Expert advisory committee twenty third session: Ouagadougou, 23-27 September 2002, report of the meetings of national coordinators on country-specific issues: Guinee Bissau, Senegal, Sierra Leone

I i ? I + WORLD HEALTH ORGANIZATION ORGANISATION MONDIALE DE LA SANTE ONCHOCERCIASIS CONTROL PROGRAMME IN WEST ATRICA PROGRAMME DE LUTTE CONTRE L'ONCHOCERCOSE EN AFRIQUE DE L'OUEST EXPERT ADVISORY COMMITTEE Twenty{hird Session Ouagadougou. 23 - 27 September 2002 8,AC23.3 Original : French RE,PORT OF THB MEETINGS OF NATIONAL COORDINATORS ON COUNTRY-SPECIFIC ISSUES Bdnin ) Burkina Faso ) Ghana )Niger )Togo ) =Page I to ll Guinde Bissau ) Sdndgal ) Sierra Leone ) =Page l2 to 19 C6te d'Ivoire ) Mali )Guinde ) = Page 20 to 32 1 B t2 GUINEA-BISSAU SENEGAL SIERRA LEONE Ouagadougou, l7-19 June 2002 l3 I. OPENING Due to the late arrival of the delegations of Guinea Bissau and Sierra Leone, the meeting of the National Coordinators and national entomologists of onchocerciasis control in Guinea Bissau, Senegal and Sierra Leone, initially planned to be held from l7 to l9 June 2002, started deliberations in the afternoon of June 18, 2002, at the headquarters of OCP in Ouagadougou, and in the presence of the Programme Director, the Chief VCU, Chief PET, the National Coordinators of Guinea Bissau and Sierra Leone and the PET technicians. Opening the meeting, the Director of the Programme, at the outset, pointed out the importance of the ad hoc restricted group meetings among countries started in 2001. These meetings pave way for in- depth discussion of issues of common interest. He also insisted on the reinforcement of the Community treatment with ivermectin in the above countries, which encounter the same problems in its implementation. When he took the floor, the Chief VCU said that the entomological surveillance in these 3 countries are a concern for the Programme. He wished that the discussions could help clear up a number of problems relating to this subject, and envisage concrete actions for the post-OCP period. As for the Chief of Administration, he first of all recalled 1) the need for all the documents-in -proof of the funds allotted to each country to be gathered, before the closing of the Programme; 2) methods of closing these accounts and 3) enquiries into certain issues by the WHO Representatives in the countries concerned, and the management of OCP. The CPET, pointing out the objectives of the meeting, informed participants of the possibility of having discussions with the Programme staff, even outside the regular hours. He hoped participants would arrive at relevant conclusions and recommendations, considering that this was the last meeting of its kind. After these speeches, the presidium of the meeting was set up: Chairperson : Dr. Antonio Tamba Nhaque, National Coordinator, Guinea Bissau Vice Chair Dr. Abdoulaye Jalloh, National Coordinator, Sierra Leone Rapporteurs : Mr. Lassana Konate and Dr. A. Fernando, National Entomologists of Senegal and Guinea Bissau respectively. With the proposed agenda adopted, the National Coordinators gave a progress report on the implementation of the recommendations of the ad hoc meeting of May 2001. IMPLEMENTATTON OF RECOMMENDATIONS OF THE AD HOC MEETING OF MAY 2O()1 1- Guinea Bissau o Resumption of evaluation activities The results of the epidemiological and entomological evaluation of 2001 are the only available ones. II. l4 o Resumption of CDTI activities The stock of 25 000 tablets of Mectizan delivered in May 2001 is still available but the preliminary training of Community distributors is still not done. The CDTI activities could still not be undertaken in2002. In all,36 nurses and health technicians in the area of Gabu and 8 in the area of Bafata were trained in May 1997, prior to the social disturbances. These trained health workers ensured, in their turn, the training of community distributors, who had carried out an initial treatment in 104 villages. 2- Senegal In the absence of the National Coordinator, no progress report was presented concerning the implementation of recommendations which had been made for Senegal 3- Discussions For the unsatisfactory wording of certain recommendations, (in particular those made for Senegal) and the repetition of some others, it was suggested, for this last meeting, that recommendations 1) be directed towards the countries and not OCP which is in a closing phase, and 2) emanate from unsolved problems, emergent or existing ones. III. EPIDEMIOLOGICAL SURVEILLANCE 1. Guinea Bissau 1-1. Results O Epidemiological evaluation a From June to September 2001, an entomological evaluation was carried out at the Medidora station in the basin of Rio Geba and at the capturing point of Cabuca in the basin of Rio Corubal. On the whole, I 1.120 blackflies (all savannah type) were collected in the two basins. The 41 flies with L3T were all caught in Cabuca in the Rio Corubal basin. For CDTI, support from WHO made it possible to train the health workers. While awaiting the training of Community distributors, treatment with Mectizan, planned for only in the villages where there are carriers of microfilaria had not yet started. A survey carried out by the Trypanosomiasis mission in 9 villages of the Basin of Rio Geba (zone of Sonaco) before the country joined the OCP Programme, had revealed prevalence rates befween 0 and 52.2% out of 350 examined persons. From 4 to l9 June 2001, an epidemiological evaluation was carried out in l2 villages of the basin of the Rio Geba and in 25 villages of the Rio Corubal basin. On the whole, 4,466 people were examined in both basins. Out of the number were 14 blind men and 40 carriers of microfilaria. All the carriers of microfilaria were detected in the area of Gabu (basin of Rio Corubal). Entomolo gical Evaluation ! t5 1-2. Constraints to CDTI activities The main constraint to the start-up of the distribution of Mectizan tablets in Guinea Bissau, is the lack of training of village distributors. A request has now been made to OCP and this training will be undertaken without delay. 1-3. Discussions The analysis of data on Guinea Bissau showed that ivermectin treatment can stop the transmission in some hypo-endemic zones. On the other hand the passage of certain foci of Rio Corubal from the hypo-endemicity to the meso-endemicity poses the problem of the duration of the treatment (when to stop). The holding of a restricted meeting at which would be discussed in detail all the problems of the CDTI in Guinea Bissau had been suggested. In addition, it was suggested that treatments be taken into account in the new action plan to be drawn up for the continuation of activities. 2 Sierra Leone 2-1. Results 2-l-1, Entomological a Before the vector control activities Between April and July 1988, the studies on transmission carried out by the Ministry of Health and OCP revealed Annual Transmission Potentials (ATPs) that were everywhere higher than the threshold of 100 (varying from 191to 6142). o After the vector control activities After four years of larviciding, ATPs fell to nearly zero (April to July 1992) o Entomolosical activities in 2001102 The entomological activities resumed on 4 December 2001. Two entomological investigations one of which centred on the infectivity of flies, and the other on blackfly movements between cross-border basins were conducted on four catching points (Arfanya and Yirafilaia in the Seli basin, Musaia and Kaba Ferry in the Kaba-Mongo basin). The savannah and forest species (soubrense/squamosum) each accounted for 38.2o/o of the 6,795 flies caught, as against 15/% of yahense. Generally, the results show a reduction in blackfly densities on all the catching points. Infective flies were caught only on two points (Yirafilia and arfanya). Monthly Transmission Potentials (MTPs), which were zero in December 2001, went up slightly in March and then zero again in April 2002. 2-l-2. Epidemiological situation before OCP Onchocerciasis is hyper-endemic and meso-endemic in 49.4% and 38.7o/o respectively of the 271 villages studied in the basins (most significant) of Sierra Leone. In 60.8% of the villages that were studied, the CMFL was > 10. The rate of blindness in the provinces of the south of the country was 6%. a tt6 2-l-3. Treatment rvith ivermectin Before the country joined OCP in 1986, the skin snip was the diagnostic method, and treatment was done with Banocide in the hospitals and clinics. Large-scale ivermectin treatment started in 1989/90, and was done by mobile teams, which made it possible for all the districts found in endemic areas to be covered. With the social disturbances, the control of the onchocerciasis in Sierra Leone was reduced only to the treatment by ivermectin, which was also suspended in 1996. 2-l-4. CDTI in Sierra Leone After its cessation in 1996, CDTI became the new strategy that was adopted for the treatment with rvermectln. With OCP funding, 301 health workers were trained in the Southern, Eastern (district of Kenema) and Western provinces. In addition, with funding from Sight Savers International,5,3l6 Community distributors were trained. Distribution takes place only in the safe zones of the Southern and Eastern provinces, and in the displaced camps in the areas under State control. The first round of treatment for 2002 is completed, and the 2nd is ongoing. The therapeutic coverage rates per district vary from 52% A 62 %. The extension of CDTI activities to the North of the country has been planned. To this end, a request was made to OCP for the beginning of training in September. An epidemiological investigation, financed by OCP will start in July 2002. 2-2. Discussions It was suggested that activities start now in Guinea Bissau and in Sierra Leone, given the priority of these two countries where activities were suspended for several years. In addition, it was suggested to the Coordinator of Sierra Leone: l) to analyze the CDTI therapeutic coverage rates village by village, in order to detect the villages where this rate is still low; 2) to take advantage of the meeting to share the experiences of other countries as regards CDTI and 3) and to strive to attain the objectives set for the therapeutic and geographic coverage for CDTL As an introduction to the session of 1916102 of the meeting of National Coordinators and Entomologists of Guinea Bissau, Senegal and Sierra Leone, the interim Chief PET recalled that the meeting was, first of all, that of the countries concerned. He, in addition, insisted on the importance of the summary document on onchocerciasis control of each country, whose representatives were called on to accord all the seriousness to it. He, in addition, insisted on the need for a close and profitable cooperation between the National Coordinators and Entomologists, within all the national teams in general. He stressed the need for information flow within the teams of each country, and among the countries. For the objectives of the day to be quickly arrived at, the agenda was adjusted, and it was agreed to discuss the issue of CDTI data banks and their transfer, CDTI after OCP, and the question of Mectizan supply. t t7 IV. CDTI DATA BANKS There are still lapses in CDTI data collection, and the geographical co-ordinates of the villages, in particular with regard to the new villages. 1. Data collection Guinea Bissau There is still no data on treatment. The training which had started with WHO assistance had to do only with trainers (nurses) and could not be carried out for the Community distributors. For the co-ordinates of the villages, the GPS does not function any more, and added to that is the high rate of movement of the village communities. A request will be made to OCP in this direction very soon. a Sierra Leone Data is available, but not entered, for lack of incentives for the agents in charge. 2. Financing after OCP a Guinea Bissau The request made to OCP is under study. There are serious difficulties in finding partners for the financing of activities. In addition to WHO, the current sole paftner, the country is soliciting other donors, especially UNICEF and other international and national NGOs. a Sierra Leone The World Bank has agreed to assist the country in her onchocerciasis control effort, after the closing of OCP. In addition, the support of the NGO Sight Savers International will, most probably, continue after OCP. 3. Integration into the national health system a Guinea Bissau The vertical nature of the Programme is a constraint to its integration into the national health system. This integration is still not be effected, due to the problems the country went through. Measures are however, being taken. o Sierra Leone The vertical nature of the Programme poses problems of self-financing of activities, in particular, the problem of logistics. The integration of the activities of data collection and analysis into that of the district is suggested, and the country will make the necessary action in this regard. , o l8 4. Mectizan Supplies a Guinea Bissau The major constraint to Mectizan supply is the UEMOA taxes on the drugs, and the difficulty in filling the purchase request forms, which are either in French or in English. A translation into Portuguese would be desirable. a Sierra Leone The orders for 2003 have already been delivered, since April 2002. At the central level, a system of control has been set up to prevent the sale of tablets to the village communities. V. TRANSFER To date, all the data available in Ouagadougou have already been transferred to the Participating Countries, and powerful computer equipment has even been sent to all the countries. The timetable drawn up and agreed on at the workshop of Bobo-Dioulasso, relating to the programmes, modules and the field training for national entomologists, and possibly statisticians and data processing specialists is almost ended. With respect to the training of the national entomologists, July-August would be favourable. Discussions a Integration The difficulties of integration of a programme as vertical as OCP are real, but the countries were called upon to find the most adapted solutions to them, and also to the problem of financing of activities after OCP. a Data collection It was recalled that data are the property of Participating Countries, and that for this reason, they are primarily useful to them. Additionally, it was suggested that advantage be taken of the meeting to review all the difficulties in obtaining data, and to propose appropriate solutions for each country. The need to have the co-ordinates of the new villages was also underscored. Accordingly,a GPS is not absolutely mandatory; other alternative means exist, in particular cartographic ones. a Transfer In the absence of data, no transfer is possible. Therefore, particular emphasis must be put on their collection before the closing of OCP.I VI l9 RECOMMENDATIONS . Guinea Bissau - Continuing training activities and implementing CDTI by September 2002. - Ordering Mectizan (ivermectin) for 2003, as soon as possible. o Sierra Leone - Starting, as soon as possible, the process of training health workers and Communify distributors so as to start treatment by the end of July 2002. a