OCP-85.5-Eng.Pdf

ocP/ 85 . 5 I^IORLD HEAITH ORGANIZATION onchocerclasis Control Programme in the Volta Rlver Basin area B.P. 549 - Ouagadougou t Burkina Faso ONCHOCERCIASIS FOCUS IN THE BISSA COUNTRY by A. Rolland and G. BalaY New edltion, November 1985 I ocP/8s.5 Page 2 FOREWORD The rernarkable work by A. Rolland and G. Balay on the onchocerclasis focus in the Blssa country, which was greatly in advance of its time (f969), was unfortunately never publlshed, although it thoroughly nerited to be so; havlng remained a report of the Onchocerciasls DepartnenE of OCCGE, it r.ras known only to t.he privileged few, for whom i.t was a valuable source of reference. Ihis document is ln effect the result of the first rational mulEidiscipllnary approach to a focus of onchocerclasis; several of the ideas put forward in it have now become basic to the epideniology of the disease; although the work of a physician and an entomologlst, the socloeconomic study that it enbodles was to be the startlng point for the research of those ethnographers and geographers who were to concern themselves wlth onchocerciasis during the next 15 years. At the time when the report was produced, no onchocerciasls control canpaign had been undertaken ln the east of rrhat is now Burkino Faso. Preclse and sober as 1t is, this report gives a.moving descrlption of the catastrophlc situation that prevailed at the tine in the Volta river valleys wlth regard to health and the socioecononlc sltuatLon, a situation which also existed in all the valleys of the major watercourses in the West African savannas; this viclous circle of disease and poverty led lnevitably to the bllndness and early decline of individuals and to the death of their cornmunltles. The Onchocerciasis Control Programme in the Volta River Basin area (OCP) was set up ln 1974, and vector control was lnstituted as from L977 in the baslns of the White Volta and the Red Vo1ta, whlch lrrigate the Bissa country; entomological surveillance has not been relaxed since that tlne. Today, nldway through the original 20 yearsr lifespan of the OCP, it can be stated that the cllnical and socioeconomic picture of the kind described in the report by Rolland and Balay no longer exists ln the Bissa focus, or for that matter la 90% of the 764 000 kmz currently treated by the Programme. How is this reality reflected in the villages that were studied during the 1960s? In Nlarba, a vlllage whose population has continuously declined under the effect of onchocerclasls si.nce lts decioati.on at the time of the ravage of the di.sease (roore than 802 of the populatlon lnfected and more than 102 bLlnd both ln 1969 and in 1976), transmlssion fell fron a leve1 of 2700 (1969) to 0 (1978) and has remained lnterrupted slnce then; between 1976 aad 1985 total prevalence decreased fron 812 to 3QZ and ocular parasitisn in adults from 797" to 2%. In Yakala, which Iras a reference village ln the Rolland and Balay study, the transmlsslon rate feIl fron 800 in 1969 to 0 fron 1978 to the present date, prevalence was reduced froa 762 to 36't! and the ocular parasitism of adults fton 74% to ZZ between 1976 and 1985. Even more striking than these figures, however, are the changes that have taken place in the socloeconooic environment and the uentallty of the lnhabltants, for example in yakala. The nunber of fanilies of 1oca1 origln fell from 11 1n 1969 to 8 in 1976, since when 24 famllles have moved ln (15 of then settled), thus lncreasing the total population from 100 to trore than 300; over the same period the Fongou district on the other bank of the white Volta took ln 20 to 30 fanilies which all settled, thereby raising the population of the dlstrict from 400 to nearly 1000. For the inltlal lnhabitants, the Bissa, who have been established in the area for uore than a century, blackflles have disappeared and onchocerciasis is beaten; the tine i.s gone when "you had to marry young because from the age of 25 onwards you could no longer a woman". As regards the numerous inmlgrants and the young people born durlng tfie last".r"r, """ decade, they know nothlng about blackflies and Eheir knowledge of the disease is confined to the blind "old people" of Bissa, survLvors froru a period regarded as over and done wlth. There is no shorEage of available, fertile 1and, and the grain stores contaln sufficient reserves to carry over fron one annual harvest to the next; a health post has been opened, ocP/85. s Page 3 another is being set up and a well has been dug; t,here are deuands for a dispensatYt a school and a borehole, all evidence of the will of the people to persevere with the lmprovement of their socioeconomic condltions. There, as in rnany regions of the area covered by OCP, villages are coming back to life and a true process of self-development has been set in notion in the lands along the river banks, which have been rendered healthy and transformed from the centre of repulsionr whi.ch once they were, to poles of attraction. This upsurge and relative wellbeing are natural to an uninformed observer. One of the reasons why thls report by Rolland and Balay is of interest is preclsely because it enables us to assess ghe advances that have been made over Ehe last 10 years, in relatlon to an initially catastrophic situation, and to realise the effectiveness and the fuopact of the Onchocerciasis Control Programme. At a tine when the spectre of onchocerciasis ls fading over vast areas, such a docuuent is also tiroely in recalling to all those concerned by the disease, governlDents, donors, and officials responsible for health, developrnent and the control of endenic dlseasesr the gerrible reallty of river blindness and the pressing need to continue to fight it until return to the draoat,ic siEuaEions describdd in the document becomes inposslble. This report also remlnds us that sinilar situations of physical wretchedness, social decay and despair ascribable to onchocerciasls are stlll the 1ot of tens of thousands of African villagers outs.Lde the present OCP boundaries, for whom Premature blindness and the abandonnent of thelr land was an inevitable fate, but to whon the achievements of OCP have given rise to tremendous hoPe. Lastly, the reissuing of thls report, whtch sets out the infornatlon that Provlded the basls for OCP In the east of Burkina Faso, enables us to Pay homage to the generatlon of doctors, entomologists, nurses, technlcians, auxlllari.es and insect collectors who were the forerunners of the onchocerciasls programme; following Physician-General P. Richet, the great promoter of oncherciasis control, these men gave of their best fron 1937 onwards, and itf" i" particular in the Blssa focus, to deuonstrate the serlousness of the problem and the posslbility of combating iE; this they did at a time when the valleys' emPty of human beiogs, had been abandoned to the bush and to the wild fauna, when prospecting was carrled out on foot or in small boats and dugout canoes, and when ophthalmological examinations took place between grain stores ln the very relative coolness of the shade of the mango trees. Through the reading of this report, which is at last brought out, let the example of these pioneers contlnue to inspire their successors in the exemplary undertaking of the restor;tion of human dignity, irhich is the be all and end all of the Onchocerciasls Control prograuroe in the Volta Rlver Basln area, the future Onehocerciasis Control Programme in West Africa. B. Philippon 0ctober 1985 ocP/85.5 Page 4 The following have also contributed to the new edition of this report: - the Ministry of Public Health of Burkina Faso; - the organizatlon for Coordlnation and Cooperation in the Control of the Major Endernic Diseases (Organlsation de Coordination et de Cooperation pour Ia lutte contre 1es Grandes End6nles - OCCGE) ' whtch have given their permission for the publicatlon of the report "Onchocerclasls focus in the Bissa count,ry" under the auspices of OCP; - Dr E.M. Sanba, who supported the idea of thls republlcatlon frorn the outset; - Professor C. Pairault; - Mr M. Gaud; - Dr A.N.L. Dounbate; - The physiclans of the OCP Epldeniological Evaluatlon Unit' through the communlcatlon of lnformatlon on the present situatlon in the vlllages of Fongou, Niarba and Yakala; - Dr R. Le Berre, through hls co'nrnents on the report, the preparatlon of whlch he had initiated ln hls tlne. Our thanks to then. ocP/ 85 . 5 Page 5 OCCGE I,IINISTRY OF PUBLIC HEALTH AND WELFARE OF UPPER VOLTA CENTRE MURAZ DIRECTORATE OF RURAL IIEALTH ONCHOCERCIASIS DEPARTMENT No. 111/oNCHo/of 30.05.1969 ONCHOCERCIASIS FOCUS IN THE BISSA COUNTRY by A. Rolland* and G. Balay:t* * Chi"f Physician, Mobile Ophthalnologieal Unit - Dlrectorate of Rural Health - Mlnistry of Publlc Health and Welfare - Ouagadougou - Upper Volta. ** oRSTOM Medical Entonologist - Head of the Ouagadougou Unit - Onchocerciasis Department of the Centre Muraz - Bobo-Dloulasso - Upper Volta. 0cP/85. 5 Page 6 ONCHOCERCIASIS FOCUS IN THE BISSA COUNTRY CONTENTS Page 10 CHAPTER I - BACKGROUND INFORMATION ON THE BISSA COUNTRY 1 The country 11 2 The people 11 3 Economlc organization of the Bissa country 11 CHAPTER II - THE VECTOR: Slmulium damnosum Th. (*) 1. Method of work 15 1.1 Preimaginal habitats (Iarval breeding sites) 15 L.2 Bioecological study of fernale blackfly 15 2. ResuIEs from observations of the breeding sites of S. dannosum . 16 2.L Site location .. 16 2.2 Seasonal variations of the distribution and size of breeding sites in relation to hydrological variaEions 16 3.

Load more