and had already talcen at least one bLood meel before theT vrere ca.u.3ht by the vector eollector); (c) tffes in marly eases were car:iring infectlve st4es of tire parasite Oechocerca volvultrs. Ihe flies pmvecl to be a reinvading populs.tion moving ln the sane direction as the prevailing monsoon ninds. Each year a slullar reinvasion has oeeurred. ln the sale areas wirlch are indicated, on r'ig. . îhese 96r00 AREAS OF REINVASION, CATCHING STATIONS AND EXPERIMENTALLY TREATED RIVERS. BAMAKO \. \. Phase I I Pont Faya Phase I N u Phaselll(W) Kouoro Radier ,Yanfolila SIKASSOI Pankouroü BOBO_DIOULASSO , NaLanviera D na Fourkoura BANFORA Routier Nan zo Ngapie I .t ,l KORHOGO T Badikaha ! Gite 7 aka Chaché It Boo Iù t ch. Ni t .rrr)\; \ tI I Bu Mar ! t SEGUELA f aouere ! MAN L. Kossou o Every dayCatching sites Areas of serious reinvasion l) r976 --- 1977 E Areas of minor reinvasion Tiassale Experimentallnsecticide Treatments I nternational boundaries Programme boundary ABIDJAN wHo 78100 tr 140 ræ r00 80 60 40 20 MEAN OAILY CATCHES OF S. DAMNOSUM AT STRATEGIC REINVADED SITES AMJJASO AMJJASO AMJJASO AMJJASO AMJJASO (o! rù a .g u-- u0 1æ r00 80 60 10 20 140 120 ræ EO 60 10 20 o oIt Pont Léraba r975 r976 197? Ch. Badikaha Treatments of Marahoue and Sassandra ?+-§t Lower Bandama Treatment Ch. Niaka NI 2s6 No Record Gite 3 314 232 r70 Marabadiassa Ef @ NI Months o iJ P\o -.t ur t.\! -l P\o -l -l ,lr f\) Norrrral CaLcl rcs+ :a() r- |F{ ;i r-l H UI C üI'll)rlI, n t{ . -t .-t ril ti T ,t],(rHI U) :1UH UJ n n ++ + I \:t+ ottJÊ,cr P. ô1.:r< (D a Irrsidc @P Âr'ea + I I vt L,'trval s[)ce 1c{;l)c.. t.c rm I na L I on+ + + .+ IJ I Qr Irem.rlc speclcs l)e te rm I n.r L t or r+ + + I -t Cl reck otl p(r:i:; I Itl I i L.Y ol local Lrmsrnisslotl (-( i:ii Lc survcy lnsldc l,r'eal,e«l .rnea+ ++ + + + \o I;rr rvcy orr Ls [dc LrcaLcd ;t l'e:l + I o I)lr.'u;e III l,lestTleltl,nrer r L Ljassrtndrn up- :; Lrc;tm Itrurrllrm;r tlovrt t - l; l,t'r.tlnr I t-t.l Tr.eal,mcn0 ol' ltotcrrti;tI :i()ltrc(r:i ( u t,s i(l(-. ît'ea l, r,) Âit'<'l'a('L t,t';rppi tlq tu:«l ntel.''o- r.o l<.'!:ic..1l :;l.u,i Ir-:.; (tUrtnc.y )+ + + + l, \.tl [,'l rr«rroL;cclr L X - r'ay' SI)ec Lro- î(:ol'r/ (lk.nrrct,L) + I t , liueLIoir Lraps (.Jolrnson) + + + UI l'latr.. Lr;rJx; (ltct te,:) + + + a,(-'r Syttol'11s troal,tl(]r sttt<l [<':; + + + P -.t [.,ocaI mcLeor'()loglcal (lÂta [.craba t a l, Cltaoter III Page 16 are e[rreas rvhere there ls an epid,erniologically signlficant inflrrx of infective fILes. Flles probably penetrate to all parts of the Progranrne area hrt generalLy ln nr:.nbers virich are epitleratologlcally instgnificant. The restrlts of the reinvaslon stud;r are shorrn in Ânnex . 51. Sourees of reinvactl.ng flles are probably located to the south.+rest of the reinvad'ed zones. Experlmental coatrol tn the llarahoue and Sassandra valleys 1n JnneJuly 1977 seemed to greatly curtail the reinvasion of the üpper Banda,ma and treraba rivers. It ls extrrected that this finding wiLl be confirre4 by the control operations being carried otrt in rvory coast during r9?8. 52. Reinvasion has proved. to be soIely by savanna cyüospecles of the fly. Extension aetirrity in Ivory Coast to cover all savanna regions should. resuLt in an improved sltuatlon in the Bandetna va].Iey, as already nentloned., and in the Bu1 region of the Black ÿolta. 53. A comparison of the rej.nvasion rnap (nte. ) *itn the ÿnap of Aîprs ln L9?? (nrg. ) sirows that raost of the catching points registering r.rnsatis- factory A[Pts fal]. w-lthin the reinva"sion zotlêo 54. lhe achral zore affected by reinvasion is less t:parL 3q, of the totaL or{-ginal Progrsmme arca, (see Fig. ) *A with alterations to the southern extension of the Progrcurrne area tn lvori, Coast this ls Likes to be considerably reduced. Epld.enl olo.,Cc a.L EValuati.on ALtn and method.s 55. The outline in the PAG report for the eplderntologtcal r,rork to be done by the OCP was as folLons: (") Sunreillance of O.51fr of the population of the reglon of the prograame, L.e. 331O0o persons dlstni.butett in the seven partlcipatlng cor.rntries of whi.ch the population concerned ls estinated at about LO nilLioe. \i. -G I U TI !t f'-.-I !. t a \ .\ t \\. i t U t. § § (n IIJÉ. Z o U' =[rJE af oo l o f o o J f 9 o E : @ )^ o .dlo è/, a tr o G E o o !o eo ! à!o -oo ê o oN ol) E f @ .9: tr ,9 -o c .9 G .Eo o 6.o .91 o -o .z3e o.-Po> OsNO I\1.;--'- s lil ffiN -^_.rr-ijl Chaoter III ?a{Ie-I? (U) Stratificatton aecorting f,6 qnfla-mleity leve1s of the localities or regions 1f these are lmcmnr'in sucir a way thet, 2/3 of the sample are sLtuated ln zones of meso- or tlytrrerentleniclty because rrthe prinarSr atm of the flrlsreys is to deteraLne the effects of the cortroL programe i.:e areas with high levels of ender,rj.eitytr. (") Idtia} selection, on the basis of d.ata previously colleeted, of a random sarîFLe eonposed of I[ clusters of JOO persons until the requirect nr.mber in eacir cormtrXr is obtained. (a) IongitudinaS- follor-up, during the inplenentation of the programe, at three-year interrrars, of each of the indlviduars fo:ming the evaluatlon clusters. (") Annual detailed exanlnation of ùLq6 of tire sarnplei corrplete ophthal-rao- Iogical examlnation, eomplementaqr 1aboratory tests. Sanple tlesigtr 56. It soon becane errictent that the focaL distri.bution of the ctisease wor.rld not a.Llow for a vaLua.ble rærd.om selection. 57. It was considerect that in entlenic sltuatlons rvhtch were far fron being homogeneous and. rvhere one eoulcl see a tlistlnct pattern of foci in relation to the profile of rvatereoursesr a careî.rI choice tvas necessa:ry. and in 1975 it was deeld.etl to uttLlze the forlo,ring criteria, agreed. upon by sîlc: (") îhe "rriLlagesrr nnrst be representative of all the ecoLogiealr trydro- logica.L and geographical zones of the basins and watercourses where breeêlng-places occur. îhe vi1la6es selected. mrst be representatlve of aLL thc lqrot'rn foci. As a result tirev are seattered ilroughout the 14,OOO lo of watereourses eovered by the prograrnme. Chapter III E;18- (U) [heÏ 5[6q1d be lnterd.ependent rrlth the entomoloryiccl eva-Iuation progralr.oee ioê. the;' s-horrld be serectecl crose to the pe:manent collecting points, partlcularly vrhea entonotogical considerationE so requlrel or else their dlstance should be taken into accounto (") trb1I attention shourtt be pald to sociologiear factors, longitudlnal stnclies being lnconpatlbre with a high drop-out rate and presupiosing social homogeneity and. an adequate revel of popula,tion stabllity. Aceozdlnglyl admlnistrative and. comenclal centres (vbich have too bJ.gh a proportlon of foreigners, tenporary resldents ætd non-resitlents), agrtculfural (lneluding proeessing) buslnesses and proJeets dependent ol rntgrant and. seasonal labour, and noinaclie eouumtnities vere aII excLuded. Oa ilre other handl Sroups resettLinS the onchocerciasts-freed areas urere included. (a) îhe different levels of prevalence need to be represented, in the sanilles. Bea^rlng ln aind the ?AG Mtsslonrs reeoîmendatlon that tlo-thlrrts of the vl1J-ages ln the sa.uple sho'utld have a prerral.ence o'j nore thar! 3rt, it rryas for:nd preferable to sele ct 75r,1 of the sarnpLe froa klytrrerender,ric vilLages (prevalence 6@) and the otlw 25ito froin vi114es vhere prevalence ts 1otr or sporad.ic. (e) As a result, of the total of jOo subjects reeonrmend.ed for the cJ-usters, it vas necessarrr scrmetimes to conbine severar $aart villages to fom one cJ.usterr sometimes to restrict the sunre;r in excesslveLl, large virrages of 1o0-L5oo lnhabltants to one or nore tllstricts, asatudn.3 tl're dlstricts were sufficiently ùistinguisSable, or to exclud.e sueh villages. Iloreover, jn some villages partictrlarl.l, (n) (r) (e) (i) Chaoter III ?qre 19 relevant to evaluetion, the nrrmerieal criterla had to be ch.anged. In the end the cluster size rlas betr-reen 2OO and. 5OO. The filjure jOO is not allays feasible, and aLso there are psycholo5f.cal difflculties i:r, getting the inhabitants of a v:ilIage to aceept a roethodology that does not cover all of them. Às far as poseible, the seLectton of ril1a6es should talce lnto aceo'-mt the econorclc ile\relopnent zonêso Randon serection was replaced by selection based on the aceeoted evaluatlon criter{.a. Comlnities from non-end€rl c reg'ions rvho come to settle ln the reclatned ar€as, such a.s the territory of the Yolta Valleys Development Àuthority (af,r) in Upper Vo1tal and who fo:m a eontrol population not foreseen in the PÀG I'Ilssion reoort, hatl to be included in the evaluation Drosraxrxe. Finallyr the need for contror data Led to the incrusion of control villages situated outsld.e the Progranme area. Current me thodoLosy 58. Slnce the begiruning of the cantrralgn, baseS-ine clata have been collected ln the seven cou:atries. Qr the basis of the criter:la nentioned abo,re, the follorring conc'lusions can be clranvn. Geographical d.ispersa-1: all r{.ver basins treated by t}re vector control unlt are represented in the sar4r1e. Relation rrith entomoJory: whenever possible the rillages close to a pe:manent Slm.rlfu-r:u catciring point lvere chosen in orrler to assess the degree of co:relation vrith the entomolog"ical restûts. In certaln ca,ses the lnvestlgations were cond.ucted upon the request of the entonolog.ists. îhe dlfferent leve1s of transnrissron (etr) are represented in the sariple. unaDter _111 ?age 20 Quantltative aspect : tlre basic sanple establisired in the ? eor.urtries totals 80ro00 peoplel orrt of a population of 11 d.llion inhabitants. îhls represents a sar,rple of O.75il of the populationl which is conslderably greater thatr the nurber origlnal-L;' envisagea (o.73;!). [iris d.ecision uas taken in consid.eration of: the need to retain a sufficiently Large sanple ln order to secure sl6rrlflesnt resrrlts in ti^.e 1ong:ihrdinal surve;,s oj villages over a period of 10 yeers or nore, ln viev of the high absentee rate of 2Ül at each exarrlnation. AJ.so, the larger sanple initially choserx nol contaj-ns a su.fficlent number of vi.llqes from vlÉch va1ld conclusiolls can be dral'.rn on the transruission resirltin; frcm infected flles irqported frorn outside the ocp area. The need to ensure adequa.te geograph-leal eoverase as reqrÉred by the entornological. controL. îhe need for mapping of foel and ehenotherapeutic trials. 59. For operatlonal rea.sonsr the epitlenlologlcal evaluation has been earried out at two different Levels, simple e,nd cletailed sn::rs5,s. [he sinpLe flu:\rey consists of a parasitolo,3"ical asb-essnent of prevalence and lntensity of oncho- cercia'sls by means of examining 2 slcln snips, plus a simple screening procedure for visual lmpai:ment and brindness. rn ilre detailed sunreJ, a careftü clinlcal and ophthalrnolo3lcal examlna'ulon ls also includ,ed. Because of the tine-consuning techniquee the detaiLed ocaninatlons have been carried^ out otl onl;,r approrinately t5% of ttre total sanple, allorving for certa-'rLn special studies eoncerning ocular lesions to be trnclerta-lien. i,Iimants: - 60' In the A1ru where there is a population of non-i.nfected tnnnigrentsl 51600 individuaLs have been regi.stered for a special sttrdy ai:red at checlci.ng the persistence of any residual transulssion. Chanter III Pat e-z].- ?eriocliett:r of exaglinattons: In general, ttre nrle of atl inte:rral of three Jrears between each visit ryas also fetained. for the detatled evaLuation sa$Fle. 61' As of t'hrch ro, 19?8, the total popula.tion exarntned by the Epitlenlological [Inlt vras as follorvs: Prellnin ar-rr unedi.cal results of entqaological on eratlons 62' îhe flrst check of the results of operations in phase I began in 19T8. slxteen llpper volta v:illages t?ere reexami ned. and the reliability of surwey and, diagnostic methods confirmed: the dlsease vas forxrd again in nore than 99i6 of the people vrhere lt had been obsenred three years earlierl the fen negatlve cases ean be aceoturted for either by an error of identificatlon or b,, nishandlinE, or by carrT'ers rrith a veq/ Lorz pa.rasitic loatt that randomlzes t]re demonstration of ni-crofil:rriae (tle diegnostic error risic is lo.er tiran 17ô. 63' Elght tlyperendenic viIla.ges vere reexa.nrined along the Bougouriba an«i Bla.clc llolta Rivers, ln an area vrhere vector controL lvas not conpletely suceessful in 1975 (AîF - 18' i-n 19?5 in Î,iabere vilLage) bqt srhere as earlly a.s 1976 A[prs r:rere belol the tirreshold of 1O0 larnae/aary'yeat. einple evaluation d,etatled evaLuation îotal of l.rbichophthalnoo êxâlls l,Ia'I1 llpper ÿoLta Ivory Coast lüiger Togo Ghana 3énin 11r891 26)r53 7,4L2 1r406 7 trgz LLr3O5 61056 Lt759 ,r3oo 2r8L2 799 1r8OI lrgr5 t1445 L3t25O 29,651 to1224 2)2q 9tL97 L3r2LB ? r5o]- 1r061 5too4 21235 624 L1262 tr53t 675 lotal 71rBL3 L7r43L 85 1244 ].org32 Chapter IiI l'}qe 22 64. In the 0-4 Tears age grmloe tire preval-ence of onehocercirsis has deereased. from 5,3,1 to 116% vrlthi:n tluee J,"ur" and. araong the 140 ciÉlclren born since ilre beg:Lnning of operationsl only tno were for.:ntl lnfectea (tney were born ln early 1975). A slight decrease even tends to appear in the 5-9 years ege group. ALthough the na6rritude of these chan8es 1s too sna"It to have any slgnlflcant iraplications at the Level of all the vil1a6es they confina tire general trend tot'rards a 2 ot 3 polnt d.ecrease in the overalL prevalence of orchocerci.asis ln ttÉs sa.uple. fhe averqe nlcrofila^m.aI density remains stairle anong t]re infeetetl people. 65. Seven other villages vere visi-ted again in late I9?? in tire Upoer CoqoË basin tYhere the control 1s reoorted to be excellent since Jalruary t975, that is for alnost three years. lIo positi.ve cases were forrnd. a;.ro:rg eirildren bora during that periorl. 0f the 277 ciÉldren exanlned in the rmd.er five a.3e group, none ha.d. oncirocerciasis lvhereas 3 out of 267 (f,li) rzere infected before the ca,:rpaign began. In the meantioe, tire prevalence has dropped fron 9;l to 6jl in ttre 5-9 ÿears a5e group. 66. trtlnaIIy, ln Da,ngouadougou, a vilLa.:e loeated on the route of the retnvasion phenomenonl tlre AîP is stj-Ll higher tiran ]rOOO. îhe disease in the villqge is becointng rrore severe3 the overall prevaLence is tncreasj.ug sLi.3irt1;7, but ilre indltridual mlcrofiLa.riaL Loads are grorring on an avera.ge of one-tïrird (32 ,nt. instead of 2O), tt:to clti-lrlren under four were found infected antt the prevalence has increased îron Jrjil to |il in tïris a6e group. 67. Ihese netllcal results cLear§ confirm the valldity of the findings of the entonological eva.Lua.tj-on. Eire tenclenc-' to a setback of tite dj_sease is still nore siSnificant lf one coirsld.ers that the transnisslon has been redueed to a lover Ievel. The AIP values establisired. in 19?6 allor:r an optirui-stlc vien of üre otreraLl Cha.rter III ?age 23 epid'ernlo}og:ical results tziricir vzil-I L:e obsenred after a ) or 6 ;rear perrod of control. îhe ageing of adtrlt wonis vrill the.n leatl to a sigulficant d.eerea.se of the parasitic loatt to vhich urill be ad,dett the effects of the renewaL of generations elnong the population. 68. In tems of ophtha.loolog'r four villages have been reexanined after a tirree year period. Prslim{narlr resuLts tlo not shov any significant difference as regards the prevalence of ocular onchocerciasis or the nunber of severe case6, imt, generally speakrn3, overalL rates have clinlnlshetl sLight§. Ilolrever, in tirree of these vi11a3es rvhere entomologicaL results are satisfactor,,r, there is a tendency to a decrease of ocular nicrofiLarial loads in data for 19?8, as compared to 1975 d.ata. ÂIso, the nu.-rber of patlents rzlth a.ggravated ocular trnpairtent is remarkabS.y 1ow. îhls ralgirt explain rztly the blindness rate has d'ecreased îrom L2fiil to Brà! in one llvperenderdc village: the nr,unber of new cases of blindness l?a,s lotz anri the blinct of the vlllage had, beee su-bjected to hlgh nortality. 69. .4.1L these results, and especially the assunption that the lnternrption of the transnlssion of onehoeerciasls raight have alreatly had a favourable stabilizing lnpact on the ocuLa.r lesions, hare to be checlced on a stattstlcaL§ rellable salaple. [irts will be done in 19?9. A strrdy of the rislc factors of blindness anong onchocerciasis patients ln a protected area w'iLL be urdertal,.en. Such a study vrlII be most valuable for the fr.rture assessment of the nr:mber of bLind people in the OCp area. 70. As to the ftrture, the obserrations collected by the enidenlolo.g:leaL evc.luation and vhlcil eoneern about ê0rO0O ireople have been stored as baseline d.ata. îhese restrlts are srma.rized 1n Annex . 71. For the evaluatj-on of the veetor controL operations in the CC? areal onJ.y a. fraction of tire sanple will be usedo Chapter III ?a€ê-û A sample of ebout 11000 - 11500 individuals rri1l be put r.mder annual sunreillance. slruilarry.in the AW territory ia Ilpper ÿorta the entLre uninfectecl d.gr"ant population rriIl be exa,nined. *rrsattÿr ress than half of the tqytrrerr. and meso-endenie clusters virl be examined. after 5 years ln order to deqonstrate the oosslble effect of the vector eontrol. À certain nr.urber of t1}4po-endenlc rnlllages wiLl be examined in orter to estimate the life-span of tire ad.ul-t ,,:/olïls. ctr-tI«lren bom after the start of the programne rrill be surrreyed in some vilIages to confirr the lnternrption of transnd-sslon, due consirleration being given to the possibility of intra-uterine transmission. [irls type of surveJ' can be extended if requlred, to other villages. The follor-up of the rrillages urith a sporadie enderni.clty rzill probably never serre any useful purpose. Villages rrill be eLirnlnated fron the netryork of reguJ-ar ristts, rzhen useful- epldeuiorogicar criteria cannot be f\rlfllLett. 72. Practlcally, the sunreJ.llance netrvork vÿlIL be establlshett as follor.rs: I,Iiger 6 virlages Upper Volta {O viJ-lages IvorX' Coa.st 2O vtllages I,IaLi JO vitlages Togo and Ghana to be dete:rrrined. ^f'-f'r'z i (.{è./' o .: m z,e m3 at = o 'n oz c)Ào c) m -tc) Ë2 v, = -m .o Fo 6) 7)D = =m D 7t mD @ m ato 7t m @ m6) = =z6) o -n c)oz 7to o! maD =ozU' §\l\ N .9 T I ... p(...a... I t aaa a a aoa \ \ 'ÿ'-'\.4 I <.(.-.-. ,sI Ê a a I a \. \ \ ,l Ëm .: ÉI \ \ \ \ \ a a a a a a a a a ::l.8asa a a o a aa \ , l -< ! a at. a a a a a E I a a a a a a Ii I û E \ NI tj 2 o D ô9 tr != 3r Èâ ëÉ ëË E§;9a -3 oB -2 -u ^é ^- Jrrr iË 5Ë Ëi =ÉBà êÏ BÏ FO-{ è<< d< O_-.1E Sr Çr xi =339J!!C§EiE{-{= oozzz zZZT11mmmôôô{{{mmmooo o C o ( a a tIô \ i \ t !I »! t a o ) » t 6 c » { o3 roZ {l E F rt o o ! o j< J<2 6)oc , ^.9,-.-. § à a t t- § 0 U'{I G'C{ oz o 'Tl @ trz oz mÎnU' 2 C !! mT ot- \\ I -.! 3 .t' .a' ! : !\ ! I a.."\...."' -! c) I ,:l .) 1 ù 1 ,.i I .: .,1 'i I:t. t @ m z 2 t - (., Cl I z { o 6l o i tr i I [: :i( C)>(oo 3 i E365 iE , o. _u4 -;'dJË I âqc:o= :GCF{l ê E<crcrf ooo-cco aarooQA 'O a o I o o ()'t -{ (nur§orN !^o2@@ idfl2a3 ,..:.lmoDlJ! C a- NEffiEI r99itr=l>:x(,l<roô11ôoo_â163 â 61 = lif9:'èBI"˧§§ülÊ * HlaIflol6l4 0o o og oô oô- o 3 <){ o (o{(, s --\ --i. \\ .: ::ri it tt .â '! to! D =oz, tr atl 2EC oz I ! ! mE o D t .t lc i- (, N - 6 N=*N{ôôôôô1>OO O O O O ôÂi=oooooÉ:Y88 . É+to -(rN-o:TfOOOOO-N8888.9 tâ 8t"Êl Et" s3 [e 8E- ['Oo IOé I:t6 tâcrr I9o la -o I§Ê [sUoI Làî Oo o .Nû,(,r(,r(,loooooooôo êcroo €côala o< 3o N § to 3È o 6ro o a CL o oq ..o \ i t .a .! a :: : Ili {.. (\§iÉ;ole 6 O^ oË ÉË aÊ Eâ i ^o.3oli3 âîiE@j tI 1c 3 o- N o o : o a -1!<t cHÂPrm ru 1aESEABCH, BMRoNLUTTAI IRoTECÎIoI; AIID IRAINTIIG Research 1. trhon the Btart the researeh sponsored by the Onchooerciasls Control h.ograme has had a etrong operatlonal blas. [Ihile nost of the work has been entrtrsted to lnstiürtlons and Untversities und.er eontract, reeeareh sclentlsts bave been enployett on the Prograrzoe. Altogether, about $2r3OOr000 have been spent on reaearch, equlvalent to aLrnoEt fi| of total expead.lture ard, withln thls araount, afurty-one contracts have been negotlated for about $116401000 or 2. lhe greateet lnput has been Ln vector ecology and vector control. fhe d,istribution of the species of the S.d.arnnosnm cornplex along the rivers inslde andoutsl.detheProBrameareahqsbeennapped.[hesavannaspeci.es,§@.s.s. ând, S.sl:'banum. bave been clearly insp{minâted as the prlncipal vectors of concern to oCP. thereas origfnêllÿ the epecles coulil, be separated, only by cytological eæuinatloa of the larnae, keys have been tleveloped to enabLe the norphoLoglcal lttentiflcation of the aduLt fLles. 3. Progressive Etudles to find. nechanlcal reans of sampling the adult and larnal popuLations have resulted ln devlces of use for everyday obsenratlons on the beh.aviour of S.dannosum but not for monitorrng act,.ral field operations. For examplel the rhlndolrpanetr i-atercepti.on trap has provided additional lnfornatlon on flight behaviour and the aluninir:n sheet trap i:as proved use{\rl in attraeting physlological atages other than those seeklng a blood meal. Alsor as rvlth üre SLmrllr:m complex research, the rnethocts have proved useful in the retnvaElon studles. I ror additionar lnfo:mation on research and, trainir:g, see Annexes -9halter rl/ page 2 4. Stutlles oamled out on the Ia:raI samplr.g nethodE have led, to a greater understandhg of the spatlaL ttlstributlon of the lalrae ln the water i their feedin8 behavlorrr and the slae of partlcles lngested hsve also been studied. §uch detall ls of value in the development of alternatlve lnsectlcid.e foruulatLons. 5. AttemIrts have been made to develop a Laboratory eolony. Otr»eratlonal1y, it has been found that the rearlng of slngle generattons of dtÊferent species to provltle naterial for more accurate Lttentification has been usefully exploltede but the contlnuatlon lnto mrltlple generations has made slow progress. Enz;noe polSmorphlso studles, u*r1Ie of value acadenically, have not produeed an operatlonally vlable tool. trlkewise, source identiflcation of vector naterlal using N-ray Fluorescent Spectroscopy has been found to have marglnal value to the Prograume at this stage. 6o iYlth the Prograr.me reLlant on only one lnsecticide, enphasis has been given to flntllmg alternatives.  stgntficant advance ln thls fleld wae the development of a floatlng trough nethod enabUng (Ilfferent products to be trietl 1n slür wlthout contanlnating the whole river. Aecordlnglÿr lt has beea posslble to shw that the ntrmber of lanlcides potentially avallable to OCP ls very restricted and, In fact, to clate, only one, Chlorphoxi.nr has gone fonrartl to large-sca1e field testi.ng. fhe naln difficrrlty here is to find an lnsecticlde that conblnes traxlrun effect against S..dawrosum with mrnirom effect agalnst other aquatic non-target organisms. Chapter IY pa6e 5 7. Stud,les undertaken on the d,ispersion of the Abate foruulatlon in the rlvers have Ehown lts property of adsorbing a colloidal matter in the llvers. Gae J.lquld chronatographic netÀods have aLso been developed to study the a.nount of Abate to be for:nd ln water, mrd, oysters and flsh. 8. îo obtain a frrller understancllng of some of the subjects and to assist the pJ-annlng of the resea:reh prograluee, a serles of Sclentiflc Advlsory panel l'Iorklrg groups have been convened. lhese have consldered (") trr" d.evelopnent of a laboratory eolony of S.d,annosrm. (u) tn" relnvasion phenomenon, (c) trapprr:g devlees, (a) tir" S.da.mnosm complex ana (e) the developnent of larvleides. 9. lhe ftrtrrre resrearch conryonent of 0C? rvlll contlnue to be closeLy lirketl to lts operatlonal requirements. In tUis respect the seareh w111 be lntenstfled torvartls (a) tfnafng alternatj-ve controS. a6ents, not only larvicidall but also ad.ultlcidal, tÊ the restlng sltes of the adults can be located ; (U) tUe clevelopnent of other technologies, where approprlate; to contæo1 or nalntaln tlre eontrol of the vector ; (") tAu shrily of .L--êgggg movements antl the factors lnfluencing ralgration. 1O. AIthoWh it bas been recognlzed, for sone tine that there are apparent tlifferences betrÿeen the 0.vohnrlus forrnd in tire forest and savanna areas and. ti:at the infective stages of the parasites for:nd ln the veetor may be other tiran O.vo1vulus. until recently no technique was available to enable cLarlficatlon. Reeent ad,vanees 1n h:Lstochemlcal sf,sining teehnlques are now begi.ru:lng to provid.e mettrods which could have futrrre operationaL consequences and, possib§ lead to a more precise entonological eval'aation of transrri.ssion potentials. rv pa,ge 4 11. On the nedical sid,e, most of the research haE been undertaken ln the course of the epiderniological evaluation activltles, producing a greater insight luto the lmplicatlons of the d.lsease. [o provide comparative data on the d;manics of onchoeerclaels traasrnlssion antl on the pathogenesis of the dlsease from 4 slrn{Isr', uncontrolled atrea, a longltudir:al study has beea rrndertaken in I{orthern Cameroon over a perlod of three years. Histological exarnlnatlons of slrln sntps have been carried. out to asslst in the ldentification of skla leslons due to onchocerciasls. L2. lhe applied research r:ndertâlcen by the Epi.d.emlologlcal Ermluatlon Unit has been nainly eoneerned. wlth operational epid.emiologlcal aspects of oncho- cereiasls 1n order to i:nprove the fieLd surrey technlques used,. In the fle14 of parasltologyr seneral different nethods for the eraninatlon of skin snips were compared to detemtlne a suitable technique both for large-scale field grxreys and for the detectioa of new and light onchocercal lnfections. Mlero- filarurlar whi.ch is an inportant sfun of sTstenrlc onehocerciasis, was lnvesti- gated, and a slnple fielil technique based on filtration of urlne was developed. 13. In the ophthalnological fleId, different vislon tests rere extrrlored to ensure reliable results on tmpalred. vision ln the nlllages exanlned. systernatic screenlng of the lntra-ocuLar pressLue ln patientE wlth oachocerclasls wag undertaken, and an analysis nade of tire importance of a q6-exlsf,ing gl.aucoma as a cauae of blindness. Anotirer inpoltant operatlonal aspect of onchocerciasis is the d.efinitlon of ease" ax high ri.sk of blindness. For this præpose the relationshlp betneen the ocular tr»araslte load and severe onehoceroal eye lesions waE lnvestlgatetlr as weLL as the iaaportance of optlc nerre lnvolvenent ln onehocerci-asls and its influence on the vi.suaL fields. Finally1 irrvestfuatlons C'lupter fÿ paae 5 v?ere carrled out Ln selectsd vJlla€es in the Prograrone area in or{,er to define a tolerable level of onchocerciasts, based on operational, metlj.caL and entomolo- glcal crlterla. Devironmental hotec tion 14. fae weekly application of the larrricide used to control the vector, Abate emrlslfiable concentrate, could have an adverse effect onron-target organims. [herefore, in the early stages of the operatlons, an aquatle nonltoring progratme was set in motlon. Unfort'.mate1y, no data was avallable as a basls for futurre comparison ; thus, strrtlles of the rivers eovered by the flrst phase of operations corunenced. aLnost at the sle time as the Ia:nriclding. onry on ü.ro rivers not brought r:nd,er treatnent rrntlL the ttrircl phase waspre-eontrol data obtained. 15. Desplte these problems, the protocol developetl for the aqrratlc noaltoring and follored consistently on eight rivers princlpally in the southern section of the Programre area, bas provecl adequate and suffleiently sensitlve to record. any slgntflcant alteration in the conposltion of tJre rlverlne farrna. Results have ladicated, as expected, a certain {irn{nuf,len in the overall quantlty of non-target lnvertebrate organlsns in thoEe rivers under continuaL control. llhi.e generally anounts to apprclnqf,sly 3ü Uat there 1s no indtcatlon of a stnrlsr. effect on the fish population. 16n the inltial impact of the insectlcid,e on the aquatic farrna appears to be more d.rastlc dtlring the first treatm,ents of a rlver but, wlthout lnterzrptlon of the weekly echedule, the riverj.ne fauna is able to recoven gradually to a level conparable with other rivers ln the etreac Ctaoter Iÿ page 6 L7. Sürdles on the fish populatlon bave not revealed the d,isappearance of angr speclee under the regular appLlcatlon of larrlcide, and the aumber of a1velrngE remalns hrghl suggestlng that breeding ls ucaffected. L8. Data collected ls recorded on speclally deslgnetl foras and fed lnto a computer for subsequent analysls. Because of the trenendous d,ifferenees in the rlvers, not only seasonal but arurrral on aceount of the varying raiafalL affectlng flow and d,lseharge, several years study w111 be necessary before firn concluslong cair be drawn. Eowever, a certaln conslstency in results has already been noted, pernltting â reduction ln rnonitoring frequency from nonttrly to quarterly inter:vals. Ihis has enabletl other rivers, partlcularLy in the ertenslon area, to be adtletl to the monitorirg clreuit at no ad,d,itlonal coet. 19. Thls environnental study has benefitted. from a back-up research progr€uuÀe whlch is contrlbutirg elgnLficantly to a greater r:nd.erstandlng of tJre natr.rral balance that exlsts iu the rj.vers and the later-re1atlonshJ.ps of the d.lfferent organims. Identification keye for the various groups of lnvertebrate fauna are alEo bei-ng d.eveIoped,. 20. In addition to the regular monitoring pro6rapme, two consultant §drobtologlsts and an lchtyologist nade suryey vislts to the Phaee III area to fLLl ln gaps ln our trorovledge. [he locations of these vari.ous stuttiee are showrr on fig Regular neetlngs are held. to coordiaate the nonltoring progra.unûe, which may be expected to continue for the tluration of the Onchocerciasis Control hogramàe and. which 1s sufflciently comprehensive and resilient to cover other larwlcides 11p1 mJght be latroduced. chapter III page 7 hainine 21. [he OnchocerclaEls Conho1 ?rograme bas, fron the Etart, taken the rnrf,tgf,lve in tralnlng personnel from the partlclpattng countrlesl elther for serrlce slth{n the Erogra.rme itselJ or to strengthen ttre cormrnlcable tlleease corrponent of the rational health serrrlces. As the control of onchocerclasls was to be achleved indirectly tbrough a prolonged anct systenatlc attaek on the veetor, the need foæ eatonologieal personnel on the hograrme wae pararcunt. Àss63dlng1y, provision was nade for the preUrnrnar.y basic 6a.rning of 4 entonologistsl I asslstant entomologist and 26 technlcians between 1974 and 1927. lheee were subsequently recmited by OCP and glven in-serrice operational trainlng. 22. lYlth ftirds providecl for fellowships a nedlcal offi.cer was sent for f,1'a{ning ln tropical ophthal-nology and another for trainins in public health. An assistant entomorogist reeeived, advance training 1n entonorogJ,. Eowever, hon best to fu1Ly utilize alL the funds avallable for training has been discussed on vaæioue occasions and. in 1978 visits were nade to all the cor:ntries to aEsi-st the authoritles ln identtÊyirg their needs on the basis of which a long-te:m trainin8 prograr,ï?re could be developed,. 23, the Prograrme, which has derneloped a serles of nethoilologles for the zu:rreillance, contæol and evaluatlon of onehocerclasls and lts vector, has provided. valuable in-serviee trainlng in these various methods, to six sci-entists from outside the hogranme area amd also to two entonologists frorn Ghana. Requests have been recelved, for simllar tralatng 1n entonology, parasitology and ophthal:nolo6ical techniques for personneL from other [Iest Afrlcan countries lnterested in morrntlng onchocerclasle control pr.ojects. ocD =cl =o = o2 =6) 2 mq, À)coc o @ a a ÿssndro I tr, z o o o ooCooC C3 §c N' o t\, c § o I >C{r()araSEEE9ccc =ôlo,o,s j j ja 999 E: 666â=.:.=.ff3(oGt(o OJ75{qt r_an, oil§+ eË I \ o o Ott o o I o c)a O o =3 m 5 clapter rv pa6e I 24. tfhile caadidates atre relativgly scarce, funtls are available for training from sources other thân OCP; elther wlthln llII0 fuon the Reglonal Offlce for Afulca and the tlDR hogr4nme, of ltom lnternatlonal agencles and. countries provldlng bllateral aselstance. IUPr,rî[rlr1JrFAîIoN' AIID Co§tS B"r dee-t- exe rgli-on §J 4-I gZ9. Âs of t''lay 19?8r êxpt.-tlclitureE for the 19?4-19?9 perio<]. are expected to be $55rr5gr5g7l, rep::ccentirg savings of $7r 2Oor4e;, that rs 12% over tl:e Pi\G esti:rates which were ji62r560rOoO2 .  comparison betizeen the P-lt] ilission estimates by activ:ty for I 971-L979 an«L total elipenditure cumently estinated as of ilay ISZB fcr the sane pericd, gi-ves tire following brealcdouan: ÂCTIlTIlY D^^ .LllU 't 7 406 'OOO lr5ggrooo 1.3 ,3gC, oOcr 91232rOO(-: of îotal CITtRi]N? affis %of lotal .+27, Ooo 572rOCO 1r3O7 r 0OO 4 r 965, OoO ( t-lgrooo), t ÿector Corrtrol Epideniological Erra.luation Econonic Developnerrt Di-rectort s Officer,iDl\iri;, tiiiO Support, Irîeetings Researchr/lraining JCC I 2 :::r5ro33rooc j6 ..35rt75eooo 64 (.,9z,ooc) 5 1 5 2 2r979eOCO 827 rOOO 11, 5Sr r ooo trrll7 i-OCO 479,000 22 2t L5 I I TOTÀ1..... -q62r56010oo roo ti55r16OrOOO lOO .l?rzocrooo  coinparison between the P.\G X.lission estimntes by cate,qorr* of e:.i.rcriditure for 1974-1979 and anticipate«l expenditure for the sarne periodr is as fol1o.ws: actual expendituues fo:. Lg71-]-}TT anount to l:,29r 2\)gr]4Z ad justed to inclrr_dc L5)4 contingenc:es t:nd aZ, inttatj-on per ycar compounded annually. 3 there tvas iio prorrision for the jOC in tlie iAG i.epcrt. Sr\lrTilGSG*rfi) CATECORT Personnel AE3iel contæact lnsectlclde BesearcVtbarn1rg op era tl on s/tcarnt/havel Capltal Items % suâREsrr ;[ of [otB,l ESTII.IAIES of îotal 3' $2OrO99rOo0 18 IOr5ogr0oo L2 5r8l8roo0 15 4rrr7ro00 ? 81067rooo 15 41616rOoo PAG SAVItrICS(o"ffi) s2o,566rOOO 11,236r ooo 7r?L2rOOo 9r282r0p,O 41 611rooo 9rl5rrOOo ,6 19 Lt I 15 I 467rOoo ?27rocp. 1894rooo 4965rooo 3456rOOO 4537rOOO Other (.fCC, Dfssf,ings, ConEultants) 1r9r4ro00 5 lg74r0o0 lotal S621560100O 10o SSS,16OroOo IOO S?2oOroOO By the above comparisons, actual expenditnres atre expected to be 25?1, Less on lnsecticlde, 57% Less on BesearcVttafning, and. 5QÉ 1ess on capital acqulsitlonE. Over the L975-L977 perlod, programre total costs per klloneter of rlver bave decreased,3*fr fron S3lr4B ln 19?5 to fi2].r5l tnLg77. hoJectlons through 19?9 also suggest decreases ln totaL cost per klloneter beyond the 19?T rate. Ihese recluctione bave occurred, as a resLllt of nalntallllng aitmlnlstratlve orerheads relattvely constant and by carefirl§ nonltorlng the most lnportant variable itens in vector contæol guch as insecticittes and evaLuation tea,ns. trbon 1975-L977) mlnimuu gr.mranteed fDght hours were exceed,ed, by 7J% tor ftxetl wing antt \6fr tot hellcqrter. Lg'..l lnseetlclde appllcatlons 1n phase I and Phase II represented decreaEes oî 5% arÉ, 4eX in lltres per !m of rtver protected compared. to 1975 and 1926. As of lIay 19781 the nr:mber of entomological srrrweiLlance teanns pen h of rlver protected^ in Phases I, If and III had been reduced by rc-i, ZA! arrd, lL/"1 respectively conpared to the first year of operatLon (tgls, Lg76? tg77, respectively). &eeptlng tlramati-c reversal of the eI'lmatLc conlltlone erperienced during the last 3 years, the satisfactory coEt-effeetiveness ratlo of our operatlons should contlnue during the 1980-1985 period aince tbe opt{nrql use of Progfame f{nqDclal resources refleets better howleêge of fleld conttltlons and Lmproved efflctency. \CHÀPIM V PTÂII OF ACîIOTI AITD BTTDGEÎ ].980-1985 A. PIÂtr OF ACIIOII 1. Du,rj*r5 the subject pei.iod, the strategy of the ttCP vtill reraain essentially as ori;irurlty plan:red by the PriG I'Iisrion. Iliis is, .gl1-the. @ to cLestro.r s. di-.r.uæqun by repeated acria.r apprications for the purpose oi so interrtlpttig transrsissior: of tlie parasite 0.volrn'ii-.;rr that at the cnd of ti:re pIaru:cd 2O-year _ceri.oc'. iro living'adr-rlt i';orm ivill remain amonE the irùrabitatrts of -r,ire aree. fhe e,Llderniologictr! r;orl: ;"i11 continue to consist of field. e.raluation, cheieo'chcrapy, airplied research errid training of staf!. iis to thc licoirci.iic Dcvelopment Unit, its prù;ri.ry ilunction vill continue to be jrrfornation-gathcring crnd liaisoir althougii i'c lrolild be prepared. to carry out acLriitic;nal taslcs i:r project iilentific.rtion e:s ai-'llrolria-te. Unless a d.ecision is macle cturin6 'che pe.riod to cxtend the Pro5ra,are into ad.ditional areas of Benin, Gircnir an<i 1o6;o, the present ad:ninistrative irr'ra- stzucture of the OCP should re:rai:r sirbstantially uncirar6t:cl, :ritlt 4e professior-.als, 643 4enet'i-:i servlces, 2 aerial oases ar:d a.pproxirnartclT 6 sectors ano 22 subsectors. Vector Control Operaticns 2. Tire plan of aetion for vectoi'cr,ntro1 over the lieriorl 1980-198, ccrlls i'or tlre arurua1 ;rrotcction of an aver&ge ot' 592 073 iqls of rivcr conpared to an averege of 4I9 O4I loas clurriig the i;ei'ioô, L975-1979t or arr incree.se of 41i:. Helicopter hours rvi11 jncrearse by 6!7o, fi-nccl vring hr-r'*rs by 157'i1 insecticice use by 7l)L, anô, vector coliectol tee.n .years by L4/". 3. Ilov,,ever, as i-ncreaaed. er'f icicncy has been achievcd in Phases I I'nci II, eonstant or ilecreasing vector control inputs per lon of river protected li.rve been reflecte.l. At thc be6iirni-n; oi ,lcetor co:irrol o.,-,e:.':,tions in r)h:-l,ses Ir II, anC III, the r.atio oi' vcctor ccllec'uor teaas to lengtir oi rivcr protectcù l';irs 17 per IO0rO0O lars. B-v L979t tirc rrulber ui1Il ir:ve been r'ed.uceci bt, Üi!, to Ii tea:s Ctaoter ÿ trn6e 2 per 1OOr000 loos of river and the nuraber of subsectors and sectors wlII have been reduced by 2L% ar'È, Z5"i respectlvely. In phase f, by the end of I9?7r heltcopter and ffured wing hour6 per kalorneter of rlver protectetl had renalned eonstant whlle the nunber of litres of lnsectlclde used hacl d.ecreased by1;fr. In Phase II, by end 1977r helicopter horrrs, fi.xed wing hours, and U.tres of lnsectieide per }É.lometer of river protected had tlecreased by \gît, L1fi ana. 4€" respectlvely since the fjrst year of operations. 4. [his trend, however, ls based, upon only 3 yearo actlvlty in ?hase r, and. two ÿears aetivity in Phase II. Phase III cannot yet be analysed. because extrrerience ls too llmited. ÏIe lave notr therefore, projected eontlnued. decreased costs per river length throughout the period L98O-198I. l]le have, instead, eEtirnated actlvlties for 19S0-1985 on the basis of lgTB LevelE and assuned thern to rernaln constant for the entire period. These projections aLso assume that the length of river protected. wlIr renaln constant. 5. irhile 1t 1s hoped that actlvity rnFuts per to of river protected wiIL contlaue to d,eerease as better Levels of conhol are achleved over wider areas, this is not reflected. in our present budgetary projections. ÿIe sha1l contlnue, horever, to effect those reductlons which are approprlate and, technlcally Justjfled, returni:g resultant savings to the Special tr\rnit aa we bave done every year since t974. 6. îo continue to ca:ry out prqgrarme aetivitles rttb.ln üee bor:ndarles originally deflnett by the PAG Ltission end in the extenslon area 1n Ivory Coast as Çlrgæter V plage J a-oproved in December L977 r'riJ.I requlre, annually s botal oI 6r4J0 helicopter' f1yin6 hours ai:d I58J fj:ced i:ring 1'1;ri43' hours ovcr the enüire perioi 19BO-I9B5. 'Ihe 6rand total r;iII be 1S5BO and. 949E hours for irelicopter encl fixed wir6, respectively. Compared to 1979 this represcnts no increase i:r ai-::craft hours per Ifu of river protected. 7 . îirese hour:r ere distributeC a:rnua117 gs follo',vs: jI*I,ICOr'l{i. Phase I 1600 Pirase II e9e Phase III 25e2 Ivory Coe.st ii>:iension l-t50 TIIIIG 767 200 5L6 5CO rlotal 6430 ]5B3 8. Since j-t has bcen possiblc to exte.ld. operations jxto lvory Coast trithout lncrelsir6 tiie size of tirc aerial fleet but onJ-y the ntr:rber or flight hours, the Programloe, u.nder'';lie rrei; aeriarl- coilbract tc be nc6ctia-tcr.i for the period 19gO-I982, vi1] bc in e. lrctter position to negotiate .:n increased nu:nt,er of hours ri'ith rio inerease :.n ti.re nr.:-orber of airera.ft. 9. [he aerial contract p:'cjeetiorrs êccount:or Z"i'i' of the total buclget. 1o attract bidclers, the Progrcrrae is obliged to guarantec a certain ru:rnber of h<.rurs for the contract period. lhe establisi:lqeut of the rnuober of guaranteed hours is d.irectly ticti. to the inunber oI aii'craft requireA as rvetl as anticipatr:l ninj:r,u:n flitht ti:ec. req'.rircnents oi the Pro.--xarcme. ÂI:oe oaco the nini-nnr.rn 6uarantued houis irre fixeci. by contrlct, econoiry* to tho llrogr:u:ne though reCuced. fli;llit tj.re belo',i the guaranteed levels is not possible. 10. $,rro irund.ret and flfty thousand lltres of lnsectlclde w111 be required trrurually. Althou,:ir the trer.ci for iusecüiciclc use in Phase f. -.rrcl il Phii;:e II reflects decreasiq5: anounts per kilometcr or' river protected, uncertai:rty Châ Y pa6e 4 exlsts rlth regard to consumption th Phase III, as well as to the effect ttrat treatuent of the Ivory Coast extension zones will have on lnsectlcid,e use in the lnterior, northern zones of Pbases I and fI. For this reason, the quantlty of lnsectlcide per klloneter of river covered, will renain the same as that p'lanhsfl for 1979. 11. A total of 27O captrre points will be senriced by ?e teern^s operating ftom 22 subsectors and 6 sectors during the period 1980-1985. lbe rllstælbutlon of these teans ls as follons : CAPT,TNEffis- 25 îl-qlts 20 22 2 §0. 7O245 I 270 l{0. SECTORS o trIo. SUB-SECÎORS Pi:ases I, II, III Ivory Coast trktenslon Total 7a 6 7-2. îhis represents no lncrease in the nrrnber of vector collector teams, sectors, and, sub-sectors respectively per !4. of river protectecl conpared to the status quo as anticipated at end^ 1979. Hlrcothesi-s of extension L3. pssfimlnqry estjmates for qctencling operatlons i.n Benln, Gbana and îogo are currently as follows : 1) À total of 5760 helicopter hor.rs ancl 3;0oo fixed wlng hours would be required.. 2) f\ro atlditlonaL hellcopters vrouLd be requiretl for the period I98O-19e1 ,) Durlng the period I9êO-1981, the 2 extra helicopters represent an est{mated ad.ditional 1r44O gr.nranteed fJ.ying hours pen year, and 1t is estt-nated, tl:ot 500 fj:ced wirrg hours would be required Chspter V pa{5e 5 4)  reêucti.on in treatnent nay be possible after ttvo years, whlch would mean tbat one of the additional hellcoptere could be dLspenssd rrlf,hrn the perlod 1982-1985. 5) Eron 1982-1985r ?20 helicopter atrd 5OO fL:red wlng hourE would be requlreô per ÿearo 14. the proposed extenslon trould rezuIt in conslderably more flying ln the south-eastern corner of tÀe Progrâmne area. lhe use of the Tamale base wouLcl Lnvolve a 2-hour reürrn fe:ry-fLight, t.ê. two hellcopters would, use 4 hor.rrE fery-flyltrg each week to reach the treatment area. This would represent 208 bZ * 4) horrrs per year, or 416 horns for the initial tvro years. At the present cost of fllght bor.us (ll,lgù this represente a total of US $153r9O4 1n ferry-flfrne alone. llhereforer this base nay lrave to be tra:asferred to anotirer more centrally Loeated slte. L5. lhe arnr.nl lnsecticlde requirement for the extenslon atreas of BErt53, Ghana ancl [ogo wouId, be 1LO10O0 litre, however itlseet{mated.that these operations wi.II decrease lnsectlcide needs ln Phases I, II and III by SOTOOO Iltres. fhue tire total lncrease in ineecticitle requiretl rvould be 80r00O lltres. L6. llhe entonological §.urreilLqnce rvould be conducted by 21 teÊrrs operating from certaln of the original subsectors as well as from 3 new gubsectors. A total of 88 generaL sosrice staff and 2 professlonal staff would be required as folLorve : IOCAîION General Serrrice Professionql vcru vcv/rq/oæea lanale Sector Bole S. Sector Iama-kara SectOf ?orga S. Sector Parakou Sector 21 (fornerly Natltirgou) Parakou S. Sector Aerial Operatlons Drtonological Srrrve illance 4 7 7 5 , 6 1 I8 C[rp'ter V pa,3e 6 l0Oit'Ir0ii Gcrrerai Scrvice Prq,ISS_iergr1 Atalcpalrc ij. Sector Hohoe S. Sector .â-Ul.'IIi.i lotal 17. The extenr,ion or'ful} o.oe::atioirs into Bonin, Gharra, antl logo rvould result ln tire annexation by the Pro5rauare of 9fJ55 L:ns of rivcr to pr«:tcct annually rcpresenttnï 17% of the total includ.ed. in the Pr,ogra.me area as of Dccenber 1979. le . ?rojected increasec iri heiicopter i:ourl, f lxed l',,ii4 hours, insec,,iciiLe, arrcL vaetor collector teans arc of the orclcr of L5i'", '2ÿilt 321', anô. 2fiJ of tite Decembcr l-979 Progr,.riirune total. Ihese a.re j.ntentiorur1l;. fjxcct at this IeveI until the results oî the extensicn str.iclics de:lct,strctc tliiit clecreascd. inputs ivould be acceptable. JJ iiviilua'l;ion 19. îhe rqain activities of EPI .Juring the pcriod. ncntioriect r,:iLL i.re: field evaluation chereotherapy and ap;:Iied research trailirr5* of st.r.:if 20. Fie1ci evaluation: lhc total nr.l.rlbei. of vilia6'es i:rclucle<i in the rirst evalugtion of tire lbo6ral:::ie area ives Jll, of rvhich 45 rvere detailed evalntitiorr /- \ '/1l14[jes (!irl. i,o'b all t[c:;c JOO vili:gei r.iill bc i:lc-i ricicrri irr f'u-burc io]io,.r-'rp for reasofls s.rch as change of popu]a-bion amcl vcr;r ]6.,,, endcmicil;y of oncliocerciasis. Abou'b JAy: of t;.ie tob,-I ruurber of si.inplc evaluation villa;;cr; (su) tlill be regularly re-exeu.iinecl, '.vhercrrs n«;arly all t':.e 45 clctailu.d. evaluatior: ÿiilrilo:, v,rill uc includ.cd. in tire .iol)-oi;-up. 20 20 2 ô6 2 Qjtgc-";l-J page 7 2L. 'Ihc sarapie for the l'utule J-oras:itudinal stuiy ',ri11 'btrerefore Le approxj-nately 150 villages lii and 45 villages DD, in prilciple eclualliy ciis bributed rvithi;r the bhree irhases of tne Progra"unc aree. 22, In soue r-rf the 5l-vi1i:.';e; at str:tjlica.tion of tire sa.mirle:nay bc usctl to coi'É j:ra the abseirc" n, j."uns-:risgior, in ccrtu.in areas, for ir'.l terrcc, exa:rinerticn onl;r of chilcLrci:. bcrn since tite begiirnin; o-f bhe vectc:. control progrâ:lme. For the sane rea.son noa-j-:uec-i;eû popul*tions reset'Lli4; onciro- freed areas may also bc inc}-rdcci.. 23. Follow-up ilqbervals: liie sclectecl vJJ-lliges urill be reexanined cvcr.,r third ÿêâxo .t\reas of vcry stable an<i. succcssfu.l vector control trill be controlled every f i-f'ch ycar b;,: sù:;,I,, evaluirtion, to coiu irn tirc :bsence of trarrsroission, vrhereas it lny be rrecê.ssary to rei.l;e ncfo frequent pirssa.;-cs in areas of d.oubtful t::a.nsinisslon control. Phase I ?hasc II Plrt se IrI lst passa6;e t9'i5 1926 L977 2nü pessase tg]e t979 t2g9 lrd pa,ssa5e l2gt 1293 lggz 4th passage 19C4 1935 ==== ==== 24. îhe criteria for selcction of villages to be i::cluderl i-n ti:e fu'uure follov-up lvi-.t-I be baseci nairùy rlpoi-:: the duratioii oi vector co;l-rrol Ievel of orr-goi.r6 t::ansi.lisr.ion, if any. 25, A third fetctor'to trricc irito coiisi,ieiation rzilI bc the statilticul background., i.e. a su,a'ficient nui:ber oi ci.ref,rlJ-y selceted ÿili.18csi rrust be exanined to enable relia.blc conclusio,is. Cir.apter ï paSc I :o. the folloiT-Llp vil'] agcs v;iII thcre;'cre iic Lllcupeu to5e-cllt:r', :.cc<.,:'d.u",* to the above eritoria, :rncl teiicirri; i:rto accourr'ü geo.;raphical ernd epiceaiolo;ical cl:a.tllcteris'üics, such as enCenlicitl' levcls. 27. An extension of i;i:re Prog:::lulc .Irea. l,,ould unclerstandahl5r ilcreasc the nceci for fielci evaluatio;r by both sinple and det::.lled srirvejrs. Chenothcrapy 28. Ihe rcle of lli.I i.erii6 ]9ôC-19L, r'illl eonsist pri.:narily of tlie evaluation of ctrug tric.Ii anct ttreir evc:rtuc,l a1;r,1icatic.i on selccte<i population$, as weli as aptlicd rcsc'irrch to rlci'it:.e cases;rt ris]: of blindncs;-, airct in nceü o1- treatnent. Anotircr i:nportl.nt er:,'pect of rcr-re.,1'cli u'ill i:ethe investi.,:rticn of m.ore refinecl cve-Iuertiou teci"-niriues tl:ut nay become ervajl-abIe in tiie future, :rnd rtirich rra;,. inprove tire dieigno:,is or treatmont of onctroceïcir-rsis. 'rnc Unit lvottld also be c:':pectec to pli'ty an active role i-rn the i-urplenentation oï the crash progranu:Ic, if the LLtter is approved by tlic JCC. Llconoraic 29. flrere rras Eerreral consensus fro:l tho ver.v begirurur; on üire. fact tira-.t the econonie unit oi' the t,,CP strould assluae aa in-fornratioi:r-gatherir4,* role :s vrel-I as liaison functions. 30. 'fhe Econom.ic Der,'elopncrit Unit sta::tcd fuirctioniir;; irr Icbrua4' fÿl§ t';ith the en'bry on C.u.'b.y- oI the ile;:cl of the Unit. the first fer'; nonths r?crc spent orr farriliuriza-tion toilrs 'aj-tLrin tire Pro5rirnino ,l1 ea, c.:tarblisiring corrtae ts r,,ti'bh ti^c aiuis'bi'icu anci ofîici:.1; coricenreC ',iit.i aevelopn:ciit activitics anc. project; i:r th.c oncho zonos of tire respectivc countrics, i'rith represent;..tives of tire ünj-t.C Àlirtiorrs Developrne:rt ?rogr.rrrice, FAO ChaltsLl page 9 Y1IIO and. other speciah-seci agencies o1'tirc United. irlationsl otkrer rmlti.:aaticrre'I aid. agencies as weII as bjLa'bcral irid eu3eneics. 3L. Close associatiorl \ïas cstablishcd. 'r;itii trie regio.r.rl d.evelof)rlent organiiations in tire Pro6r.unf,Ie alea, in p:rticul:r tlros-re base«i in Ouagad.ougou, ancl also uiti: tiie CTI,T,S a:rci the Inter-African Cerrtre for Ilydraulic Studies. ,2. Durirg the course of the year -bi're. functions oi tire Unit t'lere nore spccifically d.cfined. to be i:rionraticn and liaison, namely to : collect arnd d.isueninate basic socio-econotrtic datii '*thicil t,t.ç' be usefr.rl for plan:iir4r: and clevelopnent actions b5' 'roth lrerieficil,rr' arrC clonor coun';ries:; on the basis of the socio-eeorionric qlata collected., as;;is'[ iti thc establlohment of a socj-o-ecorrorric data bank fol the l'ro3rtflrne a:'ea; study ar:.cl elclvise ou t'Leveloprnent projects bein"; executctL or plaiiicd for the onctro zor,:e, arrbicukrting all rclc'rant socio-econoiiric il.sliects ancl ccnse(iuelrces ; maintaùr contacts i,ritir erll partics to the Prograrune and in'ierested. agencics (benc.'ici,:ries, clonors, sponsorin6,':1iei:cics, bil;:tcrai ancl muitirurtiorral aj-cr iri.;'r firÉncing lgetlcies ). 33. tr'ollor.ring on this ,-icr^irritiorr e, stand.,rd. questiotmuire for coll-ection erncl trarsmissiorr oi iru-ormation 'to tire rÏ'o,';rt'Jrtic o;i .t leg,ttl-,r i)jittri3 ,''r.i devi-scd and circtilatcd to tlie Progrt'.rune countries. Çhçrpter ÿ page 10 34. îhe responsibility for prepc.rrr.,ü.* an a^ütual rel;ort on socio-eeonoicic d,evelopments in 'uhe hogrrnrre .re'5'ahic-r had iritherto been a,ssgrned by tl,re United i'trations Developrrrer.t Prog,r-urte, passed. orr to +,he Unit at tire er':ù or. tl:.e f irst year. iiitir tho assurnption of tiris resllonsibiiit;i thc r,l1it ,;rs-rs ';.r:oviGecl with three staff :aeiabet's :t t.re i,cgirulinl ol 1977 in orderbi:at the t;:slc couid. be aclecluately perfozr.lcd. Itre areas ccverecl i;y tite stafi vre.r:c sociolc5.r, a8roecononics and. developnerrt eco:iomics. 3y ccnbir:ed use of tire cluer-.ticrrnaj-re and persotral visits by ncnberl' of tlie Unit, irrforr.ratj-on-,.'as re6,u1irr.Iy assenbLed fcr corripilatj.orr of tirc an:ru:I socio-economic rcport for L977. 35' lhe stldfing of the Unit Lras Seen cerriccl out on a nu.ltiili:ci-rrlinar;r basis i.:n order to errsurc the pror-,er intc5ration of thc various aspec'bs of development. the post of pul.rlic he.:Ibh a(iyj-§cr, r';l'ricl: had r.enaj-ire« vac:.rt during tlie ij:'st tt'io yea,rs, T/€i.s filiecl ciuring the tirird yea.r thus supplying tire missing public heeilth cclïponent oi tiro ünit. 36 ' l'he experience 6ained. by the Uni'b d.uring its f jrst tl:rec years ).ras hiShlighted tire i.crportance o.C thc following esseltial- ccml;orients for clevelopnent of the onclio zone: (") a basic socio-econonic infras,;ruc-bur.e, particularlj, b.lsic hei-i,;ii services, schocls ail roacl;j, espccia.lly i:l resetuleracr:t ,:.reas1 (U) the need. for i.ntcgration of pubtie heelth eomponents iirto developnent projects; (" ) integration or' the oncho zone into tirc iratioiiai ecolr.rrqy of each country tlirou6h regtoltil ,leve.iopnent ci:tl plirr:niru3; ::nc1 (a) the ncccusity for a,i.ticiprrting clevcloirment proi:Iens ancl botule- necks by kecpi:rg tircse unclcr contirruirl; sttrd.y .urrl rcrlier, iir order to prevent ilreir beconi:i;, ci.itic:-,-I isrjucj. îhe question for ttre IgBO-8! pcriod, therefore is one of diuccr.;rilry; tiic clilectiorrs in liirich these r.rnctions nai;. clevelop j-n ilrat pez'rod. Qlpptez' v page Ii 37. It is alreaCy clei:c t}it. i;h.rtevcr d.cvelopncnts take place il t}c oncho zone :n:st contribute r,'o tlre total devclopment of eacl: countr;r. A regionai orientati<.rn has ti:er:for: to be ;ivcn to tho j-rü'orrnation irnâ lierisorr functions of the Un1t. 38. Another input into tiie ini'o:.raatiorr functiorr of tlic i]cononic Devclopme:-rt Unit vrill con.ii-st 1-r'ihe corr.d.uct of stu<iics orr specüic developncnt proi:Iens. lirus sone applied socio-ecoironric resea:.'cii i:: envJ-saged.. A list oi'sucl.r stuûies ancl topics of intercst'.,ras i;iven j-n the anrn:a.I socio-econonic report for 197?r in tlltich it t'ras also_ envis:r3eci tir:t s;;ccierl semini.Irs or] sucir topicl ,vould. serve to clsiril'; iclues. i9' Finrl3-y ttr:re is cleeniy no'y7 a necd iol iurbhcr id.ciitüic:tion cnd. preparation of projects. the.ro1..:tho Unit cc,ul-rL be ca.lic.J upon to pl-a.y iri this f icld l'rjl-i delencl vei'y nucit on the ou.tcono of' tire iïorlcl Bitü,.t g econogic mission ancl iti, reccromend:rtii.lns sr: to the futur.c rolc cî ,rDAP. îra iniln"l anià-rRc s ea.{c h. 40' lhe trainirg progreus^re t;iII contimre to iii:a at tiu.ee objectives: (") to iraprove tlrc s-tills cf persorurcl alread;. cnploTed; (U) bo prepare neîï persoruiel as naÿ be require<i; (") to instrrrct per:oi.:nel fro,a othcr Aflicari countries in the pioceriure of surwey, co:itrol and. evaiuation of onchocerciasis anC its vectors. 41' Thc researeh activitiec uirclertlkeri or sponsored. by the Progr.anne d.uring 1960-19e5 wi-Li continue to br, clo:..:-.ly rclatcci to its ch::rgin'; rcqurire.,eirts. In ord.er to pernit species j-ctentiiication by the ficlcl ento::iologist, attcntion tvill cor:.tiirue to i.rc ;iver: to ti-c j-d.errrijicatiorr. cr di;tirguil;rirr5 Chae.[el V' page 12 e:cterrral norpftological characteristics cf the adults, pupae and larvae. Sigilar euphasis riill continue to be placed on the' develoilioent of raecha:lioirl d.evices for trappirrg acl-rlts and sanpling riverine stages. îhe vrorir on a nethocl for rearirg sir€le generations of cytotypes of the s' clarnos}4- ccmpiex will contjlrue. Research izili continue to emphasize the tcstiilg of the eff icj-ency of new insecticides, in particular rnicro-c.ocâ;)sulertecl fornullrtiorrs, an6 thejr effects on non-target organi-sns, ars tzell as seeklnq; alternirtj-tre means of control. [Ier]ical research vrill continue to empirasize stuCies involving the epid.eraiology of thc diseace and tiie search for a safe .'-tnd. effi-ciel1 ttrera.peutic agent. [he acluatic monitori:rg operer.tions ";i1I be pursuecl. frials will also bc undertalcen to rletelnine the efi'icacy cf environmeptal ma.::ripulirtion e.g. moCification of sorce brcediig site.: vtirich should lead. to a correspondirrn5: reduction in the ciuantity of i-nsecticicle to be applied to the l./atcrcourses. Follorving these exl,eri,tcilts an SAP i/or1..in6; Group will be coiivened. to consiCer the possible wider applic"ition of th<: techniquc, especiarlly in those il.re.Érs ilhcre rLevclopmcnt and. ir:.'[ensive settlenerrt is tai<ing p1acc. B. BUDGEI 42.Budgetrequbementsforttreperiod'are$148,88o'l0oofwhlch $1321 6461500 are requirecl to mq{ntaj-a actlvltlee at thejx present level antt $16, 23græO for a posslble extenslon into Benln, Gbana snd 1[ogo. Chaptet Y pa6e 13 Pre t Level 43. 'Ihe nrnount of tà 17215461100 i'or l9üO-19S5 is ci-lculate(i on t!.le basis oi estj.'lates for actttal c.-'.pita.I reiiuire,:cnts, c,itiraated aerial contrac; ccstsl, and ecti'n.r'ces foi' the re'rsinü..:r of recur:.in6 e:rpenlitures for L9Tg. +4. the foll-orrin3 assr-u.rçtic,r-s; irav,J bccn rrrade: an anrruerl inc::eage ol 7]-.j'i'' f'or staff (3.5i: fo:: sti:tutor;r increase plus ÿ3 foe. infl:..tioii); an arur'-ral increase ol ù/" fo:' all otiier cpertitionai costs (ei:c1udin6 aerial- opera-tio;r ); rei,laceitcnt of V1 ot tite total vehtcle fleet i,c:(. .,.,eêtro I the esti:aatecl aerial con-iract costs for 1980-1902 have been calcul-eted on tire basis of the ex^oecterl ilurbcr of t'Iight hour: ar:cl an licr-rrl;r ra.t.e es,tj.::iatecl on thc ba;is of rrlosing,.rr bias subnittecl i:l 1926 p,l:us l,/o ir:I.Iation per year; plus 91, for unlaorrn factors (fgZO bicl:-, + lO per cent). Ihe costs ior 1931- I9B5 represent estirnated. fliéht hours trt 19ê10-1982 ratee phus 30% (iry,l per year irrcrei.r.se clue to irr-flation and contirgencies). these eeilcul,etj-ons ere su;nnarized eis foll-orus : 19ri0 - 19e2 iielicopter Iixed vrir6 Helicopter Fi::eci viirg lüo hours 19 290 + 749 i'fo hoUrs l<) 290 + 7-t) IIe.tc .iû 659 {i 59+ 1983- 19i5 ilate fi 857 l, 772 lot+l ]-2r7t2r)JO 2r82Or906 ii 15,53710l.6 Total l:6r5itr55O 3 r665 r2'2s 1'otill fotal {p 20rI9Zr Z5B Gra"nd 'Iotal ÿ=ZZtZl=g{_!l these rertes âxg of coursertentgbive. lire actuel- rates r.'iII bc liiowu only after tite res,-llts of un interaa.tronal call i'c.rr bid:: in I9T9 roi..tiic period 1980-1982 einc i:: 1982 for tire period 19ôj-19ti. Charlter -,' pr'.ge I,i 45. the lncrease in cosr froil ll974-L97g to 1980-1935 is fi77rZB6r7C3, of v;lii-cir 4i49r275r1oo (61r;) is ctue to int'rtlbion.urd {l,za,ortr6o3 3a;,,) is iiue to inc::eased activity. 3y tiie enri. or' I9e5, hoi.it,vûï, a sufficiently higir level of control v'lili heve bccn r-rc.:.1cvecl to pcrîrit :r consiCercrltle recruc-bion of the level of :rctiviti us reeL,jreû to nain'cr.in control. 'Iiiis recluction of activj-tics vui-l-I al:aost ce.rtaii:Iy reflect <iccreaseu co.;ts. r;xtension +6, An extension of Progre;irrs::.ctivities into Beniir, Ghana ancl îo5o lcr tlre perioC 19BO-e5 r..,otrld ecs"; {à t6?Z39rBCO. +7. îhis projecticn is ba.seci aL::ost enti-::ely upon inc:c:rse,j. recluir.nents for the vector control- pro3?arln:e; i.e. an increase of 5rT60 heliccptcr hourol SrOOO fixed v'rirg- houls, SOTOOO lit::es or' irrsecticid.e, trvo .rciciitiorrri professional posts, an estirira'i;ed. increasc of t6 general ser.ricc po;:ts ancl the replacencnt of 18 vehiclcs L'r I9.3t and. in 19841. 48' ltinor staff incre-ses; es a result or er:tending Progra-iune arctivitics are anticipated for the Adninis.crative Sc::vices Unit (e CS posts). t level Extens : lhe total aineçpt for the periocl IgAO-I9e5 ivould be $l4BrBE6rIoO. I 'Ihese inputs herve beeu costed as prcviously clescribccl for the raaj-ntenlnce or' .rctrvltics at tire pr-.csent 1evcl. Chapter '/ page 1! 49. 1\zo options are prcscnred.: (a) contiruation durins tlie .oeriocl of' . ongoir6 activities at tireir rrprese:rt lcvel'r or ecti-nated voltulc by cn,i 1979t inclucli:i6 th.e arôciitiorr of tire Iy61'y Cos,st extension approvcC in Decerrrber, 1977i (U) contiiiu.:tion o-i these acti-vities p1u; üic inclus:-on o-t' a t'urtlrer Brogragite extens j-o:.r irr Berrin, Ghan r and lo6o coveri:i; tire areas approvecl 1r Decenber, l')77 for erclditio:r.tl extensicn stuclics. :\L tables referritl; to the continuartion of Progï'r.n,:,e activitics at their preseut leve1 incluCe the lettcr irArr jn their. nwiber. Hiose lrith tlic letter rrBir incluCe the costs; rela'ued. to the e::tensio::. or' hograrlr:rê activi-bies irr 3eni!r; Ghana and 'Io;o. îables reflecti:g the total of these ti'ro series include the letter rrCrr in their nLu,ibcr. 50. Ihe follov;ir5 serics of ft:bLes are prescntecL: Descripti-on r . oc P-L9-s@ps_aq_BJ^tt* tx. : A - Pre;cnt l-evel ^ bis - Preseut lcve1 - Comparisorr betrveen 19?4-1971 ariC 19EO-I9û5 B - Extension 3 bis - Exterrsion - Conpariscn 5etlicen l-gT4-LgTg end IgBO-I9O5 vriüi -x-Uension C - Prescnt Love1 plur D:ttension C bis - tteserrt L'-'veI plus lxtcnsion - Conparison betiveer; ig74-19'(r) anc. ]-9BO_I985 D - Pie Chart Frt:scnt level plus --xtensioii II. O.CP lg8o-l!)B-5*.by -C31t-e,;o37_o_l-.rt;<.itelx|i-tSf.e. A Present level 3 lxtens:-on C Prcseut trevel plus Estension l) ?ie i-)tran t Chaoter ÿ pa,.ge i6 lII. ysg.[gf Uon -UniLl'Ltl-0:1-9§5--by--c.5i!9ggr;---of. iturc a I'{. A hesent Level 3 L>:tcr.rsion C - Presont lcvel plus llzLension .I1e.i.lenælpfiigglgvClqgrforr---U3*ry__1 jl_t_0;_I_;_sl.by- a iture itu:e  &resent ievel (.i!:.:rensiorr i:aplics no co:;t i-trcrease for n?I) v. - c o@ $ t i- l-a$!p-e-5-izz-.gtt- glprz i'cure VI. A Irescnt trevel (rittcr-rsion ilrplies no cost increase for ECO) Snvriejlrne+t+}_-}\o'cc-c-t_L9tir-4rjtl+-e<]_-ilq-çr_LcÀet4l_-tra;rgi&{ }9e_ot9rr5 b7 of' A làesen'c level (i-xtensiorr iaplies no cost ùrcrea:e) VII. Office of ti:e ils^i.;rmi1s Di:'ector and. Ârtni nistrat 198O-1o,§f b.y catsso_I.i- cf expe_ils.Lt-Lxe A Prcsent lcvcl ts iktensiori C - Present treveI plus Exten$ioil VIII. Acir.irii-strative va Romc ]frn q!0 eiipe:rdir,cue A Present level ldeetiruls. 19AO-Iq85 A Prcsent Lcvel (rjxtension iuplic;' nc cost increases) rx. (,:;:ctension i:irplier; no inci.eases) x. Joint Coordinat Comlittee .lt i\ Present Level (D;:tcnsior. ir-rp-l-ies iro cost increa;ses) iI. Totcrl iixpenc.ii ures 1'17,i-l-9ê5 ( i:rc1ttûin3 lxtensicr: ) er:rpliarsiziil, transitioii pe-ciods )-979t I9ô0, 1981. oo -là\o o\ oooooooo --f t\- Ô- O c- oo \o \oO, -1 C- oO1 9 r-r -:r -ld oo CU \o o\\o co rt ooooooooO.lr\æO cO O\ Ô- -.J-Jtf\lî\-{o.u\NC- O \o r.\ coO. -{ F] E{I oo ra\ \o -i-\o ^t|.\r{ tr\@o\ -{ oooooooo æ§--f,1^ o\Ou\$1.\ rf\ t^ oCU N\ -l oo Ct- O. r{ o\ r.\ ooooooooO-l CUcU e- O\ CU ra\Otf\O\-fN-\.o \ cO -l r{r-{ ooo\ oo cv ooq{tr\ co \o c\l -$ oo o\d ooooooooOr{cO§- c\, \o (\J î.\CV r{ rÔ\ O\cv t.\ oo§- o.\otr\ r§ oooooooo\o\oÉ\o -fO-$\otr\lI\CV-l -1"1.o9 §- Fl r{ -l oo -$ cv co -l oo CU\oo tr\ C\J fô\@o\ -l oooooooo\O O\ r.\ -l r^-fo-f,Ocolr\@cu cu oo -f \oN CU r\ ooooooooc\ c- c- c\, .GGGO\ r\ cU \Or.\ rf\ \o o\c!-ll.f\-+ \O -l rl -l oo\ tr\\o -l ooIa\ o\ c\J -f ra\ AJ cu co o\Fl ooC- olr\ r{ oooooooo -fæ-l-+ o\o@ lr\O\ t.c\ c\l D- r{ C\l ooir\ co r-{ o. 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L.\ Fl l.r\ -lr-1 CU r.\ tr\ O\ -l .1 vcu tn (\J O\ O\ cOO\Orl r^ c\l r.(.\ o rl -l la\ 11àR \o o\ i("\ -l c) a(6 q) k o c)ê o .r)(ü o) Ér C)ÉH O\\O\ON-$\O O C'- La\ t^ -l@-lO\@ O \o î.\ cv -lO\ \O C.- \O \O -l\ONrt^lGVo -l F- r\ c\t r.îCV -l tf\ \OOtr\c-O -:fO-f,Nc.- co -f o\e-t/.ttrtt.f\ L^ r.\ c! -ftr\ rq -f§- -lco -f fc\oC\ \o@ cv c\N tî\@ o\ rl Io co o\ -l oooooooooôcrl-f(\§-O \oc\@\o\oO\O\-i.§-co\O rl \O F{ -f æ-l-l -l ooooooooO\tr\coÔ ooO.§--t -.j- ta\ |J\ -1O\lr\c!N cl\oîô\æo\ oo -l r1\o o\ 8t\o -f\o CU fÔ\ d O.c\ o\ -lI -:l-C-O. -l c- o\ 11\ o, r.r\|.\ tr\ LÀ §- LA r(\ o\c\ -r rl-:l-\OoO\O r'^ O. Ê'- -f -fO L^ cO C'* r{ \OOdl.\-f,Or.\cu.,{'c\trJ\ U\ -J' rl -1 @cu fô\ C\ cO C- c\ @ -:f tq@O\Oo\ -t@r^\oC\C\d-{ -l O. C- fa\ tr\cv-f fa\ o @É +) c)q) E o()È) +) ô5f{&HqE5Ê{În 'r{do§ ..{+,+'(üÉ${ O)+)tooÉ .d-lOÉ-lÀ .rl .r{ OE>.d<,(üÊ Ndde)Ét{-d(ü ca +) -l +{(üo o .r{ OÉo .C .ÉlO+{ -O cHHO (d CJ o c, +)O ,{Eooq&È\A+)tât{ ooÈ .Fl ,+r an(! l<F{o{-,(üà0|a()É ..{ .r{ ..{ÉÉ +, .d .qoEoo€o) ($ bo(d ao +)È oÀÈ a rrt o ..{ +t(ü t{ +, o .r{ É .rl ÈÉ 6 H t{ o {J o of{ .r{ê c) Ë Ê{ ôo o & d o .d +) o o +) of{À À(d +,É 0)ÉEooÉÉ..1 OO+rÈ ..{ (U .r{ tU Fl +) Éù0Ê{ <6 Ê [r]É Ê C'] E GÉo È -c.dr{ O C)(ÛF{ (U r-{ f{ ,{o o o (ÜÈt{ .r{ > q)+, b o aÉÉ o â oÉO r'{ Edc)oc) ..{ .rl 'tJÈEEq)ooo.d +)€É-lO.r{OÈ oÀoÀ Ht^H o.H rl Élrc) coqtsÈAHzÉ oO\HÈ-Ao\ r{Htca -fC\ Flo\ frl ZHÈlÊ1 È =zHÊ1f'] tnÉH 2Aou)ÉHH& Ë:r AE-'EOÉ{ o ..{ ça H LÀ æFl O. <rlHIooHoO o\d oo -l -f,rnd \o rl ooc\ 11\o r{I tlllltl oo@ o\ r(.\ CV \o -l rÀ@ o\d oo}{.\ C- CrJ@ N I 8t CU(\J ttttllt 8o- otf\ co c\J oo\o (\J d o\ c\l I oo -f o ôJ ttttttt ooo ff\ ta\ o\ c! oot\ ôotr\ (\I 8 a æ -l tl ttrrt ooo o\ r{ rf\ C\J oo r{ o\ r{1\ cr{ Ia\od trllrtt oorn tr\tf\ tf\ (\l .f oo o\ rl r\@o\Ê{ (\t @ o\ r{ d@o\d ootf\ c! co@ C§ ooc\ -f -l I ttttl ooo c\ o\ æ C\J o@o\ Fl oo ta\ l^oC- c\l ttttt 8N. 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CU 8 "o-O. ra\ "l\od o od c) t{ o oê o o(ü a, li o H oo\ 11\o -l oo -{ -sr\ -l \o -l tltl oo@ o. r.^ N \o FI + 11\@O. rl !o@ o\ -l oot\ r^o -1 + oo r{ -ff^ r{ \o -l t + trt o\ e- o\ r{ I -fN o\ -l t\ c- @ c\c.- co -t r.\cOO\OO\ .fdr.i..,;C* C\ -l Fl -l O\ C\ lr\ rf\ cu -fla\ c-rf\fr\ o\ c.- -f t\ o\ LA O.lf\ ta\ r^ rf\ dfa\o \oolf\ æ -ï\o@\oO\ C- -:l- -+LÀ@C\-l Or{rÔr-1.t\C\J-lCVta\ -f rl -l C\J Fl Ê{oH o\ '.{ É{ +JO(üÈ f{ÈFl+)a(ür/)u .lr .Fl dÉÉ'oc) E:EEÉ.i})r/)oÉ6(1)+) O+rf{ôo\r"É .Êtd;É-.(r+toijrS d-l+rêÉdôô.rl§È d É Êi.e - a ô.É É t6o 5 6 (ü È ô ii\.; EP.ç'l E - È ô 150 A d Ë o r{oê§e{+ra(a!€d'd rl <6-lhd(ltrdOÈ..{€ +)60oU)â(Û+ro2(üN+).ç:oâoÉt(6-NqOrlÉ0<116t{r{Êldor,CJOo.r{EO{r(ü(dt{o, .Ft .-t É +r E {-r 60 to a o cQ EÊ{ E E O () d r{ Ê ..{ .Êl .r{ q)ô66.àôÈô.eHHHs+,.6É;+,'ôbÀà.;.e-eà,o.ÀôÈoop.oE'o'o"JoÈoP.t{ÈÉo€qrqrç tf\ co o\ r-{ IoAH -lH AHZÉ{ o.È- rnO.t -l=t< -f,ȧ-(5co -1 ftÈ Iû >'rF] Cq =Ê{2f.l OÊaH tJ7zzO t'lrr2 HH}<R f'] À!E =Ê{OHo= o .d EI trl H llll lll rttt oô -l \o cc) co @ -s -l -l -l F] Ê{oÊ{ oooooooo -:r §- e.- O ô- cO \O \OO\-fÈ-@ -l\O-l.f, -l r-{ oo o\ r{o co o -l ooooI R3I rr\ o\ c.- .f cO lJ\ !f\ r{Otr\c!tr- c\ \o tÔ\ coo r-l oo -l r-'l\o o\ tn\@o\ -l ooO. oo cu ooooôooo@ c\ -i. lf\ O\Otr\-:l.rc\tr\l(.\OC\! l'Ô\ -l oos c\l -f,O. it'\ ooooôooof.\ -l C\l CU -f O. ^l !À t.\ tf\ O\ -to l(.\ \o c\ -l -l -lCU ootr\ -:roc\ o\ CV oô -f CU @ r{ ooooooooÔFlcOC\ cv \o cu i(-\ cV Fl rcr O\ ^J t\ oo -l oo\rf\ fr\ oooooooocu \o r.\ o e.- o -f, \o\O lf\ (\J rlON\o\o O-l-l C\J oo OJ rn O.o\ c\ ^l -:r co o. .{ fr\ co Ot -l ooooôooo\O O\ rÔ\ -ltr\-+o-f,ocorc\@CU CU oot\ -:f{ C\J rr\ oooooooo -J. tr- C- c\l o r.\ c\t \oJ rq\o o\t\r{tf\-f cO r-l rl -l ooc\ rn\o -l oo tÔ\ @ -1ro\ 11\ OJ N@ o\ r{ ooooôooo -+@-l-f G- o\o@L^O\tf\cUC- -l CU 8c\ Jfc\q C\I oooooooo\o \o \o \o -âGCOO\Nlf\C\ C\.1 O @ e4 OU\rr\ \O r{ rl rl ooc\ olr\ -l oo rf\ Ot cut\ CV CU F{ @o.Ê{ oooooooor.\U\o\o \O -l \O C-t\r^N\o -l CU 8q \o ta\\o CU oooooooococuoo c! \o co rt-\ C! l'Ô\ lJ\ @O.O\-fcU rf\ d rl ooo c: rr\ r{ ooo. -? -so\ F{ ^l ooC- rr\\o LÀ o(u oo -f -+N r'{ oooooooor(.\ C\ -l C\ rc\@-fo\ooc!\o -l CU oor^ ra\ic\J AJ oooooôoot\ t\ o o G.c- o rc\ coO\tf\rlcCO@-1 d lf\ r{d o co o\ Fl C) C)l'2 c E Eê f{ .?{ dE() PÉq) € q)È o €çH Idhr{ +J(üa +r .'{ (ü O..{O-lcEEÉÈ1 -l(DôCrdAE.d ô+rÊ.èool-E(Ü .;rg..iEt€ào+\N È(üÉtî.;i4ghÊjô>ô(üÈ(ÜÈÉlO.ttl É c Ê{ O èO A +)ô'Ê,§E-l+,(ücâÊ{E rlOo-oiSCFt'(ÛF{ÈioooogoOocrdcl{l>g.Fl +)ôooJ oAÊ{P(â.dÊt oêoÉo(sHôr1 ÉOOgt{-l0()oo.rlEÀO+'(6r'1 .,{.Êlé+)EAè0OOqÈEEOotdcnÉ.r{..JçOOO'.{OÈ'.{EEo4)ÉCd+rà0O+r.dÆ.Ft o.rlOÈOO>oEot{)(I)Q<OÊ{t{t{'dO6OC) HF'H ÈÊ{q) g =É C,oÉÀ H Éq zoHq frl E{x Ê'l rnD F]A F] râ E Ê'z ç.1U)ÊlÉA r^@o\ rl Io@o\À À C)o I q) H HÉl É{ A) o(U o)f{ O oâ 0)(,j (ü Q) h oÉH oo ,l \o @ co @ -t -l ô- o\tî\ o\r^ ff\ r^ rf\ C- ra\ îô\ o\ e- -f, rl -S \O cO \Oîc\ ol\ (\ -f -+O l1\ cO §- -{ \O O Fl l'\ -fO rô\ cu rl c\Jt^ lf\ {t r{ -l OO CU r^§-@C\C- cO -î r.\@O\OO\ -f oO î.\ \OC\ C- -l -l -l O. C- f.\ ta\ N -fta\ P !}l EToH o(J b 'H o o{.9q .r I +J .) r.É a) È1 .F{ CJ 4) .u ,tt É 1)â o r(, H o\> +)- ..{ Êr+ro6At{g{raorn .rl (ü EÉ..{!o+J È(, +) +,Él{oo Êtr{Ék P{\..{o5+r-E+)(âL6 ooÀÈ>R.E'bO .Él .i{ , É s:â+rcndo '.{ (6 -lÉOr{r{r{-l 'rlEA*)(Ü(6..1 Ji(Uq.d.À.ê1(UHÉ{..{ÉÉÉN@+r.-l.d-dNrrooEoo(ÜÉt{OÉ'oOlr É o ..1{J o c) +) o  r{(ü +)ÉÉo)OEO.'{ÉE+roEtÜÊ{du.d @(üÉÉ &f4E -lO.Ér-{(ÜÀoOOOt{ +) à3 C, U)Éoâo)Or{É()oo .r{ .r{ €t{EEOOOO.r{P6ÉrlO.r{O&oÈop. taH U)o C) È p cl. @\o .1 lt\ -fc- -lco -f r{.\otr\ \o(\J lf\ rr\ o' O\ \O \O cU -i-\o o c\ rJ^\ r.r\CO@rlO\cO tf\ \o rt^\ cu -lO\ \O tr- \O \Ocv \o c.- § o -1 v C\r.\N§CV -{ tl^\ \Odtf\NO @O-+c'-oco-+o\O. lf\lr\|r\ôô îl l"ô\ N -fc- tf\ oo o\ -lIo@O.À ooooooooooO\ -i' t\ t\ O r-t C\ @ \O \OO O\-:f C-@@À\O-l-f cOdr{ rl ooooooooo lf\æ o tô\ O\ C\ -+@ rJ.\ l.C\ rtO tî\ (U C\ C- \O rc\ @o -l oo n -l\o o\ O.c\o\ -lI -+E- o\d tr\ co O. -1to co o\ -l b{âË{ZH HFl Êtf.] C) fr:tt] g E{E f'l Éu)(,Êr1 O&ÉAÀ o\ >tc\ crlO. -l Zro -fHc.- taO\2 -l È1I:{zxÊ1 f']t4 =caE{bÈ1 FlEIA o cJ)HÉ AEo(-) a ..1 Êq o H O \O O. rt^\ -:r rl 11\ rl l.o\ -lct.J cu f^ tÎ\ o\ -lrlvCU -J. -f,o CU ! oo -l O\O-lCUtf\O -l fr\ -l èR r{ CO CC TABLE I. D ONCHOCERCIASIS CONTROL PROGRAMME INCLUDING EXTENSION 1980 1985 BY PR06RAMHE ACTIVITY Vccleun control operotions 72.1c/c aô 41 $ o. t^ 'v n4 êc ôOÀ- J â.;'ô =oo :.!<'rao rAe3 !JtIo.â ., o â1!i ê; {1 'o ,À "t"9 § "t" -/e".c ".§ a§ ,' oooooooooôtr\ C\ rU -J- -lOrr\ro\a-r-i -.f, co cu o\ \oco LÀ r^ -1 cr. O-frl-l r{ ooooooo -f \o -$ o cvoo-i-Nr.\O.-lc{NcV§- O lr\ c\J cOt^ l.\ -l ooU\ Èa\ r{ rl \o c! -l ooooooooooooo oo.uolr\§Ntf\l'\ tr- -f, "i oo ccl CU l'Ô\ ta\ \o oo|c\ \o -f,\o Nl'c\ r{ tl-\ co o\ r{ 88888OÊl OcOô. -lCOt^O\OC\-l Ot^ô -l O\ îr\ cU N N. oooooooo -f, r^ \o cv Fl c\.1 -l |.r\ -{ fô\ \O -fæ E\ -f c.- O \O CrJ r-{ -l ooq r^@q(^ cu oooôoooôoooo Olf\o.r^lf\rclc\ -1 -l ooo O.\o cv -l o(J r^ Jlr\ co \o AJ { @o\Êl 88888fc\ -l lf\ O -J-OOC\üNcu <t r^ co ^I ccio co (v c\.1 -{ "i oooooooo -$ lf\ It.\ o \o ^J O\ \OO\ l.\ C! -{\O N c\t \O O\ \O CV r-l ool.r\ -lt\ æ rq cu oooooooôOOt'-ô Ol1\Ot^lf\ \o §-o _l oot\ oO. -l r-{ oo CU CU\oo r^ CU r\@o\d 88888tr\ol^\oô- rlNrltf\tf\\o cc) \o o' \o'oO C.- CV N rt rl 8888 -f ta\ lf\ ^l\OCUO\OO\ t\ -l O\\O C\ -l -1. "t.tnîi oo o\ \o rl f("\ c§ cu sg§g o tl^\ cv rn\lf\ co No\ 8 -f C\J -l -1 -1 oo rc\ o\ CU -f rq CU 88888c\ co cu -+ c\ rc\@ cu o ocV ^t -:f O\ l.r\C- §- C\J -l -l'j 8888lf\ N cv \ô oi§i,ÂO\ C- t.r\ cOe-dO.rq§,Â-i; ooq CU t.l-\ f{.\ o\ -l g§Hg Olr\F{tr\tf\ -l No\ oô OJ d -+o rl ooq -f,o\ tô\ o C\J 88888FlOr.\f\Ô \oL^-f\Oa\O\ C\ N ô- t.^\L^ \O CU r{ -{j oooooooo -lô--fO L^NO,rqO\NOoOO\-l@CV \O t^ -l r{ ooO. l'a\No @d g§BE O lr\-$ r^tf\ -.f, Ê\'@ ooq -+c- o\ oo o\ c\ -fo o\d o co o\ rl 88888Cl\ o\ c- r\ _f, c- -+ c- rf\ sC\ C\J O \O C\J -$ \O ôJ rl rt r{ 8888\O C--+ O f.\ C- ta\ COT\C\NCOC\J -l \O rl \O t^ -l rl ooo\ C! -lo\ \o -l oo -+ @ LÀ æ c\ rl 8gflg Olr\tr\l.r\@æN §- ooIJ\ LA -fo\ 'JH0F{ C\J æ o. -l d co o\ r{ Fl E{o E-t ê & rJ (a =frl E{H r-I HHU)O+rO.ôOÉr|oCdÉ'J(r)a)c) ..1 +-lE 'O.FlOÈFl 'r{ fr -C 5 F.i Ë, E g Ê a)iF È1H H F] ErHÀ <l c)I .n F|q o e) FI F1 E{oÈ{ I aP) d 'do .Fl .-1 +)ô0(UEÈ q .Fl OÉÀr-{à'al)o..{O(r,Lr q o  oQ iu .Fl .Ft Êt Oo a + Êr «l n, .F{ id3 _B 3 H Ë.6 t 3 ;È '.t P.+) é ê (J -! ô o § 5E 6 e 9E i 5 3 tâ''r X ! I b8.EBS-Ëiü'd.: Pr r q Q çd b E t Ëd{,5#&HE3g '5 cDHtaoq) F] <r F] EÈl F{ Hzt'lU)frlÉÀ fs?Ébt:lHâ E] fr Ê1 ho 5{Ho e, H e) H Êa LA coOt -lIo@ o\ -lÀ C)o HH ril tst Êa H ), ooôoo§- O\ tÀtr\tf\ ! oo æ o|r\ FI I oo u^\ ra\ -f\o oo co o\ rc\ CU \o r{ oo r.\{ Orlr\ LAd ooc- co CU{ oo cv r.c\tr\d d 888J\o-f .1 CU \OO\-lO rf\ @ \o r.Âd, III F] ËoH oo cu r^ rl 8q o 1I.\ ro- (\J oo co .f fô\ co c\l oo\o I ooq 0-c\ 8\o \o -f C\J 888lô\ -l \O(V fc\ -lC- O C\Jc\?È- -l II oo(U r{ o\ oo c\l O.\o cu oo@ ta\\o\o (U ooo rr\ fa\ o\ CU r^ @ o. r-l { co o\ -t ooÊ{ æ -lN ooooooC-d@ c\l î.\ @O\O\O\o q\o -l oo -l -lcoI tll oo -J- c\o LA C\l oo@ LÀ oo@ I \o ooæ rf\ ooôo\o co r^ \or^ cu 8q FI -l ooo o\ rl LA CU l.\@ c§\ -l ooC)oo()it.\ -{ CU -l fc\ O\cUO-{\o o.\o Fl 8q Êlc\ ootr\ ^lo\ -l II oo -$ LÀ oo -f lr\ oo@ o -l oolr\ rf\§ 1(^\ c\t c\J@ o\ -l 888c\J r^ \o C\ el rl^\r^ L^ c\rf\ o\ t^ oo@ \o c\ rlI I oo\o LA\o ooc\ .f, N\ c\J 8N @9 OI 8 88C\J .J. (\J t^ if\ t^ro c\'l oo co ta\ -1CV ooo c\ o\ oo cv rl co o\ -l oo -l rf\\o -l ooooooc\ c,.. cu O\ l.C\ -lO\ C\t î{.\ -f-f,tr\ Êl 8 aÂ\o lll oolr\ r^oc\ CU oo -f o @ LA ÔJ oooR88 @lr\N -$ CU O. -t..f,-f r{ oo o\ .,s CU -l ooo @r^ oo n\otf\d o co o. F{ II ooq -f oood CU r'{rlt (Do)+)èCf{AÉq=oq) .r{P-lEÉ.ÊlOÈ -l É 'r{ 'Êl .r{l.r.(A a 'sod a =r'1HH F] ÉrHÀ o în Er(â o() rf, D É F{oH () .nB EOG '.,3 cèodÉÊ{É ..{OA E:P<-lf:OtA..{OoE 0() O f{ àO, (§ à; .rl .r{ +r qC f1 .É L tÜ <, ..{dO È O É -lÉ r{ A rto O 6 16 ÈO tU + 'ë9{ .Fl glJ É É â;Fl O o .§ AÉ O (6 .rt'd .à 'o |/)-À .d +) ôo iàt ? r k -g i i.5 &gl.FlOO+)Ê{(oPàr'L r. a a É6 (l) É o ;èj oj É c,) oÉ È o o ; râl HI cao C) ts] 2 j ÊtoÉ{ ê É(5 rn EH F] HHA C) F1 E-'oH r'1É Ê|Hê fslÀxH Eqo HÉI lulFrz C)H cn>{2Él È1I:{rf\ xcO [.1o.d Io@ o\ -l A() o I Eq HH frl û-l CA H lt oooooooo\O CU -5- -l cUl\C\-l r.l C\I O\ \OO L'\ -{ O\ tî.r-{-l ooÈ- r^ CA o. -lr{ oooooooo "1 ,\- .O- qlÔ\ r.\ \o -1'\O -:f O\ r-l@ r^ co e.- rc\ c\J r^ ootî\ -f r{ Fl ÈoH oo co Noc- r{ -f -1 ooooooooco o@ N OOrlt^co f^ oo co -fr{-:l- \o oo îÔ\ coN r{ c\ oo -l \o oo æ @$ -l rc\ co o\ -l -.Jooooooôr.\ o co o, O\LÀO\Ooot\oo r{.\ cu ru -l oC)ooooooooN\OCVN\O lt\tfrrcrlr\C-CO N-r oO -ir rltf\ C- r'{ C- -f -l È.- l'l.\ -{ cV -l 8t.\ o C\I -i- @ CU oooooooo\ooo\o Nt^o\cUrI-\ rî æ _l -{ o c) ^l d@N r-1 oo rf\ Jo§. o\ cu -fæO. r{ ooooooooc\,L^o-î -l C\J (V c!rc\@cv@O\ CU CU rl oooooooooo r{ \O r-{ O -i- O.tf\oO\O@@11-f-lCUlc\ N O\ \O (U O§-CUrlcU r-{ oooooooo@ o N\@ \O [l^\ \O -ltÔ\ rl oO ra\ r-{ oo tC\ tr\ rl.\ rf\ \o N oo O. o\ LA -:f -{ oo cv tr\ o\Ot c.- CU rq co o\ r{ oooooooorf\ L^ \o §- @rlLÀtf\tr\\oo\o cO CV (U -l ooooooooooC\ \O C\ cU cO N t^ O\ \O tô\d t'r.\ c\J o\ tr\f.\NC\-fO O\ t\ C\J -t C\J oo a -fcv æ- -i-N oooooooocoo-î@ rf\t^NoL^@cO o\ ooo -+ cu -{ -{ oo rq @ -so\ r^ cv cu æO. -l ooooooooJÀIJô. -fcuooO\ -+ O\ tî\C\ C! -l r{ oooooooooo§-cU@\Otr\ \OO\§-L^Or^c\t(\r@o rô\ -l t^ § O\ CO \O CV rl r-'l oolf\ c\ C! ro- d cv oooooooo -:r o c\J -f lf\ L^ -l Ot(\\r{@ o. ooo (\J rf\o -{ ootr^ o\ CUÊ'- (\I cu -{@o\ Fl oooooooor.\nt.\o \O -f \O C\l'ô\ C\J C\ l^r\§\ (\l r{ Fl oooooooooo@\o\ooc\J -+rnolc\AcF.O-ScO\O -?\orc\cu§* §-\ONrl-l oo r{ C- rf\ c- o C\J oooooooo(\toJcu tr\lf\c\-OrJ\ -f æq -l oô co ô- æ -l -4 ooo\ -:r{ o\ dN o@o\ rl ooooooooOOr\O\ GâOL^tf\O.oooc\cu t\ oo -+ o e-o rl ooc\ ta\\o|r\ o(ù: oo r.\ fc\ O. -ir o\Êl 8888O. e- rc\ -f c! C\ t\ .f,@O\or\l\O CU -l r{ ooooooooooco\o-+oN r{I^Èr@-fôJo\oCOn.\§- \O -l -l \O \O \O C! -l Êl t-l Ê{oÊ{ â É CJ : ,; Ë E{ .âl :ËI Étit HHlu)o.lJA "rlPl 3 Ë 3<l .rt .P .1 EÈtl i6 ..{ o P{ F] Al ..t Ê{ § = Èt3l Â Ë s s P râ F| U)o() È È F1 E-|oÈ' ü0É .Fl 'tbo (Üo o)E Ê{o E 'r{ OÉÉ È(U À ô0a q .d oÉ o É O O fu G+) (ü +) .rl.êl H OÉ t{ (6 f{ (û € .Fl (ü .r{ O ,{ O Ê ,{= Ê{ O €oo€(ÜÊ(Ü+rr{È.-tÀ6ÉÉo -l O o § 5ç O d O(E .rl O tâ (U .r{ {', èO C)Éd+È+).1 Co (U C) cÉ -(D (d , .r{ +r0.ÉlOO+CÊ{(D+)Étr È A A ÉO o É O.do o É o o..t À o o o r/)Hao c) F] t']É HHâ fEl Ht'] ho 5{EÈOH HH C)Ê{+ HÊ1çq(a l.r\E,coÀO. -lIo@o\ -lÀoo t q) HH f,l r-l Êq )É1 TABLE II. D ONCHOCE RCIASIS CONTROL PROGRAMME 1980 19ô5 BY CATEGORY OF EXPENOITURE- PRESENT LEVEL PLUS EXTENSION lnseclicides 10,7 c/" Reseorch ond tnoining 5.8 % Aeniol openo tions 28.6 %. Renlol supply mointenonce 4.1 ond lJa o Personol senvices 36.2"h 60ÿ ."§)\ mâ s. !l 3ô @ c o. c .,) c Tô o> ô o , )-'a ô o! o rf 3 r, : co N J§. 3- -o(' o oJ .q.I clc (x s ooq oo -$o. oO. oooooooooorÀo\ooco OO tf\ O\ \O D-\oco-J--$\o(\JtÔ\-Jolr\ \o r.\ ooooooO\ \C -J O\OOC- t\ O\?1 NC! C\ l.r\ c\tC\l l(.\ r-{ lr ooooooooOOrlO ocuo.oCO r{ rt-\ Or-l q rt-\ -+ oo@ c- -l "ice oo -l r1 îa\q LA F] ÉloH tr\@ o\ -l oooooooooo@-lcOr{C\ îô\ C\ r-{ O f(.\ta\ C\ O\ rl -lrV \O -l -1 888îqY L^ (\l -l -f t^ \o@c!-f 11\ \ô C\l I tt ooo\ to\ co -l Cr ,-1 ooooooooO()-1 O OCUO\O lÔ\ fô\ [^ o\ oo r{ -lCUo -l ooo c-o "lco r-{ ! co o.îl oooooc)oooc) cO 5 -{ ,} r{\ O\rl\O-flf\ _îe-o\\oodr\-l -{ oooooo -:l. ta\ fc\ cv cu o\ -f l.\ §-cVtr-N ta\ \O cU ooD- -{ -f cv \o t-l ooooooooOOO\O oc\rooIrc\ rô\ lf\@ oo o\ c! r{ o\ oo\o .j-tr\ r{ c\- -l fr\@o\ r{ oooooooooo -l r-{ tÀ O l.l^\ \O \O C- r^ C\ -f\ooc\to\ rl tî\ A oooooo t\lf\lr\ -{CUOO f.\ -lC\ ô- -l èG -+ \o c! I tt ooo\ -+@ ra\ rf\ -{ ooooooooooæo oc\tÂJoîqC-lr\ N oo "o- -+rn@ CU oo o\ -l ooooooooooc\ cv rJ\ I.\ rc\ CV -l ta\ -f O -:f\oc!æo.o-f -l ooooooooc\(u \o c\ -f,r{§-tÀcvÀo\ -f, ta\ Fl tt oot cv u'\o 1^ r{ oooooooooo@o Ocu\oOl(\ r{ !n\§- oo@ @o\N 8E\ o\ ra\ CU \o rl ootf\ -ltr\@ îô\ rl -l@o\Èl 88888rf\ c\ Lc\ tf\ \o O\ \O O\ CO tlr.\ 11\ -f -f cOO\ -J- ooooooO\N-f r{ C! O.cOe-O§-dCO tf\ t^ -l I oo@ \o .f r^ rU r-{ ooooooooO O e-O Oc§r{Ot\ \o L^\o oo c- |"r\ -fN oor^ o o.q l'a\ r'{ o@o\d oo oo lr\o e- d rl ooooooOC\-f G rl C\ LC\O\ Ê\ C\rr\ d \o l'^ lJ\ r{ lt oooooooooo\O lJ\ r! C\t -1- G'\O CU O\ r^ C.-|t.\ lr\ N -l e-@-f oooooooooocoo OCUC\Orqr{lf\ \o oC)@ o\ o\\o oo\o LAo d C\JFl È Ê]oÊ{ ê dq' a =t1 E{H lt F{HloO+Ê{ô0ÈoÉdçaoo() ..1 {J r-{ E6 ..{ O P. r-1 .r{ t{ .q a F{uFodo Câ HH F] HHÀ q) tAH(â o(.) rl = F1 È<oÊt C) ooPOCJ .Ft É +j(üY .r{ É :iàOrl(I)§'rl+r Êff.,{r{HaOA.t{d0.l:'38 § EÉà . .r{.FlF|c5ÉtH >+C+)rïÈ(ü'l5Êidv3b3H .9a t"9 :Eà..{PÉÉÉ,; -loo.Codôôiri:q.d()O15..{..i+lèO''1É-l*rt{.-lO{J+r.,/.--io d o cd -{ E rt <s i.; :9.rl9OgOf{rrO-rri 9o§OaoP.çaôô: tâ E{ ct)oC) È4p F] Ê1 cO f.lO\ Fl r{IFo2oo f'](}.A -rHÊtAH2D t1tr]ÉzpOFHHHâ &tllf'l ÈP{}4oÊ1 ÉhooÉÊt >{2Hooc)(5 Et]ÉF{ HOot-] >{ I HHH Èt a-t trt É{ lt F] EroÊ| oo\o co@ .f [^ .-l oo§- @ CU -f oo cv t^tr\ -l -{ ooooooC- \O -S tn ^t \o(6r{O -f oo \o l'ô\ \O lq ttt ooooOÈ- O\ t^rn f^ -f oo@ olf\ -l I ooq tr\ -t\o oo -l -.fl{.\ r{ \o r-'l 8\o \o -tCU oooooo\oÊ{\o O. lr.\ -l -:rocuc- O- §- r{ oo(U -lo\I ttr ood rU rl@ CU I oo\o § oo\o c- oo "rtr\ -l ooia\ N CU@ C\l Lr\ æo\ -l {@o\Ê{ oo rl oo rl CV oooooo r.\d@ c§ fô\ @c\o\o\oo\o -l oo -l -læ I oo -f r.\$\o GJ oooo\o oo tr\\o 11\ c\t I oo oo \o oo c\l o\\o CU oo\o AJd o\ N ooooooOr{CU l'.\ ltÔ\ O\OO-l\oÔ\o -l oo ra\ CU cr\ -{ ool^ dc\ rtt oo -l o\@ -f CU oo .o- rf\ oo@ lt\ 8\o r{ -l ooc\ ooq (\J ra\@O. 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Oô -l \O C\l r{ C\o o\ rc\ \o t^ .{ r''l \O $ d I\o rlr^ -t -$ Itll oooôooo\oo \O C\J O -flr\ -+ -l oo ro- @ o\tr\ oo[f'r o\tf\ r1\ \o rl^\ oo o\ -l oooooooooo -:r r.\ t\ -+ -f OO\\ONe-cV t\ N O\ cU r'{ oo .1 r\ LA o\ llttl oor\ o\tr\ C\J rl ooooooocoo a -1 fc\ ta\c.- ^J I oo@ O. o\ ooooooooooO\ -:f f^ \O .f G@\OÈ-trrtl^\ -l l'c\ rl cO C\l -l oo@ r^@ ttl oo -+ co f{'\ -{ FI oooooooNo rl \O ta\co cv ooN. N -ld oooooooooot^ e- \O cU Ln C- rc\ CO O\ f.\ rl lt^ O C\ CU rl oo\o \o\o c- rtl ooÊ{ O. r\Jo Fl ooooooo\oo -{@lf\c.- cuI oo\o + o -l (U @o\d oooooooooocvcu\o-f@ \O -l O 1^ r-lF{.r.\ÔC\cV F{ ooq c\@\o tttrl ooe! onO. ooooooOo\O rl C\J tÀ§- cV I ooo\ co o\ oot\ r^ r(\ r{ d oo\o o\ c\lo -l -l@o\d ooooooooooOO.CUON ' "i ,.ï .t drl C\J O\ \O C\t oo\o \o -l\o llrll ooo\ ,1 -fæ oooooootc\o -l @ lf\\o ÂJ I oo ra\ -f o\ oo CU \o tô\ o\ o@o\ rl ooooooooooO\ C\ ff\ O\ E\ 1^\o \o N @FIC\J@\Or{ o q tî\t r^f\ Irtl o() r^ Fl\o c\ ooooooocoo r{C!tf\\o cv I oo "o-@@ 8ta\ otr\@ oo r{ o\lr\ fa\ r{ oo\o o LAN d .+ @O. r{ fr\@o\ -l F1 E{oa rr! -AÈ{H È HHA c.) 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AJô.\o ooq -f, CU\o oot^ r- oo -+ c-\o -f t ! ltl ooooO\O o-+rqJ 8\o o\{ LA ood lô\ -l I oo F{ t{.\ -{ ooc\ C\J\o LA fa\ cc o\ -l cv oo o\ -1 8 "lo\ r{ -:r I oo co \o tll oooo\o@ coo(\J -f 8 -f lf\ o\ -$ I I oô(u CVd oo CU (\J r{ 8\o C-o rr\ -lco o\ -l ooo \rt c- fô\ I I I oo rr\ \o ooootf\ @\o c\C\J TA oo\o \o -fJ I 8a r{d 8 .f d -{ o 8- @ LA -ï o co o\ .{ 8 cu c- rr\r^ I I oo@ tr\ rtt oooottt\ O -f tî\c\l r.\ oor\ cuo -f oo LA o -l oolf\ od ooo rr\d -t FI Ê{oH â É(, ta ËÊ{H F] Ë{HÀ o F] FIoFI o+)tuoÉtoo +,FlE ..{OÀ C ..1 ..{ Hà)aoc a HH È Ê{H& C) CAÉttao c) FI zz F] ÈoÉ{ C)() r> oo€ .rlOÉ{Joî' .-l É -tdcè^) .Fl É .'ÉPO-lCOO.r{P+)Ot{ 'Êl ..{ d CJ È -CÊ{(û+)ÉOÊrqrOoà-l(âLO(l)Eo,U.È{(ü{rÈ..{.lJÉÉçO r'{Oo-CtodOOd€(ü..{OO6'.1.Èl+)bltqÉ-lPt{.r{O++r-lçO)OcÜo(ü-1 8(UtÜ=.Êlç4(,').r{OOP.O!rtlO.PO irf-()U)È()Cr(DÉO=ootro=ogqoc)r (â H(a o C) F1 t Ét'] f'] r-l lf\E{cozO\ tle4 U)I f']ô&coÀ o\ -l ç'1H&H!f2Ê{DHAÊ{zzË1trl O{E>1A C']otslk140 ê& o()o HÈIEE{ 2C)oCJ>.|t{m f'1 FI Eq E{ I II I II II I I F] Èo E-r oooooorc\ r.{ tr\ -:r ôJ lr\coc\\oL^ C\ -J' r-{ -l ll ll illl llOllOttOll - ll@llcoil rl ll - ll -l llII il oo r{ o CU .{ co I n ll tl u ilI il il il il ItllIll 8 c! o o\o rc\ IIll lt ilOilOllO. ll - llr-{ ll -f llooil - llf.\il I ooo -î -lc.- co IT lt lt lr ll il ItI ll il ltil l1 ltI il ooo\ r{\ o\lr\ tr\ æo\ -l ooooooq9q tr- @ r.\ -l L^ O.t\ d o.J lt llil illl ilil II il ll il il lt U ooo\ c\ lÔ\(\J ooir\ \o CU\o FI ooo oi r{\o ti lr ilIil il il it il il ililIt oo -f o\\o e- I I I I -f co o\d oooooocOO\@ f^ \O FlO\ -f C\-C\l -l (U oo ta\ o c\l CU II il il il il ilI ooo \oo[r\ Fl illl lr il It il II ilI ilililil il oo ^ll.\c\tr\ lt ilil ItI lt llil rl il il illl il oo a ntd c.- 8(\J r^ -fe- -l oôo\ @ rl rl ooo \o -l\o rl I il rlllI ltI il ilil fc\@o\ -l 8oj oC! ooooooOO\O G'CV \O r-.1c\ tf\ r^CV -l CU 8 c\l \o O. -f r{ oo CU -+o\ r.\ r{ 8\o or\ LA 8\o ctr\\o ooo C\Iorl cv oo o\ r{ ooooooO\OO rl \O r.\rf\ cu r^CV r-{ CU IIil il It ilI 1t il il il il lt il il ooq @ æ r{ oo -) r{O. -:f lt ilI llil ililI il ilil lr ll ooO. o -l\o ooFI FIo\(U r{ oo\o r^@fa\ -l lt lt il tlll lt ll t1 n il lt lt il II -fo\ -1oo o. -l 888rc\ \o co ,.ï d ,Âfr\ddCU r{ CV ooo\ -+e-FI ool'r\ r^ o\FI r{ llil il rlI ll il ltI llil lt il ll lt ilil il il ll il lril ll ilil lt ooc\ rf\\o|r\ ooO. -f,rf\ -f 8o r^@ ôJ -{ ilIIllI il illl il llI lt Itl oolîi Cs@ o@o\ -l o 8- C\J\o r{ a @@ .{ .1 o 8 D:o -1 -l II lr ilIil ltil ilil ilI il lt ll il uIllI lt ll lt il ll lt ll il oo@ t\ C\Jlr\ 8(v tl C\I -f Io- A æ ooooooooco\o@o\ -lOO.C\J r-{ -l HHH âz HH H F] HoÊ{ ê 4 TE .: Ê{z ç'lzoft o C) Ààoâ ..1 =Év 'r{(U ,r E{ I HHH HH c)É É .n H âÊlH FIÀ A{ È H P (a É{z Ê.12oAa.oo Àa o ,{(U o o c,É F{(û o '-l .15(, t Grl F]() H(5 3oEIz r4 Fl È P I Bta Êl(6 â +) o(6 t{ +, Eo c) -{o ,{ +,É o() ,{o +) C) o ..{ .r{ ..{ ,{ +)Éo C) }) ècod o o t4 Èo +) o o .Êl .Êl (a< cÊ{ (U +., rn Êl o t{ +)Éo C) È o +, C) o) .Fl É o .Êl +J o o +) ot{tÈO-lf{(Ü r{dodO..{+)ouÊooOErlEOÉÉEooo tr .Fl +) .r{ r{ É >ÈfslCP{ HHH U)Êtoo c) FT 2 (5 zH ZH HÈHÉ{oHE &A:trq)ÈÉ HtüZcâHEzoêEHHFI aâ H fElFI ra É{ ooo odd - I I I I oo(v- \o o.\o @ rl È E{o E:{ ooooooooor{-\C\.lOOe-ot^ CO ê Cl\ -{l.t|.r.\.f,Êl-f- -i- -l tf\ CO \Oc- -l ooo -lof,o -f r{ tll tt ooo oN ao- §- -l oooooooOc\J oc\r -fLl.\ -l \Ort \O 8 c\l \o CU @ n@o\ -l oooooooooo -l \O 1.\ (\J L^ C\ C\ r{ -:f cOco cu r^ \o cul'\ -l -l oo c\J ooNo ta\ ltl ooo. \o co§- r^ 888qq"o- OCUOCUd r{ I oo "o- C\J t'^\ -l ooN o\ -4O. fa\ -J' æo\ -1 oooooc)ooooC\\Ot'\OO o r.f\ tî\ cu o\ cO CV C\J L^ 11|1drl ooo\ LA -lc\ CU ttl tt 8q @ -l -f ra\ ooooooOOc\I orvo\(V CU .1 I oo CU -lLA -l oo c.- o\\o rf\ fô\ tf\@o\ -l oooooooooo@e-cVcOCU -f1.\rlOOc!cuo-fFlr,^ -l -l oo@ IJ\ ta\ -f C\J 8rf\ \o coo |a\ ooooooOOO. --O c\J C-N-l d 8o\ o\ ra\ -l oo -f \o CUN r^ cv co o\ -l \ oooooooooôC!Oor\r.\O O\cU@OCU\ONC\r.\OôJ îl -l oo\o{@ r{ rU ltl tl ooo c.- co C! 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