ALES' CONTRIBUTION TO CASE MANAGMENT OF BURULI ULCER IN AFRICA Dr Alphonse Um Boock CONTENTS •INTRODUCTION • BURULI ULCER IN THE TARGET COUNTRIES • ALES' SUPPORT •IMPACT •CONCLUSION INTRODUCTION • ALES, which was set up in 1959, is a founding member of ILEP. • It is an NGO with a deep commitment to controlling the most neglected diseases and those who are left aside. • Leprosy , tuberculosis and more recently Buruli ulcer to cite but a few, are mainly responsible for the suffering we seek to relieve. INTRODUCTION • A half century of unstinting effort to control leprosy in several countries in the world, including Cameroon and the Central African Republic in Africa. • For almost six years now, ALES has been concerning itself with the suffering of Buruli ulcer patients in Cameroon , the Central African Republic and soon, Gabon. THE BURULI ULCER SITUATION IN THE TARGET COUNTRIES 1. CAMEROON 2. GABON 3. CENTRAL AFRICAN REPUBLIC CAMEROON • A central African country • Between Lat. 2 and 13 N • Between Long. 9 and 16 E • Some 16 000 000 inhbts. • Area: 475.650 Km² • Three climate zones: • Equatorial, Sudanese tropical, Sahelian tropical. EPIDEMIOLOGICAL HISTORY OF BU • 1975 : Ravisse and collaborators • 1977 : Boisvert and collaborators • 2000 1st epidemiological survey in the Nyong river basin: Juergen Noeske and collaborators •2004 1st national survey : Um Boock and collaborators DISTRIBUTION IN THE COUNTRY 76 51 25 AD CE ES EN 229 SU 342 SU-O SELECTED DATA 800 705 700 600 500 438 400 300 265 225 200 120 100 0 0 Année 200 Année 2001 Année 2002 Année 2003 Année 204 Année 2005 RESPONSE TO THE PROBLEM AND STRATEGIES • Development of a national programme • The health district at the heart of the control effort • Redefinition of the minimum package in endemic areas, with the inclusion of rehabilitation. • Strengthening the referral and counter-referral system RESPONSE TO THE PROBLEM AND STRATEGIES • Care continuum (home visits) • Multi-sector approach to control • Awareness raising • Extra tuition for schoolchildren • Research • Supervision Sustainability • Strengthening the district management teams. • Community participation • State funding. RESULTS AND MAIN ACTIVITIES DEVELOPMENT OF THE NATIONAL PROGRAMME • Workshop to draw up the strategic plan 2006- 2009 • Extension of coverage : Mbonge, Mbalmayo • Training for 138 health workers in the six endemic districts • Disease surveillance • Provision of vehicles for the endemic districts (1 four-wheel drive vehicle and 4 motorcycles). • Financial support for programme supervision and coordination CASE DETECTION • Awareness campaigns 10 0 in all endemic districts 96 90 with financial support 90 from ALES. 80 70 • Active case detection in 60 Ayos and Messamena 50 districts. 42 40 30 • Involvement of pupils, 20 16 teachers, farm workers, 12 10 and Mectizan 4 1 2 1 1 distributors in case 0 detection Ayos Abong M Mamf e Bankim Maga CASE MANAGEMENT Dead Lost Recur- Referred NC Cured Being rence treated Sequelae No sequelae Ayos 90 0 59 1 5 0 0 25 Akonolinga 96 11 44 2 6 13 3 40 Mbalmayo 42 0 4 0 38 0 4 0 Bankim 2 0 0 0 0 0 1 1 Mamfe 1 0 0 0 1 0 0 0 Mbonge 4 0 0 0 3 0 0 1 Batouri 1 0 0 0 1 0 0 0 Maga 1 0 0 0 0 0 1 0 Abong M 12 0 4 0 8 0 4 0 Messamena 16 0 0 0 16 0 0 0 265 11 111 3 78 13 13 67 TRAINING • Provinces : Adamaoua, Sud, Est, EN, Centre, Sud-Ouest. Districts: Provinces 6 Mbalmayo, Mfou, Maga, Districts 18 Sangmelima, Ebolowa, Zoetele, Bertoua, Abong Doctors 10 Mbang, Nguelemendouka, Nurses 87 Eseka, Bankim, Maroua, Mbonge, Ekondo Titi, Kumba, Teachers 35 mamfe, Mundemba. DPSSODPSPC,DPSCE,DSPS,D PSPA,DPSPEN, EQUIPMENT FOR TREATMENT CENTRES • Equipment for the 18 endemic districts •Surgical kits • Dressing kits • Electric scalpel • Digital camera • Surgical linen • Miscellaneous medical supplies FUNCTIONAL REHABILITATION • Supervision of the activities of the physiotherapy team ( Valérie Simonet). • Monitoring patients. EXTRA TUITION FOR SCHOOLCHILDREN • Enrolled: 18 • Went up a class: 5 • Official Examination: 1 • Repeating a year: 12 • Gave up: 2 RESEARCH • Direct cost of treatment • Social cost of the disease ACTIVITIES IN THE CENTRAL AFRICAN REPUBLIC • Training health workers • Disease surveillance REPUBLIC OF GABON SITUATION REPORT AND ACTIVITIES DISEASE SITUATION • 2005: designation of a focal point. • 2005: 38 cases detected during a survey in moyen-Ogooue region. • 2005: Activities launched, advocacy, awareness-raising among health workers. OUTLOOK 2006 For Cameroon: • Consolidate achievements • Improve case management in the new treatment centres. • Strengthen disease surveillance • Early case detection • Training for community intermediaries • Programme follow-up (home visits…). OUTLOOK 2006 For the Central African Republic: • Training for health workers • Disease surveillance OUTLOOK 2006 For the republic of Gabon • Technical and financial support to develop the national programme, focusing on: 9 Training for health workers 9 Development of a primary health-care system in Moyen-Ogooue 9 Improving the case confirmation capacity of the reference laboratory. 9 Treatment of patients 9 Disease surveillances CONCLUSION Provision of case management for Buruli ulcer is still a major concern for the national authorities. • In Cameroon, where expected annual incidence is 4922 NC and where 3 281 040 people are at risk, less than 10 % actually receive case management. • Firmly establishing the control effort in the district undoubtedly marks a turning point in case management of the disease. • In the CAR, the disease is under intense surveillance. • In the Republic of Gabon ALES intends to support the development of control activities..