NATION _ WIDE RAPID EPIDEMIOLOGICAL MAPPING oF ONCHOCERCTASIS (REMO) REF,TNEMENT OF NIGERIA, , OCTOBER 30 - DECEMBER 13,2OOO
. MISSION REPORT
FOR
woru,o HEALTH ORGAI\TZATION (WHO) AFRTCAN PROGRAMME FOR ONCHOCERCIASTS CONTROL (APOC) OUAGADOUGOU, BI'RKINA FASO.
BY
DR B. E. B. NWOKE OYHO Temporary adviser) Professor of Medicawubtic Heau! rarasuotogt & Eniomologt School of Biological Sciences Imo Stote University, Nigeria PMB 2000 Owerri, Nlgeria Tel: (234) E3 230 69E
DECEMBER I2,2OOO , ::;' h ,l i;, ii a SUMMARY l.Onchoceiciasis in all the refined zones/areas of Sokoto,Zamfara, ii Adamawa,Kntsina, JigawnrNnsflrawa, Kaduna,Knno, Rnd ogun States is not a serious public health problem to warrant CDTI strategy, II 2.Of the four outstanding LGAs in Imo State(Obowo,Ezinihitte,Ngor Okpala,Ahiazu and Abor),only n the zone of Ngor Okpala LGA is CDTI area. l-r 3.Only the northern part of Ovia south west and Ovia north west LGAs of Edo State(bordering Ondo il State) is a CDTI area. 4In Ondo State,Irele,Okitipupa,Idanre and odrgbo LGAs wcre outstaldilg.'r5e present fi result showed that only Idnre LGA rone *ai GDTI area. U S.The two LGAs refined in Ekiti state(Ikole and oye) are all GDTI area ir 6'Eight LGAS were U refined in osun State. onchocerciasis is serious within the zones of Ayeda Ade,Irepodun and Egbeofe LGAs.
7'Of ir the six outstanding LGAs in oyo State,the zones of the northern LGAs of Irepo,olorunsogo,and oriri as wefl as Ido LGA are CDTI area.
Hadeji River E 9-91 th.e Basin of Yobe State,lg community were examined and 12(63%) of them had no onchocercal nodule.Five(72%) of the communities who were h positive onchocercal for nodule had l-9% nodie prevarece and onry one. TI community,Dagona had 2OYo nodule rate.This result will be made clearer when integrated into the Atlas h GIS. {r '9.A total of 43 communities were refined from six LGfu in Gombe State :Balanga,Akko,Billiri,Nafada,Dukkil and Funakaya.Except in the zones of Akko and Dukku LcAs,'onchocerciasis is a serious probl.* in a[ the other LGAs a examined.
I2'REMO exercise was refined in 4l comminities in,2l LGAS in Borno state.of ir this,only the zones Bama of and Kala Balge LGAs are CDTI area.onchocerciasis is apparently absent or of low endemicity in ti'e other 19 LGAs in this Sahefian ,egion of Lake Chad h basin. l3.The'REMO exercise was conducted in Alkaleri,Kirfi,Bpuchi, Bogoro,Tafawa Balewa,Dass,Toro,Ganjuwa and Duazo LGAs of iauchi state.A total of 35 h communities were rgfi.ned tl JHt study.The result showed that onchocerciasis was I absent n-16(46%) of them.onty the zone of Toro LGA has the disease endemicity to fi warrant CDTI approach. u h t u t
U LIST OF CONTENT
1.0 SUMMARY ------2
2.0 INTRODUCTION 4
3.0 MATERIALS AND METHODS 6
31 Study Area ()
3.2 Training 6
3.3
4.0 RESULTS AND DISCUSSION 8
5.0 REFERENCES 44
6.0 ACKNOWLEDGEMENT --.------. -45
7.0 APPENDTX ____-_ _ 46
7.1 Mission Schedule 46
7.2 List of NOCP Participants 47
7.3 List of National ScientistVConsultants ------'- 47 il 7.4 Refined REMO Data ------49 L+
2.O INTRODUCTION
Human onchocerciasis is a serious public health problem in Nigeria and other African countries (prost,l986;Nwoke,ileo; west od;iiy-;;;;g the..people at the end of the road" - the farmi'F.p^9P^YluJion who produce the urr[ oiou, food and industrial raw materials (Nwoke et at ilsl;. It is estimut.d thut about I I nrlilion Nrg;rt.;, .r; infected by the parasite and more than 100,000 are blinded by it *i,r, or".40 million at risk. with this picture, onchocerciasis is no long". a disease tnut ,touta be taken for granted in '
Fortunately, the advent of ivermectin (Mectizan) as an effective drug of scale treatmeltt of choice for large - onchocel'ciasis Itas revolutioniz-ed the Jir.ur. great ,la,agenrent an4 given hope for the contror. And with the wuo/apoC;;gy put in prace in the continent, there is greater.hope at sight for the.m"rtir. una successful control of this cluonic and debilitating disease.
APOC is committed,through partnership with.Ministry of Health (MoH) and various Non - Governmental DevJopment organizations fNcporl to control onchocerciasis in all endemic African countries through'mass iue.m".ti, j,'tTrro"o,i"n,,o point airiiii"uiSr. out here that there is general alreement that the drug should be distributed first to communities whose members are atiisk_of aereloping ihE r"u..e and disabling ocular dermal complication of onchocerciasis or lTaylor.et ir,- i,g;; This risk is accepted to be directly related to the intensity of infection in the;;;;ity (Remme et al, r989). Furthermore, the demonstration of good correration bd;;, the prevarence onchocercal nodules of and the skin m-icrofilariae i, u (Nwok e, r992b,wHo, 1992;1995) provideda.bre-akthrough "onr*rnity in_the.upia .pia..ioiogi"ut-- mapping of onchocerciasis @EMO) (Ngoumou-& Wulrh,'1993).--
Informed by the advantage of REMO in onchocerciasis control, uNICEF by 1993 lgg4 supported the first nation wide - - REMO exercise in the country with wHo providing technical guidance and logistic support. This pionee, *o.k hu, played a significant ourunderstanding ofthe role in disease puit"rn in the;r*" Gmade et al, l99g) (Fig. I) The APoc strategy is.community ownership of the contror efforts through mass treatment of a! high risk areavzones - lsing the community oirected Treatment with Ivermectin (CDTI) approach. However r"iJr."tir. pi.rr*g and implementation of the CDTI' APoc as a mitter of priority_requires *;p;.'d;ir. epidemiorogicar data generated using the wHo deveropid,na. upprorfi n i!;or;;i;i;-e;? Muiping or onchocerciasis (REMO) from aliendemic cbuntries. rn. nbnao results help to delineate the main onchocerciasis endemit ur.ur/rone-s tlrat ."quirc ibrr priority and at the time ensure adequate same coverage of all the high risk areas. Informed by this, wyglApoc, June g I0,l99g - organized a national workshop at wHo office, Lagos, on REMO/GIS on the definition;i46il'ffi.ty Dr' Nutral areas in Nigeria. with (crD/Hearth Map, Geneva) and Dr. No,,l B'giilepocr in attendance, a1 5
14. REMO was refrned in 60 communities from 16 LGAs of Kebbi State. Onchocerciasis is not a major public health pioblem in the state except at Danko Wasogun LGA (bordering southern Zamfara state)
15. Thirty communities were examined from 9 LGAs in Kogi State. Only Omalaz;lne showed definite CpU communities.
I6. By the present ex€rcise, REMO was relined in 29 communities of 8 LGAs in Kwara State. Onchocerciasis is endemic in allthe LGfu examined to warrant CDTI except Edu LGA.
17. Atotal of 83 communities from 8 LGAs in Tarabastatewere refined. The zones of Ibi, Gassol, Laq Karim Lamido, Jalingo and yorro LGAs were not CDTI areas. Only the area of Ardokola was CDTI zone. The REMO exercise in southern part of Sarduana LGA showed that the lowland areas, especially within the Donga river basin are definite CDTI as recorded in the lgg3lg4 ngUO. On the other hand the present result showed that the cold higtrland communities around Gembu zone which hitherto were mapped definite CDTI by 1993t94 are not GDTI zone.
18 In Plateau State, 3l communities were refined in l0 LGAs. Only communities within the zones of Bassa, Jos East and Pankshin LGAs are CDTI ureai. The other 7 LGAS are within the less endemic lowland zone of the State.
19. Akwa Ibom results showed that
1.0 b
the available REMO data were reviewed, analyzedand finally integrated with existing epidemiological the data. At.the *i.ortrrl *o[rr,"p,lr,. refined in map of GDTI areas Nigeria (based on the current REMO data then) *.r J[r.rrped and agreed upon by all the participating members of NorF as a true representative of the disease,s distribution as at June 10, 1998 (Fig. 2)
Furthermore the workshop observed that with the available data, there were areas/zones in the country where nrMo was not conducteJ,;;;;;s which needed and/or to be refined areavzones where trre data were inconrirt.ri *itr-, k;;*" epidemiologicauentomological information Th;;;rkffiin.r.rore recommended that for effective coverag-e, plTl1.s ana imptementation;i;il ongoing CDTI in the country, there was need to refine REMd in Nig.iia - to create a picture of the disease. It was in recognition of this necd that cricouraged "t.., Afoc ur,i1,o,t,.,.,-in tlie cllT.t srrategy to sponsor this mission. So the objectives oiry *irrion u,.1'
To train Nigerian N0TF scientists/consultants in Epidemiological Mapping onchocerciasis (REMo) ^Rapid of - to enable them successfully carry out independent exercise. REM9 To assist the national team conduct nation - wide REMO refinement in the delineate the country - to main onchocerciasis endemi" u..* ,t where *;.il;- --r-" - definite CDTI approacrr, and clinic - based strategy are to be adopted
3.0 MATERIALS AND METHODS 3.1 Study Area
Fig.2 shows the areas/zones in the country for the REMO refinement 3.2 Training
The first objective of this mission was capacity b_uilding Two different groups were trained: (l) National Scientists ana rvoci, stunuio Sraff detailed REMO training-war tzilcn The eir.nio th. Natiornar Scientisil and Nocp staffwho the rcn hearth"uunin #ffi::"ed ihe fiera whire.orau.ting the REM,
It is a statement of fact that alr the National scientists and Nocp staffare experienced and have at one time or the other been invqlved in onchocerciasis control in the country. This fact not withstanding, th..r*u, need for this training sinib REMo is a new and rr...ni Jiusnostic toor. Again, it is significant global standard of the procedure that the is ma]ntained for oulio* epidemiorogicar reasons. The eight - man national ,"i.ntirt, National un;;ffi'iloH staffred by the coordinator (see appendix) weretherefor" and detailed to a 3 - day intensive training aithe ionat ;6r;ln Kaduna. "*porra rr,ilir"iiirg covered a1 the aspects of the wHoiREMo documents Inaddition,thebiologyandecologvoi.r,.Vector,theepidemiology,6Ngoumou t w;r;h, rg93; wHO, I995) i: 5 r! ti iiF= Tt 61 i? rl u.: (trLJtr.( o II AJ? .9! i Z!
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clininopathological manifestations and socioeconomic impact of the disease, well as as the need and current control strategy, thb CDTI stiategy *er. disrursJ.' 3.3 Implementation
At theend training it was clear that every member had acquired the appropriate"{t.!.. pkill and procedure necessary to carry out successfuliy independent REMO exercise, Each national scientist *ur usig*a an area or states for REMO refinement' B.!1. leavirig for the field exercis.,"sarple villages were seiected and the states, NGDos and LGAs were inflormed and senstized for the exercise to enable them be ready with - staffand logistic suirport. with the time - table, adequate logistic and material support and efficient conrmunication, the national scierttists wcrtt.altead lbr the field bxercisc. Thc wiro adviser particrpated rn t5e exercise and also both plaved supervisory and facilitating role. At the end of the REMO .exercise, jhe results generated were impressive and consistent. Not withstanding the inherent difficulties and risks'associated with extensive and intensive vilrage studies, the REMo refinement i, trrc country was a huge success.
4.0 RESULTS AND DISCUSSION
4.1 TARABA STATE (Tabte 2 )
a) LGAs mapped as Definite CDTI by 1998
l. Part of Yorro 5. Sarduana 9. Donga 2. Zing 6. Kurmi 10. Part of Karirn Lamido 3 Bali 7 Ussa I 1 . Part of fudokola 4. Gashaka 8. Tukum
b) LGAs mapped as NO CDTI area l. Wukari 2 partoflbi
c) LGAs where REMO refine was conducted
l. Part of Ibi 5. Lau 2. Gassol 6. Part of Karim Lamido 3. Part of fudokola 7. Part of Yorro 4. Jalingo 8. Southern Sarduana to validate the 199311994 RAM exercise A total of 83 commu.nilie; from the LGfu in -eight Taraba were refined (Table 2) The results showed rTl[" zones of I6i, Gassor, r,*, i..i, Lamido, Jaringo,and Yorro LGAs are not .DTI. Two areas in ardokora L'cA ;;; definite GDTI. The REMo exercise in Southern part of Sarduana LGA showed that the low land t; 7 rl li rt ll cr' Q
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