African Programme for Onchocerciasis Conhol (APOC) Programme africain de lutte contre I'onchocercose
JOINT ACTION FORUM JAF.FAC FORIIM D'ACTION COMMTINE Office of the Chairman Bureau du Pr6sident
JOINT ACTION FORUM JAI'II/INF/DOCI Eleventh session OzuGINAL :FRENCH t Paris. France. 6-9 December 2005 October 2005
Item 24 of the Provisional Agenda
PROGRESS REPORT OF THE SPECIAL INTERVENTION ZONES OF THE EX-OCP (January - Jun-e 20105)
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October 2005 JAFlI/INF/DOC/I Page i
TABLE OF CONTENT
A. ENTOMOLOGICAL ACTryITIES...... 1 l. Vector control in Togo and Benin from January to June 2005 I 2. Results of vector control 2 2.1 Blackfly Density 2 2.2 Transmission...... J 3. Entomological activities in Sierra Leone in 2005 4
B. RESULTS OF CDTI ACTIVITIES (see table 4 in annexe) 5
C. EPIDEMIOLOGICALEVALUATIONACTTVITIES 8 1. On the Keran:...... I 2. On the Kara: 8
3. On the Mo...... 8
D MEETINGS ...... :...... I 1
1. A meeting between APOC/Sru Management and partners: SSI, HKI and the World Bank as part of the reorganisation of CDTI in Sierra Leone ...... 11 2. Meeting between the APOC/SIZ Management and representatives of the Ministry of Health of Sierua Leone (Briefing of the new Programme Manager on the organisation of a worl E. MISSION OF APOC DIRECTOR TO ACCRA TO MEET WITH NATIONAL ONCHO TEAM OF GHANA...... 16 F. APOC SUPPORT TO SIZ t6 G. SIZ MANAGEMENT SUPPORT FOR NON-SIZ ZONES...... 17 H. PARTNERSHIPWITHNON-GOVERNMENTALDEVELOPMENT ORGANISATIONS (NGDOs) 17 ANNEXES .I Figure I : Catching point of SIZ in Benin and Togo ...... [ Figure 2 : Trend of simulium fly densities on the tributaries of oti and on the Upper Oueme ...... I[ JAF1 I/INF/DOCl Page ii Figure 3: Trend of infective females and larvae at the various catching points in the tributaries of the Oti river...... IV Figure 4 : Annual Transmission Potential (ATP) March - December 2003-2004 Simulium damnosum complex species infected with Onchocerca volvulus...... V Table 1: Comparison between daily catches from January to June 2003 - 2005 .... VI Table 2: Trend of annual transmission potential (ATP) on the tributaries of Oti from 2002-2005...... VI Table 3: Entomological results in 2003 and 2004 in Sierra Leone Annual Transmission Potential (ATP) May - December 2003 VII Table 4: Results of CDTI activities in the SIZ from 2003 to 2005...... VIII JAF1I/INF/DOC/I Page 1 A. ENTOMOLOGICALACTIVITIES 1. Vector control in Togo and Benin from January to June 2005 Entomological evaluation activities centred on the tributaries of the Oti and Upper Oueme in Togo and Benin. 16 catching points, of which 11 were regularly followed up by four catching/dissection teams (figure 1). f Rainfatl As in 2004, all the rivers stopped flowing from February to March 2005, except the main Oti River and the Keran. The rainy season started a month earlier in March 2005, in the basins of the Oti and Upper Oueme, as compared to 2004. These early rains furthered the resumption of flow in the Kara and the Mo Rivers, but had very little incidence on the flow rate, which overall remained the same as in 2004.It must be noted that the Upper Oueme is still dry. As a whole, 19 water gauges were used for larviciding. The national hydrology teams of Benin and Togo were retained per letters of agreement to carry out maintenance work on the network. * Larviciding b Aerial larviciding Aerial larviciding of the Oti tributaries were intemrpted from January to May 2005. Treatment ceased in the first and second week of January following bad weather conditions during the harmattan season. A month later the breakout of socio-political disturbances in Togo also brought about a complete halt of larviciding for three weeks in February (during weeks 6, 7 and 8) and in April - May (during weeks 16, 17 and 18). All these intemrptions occurred in the Keran River basin, in an unfavourable entomological context. Aerial larviciding resumed in full swing on 12May 2005. It is worth noting that 84o/o of the treatment circuits were supervised by SZ technicians. I Ground larviciding With the exception of the weeks in question, when there were social upheavals in Togo, larviciding on the Mo, main Oti and Upper Oueme Rivers were entirely carried out on the ground by entomological evaluation teams from January to May. The teams also carried out ground larviciding in the Keran and Kara basins, as a supplement to aerial larviciding, or during the time the latter was suspended. JAF1I/INF/DOC1 Page2 b Larvicides used A total quantity of 19105 litres of B.t.H-14 and 1341 litres of temephos (143346 US $) was used from Januaryto June 2005 as against 28034litres of B.t.H-14 (17661US $) in2004 forthe same period. b Aerial Contract and flight hours used 2005 marks the end of the first three-year contract that was signed between the WHO and the Evergreen Company (EHD to carry out aerial larviciding on the tributaries of the Oti and Upper Oueme. On the whole, 636 hours were guaranteed to the company. The WHO will have to take measures right away with a view to negotiating the second two-year contract (2006-2007) given the relatively long time needed to come to an agreement. 200 flight hours were used from January to June 2005 to undertake larviciding, against 178.5 hours used for the same periodin2004, giving a surplus of 21.5 hours (26337.5 US $). 2. Results of vector control 2.1 Blackfly Density The analysis of entomological data from 1997 shows an overall gradual reduction in blackfly densities on the tributaries of the Oti. This downward trend continued and reached unprecedented densities on the Mo in 2001, and on the Keran and Kara in 2002 (figure 2). From 2001 and 2002, significant changes occurred in larvicide coverage in Benin and Togo following good entomological results. Thus, larviciding on the tributaries of the East Lake Volta, of the Mono, Sio and Kouffol were definitely suspended in 200I. A year later, aeial larviciding were stopped in the Lower Oueme and its tributaries upon the closure of OCP in 2002. The cessation of larviciding brought about an increase in catches, especially in the basins of the Mo and Upper Oueme, locate on the southern border of the SZ. The bordering basins are actually invaded on a regular basis by migrant females, at the time of the monsoon winds (figure 2). The exceptional rainfall recorded in 2003 and 2004 was also an enabling factor for the local breeding of blackflies, since it filled up the several secondary tributaries, which have been dry for the past several years, and so were not programmed for in the treatment circuit. Fortunately, the current insecticide pressure generally helped to contain the blackfly density in the basins of the Oti and Oueme Rivers. From January to mid-June 2005, available data indicate an excellent entomological situation compared to that of the previous year. A downward trend in weekly catches was observed in all the treated basins, except in the Keran, where a high density was recorded. Thus, the unforeseen cessation of aerial and ground larviciding that occurred during the social upheavals in Togo did not allow for effective control actions in this basin. (Table 1). JAFlI/INF/DOCI Page 3 2.2 Transmission Since 2002, a downward trend of the number of infective flies were generally observed in the Oti basin. However this trend did not lead to a decrease in the monthly and annual transmission potentials because of the increasing number of infective stage of O. volvulus found in the flies at some catching sites (Figure 3). From January to May 2005, no transmission was recorded on the basins (Kara, Keran, Mo and Oueme). All the transmission recorded in these areas concerned only the month of June 2005. 2.2.1Oti Tributaries From 2002 to 2004, the Annual Transmission Potentials (ATPs) by the savannah species on all the tributaries of the Oti were maintained below the tolerance threshold of 100, except for Bagan on the Mo and Tapounde on the Keran in 2003 (Table 2). It must be recalled that in 2003, a number of parasites harvested in the Mo and Keran basins could not be identified by the molecular biology laboratory, and so were considered to be of the Onchocerca volvulus savannah strain by default. From January to June 2005, the available dissection results indicated that transmission was well under control as compared to the same period in 2004. Transmission was recorded in five capture sites (Titira, Tapounde, Aleheride, Beterou and Wari Maro) in 2005 against eight capture sites ( Titira, Tapound6, Wari Maro, Kouporgou, Bagan, Landa Pozanda, Sarakawa Kpelou and Mo at Mo). o Keran At Titira, corrected ATPs in 2002 and 2003 were slightly below 100. In 2004, an ATP up to 105 recorded was due to the fact one L3H non-identified by the DNA laboratory was assumed to be O. volvulus by default (Table 2). A crude transmission potential of 21 was obtained from January to June 2005. The entomological situation remained excellent at Kouporgou, with ATPs (corrected) fluctuating between 0 and 14 from 2002 to 2004 (Table 2). No transmission was detected from January to June 2005. A marked improvement in results was observed at Tapounde. Thus, the savannah corrected ATP, which was 109 in 2003, dropped to 14 in 2004 (Table 2). The crude monthly transmission potential was 28 during the January - June 2005 period. a Kara The corrected ATP remained below 100 at Landa Pozanda from 2002 to 2004 (Table 2). No transmission was detected in the Kara from January to June 2005.It must be recalled that at the same period in 2004, the monthly transmission potential was 2l and 42 at landa Pozanda and Sarakawa Kp6lou respectively. JAFI I/INF/DOC1 Page 4 BMo The entomological situation remained excellent upstream of Mo at Aleheride, with corrected savannah ATPs fluctuating between 0 and 14 from 2002 to 2004 (Table 2). No infective female was found from January to June 2005. A marked decrease in transmission was noted in 2004.In fact, the corrected ATPs, which were 271 at Bagan, and 91 at Mo in 2003, dropped to 29 and 42 respectively in 2004. A crude monthly transmission potential of 28 was recorded from January to June 2005 at Aleheride catching site (table 2). tr Upper Oueme The entomological situation remained excellent at Wewe and Barerou. ATPs at Wewe were nil in 2003 and2004. At Barerou, ATPs (corrected savannah) were 28 in2002,18 in 2003 and zero in 2004. No transmission was detected on these two points from January to June 2005. However, corrected savannah ATPs in 2004 at Wari Maro and Beterou exceeded the threshold of 100 and reached 137 and 1 13 respectively. Apparently, the reduction in biting rates at Wari Maro and Beterou in 2004 was not enough to bring transmission under control, due partly to a quite high proportion of forest females (figure 2). Thus, 7435 females were caught at Wari Maro in 2003, as compared to 4952 females in 2004, and 3429 females at Beterou in 2003, as against 2778 females in 2004. The crude monthly transmission potential were 53 and 42 at Beterou and Ware Maro catching sites respectively from January to June 2005 (Table 2) 3. Entomological activities in Sierra Leone in 2005 The aim of these activities is to collect base data for entomological studies on the impact of ivermectin on transmission. Activities are ongoing in 2005 on all the river basins of Sierra Leone, and on 19 catching points. The results chalked in 2003 and2004 indicate that 8 out of the 35 points (23%) visited have a transmission potential below 100. 77% of the points have a transmission potential between 105 and 3806, distributed over all the basins, which confirms the high transmission noted in the entire country (see table 3 showing transmission potentials in 2003 and 2004 on the 35 points visited during the period, and the figure 4 indicating their distribution over all the river basins of Sierra Leone). Transmission is carried out at 0.38% by savannah blackflies, which means that transmission is almost exclusively due to the forest simulium. JAFI I/INF/DOCI Page 5 B. RBSULTS OF CDTI ACTIVITIES (SEE TABLE 4 IN ANNEXE) INTRODUCTION CDTI reinforcement activities are ongoing in the five SZ countries. Supervision activities enable national teams to discover new villages and hamlets and include them in CDTI. The main challenge remains the ownership of the strategy by communities. Sensitisation and mobilisation must continue at all levels of the health delivery system and in the communities living in the hyper and meso-endemic Oncho areas, so as to ensure sustainability. Efforts still need to be made to encourage the central, district and peripheral levels to further involve the communities in the planning and implementation of CDTI activities, such as sensitisation, the choice of CDDs and the incentives the communities would like to give them, training and cascade supervision. The reception of ivermectin by the Ministries through WHO offices, and the placement of ivermectin tablets at peripheral health centres, through the CDDs, are generally carried out without mishap. However, there are still problems inherent in the estimation of ivermectin needs for the SZ zones, where two rounds per year of CDTI are required. Apart from Togo, which recorded therapeutic coverage rates of 85.9% in the 2nd round of CDTI in 2003 and 86%o in the second round in 2004, the other SZ zones recorded rates varying between 72.8% and80.9o/o, which are below the85o/o required. Sierra Leone recorded the lowest geographical coverage rates of34o/o in 2003 and28%oinZ}O . Geographical coverage rates vary between 82.91%o and lO0% for the country. Drug distribution is carried out quite well as indicated by the average of 3 3mg-tablets per person treated. TOGO: CDTI was organised as planned (2 rounds/year) in 2003 and 2004. The average therapeutic coverage of 2 rounds of CDTI in 2003 was 84.75o/o, while the average geographical coveragi was 98-87%. ln 2004, after the two CDTI rounds, the average therapeutic *,n".ug" rate was 85.35oh, and the average geographical coverage was 95.52%o. In 2003 and2004, the first round was organised in April, and the second in October. ln 2005, the first CDTI round started in May, and is ongoing. 6000 family registers were prepared with the help of Sight Savers International (SS!, which gave financial a support- of 3,600,000 francs. Communities made financial contributions to the tune of 1,800,000 francs. The difficulties encountered had to do mainly with: insufficient logistics for supervision, dearth of CDTI data management (data collection, checking and on-the-sfot correction of these data). In some communities inappropriate measuring sticks are used, and some CDDs complain of lack of incentives by village communities. These problems could explain why the geographical coverage of 100% is not reached. CDTI is integrated into the health system at all levels, as attests the quality of presentations made by the district medical officers during the annual review of Oncho uitiriti"r in Togo. Data JAFI I/INF/DOCI Page 6 collection and analysis, as well as decision-making are taken care of at the district and peripheral health centres. The issue of lack of qualified personnel, and of appropriate facilities for data management was reported by most of the district medical officers. There is the need to: + Sensitise the communities to make them increase the incentives given to their CDDs, and to own CDTI. An evaluation of the degree of CDTI ownership should be conducted this year. + Encourage govemment and NGOs to increase their support to activities; + Train staff at all levels on CDTI datamanagement. BENTN In 2003 only one CDTI round was carried out in April. Therapeutic coverage was 80.9o%, and the geographical coverage rate was 99.7%. A cholera epidemic intemrpted the conduct of the second round, which was scheduled for November. ln 2004, first round CDTI activities were conducted smoothly in the months of March and April. A total of 1,553 villages and hamlets were treated. Geographical coverage varied between 95.90% and 100%, with an average of 98.6%o, while the therapeutic coverage rate varied between 72.20% and 85.89%, with an average of 80.85%. The second CDTI round was organised in November, coupled with the treatment of LF. A relative reduction in the geographical coverage rate was noticed (90.23%) during the second of CDTI in2004, as compared to that of 2003 (99.73%). This reduction could be due to the fact that some villages, which should have been evaluated, were not treated. The therapeutic coverage rate in 2004 was 79.5yo, which is slightly lower than the rate for 2003 (80.85%). The results of the first round of CDTI carried out in April 2005 indicate a geographical coverage of 94oh and a therapeutic coverage of 81%. The difficulties encountered have to do with the delay in placing the 2005 ivermectin order with MDP. The Togo national team had to lend 1,700,000 tablets to the Benin national team to enable it carry out the first round that ended not long ago. The situation has since been put in order. The integration of CDTI into the health system would need to be buttressed. This could partly resolve the issue of reduction in the geographical coverage observed in the second round in2004. GUTNEA: In 2003 the results of the only CDTI round indicated a therapeutic coverage of 77.7o/o, and a geographical coverage of 98.88%. In 2004 the results of the CDTI first round showed a therapeutic coverage rate of 78.8Yo, and a geographical coverage of gg.88yo, while the results of the 2nd round indicated a geographical coverage of 41.60/o, and a therapeutic coverage rate of 19.2%. This disturbing situation came about because ivermectin was out of stock, due to wrong estimates of drug needs for two rounds. JAFII/INF/DOCI PageT In 2005, preliminary results of the first CDTI round indicated 99.92% as the geographical coverage rate, and 79.1% as the therapeutic coverage. The number of villages to be treated was the same in 2003,2004 and2005. Among the difficulties mentioned was the late reception of ivermectin, the lapses in CDTI data analysis at all levels, lapses in the supervision of CDDs by head nurses of peripheral health centres. For the second year running, organising the second rounds CDTI treatments seem to be difficult. A survey will be conducted with the national Oncho team to identify the problems, and find appropriate panaceas for this situation. GHANA: On the Pru, only two districts were concerned by CDTI Results indicate that 2 districts (Atebubu and Nkoranza) out of 4 (see 2003 results) were involved in CDTI in June 2004, with 262 villages undergoing treatment in 2003 against 316 villages treated in 2003. The geographical coverage of 82.9%o, and therapeutic coverage rate of 67.8% in2004 are lower than the rates in 2003. It will be necessary to re-define the SZ zone in the Pru basin, and to continue identiffing villages and hamlets to be included in the CDTL SIERRA LEONE: ln 2003, the partial results of CDTI gave 28.3oh as the geographical coverage, and 34o/o as the therapeutic coverage rate. About 3,042 persons were treated in the Bandajuma refugee camp. I\ 2004, the partial CDTI results indicated therapeutic and geographical coverage rates as 22.5% and 28Yo respectively. Given the unsatisfactory results obtained in the two consecutive years, it was decided during a workshop of all partners and the Ministry of Health to undertake a strategic re-organisation of CDTI in Sierra Leone. In 2005, the strategic re-organisation process of CDTI in Sierra Leone is underway, with joint efforts by health authorities, SSI, HKI, the World Bank and the Management of the SZ. JAFlI/INF/DOCI Page 8 C. EPIDBMIOLOGICAL BVALUATION ACTIVITIES 1. On the Keran: BENIN: At Kouporgou on the Koumongou, the disease prevalence varied befween 46.5% in 2000 and 16.22%o in2004, with a Community Microfilarial Load (CMFL) of 0.45 in2004. TOGO: The prevalence at Titira was 64.50/o, with a CMFL 10.98 in 1995. This prevalence rate dropped to 39.Lo/o in2000, and to 22.7% in 2003. It must be noted that the microfilarial load at Titira dropped by 0.90 mf/b in 2001 to 0.19 mflb in 2003. The villages around Titira also had high prevalence rates (Kpesside ferme: 50% with a CMFL of 0.34 in 2002, and ll.60/o with a CMFL of 0.16 in 2005; Kpesside Narita: Prevalence rate of 24.9Yo,with a CMFL of 0.29 en2002, and22.3o/o, with a CMFL of 0.27 in 2005). 2, On the Kara: The epidemiological evaluations conducted in this basin indicate a disease prevalence rate of 2.3oh (lower than the threshold of 5%) and a CMFL of 0.14 in 2000 (prevalence was 8.lYo, with a CMFL of 0.14 in 1996). At Kpesside (Sarakawa kpelou) the prevalence was 6.7yo, with a CMFL of 0.08 in 2000, and7.7o/o with a CMFL of 0.08 (slight increase in prevalence rate with a low CMFL). However, the on the Lower Kara, the epidemiological situation is bad. Prevalence rates, though decreasing, are still above the threshold of 5o/o. Thus, at Tougel, the prevalence rate went down from42o/o, with a CMFL of 1.97 in 2000 to28.60/oin20O3, with a CMFL of 0.19; at Sakpone, prevalence dropped from 33.8%, with a CMFL of 1.44 in 2000, to 16.80/o in 2003, with a CMFL of 0.13; at Sikan, prevalence went down from 53o/o with a CMFL of 3.25 in 2000 to 36.90/o with a CMFL of 0.24 in 2003; and lastly at Kadjol 2, the prevalence rate dropped from 28.40 , with a CMFL of 0.08 in 2000 to 10.9o/o in 2003, with a CMFL of 0.10. 3. On the Mo The prevalence rates in the two sentinel villages on the middle and lower courses of the Mo are, at Bagan: 2.6ohwith a CMFL of 0.04 in 2000, and3.8o/o in 2005, and at }y'ro:6.3oh in 2000 and 8.60/o in2005. There is a slight increase in prevalence rates, though they are still lower than the threshold of 5o/o at Bagan, and above the threshold at Mo. At Kemini (Aleheride), the prevalence rate and the CMFL were zero in 2000 (prevalence was 4.5o/o, with a CMFL of O.Z3mftb in 1996). JAF1 I/INF/DOCl Page 9 GUINEA: Upper Niger/Mafou and Tinkisso Basins in Guinea Overall, the results in these basins are satisfactory. From 2003 to 2005,87 villages in all were evaluated in these basins, and following are the results: tr 36 villages out of 87 (41 %)had a prevalence rate of zero (0 %); tr 46 villages out of 87 (52 %)had a prevalence rate below 5 %; o 5 villages out of 87 (5%) had a prevalence rate above 5 %. These are Boroto on the Tinkisso (6,6 %); walia Dabourou on the Niger (8,7 %); Mamouria on the Niger (12 %); Herako on the Mafou (5,3 %) and Serekoroba (5,4 %o) onthe Mafou. The CMFL remained below 0.5 mflb The positive status of a 9-year old girl, who was declared negative in 2OO2 in the village of Yalawa on the Mafou, and that of a young man of 20 after 3 successive evaluations (1999, i002, 2005) despite taking ivermectin every year, is of concern. All these observations call for greater vigilance in this zone, and necessitate further efforts in ivermectin distribution, in order to reach the therapeutic coverage rate of 85o/o. SIERRA LEONE: Several epidemiological evaluations took place in Sierra Leone from 2OO2 to 2004. The results show that the prevalence rates are still high aroun d 77 .O% in the Kaba basin (2002), 86.24% in the Wanjei basin (2003) and 69.1% in the Taia basin (2004). Disease transmission is not abated, for children between 0-4 years are positive. In the village of Kamba/B odu,17o/o of children between 0-4 were infected in2004 The strategic reorganisation of CDTI activities in the country should enable improvements to be effected in the epidemiological parameters. GHANA: Results of epidemiological evaluations indicate that the standardised prevalence rates vary between 0%o in the village of Adaa, in the Nkoranza District, to 26.50/o in the ,illugr of Akrakuba in the Atebubu district in the Brong Ahafo region. The results of the 18 villages examined in October 2004 indicate an upward trend in prevalence rates in 14 villages, and a downward one in 3 villages. The downward trend in prevalence rates was also noticed in the village of Brehima in the Offinso district in the Ashanti Region, and in the village of Asempaneye in th. Nko.urza district, in the Brong Ahafo Region. In some villages, prevalence rates doubled (Asubende: from 4.8%o to 8.8%) or went up tenfold (Faowomang: from 0.7yo to 6.8%). JAFI I/INFiDOCI Page l0 Prevalence went up rapidly in some villages, such as Akrakuka, where the prevalence rate went up from 7 .7oh to 26.50/o after 3 years. Asubende, Ayirede Hiampe and Faowomang showed the same trends. There is infection in children under 4 years at Asubende (1.8%) and MantukwaQ.a%) Disease prevalence is higher in men (5%) than in women (3.9%). Out of 2400 persons examined, 18 were blind (0.75yo),19 had serious visual impairment problems, and 13 had distorted vision. The 1l-Z}-age bracket had the highest number of blind persons. ln conclusion, it could be said that, though there is a downward trend in some villages, the active transmission of onchocerciasis persists in several villages in the Pru basin. Blindness is still causing havoc in persons that are less than 25 years. JAF1 I/INF/DOC1 Page 11 D. MEETINGS 1 A meeting between APOC/SIZ Management and partners: SSI, HKI and the World Bank as part of the reorganisation of CDTI in Sierra Leone The objectives of this meeting, which was held in Ouagadougou on 11 March 2005, under the chairmanship of Dr S6k6t6li, APOC Director were to: a. Request the contribution of partners to the improvement of the working document, which was written by the APOC/SZ Management for the health authorities of Sierra Leone, with respect to the enhancement of onchocerciasis control in the country. b. Get the response of each partner concerning the financial support they could give toward the implementation of CDTI in Sierra Leone. The APOC Director introduced the key points of the working document, using the maps showing the processes that led to the demarcation of the priority CDTI zones in Sierra Leone. The proposal to divide the Oncho endemic area into three projects, namely the CDTI project of the northern province, that of the southern province, and that of the eastern province was presented. ln addition, a summary of the 2005,2006 and 2007 bfigets was presented, with t'wo options taking into consideration the feasibility of sensitising and mobilising all the communities on a one-to-one basis, or sensitising them on canton basis. The partners appreciated the document presented by Management for its relevance, and pledged to financially support the CDTI reorganisation efforts in Sierra Leone as follows: SSI proposed to finance Oncho activities in the southern and eastern provinces, namely those of training of CDDs for monitoring and supervision. HKI announced its commitment to support the training of CDDs on monitoring/supervision of CDTI in the northern province in 2005. The World Bank pledged to give substantial financial assistance, and called for a complementary and coordinated approach to the actions the various partners would undertake. After the meeting, the various partners subscribed to the idea of APOC/SZ Management to organise, as early as possible, a workshop on the strategic reorganisation of CDTI. By consensus the date for the workshop was given as 19 to 21 April 2005. JAFI 1/INFiDOCI Page 12 2. Meeting between the APOCISIZ Management and representatives of the Ministry of Health of Sierra Leone @riefing of the new Programme Manager on the organisation of a workshop on the strategic reorganisation of CDTI in Sierra Leone) Following the appointment of Dr J-B Koroma as prograrnme mimager of the national team of Sierra Leone, it was decided that a briefing to be held in Ouagadougou would be appropriate for him to familiarise him with wHo administrative management procedures. In addition, as part of the briefing on the reorganisation of CDTI in Sierra Leone, it was deemed appropriate to invite representatives of three health districts of the country. To this end, the coordinator and three district chief medical officers undertook a mission to Ouagadougou from 30 March to 2 April2005. In addition to the administrative and technical briefing organised for them, the document on the strategic reorganisation of CDTI in Sierra Leone was presented to them for comments and suggestions. The document was amended, taking into account the amendments of the chief medical officer of Sierra Leone. The amendments and suggestions of participants centred mainly on: 4 the delimitation of endemic areas in three projects, in line with the administrative division of the northern, eastern and southern provinces; + the definition of the Annual Treatment Objectives of 55%o was deemed reasonable; + the option of starting CDTI simultaneously in the three projects was preferred to that of implementing one project after another; c) the option of sensitisation by village (community) was considered appropriate for the success of CDTI, but somewhat cumbersome. The head medical officers proposed that the sensitisation be done at chiefdom level, by involving the peripheral health units and administrative units. 3. Workshop on the strategic reorganisation of CDTI in Sierra Leone A workshop was organised in Freetown by SZ Management, in conjunction with the Ministry of Health from 19 to 2l April 2005. Discussions centred on the CDTI strategic reorganisation document developed by the APOC/SZ Management. After this workshop, an Action Plan and Budge were drawn up with the collaboration of the partners: SSI, HKI, World Bank and Government for a sustainable establishment of CDTI before the end of SZ activities in 2007 in Sierra Leone. The CDTI strategic reorganisation document was adopted upon amendment as the "Oncho Hand Book" by the Ministry of Health of Sierra Leone. A timetable for implementing CDTI activities, in accordance with the above-mentioned workshop was drawn up. In order to find a solution to the poor management of activities that has been observed, and give a better chance of success to the reorganisation of CDTI, the Ministry of Health has since 15 February 2005 appointed a new coordinator. JAFI IANFiDOCI Page 13 4 First meeting of representatives of APOC lSlZ Management with members of the national Oncho team at Makeni on 23 April 2005, in the presence of a World Bank representative The aim of this mission was to appraise the extent of rehabilitation of the Makeni base undertaken by APOC/SVMarngement, and to take stock of the day-to-day activities. In this connection, the meeting of Makeni assembled representatives of the staff of the three Oncho bases (Kabala, Makeni and Bo) in the conference room of the health district of Makeni on23 April 2005. The key items discussed were on the strategic reorganisation of CDTI in Sierra Leone, with the support of the various partners (SSI, HKI and the World Bank), the new orientation of activities to be conducted, the course of action to be taken by the staff with respect to the new prograrnme manager, the integration of Oncho activities into health care at the district level, and the ownership of CDTI by communities. Representatives of the bases greatly appreciated the support of the APOC/SZ Management, and that of the Ministry of Health for the drastic changes occurring in the organisation of Oncho control activities in the country. They were also full of praise for the financial commitment of the partners, namely SSI, HKI and the World Bank for the strengthening of Oncho control activities. 5. Annual Review and Planning Meeting on SIZ activities The annual review and planning meeting on SZ activities was held from 17 to 19 November 2004 at the APOC/SZ headquarters in Ouagadougou. Participants in the meeting included focal points of SZ, and Oncho coordinators of the ex-OCP. Also present were NGOs (SSI, HKI and OPC) that actively support Oncho activities in SZ countries, as well as the other ex-OCP countries. The MDSC was well represented at this forum. Following very interesting and instructive discussions, major recommendations were made as follows: The importance given to operational research to find solutions to some problems coming up on the ground by the formation of a review committee of research proposals, Setting up of a data bank for SZ, Advocacy with partners to request the extension of their support to Oncho control and surveillance activities beyond 2007 . In addition, the meeting took note of the organisation in 2005 of a mid-term evaluation of activities in the SV, and the evaluation of the effectiveness of Oncho surveillance systems in the ex-OCP countries. JAFlI/INF/DOCI *ur";. for SrZ consultative committee (scc) Annual meeting or tn. special of the Special consultative organised the third annual session The Apoc rsvManagement of the committee' and a zoo5, *iltn #;"'dJ;v ar*t*uers committee from 7 ," rr JunI rtapsc' The subjects discussed the ttr". .rnit.l""*.rv APO9,;fi-""J tu11-house participation of the technical and the piesented b; *" coordinators, touched on the evaruation of oiu.tirities"riiriii", at SIZ Management level' administratiu" -*uiil"nf in the ThemeetingalsotooknoteoftheitemsofthelOthsessionoftheJointActionForumandtheSp;;";; egt*lt' oiepOC' in relation to the activities 109th session of thJCommittee "f SV Aftersomeveryfruitfuldiscus-sions,followingdeliberations,membersoftheCommitteeauthorities of SZ MDsc, jz Munug"*";i-;j the health made recommendations for the countrtes. SV, reinforcement activities in the relate mainly to CDTI and These recommendations where this strategy was applied' coupled *itr, cprr in areas continuation of vector control, operational research' environmental surveillance and T.ThemeetingbetweenrepresentativesoftheEvergreenCompanyand APoC/SIZNlznagemento',rrMay2005inouagadougou the two Ameetingwasorganisedbetweenrepresentative'sofEvergreen(EHDandtheAPOC/SZissues of common interest to May zoos,witr, trre'ai* or discussing Management on 31 Evergreen at this meeting' project Manager at Kara represenied parties. Mr. Ron G;;;, The items discussed included -Reviewofthemainpointsofthelastmeetingheldon2DecembetT004 respect,-it was stressed that larviciding of the current contract (2003-2005).h,.1i, the Bioko - Status it. triUututi'"' oi tttt Oti' and also on activities were going on ,utrsfI""t;;ly ", Island. Togo on vector controf it socio-political disturbances in _ concerning the impact of the in February' and were suspe"[". f"t tf,,ee ieekt was report-ed that aenaloperations on12 March 2005' tnutrrom,ur uttf iti"t resumed three weeks in April-Mry 20i;;;^;;; to ouagadougou Theimpactonactivitieswasminimal,exceptintheKeranbasin.However,thesocio-of profe"lo"ur staff from Kara political disturbance;;r;;;h, about thr;;i;;ion for about two weeks' the same -withrespecttorelationsbetweenEvergreenandAPOCls%,ttwasobservedthattheyti.,. totiuuorating in order to achieve were cordial, and that the ;;;;;, objectives Relatingtoprospectsofvectorcontrolin2006and,2O0T,theissueofcontractrenewalir" pit"ttor of APOC/SZ underscored the fact for the two years ,o .orn. was raised' thatAPoClsLManagementwould.notbeabletomaintainaeriallarvicidingifconstraints of SZ' The cost or nffit r'ou", a"" to budget Evergreen (EHD ir.l""i"J,rre JAFII/INF/DOCI Page 15 wish of APOC/SZ is to maintain EHI for the next contract of 2006 and 2007, if the Company maintained the prices as they are under the current contract. APOC/SZ will need the support of external experts, such as the Special Consultative Committee, for SV, in order to convince the WHO contract review committee for the two remaining years of SZ activities. The Government of Equatorial Guinea put in a request for a last year of aerial larviciding on the Bioko Island. The meeting indicated that the conditions that the Evergreen Company would accept for operations on the Oti tributaries would equally be applicable to any possible larviciding on the Bioko Island. The representative of Evergreen took note of all the information items, and promised to transmit them to his Management. JAFI 1/INFiDOCI Page 16 E. MISSION OF APOC DIRECTOR TO ACCRA TO MEET WITH NATIONAL ONCHO TEAM OF GHANIA Dr Azodoga S6k6t6li, Director of APOC undertook a mission to Accra, where he had a working session with the national Oncho/SZ coordinator and the health authorities of Ghana. The following points were discussed during the mission: q Conduct of CDTI activities in the SIZin Ghana; q The need for the national coordination unit to submit technical and financial reports on time to APOC/SZ Management; S Strengthening partnership between the national team and SSI for support for activities, not only in the SZ but also in the non-SZ areas in Ghana; S Integrating Lymphatic Filariasis into Oncho control was greatly appreciated. It was stressed that this integration should be mutually beneficial for both progralnmes; 9 The authorities were informed of the organisation by APOC ISV Management and the World Bank of the mid-term evaluation of activities in the SZ, and the evaluation in 2005 of the efficiency of the Oncho surveillance system in the ex-OCP countries; S As part of the mission, the APOC Director gave a talk on onchocerciasis control in Africa to students of the Public Health School of the University of Ghana, Legon, on 7 February 2005. F. APOC SUPPORT TO SIZ + APOC Director ensures the overall supervision of financial, administrative and technical activities of SZ. + The SZ get considerable administrative and technical support from assigned APOC staff. + The APOC Director and the Coordinator of the APOC Director's Office organise, guide coordinate all SV activities. + APOC puts its know-how at the disposal of the SZ for putting in place a data bank of CDTI activities, of entomological and epidemiological evaluations in the SV, and contributed to drawing up the document of the CDTI strategic reorganisation in Siena Leone. JAF1I/INF/DOCl Page 17 G.SIZ MANAGEMENT SUPPORT FOR NON-SIZ ZONES The Management of SZ gives technical support in the following areas Technical assistance in organising surveillance activities, and data collection/management in the non-SZ zones in Togo, Benin, Ghana and Guinea. Yearly organisation of a review and planning meeting on activities, to which national Oncho coordinators of the six non-SZ countries are invited. This helps them to take stock of activities carried out in their countries since the closure of OCP, and to share experiences with their colleagues from the SZ zone. Participation in the annual review meeting on onchocerciasis control activities. Contribution to the shooting of a documentary film on onchocerciasis in the endemic zones ofTogo. Participation in the evaluation organised by SSI on the relevance and efficiency of the support of SSI to the onchocerciasis control programme in Togo. Organisation of yearly review and planning meeting to which the national Oncho coordinators of the six non-SZ countries are invited. This should help in taking stock of activities conducted in their countries since the closure of OCP, and in sharing their experiences with the SV counterparts. H. PARTNERSHIP WITH NON.GOVERNMENTAL DEVELOPMENT ORGANTSATTONS (NGDOS) HKI continues to give support to IEC activities relating to CDTI, and which have to do with vitamin A and iron distribution in several West African countries, including Guinea, Cote d'Ivoire, Burkina Faso, Mali, Niger and Sierra Leone. SSI actively supports CDTI activities, especially in the area of training/re-training, supervision and supply of logistics to teams in SZ countries. SSI has just signed a partnership agreement with Benin this year to support CDTI activities in that country. OPC actively supports CDTI activities in Guinea, Mali and Senegal JAF1I/INF/DOC/T Page I JAF1I/INF/DOCl Page [I Fisure I : Catchine point of SIZ in Benin and Togo KqY I O poirt a (D Point g a Point C a @ Points Test I @ I -) i nou JAFlI/INF/DOCI Page Itr Fisure 2 : Trend of simulium flv densities on the tributaries of Oti and on the Upper Oueme KERAN BASIN : TREND OF CATCES (1994.2004 TREND OF THE CATCHES ON KARA RIVER BASIN 1994.2004 3500 1600 r- TlTlRA(KERAN) I + S. KPELOU(AFFL.KARA) I + TAPOUNOE(KERAN) t ,ooo SUSP: LAC VOLTA EAST, 3000 + ll I s + LANOA POZAi'rDA (KARA) MONO,STO,XOUFFO t t / lf tzoo 0 2500 T fl I rooo 2000 - r / t 0 0 ,/,'/\\ 800 1\ 1500 .,, x Y i 1000 I Y iEoo -}---- E 500 E E x 200 \ ( ( 0 1994 1995 !996 1997 1998 1999 2000 2001 2002 2003 2004 1994 1995 1996 1997 1998 1999 2000 200t 2002 2003 2004 YEARS YEARS TREND OF CATCHES IN THE MO RIVER BASIN 1994-2004 UPPER OUEME: TREND OF CATCHES (1994-2004) 4500 +glcrxlm6l t t 8000 I /t000 + ilo(irot SGP: LAC VOLTA EAST. I suSP: LOw OUEME -+ALEHERtoE (il0) MONO,STO.XOUFFO t TRIBUTARIES t a 7000 0 3500 E fl 3000 ) 6000 fl0 I 2500 I 5000 0 I I 2000 0 4000 I i 1500 I I i E 1000 I (C 500 Y \O--a EI 0 ( 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 YEARS YEAR JAFII/INF/DOCl Page [V Figure 3: Trend of infective females and IarYae at the various catching points in the tributaries of the Oti river 16 6 2002 ;2003 o 14 2004 Io E 6 E 12 g o 10 1613H E l, c 8 E h- 6 6L3H o L 7L3H 9L3H 0 7L3H a 4 1113H 5L3H tE 3L3H 3L3H 2L3H 2 1L3H 2 1&113H 0 TITIRA TAPOUNDE KOUPORGOU LANDA PO SARAKAWA BAGAN ALEHERIDE JAF1I/INF/DOC1 Page V Fisure 4 : Annual Transmission Potential (ATP) March - December 03-2004 Simulium damnosum Onchocerca volvulus PAT / ATP C <1 00 c 1 00-1 99 o 200-399 o 400-799 o >800 JAFlI/INF/DOCl Page VI Table 1: Comparis on between dailv catchgs from Januarv to June 2003 - 200s Basins Capture 2003 2004 200s points Females/man/day Females/man/day Females/man/day Titira 4 18 45 KERAN Tapound6 12 3 18 Kouporgou 2 ) 0 Landa t4 2 KARA pozanda I S.Kp6lou 7 0 2 Bagan 5 9 3 MO M6 at M6 2 5 1 Al6heride I 3 ) B6t6rou 9 OUEME 8 6 Wari Maro 6 3 4 Table 2z Trend of annual transmission potential (ATP) on the tributaries of Oti from 2002-2005 ATP 2005* PARTIAL ATP 2OO2 ATP 2OO3 ATP 2OO4 Jan.-June 2005 Capture BASINS Corrected Savannah Corrected Savannah point Corrected Savannah Brut Tapound6 42 42 109 109 t4 14 28 KERAN Titira 97 97 70 70 105 77 2I Kouporgou 0 0 1,4 t4 0 0 0 M6 0 0 9t 74 42 42 0 MO Bagan 104 83 271 222 29 2I 0 Al6h6ride 0 0 t4 t4 0 0 28 Sarakawa 0 0 18 18 42 42 0 Kr{IL{ Kpelou Landa 2t 2t pozanda I4 t4 70 70 0 B6t6rou 46 46 38 38 113 106 53 UPPER Wari-Maro 28 28 44 44 t37 I 2 1 42 OUEME Barerou 28 28 18 18 0 0 Wdwd 0 0 0 0 0 * ATPs in 2005 are crude ATPs JAFlI/INF/DOCI Page VII Table 3: Entomolosical results in 2003 and 2004 in Sierra Leone Annual Transmission Potential (ATP) May - December 2003 Code Capture Points Crude ATP ATP corrected ATP savannah 5502 KABA FERRY 763 294 63 5507 MABANTA 2518 1694 0 551 1 KATIK 1274 588 0 5513 FARANGBAIA 226 119 0 I 5515 MONGERI 553 429 0 55 16 YIFIN 0 0 0 5517 NJAIAMA I 043 469 0 5518 YIMA FERRY 1318 825 0 5519 KONTA 343 238 0 560r MUSAIA 7 7 7 5603 YIRAFILAIA 105 105 0 5604 ARFANYA 217 189 0 5606 SANKALAIA 145 9 0 5701 BATIWA 946 648 0 5705 BANDAruMA 628 s20 0 5706 LEMBEMA 484 322 0 5708 GBAIMA 2lt6 1486 0 5709 MANO 5 158 2749 0 5712 MOKASI 595 I 3806 0 Annual Transmission Potential (ATP) March - December 2004 Code Capture points Crude ATP ATP corrected ATP savanneh 5501 KAMBIA 3934 I 155 0 5503 MANGE 917 609 0 5504 KARINA 167 62 0 5505 KUNSHU 616 238 0 5509 BUMBUNA 35 28 0 55 l0 MAKPANKAW I 195 238 0 55 l4 MAKWI 546 133 0 5605 MAWOLOKO BRIDGE 252 98 0 5702 TONC,OLU 516 tt2 0 5703 GOFOR 243 159 0 5704 KAMBAMA 980 196 0 5707 MOFOWE 784 r05 0 57t0 MOKELE 173 0 0 57tt LUNGI 3839 296 0 57 t3 GOBARU 539 77 0 57t4 BUMPE t82 t2t 0 b ETo -)f L -F0) @ o (o (o N o o) o o O @ o) f.- .fo o lr) ! 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