Expert advisory committee twenty third session, Ouagadougou, 23-27 September 2002: report of the meetings of national coordinators on country-specific issues: Côte d’Ivoire, Mali, Guinee

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 C 20 - COTE D'IVOIRE - GUINEE - MALI Ouagadougou,24 - 26 June2002 2t I. INTRODUCTION A meeting of National Coordinators and Entomologists of three Participating Countries, namely C6te d'Ivoire, Guinea and Mali, was held at the headquarters of OCP in Ouagadougou from 24 to 26 June 2002, in the presence of OCP management (see list of the participants in annex II). 2. OBJECTIVES OF THE MEETING The principal objectives are defined in the terms of reference as follows: - To give a progress report on the implementation of the recommendations of last year's coordinators meeting, by indicating the actions undertaken, the strong and weak points of each country. - To give a progress report on the results of the epidemiological evaluations carried out in 2001, by analysing and interpreting the prevalence rates per basin. To determine the general problems that epidemiological data. are inherent in the processing of To analyse the problems and the measures taken in the specific intervention zones according to the outcomes of JPC22,EAC22, the last meeting of the coordinators and according to prospects under consideration in each country concerned. To take stock of the entomological surveillance carried out in 2001 and 2002 per country (to indicate the difficulties, the strong and weak points). To give a progress report on the results of CDTI in 2001 and 2002 per country, and if possible per basin (coverage, the management of ivermectin, difficulties, etc). To organize the data bank on CDTI: on data input, difficulties and suggestions. To share experiences on the arrangements made, or under consideration, for the resolution of the problem of incentives for Community distributors. To take stock, per country, of the financing of onchocerciasis control activities (current and future). To evaluate, by country, the level of integration of onchocerciasis control activities into the national health systems. To evaluate, by country, the critical mass of human resources capable of undertaking the CDTI activities, epidemiological and entomological surveillance and data management. To identi$ the problems linked to data management. To indicate the data which remains to be transferred before the end of the Programme. To agree with OCP on a timetable of transfer of the remaining data. To take stock, by country, on the documents-in-proof of funds allocated by OCP. 22 To discuss the methods of the closing of OCP accounts in the countries. To write, by country, a draft summary on onchocerciasis control, since the beginning of the OCP Programme to date. 3. OPENING OF THE MEETING In his opening speech, the acting Chief of the Unit for Planning, Evaluation and Transfer of onchocerciasis control activities (CPET), representing the Director of the Programme, recalled that the present meeting, which should be concrete and practical, will have to allow for reviewing the major difficulties encountered by our countries, in order to find durable solutions to them. Other speakers who took the floor after the CPET, namely, the Chief VCU and AIO, in their turn, indicated that this meeting will have to tackle specific problems, especially the continuation of entomological surveillance after OCP, the control of nuisance, measures to take in order to forward, as soon as possible, documents-in-proof pertaining to funds allocated a given country by OCP, given that OCP accounts in the various countries will be closed very soon. 4 PROCEEDINGS OF MEETING Following the welcome speech and presentation of objectives of the meeting A presidium for the meeting was set up as follows.4.1 Chairperson: Dr. G P. Brika, Coordinating Director of the National Programme of Onchocerciasis Control, African Human Trypanosomiasis, Bilharziasis and lymphatic filariasis (DEPOTBLF) of C6te d'Ivoire. Rapporteur I: Dr. Mamadou Oumar Traore, National Coordinator of onchocerciasis control in Mali Rapporteur II: Mr. T Roger Lama, National Oncho Entomologist of Guinea, Charg6 (I) of Recommendations: Dr. Nouhou K Diallo, National Oncho Coordinator of Guinea, - Charg6 (ll) of the Recommendations: Mr. Moussa Sow, national Entomologist of Mali 4.2. The participants amended and adopted the agenda 4.3. All the items on the agenda were reviewed (see detail in annex I) Each subject that was addressed had to do with taking stock of the situation, ascertaining the possible constraints, and proposing activities to be carried out. 5. OUTCOMES 5.1. Review of recommendations of the last meeting of National Coordinators and Entomologists of 2001: A review of the specific and common recommendations led to the observation that most of the latter had been carried out, or were in the process of being implemented. Concerning the recommendation in point 9.4 "a", relating to giving FAO the responsibility for the conhol of nuisance, the Chief VCU promised that FAO would be contacted again, and that follow-up actions were to be taken by the 23 national coordinators with the FAO resident representatives. He then gave each participant a document on operational insecticides and their characteristics, in view of future ordering of these insecticides. It is important to note that some partners have already contacted given countries for a free donation of Teknar, and the methods of this partnership are being examined. 5.2. Epidemiological surveillance in the countries: 5.2.1. C6te d'Ivoire In the initial area, the results obtained in 2001-2002 are satisfactory on all the basins. On the lower N'zi, the situation is less satisfactory; in Gbogbobo, a prevalence rate of 14.5%o was recorded, and it is important to note that a seven-year old child was found positive to a skin snip test. In all the villages that were visited, the CMFL was practically nil. The major difficulty in the initial area is that the people found positive are not taken into account under the regular annual treatment. It would therefore be necessary to, systematically, report these cases to the health workers for a regular follow-up. In prospect, an epidemiological evaluation is planned in three villages, around the villages where the prevalence rates are not yet good. Entomological studies would also be carried out: impact studies, post-treatment studies and other studies for a better appreciation of the situation in the area. 5.2.2. Guinea In 2001, l3 villages out of the planned 17, were evaluated in the basin of Upper Niger-Mafou. On the whole, the prevalence rate ranges between 0 and 60/o, with a maximum CMFL of 0.29; Fifteen villages out of l6 were evaluated in the basin of the Kolente. Here, the prevalence rate varies from 0 to l5Yo maximum. The highest prevalence rate was obtained in the village of Karimouya, a prevalence rate of llJ% was recorded in Kirimou. In this basin, CMFLs range between 0 and 0.88. All things considered, the results are more or less satisfactory in all the basins. Nevertheless, it is important to ensure a good distribution of ivermectin. The problems are, inter alia, the difficult access to some villages, the frequent breakdown of vehicles, the massive displacement of populations because of socio-political problems, which have occurred these last years in the area, and the frequent movement of the health workers already trained, due to transfers. In terms of pospects, a study of the epidemiological trend will be carried out on the basin of the Kolente for a better appreciation of the unsatisfactory trend of the prevalence rates. 5.2.3. Mali In 2001,77 villages were evaluated in eight basins under ivermectin. Prevalence rates varied from 0- 43.8%. The CMFLs fluctuate between 0-2.15. The prevalence rate of 43.8oh and the CMFL of 2.15 were obtained in Dagari, a farming hamlet, which did not benefit from CDTI. Here, the advice was that investigations should start to address the issue, and to put this hamlet under ivermectin. In the sentinel villages, the prevalence rates and the loads were nil. 24 The difficulties noted included the refusal of the skin snip test by certain communities, the lack of equipment for the regional teams, the transfer/movement of trained personnel. Discussions were, therefore, on the other diagnosis tools (DEC, ICT). The head of the OCP laboratory, on his part, indicated that for DEC the monotest was ready, and that the first samples would probably be provided in July to be tested at the OCRC in Hohoe (Ghana). In all the cases, the Multidisease Surveillance Centre will continue activities after OCP. Concerning the ICT test, studies have been suspended for the time being, since the manufacturer is facing some di ffi cu lties (bankruptcy). 5.3. Entomological surveillance in the countries: 5.3.1. Guinea In 1989, the ATP, which was 400 and above, in the majority of the basins, have today improved under the effect of larviciding and treatment with ivermectin. They are now below 100 in the majority of the catching points that were monitored. On the point of Yalawa, on Upper Niger-Mafou the corrected ATP of 2000 was I l9 in 2001, but has cunently fallen to 0. At Fifa on the Tinkisso, the entomological results clearly improved, with the corrected ATP moving from 510 in 1998 to 7l in 2001. Difficulties relating, especially, to the inaccessibility of certain areas of these basins often hampered the follow-up of entomological activities. Access roads were constructed, and entomological and epidemiological prospections were carried out in this zone. These actions made for the identification of formerly ignored villages, which escaped the treatment with ivermectin. A socio-demographic study was conducted in the two basins with the assistance of OCP. The satisfactory results obtained in the basins of Upper Sassandra, the Sankarani, Milo, Kaba and the Kolente contributed to the cessation of larviciding in these basins in December 2001. Post-treatment studies are, currently, being undertaken on six points (Tere, Lebala, Bolorosso, Morigbedougou, Kabanihoye and Badekanti). These entomological surveillance studies by the blackfly crushing method are confronted with the problem of sending the collected blackflies to OCP Headquarters in Ouagadougou. The WHO Representation has already been requested to send blackflies to the DNA laboratory. The express services of DHL will also need to be explored. In future, nuisance control will be carried out on sites of socio-economic interest, and post-treatment studies will be undertaken on certain points of basins that are still under larviciding. Taking Guinea into account in the specific intervention zones was brought up. Given the not very satisfactory entomological results on the Upper Mafou in the zone of Yalawa, a convincing document will have to be prepared and proposed by Guinea: On the one hand, to the next EAC meeting, for the continuation of the entomological activities after OCP, as part of the draft study for Leone Sierra On the other, to partners at the national level. 5.3.2. Mali In 2001 and 2002, five catching points were followed on the main Niger and its tributaries (the Fie and Dlani.) As of 3l December 2001, all the ATPs are below 100. The proportion of O.volvulus is 92oh at Tienfala, 690/o at Sanankoro, 82o/o at Pont Dylamba and 89Yo at Pont Faya. 25 There is nuisance in the rainy season, due to the abundance of blackflies in the basin of the Niger caused by the many small flowing tributary streams. A convincing document is being drafted for nuisance control. There is a trained personnel to carry out entomological surveillance in Mali after 2002. Nuisance control is planned, with the support of the partner Sight Savers International on the Niger and its tributaries. A workshop on entomological surveillance is planned to refocus vector control. Impact studies on ivermectin and the detection of recrudescence are planned on the Western Baoule and the Farako, with the support of OCP and AFROPOC. 5.3.3. C6te-d'Ivoire The situation is good on all the basins. Post-treatment studies are on-going on three catching points on the Sassandra (Vialadougou, Bac Semien and Golodougou) after the cessation of larviciding on this basin in December 2001. The control of simulium nuisance is on-going on the Lower-Bandama in the area of Tiassale. Contacts are being made with the sugar complexes of Borotou and Ferke 1 and 2 in the same context. The essential difficulties have to do with the routing of the collected biological material, and larvicide supplies. In future, WHO and the DHL mail services will be used for sending material to the DNA Laboratory in Ouagadougou, but the channels will have to be tested before December 31,2002. 5.4. Community-Directed Treatment u'ith Ivermectin: 5.4.1. C6te-d'Ivoire There was no treatment in 2001, because the ivermectin supplies ordered by the country itself arrived only in September 2001. In 2000, the geographic coverage was 44oh,the therapeutic coverage was 55.30%.For 2002, the partial results show a good trend in the southern extension. In the forest zone, all the stages of installation of CDTI were completed and treatment is on-going. The re-training of the Community agents and health workers in the area of the southern extension will start soon. The search for ways and means of giving incentives to Community distributors (CD.) is on-going. Follow-up and supervision are priority activities and willbe reinforced. The training on the ONCHO IEC technique is supported by HKI, with its IEC material that was set up in the southern extension. Special emphasis will be placed on the evaluation of CDTI and the regular supply of ivermectin to the communities. Ivermectin from MDP will be received through WHO. , 26 5.4.2. Mali The 2001 CDTI results are satisfactory, with geographical coverage rates of 92.30o/o, and therapeutic coverage of 78.89%. On the whole, 3,791,915 ivermectin tablets were distributed out of the 4,550,000 received. Supply of ivermectin was ensured by the Ministry of Health through WHO. Ivermectin is included in the supply channel of essential drugs. The constraints of CDTI are, among other things, the instability of CDs., the delay of routing of the results from the periphery towards the central level and the insuffi ciency of supervision. The 2002 treatments are on-going, but the results are not yet available. The implementation of the CDTI will be continued. AIso, health personnel and CDs will be re-trained. 2003 orders for ivermectin will be made without delay. Measures have been taken for regular follow-up/supervision of health workers and CDs. IEC will be intensified for better mobilization of decision makers and communities on CDTI. 5.4.3. Guinea Results of CDTI for 2002 are not yet available. In 2001, out of 1,454 villages that were planned for, 7 ,323 were covered by CDTI (98% of geographical coverage), and out of the 2,635,533 listed people, 2,087,603 were treated (79% of therapeutic coverage). 5,704,994 ivermectin tablets were distributed out of the 6,200,000 that were received. The supply of ivermectin was ensured by the Ministry of Health, through the central Pharmacy of Guinea. The difficulties are, among others: The non-involvement of the local authorities in CDTI. the complaints about lack of incentives by the Community Distributors Projections include Sensitizing of the local authorities, in order to draw their attention to the cessation of larviciding and the risk of relapse of the disease, if there is relaxation in the monitoring (through written and radio messages) Re-training of the health workers and CDs. Rigorous supervision 5.5. The transfer of data to countries and their management: All the countries addressed the various training components received under the transfer of data. At this Ievel, it appears that these training components are insufficient, and will have to be reinforced, especially in the area of data input and analysis relating to epidemiological, entomological, ophthalmologic and data on CDTI. AII the countries were equipped with powerful computer equipment that allow for the recording and adequate exploitation of data on onchocerciasis. In this connection, software designed to that end, namely New Epicros and the VCU data Manager is in the process of being finalized. The data on CDTI and those on ophthalmology will be integrated soon into New Epicros. 27 The need to transfer the hydrological data, and the files of the villages under epidemiological evaluation to the countries at the same time as the software in the process of finalization was also highlighted. A workshop held in Bobo, with those in charge of data processing, resulted in the development of an action plan of training of the countries in the various software, which will be implemented very soon, by August 2002. The software will be designed for easy use, for purposes of data input and analysis, and for decision- making. The input tools will have to be standard and made up of the same variables. Taking into account the time left for the Programme to fold up, the countries would like the various software to be made available to them as soon as possible. With regard to the building up of the data bank on CDTI, OCP recalled that the source data to come from the countries are still awaited. To date, only five countries have transmitted partial data on CDTI to OCP. 5.6. Financing of activities: The financing of onchocerciasis control activities benefits from State support, and that of certain partners. It is however significant that, under the financing of future activities each country works out an action plan budgeted for, which will be submitted to various partners. The development of such an action plan will, especially, have the advantage of making it possible for the partners to make a decision, thus facilitating the mobilization of the needed funds. The current situation and the prospects are indicated in the table below: 5.7. The integration of onchocerciasis control activities into the health systems of the countries: CDTI is integrated into the health system of all the countries. However, that of epidemiological and entomological surveillance is on-going. Within this framework, Guinea, for example has in its posr OCP action plan, considered the integration and decentralization of these activities. Thus, the entomological teams, which will, henceforth, be the Prefecture Directorates of Health, will have in Activities Epidemiological surveillance Entomological monitoring CDTI IEC Country Cunent situation Future situation Cunent situation Future situation Current situation Future situation Current situation Future situation Guinea OCP SSI, OPC State AFROPOC OCP State AFROPOC State OPC SSI Idem State HKI State Cdte d'Ivoire OCP State State AFROPOC HKI OCP State AFROPOC OCP State State HKI HKI State Idem Mali OCP AFROPOC SSI HKI State AFROPOC SSI HKI OPC OCP AFROPOC HKI State AFROPOC HKI SSI State OPC SSI Idem State HKI State HKI AFROPOC Support of partners to national Oncho control activities 728 addition to the surveillance of onchocerciasis, deal with that of other diseases like malaria, trypanosomiasis etc... 6. Other issues addressed The meeting deemed it important to discuss the points on the performance indicators of CDTI, epidemiological and entomological surveillance, and the criteria of installation and cessation of CDTI, in order to propose them to the next EAC for adoption (cf table in Annexe III). Finalization of the summary on onchocerciasis control in each country (see the contribution of each Country) 8. Adoption of recommendations, conclusions and closing After open discussions, six recommendations were adopted by all the participants at the meeting. A vote of thanks and a congratulatory note were delivered by the CPET, who represented the Director of Programme in recognition of the quality of work achieved in the short time. 9. Recommendations 9.1 In order to ensure the regular treatment with ivermectin of people found positive in the zones of epidemiological monitoring not subjected to the CDTI, the meeting recommends the installation of a control device involving the health personnel of these respective zones (Coord.). 9.2 As part of onchocerciasis surveillance after OCP, the meeting recommends that the countries set up an integrated and decentralized entomological inspection network for an early detection of recrudescence of the disease, and an evaluation of the impact of ivermectin on transmission (Coord. Entomo.) 9.3 Participants are full of praise that the I I countries are currently equipped with powerful computers, allowing the use of OCP data management software. However, the meeting recommends that, by the end of August 2002, all the countries must be trained in the use of this software, in order to try it out and take the corrective measures before the Programme closes. 9.4 Regarding the control of nuisance, which will be a problem in the countries, after the suspension of larviciding, the meeting recommends that: a) FAO, sponsoring agency of OCP and leader in the socio-economic development of the oncho-freed zones, should be re-contacted for the consideration of the nuisance problems that are likely to crop up in the development projects of these zones (OCP). b) The national Coordinators contact the Resident Representatives of FAO in their respective countries to review this issue (Coord.) 9.5 In order to allow the Participating Countries to celebrate the end of OCP, the meeting recommends that each country submit to the Management of OCP a programme budgeting for possible financing (Coord.). 9.6 Since resource mobilization is one of the challenges to take up in order to ensure the success of the activities of onchocerciasis control after OCP, the meeting recommends that the Participating Countries work out for the next JPC of December 2002, a programme document emphasizing each activity budgeted for, the possible partners and their level of participation (Coord). 29 ANNEXE I : MEETING OF NATIONAL COORDINATORS AND ENTOMOLOGISTS OF THE ONCHOCERCIASIS CONTROL PROGRAMME IN WEST AFRICA IIOCPII (Cdte d'Ivoire, Guinea, Mali) Ouagadougou 24 - 26 June 2002 Provisional Agenda Monday 24 June 2002 8h-9h : A. a Opening of the meeting by the Programme Director Speech by CVCU Speech by the interim CPET Speech by the Head of Administration Installation of meeting presidium (l chair + 2 rapporteurs) Adoption of agenda. th-10h: o Item on the implementation of the recommendations resulting from the coordinators meeting of 2001 (by country). o Discussion. I0h-10h1 5: Coffee break 10h15-12h15: . Epidemiological Surveillance 2001-2002: results, difficulties, solutions, prospects after OCP (presentation by country) . Discussion. 12h15-I5lt00: Lunch break 15h-16h30 . Epidemiological surveillance: results, difficulties, solutions, prospects after OCP (continuation): presentation by country . Discussion. 1 6h 1 5-1 6h3 0 : Coffee break 16h30-18h30 Entomological surveillance: results, difficulties, solutions, prospects after OCP: presentation by country. Blackfly larviciding/simulium nuisance control: prospects after 2002 including the supply of insecticides. Discussion. a a 30 25 June 2002 8h-l0h: CDTI . Results attained in 2001 and2002: presentation by country . CDTI Activities after OCP: prospects (special measures to take for some basins) o Ivermectin supplies (current difficulties, solutions and after OCP). . Discussion. 10h15-10h30: Coffee break 10h30-1 th30: G . Financing of onchocerciasis control activities (by country) o Current Situation o Prospects: possible sources of financing after OCP. o Discussion. 1 th-l2h15: H. Integration of activities into the national health systems: Progress report and prospects (by country). Discussion. 12h15-15h: Lunch break 15h-18h: (Coffie break: 16h15 nith 16h30) I - Transfer of data to the countries and their management: o Item on the training of national teams . Item on the level of transfer . Other actions to be undertaken by December 2002. - Build-up of data bank on CDTI (list of villages, geographical and therapeutic coverages, coordinates of villages). - Discussion. Wednesdav une 26 2002 8h-12h15: ( coffee break: l0h-lLhl5) J Finalization of the summary document on onchocerciasis control in each country (according to the outline of the ad hoc EAC sent to each country). 12h15-16h: K Drafting of the conclusions and recommendations by the rapporteurs. 6hI 18h: (Coffee break: I6hI5-16h30) L. Adoption of conclusions and recommendations M. Closure of meeting a 31 ANNEXE II: LIST OF PARTICIPANTS TO THE MEETING OF NATIONAL COORDINATORS AND NATIONAL ENTOMOLOGISTS National Teams l. Dr. G.P. Brika, Co-ordinating Director National Oncho, COte.d'lvoire (in charge of the recommendations) 2. Dr. G.J. Attiah, Head of Oncho service, C6te.d'ivoire (Rapporteur I) 3. Dr. N.K. Diallo, National Coordinator Oncho, Guinea 4. Mr. R. Lama, NationalEntomologist Oncho, Guinea (Rapporteur II) 5. Dr. M.O. Traor6, National Coordinator Oncho, Mali (President) 6. Dr. Mr. Sow, National Entomologist Oncho, Mali (Rapporteur III). OCP 7. Dr. L. Yam6ogo, Head VCU, OCP, Ouagadougou 8. Dr. K. Siamevi, Acting CPET, OCP, Ouagadougou 9. Mr. J.P.Thirion, AFO, OCP, Ouagadougou 10. Dr. A. Pana, PET, OCP, Ouagadougou I L Dr. L. To6, RLA, OCP, Ouagadougou 12. Mr. V. K6r6, C.HYDRO, OCP, Ouagadougou 13. Mr. S. N'Gadjaga, RBIS, OCP, Ouagadougou 14. Mr. D. Som6, BIS, OCP, Ouagadougou 15. Mr. P.A.. 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