Rapid assessment procedures for Loa Loa (RAPLOA), mapping of loa loa in the south province, Cameroon CDTI project 1 July - 20 August 2004 : final mission report

UNDPAruORLD BANI( WORLD HEALTH ORGANIZATION AFRICAN PROGRAMME FOR ONCHOCERCIASIS CONTROL (APOC) RAPID ASSESSMENT PROCEDURES FOR LOA LOA (RAPLOA) : MAPPING OF LOA tOA IN THE SOUTH PROVINCE, CAMEROON CDTI PROJECT I JULY _ 20 AUGUST 2OO4 FINAL M'SS'Oil REPORT BY WHO/APOC TEMPORARY ADVISOR Dr Innocent TAKOUGANG Department of Public Health Faculty of Medicine & Biomedical Sciences University of Yaound6 I P.O Box 1364 Yaound6 Cameroon Tel: (237) 23t 87 s3; (237) 96s 28 08 Fax: (237) 231 5l 8l E-mail : itakouganq@)rahoo. corn THE NATIONAL PROGRAMME FOR ONCHOCERCIAS'S CONIR OL, CAMEROON THE TNTERNATTONAL EyE FOUNDATTON (tEF) 3 0 anrr 200{ August 2004 a ,/i TABLE OF CONTENT ACKNOWLEDGEMENTS .......... SUMMARY 1. BACKGROUND........ 2. PURPOSE OF THE SURVEY 3. TARGET AREA 4. OBJECTTVES ......... 5. MATERIALS AND METHODS ....... 5.1. PREPARATORY ACTIVITIES ..... 5.2. PRELIMINARY FIELD VISIT ....... 5.3. SELECTION OF SURVEYORS 5.4. RAPLOA TOOLS 5.5.TRAINING OF RAPLOA SURVEYORS 6. RESULTS AND DISCUSSION 6.1 RAPLOA TRAINING 6.2. SAE RISK AND IMPLICATIONS FOR CDTI . 6.2.1. THE NTEM VALLEY DIVISION 6.2.2. THE DJA ET LOBO DIVISION .. 7. RECOMMENDATIONS 8. PROBLEMS ENCOUNTERED AND IMPLICAI'OilS 9. REFERENCES.... 10. ANNEXES 10.1. List of participants at the training session 10.2. Composition of field survey teams 10.3. Summary of RAPLOA Survey Results 10.4. Villages at Low Risk of SAE 10.5. Villages at High Risk of SAE 10.6. Villages at very High Risk of SAE 1 0.7. Community Questionnaire 10.8. !ndividua! Questionnaire 10.9. Plan of Execution of Field Activities 3 4 5 5 5 6 6 7 7 7 7 8 9 9 10 10 11 12 12 13 13 2 ACKNOWLEDGEIVIENTS I wish to thank the Dr Belinga, Provincial Delegate of Public Health (South Province) for his collaboration during the field investigations. I would like to send our appreciation to the chiefs, local administrative and traditional authorities of the study communities, together with the local populations, which participated massively to the RAPLOA exercise. My thanks also go to Dr NTEP Marcelline, National coordinator PNLO for her diligence in making the programme activities successful. Many thanks to Mr Patrice NKELLE, Country Representative for the International Eye Foundation for all his efforts in facilitating the execution of the RAPLOA. I wish to acknowledge the contributions of the following persons in the mapping exercise : Mr. KAMENI Robert, Mr EBANDA Ldopold, Mr TANEKEN Ferdinand, Mr FEI(A Jules and Mr TENEKEU. My regards to Professor Peter NDUMBE, Dean of the Faculty of Medicine and Biomedical Sciences for all his support. My appreciation goes to Dr. Hans REMME (WHO/TDR) for all the constructive comments and suggestions for improvement in the conception and execution of RAPLOA. We are most grateful to APOC Management for the opportunity given to us to serve and contribute in this study and to WR Cameroon for facilitating this mission. We thank all those who contributed to the success of the present mission. J aSUMMARY A total of l2 persons received training on RAPLOA and RAPLOA field data collection techniques. Among those one was from the central level, and I were provincial stalf members, and 3 were support persons who had participated in previous RAPLOA study. Both the WHO Temporary Adviser and the Nationul Coordinator of the Onchocerciasis Control Programmefacilitated the training workshop which lasted 3 days. a The RAPLOA study covered the heath districts of Sangmelima, Zodtdli, Djoum, Meyomessula in the Dja et Lobo Division, and Ambam in the Ntem Valley Division. Of the 193 selected RAPLOA villages II were inaccessible at the time of the study. Twenty three had RAPLOA prevalence below 40% threshold, and are at low risk of severe adverse events with encephalopathy (SAE) following standard CDTI. One hundred andtifty nine had RAPLOA prevalence above 40%, and are at risk of SAEfollowing stundard CDTI. o The risk of SAE should be lower than predicted by RAPLOA in the previous Zodtdld and Sangmelima Heulth Dtstricts htere a community-based distribution was previously conducted, Though the therapeutic coverage was low (below 40%), the geographic coverage was high, as people travledfrom Ambam to Sangmelima to get the drug. It is however recommended that CDTI should only be carried out by medically assisted teams in the South Province CDTI Project. 4 1. BACKGROUND Since 1991, there have been several reports that high microfilareamia of Loa loa is associated with severe and sometimes fatal reactions in patients who have taken ivermectin against onchocerciasis. A multi-center study carried out by three research teams from Cameroon and Nigeria using standardized questionnaires based on clinical signs of loiasis. It was found that a history of the eye worm lasting one to seven days, confirmed by a photograph of adult Loa loa worrn in the eye (RAPLOA), correlated well with parasitological indices. A cut off point of 40oh prevalence of history of eye worm (corresponding to 20o/o prevalence of Loa loa microfilareamia) was found to be a threshold for identifying high risk communities for encephalopathies following Mectizan treatment (Takougang et a1.,2002). RAPLOA was recommended for the identification of communities at risk of identification of communities at risk of severe adverse events (SAE) during Community Directed Treatment with Ivermectin (CDTI). As the extension of mass distribution of ivermectin in the Mungo Division is contemplated, it was necessary to determine the prevalence of Loa loa, so as to identify the communities that are at risk of SAE. The present work is indented to develop a prevalence map of Loa loa so as to guide community directed treatment of onchocerciasis with Mectizaninthe South Province CDTI Project area. 2. PURPOSE OF THE SURVEY The South Province - Cameroon is co-endemic for onchocerciasis and loiasis with varied levels of endemicity. Mass treatment of onchocerciasis with ivermectin through the CDTI strategy is contemplated in the Province. The purpose of the present survey is to identify villages of Loa loa meso and hyperendemicity (RAPLOA>4}% or prevalence of Loa loamiqoftlaremia>20%) which are at risk of severe adverse events with encephalopathy (SAE) during the implementation of CDTI 3. TARGET AREA The South Province CDTI Project area covers the health districts of Ambam, Djoum, Meyomessala, SangmelimaandZoetel6. The organization of the health system of the target CDTI area is as follows: - 5 health districts - 59 health areas - 97 health centers - 725 villages among which 200 will be studied. - Population of 258 817 inhabitants 5 Table 1: Population distribution, health districts and facilities of the South Province CDTI Project Health District Population Number of villages Number of health areas Number of health centers Ambam 67 548 189 l9 29 Meyomessala 43 331 t67 t2 20 Djoum 3l 718 106 8 13 Sangmelima 82 662 179 l1 22 Zoetele 33 558 84 9 l3 Total 258 817 725 59 97 4. OBJECTIVES l. To train National Onchocerciasis Control Programme (NOCP) and the NGDO partner on how to carry out RAPLOA. 2. To assist NOCP and NGDO partner carry out RAPLOA 3. To determine the level of endemicity of loiasis in selected villages (200) of the South Province CDTI Project area. 4. To determine the village communities of the South Province CDTI Project area with prevalence of history of eye worrn (restricted definition)>40%. 5. MATERIALS AND METHODS 5.1. PREPARATORY ACTIVITIES Preparatory activities were carried out from 1-9 July. Preparatory activities included consultations with a geographer to get a working map of the target study area, discussions with the authorities involved in the South Province CDTI Project at the National and Provincial levels. The RAPLOA villages were selected and a list printed. 6 5.2. PRELIMINARY FIELD VISIT During the preliminary visit in Ebolowa, discussions were held with the Provincial coordinating Team (PCT) on who, how and when to train and carry out RAPLOA activities. During a preliminary field visit, local health, administrative and traditional authorities will be briefed on the purpose and objectives of the RAPLOA investigations. Road and health maps will be obtained, and the itineraries outlying the planning for the execution of field activities drawn. Based on an equidistant and sampling interval of 10 kilometers using a 11200000 scale map, 200 villages will be selected and studied. 5.3. SELECTION OF SURVEYORS The RAPLOA survey was carried out by 3 teams. Each team was made of 3 interviewers, I driver and I field coordinator (or team leader). The team leader was selected with due orientation from the Health District teams. The interviewers (9) and 3 team leaders were trained on the creation of rapport with communities and individuals, interview techniques and the delivery of the RAPLOA questionnaires. Prior to the starting of the field activities, field surveyors were trained. The training included brainstorming, role play, practical and field exercises. During the training, participants will be informed on how to deliver the RAPLOA questionnaire and a practical exercise carried out on the collection and analysis of RAPLOA survey data. 5.4. RAPLOA TOOLS We used RAPLOA forms that were filled by surveyors in each of the selected villages. The village coordinates were collected using a Global Positioning System (GPS). The provincial Coordination Team supplied three (3) vehicles for the duration of the survey. One was based in Sangmelima (Sangmelima Health District), one in Zo6till6 (Zo6t6l6 Health District), and one in Adamaoua supplied by IEF (the NGDO partner). The Provincial Delegate of Public Health played a leading role in insuring the the vehicles were available and used for the purpose of the present study. 7 5.5. TRAINING OF RAPLOA SURVEYORS A two-day intensive RAPLOA traning course was organized at the Provincial Delegation for Public Health in Ebolowa from 10-12 July 2004. During this training, participants were exposed to the basic clinical aspects of onchocerciasis and loiasis as well as the biology and ecology of the vector flies, Chrysaps. The main components of the training were the objectives, procedures and techniques of the Rapid Assessment Procedures for Loiasis (RAPLOA). The following support documents were used : - WHO(2001) Rapid Assessment Procedure for Loiasis - WHO(2002) Guidelinesfor Rapid Assessment of Loo loa With the use of the photograph of the eye worrn and the RAPLOA forms, participants were taught how to successfully conduct a RAPLOA interview in the selected villages, as well as filling out the RAPLOA forms. At the end of the training, the trained team executed RAPLOA in the field, under the coordination of the WHO Temporary Adviser. A full description of the methods of executing RAPLOA was presented in previous study reports (Takougang, 2003 a, b). 8 6. RESULTS AND DISCUSSION 6.1 RAPLOA TRAINING A total of 14 persons received training on RAPLOA and RAPLOA Jield data collection techniques. Among those one was from the central level, 2 were recommended by the NGDO Partner (IEF), I were provincial staff members, and 3 were support persons who had participated in previous RAPLOA study. Both the WHO Temporary Adviser and the National Coordinator of the Onchocerciasis Control Programme facilitated the training workshop which lasted 3 days. 6.2. SAE RISK AND IMPLICATIONS FOR CDTI Distribution of Village Communities SAE Risk by Health District Health district Number villages low risk SAB of at of Number villages high risk SAE of at of Number of villages at very high risk of SAE Total number of villages studied Sangmelima 10 25 6 4t ZoEtEl6 0 6 8 t4 Meyomessala 9 17 27 53 Djoum t2 10 7 29 Ambam 0 7 52 59 TOTAL 31 b5 100 196 6.2.I. THE NTEM VALLEY DIVISION In the Ntem Valley, all the villages studied had a prevalence of RAPLO A>40yo and are at risk of SAE. The risk is very high (>60%) in most of the study villages (52 out of 59). Some of the villages across the Ntem were inaccessible for the study, because of the non-existence of a motorable road. These communities shall represent a major challenge to CDTI due to the expected high prevalence of Loa loa and the associated SAE risk. 9 6.2.2. THE DJA ET LOBO DIVISION The Dja et Lobo Division covers the Health Districts of Djoum, Meyomessala, Sangmelima andZoetel6. This area is the site of the previous Community Based Distribution of Mectizan,that was conducted by the International Eye Foundation under the River Blindness Programme. The prevalence of RAPLOA was generally below 40%o arotnd Sangmelima and Djoum. These are the areas which had the highest coverage rate at the time. In the Zoetele area where the coverage was lower, we still had high prevalence of RAPLOA. This indicates that during mass treatment, it is important that high coverage should be obtained. The Meyomessala Health District covers some of the hard to reach areas, in the Bengbis Health area. Some of the villages have very bad road network. Fortunately, the SAE risk Map also indicates that most villages of the area are at low risk of SAE. 7. RECOMMENDATIONS: The implementation of CDTI is highly recommended in the study area. The first reason is the amount of debilitation associated with onchocerciasis and loiasis. Mectizan is available in the informal and formal sector and is high consumed by the population. Its formal distribution, its availability free of charge to the consumer is a major asset. The local population does not make a difference between Loa loa and onchocerciasis, and seek Mectizan treatment for both conditions. Major improvement have been made on the early detection and management of SAE. There are major advantages in treating individuals with Loa loa, and this has a major impact on the reduction of Loa loa microfilareamia and SAE risk for the individual and the community. CDTI should be implemented following the the Mectizan Expert Committee Guidelines for areas with high risk of SAE. l0 8, PROBLEMS ENCOUNTERED AND IMPLICAT'ONS At the time that the present RAPLOA exercise was carried out, there were many other ongoing APOC activities in Cameroon. This put a lot of pressure on the logistic support that could have been devoted to RAPLOA. The most important implication was the availability of vehicles for field activities. The Provincial Delegate of Public Health was able to secure three vehicles belonging to the Health Districts of Sangmelima, Zoetel6, and that of the NGDO Partner (Adamaoua CDTI Proj ect). We did not have a vehicle for supervision either from WHO, National Programme for Onchocerciasis Control, or the Provincial Delegation. Supervision being a major thrust in the execution of RAPLOA, we had to rent an additional vehicle and use it for that activity. The quality of the road infrastructure was poor. This lead to frequent breakdowns as far as the vehicles were concerned, and the consequent high cost of maintenance. The many frequent breakdowns was not very pleasant to Health District authorities. At times, this triggered frustrations. Despite the problems encountered, we were able to reach our study objectives. lt 9. REFERENCES WHO (2001) Rapid Assessment Procedurefor Loiasis.Result of Multi-Centre Study. Wanji, S(Ed.) TDR/IDE/RP/ RAPL /01.1 WHO Geneva TDR/WHO (2002) Guidelines for Rapid Assessment of Loa Loa TDP.J IDE/ RAPLON}2.I. TDR WHO Geneva Takougang I.(2003 a). Rapid Assessment Procedures for Loiasis (RAPLOA): Mapping of Loa loa in the North lAest Province CDTI Project Area - Cameroon. WHO/APOC Report. Takougang I. b. 2003. Rapid Assessment Procedures for Loiasis (RAPLOA): Mapping of Loa loa in the Nanga Ebok Health District CDTI Project Area - Cameroon. WHO/APOC Report. t2 RAPID ASSESSMENT PROCEDURES FOR LOA LOA IN THB SOUTH PROVINCE CDTI PROJECT AREA TRAINING OF SUPERVISORS AND |NTERVTEWERS - EBoLoWA (12-14 JULY 2004) LIST OF PARTICIPANTS Name Fonction Affiliation TANEKEN Ferdinand KANN0 lnterviewer Previous participant in RAPLOA study Mr, NKOUELLE Alexis P.O lnterviewer NGDO Partner Mme 0L0UMAN Barbara lnterviewer Provincial Delegation of Public Health Mr. Jude MUFOR TING lnterviewer Previous participant in RAPLOA study Mr. AMOUGOU Olivier lnterviewer Provincial Delegation of Public Health Mr. EYIZO'O Dieudonn6 lnterviewer Provincial Delegation of Public Health ZAMB0 Serge lnterviewer Previous participant in RAPLOA study Mr. NKWELLE Patrice lnterviewer NGDO Partner Mme KANDO Jeanne-D'Arc lnterviewer NGD0 Partner Mr. OBATE ZO'O Team Leader POC South Province CDTI Prolect Mr. OSSONGO EKANI Charles Team Leader NPOC, Yaounde Mr, MEDJO MENYEGA Emmanuel Team Leader Provincial Delegation of Public Health MTs TSELIKEME ANTSELE lnterviewer Provincial Delegation of Public Health Dr BELINGA B,R. 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() -o o a -o oo o m (€ a a(o -obo (! >. z I N obo (J bo o6 a -oobo z (! o Io z os o E')sEa tr)N (oN t-N @N O)N o(r) cf, Nco c9co sc.) loC9 (oCO f.-cf) @c.) O)cv) ort $ Ns COs ss lo$ (os F.-s @lif o)s orr) lr) NrO (o1r) oo o 4 d F-N t--Nf.-NN t'*s (o @ r.ot*N@!if- s(e ro o, @N ro c.)(o N N(o f.-so O) to \r F--(o @N s- t- (o|r) ro tr) tr) rr)lr) ro ro lr)_ N(o (o tr) O) f.*N(o lr)(o Nt- cf) @ @ s- COtr) o o :!h cr) roa Ns @-(0 cf) t-ri. Nt-toNtr)t- o CO 5 o + o o :th o o l+ @(o 1r) (os@ colr) t-N @f.- ro$_ Ns o o + @ @ rooNs(o- t-to Ns@(o CO NN ro(olr) o)(o @ o_ [o o o + @(f) roo rr) ryo(0 (oo ro @o @ @lir o o +* o ro @(o I-rr) $f.-(oo @$ o o q) o0LE EE zv. Ns o tr) (f)tt 1r)$ ros os @N (oro (os N t\s @(o o)\ir @N o)s (oN F$ (oto $$ (oN t- $ tetri]. =o2e @@ O)N o, $@ (O(o @ $(o oro (o@ (o@ F.-lr) oo NO) O) o)() ro@ roO) No) (aO) so, Nlr) lr,N o)@ o!, =G N cf) ns(f) o cf) st- o?(o CO o(o s$q(o(O o CO N cf)q o, cf) o co ro @ O) +N o(a @ CO r sN o(f) @(o O) + (f) o,lr) rr) c.i o co o @q o o(o ao cr)q @tr) o N Nf.-\ f.-tr) o N b rr) o) Nlo oN N(o c? $tr) N ac O)q @\r o N $rt @ @v o N i- O)\ss N ao CO c.is o N bo c! O) CO oN 1r) q s o N o,N +|r) o N +(o nNN N o,[olr) CON N aoN o? N o N oE') =E'|tr o (o c! NN oN O) oN NN Nq(o c! N (o cr) o, cciN oN (r) (.) o.i c.) oN f.- F.- c! o(f) oN N\rq cr) oNr N\ co oN (f) @q cr) oNr slr) n o oN : o)tr) do oN ao @@ coo oN bN c! o oN -r.c) Nlr) rio oN F-s C9 @o oN i- co ao o N r $tt no o N F* r o,o oN 1.- o,tr) co cr) oN =o(f) @ 1r) o io COt- c.io oN io Nlo F-o Nr -N (o c.jo oNr -Eo EEro o oaoo E o o o (I, aa o) E o o = o oo at o) E o o o oaa o E o o o ooa o E o o) = o o U' at) o) E o o) o oa o o E o o o (o aa 0) E o o) o o U)a o E o o o E o.) E o)c(! U) o E o E o)c o U) o Eq) E o)c oa o Eb E o) oa o E o E o)c o C) G E o E o)c oa o E o E o)C oa o E 0) E o)C o U) o E o E o)c oa E =o5 o E o E o)co(/) E f o i5 E f o i5 E = .9. o o o G s =o G' .a -oo,c o co .a -o o)C o c0 .o -oolc oMI ,9 -oo)E o)(D .9 -o o)E o co .o -oo)c o co ,a _o o)c o co ,9 -o o)c o @ oo -)< o) E o -)< o)aa oNo o U'o o)No o E 0) E o)C oa =oc f o o =oc =o o Eo U Eo uJ Eo LrJ E fo o o E q) E o)C oa o)cq) o o)c o) o o)c o) o tr .9 .9 tIl Jo ,9 -oo)E o() ,a -ooc o) m .2 -o o)c o m .9. -oo)c o) co ,a -o o)c o) rn .9o o)c o co .a -o o)E o) @ ,9ooc o co .o -oo)c o) G] o E o E o)c o U) o E o) E ct)c o U) o E q) E o)c oa o ._E o) E o)E o U) o E o E o)E o U) o E 0) E o)c o U) o E o E o)E(E U) o E: o) E o)E o U) (E E o E o)c oa E :, o b- o E o E o)c(U al o)C o o olc o o o)c o o o E .Ez o E)s 5 C) .o C) o E orJ o -o IJ.] (n -(! -vo oaogl ,(! z E o O E (.) -o (.) .o EI <oJ z o .N -o(! z (d J C) z 0) .o ov E -o (! o0 (! -o E O C) a C) N 0) o() v ! o o 63 oo N >. z J(d a o oo I o o ob o >.q) z q o o o o €' C) sl o() €, z o E o) -o 2, E]otNIot(!l >rt >l I olJI oolElC)l 'ol ctr!l I o -v() () -o() z. N C) z (l) o co ,o E)()() .q) oN (B -o(! ovzb (o -o() 2. o E')s 5e s1o rr)rO (olr) t\lo @ro o)|r) o@ (o N@ cf)(o $(o ro(o (o(o t-(o @(o O)(o ot- N Nt- (f)N rtF.- tr)f-- (ot- t-t- @N o)N o@ @ N@ (o@ o\ o o- u (o .ir O) ro$ o, ro_ $s o o + $sss$!t s- ssf o o ++ o o 1+ cf) o)oNt-(f) @_ @s CO (f) cf)(o (f) cf) @_ os ro rr) rils Lr)lr) \t_$() o o + t-o\r CO o) ro(o- o$ o o + (os(f) N o O) t-(o f.-(o(o @(o(o(o- s N @(o(o(o(o $ rr) c; o + $tr) c.)lo(.)lo cf) tr) cr) (o (f) cf) CO(o(o co- lr)s o o + o o *+ @ cr)|r) (os @- cf)lr) o o+ o o +* (o N COo o)N -r$ (f)s t\lo @N o,(o o)(ot-o(a N s_ O)(f) o o +* o o{* o o +t o)(o C9oNN cos F-to @N$ t- lr) CO (o N o)toN o) ro Ns o)@ @ @@ @ @ @(f) 5 6 +t oba b .Hg tr!r z?,i CO cf) sN N$ O)s tr)tr) t\cf) r()ro o$ Nlr) rr)c.) $co Ns lo s$ s lo oCf) (os rr)CO teF i:. qg,29. sf.- $lr) (o@ oN o O) @ (oo, (oo) o,o, rot- @f.- $N Nr $o @ \l@ @o oo) o E' = .(! (o N o, N N s \sN oN s 1r) @ c? o cf) o N -. rr) c! 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C9 (f)(e (f) o,s (o(o o,t-t-(oo$s $t-s o)@t- lr)- r 1r, (o o,(o @o(o N.(alr, (o(o(.)[o @ 1r) @- (f) 1() CO looN@ol 1r) NNNNNNol c!s (fJ cf)(o(a(r)(a (f) lo(o @(0 1r)t-(olot-(o ro q)ht b.Hu EQE 2?,i lr,s s (o1o o)s F-CO rr) rr)lr) s Nsf Nrr) os @s O)$ f.-tr) COtil (orr) (o @lr) lr) (f)rO (f)rr) Nr() t-CO @N o)$ o,$ $$ O(o @(f) o)s Ns teFA =ozc o@ Nf.- t\t- f.-(o o,f.- o@ o@ o@ o)N (oF- o@ o@ o@ o@ o@ o@ o@ o@ o@ \rt- o@ (r)@ [ot- o)lr) lr)o, No) N@ F- oo) rr)t- sN ot,) .E o)@ F.- oi r oN (os CO oN oN N F.-q N o N NN\ s o N loN ro cc; co o N (f) \(o(r) oN (9 (f) tO + cr) oN o CfJq cf) o N @tr)qq N c.) o N o) rO o, o,N oN ss c.jN oN @tr) c.)(o N N o)(o csN oN @(o qq (O N oN lo lr)q sN N r() f.- c!(o N oN o(o @ @N oN (oot- ro N oN o,(o f.- .t N N oo nlr) o cf) o)N a? tr)s o N olif\ @s o N @ a cf)lo o N ros(o lolr) o N o) @@ F- rO oN (o o) F- rr) o N o)(oq(o rr) o N (o(o ro l'- ro o 6l |r)(o o(f) o(o o E' =E)tr o sN c!(o rrj o o f.- c.ilf) oo s oq Ntt oo Nf.*q N$ oo cr) rr) olir oo N(oq ro oo CO r c!\tlr) oo @ c! $ rr) oo o N o)lr) oo N O) nNs oo N(.)q s$ oo @ c.) @ c.i$ oo $ o)q os oo r @@ as(9 oo s O)q N CO oo t-@q o CO oo co st-N oo s lo N oo CON sN oo N o, o,o oN s o,tr) co$ o N(f)(o N 1r) @s\ 1r) o lo @(r) c"j$ o r r$: s o r t-N F-s o r (o N n ro o @ o)(o @ ro o o)t- F c.jN oNr -tro EE -o Eoo E Eo -o E E o -o E E(E -o E E o -o E E(I, -o E Eo -o E E o -o E E o -o E E(! -o E E o -o E E o -o E E o -o E E o -o E E o -o E E o -o E E o -o E E o _o E Eo -o E E o -o E E o -o E o oaa o E o o o E o E o,C o U) o E 0) Eoc oa G E 0) Eoc o U) o E o E o)c oa o E o E o)E(E a o E o E(n E oa o E: o E o)c oa o ._E o) Eoc oa o oooo E o o) (! o o -tr =(! o oc o -oq) o)c o -oq) of o ; E oaaq) ; E oaaq) ; E oaaq) = ; E o U'a 0) = ; E oaao E _o o o q) O o o C _o o c _o o c -oo c _o o _o o = c _o o E _o o c o .N -oG z c o .N -oo z c o .N -oo z c o .N -o(I, z q) aa oo Olz o)C o C o olzz Eo E_'o E o q) = o)C '6 ao Eolz o E q) E olc(U a o, .coa o E =olz ooo IU o -o c) o -oq) (, aa uJ o o _o(I' o E o -o o o E' st Jo C _o o c o o c _oo = c _o o c -(Uo c _o o = C _o o c -(!o c _o o C _oo c _o o c o o c _o o C o o = c _oo c o o c _oo c _o o C o o = c _o(! c _o o o ooa o E o o o ._E 0) E o]c oa o E 0) E o)E oa (U E c) E o)C oa o E o E(,r c oa o E o E o,c Ga o E o) E o)c C, U) o E6 EoC oa o E o) E o)c oa .a -o o)c o(n o E(! z ol EN .!l >l E ofz o; o)z OJc(o -o c) E o al,o .o o [rJ o)co >.J o) E(EfoN] =o Eooa 0) (I, E o -o E oo l.rl o E o -Yo -o aq) t! o E o .}z o o,c oN(tr D z1 o1 ol >t(1)l(!l o.l -:z Izl o)c o c(tr >l co oaa I.JJ E o)E o o,c o Eo -oo L.uo-o o- o E o o =co c oEz ao o) Eo .:zz G) o o)c o) E .; I E oF o)lcl olx(1)t EI 6l zl o o,c o q) c o .N -o(E >1 z) (h o ol >l :aaq) I(r) c o o >lJ(trl EI =lol <l alol (1)t EIolrzlzl EoY o o f, otzE(I, oo uJ ,6 aq) o LIJ Eo E c) E tu o,Co o E o(tr =llzlcl =l ololat rul ol ,ol =l _o o .E o E')g 5e o N N N N (f) N v N lr) N (o N F- N @ N O) N oNN NN NNN (f) NN sN c\ ro NN (o NN NNN @NN O)NN o CON (r) N N(f) N (f)(a N olo N $lr,N lr) ro N (olo N F* rON @[r) N o)lr) N o(o N (o N .+ N o r tr (o @N\r t-lo @ N o o + tr)(o f.- rs o)- Nlo @N i; . g'E 9..!:- trYr zv.i N o NN o,cf) teFo. =u,2c t- o rr) orr) oE' r! (o o oq NN o(.) o, CO(os o N rOo @dlo oN (0 a f--o o(f) o!,5 =E, o losN sN oN CO o,q f.-lr) o r st$N6$ o (f) rr) tr) (o N oN -Eo EEIO o (I, aa o E o o o E o E o)c oa o E o E O)E oa o (I, a U)o Eo o .Eo (E Go I .o -o o)c 0) d) o E o) E o)C(I, U) o ato tIJ o -oq) oolz o .9 ,2 E .cl a a -o(ri E o co o .E o E o)c oa o E o Eoc o U) .U' -ooc o)o o E(! z o E': s 5 EIq) E .o 'ic o E o o = q) oa tu o) -o o) oNo oY o E"sEo N(o N (9(o N rr)(o N (o(o N Table 2 : RAPLOA SURVEY IN THE SOUTH PROVINCE CDTI PROJECT (CAMEROON) : VILLAGES AT LOW RISK OF SEVERE ADVERSE EVENTS WITH ENCEPHALOPATHY (SAE) Village ID Village Name Lonqitude Latitude N respts N respts RD RAPLOA 34 Nkolenyeng 12019.323', 3'04.585' B3 31 37,3493976 42 Nyabizou/Bissombo 12"26.463 3"21.213 83 60 72,2891566 46 Doumbenyan 12'33.362 3"23.754 34 12 35,2941176 51 Douma 12'18.940 3"29.881 20 6 30 52 Mekam 12"24.126 3"31.357 25 4 16 53 Mboun 12"30.624 3'33.073 47 17 36,1702128 55 Ebodoumou 122"29.191 3'36.374 29 10 34,4827586 56 Esson/Meka'a 12.26.921 3"36.644 19 5 26,3157895 65 Atonmimbanga 12"05.591' 2'57.772' 57 21 36,8421053 67 Kamelon 12'01.27]', 2'54.362' 97 38 39,1752577 75 Ndjele/Elom 12"10.444', 2'42.316', 95 26 27.3684211 99 ZoelBikoula 12'26.O41', 2"48.267', oo 35 35,3535354 107 Abodlen 12"38.349', 2'42.408' 112 44 39,2857143 108 Djoum 12"39.898', 2'40.374', 104 41 39,4230769 113 Ayene 12"40.345' 2"23.386', B4 30 35,7142857 115 Meban II 12"40.872' 2"26.591', 90 35 38,8888889 117 Avebe-Ezafack 12"57.505 2"42.851', 79 22 27,8481013 145 Konddmeyos 1 1"57.689 2"59.284 116 39 33,6206897 203 Zodbefam 13'19.296', 2"38.774', 92 34 36,9565217 204 Mintom lU Zeh 1 3'1 8.1 55' 2',42.530', 89 36 40,4494382 205 Koungoulou/ Mekotte 13"07.755', 2"42.530' 101 29 28,7128713 206 Melen/ Mevos III 12"57.088', 2"42.961' 77 19 24,6753247 207 Mbouma./ Minkomesseng 12'59.805 2'42.402', 50 14 28 208 Ldld 13"24.891', 2"19.069' 87 25 28,7356322 250 Alouma(Melang-Messi) 11"48.594 2'45.329 75 37 49,3333333 254 Nkomevos 11"57.632 2'48.740 59 26 44,0677966 262 Metom 12"27.245 3'22.806 7 2 28,5714286 25 Table 4 : RAPLOA SURVEY IN THE SOUTH PROVINCE CDTI PROJECT (CAMEROON) : VILLAGES AT VERY HIGH RISK OF SEVERE ADVERSE WITH ENCEPHALOPATHY Village ID Village Name Longitude Latitude RAPLOA 1 MobomoA.lkolcass 11"59.364' 3"21.906' 70,4545455 8 Nkonmekak 12'08.506' 3"12.41g', 70,9677419 15 Endam 12'16.516 3"26.907 60 19 Zouameyong 1 1'59.1 1 0' 3'09.860' 73,75 21 Meyos/Eton 12'09.020', 3'09.429' 63,0136986 23 Messila/Messok 12"15.480 3'11.872 66,6666667 27 Mey6messala 12'14.645', 3'05.703', 70,1149425 28 Bidjong 12"18.430' 3'07.883' 63,75 29 Koum Yet6tan 12'08.503' 3"12.41g', 78,75 36 Ebang/Djikom 12"20.676', 03'03.633' 96,9230769 37 MinkdA.,Jkilzok 12"20.866' 3'05.686', 60,2941176 38 Nl6besse'e 12"24.947', 3"07.038' 84,1463415 40 Ndibissong/Nyele 12"20.830', 3'1 1.238' 71,25 41 Ekok/Mekin 12"24.022 3''15.361 73,8636364 42 Nyabizou/Bissombo 12"26.463 3"21.213 72,2891566 44 Nk6lmekad 12'29.831 3'23.830 68,8311688 45 Ass6k 1 1'54.563 2"45.984 52,2727273 49 Ongolzok 12'22.159 3"29.055 60,3773585 50 Ngobissong 12"27.245 3'28.083 79,6875 58 0yem 12'32.315 3'24.985 71,4285714 59 Akam 12"30.277 3"24.136 55,5555556 60 Nk6lembembe 12"31.542 3'14.969 62,5 62 Mekas 12'31 .583 3''10.690 65,1162791 78 Endengue 12'38.597', 2'41.21s', 60,2150538 82 ZodtelelEboman 12"07.525' 2"23.559', 68 95 Yos 12'13.716', 2"58.317' 67,9012346 122 Moneko I/Moneko II 11"44.529 3'02.1 5g' 62,3529412 123 Ma'anmenyin/Avebe Esse 11"45.629' 2"59.575" 66,6666667 127 Ngoungoumou II 11"43.322', 3"09.715' 62,8205128 128 Nsimi 11'49.401', 3'19.626' 66,6666667 146 Nddld/Messok 1 1"56.483', 3"18.631' 65,9090909 150 Biboulemam/ Biyan 11'57.054', 3"11.823', 60,4651163 151 Nkoumadjap II 1 1"57.053' 3'11.821', 61,1764706 152 Mekalat 1'1'59.735' 3"13.752', 67,4698795 153 Zouameyong 12"14.130 3'17.860 61,1764706 156 Meyiba 11"51.028' 3"11.037' 61,2244898 157 Nkolfong 11"54 946'. 3'09.544' 68,8172043 158 Efoulan /Evindissi II 11'54.845', 3'09.543', 77,0833333 161 Mdlen/ Ndjom 11"54.845', 3"09.543' 72,2222222 165 Avoulsobo/Mefoup 1 1"03.534 2"42.543 70,1492537 166 Nndzam 1 't'03.852 2"41.350 73,75 167 Mindimioveng 1 1"03.459 2"27.752 76,25 168 Meyo Centre 1 1'01.869 2"33.812 70 26 Village ID Villaqe Name Longitude Latitude RAPLOA 169 Nkoroveng 11"03.342 2"32.025 71,25 170 Nsessoum 11"07.248 2"31.047 76,25 171 Minsele 11"09.404 2"21.355 73,4177215 172 Ma'an 11"27.171 2'26.981 75 173 Yos 11"04.543 2"13.934 72,5 174 Meko'omengona 1 1'10.366 2'15.070 75 175 Eyinantoum 1 1"08.075 2"14.293 68,75 176 Meyo Biboulou 1 1'00.131 2"11.457 75 177 Olamze I 1'05.088 2"12.769 75 178 Olang 1 1'08.403 2"11.765 68,75 179 Ebengon 11"11.346 2'11.986 63,75 180 Minyon 11'12.533 2"14.986 67.5675676 '181 Mekomo II 11"14.274 2"12.847 66,25 182 Nsangbwang 11"17.051 2"15.807 70 183 Meyo Nkoulou 1 1'20.569 2"16.351 72,5 184 Mefoup 1 1'20.809 2',13.804 77,5 185 Bingong 11"18.741 2"11.881 70 186 Mfoulekok 1 1"10.943 2"12.065 78,75 187 Zaminkan 11"15.012 2"21.278 68,75 188 Akoulouzok 11" 16.718 2"23.193 73,75 189 Bikon 11'15.662 2"24.353 70 190 Biyii 11'12.390 2"26.528 73.75 191 NkolEfoulan 11'17.423 2'25.913 70 192 Y6s Ma'an 1 1'19.381 2'27.472 80 193 Mendjimi 11"19.219 2'29.462 70 194 Akondky6 1 '1'10.503 2"28.710 73,75 195 Ngom Essaobam 1 1'18.008 2"33.554 72,5 196 Akam Messi 'l 1'19.864 2"35.869 70 197 Mekomo 11"21.774 2'21.700 73,75 198 Nlong 11"23.629 2"20.433 77,2151899 199 Abang Minko'o 11"25.321 2'19.767 73,75 200 Nkoldkon 1 1'30.439 2"20.579 72,5 201 Mbam Essaobam 11"34.177 2"23.930 70 202 Medjounou 1 1"36.061 2"23.332 73.75 213 Evol6 10'42.841 2'12.972 72,7272727 214 Zouameyonq 73,1343284 216 Ebombama 10'40.51 3 2"38.575 63,75 217 Mbekomo 10'51.662 2'36.713 68,75 220 Nkpaevole 10'59.210 2"32.658 68,4210526 222 Biyan 10"47.497 2"29.959 60 223 Meko'omengong m Essa Mbida 10"44.632 2"22.144 61,25 224 Adjap '10"42.836 2'26.358 71,25 227 Nkomeyos 10"34.486 2'23.668 70 228 Mvi'limenqale 10"32.694 2"24.255 76,25 229 Tom 10"30.687 2'26.275 72,5 230 Nsimeyong 10"27.431 2'26.860 63,75 231 Melonqo 10"25.141 2'25.706 71,6216216 232 Nyabizan 10'24.231 2"24.769 66,25 233 Meyos 12'09.917', 3'15.418', 68,6746988 260 Meyo Esse 1 1"56.698 2"57.566 65,3333333 266 Koulaze 12"26.553 3"07.461 78 27 Table 5 : RAPLOA SURVEY IN THE SOUTH PROVINCE CDTI PROJECT (CAMEROON) : VILLAGES AT HIGH RISK OF SEVERE ADVERSE WITH ENCEPHALOPATHY Village lD Village Name Health area Health District Longitude Latitude RAPLOA 3 Nkoumadjap III Endom Zo6t6l6 12"07.573', 3"21.094', 46,25 4 Enamenga,/Ngougoumou I Nkolbanq ZoOtbl6 12"01.676', 3"19.891' 59,2592593 7 Fibot Nqoasse Meyomessala 12"05.344', 3'05.1 78', 56,7901235 I Ndj6m yekombo Ekong Meyomessala 12'09.019' 3'09.423' 55 10 Tekmo Ekonq Meyomessala 12"04.003', 3"08.1 73' 56,3218391 12 Nkdl6ton Outou Nkolotou'outou Sangmelima 12"01.484', 3'04.665' 51 ,8518519 13 Akomendibi Nkolotou'outou Sanqmelima 12"01.701', 3'01.999' 58,75 16 Melan Mbometa'a Meyomessala 12"20.065 3"25.151 41,7910448 1B Ew6l6mbama/Teng II Mbometa'a Meyomessala 12"14.130 3"17.860 48,9361702 20 Nkolendam Nqoasse Meyomessala 12"14.128 3"17.860 57,5 22 Efoulan I/lI Messok Meyomessala 12"14.483 3'1 4.1 03 59,7560976 26 Nndmeyong I Messok Meyomessala 12"13.759', 3'10.843' 54,8780488 39 Akom Ndong Meyomessi Sanqmelima 12'29.522', 2"45.892', 51,2 45 Ass6k Meyomadiom Sanqmelima 1 1"54.563 2"45.984 52,2727273 47 Bengbis I Bengbis Meyomessala 12'26.539 3'26.566 52,173913 48 Nyangbassa Bengbis Meyomessala 12"22.060 3'26.849 56,8181818 49 Ongolzok Benqbis Meyomessala 12'22.159 3'29.055 60,3773585 50 Ngobissong Benqbis Meyomessala 12"27.245 3'28.083 79,6875 54 Olembe Bengbis Meyomessala 12"27.261 3"34.437 47,7272727 57 Minld Bengbis Meyomessala 12"28.936 3'39.637 51,1904762 59 Akam Benqbis Meyomessala 12'30.277 3"24.136 s5,5555556 61 Nyabizou Bengbis Meyomessala 12"31.771 3'12.559 56 63 Konde Akon Sangmelima 12"01.454' 2'58.633' 53,4883721 66 Mezesse Mezesse Sangmelima 12'08.868' 2"57.950', 47 71 Minkang II Olounou Sanqmelima 12"05.575' 2'48.596' 53,8461538 72 Nnmeyong/OIounou Olounou Sanqmelima 12"08.347', 2"48.844', 47,4576271 74 Medjounou Elom Sangmelima 12"10.437' 2"44.791', 57,6470588 75 Ndjele/Elom Elom Sanqmelima 12"10.444'. 2"42.316', 27,3684211 76 Mbilemvom Elom Sangmelima 12'09.17', 2'39.200' 51,0869565 79 Mebemenko Sanomelima Sanqmelima 1 1"56.301' 2"54.129'. 46,8085106 81 Bitchel Ovenq Djoum 12"02.736', 2'22.464' 50 83 MebangNkoabas Ovenq Djoum 12"03.317', 2"17.923'. 46,0674157 84 Aboulou Ovenq Djoum 12"03.317', 2"17.926 44,5945946 86 Oveng-Fang Oveng Dioum 12"15.432', 2"24.714', 44,4444444 89 Ngoudjeng Oveng Dioum 12"11.656', 2"30.3854 48,8372093 90 Meyomessi Meyomessi Sanqmehma 2"12.434', 49.251' 40,8333333 91 EssangmvouUMessok Sangmelima 2"16.17s', 612', 54,4554455 93 Tatching Meyomessala 12'15.036', .456' 40,6593407 96 Mintima Nkolenyenq Meyomessala 12"20.738', "58.461' 41,6666667 97 Emvieng Meyomessi Sangmelima 12"20.264', "49.226 54,1666667 100 Akom Ovenq Djoum 12"14.953', "27.O24' 45,3333333 28 Villaqe lD Village Name Health area Health District Lonqitude Latitude RAPLOA 103 Ngbwassa Oveng Dioum 12"40.482', 2"29.552', 53,8461538 106 Mveng Mveng Dioum 12"37.277', 2"44.869' 41,1290323 112 Akontangan Djoum Dioum 12"39.836' 2'36.709', 43,220339 114 Bindoumba/Alatmekae Djoum Dioum 12"40.451'. 2"29.551', 42,5925926 120 Bikobo/Ndjom Essaman Avebe Esse Sangmelima 1 1'39.769' 3'01 .1 89', 53,0120482 134 Melomdbae/ Ngolbang Messam Zoetele 11'49.401', 3"19.625' 52 135 Fibot Fibot Zoetele 47,6190476 137 Engoudouk/Mbedouma FiboUNdele Zoetele 1 '1'57.836', 3'21.908' 57,8313253 139 Ebamina IIl Angon Ebamina Zoetele 54,1 666667 160 Mfouloveng/ Oveng Yemvak Oveng Yemvak Sangmelima 11"52.777', 3'05.571' 46,3576159 162Nkpwang Ovenq Yemvak Sangmelima 1 1'57.559' 3"02.261' 43,0232558 163 Evindissi I Nkolotoutou Sangmelima 1 1 "58.1 g3' 3'02.661' 54,7619048 204 Mintom lllZeh Mintom Djoum 1 3'1 B.1 55' 2"42.530', 40,4494382 211 Mebang Mebanq Ambam 10'56.224 2"19.789 56,25 212 Assam Mebanq Ambam 10"52.710 2"20.346 56,9444444 215 Messama ll Messama I Ambam 10'42.672 2"41.722 46,835443 218 Mekomo/Eves Messama I Ambam 10"54.213 2'34.533 51,25 219 Ndjazeng Ma'an Ambam 10"54.281 2"31.930 53,1 64557 221 Mfang Ma'an Ambam 50 225 Bitoto Ma'an Ambam 10"40.294 2'24.069 53,75 250Alouma(Melang-Messi) Nkolonyeng Sanqmelima 11'48.594 2"45.329 49,3333333 254Nkomeyos Meyomadjom Sangmelima 11"57.632 2"48.740 44,0677966 255 Mekom Akomessing Sanqmelima 11"51.749 2"53.481 51,5789474 256 Essabikoula Sangmelima Sanomelima 11'43.395 2"55.345 53,2608696 257 Evelessi Akoumessing Sangmelima 11"41.141 2"57.999 53,6585366 258 Eminemvom Avebe Esse Sanqmelima 11"47.127 2"57.196 51,2820513 259 Minkwaemioveng Avebe Sanqmelima 11"51.476 56.669 42,2222222 261 Minla'a Mbometa'a Meyomessala 12"23.179 3'30.351 56,7567568 265Avebe Esse Avebe Esse Sanqmelima 11"45.744 '58.805 52,9411765 29 aht FACULTE DE MEDECINE ET DES SCIENCES BIOMEDICALE DEPARTEMENT DE SANTE PUBLIQUE RAPID ASSESSMENT PROCEDURE FOR LOIASIS (RAPLOA) IN THE SOUTH PROVINCE CDTI PROJECT C 2. D6partement I C1. Province C 3. Arrondissement C 5. District de sant6 de C 4. Village (Localit6) C6. Aire de sant6 de C 7. Langues parl6es Iocalement (dialectes) C 8. Connaissez-vous quelqu'un de ce quartier ou de ce village qui a eu des vers dans la partie blanche ou inf6rieure de son eil et qui disparait avant de revenir? 1. Oui 2. Non C 9. Comment ddsigne-t-on cette condition ici dans votre village (Donnez le nom pour chacun des dialectes) ? Cl0. Comment ce nom se traduit-il litt6ralement ? C11. Age : ans C12. Sexe 1. Masculin 2. Fdminin C13. Fonction dans le villagel : ' Chef du vitlage, Notable, Membre de la cour du chef, Leader de pafti politique, Leader de groupe dejeunes, Leader de groupe de femmes, agent de sant6 communautaire, Prdsident d'association locale (djagui par eg), Directeur/Maitre d'6cole, Cat5chiste, Vendeur de mddicament, Tradipraticien 30 fig-tms IRE RELATIF A LA COMMUNAUTE Fn '-4/7 FACULTE DE MEDECINE ET DES SCIENCES BIOMEDICALES DEPARTEMENT DE SANTE PUBLIQUE RAPID ASSESSMENT PROCEDURE FOR LOIASIS (RAPLOA) IN THE SOUTH PROVINCE CDTI PROJECT f,nFa\q ar\t-N\ QUESTIONNAIRE INDIVIDUEL RAPLOA A1. Nom de I'enqu6teur A 2. Date de l'interview A 3. Nom du village : Equipe: Code v A4. Nom du quartier : A 5. Nom du chef de famille A 6. Num6ro du A 7. Nom de l'enqu6td A8. Num6ro d'identification (Get the names ot the end of the interview process) Caract6ristiques de I'enqudtd 2) Sexe : l. Masculin 2. Fdminin (Ne pas insister sur l'Age exact) 3) Groupe ethnique 4) Depuis combien de temps rdsidez-vous dans ce village? If less than 5 years, do not interview. EVALUATION RAPIDE DE L'HISTORIQUE DE LOASE Signes et symptdmes 5). Avez-vous eu ir sentir ou i voir se mouvoir dans la partie blanche de votre eil des vers qui disparaissent avant de revenir? l.Oui 2.Non (Utiliser le nom local obtenu du Questionnaire relatif d la communauti) A ce moment, montrer d l'enquAfui une photo de ver dans I'eil,le guider d reconnaitre le ver adulte (Loa loal dans I'eil, et passer d la question 6 ans a 6) Avez-vous jamais eu i vivre la situation pr6sent6e sur cette photo ?l.Oui 2.Non 6.1.) Si oui, Combien de temps le ver a-t-il durd dans votre ail avant de disparaitre? iours 3l RAPID ASSESSMENT PROCEDURE FOR LOIASIS (RAPLOA) TN THE SOUTH PROVINCE CDTI PROJECT (CAMEROON) PLAN D' EXECUTION DES ACTIVITES Dates Activitd Temps en jours Localitds d visiter I -11 Juillet 2004 Ac t iv it d s P r dpar at oir e s I 0 jours Yaoundd 12-13 Juillet Formation 2 jours Ebolowa l4 Juillet - l0 Aout Travaux d'exdcution de RAPLOA sur le terrain 28 jours Ebolowa, Sangmelima, Zoetele, Ambam, et autres. 11 Aout - 2l Aout Compilation des rdsultats et Rddaction du rapport final I 0 jours Ebolowa, Yaoundd,