African Programme for Onchocerciasis Control (WHO/APOC) Remaining mapping challenges for Oncho and Loa 17-18 November 2013 COR-NTD meeting, Washington DC 1 | African Programme for Onchocerciasis Control Outline • Objective of APOC • Mapping of oncho for the delineation of treatment boundaries – Steps – Survey methods – Status of implementation – Results of parasitological surveys • Assessing the intensity Loa loa infection • Way forward • Challenges 2 Objective of APOC Phasing-out and exit strategy 2008-2015 … to have established, by 2015, a country-led system capable of eliminating onchocerciasis as a public health problem in endemic countries, both those within the geographical area covered by APOC’s mandate and those in ex-OCP area that are causing concern. 3 Pre-control oncho endemicity map 4 Pre-control oncho endemicity map and areas under CDTI 5 Mapping of oncho for the delineation of treatment boundaries • Objective: Conduct additional epidemiological surveys in areas with nodule prevalence <20% (previously known as hypo-endemic areas) in order to decide on the need of extending treatment for onchocerciasis elimination. • Method: Skin biopsy on individuals 5 years old and above 6 Steps • Development of guidelines for revising IVM treatment boundaries • Workshop for selection of areas and villages to be surveyed (March 2013) • Support to some NOTFs in finalizing the selection and developing plan of action and budget (Cameroon, Nigeria, Chad, Equatorial Guinea, DRC, Gabon) • Conduct of surveys with technical and financial support from APOC Trust Fund (since June 2013) 7 Mapping needs for oncho treatment boundaries • Surveys completed in • Surveys to be conducted in 2014 – Cameroon – Angola • completed in Littoral and South regions • Ongoing in Centre and East regions – CAR – Burundi – Congo – DRC – Chad – Ethiopia – Equatorial Guinea (Mainland) – Gabon (in collaboration with CNTD/Liverpool) – Nigeria – Mozambique (borders with Tanzania and Malawi) 8 Cameroon (Littoral and South): 22 Villages selected and surveyed 9 Cameroun (Littoral and South): results of parasitological surveys Attendanc Positi Crude prev. Stand prev. District Village Bassin Census. Exam. e rate ( %) ve % % CMFL REGION DU LITTORAL DIBOMBARI BENGSE NKAM 160 111 69,38 1 0.9 0.7 0.00 DIBOMBARI YABEA NKAM 150 91 60,67 2 2.2 1.5 0.05 DIBOMBARI BWADIBO MOUNGO 324 169 52,16 5 3.0 2.1 0.06 EDEA DIBONGO SANAGA 282 166 58,87 30 18.1 10.8 0.34 EDEA KM 11 SANAGA 355 174 49,01 5 2.9 1.9 0.07 EDEA MBONGO 2 DIBAMBA 435 243 55,86 7 2.9 2.0 0.06 EDEA MOUANKO SANAGA 276 109 39,49 1 0.9 0.7 0.02 EDEA MARIEMBERG SANAGA 197 89 45,18 3 3.4 1.9 0.08 Sub-total 1 8 villages 2179 1152 52,87 54 0.9 – 18.1 0.7 - 10,8 0 - 0.031 REGION DU SUD KRIBI DEHANE NYONG 293 131 44,71 8 6.1 4.8 0.11 KRIBI MINTOM NTEM 152 74 48,68 1 1.4 0.8 0.01 KRIBI AFAN ESSO KYE NTEM 190 79 41,58 0 0.0 0.0 0.00 MVANGAN MINKOUMOU MBOUAN 443 194 43,79 4 2.1 1.6 0.03 EBOLOWA MVILA YEVOL MVILA 251 163 64,94 2 1.2 1.6 0.03 EBOLOWA EKOUMDOUM MVILA 363 209 57,58 3 1.4 1.4 0.02 KRIBI AKOM 1 KIENKE 443 237 53,50 1 0.4 0.2 0.00 LOLODORF BIKOE 1 LEKOUNDJE 391 262 67,01 2 0.8 0.6 0.00 LOLODORF ELON EFOM 320 155 48,44 3 1.9 1.0 0.02 KRIBI MAKOURE LEKOUNDJE 392 244 62,24 12 4.9 3.0 0.06 LOLODORF MOUGUE MOUGUE 135 62 45,93 1 1.6 0.4 0.01 LOLODORF KOUAMPBOER MVILA 282 131 46,45 2 1.5 0.5 0.02 LOLODORF NSOLA NSOLA 251 122 48,61 5 4.1 1.8 0.01 LOLODORF TYANGO TYANGO 205 90 43,90 1 1.1 0.3 0.01 Sub-total 2 14 villages 4111 2153 52,37 45 0 - 6.1 0 - 4.8 0 - 0.11 Total 1+2 22 villages 6290 3305 52,54 99 0 - 18.1 0 - 10.8 0 - 0.31 10 Cameroon (Littoral and South): standardized mf prevalence in the 22 villages 11 Cameroon (Littoral and South): Ensure Oncho+LF treatment in Edea district using alternative method Because of high loiasis prevalence, ensure LF+Oncho treatment in Edea district using alternative method It may be usefull to selected few more villages in South region 12 Chad: 23 Villages selected and surveyed 13 Chad: results of parasitological surveys Attendance Crude Stand N° VILLAGE BASSIN DISTRICT Census Exam. Positive CMFL rate % prev. % prev. % 1 GABRI-NGOLO LOGONE LAI 251 221 88.0 0 0 0 0 2 TCHAKANDJILE LOGONE LAI 232 210 90.5 0 0 0 0 3 BOUMOU LOGONE LAI 233 182 78.1 0 0 0 0 4 MISSERE LOGONE LAI 266 207 77.8 0 0 0 0 5 LEO BIDIM ARIWI GOUNOU-GAYA 240 199 82.9 0 0 0 0 6 MADI GOUH KOLON FIANGA 242 231 95.5 0 0 0 0 7 NGUIRFI MANKIROU FIANGA 321 229 71.3 0 0 0 0 8 KAKINGA GONRINA DOBA 486 259 53.3 0 0 0 0 9 NDOKOBO PENDE BODO 283 227 80.2 0 0 0 0 10 BEKODO II PENDE BODO 255 214 83.9 0 0 0 0 11 BEPARA PENDE BODO 231 184 79.7 1 0,5 0 0 12 BELADJIA LOGONE BENOYE 318 166 52.2 0 0 0 0 13 NDOU LOGONE BENOYE 414 280 67.6 0 0 0 0 14 BAO GUENI BENOYE 478 302 63.2 0 0 0 0 15 BOUROU KAREIGNE BENOYE 433 319 73.7 0 0 0 0 16 MOUROUGOULAYE CHARI GOUNDI 611 448 73.3 0 0 0 0 17 KOUMAYE CHARI GOUNDI 565 432 76.5 0 0 0 0 18 PARIS SAKO M0N0 KOUMRA 243 201 82.7 0 0 0 0 19 NGANGARA CHARI GOUNDI 565 468 82.8 0 0 0 0 20 MATEKAGA CHARI GOUNDI 446 379 85.0 1 0,26 0 0 21 TCHIRE AGAMI KELO 287 254 88.5 0 0 0 0 22 BERTE KABIA KELO 267 240 89.9 0 0 0 0 23 ZAMRE ADI KELO 363 329 90.6 0 0 0 0 Total 8030 6181 77.0 2 14 Chad: standardized mf prevalence in the 23 villages 15 Chad: No extension needed yet • Increase the sample size of Phase 1b epi evaluation to cover theses areas • Ensure IVM+ALB distribution is implemented for LF (if low infection of loa loa is confirmed) 16 Burundi: 20 Villages selected and surveyed 17 Burundi: results of parasitological surveys Atendanc Crude prev. Stand CMFL N° District Village Bassin Census Exami Positive e rate (%) % prev. % 1 Kabezi Magara II Ruzibazi 519 146 28.1 0 0 0 2 Muramvya Kirinzi(Mubura) Mucece 789 177 22.4 0 0 0 Gihangange 3 Kabezi karonké 826 230 27.8 0 0 (Migera) 4 Kabezi Kabezi kanyamanzi 886 337 38 0 0 0 5 Giteranyi Butihinda Pas de riviére 491 212 43.2 0 0 0 6 Giteranyi Rugese Nyamabuno 534 307 57.5 0 0 0 7 Kiyonza Kiyonza Kayaru 346 205 59.2 0 0 0 8 Nyabikere Buyaga Ruvubu 364 240 65.9 0 0 0 9 Mutaho Murongwe Mubarazi 220 158 71.8 0 0 0 10 Mutaho Ntunda (Jenda) Ruvyironza 504 279 55.4 0 0 0 11 BDS Rutana Gitaba Muyovozi 286 176 61.5 0 0 0 12 Ryansoro Muyuga (Kibagara Ruvyironza 202 142 70.3 0 0 0 Musongati 13 DS Rutana nyamabuye 288 169 58.7 0 0 0 (Buhinga) 14 Ryansoro Jungwe Ruvyironza 344 229 66.6 0 0 0 15 Kankuzo Nyamugari Ruru 233 144 61.8 0 0 0 16 Butezi Titi Kayogoro 186 126 67.7 0 0 0 BDS 17 Dunga (Rusovu) Rukoziri 195 100 51.3 0 0 0 Makamba 18 Rumonge Mugina (Ruvuga) Nyengwe 223 129 57.8 0 0 0 BDS 19 Buheka Rwaba 565 359 63.5 1 0,27 0,3 0,00756 Nyanzalac 20 Rumonge Kigwena Nyengwe 581 347 59.7 1 0,28 0,2 0,00783 Totaux 8582 4212 49.1 2 18 Burundi: standardized mf prevalence in the 20 villages 19 Burundi: Additional villages selected for ongoing epi. evaluation 20 Eq. Guinea: results of parasitological surveys N° VILLAGE Bassin Province District POPULATION mf Cens Exam Positive Crude Stand. CMFL us Prev (%) Prev (%) 1 Minang Minang et Bang Litoral Kogo 118 82 0 0 0 0 2 Nko’ho Mofom et Kongu é Litoral Kogo 106 76 0 0 0 0 3 Midjobo Anvom Onvong/Midjobo Litoral Kogo 39 21 0 0 0 0 4 Minang Woro Litoral Mbini 76 47 0 0 0 0 5 King King Litoral Mbini 75 45 0 0 0 0 6 Mbomo Bolo Litoral Mbini 228 121 0 0 0 0 7 Afana Afana Litoral Bata 63 31 0 0 0 0 8 Nfonga Ecucu et Kiri Litotral Bata 65 24 0 0 0 0 9 Alum San José Ecucu Litoral Bata 140 81 0 0 0 0 10 Nvom Gnamiquielé et Nvom Centro Sur Nienfang 105 57 0 0 0 0 11 Micomasi Gnaméyiri /Mbea / Centro Sur Nienfang 58 40 0 0 0 0 Woro 12 Ayene Aseng Centro Sur Nienfang 203 84 0 0 0 0 13 Leng Chiwo/Milong/Woro Centro Sur Evinayong 51 26 0 0 0 0 14 Ayantangan Otongmegna Centro Sur Evinayong 89 63 0 0 0 0 15 Téguete Tegue Centro Sur Evinayong 27 9 0 0 0 0 16 Akurnam Esacora Mbihi Centro Sur Akurenam 47 28 0 0 0 0 17 Esong Neng Centro Sur Akurenam 69 53 0 0 0 0 18 Ayem Kan Centro Sur Akurenam 105 52 0 0 0 0 21 Eq.