Eradication of Dracunculiasis

ERADICATION OF DRACUNCULIASIS

A HANDBOOK

FOR INTERNATIONAL CERTIFICATION TEAMS

ICT_Handbook_Final.indd 1 06/01/2015 17:20:43 WHO Library Cataloguing in Publication Data

Eradication of dracunculiasis: a handbook for international certification teams.

1.Dracunculiasis – prevention and control. 2.Dracunculiasis – epidemiology. 3.Dracunculiasis – transmission. 4.Disease Eradication. 5.Certification. I.World Health Organization.

ISBN 978 92 4 150830 8 (NLM Classification: QX 203)

All rights reserved. Publications of the World Health Organization are available on the WHO website (www.who.int) or can be purchased from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: [email protected]).

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WHO/HTM/NTD/PCT/2015.1

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Contents 1. INTRODUCTION ...... 1 2. CERTIFICATION CRITERIA ...... 1 Group A: Countries endemic for dracunculiasis ...... 2 Group B: Countries in the pre-certification stage ...... 3 Group C: Countries in the certification stage ...... 4 3. CERTIFICATION PROCEDURES ...... 5 a. The national report...... 5 Detailed history ...... 5 Supporting evidence ...... 6 b. National commissions ...... 7 4. STEPS IN THE CERTIFICATION PROCESS...... 8 5. THE INTERNATIONAL CERTIFICATION TEAM ...... 9 a. Objectives...... 9 b. Membership ...... 9 c. Timing of the visit ...... 10 d. Preparation for the visit ...... 10 e. The country visit ...... 11 f. The ICT report ...... 17 g. Before leaving the host country ...... 18 h. After leaving the host country ...... 18 Annex 1. Summary of International Certification Team (ICT) visits to countries (by end of 2013) ...... 19 Annex 2. Pre-evaluation form at regional level ...... 20 Annex 3. Pre-evaluation form at district level ...... 27 Annex 4. Evaluation form at district level ...... 33 Annex 5. Evaluation form at health facility level ...... 34 Annex 6. Evaluation form at village level ...... 36 Annex 7. Evaluation form at individual level ...... 37 Annex 8. Instructions for completing lists and forms ...... 38

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1. INTRODUCTION The successful eradication of smallpox in 1979 led public health experts to identify other potential diseases that could be eliminated or eradicated. The Thirty-fourth World Health Assembly in 1981 noted in resolution WHA34.25 that the elimination of dracunculiasis (guinea-worm disease) as a public health problem and the prevalence of the disease could serve as measurable indicators of progress for the Safe Drinking Water Supply and Sanitation Decade (1981–1991). The Thirty-ninth World Health Assembly in 1986 endorsed in resolution WHA39.21 a combined strategy of provision of safe drinking-water sources, active surveillance, health education, vector control and personal prophylaxis. The resolution called on affected Member States to establish plans of action for eliminating dracunculiasis, to give high priority to providing safe sources of drinking-water in endemic areas and to intensify national surveillance of the disease. The Forty-fourth World Health Assembly in 1991 further resolved to eradicate dracunculiasis and urged WHO to initiate country- by-country certification of elimination. In response, the WHO Director-General set up the International Commission for the Certification of Dracunculiasis Eradication (ICCDE) in 1995; its first meeting was convened in 1996. The ICCDE drew up the certification criteria and procedures for assessing whether the criteria were met by countries requesting certification. For formerly endemic countries and those countries requiring verification, the ICCDE commissions an International Certification Team (ICT) to visit the country and conduct an in-depth review by audit of surveillance reports and field visits. WHO issued guidelines for the ICT to assist the teams and ensure a common standard of assessment1. By the end of 2013, the ICCDE had met nine times and certified 197 countries, areas and territories of 185 WHO Member States. The ICTs have made assessment visits to 20 countries (Annex 1). Based on their experience accrued over these years, this handbook is issued as an update to the earlier guidelines and is expected to assist future ICTs in ensuring consistency in the assessment of the remaining countries.

2. CERTIFICATION CRITERIA

In countries known to have been endemic for the disease, the certification of dracunculiasis- free status will depend on the lapse of time since the last known indigenous case occurred and the intensity and effectiveness of surveillance procedures. Surveillance is a continuous process which should start during a national eradication programme and be continued for at least 3 years beyond the occurrence of the last known indigenous case. This period shall be sufficient to assess whether or not the elimination of transmission has been achieved. In countries which did not have an eradication programme, the country in consultation with WHO will implement appropriate

1 Eradication of dracunculiasis: guidelines for International Certification Teams. Geneva: World Health Organization; 2000 (WHO/CDS/CEE/DRA/2000.12 Rev 1).

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surveillance methods. As the programme moves towards the global eradication target, the Commission will provide appropriate guidance and recommendations.

The ICCDE at its first meeting in 1996 finalized the criteria for certification based on the status of dracunculiasis in different countries. For practical purposes, countries were classified into three groups: (Group A) countries, then endemic for dracunculiasis; (Group B) countries, where less than 3 years had elapsed since achieving zero indigenous cases (pre-certification stage); and (Group C) countries, where 3 or more years had elapsed since reporting the last indigenous case or where dracunculiasis was not known to have been reported (certification stage). Group C was further divided in two subgroups: those where the data obtained were uncertain, making it unclear whether dracunculiasis transmission had been interrupted effectively and definitely; and those which were well known to have had no transmission for many decades.

Three principal mechanisms were established to facilitate certification efforts:

i. The establishment of the ICCDE. This Commission is charged with the evaluation of the evidence presented by countries claiming to be dracunculiasis-free and seeking WHO certification of eradication. The ICCDE has recommended certification strategies, guidelines and criteria for WHO for the process of certifying dracunculiasis eradication (Annex 1).

ii. A dracunculiasis certification cell within the WHO dracunculiasis eradication programme serving as the secretariat to the ICCDE. The recommendations and advice of the ICCDE will be included in its report to the Director-General of WHO, who will decide upon and implement the daily activities of the certification process.

iii. The composition of a global panel of experts from which ICT members are selected. The aim of the ICT is to visit countries that have requested certification and have submitted appropriate evidence demonstrating that dracunculiasis transmission has been interrupted in their territory.

Group A: Countries endemic for dracunculiasis

Chad, Mali, Ethiopia and South Sudan (status as of beginning of 2014)

Group A countries are those in which dracunculiasis transmission is known to occur and where surveillance and control operations are essential. While this group of countries may not immediately be concerned about certification, they may need to document the evidence that the interventions applied led to the interruption of transmission. This evidence shall be the basis for applying for certification when the country eventually interrupts transmission. In Group A countries it is essential to:

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i. Enhance the sensitivity of case detection nationwide by maintaining a high degree of public awareness of dracunculiasis and its eradication. Awareness campaigns must be monitored periodically to assess the coverage and comprehensiveness of messages, particularly in remote rural areas where the potential risk for transmission is considered to be highest.

ii. Maintain compulsory notification of dracunculiasis cases by all units (i.e. primary health- care posts, health centres and hospitals) of the national disease-surveillance system.

iii. Maintain village-based surveillance and capacity for case containment in each village currently and formerly affected by dracunculiasis for at least 3 years after interrupting transmission.

iv. Maintain a record in all endemic villages that reported dracunculiasis infections, and indicate for each rumour and each confirmed case whether it was imported or indigenous by tracing the case to its origin.

v. Integrate surveillance of dracunculiasis with that of other diseases or other health and development activities1.

vi. Introduce a reward system at an appropriate time to detect any hidden foci of infection.

Group B: Countries in the pre-certification stage

Ghana, Kenya and Sudan (status as of beginning of 2014)

Group B countries are those of Group A in which zero reporting of cases has been achieved and where a reliable and extensive surveillance system is maintained. Pre-certification stage surveillance activities must be sustained for at least 3 years. In these countries it is essential to: i. Maintain the sensitivity of case detection nationwide by sustaining a high degree of public awareness of dracunculiasis and the risk it represents. Surveillance can be sustained by:

a. stressing the importance and need of reporting cases of dracunculiasis;

b. establishing a reward system for reporting cases;

c. responding quickly to any declaration of suspected cases or rumours within 24 hours.

ii. Conduct awareness campaigns periodically and assess regularly the coverage and comprehensiveness of messages, particularly in remote rural areas where the potential for

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dracunculiasis is highest (villages without safe sources of drinking-water and situated near borders with other countries still affected by dracunculiasis, or in a formerly endemic area).

iii. In countries that have reached zero cases, it would be too costly to maintain a nationwide surveillance system specifically for the disease during the 3-year pre-certification period, in order to meet the requirements for certification. Thus it is essential that surveillance for dracunculiasis be integrated with that of other diseases, i.e. the Integrated Disease Surveillance and Response (IDSR) system, the vaccination of children, and other national health surveillance and control initiatives.

iv. Maintain surveillance activities in formerly endemic villages for at least 3 years after reporting of the last indigenous case and investigate all rumours within 24 hours to rule out dracunculiasis.

v. Notify cases of dracunculiasis by all units (i.e. primary health-care posts, health centres and hospitals) of the national disease-surveillance system compulsorily.

vi. Maintain a register of dracunculiasis cases in order to (i) note any suspected cases of infection reported or discovered during the pre-certification period; (ii) indicate that each confirmed case was either imported or indigenous by tracing the case to its origin in a dracunculiasis-endemic area; and (iii) ascertain that all reports were well documented.

vii. Conduct at least one active case detection survey during the pre-certification period, village- by-village, in any area which may have been formerly endemic. Searches should be conducted preferably during the presumed transmission season using case recognition picture cards and the local vernacular name for dracunculiasis. School-based and market- based surveys as well as surveys at religious gatherings, in refugee camps and among other places where people congregate in addition to relevant data collected by non-governmental organizations (NGOs) working in the field can be useful in eliciting information about villages where cases might have occurred.

Group C: Countries in the certification stage

Angola and the Democratic Republic of the Congo (status as of beginning of 2014)

Group C countries comprise those in which transmission was no longer known to occur since the inception of the eradication campaign in the 1980s or those free of the disease that could be certified immediately. This group is further divided into two subgroups: (i) countries where the data obtained are not sufficiently clear to ascertain whether transmission has been interrupted definitely and where in-depth verification by an external team will be required to confirm the absence of

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transmission; and (ii) countries which are known to have had no transmission for many decades or where exceptional transmission has occurred in the past. Both groups can undergo certification procedures immediately and will be certified providing certification conditions are fulfilled. Certification of eradication in these countries may be granted after the provision of satisfactory documentation that no residual foci of infection exist. Countries of this group represent a wide range of situations, from those which had transmission during the 1950s and 1960s to those which have not had transmission for more than 100 years. Therefore, requirements for certification will need to be adapted to each situation. Two fundamental requirements have been identified: i. A detailed description of the extent of formerly endemic areas;

ii. The possible need to present the findings of at least one active case search conducted within the past 2 years in areas which may formerly have been endemic. Any searches should be conducted during the expected transmission season and carried out village-by-village, or nationally supplemented by a widely publicized reward using recognition cards with the local (vernacular) name of dracunculiasis. The results should ascertain that residual foci of infection no longer exist. To this end, data obtained by passive surveillance will also be given due consideration.

3. CERTIFICATION PROCEDURES

a. The national report All countries formerly endemic for dracunculiasis should contact WHO to initiate the verification and certification process. The certification process will include the preparation of a detailed report on the history and current status of dracunculiasis in the country. National reports should include the following information:

Detailed history

i. A historical account of dracunculiasis in the country, including a detailed overview of the dracunculiasis eradication campaign(s) as well as of the status of water and sanitation projects and of their contribution to the eradication effort.

ii. The results of active case detection, including: (i) data from at least three annual reports of case detection based on the monthly readings of daily case registers and regularly updated at the village level for at least 3 years after the last indigenous case has been detected in the village; (ii) any evidence of the validation of results from active searches and case containment measures; and (iii) the results of any other assessment carried out in various

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environments such as schools, markets or other places where nomadic or migratory people congregate.

iii. An evaluation of the effectiveness of the routine disease reporting system, including: (i) the number and distribution of primary health posts, health units and health centres throughout the endemic areas, also taking into account the smallest officially recognized administrative unit from which dracunculiasis was reported in the year preceding the application for certification; (ii) evidence of the inclusion of dracunculiasis as a reportable disease on the official disease reporting forms; (iii) the regularity and completeness with which the health reporting units reported on dracunculiasis; (iv) validation of the reports; and (v) records of action taken when dracunculiasis cases were reported during the latter stages of the campaign.

iv. A description of all public health education campaigns, including, if applicable, details of whether any rewards were paid for reporting cases of dracunculiasis and the results of these efforts.

v. Demographic information, including the distribution of the population by geographical region and known significant migration patterns.

Supporting evidence

The establishment of a claim in relation to a specific area must fulfill the following conditions: vi. Proof that an active case detection system has operated in the area for at least 3 years since the occurrence of the last known indigenous case. Preferably, a village-based surveillance system should be used and remain in place in every formerly endemic village with a system for the rapid reporting of information to the next surveillance level.

vii. Surveillance coverage will be considered to be truly adequate if: (i) 85% or more of the village clusters placed under active surveillance submit their reports each month, or (ii) each village under active surveillance provides its report at least 9 months out of 12.

viii. A reward for the patient as well as for the health worker or community health worker who identified the patient who is confirmed as a case of dracunculiasis and took the appropriate measures (i.e. containment or hospitalization) is considered essential to reinforce active surveillance. All the health staff should know the reward and its amount as well as the standard operating procedure for following up a rumour. At least 50% of the general population should be aware of the correct amount of the reward.

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Rationale. There is no asymptomatic carrier state in dracunculiasis and the incubation period does not exceed one year. Therefore, the absence of indigenous cases for at least 3 years, in the presence of adequate case detection, can be accepted as proof of local eradication of the disease.

ix. In the event of suspected importation to an area not endemic for dracunculiasis, it must be established that each confirmed case was in fact imported by tracing the case to its origin in a dracunculiasis-endemic area. If transmission from this case has been fully contained the locality will not be considered an endemic focus. If, following importation, transmission occurs for one or more transmission cycles, local transmission will be considered to be occurring in the focus.

x. Maintain a comprehensive record of rumours of dracunculiasis reported or discovered during the pre-certification period. The record should include the name, age, sex and place of residence of the alleged patient, the date of notification and investigation, the person investigated and the final diagnosis. Should the rumour meet the case definition of a dracunculiasis case, information must be recorded in the standard case investigation form with the date of worm emergence and the movements and activities of the patient since the emergence of the worm to identify all sources of drinking-water possibly contaminated, and the origin and possible source of the infection.

Rationale. Each worm emergence that is not detected or contained carries the risk of new infections one year later. Effective detection and containment of residual cases is critical. Therefore, surveillance for dracunculiasis must be active and village-based for endemic villages and be continued for 3 years after the occurrence of the last indigenous case.

xi. Give a detailed account of the history of dracunculiasis in the country, the interventions implemented to interrupt transmission and surveillance.

Rationale. A detailed history of dracunculiasis in the country is necessary in order for the ICCDE to judge the completeness of steps taken to eradicate dracunculiasis.

b. National commissions Some countries, especially currently endemic countries, should convene a national commission or group to examine programme operations and help with the writing of the national report. The National Commission could also interact with the ICT to provide evidence of the various interventions carried out by the programme.

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4. STEPS IN THE CERTIFICATION PROCESS

The sequence of events in the certification process is as follows:

i. All WHO Member States that have yet to be certified and that have interrupted dracunculiasis transmission or those that never had a recent history of dracunculiasis are encouraged to submit a formal request to WHO for certification as a country free of dracunculiasis transmission.

ii. All such requests must conform with the criteria specified by the ICCDE and given in the document and as elaborated in the guidelines published by WHO in 19962. The country will send a declaration and a questionnaire. A formerly endemic country will, in addition, provide a detailed report on all surveillance and eradication activities. Such countries may find it useful to designate a national committee to evaluate the report on the dracunculiasis eradication programme before its formal submission to WHO. The country may also request an independent evaluation as soon as it considers that it has interrupted transmission. The findings of the independent evaluation could guide the country in taking the necessary steps during the pre-certification period.

iii. WHO will designate an ICT in those formerly endemic countries and countries considered to be potentially at “high risk” for dracunculiasis. The ICT will be mandated to evaluate the national report and to make appropriate recommendations to the ICCDE.

iv. The ICCDE will, after considering the declaration, the questionnaire and the national report, and if applicable during its periodic meetings, recommend to the Director-General of WHO whether the country should be certified upholding its claim of being free of any dracunculiasis transmission.

v. If the WHO Director-General approves the recommendation, the country will then be listed on the WHO official register of countries certified as free of dracunculiasis transmission.

2 Criteria for certification: a practical guide. Geneva: World Health Organization; 1996.

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5. THE INTERNATIONAL CERTIFICATION TEAM

Once WHO receives an intent by the Ministry of Health to apply for certification after having met the certification criteria, WHO and the Ministry of Health will plan out a certification schedule which includes receipt of the declaration, the questionnaire and the national report as well as the details of the visit of the ICT.

a. Objectives The overall objective of an ICT visit to a country is to evaluate the accuracy and reliability of the national report and to ascertain the likelihood that dracunculiasis transmission has been interrupted as claimed and that the conditions for introduction and re-introduction of the parasite and re-establishment of the life-cycle are minimal.

To do so, the ICT will determine if:

i. a surveillance and health information system is operational and is able to detect and contain a new case;

ii. other factors of epidemiological importance for dracunculiasis transmission have been considered (safe drinking-water supply, case containment, availability of filtering equipment, medicines, etc.).

b. Membership Members of the ICT are identified from a panel of experts maintained at WHO, which includes public health experts including current and former National Guinea Worm Eradication Programme coordinators and managers, the WHO Collaborating Center at the United States Centers for Disease Control and Prevention and the United Nations Children’s Fund. The team is established by WHO in consultation with the Chairperson of the ICCDE. The composition and size of the ICT may vary from one country to another.

As experts selected as ICT members should be critical and independent in their assessment and views, potential conflicts of interest, such as nomination of a national from the Ministry of Health or national programme of the country under review as a member of the certification team, should be avoided. At least one member of the ICCDE may be on the ICT. Normally the leader of the ICT is a member of the ICCDE.

The size of the ICT will depend, among other things, on the size of the country, accessibility and previous epidemiology.

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c. Timing of the visit The timing of the visit of the ICT is scheduled by WHO in consultation with the Ministry of Health. Consideration is given to previous dracunculiasis transmission seasons, while avoiding periods where rural parts of the country become inaccessible due to heavy rains leading to flooding or any major political events such as elections and disturbances. The national report should be made available to WHO at least one month before the scheduled visit of the ICT.

d. Preparation for the visit Once the list of the ICT members is finalized, the WHO secretariat will provide the members with the following documents:

i. All background documents on the criteria for certification including this present handbook.

ii. The previous report of the external independent evaluation.

iii. The national report, the declaration and the questionnaire, at least one month before the country visit; a copy of the national report is also provided to the members of the ICCDE.

iv. The members of the ICT are expected to review the background documents and the national report. Should they need any further clarifications or any additional supporting documents, these may be requested through the WHO secretariat. The WHO secretariat compiles all the queries and seeks an appropriate response from the Ministry of Health, which is then communicated back to the members of the ICT and the ICCDE. The members of the ICCDE may, in addition, have specific issues that require further investigation by the ICT during its country visit. Any comments from the ICCDE may need to be taken into consideration as the ICT plans and carries out its work.

v. If necessary, WHO staff or consultants may undertake a preparatory visit to the country to arrange all the logistics and the completeness of the requests forwarded by the ICT and the ICCDE members. These preparatory visits also identify the best method for ensuring that certain areas, which may normally be inaccessible for security reasons, can be assessed.

vi. Members of the ICT are encouraged to discuss the methodology and questionnaire by email. This saves crucial time during the country visit that can be more effectively spent for in- country field visits. The questionnaires have been standardized on the basis of experience accrued from previous ICT missions (Annex 2 to 7) and will require minor changes to adapt them to the specific situation in the country to be visited.

vii. To ensure that nationwide information on dracunculiasis surveillance is obtained beyond the

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few states and districts that the ICT is able to visit in the country, pre-evaluation questionnaires (Annex 2 and 3) are sent to the national programme with a request to send them to all states and districts. The completed questionnaires are returned to the national level when the ICT arrives in the country. The teams then verify the information provided in the questionnaire against a checklist (Annex 4).

viii. The ICT members may also be required to complete an online United Nations security training depending on the country to be visited.

e. The country visit The country visit is a key element in achieving the objectives of the ICT mission. The ICT independently verifies the evidence provided in the national report about the absence of dracunculiasis transmission and the preparedness and quality of the surveillance system to detect any imported cases or hidden foci. The country visit will also enable the ICT to assess the access to improved water sources in villages, especially those at high risk.

Besides visiting health officials at the Ministry of Health, the ICT will interview health personnel and examine records at both central and peripheral levels, and visit selected villages and communities. The visit usually lasts 3–4 weeks in the selected country.

Activities in the capital city After arrival in the country, the ICT will generally spend no more than 2–3 days in the capital city and at the location of the National Guinea Worm Eradication Programme in order to:

• meet with the WHO Country Representative, the national health authorities and other partners, to explain the purpose of the mission;

• receive a security briefing by the designated United Nations security coordinator (members of the ICT are advised to strictly follow the recommendations of the coordinator during the entire duration of their stay in the country).

• review the national report and any other documentation with national health authorities, enquire about activities carried out by the National Guinea Worm Eradication Programme, partners and other programmes;

• review with Ministry of Health officials the general surveillance and health information system;

• review with the National Guinea Worm Eradication Programme (NGWEP) the Integrated Disease Surveillance and Response (IDSR) system, the Health Management Information

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System (HMIS), the surveillance data and the documentation on dracunculiasis;

• seek clarification on comments made by members of the ICCDE and WHO on the national report.

Special effort should be made to collect and review the following information:

• disease surveillance data from all relevant reporting sources (NGWEP, HMIS, IDSR) and national data with detailed breakdown for each area the ICT will visit and cross-check in the field;

• documentation from the medical literature and “grey” (unpublished) literature (theses, reports), the existing disease surveillance system and from all sectors linked to dracunculiasis eradication activities;

• maps of previously endemic areas, preferably depicting the locations of formerly endemic villages and those with the most recent cases;

• databases containing the list of all endemic villages with the annual number of cases since the establishment of the NGWEP;

• records and registers in which all cases (whether resulting from local transmission or imported from neighbouring endemic countries) and rumours are recorded:

▬ individual case investigation forms of the last recorded cases in each district should be made available as well as case investigation forms of rumours reported during the previous 3 years before the arrival of the ICT;

▬ the mechanism of the reward system and publicity concerning any rewards;

▬ previous studies concerning population awareness about the disease in various parts of the country;

▬ information concerning the geographical distribution of and coverage with safe drinking- water in the country;

▬ evidence of intensified dracunculiasis surveillance during the pre-certification period including messages inviting the population to report any suspected case of dracunculiasis, and designation of persons responsible for verification of rumours and confirmation of cases;

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▬ the work of a national commission that may have provided ongoing supervision, evaluation and support of surveillance and other eradication activities.

The ICT should also obtain an organization chart of the Ministry of Health and be informed about the mechanisms of disease reporting from peripheral and central levels, the frequency of reporting and the official list of notifiable infectious diseases, to verify whether dracunculiasis is included in the list.

In addition, the ICT should contact other relevant sectors other than Health, particularly the Offices of Water Supply, Demography and Migration.

Activities in relation to the field visit To facilitate visits to all epidemiologically important areas, the team may divide into groups of 1–2 members. The areas selected for visits should be those identified as having the least satisfactory documentation or as being at unusual risk of continuing transmission, for example: (i) areas bordering endemic countries; (ii) previous highly endemic areas within the country; (iii) areas where the last cases occurred; (iv) areas at risk where there has been no progress in the provision of safe sources of drinking-water; (v) areas with a history of poor surveillance for dracunculiasis; (vi) end-points of migrants’ flow, displaced persons’ flow; and (vii) areas with lots of rumours or no rumours.

The surveillance system of NGOs could also be utilized to collect additional information.

To conduct community surveys it may be necessary to work through interpreters, or people who are proficient in the local language in each part of the country such as teachers, university students and others who are not related to the country’s guinea-worm eradication programme. These people can be selected to help the ICT but may need to be trained in the use of the interview forms to ensure that the questions are correctly asked in the local language.

Preparation for the field visits includes:  designation by the Ministry of Health of a national counterpart for each ICT group;

 review of the documents to be completed by the ICT members during the field visit;

 review of questionnaires, if not done earlier by email exchange, to be used during field visits (see Annexes 4–7). While questionnaires may be revised before use in individual countries, most elements of the samples annexed to this document should be included in the revision;

 designation by the ICT of the areas to be covered during the field visit by each group;

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 the selection of villages to visit (as described above) will be based on risk of infection determined by previous endemicity, location in areas at risk of transmission, and introduction or reintroduction of dracunculiasis;

 Should some areas of the country be inaccessible to the ICT due to insecurity, alternatives methods using local independent NGOs that offer health care/individuals in such areas may be considered as well as indirect methods such as surveys in refugee communities within or outside the country to seek as much information as possible for these areas;

 an agreement on a general itinerary for each group of ICT ensuring that all relevant zones are covered. However, the group may decide to visit additional villages if necessary depending on the findings and information gathered as the visit progresses. Frequent and regular telephone contact should be maintained between the team, the team leader and WHO. The groups should complete their field visit taking into account the findings and recommendations of other colleagues;

 review of travel arrangements made by the host government to allow the ICT to complete its duties effectively and efficiently. It is important that the ICT member(s) decide exactly which areas, villages and health posts they wish to visit as the field visit progresses; travel time could be saved by using internal flights where feasible.

Conduct of field visit Collect information on forms (see Annex 2 to 7) regarding the surveillance system, rumour registers, the reward system, etc., while visiting provincial and district health authorities (see Annex 4).

i. Visits to provincial or regional health authorities i. While visiting health authorities of the province/state/region, explain the purpose of the visit and the method of work of the ICT.

ii. Discuss with the Programme Manager the activities carried out during the pre- certification period, the problems faced and the solutions proposed.

iii. Plan and make arrangements for visits to the selected districts, health units and villages.

iv. Make notes of daily observations the same evening. Only important points have to be mentioned in the final report.

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ii. Visit to the district level i. Remember to write the name, title and responsibility for dracunculiasis eradication of each person met.

ii. Review all the monthly reports from the basic health units (including those with zero cases) since the last reported case in the district.

iii. Review all case containment forms completed during the past 2 years of case reporting; review all rumours since the last case was reported in the district, and record the time lag between notification and investigation of rumours, barriers to timely investigation of rumours, how rewards are given and to whom and for how long after the case is confirmed.

iv. Cross-check original village reports (obtained at village level) against those at the district level.

v. Note the date at which posters were distributed for the last time.

vi. Note the number of posters distributed and list the villages receiving posters. Make note of the place where the posters are located in the village.

vii. Note the details of health education activities from the district level (in houses, mosques, churches, at water collection sites, at school, others).

viii. Note how the filters were distributed.

ix. Ask how many water collection sites were treated with Abate in the area; note the date of treatment.

x. Assess the level of knowledge of the reward.

iii. Village visit (use Annex 6) i. Visit the headman of the village and explain the purpose of the visit.

ii. See the health worker/guinea-worm volunteer in charge of this village.

iii. Meet the school principal/teacher if there is any, and try to persuade him/her to be one of your informants.

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iv. Check how they prepare, maintain and send monthly reports to the district.

v. Visit the sources of drinking-water.

vi. Note how people collect water for drinking from the sources.

vii. Conduct interviews using community survey questionnaires.

viii. Assess the level of knowledge of the reward and whether people know when and to whom to report a suspected case.

ix. Visit as many villages as possible to obtain a reasonable sample of each previously endemic area as well as high-risk but not previously endemic areas. Schools could also be considered as a community/village and provide valuable representation from a wider geographical area.

x. Interview one respondent from at least 10 households in each village or hamlet using Annex 7; interview both males and females, traditional healers, village health workers, other community-based workers, as well as members of the general public; as much as possible, interview people who have lived in the village long enough and who may have seen or heard of dracunculiasis long ago; complete a questionnaire for each interview. In order to accomplish the desired number of interviews in each village, it may be necessary for the ICT member to obtain assistance from the national counterpart travelling with the group. In this case, it is essential that the name of the person conducting the interview and that of the responsible ICT member be indicated on each questionnaire form. The ICT member should be present in the village during interviews carried out by non-ICT staff. In some instances it may be necessary for the ICT member to designate a national to conduct interviews in a separate village or hamlet from the one where the ICT member is working. In any such cases, it will be the ICT member who decides whether this is to happen and which person is to do interviews in which village/hamlet.

xi. Make notes in a diary of any activities and observations that could be relevant for preparation of the ICT report and for the deliberations of the ICCDE.

xii. Reconvene in the capital city on conclusion of the field visits to compile the findings of the individual teams in order to prepare a consolidated ICT report.

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To facilitate data entry, the questionnaires for health facilities, villages and individuals may be read by optical readers.

f. The ICT report The ICT will prepare its report in a WHO working language, preferably the one used more commonly in the country. If necessary the report will be translated into English for the ICCDE members. The ICT report should include an Executive Summary written in both English and French, which should summarize the report with the conclusions and recommendations, if any. The Executive Summary should be followed by a detailed report covering:

a) A brief extract from the national report summarizing the significant historical, geographical, cultural and epidemiological aspects related to dracunculiasis and its eradication from the country. A commentary on the evidence provided in the report in support of the interruption of dracunculiasis transmission and the risk of re-introduction of transmission as well as the preparedness of the surveillance system to detect and contain any imported case; commentary should also be made on the general surveillance system and the improved drinking-water supply system in the whole country and especially in the former dracunculiasis-endemic areas. b) A description of the methodology used and activities carried out by the ICT to validate the evidence provided in the national report, including the rationale for choosing the sample districts and villages for field evaluation. Questionnaires and forms used by the ICTs must be included as Annexes. c) The ICT’s findings in relation to the dracunculiasis situation, presented in detail, including any problems that hampered the work of ICT members. The findings should describe both the strengths and the weaknesses of the country’s surveillance records, eradication activities and surveillance system, with emphasis on the 3-year pre-certification period after the last indigenous case was reported. For countries which are applying for certification long after the last indigenous case was reported, the surveillance system in the 3 previous years from the time of the ICT may be reported on. d) Findings should be presented quantitatively. The number of villages visited and the number of community members and health workers interviewed should be summarized in an introductory paragraph of the section on findings. Results of interviews should be presented broken down by sex and relevant age groups. e) A map indicating the areas visited by team members as well as the location of the last cases and location of any rumours. Maps from the national report can be referred to or duplicated in the ICT report. f) The report should mention the discrepancies, if any, between the findings of the ICT and the national report, and the clarification provided by country officials.

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g) A clearly stated conclusion and recommendation to the ICCDE as to whether the ICT considers that: • the observations made by the ICT correlate with the evidence provided in the national report claiming that the country is free of dracunculiasis transmission; • the risk of importation of cases is minimal, possible, or high; • the country’s arrangements for dracunculiasis surveillance are sufficiently sensitive to detect any imported cases or local transmission should they occur; • local transmission could or could not easily be re-established considering the migrations, current water-supply situation, etc.; • any other conclusion.

h) Annexes in which the ICT’s itinerary, list of officials consulted, questionnaires, maps, rewards material and other relevant information are presented.

g. Before leaving the host country a. De-briefing session. The ICT presents its observations, conclusions and recommendations to the WHO Country Representative and the Ministry of Health. The debriefing includes details of the methodology adopted and the evidence on the basis of which the ICT arrived at its conclusion and the recommendation it will convey to the ICCDE. The final decision would be taken by the ICCDE on whether it accepts the conclusion of the ICT and accordingly recommends it to the Director-General of WHO.

b. All original survey forms and documents along with the draft report should be handed over to the WHO secretariat.

h. After leaving the host country c. The ICT report should be finalized by the Team Leader and submitted within one week to the WHO secretariat of the dracunculiasis eradication cell of the Department of Control of Neglected Tropical Diseases, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland.

d. Each member of the ICT should keep a copy of the report for reference during any future enquiries by WHO or ICCDE members.

e. The report is edited according to WHO style and translated if necessary into English and/or French. The final copy is then made available to the ICCDE for its review.

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ecision ertified ICCDE d Certified Certified Certified Certified Certified Certified Certified Certified Certified Certified Certified Certified Not c Certified Certified Certified Certified Certified Certified Certified

for for

ecommendation Main conclusions Recommended for certification Recommended for certification Recommended for certification Recommended for certification Recommended for certification Recommended for certification Recommended for certification Recommended for certification Recommended for certification Recommended for certification Recommended for certification Recommended certification Conditional r Recommended for certification Recommended for certification Recommended for certification Recommended for certification Recommended for certification Recommended for certification Recommended for certification

o. 013

N individuals interviewed 142 156 386 529 226 2100 282 6 449 342 450 743 555 1011 946 1630 1422 1432

(by end of 2013) of

o. N villages visited 65 90 24 26 62 90 76 98 28 60 73 35 52 81 86 98 108 136 136 113 - c ountries

of sub

N district facilities visited 33 57 16 87 199 29 61 50 63 67

v isits to

istricts

covered

d 17 5 4 28 9 12 8 3 46 7 25 12 16 19 30 26 60 33 33

(ICT)

no. of 19 in

otal otal T country

249 26 332 13 62 89 77 48 80 42

covered

3 6 3 3 5 14 9 7 8 11 6 18 10 8 no. of rovinces p

otal otal T tates/ in s

country

26 26 25 21 4 6 15 12 18 13 6 8

Duration (days) 30 28 23 10 20 17 19 15 19 9 12 16 19 15 16 12 16 19 17 19

No. of sub teams 3 3 2 2 3 3 3 3 3 3 3 3 4 4 3 5 4 10 5 6

Year 1996 1996 1997 1999 1999 2003 2006 2006 2006 2006 2007 2008 2008 2009 2009 2010 2011 2013 2013 2013

. Summary of International Certification Team

Ivoire

ission to ission to ’

m (Islamic (Islamic

ountry ICT c Pakistan Iran Republic of) Egypt Libya India Yemen Cameroon Sierra Leone Central African Republic Liberia Guinea Benin Chad Mauritania Uganda Faso Burkina Togo Nigeria Côte d Niger

Annex 1

erial o.

S n 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

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Annex 2. Pre-evaluation form at regional level

Pre-evaluation form at regional level (Form ID: RL001.1) (To be pre-filled by the Regional Health Bureau and made available to the ICT and at the regional level)

Region name:

Date form completed (dd/mm/yyyy):

Name of person completing the form:

Title of person completing the form:

Please note the following definitions when completing the information: Currently endemic A village/district/region that has reported one or more indigenous case(s) during the previous and/or current calendar year Formerly endemic A village/district/region that has reported an indigenous case in the past but is no longer endemic (i.e. has not reported any indigenous case for at least 3 consecutive calender years) Never endemic A village/district/region that has never reported an indigenous case since the inception of the programme Villages under active Villages that are at risk of guinea-worm disease (GWD) and maintained surveillance under active surveillance by the national Guinea Worm Eradication Programme (GWEP)

General information about the region 1.1 Total number of districts: ______1.2 Total number of health facilities: ______1.3 Total number of villages: ______1.4 Number of villages currently endemic for GWD: ______1.5 Number of villages recently freed from GWD: ______1.6 Number of villages formerly endemic for GWD: ______1.7 Number of villages never endemic for GWD: ______1.8 Number of villages under active surveillance (VAS): ______

Resources 2.1 Describe the resources available for GWD surveillance in the state: Items Dedicated to GWEP Resources from other programmes shared with GWEP Budget for 2014 Funds available for 2014 Staff at regional level Cars Motorcycles Others (specify)

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2.2 List all staff responsible for Integrated Disease Surveillance and Response (IDSR) and GWD surveillance: Reponsible Name Date Attended any Date of last Proportion of person position training/orientation training/orientation time spent on started on GWD surveillance attended (month and GWD (month and (circle one answer)? year) surveillance- year) related supervision (%) Regional GW YES / NO Coordinator Regional IDSR YES / NO Coordinator Regional Immunization YES / NO Officer

2.3 Describe the distribution of GWEP materials during the past 3 years:

Item Date of last Date of last Total quantity Total quantity No. of consignment dispatch to districts received in 3 dispatched in 3 districts (month and year) (month and year) years years covered GWD Surveillance Standard Operating Procedures GWD posters GWD ID cards/calendar Rumour register or record Filters Abate

Surveillance 3.1 Graph – Trend in annual incidence of GWD by year in the region stratified by indigenous and imported cases

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3.2 Specify the number of villages under active surveillance (VAS) by year:

Year No. of LGAs with No. of VAS in entire No. of VAS with an No. of VAS that sent VBHW/VV VAS region active VBHW/VV GWD reports for at least 9 months of the year 2013 2012 2011 2010 LGA, local government authority; VBHW, village-based health worker; VV, village volunteer

3.3 Specify the number of villages with CBS/VV-based surveillance by year: Year Total no. of villages in the No. of villages with a No. of villages that sent CBS/VV GWD region CBS/VV reports for at least 9 months of the year

2013 2012 2011 2010 CBS/VV, village-based health worker/village volunteer

3.4 Describe the standard procedure for responding to and recording GWD rumour:

3.5 Specify the numbers of GWD rumours, investigated rumours and rumours investigated within 24 hours during 2012–2013:

No. of Total no. No. of GWD Total no. No. of No. of rumours of rumours endemicity No. of of rumours rumours rumours investigated rumours investigated status of districts reported in investigated investigated within 24 h reported within 24 h districts 2012 in 2012 in 2013 in 2012 in 2013 in 2013

Formerly endemic Never endemic Total

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3.6 Specify the numbers of districts submitting reports through IDSR/GWEP in 2013:

No. of districts submitting a report on GWD cases (including zero cases) in 2013, by month GWD No. of endemicity status districts Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Average of districts

Formerly endemic

Never endemic

Total

Data management

4.1 Describe how data are being managed at the regional level: GWEP IDSR Are the designated forms and registers available in all districts for

reporting (circle one answer)? Yes / No / Partial IDSR001 Yes / No / Partial IDSR002 Yes / No / Partial IDSR003 GWD Rumour Investigation Form Yes / No / Partial Date by which weekly reports are

expected in the region (dd/mm) Mode of transmission of the weekly On phone / By hand / On phone / By hand / reports from district to region Postal mail / Email Postal mail / Email (circle all that apply) Date by which district’s monthly reports are expected in the region (dd/mm) Mode of transmission of the monthly On phone / By hand / On phone / By hand/ reports from district to region Postal mail / Email Postal mail / Email (circle all that apply) Regional staff responsible for data validation Are computer and internet services available for data management Yes / No Yes / No (circle one answer)? Date by which region transmits monthly report to national level (dd/mm) Mode of transmission of the monthly On phone / By hand / On phone / By hand / reports from region to national level Postal mail / Email Postal mail / Email (circle all that apply)

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Integration

5.1 List all the programmes that are or have been engaged in supporting GWD surveillance and describe what support they provide:

Information, education and communication

6.1 Describe how communities in your region have been made aware of GWD and how they have been motivated to report rumours of GWD:

6.2 Describe how communities in your region have been made aware of the reward scheme for reporting GWD:

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6.3 Frequency of health education through the following media: Media Frequency (daily, weekly, monthly, annually, ad hoc) Local newspaper Local radio National radio

Town criers

Movie theatres Schools Mosques/churches Other

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Supervision

7.1 Specify the number of districts visited for GWD surveillance in 2013:

GWD endemicity No. of No. of districts visited status of districts districts Never Once More than once Formerly endemic

Never endemic Total

Training

8.1 Specify the numbers of staff trained on GWD surveillance in the past 12 months: GWD endemicity No. of No. of staff trained/oriented on GWD surveillance in the past 12 months status of district districts District Other Health CBS/VV AFP Other IDSR district- workers at informants programme/ staff level peripheral service staff health health staff facilities Formerly endemic Never endemic

Total CBS/VV, village-based health worker/village volunteer

Safe drinking-water supply

9.1 Number of villages under active surveillance (at risk of GWD) without a single safe drinking-water source:______9.2 Number of formerly endemic villages without a single safe drinking-water source :_____ 9.3 Number of never endemic villages without a single safe drinking-water source:______

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Annex 3. Pre-evaluation form at district level

Pre-evaluation form at district level (Form ID: DL001.1)

District name: Region:

Date form completed (dd/mm/yyyy):

Name of person completing the form:

Title of person completing the form:

Please note the following definitions when completing this form: Currently endemic A village/district/region that has reported one or more indigenous case(s) during the previous and/or current calendar year Formerly endemic A village/district/region that has reported an indigenous case in the past but is no longer endemic (i.e. has not reported any indigenous case for at least 3 consecutive calender years) Never endemic A village/district/region that has never reported an indigenous case since the inception of the programme Villages under active Villages that are at risk of guinea-worm disease (GWD) and maintained surveillance under active surveillance by the Guinea-Worm Eradication Programme (GWEP)

General information about the district 1.1 Total number of sub-districts: ______1.2 Total number of health centres: ______1.3 Total number of villages: ______1.4 Number of villages currrently endemic for GWD: ______1.5 Number of villages recently freed from GWD: ______1.6 Number of villages formerly endemic for GWD: ______1.7 Number of villages never endemic for GWD: ______1.8 Number of villages under active surveillance (VAS): ______Resources 2.1 List the resources available for GWD surveillance in the district: Items Dedicated to GWEP Resources from other programmes shared with GWEP Budget (US$) for 2014 Funds available for 2014 Staff at district level Cars Motorcycles Others (specify)

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2.3 Describe the distribution of GWEP materials during the past 3 years: Item Date of last Date of last Total Total No. of sub- consignment dispatch to quantity quantity districts (month and year) districts received in dispatched covered (month and 3 years in 3 years year) GWD Surveillance Standard Operating Procedures GWD posters GWD ID cards/calendar Rumour register or record Filters Abate

2.2 List all staff responsible for Integrated Disease Surveillance and Response (IDSR) and GWD surveillance: Reponsible Name Date position Attended any Date of last Proportion of time person started training/orientation training/orientation spent on GWD (month and on GWD attended (month surveillance-related year) surveillance (circle and year) supervision (%) one answer)?

Yes / No District YES / NO GWD Coordinator District IDSR YES / NO Coordinator District YES / NO Polio/ Immunization Coordinator

Surveillance

3.1 Graph – Trend in the annual incidence of GWD by year stratified by indigenous and imported cases

3.2 Date of last indigenous case (dd/mm/yyyy):______3.3 Location of last indigenous case: Village:______Sub-district:______3.4 Date of last imported case (dd/mm/yyyy):______3.5 Location of last imported case: Village:______Sub-district:______3.6 Graph the number of villages reporting cases and villages reporting imported cases only from 1986 to 2013

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3.7 Specify the number of villages under active surveillance (VAS) by year: Year No. of sub-districts No. of VAS in entire No. of VAS with an No. of VAS that with VAS district active VBHW/VV sent VBHW/VV GWD reports for at least 9 months of the year (xxx for 2013) 2013 2012 2011 2010

3.8 Specify the number of villages with CHW (community health worker) by year: Year Total no. of villages in the No. of villages with a CHW Number of villages that district - volunteer sent CHW* / GWD reports for at least 9 months of the year (xxx for 2013)

2013 2012 2011 2010

3.9 Describe the standard procedure for responding to and recording GWD rumours:

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3.10 Specify the numbers of total GWD rumours, investigated rumours and rumours investigated within 24 hours in 2013:

No. of villages Total no. of No. of rumours GWD endemicity reporting No. of rumours rumours reported investigated within status of villages rumours in investigated in 2013 in 2013 24 h in 2013 2013

Formerly endemic Never endemic Total

3.11 Specify the numbers of sub-districts reporting GWD cases through district IDSR/GWEP during 2013:

Total no. of No. of sub-districts reporting GWD cases (zero if no cases) in 2013, by month sub-districts in the Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Average district

3.12 Specify the numbers of villages under surveillance (VAS) reporting GWD cases through district IDSR/GWEP during 2013:

GWD No. of VAS reporting GWD cases (zero if no cases) in 2013, by month endemicity No. of status of villages Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Average villages

Formerly endemic

Never endemic Total

Data management

4.1 Describe how data are being managed at the district level GWEP IDSR Are the designated forms and registers available in all sub-districts for

reporting (circle one answer)? 1. CD1 All / No / Partial All / No / Partial 2. CD2 All / No / Partial All / No / Partial 3. VAS reporting form All / No / Partial All / No /Partial 4. Rumour investigation form All / No / Partial All / No / Partial 5. Case investigation form All / No / Partial All / No / Partial Date by which weekly reports are expected in the district (dd/mm)

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Mode of transmission of the weekly reports from sub-district to district On phone / On phone / (circle all that apply) By hand / By hand Postal mail / Postal mail / Email Email Date by which VAS monthly reports are expected in the district (dd/mm) Mode of transmission of the monthly reports from VAS to the district On phone / On phone / By hand / By hand / Postal mail / Postal mail / Email Email Date by which sub-district monthly reports are expected in the district Mode of transmission of the monthly reports from sub-district to district On phone / On phone / By hand / By hand / Postal mail / Postal mail / Email Email Designation of district staff responsible for data validation Availability of computer and internet services for data management Yes / No Yes / No Date by which District transmits monthly report to regional level (dd/mm) Mode of transmission of the monthly reports from district to regional level On phone / On phone / By hand / By hand / Postal mail / Postal mail / Email Email

Integration

5.1 List all the programmes that are or have been engaged in supporting GWD surveillance and describe what support they provide:

Information, education and communication

6.1 Describe how communities in your district have been made aware of GWD and how they have been motivated to report rumours of GWD:

6.2 Describe how communities in your district have been made aware of the reward scheme for reporting GWD:

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6.3 Frequency of health education through the following media: Media Frequency (daily, weekly, monthly, annually, ad hoc) Regional newspaper Regional radio National radio Television Billboards Town criers Movie theatres Schools Mosques/churches Posters

Supervision 7.1 Specify the number of sub-districts and villages visited for GWD surveillance in yyyy: Level No. of sub-districts and villages visited Never Once More than once Sub-district office Endemic villages Recently-freed villages Formerly-endemic villages

Never-endemic villages Total

Training 8.1 Specify the numbers of staff trained on GWD surveillance in the past 12 months: No.of staff trained/oriented on GWD surveillance in the past 12 months Health CHW IDSR Polio surveillance Other programme staff workers volunteers staff volunteers

Safe drinking-water supply

9.1 Number of villages under active surveillance (at risk of GWD) without a single safe drinking-water source:______9.2 Number of GWD-endemic villages without a single safe drinking-water source:______9.3 Number of recently-freed villages without a single safe drinking-water source:______9.4 Number of formerly-endemic without a single safe drinking-water source :_____ 9.5 Number of never-endemic villages without a single safe drinking-water source:______

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Annex 4. Evaluation form at district level

(Form SL001.xlx)

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Annex 5. Evaluation form at health facility level

(Form HF0001 EN.xlx)

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Annex 6. Evaluation form at village level

(Form VILLAGE_001_2en.xlx)

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Annex 7. Evaluation form at individual level

(Form INDIVIDUAL_001_03en.xlx)

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Annex 8. Instructions for completing lists and forms

1. Instructions on filling in the master list of villages and health facilities

1. Labels corresponding to teams

Table 1 lists the serial numbers of the identification (ID) labels assigned to each team. Teams must cross-check that they have the correct health facility forms and stickers for the village-level and individual forms.

Table 1. Team assignments

Team no. File name Village ID HF ID

1 FormMV001.xls GHI00001-GHI00047 HGHI0001-HGHI0040

2 FormMV002.xls GHI00048-GHI00095 HGHI0041-HGHI0080

3 FormMV003.xls GHI00096-GHI00143 HGHI0081-HGHI0120

4 FormMV004.xls GHI00144-GHI00191 HGHI0121-HGHI0160

5 FormMV005.xls GHI00192-GHI00239 HGHI0161-HGHI0200

6 FormMV006.xls GHI00240-GHI00287 HGHI0201-HGHI0240

7 FormMV007.xls GHI00288-GHI00335 HGHI0241-HGHI0280

8 FormMV008.xls (reserved) GHI00336-GHI00383 HGHI0281-HGHI0320

2. Each team will receive a USB memory stick with two sub-directories: ▬ Background documents ▬ Form worksheets It is recommended that teams save the forms in a separate folder on the hard drives on their laptops.

3. The Excel file FormMV000# (the “#” corresponds to the number of the team; e.g. 1 form team no. 1) contains the following sheets (Table 1): ▬ villages visited ▬ health facility visited

The worksheet “villages visited” should contain the date of the visit, the name of the village, district, region and health facility, the population, number of households, latitude, longitude, endemicity status, team number, and Village ID for the villages visited.

NOTE: It is essential that the village ID entered in the Excel sheet matches the village ID of the sticker affixed to the village-level questionnaire (Form ID VL001.3E).

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The worksheet “health facility visited” contains the date of the visit, the name of the health facility, district and region, the endemicity status of the district, and the team number. Fill in the information using the details compiled in the Health Facility questionnaire (Form ID HFQ001.2E). The HFID of the health facility should be the same as the HFID assigned to the health facility in Form ID HFQ001.2E.

2. Instructions on filling in the individual-level questionnaire

This instruction sheet is intended for filling in the individual questionnaire (Form IQ001).

• Please read each question carefully before answering it.

• Choose the answer that best describes what you observed during your visit.

Marking instructions:

• On the answer sheet, locate the circle that corresponds to your answer and fill it in completely with the pencil or pen that is provided to you.

• On Form IQ001.3E, each column corresponds to an individual; this form contains 10 columns corresponding to 10 individuals or respondents.

• Correctly fill in the bubbles:

A ball-pen is acceptable for marking (blue, black or red but not yellow).

Correcting erroneous marks

• Try to avoid marking erroneously as this may cause some scanning problems.

• DO NOT USE WHITE-OUT.

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• Ball-Pen or “vis-á-vis” marks cannot be erased.

• Place a large cross “X” over the circle/bubble if the answer is incorrect.

• Do not make stray marks on the paper, especially near the barcodes.

Place the sticker with the barcode that corresponds to the village ID in the box as shown below.

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3. Instructions on filling in the village-level questionnaire

This instruction sheet is intended for filling in the village-level questionnaire (Form VL001.3E).

• Please read each question carefully before answering it.

• Choose the answer that best describes what you observed during your visit.

• Each sheet corresponds to a village.

Marking instructions:

• On the answer sheet, locate the circle that corresponds to the answer and fill it in completely with the pencil or pen that is provided to you.

•

A ballpen is acceptable for marking (blue, black or red but not yellow)

Correcting erroneous marks

• Try to avoid marking erroneously as this may cause some scanning problems.

• DO NOT USE WHITE-OUT.

• Ballpen or “vis-á-vis” marks cannot be erased.

• Place a large cross “X” over the circle/bubble if your answer is incorrect.

• Do not make stray marks on the paper, especially near the barcodes.

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Place the sticker with the barcode that corresponds to the village ID in the space as shown below by the doted-box.

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4. Instructions on filling in the health facility questionnaire

This instruction sheet is intended for filling in the health facility questionnaire (Form HFQ001.2E).

• Please read each question carefully before answering it.

• Choose the answer that best describes what you observed during your visit.

• Each sheet corresponds to a health facility.

Marking instructions:

• On the answer sheet, locate the circle that corresponds to the answer and fill it in completely with the pencil or pen that is provided to you.

•

A ball-pen is acceptable for marking (blue, black or red but not yellow)

Special instructions:

1. Question numbers 1.1, 1.2, 1.4, 2.6, 2.7, 2.8. For a health facility with 122 villages in question no 1.1, shade the number corresponding to 122 as illustrated in the figure below. The system will read the shaded bubbles sequentially: 1st row as first digit, 2nd row as second digit, 3rd row as third digit and 4th row as fourth digit. If there is no shaded number between the 1st and 3rd rows the system will read it as 1st row as first digit and 3rd row as second digit, and 4th row as third digit (as shown below in question 1.4).

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4.Instructions On How To Fill In The Health Facility Questionnaire

This instruction sheet is intended for Health Facility Questionnaire (Form HFQ001.2E).

• Please read each question carefully before answering it.

• Choose the answer that best describes what you observed during your visit.

• Each sheet corresponds to a health facility.

Marking Instructions:

• On the answer sheet, locate the circle that corresponds to the answer and fill it in completely with the pencil or pen that is provided to you.

•

A pen is acceptable for marking (blue, black, red, etc.., but not yellow)

Special instructions:

1. Question nos. 1.1, 1.2, 1.4, 2.6, 2.7, 2.8: For a health facility with 122 villages in question no 1.1, shade the number correspond to 122 as illustrated in below figure. The system will read the shaded bubbles in orderly fashion, 1st row as first digit, 2nd row as second digit, 3rd row as third digit and fourth row as fourth digit. If no shaded number between 1st row and 3rd row the system will read it as 1st row as first digit and third row as second digit, and fourth row as third digit as shown in question no 1.4.

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2. Choose one answer for each question. For question 1.3, multiple selections are allowed.

Correcting erroneous marks

• Try to avoid marking erroneously as this may cause some scanning problems

• DO NOT USE WHITE-OUT

• Pen or “Vis-á-Vis” marks cannot be erased

• Place a large cross "X" over the circle/bubble if the answer is incorrect.

• Do not make stray marks on the paper—especially near the barcodes.

NOTE:

1. Most questions have a single possible response, please ensure that only one correct response is marked. Questions which have multiple possible responses are are indicated accordingly.

2. Some questions are conditional. Based on the response to a question, the following questions are to skipped. Please ensure that if these questions are to be logically skipped, no response is marked against them.

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