Expert Advisory Committee: report of the Twenty-second session, Ouagadougou, 4-8 June 2001

Onchocerciasis Contlrl I'rograrrutte ilt Wcst ;\l'rica (OCl') Progranrnrc dc lutte contrc I'onchoccrcosc cn Al'riquc dc l'Oucst JOINT I'ITOGR \MM E CON{N,I I-ITI1E Offlce of thc Chairnran JPC - CCP conrrE coNJorNT DU pr{octRAMME Burcau du Prcsrdcnt JOINT PROGR\MME CONl\I I-fTEE Trvcnty-scconrl scssion Washinston D.C., l0-l I Dcccnrbcr 2001 JPC22.3 ORIGINAL: IINGLISIIjuly 2001 ,l t I t ProvisionaI agcnda itern 6 EXPERT ADVISORY COMMITTEE Report of the Trvcnty-second Session Ouagaclougou, 4-8 JLrnc 2001 f CONTENTS List of participants................. Executive surunary and recommendations .....'...'.... A. Opening of the session B. Adoption of the agenda C. Follow-up to the recommendations of the twenty-first session of the Expert Advisory Committee 9 D. Matters arising from the twenty-first session of the Joint Programme Committee and from the Joint JPC21-lAF6 Session... E. Review of the report of the twenty-second session of the Ecological Group............................'.10 F. Reports on the visits of EAC members to the Programme area..... "...'...11 G. Review of scientific, operational and technical issues '........... 1.4 H. Priority actions to be taken during the last ll/zyears of OCP operations ................19 I. Macrofil 24 J. Closure of OCP... 26 K. Report on the progress made by APOC, its preparations for Phase II and for the Phasing-out Period of the Programm e (2002-201.0) ................ L. Report on TDR Operational Research. M. Consideration of the Cochrane Library review on "Ivermectin for onchocercal eye disease" by H. Ejere, E. Schwartz and R. WormaId................ N. Other matters : "Integrated Data Analysis" O. Dates and venues of future EAC sessions............... P. Approval of the draft report..... a. Closure of the session...... Annex L Annex 2 List of EAC22 recorunendations Page 2 5 8 9 I 9 ....,....,........... 27 ..............,,..... 27 28 28 28 29 29 30 Annex 3 Annex 4 Annex 5 Annex 6 Annex 7 Recommendations of the April2001 OCP Operational Research and Strategy Meeting Report of Working Group A ...... Report of Working Group B ...... Report of Working Group C .... Report of the twenty-second session of the Ecological Group Report of the EAC Task Force Meeting ..32 ,..33 ..35 ...42 ...44 ...70 JPC22.3 Page2 LIST OF PARTICIPANTS EAC Members Professor Adenike Abiose Medical Director, Sightcare International, P.O. BoxL0392, Kaduna, Nigeria Tel: 234-62417373 / 238684 - F ax 234-62-410873 or 248973 i/c SSI - E-mail: abiose@infoweb.abs.net Professor S. Ofosu-Amaah C/o Director, School of Public Health, University of Ghana, P'O' Box L3, Legon-Accra' Ghana - Tel: (233) 21 715580 - Fax: (233) 21 500388 - E-mail: soa@ghana.com Professor Roger K. Prichard Institute of Parasitology, MacGill University, Mac Donald Campus, 21 111' Lakeshore Road, Beaconsfield, Quebec, Canada H9X 3V9, Tel: (514) 398 7729 - Fax: (514) 398 7857 - E-mail: roger.prichard@.mc gill.ca Professor Detlef R. ProzeskY Faculty of Health Sciences, University of Pretoria, P.O. Box 667, Pretoria 0001, South Africa tel. 2;l-tZ-35411,47 - Fax: ++ 27-12-3541758 - E-mail: prozesky@medic.up.ac.za professor Vincent H. Resh, Department of Environmental Science, Policy and Management, University of Californi a, 2O1r Wellman Hall, Berkeley, Calif orn ia 9 47 20, US A Tel. (510) 6423327 - Fax (510) 642-7428 - E-mail: vresh@nature.berkeley.edu Docteur Mamadou Soungalo Traor6 European Commission, birectorate-General, Research, SDME 1/150,200 Rue de la Loi, B- 1049, Bruxelles-wetstraat 200, Belgique - Tel: (+32-2) 296'16'65 - Fax: 32 2296'62'52' - E-mail: mamadou.traore@cec.eu. int Dr Yoichi Yamagata senior Advisor, Japan International Cooperation Agency 0ICA), 10-5 Honmura-cho, Ichigaya, Shinjuku, Tokyo, 162-8433, |apan - Tel. +81-3-3269-3851. - Fax: +81-3-3269-6992 - E-mail: yoiti@jica. go.jP Mrs Fatu Yumkella C/o The Programme for International Training in Health (INTRAH), P'O. Box 44958, Nairobi, Kenya, T el: 254-2- 229 67 O - F ax: 254-2 226824, E. mail: fy umkella@intrah. org Dr Bernard Philippon, Charg€ de Mission Sant6, Institut de Recherche Pour le D6veloppement gRb), Departement Soci6t6s & Sant6, 213 Rue La Fayette, 75010 Paris c6dex 10, T61.331 48037709 - Fax:331 48037806, E-mail : philipPo@paris.ird.fr Dr Andr6 Yebakima, Entomologiste m6dical, Centre de D6moustification, Conseil g6n6ral, B.P. 658, Bd. Pasteur , g72OO Fort-de-France, Martinique - T6l. : 05 96 60 37 21 - Fax : 05 9670 26 46 - E-ma il: yebakima@wanadoo.fr / vebakima@cs972.fr prof J. Dik F. Habbema, Erasmus University Rotterdam, Faculty of Medicine and Health Sciences, Department of Public Health, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands Tel. : +31 10 408 T985/771,4 - Fax : +31 10 4089455/9449 -E-mail : habbema@mgz.fgg.eur.nl I lPC22.3 Page 3 National Coordinators Dr Eku6 Julius Gaba, Coordonnateur national du Prograrune de Iutte contre l'Onchocercose, Ministdre de la Sant6 publique, BP 882, Cotonou, Bdnin, T€1./Fax: (229) 31,74 09 Dr Gbayoro Pierre Brika, Directeur ex6cutif du Programme national de la D6volution Programme de lutte contre l'onchocercose,0L BP 515 Bouak6 0L, Cdte d'Ivoire - Fax (225) 31 63 98 29,Tel: (225) 31, 63 20 8'1-., Cell. (225) 08 60 36, E-mail: brika@aviso.ci Dr Kofi Ahmed, Director Onchocerciasis Control, Ministry of Health, P.O. Box M.44, Accra, Ghana - Fax: (233) 21. 66381..0, Tel. : (233) 21. 68 4275, E-mail : ghorrcho@Africaonline.com.gh Dr Mamadou Oumar Traor6, Coordonnateur national du Programme de lutte contre l'onchocercose, BP 228, Bamako, Mali - Fax: (223) 2317 21,, Tel: Bur. (223) 22 64 97, Dom. (223) 24 97 83 - E-mail : oncho. ma li@spider. toolnet. org Dr (Mme) Salamatou Diallo, Coordonnateur national de la Ddvolution, Programme de Lutte contre l'Onchocercose, BP 851, Niamey, Niger, Fax: (227)7520 62,Tel: (227)752279 Dr B. Kargbo, National Coordinator Oncho Control Programme, Ministry of Health and Sanitation, Youyi Building, Freetown, Sierra Leone Tel : (00 n4 22220469/ 76 677052 - Fax : 0023222227373 - E-mail : brimakarsbo@hotmail.com Dr A. Dar€, Coordonnateur national du Prograrrune de lutte contre l'onchocercose, Directeur r6gionaldelaSant6,B.P.4ST,Kara,Togo-Tel: (228)600047 / 60171,0 -Fax: (228)600474 Dr Souleymane Sanou, Coordonnateur national du Programme de Ddvolution Oncho, 03 BP 7009, Ouagadougou 03, Burkina Faso, T6l. (226) 30 87 90 -Fax: (226) 33 49 38 wHo/HQ Dr Marc Karam, WHO/CDS/CEE, Geneva Tel.: +41227914389/4630/4743 - Fax: + 4122791,4777 - E-mail: Karamm@who.int Dr J.H.F. Remme, Coordinator Onchocerciasis and Lymphatic Filariasis Research, TRD, WHO/HQ Geneva Tel: +4122791.381.5 - Fax : +41227914774 - E-mail: remmej@who.int wHo/AFRO Dr A. Kabor6, DDC/AFRO, Harare Dr S. Bugri, IDS Programme Manager, c/o WHO Ouagadougou E-mail : bugris@oncho.oms.bf WHO-APOC Dr A. ftk6teli, Director, African Programme for Onchocerciasis Control, Ouagadougou lPC22.3 Page 4 WHO.OCP Dr Boakye A. Boatin, Director, Onchocerciasis Control Programme, Ouagadougou Dr H. Agoua, Vector Control Unit, Onchocerciasis Control Programme, Kara Mr A. Ak6, Vector Control Unit, Onchocerciasis Control Programme, Odienn6 Dr L.K.B. Akpoboua, Vector Control Unit, Onchocerciasis Control Programme, Ouagadougou Miss Angela Baffoe, Onchocerciasis Control Programme, Ouagadougou Mr P.R. B6lemgoabga, Onchocerciasis Control Programme, Ouagadougou Dr Y. Bissan, Vector Control Unit, Onchocerciasis Control Programme, Odienn6 Dr O.W. Christensen, Consultant, Onchocerciasis Control Programme, Geneva Mr A. Daribi, Onchocerciasis Control Programme, Geneva Prof M. Kabor6, Translator, Onchocerciasis Control Programme, Ouagadougou Mr V. K6r6, Vector Control Unit, Onchocerciasis Control Programme, Ouagadougou DrJ.Lazdins, Manager, Macrofil Project, Onchocerciasis Conhol Programme, Geneva Mr ].P. Thirion, Administration & Finance Officer (AFO) Onchocerciasis Control Programme, Ouagadougou Mr S. N'Gadjaga, Biostatistics and Information System Unit, Ouagadougou Mr M. Sarr, Vector Control Unit, Onchocerciasis Control Programme, Odiennd Dr K.E.M. Siamdvi, Planning, Evaluation and Transfer Unit, Onchocerciasis Control Programme, Ouagadougou Dr A. Soumbey, Chief, Biostatistics and Information System Unit, Ouagadougou Dr L. To6, Vector Control Unit, Onchocerciasis Control Programme, Ouagadougou Dr L. Yam6ogo, Chief Vector Control Unit, Onchocerciasis Control Programme, Ouagadougou a , a. b. lPC22.3 Page 5 EXECUTTVE SUMMARY AND RECOMMENDATIONS The twenty-second session of EAC was held at OCP Headquarters from 4 to 8 June, with Professor Adenike Abiose in the Chair. She stressed the importance of this session which is the penultimate one before closure of OCP operations and from which the Programme expected advise and recommendations regarding its remaining activities to ensure that OCP might come to a successful end . Dr Antoine Kabor6, representing the WHO Regional Director for Africa, referred to OCP as a programme of which Africa could be proud. It was achieving its objective after more that 25 years of control operations. The Programme Director, Dr Boakye Boatin, asked the Committee for guidance on a number of issues of prime interest to OCP activities during the last 1 % years of its life, including the efficacy of ground larviciding; future control activities in Sierra Leone; Community-directed Treatment with Ivermectin (CDTI); cross-border collaboration; the attitude to take faced with the possibility of ivermectin (Mectizan @ ) resistance; the DEC patch test; and the closure of OCP. Dr Boatin informed the Committee that practically all its recommendations adopted at its session in 2000 had been followed by the Programme. The Chair then summarised her report to the December 2000 session of the Joint Programme Committee flPC) on the proceedings of last yeay's EAC session. Hydrobiolog.v The Ecological Group recommended that a search be made for historical environmental data from the pre-OCP era for use in determining the current ecological state in the onchocerciasis-freed zones. It was further recommended that the non-technicalbrochure on the work of the Ecological Group be published by OCP and that a steering Committee to plan for the writting up of synopses of scientific results from monitoring activities be established. The Group concluded that large- scale treatment with ivermectin had no detrimental impact on the environment and did not pose a risk to terrestrial organisms. It was decided to continue monitoring activities along the same lines as those carried out in 2000 until the end of 2002. Visits of EAC Members to the Programme area Dr Bernard Philippon, reporting on a visit to Mali, expressed doubt as to the efficacy of ground larviciding for vector control in large and long stretches of rivers. Dr Yoichi Yamagata reported on his visit to Togo indicating that on the whole there was good accePtance of CDTI by the communities after an initial skepticism. Dr Andr6 Yebakima had visited COte d'lvoire and Guinea. He stressed the importance of community participation in, and ownership of CDTI and insisted on increased entomological surveillance in "Special Intervention Zones" Professor Detlef Prozesky presented his findings of a study on the motivation of health centre nurses in CDTI areas carried out in Benin and made a plea that the motivation of CDTI workers be tackled systematically through operational research. a c d e, t a 8. h. lPC22.3 Page 6 k. m. n Vector control EAC was informed that the findings of entomological surveillance were, on the whole, satisfactory. Operations had been intensified in the "special intervention zones" with good results. Field studies and investigations focused on the characteristics of vector and parasite populations to determine the risk, if any, of transmission after the end of OCP operations. Susceptibility testing continued and national teams were involved in these research activities. Additional national entomologists would be trained so as to ensure proper entomological surveillance in the post-OCP era. Planninq, evaluation and transfer The activities during the period under review focused on support to countries in their implementation of transferred activities which included strengthened collaboration in the fields of Community-directed Treatment with Ivermectin (CDTI), epidemiological and ophthalmological evaluation and data collection and analysis. CDTI operations were on the whole satisfactory with good geographical and therapeutic coverage as demonstrated by an external evaluation. All countries, with the exception of two, now ordered ivermectin supplies directly from the Mectizan Donation Program (MDP). The results of epidemiological, entomological and ophthalmological surveillance/evaluation were satisfactory although certain "special intervention zones" required particular attention. In this connection EAC recommended a proposal for continued aerial larviciding beyond closure of OCP, and without additional Donor financing, in four such zones, two in the east of the Programme area and two in the West. Retraining of national staff took place during surveillance and evaluation exercises thus allowing for effective transfer of data to the field level. The Committee heard a statement by Dr Hans Remme on intervention research by TDR. A multi-country study of drug delivery methods for lymphatic filariasis had demonstrated the effectiveness of community-directed treatment (achieving 77% - 88% treatment coverage) as compared to mass treatment by the regular health services (with only 447o - 47% coverage). Priority actions to be taken durinq the last lrh years OCP operations This agenda item was considered in three working groups which reported to Plenary: " Vector control" , " Community-directed Treatment with laermectin" and " Epidemiological Surueillance". Macrofil The Committee was informed about the progress being made in the fields of clinical studies; pre-clinical activities; and drug discovery. Moxidectin studies were in the final stage for investigation in humans. A special investigation was being carried out to determine the reasons for non-response to ivermectin in a small grouP of people. The search for an ivermectin resistance detection tool continued as did the development of the DEC Path Test. Closure of OCP a t. ? o EAC was informed about recent developments in the preparation for the closure of OCP. P. IPC22.3 PageT Progress of APOC Dr Azodoga S6k6t6li, Director of APOC, informed the Committee about the preparations for Phase II and the Phasing-out Period of the Programme. Report on TDR Operational Research A summary description of recent modifications in the TDR structure and of planned TDR operational research in support to OCP and APOC operations was provided by Dr Hans Remme. Cochrane Library review The Committee decided to respond to the review by a letter to a scientific journal. Other matters A presentation on integrated data analysis was made by Dr N. Nagelkerke of the Rotterdam University. q a r s t '.22.3 ie8 OPENING OF THE SESSION Therwenry-SecondsessionoftheExpertAdvisoryCommittee.heJdatthe rdquarters of oCP, was oPened by the Chair of tt'" Committee' Professor Adenike Abiose' : welcomed Professor Oit Uabbema as a new Member of the Committee' and Dr Antoine bor6, Director, Communicable Diseases Control in the wHo Regional office for Africa' ro is also a Member of the oCP-APOC Committee of sponsoring Agencies (CSA)' she also lcomed Dr M Hacen, WHO Representative in Burkini Faso, Drs Hans Remme and Marc ram from wHO heaiquarte.r, th" National onchocerciasis Coordinators and Dr Azodoga (6t61i, Director of APOC' Professor Abiose stressed the importance of this EAC session which was the last but e before the closure of oCP and on which the Programme depended fo-r advice on the naining 18 months or op"*ions, on the closure of the Programme' as well as on guidance the participating Countries concerning the post-oCP suiveillance and control activities luired for maintiining the achievements of the Programme' DrAntoineKabor6,representingthewHoRegionalDirectorforAfricawho p."r*J his regrets for being unable to ittend the session' referred to OCP as a Programme which Africa could u" p.oia. It had managed to transfer methodologies and tools to the rrticipating Countries ir, ti^" for them to te ready to undertake effective detection and rntrol of any localis"d .".r,.rd"scence of onchocerciasis transmission that might arise after CPcametoanend.TheProgra[unewassucceedinginachievingitsobjectivetoeliminate ," di,u,," as a problem of public health and socio-economic importance. TheDirectorofOCP,DrBoakyeBoatin,inwelcomingEAC.Membersandother articipants to OCP and Ouagadougou, underlined the importance of the annual sessions of AC for the programme, occisionr-*h..t OCP staff obtained solid scientific knowledge and perational .*p.ri.n.", essential for the work of the Programme' H: *u:-particularly leased that Dr Kabor6 had been able to attend the session uJt"pt"s"tttative of Dr Samba' . He particularly looked forward to the Committee's recommendations regarding ;suesofprimeinteresttothefinalstagesofoCPi.I:ll"twhichincludedguidanceon ontinuing larviciding in some specific.'u."u, beyond 2002 and', in this connection' on the :asibility and efficacy of ground larvicjding. fhl Ptgg-tlT-e Director also referred to the ituation in Sierra Llone and solicited thJ view of gaC ott the possible impact of the uspension of treatment in that country on Guinea and Mali' ,. As regards Community-directed Treatment with Ivermectin (CDTI)' Dr Boatin eferred to the implementation of previous EAC recommendations and encouraged the rommittee to come up with further iuggestions to ensure viabre CDTI in the Participating lountries. He also invited suggestion, oi ho* to enhance cross-border common issues and nter-country collaboration and activities' z. The possibility of ivermectin (Mectizan @ ) resistance should not be dismissed and ;uggestionswouldbewelcomedastohowtodealwithsuchresistance.Difficultieshad lrisen in regard to the signing of a Memorandum of Understanding with a commercial firm for the development of -the bgC patcn Test and, again, any suggestions for solving the problem would be welcomed' g. Preparations for the closure of oCP were well underway with the help of a committee appointed by the n"gi"."r Director of wHo/AFRO and chaired by Dr Kabor6' should any o I CIPC22.3 Page 9 EAC Member have had experience with the closure of a project or programme of similar magnitude, that experience might be useful for the future work of Dr Kabor€'s committee B. ADOPTION OF THE AGENDA g. The provisional agenda, Revision 2, as reflected in the list of contents of the present report, was adopted. FOLLOW.UP TO THE RECOMMENDATIONS OF THE TWENTY-FIRST SESSION OF THE EXPERT ADVISORY COMMITTEE 10. Dr Boatin, in referring to Annex 2 to the EAC21 report ("List of EAC21 Recommendations") informed the Committee that practically all its recommendations had been implemented. D MATTERS ARISING FROM THE TWENTY-FIRST SESSION OF THE IOINT PROGRAMME COMMITTEE 11. The following points came up during IPC21. and the Joint JPC-JAF6 Session in connection with Professor Abiose's report to JPC21 on the EAC21 proceedings: satisfaction was expressed about the progress of OCP and its preparation for closure; there was a call for strengthened ownership by communities of their CDTI projects and for a study on the impact of ivermectin treatment on transmission; a decision regarding a proposed " soft" loan by the World Bank for vector control and larviciding in Sierra Leone would be taken in the light of the findings of a special study by OCP concerning the risk of re-invasion from Sierra Leone to neighbouring countries; the plans for establishing an AFRO Multidisease Surveillance Centre (MDSC) with the help of OCP facilities and its means of communication was welcomed by JPC ; JPC supported the FAO initiative for support to socio-economic development in oncho-freed zones and agreed to the planned West African Freshwater and Management Project establishing its headquarters in the AFRO Multidisease Surveillance Centre; the Joint JPC2L-JAF6 Session agreed to JPC and APOC collaborating with the Lymphatic Filariasis Elimination Programme in co-endemic zones, excluding hypo-endemic areas; the |oint Programme Committee approved the OCP Plan of Action for 200L and the corresponding budget in the order of US$ 1,4770 000. *** Administrative briefing 12. As in previous years, the Administrative and Finance Unit provided, in addition to its support of OCP operations, services to APOC in respect to Personnel, Finance, transport and purchase of equipment. The Unit had been strengthened by a Translation Section and a Section responsible for the organization of Statutory Meetings. 13. With the scrapping of old vehicles and no purchase of new ones, the reduction in the fleet continued. The Garage activities were directed to more efficient maintenance of the vehicles and increased training for the drivers in order to reduce breakdowns. I a IPC22.3 Page 10 '14. The OCP radio network, connecting all the Participating Countries, facilitated communications with, and among,, National Coordinators as did the Codan radios equipped with cc-mail facilities. 15. Arrangements had been made at OCP Headquarters for increased efficiency in consultation on the Web and exchange of e-mail and other information. 16. As the Programme is nearing its end, the purchase of equipment is steadily decreasing. 17. The number of staff in OCP had been reduced to 278 of whom 92 were on WHO status and the remainder employed under different arrangements (e.9. Special Service Agreement). The Programme continued to provide certain benefits to 279 nationally employed staff working in their own countries under OCP technical and administrative supervision. 18. Special efforts continued to prepare OCP staff for their departure from the Programme at its end of operations. Training was provided in such fields as secretariat, documentation, informatics, vehicle mechanics, finance and laboratory work to qualify the staff for new activities after the closure of OCP. E. REVIEW OF THE REPORT OF THE TWENTY.SECOND SESSION OF THE ECOLOGICAL GROUP I 19. The report was introduced by Professor Vincent Resh, Chair of the Ecological Group, who pointed out that six of the eight recommendations made by the Group at its session in 2000 had been implemented. As to last year/s recorrunendation conceming "Land-use Changes as Part of Environmental Monitoring in Oncho-freed Zones", the Ecological Group recommended at its recent session that a search should be made for historical data on the occupational and ecological state in zones later freed from onchocerciasis, before determining the ecological state of oncho-freed zones at the end of the Programme. Inquiries should therefore be made regarding the availability of remote sensing information on study sites and related areas. 20. As regards the preparation of synopses of scientific results from monitoring activities, also recommended by the Ecological Group a year ago, the Group now recommended, that a non-technical brochure prepared by a team be published by OCP, and that a Steering Committee to plan the preparation of a technical volume should be established during the current year. 21,. On the specific issue of the impact of ivermectin on the environment, it was pointed out that as the molecule was strongly bounded to the soil with rapid degradation, the risk of contamination of the aquatic environment, for which the drug is highly toxic, was almost non-existent. As emissions occurred during two to three days only after the treatment and was limited to areas immediately surrounding the villages, the risk to terrestrial organisms was also limited. 22. A Member of the Ecological Group had undertaken a cost-benefit analysis of the Group's contribution to OCP which concluded that the consequences of acceptance of the recommendations of the Ecological Group could be estimated at an Internal Rate of Return of at least 31% which is extremely high. t aIPC22.3 Page 11 ?3. The Group expressed, once again, its satisfaction with the results of vector control during the preceding year when the Annual Transmission Potential (ATP) of savanna species, with only one or two exceptions, fell well below 100. The Group also noted the satisfactory performance of B.f. H-14 which was being increasingly applied in preference to chemical larvicides. 24. Regarding monitoring activities until the end of OCP operations, it was recommended that they should centre on the same watercourses and at the same frequency as in 2000. 25. It was finally recommended that OCP should collaborate with the West African Freshwater Biodiversity and conservation Project ready for implementation once financing by the Global Environmental Fund had been secured. REPORTS ON THE VISITS OF EAC MEMBERS TO THE PROGRAMME AREA 26. Dr Bernard Philippon in reporting on his visit in Mali to Baguineda and S6lingu6, stated that both foci were situated in previously hyper-endemic areas with considerable importance for socio-economic development. They were both under ivermectin treatment and would qualify for nuisance control by ground larviciding. 27. In the Niger area near Bamako, ground larviciding had shown good results but after cessation in 2002 the nuisance factor was likely to retum and larviciding might need to continue. 28. As to post-OCP surveillance and control of onchocerciasis and blackfly nuisance, activity plans should be developed even now. EAC comments 29. Dr Philippon expressed as his opinion that ground larviciding could be an effective means of nuisance control in restricted and isolated foci but not for the control of transmission on large river basins, Iong stretches of rivers, high discharge rates and difficult accessible terrains. After the end of OCP operations the control, wherever needed, would rely on intensified Community-directed Treatment with Ivermectin (CDTI). In this connection, the question was posed if after 2002, there would be a need for aerial larviciding in certain foci where transmission was still ongoing. 30. A report on a visit to Togo was provided by Dr Yoichi Yamagata. The purposes of his visit were to evaluate entomological achievements in the Upper Keran and Lower Kara basins; to evaluate CDTI implementation; and to make suggestions for post-OCP activities. His impressions can be summarised as follows: ground larviciding on the Kara and Keran would be sporadically possible during the dry season but almost impossible during the rainy season; sporadic ivermectin distribution by mobile teams started in 1988 while CDTI started in 1997 followed by twice yearly applications only since 2000; problems in the implementation of CDTI included lack of motivation of Community-directed Distributors (CDDs); failure of updating of community census and heighu and registers not available; good acceptance of CDTI after a couple of years of refusal and skepticism; F t lPc22.3 Page12 there was a great deal of misinterpretation of the onchocerciasis-related vocabulary and many questions apparently unrelated to the treatment were asked at the community level; they showed, however keen interest and deserved serious consideration and answers by the CDDs and health centre staff. He made the following suggestions and recommendations : there was a need to improve the format of registers; in some villages, the number of CDDs should be increased; all possible means of motivation of CDDs should be explored; they should be provided with bicycles and a stock of pamphlets; health centre nurses should ensure that CDTI periods conform with the prospect of maximum therapeutical coverage; they should consider CDDs as equal partners and return to them registers u'ithout delay; Regional Onchocerciasis Teams should promote the Bamako Initiative; ensure oncho information through radio broadcasts; and arrange for refresher courses foi CDDs; 31. The National Onchocerciasis Teams should budget for bicycles, advocate for funds, draft teaching material for CDDs and update oncho pamphlets. EAC nts: 32. In reply to a question regarding the justification for twice yearly ivermectin treatment in the Upper Keran valley, it was explained that the purpose was to intensify the reduction of transmission even if the possibility of increased selection for resistance could not be excluded. 33. It was suggested that consistenry of reviews and reporting should be attempted for future country visits by EAC Members. 34. Dr Andr6 Yebakima reported on his visits to C6te d'Ivoire and Guinea. As to ivermectin distribution, he stressed in conclusion, that the efficienry of CDTI depended not only on the effectiveness of ivermectin but also on a satisfactory supply of the drug, on the quality and involvement of CDDs as well as on an ongoing evaluation. More specifically, he had observed that although a great deal of treatment data and other information existed they were not always being used by the CDDs for the organisation of their work. 35. Dr Yebakima made a series of recommendations relating to specific situations regarding CDTI in the villages visited, including: the need for the CDDs and health centre nurses to acquaint themselves with the most important social data of the village populations; to promote community participation and ownership through information sessions for community leaders. 36. In respect to vector control, Dr Yebakima underlined the importance of increased entomologicaI evaluation in "Special Intervention Zones" under larviciding. 37. In referring to the breeding sites on the Mafou river (Yalawa, Guinea), he did not believe that ground treatment would be possible during the rainy season (although feasible during the dry season) due to difficulties in accessibility. He called for intensive discussion on future vector control and entomological evaluation in this, as in other zones with similar problems. t t JIPC22.3 Page L3 38. Dr Yebakima did not have the necessary information allowing him to pronounce on the situation in C6te d'Ivoire regarding Transfer of OCP activities and preparedness for post- OCP surveillance and control. His impression in Guinea was that the structure and staff were in place to en'sure effective operations. All possible efforts should be made to maintain the "OCP dynamic" after the Programme came to an end. Both in COte d'Ivoire and in Guinea, did he observe experienced and motivated teams at work. EAC comments 39. On the question of motivation of CDDs, it was pointed out that lack of commitment could, among other consequences, result in poor filling out of records. In this connection it was suggested that a satisfactory level of motivation did not necessarily result from financial incentives, other aspects like "satisfaction to serve" might be equally important. However, there was a need for those responsible for national CDTI programmes to consult with other programmes providing incentives to their health workers in order to avoid competition for recruitment of field workers. 40. The question was raised whether or not the CDTI mode of distribution was the only method to be applied or if other means of ensuring ivermectin reaching people in the communities should be explored. 41,. Prof. Detlef Prozesky made a presentation on the research he had done in Benin, conceming the level of motivation of health centre nurses in CDTI areas, and the factors influencing that. This followed on the previous year's similar presentation on the motivation of CDDs. The research was done in partnership with the National Coordinator in Benin, Dr ]ulius Gaba, and his deputy Dr Franck Sintondji. 42. It was found that, out of 14 nurses, only 6 were highly motivated for CDTI activities, and 3 had low motivation. The factors that facilitated motivation, or were obstacles to it, had first and foremost to do with the support the nurses received from the health service, and their relationship with the communities in which they worked. Prof. Prozesky made a plea that the question of motivation of CDTI workers be tackled systematically,by clarifying their motivational state through research; making interventions based on findings; and evaluating the result. EAC comments 43. Governments in newly independent countries had originally assumed responsibility for health care, a responsibility which people were only now beginning to take over, resulting in community-directed treatment. It was important that communities assumed full ownership of such treatment and ensured the appointment of capable and effective Community-directed Drug Distributors (CDDs). 44. It was also important to note that motivation correlated with the performance level, which was the visible result of energy spent by health staff. 45. Onchocerciasis control would not be a priority concem for health centre staff (nurses) and would therefore need to be integrated with other health development programmes ensuring, however, that sufficient attention and support be given to CDTI activities when carried out once, or twice, a year. { JPC22.3 Page1.4 46. Consideration also needed to be given to the duration of ivermectin treatment - 20 years or more while nurses frequently moved from one health centre to another every five years or so. G. REVIEW OF SCIENTIFIC, OPERATIONAL AND TECHNICAL ISSUES 47. EAC noted the generally satisfactory epidemiological and entomological situation within the Programme area. VECTOR CONTROL Prosramme report 48. During the period under review the entomological results were satisfactory with declining transmission trends throughout the Programme area. All catches in a total of 1'07 catchhgfpoints showed Annual Transmission Potentials (ATPs) below 100 when limiting the counts to savanna species transmittin g Onchocerca aoluulus with the exception of two points: Vialadougou on the Sassandra in the Western Zone (ATP 147) and Djabata on the Okpara in the Eastern Zone close to the border with Nigeria (ATP 2aa)' 49. Larviciding during 2000 remained practically unchanged from that of-the preceding year. How"*r"., op"rutions were disturbed in the basins of the Kolent6 and Kaba-Mongo iiu"., due to rebel incursions from Sierra Leone. Operations were intensified in the "specific intervention areas". Pilots were frequently accompanied by OCP staff; ground or aerial prospections were also intensified; ground treatments were largely carried out by the fp.r"tio.,rl bases to complement aerial larviciding; and new access roads to the breeding sites were identified. 50. The aerial fleet stood at 5 helicopters to be reduc6d to three during 2002, the last year of OCP operations. In the year 2000, Iarvicide consumption rose by 12% from that of 1999 due to the proportional increase in the use of biological insecticides to minimise the risk of resistance to chemical insecticides. 51. Field studies and investigations focused on the characteristics of vector and parasite populations with a view to determining the risk of such populations transmitting inihocerciasis after the cessation of OCP control. The main emphasis has been on the characteristics of Simulium sirbanum and the possibiliry of it being involved in transmitting through its seasonal migration from Sierra Leone to Guinea and Mali. SZ. The Programme continued susceptibility testing of Simulium larvae to organophosphorous compounds as well as field and laboratory studies designed to improve the formula[ions of Bacillus thurengiensisH14 compounds (Vetobac and Teknar). Much of the research activities rvere conducted with the participation of the national teams which were thus familiarised rvith field research and investigation methodologies and techniques in preparation for their involvement in such activities after OCP came to an end. 53. The Vector Control Unit has strengthened the involvement of the national entomologists in its activities through a) studies of the level of infectivity of the vector, b) their participation in the daily activities of the operational bases, and c) the writing up of synthlsis documents on the activities of the Programme in the main river basins. Former drcp rtuff members have also contributed to this last mentioned exercise. t .. jJPC22.3 Page 15 54. Additional national entomologists would be trained during the current year to increase the national capability to address entomological issues. Training modules had been finalised to support this training at the national level. PLANNING, EVALUATION AND TRANSFER Proeramme report+ 55. During the period under review, the Programme concentrated its efforts to ensure the effective implementation by national health authorities of transferred activities. The support to ivermectin distribution was strengthened as was the collaboration with Participating Countries in the fields of epidemiological and ophthalmological surveillance and evaluation with particular emphasis on data gathering, processing and analysis. 56. Distribution of ivermectin through the mode of Community-directed Treatment with Ivermectin (CDTI), adopted by all OCP countries, covered 7.3 million people out of 9.8 million registered (mean therapeutic coverage of 7a%) in 20 441, villages (mean geographic coverage: 97% in six countries Benin, Burkina Faso, Guinea, Mali, Senegal and Togo). In Ghana the annual treatment began at the end of 2000 and during the first quarter of 2001 with a few treatments carried out in C6te d'lvoire. In Sierra Leone, training and community treatment were conducted in the south of the country with financial support by OCP and Sight Savers Intemational. Epidemiological evaluation was planned in Guinea-Bissau to decide on the advisability of resuming CDTI after three years suspension in the Rio Geba and the River Corubal basins. 57. The findings of an external evaluation carried out in Benin, Ghana, Guinea and Mali were presented by the Coordinator of Mali, Dr Mamadou O Traor6 who reported that the CDTI approach was well established in the four countries visited. The mean geographical coverage was found to be 85.8% and the mean therapeutic coverage 75.7%. However, additional efforts were required in the field of sensitisation of the communities. 58. The communities paid particular attention to the choice of CDDs, their motivation and a regular and sufficient supply of ivermectin. Monitoring and supervision at the level of the communities and the health centre staff should be reinforced. Support by "Health and Social Services" workers should be solicited for strengthening community involvement. 59. With the exception of Guinea-Bissau and Niger, all OCP countries now ordered their supplies of ivermectin directly from the Mectizan Donation Program (MDP). Monitoring was strengthened in areas with unacceptable levels of transmission as well as in areas where ivermectin treatment might possibly cease as the epidemiological situation was highly satisfactory. 60. Epidemiological surveillance in the Original Programme Area was conducted in almost 90 villages in Benin, Burkina Faso, C6te d'Ivoire, Ghana and Niger. The findings ranged from satisfactory to excellent with the majority of the river basins showing zero prevalence. However, an investigation into the incidence of more than 1%, observed in two villages in the N'Zi basin in C6te d'lvoire, seemed to indicate that it was a local phenomenon. Ivermectin treatment would be implemented in these areas. Also, in the river basins of Sissili in Ghana and of Oti and its tributaries in Benin, Togo and Ghana under ivermectin treatment, the epidemiological situation remained unsatisfactory and called for a special study. a IPC22.3 Page1.6 61,. In the Extension Areas, epidemiological evaluation was undertaken in 242 villages in Benin Ghana, Guinea, Mali, Senegal and Togo under combined vector control/ivermectin treatment or exclusive ivermectin treatment. In those basins where vector control would cease end-2001 (Sankarani, Dion, Milo and Kaba in Guinea; Amou, Anie, Asukawkaw/Dayi and Mono in Togo; and tributaries of Lake Volta East to the Dayi and Asukawkaw river basins in Ghana) the evaluation results were on the whole satisfactory. In those zones in Guinea, Mali and Senegal where ivermectin distribution was the only means of onchocerciasis control, the results of evaluation were excellent with more than 40% reduction in prevalence of infection, which reached 80% in some villages before the start of large-scale ivermectin treatment. 62. To determine the impact of vector control in the Original Programme Area, ophthalmological evaluation was carried out in seven villages in Burkina Faso, three in COte d'lvoire and three villages in Ghana. Preliminary results showe d total absence of microfilariae and ocular lesions in most of the villages while new ocular lesions were detected in the villages of Mouvielo in the Bougouriba basin in Burkina Faso and the village of Kayoro in the Sisili basin in Ghana. Apart from villages in Asubende on the Pru and Kayoro on the Sisili, no new evolutionary lesions were found in the Extension Areas in Ghana, Guinea and Mali. 63. A rapid test for the detection of IgG4 antibodies of. O. oolaulus was carried out in 12 villages of six countries where transmission had been intemrpted, in areas where transmission had resumed, as in Burkina Faso, and in forest zones in COte d'Ivoire. The analysis of the results in ongoing. 64. Integrated analysis of the entomo-epidemiological OCP data continued in collaboration with the Erasmus University of Rotterdam in order to improve epidemiological predictions made by the ONCHOSIM model and with a view to making the model a useful tool for the Participating Countries. Work also continued on the use of integrated analysis to study the impact of long-term ivermectin treatment on kansmission. s 65. Retraining of national field staff was reinforced during the implementation of epidemiological evaluations in consonance with Participating Countries to ensure transfer of data to the peripheral level. planning and the interest of j t EAC comments and ations 66. In response to a suggestion by the OCP Management that it miSht be necessary to continue aerial larviciding beyond 2002 in the Oti tributaries (Kara, Keram-Mo) in Togo, the river Pru in Ghana, and Tinkisso (village Fifa) and Mafou in Guinea , Members of the Committee posed questions concerning the duration of the proposed aerial larviciding and its cost. 67. The Committee was informed that the aerial larviciding, combined with ivermectin treatment, would be required for 3 to 5 years and that the cost would be in the order of US$ 2.5 million per year, except for 2003 when the larvicide reserve from 2002 would be used, reducing the cost for that year to US$ 1.5 million. 68. This estimate included a minimum of staff to monitor and evaluate the impact of the vector control/CDTI activities. It was suggested in this connection that economist advice be sought to establish cost-efficiency of CDTI alone versus combined aerial larviciding/CDTI operations. tlPC22.3 Page17 69. Given the little time left before OCP comes to an end, it was suggested that EAC Task Force(s) be established to look into specific matters of priority importance and make recommendations for dealing with connected problems. Also, the joint vector control/CDTI activities should be reinforced. 70. The coverage of CDTI remained essential for model predictions and it was pointed out that the omission of treatment of one village could have serious repercussions on other well-covered communities. It was explained, however, that the ONCHOSIM predictions were based on the therapeutic minimal coverage of.65%. 71,. The Committee was informed by the APOC Director that the situation in Sierra Leone had been a major concern expressed recently during visits to Donors in Europe. He hoped it would soon be possible to collect blackflies in the northern part of the country to determine their capacity of transmitting the parasite. This would be more so important as it would be a critical element in the decision-making concerning the World Bank proposal to finance onchocerciasis control in Sierra Leone. In the meantime ivermectin distribution had been organised where conditions so allowed, and in refugee camps. 72. In response to a concern expressed regarding the exclusion of Liberia from OCP control, it was explained that the blackflies were of the forest type and did therefore not pose a risk of transmission of the blinding form of the disease into neighbouring countries. 73. A question was posed why it took so long for the results of the laboratory investigation of community collected blackflies for post-conkol studies to reach the offices of the National Coordinators. The answer given was that the OCP Molecular Laboratory required several thousands blackflies for DNA testing which it could very well take time to collect. National Coordinators should investigate the matter of how village fly catchers were to be motivated after 2002 and take steps to ensure sustainability of this activity. 74. Suggestions were made for expanding the predictive capacity of ONCHOSIM by including parameters on drug resistance and refining simulations to take into consideration a variety of operational conditions. It was pointed out that preliminary studies had been done and that the current updating of the model would take some time. UPDATE ON FILARIASIS INTERVENTION RESEARCH BY TDR 75. Dr. Hans Remme provided an update of the activities of the TDR Task Force on Filariasis Intervention Research. A multi-country study on the implementation and sustainability of CDTI had been completed. Key baseline findings identified that before the introduction of CDTI there was poor communication and interaction between community members and health workers. An enhanced approach to CDTI was tested with as main enhancement local stakeholders meetings of community representatives and health workers. Treatment coverage was similar for enhanced and regular CDTI. The attitude of health workers to CDTI improved over time with both approaches but most significantly with the enhanced approach. It was recommended that control programmes consider the use of local stakeholder meetings to encourage ownership of CDTI by the community and to improve involvement of district health services. 76. A multi-country study of drug delivery methods for lymphatic filariasis had demonstrated the effectiveness of community-directed treatment (achieving 77%-88% treatment coverage) as compared to mass treatment by the regular health services (with only 44%-477, coverage). In this study, CDTI was introduced to the communities by the District a a lPC22.3 Page L8 Health Management Team (DHMT) and the process was effectively managed by the regular health services. A study had also been undertaken of a simple and rapid method for monitoring treatment coverage through questionnaires administered by school teachers to schoolchildren. Coverage estimates obtained by the school survey method proved much inore reliable than those reported using the regular method based on the village register. Follow-up studies were planned to validate the school-based rapid assessment method under large scale application at district level. EAC comments 77. Responding to a concern that the communities involved in the study had benefited from the availability of resources, not available under normal field conditions, it was pointed out that routine CDTI activities in APOC communities had shown no tendency to decrease in efficiency. 78. The matter of "overloadi.g" Community-directed Drug Distributors (CDDs) with activities additional to that of ivermectin distribution had been discussed in various fora, recently in Uganda with the participation of staff from other health development prograrnmes. The overall conclusion was that any decision on additional tasks for the CDDs inouta be taken by the communities which should also ensure that the burden of work did not exceed their capacity. Zg. As to stakeholders meetings, Dr Remme explained that in many cases the first meeting was an opportunity for the various partners to establish contact and that it was only from the second meeting that operational issues and problers were considered. The initiative of calling stakeholders' meetings would mostly come from health centre staff who would see their status increase and at the same time their workload reduced by CDDs taking on certain health-related tasks. The communities would decide on the attendance at stakeholders' meethgs. 80. Some scepticism was expressed regarding the current system of preparation and keeping of records which often lacked direct correlation between the reports and the activities actually performed. There tended to be a great deal of over-reporting. 81. On the question of whether, or not, lack of incentives would result in low-level sustainability, it was emphasised that the communities would decide on the appropriateness/nature of incentives. 82. The importance of community ownership was again emphasised and it was pointed out that instead of "imposing" elements of the CDTI process on the communities, they would need to "find out" themselves. 83. Although the CDTI approach was considered the most appropriate for ivermectin distribution, it needed improvement in its application in several countries as demonstrated by National Coordinators in their reports to OCP. Generally, communities were capable of implementing CDTI in a satisfactory manner if the process was explained to them correctly and introduced in a manner which conformed with true ownership. Also, communities should have full controlover the timing of distribution. 84. Although CDTI was introduced in APOC countries from the beginning of Programme operations, ivermectin distribution had been carried out several years before, supported by Non-governmental Development Organizations (NGDOs) using more a tIPC22.3 Page L9 "vertical" approaches, a situation similar to OCP where the Programme also applied such approaches before shifting over to CDTI. 85. The CDTI concept was based on stable community structures which might even be maintained in refugee camps. Absenteeism should not be a serious problem insofar as the CDDs could ensure that those absent at a particular time were "recuperated" later. 86. The Committee was informed that any deviation from height-determined dosing to a standard treatment (say four tablets to all) would require a change in the registration of ivermectin. BZ. The Director of APOC informed the Committee that the Programme was in the process of publishing in "The Annals of Tropical Medicine" a series of papers on the different aspects of APOC operations. H. PRIORITY ACTIONS TO BE TAKEN DURING THE LAST 71/Z YEARS OF OCP OPERATIONS 88. This agenda item was considered in three working groups for presentation and comments in Plenary. The groups' reports are summarised in this report while their full text can be found in Annexes 3-5. "Vector control" 89. As regards the "special Intervention Zones" (Oti & Pru in Zone East and Tinkisso & Mafou in thsWest) the entomological situation had improved over the past few years, while the prevalence and incidence remained high. This situation called for the continuation of control activities in these river basins after closure of OCP operation by the end of 2002. 90. The working group recommended that updated ONCHOSIM data and predictions concerning the four zones be made available within the next 15 days and that the duration of combined vector and ivermectin control be determined. It was also recommended that an analysis be made within the next 45 days of the reasons for the unsatisfactory situation in the four zones. The group finally recommended that steps be taken to constitute and train national teams in vector control which, after cessation of OCP operations by the end of 2002, would take the form of aerial larviciding in the four special intervention zones. 91,. In respect to the situation in Sierra Leone, it was recommended that CDTI be applied as the sole means of onchocerciasis control. 92. The group furthermore suggested that a vector control/ivermectin treatment working group be established and that an ad hoc session of EAC be held early during2002. 93. In order to obtain support from CSA and the ]oint Programme Committee [PC), it would be necessan'to convince the two bodies of the existing problems, the conditions for maintaining the achievements of OCP, including the need for post-OCP control in exceptional cases, and the need to approach the countries involved. a lPc22.3 Page 20 EAC ts and recommendations 94. It was pointed out in a response to a question that the working group did not consider the structure to support posI-OCP aerial larviciding (see following paragraph). 95. The Committee approved in principle the recommendation to continue aerial larviciding for a few years beyond 2002 with the understanding that this be not considered an extension of OCP operations and that the larviciding could be financed by the OCP Contingency Fund, should the Donors so agree, without seeking additional Donor financing. The final decision regarding the continuation of aerial larviciding in the four "Special Intervention Zones" should, however, await the outcome of the ONCHOSIM predictions. 96. Once the finaldecision was taken to go ahead with combined aerial larviciding/CDTI control in the four "special Intervention Zones", a convincing and well argumented document would need to be presented to CSA and eventually to JPC in December 2001. To strengthen the argument, reference could be made to the deplorable situation that existed before OCP operations started and to the fact that any post-OCP control resulting in the final success would have cost implications in the order of only 1-2 % of the total amount which would have been invested in OCP by end-2002. A document of this nature was already under preparation by the OCP Management. Also it should be stressed that it was not a question to extend OCP beyond end-2002 but that it was a "mopping-up" action to ensure that the zones in question would not become sources of recrudescence. 97. Efforts should be made to strengthen the CDTI process particularly in the four zones and it was recommended that small "special intervention teams" be established to spend time with CDDs, the communities and health staff to provide support and strengthen the ivermectin distribution efforts, the communities retaining full responsibility and direction (see also paragraph 108 below). "Community-directed Treatment with Ivermectin" 98. The group analysed the causes of persistent problems in CDTI, and found that most problems were related to the extent of the lack of integration of onchocerciasis control into the national health system, which varied from country to country. The group thus presented a set of practical recommendations, understanding that they could be selectively adopted according to the specific situation of each country. 99. While the therapeutical coverage had generally met the target, geographical coverage varied and was low in certain zones. This was mainly because of difficult access to some scattered hamlets, in which it was also difficult to find literate persons willing to work for ivermectin distribution. The group recommended that ivermectin treatment should have flexibility in such cases by adopting both passive treatment of clinic attendees and active treatment by health workers. Where needed, appropriate means of transportation might be provided to CDDs by the communities at their discretion. It was further recommended that lists of eligible villages be established before the end of 2002 on the basis of maps updated by the district health staff. OCP should accelerate the development of the pictorial data reporting form to assist CDDs without formal education. 100. Motivation remained a persistent problem at various levels of the health system. National Coordinators should arrange stakeholders' meetings to advocate harmonisation of motivational schemes, while maintaining community directedness. a I a tlPC22.3 Page 21 101. It was emphasized that non-monetary incentives were the most important. Other incentives could include refresher training courses; promoting experienced CDDs assistance to training; providing CDDs with quality Information Education Communication (IEC) materials; acknowledging good performance by rewarding the communities, health centres, and districts with the "best practice"; and acknowledging and responding to reports and queries. District Health Management Teams (DHMT) should also raise the issue of using local sustainable financial resources (e.9. cost recovery for the provision of ivermectin, agricultural co-operative funds and Bamako Initiative funds). 102. National budget for onchocerciasis control existed in most countries, but not easily accessible. District budget also existed but onchocerciasis control was not given priority in some cases. OCP and National Coordinators should prepare advocacy packages for sensitisation of DHMTs on the importance of continued onchocerciasis control to prevent recrudescence. The Director of OCP should continue sensitising governments on the importance of devolution, and urge governments to facilitate the early release of funds for onchocerciasis control activities. OCP should address this issue during the next JPC in Washington. National Coordinators should also mobilise extemal resources for national and district control activities. 103. To ask the community to come twice to the health centre, first to fetch ivermectin and then to bring the register, was unpractical in some cases. During the training of CDDs, agreement should be reached between health workers and CDDs on how the drugs and register were to be transported. Health workers should use the CDD registers while on supervisory visits and not keep them in the health centres. Countries should make their own decisions on the most practical approach to ensure availability of registers. National Coordinators should help ensure smooth flow of ivermectin. 1,04. Supervision was poorly practised in most countries mainly because onchocerciasis was not integrated into the national disease control planning. AFRO should therefore urge govemments to integrate supervision guidelines to cover all prograrrunes, including onchocerciasis control. National Coordinators should initiate actions to establish an integrated supervision check list; the example of COte d'lvoire and Guinea-Bissau could be transferred. National Coordinators should work with relevant departments to include CDTI data in the health information system. 105. Training/retraining needs were high because of weak performance, high staff turn over, newly recruited CDDs and the new ivermectin tablet size. Using the existing manuals and guidelines, front line health workers should be trained/retrained where the need existed. Priorities should be on community entry/re-entry, IEC, management of ivermectin, data reporting, and supervision and monitoring. Basic curricula in onchocerciasis for doctors and nurses were deficient or old-fashioned. Up-to-date training modules should be prepared in English and French for tutors in all under-graduate health care training institutions. Since a variety of IEC materials relevant to onchocerciasis control already existed, National Coordinators should assemble/adapt their own country-specific IEC materials in collaboration with the national IEC officers. National Coordinators should ensure that all CDDs receive an onchocerciasis IEC package before the end of 2002. 106. Northern border regions of Sierra Leone were inaccessible because of persisting civil unrest. No definite plan of operations for onchocerciasis control could be drawn up until security in the area was assured. The National Coordinator should document the situation and guide OCP on the plan of action, especially on when to start training and CDTI. Special entomological studies were to be conducted during the next dry season. Meanwhile the a I lPc22.3 Page22 National Coordinator should continue with CDTI in the southern part of the country and pursue other options for financial support. lO7. There was a need for a better understanding of the cross-border problem. It was iecommended that OCP, with collaboration of relevant countries and APOC, establish a task force to address the technical issues in the cross border areas such as human movement, synchronisation of ivermectin treatment as well as the feasibility of involving commando type of mobile support to CDTI. The Director of APOC would invite Benin to the next seision of the Technical Consultative Committee (TCC) and provide the participants from Benin with the opportunity of field visits in the border area on the Nigerian side' 108. As a matter of urgency countries should consider intervention in areas where the epidemiological situation was unsatisfactory,by putting together crack teams of health workers to work for a few months at village level, to optimise CDTI in all the villages involved. This concerned Guinea, Ghana, Togo and Benin. 109. Indicators were suggested to track the implementation and accomplishment of all the key strategies recommended by the group (see Annex 4). It was suggested that OCP should support the countries' efforts to monitor the situation by means of these indicators. EAC comments and recommendations 110. It was explained that the recorunendations made by the group did not necessarily apply to all situations so that those responsible for CDTI activities would need to consider those which conformed with their needs. Several of the recommendations would be applicable to the "special InterventionZones" - 111. The list of indicators was intended to be used for trend analysis and their use would depend on the feasibility of data collection. Also, the list might usefully be compared with that in use by APOC. It was emphasised that the criteria would be in use, not only for OCP but also for the Participating Countries after the end of Programme operations. The applicability of the indicators would be tested over the coming 18 months. 112. In response to a query as to what would be the criteria for cessation of CDTI activities, the Committee was informed that this matter would be taken up during the forthcoming study on the impact of ivermectin treatment on transmission. 113. As regards the concern expressed that some Participating Countries levied customs duties on ivermectin consignments, it was recommended that contacts should be made with Ministries of Finance and that the WHO Regional Director for Africa might be requested to intervene. 11,4. In respect to the expressed intention for Sierra Leone to be included in APOC operations, it was pointed out that this would require a request from the Government to be considered by the APOC Joint Action Forum- "Epidemiological surveillance" 115. The group dealt with parasitological and entomological surveillance and how this would be affected by the Lymphatic Filariasis (LF) Elimination Programme; the occurrence of ivermectin resistance; and the use of moxidectin. The use of ONCHOSIM modelling and the specific case of Guinea-Bissau were also discussed- a a t aJPC22.3 Page23 116. As to surveillance methods, the group recommended that skin snipping, for the time being, remain the main tool, with entomological surveillance as an additional tool, and that the DEC Patch Test replace skin snipping as soon as possible. The Group further recommended that epidemiological surveillance be reconsidered in areas covered by the LF Elimination Programme and that surveillance systems be developed for both onchocerciasis and LF when the latter came to an end. 1,17. Another recommendation was that national programmes should reinforce monitoring of non-response to ivermectin and that the AFRO Multidisease Surveillance Centre (MDSC) should be capable of detecting drug resistance. It was further recommended that national programmes prepare for monitoring of failure of moxidectin when available; that National Coordinators be trained to understand the concept of the ONCHOSIM model; and that the AFRO MDSC should develop expertise for the use of ONCHOSIM. 118. The group looked forward to the results of a study which would determine whether Guinea-Bissau should undertake large-scale ivermectin treatment or confine the control to case management. 179. Professor Dik Habbema summarised the future development of the ONCHOSIM model as follows: DTI with ivermectin in integrated analysis of OCP epidemiological and entomological data in order to learn more on the effectiveness of CDTI and improving ONCHOSIM in this respect; simulations for both expected coverage and for higher/lower coverage figures; comparison of annual and half-yearly treatment; consideration of different levels of transmission; role of immigration of infected flies and humans; criteria for when to stop CDTI. Surveillance: simulation of possible development of recrudescence in onchocerciasis-freed zones; determination of sensitivity and specificity of different epidemiological/ entomological surveillance strategies. Larviciding beyond 2002: simulation of effectiveness of control strategies in "special intervention zones" based on a combination of aerial larviciding with CDTI, compared to control strategies based on CDTI alone. Macrofilaricide: simulation of the use of a macrofilaricide under different assumptions of effectiveness of the drug. Resistance: simulation of the possible emergence of resistance to ivermectin and its detection by surveillance methods. Dissemination: development of an ONCHOSIM demo-package; exploring the possibility of building up ONCHOSIM expertise in the AFRO Multidisease Surveillance Centre; helping in preparing a workshop for familiarising National Coordinators and data managers with ONCHOSIM. EAC comments and recommendations 1,20. In considering the problem of epidemiological surveillance in areas under lymphatic filariasis control, EAC recommended that negotiations take place between the coordinators of the two Programmes (in some cases one coordinator would be responsible for both) to agree a a IPC22.3 Page24 on the timing of lymphatic filariasis treatment so as to allow effective onchocerciasis epidemiological evaluation to be carried out. 121. The Committee was informed that lymphatic filariasis (LF)was found to be highly prevalent in those areas in the Original Programme areas where no ivermectin treatment had teen carried out, while the prevalence in Extension areas with a long history of ivermectin distribution was considerably lower. It was expected that LF mapping would be completed in most West African countries early next year. I. MACROFIL 122. This agenda item was introduced by Dr Janis Lazdins, Manager of Macrofil. Clinical studies 123. Drug combinations: the Onchocerciasis Chemotherapy Research Centre (OCRC) in Hohoe examined drug combinations (ivermectin + albendazole and levamisole + albendazole or ivermectin) in the control of onchocercasis, revealing that there was no advantage in using these combinations compared to using ivermectin alone. For lymphatic filariasis, efficacy, safety of albendazole + ivermectin or DEC was studied in India and Tanzania. Results were expected for the 4th quarter of 2002. They would guide the Lymphatic Filariasis Elimination Programme and the integration with the onchocerciasis control proSrarnmes. 124. htermectin 'non responders": a collaborative study (OCRC, Ghana National Onchocerciasis Control Programme and Noguchi Memorial Institute for Medical Research in Ghana) to define if the parasites of "non-responders" (more than 10 skin microfilariae per snip after multiple keatments with ivermectin) from Asubende and Bui (Ghana) were resistant to ivermectin had been initiated. The results would be available during the 4tr' Quarter of 2002 (4Q02) and might determine the need to implement key changes in the strategies for control and surveillance of onchocerciasis. 125. Moxidectin: in filarial animal models moxidectin has a better profile than ivermectin (including macrofilaricidal effect). It was promoted for drug development 4Q00. Activities required to be completed before evaluating the effect of this drug in patients with onchocerciasis had been initiated. It was expected to study the drug in infected patients under strict clinical monitoring starting 1Q02 in OCRC. Before further field clinical studies could be initiated, the Onchocerciasis Control Programmes should provide an indication on how a new product such as this would be introduced and used in the field so as to provide an idea on the type and amount of studies that would be required to achieve registration in the most rapid wa1'. 126. Wolbachia: a clinical study to determine if eliminating this endosymbiont of filarial parasites with antibiotics (rifampicin-used in the context of DOTS in tuberculosis patients co- infected with lymphatic filariasis) would kill adult worms, will be started in India (3Q01). This should help to decide the relevance in public health of this approach. Pre-clinical research activities 127. laermectin resistance detection tool: the product development team was addressing the discovery of molecular marker indicative of ivermectin resistance in Onchocerca aolaulus; the experts indicated that while there was no evidence of resistance in O. uolaulus there was also a a aIPC22.3 Page 25 no reason to expect that this may not occur - in many animal parasites exposed to this drug resistance has developed; the team required close interaction with the members of control programmes to have access to parasitological material from different geographical areas that had been exposed to ivermectin treatment. "128. Optimisation of DEC skin patch test; development of a standardised pre-packaged form of this test at an affordable price was feasible; a German company experienced in developing transdermal delivery of drugs had been contacted; while strong initial interest was demonstrated, the progress in reaching an agreement (Memorandum of Understanding) has been slow; active intervention of CSA would be desirable to transmit a message requesting mediation through the representative of the German government in the World Bank with the conlpany in question; furthermore, if such product were to be developed, a consultation to define tl-re national requirements for product release for use should be conducted for which the input of the control programmes would be important; also defining the extent of use by APOC countries would be relevant to establish a negotiating position with the potential manufacturer. Drug discovery activities 129. The emphasis of drug discovery had shifted from evaluating existing drugs in the veterinarian field in animal models to that of identifying specific filarial targets for discovering novel, specific and potent drugs. This was mainly because most of the existing molecules from animal health had been examined with poor results. Specific focus was directed to: inhibitors against aminoacyl-tRNA synthetases; assay for screening novel tubulin ligands; and genetic research (reoerse genetics of C elegans to aalidate nat antiflaial drug targets) with the scope of identifying novel drug discovery targets. Pursuing these activities was of key relevance since the only candidate for clinical testing currently available was moxidectin. 130. On the subject of resistance to ivermectin, Professor Roger Prichard informed the Committee that resistance had occurred in nematode parasites in animals and could occur in Onchocerca aolaulus .Should this happen, it could be a serious threat to OCP and APOC operations and could result in recrudescence. 131. Based on experience of nematode parasites in animals, moxidectin should it be registered for use in humans, was likely to be very useful in reducing the threat of control breakdown due to resistance. 732. Any ivermectin resistance should be detected rapidly, before it spreads. A diagnostic test for this would be needed. Progress had been made on developing a tool for detecting ivermectin resistance in O. uoluulus. However, the test needed optimisation EAC comments and recommendations 133. As to the use of moxidectin, it was explained that it might be applied in large-scale control operations. 734. The DEC Patch Test, once ready for application on a large scale, would be of use not only by OCP and APOC, but also by the Participating Countries for measuring prevalence trends. a a lPc22.3 Page26 135. In response to a question regarding the risk of more than once a year ivermectin treatment selecting for resistance, the Committee was informed that bi-annual treatment was acceptable as long as no cases of resistance were detected. 136. The Committee made the followingrecommendations; a the development of moxidectin for use in humans against Onchocerca uolaulus to be given the highest PrioritY; b. the effects of moxidectin against microfilariae, adult worms, reproduction in adult worms, in t3 and L4, in humans, and on the development of microfilariae to [3 in the vector to be assessed during its developmen| c. following successful development of moxidectin, it be employed against O. oolaulus as soon as possible; d. the development of a diagnostic tool for the detection of ivermectin resistance to be accorded the highest PrioritY; e. surveillance for ivermectin resistance within the OCP/APOC areas to be established as soon as the tool is available; this surveillance is likely to be carried out in association with either entomological surveillance for microfilaria or epidemiological surveillance (skin snips) and will involve samples (e.g. flies) being sent for DNA analysis in the AFRO MDSC; f. to facilitate the development of the ivermectin resistance diagnostic tool, the provision of O. aolaulus material by OCP to the Diagnostic Tool Development Team to be accorded a high priority by OCP. L CLOSURE OF OCP 137. In view of the closure of OCP on31./L2/2002 the Regional Director of WHO/AFRO had set up a working $oup chaired by Dr A. Kabor6 (DDC/AFRO) and comprising staff members of AFRO Regional Office, OCP and APOC. The working group had to make recommendations on redeployment, whenever possible, of staff and on disposal of the assets. 138. Staff assistance would consist in training to facilitate employment search after closure of OCP, forwarding of CV's to all possible organisations of the United System, WHO, ApOC, WRs and NGDOs. The Programme would also authorise staff members to leave the programme before 31,/12/2OOZ without losing their rights, in case employment opportunity arisis. The disposal of Programme property would be conditioned by the Memorandum of Understanding signed between the Programme and the eleven OCP countries in September 1997. l3g. The two operational Units of OCP, Vector Control Unit and Planning, Evaluation and Transfer Unit will progressively end their operations during2002. Nevertheless the Vector Control Unit would hive to extend its activities beyond 2002 for a few months in order to definitely close all field activities, larviciding treatments, dismantling of telebeacons, computerisation of Iast records etc 140. Finally, the Programme would have to retain a small administration team after 31,/1,2/ZOOZior a short period (2 to 3 months) to close all financial and pending matters of staff members. a a tJPC22.3 Page27 L41,. The Director of OCP informed the Committee that modules, and training manuals were now available at the country level and plans were underway to publish a book on the OCP experience intended for readers interested in health development programmes, as well as an update of the scientific document covering OCP operations. 142. Dr Antoine Kabor€ informed EAC that a first report on all aspects of the closure of OCP had been submitted to the WHO Regional Director by the committee of which he is the Chair, and that the committee would meet during the following week. The committee paid particular attention to making the best possible arrangements for the staff and tried, whenever it was possible, to retain them by giving them priority, as appropriate, in filling posts in APOC, the AFRO Multidisease Surveillance Centre and even within the AFRO structure. 143. The OCP telecommunication system and the library were among the facilities that would continue to serve the Participating Countries. 1,44. As to the AFRO Multidisease Surveillance Centre, Dr Kabor6 informed EAC that the basic document for the Centre was now ready and that a small team would gradually move to the Centre (the interinz responsible officer was already in place). The Centre would concentrate its efforts on the control of onchocerciasis, meningitis, malaria and HIV infections. A Plan of Action for the work of the Centre during the last 6 months of 2001 was being prepared. The Centre would develop and utilise its own public health laboratory and discussions would take place regarding the future of the Hohoe OCRC laboratory. K. REPORT ON THE PROGRESS MADE BY APOC, ITS PREPARATIONS FOR PHASE II AND THE PHASING.OUT PERIOD OF THE PROGRAMME (2002-2010) L45. Dr Azodoga ftketeli, Director of APOC, informed the Committee that a draft of a Programme Document (corresponding in OCP to a Plan of Operations) for Phase II of APOC operations (2002-2007) had been developed in consultation with all partners (including Participating Countries, NGDOs, TCC, and CSA). The Programme Document covered in addition operations during a Phasing-out Period (2008-2010). Contacts had already been taken with Donors who had all accepted the principle of the need for a Phasing-out Period. 1,46. The estimated financial requirements were in the order of US$ 68 million for Phase II and US$ 11 million for the "Phasing-out Period". By 2007,45 million people would be under ivermectin treatment in the APOC area and by the end of the Programme (20L0) in all 50 million people. EAC comments and recommendations 1,47. To a question whether Loa-loa was a problem in Nigeria, Dr S6k6t6li stressed that so far severe adverse reactions to ivermectin had only been reported from one country, Cameroon, within the Programme area. The Committee was reminded of last year's recommendation that the situation in Cameroon be investigated. L. REPORT ON TDR OPERATIONAL RESEARCH 749. Dr Hans Remme informed EAC about TDR's new overall strategy and related changes in the organisation of work. The disease portfolio of TDR was now flexible with two new diseases added recently. There would be greater emphasis on implementation research a a JPC22.3 Page28 and TDR now operated under a matrix management structure in which disease-specific planning and budgeting received greater attention. 150. The research strategy for onchocerciasis control had been updated in consultation with OCp and ApOC. The ievised strategy focused on i) sustained control using available interventions, and ii) improved tools for treatment and surveillance. 151. TDR had not yet decided if research on post-oCP surveillance and recrudescence control should be included in its research strategy for onchocerciasis, and the opinion of EAC was sought on this issue. EAC ts and 1.S2. Although the work plan of the AFRO Multidisease Surveillance Centre was still to be elaborated, it was likely thit the Centre would support operational research on surveillance. The Centre would consult with TDR in further developing its plans in this resPect. M. CONSIDERATION OF THE COCHRANE LIBRARY REVIEW ON ,IVERMECTIN FOR ONCHOCERCAL EYE DISEASE" BY H EIERE, F SCHWARTZ AND R WORMALD 153. The Committee questioned the relevance and validity of the review and decided to respond to the review by a letter to a scientific journal (e.9. Lancet). N. OTHER MATTERS : "Integrated Data Analysis" 154. Dr Nico Nagelkerke of the University of Rotterdam, The Netherlands, informed the Committee that ONCHO simulations suggested that annual, or more frequent, large-scale application of ivermectin as sole means of control had the potential for elimination of onchoce.ciasis given a sufficiently high level of coverage. This was, as a matter of fact, the strategy adopted by the Onchocerciasis Elimination Programme for the Americas (OEPA). 155. In order to establish an empirical basis for this elimination hypothesis, simulations were carried out using data from OCP areas where large-scale ivermectin treatment had been carried out, eitheialone or in combination with vector control. The interpretation of the data was complicated by a difference between epidemiological and entomological results, the latter sometime suggesting ongoing transmission in the presence of excellent epidemiological findings. The results would be presented to a Joint OCP/TDR workshop in October 2001 where conclusions regarding the potential for elimination was expected to be arrived at. 156. Another ONCHOSIM simulation study compared the potential for onchocerciasis elimination by means of a "hypothetical" macrofilaricide combined with ivermectin treatment. The comparison yielded favourable predictions for elimination by the macrofilaricide under tircumstances (coverage, frequency) that could not apply to exclusive ivermectin control. O. DATES AND VENUES OF FUTURE SESSIONS OF EAC 1S7. The Committee decided to hold its next regular session on23-27 September 2002 and an ad hoc session on L1-15 March 2002, both in Ouagadougou' , a IIPC22.3 Page29 1.57. The Committee decided to hold its next regular session on 23-27 September 2002 and an ad hoc session on 11-15 March 2002, both in OuagadouSou. .158. A Task Force with membership of Adenike Abiose, Andre Yebakima, Bemhard Philippon, Detlef Prozesky and Fatu Yumkella or Mamadou S. Traor6 would meet on L-2 Octo^blr 2001, venue still to be decided. The meeting took place as scheduled, in Geneva. The report is attached in annex 7. P. APPROVAL OF THE DRAF"T REPORT :r5g. A draft of the report was approved by the Committee with the understanding that modifications agreed upon during its consideration would be incorporated. o. cLosuRE oF THE SESSION 160. After statements by the Chair, the Director of the Programme and Dr Antoine Kabor6, Professor Abiose declared the session closed. I t IPC22.3 Page 30 ANNEX 1 LIST OF EAC 22 RECOMMENDATIONS The Committee recommended Ecological Group 1. That search should be made for historical data on the occupational and ecological state in zones later freed from onchocerciasis (paragraph 19). 2. That monitoring activities continue until the end of 2002 on the same watercourses and at the same frequency as in 2000 (paragraph 24). Vector control 3. That updated ONCHOSIM data and predictions concerning the four "special intervention zones" (Oti & Pru in Zone East and Tinkisso & Mafou in the West) be made available within the 15 days following the closure of the EAC22 session (paragraph 90). 4. That an analysis be made within 45 days of the reasons for the unsatisfactory situation in the four "special intervention zones" (paragraph 90). 5. That national teams be constituted and trained to participate in vector control activities in the four "special intervention zones" (see following recorunendation) (paragraph 90). 6. That aerial larviciding be continued for a few years beyond 2002 in the four "special intervention zones" with the understanding that this be not considered an extension of OCP (paragraph 95). 7. That CDTI be applied as the sole method of onchocerciasis control in Sierra Leone (paragraph 91). Plannine. evaluation and transfer 8. That small "special intervention teams" be fielded to support the CDTI process (paragraph 97). 9. That ivermectin treatment should have flexibility in areas with scattered hamlets by adopting both active and passive approaches (paragraph 99). 10. That lists of eligible villages be established before the end of 2002 on the basis of maPS updated by district health staff (paragraph 99). 11. That OCP, with collaboration of the countries concerned and APOC, establish a task force to address cross-border problems (paragraph 107). 12. That contact be made with Ministries of Finance in countries which levy customs duties on ivermectin consignments (paragraph 113). - Comprehensive lists of recommendations can be found in Annex 4. , t aJPC22.3 Page 3 I Annex I 13. That skin snipping remains, for the time being, the main tool for epidemiological surveillance, with entomological surveillance as an additional tool, and that the DEC Patch Test replace skin-snipping as soon as possible (paragraph 116). 1.4. That epidemiological surveillance be re-considered in areas covered by the Lymphatic Filariasis (LF) Elimination Programme and that surveillance systems be developed for the two Programmes when the LF activities come to an end (paragraph 116); and that negotiations take place between the Coordinators of the two Programmes to agree on the timing of LF treatment to allow for effective onchocerciasis epidemiological surveillance (paragraph 120). 15. That national programmes reinforce monitoring of non-response to ivermectin and prepare for monitoring of failure of moxidectin when available (paragraph 1,17). - A list of recommendations regarding Macrofil can be found in paragraph 136. a a I JPC22.3 Page32 ANNEX 2 RECOMMENDATIONS OF THE APRIL 2OO1 OCP OPERATIONAL RESEARCH AND STRATEGY MEETING 1. Given the need to pool all the epidemiological and entomological data as well as all the data on treatment with ivermectin in order to help make a decision, the meeting recommends that a document (statistical yearbook) gathering all this data should be prepared for each basin and for each country before December 2001 (OCP, NC ). Z. The meeting took note of the proposal to stop larviciding in 2001 and to suspend ivermectin distribution at the same date on the Dienkoa, Milo, Dion and Sankarani basins that have been subjected to combined control for 1,2 consecutive years. To that effect, it recommends the validation in 2002 of the ONCHOSIM model for these basins while respecting the protocol for stopping larviciding and undertaking a "post-treatment" type entomological study (OCP, NC). 3. To study the impact of ivermectin on transmission, the meeting recommends the following: a) collect, enter and analyze existing data by late May 2001 (OCP, NC); b) use infectivity rates, prevalence, CMFL and incidence as indicators to analyze the data of the selected basins (OCP, NC) c) set up in June 200L a catching network at Mako (Senegal) in order to compare the 1998 blackfly densities with those of 200L (OCP, NC). 4. In order to guarantee the delivery of ivermectin in the countries while minimizing problems of custom duties in the recipient countries, it is recommended to involve the WHO representatives in the countries in the reception of order for mectizan made by the countries (OCP, CN). 5. The meeting recorrunends that stakeholders' meetings should be organized in the countries in order to strengthen sensitization and advocacy of the opinion leaders, partners, health staff and the communities to ensure their effective participation in CDTI (NC, OCP) I , ? a tIPC22.3 Page 33 ANNEX 3 REPORT OF WORKING GROUP A Members EAC: Vincent Resh (Pdt) - B. Philippon - A. Yebakima National Coordinators: B6nin - Togo wHo staff : L. Yamdogo (vCU) - H. Agoua (CAT/Est) - M. Sarr (CAT/West)- A. Ak6 (Aerops) - Y. Bissan (Rech.) - V. Ket6 (Hydro) - M' Karam (WHO/HQ) Speci fic issues Specific recommendations on the "black spots" areas If extension of operations beyond 2002 (larviciding, cost figures) - concrete scientific evidence to support suggestions. Specific recommendations on xenodiagnostics in Sierra Leone Implication of closure of OCP (contract with Evergreen, Staff...) Update of schedule on pages 23 & 24 - EAC21 report - ref. table A of National Coordinators Meeting report. Specific issues : what priority ? The "black spot" areas - Where are the black spot areas ? Eastern Znne; Oti & Pru Western Zone: Tinkisso & Mafou Observations Entomo-Epidemiological indicators show that the situation in the 4 areas has greatly improved (especially transmission potentials) ever since the implementation of specific actions. However, prevalence levels and incidence still remain too high. This situation can cause a great harm to the achievements of the Programme and therefore calls for a continued combined action of vector control and ivermectin treatments beyond2002. In this regard, the Group recommends Situation : 2levels Eastern Zone:. Oti/Pru Total agreement of the Group for the continuation of combined VC-IVM action af.ter 2002. Western Zone : Tinkisso/ Mafou The need to gather epidemiological data for Tinkisso. Thus the urgency to have this data. t , lPc22.3 Page 34 Annex 3 1. The Group urgently recommends that all efforts be made to update, within the shortest possible time (15 days), data on the ONCHOSIM Model for the four basins in order to have a better perception of the simulation (differtent hypotheses : IVM alone; IVM-VC, at several levels of IMvI coverage) and to determine the duration of these actions. 2. The Group recommends that (within 45 days) a study be carried out on the causes of the persistence of this situation in the four areas, mainly CDTI, so that the necessary measures to ensure maximum and sustainable (therapeutic and geograhic) coverage could be taken. 3. That emphasis be placed on the formation and training of national teams in Vector control. Concerning aerial larviciding The different working Groups recognised the need for aerial larviciding to guarantee the efficiency of intervention. This procedure must therefore be continued. - Sierra Leone After discussion the Group recommends that efforts being made for this country should be centred solely on CDTI. Suggestiott To be able to say anything worthwhile on this issue vital for the post-OCP period, the group suggests: - the creation of a working Group/Task Force(lVM-VC) - an adhoc EAC meeting before the October 2001 CSA meeting. This EAC meeting could also examine other issues. Sensitization CSA October 2001 - )PC December 2001 The Group recognises the importance of sensitizng these two bodies with the aim of informing them as clearly as possible and convincing them about :o the pfgblelqg that still remain the conditions for saveguarding the achievements of OCP the need for an "exceptional" extension of some activities the need for a common and strong "lobblring" towards some countries The need for an adhoc EAC meeting , a a Recommendations IlPC22.3 Page 35 ANNEX 4 REPORT OF WORKING GROUP B The group analyzed the causes of persistent problems and found that the extent of integration of onchocerciasis control into the national health system varies from country to .o.rr,try. The group thus presented a set of practical recommendations, understanding that they could be selectively adopted according to its specific situation. Low Problems While the therapeutical coverage has generally satisfied the goal, geographical coverage is alarmingly low. This is mainly because of difficult access to some scattered hamlets; where finding Iiterate/ willing persons is also difficult. List of eligible villages is lacking. P ractical r ecomnrcn da tions : - Adapt CDTI in difficult situations, and then return to the ideal as soon as possible. - Provide one or two bicycles per health centre, for CDDs to use on rotation. - Passive treatment of all eligible health centre attendees from these hamlets. - Actively make links with hamlets through clinic attendees - even find possible CDDs. - Use health workers (e.g. nurse aides) as active distributors - as an interim measure, while continuing to motivate the community. - District level staff must update maps of their districts, showing all villages (and including hamlets and their names). - List of eligible villages to be established by OCP and NOCs before the end of.2002, which should contain Criteria of the villages in terms of oncho importance, together with latitude and longitude. - OCP to accelerate the development of the pictorial form (which can be used by literate persons). Motivation Motivation is one of the most serious and widespread problems which persist at different levels of health system. 1. CDD level . Problems Different programmes (NGDO, State, WHO related) offer different incentives, which harm other programmes and may contradict the'community directed'approach.. Practical recommendations - NCs to arrange programme stakeholders' meeting to advocate community directedness. - Communities may be informed about possibilities for raising funds for their CDDs such as cost recovery capitation for the ivermectin, funds raised by the community: agricultural co-operatives, Bamako initiative, etc. - Refresher training courses should be utilized as an opportunity of motivating CDDs. The courses should be combined with a package of good quality IEC materials, recruitment of some experienced CDDs as facilitators, and certificates. \ i IPC22.3 Page36 Annex 4 2 Community level Problems Some communities were wrongly approached and see CDTI as someone else's responsibility. Some communities have had bad experiences from health service staff, like having to pay for'free' services. P ractical r ecomnt en dations - Promote collaboration between the nurses and social workers and other extension workers, in meeting and negotiating with communities. - Health workers should be reoriented on community entry skills for CDTI, using existing OCP or APOC training materials. - District health managers may consider a'best community award' - e.g. a bicycle. - If available, districts may donate useful items to communities - e.g. empty insecticide containers (provided this is done fairly). 3. Health centre nurses Problems Some nurses resist the extra effort and change of approach involved in CDTI. It is crucial that the nurses at peripheral stations do not feel they are marginalized from the higher level of health system. P r actical r e commendations - Provide each health facility with a CDD trainer's manual and a durable'job aid' in the form of a wall chart. - Acknowledge receipt of reports and queries quickly and politely. - Send a yearly letter of thanks to the nurses, signed by the directors of disease control programmes. - Institute a yearly'best district' award. Finance Problems A national budget exists in most counkies, but not easily accessible. District budget also exists but onchocerciasis control is not given priority in some cases. P r actical r ecomnrenda tions OCP and NCs should prepare the advocacy packages for sensitization of DHMTs on the importance of continued oncho control to prevent recrudescence. OCP Director should continue sensitizing governments on the importance of devolution, and urge governments to facilitate the release of funds for oncho at the earliest time when the fund is available. OCP should address this issue during the next JPC in Washington NCs should also mobilize resources from donor agencies, i.e. HKI, Sight Savers, World Vision, Unicef, OPC, etc. NCs to sensitize DHMTs. District plans should include activities and budgets for onchocerciasis control. DHMT should mobilize external financial resources of NGDOs, bilateral, multilateral, etc. t , t,I JPC22 Page37 Annex 4 Logistics 1. Ivermectin , Problems 2. Registers . Problems Supervision . Problems Ivermectin and register are two essential materials of CDTI. The original idea of community ."rpo.,Jibility on the movement of these materials between community and the healttr faciiity is not practical for isolated communities. In addition, the flow of Ivermectin is disrupted at several levels of health system. \ trhile the community ownership of register should be respected for the distribution of ivermectin to those who were not treated P r a ctical r ecomnrendations - Ivermectin should be shipped through tax free agencies such as WHO and UNICEF. - NCs to lobby MoF for budget to clear tax. - NCs should facilitate orientation of pharmacists at central, regional and district level on relevance of smooth flow of ivermectin. - The orientation package to health workers should include population census and drug order procedures. - During the training of CDDs, agreement should be reached between health workers and CDDs on how the drugs are to be supplied from health centre to the community. t l According to CDTI policy, community should supply its register. The format of the register is not standardized. Registers are kept long time in the health centres. P ractical recommendations - Countries should make their own decisions on the most practical approach to ensure availability of standardized registers. - During the orientation of CDDs, agreement should be reached between health workers and CDDs on how the registers can be accessed for data extraction. Supervision is planned vertically mainly because the external budgets are not integrated into the national disease control planning. CDTI data are not included in the health information system. Practical r ecommendations - AFRO shoutd urge governments to validate as soon as possible the supervision guidelines for multi-disease surveillance. - NCs should initiate actions to establish an integrated supervision check lisU the examples of C.l. and Sierra Leone can be transferred. - NCs should work with relevant departments to include CDTI data in the health information system. ? -t ! IPC22.3 Page 38 Annex 4 - NCs should plan and execute training of the front line health workers on data rePorting of oncho control' Training . Problems Trainingneedshavebeenidentifiedbecauseof:weakperformance;highstaffturnover; newly r"ecruited CDDs; newly recommended dosing' P r ac tical r econtmendations Using the existing *u.rrut, and guidetines, the training and re-training for the front line healih workers u.,d COOs should give emphasis to: - Community re-entry and problem solving' - IEC - Management of ivermectin' - Supervision and monitoring' Pre-service training . Problems Basic curricula in onchocerciasis for doctors and nurses is deficient or old-fashioned' I I Recommenilations - up-to-date training modules must be prepared,- in French and English' for tutors of medical ,,,r.rir,g 6oth levels) "rra p,iUti. he-a1-th students. These must be attractive and user-fri".,ar"y;'.r"rrly describe the role of the nurse/ doctor/ health inspector in CDTI and surveillance; contain visual aids; and contain questions for student assessment (withmodel answers)' , , --:-:-- :-^d+.,+,. NOCS must deliver the modules personally to every relevant training institution in the 11 countries. IEC materials . Problems Although a lot of work has been done regarding development of IEC materials' it has not been well coordinated between countries] and as a result many districts do not have any available. . Practicalrecommendations -NCsshoulddeveloptheirowncountryspecificlECmaterialsincollaborationwith the national IEC officers. NCs should make sure that every CD receive an the end of2002. onchocerciasis IEC package before t J lPCzz Page 39 Annex 4 Specific areas 1. Sierra Leone . Situation I Although most of the Northern districts are occupied by government soldiers, 2 districts in the North are still under rebel control. Border regions are oncho endemic areas; inaccessible because of persisting rebel force. However, the government and rebels established collaboration for EPI. No definite plan of operations for oncho control can be made until security in the area is assured. CDTI South is rebel-free; CDTI fully installed in 5 southern districts. Recommendations - Southern part:continue with CDTI. - Northern part: * NC to document the situation in the North and guide OCP on the plan of action; when to start training; when and how to start CDTI. * To conduct special entomological studies (collection of flies in Nov. 2001-May 2002). * Sierra Leone to obtain a commitment from |AF and JPC for inclusion of S.L. as part of APOC. * NC to pursue other options for financial assistance e.g. World Bank and NGDOs. 2. Cross border problem Situation There is a need for a better understanding of the cross border problem. Recommendations - OCP, with collaboration of relevant countries and APOC, should establish a technical task force to address the technical needs in the cross border areas. The issues to be addressed by the task force should include at least: * human movement * synchronization of ivermectin treatment * feasibility of involving one health worker each from the district health and peripheral levels and CDDs to assist the less experienced countries. - That APOC invite Benin to the next TCC Meeting in Nigeria and provide the participants from Benin with the opportunity of field visits in Nigeria. - Benin (OCP) and Nigeria (APOC): * That each country establish lists of the eligible villages under CDTI and share them. * That the national coordinators of both countries meet regularly. * That APOC and OCP coordinate the cross border meeting. * Simultaneous implementation of CDTI in relation to the start of high transmission seasons. * APOC to provide OCP with Nigerian information. I I t lPC22.3 Page 40 Annex 4 Cross border technical meeting to share the experience in one country with other less experienced countries. 3. Critical areas Situation Coverage in critical areas remains low Recommendations As a matter of urgency countries should intervene in areas where the epidemiological situation is unsatisfactory, by putting together crack teams of health workers to work for a few months at village level, to optimise CDTI with all the villages involved. This concerns Guinea, Ghana, Togo and Benin. Indicators For low geographical coaerage: - % of villages covered For low CDD motiaation: - % of village population treated - "/o of. villages with incentive package in place - % of CDDs satisfied with incentive package For community entry: - % of target communities satisfied with CDTI implementation For motioation of health workers: - % of. health centers from which health workers visit all CDDs at least twice a year For finance: - % of districts with oncho budgets - o/o of districts have and used oncho budgets - proportion of oncho recurrent budget supplied by govemments and other donors For logistics - iaermectin supply: - % of health facitities reporting no stock out of ivermectin in the past during CDTI - % of target villages received ivermectin during the year For logistics - records: - % of villages returning records of CDTI - % of villages with accurate records of CDTI For superuision: - % of CDDs who received supervision visit at least twice annually as per standard For training: - o/o of heatth workers competent in estimating ivermectin requirement correctly - % of. health CDDs competent in performing the population census * t I I I n lPC22 Page 41 Annex 4 % of regions, districts with who have identified health workers and CDDs in need of training/ re-training % of regions, districts who have carried out necessary training/ re-training For IEC: % of communities and health facilities with at least one IEC material package Reco mmenda tions ab out in dica to r s - NCs in collaboration with OCP to implement evaluation using the above listed indicators. - NCs and OCP to study the feasibility of the collection of above listed indicators, and to consider including other indicators developed by APOC.a t a -i l.Whatactionsneedtobetakenduringthenextl|/zyearsforaneffectiveepidemiological 2.'Jiftlil::J:fiH.. system will be affected by the LF Erimination Programme in oCP 3. ff;tiffi::urveillance system wilr be affected by ivermectin resistance should it occur? 4. How this surveillance system will be affectea uy the use of moxidectin when it becomes lPc22.3 Page 42 ANNEX 5 REPORT OF WORKING GROUP C The Group addressed issues relating to Epidemiological surveillance' It tried to provide some answers to 4 main questions: available ? Finally the group further discussed the specific case of Guinea Bissau and the use of Onchosim. general. Epidemiological surveillance is done in oCP areas where there are no interventions with the objective of detecting any recrudescence. parasitorogical surve,rance using skin snip should be the priority ".,i;;,; t. .ut".t "ffu""ifn pi'f,itt.health staff shouid be trained and equipped to perfori.r tnl turt p.op".rf. rniomological surveillance should be used as an additional tool because of the io* 'u'{'itiuiry of tile skh snip method' It has proven on several occasions t" b" " useful.o*pf"ttt"tti"'i' !""f to confirm rectudescence' Following the recommendations oigeCZf u .,r*b"t of t"u'* have been formed and trained' but the bulk of the work is done by the national t"uttts' The Entomological surveillance is always done by the national teams with some assistance from the community' DEC Patch test has not been implemented during ,tt" pur, y"u. b"tu'^'u of technical difiilulties' These should be solved when the Mono *;! ;;J;"s'available' In future this Patch test could be used as a more ,".,ri,i*r" tool for the confirmation of recrudescence' MappingofLFhasbeencompletedinTogo,Benin,G|anllndBurkinaFaso.MaliandNiger are plarrning their "r*"vr. ir.e results ,3 iu, show that LF covers a wider rea than oCP' including urban settings. The implication of the LF elimination programme would be the use of Ivermectin in are-as where the treatment had ceased u^i *n..e epidemiorogical surveillance is in place. At the ,tu.t oi-ttt" ptogt-ul"^3.this surveillance witl probably no longer be necessary. 8.,,o*ological ,t"itiiru"teif feasible could still be useful' In any case' bytheendoftheLFeliminationp,ogt^t"*e'asurveillancesystemforbothonchocerciasis una lf should be worked out' Ivermectin resistance has occurred in veterinarian medicine and is very likely to happen in oCp areas sooner o. 1u,".. But this is just a speculation at this stage. Molecular markers are being developed, and the ongoing studies on Ivetmettin non-relsponders should provide some answers to the existence of resista**"ly it " *d of the year 20bt. The group thinks that Control programme Managers srrgr,{{fe equipp"a to propeily monitor all non-responses to Ivermectin *"u,-".,i- g"site tn" MDsc:r-,;,rr'i u" ,t.".,g[n"r,Ld to detect drug resistance in i t Moxidectin will hopefully be available in 5 - 6 years. similar type of surveillance system would be required ,1"n"" i, comes to be used. But most importanily there is a need to clearly tJPC22.3 Page 43 Annex 5 define the context in which it will be launched. Whether it will be launched in places where Ivermectin has (or never) been used, for case management or control management. Onchosim is a management as well as an advocacy tool. It is not intended for a routine use at district or even national level at this stage of its development. However, national coordinators should get acquainted to the concept. Training workshops are planned for the national teams and it is important that expertise be developed under the MDSC for the use of Onchosim. A survey conducted in Guinea Bissau in 1997 revealed that the endemicity was very low. Mass treatment with ivermectin was not recommended. The strategy has so far been case management. A survey is been completed and the result will be available by the end of the month. If the results show a still low endemicity, case management will continue. If on the other hand a higher level of prevalence is observed there will be a need to take a decision on the transfer of Guinea Bissau to APOC. RECOMMENDATIONS 1. The decentralisation of the epidemiological surveillance should be pursued by the provision of equipment, training of district health staff in the collection and analysis of data. The entomological surveillance should remain a responsibility of the national teams 2. The surveillance system for both LF and onchocerciasis should be developed before the end of LF elimination programme tfuough the MDSC. 3. National control progranunes should reinforce surveillance system to monitor failure of treatment for early detection of ivermectin resistance through MDSC 4. National control programmes should set up surveillance system to monitor failure of treatment with moxidectin when it becomes available through MDSC i) National coordinators should be trained to understand the concept of Onchosim model ii) Expertise should be developed under the MDSC for the use of Onchosim I , 5 IPC22.3 Page 44 ANNEX 6 REPORT OF THE TWENTY-SECOND SESSION OF THE ECOLOGICAL GROUP Accra, 7-9 March 2001 TABLE OF CONTENTS SUMMARY OF RECOMMENDATIONS... A. INTRODUCTION.... B. ADOPTION OF THE AGENDA. C. FOLLOW UP OF RECOMMENDATIONS OF THE 215T SESSION OF THE ECOLOGICAL GROUP ....... D. VECTOR CONTROL UNIT ACTIVITIES IN 2000.... E. AQUATIC ENVIRONMENTAL MONITORING ACTIVITIES.. F. ECOLOGICAL MONITORING AS PART OF THE SOCIO-ECONOMIC DEVELOPMENT OF ONCHO-FREED ZONES G. WORK PROGRAMME FOR 2001./2002 H. ARRANGEMENTS FOR THE NEXT MEETING......... I. READING OF MEETING REPORT FOR APPROVAL.. I CLOSURE OF THE SESSION.. Appendix L : List of participants .......... Appendix 2 : List of documents ........... Appendix 3 : Work Programme for 2001 Page J 45 46 51 t .......52 55 52 64 64 65 I 65 65 66 68 69 IPC22.3 Page 45 Annex 6 SUMMARY OF RECOMMENDATIONS Summary of recommendations made by the Ecotogical Group during the session are presented below Moni AS tal n zones 1. Members of the Ecologicat Group and OCP should inquire about availability of remote sensing information on study sites and related areas (Para 80). valorisation 2. Appropriate actions should be taken by OCP to publish the manuscript of the brochure presented to the session, highlighting environmental activities of the Programme (Para 8L). 3. A steering committee should be set up to draw a detailed plan for the preparation and publication of synopsis of scientific results of environmental monitoring and related activities (Para 82). 4. OCP should through a member of the Ecological Group organise a one-day workshop on the organisation of manuscripts for national hydrobiological teams. (Para 83). Aquatic monitoring -Work Programme 5. Monitoring activities during 2001-2002 should be on the same watercourses and at the same frequencies as in 2000 (Para 83). monr AS 6. OCP should closely cooperate with the WAFEM project in fulfilment of its objectives (Para 16). d - a t IPC22.3 Page 46 Annex 6 A. INTRODUCTION 1. The twenty-second session of the Ecological Group was held from 7th to the 9th March, 2001 in Accra, Ghana, under the chairmanship of Professor V.H. Resh, Chair of the Ecological Group. Present at the session were four members of the five-member Ecological Group, the Director of the Onchocerciasis Control Programme (OCP), Dr Boakye A. Boatin, the Chief of the Vector Control Unit (VCU) of the Programme, Dr L. Yameogo, invited Experts and the FAO. The FAO as focal point of the OCP Sponsoring Agencies for Socio-economic development of the Oncho freed zones was represented by Mr M. Sonou. (See appendixes L and 2 for lists of participants and documents respectively). Opening Session Z. The opening ceremony was presided over by the Chairman of the Ecological Group, Prof. V.H. Resh. He opened the session by welcoming all members of the Ecological Group and invited persons to the meeting. He especiatty welcomed Dr C.A. Biney as the Director of Water Research institute (WRI) which was providing facilities for the meeting. He then gave the floor to the Chief of VCU for his opening remarks. 3. The Chief of VCU, Dr L. Yam6ogo, expressed his pleasure in welcoming participants to the session. He indicated that for VCU, the session was as important as previous ones. This is because VCU expects to learn from it, especially as the Programme approaches its end in less than two years. ttl" Cni"f of VCU was pleased to announce that Mr M.E. Diop, member of the national hydrobiological team of Guinea, had recently earned his Doctorate degree from the University of Mali. Ae indicated that Dr Diop's success was pleasing to VCU and OCP because the Programme supported his efforts towards that end. Finally, he wished to Put on record that the meJting was thl second in less than five years to be held at the Water Research Institute (WRI). He fherefore thanked WRI on behalf of the Programme Director and the Chief VCU's Office for WRI's available support. 4. Prof Resh, as Chairman of the Ecological Group made his opening remarks. He briefly indicated that the Ecological Group had over the years contributed significantly to the resolution of problematic issues of tnu OCP. As examples, he cited the documentation of criteria for monitoring, selection of monitoring stations, approaches for the avoidance of resistance of target organismJto insecticides operationally used by OCP, provision of monitoring strategies to assess loig-term impacts of insecticides on non-target fauna and issues related to human settlements in oncho-freed zones. He indicated that the current issue at stake was to provide an overview evaluation of the status of non-target aquatic fauna in the various countries and river systems after the many years of larviciding. He therefore called on members, to put their minds to the issue, especiaily, the experiences of two former chairmen of the Ecological Group still serving. Then heiaid the hydrobiologists had worked out an approach of presenting the overall status of fauna during their meeting two days earlier, but this could be refined. The Chair concluded his opening rernarks by requeiting members to also talk on possible collaborations hydrobiologists could J.rgug. in aiter OCP. Having made the above remarks, Prof. Resh then called on the Director of the Programme for his opening remarks. 5. On taking the floor, the Director of the Programme echoed the welcome of previous speakers to partiiipants of the 22na session of the Ecological Group and thanked the WRI for its t IPC22.3 Page 47 Annex 6 support to the meeting. He then commented briefly on various issues raised for consideration by the Chief of VCU and the Chairman of the Ecological Group. 6. On the significance of the session, the Director said for those in OCP, the Ecological Group has been a very important body for various reasons. These included the Group's independent advice to the Programme, the Group being the link between OCP and the rest of the world and being part of the Expert Advisory Committee (EAC) to the Programme. Therefore, he said, the session was as important to the OCP as previous ones. 7. With respect to hydrobiologists and the imminent end of the OCP, the Director briefly indicated that, the Programme had provided several training opportunities to hydrobiologists to be able to function in relation to the environment at the end of OCP in December, 2002. He cited for example, that the EAC had already suggested that an evaluation be carried out about three years after the cessation of OCP operations, to assess the extent to which the achievements of the Programme had been maintained, suggesting that the activity could use some of the hydrobiologists. 8. With hindsight of the value of various recommendations of the Ecological Group to the OCP, the Director called for advice from the Group on ground-larviciding and the implementation of the project aimed at monitoring aquatic and related ecosystems associated with oncho-freed zones, the West African Freshwater Biodiversity Conservation and Ecosystem Management (WAFEM) project. 9. On the issue of collaboration among those who have been linked by OCP after the Programme, the Director said all must find ways and modalities to continue collaborations wherever possible. The OCP Director concluded his remarks by thanking participants for their anticipated involvement in the heavy agenda set for the meeting and wished all fruitful deliberations with expectation that, we shall all learn from the outcome of the session. )oint Hydrobiologists/Ecological Group meeting L0. This session received and commented on brief presentations and reports on i) Issues related to OCP's ending and the future from the Programme Director and Chief of VCU; ii) Summary results of hydrobiological monitoring from national teams (see Section E); and iii) Special subjects from members of the Ecological Group (EG), invited experts or participants. Prior to the presentations however, the chairman announced that a member of the hydrobiological team Mr M.E. Diop had earned his Doctrate degree, Dr C. Lev€que (member of the EG) had been awarded the Naumann Thienemann medal of the International Society of Limnology, and Prof. D. Calamari (member of the EG), had received the Environmental Education Award attributed by the Society of Environmental Toxicology and Chemistry. All three accreditations had occurred during 2000. The Chair considered those of Ecological Group members as evidence of the quality of the Group. I lPC22.3 Page 48 Annex 6 a) General information on OCP and APOC 11. The OCP Director summarised the status of the Programme with reference to its imminent end, in December 2002. He indicated that towards the Programme's end, various actions which would facilitate decommissioning activities, human and material resources of OCP have been planned and a meeting scheduled for about the end of March 2001, would initiate actions o., th" plans. Among the plans to implement, the Director said that the African Regional Office (AFRO) 6f WUO is to set up a multi-disease surveillance centre at the OCP's main building in Ouagadougou. 1,2. With reference to staff, the Director indicated that efforts to assist individuals to manage the change have been planned. For example, staff who would require reasonable training to be gainfullliengaged elsewhere would be offered the training. Also, appropriate recommendations iould U" p-"iaud on behalf of staff seeking engagements in various agencies, while personnel would be encouraged to seek available positions in \AIHO at large. The Director also indicated that, plans made to assist staff manage the change included psychological counselling for those who may need it. 13. In relation to onchocerciasis control which has been the central agenda over the pasl27 years, the Director said the Programme was on course. The subject, he said, puts OCP close to the African programme for Onchoierciasis Control (APOC) which is also involved in the control of onchocerciuiir Uy a different approach from that of OCP. Thus APOC could be considered to be continuing the control of the disease after OCP. However, APOC's first phase ends in December 2001, after which a phase of winding down, to end in2007 will have to start' 1,4. The Director then referred to the Ecological Group's input to the successes of OCP. He said the JPC has appreciated the contributions of the Ecological Group to the OCP to resolve very crucial issues of the Programme and wanted the Group to know it. 15. To end his brief, the Programme Director announced that the ]PC meeting for 2002 will take place in Ouagadougou to end the Programme where it started. b) General Information on the WAFEM proiect 1,6. The Chairman, in introducing the subject for the Chief of VCU, announced that the WAFEM project proposal had been submitted and was going through approval processes. Also, he explained that OCP's assistance and the involvement of the Ecological Group to bring WAFEM proposal to its present status was not a coincidence. This was because the mandate of the Ecological Panel, the precursor of the Ecological Group, included aspects of human settlements in oncho-freed zones. Therefore OCP should closely cooPerate with the WAFEM project for the achievement of its objectives. 17. The VCU Chiel Dr L. Yam6ogo, then took the floor and informed the meeting of the following : first, the WAFEM project had received the support of )PC. Second, a draft protocol for the projeit had been prepared and would be circulated in due course for comments which must be communicated to his office in Ouagadougou. Third, if and when the project becomes approved, it may have to be launched and information on the issue would be communicated. Finally, the meeting was informed that overall supervision of WAFEM could be provided by the multi-disease centre after OCP. t, I tlPC22.3 Page 49 Annex 6 18. The Chief VCU then reminded the meeting of some central features of WAFEM as including: i) The partnership spirit of the project, ii) The community centred approach, and iii) The need to entourage early community ownership of the project to ensure sustainability. The reminders were perhaps, directed mainly at the hydrobiologists as they have been expected to maintain contact with project community representatives after the project finalisation workshop until the anticipated approval of the project for implementation. c) Eaaluation of the impact of iaermectin on the enaironment in the OCP area 19. A presentation on the above subject was made by Prof. Davide Calamari, member of Ecologicaf Group. The data he showed were collected through an extensive review of the literature on physico-chemical properties, environmental distribution and degradation of the drug. 20. Ecotoxicological data were also reviewed and a preliminary evaluation of the risk for the environment made in relation to the type of immissions of ivermectin in relation to its use in the Programme area. 21,. It was stated that as emissions are concentrated in time and space because ivermectin is eliminated by humans mainly on soil where the molecule is strongly bounded, it was also considered that degradation occurs rapidly (photo and biodegradation) in tropical conditions. Under these conditions, the substance has a very low potential to contaminate the aquatic environment. Therefore the risk is almost non-existent despite the high toxicity for aquatic environment. For terrestrial organisms, the risk is limited due to the fact that emissions occur during a short period of two-to-three days after the treatment and in limited areas around the village. d) lnfluence of hydraulic conditions of riaer on impacts of lanticides 22. Dr Berhnard Statzner made a presentation on how hydraulic conditions in a river stretch may modify the impact of insecticides on the vector and non-target invertebrate fauna. He related discharge stages to river morphology to demonstrate how these two factors influence the velocity close to river bottom. It was indicated that for most insecticides and given concentrations, their impact on insects increases with increasing bottom velocity and the phenomenon could be scaled in the field using the Froude Number (= velocity/ [depth x 9]o's;. 23. In discussions after the presentation, hydrobiologists confirmed the general view and statement of Dr Statzner from their field observations. It was therefore considered that including a better assessment of hydraulics could contribute to explaining unusual observations of insecticide effect (on both target and non-target invertebrates). Also, an appreciation of the hydraulics and its consideration could reduce quantities of insecticides needed for ground treatment. I IPC22.3 Page 50 Annex 6 e) Potential inryact of Pennethrin impregnated bed nets on enuironment 24. Prof. Calarirari made the meeting aware that the above subject was being investigated and indicated that the results should be of interest to members of the Ecological Group since the product is one of the insecticides the Group has had to deal with in relation to its use by the OCP. 0 The economic benefts of managing ecological impacts of laruiciding. ZS. Prof D. Colman, member of the EG presented the following on the above subject. The key task of the Ecological Group has been to control the larviciding process of OCP to ensure that : The vector control activities should not reduce the number of invertebrate species; or cause a marked shift in the relative abundance of species ; temporary and seasonal variations in non-target invertebrate populations were acceptable ; The pesticides applied shoutd have neither a direct impact on fish, nor effect on the life cycle of fish species; Bio-accumulation of insecticides and bio-magnification through food webs should be avoided; Human activities in the control area should not be impaired. I a a a 26. Many reports indicate that these objectives have been handsomely met, but would not have been so without the timely intervention and planned research based on reconunendations of the Ecological Group (EG). In consequence the EG can claim to have delivered substantial benefits. Many of these benefits are non-market ones, that is, benefits not connected with things which are traded and have a price on the market. These benefits arise from the fact that bio- diversity in the aquatic fauna has been maintained throughout the OCP area, whereas it would almost iertainly hive been diminished had improvements to the dosage rate not been made or additional insecticides not been identified, tested and selected for application with appropriate protocols. 27. Indeed the preceding sections of the report have not chosen to speculate on what might have happened had key recommendations of the EG not been made, and implemented. These recommendations and the resulting actions prevented widespread resistance to insecticides devetoping in the blackfly populations, something which would have resulted in considerable cost (in the form of reduction in health benefits and smaller increases in agricultural output). It can also be confidently asserted that, had the EG's recommendations about larviciding not been implemented, the production and saleable value of fish would have been reduced. On the most conservative assumptions about the value of fish which would have been lost, and the costs attributable to the decisions of the EG, it can be shown that the economic returns to the EG's recommendations have been high. 28. Following extensive review by regional experts, the percentage of marketed fish in the OCP area which would have been lost has been estimated for every year from 1980 to 1997 ' Conservatively at its maximum this is assumed to be only 1O% of the total catch (FAO data) in the OCp area, o.3,8 % of the totat fish catch of the OCP countries in L988. This fish has been valued at the river-side price of Tilapia paid to producers around Mopti in Mali; there is a continuous published price series for this and evidence for later years that fish prices are similar across West JPC22.3 Page 51 Annex 6 Africa. Valuing in this way is an underestimate, since additional value is generated in marketing fish t 29. The costs which have been attributed to the EG in the economic analysis are (i) all the costs of the monitoring programme plus the costs of convening the EG, and (ii) a high ProPortion of the costs of the larviiides, since the additional insecticides introduced have been more costly. (The whole point of the tarviciding programme has been effectiveness with environmental protection, rather that cost minimisation). 30. Even with what is seen as the conservative estimates of the additional fish marketings attributable to the EG, and a high assessment of the costs to be charged, the returns to the EG are estimated at an internal rate of return of 31.o/o. This is high, and almost certainly an under- estimate. It therefore seerns entirely reasonable to conclude that the environmental protection component of the OCp has had large positive economic benefits of a tangible market nature. In addition there are very important non-marked benefits, which in themselves would justify any additional costs incurred. g) Major issues raised by the thesis of M. E. Diop 31. Dr. M.E. Diop presented the major subject discussed by his thesis as temporal and spacial factors or characteriitics of river systems and fish that influence the reproduction of some West Africa river fishes. Among other things the thesis concluded that reproduction and recruitment periods of fishes studied were close in time and space. With reference to OCP activities, the thesis indicated that the period of recruitment apparently coincided with the period during which OCP uses "stronger" anii-Simulium larvicides in the river systems to control populations of Simulium. Dr. Diop indicated that the effect of the larvicides on fish recruits may be noticed and was an issue that called for attention. 32. The discussion which took place after the presentation suggested that lethal impacts of anti-Simulium larvicides on small fish could occur rarely as accidents but not as a routine. However, the issue was recognised and would further be discussed in the future. h) Freshwater Fish Biodioersity Gradients inWest Africa 33. Mr. George Ganda, formerly a member of the national hydrobiological monitoring team of Sierra Leone and now a doctorate student in the United Kingdom, presented the above as the subject of investigations of his study. The goal of his study, he said, was to develop a Rapid Fish Biodiversity Assessment formula based on status of various environmental parameters and known fish fauna of freshwater systems. The aim of the presentation was to expose the subject and ask for assistance in the form of ideas and sources of possibly useful information for the work. Thus he indicated the approaches already being adopted. 34. The discussions which foltowed the presentation mainly calted on the presenter to be aware of existing approaches to fish biodiversity estimations. B. ADOPTION OF THE AGENDA 35. The agenda as presented in the table of contents was proposed to participants and was adopted. a lPC22.3 Page52 Annex 6 C. FOLLOW UP OF RECOMMENDATIONS OF THE 21ST SESSION OF THE ECOLOGICAL GROUP 36. Six of the eight recommendations made by the Ecological Group during its 2L't session were implemented. Those related to land-use changes monitoring and preparation of synopsis of scientific results from monitoring activities needed further discussions (see section D. VECTOR CONTROL UNIT ACTIVITIES IN 2OOO General overview of VCU activities g7. The Chief of VCU indicated that vector control activities had a few problems in C6te d'lvoire and Guinea. However, all the components of the Unit (aerial operations, entomological evaluation, operational research, hydrology, hydrobiology) have continued to be operational. a. Larviciding coverage (both from the air and from the ground) remained close to 11700 km of rivers treated in 2000. b. Blackfly susceptibility to the operational insecticides being a critical factor for the success of vector control opeiations, particular emphasis was placed on evaluating the situation with respect to such susceptibility in order to better adjust insecticide rotation strategy. 38. Due to the presence of resistant populations or populations showing an intermediate susceptibility to the organophosphorous compounds, the use of these insecticides was reduced in 1999 ind 20b0, giving greater preference to B.f. H-14, a biological insecticide (see para.48 to 52 below). This was intended to provide better control over resistance and a lower impact on the aquatic environment. Atl this was achieved due to the good performance of the present formulations of B.f' H- 14 whose effective carry is now competitive with that of the chemical insecticides even if its dosage still remains at least 3 times that of the organophosphorous compounds. The results were on the whole satisfactory in the areas under larviciding if we take into account the savanna form of onchocerciasis which is considered to be the most blinding type. Indeed, for the first time, the annual transmission potential (ATP) of savanna species of Simulium damnosum was below L00 at all catching points in the Oti basin. It was also below 100 in most of the basins with trouble spots. Only two points out of L07 regularly visited had an ATP above 100 (Vialadougou and Djabata). The Unit also put special emphasis on the transferable entomological activities. Thus, the national entomologists trained by the Programme conducted a number of studies in 2000 aimed at: t the early detection of any possible recrudescence, assessing the impact of ivermectin on transmission, the control of blackfly nuisance. i) ii) iii) tJPC22.3 Page 53 Annex 6 Regarding the last point, it should be noted that some initiatives were taken in the socio- economic development areas by the companies involved to assume responsibility of the nuisance control activities in collaboration with the national teams of C0te d'Ivoire and Mali. Generally, activities were centred around attempts to solve the problems encountered in the special intervention areas or black spots as well as preparing for the post-OCP period. Aerial Operations and Larviciding a) Introduction 39. The year 2000 was the second and thus 2001 is the third of the last four year contract with "Evergreen". Area covered in operations during 2000 was the same as in 1999. However, in the western zone, treatments were suspended in the upper Mongo-Kaba and Kolente basins due to activities of rebels. 40. The overalihydrological situation during 2000 showed a slight deficit compared to that of 1999. In the western zone a 25% and 1,2% def.icits were recorded in the Tinkisso and Kolente basins respectively. However, other basins in the zone showed slight increases. In the eastern zone, increased discharges were recorded on the Pru and Mono basins due to higher precipitations. Yet all other rivers in the zone recorded deficits in precipitations. 41,. Intensification of ground larviciding, exhaustive prospections in problematic basins helped in optimising treatments and to reduce supplementary flight hours. During the year, more biological, compared to chemical larvicides was used. 42. Combined action of VCU teams and local populations helped to reduce product loss during 2000. For types of larvicides, materials in store and procurements were managed to result in minimum residual stock by December 2002 when the programme comes to an end. b) Utilisation of laraicides in the East Zone 43. Treatment was maximum during week 31 (ie 31st ]uly to 6th August), minimum during weeks lL,12 and 13 (ie from 13 to 3Lst of March) and treatment was suspended during weeks L4 to 17 (ie 4 weeks of April). On the Oti, six cycles of experimental treatments were effected during January and February 2000. 44. To ensure effectiveness of the larviciding activity, actions taken included rotation of larvicides used, confirmation of susceptibility of target organism to product and have good knowledge of river discharge. Also, the advice of Ecological Group on larvicides usage was strictly adhered to. For example, temephos was used at a maximum of three consecutive cycles while Permethrin and Carbosulfan were used at a maximum of six cycles per year. 45. Entomological evaluation results were good. Out of 51 points evaluated, only one, at Dajabata, on the Okpara river near the Benin border with Nigeria, had an ATP above'100 (244). Actions are being taken to improve the situation. lPc22.3 Page54 Annex 6 c) lLtilization of laroicides in theWestern zone 46. The westem zone of the Programme covers C6te d'Ivoire from the river Sassandra to Mali on river Niger and its tributaries lncluding Sankarani, Milo, Niandan, the Upper Niger' the Mafou, and lhe Tinkisso in Guinea, Kolente ind the Kaba-Mongo also in Guinea. In this zone, the longest circuit of treatmen t (4507 km) occured during the 8th week and the shortest (436 km) in the 35,r,week. Treatment was susPended during the 36th week' 42. Larvicides used were rotated. Temephos was not used on the Sassandra and its effluents for fear of enhancing resistance of vectoi to the product. Temephos was also utilised with precaution on tl-re tirikisso and the Kaba but without restriction on the Kolente and the Mongo because susceptibitity of vector larvae is good' Entomological research and insecticides a) Monitoring of the suscEtibitity of blackfly lantae to the operational insecticides 4g. During 1999 and.2000, susceptibility tests carried out especially during the low water period (Noveirber to March) and spaie period (June, JuIy and August) made it possible to closely monitor the evolution of susceptibility bf btackfly larval populations to the organophosphorous compounds in river basins under larviciding. 49. During the low water period of 1999, the tests revealed the presence of some blackfly populations riesistant to temephos in certain river basins of the Westem Zones (Niandan, main Sankarani, Dion and uPPer Niger) and Eastern Zone (Sio and Ani6)' The phenomenon of resistance detected was eifectiv"iy ^u.ugud tfuough adequate implementation of the insecticide rotation strategy recommended to limit the impact of the treatments on non-target aquatic fauna' It should be noted that on the upper Sassandra, where temephos has for many years been excluded from Iarvicides used for treatments because of resistance, a clear improvement in the susceptibility of larval populations to the product was observed during the high water period (July) of 2000. 50. In the two operational Zones of the Programme, the susceptibility of the larvae to pyraclofos was normal or intermediate on all the sites visited. The blackfly populations least susceptibte to this product were encountered in the Westem Zone on the Milo, Niandan and Niger, and in the Eastern Zone on the Oti and Sio. 51. With reference to phoxim, the susceptibility of larvae to the product was generally satisfactory. Indeed, in the basins under larviciding treatments, blackfly populations resistant or not very susceptible to this product were observed only on the upper Kaba and certain stretches of the Milo in Guinea. 52. Considering the trends shown by the results presented above, it has been considered advisable to contiriue the implementation of all actions initiated to improve the efficiency of the. larviciding treatments. These include, closer supervision of aerial treatments, the monitoring of specific composition of blackfly populations, and the adequate use of pyrethrinoids and Teknar to acceleratelhe decline in the resistance to temephos of some black-fly populations' I tIPC22.3 Page 55 Annex 6 b) Blackfly population mouements and possible threats to the achieuements of the Programme 53. The movement of blackflies from Sierra Leone towards Guinea and Mali had led the Programme to extend its vector control activities to Sierra Leone. These activities have been suspended since 1994. Since then, increases in densities of Simulium sirbanum have been observed in the north of Sierra Leone. It is still impossible to undertake any studies in the north of Sierra Leone. Therefore some samples of larvae and adult blackflies were collected at the beginning of the rainy season in some catching points located within the corridor of re-invasion in Guinea (starting from the border with Sierra Leone) and in Mali to assess the possible impact of the apparent invasion of Mali by flies from north of Sierra Leone. 54. Part of the samples were subjected to cytotaxonomic and microsatellites approaches of population studies. The preliminary results indicated that one of the two cytotypes of S. sirbanum living on the border of Sierra Leone and Guinea is also present in Mali. It could thus be that this cytotype moved from the border of Sierra Leone into Mali bome by the monsoon winds. However, currently available entomological results do not show any obvious impact of these possible movements on the transmission in Guinea. 55. S. sirbanum being a poor vector in the north of Sierra Leone, studies of experimental transmission (xenodiagnosis) which will be carried out soon should make it possible to ascertain whether the cytotype in Guinea is also a poor vector when put in contact with patients from various origins. Discussion 56. The ecological Group congratulated the Programme on the excellent results recorded and the excellent presentations made of it. It was recognised that the excellent results were achieved in part, due to an efficient management of the resistance through the continuation of an increased use of B.t H-14 to replace the less selective chemical insecticides. This increased use of B.t. H-1,4 was made possible following the improvement of current formulations which allow their use at % of the normal amount and at discharges above 70 m3/s. More generally, the other actions taken to achieve the current satisfactory entomological results (reinforcement of both the larviciding treatments and ivermectin distribution) were also the subject of exchanges with members of the ecological Group. 57. The availability and significant amount of data on the status of blackfly susceptibility to the organophosphorous compounds caught the attention of the Group which expressed its interest in similar data being collected on the larvae of the non-target benthic invertebrates. Finally, the Group noted with satisfaction the efficient management of the logistics and congratulated the Programme for the expertise it has developed in this matter. E. AQUATICENVIRONMENTALMONITORINGACTIVITIES Introduction 58. The principal activities of aquatic monitoring teams during 2000 were the monitoring of impacts of larviciding on invertebrates and fish fauna of treated rivers, evaluation of recolonisation trends where treatment has stopped, assessment of river and land environments at monitoring stations and various involvements to contribute to finalizing a proposal for a project IPC22.3 Page 56 Annex 6 to manage ecosystems in order to conserve biodiversity in oncho-freed zones (ie the WAFEM project). Comprehensive reports on the issues have been submitted and only summaries of essentials are presented here. 59. In addition to the summaries of fish and invertebrate results, a format which attempts to cristalize overall observations on fauna in relation to larviciding at stations is also presented. Fish monitoring 60. Fish teams in all countries involved continued to monitor four characteristics of fish communities and populations at their stations in relation to OCP larviciding. These were : i) ii) iii) i'r) Continuous occurrence of fish species known at a station, Catch Per Unit Effort (CPUE) of fishing trends, Species richness of catch, and Coefficient of condition of principal species per station. a a) COte d'laoire 61,. Three stations (Pont frontiOre on river Leraba ; Ganse on the Como6 and Niaka on White Bandama) were monitored during 2000. Treatments on all the rivers were terminated at least seven years ago. - Species occurrence : The number of fish species encountered at the stations during 2000 were 36, i+ and 32 for Pont frontiEre, Ganse and Niaka respectively. The number and kinds of species encountered at the respective stations during the year were comParable to the range and species known for the individual stations. At Pont fronti0re on Leraba, a specimen of. Heterotis iiloticus (fm. Osteoglossidae) was encountered in a monitoring net for the first time. No indication of a species being persistently absent can be reported. - Species richness of catch : Species richness at all stations in Cdte d'Ivoire during 2000 was more comparable to records of 1997 which were slightly higher compared to other years. - CPUE : CPUEs recorded on Leraba and Como€ during 2000 were slightly higher compared to records of recent years. On the Bandama however, a decline in CPUE was recorded during 2000 compared to recent catches. - Coefficient of condition : Average "condition" values of principal species per station remained stable and comparable to previous years. b) Ghana 62. One station, Asubende on the River Pru was monitored during 2000. The river is still under treatment. - Species occurrence : Number of species encountered at the Asubende station during 2000 were 52. Att tn" species have been previously encountered and there was no species persistently absent taking previous records into account. IPC22.3 Page 57 Annex 6 - Species richness of catch : Fifty two species per year as recorded in 2000 was the second highest species-rich year in 23 years of monitoring the station. Species richness observed during 2000 was comparable to that obtained in 1988 and only lower than the record high richness of 1989 for any year since 1978. - CPUE : The CPUE recorded for 2000 was comparable to records of 1991/92 and higher compared to records of 1992 till present. Steady decrease observed since 1987 seem to have stopped during 799.8/99 and a definite increasing trend recorded in 2000. - Coefficient of condition : Mean "condition" factor of species monitored at Asubende remained stable and comparable to estimates of previous years. c) Guinea 63. Three stations (Mandiana on Sankarani, Boussoul6 on Milo and Baranama on the Dion) were monitored during 2000. All three rivers are still under treatment. - Species occurrence : Species occurring at all stations have been encountered before at the stations and no durable absence of any species could be reported as at the end of 2000. - Species richness of catch : Species richness recorded in 2000 was comparable to the relatively higher levels obtained since L997 in relation to earlier years. - CPUE : In Guinea, CPUE recorded during 2000 was higher compared to previous years Thus an increasing trend of catch apparently continue at all stations in Guinea. - Coefficient of condition : Mean "condition"of principal species at all stations were stable and comparable to estimates of all previous years. d) C-onclusions 64. The follorving conclusions on characteristics of fish communities and populations monitored at all station could be made. - Species occurrence : With the exception of a specimen of. Heterotis niloticus encountered on the Leraba river in COte d'Ivoire, species occurring at all stations have been recorded there before. There was also no indication of a species being persistently absent at any station to be attributed to larviciding. - Species richness of catch : Annual species richness of catch continue to increase slightly since 1994/ 95 at all stations. The situation is attributed first, to relatively persistent conducive hydrological situation in the sub region. This factor has also generally increased catch per sampling event and annually and the increased CPUE has contributed to increased species richness of catch. However, as indicated above, the species being recorded have previously been known for the individual stations. - CPUE : Considering all station, the major change in trend of recorded CPUEs was the change of study decreasing catches on the Pru river at Asubende. Evidence of "recovery" was recorded during 2000. In C6te d'lvoire the slight decline in CPUE on the Bandama was within a IPC22.3 Page 58 Annex 6 acceptable range. All other stations continue to record higher CPUEs since1994/95. Considering that alt rivers in C6te d'lvoire have not been treated for more than five years each, the decline on the Bandama, where treatment was terminated in 1993 could not be attributed to larviciding. The situation is confirmed by the obvious increase in CPUE on the Pru which is still under treatment. - Coefficient of condition : No detectable change in mean condition of principal species has been observed at any of the stations monitored since the beginning of larviciding in the programme area. Thus lirviciding could not be influencing the well being of fishes (which is expressed by the "condition"). Entomological monitoring 65. As initiated in1998/99, the emphasis of entomological monitoring since then has been on the study of recolonisation of water courses where Iarviciding has stopped. However, impact assessment of treatments on fauna continued where treatment is being maintained. Results of recolonisation studies Marahoui 66. River Marahoud monitored at two stations, Danangoro and Entomokro, has not been treated for three and a half years (ie since June 1997). - At Danangoro re-occurrence of Tricorythidae, Leptophleiidae and Neoperla spp. during post-treatment years indicate re-colonisation of river by invertebrate fauna. AIso, observed increased frequlncy of occurrence of Ephemeroptera, Tricorythidae and Leptophleiidae may support the considered re-colonisation. - At Entomokro only Neoperlahas reoccurred in samples to suggest re-colonisation. Nazinon, Ldraba andlMite Bandama 67. A station each on the Nazion, Leraba and White Bandama have been under study for indications of re-colonisation by invertebrate fauna- - The Nazion river at Pont de P6 has not been treated for more than nine years. During the post-treatment period, Neoperla spp, Sericostomatidae and Pyralidae have reoccurred in samples ind at higher frequencies indicating re-colonisation of river by invertebrate fauna. - The Leraba has not been treated for more than nine years. During the period after treatment, 33 out of 35 taxa known for the station have been encountered with Pyralidae being encountered for the first time in 2000. The re-occurrence of Pyralidae especially, has been considered as indication of re-colonisation. Also, increasing frequency of occurrence of majority of taxa (currently 23) during post treatment period has been considered as indication of re- colonisation. - The White Bandama has not been treated for eight years. During the period, Neoperla spp have re-occurred together with a general stability in occurrence of majority of taxa. The situation is considered as indication of re-colonisation by invertebrate fauna. a a) a aIPC22.3 Page 59 Annex 6 Red Volta at Nangodi 68. The Red Volta has not been treated for seven years (since 1994). During the period the taxonomic richness of the river has increased by the reoccurrence of four of five "sensitive" taxa. These include Heptageniidae, Oligoneuriidae, Tricorythidae and Neoperla spp. Tricoythidae were encountered only during 2000. The other "sensitive" taxa of the station awaited is Caridina. The situation indicates very fair re-colonisation of river by invertebrate fauna. Conclusions on re-colonisation study data 69. Indications of re-colonisation of rivers by invertebrate taxa after river treatment continue to improve. "sensitive" taxa eg. Neoperla spp, Pyralidae, Tricorythidae and Oligoneuriidae which were affected during treatment years, in the same or different rivers have re-occurred. Also, reports of stability of the majority of taxa and increased frequency of occurrence of identified ones also support the re-colonisation indications. Discussion 70. Discussion following the reports on re-colonisation studies among the Ecological Group members indicated that the Group was satisfied with the widespread re-colonisation indications. The Ecological Group also considered that continued absence of a total of six taxa, considering individual stations in the monitored area, had been anticipated and thus acceptable. b) Results of entomological monitoring at treated stations Ghana: Riuers Pru at Asubende and Oti at Sabari 71. During 2000, drift indices on the Pru which had been considered to have shown minimum impact of larviciding since L992 further improved. However, increased densities was not accompanied by taxonomic richness. Among sensitive taxa at the station Neoperla spp. and Oligoneuriidae have not been encountered since 1993 and L997 respectively. 72. At Sabari on the Oti, which has been subjected only to a few cycles of experimental treatment per year since L998, densities of entomological fauna increased in 2000 compared to L998 and 1999 data. Taxanomic richness was also recorded by the re-occurrence of Tricorythidae and Heptageniidae which had not been encountered for several years. Guinea : Riaers Milo at Boussoull, Niandan at Sansambaya and Dion at Tire 79. At Boussoul€ improvements in taxa composition and densities were recorded in 2000. The improvements were attributed to better epifaunal substrate during the year. - At Sansambaya, taxanomic richness increased by five taxa during 2000 compared to result of 1998 and 1999. However densities of samples reduced, due to lower representation of Hydropsychidae and Orthocladiinae. - At Tdre, taxanomic richness increased to 24 from L9 in 1998 and22 in 1999. Also, although night drift samples recorded taxonomic richness of 27, this was still lower and the taxa less stable compared to the 33 and 36 taxa richness of pretreatment years. IPC22.3 Page 60 Annex 6 Surumary conclusion on obseraations at treated stations 24. At majority of treated stations increased taxonomic richness and densities were recorded' The situation was attributed to improve ecological factors (e.g. increased epifaunal substrates) and reduced impact of treatment on fauna due to the rotation strategy' of f.a 75. In anticipation of summarising the status of monitored fauna after OCP, the following formats were presented for comments of the Ecological Group. a) For summary of fish status 76. Basically, a number of tables, each dealing with a parameter monitored is proposed' Each table would have columns indicating the relativJtrend of the parameter with reference to before- treatment, during-treatment and after-treatment periods of monitoring (see example below)' The subjects for the tables would include eg: a) Trend of total CPUE, b) Trend of CPUE of Principal species, .j General trend of species richness of catch' d; G".,".rI trend of coefficient of condition of species' Etc. b) For Summary of lnaertebrates status 72. Again, a number of tables each presenting the trend of a characteristic of invertebrates monitored with reference to before-treatment, during-treatment and after-ffeatment periods of a station. (See examPle below). Subjects for the tables will include : a) Taxonomic richness (Drift and Surber samples)' b) Response of sensitive taxa in Drift, c) Response of sensitive taxa in Surber' Discussions 78. The discussions which went on among the Ecological Group members after the presentation of the summary tables indicated thit the format was acceptable' They however' suggested that wherever figures could be put to indicate level of decrease or increase, it should bel-one. For example, decreasing trend up to 30%' Their comment on the contents of tables was that, they were pleased with the indications of recovery of sensitive taxa which had been a real worry about ten years ago' Also' because the data showed that reduction of number of taxa per station was maximum six' the results were acceptable because that level of effect had been anticipated. a I alPc22.3 Page 61 Annex 6 Example of Fish table Table - General trend of total CPUE Example of Invertebrateltable Table - Taxonomic Richness of Surber and Drift Habitat Assessment parameters extension to accommodate WAFEM 79. Habitat assessment study reports of various monitoring stations, hcorporating amendments made on the study format at the 2000 meeting, were submitted. It was encouraging to observe use of habitat status in the interpretations of aquatic fauna monitoring results. No more amendments on the study format was proposed. However, in anticipation of the WAFEM project, which would cover aquatic habitat, gallery areas and beyond galleries, parameters to assess the gallery and area beyond were necessary. Therefore, the following points were considered by the meeting for addition to the present habitat assessment protocol : First, it was considered that an estimation of the length, mean width and depth of river stretch should be included in the aquatic habitat assessment. River station Before-treatment (BT) During-treatment (DT) After-treatment (AT) Leraba/Pont frontidre 19xx to L9xx No data 1975 to 1989 Decreasing trend to about 50% 1989 to2002 Decreasing trend continue for 4 year then increasing Pru/Asubende 1978 to fluctuating 1987 1987 to 2002 present decreasing trend for 11 years then increasing about 7992level in 2000 Not available Milo/Boussoul6 Not available 1988 - 2000 presently stable, initially increasing since 1994 Not available RIVER STATION PRE.TREATMENTPERIOD TREATMENT PERIOD POST TREATMENT Marahou6/Danangoro Surber 27 Drift 38 Richness decrease to 23 Decrease to 35 Increase to 27 Continue to decrease to 33 a JPC22.3 Page 62 Annex 6 Second, status of gallery and the area beyond should be assessed as optimum, suboptimum, marginal or poor on the following criteria' For the gallery zone : For the area beyond gallery Discussion on land-use changes as part of environmental monitoring in Oncho-freed zones. 80. The subject continued to be discussed by the Ecological Group to identify limited approaches thaiwoutd ensure sound basis for the monitoring. Several suggestions were made by ^e^U".s. Finally the Group decided to follow two lines of action; first to search for historical perspective of occupationil and ecological state of oncho-freed zones; second to find the pomiUitify of having the ecological state of oncho-freed zones recorded at the end of the b.og.u- e. Membeis of the EG and OCP were therefore requested to inquire about availability of remote sensing information on study sites and related areas. ac the fifth 81. Dr. Leveque presented to the meeting, a manuscript of a brochure prepared by a team. The intended brochure highlighted environmental activities of the Programme as previously recommended. With a few ii.,irhi.,g items to be added, the meeting accepted the manuscript and recommended to OCP to take necessary steps to have the manuscript published in English and French. 82. Referring to preparation and publication of synopsis of scientific results from monitoring activities, Dr. Leveque said the subject had only been discussed briefly during the last meeting. However, he presented a preliminary consideration of unit parts as shown below for further deliberation by members as the recommendation to publish a synopsis was retained. Unit parts considered were : The strategy of Vector Control - Former C-VCUs Concerns for the Environment - Ex. Chairs of E.G. The EG: history, mandate & objectives - L6v€que & Calamari t Optimum Suboptimum Marginal Poor Gallery forest width > 25% of river mean width. Gallery has old trees on gallery floor. Gallery forest width < 1,0% of river mean width. Numerous old trees, shrubs and grass near river bank. Few old trees close to river bank. Shrubs and grass present in area. Some Brass and open soil. Optimum Suboptimum Marginal Poor Natural vegetation of area (to be stated) Degraded natural vegetation through deforestation, buming and/or cattle grazing. Subsistence farm land with annual crops. Area covered by large industrial type plantation. IPC22.3 Page 63 Annex 6 History of Aquatic Monitoring - L. Yam6ogo Economic importance of EG recommendations - D. Colman Larvicide screening on the vector- ).M. Hougard & Y. Bissan Screening of larvicides & non-target fauna - B. Statzner & L. Yam6ogo Long term impact assessment on invertebrates - V. Resh f Statzner / National hydrobiologiss Long term impact assessment on fish - Paugy / National hydrobiologists Sustainable development in oncho-freed zones - Sonou & OCP The discussion which took place after Dr. Leveque's brief centred on the approach to the organisation of work. Generally it was thought that a steering committee which should do some detail planning of the work should first be established. The first meeting of the committee should be held in Ouagadougou in 2001 at a date to be agreed on by the members. For the purpos€ of continuing with the eventual publication of the two documents, the Chief of VCU indicated that there was some resources available for the purpose during 2001. Response of the Ecological Group to recommendations of the hydrobiologists 83. Work done by groups of hydrobiologists taking into account the results of the monitoring during 2000lead to the following recommendations: o Monitoring activities during 2Cf],-2002 for both invertebrate and fish teams, should be at the same stations and frequencies as they were during 2000. However, monitoring teams ltould take necessary extra samples during their usual visits to obtain any other crucial information. o Habitat assessment reports should be accompanied by photographic documentation. . Common approaches to data handling and presentation in reporting shall be adopted or adhered to by the fish and invertebrate monitoring teams. o National teams should endeavour to prepare, preferable joint manuscripts based on monitoring data aimed at publishing them and submit to VCU. Meanwhile OCP shall, through a member of the Ecological Group organise a one-day workshop on the organisation of manuscripts for national hydrobiological monitoring teams. . OCP to assist national teams to train younger hydrobiologists by augmenting mission cost of regular monitoring. 84. The Ecological Group appreciated and endorsed recommendations made by the hydrobiologist and recommended to the Programme to respond positively by supporting the hydrobiologists to achieve them. The Group also appreciated the current level of reporting by the hydrobiologists. FIPC22.3 Page 64 Annex 6 ECOLOGICAL MONITORING AS PART OF THE SOCIO-ECONOMIC DEVELOPMENT OF ONCHO-FREED ZONES The chief of VCU had earlier briefed the meeting on the status of the WAFEM project and reminded participants of some central characteristics of the project. On collaboration, and the Ecological Group's call on FAO to support WAFEM, Mr Sonou of FAO briefed the meeting as below. Recent developments in Socio-Economic Development activities of FAO for Oncho-freed zones and possible relationships with the WAFEM project 85. FAO's focal point person for OCP's Committee of Sponsoring Agencies (CSA), Mr. M. Sonou briefed the meeting on FAO's activities towards sustainable socio-economic development of oncho-freed zones. He said, FAO has since 1998 focused on mobilizing resources for the said development through the designing of national pilot investment projects in almost all countries participating in OCP. This activity is expected to be completed by end of March 2001. As a iollow-up, FAO initiated the development of a concept and proposal for a regional socio- economic development programme for oncho-freed zones in 2000. 86. The Programme's goal is to ensure that rural services, food security and household income in oncho-freed areas equal or exceed that of other areas in West Africa, while ensuring that the oncho-freed areas contributed to the food fibre and feeding requirement in the region. An objective of the programme is to achieve more rational management of natural resources. In the process, the programme will maximize complementarity with ongoing projects and encourage involvement of communities and non-govemmental organisations. Thus FAO's programme for the oncho-freed zones will build synergy with WAFEM in many respects such as I puiti.iputory conununity Planning, management of shared river basins, establishment of local fora for resource access and use rights together with environmental monitoring and its assessment. In the latter field FAO intends to use GIS and Satellite Imagery Interpretation (SII). 87. As presently envisaged, the programme would start with a two-year launching phase, followed by a seven-to-nine year operational stage, and then, a two-to-three year consolidation and devolution period. Discussiott 88. Mr Sonou's brief was followed by discussion which centered on FAO's considered role in orderly settlement in oncho-freed areas, encouragement of communities in ecosystems management and conservation of biodiversity. Mr Sonou explained that while FAO does not get directly involved with who or how many people immigrate into an area, it functions through district and traditional administrative structures to organise distribution of immigrants and supports their socio-economic development. ) G. WORK PROGRAMME FOR 200V2002 89. Aquatic monitoring activities during 2OO1 - 2002 were recommended by the Ecological Group to iontinue on the same watercourses and frequencies as in 2000. - OCP would, through a member of the Ecological Group organise a one-day workshop on organisation of manuscript for national hydrobiological teams. I alPC22.3 Page 65 Annex 6 Finalisation of the economic importance of Ecological Group decisions would be completed during the year. If and when WAFEM is approved the project may have to launched with the involvement of several of members Present. At the appropriate time a draft of a protocol for WAFEM would be circulated for the comments by participants. OCP is to closely cooperate with WAFEM in fulfilling its objectives. H. ARRANGEMENTS FOR THE NEXT MEETING 90. The twenty-third session of the Ecological Group is planned to be held in OuagadouSou, Burkina Faso, tentatively, on the 7tn and 8,n of March 2002. The meeting would be preceded by the joint Hydrobiologists - Ecological Group meeting on the 6th March and the Hydrobiologists meeting on the 4tt and 5th of March 2002. I. READING OF MEETING REPORT FOR APPROVAL 91.. The main points of the Ecological Group meeting as recorded during the meeting were presented for correction and approval. The discussion after the presentation concluded that parts of the report had to be restructured and presented for preliminary approval prior to the finalisation of the report. Minutes of the meeting to be written after the preliminary aPProval will be submitted to the chairman of the Ecological Group for approval before presentation to the Expert Advisory Committee in June. l. cLosuRE oF THE SESSION 92. The meeting was closed on the 9th of March 2001 by the Chairman of the Ecological Group. As closing remarks the chair thanked his colleagues, Director of the Programme, the chief of VCU, invited experts and participants for attending the meeting and for their contributions. He also thanked the WRI and its personnel for the facilities and organisational support given to the meeting. He invited members of the Ecological Group who could make it, to a field trip to Asubende on the Pru river the next day. The session was then closed with an invitation to members for the 2002 meeting. a IPC22.3 Page 66 Annex 6 APPENDIX 1 LIST OF PARTICIPANTS Ecolo Group Members Professor Davide Calamari, Environmental Research Group, D-epartmt-"j. ol Structural and Functional Biology, U.riu".tity of Insubria, Via ].H. Dunant 3,21L00 Varese VA' Italy Tel: 00 39-0332-421546 - Fax: OO gq-oggz- 421554, E-Mail: davide-calamari@uninsubria'it professor David Colman, Schoot of Economic Studies, University of Manchester, Manchester M13 9PL, United Kingdom Fax: 0161 z7s 4g2g - rlt. OrOr 275 4804,E-mail: david.colman@man'ac'uk Dr Christian L6v€que, Programme Environnement, Centre national de Ia Recherche scientifique' Vie et soci6t6s, 1 Place Aris-tide Briand, 92195 Meudon cedex, France Tel. 01 45 07 5045 - Fax 01 45 07 5124- E-mail: Christian.Leveque@cnrs-bellevue'fr professor vincent H. Resh, Department of Environmental science, Policy and Management' u"J".s i ty of Calif orn ia, 207 Weliman Hall, Berkeley, Ca tif orn ia 9 47 20, US A i"f. 1SfOl O 42-3327 - Fax (510) 642-7428 - E-mail: vresh@nature'berkeley'edu Invited ExPert Dr Bernhard Statzner, CNRS, Ecologie des Eaux douces et de9 8ry11F191Ye's' Universit6 Lyon 1' 6g622Villeurbanne Cedex, France --Fax: +33 4724317 41- Tel: +33 472448034 E-mail: statzner@biomserv.univ-lyon1'fr Other oarticipant Mr Moise sonou, senior water development officer, FAO Regio"4-9!qt9j:r Africa' p.O. Box 1628, Accra, Ghu.ru -Tel:233'21 675000 or 70L0930 - Fax: 233 21' 668427 or 7010943 - E-mail: Moise.Sonou@fao.org OCP Secretariat Dr B.A. Boatin, Directeur du Programme,0l 8.P.549, Ouagadougou 01, Burkina Faso E-mail: boa tinb@oncho.oms.bf DrL.Yam6ogo,VCU/oCP,0].B.P.s4gOuagadougou0l,BurkinaFaso E-mail: yameogol@oncho.oms.bf Dr H. Agoua, VCU/OCP,8.P.36 Kara, Togo E-mail: catzonest@hotmail.com M. A. Ak6, VCU/OCP, B.P.504 Odienn6, C6te d'Ivoire E-mail: ocp.zo@aviso.ci M. M. Sarr, VCU/OCP, B.P. 504 Odienn6, C6te d'Ivoire E-mail : ocP.zo@aviso.ci M.].M.Tapsoba, VCU/OCP,0L B'P' 549 OuagadouSou 01' Burkina Faso I I a IPC22.3 Page 67 Annex 6 M. L. Bakon6, VCU/OCP,01 8.P.549 Ouagadougou 01, Burkina Faso M. P.R. B6lemgoab ga, CoM/ o, 01 B.P. 549 Ouagadougou 01, Burkina Faso Dr E. K. Abban, Council for Scientific and Industrial Research, Water Research Institute (CSIR/WRI), P.O. Box AH.38, Achimota, Ghana - Fax: (233) 2177 7170 - Tel.: (233)2176831.0 - E-mail wri@ghana.canl t a a lPC22.3 Page 68 Annex 6 APPENDIX 2 LIST OF DOCUMENTS OCP/VCU/HYBIO/01.01 - Monitoring of the aquatic environment in Guinea - Ichtyofauna Moussa Elimane Diop OCP/VCU /HYBIO/01..02- Fish monitoring in relation to OCP larviciding in Ghana E.K. Abban & K. Kwarfo-Apegyah OCP/VCU/HYBIO/01.03 - Monitoring of the non target aquatic entomofauna in Guinea K6l6tigui Nab6 OCP/VCU /HYBIO/0L.04 - Summary of the annual report of C6te d'Ivoire - Ichtyofauna Kouassi N'Gouan Cyrille OCP/VCU/HYBIO/01.05 - Ghana invertebrate monitoring report - 2000 J. Samman & A. Ampofo-Yeboah OCP/VCU /HYBIO/01.06 - Aquatic monitoring and progress report of the OCP team in 2000 L. Robert Bakon6 & Joseph-Marie Tapsoba OCP/VCU /HyBIO/01,.07 - Annual report of C6te d'Ivoire - Entomology (2000) Bihoum Moussa, Ayekoue Patrice & Kouassi N'Gouan Cyrille a a. a ta I lPC22.3 Page 69 Annex 6 APPENDIX 3 WORK PROGRAMME FOR 2OO1 a a. PERIOD OF SAMPLING /FREQUENCY FISHINVERTEBRATE January to DecemberJanuary to April, November and December COUNTRY/ RIVER/ SITE Once every 2 months (2 nights) Once every 2 months (2 nights) Once every 2 months (2 nights) Once every 2 months (2 nights) Once every 2 months (2 nights) Once every 2 months (2 nights) Once every 2 months (2 nights) Once a month (1 daY) Once a month (1 day) Jan., Feb., Nov. & Dec (recolonisation) Jan., Feb. And Oct. to Dec.(recolonisation) Sept. to Dec. (recolonisation) Jan., Feb., Nov. And Dec. Once a month (1 day) Aug. To Oct. (recolonisation) )uly to Nov. (recolonisation) Once a month (1 day) Once a month (1 day) Once a month (1 day) COTE D'IVOIRE Marahou6/Danangoro Marahou6/Entomokro L€raba/Pont Frontidre Bandama/Niaka Como6/Gans6 GHANA Oti/Sabari Pru/Asubende Red Volta/Nangodi BURKINA FASO Nanzinon/Pont Po GUINEE Niandan/Sassambaya Dion/Baranama Dion/TErd Milo/Boussoul6 Sankarani/Mandiana a NB: The drift samples are taken only to follow taxonomic ichness of riaers aa , JPC22.3 Page70 ANNEX 7 EXPERT ADVISORY COMMITTEE Rqport of an EAC Task Force Geneva. I and 2 October 2001 , q t JPC22.3 Page77 Annex 7 a t c A. OPENING OF THE SESSION 1' Professor Adenike Abiose, current Chair of EAC, in opening the session referred to thedecision of the June 2001, session to appoint a Task Force that would consider the recommendation of EAC to continue onchocerciasis control (including the possibility of aeriallarviciding) in the four "special Intervention Zones" (map) beyond th"e end of OCp lperations and make specific recorunendations for the implementation of such control. The Task Force would have at its disposal up-to-date entomological, epidemiological and socio-demographicinformation concerning the zones in question, reports on vector control, ivermectin distribution and the predictions of ONCHOSIM simulations on the effects of post-Ocp interventions. TheTask Force report would be submitted first to CSA at its Octobe. s"siio., before being consideredby IPC at its session in December 2001. (List of participants in the Appendix). 2' The Programme Director, Dr Boakye Boatin, summarized the findings of recent socio-demographic, migration and CDTI compliance studies. 3' Dr Laurent Yameogo, Chief of the Vector Control Unit, informed the participants about the results of up-to-date entomological surveys. 4' Details were Provided by Dr Soumbey Altey, formerly acting Chief of the planningEvaluation and Transfer Unit, regarding the methodology oi recent"ONCHOSIM simulation studies using data from the "special Intervention Zones", *a tfr" predictions arrived at. B. DETERMINATION OF POST.OCP ACTTVITIES TO BE UNDERTAKEN IN THE SpECrFrc TNTERVENTTON ZONES (StZ) 5' The four SIZ show widely differing characteristics - both in the nature of the controlproblems they are experiencing and i" the socio-demographic characteristics of theirpopulations. PRU RTVER BASIN Characteristics Population:85 000 Prevalence : 7 .5o/o (September 2001) Incidence: 1.4 Community Micro filarial Load (CMFL): Annual Biting Rate (ABR):18250 (2000) Annual Transmission Potential (ATp): 15g (2000) Vector control since: March 1989 CDTI since: 1987 O uolaulus adjusted ATP: 91 coverage: 65.1,% JPC22.3 Page72 Annex 7 6. In summa Although this zone has taken longer than expected to respond to combinedrv treatment, the situation is becoming satisfactory. The focus experiencing the problem is fairly smal[. Recommendation Annual ivermectin treatment at a high level of therapeutic coverage (85%) and maximum geographical coverage, continued until 20L2 (10 years) without vector control. Close monitoring of the control situation to decide whether, at any stage, the frequency of ivermectin treatment should become bi-annual and whether the coverage is being achieved. )ustification 7. The latest series of Onchosim simulations predicts that annual, intensified ivermectin treatment will reduce the danger of recrudescence in the zone to zero. Prerequisites 8. To ensure a high level of ivermectin treatment coverage, arrangements must be made for intensive support to those responsible for implementing CDTI: . The principle of treatment undertaken and directed by the community remains. ' The Ministry of Heatth remairu in charge of operations, but is given additional suPPort by OCP during its remaining life. Such support should be directed at health service staff (at national, district and sub-district/ health centre levet) and at community distributors. . Such support would include ensuring that all communities that need treatment are known and located; providing further sensitisation and training where needed; intensifying supervisiory encouragement and guidance; and making arrangements for these improvements to be sustained after the end of 2002. ' Additional staff and resources such as transport will be required to put these measures into effect. MAFOURIYER BASIN I ,a Characteristics Population: 844L9 Prevalence : 27 .5o/o (1999) Incidence: 7.7% (1999) CMFL:0.49 ABR:21452 (2000) ATP:74 (2000) Vector control since: March 1990 Ivermectirr treatment since: 1990 O.aolaulus ATP:25 Mean coverage:62% ta o IPC22.3 Page73 Annex 7 g. In summary: The area is at the end of the first twelve year period of control. The results of control were initially satisfactory, but there was later incomplete coverage of certain breeding sites. This probably contributed to the control problems which developed later. Recommendation . Ivermectin treatment at a high level of coverage (80%) twice yearly, continued until 2012 (10 years), without vector control. , Close monitoring. fustification 10. The latest series of Onchosim simulations predicts that bi-annual, intensified ivermectin treatment will reduce the danger of recrudescence in the zone to zero. L7. However, adding vector control would have the additional benefit of protecting the free areas in Guinea and beyond. Prerequisites 72. To ensure a high level of ivermectin treatment coverage, the steps previously outlined (see paragraph 8 above) should be taken in this zone as well. TINICSSO BASIN No current epidemiotogical data is available: however, the basin is socially similar to the Mafou basin and the recommendations for that basin would apply here too. UPPER OTI RIVER BASIN Characteristics Population:18'1. 422 Prevalence of onchocerciasis: Titira: 21.7% (year 2001) - 88.5% (1976) Tapounde: 24.6% (2000) - 30.5% (7992) Incidence of onchocerciasis: not available CMFL: Titira: 0.9 microfitariae per skinsnip (2001) - 36.62 (1976) Tapounde: 0.7 (2000) -2.44 (1976) ABR: Titia: 24072(1976) - 9 426 (2000) Tapounde: 131,47 (7977) - 7 889 (2000) ATP: Titira: 1 339 (1976) - 101 (2000) Tapounde: 1,096 (L977) - 29 (2000) O. aoloulus ATP:77 O.oolaulus ATP: 7 lPC22.3 Page74 Annex 7 Vector control since: 1977, interrupted in certain parts of the basin in1992 and resumed llr:.1997 Ivermectin treatment stnce1997, but the area was under re-invasion until L987 Mean coverage: 79.26o/, (2001) 13. In summary: This basin was part of the initial Programme area, and vector control started there in 1977. lJnsatisfactory results were already noted after its first fourteen year period of larviciding. Aerial larviciding was resum ed in 1997.In spite of efforts that optimized larviciding and ivermectin treatment, the situation remained unsatisfactory. Recommendation . Ivermectin treatment at a high level of coverage (85%) twice yearly, continued until 20L2. This is the prioritY activitY. . Aerial larviciding, continue for 5 years after the closure of OCP at the end of 2002. This is considered essential. ]ustification 14. The latest series of Onchosim simulations predicts that bi-annual, intensified ivermectin treatment will reduce the danger of recrudescence in the zone to a very low level. Bi-annual treatment will have the double effect of enhancing coverage and maintaining the CMFL at a low level. 15. The same simulations predict a zero danger of recrudescence if the intensified ivermectin treatment is combined with vector control. Ivermectin treatment alone will eliminate onchocerciasis as a public health problem (probably with some impact on transmission), while adding vector conkol virtually eliminates transmission. L6. Adding vector control to ivermectin treatment will prevent re-invasion by infected black flies from the zone, into surrounding areas where the onchocercal prevalence has been reduced to zeroby previous OCP vector control. L7. A combined treatment (ivermectin and vector conhol) ought to reduce the risk of resistance to ivermectin developing. L8. The situation will be closely studied to see how it develops. In the meantime it is essential to keep the epidemiological and entomological situations as well controlled as possible, while awaiting the development of further control options and new tools. Prerequisites 19. To ensure a high level of ivermectin treatment coverage, the steps previously outlined (see paragraph 8) should be taken in this zone as well. ' t ( JPC22.3 Page75 Annex 7 20. For postOCP control to be maintained at a satisfactory level, the necessary technical know-how and management capacity to conduct larviciding, without interruption, to be hvailable at the closure of OCP. ADDITIONAL RECOMMENDATIONS Z1^. The possibility should be considered of treating (on a case basis) infected patients with compounds of poteniial macrofilaricidal effect such as doxycycline, and research undertaken in this respect. 22. Budgets should be prepared for intensified support to CDTI in the four zones. Zg. Special research efforts are urgently needed, to find out what the reasons could be for control measures not having had the same results in the fours zones, as in other parts of the Programme area. , I a t JPC22.3 Page76 Annex 7 Members of EAC: Secretarial and specially invited: APPENDIX List of participants Professor Adenike Abiose (Chair) Dr Bemard Philippon Professor Detlef R Prozesky Dr Andr€ Yebakima Dr Soumbey Alley Dr Anarfi Asamoa-Baah Dr Boakye A. Boatin Dr Ole Worm Christensen (Secretary) Mr Abdulai Daribi Dr Marc Karam Dr Janis Lazdins Dr Hans Remme Dr Laurent Yam6ogo t a L I lPC22.3 Page77 Annex 7 U)(c -o l<o k atrp< 1 I I / / -\- (h C) l-{(d -o k U) cdp t<(D l-. o V)U' ,51 F tr v,d .o l-o t{ € cl E o) o0 z l-.oaAD / \;(r, t\ Ll /1. Tl @ 0i() c 6 () € o) L< d 6 a d .O a G) CS o\(Dq a atro H C)t(.) G '(, a C) oI (.) L{ cc() CO o)l-{ o<Qc C) )-{ a C) L{oN tro{-) l-{ G) r C) t-{ CC o C)q UC) O. CO =a a , , t