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OCP-EAC7.2-Eng.Pdf J t.- "" I NOnI.D EETLTB ORCAIIIZATION ORGAIIISATION HOTTDIALE DE LA SAIITE ! oNcHocERcrAsrs coNTRoL ipnocneuuE rN wEST AFRTcA PROGRAI{!{E DE LUTTE CONTRE LTONCHOCERCOSE EN AFRIQUE DE LIOUIjST I I EXPERT ADVISORY COMHITTEE ocP lEAC7 .2 Seventh meettng ORTGINAL : FRENCH Banako 15-20 June 1986 PARTICTPATION OF COr.MUHrtrLS IN ONCHOCERCIASIS CONTROI. IN THE BAI.IDIAGARA ARTA (REPUBLTC OF MALr) I t Descrtptton of Ehe envtronment I 2 Health problems of t.he Dogon plateau 3 HealEh tnfrastructures and nattonal cont,rol programmes 4 Onchocerctasts ConErol prograrnme - acE,tvtttes - parttcularittes and results of che OCp campatgn on the Dogon plateau 5. ParEtctpat.ton of Uhe vi. llage communtttes tn the OCP campatgn on the Dogon P la teau 6. Constderattons and prospects as regards the parttctpatton of the vtllage communtttes tn the onchocerctasts control : - foreseeabre ortentatton of ocp acttvtttes on the Dogon prateau - geographtcal exEenston of thts t,ype of acttvtttes - tnEegratlon of brackfly control tnto other acttvtctes 7 Conclus tons. 1. Descrtpt{on of the envtro nnenC I'l' The Band{a8ara Plateau, or Dogon Plateau, frorn Ehe name of tEs domtnant erhntc Sroupr ext,ends over some 7r5oo km2, to t,he ea6E of rtver Ntger, t,he Bandtagara Losrn ttself ts located ?5 km frorn Moptt. Admtntst,rattvely, the Bandiagara prateau corresponds to the BandLagara cercle (arrondtsseoents of Bandtagara, Goundaka,Kant-Go8ounaKendte'Es.rt@),whtchtasa1nost2oo,oooDourou, tnhabttants, and ln part to the Douentza, Koro i"ntags "r,a cercles. 1'2' The couutry' famous for the beauty of tce altes, te conposed tableland of a rocky of prtoary sandstones (ordovtctana) at a hetiht of between 3oo and almosE 800 metrci' deeply sculptured by eroaton, gaehed platns by waierco,rreee and dootnattng rhe of Ehe east-by an {mpresstve cltff of alno"L zoo Eetrea, the famous Eandtagara cltff, vhtch runs fron the south-uesE to the north-eaat over t-"" "o.J"Io6-;;:- The 1'3' eltuatc saa of the northern sudan rype. Eowdyer, for nore than a decade, rhe poor ratns (a ltttle oore than 3oo mn of uater pcr year at Bandtagara stnce t9tio, t.e. half of the annual mean for Ehe 195os and l96oe) ana the ehorEen{ng of the ra{ny season froo ftve mnths (June-October) bo Ehree (July-Septeaber) have led Eo a very marked and severely felc drought and an l.ncreas(ng'eaheltzatton" of the vegetaLfon ;rnd che landacape. No. 086/VcU/ LDt4l13.2 a! ocP|EACT.2 Pege 2 1.4. Tlrere ts no Peroanent HaEercourse; only a few aourceE and p'ondq tI" perenntal, The tlatn'part of Ehe hydrographtc neEuork runa froo east to uestr towarde tn the Ehe yame and other E,rtbuEartes of the Bant whtle a few Eorrents dteappear platns through spectacular falls and cascades afEer croestng the cltff' tfhtle rouSh' fhe "."a".nEhere ts no toportanl rlver, the netuork ts dense and Ehe coursea very nagural flow var{es beEseen a feu days affer Ehe heavy ratns and several monEhs (July-December). For 6ome years nou' thts pertod has been reductng dranattcally b""r,,." <lf uhe tmpover{shmenl- of the underground waters' (abour 50 eo far) on fhe r .5. For more t,han Een yearsr msoY dams are betng butlt vartous stzes (maxtmum I'3 mtllton p la E.eau for Lhe creaEton of sat,er tmpoudment-s of supply durtng the dry 6eason' m3 for Iake Daga) for trrtgatton and 'Jater for I.6. The Dogon populattons*, alnost exclustvely aqrtcult'ural, are renowned stth shtch they Eurn aEE.achmenc to the land and the tngenutty and deEerotnat,ton rhetr lands' Mtllet and Eo besE accounE a regton and a reltef havtng a prtort fes arable tn Ehe number of dao sorghum are the ma{n food crops. Hogrever, stnce the tncrease gardentng has been developed and expanded remarkably, Ehe growtng of Iakes, markeL or ontons tn parttcular, as well 4s potato-growtng and r{.ce farrntng, tn trrtgated waEered ftelds. 1.7. Ftnally, tn addtE{on ro shoutng an excepttonal farm{ng dynantsm relaEed Eo Ehe necesstEy for adapEatton Eo a very parE{-cuIar envtronmenE, Ehese populattons have been able Eo matntatn remarkably elaboraE6d soctoculEural Eradtttons and very soltd and vtvactous communtty structures as a resulE of a way of ltfe charactertzed for a long ttme by a relattve {solatton tn Ehe remarkable defenstve stEe Ehat the plateau and tEs cltffs and EorEured reltef consttcuEe' 2. Health probleos of the Dogon Plateau ,( 2.1. The matn vector-borne or {ntermedtaEe-hosE parastttc dtseases tn the Dogon Plateau are : schtsEosontasts S. haematobium and S. mansont), dracunculosts (Gutnea worm), oncltocerctasts and malarta' Among Ehese dtseases, Ehere has been a noLable and worrytng spread of fhe 2.2. water ftrsc Ehree, t n proporc'l on Eo Ehe mulCtpll.eabton or perennaE.ton of art,tf tctal collecclons. (60Z Eo 2.3 . The preva Ie nce of Schtstosoma haemaLob{um in man was above 75 Z fron 5 Alchough less frequenE l5 years ) and nearlY IOOZ tn the greaEer parL of Ehe vtllages. by s. mansont ts also prevalent on the ( g.' nerally below 2OZ) ' btlharztasts caused plateau. 2.4 . Gul.nea vorm Dracunculus medinens{.s ts also htghly prevalenE and tn cerEatn vtllages up to 8OZ of the act{ve populat ton was dtsabled durtng the ratny season by Ehts parasttosts' aE a t{me for farm work, utEh a constderable frequency of fatal compll caE,lons (ceEanus). 2.5. Onchocerctasts, rePorted more Lhan 30 years ago along Ehe matn eratercourses (che yame, the Dtaue, the presence of nhtch uas the Perou and Ehetr trtbutartes' et,c..)r presenced prevalences hardly exceedtng mesoendem{ctEy excepE tn some vtllages tn Che south-r.estern parE of the plateau' * In factr Etre 0ogon count ry exEende beyond rhe plac,eau and Lhe Bandtagara cercle, to tlre Bankass. Koro and Doue ntze cercles and parE of thaE of Tomtntan, sandy platn areas ( the Seno) uhoee hea ftn pilETil? are stratlar s{th E,he exceptton of onchocerctasts vrhtch ts not known Lhere' Ehe souLhern * Especl-a1lY S. strbanum characterlsE. l'l .rnd domtnanL s[)ecles of fr{nges of th r' flfPd O st rt button of Llrr' verLor comPlcx. I ocP|EACT.2 Page 3 2.6. Beeauad:of uhd rcltef, attee (raptda) naturally conduclve to pretnagtnal developnent of the Staultuo daunoauo vector cooplex were'parttcularly [email protected] abunJant on the vector conplex could locally, exceed 2oo per nan per day; preaented these uracirri:popri.tto"" all the vector potenttalttles charactertettc of the aevere onchocerctaels foct of the eavanna tyPe. However, beeauee of rtutted the latttude the Eransataston renalned tn ttne (re8trtcted to t,he pertod of flor of the watercoursee) and space (close to the satercoureee). 2'7 Theae characEertettce ' explatn tn part thte relattvely ntld form of che dtseaee, uhtch could have, honever, been dtsrupted ana aggravated by the consEructton of trrtgatton daus that have created arttftcal raptds conducttve to the developnent of the aquattc forue (e8Bsr larvae, pupae) of the onchocerctasts vectora both on bhe trrtgatton canala and on the sptllways, on uhtch the pertod of flow was notably long' etther tnrent{onally (on th" drr"-reservotrs, valleys) regulators of trrtgac,ton of the or tnvoluntartly (leakages from Ehe soall daos nhtch are more of tmpoundment salls t,han real dans). 2'8' Because of the expertence of other art,tftctal foct of the sane type created tn hypo or mesoendemtc areas, eleewhere tn Malt (Kongasso) or tn netghbourtng counErtes (Lounana, Burktna Faso), together wtth the presence potenctaltttes, of blackfltes wtEh htgh veccor tt can be afftrmed that t,he danger of an tncrease tn Ehe nuober of small ctrcuoscrtbed foct w{th htgh rtsks of bltidness and severe soctoeconom{c repercusstons for the communlttes that fr6quenE the new lakes lra6 very h{gh. 3 Health tnfrasEruc t,ures and nattonal conErol proqrammes 3'1' The health tnfrastrucEures of rhe Dogon plateau Dtrectorate depend on the General of Haltrs ftfth Adntntstrattve [egton (Moptt) and, through t,hat, the Mtntstry of Health tn Bamako. 3'2' In Bandtagara' Just as tn each cerclers chtef tosn, these structures are headed by a chtef Medtcal offtcer srhosfGiTncrudes : - a medtcal offtcer (asststant) t - a mtdutfe - several health t,echntctans - a communtt,y developmenE Eechntctan - several male and female nurses. 3'3' outstde Bandtagara, there ts a health toBn'headedbyachtefhea1thpostnurae,andanauxt1t..ffit;;-;",.poet tn each arrbndtssement,rs chtef of each baatc aector; each of tireo te assisted, at the vtllage level, by rural Eatrona and hygteatete/ftrst-atd rorkere. 3'4' The latter' at least one per conurbatton (141 f.or 4o7 vtllages), are vtlragers serect'ed by the connuntty on the baata of thetr abtltttee and qualtttee and tratned tn the cerclers chtef town. They are pharoaclEFEEit; tn charge of ftrst atd and have a small vtltage they aleo deal wtth envlroioental aanttat(on, vtlrage cleanltness, houstng toproveuent, drtnktng water aupply and treaEoent They of rater for doaesEtc use. are voluntary uorkera conpenaated {n- ktnd by the coomuntty for the ttme they devote to thetr healEh dut,tes to the deErtment of thetr agrtcuitrral acLtvtt,tes. 3'5' An tategrated developnent proJect, rhtch tncludes, tn parttcular, a ..Health Actton" coEPonenE' te betng carrted out, for several years norr, on t,he Dogon PIa toau. ocPlg,Ac7.2 Page 4 The..above-nenE,toned componenE, whtch gtves Sreater lnportanCc to preventlon 3.6. healch educatton' and 6he,managemenE by Ehe comraurrtttes of Ehetr orn probleoa, coverS tratntng and retrarntng of auxtltary-"o.r."." healEh peraonnel and tnprpvenenE and eanttatton uaEer aupply or dam of Ehe uaEer eupply polncs be chey and nodes of drtnk{I}8 reservotrs - 3.7.
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