Planning meeting on the phase II of the long term impact assessment of APOC operations : Ouagadougou, 24-29 March 2003

{. 1 TSRM Io Q4 PLANNTNG NTMPTTNC IMPACT March 2003 T** t" d#q, I,rJt<'qtfv !id,ireEl 1 l' i tr 1rr il. , t.t PHASE [I OF APOC' TABLE OF CONTENTS OPENING CEREMONY SUMMARY OF PRELIMINARY DISCUSSIONS Review and amendments of protocols Sites Time table Logistics issues REPORT OF GROUP WORK Team composition Plan for field work Equipment and supplies RECOMMENDATIONS APPENDIX I- II III - IV- Amended protocol Meeting agenda for planning meeting List of participants Budget 2 MONDAY 24 MARCH 2OO3 Chairperson: Dr Michel Boussinesq Rapporteur : Dr Grace Fobi The agenda was adopted as proposed. The Director traced the history of Impact Assessment studies from inception to the present stage. The Director's speech also highlighted the following issues as being important in determining the sites for the next round of studies: o Tl-rerapeuticcoverage . Geographicalcoverage He also asked participants to reflect on the possibility to undertake studies in new sites, like Ethiopia, Angola, etc. He urged that publications of results of the first round should be done as sooll as possible. It was then agreed that by the end of this workshop the francophone group will at least come up with a calendar of activities to write up their publications in order to catch up with the Anglophone group which is far advanced. After the presentation on update on CDTI treatment, the following conclusions were made: It was observed that thee were inaccuracies in the values of the coverages presented and therefore, these figures cannot be used for impact assessment. The presentation on summaries of findings raised the following issues o It was noted that the data presented has already been updated. . Participants will have to read the site reports for more details. At this point the participants broke up into groups by specialties to look at protocols and propose amendments if necessary. Before breaking up the chairperson summarised issues raised after brain- storming as follows: . Concerning ophthalmology protocol, Wu-Jones might be the main issues . Dermatology protocol seems to be appropriate with very few amendments required o Entomology protocol will need to address the issue of differentiating between L3s of animal and human onchocercal species. Groups reconvened and the following decisions/amendments were made: 1) New cross-sectional studies should be done in all sites. In this respect a new complete censlls should be done and a new sample drawn. 2) Amendment should be made to the protocol used in phase I as follow: a J Entomoloev Dermatoloe), and ophthalmoloey o Page 72 tbree lines should be added to table on scabies, dermatomycosis and lice o DEC patch test be done on all sites in children 3-5 years old o DEC crealn should be ordered well in advance as it takes long to prepare and forward the cream to the sites. . Skin photographs should be taken on all sites o Denlatology data entry be done on the field under the supervision of the investigator . Participants agreed that the Wu-Jones test all agreed is quite difficult and has a lot of constraints. o While suggesting that the Wu-Jones machine be made more user-friendly it could be continued in those sites where the test was easily done and dropped in the other sites. . All ophthalmologists meet and write a paper on the feasibility, applicability of Wu-Jones on l3 sites and on the relationships between the results of the test and the other indicators of onchocerciasis endemicity. o Fundus photographs be taken on all sites o Cohorl fundus photographs on 2 sites in Cameroon be continued o Page 80 of initial protocol to remove "uncooperative" and replace with "unable to assess". Specific objectives o Delete "peak treatment" and "therefore" and, add the sentence: "A year round data collection is necessary for comparison for baseline data" in No 2. . Add: "ln areas where there are migrant flies this phenomenon should be taken into account" in No 3. . Under "fly catches and dissection" paragraph 2 replace "then preserve in absolute alcohol" by "and infective rates". Paragraph 3 concerning staining should be removed. Staining of flies should be stopped. . Under "detection of Onchocerco volvulus", add "guidance from DNA laboratory" . Time table for visit by expert line one of paragraph 1, replace "first" by "a", second line read "training and retraining" ; do this wherever there is "training" o Under "first visit", read "day 7-\4", and delete "staining" o Timetable for the second visit should be same as the first. Due to the absence of the sociologists who participated in the first studies, the issue of sociology was not addressed in the plenary session. However a meeting was arranged between Mrs Victoria Matovu, Dr A.D. Soubeiga - the sociologist from the University of Ouagadougou - and Dr M. Boussinesq. During their discussions it was proposed to add a number of questions to the initial protocol but it was then observed that additional questions did not directly address the issue of impact assessment. It was therefore finally concluded that no amendments will be made to the original sociology protocol. Socioloey 4 TUESDAY 25 MARCH 2OO3 Chairperson - Dr. Michel Boussinesq Rapporteur - Dr. Peter Enyong At the opening of the meeting the Chairperson suggested that we keep aside the sociological discussion for the moment and go first to coverage and site selection since the sociologists were still all absent. The meeting starled with a long discussion on whether detailed coverage figures were to be recorded and the best way to collect this information. It was agreed that coverage rates by site and project will both be useful for the interpretation of results. It was also further thought that CDTI project managers could provide information on which zones were treated when we are in the countries, or collect information from community registers. After discussions, the consensus was that a specific survey should be conducted to find out the coverage in the sites. Suggestions on how this was to be done included the use of village registers in villages which had them. However, it was thought that these were not always accurate and therefore, we could question the villagers per housel-rold. The statistician suggested that we use a cluster survey to detennine coverage and this should be done by the social scientists. At this point, it was agreed that we get a copy of the arlicle by Schwart z et al. ( 1998) on the methodology of evaluating coverage and use it as a guide. Copies of this paper were distributed to the members. The paper on the same topic by Biritwum et al. (1997) was also made available later. In conclusion, the group decided that therapeutic coverage will be determined by cluster sampling. Prof. Biritwllm was requested to provide a written study design for determining coverage. During the surveys questions that are on the demiatology protocol like "Have you taken ivennectin"Yes, No If yes "how many times" and "what was the last year you took it?" could be an entry point for other questions to the individuals surveyed like - what is your view on the: - CDTI? and CDDs?, etc. However, later discussions by the sociologists showed that these issues were not related to impact assessrnent and thus should not be looked into. Regarding the sites, there were those that will no more be visited because - it is a hypo-endemic area (Lastourville, Gabon) - there has been no treatment yet, although included in a CDTI project (Inga DRC). - not treated and not included in a CDTI project (the2 CAR sites) It was then revealed that only three sites have received at least one CDTI protocol in the francophone group sites. 5 In contrast, all the sites in the anglophone group have been treated except Ethiopia which they hope to add on. The participants accepted the principle of including new sites. These new sites (DRC, Angola, Burundi, Eihiopia) could now be selected as baseline sites and could be revisited in the next five years. As far as the number of treatment rounds that a project should have had before the evaluation in 2004 was concemed, the question was: Should the second phase of studies be conducted irrespective of the number of treatment rounds? Some members thought that the assessment could be undertaken 5 years after the CDTI project has been approved and implemented by APOC irrespective of number of treatments. At this point the Director was called in to contribute in the discussion and clarify certain issues. The question was to choose between the following options. The second round should be conducted: - in 2004 as per the initial protocol, or - after 5 CDTI distributions regardless of coverage, or - 5 years after first CDTI treatment no matter the number of treatment rounds and coverage. After hearing the options on the table the Director made the following analysis - You cannot judge the impact of APOC activities without correct treatment. - Ideally the study site should have attained 100% geographical and 65oh therapeutic coverage by now. However, the Director acknowledged that such an ideal situation may not be found everywhere. It was concluded that, since the Phase II document of APOC requires an impact evaluation in 2004 and since we cannot get an ideal situation, studies should be conducted as planed irrespective of their treatment status. However, this will not apply to sites where treatment has not started. For those points where there had not been any treatment at all, it was not obligatory to re-evaluate but if we decide to carry out the new studies, the data might still be useful to APOC. In Lastourville, Gabon, at the baseline surryey, there was no need for any re-evaluation because this area was found to be hypo-endemic. Regarding the country visits before the next round of evaluation of impact assessment it was decided that the 2 Coordinators (Dr Bousinesq and Prof. Braide) will conclude preparatory visits to countries and sites before the teams start work. The workshop for review of results and preparation of reports should be held in October 2005, in Ouagadougou. Members of the core teams and their national counterparts as well as the statisticians (about 35 persons) shall be invited to attend this workshop. The house broke up into into two working groups (anglophone and francophone) to work on the inventry of equipn-rent and supplies, timetable and team composition. 6 Participants reconvened to receive repofts form the groups and discuss the issue of coverage detemination. Prof. Biritwum proposed a protocol and the discussions are summarised as follows: For the purpose of improving the interpretation of the evaluation of impact assessment results, it has been agreed that accurate geographical and treatment coverage estimates will be needed for the projects. In addition, information on the frequency of amual treatment will be required. The rnethod will involve the use of the 3O-cluster EPI coverage assessment technique. Villages within 20 to 30 kilometers radius of the impact evaluation 'village' will be listed with their population sizes to be used in selecting the 30 clusters using the steps given in appendix. lt does not matter if the village is treated or not. Due to the dispersal of the vector, impact on intensity of transmission in a given village is more closely related to treatment coverage in the area than to tl-re treatment coverage in the village. A local epiderniologist recruited by the team will select the sample and collect the data with the help of two interviewers and a local field worker. The questionnaire attached will be used to obtain information from members of households. Seven households will be selected per cluster starting from a random house in the selected cluster. Subsequent household will be from the nearest house after completing all the households in the first house. It is estimated that the team could take about 15 days to complete the exercise. 7 REPORT OF GROUP WORK BY ANGLOPHONE TEAMS List of Team members Team 1 Dr Maria Hagan (Team Leader) Dr Michael Wilson Dr Rich Unreh Dr Joseph Charles Ophthalmologist but serves as Dermatologist in team Entomologist Ophthalmologist Social Scientist Teant2 Dr Kechi Ogbuagu (Team Leader) Public Health Physician but serves as dermatologist in team Dr Bertha Maegga Entomologist Dr Ferni Babalola Ophthalmologist Mrs Victoria Matovu Social Scientist ! If Kechi Osbuasu is not available to participate, Bertha Meassa will lead Team 2 and Dr Mahdi Shqnrqrl uzill rcn'lqne Dr olrrreorr asDcmefnlno'isf If Mrs Victoria Matovu cannot participate in all sites, Mrs Edith Wellington will replace her as Social Scientist. In each country, the following counterparts as well as others listed in personnel will join the teams One Social Scientist One Ophthalmologist One Entomologist One Dermatologist One Epidemiologist Names of these professionals will be provided to APOC Management, by coordinator after the preparatory visits. 8 Preparatory Visits by Coordinator (Prof. Eka.I. Braide) Coordinator will, in each country, meet the following: * National Coordinator '.' NOCP * WHO official * NGDO officials (one per site) * Project Coordinator (one per site) During the meetings the following will be addressed o Debriefing on first round of study . Briefing on plans for second round of study o Preparation for second round ofstudy - Selection of sites (Ethiopia only) - Composition of local team - Review of available equipment and supplies - Procurement of equipment and supplies (local) - Logistics,vehicles, accornmodation. 9 Country Location Dates of visits 2003 Nigeria Lagos Arrive... Meetings Depart.. . May 6 May 7-8 inclusive May 9 Ethiopia Addis Ababa Arrive. ... ....July 13 Meetings... July 13-15 inclusive Join TCC mission on July 16 Depart..... .. July 20 Sudan Khartoum Arrive... Meetings Depart... . August 4 August 5-6 inclusive .August 7 Uganda Kampala Arrive... Meetings Depart... August 10 August ll-12 inclusive August 13 Tanzania Daar-Es-Salaam Arrive.... Meetings. Depart.... August 13 August 14-15 inclusive August 16 After the visits, the following will be provided by APOC management ,/ Names of in-country team members ,/ Revised timetable for fieldwork in each site ...if revised ,/ Information on sites in Ethiopia. Sites........Teams I and' 2 Site Project name Country Team Study period 2004 Ikom Cross River CDTI Nigeria 1 Socio:July 5-25 Team:July 12-31 Olamaboro Kogi CDTI Nigeria 1 Socio:October 4-26 Team:October 11-31 Gembu/Gashaka Taraba CDTI Nigeria 1 Socio:Auglst 4-26 Team:August 11-31 Raja Southern CDTI Sudan Sudan 1 Socio:Jan. 12-Feb. 1 Team:Jan 19-Feb 8 Bwakira Tanzania Morogoro CDTI Tanzania 2 Socio:July 5-25 Team:July 12-31 Bushenyi Uganda Phase two Uganda 2 Socio:August 4-26 Team:August 11-31 Ethiopia To be selected Ethiopia 2 Socio:Jan. 12-Feb. 1 Team:Jan. 19-Feb. 8 10 SCHEDULE OF FIELD WORK - TEAMS 1 AND 2 TEAM 1, SITE 1: RAJA, SUDAN ACTIVITIES ACTION BY PLACE PERIOD 1 Arrival of *Social Scientist in Khartoum Social Scientist Khartoum 12 January 2004 2 Social Scientist and NOTF at Site I Social Scientist, NOTF/Local helpers Site I 14 Jantary 2004 J Census/ Social Science Survey Social Scientist, NOTF/Local helpers Site I 14 to 23 January2004 4 Rest of team arives in Khartoum Team members Khartoum 19 January 2004 5 Team rneets with WR and NOTF Team members, WR and NOTF Khartoum 20 January 2004 6 Team/NOTF arrive at Site I Meet local leaders TeamAtrOTF, Local experts Site I 20 January 2004 7 Field work Team/ Local experts, Local helpers Site I 2l January to 7 February 2004 8 Depart for Khartoum Team members Khartoum 8 February 2004 9 Depart for individual countries Team members *Social scientist will be in field for twenty days. 11 TEAM I, SITE 2 _ IKOM, NIGERIA *Social scientist will be in field for twenty days ACTIVITIES ACTION BY PLACE PERIOD 1 Arrival of *Social Scientist in Lagos Social Scientist Lagos 5 July 2004 2 Social Scientist and NOTF at Site 2 Social Scientist, NOTF/Local helpers Site 2 7 July 2004 J Censusi Social Science Survey Social Scientist, NOTF/Local helpers Site 2 7-16 July 2004 4 Rest of team arrives in Lagos Team members Lagos 12 July 2004 5 Team meets with WR and NOTF Team members, WR and NOTF Lagos 13 July 2004 6 Team/NOTF arrive at Site 2, meet local leaders Team, NOTF, Local experts Site 2 15 July 2004 7 Field work Team/Local experts, Local helpers Site 2 15 to 30 July 2004 8 Team departs for Lagos Team members Lagos 3l July 2004 9 Depart for individual countnes Team members t2 TEAM 1, SITE 3 - GEMBU/GASHAKA, NIGERIA *Social scientist will be in field for twenty days ACTIVITIES ACTION BY PLACE PERIOD i Arrival of *Social Scientist in Lagos Social Scientist Lagos 4 August 2004 2 Social Scientist and NOTF at Site 3 Social Scientist, NOTF and Local helpers Site 3 6 August 2004 J Census/ Social Science Survey Social Scientist, NOTF, Local helpers Site 3 6-15 August2004 4 Rest of team arrives in Lagos Team members Lagos 11 August 2004 5 Team meets with WR and NOTF Team members, WR and NOTF Lagos 12 August 2003 6 TeamiNOTF arrive at Site 3, meet local leaders Team, NOTF, Local experts Site 3 14 August 2004 7 Field work Team, Local experts, Local helpers Site 3 14-29 August 2004 8 Team departs for Lagos Team members Lagos 30 August 2004 9 Depart for individual countries 13 TEAM 1, SITE 4 -. OLAMABORO, NIGERIA *Social scientist will be in field for twenty days ACTIVITIES ACTION BY PLACE PERIOD 1 Arrival of *Social Scientist in Lagos Social Scientist Lagos 4 October 2004 2 Social Scientist and NOTF at Site 4 Social Scientist, NOTF/Local helpers Site 4 6 October 2004 aJ Census/ Social Science Survey Social Scientist, NOTF/Local helpers Site 4 6-15 October 2004 4 Rest of team arrives in Lagos Team members Lagos 11 October 2004 5 Team members meet with WR and NOTF Team members, WR and NOTF Lagos 12 October 2004 6 Team, NOTF arrive at Site 4, meet local leaders Team, NOTF, Local experts Site 4 14 October 2004 7 Field work Team, Local experts, Local helpers Site 4 14-29 October 2004 8 Team deparls for Lagos Team members Lagos 30 October 2004 9 Depart for individual countries t4 TEAM 2, SITE 1: ETHIOPIA *Social scientist will be in field for twenty days ACTIVITIES ACTION BY PLACE PERIOD 1 Arrival of *Social Scientist in Addis Ababa Social Scientist Addis Ababa 12 Jantary 2004 2 Social Scientist and NOTF at Site I Social Scientist, NOTF/Local helpers Site I 14 January 2004 J Census/ Social Science Survey Social Scientist, NOTF/Local helpers Site I 14 to 23 January 2004 4 Rest of team arrives in Addis Ababa Team members Addis Ababa 19 January 2004 5 Team meets with WR and NOTF Team members, WR and NOTF Addis Ababa 20 Jantary 2004 6 TeamA{OTF arrive at Site I. Meet local leaders Team/NOTF, Local Experts Site I 20 January 2004 7 Field work Team/ Local experts, Local helpers Site I 2l lanuary to 7 February 2004 8 Depart for Addis Ababa Team members Addis Ababa 8 February 2004 9 Depart for individual countries Team members 15 TEAM 2, SITB 2 : TANZANIA *Social scientist will be in field for twenty days ACTIVITIES ACTION BY PI,ACE PERIOD 1 Arrival of xSocial Scientist in Dar-es-Salaam Social Scientist Dar-es-Salaam 5 July 2004 2 Social Scientist and NOTF at Site 2 Social Scientist, NOTF/Local helpers Site 2 7 Iuly 2004 J Census/ Social Science Survey Social Scientist, NOTF/Local helpers Site 2 7-16 lily 2004 4 Rest of team amives in Dar-es-Salaam Team members Dar-es-Salaam 12luly 2004 5 Team rneets with WR and NOTF Team members, WR and NOTF Dar-es-Salaam 13 July 2004 6 Team/NOTF arrive at Site 2, meet local leaders Team, NOTF, Local experts Site 2 15 July 2004 7 Field work TeamlLocal experts, Local helpers Site 2 15 July to 30 July 2004 8 Team departs for Dar-es- Salaam Team members Dar-es-Salaam 3l July 2004 9 Depart for individual countries Team members 16 TEAM 2, SITE 3 : UGANDA *Social scientist will be in field for twenty days ACTIVITIES ACTION BY PLACE PERIOD I Arrival of xSocial Scientist in Kampala Social Scientist Kampala 4 August 2004 2 Social Scientist and NOTF at Site 3 Social Scientist, NOTF and Local helpers Site 3 6 August 2004 J Census/ Social Science Survey Social Scientist, NOTF, Local helpers Site 3 6-15 August2004 4 Rest of team anives in Kampala Team members Kampala 11 August 2004 5 Team meets with WR and NOTF Team members, WR and NOTF Kampala 12 August 2003 6 Team/NOTF anive at Site 3, meet local leaders Team, NOTF, Local experts Site 3 14 August 2004 7 Field work Team, Local experts, Local helpers Site 3 14-29 August 2004 8 Team departs for Kampala Team members Kampala 30 August 2004 9 Depart for individual countries 17 Personnel Anglophone teams...1 and 2 External One (1) Temporary adviser Per Diem and honoranum (Preparatory visits) 6 days per country Per Diem and honorarium...20 days per site (team 1:4 Sites "."Team 2 :3 sites) Four (4) Team members Internal (Local/in country) per site One (1) Social scientist Per diem Two (2) Ophthalmologists Per diem One (1) additional Ophthalmologist for Sudan Per diem Two (2) Clinicians Per diem One (l ) Entomologist Per diem Four (4) Enumerators (determination of coverage) Per diem Two (2) Wu-.Iones Assistants Per diem Two (2) Data entry Assistants Per diem Two (2) Technologists Per diem Two (2) Fly catchers .."".' Per diem One ( 1) Driver . . . for entomology Per diem Three (3) Drivers ...for rest of team Per diem Two (2) Local helpers (guides and interpreters etc) Per diem One ( 1 ) National/ZonallRegional Coordinator' Project accountant Per diem One (1) CDl'l Project Coordinator "' Per diem One (1) CDTI LGA/District Coordinator Per diem Five (5) officials for preparatory meetings with coordinator Per diem In-country travel for 5 officials for preparatory meeting In- country travel for team members from city of residence to site 20 days 20 days 20 days 20 days 40 days 10 days 20 days 20 days 60 days 60 days 60 days 20 days 20 days 4 days One (1) 2 days 20 days 20 days 3 days (Return) once only 18 EQUIPMENT AND SUPPLIES NEEDS FOR TEAMS 1 AND 2 AVAIT ABLE EOUIPMENT NON AVAILABLE EOUIPMENT a 2 WU-Jones Computers. software. manual (out of order) 2 pru hsladisks 1 Direct ophthalmoscope 1 slit-larnp without stand or anterior segment camera two 20 D Lenses I Indirect Ophthalmoscope small pupil 1 Snellen's <<E>> chart+ trial frames (adult and child+pinholes) | 6160 <<E>> Chart (detachable) 3 Kidney dishes 1 Voltage regulator (current stabilizers) 1 Generator (YAHAMA, ET500) (to be purchased or hired or borrowed) per team 1 cable with switch board 1 Ice chest Blacks cuftains + rings (15m) 1 Dissecting microscope (Wild M5) + accessories * lens cleaning kit a a a a o a a a a o a a a a . box for Wu-Jones computers, chin rests and buzzers o 1 Digital Camera per team for dermatology o 2 Computers and Software (for entomologist and social scientist and dermatologist) ophthalmologist - Lotus 123 for entomologist, OCP software for data analysis (to be supplied by APOC) o two more ophthalmoscopes per team o stand for slit-lamp with Anterior Segment Camera and accessories (appropriately assembled before packaging) APOC to supply . 1 Fundus Camera (Topcon Model) and accessories KOWA II per team. APOC to supply o 1 Goldmann Applanation Tonometers (To be supplied by APOC) per team c 2Pen Torches (local purchase) o l0o/o DEC cream /lotion . perforatedhypoallergenicplaster . Filter paper o Ice patch . Foreign body extraction kit o 1 cable with switch board c 2 Collapsible tables o 4 Collapsible chairs o i Dissection kit o 4 Camp beds + mosquito nets impregnated o 2tape recorders . 2table fans per team . 1 Global Positioning System (GPS) unit 19 SUPPLIES . 1 box rnicrotitre plates (-96 wells) o 20 pkts microscope slides (50/pkt) o 10 pkts microscope cover slips (200/pkt) o 5000 catching tubes c 250 bijou bottles o 250 universal bottles o 500 plastic bags . 5 pkts filter paper (or tissue paper) . 1 lens cleaning set . 5 multiple heads adaptor o I electric cable 50mx2 TRANSPORTATION AVAILABLE EQUIPMENT NON AVAILABLE EQUIPMENT a 4 Vehicles provided by NOTF x 20 days a Fuel and Oil/Lubricants x 20 days STATIONERY AVAILABLE EQUIPMENT NON AVAILABLE EQUIPMENT . Spare bulbs + 60 watts and batteries medium size alkaline for all equipment o (cameras, slit-lamps, fundus cameras, ophthalmoscopes etc) to be supplied by APOC o PhotoBraphic Films - 25 rolls Kodak 200mm Gold (for Ophthalmology) ektachrome 100 x 25 films (To be supplied by APOC) o 5 Rolls of plaster (Local purchase) . 5 Rolls of Gauze ( Local purchase) o 5 bottles of Hydrogen peroxide (Local purchase) o 1 Litre of Methylated Spirit (Local purchase) . 2kg cotton wool (Local purchase) o 1 ELECTRIC CABLES 50Mx2 ( Local purchase) o 1 ro11 (48) toilet tissue for use on slit lamp AVAILABLE EQUIPMENT NON AVAILABLE EQUIPMENT a OCP foms 1,2-4, for fly catches, dissection, 20 booklets each (To be supplied by OCP/APOC) o Production of Questionnaires for all groups - 800 forms for dermatology - 2000 forms for sociology - 800 forms (Wu-Jones) - 400 forms (examination for ophthalmology) o Pens, clips, pencils, carbon paper, tippex, stapler (local) o 10 reams of A'4 paper (local) o 10 registers for census and record keeping (local) o 4 notebooks (local) o 2 reams of flip chart papers (local) . 1 flip chart stand (local) o 4 masking tapes (local) 20 DRUGS CHEMICAL, REAGBNTS AVAILABLE EQUIPMENT NON AVAILABLE EQUIPMENT . Chlorpheniramine 1000 tabs (local) o 20 tubes antifugal cream (tioconazole cream) local . 20 tubes antibiotic creams (Mupurican cream) - local o 6 bottles/tubes insect reppelent crearl (local) o Paracetamol 1000 tabs (local) o Piriton 1000 tabs (local) o Chloroquine phosphate x 1000 tabs o Tetracycline x 1000 caps (local) o Fersolate tabs x 1000 tabs o Vit A capsules x 1000 caps (local) o 100 bottles Chloramphenicol eye drops and ointment (local) o Diamox tabs x 1000 (local) o 20 bottles phenylephrine l0%o (local) o 20 bottles mydrilate 1"/o (local) o 10 bottles amethocaine 1o/o (local) . 20 bottles betnesol drops (local) o 10 pkts fluorescein strips (local) AVAILABLE EQUIPMENT NON AVAILABLE EQUIPMENT o 5 litres absolute ethanol (local) o 1 litre chloroform (local) . 5 litres glacial acetic acid (local) . 1 litre glycerol (local) o Physiological saline 500m1 (local) 2t OTHERS REPORT ON GROUP WORK BY FRANCOPHONE TEAMS COMPOSITION OF TEAM 3 External members: Doctor FOBI Grace Dr. OZOH Gladys Dr. ENYONG Peter Dr. ABE Claude Dr. KAMGNO Joseph Local Team members Ophthalmologist: Dermatologist: Entomologist: Social scientist: Data Manager: 2 data entry persons One ophthalmic nurse Three local helpers Four Enumerators One technician: Team leader, Ophthalmologist Dermatologist Entomologist Social scientist Epidemiologist Dr. NLATTE Berthin or Dr. EPEE Dr. BISSEK Anne-C6ci1e Mr. DEMANOU Maurice or ESUM Matthias Mrs CHIFFOR Mr. OLINGA OLINGA Jean-Marie To identify Ms. HADJARATOU To identify To identify Mr. NDAGA Simon AVAILABLE EQUIPMENT NON AVAILABLE EQUIPMENT . 2 pkts disposable gloves (local) o Disinfectant/soap(local) o 2 plastic wash basins (local) o 4 gericans (50 lit) - local o 15 metres of materials for screens and loin cloth (local) o DHL for film processing and posts/email (local) o Air fares (in country) 22 IMPACT ASSESSMENT STUDIES 2OO4 SCHEDT-ILE OF FIELD VISITS FOR TE,AM 3 ACTIVITIES RESPONSIBLE PARTY PLACE ACTIVITY OF MONTH/ DURATION SITE I NGAMBE CAMEROON 1. Notification of Local Authorities NOTF Cameroon site I Ngambe Early December 2003 2. Arrival of Entomologists Peter Enyong Yaounde 4 January 2004 3. Departure to srte I Peter Er.ryong Site I Littoral 6 January 2004 4. Arrival of Socral Screntrst Claude Abe Yaounde 4 January 2004 5. Meetings Socral Screntrsts/Team Leader,NOTF/WR Yaounde 5 January 2004 6. Departure/Census and Social Science Survey/Preparatory site visit SS/Team Leader/Local Helpers/ Yaounde 6 January 2004 7. Rehrm srte I Team Leader Yaounde l0 January 2004 8. Arrival of Dermatologist Dr. Ozoh Yaounde 20 January 2004 9. Meetings Team Leaders/Dr. OzohNOTF/WR Yaounde 2l January 2004 10 Return from srte I Entomologrst Yaounde 2l larntary 2004 1 L reportrng/departrng Entomologrst Yaounde/Kumba 23 January 2004 12. Return of Social Scientist for Meetings Social Scientrst, Entomologrst, Medrcal team Yaounde 22 January 2004 13. Arrival at site I Medical Team/Comp.Tech ( ophtalmologist/Dermatologist) + Helpers Site I-Yaounde 23 January 2004 14. Team departs fol Yaounde Medical Teanr/Comp.Tech (DermatologrsVOphtalmologrst) Srte I-Yaounde 13 February 2004 15. Data entry + Reportrng Team Leader and Computer Technician Dr Ozoh Yaounde 20 February 2004 16. Meetings Team + WR Yaounde 20 February 2004 17. Departure from Cameroon Dr Ozoh Nigeria 21 February 2004 23 SCHEDULE OF FIELD VISITS FOR TEAM 3 (Continued) SITE II KUMBA CAMEROON 18. Arrival il Yaounde Entomologist Yaounde l't February 2004 19. Meetrng Entomologrst/WR Yaounde 2February 2004 20. Departure to srte II Entomologists Srte II l't visrt 3 February 2004 2l. Return from site II Entomologists Yaounde 18 February 2004 22. Reportrng/Departure Entomologrsts Yaounde/Kumba 20 February 2004 23. Departure to site I Dr Peter Enyong Site I (2"d visit) 24February 2004 24. Return form site I Dr Peter Enyong Yaounde 10 March 2004 25.Departure Dr Peter Enyong Yaounde /Kumba 12 March2004 26. Departure Socral Screntrst Claude Abee Site II 28 March 2004 27 . Preparatory vrsit Team Leader Dr Grace Fobi Site II 4 Aprll2004 28.Return Dr Grace Fobi Yaounde 9 April2004 29. Arrwal Dr Ozoh Yaounde 12 Apri2004 30. Return of Social S and meetings Team,NOTF Yaounde 12 Aprll2004 3 1. Meeting/Departure of Med.Team Dr. OzohlDr. FobiA{OTF/WR Site II 14 Apnl 2004 32. Rehrrn of Medical team Dr. OzolVDr. Fobi/ others Yaounde 5 May 2004 33. Data entry and reporting Dr. Ozoh, Dr. Fobi NOTF, Local Helpers, Local Opht., Local Phycisian Yaounde l1 May 2004 34. Departure DR Ozoh Nigeria 12May 2004 35. Reportrng Peter Enyong Yaounde 26 February 2004 36. Retum Peter Enyong Kumba 21February 2004 37. Departure to srte II Peter Enyong Site II second visit 04 April2004 38. Retum Peter Enyong Kumba l9 April2004 24 SCHEDULE OF FIELD VISITS FOR TEAM 3 (Continued) SITE III LUNDA SUL, ANGOLA 39. Departure to Angola Claude Abe Luanda 13 June 2004 40. Meeting Claude Abe /WR/Local SS Luanda 14 June 2004 41. Departure to Angola Claude Abe Srte III 17 Iune2004 42. Return Claude Abe Luanda 7 Jdy 2004 43. Arrival in Angola Grace Team Leader/Peter Enyong Luanda 7 July 2004 44. Meetrng Team Leader/ Entomo/SS/WR Claude Abe Luanda 8 July 2004 45.Reporting/Departure Luanda/Cameroon I I July 2004 46. Arnval rn Angola Dr OzohlData Manager Luanda I I July 2004 4T.Departure Peter entomologist Site III 12 Jttly 2004 48. Return home from site III Peter entomologrst Luanda 23 lu,ly 2004 49. Reportrng Peter entomologtst Luanda 24 July 2004 50. Departure to site III Peter entomologist Cameroon 27 IluJy 2004 51. Departure team Clinical Team Site III l5 July 2004 52. Return from site III Clinical Team Luanda 5 August 2004 53. Data entry/reporting Clinical Team Luanda 6 August 2004 54. Meeting Dr. OzohlDr Fobi/SS,NOTF/WR CameroonNigeria 12 August 2004 55. Deparhrre from Angola Med.Team Nigeria Cameroon l3 August 2004 56. Anival Peter Enyong entomologist Luanda 9 August 2004 57. Meetrng WRNOTF/entomology team Luanda l0 August 2004 58. Departure to site lll Entomology Team Slte III 13 August 2004 59. Return from srte III Entomology Team Luanda 23 August 2004 60. Reportrng Entomology Team Luanda 24 August 2004 6l.Departure from Angola Peter Enyong entomologist Cameroon 26 August 2004 62.D ata analysis meetrng Team Ouagadougou April2005 25 INVENTORY OF EXISTING MATERIALS AND EQUIPMENT FOR TEAM 3 No Equipment Ouantitlr I Incomplete slit larnp (no stand) 1 2 Visual acurty chart 1 J 220 volts (does not seem to work)Transfotmer 1 4 Folding 6 5 Folding table 2 6 Stool 1 7 Parasol 1 8 Direct ophthalmoscopes (not working) 1 9 Indirect ophthalmoscope i 10 Glaucotest Tonometer 1 11 DELL computer not working again 1 POOLED REQUIREMENT/BUDGET PER SITE Personnel Team 3 has a total of 3 sites in Cameroon (Ngambe and Kumba) and Angola (Lunda Sul). Extemal One ( 1) Temporary adviser Per Diem and honorarium per country (Preparatory visits) 6 days One (1)Team Leader Per Diem and honorarium (Preparatory visit to site) 5 days One (1)Team Leader Per Diem and honorarium (Meetings with WRAIOTF/ Team rnembers etc) 5 days Two (2) Tearn members Per Diern and honorarium 21 days/site One(1) Team members Per Diem and Honorarium 30 days One (1) Team Member Per Diem and Honorarium 20 days Internal (Local/in country) per site One (1) Social scientist One ( 1 ) Ophthalmologist One (1) ophthalmic Nurse Per diem Per diem 20 days 21 days 21 daysPer diem 26 One (l) Derrnatologist Perdiem One (1) epidemiologist Per diem One(l) Entornologist Perdiem Four (4) Enumerators (determination of coverage) Per diem Two (2) Wu-.Iones Assistants Per diem Two (2) Data entry Assistants Per diem Two (2) Technologists (entomology helper) Per diem Two (2) Fly catchers Per diem Four (4) Driver ...for medical team Per diem One (1) Driver ...for entomology Per diem Two (3) Local helpers (guides and interpreters etc) Per diem One ( I ) National/ZonallRegional Coordinator One (1) CDTI /District Coordinator Per diem In- country travel for team members from city of residence to site (Return) once only 21 days 21 days 90 days 10 days 1 days 21 days 90 days 90 days 21 days 90 days 2l days 4 days 21 days 27 EQUIPMENT REQUIRED . 1 Camera Dennatology (Digital) o 2 Computers and Software (for entomologist and social scientist and demratologist) ophthalmologist - Lotus 123 for entomologist, OCP software for data analysis (to be supplied by APOC) o 2 WU-Jones Computers, software, manual + chin rest * buzzet (To be supplied . Table of slit lampe o 1 Fundus Camera (Topcon Model) and accessories KOWA II o 2 Pen Torches . 2 pin hole disks . 1 Direct Ophthalmoscope o trial frames (adult and child + pinholes) o 16160 << E >> Charl (detachable)5 days . 5 gallipots . 3 Kidney dishes o 2tape recorders . blacks cuftains + rings (15m) o 4 table fans o 1 Global Positioning System (GPS) unit o 2 Dissecting microscope (Wild M5) + accessories * lens cleaning kit o 2 Voltage regulator (current stabilizers) . 2 Generators (YAMAHA, ET500) (to be purchased or hired or borrowed) o Foreign body extraction kit o 4 Cables with switch board o 2 Dissection kit o 2 Ice chest o 4 Camp beds + 4 mosquito nets irnpregnated o 1 Porlable (for Entomologist CT) . 2 Gericans o 2 Fans o 5000 catching tubes o 1000 catching forms o 500 dissections forms . 5 liters alcohol (Ethanol) . 5 liters Chlorofonn . 500 slides o 500 cover slides . 2 kg cotton o 2 flacons de vemis ir ongle incolore o 4 rain coast o 2 tables o 4 chairs o 4 boots . 5 liters Acid Acetic o 2 clock 28 aa . 50 pens . 30 pencils o 2 reams of paper o t thermometer . 5 bubles 60 w o 6bubles6w o 2 liters physiological saline o 20 tubes o 4 torches . 4 umbrella o 48 batries 1. SUPPLIES Spare bulbs + 60 watts and batteries medium size alkaline for all equipment (Canreras, slit-lamps, fundus cameras, ophthalmoscopes etc) Photographic Fihns - 25 rolls Kodak 200rnm Gold (for both dermatology and Ophthalmology) ektachrome 100 x 25 films (To be supplied by APOC) 5 Rolls of plaster 5 Rolls of Gauze 5 bottles of Hydrogen peroxide 1 Litre of Methylated Spirit t box rnicrotitre plates (-96 wells) 20 pkts microscope slides (50/pkt) 10 pkts microscope cover slips (200/pkt) 250 bijou bottles 250 universal bottles 500 plastic bags 2 kg cotton wool 5 pkts filter paper (or tissue paper) 1 lens cleaning set 5 multiple heads adaptor 2 electric cables 50mx2 1 roll (48) toilet tissue for use on slit lamp TRANSPORTATION 4 Vehicles hired or provided by NOTF x 2i days (hired Fuel and Oil/Lubricants x 21 days 1 Vehicles hired or provided by NOTF 4 x 14 days (hired) Fuel and Oil/Lubricants 4x14 days...Entomology Entomology per year a a a a a a a a a a a a o a a a ) o a a a 29 3. STATIC}NERY . Production of Questionnaires for all groups (800 forms for dermatology - 2000 forms for sociology - 800 forms (Wu-Jones) for ophthalmology - 400 forms (examination for ophthalmology) o Pens, clips, pencils, carbon paper, tippex, stapler o 10 reams of ,A.4 paper o 10 registers for census and record keeping . OCP fomrs I.2-4, for fly catches, dissection, 20 booklets each (To be supplied by OCP/APOC) o 4 notebooks o 2 reams of flip chart papers . 1 flip chart stand . 4 rnasking tapes 4. DRUGS . Chlorpheniramine i000 tabs o 20 tubes antifugal cream (ticoncidole cream) o 20 tubes antibiotic creams (Mupurican cream) o 6 bottles/tubes insect reppelent cream o paracetamol 1000 tabs o priton 1000 tabs o chloroQuine phosphate x 1000 tabs . tetracycline x 1000 tabs o fersolate tabs x 1000 tabs o Vit A capsules x 1000 caps . 100 bottles Chlorarnphenicol eye drops and ointment o diamox tabs x 500 o 10 bottles atropine o 20 bottles phenylphrine l0o/o . 20 bottles mydrilate 10% o 10 bottles amethcaine 10% o 10 bottles bethnesol drop o 10 bottles Phenylephedrine ljoh + mydrilene 1% o 10 bottles novocaine o l0 pkts fluorescent strips 5. CHEMICAL, REAGENTS . 5 litres absolute ethanol o I litre chlorofonn . 5 litres glacial acetic acid o 1 litre glycerol 30 aa a a o a a 7, o a 6. OTHERS 2 pl<ts disposable gloves disinfectant/soap 2 plastic wash basins 4 gericans (50 lit) 15 rnetres of rnaterials for screens and loin cloth DHL for film processing and posts/email Air fares (ir-r country) FACILITIES Laboratory space at nearby institute (for entomology) - no cost Miscellaneor.rs (incidental expenses). 31 REPORT ON GROUP WORK BY FRANCOPHONE TEAMS COMPOSISTION OF TEAM 4 EXTERNAL MEMBERS Name Speciality Professor Kayembe David Professor Lapika Bruno Professor Trao16 Soungalo Doctor Mpoudi Eitel Professor Kayembe Patrick Ophthalmologist, Team leader Social Scientist Entomologist Dermatologist Epidemilologist Biostatistician NATIONAL MEMBERS NO AVAILABLE EOUIPMENT Name Speciality Muanza K. Jean Claude Kalala Auqustin Lulua Damatse Jeanne Takoma Didier Kapinga Matula Bobauea Threrry Tambwe Bantwanga Utsudi Kabasele Kanda Fly catchers Helpers Drivers Ophthalmologist Ophthalmologist Ophthalmolo gist Assistant Ophthalmologist Assistant Ophthalmologist Assistant Social Scientist Social Scientist Social Scientist Entomologist Entomologist Technician Entomologist Technician Dermatologist Dermatologist 6(2persite) 9 (5 census;2 dermato; 2 ophthalmo) 3(lpersite) 32 PROPOSE CALENDAR OF THE ENTOMOLOGIST CT (TEAM 4) I 1. Training Departure from Ouagadougou Activities Kinshasa and Inga Departure from Kinshasa 2.1 Sites I (Kasai) and III (Equateur) Visit 1 (Kasai) and visit 2 (Equateur) 7 November 2003 8-20 November 2003 21 November 2003 23 luly 2004 24 Jtly-7 August 2004 8-24 August2004 25 August 2003 27 November 2004 28 November-16 D6cember 2004 l7 December 2004. 7 May 2004 8-27 May 2004 28May-17 June 2004 18 June 2004 1'' October 2004 2-21 October 2004 22 October 2004. 3. Departure from Ouagadougou Activities Kinshasa-Equateur Activities Kinshasa-Kasai Departure de Kinshasa 2.2 Visit 2 (Kasai) Departure from Ouagadougou Activities Kinshasa-Lusambo Depafture from Kinsahsa 3.1 Sites II (Bas Coneo) and III (Equateur) Visit I (Bas Congo and Equateur) Departure from Ouagadougou Activities Kinshasa-Bas Congo Activities Kinshasa-Equateur Departure from Kinshasa 3.2 Visit 2 (Bas Congo) Departure from Ouagadougou Activities Kinshasa-Bas Congo Deparlure from Kinshasa JJ SCHEDULE OF FIELD VISITS F'OR TEAM IV Site I Sites Categories Number/ personnel RDC/KASAI/ LUSAMBO Entomologist CT Local Entomologist Entomologist Technician Fly boys Driver 1 1 2 2 1 Social Scientist CT Team Leader CT Local Scientist Enumerator/Census Data manager Driver I 1 1 5 I 1 Dermatologist CT Local Dermatologist General Physician Translator Data manager Local Helpers Driver I 1 1 1 1 2 1 Ophthalmologist CT Team Leader Local ophthalmologist Local Ophthahno assistant (Wu - .lones) Translator Data manager Local Helpers Driver 1 1 2 1 2 1 34 Activities Responsible party Place of activities Month/duration Site I: SOCIO-DEMO GRAPHICAL STUDY Site I: DERMATOLOGICAL AND OPHTHALMOLOGICAL STUDIES Meetings Prof B Lapika, Prof Kayembe, National Coord, Local ophthahnol, social scientist, NOTF, WR Kinshasa 05 May 2004 Field work Prof. B. Lapika, Prof. D Kayembe, local social scientist Lusambo 06-27 l/.ay 2004 Arrival from Yaounde Dr.E.Mpoudi Kinshasa 02Ju1y2004 Meetings + Field work Prof Lapika, Dr.Mpoudi, Prof. Kayembe, local ophta, dermat social, Scientist, National Coord. NOTF, WR. Kinshasa Luxambo 03-26luly 2004 35 Site II Sites @t Number/ Personnel RDC BAS CONGO Entomologist CT Local Entomologist Entomologist Technician Fly boys Driver 1 1 2 2 1 Social Scientist CT Team Leader CT Local Scientist Enumerator / Census Data manager Driver 1 I 1 5 1 1 Dermatologist CT Local Dermatologist General Physician Translator Data manager Local Helpers Driver 1 1 I 1 1 2 1 Ophthahnologist CT Team Leader Local ophthalmologist Local Ophthalmo assistant (Wu -Jones) Translator Data manager Local Helpers Driver 1 1 2 1 1 2 I Activities Responsible party Place of activities Month/ duration Site II: SOCIO-DEM RAPHICAL STUDY Meetings Prof. B Lapika, Prof Kayembe, National Coord, local ophtalmol, social scientist, NOTF, WHOR Kinshasa 04 June 2004 Field work Prof. Lapika, Prof Kayembe, local social scientist, helpers, Bas-Congo 05-25 June 2004 Return from site meeting Prof. B Lapika, Prof Kayembe, National Coord, local ophthalmologist, local social scientist, NOTF, WHOR Kinshasa 26 June 2004 36 S{9-III: Site II: DERMATOLOGICAL AND OPHTHALMOLOGICAL STUDIES Dr E.Mpoudi Kinshasa 27 July 2004 Prof. Lapika, Dr Mpoudi Prof. Kayembe, National Coord, local ophta, social dermat, scientist, NOTF, WR Kinshasa Bas Congo 28 July 2004 to 17 At9.2004 Departure Dr E. Mpoudi Yaound6 1SAug.2004 Sites CateeaMs Number/ Personnel RDC/EQUATEUR Entomologist CT Local Entomologist Entornologist Techni cian Fly boys Driver 1 1 2 2 1 Social Scientist CT Team Leader CT Local Scientist Enumerator / Census Data manager Driver 1 I 1 5 1 1 Dermatologist CT Local Dermatologist General Physician Translator Data manager Local Helpers Driver 1 1 1 1 1 2 1 Ophthalmologist CT Team Leader Local ophthalmologist Local Ophthalmo assistant (Wu -Jones) Translator Data managel Local Helpers Driver 1 1 2 1 1 2 1 JI Arrival from Yaounde Meetings + Field work Activities Responsible party Place of activities Month/ duration Site III: SOCIO-DEMOGRAPHICAL STUDY* Site III: DERMATOLOGICAL AND OPHTHALMOLOGICAL STUDIES EQUIPMENT TEAM IV Meetings + Field work Prof. Lapika, Prof. Kayembe, Na Coord. Local ophthahnol, Social scientist, NOTF,WHOR Kinshasa Equateur 04-26 July 2004 Arrival from Yaounde Dr E. Mpoudi Kinshasa 02 Oct.2004 Field work + Meetings Prof. Lapika, Prof. Kayembe, National Coord. Local ophtha., social scientist, NOTF,WHOR Kinshasa Equateur 03-25 Oct2004 Departure to Yaound6 Dr E Mpoudi Yaound6 27 Oct.2004 AVAILABLE EOUIPMENT NON AVAILABLE EOUIPMENT a 1 Camera o 2 Computers and Software (for entomologist and social scientist and dermatologist) ophthalmologist - Lotus 123 for entomologist, OCP software for data analysis (to be supplied by APOC) a 2 pin hole disks a 2 WU-Jones Computers, software, manual + chin rest (To be supplied by APOC) a 1 Direct ophthalmoscope o 1 Slit-Lamp with Anterior Segment Camera and accessories (appropriately assembled before packaging) table + cost to assemble o 220DLenses 1 Fundus Camera (Topcon Model) and accessories KOWA II a 1 Snellen's <<E>> chart+ trial frames (adult and child+pinholes) a 1 Goldmann Applanation Tonometers (To be supplied by APOC) a | 6160 <<E>> Chart (d6tachable) a 2 Pen Torches a 3 Kidney dishes a 1 Indirect Ophthalmoscope small pupil a I Voltage regulator (current stabilizers) a 1 Dissecting microscope (Wild M5) + accessories * lens cleaning kit a 1 Generators (YAHAMA, ET500) (to be purchased or hired or borrowed) a 1 Generators (YAMAHA, ET500) to be purchased or hired or borrowed) a 1 cable with switch board a Foreign body extraction kit a 1 Ice chest a 1 cable wiht switch board a Blacks curtains + rings (15m) a 2 Collapsible tables 38 a tables fan a 4 Collapsible chairs a 4 Camp beds + mosquito nets impregnated a 2 tape recorders o 2 table fans a 1 Global Positioning System (GPS) unit . 2 Dissecting rnicroscope (Wild M5) + accessories * lens cleaning kit o 2 Voltage regulator (current stabilizers) o 2 Generators (YAMAHA, ET500) (to be purchased or hired or borrowed) o Foreign body extraction kit . 4 Cables with switch board o 2 Dissection kit o 2 Ice chest o 4 Camp beds + 4 mosquito nets impregnated o 1 Portable (for Entomologist CT) o 2 Gericans o 2 Fans . 5000 catching tubes o 1000 catching forms o 500 dissections forms o 5 liters alcohol (Ethanol) . 5 liters Chloroform . 500 slides . 500 cover slides . 2kg cotton . 2 flacons de vernis ir ongle incolore o 4 rain coast o 2 tables o 4 chairs o 4 boots o 5 liters Acid Acetic . 2 clock . 50 pens o 30 pencils o 2 reams of paper o 1 thermometer . 5 bubles 60 w o 6bubles6w o 2 liters physiological saline o 20 tubes o 4 torches . 4 umbrella o 48 batries 39 AVAILABLE EOUIPMENT NON AVAILABLE EOUIPMENT . 1 box microtitre plates (-96 wells) . Spare bulbs + 60 watts and batteries medium size alkaline for all equipment (cameras, slit-lamps, fundus cameras, ophthalmoscopes etc) . 20 pkts microscope slides (50/pkt) . Photographic Films - 25 rolls Kodak 200mm Gold (for both dermatology and Ophthahnology) ektachrome 100 x 25 films (To be supplied by APOC) . 10 pkts microscope cover slips (200/pkt) . 5 Rolls of plaster . 5000 catching tubes . 5 Rolls of Gauze 250 bijou bottles . 5 bottles of Hydrogen peroxide . 250 universal bottles . 1 Litre of Methylated Spirit . 500 plastic bags .2kg cotton wool . 5 pkts filter paper (or tissue paper) . 1 ELECTRIC CABLES 50Mx2 . 1 lens cleaning set . 1 roll (48) toilet tissue for use on slit larnp . 5 rnultiple heads adaptor . 1 electric cable 50rnx2 SUPPLIES TRANSPORTATION AVAILABLE EQUIPMENT NON AVAILABLE EOUIPMENT . 2 Vehicles hired or provided by NOTF x 21 days (hired) . Fuel and Oil/Lubricants x 21 days 40 STATIONERY AVAILABLE EQUIPMENT NON AVAILABLE EQUIPMENT . OCP forms 1,2-4, for fly catches, dissection, 20 booklets each (To be supplied by OCP/APOC) . Production of Questionnaires for all groups (800 forms for dermatology - 2000 forms for sociology - 800 forms (Wu-Jones) for ophthalmology - 400 forms (examination for ophthalmology . Pens, clips, pencils, carbon paper, tippex, stapler . 10 reams of ,A'4 paper . 10 registers for census and record keeping . 4 notebooks . 2 reams of flip chart papers . 1 flip chart stand . 4 masking tapes DRUGS AVAILABLE NQUIPMENT NON AVAILABLE EOUIPMENT . Chlorpheniramine 1000 tabs . 20 tubes antifugal cream (ticoncidole cream) . 6 bottles/tubes insect reppelent cream . Priton 1000 tabs . Chloroquine phosphate x 1000 tabs . Tetracycline x 1000 tabs . Fersolate tabs x 1000 tabs . Vit A capsules x 1000 caps . 100 bottles Chloramphenicol eye drops and ointment . Diamox tabs x 500 . l0 bottles tropine . 20 bottles phenylphrine l0o/o . 20 bottles mydrilate 10% . 10 bottles amethcaine 1oZ . 10 bottles bethnesol drop . l0 bottles Phenylephedrrne l0o/o + mydrilene 1% . 10 bottles novocaine . 10 pkts fluorescent strips 41 CHEMICAL. REAGENTS OTHERS LOCAL ENTOMOLOGISTS TRAINING SCHEDULE OF'FIELD VISITS FOR TBAM IV AVAILABLE EOUIPMENT NON AVAILABLE EQUIPMENT a 5 liters absolute ethanol a 1 liter chloroform a 5 liters glacial acetic acid a 1 liter mayer's haemalum o 1 liter glycerol o Physiological saline AVAILABLE EOUIPMENT NON AVAILABLE EQUIPMENT a 2 pkts disposable gloves a Disinfectant/soap a 2 plastic wash basins a 4 gericans (50 1i0 o 15 metres of materials for screens and loin cloth o DHL for film processing and posts/email a Air fares (in country) Activities Responsible party Place of activities Month/duration Notification of Authorities NOTF DRC/ Kasai/ Lusambo Early November 2003 Arrival from Ouaga Prof. S.Traor6 Kinshasa 7 Nov Planning meeting of training programme Prof.S.Traor6, National Coordinator, Team leader trainees Kinshasa Inga 8Nov.- 20 Nov Deparlure to Ouaga Prof. S. Traore Ouaga 21 Nov 42 Activities Responsible party Place of activities Month/durat ion Site I ENTOMO ICAL STUDY Notification of Authorities NOTF DRC/ KasaiT Lusambo Early 2004 January Departure to site Local Entomologist Lusambo 04Ian.2004 Meetings Local Entomologist,technologists, helpers, driver Lusambo 05 Jan.2004 Field work Local Entomologist,technologists,fly catchers, driver Lusambo 06-12 Jan. Return from site Local Entomologist Kinshasa L3 Jan2004 Departure to site Local Entomologist Lusambo 04March2004 Field work Local Entomologist, Entomologist technicians, helpers, driver Lusambo 5-l2Mar 2004 Retum from site Local Entomologist Kinshasa 13 March 2004 Visit 1: Prof. S.T Activities Prof. S.Traore * local Entomologist Kinshasa/ Kasai 8- 24 {u.g.2004 Departure to Ouaga Prof. STraor6 Ouaga 25 Atg2004 Arrival from Ouaga Prof.S.Traor6 Kinshasa 27 Nov. 2004 Meetings + field work Prof. S.Traore * local entomologist Kinshasa/ Lusambo 28 Nov 16 D6c 2004 Departure to Ouaga Prof. S.Traor6 Ouaga 17 Dec.2004 Site I: SOCIO-DEMOGRAPHICAL STUDY Meetings Prof. Lapika, Prof Kayembe, National Coord local ophthalmol, social scientist, NOTF, WR Kinshasa 05 Mav 2004 Departure to site Prof.B Lapika, Prof D Kayembe, local social scientist Lusambo 06May 2004 Field work Prof Lapika, Prof Kayembe local social scientist, helpers, driver Lusambo 7 25 May 2004 Return from site Prof.B Lapika, Prof.D. Kayembe, local social scientist Kinshasa 26Mav 2004 Return from site meeting Prof B Lapika, Prof. D. Kayembe, National Coord., local ophtalmol social scientist, NOTF, WHOR Kinshasa 27 May 2004 43 Site I: DERMA LOGICAL AND OPHTHALMOL ICAL STUDIES Meetings Prof Lapika, Dr Mpoudi, Prof. Kayembe, local ophta., social, dermat. Scientist, National Coord. NOTF, WR. Kinshasa 03 July 2004 Departure to site Dr.E Mpoudi Prof. D Kayembe, local ophta, dermat. Lusambo 04Iily 2004 Field work Prof. Kayembe, Dr. Mpoudi, local ophtha, dermat., helpers Lusambo 05-24J uly 2004 Retum from site Prof. Kayembe, Dr Mpoudi, local ophtha, dermat., helpers Kinshasa 25 Iuly 2004 Return from site meetings: debriefing (site1) and briefing(Site2) Dr E. Mpoudi Prof. D Kayembe, National Coord, local ophtalmologist, dermatologist, NOTF Kinshasa 26 htly 2004 Site II- ENTOMOLOGICAL STUDY Notification of local Authorities NOTF DRC:Bas- Congo Early June 2004 Departure to site Local Entomologist Bas- Congo 04 Ian.2004 Field work Local Entomol,Technologists, helpers, driver Bas- Congo 05-11 Jan2004 Return from site Local Entomologist Kinshasa 12 Jan2004 Departure to site Local Entomologist Bas- Congo 04March2004 Field work Local Entomologist Bas- Congo 5-12Mar2004 Return from site Local Entomologist Kinshasa 13March2004 Yisit 1: Prof. S.Traor6+ Arrival lrom Ouaga Prof. S. Traor6 Kinshasa 7 may 2004 Meetings + Field work Prof. S. Traor6, Local Entomologist Kinshasa/ Bas Congo 8 May -27 May 2004 t Arrival frorn Ouaga Prof.S.Traor6 Kinshasa I Oct .2004 Meetings + Field work Prof. S.Traor6+local entomologist Kinshasa / Bas- Congo 2 - 2l Oct 2004 Departure to Ouaga Prof. . S.Traor6 Ouaga 22 Oct2004 44 Site II : SOCIO-DEMOG RAPHICAL STUDY Meetings Prof.B. Lapika, Prof. D. Kayembe, National Coord., local ophtalmol, social scientist ,NOTF, WHOR Kinshasa 04 Jlune 2 Departure to site Prof.B. Lapika, Prof. D. Kayembe, local social scientist Bas- Congo 05 June 2004 Field work Prof. Lapika, Prof. Kayembe, local social scientist, helpers, Bas- Congo 06-24 June 2004 Return from site Prof.B. Lapika, Prof.D. Kayembe, local social scientist Kinshasa 25 Jtne 2004 Return from site meeting Prof.B. Lapika, Prof. D. Kayembe, National Coord,local ophtalm ologist, local social scientist, NOTF,WHOR Kinshasa 26 J:une 2004 QifA IT . DERMATOLOGICAL AND OPHTHALMOLOGICAL STUDIES Meetings Dr.Mpoudi Prof.Kayembe, National Coord. Local ophtha, dermatologist, NOTF Kinshasa 26luly 2004 Departure to site Dr. E. Mpoudi Prof. D. Kayembe, local ophta., dermatol. Bas- Congo 27 Iuly 2004 Field work Prof. Kayembe, Dr. Mpoud, local ophtha., Dermat., helpers Bas- Congo 28 July-15 Aug 2004 Arrival Prof.Kayembe, Dr. Mpoudi, local opht. Demrat, helpers Kinshasa 16 Aug. 2004 Return frorn site meetings Dr. E. Mpoudi Prof.D .Kayembe, National Coordinator, local ophtahnologist, local dermatologist, NOTF Kinshasa 17 Aug.2004 Departure Dr.E.Mpoudi Yaound6 18 Aug.2004 Site III ENTOMOLOGICAL STUDY Notification of Authorities NOTF DRC: Equateur Early.Iune 2004 t Departure to site Local Entomologist Equateur 04 Ian.2004 field work Local Entomolo gist, Entomologist technicians, local helpers, driver Equateur 05-11 Jan2004 Return frorn site Local Entomologist Kinshasa 12 Ian.2004 45 Depafiure to site Local Entomologist Equateur 04March2004 field work Local Entomologist Equateur 5-l2March2004 Return frorn site Local Entomologist Kinshasa 13March2004 Meetings + Field work Prof. S.Traor6, Local Entomologist Kinshasa/ Equateur 28 May - 17 June 20042004. Departure to Ouaga Prof. Traor6 Ouaga 18 June 2004 Arrival from Ouaga Prof. Traor6 Ouaga 23 luly 2004 Meetings + Field work Prof. Traor6,Local Entomolo gist Equateur 24 jdy-7 Aug 2004 Meetings I'rof.Lapika, Prof.Kayembe, National Coord. local ophthalmol, social scientist, NOTF,WHOR Kinshasa 04 July 2004 Departure to site Prof.Lapika, Prof. Kayembe, social scientist Equateur 05Ju1y2004 Field work Prof.Lapika, Prof.Kayembe, social scientist, helpers, Equateur 06-241u|y2004 Return from site Prof.Lapika,Prof.Kayembe, social scientist Kinshasa 251u1y2004 24.Return from site meeting Prof.Lapika, Prof.Kayembe, National Coord. local ophta social scientist, NOTF,WHOR Kinshasa 261dy2004 Arrival from Yaounde Dr.E.Mpoudi Kinshasa 02 Oct.2004 Meetings Prof.Lapika, Prof.Kayembe, Coord. local ophtha., social NOTF,WHOR National scientist, Kinshasa 03 Oct.2004 Depafiure to site Dr.E.Mpoudi Prof.D.Kayembe,local ophta., dermat. Equateur 04 Oct.2004 Field work Prof.Kayembe, Dr.Mpoudi, local ophtha, dermat. Helpers Equateur 05-24 Oct.2004 Return from site Prof. Kayembe, Dr.Mpoudi, local ophtha, dermat, helpers Kinshasa 25 Oct.2004 Return frorn site meeting Dr.Mpoudi Prof.Kayembe, National Coord local ophta., local dermatologist, NOTF Kinshasa 26 Oct.2004 Departure to Yaound6 Dr.E.Mpoudi Yaound6 27 }ct.2004 46 Site III: DERMATOLOGICAL AND OPHTHALMOLOGICAL STUDIES RECOMMENDATIONS The participants recommended the following to APOC management: Rapidly respond to and give its opinion on the protocol amendments, particularly on the following issues: addition of a new part to the study aimed at assessment of the therapeutic coverage. Include in each team an epiderniologist who will be responsible for this coverage estimation and ensure quality of data collection and analysis on the field. Endeavour to provide all the listed equipment and supplies to the teams before the onset of the f,reld work in order to facilitate the studies. Particular effort should be made to provide (a) ablzzer, a chin rest and a box for Wu-Jones machine. (b) Tables for the slit lamps (c) A digital camera for dermatological photographs and fundus camera for ophthalmolo gical photographs. Endeavour to reduce the length of time between the shipment of entomological materials and DNA analysis. Organise an update course for entomologists in DRC, in early November 2003, since the country lacks a properly trained entomologists. The names and addresses of the national participants will be provided by the national co-ordinator and leader of team IV, a a a a a a 47 IMPACT ASSESSMENT OF APOC ACTIVITIES SECOND ROUND PROTOCOLS 48 APPENDIX I N OF GEO VERAGE OF TREATMENT AT SITES Sample size Study design for assessing therapeutic coverage in the area The well-established EPI 30-cluster coverage survey uses a sample size of 210 children, i.e. 30 clusters of seven children each (Expanded Programme on Immunization 1991, Henderson and Sundaresan 1982, Lemeshow and Robinson 1985). This is based on an anticipated level of immunization coverage of 50oh, a precision of 10oh and a 95o/o conhdence level. Several modifications of the procedure have been applied to different situations (Malilay et al. 1996). In the present survey it can be assumed that the prevalence of treated individual in a treated comrnunity could be 50o/o and based on the above specifications, one could take seven households per cluster. For an average household size of 5 in a typical developing country, a total population of 7 x 5 x 30 : 1050 persons per site will be used. Where possible, GPS will be employed to locate the households accurately EXAMPLE AND SUGGESTION Selecting 30 clusters A table should be set up with four columns with the name of each sampling unit (village in the selected site) in the first column and the population size or the estimated population size in the second colurnn (see Table 1). The third column is for the cumulative population, which will be calculated by the investigator. The fourth column indicates the particular clusters selected for the survey on thc basis of a sampling interval (S) and a selection of a random number (N) between 1 and the sampling interval. Table l. List of the sampling units within the sampling frame. with their population and cumulative population Sampling units Population Cumulative population Clusters selected for survey Village 1 34 846 34 846 Village 2 t7 904 54 750 Village 3 37 300 91 050 Village 4 t5 925 t06 975 Village 5 12 14s r19 r20 49 Village 6 34 840 153 960 Village 7 ts 440 169 400 Village 8 t2 082 t81 482 Village 9 t2 87s t94 357 Village l0 18 717 2r3 074 Village 11 10 s82 223 656 Village 12 10 807 234 463 Village 13 19 000 2s3 463 Village 14 73 000 326 463 Village 15 90 100 4t6 563 Village 16 4 200 420 763 Village 17 29 837 450 600 Total 4s0 600 In the example given in Table 1 the total population of the sampling frame is 450 600. The sampling interval S is obtained by dividing the total population by 30. s : 450 600130: 75 020 Next, the investigator will need to select a random number from a table of random numbers (Annex 3) ol use the serial number found on any bank notes. In this example, the random number which was equal to or less than the sampling interval (S) was 01100. Thus, N: 1 100. Tlre calculations for selecting the 30 clusters are outlined in Table 2.The first of the 30 clusters to be selected is located in the first sampling unit with a cumulative population equal to or more than N. The second cluster is located in the sampling unit with a cumulative population containing the random number plus one sampling interval (N + S). The third cluster is located in the sampling unit whose cumulative population equals or exceeds (N + S + S). The remaining clusters are selected in the same manner by adding the sampling interval to the previous figure and identifying the corresponding sampling unit with a cumulative population equal to or more than the calculated sum. 50 Table 2. (lalculations lbr selecting the 30 clusters Cluster number Formula Calculation Cumulative population Location of cluster 1 N 1 100 I 100 Village 1 2 N+S 1100 + 15 020 t6 t20 Village 1 J N+S+S 1100 + (2* 15 020) 31 140 Village I 4 N+S+S+S 1 100 + (3 * 15 020) 46 t60 Village 2 5 N+S+S+S +S 1 100 + (4 * ls 020) 61 180 Village 3 29 N+(28*S) 1100+(28*15 020) 421 660 Village 17 30 N+(29*S) 1100+(29*15 020) 436 680 Village l7 Table 3 shows the final results of the cluster selection procedure. Where two or more clusters are located in a single sampling unit, as in Village 1, etc. in the example, the sampling unit will need to be subdivided into the number of expected clusters, which should not overlap. 51 Table 3. The 30 cluste selected for the surveY Samplins units Population Cumulative pop![latian Cluster selected for survey Village 1 34 846 34 846 1,2,3 Village 2 t7 904 54 750 4 Village 3 37 300 91 050 5,6 Village 4 t5 925 t06 975 7,8 Village 5 t2 t45 tt9 t20 Village 6 34 840 153 960 9,10,11 Yrllage 7 ts 440 t69 400 t2 Village 8 12 082 t8t 482 13 Village 9 12 875 t94 357 Village 10 18 7t7 2t3 074 14,15 Village 11 10 582 223 6s6 Village 12 10 807 234 463 t6 Village 13 19 000 253 463 t7 Village l4 73 000 326 463 18,19,20,21,2 2 Village 15 90 100 416 563 23,24,25,26,2 7,28 Village 16 4 200 420 673 Village 17 29 837 450 600 29,30 Total 450 600 In this example there are several clusters located within a single sampling unit. 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F!: XE H8Z EEE \o tr- tt ?= o\ OJD II .- O\c.all .. .td,'ilrrj;!lo'=.Y a) () ,, tr - Y6Iil o Y C)oo !boi Us rr Htr d L. bDl^ i;' = () >-c r,'o7'i g c'= () t; I (d o,< oe H E ezz ^iU^?; etSilu x < Eql rr ll:-^ o.Ye UD c)E;EEhEE oo!l|.!'=EE|.,v-al.id o o o o?i.:0)UAZZEAfr SOCIO BCONOMIC PROTOCOL Background: Onchocerciasis is a disease of major concern in Africa. There exists a unique opportunity however of working towards the total eradication of this dreadful disease through the work of OCP, APOC and the other development partners in this area. Objective: 1. To provide information on the socio-economic characteristics and dynamics of the comrnunities affected by Onchocerciasis. 2. to provide information that will enable the measurement of the impact of the use of Ivemectin on the affected communities by using some selected social economic indicators. Methodoloey: This information will be collected using both quantitative and qualitative methods. The precise methods and guidelines have been discussed specifically and put under the respective data collection sections. A. DEMOGRAPHIC CHARACTERISTICS Ql. ID CATION a) NAME OF COLINTRY: b) DISTRICT :. . .. . .. c) STTIDY CENTRE CODE: . ... d) VILLAGE :.... e) NUMBER OF HOUSEHOLD Irtstructtort: Ettumerotor pleose list usual residents of households beginning with head of household, O2. List of members of households: No Name Relationship to Head l.: Head 2. = Spouse 3. = Daughter/Son 4. = Brother/Sister 5. : Niece/Nepherv 6. = Family Worker 7, = Other relative Age (fill age using digits in completed years) Sex M = Male F: Female Marital status l = Never married 2 = Married 3 = Separated 4 = Divorced 5. Widowed If Currently attending school, what grade/class is .... attending If not attending state reason why Educational attainment l. No education 2. Primary 3. Secondary 4. Junior/Secondary 5. Post Secondary 6. Tertiary 7. Others I 2 3 4 5 6 7 8 9 l0 l1 55 O. 3. Labour force participation htstructiotttotheEnunterator; Forthcmenrbersofthehouseltoldwhoareaged l0yearsandabove,pleaseoskifthel, huve beerr mt'olved tn v'ork that was paid /br tn lhe last one ntontlt. 10 vears T],pe of work done lbr pa),, If not working. give rea why Economic activity status: 1. Crop farming 2. Pastoral famring 3. Mixed farming 4. Fishing 6. Mining 6. Hunting/Gathering 7. CommercelTrade 8. Housework 9. Other, specify ... METHOD OF DATA COLLECTION F'OR CENSUS Area should be of uniform endemicity levels (NOTF) 2 or 4 villages with an estimated population of 1500 eligible persons 3. With 25oh or less of the population having taken (Mectizan) ivermectin Method of conducting census: a The NOTF should select the study sites before the team arrives and inform/seek for permission from the relevant authorities at least two weeks before the exercise; I 2 J The Sociologist should visit the site at least 10 days before the rest of the team; When the sociology team arrives, it should do the following Report to political and civic leadership Def,rne the boundaries of the community/villages to be surveyed List all households and institutions in the area for enumeration Enumerate all the usual members of the households/institutions and their demographic characteristics taken Edit questionnaires Process information Enumerator should be people of educational levels of at least secondary school level, e.g. teachers, administrative clerks. Supervisors (social scientist) should have a basic degree in social science. a a 56 The criteria lbr selection of villases: B. ISSUES TO BE DRESSED IN THE OUALIT TIVE SURVEY Assessment of prosperity/wealth by community members at a community meeting wealth ranking tool. Expenditure on Health and on onchocerciasis Attitude perception of community towards oncho-related diseases, e.g. river blindness: How does the community describe the situation in relation to river blindness - hopeless, powerless, fatalistic, in crisis, desparate, etc.? What is the irnpact of oncho on the society? What is the stigma associated with the conditions/symptoms of Oncho; e.g. dermatitis, blindness? Check for marginalisation, ostracism. How are the blind treated? Do they lead a normal life? Cohesion of the society: Is there any conflict in the family or society due to Oncho? Are there political groups that involve the blind? What is the responsibility of the community? Is there any social stratification due to blindness? Education and Health: Find the health/Education priorities in the society What is the situation before and after the introduction of Ivermectin? How do communities solve their healtlh/education problems related to Oncho? What is the role of the Public and private sector including that of traditional healers? METHOD: The table below shows the proposed method to be used in the collection of data at each study site. ISSUI, PROPOSI, ()t) RI,MARI(S Census Enumeration Assessrnent of prosperityiwealth by community members Wealth ranking tool Attitude/perception of community towards oncho- related diseases ; e.g. blindness Focus group discussions, SSI, observation Cohesion of the society Community meeting, SSI, observation, conflict matrix Education Focus group discussions, SSI, key informant inLerviews Health status of cornmunity and health related expenditure Focus group discussrons, Matrix ranking 1. Focus group discussions should be organised for more or less homogeneous groups a) The youths (male/female) b) The elderly c) Female heads of Households d) Chrldren 57 2. Semi structured interviews (SSI) for the civic and political leaders in a community, 3. Key informant interviews (KII) for any people that will be regarded as an important source of infomration, e.g. political and other power wielders in society, medical personnel on the program, etc.; Observation of salient features in the communities; Participatory Rural Appraisal (PRA) tools, e.g. preferences matrix ranking INTRODUCTION Tlrere is evidence that large scale distribution of ivermectin reduces transmission by 45-75%. Furtlrermore, the post-treatment pattern of repopulation of the skin by microfilariae indicates that repeated treatment may have a cumulative effect on the reproduction capacity (fecundity) of the adult wonns. On the basis of these result, it has been suggested that CDTI could lead to the interruption of transr,ission and elimination of infection. However, it is unlikely that total interruption of transmission will occur, and that CDTI will need to be continued for decades to sustain the control of the disease as a public health problem. Given the unceftainty about this issue, the likely and geographical variability in the impact of CDTI on transmission and because of the important operational implications if intemrption of the transmission were to be achieved, APOC will study the impact of CDTI on transmission. To this end, baseline data is required and studies of the reduction in vector infectivity after 5-10 years of CDTI will be undefiaken in a selected number of sites representative of the main epidemiological pattems and the principal vector-parasite complexes in APOC. To evaluate the impact of ivermectin based control on transmission, the methodology needs to be defined. It was considered that an appropriate entomological indicator was the level of infectivity of the vector. The changes over a 4-5 year period in any selected area should be available to APOC. GENERAL OBJECTIVE To evaluate the long term impact of CDTI on transmission of Onchocerca volvulus SPECIFIC OBJECTIVE To detenr-rine the long term reduction in vector infectivity as measured by the number of infective flies (flies with L3 in the head) per 1000 parous flies. In order to achieve this objective, the following points should be taken into consideration. 1. The tried and tested OCP protocol for evaluating the effect of control measures (larviciding and ivenrrectin distribution) on transmission by onchocerciasis vectors should be applied. 4 5 ENTOMOLOGY PROTOCOL 58 2. The period of peak transmission when the impact assessment will be carried out is not known for most sites. A year round data collection is necessary for comparison with the baseline data. 3. It is irnportant to establish from the beginning, whether there is invasion of sites by migrant flies. lt is known for example that, in some areas of the OCP, migrant flies introduce new infections into oncho free areas. In areas where there are migrant flies, the phenomenon should be taken into account. 4. lt is also important to demonstrate the presence or absence of infective larvae of animal origin (e.S.O. ochengi, etc in Sinrulium danutosum s./.. The molecular biology laboratory has to give the answers. Flies and infections have to be sent for analysis. 5. It is important that the entomological exercise leads to the training and acquisition of skills by local staff. However, the strategy to be adopted should be such that the information needed for impact assessment can still be obtained but at no substantial increase in costs. METHODOLOGY A 90 day fly collection during the period of peak of transmission had been previously suggested. The present protocol proposes a 90 day collection to be spread over one year and involves fly dissections by trained local staff. Dissections are necessary to establish parous rates of the flies. SELECTION OF SITES The breeding sites near the selected villages will be chosen as catching points. The geographical position of the catching site should be accurately determined using GPS where possible or shown on a map with the relative distances to the village and prominent landmarks indicated. FIELD VISITS Fieldwork will be carried out by a team comprising one entomologist-technician, one laboratory assistant, twtr fly catchers and a driver. For practical reasons, the fly catchers should be recruited locally. SAMPLING OF ADULT AND LARVAL POPULATIONS Flies will be collected over 5 days each month for 12 months during the year of impact assessment. During each visit, larvae of S. damnosunt s.l. will also be collected and preserved in carnoy fluid (9 parts absolute alcohol + 1 pat glacial acetic acid) for cytotaxonomy. The aim of doing cytotaxonomy on a regular basis is to detect any change in the local vector species population. FLY CATCHES AND DISSECTIONS The standard protocol of fly collection, data collection recording and analysis used in the OCP will be adopted, i.e. 2 fly catchers working altemately from 7.00 to 1 8.00 hr daily. 59 The flies will be dissected to determine the age and infection rates. The OCP Form 1 (Fiche 1) will be used to record hourly catches and the result of dissections will be recorded in Form 2 (Fiche 2). DETECTION OF CHOCERCA VOLVULUS IN POOLS OF CKFI,IES BY DNA ANALYSIS The main airn for utilizing this method is to detect the presence of O. volvulus and other filarial parasites. A rnaximum of 1,000 parous/flies/site/mission (i.e. 200 per day) should be sent to the OCP laboratory for analysis. We need guidance from the DNA Laboratory. DATA ANALYSIS The results of fly dissections should be summarized for each site using the format of the OCP (Fiche 3 and 4). Tlie entomological indices (parous rate, monthly biting rate, and monthly transmission potential should be calculated for both pre- and post control catches. Vector infectivity (number of O. volyulus L3l1000 parous flies) should be calculated from the data obtained by DNA analysis. In each country, the identified entomologist will be responsible for the compilation of data. REFERENCES 1. Taylor H.R., Pacque M., Munoz B. & Greene B.M. (1990). Impact of mass treatment of onchocerciasis with ivermectin on the transmission of infection. Science,250: I 16-1 18. 2. Remrne J., Baker R.H., De Sole G. et al. (1989). A community trial of ivermectin in the onchocerciasis focus of Asubende, Ghana. I. Effect on the microfilarial reseruoir and the transmission of Onchocerca volvulus. Trooical Medicine and Parasitolow,40:367-374; 3. Katholi C.R., Toe L., Merriweather A. & Unnasch T.R. (1995). Determining the prevalence of Ottchocerca volvulus infection in vector populations by polymerase chain reaction screening of pools of black flies. Journal o.f ltlfectious Diseases, 172; 1414-1417 . 4. Anonymous (1985). Ten years of onchocerciasis control. World Health Organisation: Geneva. RECOMMENDATIONS (ENTOMOLOGY) 1. Fly catches and larvae sampling should be carried out regularly each month during year 1 (baseline data) and also during the years of impact assessment (i.e. years 5 and 10). 2. In the new sites the NOTFs should be requested by APOC to identify as early as possible, an entomologist and technicians who have received training in Simttliunz entomology. In countries where the experlise is lacking persons with basic knowledge in laboratory technology should be selected for training. The identified persons should be available and ready for training during the first visit of expert 3. The NOTFs should be requested by APOC to make available vehicles for the fieldwork and the supervisory activities of local entomologist. 60 4. APOC sliould be requested by the NOTFs to make available to the local entomologist, cornputers for data analysis. 5. The originals of all data forms should be sent to APOC (Dr Noma) who will collate all the results of the fieldwork and DNA analysis. The duplicate remains with the local entomologist. It should be made clear to all persons that APOC has the sole ownership of all data collected during the impact assessment activities. 6. APOC should request from OCP some of the basic capital equipment needed for field work e.g. dissecting ruicroscopes, etc. For practical reasons, an inventory of what the NOTFs can provide should be made. Heavy equipment such as generators should be bought locally. 7. To ensure the quality of data, APOC should train where necessary, to upgrade the expertise of local personnel. For each site at least 2 entomologist-technicians should be trained on site by the visiting expert. In the short-medium term, APOC should strengthen identified African institutions to enable them carry out the molecular rnethod for O. volvulus parasite detection in flies. This should be viewed in the context of the volume of flies that will need to be processed in the future. TIME TABLE OF VISIT BY EXPERT The visiting entomologist will spend 14 days for retraining of local personnel and for beginning the catches and dissections. The follow up visit will be for further monitoring of field activities. Proposed itinerary First visit Aruival and installation at base Briefing, planning and preparation for training/recycling of local personnel Brief introduction to the biology, ecology and taxonomy of Simulium tktnmosum s./.. Morpl-rology of the life stages of S. damnosum and introduction to OCP Forms (theory). Travel to field site for practical training/recycling Prospection for pre-adult stages of blackflies and preparation of larval specimens for cytotaxonomy, rearing of pupal stages to adults. Collection, dissection and recording of data and calculation of entomological indices Departure Day 1 Day 2 Day3-4 Day 5 Day 6 Day 7-14 Day 15 Second visit: Same as above 61 i I I I : I I I I I I .t. o tro tij a E H o I I I I@l ni i I I I I I ! I I I ! I I I I : I .l tuo vl G. 6 cn @ o 2o = o :. E { e q. UJo tU a) -g, tJ- oc =gJ :f,Rg -yj ct 1/'o e, o (r't ara o tr c) t.lrv,Ia ul aJ',tl,d =t- cL (-) IA u,o .Lu 'l oE9 rA7 EL(Etd 21 (J ; lr,, =Eo e. <= n- cl + @ugE E-f,ctt, LE< Ecl6u :EO =o 3o N N r : i a I I F =utF(, UJ 13 ol i It i I i I i I a : : i .: < f UJt-a T UJ&?k (-) o F I N I C{{vS 16 svd ).J r-t tl 6o rv €l .{ YSF<]J<i +{IY-gUJ>F a 0.t F 2.d c anUct-f, I cl Y a il ro p, "\ I Is a{ I l9V tt, Q ru o. Vl TU E v, o o @I t-. Ut- Y 5N anU t 5 u, o tr, tr g o z U o F-6 F 3 I -lH 3UildVC 30 3 U IVUOH oo o 6 IF G, UJ(a o ts d) 6o|r)o (o t1I I s@ol ar c'l N(ts)ne{ E rNr{N R qNclzgr 9+{Y9 lo lvJ!u E. *:3i cg co EE iiuIu os t- .{ YPEF<?j >6E< SE UI;i :V IEUI ,F $ v,U E 2(( o. </, TJ crF 1cit'@ F <1, d Y EF IF lEgt ts u., o h 5 rUF uJF 3 E r m 3Ef<NFttl s 6u t( 5 u o UJ ta 6l B z U .E?F v) slgv ( q c{ u/o u, & ul o a 63 303ulvuoll ; * R xnvlolo6 @ Fo\t) E I Ec{o o Elq o.io LVIZS} gZZ : aP tr5eu xt''1 62 E JFd vv'.69 a6/9c./rl t1r/85/98 89 :44 I'g:- '?- I. regtt cle " Z26 38214'l flcilE 2ll(1.2) CAPTURES NULLES OU SANS DISSECTION OE S. DAMNOSUIVI SECTEUS SEMAIN E S/SECTEUfl : -,.... -- .I a POINT DE CAPTURE IIJOM OE9E flVAT IONS OATE hIOMBBE CAPTURE ESJOUF ESPECEcooE au c U T FGr>do L- AN l0 TOTAL OU JOUR 22-25 N,IOIS llt6 t 7.'l E 2G.2134 5S o-t 0 r t.1? l3.l { I 1 1 I I I I I I I 1 1 1 1 1 I I 1 I 'I I I I I 1 I I I o 518s.2 ocP la/7el 63 DERMATOLOGY PROTOCOL Backsround Literature Review In a multi-country study of the importance of onchocercal skin lesions, it was concluded that over 3O'/o of the population in the endemic communities had onchocercal skin lesions. The most prevalent among thern being chronic papular onchodermatitits affecting 13.1% of the population. The data showed a strong correlation between the prevalence and severity of onchocercal skin disease and the level of endemicity in the community. Troublesome itching as a result of onchocerciasis was reported by more than half of the population of hyper-endemic populations. The results of the study indicated that there was a significant difference between the prevalence of the onchocercal skin lesions in the hyper-endemic areas and non endemic areas. Thus if the APOC operations were to be successful, the period of treatment could be considered as making the area of treatment non-endemic. In this case the results of the multi-country study could be applicable. A second multi-country study on the effect of ivermectin treatent on Onchocercal Skin Disease (OSD) had shown a decline of 40-50% in the prevalence of severe itching after ivermectine treatment as compared to placebo, sustained for up to 2 months after first treatment. The effect was similar for 3 monthly and annual ivermectin treatment. There was also a significant decline in the prevalence of reactive skin lesions following ivennectin treatment as compared to placebo, mainly a decline in early skin lesions. It is hope that with treatment, there will be the immediate benefit of reduction in itching and OSD, as well as the long term benefit of a reduction in the transmission of the parasite as a result of low community microfilarial load. General Obiective To evaluate the denlatological impact of onchocerciasis control in APOC countries and to evaluate the effect of ivermectin on disease burden. Specific obiectives To determine the change in prevalence of onchocercal reactive skin lesions and depigrnentation (DPM). To deterrnine the change in the proportion of the population with symptoms/signs of severe itching. To determine the change in prevalence of onchocercal skin nodules. Working hypothesis Regular ivennectin treatment will Reduce severe itching, prevent the development of onchocercal skin disease and may regress early skin lesions. a 64 a a Methodology Determination of Prevalence of Nodules and Skin Lesions A cross-sectional study design will be used. Three studies will be carried out; the first at baseline, second at 5 years, and the third at 10 years. At each examination round, a new sample of the population in the target study sites will be selected and subjected to interviews using a questionnaire and followed by physical examination. The number of sites for evaluation within a country has been detennir-red by the geographical zones and endemicity levels. It is important that nurnber of treatments withir-r the period between assessrnents be taken into account in the analysis. Skin exanrination will be done according to examination methodology as described by Murdoch et al. and subsequently simplified for the multi-country study. Age-specific cohort analysis will be done to detennine incidence. The sarnple size determination For a successful programme of operations, there should be a demonstrable difference in prevalence of skin lesions of about 10o/o or rnore between the two point estimations for all the target population within 5 years. Alternatively, at the end point for evaluation, the age-group specific prevalence data should show increasing trends with age for skin nodules and chronic onchocercal skin lesions. However, for conditions expected to regress, such as itching, microfilarial loads in the eyes, early lesions of the anterior segment of the eye and early reactive skin lesions, the age group specific effect of the treatment is not expected to be significant. The aim of each cross sectional study will be to estimate the prevalence of onchocercal skin and eye lesion by age. It is expected that onchocercal skin lesions would drop from a prevalence of about l5o/o to 10o%, severe itching could drop from 30o/o to l4o/o and prevalence of microfilaria in the anterior chamber from 10% to 5o/o. Using a drop in prevalence rate of l0%o resulting from the activities of the programme. A sample of about 750 inhabitants will be required at each evaluation site. Sample selection A total of 750 persons will be examined per site Skin examination will be undertaken to detect . Skin lesions Four morphological types of onchocercal skin lesions will be classified: 1. Acute Papular Or-rchodermatis (APOD) 2. Chronic Papular Onchodennatitis (CPOD) 3. LichenifiedOnchodennatitis(LOD) 4. Depigmentation (DPM) Skin examination will be used to identify the skin lesions, their distribution and severity as evidenced by scratch marks, excoriation and super-infection. Photographs of skin lesions will be taken of a sarnple of participants with lesion at baseline, at 5 years and 10 years. This will enable the comparison of the severity of skin lesions at sites, for all three rounds of assessment. 65 :3 Skin Nodules Analysis of nodules in untreated children will be done as part of the evaluation of impact of APOC activities on transmission. Other skin deseases such as dermatomycosis, scabies, lice, etc. will be recorded. . Itching Afterthe introduction of thepurpose of the study, aquestionnaire will be used to collect information from study participants in each community on troublesome itching, as well as their responses to general health questions. The general questions will assist in masking the itching questions and therefore provide a more unbiased reported prevalence of itching. DEC Pa tch Test If DEC Patclr Test is available, it will be used on untreated children 5 years of age, to evaluate and follow-up the intensity of transmission. . Data Analysis Data entry will be done in the field using EPI-INFO. Data analysis will be done using the SPSS statistical package. REFERENCES Taylor, H.R., Pacque, M. Munoz, B., Greene, B.M. (1990). Impact of mass treatment of onclrocerciasis with Ivermectin on the transmission of infection. Science;250 1 16-8. Remme, .1., Baker, R.H., De Sole, G. et al. 1989). A community trial of ivennectin in the onchocerciasis focus of Asubende, Ghana. I. Effect on the microfilarial reservoir and the transnrission of Onchocerca volvulus. Trop. Med. Parasitol ; 40:367 -7 4. Remtne, J., De Sole, G., Van Dortmarssen, G.J. (1990). The predicted and observed decline in ouchocerciasis infection during 14 years of successful control of Simulium spp. In West Africa. Bulletin of World Health Organization 68, 3, 331-339. The Pan-African Study Group on Onchocercal Skin Disease (1995). The Importance of Otrchocercal Skin Disease - Reporl of a Multi-Country: Applied Field research Reports, World Health Oganization, 1995, no I . Brieger, W.R., Awedoba, A.K. Eneanya, C.L, Hagan, M., Ogbuagu, K.F., Okello, D., Ososanya, O.Ol., Ovuga, E.B.L. (1997). The Effect of Ivermectin on Onchocercal Skin Disease and Severe Itching - The Result of a Multi-Country Study. (Tropical Med. And Intemational Health, in press). Ogbuagu, K.F., Awedoba, A.K., Eneanya, C.I., Hagan, M., Okello, D., Ososanya Skin Disease - Clinical Findings. Annals of Trop. Medicin and Parasitology 92, Supplement 1. 66 1 2 J 4 5 6 Modified Ph],sical Examination-Dermatoloey (Questions Continued) Have you ever taken Ivermectin? How rnany times? When was the last treatment? Indicate number and site of photograph taken DEC patch test to be done t4 15 16 17 18 Skin condition Absent-0 Present-1 fomments Present with no scratch marks - 1 Present with scratch marks - 2; Present with excoriations - 3 Present with excoriation and super-infection - 4 For DPM - If incomplete DPM - 1 If complete - 2 Head & Neck Upper Lirnbs Trunk Front Trunk Back Lower limbs Acute Papular Onchodennititis (APOD) Chronic Papular Onchodermatitis (cPoD) Lichenified Onchodenlatitis (LoD) Onchocercal Depigmentation (DPM) Nodules - Present: absent Miliaria Scabies Lice Dennatomycosis Total 67 Tableau : epidemiological evaluation : skin examination form FORMULA FOR THE PREPARATION OF DIETHYLCARBAMAZINE (DEC) PATCH T CREAM A Ingredreulr Nivea cream or lotion and diethylcarbarnazine powder g. Method of Lreparation: Mix 10 grn of diethylcarbamazine powder in a 100 ml of nivea creant or lotion thoroughly to fonn a homogeneous lotion or cream. (i.e. 10% di ethylcarb antazine lotion). Other materials needed include 1. Filter paper 2. 80% alcohol 3. Perforated hypoallergenic elastoplast 4. Cotton wool 5. Indelible markers 6. Fonns for recording the result. C. Method of application : Clean about 5-10 cm diameter of the skin over the left iliac crest with cotton swab (80% alcohol'). Cut pieces of elastoplast (8 x5 cm), and number each piece sequentially. DEC lotion (keep it in a fresh state during transportation). Prepare pieces of filter paper of 3 cr-n x 2cm dimension. Place 0.3 ml 10% DEC lotionicream on one side of the filter paper. Place this on the swabbed area of the left iliac crest and cover with a labelled piece of the hypoallergenic plaster. (the label consists of : subjects identity number, date and time of application). Readings are done by 2 independent observers at 24 hours and 48 hours. The results are recorded on a standardized format. I 68 EPIDEMIOLOG ICAL EVALUATTON: S KtN EXAM tNAT|ON FORM 1. Country of the study 2- Study Cenlre Code 3. Name of Mllage 4. Household Code 5. lndrvidual Number 6. Name 7. Age 8. Sex 9 Name of Head Household 10 Schooing. Y/N-- \Mat level? 11. Duration of slay in communily 12, Dale 13. Personal Experience of lllness lf No why (Chitdren) _ l/Ve are ABSENT = 0 especially interested in your health PRESENT = 1 How have you been feelrng since last month? Record soontaneous rS Health Problems rs when orompted 1. Headach 2. Joint-bone pqin/backache 3. FatigueAl/eakness 4 itch 5. Severe/troublesome ilching 6. lnsomnia 7. Concem for Appearance 8. Diarrhoea and others 9. Others (Specifv) 69 years I .rc .E .lrcl .EE .E .E .rc ,.E !.IEl -.lI(] -.rc. -.rc .rc .lIE-_.-.r .Et .E t t { 1 i I l. Country of study: 2. Study centre code : 3. Narne of village : 4. Individual code Individual name D.E.C PATCH TEST FORM FORM NUMBER Years 5 6 Age 1. Sex t h,t_l (Tick) 8. Name of head of household 9. Duration of stay in the comrnunity Weeks IO. REACTION CODE: 0 = No reoction 1 = Positive reoction with 1 to 3 popules 2 = Positive reoction with 4 to 8 popules 3 = Posit ives reaction obove B poputes 4 = Positives reoctipn with dermol oedemo (Peau d'orange) =-ll.RESULTS I 1.1 First reading Date : / Time:_ Thereading I 1.2 Second reading Date Time : __The reading Si ruciins Y cars o tl/t t I E F H_* nature of the observer : 70 2OPHTHALMOLOGY PROTOCOL INTRODUCTION Published report indicate that most onchocercal blindness and morbidity in the meso endemic savanna and forest savanna areas are from optic nerve disease and chorioretinitis in the posterior segment whilst in the anterior segment sclerosing keratitis and uveitis along with secondary glaucoma are the blinding pathways. It has been shown that ivermectin produces an 80o/o reduction in new cases of optic nerve disease as well as 45Yo reduction in incidence of further visual field deterioration in individuals with optic atrophy. It also has beneficial effect on other onchocercal eye lesions including punctate keratitis and iridocyclitis. Ivermectin prevents or delays the onset of optic atrophy as well as slowing down the progression of the disease. General Obiective To evaluate the ophthalmological impact of onchocerciasis control in APOC countries particularly the effect of ivemrectin on disease burden. SBecific obiectives To detemrine the change in prevalence of onchocercal eye lesions, visual function defects and blindness using the standard clinical methods for eye examination and the Wu-Jones Computerized Visual Function Tests (CVFT) To detenline the incidence of onchocercal eye lesions, visual field defects and blindness. Workine H),pothesis Regulal ivennectin treatment will prevent the development or delay progression of onchocercal eye lesions and blindness; and may regress early stages of ocular lesions. EYE EXAMINATION All standard eye examinations will be perfonned by an ophthalmologist trained especially for the study. The Wu-.Iones tests will be perfonned by two trained assistants. All subjects will do the Wu- Jones tests while half of this number sampled at random will undergo detailed standard clinical methods of eye exarnination. Visual Acuitv Visual acuity will be measured using the Standard Snellen's illiterate "E" chart for distance (in addition to the Cor-nputerized Visual Acuity Test (CVAT). The test is to be conducted with the chart placed at a distance of 6 metres form the subject in broad daylight with source of light coming from behind the subject. One eye is tested at a time with other occluded after clearly explaining the procedure to the patierrt. 7t I Wu-Jones Test Subjects will be examined further using the Wu-Jones test. Testing will be carried out in a room darkened with black cuftains or plastic drapes to cut out natural light. One red light will be provided to give dim red light "dark room" conditions to enable patient and examiner observe the computer screen, recording by the examiner and movement by other subjects. d cvAT With subject seated comfortably and test explained to him or her at the computer programme prornpting, the examiner selects the eye to be tested. Subject sits at a distance of 1 metre from the screerl standard anls length or measured with a one-rnetre twine which all examiners should have. Patient it asked to indicate with the wave of his or her hand the direction the "E" appearing on the screen faces. The examiner presses the horizontal arrow key in the direction the patient has pointed to. When the subject is in doubt as to what direction "E" is facing, examiner presses the vertical arrow keys. The Motion Sensitivity Screenine Test (MSST) A series of vertical lines are displayed on the computer screen. As preliminary training, subject is asked whether he sees them and if so to count thern. This is to ensure that the actually understands tlre instructions. He is then asked to watch the lines and to press a buzzer, to be handed over to him or the space bar on the keyboard, as soon as he perceives movement of any of the lines. At tlre end of the test, which lasts about 2.2minutes, the cornpute displays the results on the screen. This is again registered on the hard disk. A recording of form for the test is also completed by the examiner. This serves as a check and an additional follow-up record for the particular individual Anterior S t Examination Subject is first asked to bend his head down between his knees for at least 2 minutes. The procedure is to allow for he emergence of microfilariae into the anterior chamber. Subject is then examined on the slit lamp biornicroscope (x25 magnification) and count of microfilariae in the comea and anterior chanrber noted. Comea is examined for dead microfilarial, punctate or sclerosing keratitis. Other cotneal pathology is looked for. Pupillary reaction to light as well as the size, shape of pupil is exaurined. Anterior chamber and iris are examined for signs of inflammation and for opacities in the lens, luxation or dislocation of the lens. Posterior Segment Exalnination This is car:ried out after dilatation with mydriaticum or phenylphrine 10%, with tlie direct and/or indirect ophthalmoscope. Fundus Examination Optic disc changes such as pallor of the disc, changes at the disc margins, sheathing of retinal blood vessels and pathological cupping of the disc will be looked for. 72 It is recommended that in all sites systematic photographs of Fundus (temporal to tlie macula) be taken in patients with or without lesions in order to evaluate the incidence of chorio retinal disease in subsequent re-exarnination of a cohort. Oncho Chorioretinitis Presence and distribution of the typical oncho signs of chorioretinitis-atrophy of the retinal pigment epithelium and atrophy of choriocapillaries will be noted. Other chorioretinal signs of possible oncho origin The nor-r-typical onchoretinal signs- pigment hyperplasia, pseudo-drusen will be looked for to test their possible association with onchocerciaisis. Training and standa of research team members It is necessary to provide adequate training and standardization for all the examining members of the team to minirnize intra and inter observer variation. If CVAT and MSST will not be feasible in all sites these could be limited to few selected sites. 73 M/AI-UA'.ION Oli uPTDEMIOLOGICAL InlpACl. OI. Apoc AC,ft'ITI,,S IiYE IXA I\1 I NATION I'ORI\f VILLAGI]. IDNO tr[]N SI]E NO tr t] NAME OF SUBJECT.............. AGE nE vns sEX fl EXAMINER. NAh-,fE OF HEAD OF HOUSEHOLD .. DISTRICT/I.GA DATE: DDA,fI\,,YY trn xn !nn n tr !nxn nt]XX RIGIIT I. VISUAL ACUITY ACTUAL AIDEDA,INAIDED ACTUAL ACUITY P.IJ , o,r.)^o,uuD-Acurry X X PINHOLE ACUITY CODE 0t : 6/t8 02:6:24 03:6/36 04=6/60 05 =3/60 06=< 3/60>Hrn 07=I-Int /pL 0ti=NPL 09=Unable to assess Use PINI{OLE if VA =< 6/t8 Do nor.use if = pL ;NpL l=onnal 2=relative scotoma 3=absolu(e scotoma 9=unable to assess | = Absent 2 = l-t0 3 = U_20 4>20 9 = Unable to assess I = Absenr 2 = t-t0j = il-20 4)-20 9 - [Ju:rblc (o asscss 2. VISUAL FIEI-DS (Dead J. MICITOFILARIA DA4FC Microfilaria in comea) MSsr (L) nntr nnr (R) MFAC X(MF irr arrrer ior clrarrrber af tcr hcatJ drrrvn ? nrirrrrles) 74 LEFT 4. COIINEA IUGI]T LIITT CODE I = Absent 2 = I_10 3 = tt_20 4>20 9 = Unablc to assess I = Absent 2:3&9O,clock 3 = confluen( inferior 4 = confluent pupil obscured 5 : circumferential 9: Unable to assess (a) Punctatc Kciariris (snorv l-lake opacity) (b) Sclerosing Keraritis I Photograph film Number (i f taken) @ Other cor-rreal signs (i) Corneal oedenra (any degree) ii) Cenrral opaclry associated rvith reduceJ r,rsrral ecuity (iii) Trachomarous paluus (ary degree) (iv) Others (Specifo) 3 measles,barrd keratitis speci ly DRAW SK ! n I =absent 2=present 9= unable to assess(applytoi-iv) r tr DRAW 75 xtr n ! n RIGIll- LEITT 5. PUPIL (r) SIIAPIi (b) Size O Ligltt resl)onse 5. IRIDOCYCLITIS SYNECHIAE Irlare A/C Cells A/C KP's Ciliary injection Iris atrophy Iridocyclitis tr (_-() I ) li l=, rrorrrral. 2:d istorred (speci [y,) (tlorvtr drarvrr, nlt-sal ly,) l: equal 2: Ii> L 3=R<L tr n tr n l: Brisk (norrnal) 2= small& fixed 3: dilated & fixed 4= sluggish 9=unable to assass I =absent 2=anterior syncclt ia 3:posterior synecltia 4 =botlr 9=Unable [o assess l: absent 2:rn ild,/nroderate 3 =heavy 9: unable to assess I: absent 2:< l0 3 =noarry 9: unable to assess I : absent 2:pigrtrented KP's 3=no pignrented 4:mixcd 9: unable to assess l:absent 2:rn ild:nroderate 3:severe 9:unable to assess l:absent 2:present 9:unable to assess I : Nomral Z=torpid 3:acute 9:rrnable to assess tr n u 76 tr tr u tr u tr ! n tr RIGHT LEFI- tr CODII nlnlhg 99=rrnable {o assrss6. iN]-RAOCU I.,A R PRESSU ITE 7. CATAIIACT u 8. SWINGING FIASII LIG}I'I-TEST(sFLl) u I:clear rcd reflex i 2-inrpared n <l12 obscur-r.l 3 :inrpared rr> l /2 obscu rcd 4:no rr 5:aphakia 6:displased lens 9=unable to assess l:Normal 2:RAPD 3:AAPD 9:unable to assess I =<0.5 2: > or:0.5 9:unable to assess [:Normal 2:m i ld/nroderate pal Ior 3:severe pallor 4:abnorrnally pink 9: unable to assess l:absent 2=present 9:unable [o assess I --clear 2=obscured 9. OPHTHALMOSCOPY OPTIC DISC a Vertical cup/Disc ratio b Color c. Sheathing of vv d. View of disc I O ONCI{O-CHORIORETTNITIS 2a Morphology [)istr ibution tr tr ffiqwNWY^ 9=unable to assess l:absent 2-rnottling of retinal pigment epitheliurn (RPE) 3=confluent atrophy of RPII 4=2+3+choriocapiIlary atrophl' 5=4 +pigment hyperplasia 9=unable to assess codes apply to all distributions | : absent 2 : temporal to trtacula 3 : nasal to ntacula 4=2+3 5 : generalised 77 tru tr u tr n b) Intraretinal deposit tr Disfribution u SPECIFY d istribution I I. OTI{ER NON ONCHO LESIONS t1- t2 specify 14 N,IAIN CAUSE OF OCULAR PATHOLOGY (R) Onchopathology (anterior) Onchopatlro Iogy (posrerior) primary optic atrophy 6 == others (specity) g = unable (o assess I =absent 9:possrbly, onclro re l.rtcti 3 =d rusen 4-cotton \yool sl)ots 5:slriny lesions 6:other (specify) n 'l : absent 2 : tentporal to nracula 3 : nasal to nracula 4:2+3 5 : generalised 6 : others (specify) Q: unable ro assess I I : absent 2 : (enrporal to rnlcLrl.r 3 : nasal to rrracul.r 4=2 t 3 5 = generalrsccl 6: otlrcrs (specrl-v) fl: unablc to asse-ss i t] r:absenr 2:focal choro idorctin itis (typical toxoplasrrrosis) 3:r,ascu lar ret inopatlry (diabetic, hl,perlensrve) 4:other (specil-y) 9: unable to assess (L) l: not a cause 2= nrain cause 3= sccorrdary cause 4=rrrinor catrsc Cataract 78 tr tr x tr tr trG lauconta Plithisis bulbi Trachoma Others (Specify) specily VISUAL STATUS n u l:normal 2:visually inrpaired 3:blind by central VA 4:blind by field \- ) \ 79 T WORLD HEALTH ORGANIZATION AFRICAN REGION ORGANISATION MONDIALE DE LA SANTE REGION DE L'AFRIQUE AFRICAN PROGRAMME FOR ONCHOCERCIASIS CONTROL (APOC) PROGRAMME AFRICAIN DE LUTTE CONTRE L'ONCHOCERCOSE B P. 549 OUAGADOUGOU, Burkina Faso T6169r.: ONCHO OUAGADOUGOU T6l (226) 30 23 01 - 30 23 t2 - 30 23 13 T6lex ONCHO 5241 BF Fax: (226) 30 2t 47 APPENDIX2 PLANNING MEETING ON THE PHASE II OF THE LONG-TERM IMPACT ASSESSMENT OF APOC OPERATIONS Ouagadoueou. 24 - 29 March 2003 ANNOTATED AGENDA Monday 24 march 2003 (6) B:00 - B:30: Registration B:30 - 9:00: Welcome address by APOC Director 9:00 - 9:15: lntroduction of Team members and resource persons 9:15 - 9:45: Review and adoption of agenda 9:45 - 10:15: Update on CDTI treatment figures (tt/r Zoure) 10:15- 10:30: Break 10:30 - 12:30: Elaboration of summaries of findings for each site (lVr Zoure) (1 ) (2.) (3) (4.) (5) 12:30 - 1 5:00: Lunch break (7.) 15:00 - 16:00: Presentation of protocols and discussion on possible amendment 16:00 - 16:1 5: Break (8.)16:15 - 18:00: Presentation of protocols and discussion on possible amendment (continued) Tuesday 25 march 2003 (9 ) B:00 - 9:00: Sites for second round(10 ) 9:00 - 10:00: Timetable for second round 10:00 - 10:20: Break (11 ) 10:20 - 12:30: Timetable for preparatory visits, fieldwork and data analysis 80 12:30 - 1 5:00: Lunch break (12.) 15:00 - 16:00: Group work anglophones & francophones : TffiIH3J:::'JIffi[J[i:H:'':: 3::H: :JI;J"' . Team composition . Budget 16:00 - 16:15: Break (13 ) 16:15 - 18:00: Group work anglophones & francophones (continued) : #:rTil?,il?,:P["Hil:: ff :::l::':Jffi"' Wednesdav 26 march 2003 (14.) 8:00 - 18:00: Group work anglophones & francophones on Budget Thursday 27 march 2003 (15 ) B:00 - 10:00: Plenary a a a a 10:00 - 10:20: Break (16 ) 10:20 - 12:30: Plenary: a a a a Reports from groups on lnventory of equipment and supplies available in sites Equipment and supplies required for second round Team composition Budget Reports from groups on (continued) lnventory of equipment and supplies available in sites Equipment and supplies required for second round Team composition Budget 12:30 - 1 5:00: Lunch break (17.) 15:00 - 16:00: Preparation of the report of the planning meeting 16:00 - 16:1 5: Break (18 ) 1 5:00 - 16:00: Preparation of the report of the planning meeting (continued) Friday 28 march 2003 (19 ) B:00 - 10:00: Discussion on arrangements/organization of data (from 1st round) between publication 10:00 - 10:20: Break (20 ) 10:20 - 12:30: Preparation of papers (from 1st round) for publication 12:30 - 1 5:00: Lunch break 81 (21 .) 1 5:00 - 16:00: Preparation of papers (from 1st round) for publication (continued) 16:00 - 16:1 5: Break (22 ) 16:15 - 1B:00: Preparation of papers (from 1st round) for publication(continued) Saturdav 29 march 2003 (23) B:00-12:30 (continued) Preparation of papers (from 1st round) for publication 12:30 - 1 5:00: Lunch break (24.) 15:00 - 16:00: Submission of report to the Director of APOC 16:00 - 16:20: Break 16:20 - 16:40: Closing ceremony 82 WORLD HEALTH ORGANIZATION AFRICAN REGION ORGAN'SATION MONDIALE DE LA SANTE REGION DE L'AFRIQUE AFRICAN PROGRAMME FOR ONCHOCERCIASIS CONTROL (APOC) PROGRAMME AFRICAIN DE LI,ITTE CONTRE L'ONCHOCERCOSE 8.P.549 OLIAGADOUGOLI, Burkina Faso T6169r.: ONCHO OTIAGADOUGOU T6l.: 34 29 53 - 34 29 59 - 34 29 60 T6lex: ONCHO 5241 BF Fax: 34 28 75 APPENDIX 3 R6union de planification de la Phase II des 6tudes relatives ir l'6valuation ir long des on6rations APOC Ouasadousou. 24-29 mars 2003 Planning meetins on the phase II of the long term inqpact 4ssessment of APOC operations Ouasadougou. 24-29 march 2003 LISTH DHS PARTICIPANI I S/LIST OF PARTICIPANTS i BURKINA FASO 1. Prof. Soungalo TRAORE, s/c OMS/APOC, 0l BP 549, Otagadougou 01, T6l : (226) 34 29 53129160 Fax : (226) 34 28 75, E-mail : pefoungo@yahoo.fr 2. Dr Andr6 SOUBEIGA, Socio-anthropologue, UFR/SH, Universit6 de Ouagadougou, 03 BP 7021 Ouagadougou 03, Burkina Faso ; Tel. : Dom: (226) 35 7l l4lcel. 61 59 42, Unlersie : (226) 31 78 14 ; Fax : Universit6 (226) 30 73 l8,E-rnail : asoubeiga@univ-ouaga.bf CAMEROUN 3. Dr Grace FOBI, Opthalmologiste, H6pital Central de Yaound6, T6l: (237) 797 21 01, T6l/Fax : (237) 220 19 08, T6l dom. (237) 221 02 28; E-mail : gakohobe@)zahoo.conr 4. Dr Peter ENYONG, Tropical Medicine Research Station, P.O Box 55, Kumba, Cameroon, Tel/Fax : (237) 335 42 3l ; E-rnail : llenvonq(A,canuret.crrr FRANCE 5. Dr Michel BOUSSINESQ, s/c Val6rie Delplanque, IRD/DU, 213 Rue La Fayette, 75480, Paris C6dexl0,France;Tel/Fax:(33)14249 38 15;Email:micl-rel.boussincsq(g)wanadoo.h' 83 GHANA 6. Prof. Richard BIRITWUM, Deparment of Community Health, Ghana Medical School, P.O 8ox4236, Accra, Ghana, Phone: (233)21 66 51 01121 6671 05, Fax : (233)21 66 81 61, Email biritu,u nr (rr,a liicaonIine.conr. qlt 7. Dr Maria HAGAN, Eye Care Unit/ICD, Ghana Health Service, Private Post Bag, Ministries, Accra, Ghana, Phone: (233) 21 66 68 15 or (233) 20 815 02 47, Fax: (233) 21 66 68 50 NIGERIA 8. Prof. Ekanem Ikpi BRAIDE, Department of Biological Sciences, University of Calabar, P.O. Box 3679, Calabar, Cross River State, Nigeria, Phone: (234) 80 33 41 68 42, Email: ekanem- b((rr ltol n'u"rt ]. ctrnt 9. Dr Rich UMEH, Department of Ophtalmology, College of Medicine, University of Nigeria, Enugu Campus, Nigeria, Tel/Fax: (234) 42 45 58 41; Email: richu(irinloweb.abs.net 11. Dr Gladys OZO}J, Department of Dermatology, College of Medicine, University of Nigeria, Enugu Campus, Nigeria, Phone: (234) 42 45 19 25, Fax: (234) 42 45 58 41, Email: gl advso zq (i. vahoe.ee []w RDC 12. Prof. David KAYEMBE, Ophtahnologiste, Clinique Kinshasa XI, RDC; T61.: (243) 98 37 00 19; Fax : prof davidkay emb e@yahoo. com Universitaire de Kinshasa, "t. w(l l\v. f$ 3tr 5roq+ BP T23, E-mail : ) TOGO 13. Dr M6ba BANLA, M6decin Ophtalmologiste, CHU Campus, Lom6, Togo; Tel. : (00228) 225 47 391902 22 8l Email : mebabanla(iirliotrrail.conr 84 SECRETARIAT APOC 14.Dr Azodoga SEKETELI, Directeur APOC 15. Dr Laurent YAMEOGO, Coordonnateur Bureau du Directeur, APOC 16. Dr Mounkaila NOMA, Chief of Epidemiology and Vector Elimination Unit (CEV), APOC 17.Dr Uche AMAZIGO, Chief of Sustainable Drug Unit (CSD), APOC 18. Mr Honorat ZOURE, Biostatistique and Mapping Officer (BIM), APOC 19. Mrs Victoria Matovu, Community Ownership Partner (COP), APOC 20. Mr Fortun6 Agboton, Budget and Finance Officer (BFO) 21. Mr Yao Aholou, Administrative Officer (AO) 22.Mr Saidou N'GADJAGA, Information Technology Officer (ITO), APOC 23. Mr Dieudonn6 SOME, Information Systern Officer (ISO), APOC 24.Mr Gilles PARE, Medical Assistant, APOC 85 APPENDIX IV BUDGET The following broad budget lines were identified A. Preparatory visits o Perdiem o Travel B Field work a Perdiern a Travel Equipment Supplies Stationery Drugs Chemicals/reagents Others C. Workshop for review of results and production of report of second round of study 35 Participants in Ouagadougou in 2005 The teams were requested to prepare specific detailed budgets a a 86 ITEMS RQUIRED FOR EACH SITE o 1 Camera Dermatology (Digital) o 1 Computer and portable printer for each coordinator (once only, not for each site) o 2 Computers and Software (for entomologist and social scientist and dermatologist) ophthalmologist - Lotus 123 for entomologist, OCP software for data analysis (to be supplied by APOC) o 2 WU-Jones Computers, software, manual + chin rest * buzzer (To be supplied . I Slit-larnp with AnteriorSegment Camera and asscessories (apporpriately assembled before packaging) needs table o 1 Fundus Camera (Topcon Model) and accessories KOWA II . I Goldman Applanation Tonometers (to be supplied by APOC) o 4 Pen Torches (1 available - no head, needs 3) o 2 pin hole disks o 3 Direct Ophthalmoscope (1 available - no head, needs 3) . I Indirect Ophthamoscope small pupil o 220 D Lenges o I Snellen's <<E>> chart + trial frames (adult and child + pinholes) . 16160 <<E>> Chart (detachable) o 5 gallipots . 3 Kidney dishes o 2tape recorders o blacks curtains * rings (15m) o 4 table fans o 1 Global Positioning System (GPS) unit . 2 Dissecting rnicroscope (Wild M5) + accessories + lens cleaning kit o 2 Voltage regulator (current stabilizers) o 2 Generators (YAMAHA, ET500) (to be purchased or hired or borrowed) . Foreign body extraction kit . 4 Cables with switch board . 2 Dissection kit o 2 Ice chest o 4 Camp beds + 4 mosquito nets irnpregnated o 1 Portable (for Entomologist CT) . 2 Gericans o 2 Fans o 5000 catching tubes . 1000 catching forms o 500 dissections forms o 5 liters alcohol (Ethanol) o 5 liters Chlorofonn o 500 slides o 500 cover slides . 2kg cotton o 2 fl.acons de vernis d ongle incolore o 4 rain coast $ 1,500 $5,200 $7,000 $60 $10 s2,500 $10 $s0 $40 $100 $s0 $ 160 $100 $400 $100 $40 $20 $20 $80 87 o 2 tables . 4 chairs o 4 boots . 5 liters Acid Acetic . 2 clock o 50 pens o 30 pencils . 2 reams of paper o I thermometer o 5 bubles 60 w . 6bubles6w o 2 liters physiological saline o 20 tubes o 4 torches o 4 umbrella o 48 batries SUPPLIES . Spare bulbs + 60 watts and batteries medium size alkaline for all equipment (Carneras, slit-lamps, fundus cameras, ophthalmoscopes etc) o Photographic Films - 25 rolls Kodak 200mm Gold (for both dermatology and Ophthalmology) ektachrome 100 x 25 films (To be supplied by APOC) o 5 Rolls of plaster o 5 Rolls of Gauze o 5 bottles of Hydrogen peroxide o 1 Liter of Methylated Spirit . 1 box microtitre plates (-96 wells) o 20 pkts rnicroscope slides (50/pkt) . 10 pkts microscope cover slips (200/pkt) . 250 bijou bottles o 250 universal bottles o 500 cotton bags . 2kg cotton wool . 5 pkts filter paper (or tissue paper) o 1 lens cleaning set o 5 rnultiple heads adaptor o 2 electric cables 50mx2 o 1 roll (48) toilet tissue for use on slit lamp s1 00 $10 $100 $s $30 s100 s80 $s0 $10 $10 s10 $100 $20 88 STATIONERY TRANSPORTATION o 4 Vehicles hired or provided by NOTF x 21 days (hired . Fuel and Oil/Lubricants x 21 days o Production of Questionnaires for all groups (800 forms for dermatology - 2000 fonns for sociology - 800 forms (Wu-Jones) for ophthalmology - 400 fonns (examination for ophthalmology) o Pens, clips, pencils, carbon paper, tippex, stapler o 10 reams of ,A'4 paper . 10 registers for census and record keeping . OCP fonns 1,2-4, for fly catches, dissection, 20 booklets each (To be supplied by OCP/APOC) o 4 notebooks o 2 reams of flip chart papers . I flip charl staud o 4 rnaskir-rg tapes . Chlorpheniramine 1000 tabs Tioconazou o 20 tubes antifugal cream o 20 tubes antibiotic creams (Mupurican cream) o 6 bottles/tubes insect reppelent cream o paracetamol 1000 tabs o priton 1000 tabs o chloroquine phosphate x 1000 tabs o tetracycline x 1000 capsule o fersolate tabs x 1000 tabs o Vit A capsules x 1000 caps . 100 bottles Chloramphenicol eye drops and ointment o diamox tabs x 500 . 20 bottles phenylpherine l0o/o o 20 bottles mydrilate 10% o 20 bottles an-rethocaine l o% o 20 bottles betnesol drop o 10 bottles Plienylepherine 10% o l0 pkts fluorescent strips o DEC crearr for patch test $4000 $2000 $1000 $100 $100 $20 $10 $10 $50 $s $50 $30 $s0 $10 $30 $20 $20 $10 $5 $s0 $100 $10 $100 $1 00 $20 DRUGS 89 $20 OTHERS CHEMICAL, REAGENTS . 5 litres absolute ethanol . 1 litre chloroform . 5 litres glacial acetic acid o 1 litre glycerol o 2 pkts disposable gloves . disinfectant/soap o 2 plastic wash basins . 4 gericans (50 lit) o 15 rnetres of materials for screens and loin cloth . Air fares (in country) o Laboratory space at nearby institute (for entomology) - no cost Miscellaneous (incidental expenses) NB : Cost to be revised $s0 $20 $s $s0 $30 $10 $10 $s0 $2,500 $5,000 FACILITIES 90

{. 1 TSRM Io Q4 PLANNTNG NTMPTTNC IMPACT March 2003 T** t" d#q, I,rJt<'qtfv !id,ireEl 1 l' i tr 1rr il. , t.t PHASE [I OF APOC' TABLE OF CONTENTS OPENING CEREMONY SUMMARY OF PRELIMINARY DISCUSSIONS Review and amendments of protocols Sites Time table Logistics issues REPORT OF GROUP WORK Team composition Plan for field work Equipment and supplies RECOMMENDATIONS APPENDIX I- II III - IV- Amended protocol Meeting agenda for planning meeting List of participants Budget 2 MONDAY 24 MARCH 2OO3 Chairperson: Dr Michel Boussinesq Rapporteur : Dr Grace Fobi The agenda was adopted as proposed. The Director traced the history of Impact Assessment studies from inception to the present stage. The Director's speech also highlighted the following issues as being important in determining the sites for the next round of studies: o Tl-rerapeuticcoverage . Geographicalcoverage He also asked participants to reflect on the possibility to undertake studies in new sites, like Ethiopia, Angola, etc. He urged that publications of results of the first round should be done as sooll as possible. It was then agreed that by the end of this workshop the francophone group will at least come up with a calendar of activities to write up their publications in order to catch up with the Anglophone group which is far advanced. After the presentation on update on CDTI treatment, the following conclusions were made: It was observed that thee were inaccuracies in the values of the coverages presented and therefore, these figures cannot be used for impact assessment. The presentation on summaries of findings raised the following issues o It was noted that the data presented has already been updated. . Participants will have to read the site reports for more details. At this point the participants broke up into groups by specialties to look at protocols and propose amendments if necessary. Before breaking up the chairperson summarised issues raised after brain- storming as follows: . Concerning ophthalmology protocol, Wu-Jones might be the main issues . Dermatology protocol seems to be appropriate with very few amendments required o Entomology protocol will need to address the issue of differentiating between L3s of animal and human onchocercal species. Groups reconvened and the following decisions/amendments were made: 1) New cross-sectional studies should be done in all sites. In this respect a new complete censlls should be done and a new sample drawn. 2) Amendment should be made to the protocol used in phase I as follow: a J Entomoloev Dermatoloe), and ophthalmoloey o Page 72 tbree lines should be added to table on scabies, dermatomycosis and lice o DEC patch test be done on all sites in children 3-5 years old o DEC crealn should be ordered well in advance as it takes long to prepare and forward the cream to the sites. . Skin photographs should be taken on all sites o Denlatology data entry be done on the field under the supervision of the investigator . Participants agreed that the Wu-Jones test all agreed is quite difficult and has a lot of constraints. o While suggesting that the Wu-Jones machine be made more user-friendly it could be continued in those sites where the test was easily done and dropped in the other sites. . All ophthalmologists meet and write a paper on the feasibility, applicability of Wu-Jones on l3 sites and on the relationships between the results of the test and the other indicators of onchocerciasis endemicity. o Fundus photographs be taken on all sites o Cohorl fundus photographs on 2 sites in Cameroon be continued o Page 80 of initial protocol to remove "uncooperative" and replace with "unable to assess". Specific objectives o Delete "peak treatment" and "therefore" and, add the sentence: "A year round data collection is necessary for comparison for baseline data" in No 2. . Add: "ln areas where there are migrant flies this phenomenon should be taken into account" in No 3. . Under "fly catches and dissection" paragraph 2 replace "then preserve in absolute alcohol" by "and infective rates". Paragraph 3 concerning staining should be removed. Staining of flies should be stopped. . Under "detection of Onchocerco volvulus", add "guidance from DNA laboratory" . Time table for visit by expert line one of paragraph 1, replace "first" by "a", second line read "training and retraining" ; do this wherever there is "training" o Under "first visit", read "day 7-\4", and delete "staining" o Timetable for the second visit should be same as the first. Due to the absence of the sociologists who participated in the first studies, the issue of sociology was not addressed in the plenary session. However a meeting was arranged between Mrs Victoria Matovu, Dr A.D. Soubeiga - the sociologist from the University of Ouagadougou - and Dr M. Boussinesq. During their discussions it was proposed to add a number of questions to the initial protocol but it was then observed that additional questions did not directly address the issue of impact assessment. It was therefore finally concluded that no amendments will be made to the original sociology protocol. Socioloey 4 TUESDAY 25 MARCH 2OO3 Chairperson - Dr. Michel Boussinesq Rapporteur - Dr. Peter Enyong At the opening of the meeting the Chairperson suggested that we keep aside the sociological discussion for the moment and go first to coverage and site selection since the sociologists were still all absent. The meeting starled with a long discussion on whether detailed coverage figures were to be recorded and the best way to collect this information. It was agreed that coverage rates by site and project will both be useful for the interpretation of results. It was also further thought that CDTI project managers could provide information on which zones were treated when we are in the countries, or collect information from community registers. After discussions, the consensus was that a specific survey should be conducted to find out the coverage in the sites. Suggestions on how this was to be done included the use of village registers in villages which had them. However, it was thought that these were not always accurate and therefore, we could question the villagers per housel-rold. The statistician suggested that we use a cluster survey to detennine coverage and this should be done by the social scientists. At this point, it was agreed that we get a copy of the arlicle by Schwart z et al. ( 1998) on the methodology of evaluating coverage and use it as a guide. Copies of this paper were distributed to the members. The paper on the same topic by Biritwum et al. (1997) was also made available later. In conclusion, the group decided that therapeutic coverage will be determined by cluster sampling. Prof. Biritwllm was requested to provide a written study design for determining coverage. During the surveys questions that are on the demiatology protocol like "Have you taken ivennectin"Yes, No If yes "how many times" and "what was the last year you took it?" could be an entry point for other questions to the individuals surveyed like - what is your view on the: - CDTI? and CDDs?, etc. However, later discussions by the sociologists showed that these issues were not related to impact assessrnent and thus should not be looked into. Regarding the sites, there were those that will no more be visited because - it is a hypo-endemic area (Lastourville, Gabon) - there has been no treatment yet, although included in a CDTI project (Inga DRC). - not treated and not included in a CDTI project (the2 CAR sites) It was then revealed that only three sites have received at least one CDTI protocol in the francophone group sites. 5 In contrast, all the sites in the anglophone group have been treated except Ethiopia which they hope to add on. The participants accepted the principle of including new sites. These new sites (DRC, Angola, Burundi, Eihiopia) could now be selected as baseline sites and could be revisited in the next five years. As far as the number of treatment rounds that a project should have had before the evaluation in 2004 was concemed, the question was: Should the second phase of studies be conducted irrespective of the number of treatment rounds? Some members thought that the assessment could be undertaken 5 years after the CDTI project has been approved and implemented by APOC irrespective of number of treatments. At this point the Director was called in to contribute in the discussion and clarify certain issues. The question was to choose between the following options. The second round should be conducted: - in 2004 as per the initial protocol, or - after 5 CDTI distributions regardless of coverage, or - 5 years after first CDTI treatment no matter the number of treatment rounds and coverage. After hearing the options on the table the Director made the following analysis - You cannot judge the impact of APOC activities without correct treatment. - Ideally the study site should have attained 100% geographical and 65oh therapeutic coverage by now. However, the Director acknowledged that such an ideal situation may not be found everywhere. It was concluded that, since the Phase II document of APOC requires an impact evaluation in 2004 and since we cannot get an ideal situation, studies should be conducted as planed irrespective of their treatment status. However, this will not apply to sites where treatment has not started. For those points where there had not been any treatment at all, it was not obligatory to re-evaluate but if we decide to carry out the new studies, the data might still be useful to APOC. In Lastourville, Gabon, at the baseline surryey, there was no need for any re-evaluation because this area was found to be hypo-endemic. Regarding the country visits before the next round of evaluation of impact assessment it was decided that the 2 Coordinators (Dr Bousinesq and Prof. Braide) will conclude preparatory visits to countries and sites before the teams start work. The workshop for review of results and preparation of reports should be held in October 2005, in Ouagadougou. Members of the core teams and their national counterparts as well as the statisticians (about 35 persons) shall be invited to attend this workshop. The house broke up into into two working groups (anglophone and francophone) to work on the inventry of equipn-rent and supplies, timetable and team composition. 6 Participants reconvened to receive repofts form the groups and discuss the issue of coverage detemination. Prof. Biritwum proposed a protocol and the discussions are summarised as follows: For the purpose of improving the interpretation of the evaluation of impact assessment results, it has been agreed that accurate geographical and treatment coverage estimates will be needed for the projects. In addition, information on the frequency of amual treatment will be required. The rnethod will involve the use of the 3O-cluster EPI coverage assessment technique. Villages within 20 to 30 kilometers radius of the impact evaluation 'village' will be listed with their population sizes to be used in selecting the 30 clusters using the steps given in appendix. lt does not matter if the village is treated or not. Due to the dispersal of the vector, impact on intensity of transmission in a given village is more closely related to treatment coverage in the area than to tl-re treatment coverage in the village. A local epiderniologist recruited by the team will select the sample and collect the data with the help of two interviewers and a local field worker. The questionnaire attached will be used to obtain information from members of households. Seven households will be selected per cluster starting from a random house in the selected cluster. Subsequent household will be from the nearest house after completing all the households in the first house. It is estimated that the team could take about 15 days to complete the exercise. 7 REPORT OF GROUP WORK BY ANGLOPHONE TEAMS List of Team members Team 1 Dr Maria Hagan (Team Leader) Dr Michael Wilson Dr Rich Unreh Dr Joseph Charles Ophthalmologist but serves as Dermatologist in team Entomologist Ophthalmologist Social Scientist Teant2 Dr Kechi Ogbuagu (Team Leader) Public Health Physician but serves as dermatologist in team Dr Bertha Maegga Entomologist Dr Ferni Babalola Ophthalmologist Mrs Victoria Matovu Social Scientist ! If Kechi Osbuasu is not available to participate, Bertha Meassa will lead Team 2 and Dr Mahdi Shqnrqrl uzill rcn'lqne Dr olrrreorr asDcmefnlno'isf If Mrs Victoria Matovu cannot participate in all sites, Mrs Edith Wellington will replace her as Social Scientist. In each country, the following counterparts as well as others listed in personnel will join the teams One Social Scientist One Ophthalmologist One Entomologist One Dermatologist One Epidemiologist Names of these professionals will be provided to APOC Management, by coordinator after the preparatory visits. 8 Preparatory Visits by Coordinator (Prof. Eka.I. Braide) Coordinator will, in each country, meet the following: * National Coordinator '.' NOCP * WHO official * NGDO officials (one per site) * Project Coordinator (one per site) During the meetings the following will be addressed o Debriefing on first round of study . Briefing on plans for second round of study o Preparation for second round ofstudy - Selection of sites (Ethiopia only) - Composition of local team - Review of available equipment and supplies - Procurement of equipment and supplies (local) - Logistics,vehicles, accornmodation. 9 Country Location Dates of visits 2003 Nigeria Lagos Arrive... Meetings Depart.. . May 6 May 7-8 inclusive May 9 Ethiopia Addis Ababa Arrive. ... ....July 13 Meetings... July 13-15 inclusive Join TCC mission on July 16 Depart..... .. July 20 Sudan Khartoum Arrive... Meetings Depart... . August 4 August 5-6 inclusive .August 7 Uganda Kampala Arrive... Meetings Depart... August 10 August ll-12 inclusive August 13 Tanzania Daar-Es-Salaam Arrive.... Meetings. Depart.... August 13 August 14-15 inclusive August 16 After the visits, the following will be provided by APOC management ,/ Names of in-country team members ,/ Revised timetable for fieldwork in each site ...if revised ,/ Information on sites in Ethiopia. Sites........Teams I and' 2 Site Project name Country Team Study period 2004 Ikom Cross River CDTI Nigeria 1 Socio:July 5-25 Team:July 12-31 Olamaboro Kogi CDTI Nigeria 1 Socio:October 4-26 Team:October 11-31 Gembu/Gashaka Taraba CDTI Nigeria 1 Socio:Auglst 4-26 Team:August 11-31 Raja Southern CDTI Sudan Sudan 1 Socio:Jan. 12-Feb. 1 Team:Jan 19-Feb 8 Bwakira Tanzania Morogoro CDTI Tanzania 2 Socio:July 5-25 Team:July 12-31 Bushenyi Uganda Phase two Uganda 2 Socio:August 4-26 Team:August 11-31 Ethiopia To be selected Ethiopia 2 Socio:Jan. 12-Feb. 1 Team:Jan. 19-Feb. 8 10 SCHEDULE OF FIELD WORK - TEAMS 1 AND 2 TEAM 1, SITE 1: RAJA, SUDAN ACTIVITIES ACTION BY PLACE PERIOD 1 Arrival of *Social Scientist in Khartoum Social Scientist Khartoum 12 January 2004 2 Social Scientist and NOTF at Site I Social Scientist, NOTF/Local helpers Site I 14 Jantary 2004 J Census/ Social Science Survey Social Scientist, NOTF/Local helpers Site I 14 to 23 January2004 4 Rest of team arives in Khartoum Team members Khartoum 19 January 2004 5 Team rneets with WR and NOTF Team members, WR and NOTF Khartoum 20 January 2004 6 Team/NOTF arrive at Site I Meet local leaders TeamAtrOTF, Local experts Site I 20 January 2004 7 Field work Team/ Local experts, Local helpers Site I 2l January to 7 February 2004 8 Depart for Khartoum Team members Khartoum 8 February 2004 9 Depart for individual countries Team members *Social scientist will be in field for twenty days. 11 TEAM I, SITE 2 _ IKOM, NIGERIA *Social scientist will be in field for twenty days ACTIVITIES ACTION BY PLACE PERIOD 1 Arrival of *Social Scientist in Lagos Social Scientist Lagos 5 July 2004 2 Social Scientist and NOTF at Site 2 Social Scientist, NOTF/Local helpers Site 2 7 July 2004 J Censusi Social Science Survey Social Scientist, NOTF/Local helpers Site 2 7-16 July 2004 4 Rest of team arrives in Lagos Team members Lagos 12 July 2004 5 Team meets with WR and NOTF Team members, WR and NOTF Lagos 13 July 2004 6 Team/NOTF arrive at Site 2, meet local leaders Team, NOTF, Local experts Site 2 15 July 2004 7 Field work Team/Local experts, Local helpers Site 2 15 to 30 July 2004 8 Team departs for Lagos Team members Lagos 3l July 2004 9 Depart for individual countnes Team members t2 TEAM 1, SITE 3 - GEMBU/GASHAKA, NIGERIA *Social scientist will be in field for twenty days ACTIVITIES ACTION BY PLACE PERIOD i Arrival of *Social Scientist in Lagos Social Scientist Lagos 4 August 2004 2 Social Scientist and NOTF at Site 3 Social Scientist, NOTF and Local helpers Site 3 6 August 2004 J Census/ Social Science Survey Social Scientist, NOTF, Local helpers Site 3 6-15 August2004 4 Rest of team arrives in Lagos Team members Lagos 11 August 2004 5 Team meets with WR and NOTF Team members, WR and NOTF Lagos 12 August 2003 6 TeamiNOTF arrive at Site 3, meet local leaders Team, NOTF, Local experts Site 3 14 August 2004 7 Field work Team, Local experts, Local helpers Site 3 14-29 August 2004 8 Team departs for Lagos Team members Lagos 30 August 2004 9 Depart for individual countries 13 TEAM 1, SITE 4 -. OLAMABORO, NIGERIA *Social scientist will be in field for twenty days ACTIVITIES ACTION BY PLACE PERIOD 1 Arrival of *Social Scientist in Lagos Social Scientist Lagos 4 October 2004 2 Social Scientist and NOTF at Site 4 Social Scientist, NOTF/Local helpers Site 4 6 October 2004 aJ Census/ Social Science Survey Social Scientist, NOTF/Local helpers Site 4 6-15 October 2004 4 Rest of team arrives in Lagos Team members Lagos 11 October 2004 5 Team members meet with WR and NOTF Team members, WR and NOTF Lagos 12 October 2004 6 Team, NOTF arrive at Site 4, meet local leaders Team, NOTF, Local experts Site 4 14 October 2004 7 Field work Team, Local experts, Local helpers Site 4 14-29 October 2004 8 Team deparls for Lagos Team members Lagos 30 October 2004 9 Depart for individual countries t4 TEAM 2, SITE 1: ETHIOPIA *Social scientist will be in field for twenty days ACTIVITIES ACTION BY PLACE PERIOD 1 Arrival of *Social Scientist in Addis Ababa Social Scientist Addis Ababa 12 Jantary 2004 2 Social Scientist and NOTF at Site I Social Scientist, NOTF/Local helpers Site I 14 January 2004 J Census/ Social Science Survey Social Scientist, NOTF/Local helpers Site I 14 to 23 January 2004 4 Rest of team arrives in Addis Ababa Team members Addis Ababa 19 January 2004 5 Team meets with WR and NOTF Team members, WR and NOTF Addis Ababa 20 Jantary 2004 6 TeamA{OTF arrive at Site I. Meet local leaders Team/NOTF, Local Experts Site I 20 January 2004 7 Field work Team/ Local experts, Local helpers Site I 2l lanuary to 7 February 2004 8 Depart for Addis Ababa Team members Addis Ababa 8 February 2004 9 Depart for individual countries Team members 15 TEAM 2, SITB 2 : TANZANIA *Social scientist will be in field for twenty days ACTIVITIES ACTION BY PI,ACE PERIOD 1 Arrival of xSocial Scientist in Dar-es-Salaam Social Scientist Dar-es-Salaam 5 July 2004 2 Social Scientist and NOTF at Site 2 Social Scientist, NOTF/Local helpers Site 2 7 Iuly 2004 J Census/ Social Science Survey Social Scientist, NOTF/Local helpers Site 2 7-16 lily 2004 4 Rest of team amives in Dar-es-Salaam Team members Dar-es-Salaam 12luly 2004 5 Team rneets with WR and NOTF Team members, WR and NOTF Dar-es-Salaam 13 July 2004 6 Team/NOTF arrive at Site 2, meet local leaders Team, NOTF, Local experts Site 2 15 July 2004 7 Field work TeamlLocal experts, Local helpers Site 2 15 July to 30 July 2004 8 Team departs for Dar-es- Salaam Team members Dar-es-Salaam 3l July 2004 9 Depart for individual countries Team members 16 TEAM 2, SITE 3 : UGANDA *Social scientist will be in field for twenty days ACTIVITIES ACTION BY PLACE PERIOD I Arrival of xSocial Scientist in Kampala Social Scientist Kampala 4 August 2004 2 Social Scientist and NOTF at Site 3 Social Scientist, NOTF and Local helpers Site 3 6 August 2004 J Census/ Social Science Survey Social Scientist, NOTF, Local helpers Site 3 6-15 August2004 4 Rest of team anives in Kampala Team members Kampala 11 August 2004 5 Team meets with WR and NOTF Team members, WR and NOTF Kampala 12 August 2003 6 Team/NOTF anive at Site 3, meet local leaders Team, NOTF, Local experts Site 3 14 August 2004 7 Field work Team, Local experts, Local helpers Site 3 14-29 August 2004 8 Team departs for Kampala Team members Kampala 30 August 2004 9 Depart for individual countries 17 Personnel Anglophone teams...1 and 2 External One (1) Temporary adviser Per Diem and honoranum (Preparatory visits) 6 days per country Per Diem and honorarium...20 days per site (team 1:4 Sites "."Team 2 :3 sites) Four (4) Team members Internal (Local/in country) per site One (1) Social scientist Per diem Two (2) Ophthalmologists Per diem One (1) additional Ophthalmologist for Sudan Per diem Two (2) Clinicians Per diem One (l ) Entomologist Per diem Four (4) Enumerators (determination of coverage) Per diem Two (2) Wu-.Iones Assistants Per diem Two (2) Data entry Assistants Per diem Two (2) Technologists Per diem Two (2) Fly catchers .."".' Per diem One ( 1) Driver . . . for entomology Per diem Three (3) Drivers ...for rest of team Per diem Two (2) Local helpers (guides and interpreters etc) Per diem One ( 1 ) National/ZonallRegional Coordinator' Project accountant Per diem One (1) CDl'l Project Coordinator "' Per diem One (1) CDTI LGA/District Coordinator Per diem Five (5) officials for preparatory meetings with coordinator Per diem In-country travel for 5 officials for preparatory meeting In- country travel for team members from city of residence to site 20 days 20 days 20 days 20 days 40 days 10 days 20 days 20 days 60 days 60 days 60 days 20 days 20 days 4 days One (1) 2 days 20 days 20 days 3 days (Return) once only 18 EQUIPMENT AND SUPPLIES NEEDS FOR TEAMS 1 AND 2 AVAIT ABLE EOUIPMENT NON AVAILABLE EOUIPMENT a 2 WU-Jones Computers. software. manual (out of order) 2 pru hsladisks 1 Direct ophthalmoscope 1 slit-larnp without stand or anterior segment camera two 20 D Lenses I Indirect Ophthalmoscope small pupil 1 Snellen's <<E>> chart+ trial frames (adult and child+pinholes) | 6160 <<E>> Chart (detachable) 3 Kidney dishes 1 Voltage regulator (current stabilizers) 1 Generator (YAHAMA, ET500) (to be purchased or hired or borrowed) per team 1 cable with switch board 1 Ice chest Blacks cuftains + rings (15m) 1 Dissecting microscope (Wild M5) + accessories * lens cleaning kit a a a a o a a a a o a a a a . box for Wu-Jones computers, chin rests and buzzers o 1 Digital Camera per team for dermatology o 2 Computers and Software (for entomologist and social scientist and dermatologist) ophthalmologist - Lotus 123 for entomologist, OCP software for data analysis (to be supplied by APOC) o two more ophthalmoscopes per team o stand for slit-lamp with Anterior Segment Camera and accessories (appropriately assembled before packaging) APOC to supply . 1 Fundus Camera (Topcon Model) and accessories KOWA II per team. APOC to supply o 1 Goldmann Applanation Tonometers (To be supplied by APOC) per team c 2Pen Torches (local purchase) o l0o/o DEC cream /lotion . perforatedhypoallergenicplaster . Filter paper o Ice patch . Foreign body extraction kit o 1 cable with switch board c 2 Collapsible tables o 4 Collapsible chairs o i Dissection kit o 4 Camp beds + mosquito nets impregnated o 2tape recorders . 2table fans per team . 1 Global Positioning System (GPS) unit 19 SUPPLIES . 1 box rnicrotitre plates (-96 wells) o 20 pkts microscope slides (50/pkt) o 10 pkts microscope cover slips (200/pkt) o 5000 catching tubes c 250 bijou bottles o 250 universal bottles o 500 plastic bags . 5 pkts filter paper (or tissue paper) . 1 lens cleaning set . 5 multiple heads adaptor o I electric cable 50mx2 TRANSPORTATION AVAILABLE EQUIPMENT NON AVAILABLE EQUIPMENT a 4 Vehicles provided by NOTF x 20 days a Fuel and Oil/Lubricants x 20 days STATIONERY AVAILABLE EQUIPMENT NON AVAILABLE EQUIPMENT . Spare bulbs + 60 watts and batteries medium size alkaline for all equipment o (cameras, slit-lamps, fundus cameras, ophthalmoscopes etc) to be supplied by APOC o PhotoBraphic Films - 25 rolls Kodak 200mm Gold (for Ophthalmology) ektachrome 100 x 25 films (To be supplied by APOC) o 5 Rolls of plaster (Local purchase) . 5 Rolls of Gauze ( Local purchase) o 5 bottles of Hydrogen peroxide (Local purchase) o 1 Litre of Methylated Spirit (Local purchase) . 2kg cotton wool (Local purchase) o 1 ELECTRIC CABLES 50Mx2 ( Local purchase) o 1 ro11 (48) toilet tissue for use on slit lamp AVAILABLE EQUIPMENT NON AVAILABLE EQUIPMENT a OCP foms 1,2-4, for fly catches, dissection, 20 booklets each (To be supplied by OCP/APOC) o Production of Questionnaires for all groups - 800 forms for dermatology - 2000 forms for sociology - 800 forms (Wu-Jones) - 400 forms (examination for ophthalmology) o Pens, clips, pencils, carbon paper, tippex, stapler (local) o 10 reams of A'4 paper (local) o 10 registers for census and record keeping (local) o 4 notebooks (local) o 2 reams of flip chart papers (local) . 1 flip chart stand (local) o 4 masking tapes (local) 20 DRUGS CHEMICAL, REAGBNTS AVAILABLE EQUIPMENT NON AVAILABLE EQUIPMENT . Chlorpheniramine 1000 tabs (local) o 20 tubes antifugal cream (tioconazole cream) local . 20 tubes antibiotic creams (Mupurican cream) - local o 6 bottles/tubes insect reppelent crearl (local) o Paracetamol 1000 tabs (local) o Piriton 1000 tabs (local) o Chloroquine phosphate x 1000 tabs o Tetracycline x 1000 caps (local) o Fersolate tabs x 1000 tabs o Vit A capsules x 1000 caps (local) o 100 bottles Chloramphenicol eye drops and ointment (local) o Diamox tabs x 1000 (local) o 20 bottles phenylephrine l0%o (local) o 20 bottles mydrilate 1"/o (local) o 10 bottles amethocaine 1o/o (local) . 20 bottles betnesol drops (local) o 10 pkts fluorescein strips (local) AVAILABLE EQUIPMENT NON AVAILABLE EQUIPMENT o 5 litres absolute ethanol (local) o 1 litre chloroform (local) . 5 litres glacial acetic acid (local) . 1 litre glycerol (local) o Physiological saline 500m1 (local) 2t OTHERS REPORT ON GROUP WORK BY FRANCOPHONE TEAMS COMPOSITION OF TEAM 3 External members: Doctor FOBI Grace Dr. OZOH Gladys Dr. ENYONG Peter Dr. ABE Claude Dr. KAMGNO Joseph Local Team members Ophthalmologist: Dermatologist: Entomologist: Social scientist: Data Manager: 2 data entry persons One ophthalmic nurse Three local helpers Four Enumerators One technician: Team leader, Ophthalmologist Dermatologist Entomologist Social scientist Epidemiologist Dr. NLATTE Berthin or Dr. EPEE Dr. BISSEK Anne-C6ci1e Mr. DEMANOU Maurice or ESUM Matthias Mrs CHIFFOR Mr. OLINGA OLINGA Jean-Marie To identify Ms. HADJARATOU To identify To identify Mr. NDAGA Simon AVAILABLE EQUIPMENT NON AVAILABLE EQUIPMENT . 2 pkts disposable gloves (local) o Disinfectant/soap(local) o 2 plastic wash basins (local) o 4 gericans (50 lit) - local o 15 metres of materials for screens and loin cloth (local) o DHL for film processing and posts/email (local) o Air fares (in country) 22 IMPACT ASSESSMENT STUDIES 2OO4 SCHEDT-ILE OF FIELD VISITS FOR TE,AM 3 ACTIVITIES RESPONSIBLE PARTY PLACE ACTIVITY OF MONTH/ DURATION SITE I NGAMBE CAMEROON 1. Notification of Local Authorities NOTF Cameroon site I Ngambe Early December 2003 2. Arrival of Entomologists Peter Enyong Yaounde 4 January 2004 3. Departure to srte I Peter Er.ryong Site I Littoral 6 January 2004 4. Arrival of Socral Screntrst Claude Abe Yaounde 4 January 2004 5. Meetings Socral Screntrsts/Team Leader,NOTF/WR Yaounde 5 January 2004 6. Departure/Census and Social Science Survey/Preparatory site visit SS/Team Leader/Local Helpers/ Yaounde 6 January 2004 7. Rehrm srte I Team Leader Yaounde l0 January 2004 8. Arrival of Dermatologist Dr. Ozoh Yaounde 20 January 2004 9. Meetings Team Leaders/Dr. OzohNOTF/WR Yaounde 2l January 2004 10 Return from srte I Entomologrst Yaounde 2l larntary 2004 1 L reportrng/departrng Entomologrst Yaounde/Kumba 23 January 2004 12. Return of Social Scientist for Meetings Social Scientrst, Entomologrst, Medrcal team Yaounde 22 January 2004 13. Arrival at site I Medical Team/Comp.Tech ( ophtalmologist/Dermatologist) + Helpers Site I-Yaounde 23 January 2004 14. Team departs fol Yaounde Medical Teanr/Comp.Tech (DermatologrsVOphtalmologrst) Srte I-Yaounde 13 February 2004 15. Data entry + Reportrng Team Leader and Computer Technician Dr Ozoh Yaounde 20 February 2004 16. Meetings Team + WR Yaounde 20 February 2004 17. Departure from Cameroon Dr Ozoh Nigeria 21 February 2004 23 SCHEDULE OF FIELD VISITS FOR TEAM 3 (Continued) SITE II KUMBA CAMEROON 18. Arrival il Yaounde Entomologist Yaounde l't February 2004 19. Meetrng Entomologrst/WR Yaounde 2February 2004 20. Departure to srte II Entomologists Srte II l't visrt 3 February 2004 2l. Return from site II Entomologists Yaounde 18 February 2004 22. Reportrng/Departure Entomologrsts Yaounde/Kumba 20 February 2004 23. Departure to site I Dr Peter Enyong Site I (2"d visit) 24February 2004 24. Return form site I Dr Peter Enyong Yaounde 10 March 2004 25.Departure Dr Peter Enyong Yaounde /Kumba 12 March2004 26. Departure Socral Screntrst Claude Abee Site II 28 March 2004 27 . Preparatory vrsit Team Leader Dr Grace Fobi Site II 4 Aprll2004 28.Return Dr Grace Fobi Yaounde 9 April2004 29. Arrwal Dr Ozoh Yaounde 12 Apri2004 30. Return of Social S and meetings Team,NOTF Yaounde 12 Aprll2004 3 1. Meeting/Departure of Med.Team Dr. OzohlDr. FobiA{OTF/WR Site II 14 Apnl 2004 32. Rehrrn of Medical team Dr. OzolVDr. Fobi/ others Yaounde 5 May 2004 33. Data entry and reporting Dr. Ozoh, Dr. Fobi NOTF, Local Helpers, Local Opht., Local Phycisian Yaounde l1 May 2004 34. Departure DR Ozoh Nigeria 12May 2004 35. Reportrng Peter Enyong Yaounde 26 February 2004 36. Retum Peter Enyong Kumba 21February 2004 37. Departure to srte II Peter Enyong Site II second visit 04 April2004 38. Retum Peter Enyong Kumba l9 April2004 24 SCHEDULE OF FIELD VISITS FOR TEAM 3 (Continued) SITE III LUNDA SUL, ANGOLA 39. Departure to Angola Claude Abe Luanda 13 June 2004 40. Meeting Claude Abe /WR/Local SS Luanda 14 June 2004 41. Departure to Angola Claude Abe Srte III 17 Iune2004 42. Return Claude Abe Luanda 7 Jdy 2004 43. Arrival in Angola Grace Team Leader/Peter Enyong Luanda 7 July 2004 44. Meetrng Team Leader/ Entomo/SS/WR Claude Abe Luanda 8 July 2004 45.Reporting/Departure Luanda/Cameroon I I July 2004 46. Arnval rn Angola Dr OzohlData Manager Luanda I I July 2004 4T.Departure Peter entomologist Site III 12 Jttly 2004 48. Return home from site III Peter entomologrst Luanda 23 lu,ly 2004 49. Reportrng Peter entomologtst Luanda 24 July 2004 50. Departure to site III Peter entomologist Cameroon 27 IluJy 2004 51. Departure team Clinical Team Site III l5 July 2004 52. Return from site III Clinical Team Luanda 5 August 2004 53. Data entry/reporting Clinical Team Luanda 6 August 2004 54. Meeting Dr. OzohlDr Fobi/SS,NOTF/WR CameroonNigeria 12 August 2004 55. Deparhrre from Angola Med.Team Nigeria Cameroon l3 August 2004 56. Anival Peter Enyong entomologist Luanda 9 August 2004 57. Meetrng WRNOTF/entomology team Luanda l0 August 2004 58. Departure to site lll Entomology Team Slte III 13 August 2004 59. Return from srte III Entomology Team Luanda 23 August 2004 60. Reportrng Entomology Team Luanda 24 August 2004 6l.Departure from Angola Peter Enyong entomologist Cameroon 26 August 2004 62.D ata analysis meetrng Team Ouagadougou April2005 25 INVENTORY OF EXISTING MATERIALS AND EQUIPMENT FOR TEAM 3 No Equipment Ouantitlr I Incomplete slit larnp (no stand) 1 2 Visual acurty chart 1 J 220 volts (does not seem to work)Transfotmer 1 4 Folding 6 5 Folding table 2 6 Stool 1 7 Parasol 1 8 Direct ophthalmoscopes (not working) 1 9 Indirect ophthalmoscope i 10 Glaucotest Tonometer 1 11 DELL computer not working again 1 POOLED REQUIREMENT/BUDGET PER SITE Personnel Team 3 has a total of 3 sites in Cameroon (Ngambe and Kumba) and Angola (Lunda Sul). Extemal One ( 1) Temporary adviser Per Diem and honorarium per country (Preparatory visits) 6 days One (1)Team Leader Per Diem and honorarium (Preparatory visit to site) 5 days One (1)Team Leader Per Diem and honorarium (Meetings with WRAIOTF/ Team rnembers etc) 5 days Two (2) Tearn members Per Diern and honorarium 21 days/site One(1) Team members Per Diem and Honorarium 30 days One (1) Team Member Per Diem and Honorarium 20 days Internal (Local/in country) per site One (1) Social scientist One ( 1 ) Ophthalmologist One (1) ophthalmic Nurse Per diem Per diem 20 days 21 days 21 daysPer diem 26 One (l) Derrnatologist Perdiem One (1) epidemiologist Per diem One(l) Entornologist Perdiem Four (4) Enumerators (determination of coverage) Per diem Two (2) Wu-.Iones Assistants Per diem Two (2) Data entry Assistants Per diem Two (2) Technologists (entomology helper) Per diem Two (2) Fly catchers Per diem Four (4) Driver ...for medical team Per diem One (1) Driver ...for entomology Per diem Two (3) Local helpers (guides and interpreters etc) Per diem One ( I ) National/ZonallRegional Coordinator One (1) CDTI /District Coordinator Per diem In- country travel for team members from city of residence to site (Return) once only 21 days 21 days 90 days 10 days 1 days 21 days 90 days 90 days 21 days 90 days 2l days 4 days 21 days 27 EQUIPMENT REQUIRED . 1 Camera Dennatology (Digital) o 2 Computers and Software (for entomologist and social scientist and demratologist) ophthalmologist - Lotus 123 for entomologist, OCP software for data analysis (to be supplied by APOC) o 2 WU-Jones Computers, software, manual + chin rest * buzzet (To be supplied . Table of slit lampe o 1 Fundus Camera (Topcon Model) and accessories KOWA II o 2 Pen Torches . 2 pin hole disks . 1 Direct Ophthalmoscope o trial frames (adult and child + pinholes) o 16160 << E >> Charl (detachable)5 days . 5 gallipots . 3 Kidney dishes o 2tape recorders . blacks cuftains + rings (15m) o 4 table fans o 1 Global Positioning System (GPS) unit o 2 Dissecting microscope (Wild M5) + accessories * lens cleaning kit o 2 Voltage regulator (current stabilizers) . 2 Generators (YAMAHA, ET500) (to be purchased or hired or borrowed) o Foreign body extraction kit o 4 Cables with switch board o 2 Dissection kit o 2 Ice chest o 4 Camp beds + 4 mosquito nets irnpregnated o 1 Porlable (for Entomologist CT) . 2 Gericans o 2 Fans o 5000 catching tubes o 1000 catching forms o 500 dissections forms . 5 liters alcohol (Ethanol) . 5 liters Chlorofonn . 500 slides o 500 cover slides . 2 kg cotton o 2 flacons de vemis ir ongle incolore o 4 rain coast o 2 tables o 4 chairs o 4 boots . 5 liters Acid Acetic o 2 clock 28 aa . 50 pens . 30 pencils o 2 reams of paper o t thermometer . 5 bubles 60 w o 6bubles6w o 2 liters physiological saline o 20 tubes o 4 torches . 4 umbrella o 48 batries 1. SUPPLIES Spare bulbs + 60 watts and batteries medium size alkaline for all equipment (Canreras, slit-lamps, fundus cameras, ophthalmoscopes etc) Photographic Fihns - 25 rolls Kodak 200rnm Gold (for both dermatology and Ophthalmology) ektachrome 100 x 25 films (To be supplied by APOC) 5 Rolls of plaster 5 Rolls of Gauze 5 bottles of Hydrogen peroxide 1 Litre of Methylated Spirit t box rnicrotitre plates (-96 wells) 20 pkts microscope slides (50/pkt) 10 pkts microscope cover slips (200/pkt) 250 bijou bottles 250 universal bottles 500 plastic bags 2 kg cotton wool 5 pkts filter paper (or tissue paper) 1 lens cleaning set 5 multiple heads adaptor 2 electric cables 50mx2 1 roll (48) toilet tissue for use on slit lamp TRANSPORTATION 4 Vehicles hired or provided by NOTF x 2i days (hired Fuel and Oil/Lubricants x 21 days 1 Vehicles hired or provided by NOTF 4 x 14 days (hired) Fuel and Oil/Lubricants 4x14 days...Entomology Entomology per year a a a a a a a a a a a a o a a a ) o a a a 29 3. STATIC}NERY . Production of Questionnaires for all groups (800 forms for dermatology - 2000 forms for sociology - 800 forms (Wu-Jones) for ophthalmology - 400 forms (examination for ophthalmology) o Pens, clips, pencils, carbon paper, tippex, stapler o 10 reams of ,A.4 paper o 10 registers for census and record keeping . OCP fomrs I.2-4, for fly catches, dissection, 20 booklets each (To be supplied by OCP/APOC) o 4 notebooks o 2 reams of flip chart papers . 1 flip chart stand . 4 rnasking tapes 4. DRUGS . Chlorpheniramine i000 tabs o 20 tubes antifugal cream (ticoncidole cream) o 20 tubes antibiotic creams (Mupurican cream) o 6 bottles/tubes insect reppelent cream o paracetamol 1000 tabs o priton 1000 tabs o chloroQuine phosphate x 1000 tabs . tetracycline x 1000 tabs o fersolate tabs x 1000 tabs o Vit A capsules x 1000 caps . 100 bottles Chlorarnphenicol eye drops and ointment o diamox tabs x 500 o 10 bottles atropine o 20 bottles phenylphrine l0o/o . 20 bottles mydrilate 10% o 10 bottles amethcaine 10% o 10 bottles bethnesol drop o 10 bottles Phenylephedrine ljoh + mydrilene 1% o 10 bottles novocaine o l0 pkts fluorescent strips 5. CHEMICAL, REAGENTS . 5 litres absolute ethanol o I litre chlorofonn . 5 litres glacial acetic acid o 1 litre glycerol 30 aa a a o a a 7, o a 6. OTHERS 2 pl<ts disposable gloves disinfectant/soap 2 plastic wash basins 4 gericans (50 lit) 15 rnetres of rnaterials for screens and loin cloth DHL for film processing and posts/email Air fares (ir-r country) FACILITIES Laboratory space at nearby institute (for entomology) - no cost Miscellaneor.rs (incidental expenses). 31 REPORT ON GROUP WORK BY FRANCOPHONE TEAMS COMPOSISTION OF TEAM 4 EXTERNAL MEMBERS Name Speciality Professor Kayembe David Professor Lapika Bruno Professor Trao16 Soungalo Doctor Mpoudi Eitel Professor Kayembe Patrick Ophthalmologist, Team leader Social Scientist Entomologist Dermatologist Epidemilologist Biostatistician NATIONAL MEMBERS NO AVAILABLE EOUIPMENT Name Speciality Muanza K. Jean Claude Kalala Auqustin Lulua Damatse Jeanne Takoma Didier Kapinga Matula Bobauea Threrry Tambwe Bantwanga Utsudi Kabasele Kanda Fly catchers Helpers Drivers Ophthalmologist Ophthalmologist Ophthalmolo gist Assistant Ophthalmologist Assistant Ophthalmologist Assistant Social Scientist Social Scientist Social Scientist Entomologist Entomologist Technician Entomologist Technician Dermatologist Dermatologist 6(2persite) 9 (5 census;2 dermato; 2 ophthalmo) 3(lpersite) 32 PROPOSE CALENDAR OF THE ENTOMOLOGIST CT (TEAM 4) I 1. Training Departure from Ouagadougou Activities Kinshasa and Inga Departure from Kinshasa 2.1 Sites I (Kasai) and III (Equateur) Visit 1 (Kasai) and visit 2 (Equateur) 7 November 2003 8-20 November 2003 21 November 2003 23 luly 2004 24 Jtly-7 August 2004 8-24 August2004 25 August 2003 27 November 2004 28 November-16 D6cember 2004 l7 December 2004. 7 May 2004 8-27 May 2004 28May-17 June 2004 18 June 2004 1'' October 2004 2-21 October 2004 22 October 2004. 3. Departure from Ouagadougou Activities Kinshasa-Equateur Activities Kinshasa-Kasai Departure de Kinshasa 2.2 Visit 2 (Kasai) Departure from Ouagadougou Activities Kinshasa-Lusambo Depafture from Kinsahsa 3.1 Sites II (Bas Coneo) and III (Equateur) Visit I (Bas Congo and Equateur) Departure from Ouagadougou Activities Kinshasa-Bas Congo Activities Kinshasa-Equateur Departure from Kinshasa 3.2 Visit 2 (Bas Congo) Departure from Ouagadougou Activities Kinshasa-Bas Congo Deparlure from Kinshasa JJ SCHEDULE OF FIELD VISITS F'OR TEAM IV Site I Sites Categories Number/ personnel RDC/KASAI/ LUSAMBO Entomologist CT Local Entomologist Entomologist Technician Fly boys Driver 1 1 2 2 1 Social Scientist CT Team Leader CT Local Scientist Enumerator/Census Data manager Driver I 1 1 5 I 1 Dermatologist CT Local Dermatologist General Physician Translator Data manager Local Helpers Driver I 1 1 1 1 2 1 Ophthalmologist CT Team Leader Local ophthalmologist Local Ophthahno assistant (Wu - .lones) Translator Data manager Local Helpers Driver 1 1 2 1 2 1 34 Activities Responsible party Place of activities Month/duration Site I: SOCIO-DEMO GRAPHICAL STUDY Site I: DERMATOLOGICAL AND OPHTHALMOLOGICAL STUDIES Meetings Prof B Lapika, Prof Kayembe, National Coord, Local ophthahnol, social scientist, NOTF, WR Kinshasa 05 May 2004 Field work Prof. B. Lapika, Prof. D Kayembe, local social scientist Lusambo 06-27 l/.ay 2004 Arrival from Yaounde Dr.E.Mpoudi Kinshasa 02Ju1y2004 Meetings + Field work Prof Lapika, Dr.Mpoudi, Prof. Kayembe, local ophta, dermat social, Scientist, National Coord. NOTF, WR. Kinshasa Luxambo 03-26luly 2004 35 Site II Sites @t Number/ Personnel RDC BAS CONGO Entomologist CT Local Entomologist Entomologist Technician Fly boys Driver 1 1 2 2 1 Social Scientist CT Team Leader CT Local Scientist Enumerator / Census Data manager Driver 1 I 1 5 1 1 Dermatologist CT Local Dermatologist General Physician Translator Data manager Local Helpers Driver 1 1 I 1 1 2 1 Ophthahnologist CT Team Leader Local ophthalmologist Local Ophthalmo assistant (Wu -Jones) Translator Data manager Local Helpers Driver 1 1 2 1 1 2 I Activities Responsible party Place of activities Month/ duration Site II: SOCIO-DEM RAPHICAL STUDY Meetings Prof. B Lapika, Prof Kayembe, National Coord, local ophtalmol, social scientist, NOTF, WHOR Kinshasa 04 June 2004 Field work Prof. Lapika, Prof Kayembe, local social scientist, helpers, Bas-Congo 05-25 June 2004 Return from site meeting Prof. B Lapika, Prof Kayembe, National Coord, local ophthalmologist, local social scientist, NOTF, WHOR Kinshasa 26 June 2004 36 S{9-III: Site II: DERMATOLOGICAL AND OPHTHALMOLOGICAL STUDIES Dr E.Mpoudi Kinshasa 27 July 2004 Prof. Lapika, Dr Mpoudi Prof. Kayembe, National Coord, local ophta, social dermat, scientist, NOTF, WR Kinshasa Bas Congo 28 July 2004 to 17 At9.2004 Departure Dr E. Mpoudi Yaound6 1SAug.2004 Sites CateeaMs Number/ Personnel RDC/EQUATEUR Entomologist CT Local Entomologist Entornologist Techni cian Fly boys Driver 1 1 2 2 1 Social Scientist CT Team Leader CT Local Scientist Enumerator / Census Data manager Driver 1 I 1 5 1 1 Dermatologist CT Local Dermatologist General Physician Translator Data manager Local Helpers Driver 1 1 1 1 1 2 1 Ophthalmologist CT Team Leader Local ophthalmologist Local Ophthalmo assistant (Wu -Jones) Translator Data managel Local Helpers Driver 1 1 2 1 1 2 1 JI Arrival from Yaounde Meetings + Field work Activities Responsible party Place of activities Month/ duration Site III: SOCIO-DEMOGRAPHICAL STUDY* Site III: DERMATOLOGICAL AND OPHTHALMOLOGICAL STUDIES EQUIPMENT TEAM IV Meetings + Field work Prof. Lapika, Prof. Kayembe, Na Coord. Local ophthahnol, Social scientist, NOTF,WHOR Kinshasa Equateur 04-26 July 2004 Arrival from Yaounde Dr E. Mpoudi Kinshasa 02 Oct.2004 Field work + Meetings Prof. Lapika, Prof. Kayembe, National Coord. Local ophtha., social scientist, NOTF,WHOR Kinshasa Equateur 03-25 Oct2004 Departure to Yaound6 Dr E Mpoudi Yaound6 27 Oct.2004 AVAILABLE EOUIPMENT NON AVAILABLE EOUIPMENT a 1 Camera o 2 Computers and Software (for entomologist and social scientist and dermatologist) ophthalmologist - Lotus 123 for entomologist, OCP software for data analysis (to be supplied by APOC) a 2 pin hole disks a 2 WU-Jones Computers, software, manual + chin rest (To be supplied by APOC) a 1 Direct ophthalmoscope o 1 Slit-Lamp with Anterior Segment Camera and accessories (appropriately assembled before packaging) table + cost to assemble o 220DLenses 1 Fundus Camera (Topcon Model) and accessories KOWA II a 1 Snellen's <<E>> chart+ trial frames (adult and child+pinholes) a 1 Goldmann Applanation Tonometers (To be supplied by APOC) a | 6160 <<E>> Chart (d6tachable) a 2 Pen Torches a 3 Kidney dishes a 1 Indirect Ophthalmoscope small pupil a I Voltage regulator (current stabilizers) a 1 Dissecting microscope (Wild M5) + accessories * lens cleaning kit a 1 Generators (YAHAMA, ET500) (to be purchased or hired or borrowed) a 1 Generators (YAMAHA, ET500) to be purchased or hired or borrowed) a 1 cable with switch board a Foreign body extraction kit a 1 Ice chest a 1 cable wiht switch board a Blacks curtains + rings (15m) a 2 Collapsible tables 38 a tables fan a 4 Collapsible chairs a 4 Camp beds + mosquito nets impregnated a 2 tape recorders o 2 table fans a 1 Global Positioning System (GPS) unit . 2 Dissecting rnicroscope (Wild M5) + accessories * lens cleaning kit o 2 Voltage regulator (current stabilizers) o 2 Generators (YAMAHA, ET500) (to be purchased or hired or borrowed) o Foreign body extraction kit . 4 Cables with switch board o 2 Dissection kit o 2 Ice chest o 4 Camp beds + 4 mosquito nets impregnated o 1 Portable (for Entomologist CT) o 2 Gericans o 2 Fans . 5000 catching tubes o 1000 catching forms o 500 dissections forms o 5 liters alcohol (Ethanol) . 5 liters Chloroform . 500 slides . 500 cover slides . 2kg cotton . 2 flacons de vernis ir ongle incolore o 4 rain coast o 2 tables o 4 chairs o 4 boots o 5 liters Acid Acetic . 2 clock . 50 pens o 30 pencils o 2 reams of paper o 1 thermometer . 5 bubles 60 w o 6bubles6w o 2 liters physiological saline o 20 tubes o 4 torches . 4 umbrella o 48 batries 39 AVAILABLE EOUIPMENT NON AVAILABLE EOUIPMENT . 1 box microtitre plates (-96 wells) . Spare bulbs + 60 watts and batteries medium size alkaline for all equipment (cameras, slit-lamps, fundus cameras, ophthalmoscopes etc) . 20 pkts microscope slides (50/pkt) . Photographic Films - 25 rolls Kodak 200mm Gold (for both dermatology and Ophthahnology) ektachrome 100 x 25 films (To be supplied by APOC) . 10 pkts microscope cover slips (200/pkt) . 5 Rolls of plaster . 5000 catching tubes . 5 Rolls of Gauze 250 bijou bottles . 5 bottles of Hydrogen peroxide . 250 universal bottles . 1 Litre of Methylated Spirit . 500 plastic bags .2kg cotton wool . 5 pkts filter paper (or tissue paper) . 1 ELECTRIC CABLES 50Mx2 . 1 lens cleaning set . 1 roll (48) toilet tissue for use on slit larnp . 5 rnultiple heads adaptor . 1 electric cable 50rnx2 SUPPLIES TRANSPORTATION AVAILABLE EQUIPMENT NON AVAILABLE EOUIPMENT . 2 Vehicles hired or provided by NOTF x 21 days (hired) . Fuel and Oil/Lubricants x 21 days 40 STATIONERY AVAILABLE EQUIPMENT NON AVAILABLE EQUIPMENT . OCP forms 1,2-4, for fly catches, dissection, 20 booklets each (To be supplied by OCP/APOC) . Production of Questionnaires for all groups (800 forms for dermatology - 2000 forms for sociology - 800 forms (Wu-Jones) for ophthalmology - 400 forms (examination for ophthalmology . Pens, clips, pencils, carbon paper, tippex, stapler . 10 reams of ,A'4 paper . 10 registers for census and record keeping . 4 notebooks . 2 reams of flip chart papers . 1 flip chart stand . 4 masking tapes DRUGS AVAILABLE NQUIPMENT NON AVAILABLE EOUIPMENT . Chlorpheniramine 1000 tabs . 20 tubes antifugal cream (ticoncidole cream) . 6 bottles/tubes insect reppelent cream . Priton 1000 tabs . Chloroquine phosphate x 1000 tabs . Tetracycline x 1000 tabs . Fersolate tabs x 1000 tabs . Vit A capsules x 1000 caps . 100 bottles Chloramphenicol eye drops and ointment . Diamox tabs x 500 . l0 bottles tropine . 20 bottles phenylphrine l0o/o . 20 bottles mydrilate 10% . 10 bottles amethcaine 1oZ . 10 bottles bethnesol drop . l0 bottles Phenylephedrrne l0o/o + mydrilene 1% . 10 bottles novocaine . 10 pkts fluorescent strips 41 CHEMICAL. REAGENTS OTHERS LOCAL ENTOMOLOGISTS TRAINING SCHEDULE OF'FIELD VISITS FOR TBAM IV AVAILABLE EOUIPMENT NON AVAILABLE EQUIPMENT a 5 liters absolute ethanol a 1 liter chloroform a 5 liters glacial acetic acid a 1 liter mayer's haemalum o 1 liter glycerol o Physiological saline AVAILABLE EOUIPMENT NON AVAILABLE EQUIPMENT a 2 pkts disposable gloves a Disinfectant/soap a 2 plastic wash basins a 4 gericans (50 1i0 o 15 metres of materials for screens and loin cloth o DHL for film processing and posts/email a Air fares (in country) Activities Responsible party Place of activities Month/duration Notification of Authorities NOTF DRC/ Kasai/ Lusambo Early November 2003 Arrival from Ouaga Prof. S.Traor6 Kinshasa 7 Nov Planning meeting of training programme Prof.S.Traor6, National Coordinator, Team leader trainees Kinshasa Inga 8Nov.- 20 Nov Deparlure to Ouaga Prof. S. Traore Ouaga 21 Nov 42 Activities Responsible party Place of activities Month/durat ion Site I ENTOMO ICAL STUDY Notification of Authorities NOTF DRC/ KasaiT Lusambo Early 2004 January Departure to site Local Entomologist Lusambo 04Ian.2004 Meetings Local Entomologist,technologists, helpers, driver Lusambo 05 Jan.2004 Field work Local Entomologist,technologists,fly catchers, driver Lusambo 06-12 Jan. Return from site Local Entomologist Kinshasa L3 Jan2004 Departure to site Local Entomologist Lusambo 04March2004 Field work Local Entomologist, Entomologist technicians, helpers, driver Lusambo 5-l2Mar 2004 Retum from site Local Entomologist Kinshasa 13 March 2004 Visit 1: Prof. S.T Activities Prof. S.Traore * local Entomologist Kinshasa/ Kasai 8- 24 {u.g.2004 Departure to Ouaga Prof. STraor6 Ouaga 25 Atg2004 Arrival from Ouaga Prof.S.Traor6 Kinshasa 27 Nov. 2004 Meetings + field work Prof. S.Traore * local entomologist Kinshasa/ Lusambo 28 Nov 16 D6c 2004 Departure to Ouaga Prof. S.Traor6 Ouaga 17 Dec.2004 Site I: SOCIO-DEMOGRAPHICAL STUDY Meetings Prof. Lapika, Prof Kayembe, National Coord local ophthalmol, social scientist, NOTF, WR Kinshasa 05 Mav 2004 Departure to site Prof.B Lapika, Prof D Kayembe, local social scientist Lusambo 06May 2004 Field work Prof Lapika, Prof Kayembe local social scientist, helpers, driver Lusambo 7 25 May 2004 Return from site Prof.B Lapika, Prof.D. Kayembe, local social scientist Kinshasa 26Mav 2004 Return from site meeting Prof B Lapika, Prof. D. Kayembe, National Coord., local ophtalmol social scientist, NOTF, WHOR Kinshasa 27 May 2004 43 Site I: DERMA LOGICAL AND OPHTHALMOL ICAL STUDIES Meetings Prof Lapika, Dr Mpoudi, Prof. Kayembe, local ophta., social, dermat. Scientist, National Coord. NOTF, WR. Kinshasa 03 July 2004 Departure to site Dr.E Mpoudi Prof. D Kayembe, local ophta, dermat. Lusambo 04Iily 2004 Field work Prof. Kayembe, Dr. Mpoudi, local ophtha, dermat., helpers Lusambo 05-24J uly 2004 Retum from site Prof. Kayembe, Dr Mpoudi, local ophtha, dermat., helpers Kinshasa 25 Iuly 2004 Return from site meetings: debriefing (site1) and briefing(Site2) Dr E. Mpoudi Prof. D Kayembe, National Coord, local ophtalmologist, dermatologist, NOTF Kinshasa 26 htly 2004 Site II- ENTOMOLOGICAL STUDY Notification of local Authorities NOTF DRC:Bas- Congo Early June 2004 Departure to site Local Entomologist Bas- Congo 04 Ian.2004 Field work Local Entomol,Technologists, helpers, driver Bas- Congo 05-11 Jan2004 Return from site Local Entomologist Kinshasa 12 Jan2004 Departure to site Local Entomologist Bas- Congo 04March2004 Field work Local Entomologist Bas- Congo 5-12Mar2004 Return from site Local Entomologist Kinshasa 13March2004 Yisit 1: Prof. S.Traor6+ Arrival lrom Ouaga Prof. S. Traor6 Kinshasa 7 may 2004 Meetings + Field work Prof. S. Traor6, Local Entomologist Kinshasa/ Bas Congo 8 May -27 May 2004 t Arrival frorn Ouaga Prof.S.Traor6 Kinshasa I Oct .2004 Meetings + Field work Prof. S.Traor6+local entomologist Kinshasa / Bas- Congo 2 - 2l Oct 2004 Departure to Ouaga Prof. . S.Traor6 Ouaga 22 Oct2004 44 Site II : SOCIO-DEMOG RAPHICAL STUDY Meetings Prof.B. Lapika, Prof. D. Kayembe, National Coord., local ophtalmol, social scientist ,NOTF, WHOR Kinshasa 04 Jlune 2 Departure to site Prof.B. Lapika, Prof. D. Kayembe, local social scientist Bas- Congo 05 June 2004 Field work Prof. Lapika, Prof. Kayembe, local social scientist, helpers, Bas- Congo 06-24 June 2004 Return from site Prof.B. Lapika, Prof.D. Kayembe, local social scientist Kinshasa 25 Jtne 2004 Return from site meeting Prof.B. Lapika, Prof. D. Kayembe, National Coord,local ophtalm ologist, local social scientist, NOTF,WHOR Kinshasa 26 J:une 2004 QifA IT . DERMATOLOGICAL AND OPHTHALMOLOGICAL STUDIES Meetings Dr.Mpoudi Prof.Kayembe, National Coord. Local ophtha, dermatologist, NOTF Kinshasa 26luly 2004 Departure to site Dr. E. Mpoudi Prof. D. Kayembe, local ophta., dermatol. Bas- Congo 27 Iuly 2004 Field work Prof. Kayembe, Dr. Mpoud, local ophtha., Dermat., helpers Bas- Congo 28 July-15 Aug 2004 Arrival Prof.Kayembe, Dr. Mpoudi, local opht. Demrat, helpers Kinshasa 16 Aug. 2004 Return frorn site meetings Dr. E. Mpoudi Prof.D .Kayembe, National Coordinator, local ophtahnologist, local dermatologist, NOTF Kinshasa 17 Aug.2004 Departure Dr.E.Mpoudi Yaound6 18 Aug.2004 Site III ENTOMOLOGICAL STUDY Notification of Authorities NOTF DRC: Equateur Early.Iune 2004 t Departure to site Local Entomologist Equateur 04 Ian.2004 field work Local Entomolo gist, Entomologist technicians, local helpers, driver Equateur 05-11 Jan2004 Return frorn site Local Entomologist Kinshasa 12 Ian.2004 45 Depafiure to site Local Entomologist Equateur 04March2004 field work Local Entomologist Equateur 5-l2March2004 Return frorn site Local Entomologist Kinshasa 13March2004 Meetings + Field work Prof. S.Traor6, Local Entomologist Kinshasa/ Equateur 28 May - 17 June 20042004. Departure to Ouaga Prof. Traor6 Ouaga 18 June 2004 Arrival from Ouaga Prof. Traor6 Ouaga 23 luly 2004 Meetings + Field work Prof. Traor6,Local Entomolo gist Equateur 24 jdy-7 Aug 2004 Meetings I'rof.Lapika, Prof.Kayembe, National Coord. local ophthalmol, social scientist, NOTF,WHOR Kinshasa 04 July 2004 Departure to site Prof.Lapika, Prof. Kayembe, social scientist Equateur 05Ju1y2004 Field work Prof.Lapika, Prof.Kayembe, social scientist, helpers, Equateur 06-241u|y2004 Return from site Prof.Lapika,Prof.Kayembe, social scientist Kinshasa 251u1y2004 24.Return from site meeting Prof.Lapika, Prof.Kayembe, National Coord. local ophta social scientist, NOTF,WHOR Kinshasa 261dy2004 Arrival from Yaounde Dr.E.Mpoudi Kinshasa 02 Oct.2004 Meetings Prof.Lapika, Prof.Kayembe, Coord. local ophtha., social NOTF,WHOR National scientist, Kinshasa 03 Oct.2004 Depafiure to site Dr.E.Mpoudi Prof.D.Kayembe,local ophta., dermat. Equateur 04 Oct.2004 Field work Prof.Kayembe, Dr.Mpoudi, local ophtha, dermat. Helpers Equateur 05-24 Oct.2004 Return from site Prof. Kayembe, Dr.Mpoudi, local ophtha, dermat, helpers Kinshasa 25 Oct.2004 Return frorn site meeting Dr.Mpoudi Prof.Kayembe, National Coord local ophta., local dermatologist, NOTF Kinshasa 26 Oct.2004 Departure to Yaound6 Dr.E.Mpoudi Yaound6 27 }ct.2004 46 Site III: DERMATOLOGICAL AND OPHTHALMOLOGICAL STUDIES RECOMMENDATIONS The participants recommended the following to APOC management: Rapidly respond to and give its opinion on the protocol amendments, particularly on the following issues: addition of a new part to the study aimed at assessment of the therapeutic coverage. Include in each team an epiderniologist who will be responsible for this coverage estimation and ensure quality of data collection and analysis on the field. Endeavour to provide all the listed equipment and supplies to the teams before the onset of the f,reld work in order to facilitate the studies. Particular effort should be made to provide (a) ablzzer, a chin rest and a box for Wu-Jones machine. (b) Tables for the slit lamps (c) A digital camera for dermatological photographs and fundus camera for ophthalmolo gical photographs. Endeavour to reduce the length of time between the shipment of entomological materials and DNA analysis. Organise an update course for entomologists in DRC, in early November 2003, since the country lacks a properly trained entomologists. The names and addresses of the national participants will be provided by the national co-ordinator and leader of team IV, a a a a a a 47 IMPACT ASSESSMENT OF APOC ACTIVITIES SECOND ROUND PROTOCOLS 48 APPENDIX I N OF GEO VERAGE OF TREATMENT AT SITES Sample size Study design for assessing therapeutic coverage in the area The well-established EPI 30-cluster coverage survey uses a sample size of 210 children, i.e. 30 clusters of seven children each (Expanded Programme on Immunization 1991, Henderson and Sundaresan 1982, Lemeshow and Robinson 1985). This is based on an anticipated level of immunization coverage of 50oh, a precision of 10oh and a 95o/o conhdence level. Several modifications of the procedure have been applied to different situations (Malilay et al. 1996). In the present survey it can be assumed that the prevalence of treated individual in a treated comrnunity could be 50o/o and based on the above specifications, one could take seven households per cluster. For an average household size of 5 in a typical developing country, a total population of 7 x 5 x 30 : 1050 persons per site will be used. Where possible, GPS will be employed to locate the households accurately EXAMPLE AND SUGGESTION Selecting 30 clusters A table should be set up with four columns with the name of each sampling unit (village in the selected site) in the first column and the population size or the estimated population size in the second colurnn (see Table 1). The third column is for the cumulative population, which will be calculated by the investigator. The fourth column indicates the particular clusters selected for the survey on thc basis of a sampling interval (S) and a selection of a random number (N) between 1 and the sampling interval. Table l. List of the sampling units within the sampling frame. with their population and cumulative population Sampling units Population Cumulative population Clusters selected for survey Village 1 34 846 34 846 Village 2 t7 904 54 750 Village 3 37 300 91 050 Village 4 t5 925 t06 975 Village 5 12 14s r19 r20 49 Village 6 34 840 153 960 Village 7 ts 440 169 400 Village 8 t2 082 t81 482 Village 9 t2 87s t94 357 Village l0 18 717 2r3 074 Village 11 10 s82 223 656 Village 12 10 807 234 463 Village 13 19 000 2s3 463 Village 14 73 000 326 463 Village 15 90 100 4t6 563 Village 16 4 200 420 763 Village 17 29 837 450 600 Total 4s0 600 In the example given in Table 1 the total population of the sampling frame is 450 600. The sampling interval S is obtained by dividing the total population by 30. s : 450 600130: 75 020 Next, the investigator will need to select a random number from a table of random numbers (Annex 3) ol use the serial number found on any bank notes. In this example, the random number which was equal to or less than the sampling interval (S) was 01100. Thus, N: 1 100. Tlre calculations for selecting the 30 clusters are outlined in Table 2.The first of the 30 clusters to be selected is located in the first sampling unit with a cumulative population equal to or more than N. The second cluster is located in the sampling unit with a cumulative population containing the random number plus one sampling interval (N + S). The third cluster is located in the sampling unit whose cumulative population equals or exceeds (N + S + S). The remaining clusters are selected in the same manner by adding the sampling interval to the previous figure and identifying the corresponding sampling unit with a cumulative population equal to or more than the calculated sum. 50 Table 2. (lalculations lbr selecting the 30 clusters Cluster number Formula Calculation Cumulative population Location of cluster 1 N 1 100 I 100 Village 1 2 N+S 1100 + 15 020 t6 t20 Village 1 J N+S+S 1100 + (2* 15 020) 31 140 Village I 4 N+S+S+S 1 100 + (3 * 15 020) 46 t60 Village 2 5 N+S+S+S +S 1 100 + (4 * ls 020) 61 180 Village 3 29 N+(28*S) 1100+(28*15 020) 421 660 Village 17 30 N+(29*S) 1100+(29*15 020) 436 680 Village l7 Table 3 shows the final results of the cluster selection procedure. Where two or more clusters are located in a single sampling unit, as in Village 1, etc. in the example, the sampling unit will need to be subdivided into the number of expected clusters, which should not overlap. 51 Table 3. The 30 cluste selected for the surveY Samplins units Population Cumulative pop![latian Cluster selected for survey Village 1 34 846 34 846 1,2,3 Village 2 t7 904 54 750 4 Village 3 37 300 91 050 5,6 Village 4 t5 925 t06 975 7,8 Village 5 t2 t45 tt9 t20 Village 6 34 840 153 960 9,10,11 Yrllage 7 ts 440 t69 400 t2 Village 8 12 082 t8t 482 13 Village 9 12 875 t94 357 Village 10 18 7t7 2t3 074 14,15 Village 11 10 582 223 6s6 Village 12 10 807 234 463 t6 Village 13 19 000 253 463 t7 Village l4 73 000 326 463 18,19,20,21,2 2 Village 15 90 100 416 563 23,24,25,26,2 7,28 Village 16 4 200 420 673 Village 17 29 837 450 600 29,30 Total 450 600 In this example there are several clusters located within a single sampling unit. 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E E oO o z oO 0) o G cl 0) q) () c') 0)() ca c)(t) o o tu o- -o o EtEo6PC)5 9rOn dLoor6e _. 6) - -y ot3Es, <^tr v _-cd9E o =v6ior' a aAOr--, o E(J oS()lr(€ c.r :z S o-rs (, -E -€<i o o ;^liv , (..l cd qJ6 - o.E4<i o E - :.H-^V0):^O E 0)* -- a-P>'=lloho'dtry-q 9=OG)-- >€ 3 = +J (!'H -UQ o tsf *Lre!.ro:Fa >--re9EEo., dYoX!U()L.oo9o.r9o, -!!eu'!!i €:vi- :^-=ulv Lu F .rt=i I vCre2 a') <*! o) ra-:EEtr 'acd;()()tri.i> a o 9'5nua* oD- tr) (J .=(,x_o o o 'o.t c-.ala o .o9 -.. E bio! E-o -(u!iP 2 ) '.!-<toro= , 6 a\ / o H orE tr 0).: >,OLr.or-sO-dtrC)oH --dL!Y< cio .-!(,iaO !uo9 u: O-CtiFcL9- 86 U F8256t^)q,TocoJE-c: cnE q) oo o q) q) (r) (n(,) q) U) z tr f-l & D(n rl f-la D ll .r, -g llf(d ,rocaPL,l^ l r E tr-r- h -,,' q i'i tr .6rrlltr"5rollqvd-a -==d;Ithf = g E'# ; r g(J(J c! O.tr tr in o ttr) ca ".r ll ,,()ll i o-l'i H.n .9os-- ^!UF .,F0)- :II EES5 oo- E rr .H tr tr.9 .^ a.' E 0).! F!: XE H8Z EEE \o tr- tt ?= o\ OJD II .- O\c.all .. .td,'ilrrj;!lo'=.Y a) () ,, tr - Y6Iil o Y C)oo !boi Us rr Htr d L. bDl^ i;' = () >-c r,'o7'i g c'= () t; I (d o,< oe H E ezz ^iU^?; etSilu x < Eql rr ll:-^ o.Ye UD c)E;EEhEE oo!l|.!'=EE|.,v-al.id o o o o?i.:0)UAZZEAfr SOCIO BCONOMIC PROTOCOL Background: Onchocerciasis is a disease of major concern in Africa. There exists a unique opportunity however of working towards the total eradication of this dreadful disease through the work of OCP, APOC and the other development partners in this area. Objective: 1. To provide information on the socio-economic characteristics and dynamics of the comrnunities affected by Onchocerciasis. 2. to provide information that will enable the measurement of the impact of the use of Ivemectin on the affected communities by using some selected social economic indicators. Methodoloey: This information will be collected using both quantitative and qualitative methods. The precise methods and guidelines have been discussed specifically and put under the respective data collection sections. A. DEMOGRAPHIC CHARACTERISTICS Ql. ID CATION a) NAME OF COLINTRY: b) DISTRICT :. . .. . .. c) STTIDY CENTRE CODE: . ... d) VILLAGE :.... e) NUMBER OF HOUSEHOLD Irtstructtort: Ettumerotor pleose list usual residents of households beginning with head of household, O2. List of members of households: No Name Relationship to Head l.: Head 2. = Spouse 3. = Daughter/Son 4. = Brother/Sister 5. : Niece/Nepherv 6. = Family Worker 7, = Other relative Age (fill age using digits in completed years) Sex M = Male F: Female Marital status l = Never married 2 = Married 3 = Separated 4 = Divorced 5. Widowed If Currently attending school, what grade/class is .... attending If not attending state reason why Educational attainment l. No education 2. Primary 3. Secondary 4. Junior/Secondary 5. Post Secondary 6. Tertiary 7. Others I 2 3 4 5 6 7 8 9 l0 l1 55 O. 3. Labour force participation htstructiotttotheEnunterator; Forthcmenrbersofthehouseltoldwhoareaged l0yearsandabove,pleaseoskifthel, huve beerr mt'olved tn v'ork that was paid /br tn lhe last one ntontlt. 10 vears T],pe of work done lbr pa),, If not working. give rea why Economic activity status: 1. Crop farming 2. Pastoral famring 3. Mixed farming 4. Fishing 6. Mining 6. Hunting/Gathering 7. CommercelTrade 8. Housework 9. Other, specify ... METHOD OF DATA COLLECTION F'OR CENSUS Area should be of uniform endemicity levels (NOTF) 2 or 4 villages with an estimated population of 1500 eligible persons 3. With 25oh or less of the population having taken (Mectizan) ivermectin Method of conducting census: a The NOTF should select the study sites before the team arrives and inform/seek for permission from the relevant authorities at least two weeks before the exercise; I 2 J The Sociologist should visit the site at least 10 days before the rest of the team; When the sociology team arrives, it should do the following Report to political and civic leadership Def,rne the boundaries of the community/villages to be surveyed List all households and institutions in the area for enumeration Enumerate all the usual members of the households/institutions and their demographic characteristics taken Edit questionnaires Process information Enumerator should be people of educational levels of at least secondary school level, e.g. teachers, administrative clerks. Supervisors (social scientist) should have a basic degree in social science. a a 56 The criteria lbr selection of villases: B. ISSUES TO BE DRESSED IN THE OUALIT TIVE SURVEY Assessment of prosperity/wealth by community members at a community meeting wealth ranking tool. Expenditure on Health and on onchocerciasis Attitude perception of community towards oncho-related diseases, e.g. river blindness: How does the community describe the situation in relation to river blindness - hopeless, powerless, fatalistic, in crisis, desparate, etc.? What is the irnpact of oncho on the society? What is the stigma associated with the conditions/symptoms of Oncho; e.g. dermatitis, blindness? Check for marginalisation, ostracism. How are the blind treated? Do they lead a normal life? Cohesion of the society: Is there any conflict in the family or society due to Oncho? Are there political groups that involve the blind? What is the responsibility of the community? Is there any social stratification due to blindness? Education and Health: Find the health/Education priorities in the society What is the situation before and after the introduction of Ivermectin? How do communities solve their healtlh/education problems related to Oncho? What is the role of the Public and private sector including that of traditional healers? METHOD: The table below shows the proposed method to be used in the collection of data at each study site. ISSUI, PROPOSI, ()t) RI,MARI(S Census Enumeration Assessrnent of prosperityiwealth by community members Wealth ranking tool Attitude/perception of community towards oncho- related diseases ; e.g. blindness Focus group discussions, SSI, observation Cohesion of the society Community meeting, SSI, observation, conflict matrix Education Focus group discussions, SSI, key informant inLerviews Health status of cornmunity and health related expenditure Focus group discussrons, Matrix ranking 1. Focus group discussions should be organised for more or less homogeneous groups a) The youths (male/female) b) The elderly c) Female heads of Households d) Chrldren 57 2. Semi structured interviews (SSI) for the civic and political leaders in a community, 3. Key informant interviews (KII) for any people that will be regarded as an important source of infomration, e.g. political and other power wielders in society, medical personnel on the program, etc.; Observation of salient features in the communities; Participatory Rural Appraisal (PRA) tools, e.g. preferences matrix ranking INTRODUCTION Tlrere is evidence that large scale distribution of ivermectin reduces transmission by 45-75%. Furtlrermore, the post-treatment pattern of repopulation of the skin by microfilariae indicates that repeated treatment may have a cumulative effect on the reproduction capacity (fecundity) of the adult wonns. On the basis of these result, it has been suggested that CDTI could lead to the interruption of transr,ission and elimination of infection. However, it is unlikely that total interruption of transmission will occur, and that CDTI will need to be continued for decades to sustain the control of the disease as a public health problem. Given the unceftainty about this issue, the likely and geographical variability in the impact of CDTI on transmission and because of the important operational implications if intemrption of the transmission were to be achieved, APOC will study the impact of CDTI on transmission. To this end, baseline data is required and studies of the reduction in vector infectivity after 5-10 years of CDTI will be undefiaken in a selected number of sites representative of the main epidemiological pattems and the principal vector-parasite complexes in APOC. To evaluate the impact of ivermectin based control on transmission, the methodology needs to be defined. It was considered that an appropriate entomological indicator was the level of infectivity of the vector. The changes over a 4-5 year period in any selected area should be available to APOC. GENERAL OBJECTIVE To evaluate the long term impact of CDTI on transmission of Onchocerca volvulus SPECIFIC OBJECTIVE To detenr-rine the long term reduction in vector infectivity as measured by the number of infective flies (flies with L3 in the head) per 1000 parous flies. In order to achieve this objective, the following points should be taken into consideration. 1. The tried and tested OCP protocol for evaluating the effect of control measures (larviciding and ivenrrectin distribution) on transmission by onchocerciasis vectors should be applied. 4 5 ENTOMOLOGY PROTOCOL 58 2. The period of peak transmission when the impact assessment will be carried out is not known for most sites. A year round data collection is necessary for comparison with the baseline data. 3. It is irnportant to establish from the beginning, whether there is invasion of sites by migrant flies. lt is known for example that, in some areas of the OCP, migrant flies introduce new infections into oncho free areas. In areas where there are migrant flies, the phenomenon should be taken into account. 4. lt is also important to demonstrate the presence or absence of infective larvae of animal origin (e.S.O. ochengi, etc in Sinrulium danutosum s./.. The molecular biology laboratory has to give the answers. Flies and infections have to be sent for analysis. 5. It is important that the entomological exercise leads to the training and acquisition of skills by local staff. However, the strategy to be adopted should be such that the information needed for impact assessment can still be obtained but at no substantial increase in costs. METHODOLOGY A 90 day fly collection during the period of peak of transmission had been previously suggested. The present protocol proposes a 90 day collection to be spread over one year and involves fly dissections by trained local staff. Dissections are necessary to establish parous rates of the flies. SELECTION OF SITES The breeding sites near the selected villages will be chosen as catching points. The geographical position of the catching site should be accurately determined using GPS where possible or shown on a map with the relative distances to the village and prominent landmarks indicated. FIELD VISITS Fieldwork will be carried out by a team comprising one entomologist-technician, one laboratory assistant, twtr fly catchers and a driver. For practical reasons, the fly catchers should be recruited locally. SAMPLING OF ADULT AND LARVAL POPULATIONS Flies will be collected over 5 days each month for 12 months during the year of impact assessment. During each visit, larvae of S. damnosunt s.l. will also be collected and preserved in carnoy fluid (9 parts absolute alcohol + 1 pat glacial acetic acid) for cytotaxonomy. The aim of doing cytotaxonomy on a regular basis is to detect any change in the local vector species population. FLY CATCHES AND DISSECTIONS The standard protocol of fly collection, data collection recording and analysis used in the OCP will be adopted, i.e. 2 fly catchers working altemately from 7.00 to 1 8.00 hr daily. 59 The flies will be dissected to determine the age and infection rates. The OCP Form 1 (Fiche 1) will be used to record hourly catches and the result of dissections will be recorded in Form 2 (Fiche 2). DETECTION OF CHOCERCA VOLVULUS IN POOLS OF CKFI,IES BY DNA ANALYSIS The main airn for utilizing this method is to detect the presence of O. volvulus and other filarial parasites. A rnaximum of 1,000 parous/flies/site/mission (i.e. 200 per day) should be sent to the OCP laboratory for analysis. We need guidance from the DNA Laboratory. DATA ANALYSIS The results of fly dissections should be summarized for each site using the format of the OCP (Fiche 3 and 4). Tlie entomological indices (parous rate, monthly biting rate, and monthly transmission potential should be calculated for both pre- and post control catches. Vector infectivity (number of O. volyulus L3l1000 parous flies) should be calculated from the data obtained by DNA analysis. In each country, the identified entomologist will be responsible for the compilation of data. REFERENCES 1. Taylor H.R., Pacque M., Munoz B. & Greene B.M. (1990). Impact of mass treatment of onchocerciasis with ivermectin on the transmission of infection. Science,250: I 16-1 18. 2. Remrne J., Baker R.H., De Sole G. et al. (1989). A community trial of ivermectin in the onchocerciasis focus of Asubende, Ghana. I. Effect on the microfilarial reseruoir and the transmission of Onchocerca volvulus. Trooical Medicine and Parasitolow,40:367-374; 3. Katholi C.R., Toe L., Merriweather A. & Unnasch T.R. (1995). Determining the prevalence of Ottchocerca volvulus infection in vector populations by polymerase chain reaction screening of pools of black flies. Journal o.f ltlfectious Diseases, 172; 1414-1417 . 4. Anonymous (1985). Ten years of onchocerciasis control. World Health Organisation: Geneva. RECOMMENDATIONS (ENTOMOLOGY) 1. Fly catches and larvae sampling should be carried out regularly each month during year 1 (baseline data) and also during the years of impact assessment (i.e. years 5 and 10). 2. In the new sites the NOTFs should be requested by APOC to identify as early as possible, an entomologist and technicians who have received training in Simttliunz entomology. In countries where the experlise is lacking persons with basic knowledge in laboratory technology should be selected for training. The identified persons should be available and ready for training during the first visit of expert 3. The NOTFs should be requested by APOC to make available vehicles for the fieldwork and the supervisory activities of local entomologist. 60 4. APOC sliould be requested by the NOTFs to make available to the local entomologist, cornputers for data analysis. 5. The originals of all data forms should be sent to APOC (Dr Noma) who will collate all the results of the fieldwork and DNA analysis. The duplicate remains with the local entomologist. It should be made clear to all persons that APOC has the sole ownership of all data collected during the impact assessment activities. 6. APOC should request from OCP some of the basic capital equipment needed for field work e.g. dissecting ruicroscopes, etc. For practical reasons, an inventory of what the NOTFs can provide should be made. Heavy equipment such as generators should be bought locally. 7. To ensure the quality of data, APOC should train where necessary, to upgrade the expertise of local personnel. For each site at least 2 entomologist-technicians should be trained on site by the visiting expert. In the short-medium term, APOC should strengthen identified African institutions to enable them carry out the molecular rnethod for O. volvulus parasite detection in flies. This should be viewed in the context of the volume of flies that will need to be processed in the future. TIME TABLE OF VISIT BY EXPERT The visiting entomologist will spend 14 days for retraining of local personnel and for beginning the catches and dissections. The follow up visit will be for further monitoring of field activities. Proposed itinerary First visit Aruival and installation at base Briefing, planning and preparation for training/recycling of local personnel Brief introduction to the biology, ecology and taxonomy of Simulium tktnmosum s./.. Morpl-rology of the life stages of S. damnosum and introduction to OCP Forms (theory). Travel to field site for practical training/recycling Prospection for pre-adult stages of blackflies and preparation of larval specimens for cytotaxonomy, rearing of pupal stages to adults. Collection, dissection and recording of data and calculation of entomological indices Departure Day 1 Day 2 Day3-4 Day 5 Day 6 Day 7-14 Day 15 Second visit: Same as above 61 i I I I : I I I I I I .t. o tro tij a E H o I I I I@l ni i I I I I I ! I I I ! I I I I : I .l tuo vl G. 6 cn @ o 2o = o :. E { e q. UJo tU a) -g, tJ- oc =gJ :f,Rg -yj ct 1/'o e, o (r't ara o tr c) t.lrv,Ia ul aJ',tl,d =t- cL (-) IA u,o .Lu 'l oE9 rA7 EL(Etd 21 (J ; lr,, =Eo e. <= n- cl + @ugE E-f,ctt, LE< Ecl6u :EO =o 3o N N r : i a I I F =utF(, UJ 13 ol i It i I i I i I a : : i .: < f UJt-a T UJ&?k (-) o F I N I C{{vS 16 svd ).J r-t tl 6o rv €l .{ YSF<]J<i +{IY-gUJ>F a 0.t F 2.d c anUct-f, I cl Y a il ro p, "\ I Is a{ I l9V tt, Q ru o. Vl TU E v, o o @I t-. Ut- Y 5N anU t 5 u, o tr, tr g o z U o F-6 F 3 I -lH 3UildVC 30 3 U IVUOH oo o 6 IF G, UJ(a o ts d) 6o|r)o (o t1I I s@ol ar c'l N(ts)ne{ E rNr{N R qNclzgr 9+{Y9 lo lvJ!u E. *:3i cg co EE iiuIu os t- .{ YPEF<?j >6E< SE UI;i :V IEUI ,F $ v,U E 2(( o. </, TJ crF 1cit'@ F <1, d Y EF IF lEgt ts u., o h 5 rUF uJF 3 E r m 3Ef<NFttl s 6u t( 5 u o UJ ta 6l B z U .E?F v) slgv ( q c{ u/o u, & ul o a 63 303ulvuoll ; * R xnvlolo6 @ Fo\t) E I Ec{o o Elq o.io LVIZS} gZZ : aP tr5eu xt''1 62 E JFd vv'.69 a6/9c./rl t1r/85/98 89 :44 I'g:- '?- I. regtt cle " Z26 38214'l flcilE 2ll(1.2) CAPTURES NULLES OU SANS DISSECTION OE S. DAMNOSUIVI SECTEUS SEMAIN E S/SECTEUfl : -,.... -- .I a POINT DE CAPTURE IIJOM OE9E flVAT IONS OATE hIOMBBE CAPTURE ESJOUF ESPECEcooE au c U T FGr>do L- AN l0 TOTAL OU JOUR 22-25 N,IOIS llt6 t 7.'l E 2G.2134 5S o-t 0 r t.1? l3.l { I 1 1 I I I I I I I 1 1 1 1 1 I I 1 I 'I I I I I 1 I I I o 518s.2 ocP la/7el 63 DERMATOLOGY PROTOCOL Backsround Literature Review In a multi-country study of the importance of onchocercal skin lesions, it was concluded that over 3O'/o of the population in the endemic communities had onchocercal skin lesions. The most prevalent among thern being chronic papular onchodermatitits affecting 13.1% of the population. The data showed a strong correlation between the prevalence and severity of onchocercal skin disease and the level of endemicity in the community. Troublesome itching as a result of onchocerciasis was reported by more than half of the population of hyper-endemic populations. The results of the study indicated that there was a significant difference between the prevalence of the onchocercal skin lesions in the hyper-endemic areas and non endemic areas. Thus if the APOC operations were to be successful, the period of treatment could be considered as making the area of treatment non-endemic. In this case the results of the multi-country study could be applicable. A second multi-country study on the effect of ivermectin treatent on Onchocercal Skin Disease (OSD) had shown a decline of 40-50% in the prevalence of severe itching after ivermectine treatment as compared to placebo, sustained for up to 2 months after first treatment. The effect was similar for 3 monthly and annual ivermectin treatment. There was also a significant decline in the prevalence of reactive skin lesions following ivennectin treatment as compared to placebo, mainly a decline in early skin lesions. It is hope that with treatment, there will be the immediate benefit of reduction in itching and OSD, as well as the long term benefit of a reduction in the transmission of the parasite as a result of low community microfilarial load. General Obiective To evaluate the denlatological impact of onchocerciasis control in APOC countries and to evaluate the effect of ivermectin on disease burden. Specific obiectives To determine the change in prevalence of onchocercal reactive skin lesions and depigrnentation (DPM). To deterrnine the change in the proportion of the population with symptoms/signs of severe itching. To determine the change in prevalence of onchocercal skin nodules. Working hypothesis Regular ivennectin treatment will Reduce severe itching, prevent the development of onchocercal skin disease and may regress early skin lesions. a 64 a a Methodology Determination of Prevalence of Nodules and Skin Lesions A cross-sectional study design will be used. Three studies will be carried out; the first at baseline, second at 5 years, and the third at 10 years. At each examination round, a new sample of the population in the target study sites will be selected and subjected to interviews using a questionnaire and followed by physical examination. The number of sites for evaluation within a country has been detennir-red by the geographical zones and endemicity levels. It is important that nurnber of treatments withir-r the period between assessrnents be taken into account in the analysis. Skin exanrination will be done according to examination methodology as described by Murdoch et al. and subsequently simplified for the multi-country study. Age-specific cohort analysis will be done to detennine incidence. The sarnple size determination For a successful programme of operations, there should be a demonstrable difference in prevalence of skin lesions of about 10o/o or rnore between the two point estimations for all the target population within 5 years. Alternatively, at the end point for evaluation, the age-group specific prevalence data should show increasing trends with age for skin nodules and chronic onchocercal skin lesions. However, for conditions expected to regress, such as itching, microfilarial loads in the eyes, early lesions of the anterior segment of the eye and early reactive skin lesions, the age group specific effect of the treatment is not expected to be significant. The aim of each cross sectional study will be to estimate the prevalence of onchocercal skin and eye lesion by age. It is expected that onchocercal skin lesions would drop from a prevalence of about l5o/o to 10o%, severe itching could drop from 30o/o to l4o/o and prevalence of microfilaria in the anterior chamber from 10% to 5o/o. Using a drop in prevalence rate of l0%o resulting from the activities of the programme. A sample of about 750 inhabitants will be required at each evaluation site. Sample selection A total of 750 persons will be examined per site Skin examination will be undertaken to detect . Skin lesions Four morphological types of onchocercal skin lesions will be classified: 1. Acute Papular Or-rchodermatis (APOD) 2. Chronic Papular Onchodennatitis (CPOD) 3. LichenifiedOnchodennatitis(LOD) 4. Depigmentation (DPM) Skin examination will be used to identify the skin lesions, their distribution and severity as evidenced by scratch marks, excoriation and super-infection. Photographs of skin lesions will be taken of a sarnple of participants with lesion at baseline, at 5 years and 10 years. This will enable the comparison of the severity of skin lesions at sites, for all three rounds of assessment. 65 :3 Skin Nodules Analysis of nodules in untreated children will be done as part of the evaluation of impact of APOC activities on transmission. Other skin deseases such as dermatomycosis, scabies, lice, etc. will be recorded. . Itching Afterthe introduction of thepurpose of the study, aquestionnaire will be used to collect information from study participants in each community on troublesome itching, as well as their responses to general health questions. The general questions will assist in masking the itching questions and therefore provide a more unbiased reported prevalence of itching. DEC Pa tch Test If DEC Patclr Test is available, it will be used on untreated children 5 years of age, to evaluate and follow-up the intensity of transmission. . Data Analysis Data entry will be done in the field using EPI-INFO. Data analysis will be done using the SPSS statistical package. REFERENCES Taylor, H.R., Pacque, M. Munoz, B., Greene, B.M. (1990). Impact of mass treatment of onclrocerciasis with Ivermectin on the transmission of infection. Science;250 1 16-8. Remme, .1., Baker, R.H., De Sole, G. et al. 1989). A community trial of ivennectin in the onchocerciasis focus of Asubende, Ghana. I. Effect on the microfilarial reservoir and the transnrission of Onchocerca volvulus. Trop. Med. Parasitol ; 40:367 -7 4. Remtne, J., De Sole, G., Van Dortmarssen, G.J. (1990). The predicted and observed decline in ouchocerciasis infection during 14 years of successful control of Simulium spp. In West Africa. Bulletin of World Health Organization 68, 3, 331-339. The Pan-African Study Group on Onchocercal Skin Disease (1995). The Importance of Otrchocercal Skin Disease - Reporl of a Multi-Country: Applied Field research Reports, World Health Oganization, 1995, no I . Brieger, W.R., Awedoba, A.K. Eneanya, C.L, Hagan, M., Ogbuagu, K.F., Okello, D., Ososanya, O.Ol., Ovuga, E.B.L. (1997). The Effect of Ivermectin on Onchocercal Skin Disease and Severe Itching - The Result of a Multi-Country Study. (Tropical Med. And Intemational Health, in press). Ogbuagu, K.F., Awedoba, A.K., Eneanya, C.I., Hagan, M., Okello, D., Ososanya Skin Disease - Clinical Findings. Annals of Trop. Medicin and Parasitology 92, Supplement 1. 66 1 2 J 4 5 6 Modified Ph],sical Examination-Dermatoloey (Questions Continued) Have you ever taken Ivermectin? How rnany times? When was the last treatment? Indicate number and site of photograph taken DEC patch test to be done t4 15 16 17 18 Skin condition Absent-0 Present-1 fomments Present with no scratch marks - 1 Present with scratch marks - 2; Present with excoriations - 3 Present with excoriation and super-infection - 4 For DPM - If incomplete DPM - 1 If complete - 2 Head & Neck Upper Lirnbs Trunk Front Trunk Back Lower limbs Acute Papular Onchodennititis (APOD) Chronic Papular Onchodermatitis (cPoD) Lichenified Onchodenlatitis (LoD) Onchocercal Depigmentation (DPM) Nodules - Present: absent Miliaria Scabies Lice Dennatomycosis Total 67 Tableau : epidemiological evaluation : skin examination form FORMULA FOR THE PREPARATION OF DIETHYLCARBAMAZINE (DEC) PATCH T CREAM A Ingredreulr Nivea cream or lotion and diethylcarbarnazine powder g. Method of Lreparation: Mix 10 grn of diethylcarbamazine powder in a 100 ml of nivea creant or lotion thoroughly to fonn a homogeneous lotion or cream. (i.e. 10% di ethylcarb antazine lotion). Other materials needed include 1. Filter paper 2. 80% alcohol 3. Perforated hypoallergenic elastoplast 4. Cotton wool 5. Indelible markers 6. Fonns for recording the result. C. Method of application : Clean about 5-10 cm diameter of the skin over the left iliac crest with cotton swab (80% alcohol'). Cut pieces of elastoplast (8 x5 cm), and number each piece sequentially. DEC lotion (keep it in a fresh state during transportation). Prepare pieces of filter paper of 3 cr-n x 2cm dimension. Place 0.3 ml 10% DEC lotionicream on one side of the filter paper. Place this on the swabbed area of the left iliac crest and cover with a labelled piece of the hypoallergenic plaster. (the label consists of : subjects identity number, date and time of application). Readings are done by 2 independent observers at 24 hours and 48 hours. The results are recorded on a standardized format. I 68 EPIDEMIOLOG ICAL EVALUATTON: S KtN EXAM tNAT|ON FORM 1. Country of the study 2- Study Cenlre Code 3. Name of Mllage 4. Household Code 5. lndrvidual Number 6. Name 7. Age 8. Sex 9 Name of Head Household 10 Schooing. Y/N-- \Mat level? 11. Duration of slay in communily 12, Dale 13. Personal Experience of lllness lf No why (Chitdren) _ l/Ve are ABSENT = 0 especially interested in your health PRESENT = 1 How have you been feelrng since last month? Record soontaneous rS Health Problems rs when orompted 1. Headach 2. Joint-bone pqin/backache 3. FatigueAl/eakness 4 itch 5. Severe/troublesome ilching 6. lnsomnia 7. Concem for Appearance 8. Diarrhoea and others 9. Others (Specifv) 69 years I .rc .E .lrcl .EE .E .E .rc ,.E !.IEl -.lI(] -.rc. -.rc .rc .lIE-_.-.r .Et .E t t { 1 i I l. Country of study: 2. Study centre code : 3. Narne of village : 4. Individual code Individual name D.E.C PATCH TEST FORM FORM NUMBER Years 5 6 Age 1. Sex t h,t_l (Tick) 8. Name of head of household 9. Duration of stay in the comrnunity Weeks IO. REACTION CODE: 0 = No reoction 1 = Positive reoction with 1 to 3 popules 2 = Positive reoction with 4 to 8 popules 3 = Posit ives reaction obove B poputes 4 = Positives reoctipn with dermol oedemo (Peau d'orange) =-ll.RESULTS I 1.1 First reading Date : / Time:_ Thereading I 1.2 Second reading Date Time : __The reading Si ruciins Y cars o tl/t t I E F H_* nature of the observer : 70 2OPHTHALMOLOGY PROTOCOL INTRODUCTION Published report indicate that most onchocercal blindness and morbidity in the meso endemic savanna and forest savanna areas are from optic nerve disease and chorioretinitis in the posterior segment whilst in the anterior segment sclerosing keratitis and uveitis along with secondary glaucoma are the blinding pathways. It has been shown that ivermectin produces an 80o/o reduction in new cases of optic nerve disease as well as 45Yo reduction in incidence of further visual field deterioration in individuals with optic atrophy. It also has beneficial effect on other onchocercal eye lesions including punctate keratitis and iridocyclitis. Ivermectin prevents or delays the onset of optic atrophy as well as slowing down the progression of the disease. General Obiective To evaluate the ophthalmological impact of onchocerciasis control in APOC countries particularly the effect of ivemrectin on disease burden. SBecific obiectives To detemrine the change in prevalence of onchocercal eye lesions, visual function defects and blindness using the standard clinical methods for eye examination and the Wu-Jones Computerized Visual Function Tests (CVFT) To detenline the incidence of onchocercal eye lesions, visual field defects and blindness. Workine H),pothesis Regulal ivennectin treatment will prevent the development or delay progression of onchocercal eye lesions and blindness; and may regress early stages of ocular lesions. EYE EXAMINATION All standard eye examinations will be perfonned by an ophthalmologist trained especially for the study. The Wu-.Iones tests will be perfonned by two trained assistants. All subjects will do the Wu- Jones tests while half of this number sampled at random will undergo detailed standard clinical methods of eye exarnination. Visual Acuitv Visual acuity will be measured using the Standard Snellen's illiterate "E" chart for distance (in addition to the Cor-nputerized Visual Acuity Test (CVAT). The test is to be conducted with the chart placed at a distance of 6 metres form the subject in broad daylight with source of light coming from behind the subject. One eye is tested at a time with other occluded after clearly explaining the procedure to the patierrt. 7t I Wu-Jones Test Subjects will be examined further using the Wu-Jones test. Testing will be carried out in a room darkened with black cuftains or plastic drapes to cut out natural light. One red light will be provided to give dim red light "dark room" conditions to enable patient and examiner observe the computer screen, recording by the examiner and movement by other subjects. d cvAT With subject seated comfortably and test explained to him or her at the computer programme prornpting, the examiner selects the eye to be tested. Subject sits at a distance of 1 metre from the screerl standard anls length or measured with a one-rnetre twine which all examiners should have. Patient it asked to indicate with the wave of his or her hand the direction the "E" appearing on the screen faces. The examiner presses the horizontal arrow key in the direction the patient has pointed to. When the subject is in doubt as to what direction "E" is facing, examiner presses the vertical arrow keys. The Motion Sensitivity Screenine Test (MSST) A series of vertical lines are displayed on the computer screen. As preliminary training, subject is asked whether he sees them and if so to count thern. This is to ensure that the actually understands tlre instructions. He is then asked to watch the lines and to press a buzzer, to be handed over to him or the space bar on the keyboard, as soon as he perceives movement of any of the lines. At tlre end of the test, which lasts about 2.2minutes, the cornpute displays the results on the screen. This is again registered on the hard disk. A recording of form for the test is also completed by the examiner. This serves as a check and an additional follow-up record for the particular individual Anterior S t Examination Subject is first asked to bend his head down between his knees for at least 2 minutes. The procedure is to allow for he emergence of microfilariae into the anterior chamber. Subject is then examined on the slit lamp biornicroscope (x25 magnification) and count of microfilariae in the comea and anterior chanrber noted. Comea is examined for dead microfilarial, punctate or sclerosing keratitis. Other cotneal pathology is looked for. Pupillary reaction to light as well as the size, shape of pupil is exaurined. Anterior chamber and iris are examined for signs of inflammation and for opacities in the lens, luxation or dislocation of the lens. Posterior Segment Exalnination This is car:ried out after dilatation with mydriaticum or phenylphrine 10%, with tlie direct and/or indirect ophthalmoscope. Fundus Examination Optic disc changes such as pallor of the disc, changes at the disc margins, sheathing of retinal blood vessels and pathological cupping of the disc will be looked for. 72 It is recommended that in all sites systematic photographs of Fundus (temporal to tlie macula) be taken in patients with or without lesions in order to evaluate the incidence of chorio retinal disease in subsequent re-exarnination of a cohort. Oncho Chorioretinitis Presence and distribution of the typical oncho signs of chorioretinitis-atrophy of the retinal pigment epithelium and atrophy of choriocapillaries will be noted. Other chorioretinal signs of possible oncho origin The nor-r-typical onchoretinal signs- pigment hyperplasia, pseudo-drusen will be looked for to test their possible association with onchocerciaisis. Training and standa of research team members It is necessary to provide adequate training and standardization for all the examining members of the team to minirnize intra and inter observer variation. If CVAT and MSST will not be feasible in all sites these could be limited to few selected sites. 73 M/AI-UA'.ION Oli uPTDEMIOLOGICAL InlpACl. OI. Apoc AC,ft'ITI,,S IiYE IXA I\1 I NATION I'ORI\f VILLAGI]. IDNO tr[]N SI]E NO tr t] NAME OF SUBJECT.............. AGE nE vns sEX fl EXAMINER. NAh-,fE OF HEAD OF HOUSEHOLD .. DISTRICT/I.GA DATE: DDA,fI\,,YY trn xn !nn n tr !nxn nt]XX RIGIIT I. VISUAL ACUITY ACTUAL AIDEDA,INAIDED ACTUAL ACUITY P.IJ , o,r.)^o,uuD-Acurry X X PINHOLE ACUITY CODE 0t : 6/t8 02:6:24 03:6/36 04=6/60 05 =3/60 06=< 3/60>Hrn 07=I-Int /pL 0ti=NPL 09=Unable to assess Use PINI{OLE if VA =< 6/t8 Do nor.use if = pL ;NpL l=onnal 2=relative scotoma 3=absolu(e scotoma 9=unable to assess | = Absent 2 = l-t0 3 = U_20 4>20 9 = Unable to assess I = Absenr 2 = t-t0j = il-20 4)-20 9 - [Ju:rblc (o asscss 2. VISUAL FIEI-DS (Dead J. MICITOFILARIA DA4FC Microfilaria in comea) MSsr (L) nntr nnr (R) MFAC X(MF irr arrrer ior clrarrrber af tcr hcatJ drrrvn ? nrirrrrles) 74 LEFT 4. COIINEA IUGI]T LIITT CODE I = Absent 2 = I_10 3 = tt_20 4>20 9 = Unablc to assess I = Absent 2:3&9O,clock 3 = confluen( inferior 4 = confluent pupil obscured 5 : circumferential 9: Unable to assess (a) Punctatc Kciariris (snorv l-lake opacity) (b) Sclerosing Keraritis I Photograph film Number (i f taken) @ Other cor-rreal signs (i) Corneal oedenra (any degree) ii) Cenrral opaclry associated rvith reduceJ r,rsrral ecuity (iii) Trachomarous paluus (ary degree) (iv) Others (Specifo) 3 measles,barrd keratitis speci ly DRAW SK ! n I =absent 2=present 9= unable to assess(applytoi-iv) r tr DRAW 75 xtr n ! n RIGIll- LEITT 5. PUPIL (r) SIIAPIi (b) Size O Ligltt resl)onse 5. IRIDOCYCLITIS SYNECHIAE Irlare A/C Cells A/C KP's Ciliary injection Iris atrophy Iridocyclitis tr (_-() I ) li l=, rrorrrral. 2:d istorred (speci [y,) (tlorvtr drarvrr, nlt-sal ly,) l: equal 2: Ii> L 3=R<L tr n tr n l: Brisk (norrnal) 2= small& fixed 3: dilated & fixed 4= sluggish 9=unable to assass I =absent 2=anterior syncclt ia 3:posterior synecltia 4 =botlr 9=Unable [o assess l: absent 2:rn ild,/nroderate 3 =heavy 9: unable to assess I: absent 2:< l0 3 =noarry 9: unable to assess I : absent 2:pigrtrented KP's 3=no pignrented 4:mixcd 9: unable to assess l:absent 2:rn ild:nroderate 3:severe 9:unable to assess l:absent 2:present 9:unable to assess I : Nomral Z=torpid 3:acute 9:rrnable to assess tr n u 76 tr tr u tr u tr ! n tr RIGHT LEFI- tr CODII nlnlhg 99=rrnable {o assrss6. iN]-RAOCU I.,A R PRESSU ITE 7. CATAIIACT u 8. SWINGING FIASII LIG}I'I-TEST(sFLl) u I:clear rcd reflex i 2-inrpared n <l12 obscur-r.l 3 :inrpared rr> l /2 obscu rcd 4:no rr 5:aphakia 6:displased lens 9=unable to assess l:Normal 2:RAPD 3:AAPD 9:unable to assess I =<0.5 2: > or:0.5 9:unable to assess [:Normal 2:m i ld/nroderate pal Ior 3:severe pallor 4:abnorrnally pink 9: unable to assess l:absent 2=present 9:unable [o assess I --clear 2=obscured 9. OPHTHALMOSCOPY OPTIC DISC a Vertical cup/Disc ratio b Color c. Sheathing of vv d. View of disc I O ONCI{O-CHORIORETTNITIS 2a Morphology [)istr ibution tr tr ffiqwNWY^ 9=unable to assess l:absent 2-rnottling of retinal pigment epitheliurn (RPE) 3=confluent atrophy of RPII 4=2+3+choriocapiIlary atrophl' 5=4 +pigment hyperplasia 9=unable to assess codes apply to all distributions | : absent 2 : temporal to trtacula 3 : nasal to ntacula 4=2+3 5 : generalised 77 tru tr u tr n b) Intraretinal deposit tr Disfribution u SPECIFY d istribution I I. OTI{ER NON ONCHO LESIONS t1- t2 specify 14 N,IAIN CAUSE OF OCULAR PATHOLOGY (R) Onchopathology (anterior) Onchopatlro Iogy (posrerior) primary optic atrophy 6 == others (specity) g = unable (o assess I =absent 9:possrbly, onclro re l.rtcti 3 =d rusen 4-cotton \yool sl)ots 5:slriny lesions 6:other (specify) n 'l : absent 2 : tentporal to nracula 3 : nasal to nracula 4:2+3 5 : generalised 6 : others (specify) Q: unable ro assess I I : absent 2 : (enrporal to rnlcLrl.r 3 : nasal to rrracul.r 4=2 t 3 5 = generalrsccl 6: otlrcrs (specrl-v) fl: unablc to asse-ss i t] r:absenr 2:focal choro idorctin itis (typical toxoplasrrrosis) 3:r,ascu lar ret inopatlry (diabetic, hl,perlensrve) 4:other (specil-y) 9: unable to assess (L) l: not a cause 2= nrain cause 3= sccorrdary cause 4=rrrinor catrsc Cataract 78 tr tr x tr tr trG lauconta Plithisis bulbi Trachoma Others (Specify) specily VISUAL STATUS n u l:normal 2:visually inrpaired 3:blind by central VA 4:blind by field \- ) \ 79 T WORLD HEALTH ORGANIZATION AFRICAN REGION ORGANISATION MONDIALE DE LA SANTE REGION DE L'AFRIQUE AFRICAN PROGRAMME FOR ONCHOCERCIASIS CONTROL (APOC) PROGRAMME AFRICAIN DE LUTTE CONTRE L'ONCHOCERCOSE B P. 549 OUAGADOUGOU, Burkina Faso T6169r.: ONCHO OUAGADOUGOU T6l (226) 30 23 01 - 30 23 t2 - 30 23 13 T6lex ONCHO 5241 BF Fax: (226) 30 2t 47 APPENDIX2 PLANNING MEETING ON THE PHASE II OF THE LONG-TERM IMPACT ASSESSMENT OF APOC OPERATIONS Ouagadoueou. 24 - 29 March 2003 ANNOTATED AGENDA Monday 24 march 2003 (6) B:00 - B:30: Registration B:30 - 9:00: Welcome address by APOC Director 9:00 - 9:15: lntroduction of Team members and resource persons 9:15 - 9:45: Review and adoption of agenda 9:45 - 10:15: Update on CDTI treatment figures (tt/r Zoure) 10:15- 10:30: Break 10:30 - 12:30: Elaboration of summaries of findings for each site (lVr Zoure) (1 ) (2.) (3) (4.) (5) 12:30 - 1 5:00: Lunch break (7.) 15:00 - 16:00: Presentation of protocols and discussion on possible amendment 16:00 - 16:1 5: Break (8.)16:15 - 18:00: Presentation of protocols and discussion on possible amendment (continued) Tuesday 25 march 2003 (9 ) B:00 - 9:00: Sites for second round(10 ) 9:00 - 10:00: Timetable for second round 10:00 - 10:20: Break (11 ) 10:20 - 12:30: Timetable for preparatory visits, fieldwork and data analysis 80 12:30 - 1 5:00: Lunch break (12.) 15:00 - 16:00: Group work anglophones & francophones : TffiIH3J:::'JIffi[J[i:H:'':: 3::H: :JI;J"' . Team composition . Budget 16:00 - 16:15: Break (13 ) 16:15 - 18:00: Group work anglophones & francophones (continued) : #:rTil?,il?,:P["Hil:: ff :::l::':Jffi"' Wednesdav 26 march 2003 (14.) 8:00 - 18:00: Group work anglophones & francophones on Budget Thursday 27 march 2003 (15 ) B:00 - 10:00: Plenary a a a a 10:00 - 10:20: Break (16 ) 10:20 - 12:30: Plenary: a a a a Reports from groups on lnventory of equipment and supplies available in sites Equipment and supplies required for second round Team composition Budget Reports from groups on (continued) lnventory of equipment and supplies available in sites Equipment and supplies required for second round Team composition Budget 12:30 - 1 5:00: Lunch break (17.) 15:00 - 16:00: Preparation of the report of the planning meeting 16:00 - 16:1 5: Break (18 ) 1 5:00 - 16:00: Preparation of the report of the planning meeting (continued) Friday 28 march 2003 (19 ) B:00 - 10:00: Discussion on arrangements/organization of data (from 1st round) between publication 10:00 - 10:20: Break (20 ) 10:20 - 12:30: Preparation of papers (from 1st round) for publication 12:30 - 1 5:00: Lunch break 81 (21 .) 1 5:00 - 16:00: Preparation of papers (from 1st round) for publication (continued) 16:00 - 16:1 5: Break (22 ) 16:15 - 1B:00: Preparation of papers (from 1st round) for publication(continued) Saturdav 29 march 2003 (23) B:00-12:30 (continued) Preparation of papers (from 1st round) for publication 12:30 - 1 5:00: Lunch break (24.) 15:00 - 16:00: Submission of report to the Director of APOC 16:00 - 16:20: Break 16:20 - 16:40: Closing ceremony 82 WORLD HEALTH ORGANIZATION AFRICAN REGION ORGAN'SATION MONDIALE DE LA SANTE REGION DE L'AFRIQUE AFRICAN PROGRAMME FOR ONCHOCERCIASIS CONTROL (APOC) PROGRAMME AFRICAIN DE LI,ITTE CONTRE L'ONCHOCERCOSE 8.P.549 OLIAGADOUGOLI, Burkina Faso T6169r.: ONCHO OTIAGADOUGOU T6l.: 34 29 53 - 34 29 59 - 34 29 60 T6lex: ONCHO 5241 BF Fax: 34 28 75 APPENDIX 3 R6union de planification de la Phase II des 6tudes relatives ir l'6valuation ir long des on6rations APOC Ouasadousou. 24-29 mars 2003 Planning meetins on the phase II of the long term inqpact 4ssessment of APOC operations Ouasadougou. 24-29 march 2003 LISTH DHS PARTICIPANI I S/LIST OF PARTICIPANTS i BURKINA FASO 1. Prof. Soungalo TRAORE, s/c OMS/APOC, 0l BP 549, Otagadougou 01, T6l : (226) 34 29 53129160 Fax : (226) 34 28 75, E-mail : pefoungo@yahoo.fr 2. Dr Andr6 SOUBEIGA, Socio-anthropologue, UFR/SH, Universit6 de Ouagadougou, 03 BP 7021 Ouagadougou 03, Burkina Faso ; Tel. : Dom: (226) 35 7l l4lcel. 61 59 42, Unlersie : (226) 31 78 14 ; Fax : Universit6 (226) 30 73 l8,E-rnail : asoubeiga@univ-ouaga.bf CAMEROUN 3. Dr Grace FOBI, Opthalmologiste, H6pital Central de Yaound6, T6l: (237) 797 21 01, T6l/Fax : (237) 220 19 08, T6l dom. (237) 221 02 28; E-mail : gakohobe@)zahoo.conr 4. Dr Peter ENYONG, Tropical Medicine Research Station, P.O Box 55, Kumba, Cameroon, Tel/Fax : (237) 335 42 3l ; E-rnail : llenvonq(A,canuret.crrr FRANCE 5. Dr Michel BOUSSINESQ, s/c Val6rie Delplanque, IRD/DU, 213 Rue La Fayette, 75480, Paris C6dexl0,France;Tel/Fax:(33)14249 38 15;Email:micl-rel.boussincsq(g)wanadoo.h' 83 GHANA 6. Prof. Richard BIRITWUM, Deparment of Community Health, Ghana Medical School, P.O 8ox4236, Accra, Ghana, Phone: (233)21 66 51 01121 6671 05, Fax : (233)21 66 81 61, Email biritu,u nr (rr,a liicaonIine.conr. qlt 7. Dr Maria HAGAN, Eye Care Unit/ICD, Ghana Health Service, Private Post Bag, Ministries, Accra, Ghana, Phone: (233) 21 66 68 15 or (233) 20 815 02 47, Fax: (233) 21 66 68 50 NIGERIA 8. Prof. Ekanem Ikpi BRAIDE, Department of Biological Sciences, University of Calabar, P.O. Box 3679, Calabar, Cross River State, Nigeria, Phone: (234) 80 33 41 68 42, Email: ekanem- b((rr ltol n'u"rt ]. ctrnt 9. Dr Rich UMEH, Department of Ophtalmology, College of Medicine, University of Nigeria, Enugu Campus, Nigeria, Tel/Fax: (234) 42 45 58 41; Email: richu(irinloweb.abs.net 11. Dr Gladys OZO}J, Department of Dermatology, College of Medicine, University of Nigeria, Enugu Campus, Nigeria, Phone: (234) 42 45 19 25, Fax: (234) 42 45 58 41, Email: gl advso zq (i. vahoe.ee []w RDC 12. Prof. David KAYEMBE, Ophtahnologiste, Clinique Kinshasa XI, RDC; T61.: (243) 98 37 00 19; Fax : prof davidkay emb e@yahoo. com Universitaire de Kinshasa, "t. w(l l\v. f$ 3tr 5roq+ BP T23, E-mail : ) TOGO 13. Dr M6ba BANLA, M6decin Ophtalmologiste, CHU Campus, Lom6, Togo; Tel. : (00228) 225 47 391902 22 8l Email : mebabanla(iirliotrrail.conr 84 SECRETARIAT APOC 14.Dr Azodoga SEKETELI, Directeur APOC 15. Dr Laurent YAMEOGO, Coordonnateur Bureau du Directeur, APOC 16. Dr Mounkaila NOMA, Chief of Epidemiology and Vector Elimination Unit (CEV), APOC 17.Dr Uche AMAZIGO, Chief of Sustainable Drug Unit (CSD), APOC 18. Mr Honorat ZOURE, Biostatistique and Mapping Officer (BIM), APOC 19. Mrs Victoria Matovu, Community Ownership Partner (COP), APOC 20. Mr Fortun6 Agboton, Budget and Finance Officer (BFO) 21. Mr Yao Aholou, Administrative Officer (AO) 22.Mr Saidou N'GADJAGA, Information Technology Officer (ITO), APOC 23. Mr Dieudonn6 SOME, Information Systern Officer (ISO), APOC 24.Mr Gilles PARE, Medical Assistant, APOC 85 APPENDIX IV BUDGET The following broad budget lines were identified A. Preparatory visits o Perdiem o Travel B Field work a Perdiern a Travel Equipment Supplies Stationery Drugs Chemicals/reagents Others C. Workshop for review of results and production of report of second round of study 35 Participants in Ouagadougou in 2005 The teams were requested to prepare specific detailed budgets a a 86 ITEMS RQUIRED FOR EACH SITE o 1 Camera Dermatology (Digital) o 1 Computer and portable printer for each coordinator (once only, not for each site) o 2 Computers and Software (for entomologist and social scientist and dermatologist) ophthalmologist - Lotus 123 for entomologist, OCP software for data analysis (to be supplied by APOC) o 2 WU-Jones Computers, software, manual + chin rest * buzzer (To be supplied . I Slit-larnp with AnteriorSegment Camera and asscessories (apporpriately assembled before packaging) needs table o 1 Fundus Camera (Topcon Model) and accessories KOWA II . I Goldman Applanation Tonometers (to be supplied by APOC) o 4 Pen Torches (1 available - no head, needs 3) o 2 pin hole disks o 3 Direct Ophthalmoscope (1 available - no head, needs 3) . I Indirect Ophthamoscope small pupil o 220 D Lenges o I Snellen's <<E>> chart + trial frames (adult and child + pinholes) . 16160 <<E>> Chart (detachable) o 5 gallipots . 3 Kidney dishes o 2tape recorders o blacks curtains * rings (15m) o 4 table fans o 1 Global Positioning System (GPS) unit . 2 Dissecting rnicroscope (Wild M5) + accessories + lens cleaning kit o 2 Voltage regulator (current stabilizers) o 2 Generators (YAMAHA, ET500) (to be purchased or hired or borrowed) . Foreign body extraction kit . 4 Cables with switch board . 2 Dissection kit o 2 Ice chest o 4 Camp beds + 4 mosquito nets irnpregnated o 1 Portable (for Entomologist CT) . 2 Gericans o 2 Fans o 5000 catching tubes . 1000 catching forms o 500 dissections forms o 5 liters alcohol (Ethanol) o 5 liters Chlorofonn o 500 slides o 500 cover slides . 2kg cotton o 2 fl.acons de vernis d ongle incolore o 4 rain coast $ 1,500 $5,200 $7,000 $60 $10 s2,500 $10 $s0 $40 $100 $s0 $ 160 $100 $400 $100 $40 $20 $20 $80 87 o 2 tables . 4 chairs o 4 boots . 5 liters Acid Acetic . 2 clock o 50 pens o 30 pencils . 2 reams of paper o I thermometer o 5 bubles 60 w . 6bubles6w o 2 liters physiological saline o 20 tubes o 4 torches o 4 umbrella o 48 batries SUPPLIES . Spare bulbs + 60 watts and batteries medium size alkaline for all equipment (Carneras, slit-lamps, fundus cameras, ophthalmoscopes etc) o Photographic Films - 25 rolls Kodak 200mm Gold (for both dermatology and Ophthalmology) ektachrome 100 x 25 films (To be supplied by APOC) o 5 Rolls of plaster o 5 Rolls of Gauze o 5 bottles of Hydrogen peroxide o 1 Liter of Methylated Spirit . 1 box microtitre plates (-96 wells) o 20 pkts rnicroscope slides (50/pkt) . 10 pkts microscope cover slips (200/pkt) . 250 bijou bottles o 250 universal bottles o 500 cotton bags . 2kg cotton wool . 5 pkts filter paper (or tissue paper) o 1 lens cleaning set o 5 rnultiple heads adaptor o 2 electric cables 50mx2 o 1 roll (48) toilet tissue for use on slit lamp s1 00 $10 $100 $s $30 s100 s80 $s0 $10 $10 s10 $100 $20 88 STATIONERY TRANSPORTATION o 4 Vehicles hired or provided by NOTF x 21 days (hired . Fuel and Oil/Lubricants x 21 days o Production of Questionnaires for all groups (800 forms for dermatology - 2000 fonns for sociology - 800 forms (Wu-Jones) for ophthalmology - 400 fonns (examination for ophthalmology) o Pens, clips, pencils, carbon paper, tippex, stapler o 10 reams of ,A'4 paper . 10 registers for census and record keeping . OCP fonns 1,2-4, for fly catches, dissection, 20 booklets each (To be supplied by OCP/APOC) o 4 notebooks o 2 reams of flip chart papers . I flip charl staud o 4 rnaskir-rg tapes . Chlorpheniramine 1000 tabs Tioconazou o 20 tubes antifugal cream o 20 tubes antibiotic creams (Mupurican cream) o 6 bottles/tubes insect reppelent cream o paracetamol 1000 tabs o priton 1000 tabs o chloroquine phosphate x 1000 tabs o tetracycline x 1000 capsule o fersolate tabs x 1000 tabs o Vit A capsules x 1000 caps . 100 bottles Chloramphenicol eye drops and ointment o diamox tabs x 500 . 20 bottles phenylpherine l0o/o o 20 bottles mydrilate 10% o 20 bottles an-rethocaine l o% o 20 bottles betnesol drop o 10 bottles Plienylepherine 10% o l0 pkts fluorescent strips o DEC crearr for patch test $4000 $2000 $1000 $100 $100 $20 $10 $10 $50 $s $50 $30 $s0 $10 $30 $20 $20 $10 $5 $s0 $100 $10 $100 $1 00 $20 DRUGS 89 $20 OTHERS CHEMICAL, REAGENTS . 5 litres absolute ethanol . 1 litre chloroform . 5 litres glacial acetic acid o 1 litre glycerol o 2 pkts disposable gloves . disinfectant/soap o 2 plastic wash basins . 4 gericans (50 lit) o 15 rnetres of materials for screens and loin cloth . Air fares (in country) o Laboratory space at nearby institute (for entomology) - no cost Miscellaneous (incidental expenses) NB : Cost to be revised $s0 $20 $s $s0 $30 $10 $10 $s0 $2,500 $5,000 FACILITIES 90