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RAPID EPIDEIIIOLOGICAL MAPPING OF ONCHOERCIASIS (REMO) (9v

Review meeting on REMO/CDTI map update or onchoT;13",il;?tTr,f"Tffil" and states

Lagos, Nigeria

Report of

Dr. MounkailaNoma Chief of Epidemiology and Vector Elimination African Programme for Onchocerciasis Contol Ouagadougou, Burkina Faso P. O. Box 549, Ouaga 01 Tel Q26\3429 53 13429 59 13429 60 e-mail : [email protected] TABLE OF CONTENTS

SUiIIMARY ""' 3 ACKNOWLEDGEMENT...... """ 3

IN 2003""""""""""""5 2. RATIONAL OF THE REVIEW MEETING OF NIGERIA REMO/CDTI MAP

3. PARTICIPAFTTS TO THE MEETING...... """"'6 REMO/CDTI }IAP"""'6 4. OUTPUT OF JANUARY 2OO3 MEETING ON THE REVIEW OF NIGERIA 4.1. Review of REMO/REA data""""' """"'6 4.l.l.ContributionofNigerStateParticipantstothemeeting...'...... '.....6 4.1.2. Output of the review of the status oionchocerciasis in Niger State. """"""""""""'7 in Niger 4.1.3. Conclusions and recommendations of the meeting on the status of Onchocerciasis State """""""""""9 4.2. Reviewof KwaraStateR-EMO/REAdata"' """""'ll 4.2.l.ContributionsofKwaraStateparticipantstothemeeting...... '...... 11 I I 4.2.2. Output of the review of the staius of dnchocerciasis in ....'...... """"' in Kwara 4.23. Conclusions and recommendations of the meeting on the status of Onchocerciasis """"""""'13 State 13 4.3. Matters arisen on likety incomplete picture of onchocerciasis in .. """""""""'

OF (fOTMCT OCP COUNTTY) AF{D 5. CROSS BORDER ISSUES BETWEEN REPUBLIC t1

6.CoNcLUSIoNsANDRECoMMAIIDATIONSFROMoURPARTICIPATIoNTOTHEREvIEw MEETING ON NIGERIA REMO/CDTI IVTAP...... """"13

16 LIST OF PARTICIPANTS """""" SUMMARY

were reviewed during a meeting Niger and Kwara States epidemiologiglda!1on onchocerciasis that was treta in from January 27h to 30e,2003' onchocerciasis The meeting updated the REMO/CDTI map of Nigeria and urged the state on the disease prevalence to enable the Coordination Team of Kwara State to release all existing data NOTF to finalize REMO/GIS status in Nigeria' by the meeting to collect all To avoid any delay from in releasing available data, a-team was set prior forwarding them to existing data on onchocerciasis in Kwara SLte and examined them critically system' epOCjvfanagement for entry and analysis in geographical information

Fie.l: Approved REMO/CDTI map signed by the meeting as at January 2003

ACKNOWLEDGEMENT in Nigeria and his team We would like to express our sincere gratitude to WHO Representalive- providinq logrstic support through the for finding time to p#.ip"ti, at the opening Jr th. meeting and grateful the National coordinator' the week of review of Nigeria REMo/CDTI rn'ap. we are also to in Nigeria and the representatives of Niger state whose contributions chairperson-irrrt of the NGilo coalition *"." u.ental in analysis onchocerciasis status in Niger and Kwara States' 1. BACKGROUNI)

In June 1998, a review meeting of the REMO/CDTI map was carried in Lagos in the premises of WHOAlligeria The meeting updated dre REMO/CDTI map of Nigeria after a critical analysis of the available epidemiological data Figure 2 reveals the REMO/CDTI map of Nigeria as at June 1998.

Fig.2: REMO/CDTI map of Nigeria approved by the NOTF in June 1998

Sourco: NOTF Nig6ria, June 1998

The June 1998 meeting concluded on the need of Additional information in:

o the areas where a REMO/REA exercise had not been carried out o the areas defined as to be refined because of lack or insufficiency of data-

As follow up of the recommendations of June 1998, the NOTFA.{igeria and APOC Management took the following actions:

o to conduct a REA exercise in Niger State r to implement a country-wide refinement exercise of Nigeria REMO map.

Figure 3 shows the results of the two above-mentioned epidemiological data collection carried out by the NOTF of Nigeria and APOC Management. Still, there are needs for additional data to define Community-directed treatnent with ivermectin in some LGAs of Kwara and 5

Niger States. These two States share boundaries with the Republic of BenirU a participant country of the Onchocerciasis Control Programme in West Africa (OCP) that came at a successful end in December 2002 (onchocerciasis is no longer a public health problem in the scope of OCP).

Fis3: REMO/CDTI map of Nigeria as at Decembet 2002

Nigeria REIIIO/CDTImap of Nigeria as at 2002

@on-

! o"tnt"cort ! N"cou

COnw d rtili *N bat, M N ilta..a Wl

2. RATIONAL OF THE REVIEW MEETING OF NIGERIA REMO/CDTI MAP IN 2003

In 2000, the sixth of the Joint Action Forum which was held in Yaounde, Cameroon requested APOC and OCP to look at onchocerciasis cross-border issues between the Republic of Benin and Nigeria This request of JAF was made again in 2001 during the seventh session of JAF.

APOC Technical Consultative Committee (TCC), at its fifteenth session in September 2002, requested clarifications on the distribution of the onchocerciasis in Niger and Kwara States with particular attention to be focused on the border with the Republic of Benin.

Based on all above, ttre NOTF of Nigeria and APOC Management called a meeting to review the REMO/CDTI map of Nigeria (Fig.3). The meeting that was held in Lagos, in the premises of WHOA.{igeri4 from January 27n to 30th, 2003, had the following objectives: arl

6

o to determine the epidemiological status of onchocerciasis in Niger and Kwara State through a review of all existing data

o to update the REMO/CDTI map of Nigeria

o to clariff the status of onchocerciasis in the sharing borders with the Republic of Benin.

3. PARTICIPANTS TO TI{E MEETING

Participants to the meeting were (list in annex):

o National Coordinator of Nigeria o Assistant of the National Coordinator o Chairperson of the NGDO coalition o two members of the NOTF HQ o Zonalonchocerciasis Coordinators of the zones B,C, and D o State Oncho Coordinators of Kwara and Niger States o SOCT members of Kwara and Niger States o Facilitators of REMO/REA exercises in Nigeria o Observers from HKI, MITOSATH

It has to be noted that APOC took in charge the per diem and the transportation cost of only six of the participants. WHO/Lagos paid the cost of the participation of one of the two REMO facilitators in Nigeria.

4. OUTPUT OF JAI\{UARY 2OO3 MEETING ON THE REVIEW OF NIGERIA REMO/CDTI MAP

4.1. Review of Niger State REMO/REA data

4.1.1. Contribution of Niger State Participants to the meeting

The two participants from Niger State came well prepared to attend the meeting. They provided the meeting with the following:

o Topographical and road maps of the State o Data of initial REMO exercise in the State as well as subsequent REA exercise data o Data of REA carried out in 2002

After receipt of the REMO/CDTI map of Nigeria (Fig.2), the National Coordinator instructed the projects of Kwara and Niger State to collect or release additional data on the prevalence of onChocerciasis in order to complete the REMO of the country. Based on the instructions of the NOTF HQ, the State oncho team under the supervision of external advisors from the institute of the Public Health Division of Nigeria lnstitute of Medical Research, Yaba/Lagos carried out a REA exercise from March 14ft to 281h,2002 in eight (8) LGAs of Niger State. The exercise, that was funded by GTZ LAFIA, covered the following LGAs: , Bid4 , , Guarq , and . irl

4.1.2. Output of the rcview of the status of onchocerciasis in Niger State

First, the meeting reviewed, validated the existing data on onchocerciasis prevalence and corrected the coordinates of the commr.rnities (Fig.4) fdling outside Niger State by using topographical maps of Niger State. Also the topographical maps as well as the road map of Niger State enabled the meeting to identift and to plot the uninhabited areas (Kanji National parks, dam and Kaqii Lake). Figure 5 reveals the distribution of onchocerciasis in Niger State after correction of the coordinates of the communities surveyed.

Secondly, the meeting examined critically the results of the REA exercise carried out in 2OO2 n the 8 above-mentioned LGAs. Figure 6 reveals the results of 200.2 REA data in Niger State.

E!4,: REMO/REA results (initial data) of Niger State submitted for review to the meeting, January 2003 Initial REMO/REA results of Niger StAe after correction of the coordinates by the meeting, January 2003 Fis.6: 2002 REA results of Niger State as plotted in January 2003

LEOEI{D

Niger State 2002 REA results trLduji Natioual Prh

! r."t..

Ri!'crs -

Nodulc (lll

o 0 o l-9

0 10-19

o 20-39 o 40-100

r-]KM 0 100 200

4.t3. Conclusions and recommendations of the meeting on the status of Onchocerciasis in Niger State

The meeting concluded for no need for collection of additional data on onchocerciasis in Niger State. Figure 7 summarizes the prevalence dda plotted on figure 5 and 6. E o. $) z (D Gt F o 7trt a ot- g)F} F F} rn JD (D c U) !, t IL U) !)Fl. o o zH) v oo m (D (t) =o o, 7 (D i m B i ao, G'I rl s, It h o o nt ot E .2 fl -t T hJ It -o a (- t, i !) I J a b N I t o I o { (^, I

oeooo I I I N JrtJO ooo.r^ F t{ ;&i-zrttv 7. ! 1' o\o\oo (a o oaL h c uiL o- z G !0 o\ o :i= $ o fu s F

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4.2. Review of Kwara State REMO/REA data

4.2.1. Contributions of Kwara State participants to the meeting

Despite the need of additional data on the prevalence of onchocerciasis in the State as pointed out be the National Onchocerciasis Task Force, the State Oncho team has not carried out a REA exercise. They had not also looked for eisting data available on the disease status in the State. Therefore, the two participants from Kwara came to attend the review meeting without prevalence data and topographical maps to guide the meeting.

4.2.2. Output of the rcview of the status of Onchocerciasis in Kwara State

Available REMO/REA results (existing in APOC GIS database) from previous studies conducted by NOCP and the State team were reviewed. At the end, it was observed that there were still gaps in the disease pattem The NGDO coalition Chairperson informed the meeting that there are historical data (at State Headquarters) generated by Africare Int. in the early 1990's. These data could help to describe the distribution of the disease in areas where data are lacking.

The data of Kwara State on onchocerciasis (Fig.8), stored in APOC GIS database, were examined based on: o Topographical and road maps provided by Niger State participants and APOC REMO facilitator o Village database with geographical coordinates provided by APOC Management.

Fis.8: REMO/REA results of Kwara State submitted to lhe meeting for review, January 2003

LEGEIIO Kwara REMO/REA results to be corrected by the meeting ffi f^tNraorrrtllo*

Ldics

Rnas

Nodul.. (%)

0

o 1.9 o l0-19

o t0-39 (t {0-100 Figures 9 and 10 reveal the REMO/REA results in Kwara State after correction of the geographical coordinates.

Fieurc 9: detailed REMO/REA results of Kwara State after correction of the geographical coordinates as at January 2003

Fieure 10: REMO/REA results of Kwara State after correction of the geographical coordinates as at January 2003

Nodulcr(%) 0 t-9

10-19 !0.19 t0-r00

L.lrnd ! re"" fu\q, - 13

4.2.3. Conclusions and recommendations of the meeting on the status of Onchocerciasis in Kwara State

Based on the above observations, the meeting recommended that a team be constituted to go to the State, to reconcile and validate the results: historical data (from 1994), REMO/REA data available at the State Headquarters. The team proposed will be made up of Prof. Nwoke (Team leader), and member each from NOCP, Sight Savers Int., SOCTNiger and SOCT Kwara-

As we are prepared to leave Lagos on February {d, 2003, data on onchocerciosis distribution in Kwara'State were handed over to AP(rc consultant in REMO. These data will be scrutinize critically andforwarded to APOC Managementfor analysis in GIS andfeeback to all the particiPants.

43,. Matters arisen from likely incomplete picture of onchocerciasis in Kogi State

A participant raised the issue of incomplete picture of the disease pattern in Kogi State; as available data were presented and entered into the Atlas-GIS. It was resolved that the REMO/CDTI map foi ttre State should remain as it is for now, until the historical skin snip results and other data are obtained and validated with appropriate coordinates of sample villages.

5. CROSS BORDER ISSUES BETWEEN REPUBLIC OF BEIIIN (former ocP country) AND MGERIA

In view of the inadequate data from Kwara State, and whereas there are about five States with international boundaries with Republic of Benin (Kebbi, Oyo, Ogun, Kwara and Niger), the meeting observed that it was premature to make any categorical statement regarding the status of onchocerciasis at the border areas-

6. CONCLUSIONS AND RECOMMANDATIONS F'ROM OUR PARTICIPATION TO THE REVIEW MEE,TING ON NIGERIA REMO/CDTI MAP

The meeting updated and approved the REMO/CDTI map of Nigeria (Fig.ll).

Kwara State REMO/REA data should critically be examined and integrated in GIS for analysis and definition of the CDTI areas.

In Niger State there is no need for additional collection of data. The project should proceed with the implementation of CDTI.

Five (5) States: Kebbi, Niger, Kwara, Osun, and Ogun are concerned with onchocerciasis cross border issues with Republic Benin. The NOTF of Nigeria should make available a list of the CDTI communities in tfue border of the Republic of Benin and Nigeria. For each of these communities, the total population and the nurnber of persons treated since the inception of CDTI projects should be collected by the NOTF HQ of Nigeria'

ApOC Management to facilitate a meeting between the two countries (Nigeria and Republtg of Benin) in order to set up a smtegy for dealing with mass distribution of ivemrectin in both sides of the two concerned countries. 14

APOC Management to froilitate o lleetiEg betweesth€ tqro corrntries (Nigeria and &epublirc of tsenin) in ordir to set up o g.atogy for dealing with mass distributiou of ivernteotin in both sides,of the trnro rnncqned ooun-fr.iras" m N

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GI cl al td E c to gr il .a 6 E 0 Cd .EE u .Eo d @ T E E"tr .E 0 at o:i Fi a z U' 5 n .!n E =l: F E a -s H o i t g 6 o z 6 E a rt oo) o I tr N I o otr (l) (\, (r) (n o cl t\l ct B h v lE a E d E(l) ? (t) I q tE E o o IU 0) d -o l- o o .gl d z q) rF oo o (Hz CL o IE a GI E E l- F o ()o o o o rI] =UI & E, €(D TI o o aL. a l-o EL CL LIST OF'PARTICPAI\ITS @, REVIEW OF MGERIA RDMOICDTI MAP, JANUARY 27o' to 30F, 2003, LAG(N - LIST OF PARTICIPAIYTS

Dr. Abdou Moudi, WM.ligeria Dr. Jonathan Jiya, National Coordinator Phone: 08034030212

Dr. Elizabeth Elhassaru Couttty Rep SSI Hadjia Rakiya Y. Datti, Niger Sate Oncho I. Golf Course Road, Kadrma Coordinator, Ministry of Healtb, Ssin (O i nfoweb. ab s. net Niger State, , Phone: 066 22lO 3l 0837 022603

hof. B.E.B. Nwoks RElvtrO/Facilitator Mr. Sule Salisq Nig€r State SOCT University, Owerri Phone: 066221Ofl nectar(a,infoweb. abs. net - ,fa I l8

RE\IEW OF MGERIA REMOICITTI MAP, JAIYUARY ZZt to lOs, 2003, LAGOS-LIST OF PARTICIPANTS

Mr. YE rli Ajayi, Kwma State Oncho Coordinatu Mr. Craniyu Kareom, SOCT/Kwara State Epideuriology Unit PMB 1477,Ilom Epidemiology Urdt, MOI! Kwara, Tel: 031 22IOAO I 03122j3076 Tel:031 22;n76

Dr. Yisa .{. Saka, Deputy National Coordinator Mrs. Patricia Ogbu-Pearce NOTF HQ / Nigeria, Lagor D Zonel Coordinator, NOCP Tel: 0l 4821285 I 0W33O29387 JahrmRoad, PMB 0291, Bauchi G2000(irthisen. ors

Dr. Yemi Fcyomi, C Tantl Coordinator It[r. Jaiyeoba rL Omooba, B Zonal NOCP, Kaduna, lul unva(allvahoo. com CoordinatorNOcP B Zonal Office Tel: 062 242533nm23136403 2, Oladejo Adigun Road Tel: 02 241 1350 / 08037 173530 , (t ( 19

REvIEW OF MGERIA REMO/CDTI II{AP, JANUARY 27t to 30t, 2003, LAGOS - LIST OF PARTICIPANTS

Mr. Yictor Odewole, Data ofEcier Dr. O. Barybore, llltrectiz*n Iventory NOCP Headquaters, FMOII, Lagos tvlanager, NOTF HQ/Nigeria, t agos Victor3000 ns(a-lva hoo. co m TeL 01 482185t 0802336403

Mrc. Frantca Olamiju, Executive Ilirector Dr. Mur Obediah HKI CountrY No 6 Road Avenue Tekan Headquaters, Jos Roprerentotive, IA, Akia W. llflechunga mitosath(a=lhotmail'com / mitosath(41)skannet'com Road, Jos, ., Tel: 073 450153 / W 454 044 / 080 33 18 085 hkwiOhisen.org

Dr. Hemy Edegbere, WHO Surveillance Supervisor Dr. Mounlsaila Noma, Chief of Epidemiology edeghere lo(iiwho. nigeria.org and Vector Elimination, WHO/AP(rc Ouaga edeghereh(dvahrro. co. u k nomamidtoncho.oms.bf- Tek 266 3429 53