Manual of procedure for skin snip surveys: simple epidemiological evaluation

WORLD HEALTH ORGANISATION ORGANISATION MONDIALE DE LA SANTE oNCHoCERCIASISCoNTRoLPRoGRAMMEINWESTAFRICA PROGRAMME DE LUTTE CONTRE L'ONCHOCERCOSE EN AFRIQUE DE L'OUEST MANUAL OF PROCEDURE rB*** tBrB** rB* * * * * * * I * For skin snip surYeYS Simple Epidemiological Evaluation . Annex L ocP/F,Pr/DOC/%.re INTRODUCTION The survey procedure presented in this manual will be used for the epidemiotogical evaluation of the surveillance village network selected by OCP in .ollubo.ution with National Co-ordinators of the participating countries. The survey methodology is an adaptation of the epidemiological evaluation technique that has been used Uy OCf teams since the start of the programme in 1975. In the survey procedure the skin-snipping wilt be limited to people aged 1 year or more. The indicaior used to establish a focus of possible recrudescence will be the presence of new infections. However any new infection should be carefully investigated io establish if that infection has been acquired locally or elsewhere and if elsewhere an effort should be made to localize as far as possible the area where the infection was acquired by carrying out a migration study. Only infections acquired locally suggests the poisibte recruAescence with indication for further investigation within the village and surrounding villages in the area concerned. During the detailed survey of an area where transmission has relapsed the same methodology of survey will be carried out in each of the selected villages. 21. PREPARATION OF THE TRIP In preparing the plan for a simple evaluation round, the team leader should bear the foltowing points in mind: 1.1. To verify from the national oncho co-ordinator if and when ivermectin has been distributed in the villages concerned. 1.2. Evaluations must be conducted during the dry season. In the rainy season farmers are busy in the fields and only a few people would be available for examination. Moreover, some villages are inaccessible at that time of the year. Avoid the Ramadan period and important festivities of the area. 1.3. To ensure maximum collaboration by the population, village authorities should be informed of the impending evaluation and if possible of the precise date of the team's arrival. I.4. The team should arrive in each village during the afternoon of the day preceding the evaluation in order to mobilize the population. 1.5. Even an experienced team cannot examine more than 300 people in a day. r.6. A pattern of one day's travel alternating with one day of evaluation is ideal unless the evaluation of one or more villages with populations of over 300 is planned. Information should be collected on the accessibility of roads and tracks so that travel times can be calculated realistically. 1.7. 1.8. In case of a follow-up evaluation, a list of all people examined during the baseline survey should be taken to the field. 2. APPROACH TO THE VILLAGE 2.1 As soon as the team arrives in a village, the Chief and the Secretary of the vitlage should be contacted, together with any other persons of note (e.g. teacher or health assistant) who are present. Explain to them the purpose of the evaluation and that the team will try to treat the sick where and if possible. 2.2. In most villages the key person will be the Secretary, whose responsibility it will be to inform heads of families of the impending examination and arrange for them to be present the following morning with all the members of their families. 32.3. If the village is being evaluated for the first time, collect information on the number of families, their size and duration of their residence in the vltate from the Secret".y u.O compile a list of families selected for the examination following the criteria expressed in paragraph 5' In the case of " toiil*-"p evaluatio-n this information and the list will be available from the Previous survey forms' 2.4. Give the list of families to be examined to the Secretary and ask him to .on.u..theheadoffamiliesincludedinthelistandarrangeforthemto be piesent the followini d1v early in the morning (latest by 8.00 a'm') at ttr" .u*"y site (for the Jhoiie of t-he survey site see paragraph 3'1) with all members of their familY' 2.5. If the village is too large for the survey to be completed-in one day' make sure that the familier'.onu"rr"d for t-he first morning do not total more than 300 individuals, Ieaving the rest to be examined the day after' N,B. Because of the longitudinal nature of the study (villages are.follo.wed for a long time), it is essential to impress upon the team's census cierks, upon the village Chief and Secretary, and upon headi of families the need to examine the entirety of the population selected in each village. If the percentage of non-attendance is too high' the data collected will be meaningless. An additional effort should be made to examine all individuals of each of the"village who were examined during the baseline survey' 3. SET.UP OF THE TEAM FOR AN EVALUATION ITINERARY OF FAMILIES STATT a t*.lrq t-] aXtcmqrtc F.ryrraglgl End I TreatjrEnt JO Xtra III 43.1. 3.2. 4.2. 4.3 4.5 4.6. 4.7 Useashadyoutdoorareaortheschoolbuildingoracombinationofboth. Families will be called one at a time, but some may contain -1^large number of p"opti^^;; i;t sufficient space between the different examination Posts. 4. GUIDELINE OF A VILI.AGE FORM 4.1 At the top left hand: Name of State (followed bY corresponding code). To facilitate the completion of the "village form" which must be prepared after each first visit, ihe main items a.J en ."rated below' Please treat them in the order indicated below so as to standardise the presentatiol:f the forms. Each form whether summary or detailed, should be signed by its author(s). At the top right hand: Name of village (followed bY its code number) I-atitude and longitude situation Council District Region. 4.4 Date of visit. Purpose of visit: (possible justification)' onchocerciasis Focus: Name of river andf or the tributary to the river. Thtr t-, *.y import.ant information. As far as possible co-ordinates must be established. 4.8 Access: Itinerary: state of the road' Working conditions: Settlement Name of the village chief Ethnic Group(s) and sub-grouPs 4.9. N.B.: As much as possible, these data should be summarized in one table' 4.10. History and structure of the village (possibly with plan in annex) population: - Available census data (showing source and date) if not available then census done by the team in the field (with comments) 4.10.1. 4.r0.2. 4.10.3. 4.10.4 4.LL. 4.tL.1. 4.tL.2 4.rr.3. 5 origin of the inhabitants, stages of settlement, contacts with the natives un{1o, modes of land occupancy, important events' I-ayoutofthehouses,inter.connectionbetweentheham]etsandthe village. Social facilities: school, dispensary, youth clubs' etc' Sociopolitical structure: Social units (family, lineage, clan) and poiiti.uf organization (traditional autirorities, modern authority)' Agriculture: I-and tenure system, Iocation of farms, modes of work (men, ;;;;;, children),- "*t.r,rio,, service bodies (governmental or non- governmental), products harvested' other activities: animal husbandry, handicrafts, fishing, etc. Infrastructures and Structures for trade: roads, markets, marketing bodies' etc. 4.72. Present migrations 4.72.1. Immigration: Since when? origin and motivations, modes of settlement, numerical volume, age groups-and sex concerned, envisaged duration of residence, activities of immigrants' 4.12.2. Emigration: Since when? numerical volume, age groups and sex .on.il*i, destination, motivations, envisaged duration. N.B. As much as possible, all these data should be summaized in one table' 4.13. Particular Problems 4.73.I. water: what water is used (for what) during the different periods of the year? Relation to the river and backwaters (met, women, children)' 4.13.2. Schoolchildren: The youth in general' 4.|3.3. Other particular problems (modes of sleep, food, dress, pleasure, etc.) 4.14. Miscellaneous notes: Questions in abeyance concerning the study' ePidemiology, etc. 4.15. Annexes: Map of the area (stretch), photographs (aerial or others), trans-lati,ons of recorded discussions, age pyramid, etc. 64.L6. For an example of the collection of general information on a village see Annex L. 5. CENSUS PROCEDIJRE (FORM N602) 5.1. First passage 5.1.1. The equipment required consists of: A table, a chair, some ball-point P€ffi, and a supply of N602 forms (see Annex 2). N.B. An interpreter, preferably native to the village, will be needed to help the census officer cope with language problems and distinguish indigenous from non-indigenous persons. 5.1.2. All families that reside in the village are included. N.B. If the trend of onchocerciasis incidence is to be properly reflected, the population studied must be stable, however, visitors, nomads, government officials and other persons only temporarily in the village selected must expecially be noted as such. 5.1.3. The first task in any village is to conduct a census of the entire population, broken down into residents present, residents absent and non-residents. Each family unit is allocated a separate form (or forms if the number of family members exceeds the spaces allocated on one form). On each form are set out data concerning the administrative division (State, village and section), the family (identity number, and ethnic group) the individual (skin snip and serial number, name, individual number, se4 age, previous registration, presence or absence, and results of skin-snip). First identify the data sheet by filling in the boxes at the top: 5-8 Date of survey, 9-10 Passage No., 1l-72 State, 13-16 Village, l7-L8 Section (to be completed only if the village contains more than one), 19-27 Family No. and 22-24 Ethnic group using the OCP/EPI list of ethnic code (see provisional listing of ethnic codes). 5.1.4. 5.1.5. 5.1.5.3. The body of the form consists of 14 columns (see annex 2), to be completed as follows: 5.1.5.1 First column: Only for those individuals who present for examination, the skin-snip number. 5.L.5.2. Second column: write the serial number 1,2,3, 4 etc. Third column : Name of person. In the first line write the name of the head of the family and in the next that of the first wife, followed by those of her children in order of decreasing age, then those of the second wife and her children, etc. AII persons sharing the household's daily meal (e.g. nephew, grandchild, widow) are counted as members of the family. 7N.B. Adults are identified by their position within the family, and children by reference to their parents. Examole 1. Coulibaly Omer 2. Ouattara Zenabou 3. Coulibaly D6sir6 4. Traor€ Bernard HF wi1 Ch 7 x2 "FR" L Key: HF = Head of Family Wi = Wife Ch = Son or daughter Sib = Brother or sister "FR"= Cousin EN = Nephew, niece, grandson or granddaughterW = Widow or widower Pa = Father or mother 5.1.5.4. 25-30 Individual number. The individual number is assigned later on at the office to enable the data to be processed by computer. 5.1.5.5. 31 Sex. Assign code l for male and2 for female. N.B. A person's name does not necessarily reveal his or her sex and errors are frequently made in this regard. Always ask whether a child is a boy or a girl. 5.1.5.6. 32-33 Agq If a birth certificate or identity paper is available, record the age indicated. If not, estimate by reference to a person of the same generation who does have one. Otherwise ask the person his age and take the average between his reply and the census taker's guess. Children's ages are determined by the dental formula, (see annex 3). 5.I.5.7. 34 Alread,v registered. The coding is as follows: 0 = Never registered before (First survey in the village) 1 = Already registered in the village 2 = Born since the last survey 3 = Born before the last survey 4 = Already registered in another village. N.B. If this is a first passage, codes l, 2 and 3 will not be used. 5.1.5.8. 35 Exam Status. The coding is as follows: 1 = Present during the visit and examined 2 = Present but refused examination 83 = Present but not examined because of old age, illness, pressure of work, etc. 4 = Absent from the village for less than a year 5 = Changed residence to another village 6 = Deceased 7 = Absent from the village for more than a year. N.B. Codes 5 and 6 will be used only on second and subsequent passages. 5.1.5.9. 36-41 Iliac crest skin-snips. Report the results on form OCP/D3 (annex 4) on the family form. 5.1.5.10. 42 This column is completed only where a skin snip that was negative on the first reading (after 30 minutes) is found positive on the second (after 24 hours). 5.1.5.11 43 weight and 44 Mectizan dose. These columns are completed only when ivermectin is indicated and given. 5.1.5.r2 [-ast column : Observations Specific mention should be made, in particular, of: (a) the whereabouts, if known, of anyone who is temporarily absent or has left the village for good. (b) Migrants who have come into rhe village. (c) Any person who did not present him/herself for examination but resides in the village and is known to be blind. After you have entered all the particulars for an individual, and before he passes to the isolation tent, put on his left wrist a piece of sticking plaster marked with hii skin- snip number. 5.2. Second and Subsequent Passages 5.2.t The census officer's work begins in the office with the preparation of an updated file. Indicate on the jacket the scheduled date of the visit and the passage number (second, third, etc.). copy on to new forms from the previous file the data in the third, fourth and fifth columns: "Name of person", "25-30 Individual number" and "31 sex", except for persons who were coded 5 or 6 under "35 Exam. status" on the previous passage. In the sixth column, increase the ages by the time that has elapsed since the previous visit. In the seventh column, "34 Already registered", code 1 for all persons listed. The skin-snip numbers will not be assigned until the examination takes place. For the old villages surveyed by OCp a computer programme called SEPT can be used to prepare the various forms in the office before the evaluation in the field. 95.2.2. 5.2.3. On a second passage, new registrations will include: children born since the first puttig"; *o-en newly married into a family and coming from another uittage; any family members overlooked on the first visit. Newly registered persons must be coded 2,3, or 4 in the seventh column to diitinguish them from those already registered on the first visit. 5.2.4. In the eigth column, "35 Exam. Status", codes 5 and 6 are used for eliminatinlg from the sample persons who have left the village or have died since the Previous visit. N.B. Often a person coded 5 on the previous visit reappears in the village: in that case the earlier fili should be corrected, iode 5 being replaced by 4 or 7 depending on the length of the absence. 5.2.5. Any correction needed to the data recorded on the previous passage must be made in the field and then brought to the attention of those responsible for the data processing. For this it is essential that the census officer keep a notebook in which all such corrections are recorded, e.g.: Individual number 738432 - Sex L onP/\ Individual number L38720 - Age 4 instead of 9 on P/1 Individual number L39OOZ - Exam. status 7 instead of 5 on P/1 5.2.6. When an individual changes family, moving for example from Family 4 to Family 12, enter all his particulars on the data sheet for Family 12 and .rors ih"rn out under Family 4, noting in the respective "Observations" columns "Transferred from Ff 4" and "Transferred to Fl12". 6. PARASITOLOGICAL EXAMINATION 6.1. Skin snip taking and time recording 6.1.1. The following equipment is needed - A table; - A canvas sheet with which to rig up an isolation tent; - A Holth type sclerocorneal punch, diameter 2.5cm; - A lancet; - Curved tweezers - A felt pen; - A watch or chronometer; - A dropper bottle of distilled water; - Cotton-wool swabs; 6.2. 10 - Glass slides with shallow wells formed by 12 raised ceramic rings arranged in 3 rows of four. - Slide trays each holding 3 slides. - Sterilization kitr Before t-aking any skin-snips, mark the numbers 1 - 4 with the felt pen in the left- hand column of four rings on the first slide, 5 - 8 on the second siide and so on. The corre-sp-onding rings in the middle and right-hand columns are for the snips from the left and right iliac crests respectively: Put one or two drops of distillid water into each. When prepared, the first tray will therefore look like this: rto tat,o 6-3. Skin-snips shourd be taken from people aged 1 year or more. 6'4' Call out the name of the first person listed on the census form. Be careful to check his identity by comparing such features as age and sex with the indications on the form and make sure the number he carries on his wrist corresponds to the serial number on the slide (number 1, as he is the first examinee). 6'5' In the isolation tent, disinfect both iliac crests with an alcohol-soaked swab. .!-eave to dry for a few seconds, then take a snip from the right crest, lift it from the punch with the point of the lancet u.,d, *ith the hIIp of the tweezers, put it in the first ring of the right-hand column. Take a snip from the ieft iliac crest and pui it in the first ring of the middle column. N'B' The sclero-corneal punch should be sterilized after each patient's skin snip has beentaken, for a minimum of 5 minutes following the sterilization instruction manual. I Sterilization kit consists o[ : . instrument trays . sterilizer forceps, tweezers . aluminium pressure sterilizer . burner butane stove ooo ooo ooo ooo ooo @oo ooo @oo @ oo @oo ooo()oo 6.6. Proceed in the same way with each examinee. N.B. Take care to check each person's identity characteristics and the number on his arm and to put the snips into the correct rings. 6'7. As each slide is filled, i.e. after every four pairs of snips, mark beside it on the tray the time in hours and minutes so that the micioscopic reading can be made 30 minutes later. Then, as each tray of three slides is filled,-sendit to the microscopist's table to await examination. 6'8' If a person listed as present for examination does not come forward when his name is called, leave the two corresponding rings unused and pass on to the next number. 11 7. MICROSCOPIC EXAMINATION After 30 minutes 7.r.2. The following equipment is needed: - A table; - A binocular mcroscope; - Curved tweezers; - A watch or chronometer (set to exactly the same time as the snip-taker's watch); - A number of plastic microtitration trays each containing 96 round_ bottomed wells arranged in 8 rows of twelve serially num6ered Ar - Alz,87-E12, -etc.; - Saline solution; - A hypodermic syringe and needle size I; - A roll of adhesive tape (as wide as possible); - Microscopic examination forms (for completed specimen, see Annex.4); - A black ball-point pen; - Water and detergent. Prepare for the examination by marking in the left-hand column (headed "Number") of the form the serial numbe.s of the skin-snips. with thehypodermic syringe fill the 96 wells of the microtitration tray with saline.Clean and focus the lens. 7.1.3. when 30 minutes have elapsed after the time marked beside it on the slide. tray, begin the examination of the first slide. If the first result ispositive, enter in the second column of the form the number of microfilaria counted in the left snip and in the third column the numberin the right snip, thus: 7.r. 7.r.1. L2 Village : ZORGHO Number 1 9 4 2 N.B. Before deciding that a specimen is negativg, liry- the skin-snip out of the ring with the tweezers and e*imine the liquid alone, Is microfilaria may have been hidden under the snip. 7.1.4 Village : ZORGHO Number 1 A1 2 N.B. Take care to wash the tweezers after each use So as not to contaminate succeeding speclmens. lf the result is still negative, take both snips with the tweezers and put them in the first saline"-filled wel (A1) of the microtitration tray. Th"l mark the number A1 in the second column of the form and leave the third column blank, thus: 7.r.5. 7.r.6. 13 Proceed in the same way, using the wells in the order of their serial numbering, so that after a while your form might look like this; When you have examined all the slides, wash them with water and detergent and stick adhesive tape over the wells of the microtitration tray so that they will not dry out overnight. 7.2. After 24 7.2.1. 7.2.2. 7.2.3. rs (check) For this you need the following additional equipment: - an Eppendorf pipette (50) with disposable tips - six clean ringed slides - two slide trays - a felt pen - a red ball-point pen (so that the results are easily distinguishable from those of the 30 minute test, marked in black). Number the rings in the left-hand columns of the first three slides from 1 to 12, as illustrated in section 6 on snip taking (para 6.2). The middle columns will be used for the specimens from wells AL - Al2 in the microtitration trays and the right-hand columns for specimens 81 - Bl2. While the examination is proceeding, a second tray of three slides will be prepared for specimens C1 - DlZ. Then the first three trays can be washed and used again for specimens E1 -F12 and so on. With the pipette, transfer liquid from the wells in the microtitration tray to the corresponding rings on the slides and examine. Village : ZORGHO Number L A1 2 A2 3 6 t2 4 A3 5 0 2 6 A4 7 A'5 8 A6 7.2.4. t4 N.B. Change the disposable tip of the pipette after each specimen to avoid contaminating the next one. 7.2.5. If the result is negative, mark 0 with the red pen in the third column of the form, which you left blank after the 30 minute reading. If positive mark the number of microfilaria counted. 7.2.6. Finally, dispose of all specimens and wash slides, microtitration trays and pipette tips. 8. VERIFICATION AND INITIAL DATA ANALYSIS IN THE FIELD 8.1. The most important objective for the surveillance is the detection of new infections. For this reason the results of the average of the 2 skin snips taken during the previous survey is compared to the present results. Any persons that were examined and found negative at the previous examination and are now positive should be treated as new infections. 8.2. 8.3 8.4. 9.1. 9 Each new infection detected must be retraced at the end of the day's work and a new pair of skin-snips is taken and examined using the usual procedure, i.e. after 30 minutes in distilled water and then, if negative, after 24 hours in saline. This verification is needed to avoid errors due to mislabelling. For each new infection, a migration history must be established at the same time as the second pair of snips is taken, to ascertain whether the person has or has not been residing in an area where onchocerciasis transmission is known to occur. Note down where the person was born and any other places where he has lived, since the last examination. In recording a previous place of residence be sure to specify name of village, subdistrict, district, region and country so that it can be located. If new infections are proven to have occurred in individuals who have never gone out of the village in question, a similar survey is to be carried out in the surrounding non indicator villages. DATA ORGANIZATION After the survey of a village has been completed the consolidated results are entered on three special forms (for completed specimens see Annexes 5, 6, and 7). The first form is for the census data, the second for the results of the parasitological examination, and the third for the summary of new cases. First complete on all three forms, the spaces for the name and identiry number of the village and for the date. 9-2. 9.3 15 First form (Annex 5): Census results In the first column write the identity numbers assigned to the families and in the second column the number of individual members in each family. In the third to eight columns enter the number of persons coded 1,2 or 3, 4, 5, 6 and 7 respectively for "Examination status". In the last column enter the total number of persons in a family known to be blind. Finally, add up the figures in each column and write the totals at the bottom. 9.4. Second form (Annexe 6): Parasitological results Record as in the annexed specimen the results of the skin-snip reading by age-group and sex. (a) If a person is negative for both snips, use the notation /0/. (b) If a person is positive for at least one snip, record both figures, e.g./O-tl or /e-ts/. Count the total number of persons found positive and the total examined in each age and sex sub-group and write the two figures in the bottom right-hand corner of the corresponding box: e.g. 0/17 for age 0-4 Male. Finally, at the bottom of the form, record on the left the total number of males positive and the total number examined, on the right the total number of females positive and examined, and in the middle the grand total for both sexes. N.B.: It is very easy to miscount so always count twice and write down the result only if it is the same both times. Otherwise re-count. 9.5. 10. DATA STORAGE 10.1. Third form (Annexe 7): New cases Enter the identification information: village name and number plus date. Enter the name of each new case, its individual number, sex and age in the respective columns. Report the result of the average number of microfilaria of the first and second microscopic examination, see paragraph 8.2. Add the detailed migration history as requested in paragraph 8.3. It is of vital importance to organize a data bank for storing the information collected. Use boxes size 34 x 25 x 10 cm. Every village surveyed should be allocated a separate box to allow room for the results of the subsequent surveys. The villages which cannot be surveyed could be grouped e.g. 5 in a box, write the codes of the villages on the boxes, e.g. "135 or "126. lZ8, t30 - r32. 10.2. 10.3. 11. ANALYSIS 11.1. L6 As the data bank may be damaged or destroyed by termites, fire, etc., make photocopies of all records and establish a duplicate bank in another bulding. Keep copies in the national team headquarters and one in ocp headquarters until further notice. Computer storage should be used if available. The basic unit used in the analysis of OCP/EPI evaluations is the village. Two types of analysis are routinely carried out: cross sectional and longitudinal. Whereas the former is based on the total population of the village the latter concentrates on the adult population (20 to 99 years). The principles and calculation of the cross-sectional analysis are straight forward and can be found in any beginner manual of statistics. The principles and calculation of the longitudinal analysis are more complex and require understanding of cohort analysis. These two methods are explained in the manual of data analysis (appendix 8). Mansuv.wp5 \nncr I lEcc dtlvolrc (03) Gbando (190) - Pannl - Bcoba Bondlalt regton Bondlalt. dktrlct Tenhourc councll (Ghando) 1. 2, 3. Data of vl and No. of 6Ce a! 24 end 25 Aprll 1976. Plrrt p.s.t8c. Purpo ce of vtatt: Dctrllcd cveluatlon Onchoccrclaalr focua: Gbanonl or Bagouc, located about 6 ko frou the vlllage, end agrer ltt Er tary, Iocated about, 0.5 ku cua/o Accccal Road froo Bondtall to Handlnanl. Froo Bondtalt, Ghando le the accond @; found aftcr tha Bagouc brldge. It 1. on the rlght-hand eide of the road, thc lefl-hend elde of uhlch le occupted by thc Nyaoro and Nyafare hlllt on che northcrn rldr of yhtch flovt the Paare. aa t{orklng -condtBtonet Llvlng rnd uorklng.ccorlrlodetlon ln a coupound slthtn, thetffEee, attuated north of the chtefrr houlc. 4 a 6. 7. 8. Naoc of thc vlllar.c chlctt HanudJo Ptne. Ethntc group: Scnoufo (codc 060), eub-group of the Nyoudougoue. Populatton: EPI enuoerat.ed 127 persona , exaulned 90 of theo ln psrsottology and;;;;1n orhthalmology 55.92 of theo ara men and 44,L/ uou€no 9. HlBtory and etruct.ure of the vtlla p €r 9. 1. 0rlgln of the lnhablcante: The lnhebttante of Gbando Bay they have aluaye Itved ln thle vtllage rrhlch euffercd greatly durtng Samoryts paeeage. I! uae the capttal of the dlstrtct vtlh thc ae'!c n6ne but lort lh6t tltlc to Bondtall aftcr the var. 9. 2 Laloul__g!$e hougeg ! Gbando har rclattvely grouped houccr. nctther .cctlon6 of ttre vlllage, noi Fouser havc clear dcltottatlone. -9 3 Soclal facllltter: None. Onc hae to 80 to Bondtalt.O 9 4 Soclopolltlcal Btructure: Chteftatncy te the pollttco-admlnletratlve eyeteru. The vlllage chlef le asstsred by a Becret,ary. 9. 4.1. The household te the bastc aoctal unlt, folloreed by the clan. There arc tyo ' clane: thaC of the Fannta. to r,rhlch the chLef belonge, and thaf of the Beobae to uhtch the vlllage Secretary belonge. 10. Econoolc_Act tvlt 1ea, reoources and problene. 10. l. Agrlcu_l!!!e: The vlllage chlcf 1r alco thc land chlcf. Thc faror erc on the oppoatte etde of the rtver. Houever, thc uocen of Ghando have had rtcc farnr on the banks o[ rlver Pacae for a long tloc, up Eo th. 1975-1976 faroing Bcaeoh. , t :l Anncr I (Contd.) Prcecnt okr atlont t I Iooltra tlonl None. Pagc 2. groundnuta, rlcc end cotton. Rlcc, cotton and 10. 10. 11. 11. 11. Ttrc celn cropr rrc yeo, uatzc,groundnutr are caah crop. 2.ffi.:.::'lf;."I"i*i::8otttandpou1try.TherctrccoI,8too, 3. Trade: Nothlng to report. t a 2' Sggl'"1-o:! of thc 37 perronr abaenr, 20 have eorgrarcdi rhle ;:::::::i::s,tt. nrc narn drrecrtonr are soiar.art (B), ^bldJan (4), ls-1e (3); ,5'] il',|i'lJ'l; Inir'?rti.ig'-e,oupe tnvorvea ire: ro-ra 1r1, L2, 'L, Part tcule r probleos: 1 Urter: UnCll L975, thc vlllagc saa drlnklng rlver yater. Slnce then, tt haaa covered uell equtpped vtth putrpo a I o o! m mc I|o o z o J- o o mIo 9. o o o z a o !I o o ;0 = m 2 { m @i TI I 6 U' =!f- m m tsE =E 3Ttol I = r-l ,l I 6 .< l-lol Io- - L_l (o 1 o ll!, oo 9,(Cl o J c 3(t oAIIH LJ : 1 No otrf e nHttLJ 6 I ot 5il(o !q rH t-lL] I o a o o *. o = (o I! 11!, 3 = f tr 3q o :1 r NN I N5 m = =.o(cl 6ct (,l Iog !, o urqc ? o L ts'It o x tY I 5 o?l ?t z o 3 o o !, o d o = f5ccLJ< rF -E @o x (o o Iirl9r cl, ftgh E3 aJ o€ o1 ool O1 E1 ol tnl I I I I I =<ooat ,69 rli i91trI o cro o ?t, n. o =o z o, o N i ! I I i I -! I ; i Jt lr , lr I't rr, -, lr, t I i I 1 I I I I I.lftx DEITIIIOI ESIN{TTI(u OD CIITLINEI ACE. i OSiDIC TIIE DE{EAL PORIIIIA tt't, 5 to I lanthr ffi ffi ADUL! DEITITICN Aoner 3 5 yeru 7 lrss8l 8 yea.ra ! I yea.1,8 IO yolra 11 yeara 12 yeara ( lr rr I I-E- I r,rl ry 8 to 1O mtbr 12 nothr L{ aothr L6 mthr(frt uo:rc) 18 qths(p."rn.). 2O to )O rothr(aa rcrrr) I r.2.rrJ.ry.y.5 rrr Y I -_l l&ridrry_: I r.rt,rlr.Ty.v I P,ya w u'B' Tbc rouo nuibera rndlcates "rr' tccll.r tbe arebic nrrabera lndlcate sdult teeth. m;":*lloc sac rccraatc vlthtn 2.aqrtha for ui.ra tceth aad t ycar fc =T v,, . tr rd od!rEHF()>EHOFtnE'C)oUFO fr, oxDE'TXHt>z1 zt>HH(.:Htsoozlt)or{oo}EE H-Dc Ed t!,n o \ s ta a0 0rF o z \ .E '|. s lnI t, e, @o' f-r c, cr d o 5 o x o 5 \a0 l'\ tb^ ucV l"l\, tr\ t [slr to t '.O s 6(a. lrOi/o aJOut D co(., 2,f,trtl o h \ I .lr I .^. A l^t \ \ \ h Ctq lcrt{ \a 5 +f n\ \F a-l s q s s s\ \ t" \ s \ ls Ss S c\ S \> q St \ \'(-- Ts \ i It\l\ Lq \N\ t.l\ \\ \ \\ l..l\l's *\ tN\ a\ \ I \ $ lx I t s (\ f7lt o t\ N N el r tli lo9 F lElc lI)\ t>N t \o l5 .,I oa .\ \ \ \ \ \ s s s s tr s \ N I hr S. E tt(Dr}! o \.r \ s [\ lN\ \\ IOo t\\, LR IL,JIt I l(,\P. t\N \\lr.\ \ N\ \lrA ^\ \' \,\-\(^ I N.N s \ h',t bE to.l hcf rh,.o I \ ,N |Gtr\r (a s IE-tt \ trLl q - tor \ et a! bo{ l-ls lo s \ Itr \ s f^, \\. tr t \ S \ q tl L. ls \ 5 lr \ \ .o t\ I\ I t \1 l-'h\ \ t t- $ I ILQ It\ t rJ tt. 4 o\ C-\ \+- L \ l- tblo, \ t/ ,\ s N \ (.\ q \1< F.los F a t^l sl' as \ \ \ I=l'r., I I sr\\, I ,S ? axauuv cv/aco, \ )O \ \ \\ F- Annere 5j. Non : Nr{64 REST'LTAT DB RBCETSniMITNuru6ro z 4Oi tt /s /f. _i. 1 Bf,.III) I I -t rI\}I Total 6 10 .lf .ll .(3 ,14 .l{ .rl ,17 .(tr 4? 2o €{ ee 4 € 3 + ,5 7 6 7 bTeL 1 2-1 4 5 5 7 5e 4g 5 ? ,(.1 2+ /7 ,l 7 d /t 4 7 5 2 3 3 {,6 E + 4 3 14 5 4 2 ,/ e3 4 4 4s 4 e {tt /3 e e 5 4 4 ,10 3 3 + c7 + 4 4 e j 45 + 3 ,/ 4 .{ 3 4 //4 3 3 44 7 3 & 41 7 ,/ 4 4 lp{ 34 .25 -{/ 3/ -l 4 c € 4 4 zs 48 5 o I 5 \rl ! \o Ho IH5 P\rl IN)\o o ts\o \,o p- o,i B Sf \ t o I + t4 t a I I o Ig a o I F0 d Do Ho oo o DF t!X E zDH oz FH U2d tsd a Ei3Or l-, o \S(rt G Iq I o , o I s + I (o I 14 S \ s s* \ \ I p cf o h, {. ts I o I s I ! o x o\ tu (S \ *t I *s I o t o I o t oI Ll ,,b rc I s I Lr \ a\ I o , o a o I o , o t ol rl ol rl ol rl \ o I o ag I o I o I o , o I s I o t s t o I o t o t ol I S sI o , o I a I o t S \ Ifrt \ I l\ I o0 , , o I o I o I -N \ I o I o I o I oI \ \ \ s , o I o I o I o ! \ (^ o a oI \ \ I I ) o o '1' m mC 9(o o D o o o tr ? o oz o -o o m7o q)il6o+oio -{zId6t'z 1'OI 'rt O o H= m o az m @ { m @ -.t l.l P o (o 1l o o tn 9'(a o =c 3tt : T-l! o oc =e trIIll 3 o o o @ o 9. : 5 o(o o DI , o N ! z!, 3 o =0,a=s=o< :, tr 3q o =o 6 trg o ox GI o -tro< EE3 E.E Aoo uEc< E 9= E3aoo <= -Qz"a o 6' 5'I a s.rt oq o o ? C) fi+. o fo