AFRICA REGION Special lntervention Zones 01 B.P. 549, Ouagadougou 01, Burkina Faso Tel: (226) 503429 53; 50 34 29 59;50 34 29 60; 50 34 36 45/46 @)P,'3fJ':,TLT,,sant6 Fax: (226) 50 34 28 75,50 34 36 47

Report of the flfth actlvlty tevlew and plannln$ meetln$ of the Speclal lnterYentlon Zones (SlZ) Ouagadougou, 8 - 10 Noaember 2006 SUMMARY

OPENING A. OF THE MEETING...... 3 B. BACKGROUND TNFORMATTON ON SIZ ...... 4 C. GENERAL INFORMATION ON THE 4th SESSION OF THE SPECIAL ADVISoRY 6' D. FOLTOW-UP OF RECOMMENDATIONS OF THE FOURTH REVIEW AND PTANNING MEETING 8'{ E.INFORMATION ON ACTIVITIES OF THE MULTI-DISEASE SURVEILLANCE CENTRE 1.0 F. REVIEW OF ONCHOCERCIASIS SURVEILLANCryEVALUATION AND CONTROL ACTIVITIES IN SIZ COUNTRIES (INCLUDING NON-SIZ AREAS) FROM 2003 TO 2006, RESOURCES EMPLOYED AND PLANNING OF ACTTVITIES FOR 2OO7 12 G. POST.OCP ACTTVITIES IN 2003, 2OO4 AND 2OO5 IN THE SIX COUNTRIES OF THE FORMER OCP THAT ARE NOT PART OF SIZ, AND ACTIVITIES PLANNED FOR 2OO7 ...... 28

H. FINANCING OF ONCHOCERCIASIS ACTTVITIES IN THE SI2...... 4't I. PROGRESS REPORT, RECOMMENDATIONS AND CONCLUSIONS OF 2006 MEETINGS OF THE NGDO COORDINATION GROUP 4't I. SUPPORT OF PARTNERS FOR ACTIVITIES FROM 2OO3 TO 2006 AND PROIECTTONS FOR 2007 43 K. IVERMECTIN TREATMENT (MULTI.ANNUAL TREATMENTS, RESISTANCE TO 44 L. WHEN CAN IVERMECTIN TREATMENT BE STOPPED, FEASIBILITY OF ELIMINATING ONCHOCERCIASIS WITH TVERMECTIN ONLY .,.,...... 46 M. OVERVIEW OF NEW CDTI DATA MANAGEMENT PROGRAMME ...... ,....46 N. RESOURCE MOBILISATION STRATEGIES FOR THE CONTINUATION OF ONCHOCERCIASIS CONTROL AND SURVEILLANCE IN FORMER OCP COUNTRIES...... 47 O. OTHER MATTERS .....48 P. APPROVAL OF RECOMMENDATIONS 49 Q. CLOSURE OF MEETTNG ...... 52 ANNEXES:

ANNEXE 1: List of pafiicipanfs...... 04 ANNEXE 2: ProvisionalAgenda ...... fg. AArrlrP(E 3.' Coverage of eapfure poiafs in counfit'es eondsetrhg eatomologieal surver1lanee...... ,.6i AAIATEKE 4r Resulh af infectivity rafes trom 2@l fo 2005...... 63- .AIvlvExE 5.'Enfomologieat Surveillance Results for 2(N5 rn Gfiana...... 64 ANTIIEXE 6.' Oncfioeererhsrb entomologfcal ne(worft for 2AO6 ...... 6d

1 uFeasibility ANNilE 7: Partial result trom surueillanee poiafs ol the stu$ an of eliminatian of Anehocerciasls by tvermectin dtstibtttion"...... ,."...... "....."..65 ANNE)(E 8.'Resulf from yectors coll*ted in APAC surueillaneepoints...... 65 ANNEJI/E 9: Plan of action and budget SIZ 2(n7 in Benin ...... 65 ANNEXE 70: Summary of distribution af iverm*tin in the SIZ dlstn'cts in Ghana durtng year

ANNFJ(E lt: Summary of epidemiological results of Eas{tern region tn Ghana e@q...... "...... 66 ANNFJ(E 12: Summary Results of Ashanti Region in Ghana OAO$ ...... 67 ANNEJ(E 73: Summery of Vatta region results in Ghana fi$q...... 67 ANNEJ(EI*SienaLeoneOnchoeontrol aefi'viffes in2(N7...... 68 ANNEXE 15: SIZ AREAS lN GUINEA ...... 68 ANNE)(E 16: Epidemialogical Evatuatian in nan-SlZ in 2Nl6: Guinea...... 69 ANNFJ(E 17: Pailial resuffs of ceptures in Guinea e@q...... 69 ANNil,E'18: Timetabte af activities to &e conducted in 2(N7 and 2Nl8 in Guinea...... 70 ANNH(E 79: Recap af the tahle af bulk captures and disseetions in Togo P(}{/,3-2U}6/...... 70 ANNEXE 20: Flan af Action and Budget: 2007 SlZITogo...... 7't ANNFJ(E 2l: Pragress af CDTI in 2003, 2W and 20Oi in Senegal ...... ".."...... 71 ANNE)(E 22: Trend af indicators of epidemiologicalsurueillance of onchocereiasis (Senega$...... 75 ANNEJ(E 23: Avervlew table of 2@3-2N)T PAB for the 5 SrZ counfrfes...... 76

2 A. OPENING OF THE MEETING

Three speeches were made during the opening ceremony

The first speech was by Dr Laurent YAMEOGO, who deputised for the APOC Director. Dr YAMEOGO, first of all relayed to participants the warm greetings of the APOC director, who went on mission in Nigeria following the plane crash that occurred in the country on29 October 2006, and in which three APOC temporary advisors lost their lives. He continued by recalling that this was the last-but-one meeting, which should take stock of our achievements, appraise our strengths and shortcomings lor a final effort that should see us achieving our objectives and maintaining the gains of OCP. He then underscored the problem of resource mobilisation to support the onchocerciasis control effort. To this end, he appealed to all partners at the session for their assistance in search of new avenues for resource mobilisation. Regarding the technical sector, he stressed that to maintain the said gains, adequate and timely surveillance was critical. In this connectiorl the countries should have a national system (available tools and protocols used) enabling a good appraisal of the sifuation, informed decisions and appropriate responses made on the basis of complete and reliable data. Then, Dr Laurent YAMEOGO appealed to the countries about the need to draw up plans of action in the endemic districts, in conjunction with partners, so as to continue ivermectin distribution until 201.2 (in line with the ONCHOSIM simulation model), in view of the imminent closure of SIZ in December 2007. Finally, he called on participants not to be complacent in their deliberations so that they could find solutions to the various problems encountered.

Dr Laurent TOE, representing the director of the Multi-Disease Surveillance Centre (MDSC), made the second speech. He announced greetings from the MDSC director to participants, after which he recalled that Review and Planning meetings were opportunities for exchange and planning among the various actors involved in onchocerciasis control, namely the coordinators from the 11 former OCP countries. This is why the MDSC is so much interested in participating in this sessiory which gives it the opportunity to once again throw some more light on onchocerciasis surveillance in the former OCP countries. Dr TOE reminded participants that surveillance and research activities undertaken by the MDSC were becoming increasingly evident in the countries, and needed to be strengthened in the years to come. In conclusion, he reassured participants of the support and effective contribution of his team to the success of the meeting.

The third speech was by the representative of the WHO in Burkina Faso, Dr Amidou BABA MOUSSA. In his opening address, he, on behalf of the WHO Director General and Regional Director for Africa, welcomed all participants to this important meeting. Next, he reminded participants of the special nature of this meeting, which was holding at the beginning of the last year of the 2003-2007 period. This period was set by partners involved in onchocerciasis to bring entomological and epidemiological parameters in the areas in question to levels that are compatible with the elimination of river blindness as a public health problem, which countries could handle. He congratulated participants on the positive results obtained during the five years of control, and called on all actors to remain vigilant

J until the final objective is achieved. Dr BABA MOUSSA stressed that, at a yeil from the end of SIZ activities, efforts needed to be geared particularly to strengthening control activities, and defining broad outlines of onchocerciasis control and surveillance activities to be conducted after 2007. He ended by exhorting participants to make objective and constructive criticisms and discussions that could address some lingering bottlenecks, so that onchocerciasis will no longer be a public health problem.

After the speeches, Dr Laurent Yameogo, Team Leader of SIZ (TL) presided the election of a three-member presidium, made up as follows:

Chair: Dr Lamine DIAWARA, NOCP Coordinator, Senegal; Main rapporteur: Dr KARABOU K. Potchoziou, Coordinator of NOCP, Togo; Second rapporteur: Mme Gracia ADJINACOU, representative of NOCP coordinator, Benin.

The Chief of the Vector Control Team (CVCT) was requested to assist them.

The new Chairperson thanked participants (llsf in Annexe 1), for the confidence placed in him, and called on all to help in steering the meeting to a successful end. He then requested participants to introduce themselves.

The agenda (in Annexe 2), proposed by the organisers, was adopted without any amendment.

B. BACKGROUND INFORMATION ON SIZ

General information on SIZ and the stakes were presented by Dr Laurent YAMEOGO, Team Leader.

The inJormation was on:

a The workshop, which was held in Ouagadougou from 1 - 2 March 2006 on onchocerciasis control on the Upper Oueme basins and the tributaries of the Oti, at which a decision was made: 1) to suspend larviciding on the Upper Oueme, and to continue treatment on the tributaries of the Oti; 2) to maintain entomological surveillance on the Oueme, and to conduct investigations to detect the source of contamination of female flies; 3) to use the saved flight hours on the Upper Oueme for aerial identification of untreated endemic villages/hamlets and specific groups;4) to train many CDDs and adopt the treatment per hamlet strategy; 5) to enhance epidemiological evaluation for the longitudinal analysis of the impact of control, and to use the ONCHOSIM model for predicting the epidemiological situation beyond 2007;6) and finally to do advocacy for integrating CDTI activities into national health systems.

4 a The workshops on the CDTI revitalization strategy in Benin (from 20 to 24 February 2006) and in Ghana (from 22 to 25 August 2006). During these workshops, discussions were held on: 1)"awareness-raising" on the CDTI strategy;2) advocacy for enlisting the full participation of districts; 3) synchronisation of ivermectin distribution periods for LF and Onchocerciasis; 4) incentives for CDDs; 5) reports; 6) review of onchocerciasis status for better planning;7) drawing up activity plans for the future, with the participation of districts and regions. a The annual meeting of the Special Advisory Committee of experts (SAC) held in Ouagadougou from 13 to 16 June 2006. The main recorilnendations are on: 1) reinforcing CDTI in the SlZ, and the documentation of persons who are still positive despite their assertion that they had been taking ivermectin on a regular basis; 2) maintaining conventional entomological evaluation in the Upper Oueme basin, and the conduct of a study on the source of seasonal re-infestation of this basin by infective female simulium; 3) integrating onchocerciasis and LF control prograrilnes; 4) preparing the cessation of SIZ activities. o The cross-border meeting between Benin and Nigeria held in Abeokuta from 17 to 20 July 2006; the conclusions are: 1) the need to set up entomo-epidemiological surveillance along the common border; 2) strengthening supervision and monitoring; 3) the need to identify sustainable funding sources; 4) holding the next cross-border meeting in ]uly 2007. o The partners' meeting on the future of onchocerciasis control in Africa; o Continuation of negotiations for signing the last aerial contract (2006-2007);

Then, participants were informed of: a the retirement in August 2006 of Dr Albert AKPOBOUA, former DTL/SIZ, and the recruitment in September 2006 of Dr Grace FOBI, former CDDT/SIZ, Ior the position of COP/APOC. The process of replacing them atSIZ is in progress; a the situation of SIZ staff members, who have already received end-of-contract notification for November 2006. The Management of APOC/SIZ is still negotiating with WHO/AFRO for a contract renewal dispensation for the entire SIZ slaff in2007; a negotiations entered into with the Rotterdam University for the use of the ONCHOSIM Model in predicting the epidemiological situation after 2007. a The development of a research protocol on blackfly movements between Sierra Leone, Guinea and Mali on one hand, and between Benin and Nigeria on the other hand. a The closure of SIZ in December 2007

5 C. GENERAL INFORMATION ON THE 4th SESSION OF THE SPECIAL ADVISORY COMMITTEE

The interim Deputy Team Leader of SIZ (DTL a.i.), in his speech recalled the role of the SAC, the mission of which is to advise the Management of AP@./S\Z andthe national teams in charge of onchocerciasis control activities in the SIZ on issues of surveillance/evaluation, control (ivermectin distribution et vector control), and also environmental issues. This multi- disciplinary committee is made up of a public health medical officer/epidemiologis! an ophthalmologis! an entomologis! a socio-anthropologist, an environmentalist and a specialist in entomology / public health.

The 4m SAC meeting (held in Ouagadougou from 13 to 16 June 2006) was attended by 4 members, namely: Professor (Mrs) Adenike Abiose, (specialist in epidemiology and ophthalmologist), Dr Christian Lev6que (environmentalist), Dr Andr6 Y6bakima (entomologist) and Dr Bernard Phitippon (entomologis! specialist in public health).

At this 4th SAC meeting, some observations and recofiunendations made at the 11ttr JAF session, following the presentation of the 2005 APOC external evaluation report and the report on the SIZ mid-term review and former OCP countries report were presented to participants:

o The CSA's proposal of holding a meeting of the 11 former OCP countries and the 19 APOC countries in order to discuss the strategy of onchocerciasis elimination from the continent.

o The need to maintain the gains of the former OCp. o The need to carry out good surveillance to ensure the sustainability of gains of the former OCP countries. In this connection, the MDSC will have to get the Lppropriate support to enable it provide all former OCP countries with effective surveillance. o Setting uP an effective inter-country mechanism to ensure a close linkage with APOC in the surveillance of onchocerciasis control activities in the whole of Africa. o Measures to be taken by WHO to ensure that SIZ does not lose its staff before its closure due to its own internal administrative regulations relating to staff contracts.

At this fourth SAC meeting, the presentation of progress reports from 2003 through 2005 and plans of action for 2006 was taken care of by four SIZ country coordinators; the coordinator of Ghana, who was absent, was represented. At the end of these deliberations, the following recommendations and observations were made:

a For vector control: 1) implementation by the Management of APOC/SIZ of the time table drawn up during the workshop held from 1 - 2March2006, and maintaining the technical assistance given by SIZ to the various countries; 2) preparation of the cessation of SIZ activities (filing, personnel, equipment, residual larvicide stock etc.) ;

6 a Maintaining conventional entomological evaluation on the Upper Oueme and organising a study on the origin of infective simulium in the basin; 4) enhancing hqman and material resources needed for the smooth functioning of the molecular biology laboratory of the MDSC with a view to increasing its entomological and epidemiological onchocerciasis surveillance capabilities; 5) Creating a Task Force on the pool screening technique and its applicability to the operational context. a With regard to CDTI, it had to do with: 1) the duration of CDTI, the timeliness of the second treatment round etc. ; 2) the aerial counting of villages/hamlets and hard-to- reach specific groups in the Oti basin (K6ran-Kara-M6) and on the Upper Oueme so they will be put under CDTI; 3) continuation of efforts at documentation of persons a that are alleged to be positive after regular ivermectin treatment in Guinea; 4) the inclusion of the region of Kolente (Sierra Leone border) in the SIZ by the NOCP/Guinea; 5) concerns expressed in relation to the use of "community relays" in Benin which could bring about low coverage rates; 6) concerns exPressed about the turnover of national coordinators in Benin ; 7) the risk of loss of contact between the NOCP and the districts and communities, following management and administrative problems in Benin; 8) the finalisation of agreements with SSI in Benin; 9) the rejection of tn" report of Ghana, once again deemed too incomplete by members of the Committee. To this end, the APOC Director will have to undertake a mission to find a definitive solution, with the highest health authorities of the country; 10) appropriate support in all aspects of CDTI implementation in Sierra Leone by APOC /SIZ;11) the financing of Sierra Leone by HKI and SSI until 2009; 12) the need to appoint an assistant to the coordinator of Sierra Leone; 13) maintainingf and or organising cross- border meetings (Togo-Benin, Benin-Nigeria, Guinea-Sierra Leone-Liberia).

a Regarding financing and resource mobilisation, the recommendations and observations centred on: 1) the respect of deadlines for the transmission of refurns by NOCP coordinatorc; 2) the separation, during expenditure breakdown, of credits awarded to national teams, of expenses pertaining to W}{O/SV teams or to specific activities such as vector control (northern Togo) ; 3) the request made to countries to honour the financial contributions listed in their respective budgets; 4) making available on a timely basis to NOCPs, contributions listed in the budgets of countries for onchocerciasis control activities; 5) creating in the countries a multi-disciplinary Task Force as a place of exchange and advocacy for onchocerciasis with a view to integrating and mobilising resources; 6) a quick drawing uP by each country of. a minimum budget for onchocerciasis control activities aftet 2007.

7 D FOLLOW-UP OF RECOMMENDATIONS OF THE FOURTH REVIEW AND PLANNING MEETING

RECOMMENDATIONS FOLLOW UP ACTIONS Rec. 1: Integration of LF and Oncho Control A11 the Oncho coordinators in the SIZ Programmes: a) That the LF and Oncho control countries are appointed also as LF control programmes be, as much as possible, integrated at prograrune coordinators except in Togo. In national leveI, in order to ensure heightened Togo, these two diseases will be always efficiency and efficacy;b\ That the officers of the two managed by two different programs. prograrunes work together with a view to ensuring However a focal point was named at a better synergy of action; c) That only one Mectizan national level for the coordination of all the order be placed with the supplier, MDP; to facilitate activities for a better synergy of actions and logistical management. resources management. Rec. 2: Each country keep a standard basic list of Benin: 1862 villages; Ghana: 247 villages; villages earmarked for treatment under CDTI, and Guinea: 2417 villages; that the said list be forward to the SIZ Management Sierra Leone: 8451villages. The list of in March 2006by the latest villages is available in the countries. Togo: 1,042 villages (list available) Rec. 3: Countries put emphasis on sentinel villages Efforts have been made by the national and catching points to be put under surveillance, and Oncho coordinators to follow as closely as which are on the list of sites selected by each country possible, this recommendation. The letters upon the closure of OCP, and examine the feasibility of Agreement for epidemiological of identifying new evaluation villages or catching evaluation take into account these criteria in points, in the event of environmental changes or selecting the villages earmarked to be population movements. evaluated by the Oncho coordinators.

Rec. 4: a) That Countries solicit financing from It arises from the various interventions that various partners in order to enhance CDTI, where seek of other sources of financing CDTI results would still be deemed unsatisfactory after the activities is ongoing. Concerning the end of SIZ activities in 2007; b) That CDTI be distribution of the ivermectin, the national undertaken in line with the criteria spelt out by the teams in their majority endeavour to respect ex-OCP in the areas where the results of entomo- the criteria of CDTI as defined by the ex epidemiological surveillance indicate a situational OCP. deterioration Rec. 5: The meeting encouraged all initiatives toward APOC/SIZ inforrned the Minister of Health the resumption of national CDTI-based of COte d'Ivoire of the decision taken during onchocerciasis control activities. The meeting the JAF11 in Paris to organise a meeting at recommends that this new opportunity in COte the ministerial level for the 30 African d'Ivoire be made known to the next JAF in Paris, oncho endemic countries to discuss future through the committee of Sponsoring agencies, so as orientation of onchocerciasis control to give rise to reflection on the various possible activities and the control of neglected options of future support by the SlZ, APOC, or other diseases. This forum may give the partners. opportunity to NOCP of Cdte d'Ivoire to present an advocacy document for a support to onchocerciasis control activities

8 in the country Rec. 6: The meeting recomrnended that the national TheSIZ area in the Pru river basin has been team of Ghana provide the elements necessary to re- re-defined now. Its include 7 districts and define the SIZ prior to the next CDTI activities in the 247 v illages/ communities Pru basin. Rec. 7: a) The Benin NOCP coordination ensure that The problem of municipal sanitation tax on ivermectin is put on the list of essential drug in ivermectin importation is definitively Benin, and explore the feasibility of using the already solved. Ivermectin could be imported now existing importation channels for these drugs; b) The in the country through WHO representative National Oncho Control Programme and APOC/SIZ in Benin without any taxes. should undertake an advocacy at the highest level to solicit from Benin authorities the application of international conventions, namely those of ECOWAS on essential drugs imported into countries of the sub- region, of which they are signatories, and which give right to waivers on drugs, such as ivermectin Rec. 8: It is recommended that, the NGDO The NGDO coordinator is invited to the coordinator be invited to SIZ review and planning present annual review and planning meeting meeting.

Rec.9: Given previous discussions relating, among Process is ongoing. A correspondence has other things, to plans to develop a brochure on been prepared by SIZ management and sent advocacy activities, in collaboration with the World to HKI headquarters to solicit their Bank and HKI, the meeting reconunends that this contribution in developing a brochure on recofiunendation be implemented, as soon as advocacy activities. possible, and that the document or the package of advocacy activities highlight the relations between "the impact of onchocerciasis control on the millennium development goals, and poverty reduction, under resource mobilisation. Meanwhile, the document written by HKI in the form slides will have to be distributed to participants of this meeting. (HKI/SlZlPartners) Rec. 10: The meeting recommends enhanced Process is ongoing collaboration between the usual partners and the OOAS, and encourages them to set up a discussion forum for decision-makers

9 E. INFORMATION ON ACTIVITIES OF THE MULTI.DISEASE SURVEILLANCE CENTRE (MDSC)

tr Introduction

In accordance with its mandate, the activities of the MDSC are centred on the surveillance of priority communicable diseases, including onchocerciasis and meningitis. In 2006, emphasis was placed on onchocerciasis surveillance in the countries of the former OCP, and on meningitis in 13 countries of the African meningitis belt. Technical and financial support was given to some countries for entomological surveillance. Field visits were undertaken by the entomologists of the MDSC in order to hold discussions with the national coordinators and central level health authorities, technical teams in charge of planning and supervision onchocerciasis surveillance activities, as well as village communities that collect vectors for the early detection of possible relapse of transmission of O. oolaulus. Advantage was taken of these visits to revitalize the vector collection networks through the selection of catching points and retraining of field actors. A study on the feasibility of elimination of onchocerciasis through the distribution of ivermectin in Africa, initiated jointly with TDR, is underway in Mali and Senegal. It is worthy of note that the MDSC undertakes also training in the area of epidemiological and entomological surveillance, data management, mapping and laboratory activities.

tr Onchocerciasissurveillanceactivities

The MDSC is currently using a network of sixty-nine (69) sites chosen on the basis of existing OCP points for the purpose of entomological surveillance activities in the 11 ex-OCP countries. The purpose is to avoid the risk of recrudescence through the continual monitoring of potential resumption of transmission due to localized relapse or the migratory behaviour of vectors and movements of human population from unclean to cleaned areas. Analysis are done based on fly samples received from each site (6000 recommended) to determine the infectivity rate in S. damnosum or screening lor Onchocerca aolaulus parasites. All results are shared with the different countries and control programs.

Between 2003 and 2004, MDSC was unable to undertake any significant activity beyond mailing and laboratory analysis of fly samples from a very limited number of countries. With the absence of significant funds, there has been a steady decline in number of sites providing fly samples and quantities of flies provided since 2003. Seven countries were able to provide flies from 24 out of the recomnended 69 sites in 2003. This number dropped to 18 sites from four (4) countries in 2004. Orly seven (7) sites from two (2) countries were able to provide samples of flies during 2005 (annexe 3).

The results of infectivity rate obtained from the vectors are summarized in annexe 4. Some real preoccupations raise from the point of Asubende in Ghana where the rate is 1.82 per 1000 while the threshold is 0.5 per 1000 (annexe 5). The team of Ghana should conduct investigations and control activities in the Pru area.

10 With the availability of some resources, it was possible to plan with countries and implement some activities in2006 (annexe 6). As at November 2006, six (6) countries provided samples from forty nine (49) sites.

MDSC laboratory carries identification for studies and for APOC studies on impact of ivermectin on transmission (annexe 7 and 8).

Support visits to countries are an integral part of the work. Visits have been carried out in 2005 and 2006 to Benin, Burkina Faso, Ghana, Guinea, Mali, Niger, Senegal and Togo to emphasize the need to reinforce entomological surveillance activities. There is currently on going collaboration with TDR to provide evidence as to the probability that onchocerciasis can be eliminated with Ivermectin treatment in endemic foci in Africa.

The perspectives for2007 are:

1. Conduct surveillance activities in the 11 ex OCP countriesby 2007 2. Continue to provide technical and financial support to national teams 3. Organize an inter-country meeting on Oncho surveillance 4. Conduct reflexions to make Oncho surveillance more efficient 5. MDSC will continue applied research activities that improve control and surveillance of onchocerciasis

Discussions

Discussions that ensued centred on the following points

a The early approval of the new plan of action of the MDSC; a The revitalization of catching networks, the selection of collection periods taking into account population dynamics and transmission periods, as well as the setting up of a reliable system for conveying samples to the MDSC laboratory after the closure of the SIZ. a The worrying situation of Ghana, considering the pool screening results, and the proximity of COte d'Ivoire at the mercy of a social crisis that has brought about the cessation of all activities.

ll F. REVIEW OF ONCHOCERCIASIS SURVEILLANCE/EVALUATION AND CONTROL ACTIVITIES IN SIZ COUNTRIES (INCLUDING NON-SIZ AREAS) FROM 2OO3 TO 2006, RESOURCES EMPLOYED AND PLANNING OF ACTIVITIES FOR 2007

BENIN

General points

Onchocerciasis control activities in Benin concern to date 51 out of the 77 communes in the country.Ot the 51 corununes, 11 make up the Special Intervention Zone.

CDTI Activities from 2003 to 2006

ln 2003, only one round of ivermectin distribution took place. From 2004 to 2006, the two annual rounds were conducted as planned. The geographic and therapeutic coverage rates recorded are as follows:

o 2003 - geographic coverage rate: 99.7% and therapeutic: 80.9To o 2004 - geographic coverage rate: 98.6% and therapeutic: 80.85% o 2005: geographic coverage rate:95.3% and therapeutic: 81,.7%

In2006, the following activities were conducted in the SIZ:

o A trainer of trainers workshop; o A session of training/retraining of 65 district nurses; o A session of training/retraining of 1000 CDDs; o Awareness-raising and treatment of populations; o Supervision of activities; o Prospection of villages and mapping of transhumance corridors.

Concerning the first round of ivermectin distributiory a total of 1752 villages were treated out of the 1862 villages in the SIZ area, i.e. a geographic coverage of 94 %.In the entire L1 communes,562436 persons were treated out of the 692996 rcgistered, i.e. a therapeutic coverage of 81..1.6"/o.

Overall, geographic coverage rates varied between 93 and 100%, except at Tchaourou (72.1,4'/"); and therapeutic coverage rates between 75 and88%.

Entomoloeical and epidemioloeical surveillance activities from 2004 to 2006

Regarding epidemiological surveillance, it only took place in 2004 and 2005. For SIZ villages, the longitudinal analysis shows a favourable trend, though in the non-SIZ area, one notes stagnant situations and even (a rise) worsening indicators that call for greater vigilance. The results are as follows: t2 In 2004, thirty-nine (39) villages were evaluated in the basins of the Koumongou/Keran, Penjari, Upper Oueme and tributaries: Zou,Sota, and Alibori:

o 25 out of 39 villages (64y.) have a prevalence and CMFL, both of which are nil o 10 out of 39 villages (25.6%) have a prevalence between 0 andS%; o 4 out of 39 villages (12.82%) have a prevalence above 5%; these are Kouporgou on the Kerary with a prevalence of '1,6.22%, Koutayagou on the Koumongou, with a prevalence of.6.74o/o, Monnongou on the Oueme, with 7.6% and Kolegou, with a prevalence of 6.6%.

The CMFL remained below 0.5 mf/skin snip everywhere

In 2005, fifteen (15) villages were evaluated:

o 8 out of 15 villages (53%) have a prevalence and CMFL, which are both nil o 5 out of 15 villages (33%) have a prevalence between 0 and5%; o 2 out of 15 villages (13.33) have a prevalence above 5%; These are Taconta on the Kerary with a prevalence of 6.9o/o (first round), Koutchoungou on the Koumongou with 5.1%.

The CMFL remained below 0.5 mf/skin snip everywhere.

In 2006, evaluations were not carried out because the Prospection Mission sent to the field realised that the villages selected no longer met the criteria (more than 2 000 inhabitants...etc.).

With respect to the entomological surveillance component, nine catching points were explored in 2003 and2004, with encouraging infectivity rates.

In activity implementation, the prograrune comes against problems, the most crucial of which is the dearth of resources. In light of this, it is worthy of note that the programme is also in charge of LF control. We are full of praise for the actions of SSI, which offered the national Coordination an amount of CFA 45,000,000 for 2006, and promised to purchase a4X4 vehicle for 2007.

In the non-SIZ areas in Benin, epidemiological and entomological surveillance and community-directed treatment with ivermectin activities are ongoing. Epidemiological surveillance was organised in2004,2005 and 2006. The results of activities point to an overall positive evolution of indicators. In 2006, all the evaluated villages have a standardised prevalence between 0 and L.3"/o, and CMFLs between 0 and 0.024 mf/skin snip.

On the entomological level, captures were made at three points in 2003, and at nine points in 2004. As regards 2003, the catching point of Kaboua shows an infectivity rate of 0.042 (lower than the threshold of 0.5); samples of the catching point of Atch6rigbe could not be analysed due to the insufficient number of flies. For 2004, the infectivity rate was lower

13 than 0.5 in all areas, where at least 6 000 flies (threshold at which the analysis is reliable is. In 2005, there were no simulium captures. Collection for 2006 is ongoing.

Nuisance control

The budget of the NOCP was increased accordingly to address this. The technical equipment is already available. Regarding larvicides, an invitation to tender for the purchase of BtH14 was publicized and offers were analysed by the contracts unit on 3 November 2006.

Resources

The NOCP of Benin in 2006 has financial support from four partners (WHO /SIZ, SSl, MDP, and State) as follows:

* wHo/srz (CDTI workshop, and Letters of Agreement) * SSI (CFAF45 000 000; training/supervisiory support) * MDP (drugs donation) * State (CFAF120 000 000: Oncho and LF)

2007 Plan of Action

The 2007 Plan of Action of the NOCP of Benin for the SIZ area, in addition to CDTI and epidemiological evaluation activities, provides for prospection of villages/hamlets and specific groups. For these objectives to be achieved, the NOCP will need financial support totalling FCFA 26300 000 (annexe 9).

GHANA

o Inkoduction

The National Onchocerciasis Control Programme of Ghana has been in operation since the devolution of the former Onchocerciasis Control Programme which was based in Ouagadougou, Burkina Faso. The present management assumed responsibility for the programme in 2003. The programme undertakes implementation activities in the Special Intervention Zone (SlZ), and other areas of hyper and meso endemicity outside the Special Intervention Zone.

The focus of the programme's activities is on Community-Directed Treatment with Ivermectin and epidemiological and entomological surveys with the support of Government of Ghana, partners, the Ghana Health Service and the endemic communities. Some other districts with endemic communities undertook both passive and active treatment with Ivermectin.

During the year under review the NOCP successfully signed a memorandum of understanding (MOU) with the Sight Savers International (SSI) to help support 3 non-SIZ

t4 regions i.e. Eastern, Ashanti and Volta regions with the implementation of Oncho control activities. Sight Savers International Ghana is already supporting the Western region with its Oncho control activities.

o Review meetings and CTDI workshop

A series of review meetings were held at the Easterry Brong Ahafo, Westerry Upper East and West regions to strategize for this year's CDTI activities. The importance of updating both the community list and populations prior to the distribution of Ivermectin, in order to have a fair idea of the geographic and therapeutic coverages, was stressed. The meeting thus reviewed activities carried out the previous year and agreed on strategies for integrating and mobilizing increased support for Oncho control activities prograrrune. The need for effective collaboration with other stakeholders was also stressed.

A CDTI strategy workshop was organized by the programme with support from APOC/SIZ in the month of August 2006 with participants from all Onchocerciasis endemic regions in Ghana. The main objective of this workshop was to strengthen CDTI activities in Ghana.

o Entomological surveillance

Entomological evaluation corrnenced in the following river basins since July 2006; Asukawkaw,Pra, Pru, Anum, Boiry \Atrhite Volta, and Kulpawn. This follows the extension of the traditional sites from 3 in last year to 8 this year to reflect the epidemiological picture of the country. Five (5) of the sites are followed up by dissection teams.

The prospection of sites, selection and training of vector collectors as well as sensitization of communities preceded black fly collection. The fly collection usually runs from July to November which is the period of highest transmission of black flies in the country.

It is evidently clear that fly collection this year has more than tripled compared to last year's collection apparently because collection is done over 5 days coupled with the number of capture sites. To date, Srgo in the Upper East region is the site which has not been able to attain the minimum of 6000 flies per site.

o CDTI implementation

In 2006, activities of cascading training including training of CDDs, sensitizatiory community mobilization, advocacy, complete enumeration of communities and distribution of Ivermectin were pursued both in theSlZ and non-SIZ areas.

Results of CDTI activities in the SIZ showed a geographic coverage of 77.7% and a therapeutic coverage of 63%. Offinso district, for obvious reasons, have scheduled the last week of November for its Ivermectin distribution exercise. It is interesting to note that9l% of

15 Ivermectin refusals (2,719) come from the Pru district. All but Techiman district failed to report on severe adverse events (SAE) thus making it difficult for the NOCP to effectively monitor side effects of Ivermectin in the communities (annexe 10).

o Epidemiological evaluation

In 2005, epidemiological survey undertaken in 9 communities in the Pru river basin in September showed some startling revelations. Community prevalence ranged from 0 - 25.7%. The overall prevalence stood at 10.4%. Of the 1187 persons surveyed 126 turned positive with males constituting 50.8%. Four out of 9 communities had prevalence above 5%, thus putting all such communities at risk for blindness.

In2006, Onchocerciasis evaluation in the SIZhas been scheduled to take place from the 27fl" of November to the 8ft of December 2006. However, the NOCP with the support of Sight Savers International (SSI), undertook epidemiological evaluation of the Oncho Control programme in the Eastern, Ashanti and Volta regions covering 24 communities from 4 to 25 September 2006.

Results of the survey demonstrate significant disease transmission in communities along the Anum, Pra, Kume, Densu and Asukawkaw river basins. Out of the 24 communities surveyed in the Eastern, Ashanti and Volta regions t had a standard prevalence above 5%. The highest prevalence was recorded at Gyankobaa 45.1,% with a micofilaria load of 2.89mf / skin snip, thus, posing a threat to communities in the Anum river basin. Another significant focal point of Onchocercal infection is the Pra river basin of which Apragya (37.1%) and Nkyesa (12.4%) showed a CFML of 2.l2mflskin snip and 0.56mf/skin snip respectively. The rates observed in the Asante Akim south district are 4 times of WHO's threshold of O.Smf/skin snip (nnnexe 11, 12 and L3).

On the other hand New ]uaben district in the Eastern region, not known to be endemic for Onchocerciasis, recorded a standard prevalence of 27.1,% and 22.7% at Densuano and Kwakyekrom respectively (annexe 11). Apart from that most persons in the surrounding communities had multiple Onchocerca nodules on their bodies.

In the Volta region low Onchocerciasis prevalence were observed at Anane, Pillar 83, and Sabram which are areas under CDTI in the Asukawkaw and Wawa river basins. However communities along the Kplaker river (Katafor Junction and Kunda), tributary of the Asukawkaw river in the Krachi East district, have shown marked signs of disease transmission. While Kunda recorded 0.8% Katafor Junction had standard prevalence of 9.9% (annexe 13).

Generally, the survey revealed that remote communities suffered poor progranune management and erratic distribution of Ivermectin tablets. Some CDDs worked in 3 to 4 communities as opposed to working in their respective communities. In order to make significant progress towards Onchocerciasis control in the country it is recommended:

t6 o That the Asante Akim South district be supported to administer 2 rounds of Ivermectin distribution in order to reduce the community parasite load at Gyankoba and Apragya

o That the New Juaben district is also supported to initiate CDTI as early as possible o Those communities are encouraged to select their own CDDs to distribute Ivermectin. The operational areas of the present CDDs should be re-demarcated in conformity with CDTI guidelines o That regions and districts strengthen their monitoring and supervisory roles of

Oncho control activities in the communities t o That all 52 sclero-corneal punches used by the NOCP be replaced as soon as possible to reduce the pain suffered by individuals during skin snipping

Challenges

The major challenges confronting the programme include delays in submission of reports from the districts and general apathy among regional and district health staff towards the prograrune. Blunt sclero-corneal punches and the use of programme vehicles which are not roadworthy impede our epidemiological surveillance activities and also monitoring and supervision. It is therefore recorunended that we embarks on an aggressive advocacy for programme support from all its stakeholders including the endemic communities and also ensure effective monitoring of all major river basins within the country.

SIERRA LEONE

Between 1991. and 2002 there was a civil war in Sierra Leone, which lead to a complete stop of all Onchocerciasis control activities. Results of epidemiological evaluation conducted in2003,2004 and 2005 show that the Onchocerciasis situation has worsened with prevalence as high as 68.8% in some areas and the disease has spread even to areas where it was not noted in the past. After the closure of the OCP in 2002, in 2003 Sierra Leone was included among theSIZ.

Due to poor management and planning, Onchocerciasis control activities were poorly implemented in 2003 and 2004. The therapeutic coverage was calculated to be 35% and 28% for 2003 and2}}Arespectively. The geographic coverage could not be calculated with the data that was available. By the end of 2004 the Ministry of Health and Sanitation (MOHS) decided to change the Prografiune Manager.

Change of Programme Manager of the NOCP was effected in February 2005. In April 2006, the NOCP organized a workshop on strategic reorganization of CDTI in Sierra Leone with the support of SIZ management. A11 Partners of the NOCP were fully represented at this workshop. It was decided among others that attention be given to sensitization on CDTI and

t7 the World Bank was asked to contribute in funding CDTI in Sierra Leone, especially sensitization activities.

The World Bank was to provide an estimated 85% of funds needed in 2005 for CDTI in Sierra Leone. Non-objection for start of World Bank funding was received in July 2005 and CDTI activities for 2005 started in August 2005. By December 2005 the NOCP had not started Ivermectin distribution in any district and activities for 2005 had to be extended to 2007. By May 2006, Distribution was conducted in only 3 districts using the CDTI method. In the remaining 9 endemic districts Health Workers, who were already trained on CDTI, were used to distribute Ivermectin. Therapeutic coverage was 54.8o/o (AtO= 55%), Geographic coverage was 64% (Target was 100%).

CDTI activities for 2006 started in June 2006 and by 7th November 2006 Training of Trainers (TOT) and training of health workers are already completed. Community meetings are also completed or ongoing in1-1, out of 12 districts; and CDD trainings in 4 districts are presently ongoing. 9 districts will start Ivermectin distribution in December 2007; and the remaining 3 districts will start in December 2006/lanuary 2007. A11 districts will complete Ivermectin distribution in February 2007.

2,149,463 treatments for Onchocerciasis &.1,,586,604 for Lymphatic Filariasis are to be conducted in 2006: 660,537 in only LF areas; '1,,223,396 in only Onchocerciasis areas; and 926,067 in Onchocerciasis /LF overlap areas. Additional40,000 treatments will be clinic based (in health facilities located in large towns). '1,,745,264 tablets of Albendazole and 8,550,000 tablets of Ivermectin are to be supplied.

Results in 2003, 2004 and 2005 are identical with no decrease in prevalence and transmission potential of the Black Fly. Results of 2005 indicate spread of Onchocerciasis to previously non- Onchocerciasis -endemic areas. Both Epidemiology and entomology activities are presently suspended and will resume after 3 rounds of Ivermectin distribution. Research on movement of the Black Fly between S. Leone, Guinea and Mali will commence early 2007.

The NOCP Sierra Leone developed a S-year Plan of Action (2006-2010) with AFRO on integration of Onchocerciasis, LF, Schistosomiasis and Soil transmitted helminthes (STH). A Budget was also developed for the additional activities for 5 years (2006-2010). It was agreed to start LF treatment in 6 districts in year 1 and add the remaining 7 inyear 2. Funding for the integration is expected from World Bank, Schistosomiasis Control Initiative (SCI), AFRO and WHO HQ. US$ 88,000 will soon be transferred to AFRO; the rest of the funding is now expected in May 2007.

WHO Experts and an International Certification Team (ICT) conducted 2 visits in ]uly and October to over 100 randomly selected villages in all the districts of Sierra Leone. No case of GW was discovered and all investigated rumours of cases were not confirmed. Findings also indicate there are minimal conditions for transmission of GW as protected wells were

18 discovered in72o/o of villages visited. For final certification of Sierra Leone as being free from Guinea Worm the following should be conducted:

o Nationwide search for the disease during Ivermectin distribution using questionnaires and pictures; o Zero Weekly and monthly reportingfor at least 1 year;

o Investigation of all rumours and prize money for detection of a case. o GW will be included in all trainings for Onchocerciasis and other integrated diseases. Very minimal extra funding is needed for activities that will lead to evenfu al certification.

The activities planned for 2007 are summarised in annexe-14

GUINEA lntroduction

In Guinea, the first Special Intervention Zones are found along the Upper Niger/Mafou and Tinkisso basins, and span the prefectures of Faranatr, Dabola, Dinguiraye, Kissidougou, Kouroussa and Siguiri, which contain a total of 2 417 villages served by 58 health centres. Following the epidemiological evaluations conducted in 2005 on the Kolente basin, Guinea made a decision to include village communities on the border with Sierra Leone in the SIZ (annexe'L5).

The activities conducted in 2006 are part of implementation of the plan of action of the National Programme for Oncho and Blindness Control (PNLOC). They had to do with:

o re-stocking the provincial directorates of health with ivermectin; . supervision of health centre workers up to the village level; o distribution of ivermectin in villages; . epidemiological evaluation of 30 villages, including 13 intheSIZ; o participation in the 4th session of the Special Advisory Committee of the WF{O/SlZ Programme held in Ouagadougou in June 2006; o Participation in the Partners' meeting on the future of onchocerciasis control in Afuica, held in Yaounde in September 2006.

Re-stocking DPS with ivermectin

Beginning February 2006, the PNLOC coordinator re-stocked the various DPS with Mectizan for the 2006 treatment round of 18 DPS, and for the first treatment round of the 9 DIIS in the SIZ area. In this connection, 6 432 500 Mectizan tablets were delivered. Besides, the SIZ areas also received in luly 2006,2507 500 tablets for the second treatment round.

19 Training of health workers

The training sessions took place at Faranah from 1, - 2 April2006, with the following participating in them: o 9 Doctors in charge of disease control in the DPS involved in CDTI; . 71. health centre chiefs of DPS mentioned above; o 10 Oncho workers working in the DPS of Faranatr, Dabola, Mamou, Gaoual, Kankan, Siguiri and Forecariah.

The training of CDDs using picture boxes proved to be of great importance, for the CDDs really appreciated this type of communication.

Suoervision of health centre workers up to villaee level

Objectives of the supervision exercise were to:

. ensure progress of the first treatment round of 2006; o determine the depth of knowledge of CDDs about CDTI; o raise the awareness of people on Onchocerciasis and its treatmen! o determine the extent of involvement of Sub-Prefects and Chairpersons of CRDs in the implementation of CDTI; . ensure the availability of management tools and examine the state in which they are.

During supervision, the team noted the following:

a there were two CDDs per village, often men who are not retrained here and there on the new integrated CDTI approaches (especially for screening of vision impairment); a availability of management tools (notebooks, measuring stick) in the villages visited. Distribution notebooks are not well filled out in some areas; a Weak supervision and re-training of CDDs by the health centre chiefs, according to the CDDs themselves;

a Involvement of sub-prefecture authorities in CDTI as part of the awareness-raising and mobilisation of the population for treatment.

Projected solutions

a Feedback was given to administrative authorities (sub-prefects and chairpersons of CRDs) in each sub-prefecture as well as to DPS and DRS teams; a Continue sensitisation of local authorities with a view to enhancing their involvement in the CDTI process where needed;

20 .] Since rural radios have a large patronage in the communities, the use of these media by the communities was strongly recorrunended for the propagation of these messages appealing to the village folk for the follow-up of ivermectin treatment.

Distribution of ivermectin in villages

In 2003, only one CDTI round was conducted, while in 2004, the second round of treatment could not take place due to a break in ivermectin stock, and an underestimation of ivermectin needs for the two rounds.

The geographic and therapeutic coverage rates from 2003 to 2005 in the upper Mafou- Niger basin and on the Tinkisso are as follows:

o 2003 - geographic coverage:98.88%; therapeutic coverage:77.7% c 2004- geographic coverage: 70.7%;therapeutic coverage: 49% o 2005 - geographic coverage:1.00%; therapeutic coverage: 80%. It is worthy of note that in 2005, new villages were discovered and integrated into CDTI.

In 2006, a total of 8,187 out of 8,233 villages were covered (i.e. 99.4'/. of geographic coverage) and2352398 out of 2959 406 registered persons received ivermectin treatment (i.e. a therapeutic coverage of 79%) inbothslZ and non-SlZ areas. The analysis of CDTI results revealed that only 46 villages in the zones were not treated, out of the 8,233 planned f.or, of which 15 are in Kindia, 2 in Kerouane,g in Mandiana,2inKouroussa and 8 in Gueckedou.

Results of the first treatment round in the SIZ were as follows: 100% geographic coverage (2412/241^2villages treated) and 79"/o therapeutic coverage/ i.e.635 653 persons treated out of the 800 797 rcgistercd.

Besides, the second round, which had to do with the SIZ only, recorded the following results: 3 218 out of the 3 221, villages planned for (i.e. 99% geographic coverage) and 890 233 out of 1,1,06 207 persons were treated (i.e. a therapeutic coverage of 80%).

Problems of Mectizan management were noted, namely in the DPS of Kindia and Kouroussa. Two villages were not treated at Kouroussa due to epidemiological evaluation.

Epidemiological Evaluation

In Guinea, the SIZ cover the river basins of the Upper Niger/Mafou and of the Tinkisso. Overall, the results in these basins are satisfactory. From 2003 to 2005, a total of 87 villages were evaluated there, with the following results recorded:

o 36 villages (41%) had a zero prevalence rate (0 %); o 46 villages (53 %) had a prevalence rate below 5%;

2t a 5 villages (6%) had a prevalence higher than 5%. They are: Boroto on the Tinkisso (6.6%); Walia Dabourou on the Niger (8.7%); Mamouria on the Niger (12%); Herako on the Mafou (5.3%) and Serekoroba (5.4) on the Mafou.

The CMFL remained below the threshold of 0.5 mf/skin snip

In2006, a total of 30 villages were evaluated using the skin snip method; 13 were in the SlZ, and 17 in the non-SIZ area in the Koulountou and Koliba basin.

The analysis of the data pertaining to the 13 SIZ villages revealed that standardised prevalence rates are very good on the Mafou/Niger basin (0.0% to 2.9%) and that of the Tinkisso (0.0% to1,.7'/,); CMFLs are all nil.

However, in the Koulountou basin, the results obtained showed prevalence rates of 0.00% to 1.6.94% in the DPS of Koundara, but the CMFL is everywhere below 'L microfilaria/skin snip (annexe 1.6).

Entomological Surveillance

Under entomological surveillance, the activities below were conducted:

o Sensitisation and training of interested health workers in charge of the L2 catching points; o Sensitisation of health and sub-prefecture authorities; o Recruitment and training of 24village vector collectors; o Capture of blackflies and supervision/ gathering of collected samples;

It must be emphasized that the results of captures are partial. Thus, at 6 out of 12 points, captures were interrupted or disrupted due to the absence of blackflies, and owing to the fact that breeding sites were completely drowned in September until mid-October. These are namely, the catching points of Balandougou, Diaragbela, Morigbedougou, Sansambaya, Badekanty and Pont Koulountou.

One needs to also note the disruption of catching, due to rains at the points of Yalawa, Balandougou and Kabanihoye.

Since 15 October 2006, activities have resumed and are ongoing at the points where the quantity of flies (6 000) required has not yet been obtained. Results of these captures will be reported on later at the end of November 2006 (annexe L7).

of Action for 2007

The Plan of Action and Budget for 2007 /2005 is in annexe 18

22 TOGO

General points

Togo's presentation at the 5th Review and Planning meeting of SIZ, held in Ouagadougou, Burkina Faso from 8 to 10 November 2006 is summed up in two components as follows:

a Results of onchocerciasis control activities in the SIZ and non-SIZ from 2003 to 2006; a Planning for 2007.

Results of iasis control activities in the SIZ and non-SIZ from 2003 to 2006

CDTI actiaities

Togo is subdivided into 30 prefectures, 28 of which are under CDTI; 11. of them are in the SIZ and 17 in the non-SIZ areas. O.Iy the two prefectures of Golfe and Vo are free from onchocerciasis. CDTI activities are undertaken in 453 health facilities - Peripheral Health Care Units (USP) and Polyclinics - of which 1.45 are in the SIZ and 308 are in non-SIZ areas.

ln the SIZ

CDTI was organised as planned (2 rounds/year) from 2003 to 2005. Geographic and therapeutic coverage rates from 2003 to 2005 are as follows:

. 2003 - geographic coverage98.87%; therapeutic coverage:84.75% . 2004- geographic coverage: 95.52%; therapeutic coverage: 85.35%. o/o. o 2005 - geographic coverage99.25o/o; therapeutic coverage:85.25

ln 2006, during the first round, 1 031 out of 'J.042 vlllages were covered (i.e. 99'/" geographic coverage) and 705 389 persons out of the 823 842 registered were treated with ivermectin (i.e. a therapeutic coverage of 86%).

In the non-SIZ areas

Overall, CDTI results are encouraging. Geographic and therapeutic coverage rates constantly improved, increasing from 97.70% to 100% for geographic coverage, and ftom77o/o to 85% for therapeutic coverage.

The other activities conducted in Togo under CDTI, from 2003 to 2006, had to do with training, sensitisation/mobilisation, follow-up/supervisiory and follow-up of specific grouPs:

23 . Training

1,179 health workers and 8 050 CDDs were trained from 2003 to 2006.

o Sensitisation /mobilis ation

Sensitisation and mobilisation activities were carried out during educative chats in health facilities, during mass sensitisation sessions and with local radio stations. These two activities enabled us to involve local authorities (prefects, mayors, general secretaries of prefectures, canton and village heads, opinion leaders) and their populations in the appropriation of CDTI activities and sensitise them on the advantages of taking ivermectin on a regular basis.

a Follow-up /supervision

This activity was conducted by officers on the following levels: coordination, regional, district and USP.

It helps to detect the lapses in performance, and to propose solutions

a Registration and management of specific gxoups

The specific groups are made up of gold-washers, Fulani nomads, sand and gravel winners, pit sawyers and fishermen. These persons have something in commory i.e. they live on a seasonal basis near rivers. They therefore missed treatments, either because they were absent during ivermectin distribution or they were excluded by the CDDs because they did not belong to the zotte. Thus, they constitute a potential reservoir of the parasite and pose a real danger to the native populations.

The NOCP registered and undertook epidemiological evaluations among the specific groups. The results of these evaluations revealed that fishermen make up the most dangerous sector, due to the high prevalence of their microfilarial loads: 13 positive cases out of the 52 examined, as against 1 positive out of the 34 examined among the Fulani. Prevalence rates are nil among the other specific groups examined (132 quarry workers, 3 gardeners, 47 functionary farmers).

a Aerial prospection and outcome

From 26 May to 26 June 2006, the National Coordination of Togo organised aerial prospections of villages/hamlets and hard-to-reach specific groups that are likely to be forgotten or ignored by field actors. Of the sample of 37 vlllages prospected, the results indicated that:

a Only 32% of the villages were treated, two months after the start-up of the first round of CDTI in April;

24 . 57% of the villages have not yet been treated; o 8% of the villages were not treated for at least two years; these villages do not have CDDs, and are located on the northern fringe of the Keran basin;

o 32o/o of the villages do not have CDDs; o 11 CDDs travel between 2 and 30 kilometres to go treat villages that have not CDDs; o In 4 villages, where there are CDDs (including a teacher), treatment has not yet started; o One case of shortage of ivermectin stock in a village, and 3 cases of late supply of the drug were noted in three villages;

. Only one case of discontent of a CDD was observed; o Insufficiency of population registration notebooks.

Given the sifuation, the NOCP took corrective measures as follows: recruitment of new CDDs, collaboration between CDDs, sensitisation of actors for making ivermectin available early, use of old registration notebooks, treatment of specific groups etc.

Epidemiolo gical and entomological Ea aluations

ln the Keran basin:

At Titira, prevalence went down from 39.1.%, with a CMFL of 0.90 mf/skin snip in 2000 to22.7%, with a CMFL of 0.19 mf/skin snip in 2003; Kpesside ferme from 50%, with a CMFL of 0.34 mf/skin snip in 2002 to 11.6o/o, with a CMFL of 0.16 mf/skin snip in 2005; Kpesside Narita, from a prevalence of 24.9% and a CMFL of 0.29 mf/skin snip in 2002 to 22.3%, with a CMFL of 0.27 mflskin snip in 2005.

ln the Kara basin:

The epidemiological evaluations conducted in 2006 in 4 villages indicated a marked reduction in the prevalence rate in the Kara basiry where results have been poor to date. At Tougel, the prevalence rate went down from 28.6%, with a CMFL of 0.19mf /skin snip in 2003 to 1,0.8%, with a CMFL of 0.04mt/ skin snip in 2006. The same evaluation was observed at Sikan from 2003 (prevalence: 39.9%; CMFL: 0.24mf/skin snip) to 2006 (prevalence:13%; CMFL: 0.17 mI/ skin snip) and at Kadjol (prevalence:10.1.% to 1%; CMFL: 0.10 to 0.04 mf/skin snip). At Sakpone, prevalence rate went down from 16.8% in 2003 to 4.5% in 2006. On the other hand the CMFL increased, passing from 0.13 to 0.28 mf/skin snip.

ln the principal Oti basin:

Both villages evaluated in 2006 have prevalence rates below the tfueshold of 5% (0 and 4.5%).

25 ln the Mo basin:

In 2006, the epidemiological evaluations conducted in 13 villages revealed that 5 villages had a prevalence below the threshold of 5% (varying between 0o/o and 3.8%), et 8 villages still had prevalence rates above 5% (between5.7% and21,.7%). A11 the CMFLs are less than 0.5 mf/ss (between 0 and 0.43 mt/ss). On the whole,T of the 13 villages evaluated showed a significant reduction in prevalence. An increase could even be observed in some villages (Koida 19.8% in 2000; 19% in 2003 and 20% in2006; Mo village,9o/o in 2000 with a CMFL of 0.05mf/ss and 8.6% wltha CMFL of 0.17m1/ ss in 2005).

ln the sub-basin of Kpassa-Koue:

The prevalence rates in some villages of the Kpassa-Koue in the non-SlZ area are on the increase.

Entomolo gi cal sur a eill an ce

Results of capfures and dissections carried out under the entomological surveillance conducted from 2003 to 2006 are found in Annexe 19.

Resources used

a) Human resources

Apart from the central level and WHO /SlZ staff based in Kara, human resources are mainly made up of:

a 5 regional districts health workers; a 28 prefecture districts health workers; a 1 500 head nurses and regional and prefecture CDTI officers; o 8050 CDDs;

b) Material resources

These resources are made up mostly of buildings housing state departments and the Oncho base in Kara; vehicles, equipment and materials, office supplies, water, electricity and telecommunication are put in place by the Togolese government.

c) Financial resources

The NOCP/Togo during the 2003-2006 period had financial support from 4 partners (WHO/SIZ, SSl, AFROPOC, STATE/COMMUNITY) amounting to CFA 239736 352 broken down as follows:

rt wrlo/sv cFA 65 7827]0

26 * SSI cFA 160 091,31,4 * AFROPOC cFA 2 062328 * Togolese Govt cFA 10 000 000 * Communities cFA 1 800 000

It must be noted that salaries of staff involved in onchocerciasis control, and the cost of equipment were not taken into account in the contribution made by the Togolese government.

Plannine for 2007

The projected Plan of Action of the NOCP/Togo for 2007 had three objectives:

a. treat 85% of the population in all the eligible villages of Togo in2007; b. determine the prevalence rates in22villages in 2007 inSIZ; c. control in2007 dam sites in the SIZ.

To achieve these objectives, the NOCP will need financial assistance in the sum of CFA 32667 536 (annexe 20).

Discussions:

Discussions centred on: o The discrepancies observed, especially in Beniry between good CDTI coverage and epidemiological evaluations, which still indicate transmission.

o The need to increasingly use the community mean microfilarial load, which is a more revealing indicator than the prevalence rate.

. The need to conduct epidemiological surveys at transmission points such as Kouporgou, of which the last evaluations date back to 2004, prior to the end of SIZ. This will enable an overview of the situation to be obtained before the closure. o The unsatisfactory results on the Kpassa-Koue tributaries of the Volta East Lake, and whether they belong or not to the SIZ in Togo. This sub-basin of the Volta Lake was not part of the SlZ, as effectively defined in 2002; the NOCP was asked to take the necessary measures as it did for the other non-SlZ basins. o Aerial prospection in Togo revealed villages/hamlets that are not covered by CDTI, the insufficiency and f or absence of CDDs in some communities, insufficient supervision etc. The meeting strongly recommended that this activity be conducted in Benin before the end of the year. o The low contribution of specific groups (Fulani, quarry workers...) to transmission observed during the epidemiological evaluations conducted in Togo. o The need to make available to the NOCP of Ghana previous epidemiological data bases of the country.

27 a The organisation of blackfly captures for pool screening, which will have to be conducted during the entire transmission period for a good appraisal of infectivity rates.

a The problem of replacement of field vehicles by the countries after 2007, and all related issues, particularly the continuation of activities, and the wish to have another institution to play the role of SIZ.

G. POST.OCP ACTIVITIES IN 2003, 2OO4 AND 2OO5 IN THE SIX COUNTRIES OF THE FORMER OCP THAT ARE NOT PART OF SIZ, AND ACTIVITIES PLANNED FOR 2007

NIGER

Niger was not represented at the meeting.

COTE D'IVOIRE

The onchocerciasis endemic disease extends on almost the entire Ivorian territory, and has epidemiological and strategic control characteristics depending on the zones. Overall, three big geographic regions have been identi2fied: The initial area, the south extension area and the forest area.

Right from 1974, a sub-regional onchocerciasis control progranune known as OCR implemented by the \zVHO and financed by the World Bank, the UNDP and FAO was set up. The objectives of the OCP were to reduce the prevalence of the disease, and to promote the resettlement and development of the areas freed of the disease.

Sixteen (16) years later, i.e. in 2000, onchocerciasis control was taken over by the national authorities as part of a devolution that was well prepared and implemented. The devolution exercise was materialised by the setting up of the National Onchocerciasis Control Programme, the THA, Bilharzias and LF (PNL-OTBF).

Since 200'1., COte d'Ivoire has the support of HKI, as part of its policy of diversification sources of financing of the health sector. The agreement between the Ivorian goverrunent and HKI asserts the willingness of both parties to strengthen onchocerciasis control through the implementation of CDTI in the whole country.

The hope that this political will brought was unfortunately shattered in September 2002 by the political and military crisis that divided the country into two, and caused the cessation of mass treatment for three years.

As a prelude to the resumption of treatment, we received in 2000 support in the form of equipment from HKI made up of measuring sticks, "pagivoltes", posters, small bills,

28 brochures, training manuals (doctors, IDE and ASC), registers, a lap-top computer, a printer and a photocopying machine.

The relocation of the Programrne, the loss of all equipment, the destruction of several health infrastrucfure, the mass movement of health workers toward the south, and the cut in the budget allocated by the state greatly disrupted our activities.

Thus, from September 2002 to December 2004, no control activity was conducted in COte d'Ivoire.

CDTI activities in the part under goverrunent of the South Extension area only resumed in January 2005. The results of this intervention (geographic coverage rate = 25.64% and therapeutic coverage rate :19.57%) were not up to the CDTI efficacy threshold.

At the end of 2005, an operational plan of action was drawn up for 2006, providing for the improvement of therapeutic coverage, through the extension of CDTI to all communities exposed to infection by Onchocerca aohtulus. Despite the palpable progress recorded, the coverage attained (geographic coverage rate = 43.28% and therapeutic coverage = 25.04y") did not meet the CDTI efficacy standard.

The insufficiency, late award and complex nature of the approval process of state budget are the three main reasons why the objectives of the 2006 plan of action were not met.

In the absence of the state-promised operating budget of CFA 40 000 000 Francs (rentals, electricity, water telephone, Interne! salaries of employees on contract etc.) and the implementation of the control of onchocerciasis and the four target diseases of the Programme, the financial contribution (14 295 300 Francs) of Helen KELLER International to the conduct of CDTI was critical.

Thus several planned activities could not be undertaken; these are:

* Support to the regions and districts for planning CDTI activities; * The overall entomo-epidemiological evaluation of the onchocercal endemic disease; * The setting up of the national coalition for the control of NTDs; * The sensitisation of political, administrative, traditional, religious authorities for their participation in onchocerciasis control in Cote d'Ivoire; * Social mobilisation; * The promotion of community participation.

For the 2007 fiscal year, we drew up, with the help of the WHO, a five-year plan of action incorporating the control of onchocerciasis, lymphatic filariasis, schistosomiasis and soil-transmitted helminthiasis. The cost of implementing this plan is estimated at CFA 3 954 000 000, i.e. US$79 080 000.

29 From this five-year action plan for 2007-2011,, we extracted a 2007 operational action plan, with the following main specific objectives:

t Build the capaciff of the national team in the area of epidemiological surveillance of onchocerciasis; the appointment training and provision of a state nurse, specialised in computer equipment; + Mobilise the needed material and financial resources for implementing activities. We plan conducting activities, particularly the mobilisation of funds from private enterprises, especially those operating in the agribusiness sector under what we term "the national coalition for the control of Neglected Tropical Diseases." * Carry out an overall entomo-epidemiological evaluation of the onchocerciasis situation; * Integrate CDTI into the routine activities of districts; * Promote community participation; * Improve the geographic and therapeutic coverage of mass treatment.

Given the estimated cost of the budget needed for a successful implementation of the 2007 onchocerciasis plan (CFA 134 000 000) and taking into consideration the dearth of the budget promised and the persistence of obstacles in the way of public expenditure outlay, the implementation of the 2007 plan of action relating specifically to onchocerciasis control risks once again to be dependent on the success of resource mobilisation from multi-lateral partners, NGOs and private businesses.

BURKINA FASO

Onchocerciasis is no longer a public health problem in Burkina Faso. Prevalence is far below 5%, and incidence rates are almost nil. The infectivity rate of blackflies collected in the various river basins are below 0.5/1000.

Activities conducted in 2006 meant to maintain the gains of the former OCP had to do with epidemiological evaluatioru CDTI and entomological surveillance.

Epidemiological evaluation started on 6 November in the health region of the "lJpper Basins;4 basins were involved (Dienkoa, Mouhoury Comoe, and Leraba). Another evaluation is planned to start on 8 December in the sentinel villages of the Oti-Pendjari, Nazinon, Sissili, and the Bougouriba. It must be recalled that 20 villages located in the river basins of the Bougouriba, the Mouhoun, the Leraba and the Dienkoa had earlier been visited in 2005. Out of 8,726 persons registered, 4349 were examined and 4 tested positive after skin snipping (0.09'/.). As usual, all persons testing skin snip positive, and for who there was no counter- indicatiory were treated.

In June 2006, a first mass treatment with ivermectin under CDTI was conducted in the health districts of Batie, Dano, Diebougou and Gaoua. On the whole, 156,178 persons were registered, of which 132,529 were treated, i.e. an average therapeutic coverage of.84.9o/o. The

30 second round is planned for ]anuary 2007, to be conducted concomitantly with the treatment of LF.

Since August 2006, blackflies are being collected at 10 sites distributed over the Nakembe, the Nazinon, Sissili, Bougouriba, Bambassou, Mouhoun, Comoe, Nemo and the Leraba. A1l the flies collected will be sent to the Molecular Biology Laboratory of the MDSC to determine their infectivity rate. It must be recalled that the infectivity rates of 45,752 flies examined in 2003, were on the average ten times lower than 0.5/1000, a threshold below which it is considered that the results are good.

For 2007:

o The sentinel villages of the Oti-pendjari, Nazinon and Sissili basins, which were not visited in2006, will undergo epidemiological evaluation in2007; o Regarding the CDTI, only villages of the health region of the South East will be involved in the 2 rounds will be progranuned (June, December). o Entomological surveillance activities will be conducted at the sentinel sites, where the number of blackflies collectedin2006, might not have enabled the determination of the infectivity rate. Two supervision sessions (Iuly, December) will be conducted in 2007 in each of the four health districts of the health region of Gaoua. Financial support:

Ln2006, the NOCP had no WHO financing during the2006/2007 Biennium. However/ the MDSC in2006, financed the collection of blackflies at 10 sentinel sites.

MALI

Obiective

Onchocerciasis control activities are conducted in Mali as part of efforts to maintain gains of the former OCP so as to avoid any recrudescence of the disease.

Shategies

The strategies chosen are:

a Epidemiological surveillance based on the active evaluation in indicative villages, and passive evaluations in health facilities for the early detection of any relapse of disease transmission; a The distribution of ivermectin under CDTI for treating the maximum of communities; a Entomological surveillance based on the captures/dissections and the blackfly pool technique for determining the infectivity level of flies;

3l . Ground larviciding to interrupt the infection transmission chain and to control blackfly nuisance in communities living at some sites of socio-economic interest; o IEC to involve administrative, political and community authorities concerned by onchocerciasis in control activities; o Capacity building of structures in charge of onchocerciasis control in terms of logistics, materials and equipmen! o Enhancing the skills of health staff and communities involved in onchocerciasis control; . Operational researcfu

Expected outcomes

o The epidemiological status of sentinel villages and follow-up is known; o Ivermectin is available in the health facilities, communities and at-risk areas are treated; o The entomological status of basins and tributaries under surveillance is known; . The residual activities of onchocerciasis control are integrated into the national health system; o The financing of onchocerciasis control activities is assured; o The capacities of facilities and skills of those in charge of onchocerciasis are strengthened; . Onchocerciasis control activities are regularly followed up and supervised; o Village communities participate in onchocerciasis control.

Indicators of follow-up

o Prevalence; o The CMFC; o The availability of ivermectin in the health facilities and in communities; o The Annual Transmission Potential (ATP); o The infectivity rates of blackflies; . The geographic and therapeutic rates of villages under ivermectin treatment; o The operational plans of health facilities that have taken into account residual activities of onchocerciasis control; o Funding obtained by virtue of operational plans (OP) of health facilities.

Results obtained from 2002 to date

The results obtained are satisfactory as per the results indicated below, which are centred mainly on epidemiological surveillance/evaluation, entomological surveillance /evaluatiory ivermectin treatment under CDTI, IEC, capacity building of periphery health facilities, and collaboration with organisations and other countries involved in onchocerciasis control:

32 Epidemiology

o One central team and five regional teams of Oncho epidemiological surveillance are available;

a About thirty indicative villages are followed up on a regular basis. The last epidemiological evaluations conducted from 2002to 2006 on all the river basins that are under control (Niger and tributaries: Farako, Lotio, Banifing IV, Kankelaba, Baoule, Bafing, Bakoye, Faleme, Senegal and tributaries) showed prevalence rates ranging from 0 to8.4%) and CMFLs between 0 and 0.54.

Entomology

o An entomology team is available at central level; o At the 4 catching points, which are followed up on a regular basis in the Niger basiry ATPs have been lower than 100 since 2002; o Entomological impact studies on larviciding, and ivermectin distribution on transmissioru and studies on the early detection of recrudescence of onchocerciasis are conducted in the basins, which used to be under OCP control. The last studies, conducted in 2005 in the basins of the Bakoye, Bafing, Farako-Lotio, and Baoule West and East revealed infectivity rates lower than one (1).

laermectin treatment under CDTI

a The health personnel of 13 circles and 2 health zones are involved in CDTI;

a More than 6000 CDDs are available;

a 3524v1llages are under treatment in 1"3 circles, and 2 health zones with a minimum therapeutic coverage of 65%. In 2005 for instance,1,664 863 persons were treated out of the 2 046023 registered (i.e. 81,.37% therapeutic coverage). The provisional results of 2006 already indicated that L464 864 persons were treated out of the 2036 023 registered (71,.95% therapeutic coverage);

a About five million (5,000,000) ivermectin tablets are ordered and received every year from the MDP for treating corununities. In 2005, 4 470 7L4 iverrnectin tablets were distributed. 7 303 500 tablets received in 2006, are being distributed for a simultaneous treatment of onchocerciasis and LF.

IEC

Educative materials on onchocerciasis (Pagivolte, audio and video micro programmes) are available in health facilities at community level

JJ Reinfor ce ment of s tr u ctur e s

o The CDTI implementation training modules for personnel in the social and health field, and the booklets on ivermectin distribution for CDDs are available;

a Activities are followed up through integrated supervisiory which are sometimes underpinned by specific supervision and quarterly meetings of districts, half yearly regional meetings, and the annual review meeting at central level;

o The five (05) regional Oncho surveillance teams were provided with technical equipment.

Collaborafion with organisations and other countries iruaolaed in onchocerciasis control

NOCP officers take part in various stafutory meetings of APOC, evaluation and monitoring missions of CDTI projects in APOC countries, and in the study on the feasibility of onchocerciasis elimination through ivermectin treatment only, a study initiated by wHo/TDR.

Operational Research: TDR study on the feasibility of eliminating onchocerciasis with laermectin

a The NOCP conducted some activities in the Bakoye and Faleme basins in the circles of Kita and Kenieba, in collaboration with TDR, APOC, SIZ and the MDSC, which led to the evaluation of the impact of 1,6 years of ivermectin treatment in the study zone;

a The involvement of health and community authorities in the study, after being informed and sensitised by the Kaye region and circles of Kita and Kenieba; this facilitated the implementation of prospection of access roads to the identified catching points, the mapping of villages, the epidemiological and entomological evaluation and field supervision; a Despite the bad state of roads, two (02) teams were able to work on the field. Eight (08) catching points were explored. More than 45 000 blackflies collected were transported to the DNA laboratory of the MDSC for infectivity rate evaluation. Forty (40) villages in the Bakoye and twenty (20) in the Faleme basins were evaluated; the overall prevalence obtained are satisfactorf , and are 0.26% (Bakoye) and 0.85% (Faleme) respectively. In both basins, the CMFL are nil, twenty-nine (29) persons were found to be nodule carriers.

Strengths

These are mainly:

a The decentralisation and integration of onchocerciasis control into activities of the regions and circles;

34 a The provision of some necessary resources for onchocerciasis control by the state and its partners, through the Operational Plans (OP) ;

a Partnership around CDTI.

Weaknesses

The main ones are:

o Insufficiency of and lateness in mobilising funds from the state and other partners for implementing onchocerciasis surveillance activities during the indicated periods; . Inadequacy and old state of logistics at the Coordination office of the NOCP; o Some field difficulties are also encountered during onchocerciasis control. These include the unstable situation of some CDDs, the lateness in submitting ivermectin treatment results from the village to the health centres, and from these to the regions and central level, the inadequacy of supervision from the regions to the circles, and from the latter to the health centres, the refusal of some communities to submit to skin snipping, and blackfly nuisance sometimes reported in the basins where larviciding is suspended (the Niger mainly).

Conclusion

Onchocerciasis is generally brought under control in Mali, but since one cannot talk about it being eradicated, there is need for vigilance to maintain and consolidate the gains made, in order to avoid recrudescence of the disease, following the closure of the WHO/OCP Programme on 31 December 2002.

The feasibility study on the elimination of onchocerciasis with ivermectin is underway in Mali.

Prospects for 2007

To succeed and guarantee thnt gains are maintained and consolidated, we need to undertal

a Make sure of financing, and its availability to all levels of funding of all activities planned in the various operation plans (OP) of health services so as to control onchocerciasis; o Continue and strengthen integration of all residual onchocerciasis control activities in the minimum activity package (MAP) of periphery health facilities, with the support of regional and central levels;

o Maintain partnership with other countries, NGDOs, communities, the MDSC, and other development institutions interested in onchocerciasis control.

35 For the continuation of the feasibility study on the elimination of onchocerciasis with iaermectin:

. a more complete report will be presented to the next JAF inTanzania; o A discussion and analysis meeting on available results of all actors involved is planned for Ouagadougou in January 2007; o The experimental cessation of ivermectin treatment in the Bakoye and Faleme basins will be effective if available results confirm the ONCHOSIM model predictions for the interruption of transmissiory i.e.: - Prevalence of 11-o/o in9}o/o of villages evaluated; - Infectivity of . 1 fly with larvae of stage 13 per 1000 parous flies at all catching points.

GUINEA BISSAU

Guinea Bissau was not represented at this meeting

SENEGAL Introduction

The closure of OCP in December 2002 was characterised by a strong commitment to maintain and consolidate the gains of several years of onchocerciasis control. Decisions were made at the highest level to allocate substantial budgets to the NOCP. The Prograrune coordinator, formerly based in Dakar, was transferred to the onchocerciasis zone in July 2001 as chief medical officer of the Tambacounda region for better management of the closure of the OCP and the post-OCP period.

The epidemiological data available at the closure of the programme were good, and CDTI was being implemented normally. A project for integrating Primary Eye Care into CDTI projects was set up in partnership with NGOs for improved eye care managemen! and the use of the community intervention strategy for the benefit of the community, beginning 2004.

Four years later, though the gains have well been consolidated, problems have cropped up and are gradually placing onchocerciasis in the group of neglected diseases. It is, perhaps, an opportunity to take advantage of the WHO orientation to once again support the control of these diseases, including onchocerciasis.

CDTI Activities

Geographic and therapeutic coverages from 2003 to 2005 varied from 95 to 100% and from 79 to 81.% respectively (annexe 21).

CDTI results of 2006 are not yet available

36 Epidemioloeical Evaluations

The results of epidemiological evaluations are in annexe 22.

Support activities

Training From 2003 to 2006, only one series of training was offered to health workers under Primary Health Care in CDTI projects. We could not conduct training or re-training for CDDs; these training sessions will be prioritised for 2007.It must be noted, however, that the new CDDs have general on-the-job training prior to distribution; the same goes for the new health post chief nurses. The mode of financing of the State for implementing these training activities is to be reviewed.

Superaision Integrated supervision was conducted on all levels, with the financial assistance of OPC and the national budget (in the form of fuel). These supervision exercises were conducted by the Coordination office, and by district teams. As part of the consolidation of onchocerciasis control gains, it would be proper to allocate more resources to these supervision activities.

Financing of control actiaities o Government of Senegal The state allocated an annual budget of CFA 70.5 million in 2003 and2004. The amount has gone down to CFA 30.5 million since 2005, thus posing financing problems to control activities. This budget, due to constraining administrative disbursement procedures, has only been used to finance the purchase of equipment for district management teams and for the Coordination office.

o OPC The Organisation for the Prevention of Blindness "Organisation pour la Pr6vention de la C6cit€" (OPC) is the only NGO supporting CDTI implementation in Senegal. In the post- OCP period, this support went to supervisiory coordination and collection of data through incentives given to health post chief nurses. OPC financed training sessions meant for health workers under the integration of Primary Eye Care into CDTI projects. During these training sessions, a component was devoted to CDTI and another to Primary Eye Care.

o Other forms of assistance Apart from state financing and that of OPC, the NOCP does not get any other assistance. Financial support from the country WHO office, under the AFROPOC Fund would be appreciated. The funds given by WHO/TDR under the implementation of the feasibility study on the elimination of onchocerciasis with ivermectin helped to conduct epidemiological evaluations in 66 villages in the Gambia and Faleme basins. This enables us to

37 better appraise the situation in the target area. An evaluation will be conducted in2007 by the project in the non-target area.

Changes in the endemic areas after closure of OCP

Re- demarcntion of T ambacounda Region Two re-demarcation exercises of the Tambacounda region took place in 2005 and 2006, which raised the number of health districts from 4 (Goudiry, Kedougou, Tambacounda and Velingara) to 9, following the creation of 3 new onchocerciasis endemic districts (Dianke, Makha, Kidira and Saraya). This brings the number of endemic districts to seven (7).

Reduction in state budget Upon the closure of OCP in December 2002, a budget of CFA 70.5 million was allocated and executed in 2003 and 2004 as part of a project for maintaining control gains. Beginning January 2005, this budget was drastically cut back to CFA 30.5 millions, i.e. a reduction of 56.7%.

At the WHO country office, the prograrrune did not get financing as part of AFROPOC Funds. All these factors show the lack of interest that is increasingly being shown in mobilising resources for onchocerciasis control.

Maintaining the national Epidemiological Eo aluation Team At the onset Senegal opted lor a single national team to undertake epidemiological evaluation activities in the network of 73 villages of the Gambia and Faleme basins. This arrangement was maintained.

lntegration of Primary Eye Care into CDTI projects Under the integration of Primary Eye Care into CDTI projects, the NOCP and the National Blind Control Programme set up the SF 935 Project, with the technical and financial assistance of OPC and Lions Club. This project aims to detect cases of partially sighted persons during CDTI activities, and also trachoma lesions and cataract cases. These ailments had appropriate therapeutic care with arrangements for picking up costs (ophthalmologists, ophthalmology technicians, logistics, equipment and infrastructure).

Planned activities for 2007

An annual technical review of Oncho control activities is planned for the '1,4,15 and1,6 November 2006 at Tambacounda. The objectives of the review are: 1. Take stock of activities of the NOCP in 2006 (CDTI, Epidemiological evaluations, Entomological impact studies, training, meetings) ; 2. Assess Implementation status of the SF 935 Project of integration of Primary Eye Care into CDTI projects;

38 3. Draw up Plans of Action for 2007, to be done by the districts for the Coordination office; 4. Address miscellaneous issues.

Invitations and notification to attend have already been sent out, and the review will be financed by the OPC in the amount of CFA 3737 740 (three million seven hundred thirty- seven, seven hundred and forty). Activities lor 2007 will be planned during this review meeting.

Constraints and difficulties

Problems relating to CDTI implementation mainly have to do with the frequent movement of health staff necessitating the repetition of training sessions. The financing of training was essentially taken care of by OPC, since the state budget could only do this through contracting with a training institution (which is not easy to find outside the health system). Thus, the major part of the state budget was used solely for the purchase of equipment for the district management teams and the Coordination office.

Also, it could be noted that the health workers are slightly worn out in the control of onchocerciasis as the disease is about to be eliminated in Senegal. The next Annual Technical Review could be used for exchange of. ideas so as to give more impetus to the control effort. It must be noted that the last Review dates back to August 2001,; this is one weakness of the Coordination office.

The difficulties relating to the mobilisation of funds of the State to conduct training (health workers, CDDs) constitute a major constraint to which we're finding a solution. Training/ re-training of CDDs is planned for 2007.

Conclusion

Onchocerciasis control is well integrated into the health system. There is even an initiative for integrated management with issues of eye health care. It is necessary to have sensitisation and mobilisation of all the actors involved in onchocerciasis control in Senegal, if the excellent results already obtained are to be maintained. Still as part of the maintenance of gains of the former OCP, a cross-border meeting with neighbouring countries (Mali, Guinea Bissau and Guinea Conakry) is an opportunity, which in the long term ease the definitive control of onchocerciasis in the sub-region. Finally, much more flexibility in the use of the state budget could help in enhancing CDTI implementation.

Discussions All these presentations gave rise to very fruitful discussions on the following points: . The important issue of integrating activities into the health systems, and the total participation of health districts and regions and their full involvement in the elaboration of various budgeted plans of action. This issue was already discussed at

39 the last review and planning meeting; unfortunately, all the presentations showed very little interest in it. a There is need to ensure some linkage between onchocerciasis and the other neglected tropical diseases. This could allow the various NOCPs to take advantage of the resources allocated for the control of these neglected tropical diseases. Efforts should be made in countries where this is not yet realised.

The integration of primary eye care into CDTI activities, thanks to the financing of OPC and SSI in Senegal, Guinea and underway in Mali. Community health workers detect the partially sighted during CDTI activities. These partially sighted persons are referred in order to benefit from in-depth eye tests and cataract operations. Thus, more than 5000 cataract cases were operated upon in two and a half years of activity. In Guinea, more than 8000 cases of partially sighted were detected in 2005. According to the representative of OPC, this integration is consequent upon the recommendation of the JPC of December 2002 relating to the integration of other activities into onchocerciasis control, with a view to continuing fund mobilisation to ensure the sustainability of gains of the former OCP. The Coordinator of NGDOs expressed the wish that the excellent results obtained in the integration of activities could be used in advocacy.

The study on onchocerciasis elimination through ivermectin alone underway in Mali, Senegal and Guinea Bissau. o Improving the operational plan of action presented by COte d'Ivoire. The national coordinator was requested to transform some objectives into activities. Similarly, the plan for integrating the African Human Trypanosomiasis (AHT) into other diseases may pose problems in its application. This is because, if some diseases to be integrated have the same targets and drugs, the same cannot be said of the AHT, which is a very peculiar disease, the medicine of which is already a problem. It was the wish of participants that management of several diseases by the National Coordination would not hamper the actual implementation of CDTI in the country. o The expiry of 456 000 ivermectin tablets in COte d'Ivoire, despite efforts made by the MDP to try and supply other Coordination offices with ivermectin. Participants called for gteater collaboration among the various NOCPs in future in the management of Mectizan so that residual stock may benefit those who have additional needs. The Coordinator was asked to consider the social situation of the country in the next orders for ivermectin, so as to avoid such situations. o Low CDTI coverage, lack of motivation of CDDs and health personnel, and the weak participation of district management teams in CDTI activities; this is a great risk to the maintenance of activities in COte d'Ivoire.

40 o The security issue in the northern part of COte d'Ivoire; the coordinator informed participants that health personnel did not face any security problem. CDTI activities had even been conducted in the regions of Montagnes and Worodogou in areas under rebel occupation.

a Updating of epidemiological data in COte d'Ivoire; The TL/SIZ informed participants that a working session would take place immediately after the meeting between Dr Dogbo, NOCP/COte d'Ivoire and Dr Diallo, NOCP/Guinea Conakry, with the support of APOC/SIZ and MDSC, with a view to drawing up an action plan and budget to be submitted to partners, for restarting activities in COte d'Ivoire. Some partners are said to be already interested in the project.

a The need for Cdte d'Ivoire to identify a qualified person to manage data, if the country does not yet have a data manager. APOC/SIZManagement is prepared to have the candidate come to Ouagadougou to undergo the appropriate training. The incumbent may learn about existing databases, and take along all available data on COte d'Ivoire.

H. FINANCING OF ONCHOCERCIASIS ACTIVITIES IN THE SIZ

In the absence of the representative of the World Bank, due to ill-health at the last minute, the TL handled this item. Dr Laurent Yameogo indicated that at the closure of OCP, an amount of about US$ 12 millions (Trust Fund) was available to finance activities in the SIZ from 2003 to 2007. At the time of reporting, about US$ 3.5 millions was available. An amount of US$ 25 000 would be used to audit the "Trust Fund". The remainder would be used to finance the closure and normal activities of SIZ.

I. PROGRESS REPORT, RECOMMENDATIONS AND CONCLUSIONS OF 2006 MEETINGS OF THE NGDO COORDINATION GROUP

Dr Tony Ukety, Responsible Officer in charge of the NGDO Coordination Group for onchocerciasis control presented a progress report of the Group for 2006. The report centred on the make-up and purview of action of the Group, the mission undertaken in Ghana and Togo, the salient points of the 28m session of the Group, held in September 2006, and the challenges to be taken up.

The Group is made up to date of 12 members: Christoffel-Blindenmission (CBM), Helen Keller International (HKI), Interchurch Medical Assistance (IMA), Light for the World (LW), Lions Clubs International Foundation (LCIF), Mectizan Donation Program (MDP), Mission to Save the Helpless (MITOSATH), Organisation pour la Pr6vention de la C6cit6 (OPC), Sight Savers International (SSI), the Carter Centre (GRBP), United Front Against River Blindness (UFAR) and US Fund for UNICEF.

Five members of the Group: HKI, LCIF, MDP, OPC and SSI support CDTI activities in 10 of the 11 former OCP countries, except Guinea Bissau, which has just requested the

4t intervention of SSI effective 2007 to assist the country in onchocerciasis control. A mixed APOC/ONGD mission is scheduled for February 2007 to consolidate this new partnership. It is to be noted that members of the Group support 12 APOC countries out of 16, where mass ivermectin treatment is conducted. Angola, Gabon, Malawi and Chad do not benefit directly from the support of Group members. However, CBM has accepted to support a CDTI project in Angola beginning 2007.

Overall, ivermectin therapeutic coverage is very encouraging, over 80To, except in COte d'lvoire and Sierra Leone, which still had rates lower than 65o/o. Group members are also involved in the integration of other interventions, such as the elimination of LF, Vitamin A distributiory malaria, schistosomiasis and guinea worm control, and finally primary eye care. Since 2005, some members have also been integrating de-worming prograrrunes through the joint distribution of Albendazole and ivermectin.

Finally, during the 28ft session of the Group, which was held in September 2006 at the WHO Headquarters in Geneva, members of the Group held a joint with their counterparts of the LF NGDO Network. Participants discussed conunon issues on the integration of onchocerciasis control activities and LF elimination. The next meeting of the Group will be in March 2007, and will also be joint as that of September 2006, but will be in conjunction with the NGDO of International Trachoma Coalition. Apart from the common issues, participants also discussed the US$ 100 million subvention offered by USAID to RTI under the new initiative on Neglected Tropical Diseases (NTDs).

Challenges include the difficult situation of onchocerciasis control in war-torn or post- conllict countries, particularly COte d'Ivoire, coordination of funds under the new NTD initiative, the fact that donors show lassitude toward onchocerciasis control, seen as an isolated and vertical programme, and lastly the harmonisation of ivermectin treatment data in the former OCP countries.

Discussions

Discussions after the presentation centred on:

a The weariness of donors in financing onchocerciasis control activities. The NGDOs are looking for other sources of financing to continue their support for Oncho activities.

a USAID making available a subvention of US$ 100 million to countries for the control of Neglected Tropical Diseases. For the first year, Uganda, Burkina Faso, Ghana, Mali and Niger are to benefit. Countries were requested to be present at the meetings initiated as part of the offer of the subvention to defend the position of onchocerciasis control.

42 I SUPPORT OF PARTNERS FOR ACTIVITIES FROM 2OO3 TO 2006 AND PROIECTTONS FOR 2007 tr wHo/slz

Results of the WHO/SIZ support from 2003 to 2007 are in annexe 23

tr MDSC

The intervention capacity of the MDSC in countries has been weak these first four years, due to consistent lack of funds for the centre. However, beginning 2005, the MDSC initiated a strategy of consultation with countries so as to provide support to strengthen entomological surveillance of onchocerciasis. This strategy is based on the system of requests. Requests with budgets are made by officers in charge of surveillance in the countries, following discussions with the Centre. These requests are then financed by the MDSC through the WHO country office. The objective is to resume blackfly collection, enhance entomological surveillance, and further involve communities in the conduct of activities. In 2006, Togo, Benin, Burkina Faso and Niger had technical assistance from MDSC. With the new strategic plan of the MDSC, which has just been finalised, the Centre hopes to have consistent financing in the years to come in order to continue and enhance the assistance given to the countries.

SSI

Sight Savers now work in 10 Countries and Supports Onchocerciasis in 9 Countries in the Sub region as follows:

Benin, Cameroory Gambia, Ghana, Guinea, Liberia, Mali, Nigeria, Sierra Leone, Togo, We also will be working in Senegal and Guinea Bissau,

Sight Savers primarily is interested in the Prevention of Blindness. As a major area of interest for us in Nest Africa is Onchocerciasis Control. This is evidenced by our heavy involvement in CDTI having Co-piloted Community-Based Ivermectin Treatment for mass treatment.

For the period 2003 - 2006, our support has essentially been in supporting partners in CDTI in the following areas:

43 For the foreseeable future, we will continue to maintain our Support at not less than what we have done so far in partnerships. Sight Savers now plans exhaustively with partners and consequently are aware of national plans. By practice we have now 3 to 5 year plans by country. We will continue our advocacy efforts in Support of Onchocerciasis Control.

The other partners present did not make any presentations, since their intervention had already been presented by the countries.

Discussions

Discussions after the presentation were on:

rI The effective application of WHO resolution 159.25 relating to eye care, already ratified by 46 country ministers. Advocacy toward Health Ministers was requested in order to encourage countries (especially in West Africa) to massively support this resolution; this could encourage WHO to effect its application.

K. IVERMECTIN TREATMENT (MULTI-ANNUAL TREATMENTS, RESISTANCE TO IVERMECTIN)

a Multi-annualtreatments

The various presentations could not show a marked difference in impact on transmission, which may exist between annual treatment and two-yearly treatment in West Africa. All the studies show that there was no major difference between the two types of treatment, even if one observes a remarkable reduction in the microfiarial load in the case of two-yearly treatments. Two treatment rounds were recorrunended by experts at the closure of OCP for SIZ in order to mop persons who might have been missed during the L't round. This is to increase therapeutic coverage.

o IvermectinResistance

Some 18 million people, mostly in Africa, are infected with this parasite. The objective of the existing control prograrunes is to eliminate onchocerciasis as a public health problem through the implementation of community-directed treatment with ivermectin (IVM), the only drug suitable for mass treatment of the disease. Presently, more than 300 million doses of IVM have been distributed in Africa, some individuals having received more than 17 annual doses.

The possibility that this drug pressure may bring about the emergence of resistant strains of O. volvulus has been considered (Boussinesq and Gardoru 1999; Grant 2000). Studies performed by Ali et al. (2002) in Sudan and by Awadzi et al. (2004a, b) in Ghana indicate that, in some individuals who had received multiple IVM treatments, a sub-optimal response of the parasite to the drug may develop. There is some genetic evidence that IVM is

44 selecting on O. oohtulus, and while this does not prove that IVM resistance is present, it suggests that the process of selection for resistance is underway and may lead to the evenfual reduced effectiveness of IVM treatment. Genetic selection identified in P-glycoprotein and tubulin may provide useful markers for monitoring genetic selection in O. aolaulus population under prolonged ivermectin treatment. Such markers need not be directly involved in mechanisms of resistance to be useful.

Ivermectin is not curative for O. oohsulus infectiory but temporarily reduces parasite microfilarial counts by eliminating most of the microfilariae in the skin and reducing the fecundity of the surviving adult parasites.

The difficulty of unequivocally demonstrating resistance in O, aolaulus is compounded because there are no adequate in aitro biological tests for resistance using this species, because of the long term reproductive effects of the drug and the difficulty of culturing O. aoloulus in aitro.Fsrthermore, O. aolaulus is an obligate parasite of humans and there are no animal hosts available for maintaining the reproductive stages of the parasite. As a result of these great difficulties to measure ivermectin resistance in O. oolaulus, either in ofuo or in aitro, and the fact that drug resistance is brought about by genetic selectiory attention has been given to looking for genetic changes in populations of O. aolaulus that have been exposed to repeated rounds of ivermectin treatment and comparing these with ivermectin naive.

WHO/TDR has initiated basic research on genetic markers that could be diagnostics for detecting the changes that could occur in Onchocerca aolaulus gemone after repetitive rounds of ivermectin treatment. The work was conducted by Dr R. Prichard's team in Canada, that of Dr W. Grant in New Zealand and the MDSC. A meeting, organized in Geneva in |une 2005, informed on the progress of the research and the way forward was discussed. The MDSC plans to address the issue of availability of diagnostic markers, raised from the progress of the research teams of Drs Prichard and Grant. A transfer of technology should be organized for the benefit of the MSDC, with the collaboration of WHO/TDR and the collaborative centres of Canada and New Zealand.

The validation of the candidate diagnostic makers should be carried out at the MDSC with the participation of the collaborative centres using parasite samples collected in different sites following defined selection criteria. This validation should provide markers that will be included in the development of a standard detection and surveillance tool that should be sensitive enough to warn of the occurrence of resistance to ivermectin in Onchocerca aolaulus.

The entomological surveillance, conducted by the MDSC in the ex-OCP countries, will serve as a basis for the detection of zones at risk of resistance to ivermectin. It will determine the infectivity rates in vector populations collected in surveillance sites in different river basins among which several are under ivermectin treatment. If the infectivity rate is found to exceed the threshold (0.5/1000flies) in a given a site, further entomological and epidemiological investigations will be carried with a view to defining the problem area and collecting parasites (adult worms, microfilariae and infective larvae). The ivermectin resistance detection tool will be applied to this biological material to determine its status:

45 susceptible or resistant. In case onchocerciasis epidemiological surveys are carried using the skin biopsy technique in areas where ivermectin distribution has been going on for several years, and if a high level of prevalence is found, then parasite collection should also be or ganized f or characterization.

Discussions

Discussions following the presentation were on:

a The continuation or not of two annual rounds of ivermectin distribution after 2007. It was suggested that countries, which already had operational difficulties, undertaking two treatments a year, could opt for one annual treatment after 2007. o The systematisation of migratory surveys of persons declared positive after taking ivermectiry as well as the preservation of microfilariae for the DNA laboratory. a Cases where actual taking of the drug in some communities proved difficult.

L. WHEN CAN IVERMECTIN TREATMENT BE STOPPED, FEASIBILITY OF ELIMINATING ONCHOCERCIASIS WITH IVERMECTIN ONLY

The answer to all these questions will be provided at the end of the ongoing research in Senegal and Mali, and later on in Guinea Bissau. The research, which started in 2005, will continue until2009.

M. OVERVIEW OF NEW CDTI DATA MANAGEMENT PROGRAMME

Introduction

In November 2004, the Management of SIZ initiated a request for technical support from APOC for the design and development of a management software for CDTI, LF and Vit. A.

In November 2005, a workshop for pre-testing the prograrrrrne was organised at Kara in Togo to enlist the observations and amendments of participants, in order to improve the software so that it would meet the needs of users. This workshop brought together the NOCPs of Togo, Guinea Conakry, Benin and the focal point of communicable diseases of the WHO country office in Togo.

The new database, named "lDC Data Manager" will have under the same interface functions of data management and mapping.

46 Data Management

This new data management programme will enable:

1,. entry, consultation and update of data on ivermectin treatment (CDTI) albendazole (FL), Vitamin A and training and sensitisation activities etc... 2. viewing of base data on strata (countries, administration, health...); this will help see villages, provinces or health areas, which have low geographic and therapeutic coverage ... 3. developing maps in gradation colours following coverage values, with options of zoorr. (in, out) and displacement of parts of the map, additions to and displacement of social strata, location of points on the map, saving and printing of maps obtained, making graphs from base data.

Conclusion

The progranune will be finalised by the closure of SlZin2007

N RESOURCE MOBILISATION STRATEGIES FOR THE CONTINUATION OF ONCHOCERCIASIS CONTROL AND SURVEILLANCE IN FORMER OCP COUNTRIES

The Team Leader indicated that this item of the agenda aimed to enlist the contribution of participants on fund mobilisation for onchocerciasis control and surveillance, which is becoming increasingly difficult. He recalled that at the last meeting, HKI which specializes in IEC had accepted to produce, in collaboration with the World Bank, a document on advocacy for the financing of disease control and surveillance. He sincerely wished this document could be finalised. The TL also called on countries to explore the various options available for the financing of Neglected Tropical Diseases. He also indicated that there were resources at the World Bank offices and at the Communicable Diseases Unit of the African Development Bank (ADB).

Discussions that followed the presentation by Dr L. Yameogo revealed:

r] that there was need for publicity, in relation to the various results obtained in the other sectors of health and development (improvement of primary eye care/ registration of populations affected in the SIZ and APOC countries etc...), directly linked to the onchocerciasis control action toward donors, who are sensitive to issues of blindness and poverty reduction. a that if there were sources of financing at the banks (WB, ADB...), their mode of access, however, seems not to be well known. There is, therefore, the need to popularise these procedures.

47 O. OTHER MATTERS

Under other matters, the following points were raised

Annual and biannual treatments: With the exception of Mali, which has always conducted only one annual ivermectin distribution, and Sierra Leone, which is in the process of setting up CDTI, it was reconrnended to all other countries, at the closure of the former OCP to conduct biannual treatments in the SIZ, where the entomo-epidemiological situation is not satisfactory, and to maintain annual treatment in the other areas. A consensus in favour of the continuation or not of the two annual treatment rounds alter 2007 was not arrived at, because the data available do not allow for highlighting the advantages of the biannual treatments as against the additional operational constraints that they entail. Moreover, there is no evidence that the 2.d treatment round makes it possible to mop up all those who were forgotten in the 1st treatment round in order to increase the therapeutic and geographic coverage rates. Finally, it is feared that without additional information, the return to annual treatment in at-risk areas could prove dangerous. Certain speakers suggested that the countries which already have operational difficulties to properly undertake an arurual treatment round (such as C6te d'Ivoire) or the two treatments per annum, could choose an annual treatment after 2007. IAtrhile the Coordinator of COte d'Ivoire opts already for an annual treatment because of the many difficulties he encounters, his counterpart of Senegal does not see any obstacle to maintaining the two modes of treatment regimens, for only 120 villages are involved in the biannual treatments. In Burkina Faso, the entomo-epidemiological situation is satisfactory. The biannual treatments will continue in 2007 while waiting for the results of further investigations before considering the return to only one treatment round in 2008. Concerning the particular case of Ghana, where the epidemiological situation is not satisfactory, certain speakers estimated that it was more advisable to reinforce the activities and to maintain two-yearly treatments in at-risk areas. Others wondered if the NOCP/Ghana could conduct two treatment rounds effectively, since for three years communities have not received ivermectin yet. It must be noted that Ghana is among the first countries to benefit from an amount of US$ 14 million as part of the US$ 100 million funds the USAID intended for the fight against Neglected Tropical Diseases. Part of this amount of US$ 14 million could thus be used for the reinforcement of CDTI activities and entomo-epidemiological monitoring in the country. The meeting was unanimous on the efforts which the countries will have to make to reach 80-85% of therapeutic coverage and 1,00% geographic coverage in all the areas after 2007, irrespective of the mode of treatment which will be used.

Activities to be carried out by APOC/SIZ Management in 2007: a) Plans are afoot to conduct a general epidemiological evaluation in the 11 countries of the former OCP in order to have an overall view of the situation before the closure of SlZ. These evaluations will relate to the villages which have been regularly evaluated since the OCP era, but which have not been visited for at least 3 yearc; b) Signing of an agreement with the University of Rotterdam in order to use the ONCHOSIM Model to predict the onchocerciasis status in the countries after 2007. The results of the overall epidemiological evaluations will be used for these simulations; c) Continuation of SIZ routine activities to draw closer to reaching the objectives set in 2002. To this end, the identification of specific groups, villages and hamlets

48 not taken into account by the CDTI initiated in Togo will also have to be done in Benin; d) Participation of all the Coordinators of the L1 countries of the former OCP in the two meetings of the Special Advisory Committee (SAC) of April (25-27) and November 2007. The 2007 /2008 plans of action and Budget of the countries will be presented and discussed at the SAC of April 2007; e) A11 the vehicles of SIZ focal points will be put in good shape for use 2007.

Support of partners: The support of the OPC will continue after 2007, according to its representative. The financing of SSI will continue in the 9 countries until 2009; an extension of the support of SSI to Guinea Bissau is in hand. Lastly, according to the representative of HKI, the support of HKI to Cdte d'Ivoire and Sierra Leone has been granted. The financing of the other countries, including Burkina Faso, Mali and Niger will be reconsidered as soon as the funds are mobilized.

P. APPROVAL OF RECOMMENDATIONS

The fifth Review and Planning Meeting on activities in the SIZ and non-SIZ areas of countries of the former OCP, held in Ouagadougou from 8 to 10 November 2006,

- Having heard the presentations of the National Coordinators; - the speeches by partners ONG (HKI, SSI, OPC), - as well as those by APOC Management and members oIWHO/SIZ, - after fruitful exchanges and discussions, made the following recommendations:

Recommendation 1,

In view of the persistence of pockets of transmission on the Upper Oti basin in Togo and Benin, and the tributaries of the Volta Lake in Togo; and

Emphasizing the short time left before the closure of SIZ (14 months),

The Meeting recommends that everything be done to identify the causes of and corrective measures to address this persistence prior to the closure:

intensify prospections for the registration of untreated villages/hamlets and screening of communities and specific groups not yet registered; evaluate and improve compliance with treatment; improve and maintain geographic and therapeutic coverage rates by increasing the number of CDDs/population treated; in the case of dispersed inhabitants, adopt the treatment by hamlet strategy; strengthen the epidemiological evaluation through additional surveys in the problem areas and adjacent foci, in order to have a clear picfure of the situation in these areas. (NOCP Togo-Benin).

49 Recommendation 2

The meeting noted that the unutilised guaranteed helicopter flight hours, paid for in 2006, to conduct larviciding and aerial prospections of villages/hamlets and specific groups cannot be postponed to 2007, according to the terms of the aerial contract.

Thus, by virtue of the 2006 decisions (workshop of 1,-2 Marctu organised in Ouagadougou and the SAC of June), the meeting recomrnends that the use of the helicopter, which proved its worth in Togo, be used in Benin to reach all human populations of the Upper Keran, the Upper and Mid Oueme in order to improve CDTI coverage, and identify possible sources of contamination of blackflies, which re-infest on a seasonal basis the Upper Oueme basin before end of December 2006.(NOCP-Beniry'CVCT)

Recommendation 3

In view of the importance of the MDSC in communicable disease surveillance in general, and onchocerciasis surveillance in particular, the meeting suggests that the MDSC quickly undertakes consultation on the pool screening technique, and its applicability to the operational context. (MDSC, APOC/SIZ)

Recommendation 4

The results presented by Ghana confirm the presence of pockets of active transmission in the SIZ and non-SIZ areas. Measures need to be urgently taken to enhance geographic and therapeutic coverage in these areas in order to neutralise these foci, namely those of the Volta Lake East, which is a threat to the adjacent basins of Togo. (PNLO-chana)

Recommendation 5

The meeting noted, during the various presentations, that the national coordinators did not put enough emphasis on2007 plans of action and budgets. Consequently, the meeting recomnends that all2007 plans of action be made available to APOC/SIZ Management by the end o12006 (National Coordinators).

Recommendation 6

The meeting took note of the availability of the new grant by the United States Agency for International Development (USAID) to the Research Technical Institute (RTI) for control of Neglected Tropical Diseases. Stakeholders' meetings will soon be organized in selected countries (Burkina Faso, Ghana, Mali and Niger) for the first year of the grant.

It was highly recommended that all onchocerciasis control actors of selected countries should endeavour to participate in all these meetings, and do their best so onchocerciasis control is not glossed over in this new initiative.

50 The National Coordinator of the other ex-OCP countries are encouraged to be proactive in staying informed about developments in this initiative.(National oncho Coordinators ex-OCP countries)

Recommendation 7

The meeting recommends to national coordinators of countries of the former OCP:

to make good use of Resolution WHA59.25 of the World Health, and the resolution of the 7ft Assembly of Health Ministers of ECOWAS for advocacy; to be proactive with their Ministry of Health for support for Resolution WHA 59.25 at the next meeting of the regional committee of WHO-AFRO. (National Coordinators)

Recommendation 8

At the closure of OCP in 2002, some vehicles of the Programme were refurbished and transferred to Oncho focal points of countries for the conduct of residual activities. These vehicles are now old and dilapidated.

Considering the need to continue onchocerciasis treatment and surveillance activities underway and after the closure of SlZ, the meeting recofiunends that:

the TLMO undertake a mission in the SIZ countries with a view to drawing up estimates for the repair of all vehicles of the focal points; the countries do all they can, in collaboration with their partners, to replace these vehicles. (TLMO, focal points, NOCP, SIZ)

Recommendation 9

Having heard new information from the coordinator of COte d'Ivoire (possible access to the northern part for NOCP teams, production of partial results on coverage and epidemiological evaluation), on the one hand, and considering the magnitude of the task of re-launching activities in the country, on the other hand, the meeting recomrnends:

o considerable assistance to the National Oncho Programme to re-launch onchocerciasis control in COte d'Ivoire; o gradual setting up of actual CDTI in the entire country; o additional epidemiological surveys in evaluation villages of the former OCP in order to have a clear picture of the situation in the country. (NOCP/C6Ie d'Ivoire, Partners)

5l a. cLosuRE oF MEETTNG

After the note of thanks by the Chairperson, on behalf of all the participants for their seriousness at deliberations, the floor was given to Dr. Amazigo, Director, APOC for the closing remarks.

In her speech, Dr. Amazigo, on behalf of APOC, SIZ and the former OCP Programmes, thanked all the colleagues, experts and partners committed to the control of onchocerciasis. The two members of the SAC (Professor Abiose and Dr Philippon), the Coordinator of NGDOs, NGOs, the WAHO, National Coordinators, staff of APOC/SIZ and interpreters for their contribution.

She expressed her gratitude to the NGDOs, which have continued to give their unllinching support to the onchocerciasis control prograrunes. It was for this reason, according to the Director, that APOC in its strategic plan and budget always tried to highlight the actions carried out by the NGDOs. She expressed concern with respect to the continuation of activities in the countries of the former OCP after 2007. In this connectiory she informed the Coordinators that a document prepared by the strategic group (including Drs Abiose and Philippon) on the future of the APOC, and the control of onchocerciasis in Africa, will be submitted to the board of governors of APOC [AF) in December 2006 for approval. If approved, this document would give APOC the mandate to continue to partly finance the fora of exchange and dialogue after 2007 within the framework of onchocerciasis control and monitoring activities. This framework of exchange will, without doubt, enable assistance to be given to Ghana, and also to counkies where the situation of the disease has deteriorated because of war (COte d'Ivoire, Guinea Bissau). She, however, emphasised that APOC would end in 2010 or 2015 at the latest. She expressed the wish that countries would start immediately to look for other sources of financing f.or the organisation of cross-border meetings. The regional offices of the World Bank, the Ministries of Health and NGDOs could be solicited for this purpose, and APOC is ready to support the initiatives. She then recalled to all, the need for maintaining close cooperation with the WAHO, ECOWAS, and NGDOs in order to continue mobilising funds for onchocerciasis control and the organisation of fora of exchange.

Dr. Amazigo reassured participants that all the recommendations of the meeting will be analysed with great interest. In conclusiory she exhorted all the Coordinators to endeavour to raise awareness at the highest level of health authorities of their respective countries for their effective participation in the very important meeting of Dar-es-Saalam from 5 to 8 December 2006, which is but the follow-up of the declaration of the Ministers in Yaounde.

It was agreed that the next Review and Planning meeting on activities in the SIZ and non-SIZ will take place in November 2007, back-to-back with the SAC from 5 to 9 November 2007. The final date will be notified in due course.

Deliberations of this fourth meeting were conducted in a cordial and brotherly atmosphere.

52 AS ANNEXE 1: List of participants

REVIEW AND PLANNING MEETING ON ACTIVITIES rN THE SPECTAL TNTERVENTTON ZONES (StZ) Fifth Session Ouasadouoou, 08 - 10 November 2006

LIST OF PARTICIPANTS

National Coordinators Benin Mme Gracia Adjinacou Repr6sentante du Coordonnateur National du PNLO 01 BP 882 - Cotonou - R6publique du Benin T6l. /Fax: (229) 33 87 17 - E-mail :[email protected]

Burkina Faso Prof. Soungalo Traor6 Coordonnateur National du PNLO 03 B.P. 7009 Ouagadougou 03 Tel. . (226) 50 30 87 90 (Bur.) - (Cell.) : 78 85 24 56 - E-mail : [email protected]

C6te d'lvoire Dr P6p6 Paul Maurice Dogbo Directeur - Coordonnateur du PNLOTBF 06 BP 6394 Abidjan 06 - RCI Tel: (225) 22 52 38 36 I (225) 22 52 38 99 - Fax: (225) 22 52 38 35 - E-mail : [email protected]

Ghana Dr Biritwum Nana Kwadwo Deputy Coordinator of Oncho Control Programme P.O. Box GP-184 - Accra - Ghana Tel: (233) 21 67 93 23 I (233) 21 68 1 1 09 - Fax: (233) 21 22 67 38 E-mail: Nana. Biritwum@hru-ohs. oro

Guinea Conakrv Dr Nouhou Konkour6 Diallo Coordonnateur National du PNLOC B.P. 585, Conakry - R6publique de Guin6e T6l. /Fax : (224) 43 37 07 - cell . (224) 25 33 71- E-mait: [email protected] Mali Dr Mamadou Oumar Traor6 Coordonnateur Nationaldu PNLO - Direction Nationale de la Sant6 BP 223 Bamako - Mali T61.. (223 2264 97) Cell.: (223) 671 17 66 t (223) 610 24 oZ Fax: (223) 22 36 74 t (223) 23 17 21 - E-mail: [email protected]

54 Seneqal

Dr Lamine Diawara Coordonnateur National du PNLO BP 59 Tambacounda - S6n6gal T6l.:(221) 981 11 64ou (221)683 03 18- Fax: (221)981 1077 - E-mail :[email protected]

Sierra Leone

Dr Joseph B. Koroma Oncho Control Programme Manager; Ministry of Health and Sanitation c/o WR Sierra Leone P.O. Box 529 Freetown. Tel.: (232) 33 40 33 59 or (232)7677 98 38 - Email: [email protected]

Toqo

Dr Karabou Koffi Potchoziou Directeur R6gional de la Sant6 - Coordonnateur National du PNLO BP 487 Kara - R6publique Togolaise Tdl. : (228) 660 17 10 - Cell. (228) 902 47 95 ; Fax : (228) 660 04 14 - E-mail [email protected]

SAC Members

Prof. Adenike Abiose Medical Director Sightcare lnternational Secretary Main Office lbadan P.O. Box: 29771Oyo State - Nigeria Tel.. (234) 803 186 510 2 or (234) 217 517 329 - Fax: 15 095 628 212 - E-mail: [email protected]

Dr Bernard Philippon Directeur de Recherches Em6rite 35 Avenue Jean Moulin,75 014 France T6l. : 331- 40 44 94 04 - Fax : 331- 40 44 94 04 - E-mail : [email protected]

NGDO Goordinator

Dr Tony Ukety Coordonnateur des ONGDs 20, Avenue Appia, CH-1211 Gendve 27 - Suisse T6l. :41 22791 1450 - Fax : 41 22791 4772 - E-mail : [email protected] Partners and NGOs WHO Burkina Faso

Dr Amidou Baba-Moussa Repr6sentant de I'OMS au Burkina Faso, a 03 BP 7013 - Ouagadougou 03 Tell. : (226) 50 30 65 09 - Fax: (226) 50 33 25 41

55 West African Health Orqanisation (WAHO)

Dr Doulaye Sacko Coordonnateur de Vision 2Q20 en Afrique de l'Ouest OOAS Burkina Faso Tel: 226 20 97 57 75; Fax: 226 20 97 57 72 E-mail: [email protected] ou wahooa hooas.orq

Sisth Savers lnternational (SSl)

Dr Aboubacar Ouattara Directeur R6gionalAdjoint de SSI pour l'Afrique de l'Ouest P.O. Box: KIA 18190 -Accra, Ghana Tel.: (233) 21 77 42 10 Fax : (233) 21 77 42 09 - E-mail ; [email protected] Orqanisation pour la Pr6vention de la C6cit6 (OPC)

Dr Seydou Mariko Coordonnateur OPC en Afrique de I'Ouest, OPCArVaro B.P. 1764, Bamako, R6publique du Mali T6l. . (223) 676 20 20 I (223) 229 63 39 - Fax . (223) 229 63 39 E-mail : [email protected]

Helen Keller lnternational (HK!)

Dr Danny Haddad Regional Eye Health and Onchocerciasis Advisor B.P. 29898 Dakar-Yoff, S6n6gal Tel./Fax . (221) 869 10 63 - E-mail: [email protected]

SIZ Team KARA & PARAKOU M. Ak6 Assi Chef Equipe Lutte Anti-vectorielle (CVCT) OMS/SIZONCHO, BP 36, Kara - Togo T6l. : (228) 660 60 75 - Fax: (228) 660 06 26 / 660 18 57 - Cell : 947 71 3o I 920 24 07 E-mail : [email protected]

M. Sedou Naniogue Chef de Base Equipe NationalelKara OMS/SIZONCHO, BP 36, Kara - Togo Tbl.: (228) 660 60 75 - Fax: (228) 660 06 26 - Cell: 944 80 63 / 906 81 21 E-mail: [email protected]

M. Amadou Adam Chef de Base Equipe Nationale/Parakou OMS/SIZONCHO, BP 160, Parakou - Benin T6l. : (229) 61 04 39 - Dom (229) 61 08 96 ; E-mail : [email protected]

MDSC Le Repr6sentant du Directeur Directeur a.i., MDSC 01 BP 549 Ouagadougou 01 - Burkina Faso T6l. . (226) 34 2277 -Fax: (226) 34 30 42

56 Dr Laurent To6 Responsable, Laboratoire Biologie Mol6culaire 01 BP 549 Ouagadougou 01 - Burkina Faso Tbl. : (226) 34 22 77 - Fax . (226) 34 30 42 - E-mail : [email protected]

Dr Yiriba Bissan Entomologiste 01 BP 549 Ouagadougou 01 - Burkina Faso TEl. : (226) 34 22 77 - Fax : (226) 34 30 42 - E-mail : [email protected]

APOC/SIZ SECRETARIAT Dr Uche Amazigo Directrice du Programme APOC 01 BP 549 Ouagadougou 01 - Burkina Faso T6l. : (226) 34 22 77 - Fax : (226) 34 30 42 - E-mail : [email protected] Dr Laurent Yam6ogo Chef d'Equipe, SIZ / Coordonnateur du Bureau du Directeur, APOC 01 BP 549 Ouagadougou 01 - Burkina Faso Tel. : (226) 34 29 53 - Fax . (226) 34 28 75 - E-mail : [email protected]

Dr Mounkaila Noma Chef, Unit6 d'Epid6miologie & Elimination du Vecteur, APOC 01 BP 549 Ouagadougou 01 - Burkina Faso T6l. : (226) 34 29 53 - Fax : (226) 34 28 75 - E-mail : [email protected]

M. Bamiky Tour6 Chef de Transport, Logistique et Maintenance, SIZ 01 BP 549 Ouagadougou 01 - Burkina Faso T6l. : (226) 34 29 66 - Fax . (226) 34 28 75 - E-mail : [email protected]

M. HonoratZour6 Charge de Biostatistique & Cartographie, APOC 01 BP 549 Ouagadougou 01 - Burkina Faso T6l. : (226) 34 29 53 - Fax . (226) 34 28 75 - E-mail : [email protected]

M. Koffi Benoit Agblewonu, BFO/APOG 01 BP 549 Ouagadougou 01 - Burkina Faso Tel '. (226) 34 29 53 - Fax : (226) 34 28 75 - E-mail : [email protected]

Mrr" N6n6 Oumou Keita, FO/APOG 01 BP 549 Ouagadougou 01 - Burkina Faso Tel. . (226) 34 29 53 - Fax : (226) 34 28 75 - E-mail : [email protected] Dr Grace Fobi Charg6e de I'Appropriation Communautaire et Partenariat, APOC 01 BP 549 Ouagadougou 01 - Burkina Faso Tel. . (226) 34 29 53 - Fax . (226) 34 28 75 - E-mail : [email protected]

Dr Lamissa Bangali Charg6 du Plaidoyer et de l'Education pour la Sant6, APOC 01 BP 549 Ouagadougou 01 - Burkina Faso T6l. : (226) 34 29 53 - Fax . (226) 34 28 75 - E-mail : [email protected]

57 M. Saidou N'Gadjaga Charge des Technologies de l'lnformation, APOC 01 BP 549 Ouagadougou 01 - Burkina Faso Tel. . (226) 34 29 53 - Fax : (226) 34 28 75 - E-mail : [email protected]

M. Yacouba lssaka Niandou Charg6 du Systdme de I'lnformation, APOC 01 BP 549 Ouagadougou 01 - Burkina Faso T6l. . (226) 34 29 53 - Fax : (226) 34 28 75 - E-mail : niandouv@oncho oms.bf M. S6ni Pierre Nikiema Assistant Gestionnaire des donn6es 01 BP 549 Ouagadougou 01 - Burkina Faso TOl. . (226) 34 29 53 - Fax : (226) 34 28 75 - E-mail : [email protected]

s8 Provisional Agenda AFRICA REGION Oroanisation Special lntervention Zones (ZlS) mdndiale de la Sant6 01 8.P.549, Ouagadougou 01, Burkina Faso Tel: (226) 50 34 29 53, 50 34 29 59; 50 34 29 60; 50 34 36 45146 Fax. (226) 50 34 28 75; 50 34 36 47

REVIEW AND PLANNING MEETING ON ACTIVITIES tN THE SPECIAL INTERVENTTON ZONES (SlZ) Fifth Session Ouaoadouqou, 08 - 10 November 2006

PROVISIONAL AGENDA REV1 OPEA"TVG OF SESS'OA' A. Speeches, election of Chairperson and rapporteurs. GENERAL INFORMATION B. General information on the SlZ. C. General information on the 4th session of the Special Consultative Committee. D. Follow-up of recommendations of the 4th Review and Planning meeting. E. lnformation on activities of the Multi-Disease Surveillance Centre (MDSC). STATUS OF ONCHOCERCIASIS CONTROL IN THE EX-OCP COUNTRIES F. Review of onchocerciasis control activities in the SIZ countries (including non-SlZ areas) from 2003 to 2006, resources allocated and planning of 2007 activities. G. Review of post-OCP activities from 2003 to 2006 in the six (6) ex-OCP countries that are not part of the SlZ, and planned activities tor 2007.

I NT ER.AG E N CY C O LLAB O RAT I O N H. Financing of the SIZ (World Bank representative). !. Progress report, recommendations and conclusions of 2006 meetings of the NGDO coordination group (Responsible officer of the NGDO group). J. Partner support for activities from 2003 to 2006 and projections for 2007. OPERATIONAL RESEARCH K. Resistance to ivermectin; multi-annual ivermectin treatment. L. When can treatment with ivermectin be stopped? Feasibility of eliminating onchocerciasis through ivermectin treatment alone. DATA MANAGEMENT AND ANALYSIS M. Overview of new CDTI data management (programme). OTHER MATTERS N. Resource mobilization strategies for continuing onchocerciasis control and surveillance in the ex-OCP countries O. Miscellaneous DRAFTING OF RECOMMENDATIONS AND CLOSURE OF SESSION

P. Approval of recommandations. Q. Closure of meeting. 59 DHTAITED AGENDA REV{

WEDNESDAY 08 NOVEMBER 2006: 1ST DAY

OPENING OF SESSION (09H-9H30)

Point A: Speech by Dr Uche Amazigo, DIR /APOC 09h00 - 09h05 (5 mn) Speech by Prof. Brehima Koumare, DIR a.i. MDSC 09h05 - 09h10 (5 mn) Opening speech by the WHO Representative in Burkina Faso 09h10 - 09h25(15 mn) Election of Chairperson, rapporteurs and adoption of the agenda (TUSIZ) 09h25 - 09h30(5 mn)

GENERAL INFORMATION (09H30-10H40)

Point B: General information on the SlZ, TL/SIZ 09h30-09h45 (15 mn) Point C: General information on the 4th session of the SCC, DTUSIZ 09h45-09h55 (10 mn) Point D: Follow-up of recommendations of the 4th Review and Planning meeting, DTL/SlZ 09h55-10h10 (15 mn)

TEA BREAK 10h10 -10h30

Point E: lnformation on activities of the Multi-Disease Surveillance Centre (MDSC) - lntroduction DIR a.|./MDSC 10h30-10h35 (5 mn) - Onchocerciasis activities (Dr Y.Bissan/Dr L.To6) 10h35-10h50 (15 mn)

STATUS OF ONCHOCERCIASIS CONTROL IN THE EX.OCP COUNTRIES (10H50-18H20)

Point F: Review of onchocerciasis control and surveillance activities in the SIZ countries (including non-SlZ areas) from 2003 to 2006, resources allocated and planning of 2007 activities (National coordinators of Benin, Ghana, Guinea, Sierra Leone : 20 min. each) 10h50-12h10(1h20mn)

LUNCH BREAK 12h10 - 15h00

Point F (Contd): Review of onchocerciasis control and surveillance activities in the slZ countries (including non-slZ areas) from 2003 to 2006, resources allocated and planning o12007 activities (National coord. of rogo: 20 min.) 15h00 - 15h20 (20mn)

a Discussions on Point F 15h20 - 16h20 (1H)

I TEA BREAK 16h20 - 16h40

Point G: Review of post-OCP activities from 2003 to 2006 in the six (6) ex-OCP countries that are not part of the SIZ and activities planned for 2007 (Nat. Coordinators of Burkina, Cote d'lvoire, Guinea Bissau, and Mali: 15 min. each) 16h40 - 17h40(1H) Discussions on Point G 17h40 - 18h20 (40mn)

60 THURSDAY 09 NOVEMBER 2006: 2ND DAY

STATUS OF ONCHO CONTROL IN THE EX-OGP COUNTRTES (8H30-9H20)

Point G (Contd): Review of post-OCP activities from 2003 to 2006 in the six (6) ex-OCP countries that are not part of the SIZ and activities planned for 2007 (Nat. Coord. of. Niger and Senegal: 15 min each) 08h30-09h00 (30mn)

Discussions on Point G 09h00-09h20 (20mn)

INTER.AGENCY COLLABORATION (9H20-15H25)

Point H : Financing of the SIZ (World Bank representative): 09h20-09h40 (20mn)

Discussions on Point H 09h40 - 10h00 (20mn)

Point !: Progress report, recommendations and conclusions of 2006 meetings of the NGDO Coordination (Dr. Tony Ukety) 10h00 - 10h20 (20mn)

TEA BREAK 10h20 - 10h40

Discussions on Point I 10h40- 1th00 (20mn)

Point J: Partners' support for activities from 2003 to 2006 and

Projections for 2007: SIZ (10min.); MDSC (1Smin.) ; SSI (1Smin.); OPC (1Smn); HKI (1Smn) 1 t h00-1 2h1 0(1 h1 0)

LUNCH BREAK 12h10 - 15h00

Discussion on Point J 15h-15h25 (25mn)

OPERATIONAL RESEARCH (15H25-17H15)

Point K: Resistance to ivermectin; - Multi-annual ivermectin treatment (Dr M.Noma) 15h25-15h35(10mn) - Resistance to ivermectin (Dr.Y.Bissan) 15h35-15h45(10mn)

Discussions on Point K: 15h45-16h05(20mn)

Point L: When can treatment with ivermectin be stopped? Feasibility of eliminating onchocerciasis through ivermectin treatment alone (Dr.Y.Bissan) 16h05-16h25(20mn)

TEA BREAK 16h25 - 16h45 a Discussions on Point L 16h45 - 17h05 (20mn) t DATA MANAGEME NT AND ANALYSIS

Point M: Overview of the new CDTI data management programme (cEV, BlM, lro/APoc) 17h05 - 17h20 (1Smn)

61 Discussions on Point M 17h20-17h40 (20mn)

OTHER MATTERS (17H15-18H)

Point N: Resource mobilisation strategies for continuing onchocerciasis control and surveillance in the ex-OCP countries (TL) 17h40-18h00 (20mn)

Discussions on Point N 18h00-18h20 (20mn)

FRIDAY 10 NOVEMBER 2006: 3RD JOUR

OTHER MATTERS (CONTD) 08h30-09h00

Point O: Discussions/other matters 08h30-09h00 (30mn)

DRAFTING OF RECOMMENDATIONS AND CLOSURE OF SESSION (OgHOO.l8H)

Drafting of report and recommendations 09h00 - 10h15

TEABREAK 10h15.10h35

Drafting of report and recommendations 10h35 - 12h00

LUNCH BREAK 12hOO.15hOO

Drafting of report and recommendations 15h00 - 16h30

TEABREAK 16h30.16h50

Point P: Approval of recommendations 16h50 - 17h30

Point Q: Date and venue of next meeting; Closure 17h30 - 18h00

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62 ANNEXE 3: Goverage of capture points in countries conducting entomological surveillance

Gountries Percentage of surveillance sites visited (Nb of planned sites) 2003 2004 2005 2006 BENIN (e) 44 67 44 56 BURKTNA FASO (10) 20 0 0 100 coTE D'tvotRE (8) GUTNEE BTSSAU ( ) GHANA (8) 0 0 63 100 MALI (12) 42 0 0 67 N|GER (2) 0 50 0 100 GUTNEE (1s) 87 87 0 80 SENEGAL (8) 0 0 0 63 SIERRA LEONE TOGO (8) 38 0 25 63

ANNEXE 4: Results of infectivity rates from 2003 to 2005

KEY O > o.sltooo bad results O = 0.5/1000 Results (threshold) o < o.sttooo good results t

63 ANNEXE 5: Entomological Surveillance Results for 2005 in Ghana

SITE BASIN SAMPLE PERIOD Onchocerca sp Onchocerca sp SIZE INFECTIVITY INFECTMry RATE (OT') RATE (0r') ASUBENDE Pru 6739 19lO7l05to 6.43 1.82 24t11t05 DODFIE Asukawkaw 11737 19107lO5to 0.701 0.0424 24t11t05 CHIASA Mole 8931 19/07/05 to 1.24 0.406 24t11t05 SAKUTI White volta 2670 04/10/05 to 7.46 0.1 83 06/10/05 MNANGODI Red volta 1 550 25108/05 to 3.33 0.316 05/10/05

ANNEXE 6: Onchocerciasis entomological network for 2006

h

Q a

a Surveillance a

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64 ANNEXE 7: Partial result from surveillance points of the study on "Feasibility of elimination of Onchocerciasis by lvermectin distribution"

Country / sites lnfectivity rate Period Nb flies Rate

MALI Fadougou / Faleme Jul-Aug 06 5605 0.091 [\Iahina Mine / Faleme Jul-Aug 06 7375 0.303 Manankoto / Faleme Jul-Auq 06 32636 0.18

SENEGAL Bantacokouta / Gambie R. Jul-Auq 06 14330 0.1 55 Saroudia / Koila Kabe R. Jul-Aug 06 2266 0.787 Sekoto / Gambie R Jul-Aug 06 12028 0.032 Soukouta / Gambie R Jul-Aug 06 17140 0.286

ANNEXE 8: Result from vectors collected in APOC surveillance points

Country / sites lnfectivity rate Period Nb flies Rate

CAMEROUN Bolo 2004 12234 2.95

CENTRAL AFRICAN REPUBLIC Boali 2004-2006 9896 0.1 05 Zinga 4565 0.691

DEMOCRATIC REPUBLIC OF CONGO lnga 4524 0.691

ANNEXE 9: Plan of action and budgetSlZ2O0T in Benin

ACTIVITIES COST Hold a departmental workshop 1.200.000 Train 25 health workers transferred to the Zone 2.200.000 Train/retrain CDDs 6.500.000 Sensitise and treat populations 2.000.000

Supervise the two CDTI rounds 4.000.000 li Conduct a coverage survey 1.200.000

Prospection of CDTI villages and mapping of specific groups 4.000.000 !. Prospection of villages, epidemiology and evaluation 4.000.000 Give assistance in fuel 1.200.000 TOTAL 26.300.000

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, , sE vsrrrsATtoM ACTIVITY TIME FRAME SOURCE OF FINANCING District Levels Feb. 2007 1't Radio/TV discussion at National and ; - SIZATI/ORLD BANK Airing of Jingles in radio stations of 8 Districts Week Nov. 2007 Community Meetings in 2,860 villages of 4 Districts SIZA//ORLD BANK (Bonthe ; Bo ; Port Loko and Kambia) March 2007 in 2,899 villages of 4 Districts Community Meetings May 2007 SIZMORLD BANK (Kenema; Koinadugu; Tonkolili and Bombali) Community Meetings in2,692 villages of 4 Districts June 2007 SIZ^/VORLD BANK (Pujehun; Kono; Kailahun and Moyamba)

II-TRAINING&OTHERS Trainins of Trainers (TOT) Februarv 2007 SIZSSI Training of PHU Staff March 2007 WORLD BANK/SIZSSI Training of CDDs and Community Census by Trained August - WORLD BANI(SIZSS!/HKI CDDs September 2007 Distribution of lvermectin and collection of returns September- SIZA/VORLD BANK October 2007 February-March; WORLD BANKSIZSSI Monitoring and Supervision of Trainings and September- lvermectin distribution October 2007 1't Week WORLD BANK Annual Review of Distribution Results December 2007

ANNEXE 15: SIZ AREAS lN GUINEA

No. of No. of No. of DPS Population Partners involved GS villages distributors DABOLA I 306 122863 522 DINGUIRAYE I 524 162809 1046 Sight Savers lnternational FARANAH 12 444 1 36,1 79 645 SIGUIRI 4 669 276,333 1,293 Organisation pour la pr6vention 12 296 143,785 527 KOUROUSSA de la C6cit6 (OPC) KISSIDOUGOU 13 178 53,385 354 MAMOU 3 128 39,941 209 a KINDIA 5 273 71,283 500 Sight Savers lnternational FORECARIAH 5 403 99,680 728 TOTAL 71 3 221 I 106 258 5 824

68 ANNEXE 16: Epidemiological Evaluation in non-SlZ in 2006: Guinea

Part. Crude Health Villages Gode Basins Regist. Pres. Exam Positive % Prev olo Centre Kirimani 1 338 Koliba 236 198 178 90 2 1.12 Foulamory Samba Poulo 1340 Koliba 163 159 145 91 0 0.00 Koulounto Tabadian 1025 Koliba 205 203 169 83 0 0.00 Koulounto Koliba Bac 1451 Koliba 72 61 58 95 I 13.79 Koulounto Kankonkan 1 339 Koliba 231 192 160 83 0 0.00 Koulounto Goumbambel 1341 Koliba 146 109 95 87 0 0.00 Koulounto Bantala Bac NV Koliba 204 203 168 83 0 0.00 Koulounto Akadasso 1404 Koliba 275 252 236 94 0 0.00 Kamabi Sinthiourou 1 399 Koliba 1 4 1 140 132 ModiAbd 94 0 0.0 Sa16boldo Gada Louguel 1 398 Koliba 130 122 111 91 0 0.00 Kamabi Sinthian Modi 1029 Koliba 365 330 289 88 6 2.08 Sa16boido Bhafelo Andef 1 009 Koulountou 264 238 202 85 18 8.91 Guingan Boussoura 1014 Koulountou 76 63 59 94 1 1.69 Guingan Fede 1274 Koulountou 168 151 124 82 17 13.71 Youkounkoun Karionko 1281 Koulountou 190 143 124 87 21 16.94 Youkounkoun Adjine

Thioupitel 1280 Koulountou 307 270 212 79 1 0.47 SambaTlo 1275 Koundara Saint Laurent Koulountou 332 294 212 72 25 11.79 centre

ANNEXE 17: Partial results of captures in Guinea (2006)

NO Gatching point Basin No. of flies collected Observations

1 Balandougou Niger 2 125 Collection ongoing 2 Yalawa Mafou 3 441 Collection ongoing 3 56rekoroba Mafou 8 000 Collection ended 4 Fifa Tinkisso 6 030 Collection ended 5 Tere Dion 6 176 Collection ended b Kabanihoye Kaba 2 206 Collection ongoing

t

69 ANNEXE 18: Timetable of activities to be conducted in 2007 and 2008 in Guinea

Cost (in US 2007 2008 Sources Activities to be conducted T T T T T T T T Place dollars) financing 1 2 3 4 1 2 3 4 Sensitise the local persons in charge of the 58 health centres (sub-prefects, religious leaders and X X S/P 21,000 SIZ council of elders)

Take part 2 times per annum in the RegionalTechnical Committees of Health (CTRS) of X Regions 8,000 State Faranah and Kankan

Organize radio broadcasts on Faranah, in national languages on Oncho Kanakan HKI/ SSI/ the rural radios of Kankan, X X X X X 15,000 Mamou, oPc Mamou, Lab6 and Faranah Lab6 Organise the annual review of X X stz 25,000 OPC/SSI/SIZ CDTI Conduct joint Supervision X X X X stz 26,000 OPC/SSI/SIZ Train actors HKI/SSI/ X X X X 20,000 stz OPC Ensure funding of training and SIZ and supervision of CDDs by nurses of X X 40,000 SIz/SSI/OPC non- SIZ CS (fuel) Epidemiological Evaluation and SIZA/VHO/SS X X srz 28,000 Entomological surveillance I TOTAL 183,000

ANNEXE 19: Recap of the table of bulk captures and dissections in Togo (2003-2006)

Catching Parous Sent to DNA Collected Dissected An Basins points (infective) Lab, Ouaga Zio Kati Amou Amou-Oblo 408 parous 2003 M6 Landa-Mono 85815 626 85189 (3 infective) Ani6 Akaba a Mono Mono Kpessi Wawa Dzodzi 175 2005 Amou Amou-Oblo 14826 252 14575 ({ infective) Amouta Adeda Kop6 Mono Ani6 2006 Amou 18397 18397 Kpaza-Kou6

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a C) o 6 Esr .q f f f E, Lt- -o- Q o- Lr tr tL d3 -oX o E o E E E ;.0 =- o .q .q .q oo o o o D € .C L L L EE ile c) c) o oC: 8E U TL (L (L (L (L_

chn o t6 o o Or o oJ J o J -J -J -J (Lz (Lz da (Lz (Lz (Lz (Lz -JI (Lzo

c .E E co o -o'- o a g ov oE E o a.9 o o o F o- R8 E E a (U:J o- b. .9- o c o a'- EOE-c c ) :6o0) Ol- oo o 'Eo ip_ po E o 6(, or9 o oc) EE o EcD P)6 6; crl 9; = 0) tsC 6.a o .E.E N oo -o oE -cf o o -c OCrj .n B sc) 8e, o) EE .E>s) .c o tA o'= .Ec s- oiir Nb .c. =ts E;O o\ c o E-o o(Utr aH oP o .o U,o gx 9 eE >o o) P-o E ds ou) E 0) ol o-= r= EE oE -co o.-l, Oa k'= c{o o-oL 0) ai =6>c c al, ots f EE 'E()^ESH o o'.Y N o! c o_o 'a EE 'o'o;E >l) o= b.Y =U}(E a OE tN 9o o lzr E hb i'E* o oE oa d9 sEg E.E FE€ alt oxe AE -O No. co9o -o\.o qE6 r,igX.g NO 6.t € ctt o c.tbE (9.E (9(,()

Po c c a o o bg c 0gH o o >'o o ! (,= o .a g# E 2 o- o-o o o -o 0) e o =o) Bsg (L a2 F 6o =

a U, o q) LA tu, E E e* 6urure:1 e. Eg

Overall Effective Geographic Population Population Year therapeutic therapeutic GOVerage registered treated coverage coverage 606/606 592/606 2003 172 757 136 980 79o/o 100% 97,70/o 108t120 2003 108t120 90% 30 305 24 225 80% 2nd round 90% 604t604 591t604 2004 172 448 139 925 81o/o 100o/o 97,go/o 2004 2no 120t120 119t120 33 939 27 450 81o/o round 100o/o 99,20/o 613/613 583/613 2005 100% 170 973 136 811 80Yo 95,1o/o

This second CDTI round of 2005, originally planned for in villages on the Gambia in Senegal in November, was not conducted because of the risk that might distort the 2oo5 2nd results of the epidemiological evaluations (by the treatment of villages planned for the round evaluations) within the framework of the Draft Study of the elimination of onchocerciasis by ivermectin alone. A decision is made at the Coordination.

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Y

74 ANNEXE 22: Trend of indicators of epidemiological surveillance of onchocerciasis (Senegal)

lndicators I 996* 1 999* 2000* 2001* 2002* 2003* 2006*

No. of villages evaluated 12 12 20 31 25 15 66

No. of persons 2118 3696 4761 8541 4334 11 814 registered 5744 No. of persons 1416 2841 3595 6300 4099 3042 8 331 examined (sntp) No. of positives 135 soit 70 soit 119 soit 27 soit 44 soit 7 soit 29 soit o/o and percentage 9.53 % 2.5 % 3.3 Yo 0.4 1.07o/o 0.23Yo 0.4%t No. of persons under 15 I 1 6 0 4 0 0 infected No of persons 127 69 113 27 40 7 29 over 15 infected Variation des From From From 0.5 From 6.09 From 0.6 From 0.3 pr6valences From 0.6 0.36% to 0.21o/o to o/o to 5.60/o o/o to o/o to %to obtenues dans to 8.3 % 6.96% 1.660/o 17 .71 o/o 5.3 o/o 3.8 o/o les villaqes **

" Evaluation reports available (except for 2006). No evaluation was conducted in 1997, 1998, 2004 and 2005. The technique used during the evaluation is the skin snip in persons aged 1 and above

** Regarding the last indicator, severalvillages had zero prevalence; this change in prevalence is observed in the few villages parasite carriers (see available evaluation reports at Coordination office).

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