-, [email protected] ANtlEx o-1 ONCHOCERCIASIS CONTROL IN THE VOLTA RTVER BASIN AREA RePort prepared for the Governnents of Dahomey, Ghana, Ivory Coast, Mali, Niger, Togo and UPPer Volta TO TTIE AT.INEX O.I: TERMS OF REFERENCE OF THE PREPARATORY ASSISTAI'ICE MTSSION AI'ID UPPER VOLTA GOTIERNMENTS OF DAHOMEY, GHANA, MRY COAST, MALI , NIGER, TOGO I I Geneva I973 t a I a United Nations Development programme a Food and Agriculture Organization of the Unlted Nations fnternational Bank for Reconstruction and Development World Health Organization 1- TERiIS OF REFERET.ICE OF 1TIE PREPARATORY ASSTSTAI'ICE MISSION TO THE COVERNMENTS OF VOLTA DAIIOMEY, GHANA, I.RY CIOAST, MAL[, NIGER, TO@ Ar'ID UPPER a INREI,ATIoNTooNcHocERcIAsIscoNTRoLINT1IEvoLTARIVERBASIN CONlENTS Paragraph I. TTfIRODUEIION A. Basis for the Mission I B. Epideniological background . 7 T2 II. O&IECTTVE L4 III. ORCAT.IIZATIONAL STRUCII'RE . IV. WORI( PT.AT,I FOR TTTE MISSION t5 A. Phases . 16 B. Activities . 8.1 Collection of data L7 8.2 Analysis of data 27 B.3 Establistrment of work plan for the control of onchocerciasis in the recomended zone . 3I C. Milestones (events) 46 D. Work procedures of the Mission . 47 E. Manpower requlrements 51 F. Supplies and equipment . 52 G. Miscellaneous 55 v. BUDGET OF THE MISSTON 56 t -2- I. INTRODUCTION A. Basis for the Mission I 1. In July 1968, WHO, jointly with the United States Agency for International Development (US-AID) and the "Organisation de Coop6ration et de Coordination pour la Lutte contre les Grandes End6mies" (OCCGE), convened a technical neeting to obtain advice fron the most promi- nent experts in the field of onchocerciasis as to the technicat feasibility of onchocerciasi.s control with available nethods as well as guidance concerning requirenents to be net in any large-scale control project. 2. In their reportrl ah" experts stated that onchocerciasis control is at present technically feasible, as has been denonstrated in some geographically well-defined foci, and that its chances of producing successful, durable effects, are greatest if it is carried out in sufficien- tly large ecological zones which obviate the need for continuous protection against re-invasion of flies from untreated areas. Large-scale campaigns are also cheaper to operate. 3. When considering the possibility of launching a large-scale onchocerci.asis control programae, the meeting reconrmended that, at the present time, Africa receive priority and that first atten- tion be given to an area related to the Volta River Basin including adjoining parts of seven countries - Dahomey, Ghana, Ivory Coast, Mali, Niger, Togo, and Upper Volta. This area, as delineated on the accompanying Eap, was recomnended because onchocercal disease is not only highly prevalent but also severe with particularly high rates of blindness; successful opera- tions are under way; an appreciable a.oount of data both technical and economi.c is already available; and the governments as well as the people are anxious to co-operate i.n a control act ion. 4. In 1969 and 1970 letters emanating from the highest authorities in several countries have been addressed to international and bilateral assistance organizations likely to interest themselves in the project, among others to UNDP, WHO, FAO, IBRD, FED and US-AID. Such re- quests for assistance were received fron the President of the "Conseil de lrfitente" on be- half of the Member countries - Dahomey, lvory Coast, Niger, ?ogo, Upper Volta - as well as from the Presidents of the Republic of Ivory Coast, Mali, Niger, Togo and Upper Volta, and from the Minister for Foreig-n Affairs of Dahomey. Ghana has also indicated its interest in principle, to WHO in discussions that took place with authorities in the country. 5. The seven Governments concerned having declared their interest in participating in the recortrmended regional onchocerciasis control project in the Volta River basin, UNDP agreed to give consideration to a proposal Eade by t{HO to provide assistance, in a first stage, for a Preparatory Assistance Mission which would have as broad objectives: (i) to cotlect and assess all available epideniological, entomological and other data required for the pre- paration of a regional onchocerciasis ca.Epaign; (ii) to draw up a feasible plan of work to undertake the control of onchocerciasis in the area, taking into account the econonic develop- ment of reclained areas; (iii) to work out the costs involved and identify and analyse the possible financial resources available; and (iv) to assist the Governnents in preparing such requests for assistance to I,JNDP and other sources cf assistance as are required for the im- plementation phases of the project on the basis of the plan of work drawn up by the Mission. 6. UNDP then invited WHO to prepare draft terns of reference for the proposed mission. a These were eranined in detail and completed at an inter-agency consultation which UNDP and WHO jointly organized in Geneva on 6 and 7 July 1970 at the suggestion of IBRD and with the participation of representatives fron the Conseil de lrEntente, Ghana, OCCGE, FAO, FED, IBRD, UNDP, US-AID and WtlO. The resulting terns of reference for the UNDP Preparatory Assistance Mission to the Governments of Dahoney, Ghana, Ivory Coast, Mali, Niger, Togo and Upper Volta are defined in the present document. ' roirr. us-AlD/occGE/vHo Technical Meeting on the Feasiblllty of Onchocerciasis Control, I\rnis, 1-8 July 1968, RePort, unpublished docr-ment wHo/otcHo/es. zs -3- I I I I \ I I E! I P sr< a = t i \ TI :l \ ir e!:caE<Eg.6e TB I:3:ET (' lglEae \ .gEEEEE ) s-t looooo "s I t t , o -c c I c l'- o-c I 2 o I $ a -c e c C a a- 0I o t I t 1- al e. I I I s (s. (\. s0 -4- B. Epideniological background 7. In West Africa, onchocerciasis, or river blindness, a disease resulting from infection with the filarial worm Onchocerca volvulus, is found in association with principal the river t systens with foci of partlcularly high endenicity in the Sudan savanna. Light infections produce few s5rnptoms, but heavy and repeated infection may cause severe manifestations and blindness. In villages subject to hyper-endenic onchocerciasis, blindness rates of over 10 per cent., often representing 3O per cent. or nore of the working population, are not uncoEmon. While the disease is not fatal, its over-all effect on the communities can be disastrous, and is the main reason for the continued depopulation of the river valleys. 8. The only vector of hunan onchocerciasis in West Africa is Simulium daronosr.m. The larvae and pupae of S. damrosum, Iike those of all other species of blackfly, are attached to supports of various kinds and hence can develop only in water flowing at a certain speed and bringing them food, oxygen, etc. These relatively rigid conditions of life for S. damnosun are re- flected in a fairly strict localization of the breeding sites. These ecological conditions hence allow accurate location of the larval resting places, which constitutes a favourable factor for the developaent of a larviclding campaign. 9. One basic peculiarity should be borne in mind with regard to the bio-ecology of the vector female; the dispersal of fenale blackfly, more particularly of the species we are concerned with here, is considerable and may attain, if ecological conditions permit, several dozen kilornetres. It is thus obvious that, from the point of view of a campaign for the con- trol of this insect, such a leve1 of dispersion activity largely nullifies the advantage ob- tained from the relatively strlct localization of the breeding places. I't therefore con- stitutes the nain obstacle to control ca.mpaigns, since it necessitates the creation of a wide belt of insecticide protection to shield the zone under treatment from reinfestation by females from breeding places outside the zone. IO. Apart fron its effects on the health of populations (mainly the savanna populattons), this disease can have a c.rucial inpact on the economies of the countries of West Africa. The savanna populations are, under normal conditions, in a state of precarious equilibrir.rn and the adults experience considerable difficulty in providing for the needs of the rest of the population (children and old people). When, in addition, a substanttal proportion of the adult population is suffering fron economi.c or even total blindness, the disequilibrium is further accentuated and the population concerned moves away from the water-courses where transmission is Eost intense and, often, where the best land is located, settling.at the outer limit of the area. 11. To conclude, it is at present fair to state that in Africa little can be achieved to- wards the further developnent of the savanna territories (fron 80 to l2o north in West Africa) if account is not taken of this endemic disease; in the worst affected zones human population wiLl refuse to come - or return - and settle near water-courses if transmission is not reduced. I T. OBJECTIVE L2. The objective of this document is to present the tentrs of reference for the Preparatory Assistance Mission to Dahomey, Ghana, Ivory Coast, Mali, Niger, Togo, and Upper Volta, here- after referred to as "PAG Mission" or "Missi.on". This nission will be organized and financed under Preparatory Assistance to Governments (PAG) arrangements of UNDP. 13. Thus the present objective supports the over-all objective which is the control of onchocerciasis in the recommended project zone. The time sequence of the objectives is shown in Figure 1. -5- FIGURE I. TIME SEQUE{CE OF OBJECTMS OF IIIE ONCHOCERCTASTS CONTROL PROJECT IN THE VOLTA RTVER BASTN llork plan for achieving Terms of reference Control of control of onchocerciasis onchocerciasis for PreparatorY and deterEination of Assistance Mission in reco@tended econonic develoPEent zoner to GovernBents activities Initial Intervening ultimate obiective sub-object ive sub-objectives (over-al1 obiective) * Wrth concurrent or subsequent development of reclaimed areas identified as Dost promising for economic development.