Progress report on the implementation of transfer activities of the Onchocerciasis Control Programme in Côte d’Ivoire: 1st September - 31 August 1998

Onchocerciasis Control Programme in West Africa Programme de Lutte contre I'Onchocercose en Afrique de I'Ouest JOINT PROGRAMME COMMITTEE Office of the Chairman JOINT PROGRAMME COMMITTEE Nineteenth session Accra. 7-9 December 1998 JPC - CCP COMITE CONJOINT DU PROGRAMME Bureau du Pr6sident JPC19.8(c) ORIGINAL :FRENCH September 1998 Provisional asenda item 6 PROGRESS REPORT ON THE IMPLEMENTATION OF TRANSFER ACTIVITIES OF THE ONCHOCERCIAIS CONTROL PROGRAMME (1st September-31 August 1998) COTE D'IVOIRE .L JPC l e.8(c) Page 2 1 TABLE OF CONTENTS INTRODUCTION IMPLEMENTATION TRAINING RESULTS DATA MANAGEMENT CONSTRAINTS AND CORRECTIVE, MEASURES TAKEN Page 3 J 2 3 4 5 J 4 6 7 8ACTION PLAN FOR 1999.2002 JPC l e.8(c) Page 3 INTRODUCTION The general objective of the national onchocerciasis control prograrnme in C6te d'lvoire is to maintain the achievements of the OCP Prograrnme through the integration of the forest and savanna onchocerciasis control activities into the other health care activities of the country within the framework of the primary health care strategy. To this end, a number of activities have been developed since 1996 to make it possible for the decentralized structures to effectively take charge of the residual activities of the OCP Programme. I IMPLEMENTATION At the conclusion of the national workshop on the devolution of onchocerciasis control activities held in Bouake from 15 to 17 April 1996, it had been recommended that : A sustainable community-based system of treatment with ivermectin be put in place A policy for the epidemiological surveillance of onchocerciasis by the Districts be established. A sustainable system of compensation or motivation of the community distributors be investigated. Consequently, from July 1996 to July 1998, a series of training sessions in both ivermectin distribution and the epidemiological surveillance of onchocerciasis were organized for the concerned participants, cucurrently with the ongoing onchocerciasis control activities. This was done with technical and financial support from OCP. In addition to the training of onchocerciasis control participants, the Ministry of Health which is deeply involved in the devolution process has provided through its Executive Directorate, 1725 record books and 1659 height measures to the villages that have been selected for community-directed treatment with ivermectin. 2. TRAINING From lst October 1996 to 9 February' 1997 :22 doctors and 146 nurses were trained in CDTI From February 1997 to December 1997 : 1276 community distributors (ASC) were trained in CDTI FromJuly 1996to July 1998 :7 doctors and 35 nurses were trained inthe Districts of the original area (Bouna, Boundiali, Dabakala, Ferke, Korhogo and Odienne) and of the southern extension (Adzope. Dimbokro, Bouafle. Daloa, Touba, Odienne, Bondoukou, Bouake). JPC 19.8(c) Page 4 3. RESULTS a) Community-directed treatment The results shown are for the period 1996-1997 only; those for 1998 are not available yet. Table 1: Results of Community-directed treatment Contmunity-directed treatment was not totally implemented in the Marahoue and Sassandra basins because of ongoing epidemiological evaluation in these two basins. Only 42 villages were treated. Overall. 811 (70%) villages out of 1169 selected for CDTI were actually trcated \vltl) lvt:rnrcctrll rlLrnng ttlrs pcfiod. lilu nreali eovcrage ratc \\15 0l.i:90. The coverage rates per basin ranged from 44.22% (Sassandra) to 89.39% (Black Volta) witlr 63.550% (Comoe), 68.320 (Marahoue), 74.43% (N'Zi-Bandama) and 84.45% (Bou- Bandama) in between. 84,457o Basin District Number of Health centres Number of villages Number of Commu- nity distributors trained Population registered Population treated Number of tablets distributed Coverage rate COMOE ABENGOU- ROU 08 51 102 18134 13601 1760t ABIDJAN 0l OZ o4 872 161 t220 ADZOPE 05 20 40 r4196 4937 5105,5 BONDOU- KOU 08 54 r08 32503 17600 29947 BOUAKE 05 43 76 2t290 r5927 20198,5 DABAKALA 01 09 t7 3 190 2303 3208 DIMBOKRO 04 65 82 9465 8201 9214,5 Sous-total 't7 244 429 99650 63330 86494,5 63,55Vo NZI- BANDA- MA BOUAKE 06 113 198 28803 23258 30894,5 DABAKALA 05 4t 18 7170 5419 7 t57 DIVO 01 07 t6 17402 11410 t6t26 DIMBOKRO 08 161 249 39993 31t23 28863,5 YAMOUS- SOUKRO o1 51 tt4 35112 24375 30500,5 Sous-total 27 379 595 128420 9558s 113541,5 74,43Vo BOU- BANDA- MA BOUAKE 02 23 27 6166 4861 6806 DABAKALA 03 18 15 6442 5442 7586,s KORHOGO 06 46 79 r0924 951 I 13000 Sous-total 11 87 t2t 23532 19874 27392,5 VOLTA- NOIRE BOUNA 0l 59 59 7801 6974 9484 89,39Vo SASSAN- DRA TOUBA 01 04 04 625 s33 780 MAN 03 25 42 9724 5927 8398,5 DALOA 02 10 20 33475 t2919 t9442 Sous-total 06 39 66 43824 19379 28620,5 44,22Vo MARA- HOUE BOUNDIA- LI 01 03 06 I 165 796 889 68,32% TOTAL 78 tilI 1276 304392 205938 266422 JPC 19.8(c) Page 5 b) Passive treatment Overall, 10,801 people were treated with 14,575 tablets in the Districts of Danane, Dabakala, Odienne, Abidjan and Soubre. c) Eoidemiolosical surveillance A number of activites were carried out both in the orginal Programme area and in the Southern Extension in connection with the epidemiological evaluation and surveillance of the disease. The tables below give a summary of the results recorded from May 1997 to July 1998. Table 2: Results of epidemiological evaluations in the original Programme area Period Number of villages Population registered Population examined Positive cases Mean crude prevalence From 8 Sep. to 15 Oct.1997 34 9954 6680 47 0.70% From 22 Juneto 2l July 1998 t4 4157 2489 1,2 0.48% The lower and upper limits of the prevalence rates were 00o/o and 4.41% for 1 997 with two children under 15 years of age found positive at Tafolo Qrl'Zi-Bandama) and Kokpingue (Black Volta). For 1998, the range of the prevalence rates was from 00% to 3.84o/o with three children under 15 years of age found positive at Lognene (N'Zi-Bandama). The CMFL computed from these two evaluations was close to 0. To assist in decision-making about the cessation of larviciding in the basins of the Sassandra and Marahoue, the national team also carried out some epidemiological evaluations in the southern extension area. Table 3 : Results of epidemiological evaluation in the Southern Extension area Bassin P6riode Villages Recens6s Examines Positifs Pr6valence brute moyenne Marahou6 From 2 to 23 May t997 19 42LI 2826 55 1,96% Marahou6 From 4 to 24 Nov. 1997 18 4283 2882 63 2J8% Sassandra From 10 June to 2 July 1997 t9 3681 2636 108 4.09% Sassandra From 28 Nov. To 18 Dec. 1997 T9 4t49 2874 99 3,44% JPC 19.8(c) Page 6 The mean crude prevalence rates recorded during these surveys, even though satisfactory, should not conceal the fact that at Kawaka (Marahoue), prevalence remained above l0% (15.43yo in May 1997 and 13.88% in November 1997).ln the Sassandra basin, prevalences remained relatively high at Vialadougou (11.42oh, then 14. ll%).lt must be noted that surveys carried out by the Bouake sector during the same periods in the Marahoue basin produced excellent results. Based upon the results of these various evaluations, the migration surveys carried out produced no indication of any particular population movements. d) Rapid epidemiological evaluation For the purpose of rapid production of epidemiological maps of onchocerciasis using the survey method of rapid epidemiological mapping (REMO) (palpation of nodules) in the forest zone of southern C6te d'lvoire, validation surveys were carried out from l5 January to l4 June 1998 in the areas that had undergone REMO. Table 4: REMO and validation results Despite a few problems encountered by the teams during these surveys, 179 people were examined both for the rapid evaluation and for the validation. If the infection appeared to be meso-endemic or hyperendemic in almost all of the districts (Abidjan, Aboisso, Danane, Divo, Sassandra, Soubre, Tabou), it remained equivocal in others (Agboville, Gagnoa, Guiglo, Issia). Community-directed treatment is to be installed very soon in this part of C6te d'lvoire after the training of the trainers and of the community distributors. 4. DATA MANAGEMENT With respect to community-directed treatment, the data llow is as tbllou's Period Activify Number of villages Number of people examined Number of people with nodules Mean raw prevalence From 15 Jan. to27 Feb. 1 998 Rapid epidemiolo- gical evaluation 94 3793 640 16.87% From 26 May to 14 June 1998 Rapid epidemiolo- gical evaluation t9 967 351 36.2904 Villages+ Health Centre + Districts+ Executive Directorate 1.IPCl9.8(c) Page 7 The data are analysed at the Executive Directorate level, then they are sent to OCP and to the Ministry of Health (Directorate of control, Evaluation and Health Information (DEIS) as well as Directorate of Community Health (DSC)). Until epidemiological surveillance is actually taken over by the Districts, the data flowing from this activity will continue to be managed by the national team. 5. CONSTRAINTS AND CORRECTIVE MEASURES TAKEN a) With respect to community-directed treatment The shortage of logistic means experienced by the Executive Directorate has affected the supervision and monitoring of this activity. In some Districts, the performance of these duties was made difficult by the lack of basic equipment (motorbikes, motorcycle, vehicles). The considerable delay observed in the collection and transmission of the data has also posed the problem of information flow within the system. The change in the dosage and presentation of the Mectizan tablets has required a review of the tools and materials used in the distribution of the drug. b) With respect to eoidemiological surveillance - Despite the training carried out in the districts and health centres, it was observed that the nurses did not fully master the technique of epidemiological evaluation. - Insufficient supply of the districts with skin snipping equipment - Insufficient integration of epidemiological surveillance activities in the districts. c) Corrective measures taken and suggestions At the conclusion of the symposium on the activities of the national onchocerciasis control programme held in Bouake in November 1997, it was recommended that : The IEC campaigns should be intensified to promote a better acceptability of the new Mectizan distribution strategy by the populations. The nurses and community distributors should be retrained In connection with the training of nurses in epidemiological surveillance, some epidemiological evaluation surveys should be planned in the zones u,ith more or less high prevalence rates, (forest zones) l'1 I t I ! t , a -)r\rri JlrtPPrrtB r\rl,J rlrL)Lrlu uv UUUgUteLl tUl dllu |_lUlrilctJeu tU CqUIlr Lllr r!_iurr.) culLl districts. Supervision should be strengthened with logistical support from OCP (tuo vehicles have just been transfered to the Executive Directorate for that purpose). JPC l e.8(c) Page 8 ACTION PLAN FOR 1999-2002 1. OBJECTIVES A) General objective To maintain the achievements of the OCP through the integration of the forest and savanna onchocerciasis control activities into the other health care activities of the Country within the framework of the primary health care strategy. B) Specific impact objectives l. To reduce the prevalence of onchocerciasis to less than 5Yo within the OCP area by the year 2002. 2. To reduce the prevalence of onchocerciasis from 600/o to 30Yo in the forest zone by the year 2002. C) Specific result objectives L To take to 90oh the proportion of trained community distributors (ASC) within the OCP area who are actually capable of performing community treatment according to the guidelines established by the programme. 2. To take to 90Yo the proportion of districts trained in epidemiological surveillance which are actually capable of detecting in time any recrudescence of the onchocercal infection by the year 2000. 3. To take to 90o/o the proportion of teams trained in epidemiogical surveillance in the Southern Extension which are actually capable of detecting in time any recrudescence of onchocerciasis by the year 2002. 4. To take to 90o/o the proportion of trained community distributors (ASC) in tl.re forest zone who are actually capable of performing community treatmeut. 5. To take to 90o/o the proportion of villages eligible for treatment which are actually receiving ivermectin in the forest zone by the year 2000. D) Specific operational objectives A.2.1 To train in each of the districts of the OCP area a teanr of 3 technicians in cpidemiological sun'cillancc by the y,ear 2000. A.2.2: To equip allthe districts of the original Programme area u'ith epidemiological Sttfyeil!:,.'tC,-. l.it" L.'thi- , ,-'r. l ooo To equip all the districts of the southern extcnsion u'ith epidcrniological surveillance kits by the year 2002. A.3.1 )JPC19.8(c) Page 9 B.1.1 : To produce a forest type onchocerciasis distribution map by the end of 1998 8.1.2: To train the community distributors in all the onchocerciasis affected villages ofthe forest zone by the end of 1999. 8.2.1 To ensure the availability of ivermectin tablets in all the villages eligible for treatment within the forest zone from the year 2000. STRATEGIES AND PERFORMANCE INDICATORS (See table) Abbreviations used: SE: MCD : DR: IDE : SF D-E epidemiological surveillance District medical officer Regional Director State registered nurse Midwife Executive Directorate a IC) =q- o o C)o() bo CB tl] o (! o ot-A^ o. o-oo. O- -q oo E o -o r -o !o) 'E >, =a) o.-oS .a oF tr6o> 9()d9 0) E o) () o9o botr (!c ()o bo 0) '=o li 0)OL ^CEY() Oll] o) I o- Eo^o >{\ ooo\ '! t*ho -E 11 a- .9(.) L() -O ;,. 6<s !LEO) ZE 0) () o. a a(n o (c o -o F o E (+< o r o .o E z q() (! -oC) Io -v(c (.) () (.) (.) o oo() L b3 bs -o0.Erz z9 o () () -o o f!a cO r! o (H o o t- 8-- -O\TO\ -o ! 0) d ak o -o @ E E Ro. ,-o\Xor .9oEsotrQc)I o.r -o ! 0.) dL aLoot:(Li o do o) o r a;o\ ,: o\:o\ .9b o(0. 0)O ar o L Jo o o o0.)6)L -O) Qta (HO oE?o .)ic) ^6) c) -.o0! 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N N X X X GI X X X X X X X X N X X X X X X x X 0) o q) o\ o\ o\ X X X X X x X I ^q)ab A)0& r!Io E] I o tr.l I o tr.l I o r! o tJ.V) a() z rl] I t-l rl] I a rl] I l-1 rr.l I t-,1 E] I o sl I o U)q) U =ci cl .= coooo L^o.y oEto)P.1J 'q o.) - >= (Jd- ;EE tc)- qr== = ='E 9L> tr.l Q- cr .; = Cg a)I(J Cir -e(J - ol] ay 9O eEqi c-) O(J L..= -. - o.)Io.c L .- 6) O) dx El!tr.l t o) tr Cq(.) <) L .1, () (Ho- boo .='ao.2(!tr -- (H() o)> 6A Lr-t o do oo o o C)H cl- EOo0) oo =o L(d 0)- ets ,!: >LI.J () a L. u(d .vs i''E;s E(Jotr C) -O):E() oE b.6 f cilao- F aQ PLa L u (.) o). :.. cdH lJ o) C).= ,o^ - .- (-) >'E()> =i)7) cd L o >. dEa, =o;ro ;^ 0")l-1 oQE E= o9;i L 4- t.9SbouO o= b6 =6AG a() :: (!H r- c,h3 ( l\e -=X o-l t.l ac!E.o3P- o.9 Y dP c-ro*:l o = o-EAaO () :(- t-.,1() L .o () V ()9 +:N6; 'o c) D€ Lc o 'o -o Cq .E 0 F o O c o .9o(.) E() a() bo ='t 9ar L ^L lo .-6 -o -oe ;.!p =0)9>. ()C ()= d)= oE- 0) 0.) C) o 0) r a E -o(no o)- tiaEo0)q1' 50 JE a' - ' JOa X'7 rntnAa o?& I &Pz av) :r-.l 4 i r!r!PY>U?o r'^z o-oD <IJ.]J(,J b! 0) a t JPC 19.8(c) Page 12 Ivermectin needs for 1999 Basins Districts Number of Health Centres Number of villages Total population Eligible population Quantity of Mectizan COMOE Sub-total ABENGOUROU 8 57 23 6tt 20 070 I 30 000 ABIDJAN I 2 961 811 6 000 ADZOPE 5 23 15 196 t2 067 108 000 BONDOUKOU 8 14 32 503 21 628 160 000 DABAKALA I 9 4124 3 505 15 000 DAOUKRO 4 65 n 877 15 196 91 200 M'BAHIAKRO 5 43 39 223 33 340 196 956 1 J/. 273 t33 495 t12 623 709 156 N'ZI- BANDAMA Sub-total BOUAKE 2 35 7 572 6 039 20 000 DABAKALA J 23 4 489 3 816 15 100 DIMBOKRO 14 137 32 198 27 878 1 66 088 DIVO I 7 t0 419 8 907 50 624 GAGNOA I 11 16 418 13 955 79 308 KATIOLA 2 7 2 8r5 2 392 10 000 M'BAHIAKRO 4 74 18 172 16 354 120 000 TIASSALE 5 55 l8 709 t5 903 r 00 500 YAMOUSSO- KRO 13 t6 40 812 34 690 215 000 9 45 425 tsz 864 t29 935 176 620 MARAHOUE Sub-total BOUAFLE 9 8',7 26 066 22 156 65',l14 BOUNDIALI I J 1 405 1 194 3 150 DALOA I 16 t2 153 r0 334 2t 182 SEGUELA 12 102 40 245 34 208 1 00 000 4 /.5 208 '79 869 61 892 190 046 ll -l a IJPC 19.8(c) Page 13 N.B.: This order does not take into account the quantitl'of Mectizan tablets needed for the treatment of the forest zone. Basins Districts Number of Health Centres Number of villages Total population Eligible population Quantity of Mectizan SASSANDRA Sub-total DALOA 2 l0 37 013 3t 461 64 512 MAN 6 58 t5 663 t2 454 50 000 ODIENNE l1 118 70 416 s9 8s3 175 754 SEGUELA 6 5l 27 508 23 382 6s 332 TOUBA l5 t57 32 981 28 034 16 720 5 40 394 183 581 154 879 432 318 N'ZO KOH Sub-total DANANE 5 59 74 476 63 305 r70 240 MAN 14 143 6t 557 53 824 135 000 2 t9 202 136 033 111 129 305 240 BOU- BANDAMA Sub-total BOUAKE 2 23 6 161 5 242 t4 902 KATIOLA ) l8 7 113 6 046 18 048 KORHOGO 4 45 ll 505 9 179 33 400 SEGUELA 1 t9 5 024 4 270 t2 738 4 l0 105 29 809 25 337 79 088 VOLTA NOIRE Sub-total BONDOUKOU 4 35 20 884 17 751 50 524 BOUNA I 59 7 801 6 914 18 000 2 5 94 28 68s 24 125 68 524 TOTAL 24 t74 I 701 744 516 632 520 2 560 992 b