JPC.CCP Bureau Du Prdsident

Onchoccrciasis Control Programmc in the Volta Rivcr Basin arca Programme de Lutte contre I'Onchocercose dans la R6gion du Bassin de la Volta

JOIN'T PROCRAMME COMMITTEE COMITE CONJOINT DU PROCRAMME Officc of the Chuirrrran JPC.CCP Bureau du Prdsident

JOINT PROGRAII"IE COMMITTEE JPC3.6 Third session ORIGINAL: ENGLISH L Bamako 7-10 December 1982 October 1982

Provisional Agenda item 8

The document entitled t'Proposals for a Western Extension of the Prograncne in Mali, Guinea, Guinea-Bissau, Ssnegal and Sierra Leone" was reviewed by the Corrrittee of Sponsoring Agencies (CSA) and is now transmitted for the consideration of the Joint Prograurne Conrnittee (JPC) at its third sessior:.

The CSA recalls that the JPC, at its second session, following its review of the Feasibility Study of the Senegal River Basin area entitled "Senegambia Project : Onchocerciasis Control in Guinea, Guinea-Bissau, l,la1i, Senegal and Sierra Leone", had asked the Prograrrne to prepare a Plan of Operations for implementing activities in this area. It notes that the Expert Advisory Conrnittee (EAC) recormnended an alternative strategy, emphasizing the need to focus, in the first instance, on those areas where onchocerciasis was hyperendemic and on those rivers which were sources of reinvasion of the present OCP area (Document JPC3.3).

The CSA endorses the need for onchocerciasis control in the Western extension area. However, following informal consultations, and bearing in mind the prevailing financial situation, the CSA reconrnends that activities be implemented in the area on a scale that can be managed by the Prograrmne and at a pace concomitant with the availability of funds, in order to obtain the basic data which have been identified as missing by the proposed plan of operations.

, Furthermore, the CSA recournends the JPC to dpprove this action and to request the Executing Agency to negotiate the appropriate agreements with the countries concerned WORLD HEALTH ORGANIZATION ocP82.3

ORGANISATION MONDIALE DE LA SANTE @ ORIGINAL: ENGLISH

ONCHOCERCIASIS COMROL PROGRAMME

PROPOSALS FOR A WXSTERN EXTENSION OF THE PROGRAI,II,IE rN MALI, cUlMA, GUINEA-BTSSAU SENEGAL AND SIERRA LEONE ocP 82.3 Page 2

CONIENTS

Page

SI]MMARY 5

PART I INIRODUCTION TO ONCHOCERCIASIS IN TIIE PROPOSED OCP WESTERN EXTENSION AREA AND TIIE BASIC PRINCIPLES FOR ITS CONIROL:

Chapter I. IIfIRODUCTION 7

1 Background . . 7 2 New approaches and developments 8 3 The proposed Western Extension area 9 3.1 Limits 9 3.2 Physical geography 10

3.2.t Mali . lo 3,2.2 Senegal L2 3 .2.3 Guinea 13 3.3 Social and economic geography t4 3.4 LogisEical aspects of the area 15 4 The need for onchocerciasis control l6

4.t Health considerations . 16 4.2 Socioeconomic considerations 19

Chapter II'. THE PRINCIPLES OF ONCHOCERCIASIS COMROL 20

t. Introduction . 20 ) Vector control . . 20

2.L Vector species in need of control . . 2T 2.2 Vector control techniques . . 22 2 .2 .1, Environmental rnethods 22 2.2.2 Chemical control techniques 22 2.2.2.1 Adulticiding 22 2 .2 .2 .2 Larviciding 23 2.3 The evaluation of vector control operations 25 2.3.L Entomological evaluations 25 2 .3.2 Epidemiological evaluat ions 26 2.3.3 Environmental monitoring . 26

REFERENCES CITED IN PART I )7

PART II PI.AN OF OPERATIONS FOR TIIE FIRST SIX YEARS OF ONCHOCERCIASIS COMROL IN THE I,IESTERN EXTENSION AREA:

Chapter III. RESPONSIBILITIES 29

1 Introduction. 29 2 Responsibilities of the OCP 29 3 National responsibilities 30 ocP82 .3 Page 3

Page

31 chaprer rV. PHASTNG OF EXIENSTON ACTTVTTTES I Introduction. 31 32 2 Spatial phasing 33 3 TimeEable for phasing of activities 3.1 In the northern subregion 33 3.2 In the southern subregion 34

35 Chapter V. PREPARATORY ACTIVIT]ES 35 1 Introduction. 35 2 OCP activities 2.L In the Phase I zone 35 )) In the Phase II zone 36 36 2.3 In the Phase III zone . . 36 3 National activities 3.I In the Phase I and II zones . . 36 3.2 In the Phase III zone . . 37 4 Activities conducted jointly by the ocP and national authoriEies 37 the 5 ocP requirements for addirional hydrological stations and roads in Phase I and fI zones . . 37 5.1 Requirements for hydrological stations 37 5.2 Requirements for additional roads 39 6. Other considerations 40

Chapter VI. VECTOR COMROL OPERATIONS IN THE PHASE I AND ]I ZONES 4t l. Operational bases 4L 1.1 Primary operational' base 4l L.2 Secondary operational bases 4t 1.3 OCP helipads 4L r.4 Logistic support 42 2. Aerial operations logisEics and costs 42 2.L Aircraft requirements . 42 ?? Deployment of aircraft . 42 2.3 Basic aircraft costs 42 2.4 Flight hour requirements and costs 42 3. Insecticide requirements 42 3.1 Temephos requirements for the Phase I zone 43 3.2 Temephos requirements for the Phase II zone 43 3.3 Total temephos requirements and costs . . 43 4 Managerial staff 43 5 Applied research 44

chaprer vII. ENIOMOLOGICAL EVALUATIONS IN TI{E PHASE I AND 11 ZONES 45

I Introduction . 45 2 Entomological evaluation sub-unit 45 2.t Sectors and subsectors 45 ,) Staffing of sectors and subsectors 46 2.3 Responsibilities of sector and subsector chiefs 47 2.4 Timetable of sector activities 48 ocP82.3 Page 4

Page

2.5 Sector requirements for vehicles 48 2.6 Sector requirements for equipment 48 2.7 Requirements for radio stations 49 3 Cytotaxonomy sub-unit . 49 4 Duration of pre-control evaluations 49 chapter vrrr. EPrDEMroLocrcAL EVALUATTONS rN THE PHASE r AND rr zoMs 50

1 Introduction 50 2 Selection of indicator viltages 50 3 Population covered by evaluations in indicator villages 51 4 Evaluation teams 51

4.L For parasitological eval-uations 51 4.2 For ophthalmoLogical evaluations 51

5. Capabilities of national health authorities 52

5.1 Simple evaluations . 52 5.2 Detailed evaluations . 52 5.3 Options for ophthalmological evaluations . 52

ENVIRONMENTAL Chapter IX MONITORING IN TIIE PHASE AND 1I ZONES 53

1 Introduct ion 53 2 Intercountry monitoring Eeam 54

2.1 Staff requirements 54 2 .2 Equipnrent requirement s . 54 3 Monitoring procedures 55

3. t Methods 55 3.2 Recording and analysis of data . 55

Chapter X. oPERATIONAL BASE, BAI,IAKO 56

1 Int roduc E ion s6 2 Staff.. 56

2.\ Vector Control Unit 56 aa Epidemiological Evaluat ion Unit 57 2.3 Administration Unit 57

3 Vehicle requirements 57 4 Requirements for equipment and supplies 57 chaprer xI. BUDGET 58

I Introduction 58 2 58 3 International- contributions 58

3.1 Guidelines for the preparation of the budget 59 3,2 Budget . . 60

Tables 1-9 61

Maps 1-7 73 ocP82.3 Page 5

SLII"{MARY

i^Ihen proposals for a Senegambia Onchocerciasis Control Project were reviewed by the Joint Prograrnme Committee in December 1981 it was acknowledged that there r^7as a serious onchocerciasis problem in the region to the west of the onchocerciasis control programme in the Volta River Basin area and that for both health and socioeconomic reasons there \^ras justification for a WIIO control activity. In addition iE was agreed that any such control activity in that region should be implemented as an extension of Ehe OCP and not as a seParate and multi-disease project.

Accordingly the OCP was charged with appraising and studying the original feasibility report, with collecting additional information from the region, and with the preparation of a revised plau of operations.

lnvestigations conducted during 1982 both in the existing OCP area and in the proposed tr'Jestern Extension area brought to light information which was either not available at the time of the original feasibility survey or was not fully apparent at that time, but which is now considered of such importance that a completely different approach to onchocerciasis control in the Western Extension area has to be adopted. This new informaEion relates primarily to an incomplete picture of vect.or distribution, to the insecticide resistance problem in the Ivory Coast, to infrastructural and logistic constraints in the extension zone, and to topographical and climatic constraints in the southern part of the extension zone.

Although the vector species of the VJestern Extension area are the same as those in the OCP, precise information is not yet available on the distribution of all the species. Similarly the vectorial capacity of at least some species has not yet been fully assessed. However, what is kno\^m with some certainEy is that S. soubrense is widely distributed in the upper basin of the River Niger and that the zone of distribution is contiguous with infestations in the OCP which are now double resistant to the larvicides temephos and chlorphoxim. Thus until such time that Ehe present resistance problem is satisfactorily resolved, an extension of vector control operations into the upper Niger basin would involve unjustifiabl-e risks and could have serious repercussions. With regard to infrastructural and logistic constraints the main problems relate to the inadequacy of road networks in many technically critical parts of the extension area, and, to the generally poor condition of many existing roads. Because of the higher rainfall in the southern part of the area (annual means of 15OO-280O rprn compared to 7OO-1500 mm in the north) road conditions are generally poorer in the southern subregion than in the northern subregion, especially during the r^7et season. The implication of these situations is that even if vector control was technically justified in the southern subregion there would be many logisEic problems and it would not be possible to conduct entomological evaluations on a sufficiently large scale to meet OCP requirements.

The remaining constrainEs to an early extension of operations in the southern subregion are imposed by topographical, vegetational and climatic factors. More specifically the constraining factors are combinations of mountainous terrain, very lush riverine fringing foresEs (which conceal many of the rivers when viewed from Ehe air), and much low cloud which would make 1ow-level flying by larviciding aircraft impossible in some localities and extremely dangerous in others.

These constraints require much more detailed study in order to identify the aPProPriate measures to be taken to remove, reduce or circumnavigate them. In the meantime it has been necessary Eo make a decision on those parts of the extension area which could receive early onchocerciasis control action, and those which, contrar)Mise, cannot be considered until such time that constraints to effective conErol have been diminished to accePtable levels. Accordingly it has been assessed that an early extension of OCP activities is feasible in the northern subregion, which is a generally low-lying, dry savanna area containing only the truly savanna vectors of onchocerciasis, S. sirbanum and !!ryg s.s. Conversely, for the time being an early extension cannot be envisaged for the southern subregion which contains much humid savanna, rain forest, and rugged upland terrain, and which provides habitats for a ocP82 .3 Page 6

Sreater number of vector sPecies. The northern subregion includes r{estern Mali, much of eastern Senegal and a narroi^7 frontier zone of Guinea, while the southern subregion includes most of Guinea, a smal1 part of eastern Senegal, all of Guinea-Bissau and the affected areas of Sierra Leone.

The strategy ProPosed for the implementation of the extension is to subdivide the northern subregion into two phase zones designated I (the R. Senegal basin, mainly involving western Mali) and II (Ehe R. Gambia basin, mainly involving eastern Senegal), and to consider for the time being, the southern subregion as the phase III zone.

Depending on when the starting date is set for the commencement of OCp activities in the Phase I zone, activities will commence in the Phase II zone one year later. In both phase zones vector control operations will normally not coutrnence until a two-year preparatory activities period has been completed. During these preparaEory periods logistic problems will be resolved as far as possible and the necessary evaluation units will be created in order to ensure at least one ful1 year of pre-control data are available before vector conErol sEarts.

During both the Preparatory activities period logistic and technical investigations will be intensified in the Phase III zone with a view to defining an appropriate control strategy(ies) and a tentative starting date for vector control in that zone.

It is envisaged that in all phase zones aerial spraying operations for vector control will be implemented through an appropriate extension of the present OCp aerial operati-ons contract.

With regard to the responsibilities for and the staffing of the various activities necessary for an effective extension, these will be shared between the OCp and participating governments. The OCP will have overall directorial and managerial responsibility, will conduct all vector control operations, and \^7ilt also be responsible for entomological evaluations. Epidemiological evaluations and environmental monitoring activities will be conducted by participating governments, either individually or collectivety. tJhichever is the case, these two national activities will be supervised and coordinated by the OCP. Furthermore the OCp will assist in the creation of the epidemiological and environmental teams/services, by providing basic equipment and by training the personnel required. As none of the participati-ng countries has an environmental monitoring service the establishment of the appropriate national teams will be quite an undertaking. It is therefore proposed that the OCp will be responsible for an initial tl^/o-year monitoring contract with a specialized Institute, during the implementation of which staff will be trained and the teams created.

In view of the distance of the Western Extension area from oCp headquarters in ouagadougou, it is proposed that extension activities will be conducted from a primary operational base located in Bamako, Mali.

If the Ecological Group endorses the strategy proposals contained in this report and if the JPC aPProves the early implementation of the extension, preparatory activities could coflImence in the Phase r zone in 1983, with vector control operations conunencing approximately two years later in February 1985.

The anticipated cost of the international contribution to the Western Extension has been calculated in some detail for the first three years of operations, and a more generalized prediction made of costs for the next three-year period. The resultant six-year budget can be sununarized as follows:

Year 1 L L t : 9.

US$ 3 018 5 407 7 149 7 909 8 391 6 876 (ooos)

giving a toral of US$ 38 751 OOO. oCP62 .3 page 7

PART I

]NTRODUCTION TO ONCHOCERCIASIS IN THE PROPOSED OCP I^IESTERN EXTENSION AREA AND THE BASIC PRINCIPLES FOR ITS CONTROL

CHAPTER I

INTRODUCTION

1. BACKGROUND

During the Second Session of the OCP Joint Prograrme Cornlittee, held in Geneva in December 1981, the OCP was requested to prepare a Plan of Operations for a prograrme extension into Mali, Guinea, Guinea-Bissau, Senegal and Sierra Leone. To facilitate the early execution of this task the JPC approved a budget for L982 of US$ 442 OOO, and accepted the following Terms of Reference:

l. To sEudy the report of the feasibility study of an onchocerciasis control campaign in the Senegal River Basin area and annexes and have detailed discussions with those who prepared Ehe report and collect a1l the relevant information available (cf. document JPC 2.8).

2. To visit the count.ries concerned and determine what personnel is available to mount vector control.

3 To draw up a Plarr of Action for the implementation of Phase I. This will include: (a) establishment of staff and logistic network - buildings, transport, radio- comnunication, etc; (b) collection of base-1ine entomological and hydrobiological data; (c) preparation of insectide application circuits, assessment of insecticide required and the number and type of aircraft; (d) drawing up of timetable of events for launching control operations.

4. Collaborate with the Office of the Lega1 Counsel, HQ-WHO to review the legal implications for extending into Seneganbia countries.

5 To project the requirements for Phases 1I and IIl with a timetable for implementation.

6 To prepare the Budget for the Western Extension Programme.

7 . To ensure, in association with the Regional Office for Africa that the structures are avai.lable within the countries to pursue the epidemiological monitoring activities

8. To prepare a comprehensive report for presentation to the third session of the JPC.

Since January, L982, a Consultant Coordinator has worked in close association with staff of the oCP and of the Project lfx/tCt/VtO/OOl to assist in data collection and to prepare this report i-n accordance with clause 8 of the above terms of reference.

The report is presented in t$/o parts. Part I is an introduction to onchocerciasis in the proposed Western Extension area and to the basic principles for its control, while Part II presents the Plan of Operations and Budget. ocP82 .3 Page 8

2. NEW APPROACTIES AND DEVELOPMENTS

In collecting data and in considering various scenarios, due attention has been given to various options for new approaches to onchocerciasis control and evaluation in the Western Extension, to recent socioeconomic developments in some of the involved countries, and to new technical developments in the existing OCp.

Noting the need for a conservative approach to the Western Extension, and, taking a broad view of national resources and capabilities on the one hand, and the technical know-how and resources of the OCP on the other hand, mush consideration has been given to various options for striking a balance between national and international participation. The option which has most to comnend it is that the oCP be responsible for overall administration, for vector control operations, for entomological evaluations and for the overseeing of epidemiological, hydrobiological and economic development moniEoring. Conversely, nat1onal authorities of the Participating Countries, either individually or collectively, should be responsible for: (i) the provision of basic infrastructural facilities and servicesl (ii) the provision of national parasitological and ophthalmological teams for the the collection of data necessary for accurate long-term epiderriological evaluation (these teams could be part of a multidisease surveillance service depending upon the particular requirements of the counEries concerned); (iii) making available comprehensive networks of hydrological and of meterological s tat.ions ; (iv) ensuring adequate lines of cotrEtunication;

(v) surveillance of the possible effects of repeated long-term use of pesticides on aquatic eco-systems.

fhese are ideal objectives, and some nati-onal authorities nay have difficultyin attaining them. Consequently, very flexible approach must be maintained to the apportionment and funding of the various" responsibilities.

In atEempting to define the most appropriate strategy for extending OCP vector control operations westward, much attention has been given to studying the major technical problems which currently plague the OCP: insecticide resistance and reinvasion. Of particular importance is the critical insecticide resistance problem which affects urany of the valleys of the Ivory Coast. The situation is very serious in the present conEext by virtue of the fact that resistant blackfly populations extend to the frontier between Guinea and lvory Coast. Consequently, it is logical to assume that these resistant populations of blackflies have already spread into eastern Carinea, or, are likely to appear there in the near future. At present the resistance problem priurarily revolves around Simulium soubrense, a species largely confined to the rain forest and humid savanna belts. The epidemiological significance of these temephos-resistant popu lations of S. soubrense is at present unclear. Experience has shown that once insecticide resistance appears its spread to other river systems can be very rapid. This is amply illusErated by the following list of dates on which temephos resistance was detected in S. soubr ense throughout Ehe lvory Coast:

Date River

lfay 1980 Lower Bandama August 1980 Marahou6 November 1980 N'zi and Kan January 1981 Middle Sassandra February 1981 Leraba March 1981 White Bandama and Upper Sassandra May Middle and lower Como6 ocP 82.3 Page 9

A subsequent serious complication of this resistance \^/as the developent by temephos- resistant S. soubrense of double-resistance to ch lorphoxim; the alternative compound first introduced in an attempt to control temephos-resistance.

At the Present time every effort is being made to bring the double-resistance problem under control by the aerial application of a larvicide containing the biological control agent, Baci 1 lus thuringiensis, sero type H-14 @_!. H-14) Unfortunately, the B.t. H-14 formulation available to the OCP is not ideally suited to conventional OCP aerial spraying equipment and techniques. Because of its special formulation characteristics it has to be applied:

(i) after dilution with hTater; (ii) as a conventional spray, otherwise, because of its high specific gravity it rapidly sinks to the bottom of the rivers to which it is applied; (iii) at volumetric dosage rates three to ten times those of temephos, depending upon local hydrological conditions.

Consequently, it has been, and conti-nues to be necessary to develop and install into oCp aircraft different and more complex types of spraying equipment than have hitherto been |trapi-d-releasert necessary for applications of Eemephos. Furthermore, in situations where river discharge rates have been high, the quantity of B.t. H-14 required to be applied to treat a single S. soubrense breeding site, has exceeded the insecticide reservoir capacity of the aircraft. This situation has created new ope-ational and logistic problems which have not been insurmountable under dry season conditions when ri-ver discharge rates have generally been low. However, under wet season conditions the discharge rates of some Ivory Coast rivers, e.8. Como6 and Bandama, have been sufficiently high to sake B.t. H-14 aerial appti- cations impracti-ca1, resulting in a temporary suspension of vector controlmeasures using this insecticide in some areas.

This emphasizes the need to accelerate the search for and the evaluation of alternative larvicides.

The problems of insecticide resistance and of applying B.t. H-14 in the Ivory Coast confirm the dangers of extending vector control operations into those parts of the humid savanna and forest zones of the Western Extension area where S. soubrense is knovrn or suspected to occur, until such time as alternative, back-up larvicides are available. This expression of the situation is in accordance with the constraints introduced into the OCp by the Ecological Group.

3. IIIE PROPOSED WESTERN E}CTENSION AREA

The region proposed for the Western Extension, which has a human population of at least 5.3 million persons, is depicted cartographically in Map l.

3. I Limirs

Bearing in mind that there are stil1 many gaps in our knowledge of the distribution of the various Simulium species and of onchocerciasis in the high rain-fall parts of the region, there may eventually be justification for modifying the southern and south-western boundaries. Relocation of these boundaries may be deemed necessary to include areas outside the current proposed limits; the endemic onchocerciasis area of Liberia is a case in point.

In addition, it must be noted that the Government of Guinea would wish that the River Konkour6 basin be included in any Western Extension proposal, in view of current plans to construct two dams (at Souapiti and Amaria) on the R. Konkour6. 0cP 82 .3 page 10

The western limit of the Western Extension area would seem to be valid, although the Simulium and onchocerciasis situations in the Gambia are by no means clear. The importance of clarifying this situation as soon as possible has recently been stressed at ministerial level (Anon, 1981).

Although the available evidence suggests that the R. Gambia (within the national boundary of the Gambia) is unsuitable for S. damnosum s.1 breeding and that the occasional cases of onchocerciasis detected are not autochtonous, detailed entomological surveys of the R. Gambia should be conducted before plans are formulated for vector control operations along the upstream reaches of this river in south-eastern Senegal.

3.2 Physical geography

A re-examination of the spatial area of the Western Extension zone, according to its original limits shows that the area u4der consideration is about 365 OOO trl.2 lZlO 0OO km2 according to Orai-n, 1981; 361 7OO krn2 according to this report). The extension of the control operations into the Konkour6 basin (Guinea) would increase the size of the area by ca L2 OOO km2. If, to lhe east of Freetown (Sierra Leone) the southern limit is extended southwards to occupy a position g 90 km from the coast and parallel to it, Ehe area would be further increased by ca 62.OOO k*,.n Including all these possible expansion zones, the final control zone could reach 440 OOO kmz. In terms of topography the region is dominated by a crescent-sh,aped highland range (mount.ainous in some areas) which extends westwards from the Guinea/Ivory Coast frontier, northwards through west-central Guinea and Ehen north-eastwards into western Mali. The rain components of this highland range are:

the Guinea Highlands and l,Iont Nimba in south-eastern Guinea; the Guinea Highlands, with their l,rlara l^lara, Loma and Tingi Mountains in Sierra Leone; the Fouta DjaIon Plateau in west-central Guinea; Ehe Monts Manding in the extreme west of Mali and the Malinke Plateau more centrally positioned in western Mali. Of particular interest is the dramatic influence of this crescent-shaped highland range on the drainage system of the region. The crescent cradles the sources of the R. Niger which ramify through the so-called Upper Niger Plains (see Map I). It also forms the watershed which separates Ehe Niger Basin from other savanna river basins (the Gambia and the Senegal) and from a coast complex of drainage systems (Corubal, Konkour6, Little Scarcies, I"Ioa, Loffa, Cava1ly, etc.). Altogether, the Western ExEension area is much more complex than the existing OCP both with regard to the patterns and characteristics of the drainage system and to their fauna and flora.

The bioclimatic zones of the region, based on the work of Aubreville et al. (1959) are illustrated in Map 2. I,lean annual rainfall patterns of the region are shovm in Map 3.

More specific geographical details of the three countries which constitute the greater part of the Western Extension area, Mali, Senegal and Guinea, are Presented be1ow. 3.2.L }(ali

The part of Mali included in the !,iestern Extension has an area of ca l5O OOO 1qn2 and a population of ca I 150 OOO persons. It includes a small part of the R. Niger valley but is otherwise coincident with the upper basin of the R. Senegal. Within this region three subregions can be distinguished, as follows: ocP82 .3 PaSe 11

(a) The upper basin which is dominated by the northern flanks of the Fouta Djalon range. These uplands look down on the Mandingo plaEeau which stretches as far as the iine formed by the Senegal, Bakoye and Baoul6 rivers. The average height of the pLateau is 5OO m but it reaches an altitude of 7OO-8OO m and more in its s,ruEhern parts where the Bakoye and Baou16 rivers rise. The average alEitude is 5OO m but it increases to 7OO-8OO m (and more) in southern parts where the Bakoye and Baou16 rise,, Despite its name, the Mandingo pLareau is not a vast and uniform plain but is made up of a series of p1-ateau of unequal heights falling in steps not only from south to norLh but also towards the courses of the rivers Lhat divide it up into sections.

Along iEs western border, the plateau becomes more massive and ends abruptly in a cliff that rises 2OO m above the flat low-Iying land along the Bambouk and Fal6me rivers. As a general rule the plaEeau runs out in gentle siopes. The rivers of the region are permanent watercourses and in their middle and upper reaches often run through gorges and are punctuated by waterfalls and rapids. The valleys open out only in their lower reaches, generally where they join other rivers.

(b) The Kaarta (or Sarakol16) range is bounded on the south by the combined valleys of the Senegal and Bakoye rivers and then by the valley of the River Baou16 as far as the extreme point of its "loop". On the west, it is bounded by the Kolimbin6 river, and on the north by the Hodh depression. In the east, the pLateau gradually sinks under a sandy desert of Sreat antiquity. Depending on altitude, relief and soil type, four sectors or natural microregions may be distinguished:

(i) The south-western sector is the highest part of the massif with arr alt.itude of over 5OO m and includes the Kaarta's highest point which lies to the north of Bafoulab6. The valleys of the Bakoye and Kolimbin6 rivers are dominated by a 3OO m cliff forming a waIl that runs on towards Ehe North wiEh slightly lower peaks and heights. Inbetweenthe hilIs, valleys rich in clayey soil run far into the nassif.

(ii) The south-eastern zone, known as the Kaarta-Bagu6 because it is near the Bakoye river (Bagu6 in }4alink6), is made up of broad valleys and bottom-Iands with a gentle gradient that keeps its moisture well into the dry season.

(iii) The central zone is the true Kaarta. It is a region of varied topography and the plains and bow-shaped depressions it contains are filled with deep, black, very fertile soi1.

(iv) The sector to the north and north-east is low in altitude with a fairly shallow relief. There is some bottom-land with heavy soil, but ocherwise the soils are light. The vaLleys that the Kolimbin6 and its tributaries have cut across the Kaart.a collect the run-off water and degradation products from schist, limestone and dolerite. These degradation products account for the high fertility of the soil in the va11eys, depresslons and plains within this area and make the Kaarta the "milleE basket'r of the upper Senegal basin.

(c) The higher ground on the plat.eau of the upper basin which varies in detail and changes from one region to another, is cut up by river valleys of varying width depending on the nature of the underlyi-ng rock and pierced by enclosed plains that have formed at the confluence of rivers.

The rivers in the northern part of r^Testern Mali flow through relatively wide, shallow valleys. Most of them are temporary watercourses, flowing only in the wet season and drying up for the rest of the year. Only the Kolimbin6 and the Karakoro have water all the year round in their lower reaches, but it is stagnant during the dry season. ocP82.3 Page 12

In the South, and unlike the Sahelian regions to the North, water is not a problem, or at least is not the same kind of problem. Although the rdatercourses flow a1l the year round, two factors cancel out the advantages of having a pernanent supply of water in the valleys. One is that most valleys have a V-shaped cross-section and steep sloping side unlikely to retain considerable deposits of alluvium, and the other is that the humidity resulting from the heavy rainfall (8OO-15OO mm during five to seven months) is favourable to rnny insect vectors of disease, including onchocerciasis.

3 .2.2 Senegal

The Western Extension area coincides with Eastern Senegal, the largest region of Senegal, with an area of ca 56 ooo krn2 and a human population of g 3oo ooo persons.

Eastern Senegal is composed of the adminisErative departments of Bakel, K6dougou and Tambacounda, and is bounded by:

Ehe Fleuve Region to the north, the frontier with Guinea to the south, the frontier with Mali to the east, Ehe regions of Casamnnce and Sin6-Sa1oum, and the frontier with the Gambia.

The pre-Cambrian basement complex outcrops in the south-east of the Region in the form of folded metamorphic series (quartzites, arkoses, schi-sts, micaceous schists, gneiss) and synklnematic (Saraya and south-east of Kidira) or post-tectonic Birrimian granitic massi-fs (north of K6dougou). The socle is cross-bedded by primary strata forming a north-south band betr.Teen Kidira and Gambia, and comprising:

Lower Cambrian sandstones and quartzites making up the northern edge of the Fouta- Dj a lon; Cambrian, made up of a volcanic complex and conglomerates overlaid with sedimentary strat.a ending in red clayey sandstones of the Upper Cambrian; Ordovician: hrhite sandstones cross-bedded with the Cambrian; Schistose Silurian outcropping west of the north-south band of Cambrian and Ordovician series.

Post-Devonian dolerite intrusions appear to the north and west of K6dougou. The northern half of the region is a vast peneplain, less than 1OO m above sea leve1, gradually rising to 2OO m (the hills of the Bassari country). The only real uplands (4OO-5OO m) are to the south (frontier of Guinea and the loop of the River Gambia) and correspond either to the edge of the Guinean Plateau or to outcroppings of dolerites forming series of terraces along the rivers.

0n the uplands there is Combretum or Andropogon savanna, which may be tree-studded, wooded or shrubby. The vegetation in the hydromorphic soil areas reflects the conditions of hydro- morphism. Inlention may also be urade of two special plant formations - the I'Bow6r' (where the laterite slab appears bare) and bamboo thickets.

The river basins of imPortance for the area are the following

(i) The River S I basin. with the R. Fal6me, whose catchment area is 28 9OO km2 at the Kidira Station. Discharges range from over 3OOO #/s f."r the highest f loods to practically zero at 1ow water.

(ii) The River Gambia basin. The river has its source in the Fouta Djalon and its catchment area is Z5SO tmz at K6dougou and 10 45O km2 at },lako. In the K6dougou area its rrain tributaries are the Koumboutourou, the Tiokoye, the Din Ktra and the Niokolo-Koba. 0cP82 .3 PaSe 13 At Wassadou the River Gambia has a catchment of 20 900 km2. Its low-water bed is well- marked (width 12O m) and its vertical banks lO m high. Ar the height of the flood rhere are extensive innundated areas.

In this area the River Gambia receives the Nieri-Ko, which drains a catchment area of 1l 946 krr,z. It then receives the Koulountou and just before Gouloumbou the Niaoul6, which has a small catchment area of 1584 km2. At Gouloumbou its catchment area is 41 4OO km2, its bed is wider and in the shape of a vast trapezium. After crossing the Guenoto plain it enters Gambia, where it receives the Sandougou, which has a catchment area of 9960 kmz. The Sandougou flows sometimes downstream when the runoff from its catchment area is preponderant, and sometimes upstream (reflux arising from the Gambia flood which arrives earlier and is larger than that of the Sandougou).

(iii) The Rivers Kayanga and Anambe basins The Kayanga rises to the south of the Senegal-Guinea frontier and enters Senegal south of Patim-Kouta. lt joins the Anambe near Niapo, where its catchment area is about 1755 km2.

The Anambe basin is a vast depression, separated from the River Gambia catchment area to the norttr, that of the Casamance to the west and that of the Kayanga to the south and west. Its area is about 11OO km2.

3 .2.3 Guinea

Guinea is one of the coastal States of West Africa. It lies between 7'and 12"latitude north and 8'and 15'longitudinal westl it is 246 OOO kn2 in area, and situated in the humid tropical zone of West Africa. The States bordering it are Guinea-Bissau, Senegal and Mali to the north, the lvory Coast to the east, and Liberia and Sierra Leone to the south; and it has a coastline some 3OO km long, which gives it an exceptional geopolitical position.

The major factors of relief, cliunte and vegetation combine to form four natural regions, which make possible the production of a very wide range of different types of agricultural produce. These regions are as follows:

(i) Maritime Guinea is a low I.ying coastal region; it has a tropical humid climate of the south Guinean type, and annual rainfall is everywhere over 2OO cm, the dry season lasts five months (December to April), It is a regi-on of mangrove swamps, rainfed rice-growing fields and orchards; it is also the site of substantial mining operaEions (bauxite).

(ii) Middle Guinea corres ponds to the Fouta-Djalon massif, with an altitude ranging from 600 to l5OO m (Mount Loura); the dry season lasts five to six months (November t.o April) and mean annualrainfallisabout 18OO mm. Themainriversofthe region rise in the Fouta-Djalon; formerly forest-clad, the massif now has a degraded vegetation anderosionhasassumedalarming proportions. The region is used for agriculture and stock-raising and has one of the highest population densities in the country (over 40 people per km2). 1t is also, of course, an area of high emigration to the towns and to adjoining countries, parEicularly Senegal.

(iii) Upper Guinea covers the north and east parts of the country and has an area of some 97 OOO kn2. The climate is of the south-Sudan type and the mean rainfall is 15OO nrn but the dry season may last eight months and variati-ons are extreme, causing wide fluctuations in the level of agricultural production. This is a zone of savanna, where activity is centred on the river valleys, particularly the Niger valley, and the population is distributed unevenly, mainly along the rivers.

(iv) Forest Guinea, in the south of the country, has a climate of the equatorial type, with a r{et season frequently lasting more than 10 months and a mean annual rainfall of over 2OOO mm. Basically iE is the zone of deep forest and it has a dense population; iE also contains an iron ore deposit of first-class importance (Mount Nimba). ocP 82 .3 Page 14 Area and population estimates of these regions are as follows

Mar i t ime Midd 1e Upper Fores t Guinea Guinea Guinea Guinea

Area (km2) 45 000 55 000 97 000 49 000

Population (1978) 1 300 000 1 550 000 1 140 000 1 160 000

3.3 Social and eee4omi! €ee€rep y Historically and culturally, despite the frontiers inherited from the colonial period, the populations of the region display very strong affinities. The great majority of them belong to one of two main ethno-linguistic groups, the Fulani (Peul) and the Bambara-Malink6, who have shared pre-eminence in the region's history in recent centuries: the Mandingo Empire of Soundjata in the fourteenth century; Ehe heyday of the Fulani of Koli Tenguela in the sixteenth century; the kingdoms of Gabou, Boundou, Kaarta and S6gou; the Fulani regimes of Lab6 and Timbo from the seventeenth to the nineteenth century; the jihad of El Hadj Ourar which, starting from Dinguiraye in the l85Os, subjected the whole of Western Mali before fading out in the Macina; finally, there was the emergence of the Samori Empire at the end of the nineteenth century from Upper Guinea and its extension over a large part of central West Africa. Alongside these major population groups there are sma11 ethnic groups, linguisEically and culturally different, which at some point in their history were driven back either into the mountainous areas (Bassari, Coniagi, Diakhand6) or to the edge of the forest (Kissi, Toma, Goerz6., etc.) at the border between Liberia and the Ivory Coast.

The peasants of the region mainly grow cereals (sorghum, mi1let, maLze, rice) and also cowpeas, groundnuts and sometimes cotton. In the southern part of the area fruit crops (mangoes, citrus) are comparatively plentiful, as are tuber crops, especially cassava. There is a great deal of livestock raising: not only cattle (mainly in the form of trypano-tolerant varieties such as Ndama, which appears to originate from Guinea) but also small ruminants, sheep and goats. Itinerant cultivation of burned land with fairly long fallow periods rernains the predominant system, despite the introduction of more intensive practices (animal traction, use of fertilizers, bottomland crops) at some places in the area.

From a demographic viewpoint the region can be regarded as underpopulated (about 10 inhabitants per kmz on average) but there are some more populated areas and even one area which can be regarded as overpopulated. The majority of the region has population densities between 5 and 20 inhabitants per icrn': almost all the First Region of Mali, Upper Guinea, Forest Guinea and the Gabu region in Guinea-Bissau. One area i.s distinctly underpopulated: EasEern Senegal with less Ehan five inhabitants per km2. One area can be regarded as overpopulated: rhe central part of the Fouta Djalon massif (over 40 inhabitants per km2): on the other hand, some areas can be defined as averagely populated (25-40 inhabitants per km2): the Khassonk6 country in Mali, forested subareas of l"lacenta and Nz6r6kor6 in Gui-nea. Senegal is an example of inequality in the geographical distribution of population: while the mean national density is about 25 inhabitants per km2, the population density exceeds l2O per km2 in some rural areas of the Groundnut Basin and drops below four in some parts of Eastern Senegal- (K6dougou area). The reasons for this uneven population distribution are extremely complex and are linked to the nature of the soil, the environment, the prevailing health conditions in the area, and finally to history.

From a socioeconomic viewpoint the region can also be regarded as a fairly homogenous whole; except in certain subareas of Gui-nea, either with diamond deposits (K6rouan6) or at the fringe of Lhe tropical forest (Nz6r6kor6, Macenta) where some shrub crops are gror,rn (coffee, ocP82 .3 page 15 bananas), incomes are extremety low; the region is among the poorest in the world and annual incomes in the rural areas are generally between US$ 5O and iOO; and of course there are al1 Ehe diseases, hardships and sufferings which usually accornpany such income levels. This situat-ion is found particularly in the northern part of rhe area (between isohyets 7OO and 1OOO nun) at the edge of the Sahel where rainfall is lor.r and displays wide variations from year to year. The decade f97O-1980 saw a series of drought vears which jeopardized the entire food balance of lhe area and prcduced genuine famines. As a result of this, and the prevalence of many endemic diseases (particularly malaria) and a very 1ow level of infrastructure and of social and health resources, the mortality rates for children under five are among the highest in the world. Finatly, a characteristic common to almost all parts of Ehe region must be stressed: this is the isolation which hampers the movement of peopLe and goods and in particular substantially restricts the opportunities for urarketing crops. Because of the lack of any real road network, four-fifths of the region are totally impenetrable during the rainy season and three-fifths are very difficult to reach even during the dry season.

3.4 Logistical aspects of the area

As a result of various combinations of topographic, climatic, vegetational and social factors, a number of critical logistical problems have been identified. MenEion has already been made briefly to the deficiencies of the road networks of the Western Extension area which make about four-fifths of the area impenetrable during the wet season, and three-fifths very difficult to reach during the dry season. These situations are largely due to a combination of rugged mountain terrain, heavy rainfall and dense vegetation in many of the upland areas, and to sandy soils in the drier more northerly parts of the area.

In order to obtain up-to-date first-hand information on these situations road journeys \,rere nade through western }4ali in March 1982 and through eastern Guinea in April 1982. In both countries all towns tentatively earmarked as sector or sub-sector headquarters for entomological evaluations and/or aerial operatj-ons, were visited. The findings of the two missions are suflmarized separately below:

Western Mali

The limited road network in western Mali is not in good condition. In the Monts Manding and the Malink6 Plateau the roads are rocky and traverse a great many sma1l rarzines which are often difficult to negotiate. Along the north (right) bank of the Senegal and Baou16 rivers, sandy roads are an ever present problem. In the region of the t'Boucle de La Baoul6" sandy roads so quickly become impassable that they are frequently abandoned and realigned. Ihis situation makes road travel very frustrating and time-consuming for the newcomer, but, might not be too much of a problem for regular travellers, e.g. an entomological evaluation team.

A reassuring factor is that work to improve the condition of nany of the roads in the Senegal-Baou16 valley, is in progress. Furthermore, what can only be described as a highway, between Bafoulab6 and Manantali, is nearing completion.

Another factor of appreciable logistic importance is the fact that a very frequent and regular rail service connects most of the towns destined to be sector or sub-sector headquarters, with Bamako (the overall centre of operations for the Western Extension). Consequently, at least some of the constraints imposed by inadequate roads could be diminished by resorting to rail transport.

Eastern Guinea

This area, which involves part of the upper and of the forest regions of Guinea, has two major road conununication problems. The first is the lack of roads in the extreme east of the area, which prevents or restricts accessibility to the headwaters of River Sankarani subsystem, i.e. to the rivers Dion, Limou and Kourai; the second is the condition of the existing ocP82 . l Page 16

road network, resulting from many broken bridges and generally poor road surfaces. The general impression gained during the road survey was that the condition of almost all the roads was progressively deteriorating, with virtually no repair work in evidence. Most of the diversions around broken bridges were well worn, suggesting that they were of considerable a8e.

Kankan is at the end of the railway from points west but the rail services are neither frequent nor regular and so offer no real alternative to road transport in this area. Accordingly, any OCP extension activities in the area will have to face the reality of an inadequate road corurunication system. AIso, with the general absence of electricity, running water, vehicle fuels and lubricating oils, equipment and supplies, food, etc. in eastern Guinea, the region currently lacks the minimal infrastructural and logistic support facilities for the introduction of a conventional onchocerciasis control operation.

Climatically there is another potential major problem. In the region of the Guinea Highlands (in eastern Guinea) low cloud which enshrouds the tops of the many mountains and which descends far down into many of the valleys, will pose serious threats to the efficient execution of aerial spraying operat.ions and surveys, and, to the security of aircraft.

Although the region around Beyla (in the Guinea Highlands of eastern Guinea) is classified as being covered byttmoist savanna woodlandst'the vegetation is much more luxuriant than one normally associates with this type of woodland. On many of the mountainsides there are patches of climax forest. I4any of the rivers run through very steeply-sided valleys and under the protection of dense riverine forest canopies. Thus, apart. from the basic problems of operating 1ow-flying aircraft in these conditions, specialized aeronautical problems will be encountered. In many places it will be impossible to conduct aerial surveys of Simulium breeding sites, and there will be other places I^rhere it will be impossible to discharge insecticide at the required points, because the rivers are concealed by vegetation. Walsh et al. (1981) working in this type of situation in the Man region of the Ivory Coast reported, "Among these heavily forested ravines aerial control is difficult to achieve without risk to the aircrews. Accordingly, larviciding was curtailed where this risk was judged to be exces s ive.

Although no road survey has yet been conducted in eastern Senegal, it is evident from information available that the road network is not very extensive, especially with regard to access to the River Faleme valleY.

4 THE NEED FOR ONGHOCERCIASIS CONTROL

4 1 Health considerations

The prevalence and severity of onchocerciasis in the Western Extension area have long been recognized, and the extent of the problem can be judged from the statistics presented in the following table.

ENDEMIC ONCHOCERCIASIS: SITUATION IN 1980*

Population of areas where the disease is endemic 5 390 ooo Non-exposed populaEion 2 LgL o00 Population directly exposed 3 t99 000 - at the hyperendemic Ievel 428 ooo - at the mesoendemi-c level 904 500 - at the hypoendemic leve1 I 866 500 Number of blind persons 33 700

* Data from Sierra Leone is not included. ocP82.3 Page 17

I"Iore specific infornation on onchocerciasis in the Participating Countries of the region are given below.

Guinea

Upper Guinea is a hyperendemic zone where onchocerciasis has very serious consequences in the form of high percentages of blindness and the abandonment by the population of vast valley areas even though they are reputed to be very fertile.

Middle Guinea is generally mesoendemic but with serious hyperendemic foci on the Bafing, Bantala-Kornba, Coliba and Koulountou rivers resulting in high Percentages of blindness. However, the disease is hypoendemic in the administrative regions of Lab6 and Pita, situated on the high ground of the Fouta-Djalon. In Forest Guinea, onchocerciasis is hypoendemic to mesoendemic, with one hyperendemic focus in the Beyla region. The generally low rate of blindness, however, means that the disease is less serious in this zone.

Finally, in Lower Guinea onchocerciasis does not appear to be endemic and prevalence and rates of blindness are 1ow.

On the basis of existing data it appears that in Guinea it is UPPer Guinea and Middle Guinea (with the exception of the Fouta-Djalon highlands) where the serious form of onchocerciasis is rife and which should be included in an onchocerciasis control campaign as a matter of priority.

It can therefore be concluded that onchocerciasis is Present to varying degrees in most of Guinea. Some regions are particularly seriously affected, mainly in Upper Guinea (Kankan, Faranah and Dinguiraye), but in the other regions numerous arrondissements are also stricken. In Middle Guinea the endemiciEy level seems low in the central part of th,e Fouta-Djalon massif, where population density is relatively high (over 40 inhabitants/kr;rt). In the areas surroundi-ng the Fouta-Djalon, on the other hand, where population is sparse, the level of endemicity is higher. Onchocerciasis does exist in Forest Guinea (Yomou, N'Z6r6kor6 and LoIa) but is not as serious as the savanna form.

The area proposed for inclusion in the Western ExEension covers approximately 22O OOO km2, with a population of ca 3 557 OOO. The population directly exposed Lo onchocerciasis is estigrated at 2 OO9 OOO persons, of whom 254 OOO live in hyperendemic, 545 OOO in mesoendemic, and 1 210 OOO in hypoendemic, areas. The number of people suffering from onchocerciasis is estimated at 560 OOO and the number of blind persons at 20 OOO, so that of the population at risk, 287" have the disease and l% are blind.

Guinea- Bis sau

In Guinea-Bissau, onchocerciasis is prevalent only in the two eastern regions of the country, Gabu and Bafata, with an area of 13 9OO kmz, a populaEion of 2O4 OOO and a population density of 15 km2. The whole Gabu region is affected, while in the Bafata region only the Contuboel secEor is affected. The population directly exposed to onchocerciasj-s numbers 132 OOO individuals, 13 OOO of whom are living in hyperendemic zones, 59 OOO in mesoendemic zones, and 59 OOO in hypoendemic zones. The total number of onchocerciasis sufferers is estiEraEed to be 30 OOO, with I4OO cases of blindness.

Ma 1i

Two administrative regions of Mali are affected by endemic onchocerciasis: the first Region (Kayes) and the Second Region (Koulikoro or the former Bamako Region). The Western Extension area covers 138 94O km2, with a population of I 214 OOO inhabitants and an averaSe ocP82.3 PaSe 18 population density of 8.7 inhabitants per km2. In the First Region (fayes), Y6liman6, Nioro, Di6ma and Kayes Cercles are only slightly affected, while Kita, Bafoulab6 and K6ni6ba Cercles are areas of medium to high endemicity. In the second Region only three cercles are affected: those of Kangaba and Kati in the case of the arrondissements on the left bank of the Niger and that of Kolankani in the western part of the Region.

ln l98O it was estiflEted that 860 OOO persons were directly exposed to onchocerciasis (73% of the population of the area), 138 OOO of them living in hyperendemic, 27O OOO in mesoendemic and 455 O0O in hypoendemic areas. The number of people with onchocerciasis in the area is estimated at 28O OO0 and the number of blind at lO 5OO.

Senega 1

In Senegal- the endemic onchocerciasis area covers the southern part of eastern Senegal and in the north does not extend beyond an imaginary line joining the eastern frontier of the Republic of Gambia to Kidira. To the west the focus also covers Velingara DepartmenE in Upper Casamance, without, however, extending beyond Baconto arrondissement. The total population of the endemic area is 418 OOO, while the population directly exposed to the risk of onchocerciasis is estimated to number 198 OOO; 23 OOO of them in hyperendemic, 40 OOO in mesoendemic and 135 OOO in hypoendemic areas. It is estimaEed that there are 44 OOO people with onchocerciasis and 15OO blind persons out of 198 OOO exposed to endemic disease, i.e. 22% wi-tt, onchocerciasis and 17" blind.

Sierra Leone Existing entomological data suggest Ehat savanna onchocerciasis can exisE in the Northern Province of Sierra Leone, although few surveys have been conducted.

The limited epidemiologi.cal surveys undertaken have shown that ocular onchocerciasis is present; in two localities blindness rates of O.7-8% and of 4.75-8% have been recorded. Further detailed parasitological and ophEhalmological surveys are required in the Northern Province in order to demarcate the focus of savanna onchocerciasis.

The data presented country by country above are collectively summarized in the following table:

Endemicity level Total Popu Iat ion population not Hyperendemic Mesoendemic Hypoendemic exposed exposed

Guinea-Bis sau 13 000 49 500 69 500 132 000 72 000

Gu inea 254 000 545 000 1 210 000 2 009 000 r 548 000 Mali 138 000 270 000 452 000 860 000 351 000 Senegal 23 000 40 ooo 135 000 198 000 220 000 Region as a whole (except Sierra 428 000 904 500 I 866 500 3 199 000 2 191 000 Leone)

In conclusion, onchocerciasis control in the proposed Western Extension would benefit at least 3.2 million persons; approximately 1.2 million in the northern dry savanna Part of the region, and approximately two million in the southern humid savanna and foresE parts of the region. ocP82.3 page 19

4.2 Socioeconomic considerations

In addition Eo the health benefits which would derive from onchocerciasis control in the Western Extension area there would also be importanr sociucconomi.c benefi-ts, Particularly with regard to:

(i) increased incomes resulting from increases in the quantity and quality of labour and land resources; (ii) distributional benefits relating to the fact that the beneficiaries are amongst the poorest in the world.

Between 1978 and 1981, when feasibility surveys were conducted in the Western ExEension area, much attention was given to socioeconomic studies in Guinea, Guinea-Bissau, Mali and Senegal, and appropriate reports were prepared and annexed to the final feasibility rePort.

Those country studies identified 22 development projects in progress, rePresenting a capital investment of US$ 539 million, and 2O potential developmerrt projects the cost of which was estiunted at US$ 685 million. These projects, to a toEal value of US$ L224 r;rillion are benefiting, or could benefit 3.6 million people.

An important recent socj.oeconomic developmenE. in the proposed Western Extension area was the awarding by the Organization pour Ia Mise en Valeur du Fleuve Senegal (OMVS), in Yrarch 1982, of a conEract for the constructi-on of a large dam near the village of Manantali on the River Bafing in western l,lali. Construction costs are estimated at US$ 8OO million. When completed, this dam will modify the River Senegal valley to the extent that some 350 OOO hectares of good agricultural land could be opened up for cultivation. ocP82.3 Page 20

CHAPTER II

THE PRINC]PLES OF ONCHOCERCIASIS CONTROL

1. INTRODUCTION

As in the existing OCP, the objective of the proposed Western Extension is to reduce the impact of clinical onchocerciasis to a level where it no longer represents either a public health problem, an obstacle to socioeconomic development, or a hindrance to the reclamation of good agricultural land that is currently unoccupied.

Similarly, the principles and strategies of control proposed for the Western Extension will, as far as possible, be the same as those currently employed by the OCP.

Despite encouraging indications in the field of chemotherapy research, the absence of a specific drug that can be easily and safely used for mass treatment dictates that onchocerciasis control must at present be achieved by reducing or interrupting transmission through vector control.

In general vector control operations are directed against Simulium larvae, using insecticides which do not cause unacceptable hazards to the aquatic environment. However, it must be noted that the OCP is intensifying its applied research programne on adulticiding to determine whether this might offer an alternative and efficient technique (or techniques) for reducing the local impact of the reinvasion problem. It is possible therefore that adulticiding activities could play a role in parts of the Western Extension area where the consequences of reinvasion may be serious.

It is generally acknowledged that the migratory (dispersal) potential of adult Simulium makes it necessary to undertake simultaneous control action over large areas so as to reduce the risk of reinvasion of the treated areas. This is an ideal objective which it has been possible Eo attain in the existing OCP (although reinvasion remains a serious problem on the western and eastern flanks). As far as the dry savanna regions of the Western Extension area are concerned (western Mali, eastern Senegal and the northern fringe of Guinea), this is also a valid objective, but there may be some constraints to implementing it totally in the humid savanna and forested uplands of Guinea and Sierra Leone. Because of the combined problems of difficult terrain, heavy vegetation, bad weather conditions, inadequate logistic facilities and the dangers of the development of insecticide resistance, an alternative modified strategy involving much more spatially restricted attacks on the vector might be necessary.

The extended life-span of the parasite (both adult rrorms and microfilariae) dictates thaE control activities must be conducted continuously for several years. Ihe latest OCP parasitological findings suggest that the period could be less than the 20 years originally estimated as being necessary but it is premature to identify how many years less.

If current research should lead to the development of an appropriate drug or of any other onchocerciasis control technique which meets the requirements of the OCP (see the Final Report of the Independent Commission), the strategy of control, both within the existing OCP area and the Western Extension, would have to be revised to incorporate such an important development. However, no such alternative influence will have a major impact on the Progranrne during the six-year period for which the present report has been prepared, but it may be reflected in subsequent operations.

2. VECTOR CONTROL

In general, the vector control techniques and strategies which will be appropriate for the Western Extension area are those which are currently employed by the OCP, i.e. aerial larviciding of Simulium breeding sites employing biodegradable compounds. It is anticipated that, altogether, at least 22 OOO km of watercourse in the Western Extension will need to be treated in this way. This compares with the 18 OOO km under control in the present OCP area. ocP 82 .3 Page 2L

2.L Vector species in need o

Current knowledge of the distribution of the sp ecies of the S. damnosum complex in the Western Extension area is surmnarized in Map 4. When consulting Map 4 iE must be borne in mind that there is no relationship between the numbers of species symbols and the abundance of the various species. The Breater number of records shown in the southern half of the region is due to the fact that:

- anxiety abouE the possible spread of temephos resistance from the existing OCP into the adjacent southern part of the Western Extension area has inspired much more intensive sampling,

- there are many more species in the southern half of the region (at least five known vectors) than in the northern half (on1y two known vectors). After careful consideration of the geographical distribution of the various species, of their bioecological characEeristics, and of their vectorial capacity, certain conclusions can be drawn concerning the areas which require to be treated.

It is essential that regions occupied by S. damnosum s.s. and S. sirbanum be treated. These two species transmit the savanna strain of Onchocerca that is most Pathogenic to man. Their range coincides with hyperendemic foci of onchocerciasis. In addition both species are highly mobile and capable of covering distances of 3OO-4OO km under appropriate reinvasion weather conditions.

S. soubrense, a species of forest origin, is capable of establishing itself in the grineaiIZGIia-Ed remaining there throughout the year, although it is not renowned for long disEance travel. Studies of transmission under natural and experimental condiEions have given conflicting results which at present make it difficult to judge whether this species should be regarded as a target or a non-target species. Further research is therefore required.

S. sancEipauli a species confined to humid zones, has practically no vectorial capacity under natural condiEions, having regard to its short life span and to the fact that it is largey zoophilic. It is noE usually a mobile species. There is therefore no point in treating zones populated by this species.

S. yahense and S. sjuernerym are species that are excellent forest vecEors, but the Onchocerca strain which they transmit is not especially pa thogenic to man (absence of ocular lesions). Furthermore, they are Poor vecEors of the savanna strain. While S. squamosum is known to move for distances up to 1OO km, S. yahense is a much more sedentary species. There seems, therefore, to be no point in treating the breeding places of these species.

To surmnarize, only the range s of S. damnosum s.s., S. sirbanum and possiblY S. soubrense should be included in the treatment zone.

It follows, therefore, from the data p resented above that S. damnosum s.s. and S. sirbanum are the species of greatest epidemiological importance with regard to the rei-nvasion problem. However, the 1oca1 importance of ttarrivalrr flies is not geographically uniform. In fact, there appears to be a relationship between vectorial capacity and mean annual rainfall (Dr J. B. Davies, Personal cormnunication).

In the 1250-1500 run mean annual rainfall belt of the OCP area, reinvading flies are usually so numerous that transmission leve1s are unchanged by larviciding operations. (Situation I. ) ocP82 .3 Page 22

In the 1OOO-125O nm mean annual rainfall belt of the OCP area, reinvading flies are usually in sufficient numbers to maintai.n transmission. (Situation 2.)

In the 750-1OOO mrn mean annual rainfall belt of the OCP area, reinvading flies are not normally in sufficient numbers to pose a threat. However, if 1ocal breeding is able to take place, a dangerous, but localized disease situation, can develop. (Situation 3.)

By projecting these relationships Eo the Western Extension area it is possible to obtain some foresight of the severity of reinvasion problems which may develop. The following predictions must however be read with caution:

Situation 1

- The conunon frontier region of Senegal and Gui-nea. - The extreme southern part of western Mali.

- The northern part of Guinea (below Mati) affecting the valleys of the lower River Bafing, of the middle and lower River Tinkisso, andoftheheadwatersof the River Bakoye.

Situation 2:

- The valley of the River Gambia in eastern Senegal.

- In western Mali, most of the River Bafing system, the middle and lower River Bakoye and the headwaters of the River Baou16.

Situation 3:

- In eastern Senegal the valleys of the River Nieriko and the lower River Faleme.

- In western Mali, the River Senegal and the middle and lower River Baou16. 2.2 Vector control techniques

Vector control may take various forms, such as environmental management, the application of insecticides to adult insects or larvae, or the use of biological agents. These different forms of control may be applied by various means. They can be employed separately or in comb ination .

2.2.1 Environmental methods

Although environmental managemenE, environmental modification and environmental manipu- lation might be effective in very special circumstances, these methods cannot be reconrnended for large-area control.

2.2.2 Chemical control techniques

Since environmental management will never result in the elimination of all the vector populations, it has been necessary to resort to insecticides, which seem still to be the best weapon available. 2.2.2.1 Adulticiding

Efforts to control Ehe onchocerciasis vector by killing the adult blackfly cannot at present be considered a method of control, because of the great dispersal capacity of these insects, which would make necessary the application of treatment over vast areas. Localized Protection of certain areas might be considered, however, provided suitable insecticides are available and the resting places of the females are accurately known. octsz. r page 23

While there is no case for the rouEine use of adulticiding techniques on a large scale, there is an urgent need to develop appropriate adulticiding techniques to assess their effect in controlling reinvasion problems under \,ret season conditions. The endorsement of this view has been presented in the Final Report of the Independent Cornnission, and in the OCP Progress Report for 1981 (ocPfPRf8L.4).

Davies eE al. (in press) have reviewed the various tyPes of adulticiding techniques employed in different parts of Africa, and together with Baldry et al. have described the results of trials that were conducted in the OCP area in 1978. Very encouraging results were obtained from the latter trials. A single discriminative helicopter application of deltamethrin (OMS 1998) at a swath dosage of LZ.S gfl'ra (swath width 30 m) to riverine forests varying in width from 3O-1OO m, was effecEive in controlling S. damnosum for ca 12 days under late dry season conditions. A similar application of endosulfan (OMS 57O) at a swath dosage of IOO gfha was effecEive for ca 9 days.

Subsequently, and as interest in adulticiding techniques has mounted, the OCP has awarded a research contract to IRTO, Bouak6, for Ehe screening of insecEicides which would be act.ive against Simulium. At the present time Ehe OCP is actively stepping up its own research programme towards the development of some effective and economic adulticiding techniques. In this regard it is reassuring to note that it is now known that the majority of reinvading Simulium settle very close to watercourses; Eheir numbers decline progressively over a distance of 3 km from a watercourse. It may Eherefore be possible to develoP adulticiding techniques which are far more discriminative than was earlier supposed possible. 2,2.2.2 Larviciding

The vector reproduction sites are disEributed irregularly along ri-vers because they occur only where Ehere',.s flowing water. The larvae constitute the most vulnerable link in the development cycle of the blackfly and their destruction seems at Present to be the most appropriate method of controlling t.he vectors of onchocerciasis. The treatment periodicity depends on the duration of the vector's larval stage, which averages seven days in the climatic conditions of the West African savanna.

The larvicidal formulations must be of such a type as to permit easily rePeated and effective treatments on a weekly basis and must not cause irreversible damage to the aquatic environment. The insecticides used must be of low toxicity for man and manrnals. Ihe active substance should not persist in the environment, since, otherwi-se, an accumulation in food chains may result.

The compounds currently in use in the OCP area are

Organopho sphate s :

A 20% (active ingredient) emulsifiable concentrate of temephos is the compound which has been used most extensively by Ehe OCP, and at the present time approximately 75% of the OCP area i-s under successful temephos treatment.

In I980, unfortunately, temephos resi-stance appea red in the OCP area in S. soubrense and S. sanctipauli and could not be overcome by increasing the quantities of insecticide used. It is worth noting, however, that no case of resistance has yet been reported in S. damnosum s.s. or S. sirbanum the typical savanna vectors. In view of the conEinuity of distribution of S. soubrense between the south-western part of the Ivory Coast, where the resistance appeared, and south-eastern Guinea, it is likely that this sector of the Western Extension area Eemephos resistance is either already present, or, r,ril1 soon develop (especially if it is directly exposed to Eemephos treatments).

Chlorphoxim as a special 20% emulsifiable concentrate was introduced into the OCP area to control temephos-resistant populations of S. soubrense (at less than half the temephos dosage). This forrmrlation has the drawback of being more toxic to non-target aquatic fauna than temephos. Its utilization in the OCP was short-lived because temephos resistant populations of S. soubrense quickly developed double-resistance to chlorphoxim. ocP82.3 Page 24

Field trials are now continuing with three other compounds, chlorpyrifos-methyl, pirimiphos-methyl and bromophos.

Bacillus thuringiensis (biological control agent)

Because of its harmlessness for mamnals and non-target aquatic fauna, Bacillus thurin rensrs sero type H-14 was introduced i.nto the OCP to control populations of S. soubrense which were resistant to both temephos and chlorphoxim

Unfortunately, B.t. H-14 is only effective when applied in high volumetric dosage (up to 10 times that of temephos), and, as a spray (otherwise it rapidly sinks and becomes ineffective). As these are very largely incompatible parameters many technical and logistic problems have been and continue to be, experienced by the OCP. During the 1982 wet season these problems became unsurmountable with regard to the control of S. soubrense in parts of the southern Ivory Coast, with the result that the use of B.t. H-14 has been discontinued in situations where river discharge rates are high.

Evaluations are now being made of BJ. formulations which are two and three times more concentrated than the one currently employed by the OCP. Unfortunately, neither of these formulations is at present being produced in large quantity.

The costs per liEre of the compounds used by the OCP are: temephos US$ 7.80 chlorphoxim US$ 7.4O, and B.t. H-14 US$ 5.20.

Taking note that chlorphoxim is applied at approximately one third the dosage of temephos and that B.t. H-14 is applied at dosages of 3 to lO times those of temephos (depending on hydrological conditions), the comparative costs, using one litre of temephos as standard, are:

- temephos US$ 7. 80 - chlorphoxim US$ ) 50 - B. t. H-14 US$ 15. 60 to 52.O

When one takes into account the facts that B.t. H-14 has to be diluted with water, and that for applying it in large quantities, the flying costs are greatly increased, it is very clear that this is a very expensive larvicide in its presently available formulation. It should be improved or replaced as soon as an alternative compound becomes available.

Various methods can be used to apply larvicides

(i) Ground applications

Ground applications can be reconrnended for the treatment of a single breeding site (dam, ford, broken bridges, etc.) which is fully accessible at aII times of the year, or a series of sites situated only a short distance from a road. Ihis method cannot be used, however, for general and continuing treatment of an extensive area including many drainage basins. (ii) Aerial applications

Ihe most reliable and economic means of reaching all the larval sites in all seasons is to use aircraft. this will be the method of choice for treatment of the breeding sites in the Western Extension. The type of aircraft will vary according to the type and discharge of the river to be treated. For the treatment of large watercourses or rivers, where large quanEities of insecticide have to be used, preference will be given to fixed-wing aircraft. It should be noted that the same rivers may only require sma1l quantities of insecticide during the dry season, and helicopters may then be used. Generally speaking, hohlever, helicopters will be used for treating smal1, winding rivers with a limited discharge to take advantage of the greater manoeuvrability of these aircraft, which in any case have a smaller insecticide capacity. this is the control method used successfully by OCP and it will also be used in the Western Extension area. ocP 82 .3 PaEe 25

The quantities of insecticide used at each treatment point are calculated on the basis of river discharge. In order to avoid either an excessive dose of larvicide, which will be harmful to the non-targeE aquatic fauna, or too sma1l a dose, which will make the application ineffective, it is necessary, for any onchocerciasis vector control camPaign, to have a relatively dense network of gauging stations.

2.3 The evaluation of vector control operations

2.3.L Entomological evaluations

Because of the cumulative nature of onchocerciasis and the long life span of the parasite in man, the effects of a vector control campaign aimed at eliminating transmissi-on or reducing it to an acceptable level for human conrnunities will not become apparent in the protected populations for several years.

In order to assess the efficacy of larvicide treatments as early as possible, to detect and swiftly remedy any shortcomings, and to adapt the treatments ad hoc to the extremely fluctuating environmental conditions it is necessary to make provision for detailed entomological evaluations.

The objectives of Ehese evaluations, which should be continuous and have the greaEest possible geographical spread are as follows:

to establish, prior to the campaign, the blackfly population densities and transmission potentials;

to monitor, during the campaign, the results of insecticide applications, which should be adjusted in the light of the data obtained (temporarily suspended, continued according to plan, possibly intensified); to determine the levels of residual transmission;

to collect the hydrological data needed for the p1-anning and implementation of insecticide applications ; to monitor continuously the susceptibility of the vectors to insecticides.

Ihe simplest way of evaluating the effects of larvicide applications is to observe the d i sapp earance first of the larvae and then of the pupae of S. damnosum s.1. from the breeding sites concerned. In view of the very large number of sites to be examined, the sheer size of some of them and Ehe difficulties of access, this purely qualitative method provides only an imperfect impression of the real effects of the treatment and can be used only as an occasional supplementary measure.

The only reliable method for the quantitative measurement of the results of treatment consists of capturing female vectors seeking a blood mea1. This is done by staEioning human insect collectors at specified places, generally adjacent to rivers or villages; these collectors catch all r-he S. damnosum s.1. females that settle on them before the b In view of the daily and seasonal variations in biting activity collection takes place throughout Ehe insect's period of activity (7 a.m. to 6 p.m.); the number of collection days per week or fortnight is determined according to the importance of the collection point, its accessibility and the availabte manpower and transport.

By dissecting these females it is possible to determi-ne the extent to which they are infected with O. volvulus and their physiological age. A young population indicates the appearance of an active breeding site close to the collection point, while an o1d population gives a definite indication of reinvasion by females from elsewhere. ocP 32.3 pa9e 26

Since it is now possible to establish a relationship between the number of infective O. volvulus larvae received by the individuals in the conrnunity and the endemicity 1eve1 (prevalence and incidence) observed in that conununi-ty, it is also essential to be able to measure the vectors' transmission potential before and during a control campaign. Ihe method for evaluating this transmission potential per unit of time is to take the number of infective larvae obtained by regular and periodic collection at a given point and extrapolate this to one month (monthly transmission potential; MTP) or one year (annual transmission potential: ATP). It was concluded at a meeting held in Geneva i,t 1977 that, in the savanna area, an ATP of 100 and an annual biting rate (ABR) of 10OO formed the upper threshold of tolerance, above which severe lesions were likely to appear in the long run.

2.3.2 Epidemiological evaluations

As in the existing OCP, the objectives of epidemiological evaluations in the Western Extension area will be the continuous collection of data in certain indicator villages selected with a view to following the epidemiological situation before and after t.he introduction of vector control operations. The aim of the studies is to assess the impact of vector control on the prevalence and incidence of onchocerciasis and to follow the evolution of ocular lesions.

The epidemiological evaluation of onchocerciasis in the Western Extension area must take into account the practical experience acquired by OCP in that fie1d. The mode of operation, however, will require to be adapted on the basis of the experience gained. After six years' interruption of transmission it has been found that the O-5 years age-group shows no further infection by O. volvulus or that such infection is exceptional. Moreover, prevalence has been spectacularly reduced in the 5-9 years group. Furthermore the absence of superinfection means that the cumulative process has been interrupted in adults. In this way hyperendemic leve1s are reduced to mesoendemi-c and then to hypoendemic leve1s.

Depending upon the different methods that can be employed, one can distinguish between simple and detailed evaluations. Ihese are surtrnarized be1ow.

(a) Simple evaluations

A simple evaluation is designed to study the prevalence of the disease in the whole population of an indicator vi1lage. These evaluations, repeated every three to four years, enable the evaluation of the epidemiological situation to be followed. They involve census- taking of the population of a village by family, clinical examination (for nodules, cutaneous lesions, etc.), parasitological examination (by skin snips), and a test for visual acuity.

(b) Detailed evaluations

Detailed evaluations in a smal1 proportion (ca 1O%) of the indicator villages, involve in-depth clinical and epidemiological studies designed to provide detailed information on the evolution of the disease situation. These studies involve the taking of a census of individuals (noting particularly Eheir migration status), brief clinical examination, parasitological examination and detailed ophthalmological examination of both eyes.

2.3.3 Envi-ronmental monitoring

Evaluation of the impact of insecticide applications on the non-target aquatic fauna is a fundamental technique designed to preserve the quality of the environment to the highest degree possible.

In 1981 the OCP Ecological Group concluded that the use of temephos for controlling S. damnosum at the doses and with the formulations adopted by the Programme, does not constitute, afEer six years, a major hazard for the aquatic ecosystem. Specifically ocPS:.3 page 27

the irmnediate effect of temephos on the invertebrate fauna is ecologically acceptable since, although considerable acute mortality may be recorded among ttie i.nvertebrates, there is a proporEion of survivors in almost a1l taxonomic Sroups;

temephos reduces the density of invertebrates in the larval breeding places to an extent that has never produced an imbalance under normal condiEi-ons of insecticide application;

- there is no evidence of any species disappearing; - no mortality has been recorded among fish and no unstable change in fish populations has been detected;

- accumulation in the food chain seems slight.

To the extent that Ehe insecticide applications envisaged for the Western Extension would be identical with those practised by OCP (temephos in the same formulation, at the same dosages and applied by the same techniques), it might be considered advisable not to repeat, to no purpose, the monitoring of the environment carried out in the OCP area. However, in view of the fact that other larvicides might have to be elnployed, €.8. to overcome a temephos resistance problem, environmental monitoring activities must be envisaged from the outset.

Ihe environmental monitoring techniques which have been used very successfully for studying both aquatic inverEebrates and fish in the OCP area, and which would also be used in the Western Extension area, have had the following objectives:

- determination of those components of the fauna that are most affected by larviciding; the drawing up of qualitative and quantitative comparative balance-sheets for Ehe pre- larviciding period and for the periods following the beginning of treatments; and the forestalling of any deleterious effect that is considered important for established biological equilibria.

RXFERENCES CITED IN PART I

Anon. (1981) Rapport de la 3Eme R6union Minist6rielle de Concertati-on des Etats du Bassin du Fleuve S6n6gal (Dakar, Novembre 1981)

Aubreville, Duvigneaud, Hoy1e, Keay, Mandoga, Pichi-Sernolli (1959) Vegetation l"lap of Africa (South of the Sahara), CCTVCSA Oxford University Press

Baldry, D. A. T., Everts, J., Roman, B., Boon von Ochssee, G. A. & Laveissiere, C. (1981) 'Iqoglcal Pest Management, 27, 83-lr)

Claude, J. (1980) Donn6es hydrologiques necessaires pour une campagne de lutte contre I'onchocercose dans 1a r6gion du bassin du fleuve S6n6ga1, document OMS/ORSTOM,25 pp. text, 6 annexes and 1 map

Coleman, M. & White, P. T. (L979) Farmer health survey (Sierra Leone)

Colussa, B. (1981) SynthEse, par riviEre, des donn6es concernant I'onchocercose dans la R6publique Populaire R6voluEionaire de Guin6e, au 30 mars 1981, [.IHO document rcefr"eofoot (unpublished), 88 pp. text and 19 maps

Connor, D. H., Cupp, E. W., Ganley, J. P., Gibson, D. W. & Schiller, E. L. (1979) Draft report. Studies on onchocerciasis in northern Liberia, including topical treatment with diethyl- carbamazine: pathology, ophthalmology, parasitology and entomology; and reconunendations for control of the disease (26 November - 18 December 1978). Published by the American Public Health Association, 115 pp. ocP 82 .3 page 28

Crosskey, R. W. & Post, R. J. (1981) A synopsis of present knowledge of the Simulium damnosum comPlex in the Republic of Sierra Leone, with special emphasis on its geographical distribution and relation to onchocerciasis (unpublished report; 35 pp. textr 4 tables and 4 maps)

Davies, J. B., Gboho, C., Baldry, D. A. T., Bellec, C., Sawadogo, R. & Tiao, P. C. (In press) The effects of nelicopter applied adulticides for riverine tsetse control on Simulium populations in a West African savanna habitat. I. Introduction, methods and the effect on biting adults and aquatic stage of Simulium damnosum s.1., Tropical Pest Management

Garms, R. & Vajim6, C. G. (L975) Tropenmed. Parasit.,26,375-380

Orain, H. L. (198f) Projet d'Etude de Eaisabilit6 d'une Campagne de lutte contre 1'Onchocercose dans la R6gion du Fleuve S6n6ga1, document OuSfrcYfVeOfOfsl , 12 pp. text and 129 annexes

Qui116v616, D., Gui11et, P. and 56chan, Y. (1981) Cah. O.R.S.T.O.M. s6r. Ent. med. et Parasitol. , 14 (4), 303-309

Vajim6, C. G. & Dunbar, R. W. (1975) Tropenmed. Parasit. 26, 111-138

Walsh, J. F., Davies, J. B. & Garms, R. (1981) Tropenmed. Parasit., 32, 269-273 ocP82 .3 Page 29

PART II

PLAN OF OPERATIONS FOR IIIE FIRST SIX YEARS OF ONCHOCERCIASIS CONTROL IN TIIE WESTERN EXTENSION AREA

CHAPTER III

RESPONSIBILITIES

1. INTRODUCTION

Brief mention has already been made in this report to the respective responsibilities of the OCP and of national goverrunent.s in the execution of an OCP Western Extension. However, before proceeding to consider the finer details of the planning, i.mplementaEion and evaluation of such an extension, it is important Eo consider the apportionment of responsibilities in much more detail.

2. RESPONSIBILITIES OF TltE OCP

The responsibilities of the OCP, which will be meE from international funds, will, in broad terms, be as follows:

(i) Ihe overall administration of the Western Extension, in close liaison with National Onchocerciasis Corrnittees.

(ii) A11 vector control activities and associated support activities. Al-1 aerial operations, r^rhether for vector control or for surveillance purposes require the most perfect coordination and extremely good logistic support facilities. Consequently, it is essential that all these activities are strictly controlled and managed by the OCP.

(iii) The conducting of entomological evaluations. Ihe regrrlar and efficient collection of entomological data, particularly in relation to the orientation and evaluation of vector control operations, makes it essential that entomological evaluations are the responsibility of the OCP.

(iv) Supervising national and/or intercountry epidemiological evaluation teams.

(v) Assistance in the establishment of national and/or intercountry environmental monitoring teams or services.

(vi) Assistance in the establishment of additional hydrological stations arrd in the refurbishing of existing stations.

(vii) The training of national staff required for the efficient implementation and evaluati,on of the extension.

(viii) Applied research

(ix) Reporting (through Ehe established OCP reporting system)

At the logistic and operational Ievels the OCP will be responsible for:

(x) The construction of an aircraft hangar with supporting workshop and storage facilities for aviation fuels and insecticides, at the main operational base. (xi) Ihe construction of helipads and storage depots for aviation fuels and insecticides at strategically located rural sites. ocP 82.3 Page 30

(xii) The equipment and furnishings of premises used by the ocp.

(xiii) Itre purchase and operation of vehicles, and all other items of supplies.

(xiv) An exEension of the OCp radio network.

(xv) Ihe distribution of all equipmenr and supplies.

(xvi) The recruitment and costs of all- international staff.

3. NATIONAL RESPONSIBILITIES

Activities which will be the responsibility of the govergnents of the countries participating in the Western Extensi,on will be as follows:

(i) Ihe establishment of National Onchocerciasis Committees (Ma1i excluded).

(ii) Ttre appointment of nati.onal liaison officers who will work in close collaboration with the national and international bodies to ensure Ehe smooth day-to-day execution of all operations.

(tii) rtre provision of all buildings and premises required to accomodate the main oPerational base and the teams responsible for entomological, epidemiological and environmental monitoring at their respective locations.

(iv) Ihe employment of all staff required for epidemiological evaluations and for environmental monitoring activities, and the creation of the services (where appropriate) to accorunodate them. In connexi.on with these activities, governments will- be responsible for assessing training requirements and for submitting candidates to the oCp for appropriate training.

(v) Ttre operati.on and maintenance of alL existing hydrological stations. (vi) fhe construction, oPeration and malntenance of any additional hydrological stations required by the oCP (in this respect the oCP will assist in the purchase of essential equipnent). (vii) ltre maintenance and repair of all roads needed by national and international teams to gain access to hydrologicaL stati.ons, helipads, indicator vi1Iages, entomological evaluation points (catching stations) and aquatic monitoring sites.

(viii) The construcEi,on of new roads to al1ow access of the various evaluation teams to othendise inaccessible areas. (Ihese activities could require very substantial funding, which may be beyond the means of the appropriate national auEhorities. c,overmnents may therefore find it necessary to seek the required funds from external sources.) (ix) Arrangements with the approprlate civil aviation authorities for the construction of aviation suPPort facilities, for the waiver of duty on aviation equipment, fuels, lubricants, sPare Parts and tools, for the waiver of aircraft landing and parking fees at urban airfields, and for over-flight clearances.

(x) Comprehensive public relations campaigns wtrich will ensure that all ministries, national services, administrators and armed forces, in addition to rural populations, are completely familiar with and cooperate with all nationaL and international personnel involved in the Western Extension.

oCP requirements for additional hydrological stations and roads (see clauses (vi) (viii) and above) are specified in later sections of this report wtrich deal specifically with these subj ects. ocP82 .3 Page 31

CHAPTER IV

PHASING OF EXIENSION ACTIVITIES

1. INIRODUCTION

The original proposals for the spatial phasing of operations were as follows:

Phase I: The River Niger Basin, and some coastal rivers in Sierra Leone. Phase I1: The River Senegal Basin and some coastal rivers in Sierra Leone. Phase III 411 other river basins in Senegal, Guinea-Bissau and Western Guinea

With regard to temporal phasing it was proposed that once operations cornmenced in the Phase I zone, activities would follow in the Phase 1I and III zones one and th,o years later, respectiveiy. However, in the light of recent additional findings in the Western Extension area and of recent developments in the OCP it is no longer considered feasible to adhere to the original phasing proposals. The most important of these factors are discussed separaEely be1ow.

(f) Distribution of llackf1y species

The data on Simulium species distribution, presented in Map 4, by no means gives a complete picture of the distribution of all the species. Much of the information collected is restrictive both in space and time, especially with regard to many of the upland and forested areas. While the northern half of the Western Extension area appears to be dominated by a very limited number of savanna species (mainly S s irb anum , with some S . damnosum s. s. ) a converse, much more complex and less understood situation exists in the southern half of the area. In this latter area there are five important species (six if the Konkoure form is considered to be separate from the others), knowledge of whose distribution is aE present scanty, if not non-existent. In this connexion it must be pointed out that, at the present time, no information exists on the species of many long stretches of rivers which form what has been referred to earlier as the coastal complex, e.g. Rio Geba, Rio Corubal, Little Scarcies and I"Ioa. This situation applies equally further north in the easternmost hyperendemic onchocerciasis focus associated with the rivers Dion, Limou, Yeremou and Kourai.

(ii) Temephos-resistance and the need for alternaEive larvicides

In the Report of the 2nd Session of the JPC (which met in December, 1981) it was stated:

trAs with the extensions inEo southern Benin, Ghana and Togo, considerable stress was laid by partic.ipants on the importance of having back-up larvicides available before embarking on vector control in Lhe Senegambia area. At least two and preferably three larvicides should be kept in reserve, and should all belong to different insecticide groups to avoid cross-resistance."

Although Progress has been made in controlling temephos-resistant populations of S. soubrense in the Ivory Coast, the situation in some forest and hrrmid savanna localities is such that, at the moment, the OCP does not have total capability for control under wet season conditions. Every attempt is being made to improve this situation by using larger aircraft, by spraying a more concentrated formulation of BJ. H-14, and by intensifying the search for alEernative larvicides. However, until such time as additional larvicides have become available and have regularized the resistance problem in the Ivory Coast it would be unwise to extend temephos and BJ. H-14 treatments into the humid savanna and forest regions of the Western Extension area. ocP 82.3 PaEe 32

( 111' Infrastructural and 1 oq stic support facilities

Recent field surveys in western Mali and eastern Guinea have revealed that there are many Parts of the Western Extension area which lack the fundamental infrastructural and logistic support facilities which are essential for the introduction of large-scale onchocerciasis control acEivities. This applies particularly to the poor condition of many roads, and to the inadequacy of the road networks in many regions where al1-season accessibility is essential for the effective execution of vector control and evaluation operations but presently not possible. The situation is particularly critical in many of the humid savanna and forested regions of the southern part of the Western Extension area.

As sEated earlier in this report the OCP has already conducted some logistic surveys in the Western Extension area. These studies are continuing and will be continued into the preparatory activities phases of the extension.

( iv) lgpograIlrica1 and climatic factors

The situation referred to in item (iii) above, is in many cases aggravated by extremely rugged mountainous terrain and by high precipitation rates. These factors, both individually and collectively, impose serious constraints to the free movement of vehicles and the technical personnel dependent upon them. Lengthy wet seasons (of up to seven months' duration, and with each monEh having a minimum of 50-1OO rnm of precipitation) in combination with rugged terrain at high alEitude, result in much 1ow cloud and ground mist which impose serious constraints to the unrestricted and safe operation of low-flying aircraft.

Thus topographical and climatic factors impose two important constraints; a logistic one and a technical one. As part of the continuing logistic surveys referred to in section (iii) above, more information will be collected during the coming months. With regard to the technical problems of vector control in mountainous and densely vegetated terrain, it seems unlikely appropriate solutions will be quickly identified. In all probability the applied research service of the OCP will be required to expand its current programme in order to provide the speciaLized attention that this problem requires.

If all these factors are read in combination with the JPC recormnendation on the need for alternative, back-up larvicides the prospects for early implementation of a Western Extension are not encouraging, especially with regard to forested, humid savanna and upland areas. However, the fact that the JPC has cornmissioned the OCP to prepare a Planops for the Western Extension infers that the JPC reconrmendation on back-up larvicides was formulated as a guideline for the OCP and not as a total embargo on all extension proposals. By accepting this thesis we can proceed by considering what activities could be implemented in the Western Extension area, cautiously, flexibly, at the discretion of OCP experts and their professional advisers, and without undue de1ay. Furthermore, vre can define those areas and activities which must for the foreseeable future be left in abeyance until such time as the many consfraints, discussed above, have been satisfactorily removed, reduced or circumnavigated.

2. SPATIAL PHASING

In the northern hal-f of the Western Extension area which is dominated by generally low altitude dry savannas, only the savanna species of the S. darnnosum complex occur, and the vector situation is, therefore, not unlike the northern part of the existing OCP area where vector control is feasible and has been very successful. Consequently, vector control in this region, utilizing existing OCP spraying technology and the larvicide temephos, can be considered feasible, provided that such a concept meets with the approval of the Ecological Group and the Expert Advisory Cormnittee. 0cP82 .3 Page 33

Conversely, and in view of the many constraints to effective onchocerciasis control and evaluaLion in the humid savanna and forest regions of the Western Extension area, as discussed earlier in this chapter, OCP operations in the southern part of the region must be posEPoned for the timebeing. However, the OCP is continuing its studies in this part of the region, and those studies will be considerably expanded when the Western Extension is implemented.

After very careful consideration of the technical and logistical consequences of having two parts of the Western Extensj-on area (northern and southern) with different timetables for the commencement of onchocerciasis control activities, it was found that no one parameter could adequately constitute the dividing line between the two subregions. Corrsequently, many parameters were considered in order to derive \,rhat can be called a realistic compromise. As precipitation patterns constitute a very important factor in distinguishing dry savanna regions from humid savanna and forest regions, much attention was given to them (see Map 3). Similarly, much attention was given to the delineation of areas in which only the savanna species S. sirbanum and S. damnosum s.s. occur (see Map 4). Finally, consideration was also given to drainage patterns, topography and accessibility of \nTater- cour se s . In the final analysis of the different sets of data appraised, the conclusion was derived that the dividing line should be located between the mean annual rainfal-l isohyets of 13OO and 15OO rnm (see Map 3). I'laking allowances for the oEher criteria, it can be defined (see maP 5) as a line which proceeds in a westerly direction:

from the existing OCP western limit on the lower R. Niger, at the Mali-Guinea frontier ; - along the watershed which separates the Senegal River basin from the R. Tinkisso subsystem (of the R. Niger basin);

- across the upper R. Bafing at the Boureya hydrological station;

along the watershed which separaEes the R. Faleme (Senegal River basin) from the upper R. Gambia;

across the upper R. Gambia at the Madina-Kouta hydrological station;

along the watershed which separates the R. Gambia from Ehe R. Corubal and the R. Geba.

Thus the northern, dry savanna subregion of the Western Extension area embraces western Mali, much of eastern Senegal and the northern frontier districts of Guinea. Conversely Ehe southern, humid savanna and forest subregion embraces a sma11 part of eastern Senegal (the R. Geba basin), the whole of Guinea-Bissau and Sierra Leone, and the greater part of Guinea.

3 TI},IETABLE FOR PHASING OF ACTIV]TIES

3 1 In the northern subregion In formulating phasing proposals for this subregion careful consideration has been given to the following factors:

- the expediency of restricting one phase zone to a whole river basin;

- the need to take over responsibility for and expand any locaiized control operations which the O.M.V.S. may have introduced in the R. Bafing subsystem in order to protect the Manantali Dam site;

the need to give early protection to the expanding populations of the R. Faleme hyperendemic focus. ocP82.3 page 34

Thus it is proposed that Phase I will be confined to the Senegal River basin and Phase 1I to the R. Gambia basin (see Map 5).

The main operational base for OCP operations in both phase zones will be Bamako, Mali.

It is proposed that OCP operations will conrmence in the Phase I zone, and will be followed one year later in the Phase II zone. Unless future developments in the subregion indicate otherwise, vector control operations in each phase zone will not commence until a two-year Preparatory activities period has been successfully concluded. Thus within the six-year time frame of this WesEern Extension proposal, vector control operations will be conducted for four and three years in the Phase I and Phase II zones, respectively. 3.2 In the southern subregion

Until such time as much more information is available on the distribution of Simulium species, on log,istic factors and on appropriate strategies for vector control in mountainous and forested areas, it is impossible to say whether the subregion can eventually be considered as a single spatial phase zone or as a group of smaller phase zones.

For the time being and for the purposes of this report, the southern subregion will be referred to as the Phase III zone. 0cP8:) .3 Page 35

CiAPI'Ei. V

PREPARATORY ACTlvil'Iii 5

1. INTRODUCTION

The training of staff, the collection of the additional data essential for planning, the setting-up and calibration of additional hydrological staLions, the estabLishment of the infrastructure for the aerial applicacions, the ordering ctf equipment anrl i:upplies, the organi-zation of conmunications with the operations centres, and the efficient organization of the extension will require a preliminary period of two yea:s, in most cases '

For each phase zone the first and sc-cond years of preparatory activities are hereafter referred to as extension year 1 and extension year 2, respectively. Similarly the years duri.ng which vector control operations are in progress are referred to as extension year 3 ot 4 or 5 or 6.

In the case of the Phase 1 zone, extension year I could be synonomous with calendar year 1983.

The various preparatory activities which must be completed in a timely fashion are considered separately below according to the proposed apportionment of resPonsibilities.

2 OCP ACTIVITIES

2 1 In Ehe Phase I zone

The most important OCP activities to be conducted during extension year I (EY1) in the Phase I zone are:

(i) the recruitment and installation of interrrational personnel at the Bamako main operational base and in the entomological evaluation sectors and subsectors;

(ii) construction of an ai-rcraft hangar and support facility at Bamako;

(iii) equipment and furnishing of all bases for operations, and evatuations, including the purchase and distribution of vehicles, equipment and supplies ;

(iv) extension of the OCP radio communication network;

(v) conducting of aerial surveys of Simulium breeding sites and coll-ection of samples for cytotaxonomic study and for insecticide susceptibility testing;

(vi) awarding of a two-year contract to an independenE institution for the conducting of environmental monitoring activities, and for assistance in the training of national staff; (vii) assisting in the training of epidemiological evaluation staff;

(viii) comrnencement of entomological evaluations ;

(ix) assisting governments (Ma1i and Senegal) in the establishment of epidemiological evaluation teams, and supervising the conrmencement of evaluations;

(x) commencement of applied research on adulticiding.

Needless to say some of these activities will continue into subsequent extension years It is however essential that Ehey be conmenced as early as possible in EYl. ocP82.3 Page 36 Other activities , which can be conducted during EYI and EY2 are:

(xi) assessment of aircraft requirements and the making of arrangements for an expansion of the OCP aerial operations contract;

(xii) construction of helipads and storage facilities for aviation fuel and insecticides;

(xiii) conducting logistic and technical surveys in the Phase 1 and Phase II zones;

(xiv) establishment of, a system of river codings appropriate to larviciding operations and to the recording/processing of entomological evaluation data; (xv) reporting.

2.2 In the Phase II zone

The preparatory activitles to be conducted in the Phase II zone are essentially the same as those listed in sectLon 2.1 above for the Phase I zone. However, it will not be necessary to:

(i) instalL an operational base;

(ii) construct an aircraft hangar and support facility;

(iii-) award a contract for environmental monitoring (the contract referred to in section 2.1 (vi) above will cover both phase zones);

(iv) conduct adulticiding trials.

2 .3 In the Phase III zone

As stated earlier in this report those staff of the OCP who are directly concerned with the planning of the Western Extension are continuing their investigations in the proposed phase lII zone, even if they are on a limited scale. However, with the cormnencement of exEension operations in the Phase I zone and as soon as the initial settling Process has been completed extension staff will be in a position to conduct much more extensive investigations in the Phase III zone. Thus during the period EYI to EY3 surveys in the Phase lII zone will concentrate on logistic factors, but, eventually more attention will be given to technical aspects of onchocerciasis control. In particular, studies will be made of Simulium species distribution, and insecticide susceptibiLity testing.

3. NATIONAL ACTIVITIES

3 .1 In the Phase and zones

National activities which apply equally to the Phase I and fI zones, but which are fitted to different time scales and which mainly concern the governments of Mali and Senegal, are as fo1 lows :

(i) establishment of National Onchocerciasis Conrnittees in Senegal and Guinea;

(ii) appointment by the National Onchocerciasis Committees of Ma1i, Senegal and Guinea of a liaison officer in each country who will work in close collaboration with national and international bodies and who will assist them in day-to-day problem solving;

(iii.) ensure that all hydrological stations are functioning properly, and that they are readily accessible at all ti-mes of the year; (iv) construction of additional hydrological stations in accordance with the requirements expressed later in this chapter, ensuring all-season accessibility; ocP82.3 page 37

(rr) improve and maintain the existing road network anrJ construcL and maintain additional roads in accordance with the requirements expressed laler in this chapter;

(vi) the making available of buildings Eo acconmod;te Lh.r teams that will be responsible for entomological, epidemiological and environmentaL mcnitoring acEivities;

(vii) the making of arrangements with the appropriate civil aviation authorities for the construction of an aircraft hangar at Bamako international airport , f or the consEruct ioi"l of helipads in rural areas (construction costs will be met by the OCP), for the waiver of duEy on aviation equipment, fuels, lubricants, sPare Parts and tools, for Ehe waiver of aircraft landing and parking fees at urban airfields, and, for o'ver-flight clearances ; (viii) the creation of epidemiologicatr- and environmental monitoring units, involving the early iCentification of personnel who will have to be trained by the OCP; (ix) the initiation of a comprehensive information campaign.

3.2 In the Phase III zone Noting that the National Onchocerciasis Conrmittee of Guinea will be created during EYI in relation to extension activities in the Phase I and II zones, it is anticipated that similar conrmittees for Guinea-Bissau and Sierra Leone will be established during EY2. In view of the uncertainty about a possible starting date for extension activities in the phase III zone, it is considered unnecessary to Present here a detailed list of the activiEies to be conducted during the preparatory period(s); in any case they wi1l, to all intents and purposes, be similar to those which have been described above for the Phase I and I1 zones.

4. ACTIVITIES CONDUCTED JOINTLY BY TI{E OCP AND NAT]ONAL AU'THORITIES

The most important of these activities can be summarized as folLows: (i) the selection of indicator villages for epidemiological evaluation purposes and the collection of baseline, Pre-control data; (ii) the selection of sites for hydrobiological studies.

5 OCP REQUIREMENIS FOR ADDITIONAL HYDROLOGICAL STATIONS AND ROADS IN THE PHASE I AND I1 ZONES

5.1 Requirements for h ro loe 1C a1 stations

A detailed hydrological survey was made of the Western Extension area in L979f8O and from the resultant report it is possible to summarize Ehe situation in the Phase I and II zones and to identify additional requirements for control operations. These are considered on a national basis be1ow.

( 1.) Western l'Iali:

T\,renty-nine hydrological stations were in operation in 1980 and an additional five stations were proposed for the following rivers: Baou16, Badin-Ko, BaLe-Z, Balinn and Bale-1.

In March 1982, LE was observed that t\^/o new stations, not included in the above list, had been installed to Ehe east of Kayes on the R. Korigon at Segala and on the R. Gari at Lambatara. The extent to which these stations could be of use to the OCP has noE yet been determined. ocP82.3 Page 38

Additional hydrological stations and those existing stations requiring rercalibration are as follows:

Bafing subsystem

New stations on the Bale-1, BaIe-2 and Balinn.

Bakoye subsystem

Recalibration of the Diangola station on the R. Bakoye

Baou16 subsystem

Ne\n7 stations on the R. Baou16 downstream from the Baou16 Loop, and on the R. Badin-Ko.

Recalibration of the stations at the Baoul6 Railway Station (Toukoto) and in the Baoul6 Park.

(ii) Senegal:

Twenty-six staEions were in operation in 1980 and an additional two were proposed for the rivers Faleme and Niokolo-Koba. Additional stations are as follows:

Faleme subsysEem

New station at Sansande.

River Gambia system

New station on the lower R. Niokolo-Koba, near Simenti.

(111) Guinea

There were 63 stations in Guinea in 1980 and an additional seven stations were proposed for the following rivers: Ibulai, Bakoye, Le1e, Niantan, Banie, Bouka and Koulountou. A more recenE survey indicates that at least 25 of the existing stations are no longer in operation. For the implementation of vector control operations in the Phase I and II zones there will be no dependence on hydrological stations located in Guinea. Partly for this reason and partly in view of the fact that OCP requirements in Guinea have not yet been fully assessed full details of the possible hydrological network there cannot be presented here.

It should be emphasized that for OCP PurPoses ( - two years' data are required from a new hydrological station or from a recalibrated one before dosages can be calculated with optimum efficiency; - water 1evel gauges should be fitted with large figures and positioned ir;r open situations so that they can easily be read by an aircraft pilot.

The estimated basic costs of improving the hydrological networks of Mali,and Senegal to meet OCP requirements are as follows: ocP82 .3 Page 39 Activity US dollars

Constructionfrepafi of five stations in Mali 3 500 Calibration of eight staEions in Mali 11 200

Sub-total t4 700

Construction of two stations in Senegal 1 400 Calibration of two stations in Senegal 2 800

Sub-tota1: 4 200

Total 18 900

The provision of funds for these activities is the responsibility of the Mali and Senegal governments. However, in order to ensure the timely completion of these activities the OCP may contribute towards the cost of materials.

5.2 Re irements for additional road

Until such time as OCP officials have had detailed discussions with road engineers of the appropriaEe national authorities the lists of roads required by the OCP must be considered as tentative. Similarly, until the precise a1-ignment of proposed new roads has been agreed upon by al1 parties concerned, it is impossible to esEimate the financial conwritment that will be required. However, it is safe to assume that substantial funds will be required to extend the network in Mali and Senegal.

Additional roads that will be required have been identified as follows In Mali:

(i) westwards from Kolokani to the junction of the rivers Baou16 and Dia;

(ii) westwards from Kita to the R. Bakoye;

(iii) northeastwards from Kita to the R. Baou16, crossing the rivers Badinn-Ko and Kenieba-Ko;

(iv) southwards from Manantal-i to Bafing Makana, along the right bank of the R. Bafing;

(v) southeastwards from Koundia, through the R. Balinn valley, to Bafing Makanal

(vi) southeast\^rards from Kenieba to the rivers Kouloun-Ko and Dassabola;

(vii) westwards from Dialafara to the R. Faleme.

In Senegal:

(viii) northwards from the Kedougou-Kenieba road to the R. Faleme;

(ix) southeast\^7ards from the Kedougou-Kenieba road to the rivers Koila-Kabe and Badinn-Ib;

(x) northwards from Salemata to the R. Gambia;

(xi) eastwards from the Tambacounda-Youkounkoun road to the R. Koulountou. ocP82.3 Page 40

6. OTHER CONSIDERATIONS

It must be mentioned here that there are several mineral exploitation activities in the lJestern Extension area (and others are planned), which could have an influence on vector control operations (see Map 6). In the first place, effluent from certain t)'pes of mining activity which is discharged into nearby rivers could reduce the efficiency of larviciding operations. Secondly, oEher types of mining activity associated with the extraction of precious stones, such as diamonds, have very strictly enforced securi-ty regulations; some may be totally ttrestrictedtt areas. In such situations very complete and well-documented clearances would have to be granted by the appropriate government authorities before any vector control andfor eval-uation activities could be planned and implemented. For obvious reasons, all rhe appropriate clearances will have to be secured during the preparatory activities phases ocP82 -1 page 41

CHAPIER VI

VECTOR CONTROL CPERATIONS lI'J T}IN P}{.\S'E AIIL 11 ZONES

1. OPERATIONAL BASES

1,1 Primary operat ional base Since aerial larviciding operations will- be under the sti:ict controL of the OCP, and anticipating thaE aerial adulticiding operations may also be introdrrced, all aerial operations will be centralized.

The primary operational base will be,at Bamako, Mali, where it wi.1l be necessary to construct an aircraft hangar and workshopfottice complex. It is foreseen that Bamako will not initially be responsible for major repairs and overhauLing of aircraft (this will continue to be done at Bobo-Dioulasso), but solely for routine and day-to-day servicing activities.

I.2 Secondary operatj,onal bases

As far as possible aircraft will make full use of existing aeronautical facilities to which the supply of fuel and insecticide does not create a big problem in Mali and Senegal. The airfields identified as being suitable for both helicopters and fixed-wing aircraft are listed below:

In Mali (Ph499 I):

Kayes: can be supplied by rail from Bamako Kenieba: can be supplied by road from Kayes Bafoulabe: can be supplied by rail from Bamako, through the railway station at I'lahina Manantali (Bingassa): can be supplied by road from Bafoulabe Kita: can be supplied by rail from Bamako Kolokani: can be supplied by road from Bamako.

In Senegal (Phase II)

Tambacounda: can be supplied by rail from Dakar Kedougou: can be supplied by road from Tambacounda.

1.3 QlP helipeds

Tentative lists of places where it will be necessary to construct OCP helipads are given be low :

In l,lali (Phase I)

Bafing Makana: can be supplied by road from Bafoulabe-Mahina, via Manantali Torodo: can be supplied by road from Bamako Toukoto: can be suppli.ed by rail from Bamako, and possibly by road from Kita.

In Senegal (Phase II):

Simenti: can be supplied by road from Tambacounda.

Helipads constructed in remote ar,d,for sandy areas should be made reasonably durable making m m plinth 4OO packed, gravel, either by a 5 x 5 concrete surrounded by ^2 of coarse, oEt by putting down the gravel without the concrete plinth. OCP82.3 PaBe 42

L.4 Logistic support

As far as possible heavy duty lift-trucks and railway services will be used to supply insecticide and aviation fuel to the secondary operational bases and helipads.

In the first instances, four trucks will be required in Mali (two at Bamalco, one at Bafoulabe and one at Kayes) , and two in Senegal (at Tambacounda). The safe-keeping of rural stocks of insecticide and aviation fuels will be entrusted to 1oca11y-recruited watchmen.

2. AXRIAL OPERATIONS LOGISTICS AND COSTS

2.L Aircraft requirements

For conventional applications of temephos aircraft of the type currently r:mployed by the OCP would be acceptable, i.e. a helicopter capable of carrying 2OO litres of irrsecticide and a fixed-wing aircraft capable of carrying 600 litres. From a logistic vie\^7point, aircraft with greater load carrying capacities would be advantageous.

2.2 Deployment of aircraft

A11 aircraft will normally be based at, and operated from, Bamako. Howe'rer, in order to make aerial spraying flight circuits as economical as possible, pilots will be required to make rest-over-night stops at a Iimited number of secondary operational bases, e.B. Kayes and Tambacounda.

2.3 Basic aircraft costs

The costs presented below are those which will be appli.cable to the OCP drrring the period 1983 -8 5 (both years inclusive) :

Helicopters US$

Basic hourly hiring charge: 42)_ 1oO litres of fuel at $ o.llftitre: 37

Total hourly cost 45)

(say US$ 460)

Fixed-wing aircraft

440 Basic hourly hiring charge: , 150 litres of fuel at $ 0.37/lttre 55 .5

Total hourly cost: 495.5

(say US$ 5oo)

2.4 Flisht hour requi rements and costs

These data are presented in Table 1.

3. INSECTICIDE REQUIREMENIS

AII calculations for insecticide requirements have been based on the assumption that Ehe 20% emulsifiable concentrate of temephos which is routinely employed in the existing OCP area, or similar, will be used. OCPg2 2 page 43

3.1 Temephos requirements for the Phase I zorte

Requirements of temephos for ll months of the first year of treatments have been estimated on a month-by-month basis and presented in Table 2. The total is 117 498 litres, but no contingency provision has been included.

It would therefore be advisable to allow for 13O OOO litres.

Estimated requirements for three subsequent treatment years are 135 OOO litres annual1y.

If construction work on the Manantali Dam is completed during any one of the years and breeding sites on part of the R. Bafing are flooded out by the newly created lake, there would be some savings in temephos. At this stage, it would be premaEure to try and calculate the magnitude of any such savings.

3.2 Temephos requirements for the Phase II zone

Tentative estimates of temephos requirements and costs for the R. Gambia system are 39 OOO litres for the first year and 4l OOO litres annually thereafter.

3.3 Total temephos requirements and costs

In making the following calculations it has been assumed that the first year's supply of temephos will be purchased in 1984.

Phase, zone and Temephos US treatment vear (litres) dollars

Ph.I-Yr 1 (1984) 130 000 1 170 000 Ph.I-Yr 2 135 000 1 309 500 Ph.I-Yr 3 135 000 L 4L4 260 Ph.I-Yr 4 135 000 r 527 400

Sub-totals: 535 000 5 42r L60

Ph.II-Yr 1 (1985) 39 000 378 300 Ph.II-Yr 2 41 000 397 700 Ph . II-Yr 3 41 000 426 400

Sub-totals 12 1 000 L 202 400

Tot a ls 656 000 6 623 560

4. MANAGERTAL STAFF

An Assistant Chief of the Vector Control Unit (Bamako) will be appointed with responsibility for the operations in the Western Extension area. His duties will be as follows:

permanenE liaison with the Chief, VCU on aIl technical matters;

coordi-nation and supervision of aerial spraying operations and entomological evaluations, in direct consultation with subunit chiefs;

supervision of environmental monitoring in consultation with the OCP hydrobiological contractors and national teams;

liaison with the national epidemiological evaluaEion teams; ocP82.3 Page 44 - transmission of resutts to the data recording and analysis service; - supervision of progress reports of the units; - participation in the training of national personnel.

TheAssistantChief, VCU will visit the sectors and subsectors as frequently as possible in order to ensure the best cohesion and the maximum motivation among the teams. He will have to initiate meetings of the sector chiefs and periodic radio link-ups.

The Aerial Qperations Sub-Unit at Bamako will be headed by an Aerial Opere.tions Officer who will work direcEly under the AssistanE Chief, VCU. The Aerial Operations Officer will be responsible for: organizing and supervising aerial operations in close collaboration wittr the entomologist in charge of the entomological evaluation work, who will also be based i.n Bamako;

arranging, in conjunction with the OCP administration unit, for the orde:ring, taking delivery and distribution of insecticides and aircraft fuel;

- assisting in working ouL the weekly flight plans, deciding on the amount.s of insecEicide to be applied, and selecting the treatment Points; arranging with appropriate officials of the entomological evaluation un:-t and of the research team, for Ehe conducting of logistic operations, aerial entomol-ogical evaluations and research activities requiring the use of aircraft (inse<:ticide susceptibility tests, collection of samples for cytotaxonomic examinati<)n, evaluation trials of adulticides, etc.);

close liaison with the QCP's overall Chief of Aerial Operations based irr Ouagadougou, and with the Aerial operations officer based in Bobo-Dioulasso.

The Aerial Operations Officer assigned to Bamako will be assisted by two

5. APPLIED RESEARCH It is anticipated that the Phase I and II zones will be exposed to a Simulium reinvasion phenomenon similar to, if not identical to, that which occurs annually in the 'axisting OCP area. It is therefore important for the Western Extension area, the same as for the existing OCp area, that effective adulticiding techniques be developed as soon as Possible, in order to determine their effectiveness in countering reinvasion problems, which could have serious epidemiological repercussions. Accordingly, and in support of the current OCP applied research programme, provision has been made in Table I for addiEional helicopter flight hours for adulticiding trials. ocP 82 .3 page 45

CII{PTI,R V]I

ENTOMOLOGICAL EVALUAT lONS IN THE PHASE i AND 1I ZOI{T''I

I. INIRODUCTTON plans for entomological evaluations in the Western Extension area can be drawn up on the basis of the methods described in Chapter 1I. As in the existing OCP area. these plans are in large measure based on the deployment of teams in the field, so that catching points selected by the entomologists, in consultation with the national epidemiological evaluation teams, can be regularlY visited.

However, along many stretches of river in the Phase I and 1I zones, where it is essential to conduct entomological evaluations, access roads are either in very bad condition, or, totally non-existent. During the Ewo-year PreParatory phase every attemPt will be made to improve and extend the road networks, but it is extremely unlikely that totally satisfactory progress will be made before the comnrencement of Phase I vector control operations. Against this background of constraints it is obvious that conventional enEomological evaluation methods cannot be effectively implemented in al1 areas. In order to overcome this problem consi-derable ftexibility will have to be exercised boLh wittl regard to the tyPes of ground transport to be used, and to the arrangement of vector sampling procedures. In some extreme cases, helicopters may have to be ca11ed in to assist entomological personnel.

2. ENIOMOLOGICAL EVALUATION SUB-UNIT A1l entomological evaluation activities will be conducted by an Entomological Evatuation Sub-Unit (EESU) which, like the Aerial Operations Sub-Unit, will be under the direction of the Assistant Chief, VCU.

The EESU, with headquarters in Bamako, will be headed by a senior entomologist and an entomologist.

The Chief of the EESU will have direct responsibility for the whole evaluation network with the following duties: - selection of catching points in cooperation with the sector chiefs, their assistanEs and technicians, and with the responsible officials of the epidemiological evaluation teams ; - coordination of evaluation activities by constant liaison, taking t,he form of visits and radio contacts with the sector chiefs; - reception of reports from the sector chiefs;

- gtobal weekly and monthly analysis of results on the basis of consolidated data sheets from the sector heads ; correction of these sheets, if required, on the basis of the original data; - participation in the supervision of envj.ronmental monitoring activities;

- permanent technical Iiaison with the Aerial Operations Officer.

2.1 Sectors and subsectors

Two sectors will be required for the Phase I zone, and one sector for Ehe Phase II zone. lnformation pertinent. to these sectors is given be1ow.

Bamako (Phase I zone): Responsible for the Baou16-Bakoye river subsystem and the lower R. Niger. oCPg2. j page 46

Bamako city, with many facilities and amenities, is already the site of an OCP sector headquarEers. For the PurPoses of the Phase I zone it should be a relatively simple matter to expand the Bamako sector bY:

- enlarging the present Bamako subsector so that it has the capability of evaluating the lower R. Niger and the uPPer R. Baou16;

creating a new subsector with headquarters at Kita, and responsible fot the middle R. Baou16 and the R. BakoYe.

Although Ehe town of Kita has no electricity and running water supplies, it is nevertheless suitable for a subsecEor headquarters because it is on the railway link and has a good airfield.

Kayes (Phase I zone): Responsible for the rivers Senegal, Faleme and Bafing

The town of Kayes, is on the railway 1ine, is supplied with electricity zLnd running InTater, has a good airfield, and always has stocks of vehicle fuel. It is thus more than adequate asa Iocation for a sector headquarters.

Tambacounda (Pha se II zone): Res ponsible for the rivers Faleme and Gambia

Tambacounda is on the railway line, is supplied with electricity and runrring water, has a good airfield and usually good stocks of vehicle fuel. It is thus adequat

Sector HQ Sub se ct ors

Phase I zone Bamako Kita Kayes Kayes Kayes Bafoulab6 or Manantali Kayes Kenieba Kayes Kedougou, Senegal (a temporary measure for Phase I evaluations).

Phase II zone Tambacounda Tambacounda Tambacounda Kedougou.

The distribution of the sectors and subsectors for the Phase I and II zones, together with predictions for the remaining part of the Western Extension area, are illustrated in I"lap 7 . 2.2 Staffing of sectors and subsectors In preparing the staff lists of the various sector and subsector units allowance has been made for the facts that:

some units will be required to use boats for surveillance purposes;

some units will require a small road repair team;

laboratory technicians in some subsectors will have to accomPany the vector collecEors to the field and dissect flies on the spot.

The numbers and caEegories of staff required for sectors and subsectors in the Phase I and 11 zones are Presented in Table 3. 0cP 82.3 Page 47

na Responsibilities of sec tor and subsector chiefs

Under the technical supervision of the Entomological Evaluation Sub-Unit in Bamako, sector chiefs will: - organize the catching network in their sector; - give the chief technicians of the subsectors the necessary instructions for the smooth running of catching operations and the survey of larval breeding places; - maintain permanent contact with their technicians through visits and radio contact; - receive information by radio on insect catches and dissection; - analyse these results and pass them on to Ehe Chief, EESU;

- check the validity of the catches and dissections recorded on the occasion of frequent visits; - receive and verify hydrological data and pass them on to the Aerial OperaEions Officer or one of his assistants; - supervise sector administrative activities. In addition to the subsectors which Ehe sector chiefs will have to supervise, each will have under his supervision: - an adminisErative nucleus; I - a garage for maintenance and repair of the vehicles of the sectors and subsectors; - a small catching team that will enable him, should the need arise, to come to the I assistance of a subsector chief, or to make periodic checks of the results obtained by the subsector Eeams. To carry out all these activities the sector chiefs will have to be constantly on the move, motivating activities and endeavouring to verify the results. Sector assistant entomologists will assist sector chiefs in all their duties. In particular, they will maintain permanent liaison with the chief technicians of the subsectors.

By virtue of their technical level and their deployment over the area' Ehe chief technicians of the subsectors will be the link between the teams engaged in data collection and the higher levels responsible for their analysis and use. Because of this they will play a major role in the camPaign.

Under the direcE supervision of their sector chief and his assistant, they will- be responsible for: - organizing the catching itineraries in their subsector on the basis of instructions received from their suPeriors; - supervising the catches; - ensuring the preservation of the blackflies caught, and their rapid despatch to the dissection points; - dissecting the blackflies caught to determine their physiological age and infecEion with O. volvulus ; should the need arise, dissections will have to be performed at the point of capture; ocP82 .3 Page 48 - entering the results on record sheets and cornmunicating them to the sector; - prospecting of larval breeding places; - collecting of hydrological data and their transmission to the sector; - ensuring that vehicles are in good running order and innnediately informing the sector garage mechanic in the event of a breakdown; - assisting the crews of the treatment aircraft as necessary.

Depending on Ehe staff complement, between eight and 15 catching days a week should be worked at from 10 to 15 points. This will provide good overall coverage of the area, i.e. 180-270 catching points. 2.4 Timetable of sector activities

The entomologists, assistant entomologists and technicians for the Phase I sectors and subsectors should be selected, recruited and sent on a training course (IRTO, Bouak6 and OCP) so as to Eake up their posts as early as possible during the first year of PreParatory activities.

For Mali, one trained entomologist is available (currently employed by the OCCGE at Bafoulabe). An assistant entomologist and six Eechnicians (entomology) will have to be recruited and trained. For Senegal, one Eechnician (entomology) will have to be recruited and trained.

As soon as they are installed in their respecEive bases the entomologists, assistants and technicians will select catching points jointly with the EESU in Bamako. ,l At these catching points they will train their staff in techniques for the catching and preservation of blackflies and their transPort to the laboratory.

Once the staff have been trained, the subsectors will commence regular catching operations in order to obtain Pre-sPray evaluation data (ATP and ABR). The subsector teams will have to give assistance, in as far as possible, in setting uP and calibrating the hydrological stations. They will have to learn how to read flood gauges and water-Ievel- recorder curves.

During their field tours they will have to check the location of knovm breeding places and bring the records uP to date in this connexion'

They witl have to take part in every specialized survey (insecticide susceptibility, cytotaxonomy) needed during the preparation of the treaLment Phase.

2.5 Sector r u rements for 1es

These are listed in Table 4.

2.6 Sector requirements for equipment

These are listed in Table 5. ocP82.3 Page 49

2.7 Requirements for radio stations In anticipation of extending the existing ocP radio network into the Western Extension area, some long distance radio checks (on frequency 10.1.43) irere made in January 1982. The radio links tested, al1 of which gave satisfactory results, were:

Bamako-Parakou 13OO km Bamako-Hohoe 12OO km Bamako -N i ameY 1l2O km Bouak6-NiameY 1O2O km

The OCp has requested an additional radio frequency (12.OOO) and if this is approved, very good transmissions should be possible throughout the expanded OCP area.

However, anticipating that there may at times be transmission problems, it has been considered advisable to a1]ow for a more powerful staEion to be installed in Bamako, Eo replace the present station.

Requirements for radio sLations in the sectors and subsecEors of the Phase I and II zones have been presented in Table 5. The services of a consultant radio engineer will be required to install the new stations.

3. CYTOTAXONOMY SUB-UNIT In view of the taxonomic complexity of the WesEern Extension area, and the need to monitor very carefully the seasonal movements of different Simulium species, it will be necessary to form a small cytotaxonomic sub-unit.

This sub-unit will operate from a smal1 laboratory in Bamako and will be staffed by:

a cytotaxonomist (a zoology graduate with postgraduate training and experience in taxonomic techniques) ;

a laboratory assistant (trained by OCP); a laboratory auxilliary; a driver.

The sub-unitwillbe equipped with one four-wheel drive-vehic1e, essential laboratory equipment (ca US$ 600O) and will require an annual budget of ca US$ 10 OOO for supplies and operating costs. ) 4, DURATION OF PRE-COMROL EVALUATIONS It is repeatedly stated that pre-control entomological evaluations should be conducted for at least one year before the commencement of vector control oPerations, In principle, this is an excellent procedure especially if new techniques are being evaluated, but it may not be altogether necessary in relation to the extension of a control technique of Proven efficiency from one region to another identical region. The aerial spraying technique currently used successfully over about 75% of the OCP is a proven technique for dry savanna situations. If the same technique (without any variation) is used slightly further west, a reduced pre-control entomological evaluati-on may be adequate. Post-treatment evaluations are very important because, on the basis of the results obtained, the next treatment cycle can be planned; pre-treatment evaluation data Co not influence such planning but are necessary when a complete epidemiological evaluation of the control operation is required. In the long term, the only valid way of evaluating the control operations is by medical means, not entomologi-ca1. ocP 82 .,l page 50

C}IAPTER VIII

E P I DEI.IIOLOGI,IAL EVALUAT IONS IN THE PHASE I AND II ZONES

1. INIRODUCTION

It is proposed to make use of national teams and staff to carry out epidemiological evaluations. However, considerable OCP inputs will be required, for example: (i) for the training of personnel;

(ii) for the provision of equipment and supplies;

(iii) to supervise evaluations and to analyse the data collected.

The participation by national teams will constitute a direct contribution by the five countries to the Western Extension, supplementary to their other contributions (premises, acconrmodation). However, national participation implies certain constraints: (a) Correct evaluatj-on of the situation cal1s for a unified basic methodology; this applies both to day-to-day and long-term evaluations. The evaluators of the five counEries will have to agree to abide by specific protocols which cannot be altered on any account. The only latitude they will have is to add supplementary information they consider useful.

(b) The intercountry evaluation activities should be coordinated by the OCP Epidemio- logical Unit. This will bring together and analyse the data collected. It will see that regular meetings of the team leaders are organized so that they can discuss the ways and means of implementation, the difficulties encountered and the needs. These meetings will also provide an opportunity for refresher training and for briefing by consultants.

(c) The willingness to participate should be reflected in the establishment of national committees for onchocerciasis control which will organize ad hoc technical groups. Regular meetings should be organized at the national and intercountry levels.

National teams responsible for the evaluation of endemic onchocerciasis should be set up as soon as the preparatory phase begins. Their training should attemPt to familiarize them with the techniques developed by OCP for the standardized collection of clinical, parasitological and ophthalmological data. Data collection of this kind is essential for the implementation of the extension.

2. SELECT]ON OF INDICATOR VILLAGES I

The selection of indicator villages in accordance with established OCP cri-teria will be made as soon as possible (as soon as national reams are up to strength and appropriately installed) during the preparatory periods.

Initially, in both Mali and Senegal, national teams composed of a sociologist and a statistician, will be required to:

identify potential indicator villages ;

census the populations ;

establish sociodemographic records of each village.

Once the necessary information has been obtained, national and OCP epidemiologists will jointly select the most representative indicator villages which accord with OCP criteria. ocP82.3 Page 51

3. POPULATION COVERED BY EVALUATIONS IN INDICATOR VILLAGES Table 6 gives the distribution of the population to be evaluated during Phases I and II making allowance for inevitable absentees (20%) who will be noted during successive visits to the indicator villages.

4. EVALUATION TEA},IS

4 .l For paras ilS1ogicql €\/elu4! renq

Parasitological evaluations will be made at both the simple and detailed levels

One parasitological team should be able to examine at least 1OO person"fa^y.

The composition of a parasitology team is: - 1 clinician/epidemiologist (team leader),

- I census clerk,

- 1 nurse,

- I nurse for measuring visual acuity,

- 3 microscopi-sts, - 1 laboratory assistant, - 3 drivers.

One team will be provided with the following vehicle fleet:

- I minibus camper (US$ 10 OOO) ,

- 1 four-wheel-drive vehicle (US$ 13 23O) ,

- 1 rruck - Saviem Cabine (USg f6 3OO), and scientific/technical equipment to the value of US$ 16 OOO.

4.2 F r thalmo ical tions

oPhthalmological examinations will only be made at the detailed evaluation level one team should be able to examine approximately 6o peopLefday.

The composition of an ophthalmological team is:

- 1 clinician/ophthalmologist (ream leader) ,

- 1 nurse specialized in ophthalmology,

- 1 census clerk, - 2 drivers.

One team will be provided with Ehe following vehicle fleet:

- 1 minibus camper (US$ 10 OOO),

- 1 Saviem mobile laborarory (US$ 54 OOO). ocP82 .3 page 52

5 CAPABILITIES OF NATIONAL HEALTH AUIHORITIES

5 .1 Simple evaluations

Because highly specialized personnel are not required for parasitological examinations, it is quite like1y that both national health authorities will be able to provide teams for s imple evaluat ions .

Mali does not have a team aL present which could be charged with epidemiological evaluations in the Western Extension area. However the Malian authorities are in favour of the formation of such a team, and consider that doing this should not present any grave problem.

The parasitological unit can probably be formed by staff already available in Bamako (one clinician, one census c1erk, , rr,raa./"aripper, two microscopists and one nurse for visual acuity tests).

Similarly, it seems likely that the Senegal authorities will not have too much difficulty in finding the necessary staff. 5.2 Detailed evaluations

A number of nurses have been trained in ophthalmology at the I.O.T.A., Bamako (see Table 7). In Ma1i, one ophthalmologist, destined for the operation "LumiEre" at Kayes, could be available and if necessary additional staff (mainly nurses) could be drawn from r .0.T .A. While it is fairly certain that the Malian health authorities will be able to provide rhe ophthalmological expertise required for detailed evaluations, it may not be so easy for the Senegalese authorities to do so. This does not necessarily mean that qualified personnel do noE exist, it is just that they may not be available for onchocerciasis investigations.

5.3 Options for oph thalmological evaluations In view of the difficulties which the national health authorities may encounter in creating efficient ophthalmological evaluation teams, it is pertinent to consider some possible alternatives to each government having its own team.

The most obvious options that can be considered are

(i) Creation of national ophthalmological teams which will devote only part of their time and energy towards the evaluation of onchocerciasis control operations. However, this might be difficult to achieve and, as equipment would have to be provided by the OCP to enable the teams to meet OCP requirements, and the same equipment would be used for other purposes, the cost/benefit ratio would not be very favourable.

(ii) Creation of one intercountry team which would have the capability of making the required evaluations in both Llali and Senegal. This system would not only al1ow national participation but would also enable equipment costs Eo be kept to a minimum.

(iii) Creation of a new OCP ophthalmological team which would conduct evaluations in each of the countries. This option would also enable costs to be maintained at a low level but lacks appeal on the grounds that it does not al1ow any national involvemenE.

In conclusion, it must be stated that as the OCP epidemiological evaluation unit will have the responsibility for supervising evaluations in the Western Extension area, and may from time to time be able to give assistance in the fie1d, oPtion number (ii) above has most to conrnend it, and is the one which has been used for budget calculations.

If the concept of a single intercountry team is accepted it would be up to the Malian and Senegalese authorities to suggest where its headquarters should be located. Logistically, Kayes could be a suitable location. ocP82.3 Page 53

CHAPTER IX

ENVIRONMEMAL MONITORTNG IN THE PHASE I AND II ZONES

1. IMRODUCTION

Assessment of the impact of insecticide treatments on fhe non-targeE aquatic fauna is of fundamental importance for maintaining the environment at the highest possible level of quality. In this context, the ecological surveillance of treated watercourses will take the form of continuous assessment of the extent of fhe impacE of the treatments.

The study methods used will be those developed in OCP and designed, as regards both invertebrates and fish:

to determine the faunal components most affected by the larviciding;

to take qualitative and quantitative stock of the situation during the pre-treatmenE period and at regular intervals once larviciding has cournenced;

Eo prevent any adverse effect considered important with regard to the existing biological balances.

The results obtained will have to take into consideration specific taxonomic groups but also biological conrmunities taken as a representative ecological entity. It is certain that the conducting of hydrobiological surveillance by Malian and Senegalese teams will entail onerous and costly infrastrucEures, and will require very careful and detailed coordination. From the scientific standpoint such intensity of surveillance is not entirely justified and it would obviously lead to duplication in the collection of information.

To avoid this situaEion developing, it would be realistic to envisage a single intercountry team which would meet the requirements of both Mali and Senegal. Such a team could be based in Kayes and operate through a substation located at Tambacounda. The monitoring responsibilities of the two stations would be as follows:

From Kayes

the River Senegal dovinstream from Bafoulabe,

the River Bafing from Bafing-Makana downstream to the junction of the rivers Bafing and Bakoye ,

the River Faleme from its junction with the River Koba-Koye to its junction with che River Senegal.

From Tambacounda:

the River Gambia and its main tributaries, the rivers Koulountou, Niokolo-Koba and Tiokoye .

At this point it must be stressed that neither Mali nor Senegal has a hydrobiological service; nor do they have suitably qualified and experienced personnel necessary to create a servi-ce or team. ocP 82.3 Page 54

Initially, a tr^7o-year contract should be awarded for hydrobiological surveillance to a suitably qualified independent institution. Such a contract would be executed under the supervision of an OCP hydrobiologist.

During the first year of the contract national candidates for training would be identified and awarded scholarships (six months for a graduate and three months for a technician) to undergo training at one or more of the following instiEutions:

the ORSTOM Hydrobiology Laboratory (Bouak6, Ivory Coast);

the Aquatic Biology Institute at Achimota (Ghana) ; the University of Dakar (Senegal).

Successful trainees would then be assigned to the intercountry team and receive additional field training from the hydrobiological monitoring contractor's staff, and from the OCP hydrobiologist.

During the second year of the contract national hydrobiologists would assume increasing responsibilities in preparation for the time, on the expiry of the contract, when they would have to assume full responsibiLity.

2 INIERCOUNIRY MONITORING TEAM

2 .1 Staff requirements

The minimal staffing of the intercountry monitoring team is as follows:

2 ichthyologists ) Contracted expatriates who would be replaced by ) nationals within two years. 2 invertebrate biologists ) - 5 technical assistants (national) - 3 fishermen (national) - L clerkftypist (national-) - 3 drivers (national)

The salaries and associated allowances of al-l national staff will be the responsibility of their respective governments.

2.2 Equipment requirements

The equipment required to establish the intercountry monitoring t.eam is as follows

- 2 four-wheel-drive vehicles,

- 2 PeugeoL 4O4 pickups, - 4 dissecting microscopes,

- 1 microscope Wild MI1 or equival-ent, - 4 sets of fish nets (replaced annually), - 2 light plastic boats, ocP82.3 Page 55 - 4 outboard engines (9.9 or 20 HP), - 2 tents, - 2 office calculators, - 1 typewriter,

- smal1 items of laboratory and office equipment and supplies.

To ensure the timely commencement of hydrobiologicalmonitoringactivities, the OCP will be responsible for the purchase of the equipment necessary to establish the intercountry team. Thereafter, the governments of Mali and Senegal will be responsible for the replacement of all items, other than the standardized sampling equipment, if and when required.

3. MONITORING PROCEDURES

3 .1 Methods

The hydrobiological monitoring methods to'be employed will be the same as those which have been approved by the Ecological Group and adopted in the existing OCP area.

3.2 Recordine and lysis of data

Taking into account:

- the existence at WHO headquarters of a data processing and statistical unit working for OCP;

- of the experience accumulated by OCP in the spheres of recording and analysis of results; the analysis of all hydrobiological data collected by the intercountry monitoring team should be conducted by the OCP data processing team in collaboration with national and OCp hydrobiologists. Should some of the data collected and processed in this lray be difficult to interpret the OCP will arrange for them to be appraised by an independent authority. ocP 82 .3 page 56

CHAPTER X

oPERATTONAL BASE, BAI"IAKO

1. IMRODUCTION

As a branch of the OCP headquarters, Ehe operational base for the Western Extension will be housed in premises provided by the Government of l"1ali at Koulouba, Bamako. These premises are currently occupied by staff of the rcefUYOfOoT Projecr.

The operational base will be composed of a vector control uni-t, an epidemiological evaluation unit and an administrative unit, each of them operating under the direction of, and in close liaison with, respective headquarters units in Ouagadougou.

2. STAFF

2.L Vector Control UniL

The professional staff of this unit will include:

- I AssisEant Chief VCU, - 1 aerial operations officer, - I senior entomologist ifc evaluations, - t hydrobiologist, - 1 entomologist, - I cytotaxonomist, - 2 technical officers, Aerial Operations, - 1 technical officer, Entomological Evaluations,

The minimal requirements for general service staff are:

- 1 administrative assistant, - 1 secretary, - 1 clerk, - I cLerkfstenographer, - 1 draftsman, - 4 Iaboratory assistants (entomology, cytotaxonomy and hydrobiology), - 9 vector collectors,

- 7 drivers,

- I messenger,

- 1 storeman. ocP82.3 Page 57

For technical purposes the unit will be subdivided into an Aerial Operations Sub-Unit, an Entomological Evaluations Sub-UniE and a Cytotaxonomy Sub-Unit.

The Assistant Chief VCU will be the senior officer having overall responsibility for the operational base.

2.2 E pidemioloeical Eva l-uation Unit

This unit will be composed of one epidemiologist, one clerk/tyPist and one driver.

2.3 Administration Unit This unit, which will provide the logistic support essential for the implementation of the Western Extension, will be responsible for finance, personnel, supplies, transPort and mai,ntenance.

The professional staff of this unit will include an administrative officer and an assistant administrative officer.

Minimal requirements for general service staff are: - 4 administrative assistants, - 4 clerks, - 4 typists,

- 1 sEorekeeper,

- I senior mechanic,

- 2 mechanics,

- I messenger,

- 10 drivers, - 3 security guards.

3. VEHICLE PEQUIREMENTS

The vehicle fleet required for the Bamako operational base will include:

- 8 four-wheel-drive station wagons, - 2 lift-trucks for insecticide and fuet,

- 2 standard trucks for ordinary supplies, - 2 vanettes/pickups, - 5 saloon/estate cars.

It is possibl-e that some of these vehicles could be provided from the ICP/MPOfOOI Project.

4. REQUIREMENIS FOR EQUIPMENT AND SUPPLIES

The premises in Bamako available for the operation base will require additional- office furniture, equipment and supplies. ocP82.3 Page 58

CHAPTER XI

BI]DGET

1. INTRODUCTION

A budget has been prepared for a period of six years. For convenience, it has been fitted to the 1983-1988 calendar period, covering the last three years of the second OCp funding cyc1e, and the first three years of the third ocp funding cycle.

Only the first three years of operat.ions have been costed in any detall; the costings for the last three years are predictions only.

2. NATIONAL CONTRIBUTIONS

Each of the participating governments will be required to contribute:

(i) the cost of salaries and related allowances for all national staff concerned with epidemiology, hydrology and hydrobiology, according to national salary scales in forcel

(ii) the cost of land and buildings required by the OCP as well as recurrent expenditure for accormtodation, such as rental and cost of electricity, rdater, postal services and teleconununications (where these exist) ; (iii) the cost of installing additional hydrological- stations;

(iv) the cost of building additional roads;

(v) Ehe free use by the OCP of national services of aviation, meteorology, hydrology and cartography;

(vi) an annual cash contribution, in convertible currency, the size of which wilt accord with those currently received from participating states of the existing OCP.

While it would be useful to prepare a budget of national contributions, such an exercise is at Present impossible in view of the many unknoum factors which currently exist and which even the governments themselves are not yet in a position to quantify.

3. INTERNATIONAL CONTRIBUTIONS

International funds will cover the following items:

(a) the cost of aerial operations including the provision of aircraft, hangar facilities, helipads and insecticides;

(b) the cost of radio communication equipment;

(d) the cost of office and laboratory equipmenE and furniture, and other equipment, such as generators, garage tools, camping outfits; (e) all operating costs;

(f) part of the costs of extending hydrological networks;

(g) the cost of salaries and related allowances for international staff and consultants;

(h) contracts for hydrobiological evaluaEions for a period of two years; ocP82.3 Page 59

(i) the cost of training and retraining national personnel;

/ (j) the cost of any meetings that rnay be required;

(k) the cost of data collection surveys in the phase III zone.

3.1 Guidelines for the p reparation of the budget (excluding national component)

The document "lfno/oce/at oct Plan of Action and Budget for 1982rr, has been used as a guideline in the preparation of the budget for phase r and rr operations.

Costs in US dollars have been calculated on the basis of figures seeming to be appropriate for 1983, as follows:

(i) professional staff, $ 64 96O increasing annuaLly by l2%;

(ii) general service staff, $ 44BO increasing annually by l2%;

(iii) consultants, $ 6272 (one man/month, including travel, stipend and per diem) increasing annually by l2%;

(iv) temephos, $ 8.40 per litre increasing annually by g%; (v) trainees:

- stipend, $ 9OZ p". *"rr/*onth, increasing annually by lZ%; - tuition, $ 497 increasing annually by g%; - travel, $ 54o increasing annually by g%. (vi) vehicles:

- ophthalmology mobile laboratories, $ 54 OOO increasing annuaLly by 8%; - large heavy duty four-wheel-drive vehicles, $ 2t 527 increasing annuaLLy by g%; - all other automobiles, $ 14 2gg increasing annualry by g7.; - bcats with outboard engines, $ 34go increasing annually by g%; - mobylettes, $ 8oO increasing annually by g%. (vii) large electric generarors (diesel), $ Z99O increasing annually by g7"; (viii) radio transceivers, $ 5O4O increasing annual_1y by g%; (ix) aircraft hangars, $ 40 000 increasing annually by approximate:..y g"/". In making estimates for Ehe six-year budgeting period the following requirements and factors have been taken into consideration:

(a) only six months' operations have been allowed for during the first year;

(b) radio stations will be required for all sector and subsector headquarters; (c) larger four-wheel drlve vehicles than currently employed by the ocp will be required in all sectors and subsectors; (d) inaccessible surveillance sites will have to be reached by boat or mobylette; (e) two professional level staff have been allocated Lo each sector headquarters (eventually some of these could be replaced by general service staff); ocP82.3 page 60

(f) provision has been made for a single intercountry ophthalmological Eeam, but two nati-ona1 parasitological evaluation Eeams ;

(g) provision has been made for a single intercountry hydrobiological Eeam;

(h) the research provision covers only applied research on adulEiciding techniques I

(i) allowance has been made for the purchase of insecticide during the year before the one in which it is needed;

(j) no i,nsecticide has been purchased during the sixth year.

3 .2 Budget

Estimated costs for the first three years of the Western Extension in the Phase I and II zones, are presented in Table 8.

Predicted costs for the first six years of the Western Extension in the Phase I and II zones are presenEed in Table 9. ocE82 .3 Page 61

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TABLE 4. SECTOR AND SUBSECTOR RNQUIREI'IENTS FOR VEHICLES NECESSARY TO COMMENCE ENTOMOLOGICAL EVALUATIONS IN THE PHASE I AND II ZONES

Large Medium Tractor Location 4wD 4wD trailer Mobylettes Boat units9 vehicleP vehiclesE unit s

Bamako o 1 o 2 1

Ki Ea 2 3 0 6 o

Kayes 5 5 1 6 1

Bafoulabe 3 2 o 6 2

Kenieba 3 2 0 6 o Kedougou o 4 o 4 o

Tambacounda 4 4 I 6 t

TotaI L7 2L 2 36 5

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TABLE 8. ESTII',IATED COSTS FOR THE FIRST THREE YEARS OF THN WESTERN EXTENSION IN THE PHASE I AND II ZONES (us DoLLARS, C,ALCULATED rN JUNE 1982)

Category Year 1 Year 2 Year 3 Total 1. Professional staff VCU (Bamako) il* 60 L20 L20 300 $ 324 800 727 550 814 850 I 867 200 EPI (Bamako) ^/^ 6 L2 L2 30 $ 32 480 72 755 81 485 L85 720 ADMIN. (Bamako) ^/* L2 24 24 60 $ 64 960 145 510 t62 972 373 442 EESU sectors: Phase I ,ry'* L2 24 24 60 $ 64 960 145 5lO L62 972 373 442 Phase I1 ^/^ L2 24 36 $ 72 755 L62 972 235 727

,r/^ 90 L92 204 486 Sub - total $ 487 200 1 164 080 1 385 251 3 036 531

2. General Service staff VCU (Bamako) ,r/^ L62 324 324 810 $ 60 480 L35 459 151 713 347 652 EPI (Bamako) ,ry'* t2 24 24 60 $ 4 480 10 034 It 238 25 752 ADMIN. (Bamako) ,r/^ 180 360 408 948 $ 67 200 150 510 191 046 408 756 EESU sectors 1 608 1 608 4 L46 Phase I ^/^ 930 $ 347 200 672 278 752 95L L 772 429 Phase II ,"/* 396 792 1 188 $ 165 561 370 854 536 4L5

L 284 2 7r2 3 156 7 152 Sub - to ta1 ^/^ $ 479 360 L L33 842 L 477 802 3 091 004

3. Consultants Radio engineer ,r/* 3 3 6 $ 18 816 2L O72 39 888 Environmentalist ,d^ $

,d^ 3 3 6 Sub - to ta1 888 $ 18 816 2l o72 39

,r/^ L 377 2 907 3 360 7 644 Component 423 $ 985 376 2 3L8 994 2 863 053 6 167 OCP82 .3 Page 69

TABLE 8. ESTIMATED COSTS FOR THE FIRST THREE YEARS OF THE WESTERN EXTENSION IN THE PHASE I AND II ZONES (continued)

Category Year 1 Year 2 Year 3 To ta1

4. Professional tra 1n1nq Entomology ,r/^ 6 6 t2 $ 6 400 7 000 13 400 Epidemiology "/^ 6 6 L2 $ 6 400 7 000 13 400 Ilydrobiology ,"/^ L2 L2 24 $ 12 800 14 000 26 800

,"/^ 24 24 48 Sub-tota1 $ 25 600 28 000 53 600

5. Technical trainin EnEomology */^ 6 3 9 $ tL 664 6 402 18 066

Epidemiology ,'r/^ 5 5 10 $ 9 720 lo 670 20 390 Hydrobiology ^/^ 4 2 6 $ 7 776 4 268 L2 044

*/^ 15 10 25 Sub - to tal $ 29 L60 2L 340 50 500

*/^ 39 34 73 Component $ 54 760 49 340 104 100 6. Aerial operations

6.1 Non-spraying: $ 27 600 46 000 46 000 119 600 6.2 Spraying:

Phase I, helicopters $ 828 000 828 000

Phase I, aeroplanes $ 350 000 350 000

Sub-tota1 $ 27 600 46 000 L 224 000 L 297 600 7. Insecticides 7.1 Larvicides: Phase I: Litres 130 000 135 000 $ 1 170 000 I 309 500 2 479 500 Phase II Li Ere s 39 000 $ 378 300 378 300

7.2 Experimental $ 5 000 7 200 L2 200

Sub -tota1 $ I 175 000 1 695 000 2 870 000

8. Hydrobiology contract $ 150 000 300 000 150 000 600 000 ocP82.3 Page 70

TABLE 8. ESTIMATED COSTS FOR THE FIRST THREE YEARS OF THE WESTERN ExrENsroN rN THE PHASE r AND rr zoNES (continued)

Category Year 1 Year 2 Year 3 Total

9. Applied research $ 10 000 5 000 15 000

Component $ L77 600 1 531 000 3 074 000 4 782 600

10. Operational travel $ 195 000 346 000 385 000 926 000

11. Operations and malntenance $ 295 000 482 000 570 000 1 347 000

Component $ 490 000 828 000 955 000 2 273 000 12. Buildings: Aircraft hangar $ 20 000 26 000 46 000 Helipad facilities $ 3 000 4 000 2 000 9 000 Sectors and subsectors $ 35 000 40 000 13 000 88 000

Sub - to tal $ 58 000 70 000 15 000 143 000

13. Furniture $ 9 000 17 000 6 000 32 000 14. Vehicles

Large 4WD No. 15 4 1 20 $ 4L2 905 118 916 32 LO7 563 928

Eye laboratory No. I 1 $ 54 000 54 000

Others (lorries, pickups, No. 40 18 1 59 vannettes etc. ) $ 57L 520 277 758 L6 665 865 943 Moby Ie t tes No. 30 6 2 38 $ 24 000 5 184 1 866 31 050 Spare parts $ 5 000 10 000 15 000 30 000

Boats No. 6 6 $ 5 L84 5 184 { Sub-tota1 $ L O72 609 411 858 65 638 I 550 105 15. Equipment

Radlo stations No. 7 7 $ 36 000 36 000 Diesel generators No. 4 4 $ 33 L52 33 L52

Petrol generators No. 8 8 $ 2 458 2 458 Water pumps No. 4 4 $ 3 763 3 763 Hydrological $ 4 000 8 000 4 000 16 000 ocP82.3 Page 71

TABLE 8. ESTIMATED COSTS FOR THE FIRST THREE YEARS OF THE WESTERN EXTENSION IN THE PHASE I AND II ZONES (continued)

Category Year 1 Year 2 Year 3 Total

Laboratory $ 25 000 10 000 12 000 47 000

Camping $ 6 000 3 000 2 000 11 000

Electrical fittings $ 1 000 500 300 1 800

Misc. smal1 items $ 5 000 3 000 2 000 10 000

Sub - to tal $ 110 152 30 72L 20 300 L6t L73

Component $ L 249 76t 529 579 106 938 | 886 278

TOTAL $ 2 9s7 497 s 256 9L3 6 998 99L L5 2L3 40L ocP 82.3 Page 72

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EXPLANATORY NOTES ON THE BIO-CLIMATIC ZONES (I'{AP 2)

Zone Name Descript ion

I Sahel savanna Wooded steppe with abundant Acacia and Conrniphora

II Sudan savanna Dry savanna woodlands

III Northern Guinea savanna Savanna \^Toodlands with abundant Isoberl inia

IV Southern Guinea savanna Moist savanna woodlands v Forest-savanna Mozaic Derived savanna, i.e. savanna derived from forest

VI I"loist forest Coastal rain forest

EXPLANATORY NOTES ON THE l,llNERAL DEPOSTTS (MAP 6) Abbreviation Description

A1 Aluminium deposits (Bauxite)

Au Alluvial gold

Cr Chromite

Cu Copper

D Diamonds

Fe Iron ore

L Limestone and marble

Pb Lead Page 74

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