Report of the first post-SIZ review and planning meeting on activities in the ex-OCP countries: Ouagadougou, 11-13 November 2008

REPORT OF THE FIRST POST..SIZ REVIEW AND PIANNING MEETING ON AGTIVITIES IN THE il.OGP GOUNTRIES Ouagadougou, L1-13 Noztember 2008 .=;:. " 'a-.-;, .=;.' --.:tttilz .=i:: -.1.. ,.r=2.._ I October 2009 A. OPENING OF MEETING Three speeches were made during the opening ceremony: The first to take the floor was Dr Uche Amazigo, Director of APOC, who welcomed all participants to the first post-SZ meeting of coordinators of the l1 former OCP countries, and especially SSI, WAHO and APOC country delegates from Cameroon, Malawi, CAR and Nigeria. She highlighted the importance of the Review and planning meeting in following up onchocerciasis control and surveillance activities in the former OCP countries, and also for sustained advocacy to safeguard the control gains. She expressed the hope that the meeting would provide a good opportunity for mutually beneficial interactions between APOC and former OCP countries, since blackflies, the onchocerciasis vector, are no respecter ofborders. The Director listed major challenges to be addressed to include: l) financing of activities using national budgets; 2) effective disease surveillance; 3) increased level of transmission in some villages where prevalence had formerly been below the tolerable threshold. Dr Amazigo called on all stakeholders to redouble their efforts and to help safeguard the gains of the former OCP. She urged national coordinators, particularly those of C0te d'Ivoire, Ghana and Sierra Leone, to draw up in 2009 elaborate, implementable action plans, which will be financed mainly with national budgets and not partners. The Director said that national coordinators should develop strategies from sourcing funds from governments. With regard to co-implementation, she explained that this was one of the strategic means of guaranteeing sustainable distribution of ivermectin and delivery of other health commodities including anti-malaria drugs and Insecticide treated bed nets (ITNs). In conclusion, the director reiterated APOC continued support to countries, so long as funds made available to projects are put to good use for the benefit of onchocerciasis endemic communities. The Director a.i. of the Multi-Disease Surveillance Centre (MDSC), Professor M. Kader Kond6, noted that the mission of the MDSC was to assist countries strengthen onchocerciasis surveillance. Unfortunately, the Centre had not been able to fully play its expected role, due to institutional issues and lack of resources. However, with the modest means at its disposal, it has continued to assist some countries in the area of entomological and epidemiological surveillance, and putting a molecular biology laboratory at their disposal. Professor Kond6 explained that this year, the MDSC could not organise the annual meeting of coordinators of former OCP countries due to budget constraints, and the fact that the Centre devoted considerable effort to institutional reform. The reform is within the framework of the vision of the WHO African Regional Director to develop and set up Centres of Excellence for disease prevention and control in the African region. The MDSC is to be transformed into one of the Centres of Excellence. Professor Kondd thanked WAHO, APOC Management, and the WHO country office in Burkina Faso and countries for their understanding and confidence in the Centre. The WHO Country Representative in Burkina Faso, Dr Djemila Cabral who, in an opening speech, on behalf of the Regional Director for Africa, welcomed all parlicipants to the meeting. She commended the initiative by APOC Management and WAHO in organising the meeting, a year after closing the Special Intervention Zones (SIZ). This, she said, would enable various players to review their activities, resources used and the results obtained in 2008 on onchocerciasis control and surveillance. Dr Cabral explained that such forums would help sustain the awareness and interest of partners to ensure that onchocerciasis no longer constituted a public health problem, or an impediment to socio-economic development in Africa. She said the concerted efforts were proof of the commitment of the two institutions in developing partnership for effective implementation of activities and in the coordination and harmonization of support to countries. She also noted the marked improvement in entomological and epidemiological parameters, and CDTI coverage rates after five years of activities in the SIZ in Guinea Conakry, Ghana, Benin, Togo and Sierra Leone. t 2 However, Dr Cabral emphasized the need to address the key challenges, namely: effective control activities in the residual foci in the tributaries of the Eastern Volta Lake in Togo and maintaining the good results obtained in order to preserve the gains made by OCP. In conclusion, she called a thorough review of the results of 2008 and a realistic planning of activities to be carried out in 2009 and beyond, taking into account the following challenges: l) scaling up epidemiological and entomological surveillance; 2) organising cross-border meetings for countries 3) effective integration of onchocerciasis control activities in health programmes and facilities in endemic areas; 4) developing local partnership with all sectors and communities concemed; 5) co-implementation of CDTI with other health interventions; 6) diversification of sources of financing at all levels (local, regionat, central) ;7) increase in national subventions for national programmes. The speech by the WR/Burkina Faso was followed by self-introduction of participants. The full list of participants is attached as Annexe l. Dr Laurent Yam6ogo, Coordinator of the Office of the APOC Director, then took the floor to organise the election of officers for the meeting. The follow officers were elected: Dr Franck Sintondji, Coordinator of NOCP of Benin, as Chair; Dr Salissou, Coordinator a.i. of Niger, as main rapporteur; Dr Sarr Dieng, Coordinator of Senegal, as assistant rapporteur; M. Assi Ak6, APOC, as assistant to the rapporteurs. The meeting adopted the meeting agenda, which is attached as Annexe 2. B. BACKGROUND INFORMATION ON FINAL EVALUATION OF SIZ Dr Yam6ogo presented a summary of the report on the final evaluation of SIZ, highlighting the following: The success of vector control activities in the SIZ in Togo and Benin, with considerable reduction in annual transmission potential (ATP) in the treated areas. However, it is difficult to distinguish the impact of ivermectin distribution from that of larviciding; It is imperative to find solutions to the institutional problem and financial difficulties of the MDSC to ensure surveillance of onchocerciasis, Good conduct of CDTI activities as planned: two-yearly treatment (Togo, Benin, Guinea) and annual (Ghana and Sierra Leone); regular supply of ivermectin to the programme; accurate population census(including specific groups) in difficult-to-reach villages and hamlets. The evaluation team noted the low participation of women ; Three out of the five SIZ countries reached the objectives set, namely, geographic coverage of 100% and therapeutic coverage of 80-85%. The remaining two countries made progress, but a lot still remains to be done to reach the objectives; The need to consolidate the gains and avoid the risk of re-infestation by infected blackflies coming from areas that are not totally cleaned up. It is necessary to maintain pressure for some time (even in countries, where the objectives have been met, so CDTI must continue until 2012 at least). Consequently, the evaluation team requested countries to step up efforts, and the international community to assist countries as they strive to safeguard the gains made by the OCP; The need for all stakeholders to pool resources to address incentive issues, so as to harmonize policies, and so that this does not become an impediment to the smooth implementation of the onchoierciasis control and risk elimination strategy in the countries; J On low female participation, the team was of the view that the involvement of women was a critical issue related to the customs and practices in different countries. It is necessary to take into account cultural constraints during sensitization and advocacy to scale up women's involvement; The necessity for training of technicians in surveillance to take over from ageing high-level technicians; Lessons learnt that could be of benefit to other programmes, namely (l) periodic epidemiological evaluations, which are carried out in SZ countries, and which need to continue; (2) reaching therapeutic coverage of between 80%o and 85o/o in the SZ, which could be experimented elsewhere; Improving and keeping census registers, an important and useful tool that other programmes are now using; Continuation of annual meetings, which are avenues for sharing experiences; Organising CDD meetings, following ivermectin distribution sessions, is a practice that needs to be encouraged. This is because it is a source of incentive for them, and also it shows the interest people have in what they are doing. These meetings also give CDDs feedback on the activities conducted, and the corrections that need to be made; The use of cards for nomads could be useful; this may help to better manage treatment of nomadic communities in the areas visited. DISCUSSIONS ON ITEM B Discussions following Dr Yameogo's presentation: - Onchocerciasis control efforts recorded positive results in former OCP countries, however some challenges need to be addressed in order to achieve elimination of transmission of the disease in the WHO African region. One of the biggest challenges has to do with resources, which calls for innovative strategies to mobilize funds to finance onchocerciasis control activities, including incentives for community distributors. This incentive issue spans all community-based activities, and calls for an integrated approach as one of the solutions, i.e. the need to integrate onchocerciasis control with programmes that are already running in the countries. - With respect to women's participation in onchocerciasis control activities, it was suggested that advocacy should be stepped up at all levels to raise the awareness of communities to ensure increased involvement of women, while respecting the customs and practices of communities. - APOC Director took the opportunity to announce that the Programme was working on a plan to award scholarships to the tune of US$500 000 per year, from 2008 to 2015 for Masters degree studies in epidemiology, entomology, programme management, public health etc..., and that priority would be given to women. - Need to maintain cross-border activities (blackfly movement studies, cross-border meetings etc.) - Cross-border meetings remain APOC's priority. - Togo and Benin (except a pocket at the Togo-Ghana border) may be considered as having achieved SIZ objectives. C. FOLLOW T]P OF RECOMMENDATIONS OF'TIIE 6TH REVIEW AND PLANING MEETING AND sTH SESSION OF THE SPECIAL CONSULTATTVE COMMITTEE OF SIZ RECOMMENDATIONS FOLLOW-UP ACTIONS Former OCP countries Former OCP countries are encouraged to efficiently continue: CDTI in SIZ and non-SIZ areas, adequate long-term monitoring and surveillance activities following cessation of SIZ activities to see to early detection of possible recrudescence of the disease. Actions are ongoing Governments are encouraged to continue deploying personnel and disbursing national budget funds with a view to continuing CDTI and survei llance activities. See presentation of coordinators for action taken. Given that several governments and private companies have drawn up See presentation of coordinators 4 plans and allocated budgets for nuisance control, the SAC recommends that countries approach APOC for advice on appropriate products/chemicals (so as to avoid disastrous ecological effects, and conform to control ces for actions taken. Continuation of routine cross-border meetings in order to assess epidemiological status and take necessary corrective action. (For example between Ghana and rogo, between Sierra Leone, Guinea and Liberia, and between Benin and Nigeria, and between Burkina Faso and Cdte d'Ivoire...). Togo-Benin: t9/tt/2009. planned for S. Leone-Liberia-Guinea: Done Benin-Nigeria ongoing The threat posed by the unsatisfactory entomo-epidemiologi cal situation of Ghana, Togo (border with Ghana) and Burkina Faso (ln vil ages of some districts) was discussed ln depth, and the need for high-level advocacy to improve GDTI to address the issue was reiterated. Actions are ongoing Regarding inter-country co aboration, the group recommends that, ln order to avoid any interruptiOD, and while awaiting the formal setting up of a coord ination outfit, APOC MD SC and wAHO co-organlse the annual forum of national coordinators, with the assistance of the NGDO The forum will be held in Novem as usual. Action taken. This meeting is co-organised by APOC and WAHO. Benin: Looking for other partners: The Plan of action for ensuing years provides for a budget, about a third of which will be borne by the national budget, and the other two-thirds by only one NGO. This situation is deemed Lion's Club/Parakou plans to support CDTI activities in the northern part ofthe country (14 communes) The future of the Parakou base and personnel currently at post, after closure of SIZ. To transfer staff, h itherto employed by WH,o to the Benin civilservice. Discussions are ongoing Committee recommends reflection or help keep up community mobilisation deliberation on new approaches to under CDTI, particularly in areas where people no longer remember anything about the disease; this blem will be on the increase in all former OCp countries. See presentation of coordinators for actions taken. Ghana: The team must redouble its efforts to achieve geographic and therapeutic coverage rates of 100% and Bo-85% respectivery, using the same annual Mectizan distribution strategy in all the oncho endemic communities in Ghana. committee recommended also to Ghana team to intensiff advocacy toward decision-makers partners so as to further benefit from their support for its activities. Health workers trained on census taking of small villages and hamlets around bigger and often forgotten villages. Recruitment of CDDs ongoing (meetings/workshops held) Resumption of onchocerciasis control activities in Ghana, with ApOC assistance due to the consequences the unsatisfactory entomological and epidemiological situation in Ghana may have on neighbouring countries in the region: Update of REMO map; Establishment and strengthening of GDTI for achieving maximum and A national review and planning meeting was held to discuss challenges facing Ghana, and to draw up strategic plans to address them. 5 High-level advocacy toward Ghanaian authorities to be undertaken by APOC director. Cross-border meetings must hold, as scheduled, with Togo to address border issues between the two countries. The budget proposal must be reviewed, a clear indication given of the projected source of financing of the plan of action. Slated for l9ll l/08 Instructions taken into account in 2008-2009 Budget Togo: The Committee recommends Clearer documentation on transmission in Lower Kara, Lower Mo and Kpaza Kou6; Continuation of search for communities that might have missed treatment; Epidemiological evaluation and entomological surveillance (pool screening) well representative of foci, especially during the next trienn ial evaluation round. Actions taken; different activities already undertaken. Actions are ongoing The Committee would like to see a less blanket-fype CDTI results, teasing out any discrepancies, and helping to appreciate the regions, basins and communities that do not meet the set acceptability criteria; In view of the closeness of the areas with problems along the Ghana border, the Committee endorses the request of the Togo coordinator for periodic consultation with his G!g!4!qq Outcomes will be presented accordingly Scheduled for l9l11/08 Sierra Leone: The SAC called on the NOCP to obtain, with APOC assistance, the remaining data needed for completing the REMO map. The Committee recommends to the NOCP to ensure that health personnel and CDDs have the requisite skills to undertake CDTI activities, including data reporting. NOCP must also examine merging the IEC materials and strategies to determine if it is tou te IEC materials or strate REMO map made See presentation of NOCP for actions taken. See presentation of NOCP for actions taken. SAC recommends that after the final closure of SZ, entomological skills available be maintained and used in several African regions where could be to use Actions under way in Togo and Benin Guinea Bissau: The SAC recommends that APOC makes available to NOCP/Guinea Bissau all the necessary resources to fully re-build and reactivate CDTI and re-start epidemiological surveillance, based on standards and protocols for the former OCP countries. The second part of epidemiological evaluation of 2007 needs to be conducted right now, and must include villages in the Rio Corubal basin, which have not been visited since 2001 or 2004. Technician training completed. Evaluation of Epidem./Entomo activities funded; Cdte d'Ivoire: The SAC recommends that an investigation be conducted into conditions under which ivermectin treatment was carried out during the time CDTI was interrupted/disrupted, so as to explqin [gw the overall lnvestigation carried out. 6 epidemiological situation was maintained satisfactorily The SAC recommends: An evaluation and rehabilitation of CDTI in the entire country Resumption of regular epidemiological evaluation in line with the triennial pattern of coverage of all basins, particularly where surveillance parameters could indicate a trend of recrudescence. That the MDSC put in place an entomological evaluation network, based on epidemiological evaluation results and on the background information of foci. Epidemiological carried out Actions taken evaluation A specific epidemiological evaluation, including an ophthalmological survey, must be conducted in 2008 to assess the extent of blinding onchocerciasis in the previously forest areas (low latitudes) of COte d'Ivoire. All resources needed for these operations must be provided by APOC. Actions taken Actions taken DISCUSSIONS ON ITEM C The discussions centred on the following: IEC should be strengthened, in view of many remarks made on the need for vigilance, and in the interest of communities, health personnel and governments, in relation to onchocerciasis control and the need to tackle communicable diseases and/or NTDs. National coordinators and countries should draw up plans that should be supported by partners for this activity to be conducted in order to correct the notion that onchocerciasis has been eliminated, and that further funding is no longer necessary. Regarding APOC support, Management apologised for the delay in making funds available due to the launch of the new WHO Global management system (GSM). It must be noted, however, that some of the recommendations were not implemented because budget requests and supporting documents were not submitted to APOC for Management to take action. With respect to the submission of research projects on repellents, the national coordinator of Burkina Faso informed participants that a project proposal on repellents had already been prepared and would be submitted to APOC Management. D. ONCHOCERCIASIS CONTROL-RELATED INFORMATION ON WAIIO 1) Background WAHO is a health specialised agency of ECOWAS, the Economic Community of West African States grouping 15 countries. WAHO was set up in 1987, through the merging of OCCGE (for francophone countries) and WAHC (for English-speaking countries), and started operations in 2000, with headquarters in Bobo-Dioulasso, Burkina Faso. WAHO's five-year (2003-2007) strategic plan, made prevention of blindness a priority intervention. The strategic plan for the prevention of blindness seeks to implement the "Vision 2020:The right to sight" initiative, with the overall objective of eliminating the causes of preventable blindness by 2020. This initiative covers a number of priority diseases, including onchocerciasis. 7 Out of the l5 ECOWAS member states, l3 are onchocerciasis endemic, I I of which are members of the former OCP and two of APOC. 2) Oncho-related information WAHO has set the following objectives for onchocerciasis control Overall objective: The preservation, sustainability and scaling up of ongoing onchocerciasis programmes in the sub-region based on community participation. Specific objectives . Collaborate with APOC and other partners in coordinating onchocerciasis control in the sub-region. . Support ongoing onchocerciasis control programmes through technical assistance and information management. . Advocate for resource mobilisation. . Advocate for onchocerciasis control to remain a priority in national health programmes and policies. Actions carried out . Participation in coordination activities and in group discussions: TCC, SIZ, JAF . Participation in NGDO coordination group meetings. . WAHO intends to support ongoing programmes within the framework of consultation with other partners: APOC, countries and technical and financial partners. Under advocacy: i. ECOWAS ministers of health adopted in 2006 a resolution on sustaining onchocerciasis control programmes in West Africa, and safeguarding the control gains ii. Placing onchocerciasis control on the agenda of the 9th annual session of the ECOWAS Health Ministers, held in Cotonou, Benin in July 2008. A presentation titled: "Update of onchocerciasis control in West Africa" was made during the session and two recommendations were made for the attention of WAHO: l. Collaborate with APOC and MDSC for onchocerciasis surveillance in the former OCP countries. 2. Collaborate with APOC to undertake studies so as to identiff areas in the former OCP, where ivermectin treatment could be stopped without any risk of re-infection or transmission. DISCUSSIONS ON ITEM D Discussions centred on the role WAHO could play: l) in organising cross-border meetings; 2) to encourage countries to assist in onchocerciasis control activities. A WAHO representative provided the following response: WAHO is able to play a critical advocacy role toward countries, due to its strategic position. The organisation has the political mandate and advantage to reach out to various levels in the states. For instance, WAHO is in charge of bringing all priority health issues in the sub-region to the attention of health ministers during their annual meetings. It could take advantage of this to advocate for onchocerciasis control especially the need funding. If health ministers endorse a proposal, it is then forwarded to the Council of ministers (made up of finance and planning ministers), which takes a 8 decision on all financial issues. If a political decision is required, the Council may refer the matter to the heads of state summit. WAHO has the mandate to manage all cross-border health issues between member states. To this end, the organisation will assist in organising cross-border meetings, in consultation and with the consensus with all partners. E. BACKGROT]}TD IhTFORMATION ON THE MDSC 1. Introduction The MDSC was set up in 2003 to provide quality assistance to countries in the area of priority disease surveillance, including that of onchocerciasis. The interim director of MDSC, Pr Konde Kader, in his introductory remarks touched on the evolution the Centre, its surveillance activities on meningitis and the introduction of conjugate vaccine. He also mentioned the Centre's research activities on diagnosticiests on viral hemorrhagic fever. MDSC carried out the following activities in2007 and 2008 Support for surveillance activities Research Training 2. Surveillance assistance 2.1 Identification of parasites An entomological surveillance network has been put in place in the river basins of the Oti, upper Ou6m6 since 2003, and in Sierra Leone. The blackflies collected are dissected, and the parasites found are sent to the MDSC laboratory for identification. The assessment of the impact of control activities in the Special intervention Zones(SIZ) is carried out by calculating the entomological parameter, which is the annual transmission potential(ATP). It is imperative to identif, parasites and to choose only those that cause human onchocerciasis. this is the responsibility of the MDSC molecular biology laboratory. The farvae of 1717 infective female flies were received from Benin, Sierra Leone and Togo (Table l). The highest number came from Sierra Leone, with 42Yo being O. volvulus. It was observed toward the end of the SIZ that, as numbers dropped during the year, the number of blackflies infected with parasites of human origin also dropped even to zero at most of the surveillance points.In 2006 and 2007, no infective larvae of O. volvulil.r were found in the entomological evaluation network points. Tableau I : Identification of parasites Year Countries Other parasites O.volvulus Savannah O.volvulus Forest O.ochengi Total 2003 SLEONE 253 264 20 t2 549 Total2003 253 264 20 t2 549 2004 BENIN l8 22 0 0 40 SLEONE 221 ll6 ll 6 354 TOGO 8 l5 I I 25 Total 247 1s3 t2 7 419 2005 BENIN 20 26 0 0 46 9 SLEONE 290 265 0 s62 TOGO 5 8 0 0 t3 Total 315 299 0 7 621 2006 BENIN 35 0 0 0 3s TOGO l0 0 0 0 l0 Total 45 0 0 0 45 2007 BENIN 58 2 0 ) 63 SLEONE 0 I 0 0 I TOGO l8 I 0 0 19 Total 76 4 0 3 83 Grand Total 936 720 32 29 t7t7 2.2 Entomological surueillance in former OCP countries For the first time, all the results of entomological surveillance conducted in the countries from 2003 to 2008 were presented. Surveillance was not carried out the same way in all the countries, at the same frequency and intensity. Thus, in Cote d'Ivoire, Guinea Bissau and Sierra Leone there were no activities, due to the conflict situations. Results of the other 8 former OCP countries were presented and commented on. The analysis of results of six years of surveillance showed: Irregularity in organisation. It is difficult to undertake follow-up of surveillance points on a yearly basis; The non-application of the rotation principle of surveillance points, given the infectivity rates observed. New surveillance points could be selected to replace those with satisfactory infectivity rates, and which must only be visited every three years; The scanty number of blackflies collected. The value of infectivity rates is only significant, statistically, if the minimum of 6000 blackflies is reached. Coordinators need to make specialefforts to achieve this objective. Transporting blackflies to MDSC: Lateness in transporting blackflies to the MDSC, and the choice of transportation means have always been a problem for which each coordination office will have to grapple with, in collaboration with the MDSC. The latter will propose a plan, and each country will have to adapt it to its situation. 3. Research 3.1 Blacklly movements Two studies were conducted: one in the west of former OCP area, between Sierra Leone, Guinea and Mali; the other was on the eastern fringe, between Benin and Nigeria. The two studies involved several aspects and the main ones were: a) Study on blackfly population dynamics b) The evaluation of the impact of fly movements on transmission The results obtained were presented. These were made up of vector morphological analyses, molecular biology analyses and parasite transmission. It was evident from the results that, for the Nigeria-Benin cross-border study: - Simulium beffa is found in the samples collected in Benin and Nigeria - Partial results do not make for drawing definite conclusions on blackfly movements and their impact 7 1 2 ) 4 l0 Human onchocerciasis transmission is below the tolerable threshold. Though the number of vectors collected was found to be low. The second part of the study will be conducted with the protocol strictly adhered to, and with the right technical assistance. 3.2 Feasibility of elimination of onchocerciasis transmission The feasibility study on elimination of onchocerciasis transmission in some foci, using ivermectin, was launched in 2005 through a TDR-MDSC-APOC collaboration, with financial support from the Bill & Melinda Gates Foundation, based on a proposal submitted by the TDR in 2004. The study involved detailed field entomological and epidemiological investigations, as well as laboratory analyses, using molecular biolory techniques to determine infectivity rates of vector populations and to identi! the parasites collected. The objective is to precisely determine where, when and how ivermectin treatment programmes could be stopped without any risk of re-infection. The study areas were selected in the onchocerciasis foci in western Mali and eastern Senegal, where annual and twice yearly mass treatments have been going on for almost two decades. In Senegal, the areas selected for this study are in the Gambia and Faleme basins, where entomological activities(vector collection and dissection) are carried out on four points (Bantakocouta, Sekoto, Soukouta and yamousa) and two points respectively (Saroudia and Bambadji). In Mali, the study areas are located in the Bakoye and Faleme basins, with the same entomological activities being carried out on four points in each of the basins: Badala, Tieourou-santankoto-barrage, kolontan and Toufinko for the Bakoye River, Manankoto, Satadougou-Tintimba, Fadougou and Mahina mine for the Faleme River. In line with the protocol, which was initially drawn up in 2004, investigations should continue until the end of 2009, when a final conclusion could be made with certainty, concerning the feasibility of elimination onchocerciasis transmission. Following a workshop held in March 2008, to analyze the results obtained in2007 in the test areas, as well as in the rest of the study areas, the following decisions were made: 3.2.1. On the Gambia: Cessation of treatment in the entire study area of the Gambia basin in Senegal 3.2.2. On the Bakoye: Cessation of treatment in all the study area of the Bakoye basin in Mali 3.2.3. On the Faleme: - Stick to cessation of treatment in all villages in the test area selected in2007 on the Mali bank of the river; - Cessation of treatment in two new test areas, selected in the southern part of the basin, on the Senegal and Mali banks; - Continuation of treatment in every other area of the study zone of the basin. These special alrangements made for the Faleme led to a slight amendment of the original protocol, with respect to this basin. This amendment stipulates the continuation of investigations until end of 2010 (instead of 2009) on the two banks (Mali and Senegal). ll 4. Training and re-training at MDSC ln 2007 and 2008, MDSC strengthened the capacity of countries of the former OCP and APOC in different areas: - For programme designers and management staff: accelerated course on applied field epidemiology and laboratory GELTP) integrated a module on onchocerciasis surveillance. 01 Burundi national and 0l Central African lady took part in the course; - For programmes officers: training of a senior entomologist of Siena Leone; - For programme implementers and field workers: MDSC trained 5 entomology technicians of Nigeria and re-trained 8 entomology technicians of Sierra Leone; - Molecular biology laboratory: an American student in public health had mentoring on disease surveillance and CDTI. DISCUSSIONS ON ITEM E Discussions centred on the following: - Regarding the recurrent issue of the transportation of biological samples (L3head, blackflies, etc.) from countries to the MDSC, which was brought back to the floor by coordinators, a decision was made to make realistic and concrete proposals with a view to finding long-lasting solutions. Thus, an APOCA4DSC task force was set up to make proposals, and to follow up for setting up a common network for forwarding biological material, in collaboration with national coordinators. - The need to train technicians in the area of entomological surveillance and epidemiological evaluation in replacement of aged technicians. - The use of skin snipping and the DEC patch test in the Oncho elimination study: Both techniques have their importance, due to the low parasite burden in the study area. Their combined use, in the final analysis, allows for the comparison of sensitivity and the final validation of the DEC technique. Persons are increasingly rejecting the skin snip, whereas the DEC patch test, which is painless, could gradually replace the skin snip. REVIEW OF SUR\IEILLANCE/EVALUATION AND ONCHOCERCIASIS CONTROL ACTIVITIES IN EX-OCP COUNTRIES IN 2008, RESOURCES USED AND COLLABORATION WITH OTHER DISEASE PROGRAMMES, INCLTIDING NTDS BENIN The Republic of Benin is administratively sub-divided into ll communes, organised into 12 departments, and the communes are sub-divided into districts (Arrondissement). The health system is based on the administrative divisions: The Arrondissement Health Centres (CSA), are managed by nurses. Commune Health Centres (CSC), which head a group of CSA in addition to the central CSC, are managed by a medical officer. Several communes are within the same health zone under the direction of a health zone doctor-coordinator. This report covers the review of the programme, which took place in April 2008, CDTI support activities and the outcomes achieved to date, epidemiological and entomological surveillance activities, as well as efforts made to effectively undeftake ground larviciding. 1. Review of Programme The review of the programme took place at a meeting in Lokossa from 28 to 30 April 2008, during which the following concerns were raised: Difficulty in mobilising resources from the national budget; with the alternative being to explore ways of decentralizing the fu nds; F a t2 The recurring issue of incentives to CDDs was raised, and the minister was requested to put in place a mechanism to pool incentive packages offered by all programmes under the ministry; The actual integration of CDTI into prevention and health promotion services is a concern, and peripheral officers were called upon to fully play their role. 2. CDTI and support activities The CDTI is driving the onchocerciasis control activity. The implementation requires a series of support activities; the following were undertaken this year: . Training of 52 health workers on CDTI in the health zones of Pob6, Natitingou; . Training/re-training of 1670 CDDs in the departments of Alibori, Atacora and Plateau; o Exploring villages and hamlets that are eligible for CDTI in the communes of K6tou and Adja-Ouere (updating the list of villages/hamlets that could be treated); o Supervision of CDTI activities in the SZ area from 3 to 9 August 2008: All communes were visited by supervision teams, which made sure that the CDTI was actually being implemented; o Implementation of first round of CDTI in the SIZ area, with 662,327 persons being treated in 1804 communities in the I I communes (geographic coverage: 97%o and therapeutic coverage: 85%). 3. CDTIEpidemiologicalsurveillance Two epidemiological surveillance exercises took place this year; One in the SIZ area and the other in the non- SIZ area: Non-SIZ: l6 villages were visited, T of which had zero-prevalence, T had prevalence rates of between 0 and 5%o;2 villages had prevalence rate above 5%o, with downward trends, and CMFL lower than 0.5. In the SIZ area, l0 villages were visited, out of the l2 planned. Prevalence was nil. This means that the overall epidemiological situation is good 4. Entomological surveillance With respect to entomological monitoring, efforts centred on the SV area, so as to confirm the good trends observed at the closure of SIZ. Thus, fly catching points were visited at B6tdrou, Wari Maro and Kouporgou and flies collected for onward transmission to the MDSC DNA-Lab. It must be noted that the blackfly movement study between Nigeria and Benin, which experienced administrative and financial difficulties at the onset, is now underway. 5. Resumption of ground larviciding For resumption of ground larviciding, resources were made available to procure materials. 1800 litres of BT H l4 were acquired in2007 and 2500 litres in 2008. However, the issue of staff transfer from the Parakou base to the public service for field operations is yet to be resolved. Besides, the official closing ceremony for the Parakou base, which has been postponed several times, was again rescheduled to 28 November 2008. 6. Administrative, logistic and financial support Apart from the national budget, SSI remains the only partner in the control of onchocerciasis in Benin. SSI financed the review programme, the training activities mentioned above, and provided a vehicle in 2008 for supervision activities. a a a a 13 Substantial support was also received from the national budget to manage other diseases. This enabled the purchase of rwo vehicles for supervision in 2008. APOC provided great support, through the supply of 50 bicycles for CDDs, and a vehicle for supervision activities There were discussions with the LIONS CLUB, which indicated its willingness to support social mobilisation under CDTI in the departments of Borgou and Alibori. An official launching ceremony for this partnership was scheduled to be held before the end of November 2008. There was a plan to submit to RTI in December 2008, i.e. the NTD control plan, including onchocerciasis BIJRIilNA F'ASO 1. Background In Burkina Faso, onchocerciasis was causing havoc in all the river basins and 34 health districts were affected, with prevalence rates, community microfilarial loads (CMFL), monthly biting rates (MBR) and annual transmission potentials (ATP) over and above the tolerable thresholds. However, satisfactory entomological and epidemiological parameters were recorded by the end of 2002,with blackfly infectivity rates close to zero; prevalence rates lower than 5Yo; incidence rates almost nil; ATP close to zero on all the river basins in the country and CMFL were equally low. CDTI was in place in all the basins. Therefore, onchocerciasis is no longer a public health problem in Burkina Faso. However, 85 sentinel villages and l0 catching points were selected, in consultation with the WHO, to undergo longitudinal epidemiological disease surveillance. These villages are found in the river basins of the Bougouriba, Lower Mouhoun, Bambassou, Naimo, Upper Mouhoun, Dienkoa, Ldraba, Comod, Sissili, Nazinon, Nakamb6, Koulp6ologo, Arly- Oti-Pendjari, Tapoa, Sirba and the Paga. Onchocerciasis surveillance and control activities in Burkina Faso in 2008 centred on epidemiologicaUentomological monitoring, CDTI), building the capacity of health services and collaboration with other countries and/or organisations involved in onchocerciasis control. 2. Epidemiological monitoring/evaluation Thanks to state financing, an Oncho epidemiological evaluation was scheduled for 2008 in the health regions of the East, Mouhoun and Cascades. Survey had been completed in the East, where Kpanliangou and Nianla villages were visited. Work was still ongoing, and expected to be completed by l0 November 2008. The outcomes show prevalence rates of lYo at Kpanliangou and 2.08% at Nianla, but in 2003, the prevalence for these villages were l3%o and 11.2% respectively, during the last epidemiological evaluation. CMFL were almost nil in 2003, the same level in 2008 (Annex 4b). 3. Entomological Surveillance No entomological surveillance was carried out in 2008. However, the ten sentinel sites of Burkina Faso were visited in2006, with infectivity rates everywhere lower than the tolerable threshold of 0.5/1000. Infectivity rates were higher (maximum: 0.39/1000) at the catching points of Loaba, Zambo, Pont L6raba, pont Dan, where the number of blackflies collected was the lowest (less than 6000 blackflies). t4 4. CDTI As obtains every year, CDTI was carried out in the health region of the South West, which has four health districts: Bati6, Dano, Di6bougou and Gaoua. The latter were treated in June and December for onchocerciasis and LF respectively. In 2008, the average therapeutic coverage of the health region was 84.6Yo for the first treatment round (Annex 3d). 5. Capacity building of health services and communities Two training/re-training sessions were organised for biomedical technicians, nurses and medical doctors. Overall, about 60 persons underwent training, i.e. 20 per category, toward implementing Oncho control and surveillance activities. The objective of the training was, among others, to scale up integration of onchocerciasis control into health activities of the regions and districts. The districts, through their operational plans, are able to directly receive the needed resources for onchocerciasis control (CDTI), either through the state or their partners. 6. Collaboration with organizations and other countries involved in onchocerciasis control In 2008, collaboration was limited to funding requests made to APOC and MDSC. However, a representative of the NOCP participated in a WHO/APOC epidemiological evaluation and training mission in Guinea Bissau. In 2007, the national coordinator took part in various statutory meetings of WHO/APOC, WHO lSlZ and WHO/MDSC. A project named "Promotion of community dynamics for eliminating LF, Onchocerciasis control and Vitamin Supplementation in Burkina" is being developed. The project, which seeks to provide PHC access to the poor and vulnerable, should also contribute to the achievement of the objectives of the country's Poverly Reduction Strategic Paper "PRSP," particularly to Axis 2, which targets "Guaranteeing basic social amenities to the poor". The project which is planned to run from 2008- 2012, will involve partners such as Helen Keller Internaiional, Handicap international, the Ministry of health (Disease control Department), the NOCP, Regional, as well as South-West and Centre-East health districts. 7. Challenges/Constraints - Resource mobilisation; - Scarcity of financial partners for the programme; - Population census due to migration; - Instability of health workers due to transfers and success in state professional exams; - Refusal of skin snipping in some villages; - Lapses in treatment data processing; - Delay in forwarding treatment reports. 8. ONCHO/I'{TDs In 2008, the NOCP staff participated in activities financed by the NTD project: i) supervision of treatment of Schistosomiasis, Trachoma and LF; ii) supervision of mapping of Trachoma and iii) various meetings under NTD activities. However, the NOCP staffdid not undertake any Oncho activity on NTD financing. However, in 2007, ajoint mission with the Schistosomiasis project, financed by the NTD programme was used to conduct epidemiological evaluation covering villages of the health regions of the Cascades and Hauts Bassins. 15 9. Reports The epidemiological evaluation of 2007 revealed that prevalence rates were higher than the threshold of 5% at Bodadiougou and Sakora on the Como6. There is, therefore, the need to better demarcate the area in question to put CDTI in place; The last entomological evaluation dates back to 2006, and yet each site should have been visited at least every three years; Therapeutic coverage is still good, but there is the need to maintain the momentum and remain vigilant. The last supervision carried out by the NOCP Coordination dates back to 2005; Human resource development allows for continuity in the control effort. The last training/re-training was carried out in August 2008, but the number of workers trained was insufficien. In view of the foregoing, it is recommended that routine surveillance activities be conducted for early detection of any recrudescence of the disease. This will involve epidemiological and entomological activities, CDTI, supervision and training/re-training. 10. Conclusion The overall epidemiological status of onchocerciasis is still satisfactory in Burkina Faso, but there is the need to undertake surveillance for timely detection of recrudescence of the disease. Projections for 2009 include: o Evaluating villages within a l5-km radius around Bodadiougou (CSPS of Toumousseni) and Sakora (CSPS of Kankounna); o Instituting CDTI in the Cascades region, if need be; o Maintain and reinforce surveillance of onchocerciasis in the Comoe-Leraba basin. 11. Activity planning in 2009 a a a a Activities Health region Cost @CFA) Source financing of Train/re-train technicians control nurses and Lab. in onchocerciasis Upper Basins, East Cascades 9 052 500 STATE Epidemiological evaluation Cascades 11 202 750 WHO/APOC Entomological surveillance South West /Cascades I 930 000 3 000 000 WHOA4DSC STATE Support to CDTI implementation and supervision (l" round) South West /Cascades 8 000 000 STATE Supervision of CDTI (2"d round) South West Integrated with LF STATE NTD Training of 40 CDDs Cascades l 600 000 Support to CDTI implementation and supervision (Oncho) Cascades 4 000 000 Operational research on repellents l7 000 000 IEC South West /Cascades 4 000 000 TOTAL 59 785 250,0 r6 COTE D'TVOIRE I Introduction There were two major onchocerciasis control activities in Cdte d'Ivoire: l). The establishment of a national programme for the control of blindness (PNLC6) integrating onchocerciasis control; 2) conduct of epidemiological evaluation in the whole country. This report covers the implementation of these two activities, as well as the additional training of health personnel involved in control activities, which took place in December 2007. The national blindness control programme The issue of scaling up blindness control as part of the Vision 2020 Initiative has, since 2000, been a priority concern in the health policy of the Ministry of Health and public hygiene. Beginning from 2000, the Ministry had expressed the desire to set up a blindness control programme, and thanks to the support of organisations such as WHO, WAHO and HKI, a technical task force to finalize the national programme for the control of blindness was set up on 13 December 2007. The technical task force met fortnightly, with the technical and logistic support of HKI, which organized a workshop on the development of the strategic plan of the National Programme for the control of blindness. Following consultation of the technical task force, the Minister of Health and Public Hygiene signed two orders, in June and August 2007: One was for setting up the PNLC6 (National Programme for the control of Blindness), integrating onchocerciasis control activities, and the other was on the nomination of the Director/coordinator of the PNLC6. In addition, the PNLCd and the Vision 2020 plans, drawn up by the task force were submitted for international validation during a workshop organized by the MSHP from 12 to l4 September through the PNLC6 with the technical and financial assistance of WAHO, HKI and WHO. The objective was to reduce by 30% onchocerciasis incidence in the country by the year 2012. The management of the PNLC6 Coordination was fully constituted in 2008, comprising 5 departments as follows: - Onchocerciasis; - Eye diseases excluding onchocerciasis; - Health promotion and public relations; - Epidemiology, follow-up/evaluation, training and research - Administration and finance. Each department is managed by an officer in charge of studies. The PNLC6 employed 24 workers, including l0 on temporary contracts. The management of the PNLC6 had its first operating budget of FCFA78, 870, 000 in 2008. It was provided a headquarters which was equipped with office furniture, computer and office supplies, all with state funding. 2 Resumption of onchocerciasis control activities Originally limited to the northern part of the country, onchocerciasis control was gradually extended to the central part of the country (South extension) in 1986, then to the forest area in 2001, covering the forest clump of the South and West, where the disease was prevalent but, without perceptible morbidity and a relatively less blinding effect. t7 At the end of OCP's mandate, the disease had almost been eliminated from the original area, and prevalence rates ranged between 5%o and 15% in the South extension, and between 30Yo and 60% in the forest area. CDTI has been established in the South extension. Unfortunately, from September 2002to December 2004,the distribution of ivermectin to the population at risk of the disease, and surveillance activities were intemrpted due to social and political unrest in the country. Thus, despite the resumption of treatment in 2005 and 2006 in the government-controlled zone of the extension area, an epidemiological evaluation of the disease was still necessary. CDTI was not implemented in the country in 2007, due to lack of ivermectin for the whole year, with epidemiological evaluation due to be carried out in the entire country. 3.1 Epidemiological evaluation of onchocerciasis from June 2007 to March 2008 With the support of the WHO country office, WHO/APOCISIZ and HKI, an epidemiological evaluation was conducted in 53 villages (3 8 villages in June-July 2007 , and in I 5 villages in March 2008) of the initial area, the South extension and the forest area. The results indicated that: i) The status of onchocerciasis in the initial area, which was cleared in the past, remains stable, though in some areas prevalence rates of up to 8% could still be observed in Bawd. ii) The gains of mass treatment in the South extension area for seven years could not be safeguarded, with some prevalence rates going up to 18.72%o. iii) The situation in the forest area continues to deteriorate, with prevalence rate of between 31.88% and 47.41% being recorded there. In view of these results, the resumption of CDTI is recommended, with the scaling up of efforts in the forest area. Also, epidemiological surveys should be conducted on a regular basis, coupled with local evaluation of CDTI, as well as the collection of clinical, sociological and demographic information (recording ocular and skin symptoms). Training of CDTI actors Within the framework of CDTI implementation, and in view of preparations toward the next treatment round scheduled for the second quarter of 2008, four (4) capacity building training sessions of CDTI implementers were organised from l0 to 23 December 2007 at Abengourou, Daoukro, Sdgudla and Yamoussoukro, with material, logistics and financial support from Helen Keller International (HKI). Participants in the four sessions were health workers who did not benefit from CDTI training in2006, and who are from 22 health districts: Abengourou, Agnibildkrou, Tanda-kounfao, Bondoukou, Adzope, Daoukro, Bongouanou, Dimboko, Bocanda, M'bahiakro, S6gudla, Mankono, Yamoussoukro, Didi6vi, Toumodi, Ti6bissou, Zudnoula, Bouafld, Daloa, Divo, Tiassal6 and Oum6, 18 doctors,88 IDE/SF and 5 nursing assistants were trained. These were intermediate and peripheral actors required for the effective implementation of CDTI. Six doctors and 8 nurses were trained at the Sdgudla training session of health workers from Worodougou, financed by HKI. Given the lack of qualified staff in some first line health facilities in this part of the country, 5 health assistants were also made to participate in the training. Training on the APOC philosophy and CDTI strategy, organised for 42 high-level public servants (6 regional directors and22 departmentaldirectors) of the health sector in the onchocerciasis zone, took place22 to 24 July 18 2008 in Yamoussoukro. The training was conducted by experts from WHO/APOC, and financed by WHO and APOC 3 Other onchocerciasis control activities o January 2008: Finalizing and circulation of the PNLCd 2008 plan of action r Participation in the cross-border coordination meeting on onchocerciasis control of the MANO River in Freetown, Sierra-Leone from 7 to 8 February 2008; o Writing the terms of reference and proposals of onchocerciasis activities to be financed by WHO/APOC; o Initiation of a blackfly nuisance control project in the Como6 basin. Another project is being developed for the other three major rivers of C6te d'Ivoire. 4 Plan of Action for 2008 . Training of nurses/midwives of l9 health districts in the South extension area on CDTI; . Training of CDDs of l9 health districts in the South extension area on CDTI; o Organisation of ivermectin distribution in the l9 health districts, in collaboration with the communities concerned; o Supervision of training of IDE/midwives; o Supervision of training of CDDs; o Supervision of ivermectin distribution. 5 Partnership and resource mobilisation The key partner on onchocerciasis control in Cote d'Ivoire is WHOiAPOC with support by Helen Keller International, which signed a Memorandum of Understanding with the Ministry of Health and Public Hygiene this year. With respect to resource mobilisation for onchocerciasis control, two projects were submitted to the Medical Assistance Program (MAP) International and Standard Chartered Bank. A procedure for partnership with Sight Savers International in C6te d'Ivoire is also under way. DISCUSSIONS ON ITEM F Discussions centred on: The difficulty in organising cross-border meetings between Benin and Nigeria: The Coordinator of Benin came back to the thorny issue of timely disbursement of the national budget for financing this meeting, and especially field activities conducted on a seasonal basis. The detection of two villages with high prevalence in Benin, during the last epidemiological evaluations: The Coordinator indicated that the two villages were located in a commune, where CDTI coverage was poor. Besides, the NOCP later realised from investigations, that some communities were excluded from treatment. Village/hamlet prospection was carried out, leading to the drawing up of a new list to be taken into account during the next treatment rounds. The integration of former SIZ-Benin employees into the national structure: The coordinator indicated that the process was being delayed due to several ministerial reshuffles in the country, which made it difficult to ftnalize the dossier. Forwarding to APOC, village dossiers on epidemiological evaluations conducted in Benin in 2008. Detection of prevalence above the tolerable threshold in two villages in the Cascades region (Burkina Faso): The coordination plans to conduct in 2009 additional epidemiological surveys in the area, and establish CDTI, if necessary. Blackfly nuisance control in Cdte d'Ivoire: The coordinator mentioned that control projects were elaborated at the request of some political and administrative authorities. The CSB (agro industrial company operating t9 in the area) is interested in the control project on the Como6, and plans to finance it. CSB is already involved in blackfly nuisance control with vectobac inthe Lower-Bandama and N'zi basins. The delay in the resumption of activities in Cote d'Ivoire was due to late disbursement of funds by partners APOC, HKI and Standard Chartered Bank. The search for other partners to support CDTI is ongoing. Some Project proposals have been submitted to the Medical Assistance Program (MAP) lntemational for financial support and a request for support has also been forwarded to SSI. Disbursement of budget allocated by the government of C6te d'Ivoire: The state budget allocated to the PNLC6 is used to run the project and for investment. There is no component for financing field activities. Consequently, it was suggested that a specific letter be addressed to the Ministry of Health to explain the need for the country to create a budget line item to cover field activities. After several years of cessation of surveillance and control activities, the risk of recrudescence of the disease willbe very high if urgent actions are not taken. Another suggestion was made that APOC, with the support of other partners undertake advocacy toward the Minister of health and government authorities, so that the state can assume ownership of onchocerciasis control activities. GHANA 1. Introduction The year 2008 got underway with a series of planned activities both for the SIZ and non-SIZ areas following recommendations from surveillance and research activities conducted in year 2007 as follows: . Identifu and map out all farm-huts, hamlets and fishing communities for Ivermectin treatment; . Ensure integration of CDTI into mainstream NTD strategy; . MonitorOnchocerciasis recrudescence through o Strengthened cross border activities with Togo NOCP o Employment of limited larvicidal activities at high breeding areas to reduce black fly population and nuisance . Improve supervision and monitoring of CDTI activities at all levels of the health system; . Improve partnership with partners and collaborators such as Sight Savers International (SSI) and communities to facilitate programme ownership and sustainability; . Build capacity of regional staff to conduct surveillance activities for evaluation of programmes . Conduct operational research into motivation of CDDs. 2. Meetings 2.1 Collaborative Meetings with Sight-Savers, Ghana As a way of improving Oncho control activities in Ghana, a 7-member working group comprising technical staff from both Sight-Savers International and the Ghana Oncho Control Programme were put together under the leadership of Mr. Simon Bush, Regional Director of Sight-Savers operations in West Africa. The terms of reference were as follows: . Identiil the areas of weaknesses in the national Oncho control efforts and suggest ways of addressing them; o Determine any other ways that would improve the performance of Oncho control in Ghana. The group met 6 times and summed up weaknesses identified in the implementation of activities as Planning: It was identified that planning for Oncho activities were not well integrated at all levels since there is no policy as well as contractual agreement from the Ghana Health Service used in assessing the performance of regions and districts towards the achievement of the therapeutic target of 85% as pertains in the other programmes. In effect it is not a priority. Packaging Oncho with the Neglected Tropical Diseases may be the way forward. a 20 aa Supervision: This was identified as one of the major weaknesses of the programme. Several CDDs, after the initialtraining, receive inadequate support from health workers during implementation of activities. The low morale and non-commitment of health workers are responsible for this performance. Late Reporting. 2.2 Planning and Review Meeting The second national planning and review meeting was organized from the 26s -30th May 2008 at hotel Splendour, Kumasi. It was attended by Regional and Deputy Regional Directors of Aealth and their representatives, Regional Oncho Coordinators, representatives from research institutions, Directors from Ghana Health Service headquarters and Programme Managers of Buruli Ulcer Control programme and yaws Eradication Programme. Partners such as Sight Savers lnternational, APOC and WHO *e.e ilro present. The rationale of the meeting was to: ' Explore fufther, in collaboration with stakeholders, challenges faced by the National Oncho Control programme in the implementation of activities and suggest ways of improving them; . Develop strategic plans for addressing key issues identified in the regions and districts; During the main discussions and plenary sessions participants debated and brain stormed on the key issues that emerged from the presentations and developed action steps for addressing the challenges identified, t-hus: CDTI: CDDs working in several communities: It was agreed that as many CDDs as possible should be recruited for each community in order to lessen CDD workload which directly affects demands for improved incentives. The present recommendation was to have one CDD work on a population of approximitely tOO persons. Married CDDs, especially females, were preferred to their male counterparts since their continued stiy in the community is assured. 2. Communities with links to hamlets: Participants resolved that all hamlets and fishing communities were to be mapped immediately for CDTI. This implies identifring and listing all hamlets and fishing communities, recruiting cDDs and supplying registers and other logistics to facilitate implementation of CDTI activities like census taking, Ivermectin distribution, etc. any merged communities were therefore to be separated.3. CDD incentives: Allowances to CDDs are very sensitive, and so, needed further discussions and consultations. Members resolved the way forward was to discuss with communities for a determination of the form of incentives it desired to offer its CDDs. In the meantime programmes were to collaborate with the much endowed programmes like malaria, TB or Hry/AIDS for a harmonization of incentives.4. High absenteeism due to migratory habits of farmers: Treatment period should be changed to suit the social lifestyles of communities, especially prior to the raining season 5. High Ivermectin refusals: Apart from intensiffing social mobilization activities participants suggested operational research into reasons of drug refusals to reinforce key messages. It was also suggested that the programme collaborates with organizations with expertise in communication and behavioural change to support the regions. 6. Shortage of Ivermectin: Regions and districts were urged to make accurate forecast of Ivermectin tablets required to treat all eligible persons in order to prevent such occurrences. As such it was suggested that regions revisit their population estimates and project using the registered census data. Ad hoc distributions by regional officers were also to stop and steps taken to mop up all left-over drugs for storage at the regional medical stores. 7. Poor data management: It was agreed that the capacities of all data managers be built to ensure that mechanisms for the collection, analysis, storage, easy retrieval and dissemination exist. ln all cases back ups of all data collected must be done. 2t 8. Non-Standardized Measuring Poles: the preparation and distribution of measuring poles should be devolved to the regions. The national office should collaborate with the regions to ensure standardization across the country. 9. Ivermectin distribution in urban areas: There is the need to sub-divide the areas into smaller units and put CDDs in charge. The example of Congo Brazzaville was sited as a possible example to follow. 10. Lack of funding for non-SIZ areas: The national office was urged to collaborate and integrate with other programmes as well as strengthen advocacy for increased financial support. Entomological su rueillance l. Nuisance Control: It was recommended that the national office support regions to undertake limited residual larviciding in areas noted for complaints of black fly nuisance. Specific breeding sites on the white and Black Volta, Asukawkaw, Pra, Pru and Kulpawn river basins were to be identified for larviciding. 2. Capacity Building of regional staff: It was recommended that the capacities of regional Biologists be built to support entomological surveillance activities in their regions by monitoring fly collection and dissection. 3. Partnership with Local Research Institutions: The need to effectively collaborate with local research institutions like Noguchi and KCCR to provide research support to the national programmes in surveillance activities was highly recommended. Epidemiological surveys l. Non-involvement of regions in epidemiological and entomological surveillance. It was observed that expertise in the requisite surveillance fields abounds, and that, steps must be taken to bring all on board including institutions like Noguchi and KCCR. 2. REMO in forest areas. The meeting recommended an Oncho REMO be done immediately to reveal the real picture in the forest areas for treatment. 3. Inadequate sclera-corneal punches: The Oncho programme management was urged to procure adequate skin snip equipment to facilitate epidemiological surveys in the regions. Superwision, Monitoring and Reporting l. Empowerment of Communities: It was suggested that communities be empowered through training to undertake monitoring and supervision of CDTI activities in what is popularly known in Oncho circles as 'community self-monitoring'. 2. Integrated monitoring: Regions and districts were encouraged to promote integrated monitoring as part of efforts to integrate programmes and ensure efficient use of resources of all programmes. 3. Non-Availability of Standardized lndicators and Monitorine Check-list: The national office was tasked to develop standard monitoring indicators and check-list to aid regions and districts in their supervisory activities 4. Lack of feedback from national surveillance activities: It was suggested for the national office to explore various mechanisms for disseminating and sharing reports resulting from activities undertaken in the regions. Suggestions such as written feedbacks or reports were recommended. 3. Follow up Actions on r€commendations As part of efforts to facilitate the early implementation of the recommendations the national programme staffs have undertaken several field visits to ensure the conduct of the under-listed activities in the regions and districts: 22 o Provided guidelines and logistics for mapping up farm-huts, hamlets and fishing communities in remote communities of the Brong Ahafo region; o Supported recruitment and training of CDDs ; o Commissioned update of register and subsequent follow up and treatment of communities. 4. CDTI 4.1 Regional Training and Review meetings The national programme staff, as part of the implementation plan for the broader Neglected Tropical Diseases programme, embarked on series of review and trainings for Supervisors at both regional and district levels throughout the country. The meetings formed the basis for commencement of activities leading to the successful implementation of the 2008 mass drug administration. The meeting assembled regional focal persons and supervisors, District Directors of Health Services, public Health Nurses, Disease Control Officers and Medical Statisticians to deliberate, review previous activities and strategize for year 2008' Other issues discussed include importance of updating the community register prior to the MDAs, social mobilization strategies, effective communication of IE&C ,Jrrug"r; *urag".en1 and ieferral of severe adverse reactions, etc. were stressed. The meeting also reviewed actiiities carr]ed out during theprevious year and agreed on strategies for integrating and mobilizing increased support for Oncho control in the regions' The need for effective collaboration with other stakeholders was also stressed. 4.2 Logistics Delivery All regions received the required quantities of drugs and logistics from the central medical stores for onward delivery to endemic districts in June. 4.3 Community Education and Mobilization Most communities have commenced sensitization activities with a view to ensuring that Ivermectin reach all eligible persons for an improved coverage. The focus of activities has been on co111*inity meetings and durbars to solicit the full cooperation and participation of individuals for a successful treatment campaign. The regions are also engaged in media briefings and radio discussion, especially in areas endowed with iadio faciiities. Traditional communication channels such as gong-gong beating, rooftop announcements, etc. are also being employed. 4.4 Distribution of Drugs to Eligible Population AII districts, including both SIZ and non-SIZ, have commenced Ivermectin treatment but are at various stages of the distribution process. Monitoring of treatment and severe adverse events are still on-going (Annexe 3c). 5. SurveillanceActivities This year's entomological and epidemiological surveillance activities have been put on hold following extensive surveys carried out in year 2007, especially for the latter. Entomological activiiies were stalled in view of the non-receipt of reports on the batch of black flies transported to the MDSC since 2006 for DNA analysis. Theprogramme management's position is to strategize and focus interventions for the new foci identified while we wait for the final report from MDSC, Ouagadougou. 6. Key Challenges Implementation of the CDTI activities continues to face challenges some of which are listed below: ' Strong competition among programmes at the district level for implementation; . Delays in funding oncho-only areas for imprementation of activities. 23 7. The way Forward In the ensuing months the NOCP hopes to accomplish the following; . Complete treatment at both SZ and non-SIZ areas and report; o Continue advocacy with Ghana Health Service authorities and various stakeholders to advocate for declaration of 'national NTDs day'; . Engage Togo NOCP in cross-border meeting. GUINEA Summary of activities carried out in 2008 l. Epidemiological evaluation Following the recommendations of the tripartite meeting of the Manova Rivers in February 2008, as part of the follow-up/evaluation of cross-border villages of Guinea, Liberia and Sierra Leone, the NOCP identified l2 villages, which were evaluated in April-May 2008 with the financial support of SSI. Three out of 12 villages evaluated have prevalence rate above the threshold of 5Yo (Annexe 4c) 2. Entomological surveillance An entomological surveillance was conducted at Yalawa and Diaragbela (Upper Niger-Mafou river basin) and at Morigbedougou (Milo river basin). A total of 5083 female flies were dissected and 02 infective females were found with 15 infective larvae. 31239 female flies were sentto the MDSC DNA Lab for identification (Annex sb). 3. Training A training/re-training workshop was organised, as part of onchocerciasis activities at Dabola and Faranah on 4 and 6 August 2008 respectively, for doctors in charge of disease control and for health centre heads on onchocerciasis and CDTI. Overall, 39 health workers were trained, broken down as follows: o Doctors in charge of disease control; . 3 I health centre heads of Faranah, Dabola and Dinguiraye; . 03 Prefecture health directors, 6 Oncho technicians; . 02 Ophthalmology technicians of Dabola and Faranah; A training/re-training workshop on onchocerciasis and CDTI was also organised at Koundara on 3l October 2008; the participants were: . 02 Doctors in charge of disease control . 24 health centre heads of prefecture health directorates of Gaoual and Koundara; . 0lPrefecture health director; . 01 ophthalmology technician from Koundara; . 0l Oncho technician from Gaoual; . 01 regional Doctors in charge of disease from Bokd All these activities were conducted with the financial assistance of SSI 4. Other activities The workshop for drawing up the national NTD control strategic plan was held at Mamou from 8 to 12 April 2008 in the conference room of ACAUPED on the premises of the regional health directorate of Mamou. The 24 workshop, organized by the Ministry of public health, in collaboration with partners (Plan Guinea and WHO), gathered I I health workers from the central level, 8 from regional level, I consultant of the WHO and 5 partners, i.e.25 out of the 29 participants invited. 5. Supply of Mectizan to health districts in 2008 All the health districts were supplied with ivermectin in May 2008, to cover the 8229 villages under CDTI in Guinea. GUINEA BISSAU l. Introduction Onchocerciasis control and surveillance activities were disrupted due to social unrest in the country. As part of the resumption of CDTI activities, entomological and epidemiological evaluations were conducted in the Rio Corubal and Rio Geba basins in 2007 to appraise the endemicity status. The results of the entomology evaluation could not be exploited, because the NOCP did not follow the study protocol. On the other hand, eptemiological evaluations in 33 villages, with oversight by APOC's technical advisers, went well and recorded excellent results. Of the 33 villages evaluated, 27 had zero prevalence,4 had prevalence ranging between l.l yo and 4.5%o. only one village on the Rio corubal had prevalence of l0%o and a GMFL of 0.54. 2. Activities carried out in 2008 2.1 Epidemiological evaluation In 2008, an additional epidemiological evaluation was carried out in 26 villages, with24 of them recording zero prevalence' Two villages on the Rio Curubal had prevalence rates of 1.3%o ind 5.7%. CMFL were nil in iltttre villages evaluated. 2.2 CDTI activities l5 health areas out of 19 under the regional health directorate (RHD) of Gabu are oncho endemic, so also are 2 health areas out of the 14 in the regional health directorate (RHD) of Bafata. Of the, 848 communities involved, 644 in the RHD of Gabu and 204 in the RHD of Bafata are under CDTI. Lymphatic filariasis, affects the entire country. Co-implementation of ivermectin and Albendazole in villages of the RHD of Gabu and Bafata was carried out from 5 May to 30 June 2008. CDTI results for 2008 (except for the health area of Contuboel), show geographic coverage rates ranging between 22%o and l00yo, and therapeutic coverage between 30%o and 88% (Annix 3a).Prior to receiving treatment data from the health area of Contuboel, residual stocks of ivermectin and Albendazole as of December 2008 were 747 877 and 491,364 respectively. Due to a lack of funding, the co-distribution of ivermectin and Albendazole in the non-Oncho areas of the country did not take off in 2008. 3. Other activities Sensitization sessions by community radios in Gabu, Contubel and Bafata, followed by training of trainers (head nurses of district health posts of Gabu and Bafata) were conducted in March 2008. 25 Supervision of CDDs by peripheral health workers was carried during the treatment period from 5 May to 30 June 2008. The NOCP also undertook supervision missions in the health districts and villages, and recovered remaining tablets as well as treatment data. 4. Supply of equipment to NOCP by partners (APOC and SSf). As part of efforts to resume programme activities, the NOCP received from partners the following equipment and materials in 2008: - A 4X4 Nissan Hard Body vehicle, donated by SSI. - 2 motorbike "Wolf make" 125 (SSf - I deep freezer (SSI) - 3 writing desk (SS! - 3 three wooden cupboards (SSf - 6 office chairs (SSI) - I Fax machine (SSI) - I Safe (SSI) - I projector (SSI) - I video set (SSI) - 124 bicycles (APOC) - 965,000 3 mg ivermectin tablets 3 mg (MERC CHARP & DOHOME CHIBRET) The vehicle promised by APOC has not yet arrived. The building housing the NOCP at Gabu was renovated by SSI NIGER 1. Introduction Onchocerciasis accounted for many blindness cases in Niger with severe socio-economic impact. The disease was rampant in the fertile areas of Niger River region, forcing farmers to abandon the area. The concerted efforts by international community in vector control have led to significant reduction in blackfly nuisance and disease levels. Abandoned lands are being cultivated. Consequently, onchocerciasis is no longer a public health problem in Niger today, thanks to the actions undertaken by the OCP. However, there are recrudescence risks, and as part of transfer of OCP activities to the countries, a National Oncho Devolution Programme (NODP) was set up in 1992. The cessation of vector control led to an increase in blackfly densities and relapse of nuisance, which greatly impedes agricultural activities. The seasonal blackfly migration from south to north during the rainy season, and the exodus of human population to the infested regions, raise the risk of re-infection of the disease. This calls for an effective and sustained surveillance system. To this end, several strategies were developed by the NODP in 2008. 2. Early detection of recrudescence This is done per epidemiological and entomological surveillance 26 Epidemiological Surveillance Overall, l0 villages underwent epidemiologicalevaluation, but prevalence rate and CMFL were nil. Entomological Surveillance There was no funding for this activity in 2008. However, the last results of DNA tests on blackflies collected indicated a zero infectivity rate. 3. Sensitisation Field visits were organised this year, however, due to lack of IEC material, this activity could not be carried out smoothly. 4. Capacity building Training/re-training of personnel involved in onchocerciasis surveillance was not done. However, the State supplied the NODP with office equipment. 5. Patient management Since Niger does not meet the criteria for CDTI implementation, ivermectin is only used for treating diagnosed cases. Patient management was only carried out, when mass distribution of ivermectin started within the framework of the neglected disease control programme. 6. Follow-uplEvaluation Evaluation of activities is carried outthrough supervision bythe central level of the districts, the districts of the cSI and the peripheral health workers of the ASC (community health worker). This activity was organised in an integrated manner with the NTD control programme. 7. Nuisance control Attempts were made to carry out ground larviciding of some blackfly breeding sites in Tapoa and the Sirba, with the support of some political leaders, but this produced very Iimited results. 8. Collaboration with other Health Programme Most of the activities of the NODP are carried out in collaboration with other health programmes, mainly NTD control programme. Other activities are undertaken with the Malaria Programme, particularly in the area of human resource support. 9. Financing Resource mobilisation always falls short of target. In 2008, it was 13.gyo, and this is a major concern, for the NTD and onchocerciasis control activities. The only funding available, to date, is from the state, and with a large portion going into the purchasing of office supplies. 10. Projections Strengthening collaboration with NTD control programme 27 DISCUSSIONS ON ITEM F (Contd) Discussions centred on The wrong application of the CDTI strategy in Guinea Bissau: The NOCP reduced the number of CDDs by doing away with the illiterate ones, and by giving incentives to those remaining etc. This is due to the fact that the plan to re-launch CDTI developed by APOC, in collaboration with SSI, could not be implemented. The national coordinator could not be contacted, so APOC management could not liaise with the country to implement the plan, and the scheduled "training of trainers" session could not take off. Arrangements will be made with the coordinator to carry out training of the NOCP team on CDTI strategy and APOC philosophy. In Ghana the NTD Control Day was instituted to raise awareness of all opinion leaders, administrative, political and traditional authorities in order to enlist their full support for onchocercerciasis control. NOCP/Ghana was requested to send to the Ouagadougou DNA Lab the infective larvae (L3 head) collected during dissection for identification. Incentive-related issues: At the launch of CDTI from 1996 to 1998, motivation was not on the agenda. The control progmmmes, which now give monetary incentive to community distributors, did not exist at the time. Unfortunately, with the new trend the refusal of CDDs to work as volunteers has been on the increase. This phenomenon is becoming alarming, and could, in the long term, be destructive to the CDTI structure. There is, therefore, the need for Oncho and NTD programmes to find an innovative approach to address the incentive issue once and for all. In Guinea, CDTI treatments and entomological surveillance are under way, and results will be presented during the 2009 review meeting. With regard to the drastic drop in epidemiological prevalence between 2005 and 2008, the coordinator was asked to ensure that evaluations were done at least eleven months after the last treatment. SENEGAL 1. Introduction The National Onchocerciasis Control Programme (NOCP) of Senegal has been in existence since 1986, as part of the extension of the OCP. Onchocerciasis is mainly found in the south-east region of the country, covering eight health districts in three medical regions, in line with the new administrative and health divisions. There are: 3 health districts in the K6dougou region (Kddougou, Saraya and Sal6mata), 4 health districts in the Tambacounda region (Tambacounda, Diankd Makhan, Goudiry and Kidira) and lastly, I health district in the Kolda region (V6lingara). The river basins of the Gambia and the Faleme and their tributaries constitute the base of the disease. The determination of eligible villages for CDTI treatment was carried out gradually until end of 2003, reaching the number of 606 villages with a total exposed population of 185,000 (registered) to date. The population at risk is distributed among the eight affected health districts. The objective of the programme - eliminating all risks of blindness due to onchocerciasis in the programme area, through mass treatment of the population with ivermectin (Mectizan) - seeks to achieve an annual therapeutic coverage of at least 65Yo of the population of each eligible village. The target was raised to 80% in the villages that are co-endemic for LF, and which were under treatment. The impact of this annual Mectizan distribution is followed by the normal study on prevalence and incidence of the disease in target communities, through the conduct of periodic epidemiological evaluations. 2. Outcome of activities 2.1 Preventive chemotherapy with mass ivermectin treatment using CDTI strategy 28 The villages involved in this ivermectin distribution campaign are broken down as follows - K6dougou district: 238 villages - Saraya district: 84 villages - Kddougou + Saldmata districts: 238 villages - Tambacounda district: 6l villages - Kidira district: 76 villages - Goudiry district + Diank6 Makhan district: 48 villages In 2008, the distribution of ivermectin was planned in allthe 8 endemic health districts of the country. CDTI has started in 4 districts (Saraya, Kidougou, Sal6mata and Vdlingara), and the other four districts (Tambacounda, Kidira, Diankd Makhan and Goudiry) are expected to undertake integrated distribution with the LF elimination programme in December 2008. In 2007 co-endemic health districts carried out integrated treatment with the LF programme. The data collection system did not allow detailed data recording as under the CDTI system. Thus, the coverage rates recorded corresponded to the average therapeutic coverage of the district in question. The CDTI results of health districts in2007 showed therapeutic coverage rates ranging between 79o/o and859% (Annex 3f). A study on the feasibility of onchocerciasis elimination using ivermectin has been ongoing since 2006 in the health districts of Kddougou, Saraya and Saldmata. The aim of this project is to show that transmission of onchocerciasis can be eliminated with ivermectin treatment in some foci in Africa, and to also provide indications on where, when and how ivermectin treatment could be stopped without any risk. Consequently, 9 villages of the health district of Saraya would not receive treatment in 2008, and 92 other villages in the health districts of K6dougou and Saldmata would not be treated this year. This study is jointly being conducted over 5 years (from 2005 to 2009), with the support of TDR/WHO Geneva, MDSC/WHO Ouagadougou and APOC. 2.2 EntomologicaUepidemiological surveillance . Epidemiologicalevaluations Epidemiological evaluations are ongoing as part of planned study on the feasibility of elimination of onchocerciasis transmission with ivermectin treatment. The usual survey methods are used for these evaluations, namely skin snipping and the DEC patch test. Persons involved in the evaluations are those aged I year and above in all the target villages. This activity is scheduled for between January and December 2008. In2007, epidemiological surveys conducted in l0 villages in line with the skin snip method and the DEC patch test showed zero prevalence rates. (Annex 4a). Entomological evaluationsa Entomological evaluations have been under way in the Gambia and Faleme basins since August 2008, and will continue until December 2008, as part of the study. From September to December 2007, entomological surveillance centred on the catching points of Sdkoto, Soukouta, Bantankokouta and Thiabdcard in the Gambia basin. Overall, 13 020 female flies were dissected at the four catching points, but no infection was observed. 106 093 female flies were sent to the MDSC DNA Lab (Annex 5a). 29 3. Difficulties/constraints Human resource problems (many of the technicians have retired); Difficulty in mobilising state resources; Insuffi cient logistics. TOGO l. Background The official closing ceremony of the WHO/SZ project took place at the "Palais des Congrds" of Kara on 28 January 2008, with the state minister of health of Togo presiding. A live band of blind people provided music and testimonies were given by the village chief of Landa Pozanda, a formerly onchocerciasis endemic village. The NOCP coordinator participated in a workshop on NTDs organised by WHO from 25 to 27 February 2008 at Ouidah (Benin), as part of training of nationals in the implementation of integrated control of NTDs; A working session took place on l3 March 2008 between the team of evaluators of the NOCP project, made up of Drs Bernard Philippon and Marc Karam and members of the NOCP. The evaluation involved field visits to the prefectures of Kozah, Dankpen and Bassar from 14 to 18 March 2008, followed by severalworking sessions in Lom6 from 19 to 26 March, attended by the minister of health, the director general of the ministry of health, the director of primary health care, the WHO representative and the SSI project manager for Togo and Benin.. 2. Activities carried out in 2008 2.1 Awareness campaign Sensitisation activities were carried out in 33 villages and farmsteads of Ouest Fazao in the Kpaza-Kou6 basin. On the whole, 155 CDDs, village chiefs and other villagers were sensitised on drug distribution and the swallowing of ivermectin during the first treatment round of 2008. 2.2 Monitoring CDTI activities Two monitoring sessions on CDTI data were organised in September 2008, one at Dapaong and the other at Kpalim6. The advantage of this activity is that it contributes to improving CDTI indicators on the basis of reliable data. A total of 33 participants, including 28 prefecture officers in charge of CDTI and 5 regional CDTI managers took part in the activity. 2.3 Follow-up/supervision Four targeted supervision sessions were conducted in the basins of Upper Kdran, Lower Kara, the Md and the Kpaza-Koud. Overall: ,/ 37 USPs and 70 villages were visited; ,/ 37 ICPs and76 CDDs were met, and in-depth discussions were held on management, taking of tablets, report writing and timely submission of reports. a a a 2.4 Briefing of doctors in endemic districts on NOCP management 30 This briefing was deemed necessary for information sharing on decentralised and integrated management of NOCP activities, with newly recruited public servants serving the health posts. On the whole, 5 regional directors of health and 28 prefecture directors of health (DPS) and 5 regional CDTI officers took part in the briefing. 3. CDTI results for 2008 During the first CDTI round, 2882villages with a population of 2,611,783 were registered, and a total of 2855 villages with a population of 2,231,1 l0 were covered. Geographic and therapeutic coverage rates were 99yo and 85oZ respectively with a total of 6,280,947 tablets dishibuted. 4. Epidemiological surveillance Epidemiological surveys were conducted in the basins of the White Volta, Oti, Kara, Asukawkaw, Ghan Hoou and the Wawa. These were 16 border villages between Togo and Ghana and 4 target villages, on the basis of prevalence rates of 2005, during the last round. On the whole: ./ 23 villages were evaluated (3 of which with state financing) ,/ 6949 persons were registered '/ 4l0l persons were examined ./ 90 positive cases were reported ./ Standard prevalence varied between 0 and 9.20%o '/ CMFL ranged between 0.00 and 0.08 Prevalence rates in all the border villages evaluated were between 0.\yo and 5.g% 5. Visual acuity test Out of the 6682 persons registered, 3682were examined, i.e.60.04%o; ./ 3633 have normal sight, i.e. 98.67 %; ./ 28 persons, i.e.0.760/o have average sight; '/ l0 persons, i.e.0.27%o have low vision; ./ l l persons (adults), i.e.0.30Yo were blind, with onchocerciasis scars NB: The 3307 persons not examined were absentees or children under 5 years. 5. Entomological surveillance Five catching points were selected, namely Sikan in Kara,Tintsro on the Asukawkaw,Fazao in Ani6, Addda Kopd in Amou and Kati in the Zio health district. 449 persons were sensitized in communities around the catching sites, followed by the training/re-training of 20 village vector collectors, 5 health post head nurses (ICP) and 5 entomology technicians from ihe regionJefore the beginning of activities. During the sensitisation sessions, emphasis was placed on blackfly nuisance, treatment and the taking of ivermectin tablets. Some 16.984 collected blackflies were to be sent to the MDSC DNA Lab in Ouagadougou. 3l 6. Activities conducted by the support team at the WHO/Kara base From July to September 2008, collection and dissection were canied out at 5 catching points (Landa Pozanda, Titira, Tapountd, Baghan and Oti Titionga). On the whole, 23.987 blackflies were collected, and 23.466 female flies were put in alcohol. The 521 remaining female flies, collected at Tapountd were dissected. Three infective females and four infective larvae were recorded. 7. Annual review of activities in2007 The review made it possible to: l) take stock of activities carried out during the year; 2) discuss intervention strategies used in CDTI; 3) analyze the problems and difficulties identified: 4) propose solutions. Overall, 54 persons took part in this review, including: - The advisor to the minister of health, representing the minister - The deputy director general of the ministry of health; - Central directors; - Head of programmes; - partners (WHO country Office, Sightsavers International, APOC), - Regional and prefecture directors of health; - Regional CDTI offi cers-in-charge. 8. Celebration of World Sight Day This was celebrated on 23 October 2008 in the Tchitchira Maison zone (health district of the Kdran). The theme was on blindness in children. The day was marked by ophthalmological consultations and eye care in seven primary schools. Administrative, traditional and school authorities were also sensitised on the prevention of blinding diseases (Trachoma, cataract, glaucoma, onchocerciasis and Vitamin A deficiency). 9. Resources used in 2008 The cost of activities from January 2008 amounted to CFA34.09l.030 Table 3: Resources allocated ACTIVITIES STATE AND PARTNERS SSI STATE wHo COUNTRY/APOC TOTAL Fol low-up/Supervi sion 4 726 400 3 547 000 8 273 400 Meeting on monitoring 2 638 500 2 638 s00 Entomological surveillance 3 146 100 2 566 000 5 712 100 Review of NOCP 7 515 750 7 515 750 Training on procedures of SSI 264 000 2 64 000 Briefing of doctors 2 674 000 2 674 000 Celebration of IVD 573 280 573 280 Epidemiological evaluation 2 149 500 2 151 000 2 149 s00 6 450 000 TOTAL 23 104 250 6 271 280 4 715 500 34 09r 030 32 SIERRA LEONE The main strategy for Onchocerciasis control in Sierra Leone since 2003 is Mass Drug Administration (MDA) through Community-Directed Treatment with Ivermectin (CDTI), which is generally a pro-poor, self help project. The MDA is expected to cover a population of about 2.3 million people living in 12 outof tne t: health districts of Sierra Leone that are endemic for Onchocerciasis. The NOCP was unable to conduct MDA using the CDTI strategy in 2003 and 2004. However, since August 2005, the NOCP has succeeded in conducting 3 rounds of MDA: by May 2006 about 1,300,000 people (54.5% of the targeted population) were treated; 1,700,000 people were treated by February 2007 (74.3% of the targeted population); and l,'|7O,OOO people were treated by February 2008 (75.3% of the targeted population). The NOCP is presently covering 8,45i viilages in all the 12 provincial districts of Sierra Leone that are endemic for Onchocerciasis and use 16,902 CDDs for Ivermectin distribution (an average of 2 in each village). According to the Onchocerciasis Control Programme(OCP) Onchosim simulations, it is necessary to have a therapeutic coverage of at least 65%o and a geogiaphical coverage of 100% over a period of 14 years and above in order to break transmission of Onchocerciisis. this target was achieved in 2007 treatment (which ended in February 2008) and should be maintained for the next l3 years. A review of 2007 NOCP activities was conducted in April 2008. Representatives of all the l2 Oncho-endemic districts made a PowerPoint presentation on activities conducted in 2007 and early 2008, results of mass distribution of Ivermectin, problems encountered and possible solutions to these problems. 2,352,586 people were targeted for treatment and 1,770,757 were treated with Ivermectin, giving a therapeutic coverage of iS.lN. All 8,451 villages targeted for treatment were covered for the first time in 3 years, giving a g"ogrup[ic coverage of 100%. 5,183,488 tablets of Ivermectin were used to treat the 1,770,757 people anO iOq-0 casei of mild drug reactions were reported in the l2 districts. Constraints reported during the review included the following: o Presence of some hard to reach areas, especially the river areas; . Some CDDs still have problems preparing the yearly report forms; . Some CDDs are demanding incentives for the service they render. Recommendations of the review included: 1' CDDs are to be motivated through the provision of certificates, T shirts, flyers, badges etc., and through use of CDDs for the integrated management of NTDs, Malaria and other health interventions.2. Provision of motor cycles preferably XL l25s which are appropriate for the bad roads or difficult terrain.3. Intensification of community meetings to reach all populations. 4. Advocacy meetings with the newly elected city and district local councils.5. Continue training for DHMT, PHU staff and CDDs. 6. Strengthening of suppoftive supervision at all levels. After December 2007, the NOCP is receiving financial support from the Government of Sierra Leone, the African Programme for Onchocerciasis Control (APOC) and Sight Savers International (SSD. Since 2007, the NOCP is also responsible for treatment of neglected tropical diseases (NTDs) in Sierra Leone. The NOCpNTD Control Programme is receiving funding also from Research Triangle Institute (RTI) through Helen Keller International (HKI) for integrated treatment of Other NTDs such as Lymphatic Filariasis (LF), Soil Transmitted Helminthiasis (STH), Schistosomiasis and Trachoma with Onchocerciasis. Therefore all activities conducted are integrated to cover all Onchocerciasis and the other NTDs. The NOCP started a new cycle of CDTI activities for the year 2008 and between July and October 2008 succeeded in completing the following activities: JJ A refresher TOT on CDTI was organized in 2 sessions by the NOCP in Makeni (07 - 09107/08) and Bo (10 - 12107108) towns. 4 members of the District Health Management Teams (DHMTs), including the District Medical Officers (DMOs) and the District Oncho Focal Points, were invited from Kono, Port Loko, Kambia, Koinadugu, Bombali and Tonkolili districts to the TOT in Makeni between 7h and 9'h July 2008. The same groups of 4 people were invited from Kailahun, Kenema, Bo, Bonthe, Pujehun and Moyamba districts to attend the TOT in Bo Town between the l0'h and l2s July 2008. Representatives of the OnchoA.,lTD working group participated in the 2 training sessions. These included representatives from Partners such as HKI and SSI, the Eye Care, School Health and Health Education Programmes of the Ministry of Health and Sanitation, 12 NOCPNTD Stafi including 8 Entomology Technicians. The TOT lasted for 3 days each and the agenda was on operational issues such as problems detected in the districts during previous CDTI and how these problems can be avoided in the future. New issues relating to integration of Onchocerciasis and LF treatment in the districts were discussed. Please see agenda (Annex I below) for details of training. The forms used for CDTI were also reviewed to accommodate treatment for LF. The NOCP succeeded in completing training of all 800 PHU Staff working in areas where Onchocerciasis is endemic in the 12 Districts using funds from the APOC, SSI, and RTruKI lz'h - 22nd July 2008. The agenda used was identical to the agenda used at the TOT. The Training of PHU staff in the districts lasted for 3 days each and the agenda was on operational issues such as problems detected in the districts during Ivermectin distribution and how these problems can be avoided in the future. New issues relating to integration of Onchocerciasis and LF treatment in the districts were discussed. The forms reviewed to accommodate treatment for LF at the TOT were also discussed. 800 PHU Staff were trained in the 12 Districts endemic for Onchocerciasis in July 2008. DHMT members that attended the TOT conducted the training of PHU staff within their respective districts. Members of the NOCP also attended all PHU trainings and acted as additional facilitators. Since CDTI is being established for the first time in Sierra Leone, there is need to enter and hold meetings in each of the villages where CDTI is to be conducted. This is to improve the knowledge of various communities on CDTI and to get them committed to playing the major role of distributing Ivermectin once a year, which needs to continue for at least l5 years. The NOCP conducted community meetings in 7,645 villages of ll districts between 23'd July 2008 and 6'h August 2008. Many problems were detected during the last CDTI cycle relating to communities, such as: -High refusal rate due to "wait and see attitude" due to the side effects that occurred in some communities; -CDDs are now demanding incentives. The promise by communities to provide some form of incentive was not fulfilled. District health workers conducted the community meetings in the villages and these meetings were supervised and monitored by members of the respective DHMTs, Representatives of Supporling Agencies such as Helen Keller International (HKI) and SSI, and Staff of the NOCP. District health workers had to address these problems during community meetings and ensured that CDDs were reselected in communities where previously selected CDDs had refused to distribute Ivermectin during the last MDA. Salaries were paid to non-ministry of health workers who are attached to the NOCP for the months of January, February, March, April and May 2008. Lump sums were also paid to the Programme Manager and some other members of the NOCP for the period January-May 2008. Repairs and maintenance were carried out on the 4 ONCHO/SIZ vehicles remaining with the NOCP. 34 MALI l. Introduction Surveillance and onchocerciasis control activities carried out in Mali in 2008 centred mainly on epidemiological surveillance/evaluation, ivermectin treatment of communities, entomological surveillance,-.upu.ity building of health and research services: 2. Epidemiological surveillance/evaluation About thirty sentinel villages were monitored in 2008 in the following river basins: the Niger and its tributaries, Banifing II and IV, Baoul6 East and West, Bago6. A total of 5996 persons were examined in all the basins. Prevalence rates and CMFL were nil in the communities. 3. Community-directed treatment with ivermectin (CDTI) A total of 3425 out of 3524 villages under CDTI were treated with ivermectin as part of the implementation of the control of NTDs. 99 villages did not get treatment, since they are test villages where ivermectin is suspended for purposes of a study on the feasibility of elimination of onchocerciasis transmission with ivermectin. The overaf l therapeutic coverage was 78.7%o,with more than 6000 CDDs available. About 4,946,046 ivermectin tablets were distributed for treating communities. 4. Entomological surveillance Standardized catching, followed by dissections and bulk collection of blackflies were cagied out in the Niger basin at the Tienfala and Pont Faya catching points from I July to 3l October 2008. Out of a total of 3gg73 blackflies caught, 5369 were dissected, of which 30 were infective females with 58 L3 Head. 34505 females were put in alcohol and sent by DHL to the MDSC DNA Lab. The rates of infectivity and results of infective larvae identification are being awaited. 5. Capacity building of health services and communities Training/re-training sessions were organised for social and health staff and communiry workers within the framework of the implementation of NTD control. Supervision, periodic reviews after NTD treatment campaigns and the annual review which were carried out allowed for proper appraisal of activities. The NOCP was provided with technical and computer equipment for onchocerciasis surveillance activities. 6. Resources used a. Finance The state and its main partners (WHO/AFROPOC, SSI, OPC) contributed to onchocerciasis control to the tune of about CFA24 744 380. 35 USAID/HKI mobilised FCFA540 000 0000 in support of integrated mass treatment of NTDs b. Human resources The NOCP teams collaborated with the regional, district and community teams to implement activities c. Logistics The vehicles inherited from the former OCP, and those available for studies on the feasibility of elimination of onchocerciasis transmission with ivermectin, were put to use. APOC supplied a Toyota Hilux vehicle and about 60 bicycles to the NOCP 7. Constraints o The dearth of funding and lateness in mobilizing funds from the sate and some partners for carrying out Oncho surveillance activities at the time indicated in the operational plans. o Insufficient and timeworn logistics at the national coordination office of the Oncho control programme. . High turn over of CDDs, the reluctance of some communities to undergo skin snipping and lateness in transporting ivermectin treatment results of communities to the health services. 8. Conclusion Surveillance and onchocerciasis control results are encouraging in 2008. However, much remains to be done to address the constraints mentioned above, in order to safeguard the gains of the former OCP. To this end, it is necessary to finance, at all levels, the entire activities scheduled in the various operational plans of the health services to control onchocerciasis. DISCUSSIONS ON ITEM F (Contd) In discussions after the presentations, the following points were raised: The director of APOC noted that blanket presentations of CDTI results did not show villages that had low coverage. She, therefore, suggested that in future coordinators should highlight villages and hamlets with low therapeutic coverage and areas with low geographic coverage rates. This, she said, would enable the targeting of communities that required additional supporl to raise their coverage rates; The last epidemiological evaluation in Togo showed an overall downward trend of prevalence in all villages that bordered on Ghana, where the situation was previously not good. ln the Md village, 8 new persons that tested positive were found during the last evaluation. The coordinator was asked to check whether these were incidental cases; Due to the old age of entomological technicians, and the high number of staff going on retirement in the former OCP countries, APOC and MDSC are arranging short-term training courses at the United Nations Kara base in preparation for take-over. Some countries have been contacted to present candidates. APOC and MDSC managements were asked to organise the training sessions to benefit all APOC and former OCP endemic countries. Togo and Benin have a pool of entomology technicians, trained by WHO/SIZ from2003 to 2007;' In Senegal, all the CDTI villages were treated with 100% geographic coverage. Regarding epidemiological evaluation, 68.2oh of persons were examined. ln 2009, the inclusion of an awareness- raising activity is planned prior to evaluations, in order to increase the rate of participation of the communities. 36 G. FINAIYCING OF CONTRIBUTIONS ONCHOCERCIASIS CONTROL ACTIVITIES: PARTNER In the introduction to her presentation, APOC director recalled, for the benefit of new coordinators, the key concepts of CDTI as follows: Empowering communities right from the outset of control; community ownership; the for effective partnership between all actors (communities, medical staff, NGDO partners), and government commitment, which should no longer be limited to the signing of memoranda, but respecting commitments made; all of which contribute to the sustainability of interventions. Besides, she highlighted the role and responsibilities of donors. To fully play their role, she said, donors have put in place the APOC Trust Fund designed to ensure that even in the event of failure of one of them funds are still made available for activities to be carried out. With regard to the adoption of the CDTI strategy, the APOC director explained that prior to 1994 several programmes carried out activities for the benefit of communities without the involvement of the latter, but with the advent of ivermectin, the tablets had to be distributed to thousands of persons. There were also the problems of dearth of health staff, hard-to-reach communities, as well as the weak health systems, scarce resources of NGDOs and donor fatigue. Through operational research activities, it was realized that communities which are organised and empowered to distribute the drug recorded excellent coverage rates. In other words, health interventions conducted in the communities directed by the community itself were more effective, and hence sustainable. The only lapse observed had to do with the preparation of treatment reports. This was the rationale behind the adoption by OCP and APOC of this strategy for the distribution of ivermectin. What must governments finance? Each government has signed with partners a memorandum of understanding, which makes co-financing of activities mandatory. Under the MOU, the health systems of countries should be able to allocate funds for CDTI activities in their current budget. Oncho coordinators are, therefore, called upon to advocate to health authorities of districts, regions and local governments so as to integrate onchocerciasis surveillance and control activities into their plan of action and budget. On the financing of CDTI projects in APOC countries, APOC co-finances the projects during the first 5 years, during which the APOC Trust Fund finances at least 75Yo of the annual budget of the project. Governments and partner NGDOs bear the remaining 25Yo. Following this five-year period, the project is evaluated, and an additional 3 years are granted to ensure sustainability. These 3 years are of utmost importance, because safeguarding gains depends on the commitment of governments. Thus, government contributions are meant for a range of activities, including the procurement and delivery of Mectizan, support for training and re-training of health staff and CDDs, supervision, monitoring and evaluation carried out by health personnel, census-taking and updating of data co-financing of Onchoi\lTD meetings, management of serious adverse events,IEC materials and their development etc. The three groups of indicators, which are key to guaranteeing the sustainability of a CDTI project are: I ) training/re-training, health education, sensitisation and mobilisation;2) supply and distribution of Mectizan;3) monitoring and supervision. State contribution to essential onchocerciasis control activities from 2005 to 2007 was below expectation in that, of the earmarked amount of US$6,897,137 for 2005, only US$1,638,933 was disbursed, and for 2006 out of the US$9,070,484 earmarked, only US$ 1,570,107 US $ was disbursed. ln 2007, out of an amount of US$7,314,283 earmarked, only US$1,450,886 was disbursed. On the other hand, staff salaries are regularly paid and are being increased. It is obvious that if the number of health staff is being increased, governmenis are not going to give them adequate means to carry out key CDTI activities. An increase of 38%o in state contributions was, however, noted between 2005 and 2007 . 3t H. DISCUSSIONS ITEM G Discussions after this presentation centred on The need to make the APOC director's presentation available to ministers of health, in order to raise their awareness. A suggestion was made that the session of the Joint Action Forum, the governing board of APOC scheduled to hold in December 2008, was a good opportunity, since it would bring together all the health ministers. To this end, the APOC director recommended urged national coordinators to solicit the support of WHO country representatives in sensitising ministers to participate in this meeting. Also, in consultation with the West African Health Organisation (WAHO), the annual assembly of health ministers of the sub-region could be another opportunity; Financing by APOC of four former OCP countries: The APOC director assured Oncho coordinators of C6te d'Ivoire, Ghana, Sierra Leone and Guinea Bissau of the programme's support until 2012, and indicated that this was an opportunity for them to re-vamp CDTI activities; With respect to financing APOC projects, the director explained that the programme usually gave maximum support during the first five years, and the funding is gradually reduced to enable countries to take over in a smooth manner. tn the last 3 additional years, (6ft to 8s year), only equipment is taken care of. The programme no longer finances the other activities although it still supports projects to attain sustainability. It behoves countries to take over financing of the key activities. But when a reduction in coverage is noticed in some projects, a "Special country Initiative" is initiated by APOC, enabling the programme to finance a number of activities, including sensitisation, and training/re-training of CDDs to increase their number and enhance efficiency, so that the project does not completely collapse. PLANS OF ACTION AND BTJDGET 2OO9 FOR SAFEGUARDING AND STRENGTHENING CONTROL GAINS All national coordinators of the former OCP countries, except Mali and Sierra Leone, which were not at the meeting, took turns to present their 2009 plans of action and budget (Annex 6). DISCUSSIONS ON ITEM H The following points were raised in discussions after the presentations: The need to have budgets approved by partners, and also for health districts to put CDTI activities in their action plans; The need to take into account weaknesses observed in 2008, so as to plan 2009 activities better. This will provide strong points to convince partners, and also to put in place corrective measures to address identified problems; Dr Yam6ogo, Coordinator, APOC Director's office, reassured national coordinators that the software for managing CDTI data, initiated by SlZ, was still valid and that APOC would take measures to make it available to countries when it was finalised; The representative of Ghana was asked to assess the cost for updating the REMO map in the country; The budget of the PNLC6 of Cdte d'Ivoire comprises an operational line item and an equipment line item, but field activities are not taken into account; The onchocerciasis coordination outfit is virtually non-existent in Niger. The devolution programme has not functioned for the past three years, because of lack of funding; The APOC director raised the issue of management of the bicycles given to CDDs. She asked participants to define transparent criteria for allocating these bicycles to CDDs in order not to create conditions that would jeopardize CDTI activities. Several suggestions were made: l) allocating bicycles to CDDs of the most deserving health districts; this competitive spirit could encourage other districts to improve their performance; 2) giving the bikes to oldest CDDs; 3) to CDDs that have several communities to serve; 4) to CDDs that are far away from health facilities. 38 I. CO.IMPLEMENTATION AS A FACTOR OF SUSTAINABILITY OF CDTI ACTTYITIES AND STRENGTHENING OF HEALTH SYSTEMS CAMEROTJN l. Introduction Onchocerciasis is the third cause of blindness in Cameroon. More than 9 000 000 people live in areas that are at risk of onchcocerciasis, with about 6000 000 infected persons. There are 15 CbTI projects in 105 districts out of the 174 districts in the country. All the ten provinces of the country are oncho endemic at varied endemicity levels. 2. Co-implementation and sustainability CDTI activities in a given region are deemed sustainable, when they are carried out in an efficient manner ensuring high coverage, are integrated into existing health structures and show strong community ownership, while using resources mobilized by the community and government. In Cameroon,22,508 CDDs were registered in 2008 in the 15 CDTI projects. Concerning Mectizan distribution, government decided since 2002, to give incentives to the CDDi, but th" incentives often came late. On the contrary, CDDs in other community-based health programmes enjoy incentives given by these programmes. Co-implementation promotes sustainability of CDTI and other health programmes. MALAWI l. Introduction The Malawi Onchocerciasis Control Programme was started in 1984. During the first years the programme focused mainly on assessing how many people were affected by the diseaie, determining infettioln rates, identi8ing vector species involved in transmission of the disease and recommending appropriate control measures to the Ministry of Health (MOH). After extensive trials with a new drug called Ivermectin (Mectizan@) from 1987 to 1990, mass distribution was started in Thyolo District in l99l and Mwanza District in 1993. With assistance from ApOC, a countrywide survey using the Rapid EpidemiologicalMapping of Onchocerciasis (REMO) was conducted in 1997' Results from this survey showed that besides Thyolo and Mwanza,/Neno, the disease is found in parts of Mulanje, Phalombe, Blantyre, Chiradzulu and Chikwawa Districts. In 2000 the onchocerciasis programme extended activities from Thyolo and Mwanza to what is known as the Extension CDTI Project comprising of Mulanje, Phalombe, Blantyre, Chiradzulu, and Chikwawa Districts. 2. Partnership The NOTF Malawi which oversees the programme, comprises the Ministry of Health (MoH) and other partners such as Sight Savers International (SSI), Tea Estates Association of Malawi, and the World Health Organization (WHO). For the past 8 years, the Tea Estates in Mulanje and Thyolo districts have actively carried out treatments on their establishments. Mectizan distribution on the Tea Estates is carried out by voiunteers who are trained by the Estate Clinic Health personnel assisted by the District Onchocerciasis Coordinator. 39 3. Drug flow Mectizan tablets are ordered by the NOTF Secretariat from Merck. After the tablets are received at the National Office, they are taken to Blantyre DHO Pharmacy from where all the districts make their orders. When their allocation is approved, the districts collect the drugs from Blantyre Pharmacy. From the district, Mectizan is delivered to health facilities which are closer to the communities. Health Surveillance Assistants (HSAs) who are direct supervisors of the CDDs collect Mectizan from the Health Facilities and the CDDs collect the drug from the HSAs who are based in the communities. 4. Supervision Supervisions are done at National, District, Health Centre, and CDD level. 5. NOTF Meetings NOTF Meetings are held quarterly. For 2008, the periods of meetings are January, April, July and October (to be held in November due to APOC mission). 6. Successes/Achievements Maintenance of 100% geographic coverage and over 650/o treatment coverage since 2004 (Fig.I ) Fig. l: Couvertures g6ographique et th6rapeutiques des projets TIDC du Malawi (2004-2007) . Uninterrupted treatment since 1997 and 2000 for Thyolo/Tvlwanza and extension projects respectively . Assurance of funding from the Government . Ability of districts to plan and fund oncho activities (integration) . Completion of determination of coordinates for all the CDTI villages 7. Challenges Staffturnover I CDD serving a population of slightly more than a population of 100 Employment of new HSAs who would require training 8. Opportunities Availability of first line health workers (HSAs) at community level who enhance supervision of CDDs NGDO partner EThi,ll,A,a IExtensPn Therapeutic coverage (2004-2007) (C ouvertu rc th6 npe uti q ue) \tJts 2m5 a06 200720t)4 100 80 P60 5ao c 120 0 2$4 2offi Thuap ?utic covrlagr p or d lstrlct 1200{ -2007) (C ouve r7u re gE og r aph I q ue) t3 m mil n E] H U trj] """ --'"- *S o-nod -.t$".C ffi -70 3ffi 5fl 920 rlg D rslil cts 40 I 2 J 4 5 6 7 NIGERIA Single disease controU eliminatior/ eradication programmes implemented in a vertical manner used to be the norm. Though successes were recorded, implementation could be more far-reaching in a cost-effective manner with more interventions accessible at end-user level/same service point. The following factors assisted in enhancing co-implementation in the country: o Establishment and adoption of the CDTI strategy o The change in donor-community emphasis from single programme support to multi- and integrated programme implementation approach o The NGDO Pull (adding on other programmes to sustain existing assisted programs as donor fatigue sets in) o APOC Initiative in convening various meetings on integration and co-implementation ' The Health Sector Reforms in Nigeria culminated in the formation of Division/Branches that promote integration/co-implementation (e.g. Neglected Tropical Diseases; Lymphatic Filariasis elimination merged with Onchocerciasis control programme) as well as the setting up of NTD Steering Committee(and its Terms of Reference). The Ministry of Health, especially at the Federal level is now driving co- implementation Current Situation LF/Oncho being co-implemented in 3 States (Ondo, Osun, Ekiti). vAS/oncho being co-implemented (some on a sporadic basis) in l2 States. LFiOncho /Schisto /VAS /ITN being co-implemented in 2 States (Plateau & Nasarawa). cDI is being expanded (vAS/ oncho iHMM /ITN) in 3 States (Taraba, Kaduna, oyo). Schisto/Oncho being co-implemented in Delta State. Baseline surveys are being conducted for LFl Schisto /STHs in 3 States. Integrated Mapping of Schisto/Trachoma /LF in 2 States (plateau & Nasarawa). Successes recorded include: o Coverage rates for Onchocerciasis control increased/sustained o Re-awakening of the interest of the target population getting bored with the same story of Mectizan o Involvement of more health workers in the CDTI process ' Increasing awareness of CDI strategy as the 'in-thing' for community-based interventions. o Greater access to health services by the rural poor . Huge cost savings in programme implementation Future Plans Plans for 2009 are l. Co-implementation of Malaria and Ivermectin distribution in 9 World Bank Assisted'Booster states,(lTN/HMIWOncho) 2. Mass Drug Administration for oncho/LF targets l2 states (ATo:7.5 Million)3- CDTI to be implemented to cover all parts of the 3 focal states, and possibly initiated in 3 other contiguous states. 4. Co-implementation of Schisto and STH treatments with LFlOncho in 3 states5. Co-implementation with Trachoma programme(distribution of Zithromax) in 2 additional states 41 The challenges are: . Availability of commodities in sufficient quantities and in a timely manner . Complexity in management when several programmes are being co-implemented in different parts of a project. o Work load and demand for incentives at all levels . Inadequate funding Despite these challenges, there are opportunities to be seized upon in the spirit of integration and co- implementation, especially: l. NTDs Policy due for presentation at the 2008 National Council on Health Meeting l7-21 Nov. 2. Neglected Tropical Diseases viz; Buruli Ulcer, Human African Trypanosomiasis, Schistosomiasis, Soil Transmitted Helminth and Trachoma are now incorporated in lntegrated Disease Surveillance and Response system. 3. CDDs have been harnessed during Immunization Plus Days for extensive Guinea Worm Disease case search in over 50, 000 communities. 4. Annual Measles campaign is also being harnessed for ITN distribution by utilizing the CDDs. 5. Integrated Training Manual for Neglected Tropical Diseases (still being developed) 6. 5-year Strategic plan for Neglected Tropical Diseases (still being developed) CENTRAL AFRICAN REPUBLIC 1. Introduction Onchocerciasis is endemic in l0 of the 16 prefectures of the CAR, with I 500 000 persons at risk of onchocerciasis. . Overall, 5014 communities are under CDTI. Following the military/political upheavals that took place between 2001 and 2003, CDTI activities were disrupted, making it difficult to ensure the sustainability of CDTI. Between 2003 and 2006, all partners suspended their financial support. Only afterthe APOC director's visit in 2007 that partners renewed their support for activities to resume. 2. Co-implementation Co-implementation of CDTI with other health interventions was experimented in CAR between 2001 and 2002, with LINICEF. This had to do with the administration of vitamin A, coupled with ivermectin in the communities under CDTI. The military/political disturbances, between 2001 and 2003, brought about a change in strategy and targets for LINICEF, especially emergency interventions in the areas affected by the conflict. Co-implementation was neglected and national inoculation days instituted instead, during which vitamin A was administered. 3. Current status of co-implementation A strategic plan for NTD conffol implementation in CAR by the NOCP (onchocerciasis, LF, trachoma, schistosomiasis and soil-transmitted helminthiases) was drawn up in 2007. The national NTD control programme was set up in July 2007. This programme was piloted by the national coordinatorA.lOCP prior to the appointment of a substantive NTD national coordinator. In June 2008, partial mapping of NTDs in 8 of the l6 prefectures of CAR was conducted. Training modules on chemo-prevention of NTDs were also elaborated in line with the CDTI approach. 42 3. 2009 Action Plan . Finalising NTD mapping in the other 8 prefectures; . Joint administration of chemo-prevention of NTDs. 4. Conclusion Before co-implementing other health interventions, CDTI needs to be well established in CAR. UGAhIDA 1. Background Onchocerciasis is endemicin2T districts of Uganda. More than 2 million people are at risk and 85% of the transmission is by S. neavei. s. s. 2. Uganda's strategy to achieve elimination: Semi-annual treatment with ivermectin using community-directed treatment approach. Annualtreatment with ivermectin using community-directed treatment approach. Vector elimination where feasible Targeted vector control where needed in order to put pressure on the vector. 3. Co-implementation with Child Days 2008 Albendazole heatment: In Mbale, Kanungu, Kisoro, Kabale, Manafua districts LF treatment using albendazole: 144,325 peoples where treated in Adjumani district and 149,896 peoples in Moyo districts with coverage rate of 82.9%o and 76.0 o/o) respectively. Vitamin A supplementation Kabale, Kanungu, Kisoro, Mbale, Manafua. Children treated were 4,090; 7 ,138; 5,6071. 6,907;5,186 respectively Other areas include EPI and malaria Control Programs 4. Achievements . Elimination by vector control from Victoria Nile focus ' Vector elimination achieved in some isolated foci (Itwara focus in Kabarole and Kyenjojo districts) with assistance from GTZ and APOC. ' Vector elimination achieved in Mpamba-Nkusi in Kibaale with assistance from APOC. ' Ivermectin treatment coverage has been >7|yo of total population for the past 10 years. ' Onchocerciasis is no longer a public health problem (nodule prevalence <2Oo and mf prevalence <40%). 43 a W.stNlL Focur o XrshoFxlloml Focor NIIc Fmus Mt Elgotr Fotu.s Caae lpidbnobjpr dt l'orchocms u OuSuL nnmtbJola isut Onthoccrdulr Epldcnlologlcd Mrp olUgudr rtorlng bohtcd focl KEY L€gende Ps dc lrcwn D.pus 2N5 Cumr boltd loci Itwrr Nad Purtlcr Nk.M hrenijrtiu ,nwdtgalbn conqUmn!@ Yrtorir Nrh foo .t6i!ea Bhwl Nnt prior lgiL l98o 5. Major issues to consider After a decade of annual ivermectin treatment: There are still infected old children l0 years and above and adults. Young children are still infected showing that transmission continues There are still inseminated female worrns, and A substantial percentage of live female and male worns indicating that halting annual dose could result into recrudescence of onchocerciasis. DISCUSSIONS ON ITEM I Observations and discussions following APOC country presentations: Each country in its presentation highlighted the epidemiological status of NTDs, the level of integration of onchocerciasis activities with other health programmes, the results obtained as well as difficulties and constraints. It was clear from the presentations that countries are at various degrees of progress in terms of co-implementation. Activities that are integrated vary from one country to another. It was obvious also that the strategy for co-implementing activities is more widespread, and that CDTI basically served as the powerhouse. Discussions helped to throw light on the CDD incentive system put in place by the government of Cameroon, as well as on progress made with respect to the activities planned by the govemment of Malawi in the Zomba area, and also those planned by the Central African Republic in the Zonga and Bwale areas. The director of APOC urged the Malawi representative to send to APOC the base data on onchocerciasis prevalence in the Mwanza and Thyolo, as well as on the beginning of ivermectin treatment in these areas. ln addition, she informed the meeting that the CAR would henceforth be part of post-conflict countries 0 0 0 0 No E D&irrio br2ll)s @Ueu.l Fqnr 44 o ffi o o J. PARTNER SI]PPORT FOR ONCHOCERCIASIS CONTROL IN 2OO8 AI\TD PROJECTIONS FOR 2009-2012 WAHO Introduction Onchocerciasis control remains a priority for WAHO, which expects countries to also treat the disease as a priority. For this reason, WAHO is ready to assist with advocacy at all levels to ensure: . enhanced ownership by countries;! resourcemobilisation; . respect of partners' commitments. Line of Action WAHO has drawn up a second strategic plan for the2009-2013 period. This plan puts special emphasis on support to ECOWAS member countries, and targets programmes instead of diseases. Stratesic orientations The2009-2013 plan is structured around four strategic orientations: 1. Support to improve health system quality; 2. Support for improving health coverage in the sub-region; 3. Assistance in developing sustainable financing of health; 4. Institutional development of WAHO. Priority Programmes The strategic orientations have 9 priority programmes: . Coordination and Harmonisation of health policies ' Health information . Research development . Promotion and Diffusion of good practices . Human resource development in the health sector . Drugs and Vaccines . Traditional medicine . Diversification of mechanisms of health financing . Building institutional capacity of WAHO Suonort for on sis control WAHO has, since 2005, introduced one budget line for collaboration with APOC and other partners for coordinating onchocerciasis control in West Africa. This budget line enabled WAHO to participate in various meetings, and for 2008, specifically, in co- financing the first post-SIZ meeting of Oncho coordinators of the former OCP countries. P riorities/Pro i ections WAHO is particularly interested in: ' Human resource development; 45 Capacity building, particularly in training and re-training of entomologists; training in the use of the Geographic lnformation System (GIS); The coordination and follow-up of regular holding of cross-border meetings for onchocerciasis surveillance activities. Establishing a formal framework of collaboration with APOC and MDSC is WAHO's priority for diversiffing activities conducted with APOC, and for increasing the areas of collaboration with MDSC beyond onchocerciasis control activities. With OCP, a satisfactory level of onchocerciasis control had already been achieved in the sub-region. These results were consolidated by APOC under SlZ. The results from using ivermectin to eliminate onchocerciasis transmission, revives the hope of seeing the disease as a scourge of the past. WAHO expects to collaborate with all partners beyond the control effort by committing itself totally to onchocerciasis elimination. MDSC The director of MDSC indicated that the role of the Centre was disease surveillance, and highlighted the activities of its molecular biology laboratory. He also mentioned the MDSC's collaboration with WHO/TDR in the study of onchocerciasis elimination feasibility in West Africa, collaboration with APOC on cross- country studies (Nigeria/Benin), blackfly movements, and the development of surveillance tools. He underscored the role the MDSC could play in training and re-training of entomologist technicians. The MDSC director however, noted that the centre was undergoing a transition phase and as soon as the institutional reforms, being put in place for a new centre, were over, the MDSC would be better positioned to serve countries. SSI The representative of SSI made a presentation on the financialcontributions of the organization to countries where it operates. See the table 4 below with the amounts in Pounds Sterling: Table 4: SSI contribution200T-2008 (ln Pounds Sterling) Country Contribution: 2001 Contribution : 2008 Benin 54 500 55 000 Cameroun 83 000 84 400 Ghana 43 500 50 400 Guinea Conakry 18 800 l8 800 Guinea Bissau 21 700 2t 700 Liberia 24 900 24 900 Mali l5 300 ls 300 Nigeria 50 500 39 600 Sierra Leone 91 000 59 500 Togo 58 900 54 500 Total 462 100 424 500 HKI The representative of Helen Keller International (HKI) said the objective of the NGDO, founded in Paris in 1915, is to save sight and the life of the most vulnerable and disadvantaged. HKI's activities are in the area of onchocerciasis control (support to CDTI, advocacy, IEC), trachoma, cataract and refraction problems. The 46 organization's area of intervention, cover some former OCP and APOC countries. The HKI has started activities in Vitamin A supplementation, lymphatic filariasis and cataract screening. It also plans to, intervene in NTDs, although it currently has funding difficulties, due to the abrupt suspension of Japanese funding, which is being re-directed to Asian countries. However, the HKI representative reassured the meeting that some funding has already been acquired, and that it was continuing advocacy toward donors to mobilise additional resources. HKI's activities in Cote d'Ivoire started in 2000, though they were intemrpted from 2002 to 2004, following the political crisis in the country. HKI resumed activities in the country, giving support in re-launching CDTI in 1,079 sites in 2005, and in 1,718 sites spread over l6 districts in 2006. In2007, HKI contributed to the development of a strategic plan for blindness control (Vision 2020 lnitiative) with the integration of onchocerciasis control. It projects to finance the implementation of CDTI in 8 districts, with community mobilisation being strengthened, with financing from Standard Chartered Bank to the tune of US$29,000 in the government-controlled area, and in two districts of the New Forces (rebel) area, with funding from the Mectizan Donation Program, to the tune of US$19,000. Other funds are being mobilised from Afrijapan/Japan Fund for implementing CDTI in 45 other health dishicts of the country. DISCUSSIONS ON ITEM J As part of discussions after the presentations: - Dr Yamiogo, on behalf of the director of APOC, congratulated various paftners for their commitment to onchocerciasis control, especially for the clear presentations of their financial input. He stressed the need for national coordinators to ensure that in the countries, the amounts allocated by other partners were reflected in the returns sent to APOC. He also thanked WAHO, which is willing to support countries in the area of operational research and training. Dr Yamdogo said there would be consultation between MDSC, WAHO and APOC on entomology and epidemiology training. - Dr Sacko explained that correspondence to WAHO for any assistance should be addressed to the ministers of health of countries, who have the mandate to put in a request to WAHO. It was also made clear hat the area of intervention of WAHO is limited to the ECOWAS sub-region. - The meeting was informed that there were no particular criteria for applying for SSI assistance, as far as onchocerciasis was concerned, but it would be preferable to channel such requests through APOC. - The HKI representative urged countries to make further commitments to onchocerciasis control. In view of dwindling interest by donors, countries' commitment will motivate partners. The HKI representative noted that NTDs could be an opportunity for onchocerciasis control. K. INTER-COUNTRYCOLLABORATIONFORSTRENGTHENING ONCHOCERCIASIS CONTROL AND STIRVEILLANCE ACTIVITIES AND THE OTHER NEGLECTED TROPICAL DISEASES BENIN The representative of Benin stated that a meeting was held with Togo in 2008. The other slated meetings could not hold due to lack of funding and organisational problems. He also mentioned the study on blackfly movements being carried out in collaboration with Nigeria. BT]RKINA FASO Burkina Faso did not hold any inter-country meeting, but is expected to participate in such meetings. In this connection, the country is in touch with Cote d'Ivoire and Ghana. 47 COTE D'fVOIRE From 7 to 8 February 2008, a meeting was held in Freetown involving Cote d'Ivoire, Guinea Conakry, Liberia and Sierra Leone within the framework of consultations of the Mano River Union. During the meeting, cross- border control activities, training on screening of eye diseases, advocacy for annual coordination meetings, synchronisation of treatments at the border, treatment of children with ivermectin and joint mapping activities were reviewed. GHANA In Ghana there was no cross-border meeting. At the beginning of 2007 a meeting, initiated by SSI, was planned with Togo, but it could not hold. Contacts were, however, made with Togo and the other border countries for Ghana to organise the cross-border meeting next year. GUINEA BISSAU There was no cross-border meeting, but one is planned with Guinea Conakry GUINEA CONAKRY Guinea Conakry participated with Nigeria in the Freetown meeting organised with Cote d'Ivoire. This meeting resulted in an epidemiological and entomological evaluation, with results showing a resurgence of prevalence. Entomological evaluation is ongoing. NIGER In Niger, there was no meeting, but the representative acknowledged the need for these meetings, noting that, as part of NTD control activities, there is a platform of collaboration with neighbouring countries. SENEGAL Senegal and Malijointly participate in the feasibility study on onchocerciasis elimination. TOGO The country plans a meeting with Ghana and Benin. DISCUSSIONS ON ITEM K Discussions after the presentations: - The WAHO representative indicated that his institution may give support in organising cross-border meetings, and proposed, in this connection that for equity and sustainability, there was need for a platform for all the countries to discuss the financing, practical organisation and follow-up of these cross-border meetings - The director of APOC emphasized the need for the cross-border meetings, and the necessity to highlight the potential of available resources for eliminating onchocerciasis as a public health and socio-economic problem in the sub-region. The director said APOC was willing to co-finance the meetings to the tune of 75Yo, and since WAHO also wanted to co-finance them, she suggested to the coordinators to draw up a time-table for holding the various meetings so as to institutionalise them, in order to facilitate their co-financing. Following discussions, former OCP countries were asked to get together to reflect on organising these cross-border meetings. - The director of APOC urged coordinators in former OCP countries, which receive APOC funds, to use the funds judiciously, and to submit financial returns on time in order to continue benefiting from financing. 48 L. RECOMMENDATIONS After discussions, the meeting made the following recorunendations: l. Recommendations to national coordinators Presentation of CDTI and epidemiological evaluation results The meeting noted that an overview of CDTI and epidemiological evaluation results did not show the discrepancies among the regions, basins and communities, with coverage and endemicity level challenges. To better monitor the evolution of CDTI and epidemiological indicators in the target areas, the meeting recommended that national coordinators should: Illustrate in their presentations, villages and hamlets, with low therapeutic coverage rates and areas with low geographic coverage rates; Indicate epidemiological trends of such villages or hamlets Financing activities For CDTI to be sustainable in the former OCP countries, there is the need for all field actors to assume ownership of control activities. Administrative and political authorities should also be encouraged to understand the CDTI philosophy, and the need for mobilization of substantial financial resources. a a a The meeting also recommended: The scaling up of advocacy toward Governments in order to increase their financial support to onchocerciasis control programmes; Continued efforts at raising the awareness of ministries concerned, by inviting representatives of departments in charge of budgets in the ministries of health and finance to meetings for the drawing up of the plan of action and budget for onchocerciasis controlprojects. This will enhance understanding and facilitate the disbursement of funds allocated to onchocerciasis control from the national budget; Continued sensitisation of Directors of Disease Control and heads of health districts so that CDTI activities are taken into account in their plan of action and budget. 2. Recommendations to countries Financing of activities The meeting noted that the results presented by countries were generally satisfactory. However it was observed that some residual foci of transmission still persist, and this could constitute a threat to areas that are already cleaned up. In order to safeguard the gains of onchocerciasis control and elimination of the disease as a public health and socio-economic problem, the meeting recommended that: o Governments should allocate more money to onchocerciasis control activities, in line with the commitments under Yaoundd Declaration of 2006, as well as the Resolution of the 57th Session of the WHO/AFRO Regional Committee and the Resolution of the 7h ECOWAS Assembly; o Funds allocated to national onchocerciasis control programmes should be disbursed on a regular basis and on time, to improve control activities; a a 49 a Countries, whose financial systems do not allow national budgets to finance field activities (training, follow-up, supervision and sensitisation), should make provisions for a budget line to be allocated to national onchocerciasis control teams to finance CDTI activities. 3 Recommendations to the MDSC and countries Transporting samples to the MDSC DNA Laboratory in Ouagadougou The meeting noted that most countries reported problems in transporting blackflies, larvae and parasites to the MDSC Lab in Ouagadougou. As a solution, the meeting recommended: a a That Benin, Ghana, Niger, Togo and Mali should negotiate with road transport companies (SKV, TCV, STC, TSR, STMB...) for the transportation of samples to Ouagadougou Other former OCP countries (Siena Leone, Senegal, Guinea Bissau, Guinea Conakry, C6te d'Ivoire), should make arrangements for the transportation of blackflies to the MDSC Lab in Ouagadougou. The MDSC, in collaboration with national coordinators of various countries should put in place a safe and dependable system for bringing samples to MDSC Lab by March 2009. Countries will bear the cost of transporting the samples to the MDSC Lab in Ouagadougou. a 4. Recommendations to APOC, WAHO. Partners and countries Organising cross-border meetin gs In order to share CDTI entomological and epidemiological evaluation results, and to find solutions to inter- country problems in the border areas, the meeting recommended: The holding of cross-border meetings among former OCP countries to share experiences on specific field issues; a Governments should contribute to the financing of the cross-border meetings. Training The meeting noted the ageing or retirement of entomologists and entomology and epidemiology technicians in many of the countries. To ensure constant availability of required human resources, the meeting recommended the training of personnel in various professional categories who will take-over and ensure sustainable implementation of control programmes in the countries (MDSC/APOC). 5. Recommendations to WHO/AFRO The meeting took cognizance of the information provided by the Director a.i. of the MDSC, especially the research efforts by the Centre and support to countries. To enable the MDSC to play its sub-regionalrole of supporting onchocerciasis control, in line with the set objectives, the meeting recommended: Speeding up of the process of institutionalizing the MDSC as a Centre of Reference; Providing the MDSC with adequate technical, human and financial resources to carry out its mandate. a a 50 M. CLOSURE OF THE MEETING Several speeches were made during the closing ceremony Dr Sintondji, chairperson of the meeting, thanked all participants for the smooth deliberations, while indicating that conclusions and recommendations remained the property of the group, but each person had to ensure their implementation. He then thanked NGOs, which have always supported the countries through technicaUequipment and/or financial assistance. Dr L.Yam6ogo, in turn, thanked Dr Sintondji for accepting to preside the first post-SZ meeting. He said the meeting was co-organised and co-financed by APOC and WAHO. He then thanked all partners (governments, NGOs) for their support to the conduct of onchocerciasis control activities. Dr Sacko underscored the need to safeguard at all cost, the gains of several years of onchocerciasis control, and for WAHO, just like the other partners, to continue its modest contribution to safeguarding the OCP gains. He emphasized the importance of the meeting of coordinators of former OCP countries, which, he said, was a forum to review activities and share experiences toward consolidating the gains and control activities in the countries. He, on behalf of the director general of WAHO, reaffirmed the readiness of the organisation to collaborate with all partners to continue with control activities in the sub-region. In conclusion, Dr Sacko appealed to the three institutions (APOC, MDSC, and WAHO) to set up a formal framework of partnership to pool efforts in taking onchocerciasis control actions. Dr Tanoh thanked APOC Management for inviting HKI to participate in this important meeting. She exhorted coordinators to continue with advocacy for mobilising the needed resources to finance activities, and reaffirmed HKI's support to countries. Mr Ouattara, in turn, thanked APOC Management and WAHO for organising this first post-SZ meeting. After reiterating SSI's support to the countries, he took the opportunity to inform the meeting that his institution was undergoing restructuring, which started in 2007, and of which the interim plan will be finished in December 2008. A new strategic plan will be implemented, beginning January 2009 and ending in 2013. Also, Mr Ouattara informed the meeting that since l" October 2008, he is the director for Partnership, Advocacy and Alliances for Francophone Africa. Dr Amazigo, APOC director, took the floor to thank Dr Sintondji for the exemplary manner in which he chaired the meeting. She then congratulated coordinators of former OCP countries for their commitment and excellent work done all these years in safeguarding the gains of OCP, and reassured the other countries, which do not benefit from APOC support, that the programme has the mandate to give them financial assistance, in the event any major problems jeopardized the several years of control gains. Dr Amazigo also expressed her gratefulness to coordinators of APOC countries, who accepted the invitation to attend this first postSIZ meeting, and wished APOC Management could keep up this initiative. Since these meetings are an ideal setting for discussions and experience-sharing, she hoped this would lead, in the long term, to cross-border collaboration in onchocerciasis control among coordinators of the former OCP countries and those of APOC. She thanked, in particular, WAHO for accepting to co-organise and co-finance the first postSIZ with APOC and also on behalf of SSI and HKI for their unfailing support to control activities all these years. Last, but not the least, she thanked the following: MDSC, which co- facilitated the meeting, the interpreters and all the support staff. She then wished all participants, a safe trip back home. 5l ANNEXES 52 AIIINEXE 1: LIST OF PARTICIPAITTTS First session Ouagadougou. I l-13 november 2008 FORMER OCP COUNTRIES BENIN l. Dr Paul Franck Roland Sintondji, Coordonnateur National Adjoint/PNLO, 0l B.P. 882, Cotonou, B6nin, Tel.: (229)2133 87 17, Cell: (229)90 93 53 05, Fax: (229)2133 87 17, E-mails : sedjros@hotmail.com et sintofranck@yahoo.fr BTJRI(INA FASO 2. Prof. Soungalo Traor6, Coordonnateur/Programme Oncho, Direction de la Lutte contre la Maladie, B.P. 7009 Ouagadougou 03, Burkina Faso, Bureau: (226) 50 30 87 90, Cell: (226) 78 85 24 56 ou (226) 78 84 79 84, E-mail : pefoungo@yahoo.fr COTE D'fVOIRE 3. Dr Kouakou-Ilunga Marie Madeleine, Directeur Coordonnateur PNLCd C6te-d'Ivoire, Cocody-Danga d Abidjan, Cdte d'Ivoire, Tel.:- Secretariat: (00 225)224437 01, Ligne direct du Coordonnateur/ FAX: (00 225) 22 44 37 83, Portable: (00 225) 07 08 38 03, E-mail : magdy_koua@yahoo.fr GHANA 4. Mr. Odame Asiedu, Programme Officer of the National Onchocerciasis Control Programme of the Ghana Health Service, Accra, Ghana, Tel. : (00233)21 670 102, Mobile: (00233) 244 761357, Fax: (00233)2122 39 67, E-mail: odame I l4@yahoo.com GUINEE BISSAU 5. Dr Ramalho Joiio Correia, Coordonnateur National du PNLO, Cabu, Guinde Bissau, Tel./Fax : (2a5) 5l l8 45, Cell: (245) 677 19 16 I 596 65 69, E-mail : rantonia2006@yahoo.es GUINEE CONAKRY 6. Dr Sylla Mohamed Sako, Epid6miologiste du PNLOC, Guinde Conakry, Tel.: (00224) 60 27 22 87 I 64 49 60 61, E-mail : svllamohamedOT@vahoo.fr NIGER 7. Dr Salissou ADAMOU BATHIRI, Entomologiste National Onchocercose, Ministdre de la Santd Publique, BP: 623 Niamey, Niger Tel. : (00227) 20 72 28 19, Cell. : (00227) 96 96 03 76, Fax: (227) 20 72 32 24,8- mail: sadamouba@yahoo.fr SENEGAL 8. Dr Moussa Dieng Sarr, Coordonnateur National du PNLO, BP 4024, Ministdre de la Santd et de la Prdvention, Fann Rdsidence, Sdn6gal, Tel. : (221)33 869 43 09 ou (221)33 869 42 91, Cell : (221)77 533 78 24,Fax: (221) 33 869 42 06, E-mail : mdiensarr@yahoo.fr TOGO 9. Dr Karabou K. Potchoziou, Coordonnateur National/PNLO, B.P. 487,Kara, Togo, Tel. : (228) 660 11 10 I 660 00 35, Cell. : (228) 902 47 95, Fax : (228) 660 04 14, E-mail : karaboup@yahoo.fr 53 APOC COTINTRIES CAMEROT'N 10. Dr NTEP Marcelline, Coordonnatrice Nationale du Programme de lutte contre l'Onchocercose, Ministdre de la Sant6 Publique, B.P. 155, Yaound6, Cameroun T6l. / Fax (237) 22 22 69 l0 (ligne Directe); Portables (237) 99 8l 08 0l / (237) 77 30 0l 60, E-mails : mangamar20Ol @yahoo.fr & sgoa@camnet.cm ll. Dr Joseph Kamgno, Centre de Recherche sur les Filarioses/PNlo, BP 5261, Yaound6, Cameroun, Tel (237) 22 20 24 42, Portable: (237) 77 78 97 36,Fax: (237) 22 20 24 43, E-mail : ikamgno@yahoo.fr NIGERIA 12. Dr Olufemi Ajumobi, Secretary of the National Steering, Committee on NTDs, Federal Ministry of Health, Abuja - Nigeria, Tel.: (234) 070 35 59 03 29, Mobile: (234) 080 85 85 36 71, Fax: (234) 95 23 70 99,8- mail : femiaiumobi2002@vahoo.com 13. Mr Chulrwu Okoronkwo, Programme Officer, NOCP Headquarters, Federal Ministry of Health, Abuja- Nigeria, Mobile: (234) 80 33 61 98 941 80 73 49 93 81 , Fax: (234) 95 23 70 49, E-mails: chukoro_christ@yahoo.co.uk & chukwu@gmail.com MALAWI 14. Dr Malangizo Mbewe, District Health Officer, Chikwawa, Malawi, Tel.: (265) 014 20 266, Mobile: (265) 9 369 688, Fax: (265) 01420264, E-mail : mmalan gizo@vahoo.co.uk REPUBLIOUE CENTRAFRIC 15. Dr B6noit Kemata, Chef de Service, Coordonnateur National du Programme de lutte contre l'Onchocercose,BPlTT2,Bangui,RdpubliqueCentrafricaine,Cell.: (236)70402601, Fax:sicWR(236) 21 61 0l37 ; E-mail : bkemata@yahoo.fr TCHAD 16. M. Hassan Guialoungou, Chef de Service de l'Unitd Epiddmiologique, Programme National Tuberculose i Division des Maladies transmissibles et non transmissibles (PNT/DMTNT), N'Djamena, Tchad, Tel.: (235) 252 60 10, Cell.: (235) 626 47 43, E-mail: guialoungouhassan@yahoo.fr UGANDA 17. Dr John Bosco Rwakimari, National Coordinator, P.O. Box 7272,Kampala, Uganda,Tel.: (256) 414 34 83 32, Mobile : (256) 712 04 21 29, Fax : (256) 414 34 83 39, E-mail : dr ibr@vahoo.com NGOs HKI 18. Dr Marie Brou-Tanoh Adjoba, Directrice Nationale HKI pour la C6te d'Ivoire, Abidjan, Tdl.: (22522 4l ll 1412241 1097,Cell.:(225)2241 11 14, Fax:(225)2241 1097,B-mail:mtanoh@hki.org OrsanisAliantQueqt Afriqaine pour la Sant6 (OOAS) 19. Dr Doulaye Sacko, Coordonnateur de Vision 2020 en Afrique de l'Ouest, OOAS Burkina Faso, Tel: 22620 97 57 75, Cell.: (226) 76 53 35 73, Fax: 226 20 97 57 72, E-mails: bayesacko2000@yahoo.fr, dsacko@wahoo.org & wahooas@wahooas.org 54 Sieth Savers International (SSf) 20. Dr Aboubacar Ouattara, Directeur de l'Afrique Francophone pour Ie Plaidoyer et les Alliances, P.O. Box : KIA 1 8190 - Accra, Ghana, Tel.: (233) 21 77 42 l0 Fax : (233) 21 77 42 09 - E-mail : abouattara@SightSavers.org OMS/ MDSC 21. Prof MandyK. Kond6, Directeura.i. MDSC, Ouagadougou, BurkinaFaso, T6l. :50 34 38 18, Cell.:7020 02 63, Fax : 50 34 28 75, E-mails : kondek@bf.afro.who.int & kondek@oncho.afro.who.int 22.Dr Laurent To6, MDSC, Ouagadougou, Burkina Faso, T6l.: 50 36 38 18, Fax: 50 34 28 75, E-mail toee@oncho.afro.who. int 23.M. Moussa Sanfo, MDSC, Ouagadougou, Burkina Faso, Tdl.: 50 36 38 18, Fax: 50 342875, E-mail : sanfom@oncho. afro. who. int 24.Dr Bissan Yiriba, MDSC, Ouagadougou, BurkinaFaso, T61.50 36 38 l8/60, Fax:50 342875, E-mail bissany@oncho.afro.who. int WHO/APOC 25. Dr Uche V. Ama,zigo, Directrice du Programme APOC, Ouagadougou, Burkina Faso, Tdl. : (226) 34 29 53 - Fax : (226) 34 28 7 5, E-mails : amazigouv@oncho.afro.who.int et dirapoc@oncho.afro.who.int 26. Dr Laurent Yam6ogo, Coordonnateur du Bureau de la Directrice, APOC, Ouagadougou, Burkina Faso, T 61. : (226) 3 4 29 53 - Fax : (226) 3 4 28 7 5, E-mai I : yameogol@oncho.afro.who.int 27. Dr Mounkaila Noma, Chef de l'Unit6 Epid6miologie et Elimination du Vecteur, APOC, Ouagadougou, Burkina Faso, Tdl. : (226) 34 29 53 - Fax : (226) 34 28 75, E-mail : nomam@oncho.afro.who.int 28. M. Honorat Gustave Zour6,, Chargd de la Biostatistique et de Ia Cartographie, APOC, Ouagadougou, Burkina Faso, T6l. : (226) 34 29 53 - Fax : (226) 34 28 75, E-mail : zoureh@oncho.afro.who.int 29. M. Saidou N'Gadiaga, Chargd des Technologies de l'Information, APOC, Ouagadougou, Burkina Faso, T6l. : (226) 34 29 53 - Fax : (226) 34 28 75, E-mail : nsadiasas@oncho.afro.who.int 30. M. Issaka Yacouba Niandou, Charge du Systdme de I'lnformation, APOC, Ouagadougou, Burkina Faso, Tdl. : (226) 34 29 53 - Fax : (226) 34 ZB 75, E-mail : niandouy@oncho.afro.who.int 31. Dr Grace Fobi, Charg6e de l'Appropriation Communautaire et du Partenariat, APOC, Ouagadougou, Burkina Faso, T6l. : (226) 34 29 53 - Fax : (226) 34 28 75, E-mail : fobig@oncho.afro.who.int 32. M. Koffi Agblewonu, Administrateur du Budget et des Finances, APOC, Ouagadougou, Burkina Faso, Tdl.: (226)3429 53 -Fax: (226)342875, E-mail : agblewonuk@oncho.afro.who.int 33. Mlle Nine Oumou Keita, Administrateur des Finances, APOC, Ouagadougou, Burkina Faso, Tdl. : (226) 34 29 53 - Fax : (226) 34 28 75, E-mail : keitano@oncho.afro.who.int 34. M. Assi Ake, APOC, Ouagadougou, Burkina Faso, T6l. : (226) 34 29 53 - Fax : (226) 34 28 75, E-mail akea@oncho. afro.who.int 35. M. Samuel Odame Bamfo, Traducteur, APOC, Ouagadougou, Burkina Faso, T6l. : (226) 34 29 53 - Fax (226) 3 4 28 7 5, E-mail : bamfos@oncho. afro.who. int 55 INTERPRETERS 36. Mme Safi6tou Barry, Traductrice/lnterprdte de conference (frangais-anglais-frangais), 09 B.P. 526 Ouagadougou 09, Burkina Faso, Tel : (226) 50 46 02 82, Portable (226) 70 21 41 14, E-mail : barrysafietou@yahoo.fr 37. M. Douramane Sidib6, TraducteurAnterprdte, 09 B.P. 1136, Ouagadougou 09, Burkina Faso, Tel: 50 36 08 38, Portables (226) 76 60 08 42 I 70 5l 64 59, E-mail : doursid@yahoo.fr 38. M. Sita Djerma, Traducteur/lnterprdte, Ouagadougou, Burkina Faso, Tel. : 50 46 46 64, Portable :70 20 00 58176 20 00 58, E-mail : sitadjerma@yahoo.fr s6 ANNEXE 2 : PROVISIONAL AGENDA First session Ouagadougou. I I - 13 November 2008 OPENING OF SESSION A. Speeches, election of Chairperson and rapporteurs. GENERAL INFORMATION B. General information on the final evaluation of the SZ. C. Follow-up on recommendations of the sixth Annual review and planning meeting of the activities in the SIZ (6-10 November 2007) and the 5'h session of the Special Consultative Committee (12-14 November 2007) D. Information on onchocerciasis control activities of WAHO E. Information on activities of the Multi-Disease Surveillance Centre (MDSC) STATUS OF' OCERCIASIS CONTROL IN EX-OCP COUNTRIES F. Review of onchocerciasis control and surveillance activities in Ex-OCP countries in 2008, resources utilized, and collaboration with other programmes such as Neglected Tropical Diseases (NTDs). G. Financing of onchocerciasis control activities: Partners' contribution H. Plan of Action and Budget 2009, within the framework of maintaining and strengthening the ex-OCp results. STATUS OF ONCHOCBRCIASIS CONTROL IN APOC COT]NTRIES l. Co-implementation as a factor of sustainability of CDTI activities and strengthening of health systems. I NTE R-A G E NC Y C O L LA B O RA TI ON J. Partners (WAHO, MDSC, SSI, HKI, OPC) supporlof onchocreciasis control and surveillance activities in 2008, and projections for 2009-2010. OTHER MATTERS J. Inter-country collaboration for strengthening onchocerciasis control and surveillance activities and the other Neglected Tropical Diseases. DRAFTING OF RECOMMENDATIONS AND CLOSURE OF SESSION K. Approval of recommendations. L. Closure of meeting. 57 DETAILED AGEI\DA R-EVI Tuesday II NOWMBER,2008: tsr DAY OPENING OF SESSION Point A: . Speech by Dr Uche Amazigo, DIR /APOC . Speech by Prof. M. Kader Kond6, DIR a.i. MDSC . Opening speech by the WHO Representative in Burkina Faso . Election of Chairperson, rapporteurs and adoption of the agenda (COORD) GENERAL INFORMATION Point B: General information on the final evaluation of the SIZ (COORD) Discussions on Point B TEA BREAK: 10h10 -10h25 Point C: Follow-up on recommendations of the sixth Annual review and planning meeting of the activities in the SIZ (6-10 November 2007) and the 5th session of the Special Consultative Committee (12-14 November 2007). (Mr. Ak6 Assi) Discussions on Point C Point D: Information on onchocerciasis control activities of WAHO . WAHO Representative Discussions on Point D Point E : Information on activities of the Multi-Disease Surveillance Centre (MDSC) . Introduction DIR a.i./MDSC . Onchocerciasis activities (Dr Y. Bissan/Dr L. Tod) Discussions on Point E LUNCH BREAK: 12h30 - 15h00 STATUS OF ONCHOCERCIASIS CONTROL IN THE EX-OCP COTJNTRIES Point F: Review of onchocerciasis control and surveillance activities in Ex-OCP countries in 2008, resources utilized, and collaboration with other programmes such as Neglected Tropical Diseases (NTDs) . National Coord. of Benin, Burkina Faso and Ivory Coast: 20 mn each (09H-9H40) 09h00 - 09h10 (10 mn) 09h10 - 09h20 (10 mn) 09h20 - 09h30 (10 mn) 09h30 - 09h40 (10 mn) (09H40-12H30) 09h40-10h00 (20 mn) 10h00-10h10 (10 mn) 10h25-10h50 (25 mn) 10h50-l lhl0 (20 mn) l1hl0 - 11h30 (20 mn) I lh30-11h45 (15 mn) I lh45-l lh55 (10 mn) I lh55-l2hl0 (15 mn) l2hl0-12h30 (20 mn) (15H00-18H30) lsh00-16h00 (lh) 16h00-16h25 (25 mn)Discussions on Point F 58 TEA BREAK: 16h25 -16h40 Point F (Contd): Review of onchocerciasis control and surveillance activities in Ex-OCP countries in 2008, resources utilized, and collaboration with other programmes such as Neglected Tropical Diseases (NTDs) National Coord. of Ghana, Guinea, Guinea Bissau and Niger: 20 mn each 16h40-18h00 (1h20) Discussions on Point F 18h00 - 18h30 (30 mn) Wednesday 12 NOVEMBER,2008: ld O,qY Point F (Contd): Review of onchocerciasis controland surveillance activities in Ex-OCP countries in 2008, resources utilized, and collaboration with other programmes such as Neglected Tropical Diseases (NTDs). Discussions on Point F Point G: Financing of onchocerciasis control activities: Paftners' contribution . DIR/APOC Discussions on Point G TEA BREAK: 10h20 -10h35 LaNCH BREAK: 12h35 -15h00 Point H (Contd): Plan of Action and Budget 2009, within the framework of maintaining and strengthening the ex-OCP results. . National Coord. of Mali, Sierra Leone, Ghana: 15 mn each Discussions on Point H TEA BREAK: 16h15 -16h30 STATUS OF ONCHOCERCIASIS CONTROL IN APOC COUNTRIES Point I: Co-implementation as a factor of sustainability of CDTI activities and strengthening of health systems . Cameroon, Nigeria, Malawi, Central African Republic, Chad, (08h00- l2h3s) National Coord. of Mali, Sierra Leone, Senegal and Togo: 20 mn each 08h00-09h20 (1h20) Point H: Plan of Action and Budget 2009, within the framework of maintaining and strengthening the ex-OCP results. . NationalCoord. of Benin, Burkina Faso, Ivory Coast, Togo, Guinea, Guinea Bissau, Niger, Senegal : 15 mn each 10h35 - 12h35 (2h) 09h20 - 09hs0 (30 mn) 09h50 - 10h05 (l5mn) 10h05 - 10h20 (15 mn) lsh - 15h45 (45 mn) 15h45 - l6hl5 (30 mn) (l6Hls - lsHls) 59 Uganda: l5 mn each Discussions on Point I l6hl5-17h45 (lh3Omn) 17h45 - l8hls (30mn) Thursdav 13 NOYEMBER,2008: 3'd DAY Point K: Inter-country collaboration for strengthening onchocerciasis Control and surveillance activities and the other Neglected Tropical Diseases. (5mn for each OCP country) TEA BREAK: 10h30-10h45 DRAFTING OF RECOMMENDATIONS AND CLOSUKE OF SESSION 10h45 - I8h45 I NTE R-A GE NC Y C O LL,A B ORA TI O N Point J: Partners support ofonchocreciasis control and surveillance activities in 2008, and projections for 2009-2010. , WAHO, MDSC, SSI, OPC and HKI: l5 mn each Discussions on Point J OTHER MATTERS Drafting of report and recommendations LUNCH BREAK: 12h30 - 15h00 Drafting of report and recommendations Point L: Approval of recommendations Point M: Closure of meeting 08h00 - 09h3s 08h00 - 09h15 (1h15mn) 09h15- 09h35 (20mn) 09H35 - loH 09h35 - 10h30 (55mn) 10h45 - 12h30 lsh00 - r7h00 17h00 - 18h00 18h00 - 18h45 60 \oI .9o s I b @s (o o oo N N@ o,F. (oc, r,t @ o)(.) (.) o @o -I coc o) E(L oI \l@ F @(.) N o) oN6l o F- al Frt N @@ @o otl F-o 6t(, N o @t ar €N ro eYre -b(E o- oo @ CO o, @ s(l) @oo (o N sN NF.F. F-No CO ro N t- (oc\,1 @@o tF- o o N II oO ooZ<) o o O o o o O o o o o O o o o o.l O o o o O o o O O O o E EE>Eh O O O o ! oE 93 o N s € € r r 6N doo €ooN r q N a N r o I6r € ci o! FO >? €- N o N o N r, N a. O. O N o. N N o N 5 H IO 6 NIr € I a$ r 6 o N raN r € o o r € N r I I a6 O 6 N € N N N r N ? e d, O N N rI O I O€ O r o O € € €a E .9 saeo o. ciu rr E-6 9)< -o I o\ 6\N 6\ II o\or 6\ r 6\ r 6\ 6\ 6\ $ 6\6 6\or O o\ o\o sd ! oo Oz OI 6 N a I r N € O a 6 6 a r O 6 d rN IIN I 6 Nrr O r I I r c aq o F a r N3 N N IN € 6 r r r r N r r 6r6 N r NNO Nn us : a E E o() g 3s t oMY66 = u0eo>e $€ c\ dr I o\r o\o 6\ r o\6 oI N I r N6 oO O O 6\NN s o=d tr() r d N N N rd NN IN N O r N o o NN d t dE :E d d N i e I N ad ! h d v r a q o( lq c iJ o IQ o E6Q a I Cr 0 !r nL 6E IL E ! d a o a U) o o cU j o E o o oo j F F € N tr U) U)q) t-{ U a C,) ri z () c! ?.) q) >1q) aFI at{& F< aQ -, r-ll XI r{l z1 4t g Annexe 3b: BENIN Results of CDTI in 2008 (lst Round treatment) in the former SIZ Annexe 3c: GHANA Provisional treatment results of both SIZ and non-SIZ areas, Brong-Ahafo 2008 COMMTINES Total villases N0. villages treated Geograp. Coverage Pop. Reqist. Pop. treated Therap. Coverage Refus. Iverm. Receiv Iverm. supplied. Natitingou 224 224 100 52606 40890 77,7 0 120000 I 10403 Boukoumb6 202 201 99,5 69154 61210 88,5 0 148000 139s44 Tchaourou 135 135 100 48468 44209 91,2 I 132000 I I 1468 N'dali 266 240 90,2 139333 l 14848 82,4 92 205000 2t1430 Bassila 97 97 100 63149 50210 79,5 2 I 50000 120276 Parakou l6l l6t 100 7397t 64084 142 I 75000 15676s Toucountouna 90 90 100 26278 21s05 81,8 0 60000 57954 Ouak6 77 77 100 29001 21408 73,8 2l 85000 71224 Kouand6 178 168 94,3 59414 45565 76,69 0 100000 96500 Diougou r08 100 92,5 64815 54287 83,75 0 130000 124204 313 3ll 99,3 152605 144ttt 94,4 0 2 I 5000 178998 Total l8s 1 I 804 97,46083 778794 662327 85 258 1520000 1378766 DISTRICT Total Population Drugs. Supplied N0 pers Treated % coverage Non - Eligibles N0. Tabs. Used Pregnant Seriously Sick Under Height Asutifi 4.970 13.000 12.474 4.317 86.86 0 0 0 Kintampo North 0 0 0 Kintampo South 0 0 0 Sene 20.128 49.030 44.254 ls.579 77.40 487 60 1,525 Tano North 5.1 06 12.500 9.973 3.79s 74.32 ll 0 790 Tain 17.808 38.36s 34.306 11.336 63.66 0 0 0 TOTAL 48.012 112.895 101.007 35.027 72.95 498 60 2315 62 Annere 3d: BIIRKINA FASO Resulb of the lst round treetment with lvermectin in 2008 Annere 3e : MALI Results of CDTI activities ( 200G2008) Annexe 3f : SENEGAL Results of CDTI2007 Districts Pop. Registered Pop.Treated TherapeuticalCoverage Di6bougou 23534 20338 86,60yo Bati6 64447 57055 84,00yo Dano 396s3 33320 87,00yo Gaoua 40702 32610 80,00% Rdgion 169336 143382 84.60% Years Villages Population Mectizan CDDs train. Total villases Treated Therap. Cover.(Yol Registered Treated Geog.Cov (%') Used 2 006 3 524 3 132 88 2 189 000 1762300 80,5 4 945 024 6 600 2 007 3 524 3 524 100 2 164 252 I 685 532 77,8 5 047 359 6 550 2 008 3 524 3 425 97 2 t6t 584 I 70 1298 78,7 4 946 046 6 150 Districts N0. of villages Populations Registered Populations Treated Therapeutical Coverage Kddougou + Saldmata 226 5t 645 4t 520 80,3V/o Saraya 97 38 984 30 741 79,00yo VClingara 92 24 090 l9 098 79,30yo Tambacounda 6l 23 527 l8 892 80,30yo Goudiry 48 t2 590 t0 337 82,|V/o Kidira + Diankd Makhan 76 l8 506 t5 897 85,90yo Totaux 600 169 342 137 336 81,10% 63 AITIND(E 4 : RESIILTS OF EPIDEMIOI.,OGICAL SI]RYEILI,AITICE Annere 4 a: SENEGAL Results of epidemiological evaluation in2007 (Senegal) Annexe4b:BURIilNAFASO Results of epidemiological evaluation in 2008 Annexe4c:GUINEA l-Results of the epidemiological evaluations in the Niger, Mafou and Tinkisso river basins in 2007 Villages (Villages) Recen#s (registered) Skin snip Test DEC (DEC patch test\ N0+and% Samal 183 99 99 00% Baraboye 122 82 82 00% Oussounkala 226 t78 178 00% Tinoni 6 5 5 00% Kourounkhoto 166 t2s t25 00% Soukouta 159 120 120 00% Bomboya 53 23 23 00% Habi Soubakhouna 42 35 35 00% Tikankali 124 82 82 00% Kolon 55 26 26 00% Total 1136 77s (682%) 77s (682%) 0 0,/" Bassins Villages Examind Positifs Prfval.(%) en 2008 Prdval.(%) en 2003 Oti-pendjari Kpanliangou 204 0 0 l3 Oti-pendjari Nianla 288 6 2,08 ll,2 Mouhoun Tangouma 279 ll 3,94 8,5 Como6/Ldraba Bossobougou t99 l3 6,53 Como6lLiraba Sankara 173 0 0 Totaur 1143 30 2162 2,62 No Villages Basins Regist. Presents Examined participationRate (%) positifs Crud Prev o//o Stand Prev I Kondian Niger 272 227 134 59 0 0,00 0r0 2 Mamouria Niger 148 126 92 73 3 326 4,6 3 Mdliboum Bogora Niger 342 291 145 50 0 0,00 0,0 4 Bdl6yani Niger 193 1s5 108 70 I 0,93 0,9 5 Walia Dabourou Niser 78 57 33 58 3 9,09 5,7 6 Sansanbou Niger 262 198 144 73 1 0,69 0,9 7 Hafia Niser 64 56 26 46 2 7,69 3,8 8 Sdrdkoroba Niger 244 229 204 89 ) lr47 1J 9 Filako Doula Niger t2l l7 111 95 0 0,00 0'0 l0 BClinkoro Niger 270 266 230 86 0 0,00 0'0 ll Djindo Niger 356 321 256 80 4 1,56 15 CMFL 0 1901 64 0 1465 l3 Illinko Tinkisso 188 t73 164 9s 0 0,00 0rot4 Sakola Tinkisso 369 336 285 85 2 0,70 0;tl5 Boh6rd Tinkisso 2t2 20s 197 96 2 l,u2 0J r5 S6rdfoula Bani6 Tinkisso 27t 2M 220 90 0 0,00 0'0t7 Boroto Tinkisso t32 128 123 96 I 0,El 0'5It Sounsoun Tinkisso 202 189 t24 66 I 0,81 r,6l9 Sambatign4 Tinkis5s t42 tt7 76 65 0 0,fl) 0,0 20 Foula Tinkisso 248 198 134 68 2 1,49 Irl t2 H6rako 442 413 306 74 4 I I I 154 72- Results of the evaluetions in non- SIZ erea 2007 CMFL 0 0 0 0 0 t2 0 0 0 0 0 0 0 13 0 0 0 0 No Villages Basins Regist Presents Eramined participationRate (%) positifs Crud Prev o,ta Stend Prev I Dalagnan Milo 397 321 ls9 50 I 0,6 013 2 Narina Milo 288 2st 212 84 0 0 0 3 Koumana Milo t62 153 t28 84 0 0 0 4 LeIe Milo ll8 ll3 93 82 0 0 0 5 Bassikoro Niandan 203 r88 148 79 0 0 0 6 Niandan scidrie Niandan 2t2 192 80 42 0 0 0 7 Yradou Niandan 230 206 175 85 I 057 016 8 Djifoua Sankarani 291 274 212 77 0 0 0 9 Oulo'Ouloko Sankarani 546 481 374 78 0 0 0l0 Ldbala Sankarani 137 t2t 106 88 0 0 0ll Wandjiladou Sankarani 338 326 286 88 0 0 0 12 Woroworodou Sankarani 350 315 240 76 0 0 0l3 Orossia Sankarani 699 641 510 80 0 0 0t4 Gbenkoro Sankarani 252 240 195 81 0 0 0l5 Damba Makona 168 t34 96 72 5 s2r s5 r6 Kondodou Makona 365 336 261 78 l0 3,E3 3l7 Sokotoro Bafing 267 225 174 77 0 0 0l8 l-"sel, Bafing 168 t4t 96 68 0 0 0t9 Bantanko Bafing t28 97 63 65 I 159 lrl 20 Balabori Bafing t65 tt6 99 85 0 0 02t Kissi I et II Mongo 27t 252 150 60 0 0 0 5 755 5 123 3 857 75 18 0,47 3- Results of the evaluations in Koliba river basin 2007 CMFL 0 0 0 0 431 0 0 0 ,7, No Villages Basins Reglst. Presents Eramined participationRate (%) positifs Crud Prev o//o Stsnd Prev I KanthiC Koliba 149 135 120 89 0 0 0 2 Kambala Koliba 418 401 351 88 0 0 0 3 Kirimani Koliba 278 215 172 80 0 0 0 4 Kankonka Koliba 242 160 150 94 0 0 0 5 Koliba Bac Koliba 84 4l 38 93 7 19,42 l8 6 Goumbanbel Koliba 176 100 83 83 0 0 0 7 N'GalloukadC Koliba 5ll 367 306 83 0 0 0 8 Koumbagni Koliba 66 59 56 95 0 0 0 I 924 I 478 I 276 86 7 015 65 No Village Bassin Recens6e Present Eramin6e Taur participation o/o Oncho + Pr6v bmtc % Pr6v stend a,la I Yalamban Makona 8l 80 72 90 6 E% 690 2 Gbdssd Makona 236 2t9 195 89 I l'/. 0,90 3 Soumay6r6ya Mongo/Kaba 274 208 t64 79 2 106 2,60 4 Kouroubon Mongo/Kaba 378 3r0 267 86 2 t% 050 5 Falandian Kolentd 313 145 t17 81 28 24% 21,00 6 Kouydya/Botokoly Kolentd 288 226 199 88 3 20h r5o 7 Baddkanti Kolentd 433 380 2st 66 2 t% 0,70 8 Malifou Kolent6 120 83 57 69 22 39% 28,70 9 KondCdakha Kolent6 284 2t5 144 67 l6 llo/o e5o l0 M'Bendia Dianda Kolentd 193 174 128 74 I lY" 1S0ll Daffira Kolent6 454 401 236 59 5 20h 2,10 12 Sakhoya Kolent6 t85 130 80 62 l6 20Y. 0,70 3239 2 571 I 910 74 104 50h 4- Results of the evrluations in 2008 Annexe4d:MALI Results of the epidemiological evaluations in 2008 CMFI, 1695 ll 956 I 956 Basins Villages Total Population Examined N0. Positifs Prevalence (%\ Niger and Tribs. t7 3 749 0 0 Banifing II et tV J 723 0 0 Baould East and West 9 1295 0 0 Bagod I 229 0 0 Total 30 5996 0 0 66 AIIINEI(E 5 : RESULTS OF ENTOMOLOGICAL SIJRVEILLAITTCE Annexe5a:SEI\IEGAL Entomological results (partial results) in Gambie river basin ( september - december 2008) S6koto Soukouta Bantankokouta Thiab6ca16 Sept Oct Nov Dec Total Total days of fly collect. l6 20 16 l6 68 Females collected 7627 5889 11315 6055 30886 Females dissected 800 841 800 763 3204 Parous 699 741 677 671 2788 Parous rate 87% 88% 85% 88% 87% Infective females 0 0 0 0 0 Females in alcohol 6827 5048 105 l5 5292 27682 Sept Oct Nov Dec Total Total days of fly collect. t6 20 t6 t6 68 Females collected 7037 10715 9077 14165 4099 Females dissected 800 1000 800 800 3400 Parous 680 837 654 667 2838 Parous rate 85% 84% 82% 83% 83,500A Infective females 0 0 0 0 0 Females in alcohol 6237 9715 8277 13365 37594 Sept Oct Nov Dec Total Total days of fly collect. t6 20 t6 t6 68 Females collected 5499 12989 7614 6l6l 32263 Females dissected 800 1000 800 772 )J I Z Parous 740 894 726 620 2980 Parous rate 93% 89% 9t% 80% 88,40yo Infective females 0 0 0 0 0 Females in alcohol 4639 l 1989 6814 s389 2883 I Sept Oct Nov Dec Total Total days of fly collect. 16 t9 l7 t6 68 Females collected 4103 3314 3821 3792 r s030 Females dissected 545 776 936 787 3044 Parous 469 629 657 537 2292 Parous rate 86% 8t% 70% 68% 75,300A Infective females 0 0 0 0 0 Females in alcohol 3558 2538 2885 3005 l 1986 67 Annexe5b:GUINEA Results of fly dissection and females in alcohol (August-December 2007) Annexe5c:MALI Results of fly dissection (July-October 2008) Capture site Basins Total capt. o I c)(A ar) a Parous o//o parous q) I .q) ar)q) (J -o N0. L3H Species Females in alcohol (DNALabo)6 7 8 Yalawa Mafou 5 043 | 792 1 189 66% 0 0 0 803 972 t7 15 020 Diaragbela Niger 2 712 I 89r 929 49% 2 2 l5 I 891 0 0 9 381 Morigbedou Milo I 452 I 400 93s 67% 0 0 0 I 391 9 0 6 838 Total 9 207 5 083 3 053 60, 2 2 15 4 08s 981 t7 31239 NO Site Basin N0. collected NO dissected NO infectives NOL3H N0. Females sent to MDSC I Tienfala Niger 13323 2319 t7 39 I 1004 2 Pont Faya Niger 25550 3050 l3 l9 22500 Total 38873 5369 30 58 34504 68 o\\o!tF XF X X X xFIF () z z, t- F X X X EV O A o > o- E V Bl) .E, o o o C') Oo B () o o > o c.l o\ € ao z F. o oo 6, 6 k € L 6) -:z o .tz o ov q) o o& c- G6l EFd{Etr6 ^>oq \'i;'i .:l 6 d *E.EgO'- O o > eE- G, ^> oa \'=UEsb o'- O o} E€- cO & FQ z 2 .o(J JzE. .o UJ z .o(J Jz .o (-) J z .o() J z o. L o.o bo F P o.o do (6 F o o-o o z. 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