Progress report of the special intervention zones of the ex-OCP, January - August 2006

African Programme for Onchocerciasis Control (APOC) Programme africain de lutte contre I'onchocercose JOINT ACTION FORUM Office of the Chairman JAF-FAC FORUM D'ACTION COMMUNE Bureau du Pr6sident JOINT ACTION FORUM Twelfth session Dar-es-Salaam. Tanzania. 5-8 December 2006 JAF12/INF/DOCI ORIGINAL :FRENCH October 2006 Item l7 ofthe provisional agenda PROGRESS REPORT OF THE SPECIAL TNTER\ZENTION ZONES OF THE EX-OCP (January August 20061 October 2006 JAFI2IINF/DOCI Page i TABI..E OF OONTEI\IT A EI\ITOMOLOGIGATACIMIIES I I I I I 2 2 1 Vector Control iyt Togo and Benin fuom January to1.1 Entomological Evaluation Network............_.....1.2 Hydrotogy August 2006........ 2. Outcome of vector controt............2.1 Biting rate and transmission........... B. RESUIITS OF CDTT AGItvlNES 5 G. EPtDEiflotoetcttt EVAIUAT|ON AcilvtnEs............ ............9 D. MEENNGS 121. Annual Review and Planning Meeting on SIZ activities (Ouagadougou, 9- 1 1 november 2005) ........ l22' Repoft of the tnOartjje meeting betw.ee.n sightsayers intemational (SS/) country representatives and national onchocerclbsr.s cintrot progrcmmes (NOC1) 6taff of di,uLeone, Guinea and Libeia (26 Januail.....................:...... .................. /Jq' lepoft of the-workshop on onchocerciasis confio t opentions in the tributaries of theoti river basin in Benin and Togo and in the upper ou"^" iver basin in Benin(Ouagadougou, from lst - 2nd March 2006).:.:......._.... ..... 134. Annual meeting of the Special(Ouagadougou, 13-16 June 2006). Consultative Commiftee (SCC) for SIZ 145' 2nd Crcss Bordgl Megting Nigeria and Benin Republic onchocerciasis Confro t heldin Abeokuta, Ogun Sfafe lNigerla,-17-20 July 2006)....... ....................14q Summary repo\of the 2ND tripaftite meeting between the Nationatonchocerciasr.sCoodinators of the Mano iver lJnion Countie"...I.......... .................... /j E ITPOC SUPPORT TO st7 15 F. StZ MAITIAGEmEI\IT supponr FoB NON€IZ ZONE8. ............................15 G. PARTNERSHTP W]ITI NONGOT/ERNMEAITIIT DEVETOPMEI\IT ORGANISANONS (NGDOS) 16 JAFI2/INF/DOCI Page IA. ENTOMOTOGTCITT AGilVlTlES lntroduction The cond.uct of entomological activities in the special lntervention Zones (slz) in 2006 w.as qa{9d by !hp9 major events: (i) the new aerial contract for 20@-2007 period is not yet signed, (ii) the definitive cessation oi ground and aerial larvicidingln n" UppLr Oueme basin(recommendation ladg during a workshop held in Ouagadoigor,- 1-2 March 2006 andendorsed by the Special Advisory Commitiee for SIZ in June z]ooo and approved by SIZManag.ement), and (iii).the strengthening of entomological surveillance in Benin. The activitiestook place under good conditions, thanks to the avaltabitity of resources (technical, lLlistic, administrative and financial), and also owin_g to the agreement reached Oy tfre Orginijationand the helicopter Company in charge oilarvicidinj for ttre coniinuation of activities, inaccordance with the tenns of the formei contract, while-awiiting ttre signing of tfre new one. 1. Vector Gontrol and/or entomological situation in Togo and Benin ,l.{ Entomological Evaluation Neturork This activity has to do with the Keran, Kara and Mo basins in Togo, and that of theUpper Oueme in Benin. \Mth respect to the tributaries of the Oti river, all the 11 catching points, including the 4which are visited ev.ery week (A points), were maintained. nowevei'in tne uppei 6u"r"basin, only three points were maintainei, foltowing the reduction in larviciding i5r"og". ntthese lhree pointrs, catches/dissections "re organtsed every two weefs. ln addition to thenormalized catches, bulk catches were organis-ed from June to October 2006 at Wari-Maroand Beterou' two of the three catching floints of Benin, for evatuaiing the prevalence ofinfection using the poolscreening method.' 1.2 Hydrotogy Th9 I?'ly season, from January to_August 2006, recorded lower figures, as comparedto those of 2005 in the oti and the Upper oueire basins. It must be noted that, the Upper Oueme and alt its tributaries stopped flowing by theend of.January 2006. The Kara anci illlo rivers stoppeo flowing in February. only the main otiriver, the flow of which is rendered perenniat oy irie Kompieigj orr, "nd the Keran flowedpermanently. The low rainfall recorded caused a two-month delay in the flows from the Mo and Kararivers' These rivers actually started flowing in tne nrct ani second week of May respectively.The oueme and its tributaries started flowiig ratei aiine ueginning oiJune. A total of 1 1 river gauges are being used this year to monitor the hydrologicat situation. 1.3 Larviciding The end of the social unrest.in Togo altowed-smgoth running of aerial and groundlarviciding activities in 2006. lt must be noied ffrat go"/" of the aerial treatment circuits weresupervised by wHo observers for maximum efficiency JAF I2IINF/DOCI Page2 o Aerialcontract The first three-year contract, signed between WHO and the Evergreen Company (EHl), to carry out larviciding of the tributaries of the Oti and the Upper Oueme between 2003 and 2005 ended in December 2005. Negotiations for signing the second and last two-year contract (2006-2007\ are stil! ongoing. The two parties agreed to continue activities on the basis of the expired contract, while awaiting the finalisation of the new one. . Flight hours used for larviciding I A total of 307.2 flight hours (of which 9.1 hours for the aerial identification of villages, hamlets and specific inaccessible groups on the ground, and 298.1 hours for the treatment of tributaries of the Oti river) were used from January to august 2006, as against 392.8 houts for the same period in 2005. The difference in flight hours, i.e. 85.6 hours, compared to the 2005 figure is the result of several factors including the low rate of utilisation of flight hours allocated to the nationa! teams of Togo and Benin for aerial investigations, the early and prolonged drying up of the Mo and the Kara rivers, and the suspension of aerial treatments as a result of the excellent entomological situation. Laruicides used All the six insecticides available were used in accordance with the larvicide rotational scheme developed by the ex-OCP. Thus, 1279 litres of temephos, 25 371 litres of BtH14, 230 litres of permethrine, 996 litres of pyraclofos and 466 litres of etofenprox were sprayed from January through August 2006 in the Oti basin. During the same period, in 2005, a total of 2 767 litres of temeph os (29o/o of which was sprayed on the Ouem e), 22 172 litres of BtH14 (8% on the Oueme), 723 litres of permethrine (100% on the Oueme), 2 2O1 litres of pyraclofos (28o/o on the Oueme), and 679 litres of etofenprox (21To on the Oueme) were used. 2. Outcome of vector control CDTI was established in the OCP area in 1997, and implemented concutrently with vector control as a second onchocerciasis control strategy. Since 2003, the two control methods were scaled up in the SIZ in Togo and Benin. Thus, the transmission results obtained in the SIZ area are actually the outcome of Lintegrated control: larviciding and community- directed treatment with ivermectin. 2.1 Biting rate and transmission The analysis of the trend of annual biting rates (ABRs) and the annual transmission potential (ATP) in the Keran, Kara, Mo and Upper Oueme basins during the SIZ period (2003 to 2005) and the OCP period, in relation to the different operational phases, reveals the following points: 2.1.1 Otitributaries Biting rate on the reduction in ABRs on the Otitributaries, depending on their geographic location (Fig.1a to 1d). under control from 2OO2 to August 2006 in the Keran and Kara basins. \Mth the exception of JAF \2IINF/DOCI Page 3 the peak obtained in the two basins in 2003 (due to the exceptionally high rainfalt figures, and shortage of insecticides for high tides), the rate of aggressiveness remaTned the saire, "nO "ttimes lower than that of the OCP period, which haO i much wider larvicide .or"ra!JiFig.ta, 1b). larviciding in the South Extension at the end of 2001 brought ab-out a high increase in blackflydensity right from 2OO2 at Bagan and Mo (lower and middle course of th'e river). The situation was relatively well under controt from. 2003, despite the contamination of ttre basin by exogenous females; a substantial reduction in annuaiOiting rates was even observed at Baganin 2005 (Fig. 1c) all the basins. The biting rate recolded is tower than the rites of the same period in the threepreceding years. Tl ,nsmission The ATPs..SI"O.changing to the threshold of about 100, beginning 2000. From 2OO2to 2005, ATPs at Titira.dropped from 153 to 35, with a fluctuation 6t,tze observed in 20o4.During the same period, the ATPs at Tapounde dropped from Zl to 42 in 2OO4 and 2005; apeak of 109 was recorded in 2003 (Fig.1a) Dg!19 the January-August 2OOO period, two infective females were detected in thebasin at Titira, colresponding to an ATP oi M. Tire ATPs at TapounaJano Kouporgou are nit. The entomological situation is excellent in this basin. ATPs at Landa pozanda have remained below the threshold of 100 since 2OOO. At Sarakawa kpelou, this encouraging result was achieved since 1994 (Fig.1b) During the period of January to August 2006, no infective female was caught in theKara basin. ATPs at Landa pozanda, saraklwa Kpelou and sikan are nil. The entomological situation has been excellent in the upper part of the river basin atAleheride for several years. From 2OO2 to 2005, ATPs were beileen 0 and 2g. In the middle and lower courses of the river, ATPs, which were lower than the threshold of 100 from lggg to2001, gre-atly exceeded this threshold. in 2}O2foltowing the cessation of larviciding in the forestarea in Ghana. Fortunately, the reinforcement of iontrot activities (CDTI an-a nrvlciOinglhelped to make amends in 2oo4 and 2005 when ATPs were 60 and 0 respectively. At Balan,these rates were 29 and 28forthe same period (Fig.1c,1d) D-uring the Janu.ary- August 2006 period, no infective female was caught in the basin.ATPs at Bagan, Mo and Aleheride are nil. Overall, there is some improvement in the entomological situation on the Keran, Karaand Mo river basins. tir|r. l.z aamtEftrE{ts EOlOtmi gtgllc{lo@flx^8t JAF I2IINF/DOCI Page 4 F'ig.I: Trend of entomological indicators (ABR-ATP) on the Oti tributaries ABR !0000 !-TmRA0GRANnnER l=cRlrDArP-AERI 25000 2oo0 16000 l00m 6000 o ATP t@o ItOO 12,,o 1000 too 3@ aoo DO o !0000 m &00 r4000 t0o0o u o ABR 60000 60000 r00oo0 toooo 20000 10000 0 ABR trI-AI,IDAPOZANDA(I<ARAR\rER ATP It@ 1600 l.lO0 1200 l@0 E00 coo 400 200 0 (ll4,3tal'I.lnto00c ll|6rl,araurrrxrx€r ?ITETTXIO!6I lrlo.0 G. BAGAN O,O RN,ER} ICRUDATP +AER 2.1.2 Upper Oueme The entomological situation of the upper course of the Oueme river was satisfactory at the time of OCP closure in December 2OO2. This area was added to the SIZ in Benin, so as to avoid any possible contamination of the upper courses of the tributaries of the Oti by females, which may migrate from the Upper Oueme. lt must be noted that, at the closure of OCP, larviciding was intenupted on the middle and lower courses of the Oueme. ATPs, which were 98 and 49 at Beterou and Wari-Maro respectively in 2002, changed concomitantly with blackfly densities, from 116 and 136 in 2003, to 264 and 253 respectively in 2005, despite the maintenance of good larvicide coverage in the area. lt was decided, during the workshop held in Ouagadougou, 1-2 march 2006, to stop larviciding in the Upper Oueme basin on the basis of observations, which indicate the absence of involvement of this basin in the dynamics of blackfly populations on the tributaries of the Oti. However, it was recommended that entomological surveillance be strengthened in the upper Oueme river basin. As part of this enhanced surveillance, during the period January to August 2006, a total of 7 infective females were caught at Beterou and 9 at Wari-Maro. Annual Biting Rates were 9123 at Beterou and 10803 at Wari-Maro as against an average of 20 000 to 40 000 before treatment. Mid-way during the peak transmission period, crude ATPs were already higher than the threshold of 100, i.e. 135 and 174 at Beterou and Wari-Maro respectively. The upward trend of infectivity rates, noted in 2003, continues. Pending the outcome of the investigations under way on the origin of these infective females, the available partial results seem to confirm the very low transmission rate or non- involvement of this basin in the transmission recorded on the Oti. Thus, while the ATPs were far above the threshold of 100 in the upper course of the Oueme, transmission remained low in ATP ABR 2600 25000 2400 2200 zooo E@ tEoo 1600 16s6 1400 t20o r00o 10000 000 ::3 cooo 200 0g d- ALE|{ETRDE (rio EI,ES ICRUDATP +AER ATP .l5O ro0 350 300 zfi N t80 100 @ 0 3r.a(|,arta&urtao6a .ormrsrE rqrrr Bffi*"Hf*H.!nllt.lt,? r::A-FFIEI?] ffi Ef,tnfi,lm aorrDcmt] rofln It JAF I2IINF/DOCI Page 5 the tributaries of the Oti; only a crude ATP of 14 was recorded in the three tributaries of the oti. B. RESULTS OF CDT! AGTIVITTES lntroduction TOGO CDTI reinforcement activities are-ongoing in the five SIZ countries and the budget earmarked for ivermectin distribution, and eplderiiotogical evaluationJ has been increased in ?096r Prospection activities enable national teams totiscover new vilages and hamlets andinclude them in CDTI. The reinforced prospections, using .ar"d niglit hourc (due to the susPension of aerial.larviciding on the Uiper'Ou;;i in thi Keran, faia ana Mo river basins ,,n Togg !".r" greatly enhanied the identification 6r vittageilrraririeii and specific jroups(nomad Fulani, gold diggers, fishermen) that have bee-n included in CDTI. The main challenges include replicating this exercise in the upper Keran and Oueme river basins inBenin. lmproved ownership oi the programme by the health staff at all levels, and community ownership of the strategy has been obie.rved miinty in Benin and Siena Leone. Neverthetess, sensitisation and mobilisation must continue at all levels of the health delivery system jnd inthe communities living i-n the hyper and meso-endemic Oncho areas, so as to ensure sustainability. A series.of workshops on CDTI have been caried out in an effort to encouragethe central' district and peripheral tevels to further own the CDTI strategy and involve the communities in the.planning and implementation of cDTl activities, sucn al sensitisation, the choice of cDDs and the incentives communities would like to give them. - . Th9 leception of ivermectin by the Ministries of Heatth through WHO offices, theplacement of ivermectin tablets at peiipheral health centres,-ano-.oir"ition Oy communitiesthrough the CDDsr. have. greatly improvilo. ln Benin, lvermectin could now be received oy greMinistry of Health through the WHo country office in Benin without paving taxes. However, theestimation of ivermectin needs should be improved. The strategic re-organisation of CDTI activities in Siera Leone is being satisfactorityimplemented with the support of the health authorities, sst, HKl, the world Bank and theAPOC/SIZ Management. ln the SIZ areas in Togo, Benin and Guinea, biannuat treatment is carried out, usua[yin April and Octobel..grfliiing second-round COI treatments seem to be difficult for attprogrammes in the SlZ, which cqrry out two rounds of treatment. A survey will be conducted with the national oncho team to id6ntify the problems, and find approfriate panaceas for thissituation. CDTI was organis.ed as planned (2 rounds/year) from 2003 to 2005. The mean lheraqg$lc ,1d-ggographical coverage rates in the x6ran, Kara and Mo river basins in Togofrom 2003 to 2005.are given in tablJ 1. The geographi.ai cor"rrgJ varieo between gl.5zo/o and 99.25% while the therapeutic is maintainea"ao6vd gso/o. ln 2006' the partial results of the first round of distribution show high coverage for 9districts for which results are available:98.4o/o geogr"fnicat and as.t"z" tnerapeutic coverage. JAF I2IINF/DOCI Page 6 The list of villages under CDTI has been reviewed by the NOCP and a standard list of 1042 villages and Hamlets has been identified, and will serve as the denominator for geographical coverage in Togo. The total population is just over 816 171 persons. The difficulties encountered are mainly: insufficient logistics for supervision, dearth of CDTI data management (data collection, verification and on-the-spot conection of these data). ln some communities, inappropriate measuring sticks are used, and some CDDs complain of lack of incentives by their communities. These problems could explain why the geographical coverage of 10Oo/o is difficult to achieve. Nevertheless, CDTI is integrated into the health system at all levels, as attests the quality of presentations made by the district medical officers during the annual review meetings of Oncho activities in Togo. Data collection and analysis, as well as decision-making are taken care of at the district and peripheral health centres. The issue of lack of qualified personnel, and of appropriate facilities for data management was reported by most of the district medical officers. There is the need to: Sensitise the communities to own CDTI, and to find appropriate incentives to their CDDs where necessary . An evaluation of the degree of CDTI ownership should be conducted. Encourage government and NGDOs to increase their support to CDTI activities; Train staff at all levels on CDTI data management. At the central level, there is also the need to appoint a new data manager as the one at post is retiring. ldentiff all specific groups and new villages/hamlets to be treated. BENIN ln 2003, only one CDTI round was carried out in April due to a cholera epidemic, which interrupted the conduct of the second round that was scheduled for November. CDTI was organised as planned (2 rounds/year) in 2OO4 and 2005. lt is worth noting that in 2004, the second round of CDTI in November was coupled with the treatment of LF. The therapeutic and geographical coverage in the upper Keran and Oueme river basins from 2003 to 2005, given in table 1, indicate a drop in the geographical coverage in 2004 and 2005 while the therapeutic coverage is always around 8Oo/o. ln 2006, data of 1"t round treatment are still being gathered by the NOCP. The difficulties encountered have to do with the delay in placing the 2005 ivermectin order with MDP. The Togo national team had to lend 1,700,000 tablets to the Benin national team to enable it carry out the first round of distribution. The situation has since been put in order. ln 2006, the issue of importating ivermectin through Togo was resolved by Benin government. The integration of CDTI into the health system is improving as more District Medical Officers have underctood the CDTI strategy and are willing to implement. This is the result of the numerous meetings and workshops held with them by the SIZ Management. This could partly resolve the issue of reduction in the geographical coverage observed in the second rounds. The continual change of National coordinators is a major issue that might have an I JAF I2IINF/DOCI PageT impact on the supervision of activities and the overall performance of the Programme in Benin. There is also the need for the NOCP to get befter population data, as it has blen reported that ,3ny villages in the. qgso and hyper-endemic zones are not treated. Advantage should betaken of the sgved flight hours to scale up the identffication of specific groups and villages/hamlets in hard-to-reach areas. GUINEA ln 2003, only one CDTI round was conducted. ln 2OC!,, a disturbing situation occuredduring the second round of CDTI, i.e. the shortage of ivermectin, due to-wrong estimates ofdrug needs for two rounds. The treatment data from 2003 to 2005 in the Upper Niger-Mafou and Tinkisso basinsgiven in table 1 indicate that the therapeutic coverage varied betrneen 77 and BOo/o, wh1e thegeographical coverage was between g8.8 and 1OO%.lt should noted that in 2OOS new villages were discovered and included into CDTI. The results of the first round of treatment in 2006 show a lOOo/o geographical coverage and a therapeutic coverage of BO.2o/o. . 4r_o!g the dfficulties mentioned over the years are the late reception of ivernectin, thelapses in CDTI data collection at alt levels, lapsei in the supervision of'CDDs OV neiO nri="t of peripheral health centres. The issue of incentives to CDD; is yet to be solved.ihe 1."sponr"from the CDDs seems to be very positive, but there is need to continue sensitisation of the communities and the CDDs on the issue. There have been a lot of efforts made by the NOCpto overcome maly of these difficulties. ln particular, the distribution of certificates of satisfaction to CDDs has greatly enhanced their ownership of the projramme. GHANA The limits of the SIZ in the Pru river basin have been changing since 2OO3 passing fromfive districts with 280 villages in 2003 to four districts in 2oM. ln 2005, re-defining exercises in the SIZ zone in the Pru river basin showed that a total of 247 communities made up the SIZ in 7 districts. Following recommendations of the 2OO5 Review and Ptanning meeting of the StZ, theNOCP has provided a new list of districts, but the tist of communities ii still awiited. . Iq help reorganize CDTI in Ghana, SIZ Management recenfly supported a workshop on the CDTI strategy, which was hetd in Sunyani. The-Management of epOClSlZ (Director) is also planning an advocacy visit to the highesi authorities in tf,e near future. SIERRA LEONE ln 2003, the partiat CDTI resutts were as foltows: 28.3o/o geographical coverage, and 34o/o therapeutic coverage. ln addition, about 9,042 persons were treat6O in the ean-Oaiuma refugee camp. ln 2004, partial CDTI results indicated therapeutic and geographicat coverage rates as 22.5o/o and 28o/o respectively. JAF 12/INF/DOC1 Page 8 ln 2005, the strategic re-organisation process of CDTI in Sierra Leone was completed through the joint efforts of the health authorities, SSl, HK!, the World Bank and the APOC/SIZ Management. Due to the late start-up of CDTI activities (August 2005), and the difficulties encountered in accessing the funds promised by one of the partners, 2005 planned activities were not completed. ln 2006, lvermectin distribution using the CDTI method was conducted in Bonthe and Pujehun Districts in January 2006, and later in may 2006 in Moyamba District. Community Directed Distributors (CDDs), who are selected within communities, conduct distribution of lvennectin. The other nine districts (Bo, Kenema, Kailahun, Kono, Bombali, Tonkolili, Koinadugu, Port Loko and Kambia) conducted Mass Drug Administration (MDA) using Community Based Treatment with lvermectin (CBTI) also in May 2006. This decision was taken by the NOCP, together with members of the DHMT of these nine districts, and in consultation with Partners and members of the Top Management Team (TMT) of the MOHS because of time constraints and difficulty in accessing funds for community meetings, census and CDD training. Since 800 PHU Health workers were trained in 2005, they were used to conduct MDA in their respective districts. MDA was completed at the end of May 2006 in these districts. Because of the difficulties experienced by the NOCP to access World Bank funds in Sierra Leone, and on the suggestion of the World Bank, APOC/SIZ management increased the budget for CDTI activities from US $ 108 535 to US $ 508 128 for proper implementation of CDTI activities in 2006. The results of CDTI in Bonthe and Pujehun and Moyamba Districts are as follows: Bonthe District 32,347 people treated out of 44,429 total population. 183 villages were targeted for treatment. A total of 90,785 tablets of lvermectin were used (2.8 per person treated). Pujehun District 91,277 people treated out of 131,639 total population. 502 villages were targeted for treatment. A total of 264,976 tablets of lvermectin were used (2.9 per person treated). Moyamba District 101,658 people treated out of 152,319 total population. 1,000 villages were targeted for treatment. A tota! of 293,056 tablets of Ivermectin were used (2.9 per person treated). The MDA results in the other nine districts are in annexe 1. lt is worth noting that the therapeutic and geographical coverage rates recorded in Districts, where CDTI is implemented, are higher than the rates in areas where the MDA strategy is used. I n n JAF L2IINF/DOCI Page 9 lgbl. l: REST LTS OF CDTI ACTwITIES IN THE SL,z (2003-2000 C. EPIDEIT IOLOGICAI EVALIJATION ACTIVTNES 1. On the Keran river basin ln Benin A! Kguporgou on the Koumongou, the disease prevalence varied between 46.50/o in 2000 and 16.220/o in 2004, with a Community Microfilariai Load (CMFL) of O.45mf/b in 2004. ln 2005, Taconta was the gnly viltage, out of 7, that undenrent epidemiological evaluation and had a prevalence of 6.90/o with a Community Microfilarial Load tCnAF[l ot0.42mllb. The epidemiological evaluation has not yet been conducted in 2006. Vllhgeo PopuhtoncoulrtTRY S.qucncc Yorr(moiltl) Pl.nned Tra!.d R.gEbttd Ttrrt d Geogarp. oownge Th.npouL ooYrrrgo Numb.rol trbl6 uaad NDe ot lrbb!] p.r Paramf't 0d CDDe Nb.CDB tnln.d, trlElnad 'tound 2o(ts ilunsl I 470 I rt€6 53It 7!t8 431 905 99.7% t0-9% .5 l&Z- round xre No trEat. 7 170 I 553 1t66 oJ, /30 B2t 680 s9,7% 08.6% eo,cb 80.$r 3m2 1 627 I 468 3 U21 I 248 059 a27 2te eo2% u.gN 79,M w,ax1@1 627 1 2o(l5 I 6t5 I 557 652 o8r 53r re? 93,1% 81.5% t 3!r oa3 _5 tmo?" roond zq)5 t 615 1 5i21 elg 288 531 .192 u.nL lr,s!6 1 372 179 2,6 ,,.,,a frot I 2:rO 3 074 1 301 360 1 06it 689 95.t% 1,7% Benln Omdno ?006 tt tDund Xl3 (ADdn 2172 2 385 893221 604 4m 98.9% ft.7 202A 2A7 .9?- Dund am No tBet. tru6 2 112 2 385 221 au4oo cE,9% 77,7% 2qx (Aorin r 3062 411 2 111 1(x)3 2M 87i2021 872U21 687 382 t67 598 1e,* 7E.a% I 9035G 607 5:13 4 306 { g)6t..a ruo1 4 &Ut 3 4r1 I 744 U2 cu0w t9,gx tormd 2m5 2 417 2 417 867 7r5 686 600 1@% fe.lq I 857 300 2,7 4392 1373 z'- round 2006 2 117 2 117 878 700 It 3ge t00?g El.0,6 1 844 Cr3 2.8 4373l3|n fla a84 lUv 7,!6 115 1 3C7 099 1@t% co,g,4 Gulnre Con.Iry l" roond 2q)6 2417 2417 876 590 7U2871 o% EO.Z* 4 478 1?91 r 525 2,82* mund 2(D3 (Aprll) 20Gt (Nov.) 13?2, 1 525 5t7 577 4gl 610 232 t 608 808 1 798 009 2924 176 .1399.at ,M 247 z 8t6 , 217 663 0g16 ' torrnd t 545 I a93 750 918 il3572 .6% u.nL 20g8aa, 3,1 2870f round 2s0a (octJ 1.1E5 tq2 723 1e0 626 116 u,1y. 86,0% I 885405 0 ean 2@1 0(ro 2@5 1 1EC O7e 1 2d9 688 95,6t6 5,1% l* round 1.J,,2 1(N0 t6 r71 69:t 620 t.Cyc !5.0% 201A 27e ,0 3 0622'* tound 20(E tu2 I 020 naT0,3 688 E18 9!.7t6 85,596 r 886 545 B 3 07t aaa I 2M 2W z aaa 1 357 438 99,2,6 E5,7X Togo l- round ax)6 ll4 1 126 879 078 71a42e 9t,416 E6,t% 21UUN 2.9 3 48t zoo:, (ocr. Norr.l 316 3t6 173 412 12t215 100% l2,E% gtg 2il 2.7 ao(,4 t6 I 795 129 151 12.9% -t% 4324 2,8 47 '4 I 5 6121 1E-a,. .r96 Ghana 2000 zoq, (JutY) I 2,J9 I '71 590 tE.l% 1.Ot% 014 151 6 7 412 t40 ZXX (F6b.) t 879 418 338 887 94 785 22.2% 2E-O% 284 35!i 3,0 rlSO No tEalrnant 2005 Slera Lcone t Dlrtrlct naaultr 2(xl6 (Jan.,May) 685 225282 6.18 817 2,9 2(x)0 r- rI I- r ililrlrfirIEilI -I 2.5 qar,1l JAF I2IINF/DOCI Page 10 ln Togo The prevalence at Titira was 64.5%, with a CMFL 10.98 in 1995. This prevatence rate dropped to 39.1% in 2000 and to 22.7o/o in 2003. lt must be noted that the CMFL at Titira dropp6d from 0.90mf/b in 2OOO to 0.19mf/b in 2003. The villages around Titira also had high prevalence rates (Kpesside ferme: 50o/o with a CMFL of 0.34 in 2OO2, and 1 1.60lo with a CMFL of 0.16 in 2005; Kpesside Narita: Prevalence rate of 24.9o/o, with a CMFL of 0.29 en 2002, and 22.3o/o, with a CMFL ot O.27mflb in 2005). 2. On the Kara river basin in Togo The epidemiological evaluations conducted in 2006 in 4 villages indicate noticeable reduction of prevalence rate on the Lower Kara river basin where results have been so far bad (see annexe 2). The prevalence rates registered are as follow: Tougel: the prevalence rate went down from 41.4o/o, with a CMFL of 1.97mf/b in 2000 to 28.60/o, with a CMFL of 0.19mf/b in 2003 and to 10.8o/o with a CMFL of 0.04mf/b in 2006. Sakpone: prevalence dropped trom 37.7%, with a CMFL of 1.44mtlb in 2000, to 16.80/o, with a CMFL of 0.13mf/b in 2003 and to 4.5o/o with a CMFL of 0.28mf/b in 2006. Sikan: prevalence went down from 53.5% with a CMFL of 3.25mflb in 2000 to 39.9% with a CMFL of 0.24mflb in 2003 and to 13% with a CMFL of 0.17mflb in 2006. Kadjol 2: the prevalence rate dropped from 29.1o/o, with a CMFL of 0.08mf/b in 2000 to 10.9olo with a CMFL of 0.10mf/b in 2003, and to 1% with a CMFL of 0.04mf/b in 2006. Two villages evaluated in this river basin out of 4 have a prevalence rate below the threshold of 5o/o in 2006. All the CMFL in this river basin are below the threshold of 0.5mf/b. The two remaining villages have a prevalence of 10.8% and 13o/o. 3. On the Oti main river basin in Togo All the two villages evaluated in 2006 have prevalence rates below the threshold of 5o/o (0 and 4.So/oXsee annexe 2). 4. On the Mo in Togo The prevalence rates in the two sentinel villages on the middle and lower courses of the Mo are, at Bagan: 2.7o/o with a CMFL of O.O2mflb in 2000, and 3.8% in 2005 with CMFL of 0.04mf/b, and at Mo: 9% in 2000 with CMFL of 0.05mf/b, and 8.6% with CMFL of 0.17mflb in 2005. There is a slight increase in prevalence rates, though they are still lower than the threshold of 5o/o at Bagan; At Mo the prevalence is above the 5% threshold and has remained almost stationary although a slight increase in the CMFL is observed. ln 2006, the epidemiologica! evaluations conducted in 13 villages revealed that 5 villages have a prevalence below the threshold of 5o/o (varytng from 0% to 3.8olo), and 8 villages stil! have prevalence rates above 5o/o (varying from 5.7o/o lo 21.7o/o). All the CMFL are l JAF I2IINF/DOCI Page 1l below.0.S mf/b (between 0 and 0.43 mf/b). A total of 7 villages out 13 villages evatuated show a significant decrease in prevalence rates. A slight increase of prevalence is observed in the remaining villages (see annexe 2). ln conclusion, in the Kara and the Oti main river basins the epidemiological evaluations results in 2006 show a significant decrease in prevalence rates; 4 out of 6 vil-lages evaluated haveprevalence rgtes below 5% (varying from 0 to 4.5). Two villages have preva'ience rates of 10.8 olo and 13o/ot the prevalence rates in these two villiges were 41.4o/o anci sg.Syo in 2000. ln the M6 river basin, 53o/o of villages examined have prevalence above the 5% threshold in 2006 with CMFL below the threshoH of 0.5mf/b. Prevaience has remained almost the same in some_villages over the years, and even an increase is observed (Koida 19, golo in2000; 19o/o in 2003 and 2Oo/o in 2006; Mo village as shown above). These are irontlin" ,illage. on the Mo river. It is worth noting that the Mo river basin situated to the southem border of the SIZ are actually invaded on a regular basis by migrant females at the time of monsoon winds and also most of the flies involved in the transmission are forest species. 5. upper Niger/Mafou and rinkisso river basins in Guinea The SIZ in Guinea are made of the upper Niger/Mafou and Tinkisso river basins. Overall, the results in these basins are satisfactory. From 2OO3 to 2005, 87 villages in att were evaluated in these basins and the results show thit: . 36 villages (41 olol had a prevalence rate of zero (O o/o); . 46 villages (53 %) had a prevalence rate below S %; ' 9 v_illages (60lo) had a prevalence rate above 5 %. These are Boroto on the Tinkisso(6'6 %); Walia Dabourou on the Niger (8,7 o/o); Mamouria on the Niger (12o/o): Herako on the Mafou (5,3 o/o) and Serekoroba (S,4 %) on the Mafou The CMFL has remained below the threshold of 0.5 mf/b. The positive-status of a 9-year old girl, who was declared negative tn 2OO2 in the village of Yalawa on the Mafou, and that of a young man of 20 after 3 suciessive evaluations (19gig,209?'2005) who declared taking ivermectin every year, is of concem. All these observations call for greater vigilance in this zone, and necessitdte further efforts in ivermectin distribution, in order to reach the therapeutic coverage rate of g0 - gso/o. ln 2006, the epidemiological evaluations conducted in 13 villages (6 villages on theMafou/Niger, 7 villages on the Tinkisso) revealed excellent result. The-prevalence rates in all the basins varied from 0% to2.9o/o and the CMFL from 0 to 0.09 mf/b (see annexe 3). 6. Sierra Leone No epidemiological evaluation has been conducted in 2006 as 'pre-controt, data havebeen collected and it is important that control efforts be welt installed before evaluating theimpact of the treatments JAF I2IINF/DOCI Page 12 7. The Pru river basin in Ghana: According to the report of the Joint Programme Committee (JPC23.4a), at the closure of OCP in 2OO2 the prevalence of onchocerciasis in the Pru river basin was around 7,8% with CMFL close to 0 mf/b (2001 results). Epidemiological evaluation results in this river basin in 2004 show that out of 17 sentine! villages evaluated in 2OO4 there is a tendency in the increase of the prevalence in 14 villages. For example, it went trom 7.7o/o in Akrakuba village in 2001 to 26.5o/ot 4.8o/o in Asubende in 2000 to 8.8%; O.7o/o in Faowomang in 1997 to to G.8 ln Asubende 02 male children in the age group 04 years were found positive. ln Mentukwa 01 female child in the age group 0-4 years was found positive. This indicates that transmission of Onchocerciasis is still ongoing in these two villages. ln 2OO4 out of 24OO people surveyed 18 were blind, 19 had severe visual impairment and 13 had visua! impairment. The highest number of blind was in the age group 11 -20 years old. lt is not possible to say if the blind and severe visuals impaired are a consequent of Onchocerciasis. This can only be ascertained after a cause of blindness survey in these villages. The epidemiological evaluation results of 2005 are equally alarming. Out of g sentinel villages evaluated in 2005 the prevalence of onchocerciasis is above the threshold of 5% in 4 of the villages. lt ranges between 8.1o/o (Tanfim village) lo 25.7o/o (Damongo Nkwanta village). The community microfilarial load CMFL, which is an indicator of the risk of blindness in a community, is on the increase, varying from 0.11mf/b (Tanfim village) to 2.65mf/b (Damongo Nkwanta). This situation calls for concern and efforts should be made to carry out regular ivermectin treatment in these communities. Epidemiological evaluation of sentinel villages has not yet been conducted in 2006. D. IIEETINGS Annual Review and Planning Meeting on SIZ activities (Ouagadougou, 9-l l november 2005) Participants in the meeting included national Oncho coordinators of the former OCP countries, representatives of NGOs (SSl, HKI and OPC), and the MDSC. The objective was to review all aspects of onchocerciasis control in the countries, and agree on plans to be implemented to avoid any risk of recrudescence of the disease. The main issues that came up during fruitful discussions were: 1) lntegrating Onchocerciasis and LF control Programmes, as much as possible, at nationa! level for increased efficiency and efficacyi 2) drafting up a basic standard list of all villages eligible to CDTI; 3) priority to be given by countries to sentinel villages and catching points to be put under surveillance, and which are on the list of sites selected by each country at the closure of OCP; 4) need for countries to solicit financing from various partners in order to enhance CDTI, where results would still be deemed unsatisfactory after the end of SIZ activities in 2007;5) support to all initiatives toward the resumption of national CDTI-based onchocerciasis control activities in C6te D'lvoire ; 6) need for a better delineation of the SIZ area in Ghana; Ghana National Team should provide the elements 1 JAF I2IINF/DOCI Page 13 necessary to re-define the SlZ, prior to the next CDTI activities in the Pru basin; 7) advocacy to be made at the highest tevel in Benin for the abrogation of the municipal sanitation tax on the importation of ivermectin into the country ; 8) invitation of the NGDO coordinator to SIZ and ex-OCP country review and ptanning meetings; 9) need to develop a brochure on advocacy activities, in collaboration with the Woild Bank and HKI for resource mobilisation in the countries; 10) need for enhanced collaboration between the usual partners and the OOAS to ensure good coordination of onchocerciasis control in West Africa. 2. Tripartite meeting between sight savens international (SSl) country representatives and national onchocerciasis control programmes (NOCP) staff of Sierra Leone, Guinea and Liberia (26 January) The objective of the meeting was to improve onchocerciasis control in the border areas between Siena Leone, Guinea and Liberia by synchronizing CDTI activities in these areas. The main recommendations of this meeting were: 1) the harmonization of ivermectin distribution in the three countries; 2) the Holding of a tripartite meeting twice a year during which achievements and problems can be discussed and recommendations made to sotve the problems; 3) the need to strengthen communications between the three member countries of the Mano River Union through e- mails, rgports, letters, telephone calls. NGDO partners promised to continue to pr6vide support for Oncho control in the various countries of the Mano River Union. 3. Workshop on onchocerciasis control operations in the tributaries of the Oti river basin in Benin and Togo and in the upper Oueme river basin in Benin(Ouagadougou, from 1st-2no March 2006) The objectives of the workshop were to review the onchocerciasis controt activities caried out in the tributaries of the Oti and Upper Oueme river basins since 2003, to review the CDTI, entomo-epidemiological and socio-anthropotogicat data for a befter understanding of the impact of the control operations, and to propose appropriate activities to be cagied out in the basins before the closure of the SIZ programme in 2OOZ. . Following SIZ Management presentations and intensive discussions, experts drew the following conclusions/recom mendations : 1) the interruption of vector control in the Upper Oueme river basin for 2006 - ZOO7 the period. Only surveillance activities wilt be maintained on the basin by carrying out capture/dissection, morphological identification of adult flies, cytological identification of larvae and pool screening to monitor the infection levet in the vectors; Z1 ttre investigations to be conducted to id.entify th9 origin of these infected btackflies; 3) the coniinuation of larviciding in the Oti tributaries , while maintaining a high level of ivermectin delivery; 4) the use oi savings made from unused larvicides and flight hours on the Oueme, for-iAentification of untreated endemic villages and detailed mapping of settlements in order to reinforce CDTI|,"|P .ensuring 10}%_geographical coverage; 5) the need to strength CDTI bytraining/retraining more CDDs, and adopt the hamlet treatrment strategy, intensiff community sensitisation, mobilisation and advocacy to enhance comptiance to long+erm treatrneni,providing enhanced supervisory support by the health syitem; 6) the need to reinforce epidemiological evaluation activities in the SIZ to ensure [ngitudinil fol6w up of impact of JAF I2IINF/DOCI Page 14 control activities on transmission, to use onchosim model to predict the epidemiological situation beyond 2OO7;7) the need to continue advocacy with governments and NOCP, to integrate CDTI into national health systems; ) the organization of cross-border meetings between Benin and Nigeria. The full recommendations of the meeting are presented as annexe 4. 4 Annual meeting of the Special Advisory Committee (SAC) for SIZ (Ouagadougou, 13-16 June 2006) The meeting was attended by all members of the committee, and a full-house participation of the three Programmes, namely APOC, SIZ and MDSC. The subjects discussed touched on the evaluation of the activities presented by the coordinators, the technical and administrative management of activities at SIZ Management level. Members of the Committee made observations and recommendations to SIZ Management, MDSC and the health authorities of SIZ countries. These recommendations relate mainly to: 1) the preparation of the cessation of SIZ activities; 2) the human and material resources required for the smooth running of the molecular biology laboratory of the MDSC and a task force on the poo! screening technique, and its applicability to the operational context; 3) the integration of onchocerciasis control programmes and those of Lymphatic Fitariasis (LF), at various levels, depending on the country; 4) CDTI reinforcement activities in the SIZ and the continuation of efforts to document persons who remain positive, though they claim to take ivermectin on a regular basis ; 5) maintaining of the conventional entomological evaluation in the Upper Oueme basin, and conducting of a study on the source of blackflies invading this basin on a seasonal basis; 6) the problem of frequent changes of National oncho coordinator and the Health Ministry's lack of respect for its budget commitments; 7) Need for APOC Director to carry out a high-level advocacy visit in the near future to Ghana. 5. 2nd Cross Border Meeting Nigeria and Benin Republic Onchocerciasis Control hetd in Abeokuta, Ogun State (Nigeria, 17-20 July 2006) The Federal Ministry of Health of the Republic of Nigeria in collaboration with the Ministry of Health of the Reiublic of Benin, and the APOC/SIZ tfranagement held the 2nd Cross Border Meeting between Nigeria and Benin on Onchocerciasis control in Abeokuta, Ogun State, Nigeria from 17h - 2oth Ju[ 2006. The major outcome of this meeting includes the creation of a joint monitoring team, the development of a plan of action for synchronized activities, the development of the format for listing of communities in border LGA/Commune, and the development of a strategic plan for epidemiological and entomologicalsurveillance on Nigeria side of the border. The main recommendations were: 1) the need to establish epidemiologica! and entomological surveillance along the Nigerian border; 2) the necessity for the government and projects to identify and mobilize internalty sustainable sources of funding, for implementation of CDTI activities at the border areas; 3) the need for CDT! projects to submit by November 2006 to their national offices comprehensive and reliable list of communities and their populations in the borde[ 4) the holding of stakeholders meetings once a year at local levels between adjacent districts and communities of both countries; 5) the reinforcement of supervision and monitoring in Nigeria and Benin in order to achieve and sustain 100% geographic and 85% therapeutic coverage ; 6) the next cross border meeting will be held in Benin Republic in July 2007. JAF I2IINF/DOCI Page l5 6. 2ND tripartite meeting betureen the National Onchocerciasis Coordinators of the Mano River Union Counties The meeting was held in Liberia from 1-2 August 2006, as recommended during the first one held in Sierra Leone. Participants included representatives of SS! Sierra Leone, SSI Liberia, SSI Guinea, the Mano River Union (MRU) Secretariat, The WHO Country Office in Liberia, and the top management team of the Ministry of Health of Liberia. During the 2 days of the meeting the recommendations made were related mainly to: 1) collaboration between the three countries as they have similar problems; 2) the conduct of joint surveillance in border areas, and sharing of surveillance resutts; 3) synchronized treatments with lvennectin in the 3 countries or at least in the border areas; 4) the invitation of the Nationat Coordinator of the lvory Coast to the 3rd meeting; 5) the 3rd meeting be held in Guinea in January ZOOZ. E" APOC SUPPORT TO SIZ +APOC Director ensures the overall supervision of financial, administrative and technical activities of SlZ. o The SIZ get considerable administrative and technical support from assigned APOC staff. o The APOC Director and the Coordinator of the APOC Directo/s Office organise, guide coordinate all SIZ activities. +APOC puts its know-how at the disposa! of the SIZ for putting in place a data bank of CDTI activities, of entomological and epidemiological evaluations in the SlZ, and contributed to drawing up the document of the CDTI strategic reorganisation in Siera Leone. F. SIZ MANAGEIIENT SUPPORT TO NON€IZ ZONES The Management of SIZ gives technical support in the following areas: Technical assistance in organising surveitlance activities, and data collection/management in the non-SlZ zones in Togo, Benin, Ghana and Guinea. Yearly organisation of review and planning meetings to which national Oncho coordinatorc of the six non-SlZ countries are invited. This helps them to take stock of activities caried out in each country since the closure of OCP, and to share experiences among themselves and with other participants. Participation in the annual review meetings on onchocerciasis control activities in Togo, and in the evaluation organised by SSI on the relevance and efficiency of the support of SSI to the onchocerciasis control programme in Togo. Contribution to the shooting of a documentary film on onchocerciasis in the endemic zones of Togo. JAF I2IINF/DOCI Page 16 G. PARTNERSHIP WTH NON€OVERNIIENIAI DEVELOPMENT oBcANlsATtoNs (NGDOS) HKI continues to give support to IEC activities relating to CDTI, and which have to do with vitamin A and iron distribution in several West African countries, including Guinea, Cote d'lvoire, Burkina Faso, Mali, Niger and Sierra Leone. SSI actively supports CDTI activities, especially in the area of training/re-training, supervision and supply of logistics to teams in former OCP countries including Benin, Ghana, Guinea, Mali, Senega!, Sierra Leone and Togo. Plans are made to extend support to Guinea Bissau. OPC actively supports CDTI activities in Guinea, Mali and Senegal. ANNEXES JAFI2IINF/DOCI Page I ANNEXE 1: SUMMARY FOR DISTRIBUTION OF TVERMECTTN tN STERRA LEONE ( MAy 2006) ANNEXE 2 : EPIDEMIOLOGIGAL EvALUATtoN IN THE s.z IN ToGo (2000-2006) District Total Pop. registered Pop. Treated Ther Cov (Yol Total No. of Mllages Mllages Treated Geo Cov (vo) Tabs Used Tabs Remain. Tabs SpoilU Lost un 177 903 91 874 51.6 570 312 il.7 263 005 0 42 Bombali 270 48 170 035 62.9 1000 637 63.7 463 281 0 67 Port 283 635 159 170 56.1 920 546 62.3 450 698 0 45 148 053 u 914 57.3 490 289 62 239 031 0 26 Koinadugu 151 483 85 785 56.6 516 296 57.4 238 695 0 30 Tonkolili 210 403 101 379 48.1 631 324 51.3 288 046 0 u Kono 191 179 108 005 56.5 620 365 58.9 304 053 0 49 312 500 117 021 37.4 752 302 47.3 335 216 0 67 Bo 367 001 193 861 52.8 1,267 674 53.2 569 102 0 84 DATES lrtrt GEs OODE IGAITHCEI{IER UATEGT' PNE:EGruRE REGPilS BAISNS POFULANOiI ElrAurAnox T.rtobd Errnln d Poal{rr. 2003 ,00:! 20m GilFt- PrtY PilBafro s950 Tindir$6 Sobubora ientnBls M6 56 43 1i 0.4 3g.tlta 24nin0lJ6, ]{aboun- Kotra 5945 Tindh!s5 iobuboua Centrale M6 1:, I 269 l5 O-tl U. 21rc/5n00,J Moussoukoudixt 5944 Tindhs!6 Sobuboua Ccntnlc l(paara-loue 1t: t00 3A% 0.ll.t -g:: EA 2ilO5n0s6 Gn6zimc lG-rda 5950 lodohou Sobuboua Canualc ]Qas6a-kouG 329 t& 20t 0.0( 0.3325l05/2006 26105/2006 TcfiSEl6lrou A0blrmEsoumou 5941 Boulohou Sobuboua Ccnualc frpasse-kou€ 283 266 208 0.ll 0-0rTchldoue 5946 Djnrkpanoa Sobuboua Ccntale M6 73 3! EA 0.00Sakpaonlnka 5343 Boulohon Sobuboua Ccntsalr M6 129 77 0.3227nsfrzoo,3 Mauutom Boulohou iobuboua Ccntalc M6 130 110 11 0.128r05/2006 Barlda 5954 Eoulorrou otouboua Cenhalc M6 21 ,11.9% 0.193t/05f2006 31/05/2006 Kq!,la-fonkoriba 1162 Baohan Bagh.n Balcar Kera 335 190 t53 0.10 0.00 oa3ao 5616 Nandouta Dankpcn iIa od t6t 0.08 2,1% 5.E% oz(l6noo6 5618 ](patab ankpcn lGra oti 197 103 0 EA 0-l o% o2nil2006 5820 ,oly G ,6uke Dankocn Krra Kera 473 ,14,1 ,l: 10.Eca 0.06 0u0@006 ekpon6 5628 Polv G l(ouka Dankpcn Krra lGra 4gI 215 0.2r 16.8%Sikan 5630 Nernon Dankpcn lGra Kara 190 21 0,17)Gifi2 5629 Narnon Dankocn lGra lGra 397 17 2 \e/. 0.lttl JAF |2IINF/DOCI Page tr ANNEXE 3: EPIDEMTOLOGICAL EVALUATION lN THE SIZ lN GUTNEA (2004-2006) DATES vtlr cEs CODE HEALTHCENTER BA$ns FOPUI-ATblt EVALI.IATION f.tt.bd Elmlrd P€10[ 2m mil Pd CIIFL PEv juil-06 Kini6dougouba 1oE2 CSUlGmus lr<rr.r""" l** 1lt 86 0 0'0 0,00 0,0 Banken csuKourcGsa lrco,r.,r"* ln,* 2t26 t34 0 0'0 0,00 0'0 lGuEutsele emuiana llGt.roussa lNioer 255 .172 ,| o.? o.o4 l.t Friab€ndouoqJ 9:t7 Passaya lFaran€h Ittioer 36r 271 t.r 0.04 0.6 ilrcro 1058 Ilouako llGuroussa lMeIot 2- o- 1,3 Bamr{(orc ouako llGuroussa lMefou 225 194 o 0.0 o.o0 0.6 Bassi w. lcnkama lDabola Itinticso .16l 3/U 5 l.( 0.07 4A londouoou 895 BiEsikirima loabol€ lTinkieso t7a 286 o-7 O-O/ 0,0 Sodara 12j25 354 216 0 0'0 0,00 1,5 Hsrko Bona loamuirBye lTinticso 301 207 o 0.0 0.00 0.0 Thianl(ornr6 923 csuDimuiEre loingrir.lo lri*i"* 171 130 0 0p 0po 2r5 Es6la lKourousaa lTinkisso 597 39/t o 0-o 0.00 0.0 ANNEXE 4: RECOMMENDATIONS OF THE WORKSHOP ON THE OT! TRIBUTARIES AND UPPER OUEME (Ouagadougou,lst -2nd march 2006) The objective of the workshop were: a) To review the onchocerciasis confiol activities carried out in the Keran, Karao Mo and Upper Oueme river basins since 2003 b) To review the CDTI, entomo-epidemiological and socio-anthropological data for a better understanding of the impact of the control operations c) To propose appropriate activities to be ca:ried out in the basins before the closure of SIZ progftlrnme 1fa2007. The recommendations made during this workshop by the experts are listed as follows: COMMT'NITY DIRECTED TREATMENT WITII IVERMECTIN (CDTD Recommendotion I Strengthening CDTI in Togo and Benin as recommended by this group and the mid term review committee by: o Training/retaining more CDDs and adopt the harnlet teatuent strategy o Intensi$r commtrnity sensitizatiorU mobilisation and advocacy to enhance compliance to long term teatuent o Providing enhanced supervisory support by the health system. lr csu DimuiEw loinguir.y" lrinri""o l2t Iar o-7 IJAF I2IINF/DOCI Page Itr VECTOR CONTROL Recommendotion 2 Intemrpt vector control in Upper Oueme river basin (Benin) for the period 2006 - 2007. Use the saved flight hours for identification of untreated endemic villages and detailed mapping of settlements in order to reinforce CDTI hence ensuring IOO% geographical coverage. Recommendation 3 Concerning Keran, Kara and Mo (KKM) river basins (Togo and Benin), the group recommends that vector contol should continue till end of 2007 as it provides as much protection as possible against transmission. S I,R\{EILLANCE/EVALUATION Recommendotion 1 Shengthen the entomological sr:rveillance in the Upper Oueme river basin (Benin) by maintaining entomological monitoring activities (capture/dissection, pool screening, morphological identffication of adult flies and cytological identification of larvae). Recommcndation 5 Reinforce epidemiological evaluation activities in the KKM (Togo and Benin) to ensure: . Longitudinal follow up of impact of control activities on transmission o To determine the prevalence of oncho in the specific groups (e.g. nomad fulanis, gold miners, fishermen and in the newly identified co--unities) Recommendation 6 Given the prevailing epidemiological and entomological situation the group recommends that SIz management explores the possible benefits of using the onchosim model to predict the epidemiological situation beyond 2007 onthe basis of the intenrentions proposed by thi group and the SIZ mid term review. SIZ MANAGEMENT Recommendation 7 The group considered that CSA should be cognizant of the need to maintain SIZ achievements in particular strengthen CDTI given that the epidemiological situation at the end of 2007 is unlikely tobe sqmPatible with the overall objectives and expectations of former OCP. The risk of recrudescence is considered a threat tothe former progrr-- e areaand too high for control options to be abandoned at this stage (given the geographical and sociological conditi-ons, the proximrty of borders and migration of populations), Th9 workshop recommends that opportunities of funding post SZ activities should be explored to maintain enhanced CDTI through cormty budgets or with ixternal support e.g. NGDOs. The group firttrer recommends that the cost of on going activities be estimated and any opportunity for integrated approaches in the funre be explored. i JAF I2IINF/DOCI Page IV Recommendation I SZ management will take necessary action to implement the plan of action 2006 -2007 elaborated during the workshop. I