Progress report of the World Health Organisation for 1996: 1 September 1995 - 31 August 1996

Onchocerciasis Control Programme in West Africa Programme de Lutte contre I'Onchocercose en Afrique de I'Ouest JOINT PROGRAMME COMMITTEE JPC . CCP COMITE CONJOINT DU PROGRAMMEOffice of the Chairman - Bureau du Prdsident I JOINT PROGRAMME COMMITTEE Seventeenth session Cotonou. 2-4 December 1996 JPCI7.2 ORIGINAL : FRENCH September 1996 Page 6 6 6 7 9 10 10 12 12 t2 l4 15 15 l6 t6 l8 18 t9 Provisional aeenda item 5 PROGRESS REPORT OF THE WORLD HEALTH ORGANIZATION FOR 1996 (1 September 1995 - 31 August 1996) Table of contents SUMMARY VECTOR CONTROL Climatic conditions Aircraft fleet and aerial operations Treated areas lnsecticides and control strategy Hydrology and tel etransmission Entomological surveillance and evaluation network Monitoring of the aquatic environment IVERMECTIN (MECTZAN@) DISTRIBUTION AND EPIDEMIOLOGICAL ACTIVITIES . . . Ivermectin treatment Evaluation of the ivermectin delivery system Epidemiological evaluation . . Evaluations in the Original Area . . . . . Evaluations in the extension areas Ophthalmological evaluations 3 BIOSTATISTICS AND INFORMATION SYSTEMS . . . . 17 TRANSFER OF ACTIVITIES TO THE PARTICIPATING COUNTRIES . . . Training Public awareness and population mobilization effort by OCP Country-specific workshops for decentralized epidemiological surveillance of onchocerciasis and the installation of community-based ivermectin treatment. 20 I JPCI7.2 Page 2 INTERDISCPLINARY RESEARCH Insecticides Vector identification Parasite identifi cation Special entomological studies Epidemiological modelling . . . . . Diagnostic tools . Macrofi I Chemotherapy Project Potential macrofilaricidal compounds . . Possible resistance to ivermectin . . . Continuation of the Macrofil Project after 1997 - ADMINISTRATION AND SUPPORT SERVICES Objectives, organization and functioning of services Administrative costs Budget and Finance Personnel Supply and services Transport and commu;i.;i";; . PUBLIC RELATIONS, INFORMATION AND DOCUMENTATION ACTIVMES With the World Health Organization With the Participating Countries . . . With the statutory bodies With the donors With the aerial spraying contractor With the scientific community . . . . With the general public Public relations and documentation Internal meetings FIGURES AND ANNEXES Fig. 1 VCU Plan of operations for 1996 35 Fig.2 Annual transmission potentids (May 1995-April 1996) Stmuliwn damnosurn complex species infected with Onchocerca volvulus 36 Fig. 3 Annual transmission potentials (May 1995-April 1996) Simuliwn damnosum complex savanna species infected with Onchocerca volvulus . . 37 Fig. 4 Weekly trend of infective females of S.damnosurn and infective larvae of Onclucerca sp.38 Fig. 5 Mode of ivermectin treatrnent in OCP (1995-1996) . . . 39 Fig. 6 Number of persons treated with ivermectin in OCP 40 Fig. 7 Ivermectin treatment coverage as per distribution mode in OCP 4l I 20 20 2t 22 23 23 25 26 26 27 27 27 27 28 29 29 ,o 30 30 30 31 32 32 32 32 33 33 34 I I IJPCI7.2 Page 3 STJMMARY a) In 1995, the rainy season was particularly abundant in the whole of the Programme area, leading to considerable swelling of the rivers in most of the basins under larviciding. In contrast to the previous year, the dry season was clearly marked, particularly in the south-eastern basins of the Programme. b) The aircraft fleet used during the period under consideration decreased in number from eight helicopters during the 1995 rainy season to two at the end of the 1996 dry season. As regards the 1996 rainy season, only seven larviciding helicopters are planned to be used but an eighth aircraft is considered in case larviciding is to resume in northern Sierra Leone. c) The aerial spraying contract between OCP and the Evergreen Helicopter Inc (EHD company wils renewed in January 1996 for a three-year period after winning an international invitation to bid. This is the seventh contract signed with an aircraft company since the beginning of the Programme. d) During the period from May 1995 to April 1996, there was a ITVo decrease in the number of flight hours and about 3% decrexe in insecticide consumption. This decrease was due mostly to the cessation of aerial larviciding on the tributaries of the White Volta (Kulparvn, Mole) and the Niger (Sota, Alibori) at the beginning of 1995 and the compelled cessation in March 1995 of aerial larviciding in the basins of north-eastern Sierra Leone (Mongo, Kaba and Kolente) because of insecurity reasons. e) The insecticide rotation strategy, aimed at preventing blackfly resistance and keeping the effects of larviciding on the non-target aquatic fauna to a minimum, was the same as that of the previous years. The use of the insecticides took into account the usual restrictions related to their toxicity, their cost-effectiveness and the level of susceptibility of the blackflies to the different chemical insecticides, namely the organophosphorous group (temephos, phoxim and pyraclofos). 0 At present, the OCP hydrological monitoring network comprises of about 150 water-gauges including 79 equipped with hydrological beacons, being an increase of four units as compared to the previous year. This increase is due to the refurbishing of some beacons in Sierra Leone in preparation for resumption of larviciding in ttrat country when the security situation improves. g) In the period from May 1995 to April 1996, ten catching points out of 127 (8.6%) monitored regularly showed Annual Transmission Potential above 100 infective larvae per person per year. If the transmission due to the savanna species of the S. datnnosurn complex alone were considered, only five catching poins (4.7Vo), including three on the tributaries of the Oti, had an ATP above 100. h) The cessation of larviciding on some rivers in the original area had repercussions on the structure of the programme resulting in the closure of Tamale (Ghana), Kandi @enin), and Bamako (MalD subsectors on 31 December 1995. Another major event was the closure of the headquarters of the Western Zonein Bamako in June 1996. The Odienne aerial operations base situated at the gateway to the western extension and within the southern extension of C0te d'Ivoire henceforth caters for the Western Zone headquarters. D The environmental impact studies initiated in 1995 in the basins of the Sassandra in COte d'Ivoire, Pru in Ghana, Milo in Guinea, and Mongo in Sierra Leone showed some influence of human activities as a whole on the aquatic environment. The degree of importance of this influence depends on the localization of these activities in relation to the concerned watercourses. These studies confirmed the I i a JPCI7.2 Page 4 importance of such activities in contributing to the understanding of the results of the aquatic environmental monitoring which has been established by the programme. j) ln 199511996 the Planning, Evaluation and Transfer Unit (PET) coordinated ivermectin treatment by the national tqlms to 2.6 million people in more than 11,500 villages and hamlets using the various methods of distribution. The coverage in terms of percentage of people treated compared with the census population was on the average 74.9Vo for large-scale treatrnent by the mobile teams. Distribution through community self-treatment was pursued, with varying degrees of success, with a coverage around 79.6%. No severe adverse reactions were recorded. k) Eight non-governmental organizations (NGOs) were involved in ivermectin distribution in six of the Participating Countries; community self-treatment was the main method used. Large-scale (mobile teams) and passive distributions were also used. l) Epidemiological evaluations were carried out in the Kankelaba basin in the Original Programme area to help in decision-making on the cessation of larviciding. Complementary results will be necessary in 1997 before a decision can be made on definite cessation of larviciding in this basin. m) In the extension areas under combined larviciding and ivermectin treatment, several villages were evaluated in order to determine the incidence of infection in the cohort of parasitologically negative individuals who had never received ivermectin. In the eight villages situated in the basin of the Comoe in COte d'Ivoire, and the five villages in the basins of the Oueme and Okpara in Benin, the incidence of infection was zero as compared to an average of 25% if there had not been any intervention. n) In the river basins of the Original Programme area where larviciding has stopped, epidemiological evaluations were carried out by the national teams in the context of the epidemiological surveillance activities with a view to detecting any possible recrudescence of infection. The results were good in most situations. In one village, Zoulo on the Bougouriba river in Burkina Faso, the observed 25.SVo prevalence of infection confirmed the recrudescence of transmission in that basin. Further intensive evaluations undertaken have revealed prevalences ranging from 0,0vo to 53%. o) The ophthalmological and parasitological assessment of the medium and long-term effects of large- scale ivermectin treatment after seven years of annual treatment in the basins of the Niger, Milo and Niandan in Guinea showed satisfactory results. Significant improvements in lesions of the anterior segment of the eye and of the optic nerve were observed. The overall results in the population showed a beneficial effect of ivermectin treatment on the ocular disease. p) The integrated analysis of the results of the entomological and epidemiological evaluations was carried out within the Programme under the coordination of the Biostatistics and Information Systems @IS) of the PET unit. This analysis is now used in epidemiological modelling more and more. In order to better prepare the nationals for epidemiological analysis, emphasis has been laid on training and the transfer of OCP's data to the Participating Countries. BIS has also continued to assist the other OCP units in the use of computer technology. q) The countries, through the coordination of the PET unit, have carried out awareness raising of the communities, epidemiological surveillance and treatment of patiens with ivermectin, and mobilization of resources for the implementation of the residual activities. In this respect, the Ministries of Health of the Participating Countries have organized workshops in collaboration with OCP in order to develop action plans and budgets for the short, medium and long term on the t 1 a I IJPCI7.2 Page 5 installation of community-based distribution of ivermectin and the decentralization of the epidemiological surveillance of onchocerciasis. The activities are presented in document lPClT .6. r) During the period under review OCP has pursued its usual training activities and awarded 23 fellowships between August 1995 and July 1996, thereby increasing to 453 the number of nationals from OCP Participating Countries having benefitted from OCP fellowships between 1974 and July L996. A survey was conducted among the Ministries of Health of the Participating Countries on the utilization of fellowship candidates after their training. Out of the 437 OCP fellows surveyed in February 1996, it was found that 22.7% work at OCP or in national onchocerciasis control prograrnmes of the countries. s) With six chemical and one biological insecticides, all fully operational, the evaluation of the efficacy of new anti-blackfly larvicides is no longer a priority. As a result, research efforts are now focused on the quality control of the operational lots and the improvement of the existing formulations, B.t. H-t4 in particular, given the gain that a decrease, even if minimal, in the operational dosage would represent. The monitoring of blackfly susceptibility to the currently used insecticides was pursed with the usual rigour on all the rivers treated. 0 The identification of female blackflies of the S. dannosurn complex through the heteroduplex analysis of the DNA has been operational since May 1995. Priority is currently given to the females originating from the forest/savanna transition zones where the possibilities of identification by morphological and morphometric techniques are limited because of the heterogeneity of the vector populations and of the over-lapping of the criteria used for certain differentiations. u) During the period under consideration, special entomological studies were undertaken in some of the Programme areas where onchocerciasis control is experiencing some difficulties. They are northern Sierra Leone, the lower Black Volta region, the Kulpawn/Mole and Oueme basins. These studies were aimed at gaining a better knowledge of transmission conditions in order to take appropriate measures. v) High, single doses of ivermectin, while proving safe to administer, did not show any additional macrofilaricidal action over the standard (l50pg/kg) doses. However, results from the O.ochengi I cattle model show that administration of ivermectin is prophylactic. Further clinical trids on amocarzine, for both onchocerciasis and lymphatic filariasis, have been completed during the year, with no adverse results which prevent further development. Single intramuscular doses of UMF078 have shown macrofilaricidal activity inthe O.ochengi lcattle model, and its preclinical development continues. Studies of the mechanisms of ivermectin resistance in parasitic nematodes of veterinary importance are being continued, with the aim of generating a molecular probe able to detect ivermectin resistance in onchocerciasis if it should occur. w) The Administration and Support Services Unit has continued to support all the OCP units and prograrnme activities by managing in the most rational way possible and in the best interests of the Programme, the human, material, financial and informational resources at its disposal. Special emphasis has been laid on staff reduction both in the categories of professional and general service staff. The unit has also carried out the moving of the Bamako base in the context of the transfer of the zone headquarters to Odienne. x) The Programme has pursued its liaison, information and public relations activities and continued to keep the Donors, the Participating Countries, the countries not included in the Programme area, the scientific community and the public at large regularly informed about these activities. JPCI7.2 Page 6 VECTOR CONTROL Climatic conditions l. The months of July, August and September 1995 were particularly wet in the whole of the hydrological network of the Programme, causing considerable swelling of the rivers in most of the basins under larviciding, especially those of the Niger, Milo, Niandan, Tinkisso, Lake Volta, Oti, Mono and Oueme. In contrast to the previous year, the dry season was clearly marked in 1996, especially in the basins of the south-east extension (Ghana, Togo, Benin) where larviciding was totally interrupted from 18 March to 27 April because of poor water flow. Aircraft fleet and aerial operations 2. The number of helicopters used under the contract during the period under consideration ranged between eight (from July to December 1995) and four (April 1996). From 15 to27 April1996, only two helicopters were actually used due to the good entomological results following very low discharges in the whole Programme area. For the 1996 rainy sqnon, only seven larviciding helicopters are planned but the use of an eighth aircraft is considered in the event of resumption of larviciding in norttrern Sierra Leone. 3. 1995 was the last year of the third contract between OCP and the Evergreen Helicopters Inc. (EHI) in charge of the aerial spraying of anti-blackfly lanicides. Following the issuing of an international invitation to bid, the same company was selected for another three year contract which began in January 1996 and is due to end in December 1998. This is the seventh contract awarded to an aerial contractor since the beginning of the Programme. In the execution of the present contract, it was decided between EHI and OCP to keep two spare helicopters in the Programme area instead of one and have the possibility of calling for only four additional helicopters instead of five. As in the previous contract, OCP guarantees the company that it will use a minimum of four helicopters during the dry season and six in the rainy season. Some problems of aircraft and pilot availability have however been brought up in February 1996 at a meeting held in Ouagadougou between OCP and the aerial contractor. 4. During the period of May 1995 to April 1996, the helicopters used 4850 flight hours for larviciding (none for prospecting) as against 5882 during the same period in 199411995, viz 1032 hours less which represents a saving of about US$ 750 000 (table 1). This decrease of l7 Vo in flight hours is mainly due to the cessation, at the beginning of 1995, of aerial larviciding on the tributaries of the White Volta (Kulpawn, Mole) and the Niger (Sota, Alibori) and to the compelled cessation in March 1995, for security reasons, of aerial larviciding in the basins of the north-east of Sierra Leone (Mongo, Kaba and Kolente). 5. Compared to the period of May L994lApril 1995 (Iable 2), the Programme has reduced is larvicide cost by about US $ 108 000 (3Vo approximately). This difference is due to a decrease in the consumption of permethrin and pyraclofos, partially compensated for by an increase in the consumption of carbosulfan and etofenprox (Vectron), the latter having become fully operational since its definite acceptance by the Ecological Group in January 1995. Temephos, B.t- H-14 and phoxim were used in about the same quantities. o' ? JPCI7.2 Page 7 Treated areas @g.1) 6. Vector control operations in the Original Programme area, at the beginning of 1995, had definitely ceased on the Sota and Alibori (tributaries of the Niger in Benin), and on the Kulpawn and the Mole (tributaries of the White Volta in Ghana). Treatment operations, however, are still continuing on the Kankelaba (tributary of the Bagoe in Mali) and on the Dienkoa (tributary of the Black Volta in Burkina Faso as ground larviciding), on the Kara, Keran and Mo (tributaries of the Oti in Togo) and on the lower Black Volta in Ghana (downstream from is confluence with the Fako) including its tributaries the Tombe, Tain and Subin, as aerial larviciding. 7 . As a result of the persistent insecurity, none of the basins of northern Sierra Leone were treated during the period under consideration. The Sewa and Bagbe rivers have not been treated for almost four years. Larviciding on the Rokel had also been suspended since April 1994 and on the Kolente, Mongo and Kaba since March 1995. Security conditions, however, seem to be returning to normal and the distribution of ivermectin which was resumed in March 1996 in all of these basins is scheduled to be followed by a resumption of larviciding very soon. 8. Since January 1996, ground larviciding on the Niger, near Bamako, and some of its tributaries Fie, Faya and Dylamba is being entirely carried out by the national team of Mali, with financial support and technical supervision from OCP. 9. In the basins of the southern extension in COte d'Ivoire, the south-eastern extension and the western extension in Guinea, which have been under larviciding respectively since 1979, 1988 and 1989, there has been no change in the larviciding coverage during the period under consideration. It must be recalled that the tributaries of the Oti (Keran, Kara and Mo) are now considered part of the south-eastern extension because of the permanent infiltration, up to 1988, of infective blackflies originating from adjacent basins situated fur0rer south. a JPCI7.2 Page 8 Table I Use of larviciding flight hours from May 1995 to April 1996 and comparison with the previous period. Table 2 Iarvicide consumption from May 1995 to April 1996 and comparison with the previous period. Months Flight hours Difference between 94/95 and 95196 May 94-April 95 May 95-April 96 May 355 322 -JJ June 619 s38 -81 July 599 379 - 220 August 6r7 497 - 120 September 557 345 - 212 October 409 246 - 163 November 477 576 +99 December 562 480 -82 January 476 472 -4 February 444 ss9 + 115 March 507 288 219 April 260 148 - ttz Total 5 882 4 850 -1032 Larvicides Quantity used Difference between 94195 and95196 Cost US$May 94-April 95 May 95-April 96 Temephos 042 3t4 040 432 - 1 882 (4%) - 26 23s B.t. H-14 218 335 228 773 + t0 438 (s%) + 48432 Phoxim 017 944 020 361 + 2 417 (l3Vo) + 4t 137 Permethrin 028 995 015 155 -13 840 (48Vo) - 142 4t4 Carbosulfan 013 991 019 165 + 5 174 (37Vo) + 107 723 Pyraclofos 047 t95 03s 0s3 - t2 t42 (-26Vo) -321 156 Etofenprox 009 176 016 825 - 7 @e (83%) + 184723 Total 377 950 375 764 - 2 186 (-t%o) - 107 790 (-3V") a tPCt7.2 Page 9 Insecticides and control strategy 10. The insecticide rotation system, which is aimed at preventing possible blackfly resistance and keeping the effects of larviciding on the non-target aquatic fauna to a minimum, has been the same as in previous years. The insecticides have been used by taking into account the usual restrictions related to their toxicity, their cost-effectiveness and the blackfly susceptibility levels, particularly with regard to the organophosphorous (temephos, phoxim and pyraclofos). 11. As is the case every year, the basins of the lower Bandama, N'zi, Comoe, Maratroue and lower Black Volta have been the subject of particular attention on account of the noted resistance to the organophosphorous. Temephos is still not used in these four basins, while pyraclofos and phoxim have been used sparingly, with phoxim totally excluded from use in the larviciding on the lower Bandama. This control strategy has had consequences on the consumption of the other insecticides, particularly that of etofenprox, the only non-organophosphorous insecticide that can be used at discharges between 15 and 70 m3/s. I2. In the other basins, no particular restriction was observed during the period under consideration, with the exception of the Niger, in the Bamako area, where the savanna blackflies developed resistance to pyraclofos in 1995. For that reason and despite the clear improvement of their susceptibility to temephos, permethrin, carbosulfan and etofenprox were used preferentially. 13. In accordance with the recommendations of the Ecological Group, permethrin and carbosulfan were not used at discharges below 70 m3/s and never for more than six consecutive cycles over the same river stretch. The Niger was the only exception, due to the very high discharges recorded over several weeks and the restrictions on the use of organophosphorous. Carbosulfan was practically not used on the Sankarani, the Milo and the Niandan so :rs to allow the continuation of the long-term impact shrdies of permethrin on the non-target aquatic fauna. 14. During the period under consideration, ceftain operational los of B.t. H-14 (Vectobac), did not quite meet the terms of the specifications of the contract between OCP and the Abbon Company. The value of the CL, at the time of delivery had then to be revised upward (135 mg/l/s instead of 115 mg/l/s) at the cost of split up deliveries in order to reduce stocking time in the field (four months instead of six). The Abbott company is continuing research to determining the re:sons for the recent poor performance with a view to deliver to OCP in the shortest time possible a formulation that meets the terms of the contract. 15. In 1996, the total length of rivers likely to be treated from the air and from the ground for the purpose of preventing transmission is 12,433 tiln. This maximal larviciding coverage is, of course, theoretical as it includes northern Sierra Leone. During the week of 30 October to 5 November 1995, period of fall in water level and therefore of high larval productivity,9,l35 km of river were treated Qa% of the maximal coverage), mobilizing seven helicopters under contract. The week of 12 to 18 June 1995, period of rise in water level and therefore of high larval productivity also saw a high larviciding coverage with 7,032 km of river treated,viz.5T% of the theoretical maximal larviciding coverage. Conversely, the week of 15 to 20 April 1996, low-water period and therefore low larval productivity, saw the lowest larviciding coverage with 1,630 km of river treated (13% of the maximal coverage) and the use of only two larviciding helicopters. JPCI7.2 Page l0 Hydrology and teletransmission 16. At present, the hydrological monitoring network consists of 150 water-gauges including 79 equipped with hydrological beacons, i.e. an increase of four units compared to the previous year. This increase is due to ttre refurbishing of some beacons in Sierra Leone in the hope of resuming larviciding in the near future. This hydrological system, which is linked to a discharge forecasting software (PERLES) that relies on the teletransmitted data, makes it possible to improve considerably the efficacy of larviciding by providing hydrological data in real time and allows sometimes forecast of hydrological conditions of the rivers. 17 . The utilization of all the beacons is made on the basis of a flat annual charge under a contract signed between OCP and the company in charge of teletransmission (Argos Company). The satellite reception stations are located at Odienne and Kara, ttre two aerial operations bases for which the information is indispensable. The coordination of the hydrological monitoring activities which was previouslybased at Odienne, has just been relocated in Ouagadougou, at the Prograrnme headquarters. A third station is due to be installed for that purpose. It will be operational on an equal basis with the other two, thereby allowing OCP to have at its disposal a source of supplemenury information in case of a failure of the Odienne and Kara stations. 18. Two OCP hydrologists brigades (one at Odienne, one at Kara) and three national brigades (two in Guinea and one in Sierra Leone) carry out the day-to-day maintenance of the Programme's hydrological monitoring network. They have the capacity to diagnose any failure in the beacons, make the necessary repairs and redeploy them if needed after performing a new gauging of the stations and readjusting the former hydrography chart. During the period under consideration, two training seminars were organized in the Programme area. One of these was more particularly aimed at the national hydrologiss in the context of their in-service training. The second, which was more specialized, made it possible for two OCP hydrologiss and three electronic technicians to receive training enabling them to repair 80% of the defective parts of the beacons and their accessories, thereby going beyond the simple day-to{ay maintenance performed before. Entomological surveillance and evaluation network 19. At present, the entomological evaluation network in the treated zone comprises 127 catching points visited regularly, 76 of which are monitored every week and 5l every fortnight. Catches can be organized on demand in occasional monitoring poins for the purpose of finding explanations or solutions to incidental entomological problems raised during the weekly briefings. 20. On the whole, the results of the entomological evaluation were satisfactory in all of the treated zone of the Programme. Transmission was negligible in the dry season (only one infective female was caught during the week of 8 to 14 April 1996) but intense during the periods of high larval productivity and of increased man/vector contact (38 infective females caught during the week of 28 August to 3 September 1995). 2l . In all of the treated basins, transmission continued to be contained . However, some rivers have posed some problems. These include particularly rivers to the east of the Programme area in the forest/savanna transition zones (lower Comoe in C0te d'Ivoire, Oueme and Okpara in Benin), the Pru river in Ghana and the tributaries of the Oti in Togo (Keran, Kara and Mo). Yet, a significant decrease of Annual Transmission Potential (ATP) was observed in these basins even though the values remained above 100 infective larvae per person per year. tPCt7.2 Page 11 22. As in every year at the same period (February, March and April), high densities of blackflies were caught to ttre west of the Programme area on the Sankarani, the Marahoue and the Sassandra. These populations, however, were lightly infected, as they had probably been brought in the area by the harmattan winds blowing from the regions further north freed from onchocerciasis. 23. Since the installation of the Bouake molecular biology laboratory, all infective larvae of onchocerca collected during the dissections have been identified through specific DNA probes. Witlt this method, parasites of animal origin can be separated from the human onchocerca which, in turn, can be differentiated further into"forest" and "savanna" strains. The DNA-technique, combined with the morphological identification of vectors, makes it possible to establish two types of ATP. The first type shows the transmission of human onchocerciasis by all the species of the Simulium datnnosum complex. The second type shows the transmission of human onchocerciasis by savanna blackflies alone. 24. A third type of ATP, proposed during the previous year, concerned ransmission of the "savanna" strain of the parasite alone, regardless of the identity of the blackfly. However, this last type will not be recognized in the immediate future as there seems to exist, especially in the forest/savanna transition zones (northern Sierra Leone, southern COte d'Ivoire, Oueme basin, etc...), intermediate pathogenicity levels which are difficult to identifiy by the "savanna" or "forqst" probes of the parasite. 25. On the basis of this distinction and taking into account the same catching points as those of the previous period, only 10 catching points out of 127 visited regularly showed ATPs of human onchocerciasis above 100 infective larvae per person per year (figure 2). Five of the poins are located in the border zones of the Programme area, four in the basin of the Oueme and one on the lower Comoe. If only transmission by the savanna species of the S. damnosutn complex (figure 3) is considered, only five points out of 127 show ATPs above 100, three located on the tributaries of the Oti (Iitira, Tapounde and Bagan), one on the Pru (Asubende) and one in the basin of the Oueme Q(aboua). 26. Figure 4 shows the evolution of the average number of infective blackflies (5. dannosurn s.l.) and of infective larvae of the parasite (without species distinction) in the 146 catching points visited regularly since 1990. The downward trend was confirmed again this year, especially as regards, infective larvae, but a stationary situation seems to be developing with regard to infective females during the past three years. 27. Even though it is operational, the technique of DNA mitochondrial (heteroduplex) identification of the adult species of the S. damnosurz complex was applied this year mainly for experimental purposes with a view to its validation against the cytotaxonomy method, the reference technique. Research is currently under way to adapt this technique of the identification of the parasite, in particular of the infective larvae for which a finer identification would be desirable (cf.76). 28. The definite cessation of larviciding on certain rivers of the original area had repercussions on the structure of the Programme which saw the closure, at the end of 1995, of the Tamale (Ghana), Kandi @enin) and Bamako (MalD sub-sectors. The closure of this last sector enabled the reactivation of the Operational Base and the national team of Mali to take over ground larviciding and entomoloErical evaluation. Another major event was the closure, on 30 June 1996, of the zonal headquarters at Bamako which was no longer central in relation to ttre treated areas. The Odienne aerial operations base, located at the gateway to the western extension and within the southern extension of COte d'Ivoire henceforth caters for western zone headquarters. tPC17.2 Page 12 Monitoring of the aquatic environment 29. Since the expansion of the mandate of the Ecological Group, emphasis has been laid on the aquatic environment monitoring activities and the evaluation of the impact of factors other than insecticides on the aquatic environment. However, the study of the long-term impact of the less selective larvicides (permethrin, carbosulfan and pyraclofos) on the non-target aquatic fauna is continuing. The national hydrobiology tquns which have been initiated in environmental impact studies, continue to take an active and primordial part in the implementation of this monitoring prograrnme. The coordination of these activities as well as of some special evaluations is ensured by the Hydrobiological Monitoring Sub-unit (HMS) of the Programme. 30. The environmental impact studies initiated in 1995 in the basins of the Sassandra in C0te d'Ivoire, of the Pru in Ghana, of the Milo in Guinea and of the Mongo in Sierra Leone indicate some influence of human activities as a whole on the aquatic environment. The degree of importance of this influence depends on these activities location in relation to the watercourse. On the Milo and the Pru for instance, an absence of activities likely to influence the biological quality of the watercourses is noted. Disturbances in the structure of the invertebrate populations were observed in the Milo but fish stocks have increased compared to those of the previous years in the two watercourses. However, in the Sassandra and the Mongo, human activities have been on the rise causing significant disturbances both in the fish and benthic invertebrate populations. These studies confirmed the importance of such activities in contributing to the understanding of the results of the aquatic environmental monitoring which has been established by the Programme. They are being consolidated in order to ensure a better appreciation of the impact of such activities in the current biological situation of these watercourses. 31. The routine monitoring shows a decrease in the densities of the non target insects and some modifications of their population strucnrres in the form of rareness of some taxa such as the Tricorythidae. These modifications do not seem to be prejudicial to the energetic balance between the different guilds and are therefore considered to be acceptable. With regard to the fish fauna, a relatively stable abundance has continued to be observed in most of the watercourses treated except in COte d'Ivoire where catches have been decreasing gradually in even those rivers no longer under treatment. The situation of "fleshy" fishes is fluctuating around a relatively stable average; thxe fluctuations are to be linked to the hydrological conditions and to reproduction phenomena. In respect to species diversity, the almost total disappearance of Petrocephalus bovei from catches in COte d'Ivoire and the decrease in the abundance of Chrysichtys auratus in Guinea are to be noted. Special attention is currently paid to these species. 32. This year, the hydrobiologists have started the preparation of two consolidated reports (one on ichthyologic and the other on invertebrate faunas) over the 20 years of monitoring of the aquatic environment subjected to anti-blackfly larviciding. Emphasis will be laid on the evaluation of the possible impact of the alternated use of these larvicides. IVERMECTIN (MECTIZAN) DISTRIBI.ITION AND EPIDEMIOLOGICAL ACTIVITIES Ivermectin treatment 33. The Planning, Evaluation and Transfer Unit coordinated the distribution of ivermectin carried out by the nationd teams. These were supported financially and logistically by the Programme. Eight non-govemmental organizations (NGO) supported the treatment in Guinea, Mali, Senegal and Sierra Leone, in the form of funds and other logistics for a community-based delivery. The treatment tPCr7.2 Page 13 was carried out through large-scale-scale distribution in the areas previously mapped out to be areas of high risk of onchocercal eye disease and/or blindness, i.e., areas that previously had CMFL1 of l0 mf/s or more. Treatment was also extended to all the endemic areas The areas concerned are in the southern extension: Benin, Cdte d'Ivoire, Ghana and Togo; and the southern part of the western extension, Guinea and Sierra Leone. It is recdled that in the northern part of the western extension, in the area north of the Tinkisso river basin, there is no larviciding and ivermectin use is the only means of control. Large-scale ivermectin treatment was continued in the zones where the CMFL was at or above 5 mf/s. Large scale distribution was enlarged to cover other villages in the endemic areas after having satisfied the set criteria above, Fig. 5. Ivermectin treatment was suspended as from January 1994 in Sierra Leone due to the uncertain security situation in the country, however, since Marcir this year treatment has been restafted in a limited area in the north of the country. 34. Large-scale ivermectin treatment was carried out in certain parts of the Original Programme area. These were well defined and specific areas where the entomo-epidemiological resuls had not been fully satisfactory, such as in the Kulpawn/Sissili, Mole and Black Volta basins in Ghana, Dienkoa basin in Burkina Faso, the previously reinvaded zones - Bago6, Kankelaba (Mali), Sota, Koumoungou @enin), Kara-Keran-M6 (togo) and the north of the extension zones in C6te d'Ivoire. Large-scale ivermectin treatment has been started in a circumscribed area in the Bougouriba basin in Burkina Faso as a measure to stem the recrudescence which has occurred in the area. 35. All the ivermectin distribution in the field was carried out entirely by the national teams using mostly the large scale (mobile) method. This accounted for around 63% of all treatments. The community-based treatment which is also large scale distribution but operationally different in terms of logistics, financing and the personnel involved, accounted for around 33Vo of the ivermectin distribution in contrast to the 26 % obtained the previous year. About 4% of the treatment was through other modes of distribution, as for example passive treatment. 36. Community-based treatment already firmly established in Guinea and Mali'was also undertaken in varying patterns and to several degrees in several ofthe countries including Senegal, Benin, Ghana and Sierra Leone. In this form of distribution, literate members of the village, selected by the villagers themselves, carry out the distribution under the supervision of the health staff from the nearest health centre. 37. The use of other volunteer services for ivermectin delivery was extended in Ghana to other basins hi0rerto under the mobile form of treatment .These volunteers took part in the distribution exercise at the same time with the national team. This has helped to reduce the workload on, and the time spent in the field by the treatment teams. The communities' acceptability of the community-based treatment method of distribution has been excellent. So far, drop-outs of the village distributors has been insignificant. 38. In the year under review, eight NGOs were involved in the ivermectin distribution in the OCP area at varying degrees of participation. The NGOs worked in concert with the national teams in well demarcated and specific river basins, making full use of the epidemiological mapping prepared by OCP and in collaboration with the National Onchocerciasis Coordinators. Their main support was in logistics and funds for the community-based ivermectin distribution. The number of people treated with the support of/or by the non-govemmental organizations was 868,000 which accounted for about 33Vo of the treatmens in the OCP. t CMFL: Community Microfilarial load ORGANIZATION COUNTRY MODE OF TREATMENT BMRC xSierra Leone Large-scale (mobile) treatment CBM (Lunsar) *Sierra Leone Large-scale (mobile) treatment CFAR Mali Community based treatment OPC Guinea, Mali, Senegal Community based treatment PhilAfricaine Suisse Guinea passive Save the children Sight Savers Mdi *Sierra Leone, Mali Ghana, Guinea Community based treatment Community based treatment Trop. Inst. Germany Togo passive JPCL7.2 Page L4 Table 3. NGOs involved in ivermectin distribution in the OCP aru,1995196 x Treatment in this area was suspended in early 1994 due to security problems in the area. BMRC: British Medical Research Council CBM : Christoffel Blindenmission OPC : Organisation pour la prevention de la c6cit6 CFAR: Centre de formation d'animatrices rurales. 39. From September 1995 through July 1996, more than 2.6 million people were treated with ivermectin through the various modes of distribution in over 11500 villages and hamlets (Fig.6). Most of these villages are in the extension areas. The average coverage i.e. number of people treated divided by the total census population, through large-scale distribution by the national onchocerciasis tqrms wx 74.9%. The distribution through the community-based treatment ensured a higher coverage of 79.6Vo (Fig.7). This high coverage from the community-based treatment is due to the fact that treatment was available for a relatively longer period at a time in the villages than it is through the mobile team. Thus, individuals who might have been excluded from treatment for some reason, and become eligible later, receive their treatment without having to wait until the following year. 40. Monitoring for severe adverse reactions was carried out as required, after each treatment especially in areas or for groups of individuals receiving ivermectin for the first time, by the teams carrying out ivermectin distribution. Each team undertaking large-scale distribution has a drug monitoring kit to undertake treatment of any severe adverse reactions, should this be necessary. The system of several treatment teams being supervised by a medical off,rcer during the distribution period was maintained. In the case of community-based treatment, the occurrence of any severe adverse reaction would be reported to the distributor who would then report to the nearest health centre. No severe reactions were recorded during this treatment season. Evaluation of the ivermectin delivery system. 4l . Evaluation of the ivermectin d istribution system in Benin, COte d'Ivoire, Ghana and Togo was carried out in the year under review. This was a follow-up to a similar exercise which was undertaken in Guinea, Mali and Senegal last year. In all a sample of 130 villages were selected at random and used for the evaluation, employing a structured questionnaire, examination of records and focus group discussions. aJPCI7.2 Page 15 42. In general the population treatment coverage was good, at an average of 67.2%. This was higher than the optimum treatment coverage, 65%, u a proportion of the total population which has been established for adequate morbidity control. The population coverage in Togo was the lowest at 6l.8Vo . About 30% of those questioned admitted to have received treatment during each of the five to six cycles of distribution, while 26.1% claimed never to have received treatment. Of those that had 'never been' treated, 54% had, been absent during treatment periods and only 2.6Vo had actually refused treatment. In general the acceptability for ivermectin treatment was excellent. Epidemiological evaluation 43. Epidemiological evaluations were carried out in the OCP with the help of the national onchocerciasis teams and as before with the following objectives: to help decide on stopping larviciding; to assess the impact of the control activities through the measure of incidence in the western and southern extension areas and other specific areas in the original area which are subjected to both ivermectin distribution and larviciding. Evaluations in the Original Area 44. In the Original Programme area, epidemiological evaluations were carried out in the Kankelaba basin in Mali in January this year as a first step towards obtaining results to help with the decision as to whether larviciding could be stopped in the basin. Given that ivermectin treatment is also carried out in the area, the results of a subsequent evaluation planned for 1997, at least two years after the last ivermectin treatment in the area will be needed to be able to take the decision of whether or not larviciding could be stopped in the basin. 45. For this evaluation three indicator villages, i.e., first-line villages which have had several evaluations in the past, in addition to three newly identified villages were examined in January 1996. The classical parasitological method of skin snipping was used to assess the prevalence of infection, the intensity of infection and the presence of any new infections. For this particular situation in the Kankelaba basin new infections are defined as infections in children of five years of age or less and do not receive ivermectin treatment. The prevalence of infection at this preliminary stage from the six villages evaluated ranged from 0.0% to 8.1%. No new infections were observed. M. In the river basins of the Original Programme area in which larviciding has stopped, epidemiological evaluations :re carried out by the national teams in the context of the surveillance of the sentinel villages so zls to detect any possible recrudescence of infection. The results which were excellent in most of the situations were recorded in document JPC 17.6. However, in one village, Zoulo on the Bougouriba in Burkina Faso, the observed prevalence of infection of 25.5Vo made it possible to confirm a resumption of transmission of the infection in this basin. Complementary intensive epidemiological evaluations which were carried out showed prevalence rates ranged from O.lVo to 53Vo. In accordance with the ONCHOSIM model predictions, a biannual distributionof ivermectin was instituted and began in June 1996 in order to bring this resumption of transmission in the area under control. (See para. 90 and 91) JPCI7.2 Page 16 Evaluations in the extension areas 47. Evaluations were undertaken in eight villages in the Comoe basins ( COte d'Ivoire) and the Okpara and Ou6md basin @enin) in the south-eastern extension. The parasitologically negative individuals (individuals shown to be negative on two consecutive occasions) in these villages constituted a cohort of individuals for follow-up in respect to incidence of infection. Such individuals did and will not receive ivermectin treatment in the course of the annual ivermectin distribution campaigns. However, any such individuals who are subsequently found to be parasitologically positive will be placed on ivermectin treatment; the so treated individuals will be removed from the cohort being followed up. The cohorts include both aduls and children. 48. In the Comoe basin, the prevalence of infection ranged from 5.8% to 50.6%. Four of the villages evaluated recorded no new infections in the time between the evaluation carried out three years ago and the present evaluation. In the other four villages infection were recorded in all age groups. In one of these villages, 12 positive cases were recorded in children of five years old or below out of the 42 examined, i.e.28.6Vo compared to about 30% expected cases if there had been no intervention. In the five villages evaluated in the Oueme/Okpara basin, the prevalences of infection ranged from 5.3Vo to 31.5% as compared to prevalences above 50% observed before the beginning of the interventions. 49. Evaluations were carried out in the six villages in the Koulountou-Koliba basins in Guinea and five villages in the Rio Geba basin in Guinea Bissau both in the northern part of the western extension area, where ivermectin treatment is the only means of control. Treatment has been carried for at least five years in these basins. The emphasis in this evaluation was to assess the parasitological profile (incidence of infection) of children of five years old or below. These are children excluded from ivermectin treatment. The prevalence of infection in the Koulountou-Koliba and the Rio Geba basins ranged ftom 8% to 45 % and 0.0% to 3.27o respectively. In comparison, the pretreatment prevalence for the Koulountou-Koliba basin was over 5O% in all the villages while that for the Rio Geba basin ranged from 16% to 23.5%. In both basins none of the children of or below five years old were found to be infected. Furthermore it was observed that only seven out of the over 774 individuals examined in the five villages of Rio Geba were found to be positive. 50. In northern Sierra Leone, epidemiological evaluations were undertaken at the beginning of 1996 as soon as security was restored in 23 villages situated in the basins of the Kaba, Mongo, Mabole, Seli and Bagbe. In spite of the suspension of operations for two years, a stagnation of the crude prevalences of infection ranging ftom 7% to 73% was observed during this evaluation. The rate of participation by the population in the course of these evaluations was excellent, ranging from 59% to 94%. Ophthalmological evaluations 51. Ophthalmological evaluations were carried out in four follow-up villages in the Milo, Niger and Niandan basins in Guinea in the western extension. These evaluations were being carried out after seven cycles (seven years) of ivermectin treatment given once annually combined with larviciding. The present results were comp:red to those obtained at the five years post annual ivermectin treatment, in order to determine the medium-term evolution of ocular onchocerciasis. 52. The results showed significant improvement over the five year period evaluation in the anterior segment of the eye with respect to iridocyclitis. There was no appreciable change in sclerosing keratitis. With respect to the posterior segment lesions, there was significant improvement JPCI7.2 Page 17 in lesions of the optic nerve. The microfilarial load in the anterior chamber of the eye had reduced significantly with the present mean of 0.03 mf (maximum 7mf).The overall results indicated a progressive beneficial effect on the eye from the ivermectin treatment. The level of ocular microfilariae is now at such low levels as not to induce any further development of serious eye disease. BIOSTATISTICS AND INFORMATION SYSTEMS 53. The Biostatistics and Information Systems subunit (BIS) of the PET Unit has continued to c:ury out the processing of the entomological and epidemiological evaluation data, with emphasis on supervision of the data entry and validation by the staff of the technical units of the Programme. The subunit has also continued to play a major role in computer assistance within the Programme. This assistance concerns training, management of the different data banks and their backup, and the routine maintenance of the various computer equipment installed in OCP. 54. The data banks for the administration have been completely reviewed during the period under consideration in order to improve the management of staff, finance, services and supplies. To standardize these different data banks in order to make their users more independent in their utilization, an updating of the prograrnmes and training of the users was carried out. The effective use of the programmes by the concerned staff has made it possible to iron out the diff,rculties encountered as the prograrnmes were being used. 55. The use of the SEPT-ONCHO software package @pidemiological Surveillance and Treatment of Onchocerciasis) for the transfer of OCP's data to the Participating Countries has continued to be the subject of training of the nationals. This computer programme and the epidemiological data once transferred to the countries will make it possible for the national epidemiologiss to exchange later with OCP the results obtained and to make routine analysis of data collected after each evaluation by comparing them with already existing data. To carry out this transfer correctly, the checking and general update of the epidemiological data bank remains still a priority at BIS. 56. The intensive use of the Geographical Information System (GIS) has facilitated the analysis of the entomological and epidemiological data. The computer'ud mapping component of the system has allowed the Programme's cartographer to produce maps which can easily be updated. The Map- Info software which has been used for nearly two years have allowed OCP to make considerable progress in the use of the GIS. Base maps of the countries in Africa have been ordered and received. This allows a visualization of the data in the OCP area as a whole, and also in detail at the country level. Attempts have been made this year in the basins of the Oti in Togo and of the Bougouriba in Burkina Faso to use the system of automatic determination of the coordinates in the field to supplement our data banks on ivermectin distribution. This management and analysis tool will be introduced this year to the national teams for whom training sessions are planned towards the end of 1996. In order to better utilize the resources of the system, collaboration with other institutions will be established to complement the data bank on villages located by their coordinates (longitude-latitude) in each country. 57. Routine analyses involving ophthalmological data, those of the epidemiological sildies on ivermectin and those collected during the study on new diagnostic tools were made. A protocol has been developed and applied in the Kankelaba basin in order to better appreciate the epidemiologicd uends observed in a basin under both larviciding and ivermectin distribution. Data collected in the villages as part of the ophthalmological monitoring in the origind area where vector control has been JPCI7.2 Page 18 totally stopped and of the monitoring of the impact of ivermectin on morbidity in the extension areas, have been analysed. The epidemiological data available have made it possible to monitor and improve the predicted trend and to validate the important parameters of the ONCHOSIM model along the way. TRANSFER OF ACTIVITIES TO THE PARTICIPATING COIJNTRIES 58. As in the previous years, efforts have been made by OCP in the transfer of the onchocerciasis control residual activities to the countries through training, raising of awareness of the authorities and general public, and support to operational research. In is implementation, OCP as usual, has worked in close collaboration with the WHO Regional OfFrce for Africa. Besides, contacts between OCP and the Participating Countries have been continued, notably through missions and meetings organized periodically or seminar workshops organized in the countries. 59. The impact of the devolution process can best be measured through the activities actually carried out by the Participating Countries themselves, which document JPC 17.6 attempts to reflect. Consequently, this progress report on the transfer of activities to the countries is confined to some particular issues such as training, the raising of awareness of the populations, the programming and evaluation meetings organized by the countries in collaboration with OCP. Training 60. In order to guarantee the success of the devolution process, the Programme has pursued is training policy by awarding fellowships to the nationals of the Participating Countries for the specialization in the following main fields: epidemiology, health services management, public health, and medical entomology. Between August 1995 and July 1996, the Programme awarded 23 fellowships broken down by discipline as follows: - Entomology - Epidemiology - Public Health - Health services management - Health education 61. This figure increases the number of beneficiaries of OCP fellowships from 1974 to July 1996 to 453. A survey was carried out in the ministries of health of Participating Countries on the utilization of the trainees after their return from training; ten out of the 1 I countries responded to this survey. Out of the 437 OCP fellows considered at the time of the survey in February 1996, it was found that 58-2Vo of this staff worked for OCP or for the national onchocerciasis control progralnmes of the countries and in the ministries of health, while 8.0% worked in the other departments. It was noted that 6.6Vo were still in training while 27.2% were not in active employment or were not identified (table 4). 62. As in the past, OCP continues to put emphasis and preference on in-service and field training centred mainly on the methodology and epidemiological evaluation of onchocerciasis, ivermectin disuibution and post-treatment surveillance, the different blackfly monitoring and control techniques and finally, management. Special emphasis continues to be laid on the training of the National Coordinators and other national team workers in the OCP methodology for the analysis and interpretation of active epidemiological surveillance data and on the initiation of the workers concerned to the use of computers. 4 11 5) 1 23 aIPCL7.2 Page 19 63. As regards the blackfly control methods, OCP is attaching more and more importance to the training of technicians and villagers in the ground larviciding technique in order to prepare the nationals to control, by themselves, if need be, any blackfly nuisance detrimental to socioeconomic development activities. Such training has taken place this year, principally in Burkina Faso, Niger and Ghana. Table 4. Beneficiaries of OCP fellowships by type of service engaged in after training and per country Public awareness and population mobilization effort by OCP (see also pan. 120 to 145) &. The unit continues to coordinate, in close collaboration with the Vector Control Unit, an information campaign conducted every week by subsector and sector chiefs during their routine field visis. The main themes treated during these sessions are still the same, i.e., the return of the blackfly after the cessation of larviciding, the role of ivermectin in the prevention of blindness and in the control of onchocerciasis-caused morbidity, and the need for community participation in all activities aimed at preventing recrudescence of onchocerciasis or controlling this recrudescence, if necessary. Service Country OCP + National Devolution Programme Ministries of Health Other Services Beneficiaries in training Beneficiaries not in active employment Non identified Total benefi- ciaries Benin 47 47 Burkina Faso 5 33 6 t3 t7 J 77 COte d'Ivoire 5 7 5 2 J 8 30 Ghana 8 4 8 1 8 2 31 Guinea 32 t2 I 3 5 53 Guinea Bissau 7 0 0 0 2 0 9 Mali 10 6 10 I l0 0 77 Niger 2 27 0 3 1 0 33 Senegal 10 9 3 2 I 0 25 Sierra Leone t2 2 2 1 7 0 24 Togo 8 15 0 3 5 0 3l Total 99 155 35 29 59 60 437 Percen- tage 22.7% 35.5Vo 8.OVo 6.6% 13.5% 13.7Vo JPCI7.2 Page 20 65. As a consequence of this awareness-raising effort, unlike what happened in 1991, practically, no more complains have been received from the populations concerning blackly nuisance in the zones of the Original Programme area where larviciding operations have ceased although blackfly densities have remained the same as those obtained in 1991. However, the fear of the blackfly by the populations as a cause of blindness has not completely ceased and the sensitization effort undertaken by OCP must be continued together with that made by the states themselves in this field (see document JPC17.6). Country-specific workshops for decentralized epidemiological surveillance of onchocerciasis and the installation of community-based ivermectin treatment. 66. Country-specific workshops were organized by the Ministries of Health with financial and technical support from the OCP as well as logistic input from AFRO in all the Participating Countries. Plans of Action based on a decentralized active epidemiological surveillance for onchocerciasis for the detection of recrudescence of infection and the installation of community- based ivermectin treatment in the countries were developed for implementation in the short, medium and long term. Training of the appropriate staff to qrry out the active epidemiological surveillance in a decentralized manner was carried out in Senegal, COte d'Ivoire and Mali according to schedules worked out at the workshops. Training of technicians in the remaining countries will be carried out later in the year with a spill over into next year. The training is almost wholly by 'on-the-job" training and is therefore scheduled to coincide with planned epidemiological evaluation activities. The installation of community-based ivermectin treatment was also begun and is continuing throughout the year in all the countries (see document JPC17.6). 67 . The evaluation of the current capacity of the countries to effectively carry out the detection and successful control of recrudescence of onchocerciasis can be judiciously done only after the institutionalization of community self-treatment with ivermectin and the actual decentralization of active epidemiological surveillance, and is an integral part of the plans developed by the countries during the workshops. Thus the ten criteria for such an assessment proposed last year, will be reviewed to take into account the implementation of the plans of action developed during the country- specific workshops. INTERDISCIPLINARY RESEARCH Insecticides 68. With six chemical and onebiological insecticides, all fully operational, the evaluationof the efficacy of new anti-blackfly larvicides is no longer a priority. As a result, research efforts are now being orientated toward the quality control of operational los and the improvement of the existing formulations. 69. The finalization of the systems and protocols for bio-testing under controlled conditions is now completed. The orbital shaker system for B.t. H-14, which has been operational since 1995, has proven its reliability, notably on the occasion of numerous quality controls carried out under the contract between OCP and the Abbott Company. The other tests of efficacy are carried out with the magnetic multi-stirrer system developed in 1995. It advantageously replaces the "mini-gutter" and the "trough" systems and can be used for both blackflies and non-target fauna, for the evaluation of chemical or biological insecticides. a a aIPCL7.2 Page 2l 70. Collaboration with the Entomopathogenic Bacteria Laboratory of Institut Pasteur in Paris and with the Roussel-Uclaf Company made it possible to test, in 1995, new strains of Bacillus and formulations of recombinant strains of B.r. H-14. Though the obtained results are not satisfactory yet, research is being continued given the interest that an increase, even minimal, of the efficacy of B.t. H-14 would represent. Indeed, a gain by only one third of the operational dose would make it possible to use this insecticide without any logistic diffirculty up to a discharge rate of 70 nf/s or more if the formulation presented better capacities of spontaneous dispersion. 71. The monitoring of blackfly susceptibility to these insecticides was pursued with the usual rigour over all of the rivers treated. As in every year, priority was given to the organophosphorous insecticides (temephos, pyraclofos and phoxim), notably in the basins in which cases of resistance or significant lowering of susceptibility were recently observed or reported in the past (eastern tributaries of Lake Volta, lower Black Volta, basins of south COte d'Ivoire, Niger in Bamako, Marahoue, Niandan, etc.). The susceptibility levels, particularly to temephos, have not changed when data from the 1995196 period is compared to the previous period, a proof of the merits of the seven insecticide rotation strategy used by the Programme. 72. Etofenprox has played, in this yqr, a primordial role in the insecticide rotation strategy, which explains the increase of its consumption in significant proportions (over 45% compared to the previous period). It was used in every place where the use of the organophosphorous compounds has become problematic (Sankarani, Niger, Sassandra, lower-Bandama, lower Comoe and Black Volta), especially when the discharge of the rivers to be treated was between 15 and 70 m3/s (within this discharge bracket, permethrin and carbosulfan cannot be used for toxicity reasons whereas B.t. H-14 is too costly to use). Finally, it should be noted that the first investigations undertaken after the partiat failure recorded in treatments with etofenprox in January 1995 seem to point towards the evidence, as in the cases with pyrethrinoids, of an influence of water temperature on the efficacy of this product. These investigations are continuing so that the phenomenon can be more taken into consideration in treatment decision-making. Vector identification 73. Cytotaxonomy, applicable only to the larval stages of the vector, remains the most reliable tool and the reference technique for the identification of the species of the S- darnnosum complex. For that reason, it is widely used for the identification of larvae subjected to insecticide tests and of those collected during the prospection of treated rivers. The analysis of the results has made it possible to monitor the dynamics of the species and their level of resistance to the operational insecticides. This analysis is more and more facilitated by the existence of a regularly updated cytotaxonomic data bank and of various possibilities of representation offered by the computerized mapping systems. 74. Since 1993,thetechniqueof morphologicalidentificationofthefemales of S.datnnosara,used to differentiate between the savanna and forest species, is used operationally by the Programme's technicians in the context of the regular entomological surveillance activities. The results are recorded in a morphological data bank widely utilized for the interpretation of the Programme's entomological data. The retrospective analyses of this bank notably give a precise enough image of the spatial and seasonal distribution of the different species. 75. In the context of is collaboration with OCP, the team of the "Division of Geographic Medicine" of the University of Alabama has put the final touch this year to the development of the method of identification of female flies of the ,S. damnosurn complex through the DNA-based JPCI7.2 Page 22 heteroduplex analysis technique. This technique which has been operational since May 1995 is based on the existence in the DNA of mitochondria of spectfic sequences making it possible to characterize six species: the S. damnosum s.s, S. sirbanwn (savanna species) complex and the S. squarnosum, S. yahense, S. sanctipauli and S. leonense (forest species) complex. 76. At present, priority on identification of vectors with the heteroduplex technique is being given to the flies originating from the forest/savanna transition zones. These are the zones where the possibilities of morphological and/or morphometric identification are limited because of the heterogeneity of the vector populations and the overlapping of the criteria used for certain differentiations, notably the separation of species in the Sanctipauli sub-complex and, to a lesser extent, the savanna species. 77 . In most cases, a satisfactory agreement is observed in the vector identification results obtained through the different techniques currently operational, i.e. cytotaxonomy (the reference technique), morphology/morphometry and heteroduplex (electrophoresis is now used only on exceptional occasions). However, some important discrepancies have been noted in recent studies carried out on tlre N'zi, the Oueme and the Sassandra on the parallel validation of these techniques. Complementary strrdies (laboratory monitoring of reference populations born from individual laying of wild females) will soon be undertaken to gather more precise information on the nature and importance of these discrepancies in the Programme area. Parasite identi fication 78. The identification of parasites from infective blackflies has been going on at the Bouake laboratory for more than four yffirs. To this effect, the Programme has at its disposal four specific probes. Two are species specific, one to O. volvulus (probe OVS2), the other to O. Ocheng, (OCH). The other two are strain specific, probe PFS-I is specific to the forest strain of the human parasite while the other, PSS-IBT, is specific to the savanna strain. As is the case every year, this technique combined with the morphological identification of vectors makes it possible to provide, for the entomological evaluation of larviciding, two types of results. The first type concerns the transmission of human onchocerciasis by all the species of the Simultum damnoswn complex (figure 2) whereas the second type relates to the transmission of human onchocerciasis by the savanna blackflies only (figure 3). 79. In 1995, the technique used to determine the prevalence of the infection from a pooled mass of blackflies collected in the Bougouriba basin, was tested in parallel with the classical technique of catches/dissection. The resuls were very encouraging and what remains to be done is only determining with more precision the details of its use particularly in the oncho-freed zones, as an entomological tool for the early detection of recrudescence. 80. Quality control of the identifications made in the Bouake laboratory is being pursued each year by the forwarding of coded samples to the laboratory in the University of Alabama. The verifications made so far show perfect agreement between the identifications made in Bouake and those made in the United States. These results confirm the reliability of the technique and the qualtty of the work done in Bouake. Quality control will also be instituted for the heteroduplex analysis of the DNA as soon as this method becomes fully operational. Collaboration between OCP and the University of Alabama will continue in the coming yqrs. With regard to entomological research, other research investigations will be undertaken, such as the adaptation of the heteroduplex technique to the parasites (onchocerca) with a view to determining the phylogeny between the "blinding' forest strains. a oJPCI7.2 Page 23 Special entomological studies 81. In June 1995, atthe closing of the Expert Advisory Committee's 16th Session, it was decided that special entomological studies would be undertaken in those Programme areas where onchocerciasis control seemed to pose some problems. These studies, which numbered four, aimed at acquiring a better knowledge of transmission conditions in order to take, if needed, appropriate measures to ensure more efficient control. 82. Northern Sierra Leone: in the hope of a resumption of larviciding, the entomological evaluation network was strengthened during the months of April and May 1996 in order to elicit the dynamics of the different blackfly species and their involvement in the transmission of onchocerciasis. The results of this study indicate that larviciding should recommence (complemented with ivermectin distribution which was already resumed since March 1996) provided security conditions return to normal. The objective of such larviciding will be to prevent an excessive proliferation of savanna blackflies in this region which would form a source of renewed reinvasion of infected flies into Guinea to start transmission foci in an area with infection reservoir which is on the way to becoming extinct. 83. Lower Black Volta in Ghana: after 22 years of uninterrupted larviciding, the epidemiological results remain disappointing and a contamination of this basin by savanna blackflies originating from southern Ghana, outside the limits of the Prograrnme, was suspected. In order to monitor the possible movements of blackflies between the lower Black Volta and southern Ghana, some special entomological studies were begun in 1996 and will continue in 1997, in collaboration with entomologists from the Noguchi Institute in Accra (Ghana). The initial results confirm the presence in southern Ghana, from February to April, of a significant proportion of S. sirbanutn, although uninfected. Deforestation, which currently covers 30Vo of the Tano basin, has reached this area and could be the reason for the existence of this savanna population. 84. Kulpawn and Mole basins in Ghana: a reinforced distribution of ivermectin given nvice a year replaced more than 19 years of vector control from 1975 to 1994 in an area where epidemiological sinration is still unsatisfactory. In order to determine the impact of this strategy on the transmission of onchocerciasis, the Programme is currently supervising a three-year entomological study aimed at determining the infectivity levels in the absence of larviciding. Consideration of these results will make it possible to elicit, through modelling, the frequency and duration of ivermectin distribution in these two basins. 85. Oueme basins. near the border with Nigeria: in 1995, some blackflies which were morphologically identified as of the forest species had been classified as savanna species by the heteroduplex technique. Given the high rate of infestation of these blackflies, special entomological studies were necessary to elicit the type of onchocerciasis prevailing in that area. The results obtained through cytota(onomy and morphology confirmed the previous data and showed that the dark wing tuft blackfly population caught in that region was in is majority made up of forest species. The results of identification through the heteroduplex method are not yet available but it seems now that the existence of a relatively high proportion of hybrid flies could account for the disagreement between the two methods. Epidemiological modelling 86. The ONCHOSIM model has been used this year to determine the risks of recrudescence after the implementation of different strategies used in the Programme. One of the important parameters tPCt7.2 Page 24 adopted at present in the ONCHOSIM model is a factor termed the "potentiality" of ivermectin which is a measure of irreversible effecs on the adult worms. This factor was examined, by analysing data from annual ivermectin treatments in Asubende, Ghana with the help of the ONCHOSIM model. 87 . The two types of irreversible effect estimated are: (1) a permanent decrease (26-40%) in the productivity of all the worms; ot Q) the complete loss of fecundity of a proportion (22-35Vo) of the worms. Therefore, after each ivermectin treatment, the worms recover during a period of 10 to 11 months and reach a new stable level of microfilarial production which is30Vo less than the pre-control one. These estimations have favourable implications on the cost-effectiveness of the onchocerciasis control strategies based on an annual ivermectin treatment. 88. On the basis of the above results, the model was used to predict the epidemiological situation and the optimal strategies to be adopted in the following basins : Kulpawn/Mole (Ghana), Gambia (Senegal) and basins in the north of Sierra Leone. The simulations showed that ivermectin can stop the transmission in the basins where the force of infections expressed in CMFL before the intervention by ivermectin is less than 30 microfilariae per snip (mf/s) as is the case in Kulpawn/Mole and the Gambia. 89. The epidemiological impact of several years of temporary intemrption of an ongoing combined larviciding and ivermectin distribution, in the course of the presumed duration of 12 years, as is the case of Sierra Leone, was simulated. The results showed that four yqtrs or more of this suspension could result in a high risk of recrudescence even if it is planned to continue the ivermectin treatment progr:rmme alone for additionnal 15 years after the resumption. The simulations also showed that at least 15 years of consecutive ivermectin distribution, after the four years of interruption, can bring the risk of recrudescence to less than L% if larviciding resumes and lasts for five years. 90. The epidemiological modelling had been used to study the recrudescence observed five years after the stopping of the larviciding in the Bougouriba basin (a tributary of the Black Volta) in Burkina Faso. As a background information it may be noted that larviciding had been effective from February 1975 to September 1990, a period of 15 and a half years. In December 1989, one yffir before the cessation of larviciding, a 6Vo prevalence of infection was observed in Zoulo, one of the villages of that area. Subsequent epidemiological evaluations in March 1991, Februuy 1994, ard November 1995 showed prevalences of 5%, tlVo and 257o rspectively. These two last results confirmed the presence of recrudescence of infection in the Bougouriba. 91. To explain the occurrence of such a rapid occurrence of recrudescence, different hypothesis or questions were considered and tested against the epidemiological data observed in the sentinel village of Zoulo using the ONCHOSIM model : 1) Was vector control really inefficient?; if yes, to what extent? 2) Were the 1989 and 1991 prevalence rates "artificially" low due to ivermectin distribution in the region? 3) Were there any infected migrants in the region? 4) Were there other unknown sources of the infection? For example, an important breeding site which might not have been detected through entomological surveillance? a tPCfi.2 Page 25 5) Might any important aspects of the parasite's dynamics not have been taken into account in the epidemiological simulation model? For example, a loss of immunity which might have been caused by a lowering of the parasitic load. 92. Preliminary results of the simulations have shown that the most plausible hypothesis which would allow for the best fit of the epidemiological data recorded at Zoulo would be the probable incoming of migrants in 1989, 1990 and 1991. In this situation, simulation of bi-annual distribution of ivermectin for l0 consecutive years could reduce the risk of a resumption of infection in the area to less than I %. T}l.ese studies will be pursued by making an integrated analysis of all existing data in order to better explain and understand this first case of recrudescence recorded in the original OCP area and to readjust, if necessary, the ONCHOSIM model. Diagnostic tests for the surveillance of onchocerciasis. 93. The search for an alternative diagnostic test to the skin snipping for onchocerciasis was continued. In this respect specimens were collected as follows : a) filter paper blood spots for immunodiagnostic test, b) skin scratch material and skin snip for DNA tests, c) skin snips for parasitological diagnosis, d) application of diethylcarbamazine @EC) in l0Vo Nivea crqrm for a patch test. 94. The specimens were collected from five villages in the Bougouriba basin and from Foungou village in the White Volta basin in Burkina Faso. The results from these tests together with results from other studies which had employed similar methods aimed at community diagnosis for onchocerciasis were discussed, at a meeting held in February 1996 in Geneva. The meeting critically reviewed the results of the new diagnostic tests currently being developed. It placed emphasis on simplicity of application , reliability, cost and capability to detect new onchocercal infection in areas under control (Iable 5). Based on these criteria the meeting recommended the DEC Patch test to be provisionally adopted by the OCP as a method of choice for epidemiological surveillance for further development. Following this recommendation, further tests were carried out in a sample of one hundred children of age 5-15 years in Soubr6, in COte d'Ivoire to ascertain the reaction of individuals to plain Nivea cream, the medium for the DEC patch test. Only 2% of the children showed equivocally mild reaction to the cream. Test Species specificity Epidemio specificity % Sensitivity % Method Cost Reagent Serology Tricockail I Tricockail 2 c27 Ov 3.6 Ov 9.4 Excellent Good Excellent 96-100 98 98 Not done 26-89 41-100 10-88 98 Blood spots Blood spots Blood spots Blood spots 15-25 US Cents Not yet readily available DNA 0-150 PCR Scratch test Excellent rco% Excellent 100 ? 100 87 Skin snip Scratch 66 cents 3.3 cents Available DEC Patch test To be determined 97 80 variable in different geographi- cal areas Non lnvaslve Cost less than a few cents Available tPCt7.2 Page 26 Table 5. Performance/Characteristics of the Diagnostic Tests Macrofi I Chemotherapy Project Potential macrofi laricidal comoounds 95. Following full analysis of the macrofilaricidal effecs of highdose ivermectin (single doses up to 800 pglkg, and multiple doses 950pglkg or 1600pg/kg within a two-week period), it was concluded that high doses of ivermectin, although safe to administer, showed no additional macrofilaricidal action over standard (150pg/kg) doses of ivermectin. The Macrofil Steering Committee therefore recommended that no further high dose ivermectin studies should be carried out, but that the effects of multiple, standard doses should continue to be monitored during routine community treatments. 96. However, studies on the prophylactic effects of monthly doses of ivermectin (given by injection at two dose levels - 200 and 500pg/kg) in the Onchocerca ochengtlcattle model indicated that such monthly treatments over 20 months, protected animals in either group, although control animals developed nodules, and microfilariae were present in their skin. The Expert Advisory Committee therefore recommended that Macrofil develop a clinical protocol to study the possible prophylactic effects of ivermectin in human onchocerciasis. 97 . The clinical stages of a Phase II study of amocarzine in 100 onchocerciasis patiens have been completed at the Onchocerciasis Chemotherapy Research Centre (OCRC), Ghana, and currently nodules excised from these patients are being evaluated for the drug's macrofilaricidal activity. The dosing regimen of amocarzine used was that optimized during clinical studies on onchocerciasis in Latin America, i.e., 3mg/kg, bid after meals, for three days, but in addition, the effect of treating patients one week earlier with a standard dose of ivermectin (150pg/kg) has been studied. The study is "double-blinded" and decoding of individual patients and treatment groups will be done once the efficacy component is completed. All resuls will be available before JPC meeting in December. No I tPCt7.2 Page 27 unacceptable adverse effects were recorded in any patients, although the usual adverse effects related to ttre Mazzotti reaction were seen at the time of dosing with either ivermectin or amocarzine. 98. As a preliminary study to evaluating the clinical effects of amocarzine on patiens with lymphatic filariasis, a Phase I volunteer clinical study on patiens has been carried out in Bombay. Doses up to 3mg/kg, bid after food, for three days have been given. Again no unacceptable adverse effecs of amocarzine were recorded, but mild to moderate giddiness, which was dose-related, was noted, confirming that this symptom, also observed in previous onchocerciasis trials, is a direct effect of the drug on the central nervous system. A protocol for Phase II clinical studies on Bancroftian filariasis have been prepared, and these will be carried out at two centres in India, when government authorization is received. The Expert Advisory Committee recommended that provided adequate macrofilaricidal activity was shown in the current Phase II trids in Ghana, multicentre clinical studies with amocarzine should be carried out in other regions of Africa. If such studies proceed optimally, registration of amocarzine could take place in 2000. 99. The benzimidazole prodrug UMFO78 has now been tested in the O. ochengilcattle model, and resuls indicate that single intramuscular doses of this drug (5Omg/kg and 150mg/kg show macrofilaricidal activity using two assay parameters. A single oral dose of 150 mg/kg showed only paftial macrofilaricidal activity. The minimum number of doses to give complete macrofilaricidal activity will be determined in funrre trials. This macrofilaricidal activity of UMF078 against the best available animal model for onchocerciasis is extremely encouraging, and successful completion of preclinical toxicological studies will allow Phase I clinical studies to be initiated. With optimal development, registration of UMF078 could be completed by 2002. 100. Three potentially macrofilaricidal compounds, selected from Macrofil screening activities (WR 251993,WR 129577 and PD 105666) are currently being evaluated inthe O.ochengilcattle assay, and provide "back-up" compounds for the two lead compounds noted above. Detection of ivermectin resistance genes 101. Work continues to be supported on the genetic mechanisms of resistance in those parasitic nematodes of veterinary importance, which have become resistant to ivermectin. The most common genes responsible for resistance in these nematodes will be identified in O.volvulas with the aim of developing a diagnostic test for early detection of ivermectin resistance should it appear in O.volvulus. Continuation of the Macrofil Project after 1997 IO2. While the decision to continue the work of the Macrofil Chemotherapy Project beyond 1997 was confirmed by both JPC of OCP, and JCB of TDR, the future source of funding has not been so clear. Discussion carried out during 1996 on the source of funding has lead to the recommendation that the Project should be jointly funded by TDR, OCP and APOC (African Programme for Onchocerciasis Control) from 1998 onward. ADMIMSTRATION AND SI.]PPORT SERVICES. Objectives, organisation and functioning of services 103. The basic function of the Administration and Management Unit is to support the activities of the operational, technical and scientific unis of OCP and to assist in assuring that these activities are carried out efficiently and at optimum cost. The unit manages the Programme's infrastructure and is human, financial, material and information resources. It is structured to offer services in the areas of Purchasing, Finance, Personnel Management, Transport Management, Documentation and General Administration. During the period under review the Unit provided special logistic support to the following activities: tPct7.2 Page 28 a) the closure of the zone office in Bamako in June 1996, and the transfer of the operations to Odienne, including 56 vehicles and spare parts; b) the start up of activities of the African Programme for Onchocerciasis Control which is housed in the OCP head quarters at Ouagadougou, but has a separate identity and funding; c) the orderly termination of contracts of staff whose posts were being abolished due to closure of sectors where larviciding activities were about to stop. Administrative costs. 104. Administrative costs in the Prograflrme are defined as those associated with the budget items for Office of the Director, Administration and Support Services Ouagadougou and Support Services, Geneva. For the years 1991-1995, expenditure on Administrative Support costs ils a percentage of programme expenditure is shown in table 6. 105. The dollar expenditure on administrative costs has fallen from US $ 3,713,859 in 1991 to $3,034,717 in 1995 which is a reduction of 18 %.However, annual prograrnme expenditureas a whole has been falling more rapidly than expenditure on administrative costs. The ratio has risen to 14.04 percent in 1995 and has attracted the attention of Programme management. One response has been the decision to fill vacancies only where necessary and then by using short term special Service Agreements in preference to the more expensive WHO fixed term contracts. The duties being performed by staff members are being critically reviewed with a view to rationalization. This ratio of expenditure on administrative costs as a percentage of total expenditure is a parameter which will be kept in view and monitored. Table 6. Cost of the Administration and percentage (US$) I Unit t99t t992 1993 t994 t995 Office of the Director 948,949 743,449 585,650 656,831 718,500 Administrative and Support Services Ouagadougou 2,405,602 2,622,24 2,679,531 1,842,485 01,910,737 Support Services Geneva 359.308 398,577 408,451 451,,274 405,480 Total Administrative costs 3,713,859 3,7&,270 3,673,632 2,950,590 3,034,717 Total Programme Expenditure 32,543,360 31,716,197 26,503,ffi3 23,L50,289 21,614,710 Administrative costs % tt.4 % tt.g % 13.86 7o t2.75 % r4.M % JPCI7.2 Page 29 Budget and Finance 106. The 1996 budget was prepared using an average rate of exchange of US$ 1 : 450. The dollar has been strengthening in 1996 from just under $l = 500 in most of 1995 to 511 (in February), 500 (in March), 507 (in April), 517 (in M.y), and 520 (in June). The World Bank suggested that the dollar was likely to remain strong throughout 1997, so the 1997 Budget was prepared on an average rate US$ 1 = 500 FCFA. lO7. The Finance section operates 14 bank accounts spread across the eleven countries and reconciles them monthly with the accounts sent in from the eleven National Teams and those sent in by the Eastern and Western operational zones. Three members of the National Onchocerciasis Control Team of Sierra leone, were brought to Ouagadougou for training on the use of computers for managing their imprest accounts. A follow up visit was made to ensure the correct installation of the software in their office. 108. The unit took on board the work arising from the start up of African Programme on Onchocerciasis Control (APOC) and established the necessary accounts and financial control mechanism. In this regard contact was made with WHO-HQ and the World Bank leading to the first release from the Trust Fund of US$ 800,000 in April 1996. Personnel 109. During the period under review, the zone office in Bamako was closed and a number of staff contracts were terminated. Guidance was given to staff in completing their pension forms and other termination formalities. The decision was taken to close the Tamale and Parakou vector control sectors in December 1996. The termination procedures were put in motion from May 1996, to give the staff early notice of termination. 110. Staff reduction is consistently being pursued as a cost containment measure. It is no longer automatic to fill professional posts which become vacant. Posts are being abolished where possible by the regrouping of duties, and the use of temporary staff. Security and cleaning have been contracted out and other services are being considered for similar treatment. In January 1996 the total stafflrng was 695 compared to737 in 1995. For 1997 the projection is for a total of 635. Supply and Services. 111. This unit deals with the purchases of goods and services, the maintenance of the projects' inventories and the disposal of items which are no longer useful or in excess of the Programme's needs. On the other hand it also supervises administrative services such as office management, air travel and visas, registry and mailing, and fax and telephone. It also supervises the contractors to whom we have out sourced security and cleaning services. lI2. The unit gave comprehensive logistic support to the Vector Control Unit in the transfer of the zone office from Bamako to Odienne. A storekeeper from Ouagadougou went to assist with closing inventories cards and loading goods in Bamako, road transport and unloading in Odienne, then, stocking and opening inventory cards in the new location. The staff member who deals wittr transit and importations was involved in re-exporting 56 vehicles from Bamako to their new base in Odienne and "importing" them into C6te d'Ivoire at the inland frontier. At Odienne, significant refurbishing was done to the main office. The garage was extended, an extension to the building was done to make the spare parts store and a standby electricity generator was installed. tPCt7.2 Page 30 113. The expenditure on the purchase of equipment and other goods and services needed by the Programme from the 1995 budget was $ 6,954,280. Larvicides accounted for US$ 3,096,100 petroleum products US$ 448,330, spare parts and vehicles US$ 1,135,715. Water, electricity and telecommunication cost 386,875. Of the total, 88 % in dollar terms was processed by the central purchasing division of wHO/Geneva, while 12 Vo represented local purchases. Transport and Communications. lI4. The Transport and Communications unit gave guidance and supervision to the more technical activities of moving the zone office to Odienne. These included dismantling and relocation of the radio telecommunication system in Bamako, the removal of the telephone switchboard and its reinstallation at Odienne, the installation of a standby electricity generator and rewiring of the main office in Odienne. Landscaping the compound was done to avoid flooding and to provide parking for the vehicles. The activities of the Transport service in the Western Zone were transferred from Bamako (Mali) to Odienne (C0te d'Ivoire) at the same time as the zone ofFrce was transferred. 115. The unit is responsible for management of the transport fleet as an ongoing activity, which is required to keep in step with the progressive phasing out of the Programme. Fleet reduction is also a component of the transfer to the countries of responsibility for onchocerciasis detection and control. Accordingly a progrillnme was initiated to write off those vehicles which were more than 10 years old, and not to replace all of them. The fleet will be trimmed from 300 vehicles in 1996 to 200 in the year 2000, with targets set for each of the intervening years. I 16. Between I September 1995 and 3l August 1996, nineteen new vehicles were put into service, while 26 were taken out of service. As at 31 August 1996 there were 290 vehicles in the fleet. During this period, the vehicles covered a totd distance of 7,188,418 kilometres and consumed 867,178 litres of fuel. The fleet has been 94.02 % operational. It7 . Out of the whole fleet, 98 vehicles were loaned to the western extension countries for the duty travels of the national tqrms. The maintenance of these vehicles was carried out by the national teams while OCP supplied fuel, lubricants and spare parts and retained responsibility for technical supervision. As part of in-service training a seminar/workshop was organized to improve the services of the mechanics and storekeepers of these teams. OCP also financed the participation of two mechanics from national teams in training courses run by the Toyota company in Nairobi ((enya). 118. A computerized system is operational in the main stores in Ouagadougou for managing the spare parts for vehicles, motor cycles and radio equipment. The information for the new substores in Odienne have been introduced in this system to improve control of these items. 119. All the radio/teletype stations are in good working order. The base at Makeni (Sierra Leone) has been furnished with a teletype to facilitate transmission of the statistical data required for vector control as well as communication for administrative and management purposes. PTJBLIC RELATIONS, INFORMATION AND DOCI]MENTATION ACTIVITIES With the World Health Organization I20. The Programme Director attended the following statutory meetings: the 45th session of the Regional Committee of the WHO Regional Office for Africa (WHO/AFRO) from 5 to 14 September 1995 in Libreville (Gabon); the 87th session of the Executive Board from 15 to 24 January 1996 in t tPct7.2 Page 31 Geneva; the 49th session of the World Health Assembly form 20 to 25 May 1996 in Geneva. He took the opportunity of his presence at WHO Headquarters to have discussions on OCP issues in particular, with the Ministers of Health of the countries participating in the Onchocerciasis Control Programme in West Africa and their collaborators. l2l. The WHO Representative in Togo, Dr. Moustapha Sidatt chaired the opening session of the OCP Eastern Zone Meeting held from 30 October to 4 November 1995 in Kara. In company with OCP officials and the National Coordinator of Onchocerciasis Control in Togo, he met with Kara's administrative authorities. 122. The WHO Representative in Bamako (Mali), Dr.(Mrs.) H. Mambu-ma-Disu presided over the opening and closing sessions of the OCP Western Zone meeting held from 13 to 18 November 1995 in Bamako. 123. The Prograrnme Director travelled to Brezzaville with two collaborators from 26 to 29 February 1996 where he had discussions on OCP issues with the WHO Regional Director for Africa (WHO/AFRO) and his collaborators. 124. The Programme Director and his close collaborators attended all meetings in connection with the creation of the African Programme for Onchocerciasis Control (APOC), the launching of is activities among which the preparatory meeting and the first session of the Technical Consultative Committee for APOC CICC) held in Ouagadougou from I to 3 April 1996. The Administrator (Programme Manager) for APOC went on mission, along with nvo APOC technicians and one WHO/AFRO representative, to Nigeria, Uganda and Tanzania to have talks with the authorities of these countries on the objectives and strategies of APOC. With the Participating Countries I25. The hydrobiologists of the Participating Countries held their annual meeting on29 and 30 January 1996 in Lome Clogo) which senior staff of the OCP Vector Control Unit, ORSTOM experts and the Chairman of the Ecological Group attended. One day was devoted to a joint meeting with the members of the Ecological Group. t26. The Chief of the Planning, Evaluation and Transfer Unit (PET) and his collaborators attended workshops on the decentralization of epidemiological surveillance of onchocerciasis and the installation of community-based distribution of ivermectin. These workshops were held in all the countries participating in the Programme (see paragraph 67). The Programme Director attended the first of these workshops which was held in Bobo-Dioulasso @urkina Faso) from 29 to 3l January 1996. 127. The Programme Director met with the Ministers of Health and other high-ranking officials of Benin (16-20 October 1995), Ghana Q0-25 October 1995), C0te d'Ivoire (3{ January 1996), Guinea (7-9 January 1996) and Sierra Leone (10-11 January 1996) to discuss issues of common interest. During his stay in the Participating Countries, the Programme Director also had talks with staff members of the Onchocerciasis Control National Teams. JPCI7.2 Page 32 With the OCP statutory bodies 128- The Ecological Group held its 17th session on 1 and 2 February 1996 in Lome (togo) while the Expert Advisory Committee (EAC) held is own (l7th session) from 10 to 14 June 1996 in Ouagadougou @urkina Faso). 129 . The Committee of Sponsoring Agencies (CSA) met successively on 28 and 29 Septemb er 1995 in Rome (Italy), 3 to 8 December 1995 in Washington D.C. (USA), 15 and 16 April 1996 in Paris (France) and 23-24 July 1996 in London (Great Britain). With the Donors 130. The Programme Director met representatives of the Donor countries in Geneva and in their respective countries. Discussions mainly covered the generous contributions of OCP's donor organizations and countries. The last meetings of the period covered by this report were held in Amsterdam (the Netherlands) on 23 and 24March 1996, in Brussels @elgium) on26 March 1996, in Bonn (Germany) on27 March 1996 and London (Great Britain) on 18 April 1996. With the aerial spraying contractor 13 I . The managers of the Evergreen Helicopters Company in charge of aerial larviciding and their field collaborators based at Odienne (COte d'Ivoire) and Kara (fogo) respectively, have continued to maintain, as in the past, very good working and human relations with the OCP and Programme Headquarters staff, as confirmed by the last Evergreen-OCP meeting held in Ouagadougou on 23 February 1996 which was attended by the Programme Director and the Chief of the Vector Control Unit (VCU). With the scientific community 132. The Programme participated in the following meetings: From 28 September to 7 October 1995 @aris) and from 12 to 15 March 1996 (Atlanta, USA), the Programme Director participated in the Mectizan Expert Committee meetings; on 1l and 12 December 1995, he visited in Chicago (USA) the laboratories of the Abbott Company which sells insecticides to OCP. From 8 to 14 February 1996, the Programme Director participated in a workshop held in Geneva on the diagnosis of onchocerciasis. Concurrently with the workshop, he had discussions with WHO technicians of the OCP Phasing out Plan of Operation which covers the period 1998 to 2002; he also attended a meeting of NGOs. From 24 June to 1 July 1996, he attended the 19th session of the Joint Coordinating Board (JCB) of TDR and other HQ programme meetings. From 20 to 25 January 1996, the Chief of the Planning, Evaluation and Transfer Unit (PET) took part in Accra (Ghana) in a workshop to evaluate the instruments of the multidiscipliriary studies on community self-treatment with ivermectin; from l0 to 14 February, helattended a workshop on methods of diagnosis of onchocerciasis held in Geneva; froni 29 June to 6 July 1996, he participated in Victoria Fdls (Zimbabwe), in a workshop on the integration of health care services. tPcfi.2 Page 33 From 12 to 26 August 1996, the Chief of the Vector Control Unit (VCU) attended a conference in Jerusalem (srael) on the 20th anniversary of the discovery of B.t.i. From 25 to 31 August 1996, the Chief of OCP Western Zone attended the 20th International Congress on entomology in Florence (Italy). From 3 to 5 January 1996, the Coordinator of the Entomological and Hydrobiological Evaluation (CEHE) took part in a workshop in Jutland @anemark) on environmental problems organized by the Sahel Sudan Environmental Research Initiative; from 15 to 29 June 1996, he attended a seminar in Maroua (Cameroon) on the Geographical lnformation System (GIS). With the general public 133. From 18 to 23 December 1995, the Chief of the Biostatistics and Information service @IS) participated in Bamako (MalD in a training course in epidemiology aimed at the prevention and control of epidemics at the district level, organizdby WHO/AFRO. From 12 to 17 April 1996, he attended the second conference on health information systems in Johannesburg, South Africa (the first was held in 1993 in Nigeria). It should be noted that the first prize for presentation of the system was awarded to the representative of OCP. 134. The OCP periodical, "Oncho Information" has continued to be published since 1986 in the two working languages of the Programme, English and French, and seems to be fairly well appreciated by the Participating Countries, the donor countries and organizations, universities and research institutes, public health training centres, etc. New readers are regularly asking for it. 135. The Programme Director was interviewed by the national television of Burkina Faso in connection with the production of a documenfiry on the 50th anniversary of the UNO. 136. The daily newspapers "Togo-Presse' in Lome (issue of 31 December 1995) and "l'Essor" in Bamako, Mali (issue of 14 November 1995) reported on the meetings of the Eastern and Western Zones of the Programme (see paragraphs 120 and 121). 137. The Programme Director granted a long interview to the weekly paper "Le Populaire" from Abidjan, COte d'Ivoire (issue no 189 of 19 January 1996). 138. The Burkina Faso daily "L'Observateur Paalga" featured the workshop on the decentralization of the epidemiological surveillance of onchocerciasis and the implementation of the community-based distribution of ivermectin held in Bobo-Dioulasso from 29 to 31 January 1996 (issue of 8 February tee6). I39. After the publication of an article by "OMS-Presse" at WHO Headquarters in Geneva and the periodical "Banque mondiale/Actualitds" on the creation of APOC, most of the weekly and daily papers in the Participating Countries of OCP relayed the information. Other newspapers featured the appointment of the OCP Director as APOC's Director a.i. Public relations and documentation 140. OCP is represented in the sub-committees of the Coordination of the United Nations Agencies which deal with the Administration, Emergencies, Communication and Programmes. In the Communication sub-comminee, OCP is represented by is OfFrcer in charge of Information and Public Relations and by the Programme's Documentation Specialist. t JPCI7.2 Page 34 l4l. The OCP Documentation Centre continues to improve its services. The documentary stock comprises 4,467 documents, 75 periodicals of which 57 are active, 24 L6 mm films, 64 video cassettes, over 3,000 slides, CD-ROMs and some currents contents series on diskettes. The centre has ordered 156 books and subscribed to the CD-ROM CAB Health of Silver Platter Information. 142. During the period covered by this report, the OCP Documentation Centre has been visited by 750 users, internal and external combined, it has loaned 371 books, sent out 296 off-prins and reports in Africa and other parts of the world, distributed 5,000 leaflets, 1,500 brochures and 90 video cassettes of OCP films. It publishas a Bulletin of Summaries and lists of new acquisitions, and also prints out bibliographic listings on demand. An index of the maps of the OCP area has been produced. 143. The centre keeps good relations with many documentation centres and libraries in Burkina Faso. Thus, in addition to the inter-library loan that it practices, it participates in projects for the creation of documenfify networks. Among these can be mentioned the "Rdseau Santd Burkina Faso" which regroups WHO, the School of Public Health, the Faculty of Health Sciences, the National Centre for the Control of Malaria, OCCGE, ORSTOM and the Departmental Directorate of ttre Ministry of Health. Among the centre's collaborator institutions can be mentioned the libraries of the University of Ouagadougou, IPD/AOS, ONAT and the SYFED Centre (SystUme Francophone d'Edition et de Diffirsion). The collaboration with the centre is also materialized by the reception of students and trainees from these organizations for bibliographic research on the available data bases. These students in their last year of training at the "Ecole des Bibliothdcaires, Archivistes et Documentalistes" of the university of Dakar (Senegal) were beneficiaries of a three-month uaining session at the Documentation Centre during the period covered by this report. Internal meetings 144. The Programme organized several internal meetings, the most important of which were: Meeting of the Eastern and Western operational zones, from 30 October to 4 November 1995 in Kara (Iogo) and 13 to 18 November 1995 in Bamako (Mali) respectively. 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