Onchoccrciasis Control Programmc in the Volta Rivcr Basin arca Programme de Lutte contre I'Onchocercose dans la R6gion du Bassin de la Volta JOIN'T PROCRAMME COMMITTEE COMITE CONJOINT DU PROCRAMME Officc of the Chuirrrran JPC.CCP Bureau du Prdsident JOINT PROGRAII"IE COMMITTEE JPC3.6 Third session ORIGINAL: ENGLISH L Bamako 7-10 December 1982 October 1982 Provisional Agenda item 8 The document entitled t'Proposals for a Western Extension of the Prograncne in Mali, Guinea, Guinea-Bissau, Ssnegal and Sierra Leone" was reviewed by the Corrrittee of Sponsoring Agencies (CSA) and is now transmitted for the consideration of the Joint Prograurne Conrnittee (JPC) at its third sessior:. The CSA recalls that the JPC, at its second session, following its review of the Feasibility Study of the Senegal River Basin area entitled "Senegambia Project : Onchocerciasis Control in Guinea, Guinea-Bissau, l,la1i, Senegal and Sierra Leone", had asked the Prograrrne to prepare a Plan of Operations for implementing activities in this area. It notes that the Expert Advisory Conrnittee (EAC) recormnended an alternative strategy, emphasizing the need to focus, in the first instance, on those areas where onchocerciasis was hyperendemic and on those rivers which were sources of reinvasion of the present OCP area (Document JPC3.3). The CSA endorses the need for onchocerciasis control in the Western extension area. However, following informal consultations, and bearing in mind the prevailing financial situation, the CSA reconrnends that activities be implemented in the area on a scale that can be managed by the Prograrmne and at a pace concomitant with the availability of funds, in order to obtain the basic data which have been identified as missing by the proposed plan of operations. , Furthermore, the CSA recournends the JPC to dpprove this action and to request the Executing Agency to negotiate the appropriate agreements with the countries concerned WORLD HEALTH ORGANIZATION ocP82.3 ORGANISATION MONDIALE DE LA SANTE @ ORIGINAL: ENGLISH ONCHOCERCIASIS COMROL PROGRAMME PROPOSALS FOR A WXSTERN EXTENSION OF THE PROGRAI,II,IE rN MALI, cUlMA, GUINEA-BTSSAU SENEGAL AND SIERRA LEONE ocP 82.3 Page 2 CONIENTS Page SI]MMARY 5 PART I INIRODUCTION TO ONCHOCERCIASIS IN TIIE PROPOSED OCP WESTERN EXTENSION AREA AND TIIE BASIC PRINCIPLES FOR ITS CONIROL: Chapter I. IIfIRODUCTION 7 1 Background . 7 2 New approaches and developments 8 3 The proposed Western Extension area 9 3.1 Limits 9 3.2 Physical geography 10 3.2.t Mali . lo 3,2.2 Senegal L2 3 .2.3 Guinea 13 3.3 Social and economic geography t4 3.4 LogisEical aspects of the area 15 4 The need for onchocerciasis control l6 4.t Health considerations . 16 4.2 Socioeconomic considerations 19 Chapter II'. THE PRINCIPLES OF ONCHOCERCIASIS COMROL 20 t. Introduction . 20 ) Vector control . 20 2.L Vector species in need of control . 2T 2.2 Vector control techniques . 22 2 .2 .1, Environmental rnethods 22 2.2.2 Chemical control techniques 22 2.2.2.1 Adulticiding 22 2 .2 .2 .2 Larviciding 23 2.3 The evaluation of vector control operations 25 2.3.L Entomological evaluations 25 2 .3.2 Epidemiological evaluat ions 26 2.3.3 Environmental monitoring . 26 REFERENCES CITED IN PART I )7 PART II PI.AN OF OPERATIONS FOR TIIE FIRST SIX YEARS OF ONCHOCERCIASIS COMROL IN THE I,IESTERN EXTENSION AREA: Chapter III. RESPONSIBILITIES 29 1 Introduction. 29 2 Responsibilities of the OCP 29 3 National responsibilities 30 ocP82 .3 Page 3 Page 31 chaprer rV. PHASTNG OF EXIENSTON ACTTVTTTES I Introduction. 31 32 2 Spatial phasing 33 3 TimeEable for phasing of activities 3.1 In the northern subregion 33 3.2 In the southern subregion 34 35 Chapter V. PREPARATORY ACTIVIT]ES 35 1 Introduction. 35 2 OCP activities 2.L In the Phase I zone 35 )) In the Phase II zone 36 36 2.3 In the Phase III zone . 36 3 National activities 3.I In the Phase I and II zones . 36 3.2 In the Phase III zone . 37 4 Activities conducted jointly by the ocP and national authoriEies 37 the 5 ocP requirements for addirional hydrological stations and roads in Phase I and fI zones . 37 5.1 Requirements for hydrological stations 37 5.2 Requirements for additional roads 39 6. Other considerations 40 Chapter VI. VECTOR COMROL OPERATIONS IN THE PHASE I AND ]I ZONES 4t l. Operational bases 4L 1.1 Primary operational' base 4l L.2 Secondary operational bases 4t 1.3 OCP helipads 4L r.4 Logistic support 42 2. Aerial operations logisEics and costs 42 2.L Aircraft requirements . 42 ?? Deployment of aircraft . 42 2.3 Basic aircraft costs 42 2.4 Flight hour requirements and costs 42 3. Insecticide requirements 42 3.1 Temephos requirements for the Phase I zone 43 3.2 Temephos requirements for the Phase II zone 43 3.3 Total temephos requirements and costs . 43 4 Managerial staff 43 5 Applied research 44 chaprer vII. ENIOMOLOGICAL EVALUATIONS IN TI{E PHASE I AND 11 ZONES 45 I Introduction . 45 2 Entomological evaluation sub-unit 45 2.t Sectors and subsectors 45 ,) Staffing of sectors and subsectors 46 2.3 Responsibilities of sector and subsector chiefs 47 2.4 Timetable of sector activities 48 ocP82.3 Page 4 Page 2.5 Sector requirements for vehicles 48 2.6 Sector requirements for equipment 48 2.7 Requirements for radio stations 49 3 Cytotaxonomy sub-unit . 49 4 Duration of pre-control evaluations 49 chapter vrrr. EPrDEMroLocrcAL EVALUATTONS rN THE PHASE r AND rr zoMs 50 1 Introduction 50 2 Selection of indicator viltages 50 3 Population covered by evaluations in indicator villages 51 4 Evaluation teams 51 4.L For parasitological eval-uations 51 4.2 For ophthalmoLogical evaluations 51 5. Capabilities of national health authorities 52 5.1 Simple evaluations . 52 5.2 Detailed evaluations . 52 5.3 Options for ophthalmological evaluations . 52 ENVIRONMENTAL Chapter IX MONITORING IN TIIE PHASE AND 1I ZONES 53 1 Introduct ion 53 2 Intercountry monitoring Eeam 54 2.1 Staff requirements 54 2 .2 Equipnrent requirement s . 54 3 Monitoring procedures 55 3. t Methods 55 3.2 Recording and analysis of data . 55 Chapter X. oPERATIONAL BASE, BAI,IAKO 56 1 Int roduc E ion s6 2 Staff.. 56 2.\ Vector Control Unit 56 aa Epidemiological Evaluat ion Unit 57 2.3 Administration Unit 57 3 Vehicle requirements 57 4 Requirements for equipment and supplies 57 chaprer xI. BUDGET 58 I Introduction 58 2 58 3 International- contributions 58 3.1 Guidelines for the preparation of the budget 59 3,2 Budget . 60 Tables 1-9 61 Maps 1-7 73 ocP82.3 Page 5 SLII"{MARY i^Ihen proposals for a Senegambia Onchocerciasis Control Project were reviewed by the Joint Prograrnme Committee in December 1981 it was acknowledged that there r^7as a serious onchocerciasis problem in the region to the west of the onchocerciasis control programme in the Volta River Basin area and that for both health and socioeconomic reasons there \^ras justification for a WIIO control activity. In addition iE was agreed that any such control activity in that region should be implemented as an extension of Ehe OCP and not as a seParate and multi-disease project. Accordingly the OCP was charged with appraising and studying the original feasibility report, with collecting additional information from the region, and with the preparation of a revised plau of operations. lnvestigations conducted during 1982 both in the existing OCP area and in the proposed tr'Jestern Extension area brought to light information which was either not available at the time of the original feasibility survey or was not fully apparent at that time, but which is now considered of such importance that a completely different approach to onchocerciasis control in the Western Extension area has to be adopted. This new informaEion relates primarily to an incomplete picture of vect.or distribution, to the insecticide resistance problem in the Ivory Coast, to infrastructural and logistic constraints in the extension zone, and to topographical and climatic constraints in the southern part of the extension zone. Although the vector species of the VJestern Extension area are the same as those in the OCP, precise information is not yet available on the distribution of all the species. Similarly the vectorial capacity of at least some species has not yet been fully assessed. However, what is kno\^m with some certainEy is that S. soubrense is widely distributed in the upper basin of the River Niger and that the zone of distribution is contiguous with infestations in the OCP which are now double resistant to the larvicides temephos and chlorphoxim. Thus until such time that Ehe present resistance problem is satisfactorily resolved, an extension of vector control operations into the upper Niger basin would involve unjustifiabl-e risks and could have serious repercussions. With regard to infrastructural and logistic constraints the main problems relate to the inadequacy of road networks in many technically critical parts of the extension area, and, to the generally poor condition of many existing roads. Because of the higher rainfall in the southern part of the area (annual means of 15OO-280O rprn compared to 7OO-1500 mm in the north) road conditions are generally poorer in the southern subregion than in the northern subregion, especially during the r^7et season. The implication of these situations is that even if vector control was technically justified in the southern subregion there would be many logisEic problems and it would not be possible to conduct entomological evaluations on a sufficiently large scale to meet OCP requirements.