Thyolo/Mwanza-Thyolo district CDTI annual project technical report submitted to Technical Consultative Committee (TCC): from January 2009 to December 2009

RESERVED FOR PROJECT LOGO/IIEADING I OzuGINAL : English For Actlon To: Tcc6D for Ldomabn Tor brA c6oRL $,l.oal COUNTRY/NOTF: MALAWI Proiect Name:THYOLO/NIWANZA THYOLO DISTRICT Approval year: 1996 Launching year: 1997 Reporting Period: FROM :JANUARY,2009 To: DECEMBER,}OD} (Month/YeaD ( Month/Year) Pro ect this re circle one t2 3 4 5 67 8 9 t0tttz 13 Date submitted: 2O-, JANUARY 2OIO NGDO partner:SIGHT SAYERS INTERNATIONAL, TEA ASSOCIATION OF MALAWI \ 1 j '. ,r9'11t;i: ' i' 't 0 I FEV. 2010 APOC/ RECU LE DIR WHO/APOC, 24 November 2004 I ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) DEADLINE FOR SUBMISSION: To APOC Management by 31 Januarv for March TCC meeting To APOC Management by 31 July for September TCC meeting AFRICAN PROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC) ll WHO/APOC, 24 November 2004 ANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) ENDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFFICERS to sign the report: Country: District Health Offi cer: MALAWI Name: Dr G. Chatsika... Signature: . . GQ.,,er-f.Br[cg. . . ... Date: ..... aa. Q.l.,lO. District Environmental Health Officer \o National Onchocerciasis Coord Name: L. Sitima Signature: ... Date: tflvt.l'0. This report has been prepared by Name : Aggrey K. Simika Designation : ...D.O.C... Signature : Date -,,21 .- ot- p_-( a lll WHO/APOC, 24 November 2004 Name...K Signature... Date. ..LL .=r..Q Table of contents Acronyms vi Definitions vii FOLLOW UP ON TCC RECOMMENDATIONS 1 Executive Summary 2 SECTION 1: Background information 3 l.l. GeNpRar- INFoRMATIoN ............ ........Ennon! BooxllARK Nor DEFTNED. 1.1.1 Description of the project (briefly) ...Error! Bookmark not defined. 1.1.2. Partnership ................4 1.2. Popu1nroN............... .......5 SECTION 2: Implementation of CDTI 7 2.1. Truer-rNp oF AcrrvrlEs..........., ..........7 2.2. Aovocecy ........................8 2.3. MoerI-rzerroN, sENSrrrzATroN AND HEALTH EDUCATIoN oF AT RISK coMMUNITIES ..9 2.4. CouuuNrry TNVoLVEMENT ..............10 2.5. CRpncrty BUTLDING ........10 2.6. TReerueNTS............. ......13 2.6.1. Treatmentfigures............. .........13 2.6.2 Vf/hat are the causes of absenteeism?.......... ..................1 5 2.6.3 l[lhat are the reasons for refusals? ............... ................152.6.4 Brie/ly describe all known and verified serious adverse events (SAEs) that....l5 2.6.5. Trend of treatment achievement from CDTI project inception to the current year I 62.7. ORoeRlNG, sroRAGE AND DELTvERv oF IVERMECTTN ............17 2.8. Corvtrlrrt.trry sELF-MoNIToRTNG AND STAKEHoLDERS MperrNc... ..........18 2.9. SwpRvrsroN............... .....19 2.9.1. Provide aJlow chart of supervision hierarchy.. ............19 2.9.2. l[hat were the main issues identified during supervision? ...............................19 2.9.3. Was a supervision checklist used? ........ ......19 2.9.4. What were the outcomes at each level of CDTI implementation supervision?.19 2.9.5. Was feedback given to the person or groups supervised? ................................192.9.6. How was the feedback used to improve the overall performance of the project? t9 SECTION 3: Support to CDTI 20 3.1. EqurueNr ......................20 3.2. FrNeNcw- coNTRTBUTToNS oF THE pARTNERS AND coMMUNrrrES ............ ...............21 3.3. Oruen FoRMS oF coMMr.rNrry suppoRT............... .................22 3.4. ExppNprruRE pER AcTrvrry ..............22 SECTION 4: Sustainability of CDTI 24 4.1. IureRNnr-; TNDEIENDENT pARTrcrpAToRy MoNrroRINc; EvaluarroN.......... ...........24 4.I.l Was Monitoring/evaluation caruied out during the reporting period? (tick any of thefollowing which are applicable) ........... ............24 4.1.2. What were the recommendations? ..............24 4.1.3. How have they been implemented? ............. ..................24 4.2. SusrnrNnsILITy oF eRoJECTS: ILAN AND sET TARGETS (MANDAToRv AT ................24 Yn 3)......... .................24 4.2.1. Planning at all relevant levels ....................25 IV WHO/APOC, 24 November 2004 4.2.2. Funds........ ...............25 4.2.3 Transport (replacement and maintenance)..... . .. . ......................25 4.2.4. Other resources.. .....25 4.2.5. To what extent has the plan been implemented................ ...............25 4.3. INrecRarroN............... ......................25 4.3.1. Ivermectin delivery mechanisms................ ...................25 4.3.2. Training.... ...............25 4.3.3. Joint supervision and monitoring with other programs.... ..............25 4.3.4. Release offunds for project activities... ......264.3.5. Is CDTI included in the PHC budget?.............. ............26 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. Wat have been the achievements? ............. ....... ............26 4.3.7. Describe others issues considered in the integration of CDTI. ......26 4.4. OpenerroNAL RESEARCH. .....26 4.4.1. Summarize in not more than one half of apage the operational research undertaken in the project area within the reporting period.... .. ...26 4.4.2. How were the results applied in the project? ............ . . ... .... .......26 SECTION 5: Strengths, weaknesses, challenges, and opportunities 26 SECTION 6: Unique features of the projecUother matters 27 WHO/APOC, 24 November 2004 Acronyms APOC ATO ATrO CBO CDD CDTI CSM LGA MOH NGDO NGO NOTF PHC REMO SAE SHM TCC TOT {.]NICEF UTG WHO African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Objective Community-Based Organization Community-Directed Di stributor Community-Directed Treatment with Ivermectin Community Sel f-Monitoring Local Government Area Ministry of Health Non-Governmental Development Organization Non-Governmental Organ ization National Onchocerciasis Task Force Primary health care Rapid Epidemiological Mapping of Onchocerciasis Severe adverse event Stakeholders meeting Technical Consultative Committee (APOC scientific advisory goup) Trainer of trainers United Nations Children's Fund Ultimate Treatment Goal World Health Organization VI WHO/APOC, 24 November 2004 Acronyms APOC ATO ATrO CBO CDD CDTI CSM LGA MOH NGDO NGO NOTF PHC REMO SAE SHM TCC TOT UNICEF UTG wHo African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Obj ective Community-Based Organization Community-Directed Distributor Community-Directed Treatment with Ivermectin Community S el f-Monitoring Local Government Area Ministry of Health Non-Governmental Development Organization Non-Governmental Organization National Onchocerciasis Task Force Primary health care Rapid Epidemiological Mapping of Onchocerciasis Severe adverse event Stakeholders meeting Technical Consultative Committee (APOC scientific advisory group) Trainer of trainers United Nations Children's Fund Ultimate Treatment Goal World Health Organization vl WHO/APOC, 24 November 2004 Definitions (i) Total population: the total population living in meso/h1,per-endemic communities within the project area (based on REMO and census taking). (ii) Eligible population: calculated as 84o/o of the total population in meso/hyper- endemic communities in the project area. (iii) Annual Treatment Objective: (ATO): the estimated number of persons living in meso/hyper-endemic areas that a CDTI project intends to treat with ivermectin in a given year. (iv) Ultimate Treatment Goal (UTG): calculated as the maximum number of people to be treated annually in mesolhyper endemic areas within the project area, ultimately to be reached when the project has reached full geographic coverage (normally the project should be expected to reach the UTG at the end of the 3'd year ofthe project). TheraDeutic coveraqe: number of people treated in a given year over the total population (this should be expressed as a percentage). (v) (viii) (vi) Geographical coverage: number of communities treated in a given year over the total number of meso/hyper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage). (vii) Integration: delivering additional health interventions (i.e. vitamin A supplements, albendazole for LF, screening for cataract, etc.) through CDTI (using the same systems, training, supervision and personnel) in order to maximise cost- effectiveness and empower communities to solve more of their health problems. This does not include activities or interventions carried out by community distributors outside of CDTI. Sustainabiliqv: CDTI activities in an area are sustainable when they continue to function effectively for the foreseeable future, with high treatment coverage, integrated into the available healthcare service, with strong community ownership, using resources mobilised by the community and the government' (ix) Communitv self-monitorine (CSM): The process by which the cornmunity is empowered to oversee and monitor the performance of CDTI (or any community- based health intervention programme), with a view to ensuring that the programrne is being executed in the way intended. It encourages the community to take full responsibility of ivermectin distribution and make appropriate modifications when necessary. vll WHO/APOC, 24 November 2004 FOLLOW UP ON TGG REGOMMENDATIONS Using the table below, fill in the recommendations of the last TCC on the project and describe how they have been addressed. TCC session (Please add more rows if necessary) I Number of Recommendation in the Report TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROTECT FOR TCC/APOC MGT USE ONLY WHO/APOC, 24 November 2004 Executive Summary Since l997,the National Onchocerciasis Prograrrrme in Malawi had been carrying out Community Directed Treatment with Ivermectin (CDTI) strategy and Thyolo is one of the districts implementing CDTI project. The district has 404 villages which are headed by village headmen.andl2Tea estates. In 2009 the District stil incorporated Lymphatic Filariasis Control into the CDTI Programme where CDDs are distributing Albendazole on top of Mectizan. The district has a total population of 648958 out of which 539487 people were treated representing 83.1o%therapeutic coverage. Thegeographical coverage is 100%. People of Thyolo move about the district and outside to conduct businesses and farming since these are the main activities in the district. During the dry seasons people who live close to the boundaries with Mozambique move into that country to engage themselves in farming since there is plenty of spare and fertile land there. Other people living close to Chikwawa District also move to the district to farm. Some people move from their villages to seek employment in the tea estates.It has also been found that a certain section of the society move about the district and some parts of the country to sell bananas which is the main cash crop. In 2009, Health Surveillance Assistants and TOTs conducted several meetings with an aim of finding out treatment progress and strategizing ways of achieving good coverage, 60 new recruited H.S.A and 400 CDDs were trained,.20 TOTs,584 health workers and 2955 CDDs attended review and planning meetings before Mass Drug Administration. This helped the District to review and plan ways of maintaining good coverage in order to control Onchocerciasis and Lymphatic Filariasis. Currently the district has a ratio of ICDD to 193 people. The challenges faced by the district Late start of MDA because of late arrival of Albendazole for co-implementation. The challenge was overcame by intensifying the supervision during the mass drug administration. 2 WHO/APOC, 24 November 2004 SEGTION {: Background information Onchocerciasis control activities in Malawi started in 1984 upon the launching of the Onchocerciasis Control Programme in the Ministry of Health. Thyolo District is situated to the Southern Region of Malawi and it forms part of the international boundary with Mozambique to the South --€ast, it also borders with Blantyre, Chikwawa, Chiradzulu and Mulanje Districts who are also implementing the CDTI concept. The district is one of the densely populated districts in the country with about 648958 people. It is hilly with numerous riverline systems which make it favourable for the bleeding of the Onchocerciasis vector, black fly. People in the district engage themselves in small scale farming and businesses. They grow maize, bananas and cassava for consumption, they sell the surplus. The tribes found in the district are Lomwe (which form the majority), Ngoni and Yao. The favourite dance of the Lomwe is Tchopa. There is a tarmac road which runs from Blantyre and crosses the district to Mozambique via Mulanje District. This is the main communication outlet for the district with other outside areas.Another tarmac road branches from the above main road to Malamulo Hospital, this road is very small and is not used much by traffic. The rest of the roads in the district do not have tarmac hence slippery during rain season. The administrative structure of the district is arranged in the manner whereby the topmost post is occupied by the District Commissioner,under him/her are Traditional Authorities. At the bottom of the structure are Village Headman. The Village Headman looks after clans of people who have joined together to form a village. A combination of villages form a very large area looked after by a Traditional Authority. Thyolo District has 22 health facilities including 2 hospitals namely Thyolo District Hospital and Malamulo Hospital-and 12 Tea Estate health facilities which provide curative, preventive and maternity services. In this District 664 health workers are directly involved in CDTI project. Table l: Number of health staff involved in CDTI (Please add more rows if necessary) J WHO/APOC, 24 November 20M DistricULGA Number of health staff involved in CDTI rctivities. Total Number of health staff in the entire project area Bl Number of health staff involved in CDTI B, Percentage B"=Brl B' *100 THYOLO 664 664 l00o/o Total 664 664 100Y" 1.1.2. Partnership Indicate the partners involved in project implementation at all levels [MoH, NGDOs (nationaVinternational), communities, local organizations, etc. ] Describe overall working relationship among partners, clearly indicating specific areas of project activities (planning, supervision, advocacy, planning, mobilization, etc) where all partners are involved. State plans, if any, to mobilize the state/region/district/LGA decision-makers, NGDOs, NGOs, CBOs, to assist in CDTI implementation. The partners involved in project implementation are Ministry of Health, Tea Association of Malawi, W.H.O. and Sight Savers Intemational These partners are involved in planning, supervision and implementation of CDTI activities. For 1 .1.1 and 1 .1.2 see copies attached overleaf 4 WHO/APOC, 24 November 2004 *OO(\ 0) -o () o z$N O op. C)o 'a ti o (H o o tE o o. o dC6E 0)6 €ctCq) o. = c.)Xao cl a =GF! c) bDcg(€(, =t) o:bE Ca)oFq) Ec) oA() -. c) .q oo 00) t) Ecq 5.ooE =6)EbeeEa0()! 'O= C'E oodu) '=G .CJ o 4r cl ctii0 =o8tr o bE o.l= t c.) bo6 E a.2 etC!clt =.4-Y(B> -r c)HH< o\ ON I l< do/ t Ia E] Io d 9. 3a 3 I e oo B cto L< ?, *<() 6 t =[ to oO (A C') oo (\, o (s 4 o)ol< o C') * \r) U1 s Us'-\\q) 0) -s 3\g U(lq) :\ q) s$q) ll :lg CJ O'UL:\ 9t o' o' \TJq)9 'S >r s! hO' 9: <3q) qJ qJ'is \s U< q)U $qr o-Rbogs a\i gl .:s / Sr: A.Bi E:sp oRX.F s$. INA oo t q){ .n ;-!x E ;es R dNc.itc)st r =u.Y C) d:o'-c€ t*h {i c)u:1 ho _ce+.E :o'-- k n b=' 4 dtF e E s: L? (1) evsSq, e .-SS E EEb'a oN6 E. 9qrl o 7ss € a3$ k I *b. d :;io(ra<l$-\ho 6 =*= I id5 o 5 nd c6 -.PT -E Z\$l(HU\ aa ot\ vL \ \3 !o tiq) bo L o o. C) r< o o{) tr t< a o *ro !o(! o)L{ ol-r(g o Fr(D o ts clq) ,r q) q) oL q) trq) () J U) t< (n o <n =o.o (d U)o tr ti oU ojr O.lI -oldlFI E o .Ig r! -3c oE IN a F (, Fp (U- 9- =cd E sc ta) N ra)srn in N ra$t,n € ra o\6$\o + il .o)ir -(uo .= o.N s {'E F AE @ tar o\ @$\o , .-E Ei'=ed&E.=s; >.Eo)q)-E E 5'FNa \o$ta, r- c\ \o$ rat c- on o tr o G ao Pr 'Eg3 9! h F; E #si N $ ca$ c\ cat I Irq) oN qJ .= -q) cl o) oir +_ il a() (n (n() (n 0.) on +$O$ ar,q) 6l q) c) clq) al + !+ !C .eE E9o= E E-tro::9E f,i-cot= >q);tr -O N \c)\o \o\c) u)q) ut(! ar, o) o(J o L o)E z 'EgS 9t Htr.=:?crUo tr.=gsi o(r) co o rr} ra GI -C) .Eel9.rd!-ri E.E E 3E t'H O.E A @ ra, o\@ .t\o 6ln o\ €t\o ?6)e) .29 ot EqEc5; rH t-{ I'5A-l F o .lo +iF Fl H o F< $ ON o .o C) o z$(\.l O oA o \o SEGTION 2: lmplementation of GDTI 2.1. Timeline of activities Fill in table 3, timeline of activities for areas treated in cunent year, indicating when the key activities were implemented by the month they began and the month they ended. THYOLO DISTRICT CDTI PROJECT PLAN OF ACTION. JAI\UARY 2OO9 TO DECEMBER 2OO9 7 NO PLANNED ACTIVITIES J F M A M J J A S o N D I T.O.T Planning meeting x 2 H.S.A s Planning meeting x aJ CDDs Planning meeting X 4 Training of new H.S,A x 5 Census update x 6 Ordering of Drugs x 7 Community Mobilisation X X x X 8 Distribution of Mectizan to Health Centres x 9 Distribution of Mectizan to Communities X X 10 Supervision of CDTI activities x x x x x 1l Compilation of Mectizan Distribution Summary forms X t2 Attending NOTF Meeting x x X x 13 Compilation of Annual Report x WHO/APOC, 24 November 2004 oo $O(\ ts 0) -o {) o z$ c.l O oA4 o Jr > co ct) o c) 'e L tr Fo(, C) oo '= a)a 'o bo ,= o c) 50 L tr tr tr O E d a9- c) €(o c) -l d9aO 6r c)E 9eoP -q rJ9g 106 Ne a* -cE b€ )' ca -o c)rPo=>oPEp< t< trc> od 6: o.v >.iO-ddoooo do () ; (d -L(a'6E-qo964bodo €(D u eHbotrdL vli *bDToHLo;iE; =-(L6A(lr (EG.b 'r,5X a(oc0) .:ili cr)gE r ic-0C):Y o-x9-5E a(J ;'- +trl () tr n P H-l g <?i eEE E(J-^.ji! e d- o<E 19 u tr --LOhn-H'Jf 6s " EL-L;1>6o 6 = 6Ec E6-i'o q C)!(U -e 8E c 3eoa(u(DE E E FE 6\.rvvr .a.j c! Cg r<vurFi) E s"EE X, - OOO oE ary s -E;-,- ()- ev I hA-iW.HdH HS> .= BEE 3; qN O'^ o cri .: 'x- 6O H '.= = orJE (JY tr li ur..! dtr'6 H.9 9 r <a -O cl.E t oi:tEi EESHZ6 a"''-=<o o E HS= ? €H! +83 .egg.EE=Ea >E t'J E U e t= '9.Qatro:-PEE g sE E s a-: E e .T E eO9XHtrb€E€EH6 -oo-t--()d9 EAi T ZY TE}STETEE;ts((l-di-j(tleJLi E ! E E E 3 +E t?: # E,= E 14 d tro (n Lq) a o EE U dgl co rrl o z & Irltr 2 F] z o o! 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Q)E o d o 0aoxsaI o.r a= O,(l) .- 0) =.n =a :sq) O0 c)L@Gltr lE O.Ooq)g Q')EC) qF(A q)&, (t) q) fr tr E G c) o a0 () tr (a) q) oq) o Au)600 +..= !1 6 =o) o -o.ioGIL(l)bo g!o c! 66tr.9o irb :6 Na €(J rr{a h; 8.qe.3 -c() .P .nBg A.d}Eoo -d=utt(d trl E-eCB= €E 6 tJl (d Li rtO =.rLie(l)'5 =G)ug dEiDo E.s o. 6. tsd e8Hl ca I o G L tr q) CE q)(,(r, q, () U) U) cqI o (l) o ,r o G G 4) o c)(n o) F o o Cd t< ,o () '1, oLA o o II =E3 E E o(, J otIL +,t! F o E o .I +r IU(, IJE o ttI(! oE E tr IU tr .9{.t! NIIE o E o o D tr o .I *,t! Nlr I II! o = I(l, !N 2.4. GommuniQr involvement Table 4: Communities participation in the CDTI (Please add more rows if necessary) Comment on: Attendance of female members of the community at health education meetings More women attended community meetings than men, this is so because men tend be busy with work because in most area are bread winners. The other reason men consider health issues as mainly for women. In general, how do you rate the participation of female members of the community meetings when CDTI issues are being discusses (attendance, participation in the discussion etc) The females contribute much to the deliberations than males. Incentives provided by communities for the CDDs No monetary incentives are provided.to CDDs, but something like snacks were given from some households. Attrition of CDDs. Is attrition a problem for the project? -This year the attrition of CDDs was not bad since other community structure like village health committees are also taking part in mectizan distribution Other issues 2.5. Gapacity building Describe the adequacy of available knowledgeable manpower at all levels. -There is adequate knowledgeable manpower. Where frequent transfers of trained staff occur, state what the project is doing, or intends to do, to remedy the situation. (The most important issue to describe is what measures were taken to ensure adequate CDTI implementation where not enough knowledgeable manpouter was available or if staff are frequently transferred during the course of the campaign). DistricVLGA Number of communities/villages with community members as supervisors Number of CDDs and the communities involved Number of communities /villages with femele CDDs Total no. communities in the entire project area B1 Number with community members as supervisors B( Percentage Br B/ B. *lo0 Male CDDs B7 Female CDDs B8 Total Bo= [r*[, Number of communities with female CDDs Bro Percentage Bn= Bro/8.* 100 THYOLO 404 +12 Tea Estates 0 00/, t607 t'748 3355 405 97.3 " Total 404 + l2Tea Estates. 0 0% 1607 1748 3355 405 97.3 "h 10 WHO/APOC, 24 November 2003 - By conducting local trainings to the new staff using local resources. - Training new staff using Ministry of Health Funds 1l WHO/APOC, 24 November 2004 : O + () U il (J 6 oF bq i- *d c.t co o\N Oos rr)if| o\6l oO * cO c.l ra ra(\l(t) q) o) Q) e s roo rC) o6) cl q, aQ o)! z ?eF(.) c! cO LqJ 9 \: :- ev oC! O e.l O o6l O6l e o2 q) q) q) (, s oo 0 6) .1a ctL 6)l oq) .c) r- 6l6JL z OF O(\ al =t\o rf, € rA o\o Uo< Uie Q +(, En O ri $$ $ co \o O otO rn o -r'_ c) q) o <) s r- 6) dL *s H8 '= o.tr --- Z2 (D <, (.)LF 6o< di = 6,'i +F-d O o o o o o 6l (a o F]3=o() rr .=Ed o o) z ()oLF o oJ o F Fl t-r o3 so c) q) (l) I s o Fl o o(\ o -o (.) oZ sfN O(J A o F ol bo o -o o s B i o bo o $ o BtS s< z ; -:\ a N U)q q) Q a) v) o\ q) r_ o \ A) c1 q,) s. o (! trq) E C) o. F oOqr o U) 0.) 0.) oti ,(Dq! 0) (d bo (s LrF ,iir o->l =ldtFI Trainees Type of training CDDs Other Community memberse.g Community supervisors Health Workers (frontline health facilities) MOH staff or Other Political Leaders Village heads Program management 0 0 ^i 0 0 0 How to conduct Health education ^/ 0 ./ 0 0 0 Management ofSAEs 0 0 0 0 0 0 CSM 0 0 0 0 0 0 SHM 0 0 .i 0 0 0 Data collectron ^/ 0 ./ 0 0 0 Data analysis 0 0 ./ 0 0 0 Report writrng n 0 ./ 0 0 0 Drug distribution ./ 0 { 0 0 0 Table 6: Type of training undertaken (Tick the boxes where speciJic training was carried out during the reporting period) Any other comments 2.6. Treatments 2.6.1. Treatment figures If the project is not achieving 100% geographical coverage and a minimum of 65% therapeutic coverage or the coverage rate is fluctuating, state the reasons and the plans being made to remedy this. l3 WHO/APOC, 24 November 2003 $OO c! k() -o E 0) o z t6l (J p. o * > $ \) OOt\) aU\B .cs\G\ Oosa 0O \o!F{ () as d\gE i13 .sEE o'..\t-=\a-i! o+ii E ilS +E*E s-s 6.=tldlqJg!: .dis OS .=>! -'ratr.ril'q).=iE:iC)B'i ,r9:() o-aBFiitEsI .S 'B'oHE\.UE 'S !!',L\qX \ rqr .Y - '=<Co t\ i- ot I F 'iE'ol * \) q \ -t(u !r ltHxl P t I *p[ e s :L EtB s $B o.rl L .S ?'r:EI S E.T4q $ SSEE i. S3 El d .n :\J.JI_ A .{vFl -d ; \ c)51.6 i :EAti - p* EE Ea $URQ\ :: SSr I tEs 8-Bt s$r Gss tss \SS :ls = t.s\-b6 t sr\rq 'o S .S'+ _c i da.H s s*o s EsF rr rt!? P HSo\ \ aC olol -l ,xl> EI E Els st.Eot o)oftr BI E ,-l !,r 3F #tEtrttrJtc zl< (d ol<(n Io C) 'a !(d ;^(L) l- 0)(l,- !9()do.= 'A i-! 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