i'itogr e con{n,i jpc ccp conrre
TRANSCRIPT
Onchocerciasis Contlrl I'rograrrutte ilt Wcst ;\l'rica (OCl')Progranrnrc dc lutte contrc I'onchoccrcosc cn Al'riquc dc l'Oucst
JOINT I'ITOGR \MM E CON{N,I I-ITI1E
Offlce of thc Chairnran
JPC - CCP conrrE coNJorNT DU pr{octRAMME
Burcau du Prcsrdcnt
JOINT PROGR\MME CONl\I I-fTEETrvcnty-scconrl scssionWashinston D.C., l0-l I Dcccnrbcr 2001
JPC22.3ORIGINAL: IINGLISIIjuly 2001
,l
t
It
ProvisionaI agcnda itern 6
EXPERT ADVISORY COMMITTEEReport of the Trvcnty-second Session
Ouagaclougou, 4-8 JLrnc 2001
f
CONTENTS
List of participants.................
Executive surunary and recommendations .....'...'....
A. Opening of the session
B. Adoption of the agenda
C. Follow-up to the recommendations of the twenty-first session of the Expert AdvisoryCommittee 9
D. Matters arising from the twenty-first session of the Joint Programme Committeeand from the Joint JPC21-lAF6 Session...
E. Review of the report of the twenty-second session of the Ecological Group............................'.10
F. Reports on the visits of EAC members to the Programme area..... "...'...11
G. Review of scientific, operational and technical issues '........... 1.4
H. Priority actions to be taken during the last ll/zyears of OCP operations ................19
I. Macrofil 24
J. Closure of OCP... 26
K. Report on the progress made by APOC, its preparations for Phase II and forthe Phasing-out Period of the Programm e (2002-201.0) ................
L. Report on TDR Operational Research.
M. Consideration of the Cochrane Library review on "Ivermectin for onchocercaleye disease" by H. Ejere, E. Schwartz and R. WormaId................
N. Other matters : "Integrated Data Analysis"
O. Dates and venues of future EAC sessions...............
P. Approval of the draft report.....
a. Closure of the session......
Annex L
Annex 2
List of EAC22 recorunendations
Page
2
5
8
9
I 9
....,....,........... 27
..............,,..... 27
28
28
28
29
29
30
Annex 3
Annex 4
Annex 5
Annex 6
Annex 7
Recommendations of the April2001 OCP Operational Research and StrategyMeeting
Report of Working Group A ......Report of Working Group B ......Report of Working Group C ....Report of the twenty-second session of the Ecological GroupReport of the EAC Task Force Meeting
..32,..33
..35
...42
...44
...70
JPC22.3Page2
LIST OF PARTICIPANTS
EAC Members
Professor Adenike AbioseMedical Director, Sightcare International, P.O. BoxL0392, Kaduna, Nigeria
Tel: 234-62417373 / 238684 - F ax 234-62-410873 or 248973 i/c SSI -E-mail: [email protected]
Professor S. Ofosu-AmaahC/o Director, School of Public Health, University of Ghana, P'O' Box L3, Legon-Accra'
Ghana - Tel: (233) 21 715580 - Fax: (233) 21 500388 - E-mail: [email protected]
Professor Roger K. PrichardInstitute of Parasitology, MacGill University, Mac Donald Campus, 21 111' Lakeshore Road,
Beaconsfield, Quebec, Canada H9X 3V9, Tel: (514) 398 7729 - Fax: (514) 398 7857 -E-mail: [email protected] gill.ca
Professor Detlef R. ProzeskY
Faculty of Health Sciences, University of Pretoria, P.O. Box 667, Pretoria 0001, South Africa
tel. 2;l-tZ-35411,47 - Fax: ++ 27-12-3541758 - E-mail: [email protected]
professor Vincent H. Resh, Department of Environmental Science, Policy and Management,
University of Californi a, 2O1r Wellman Hall, Berkeley, Calif orn ia 9 47 20, US A
Tel. (510) 6423327 - Fax (510) 642-7428 - E-mail: [email protected]
Docteur Mamadou Soungalo Traor6
European Commission, birectorate-General, Research, SDME 1/150,200 Rue de la Loi, B-
1049, Bruxelles-wetstraat 200, Belgique - Tel: (+32-2) 296'16'65 - Fax: 32 2296'62'52' -E-mail: [email protected]. int
Dr Yoichi Yamagatasenior Advisor, Japan International Cooperation Agency 0ICA), 10-5 Honmura-cho,
Ichigaya, Shinjuku, Tokyo, 162-8433, |apan - Tel. +81-3-3269-3851. - Fax: +81-3-3269-6992 -E-mail: yoiti@jica. go.jP
Mrs Fatu YumkellaC/o The Programme for International Training in Health (INTRAH), P'O. Box 44958,
Nairobi, Kenya, T el: 254-2- 229 67 O - F ax: 254-2 226824, E. mail: fy umkella@intrah. org
Dr Bernard Philippon, Charg€ de Mission Sant6, Institut de Recherche Pour le
D6veloppement gRb), Departement Soci6t6s & Sant6, 213 Rue La Fayette, 75010 Paris c6dex
10, T61.331 48037709 - Fax:331 48037806, E-mail : [email protected]
Dr Andr6 Yebakima, Entomologiste m6dical, Centre de D6moustification, Conseil g6n6ral,
B.P. 658, Bd. Pasteur , g72OO Fort-de-France, Martinique - T6l. : 05 96 60 37 21 -Fax : 05 9670 26 46 - E-ma il: [email protected] / [email protected]
prof J. Dik F. Habbema, Erasmus University Rotterdam, Faculty of Medicine and Health
Sciences, Department of Public Health, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands
Tel. : +31 10 408 T985/771,4 - Fax : +31 10 4089455/9449 -E-mail : [email protected]
I
lPC22.3Page 3
National Coordinators
Dr Eku6 Julius Gaba, Coordonnateur national du Prograrune de Iutte contre l'Onchocercose,
Ministdre de la Sant6 publique, BP 882, Cotonou, Bdnin, T€1./Fax: (229) 31,74 09
Dr Gbayoro Pierre Brika, Directeur ex6cutif du Programme national de la D6volution
Programme de lutte contre l'onchocercose,0L BP 515 Bouak6 0L, Cdte d'Ivoire -Fax (225) 31 63 98 29,Tel: (225) 31, 63 20 8'1-., Cell. (225) 08 60 36, E-mail: [email protected]
Dr Kofi Ahmed, Director Onchocerciasis Control, Ministry of Health, P.O. Box M.44, Accra,
Ghana - Fax: (233) 21. 66381..0, Tel. : (233) 21. 68 4275,
E-mail : [email protected]
Dr Mamadou Oumar Traor6, Coordonnateur national du Programme de lutte contre
l'onchocercose, BP 228, Bamako, Mali - Fax: (223) 2317 21,, Tel: Bur. (223) 22 64 97,
Dom. (223) 24 97 83 - E-mail : oncho. ma li@spider. toolnet. org
Dr (Mme) Salamatou Diallo, Coordonnateur national de la Ddvolution, Programme de Luttecontre l'Onchocercose, BP 851, Niamey, Niger, Fax: (227)7520 62,Tel: (227)752279
Dr B. Kargbo, National Coordinator Oncho Control Programme, Ministry of Health and
Sanitation, Youyi Building, Freetown, Sierra Leone
Tel : (00 n4 22220469/ 76 677052 - Fax : 0023222227373 -E-mail : [email protected]
Dr A. Dar€, Coordonnateur national du Prograrrune de lutte contre l'onchocercose, Directeurr6gionaldelaSant6,B.P.4ST,Kara,Togo-Tel: (228)600047 / 60171,0 -Fax: (228)600474
Dr Souleymane Sanou, Coordonnateur national du Programme de Ddvolution Oncho, 03 BP
7009, Ouagadougou 03, Burkina Faso, T6l. (226) 30 87 90 -Fax: (226) 33 49 38
wHo/HQ
Dr Marc Karam, WHO/CDS/CEE, GenevaTel.: +41227914389/4630/4743 - Fax: + 4122791,4777 - E-mail: [email protected]
Dr J.H.F. Remme, Coordinator Onchocerciasis and Lymphatic Filariasis Research, TRD,WHO/HQ Geneva Tel: +4122791.381.5 - Fax : +41227914774 - E-mail: [email protected]
wHo/AFRO
Dr A. Kabor6, DDC/AFRO, Harare
Dr S. Bugri, IDS Programme Manager, c/o WHO OuagadougouE-mail : [email protected]
WHO-APOC
Dr A. ftk6teli, Director, African Programme for Onchocerciasis Control, Ouagadougou
lPC22.3Page 4
WHO.OCP
Dr Boakye A. Boatin, Director, Onchocerciasis Control Programme, Ouagadougou
Dr H. Agoua, Vector Control Unit, Onchocerciasis Control Programme, Kara
Mr A. Ak6, Vector Control Unit, Onchocerciasis Control Programme, Odienn6
Dr L.K.B. Akpoboua, Vector Control Unit, Onchocerciasis Control Programme,
Ouagadougou
Miss Angela Baffoe, Onchocerciasis Control Programme, Ouagadougou
Mr P.R. B6lemgoabga, Onchocerciasis Control Programme, Ouagadougou
Dr Y. Bissan, Vector Control Unit, Onchocerciasis Control Programme, Odienn6
Dr O.W. Christensen, Consultant, Onchocerciasis Control Programme, Geneva
Mr A. Daribi, Onchocerciasis Control Programme, Geneva
Prof M. Kabor6, Translator, Onchocerciasis Control Programme, Ouagadougou
Mr V. K6r6, Vector Control Unit, Onchocerciasis Control Programme, Ouagadougou
DrJ.Lazdins, Manager, Macrofil Project, Onchocerciasis Conhol Programme, Geneva
Mr ].P. Thirion, Administration & Finance Officer (AFO) Onchocerciasis Control Programme,
Ouagadougou
Mr S. N'Gadjaga, Biostatistics and Information System Unit, Ouagadougou
Mr M. Sarr, Vector Control Unit, Onchocerciasis Control Programme, Odiennd
Dr K.E.M. Siamdvi, Planning, Evaluation and Transfer Unit, Onchocerciasis Control
Programme, Ouagadougou
Dr A. Soumbey, Chief, Biostatistics and Information System Unit, Ouagadougou
Dr L. To6, Vector Control Unit, Onchocerciasis Control Programme, Ouagadougou
Dr L. Yam6ogo, Chief Vector Control Unit, Onchocerciasis Control Programme,
Ouagadougou
a
,
a.
b.
lPC22.3Page 5
EXECUTTVE SUMMARY AND RECOMMENDATIONS
The twenty-second session of EAC was held at OCP Headquarters from 4 to 8 June,with Professor Adenike Abiose in the Chair.
She stressed the importance of this session which is the penultimate one beforeclosure of OCP operations and from which the Programme expected advise andrecommendations regarding its remaining activities to ensure that OCP might cometo a successful end .
Dr Antoine Kabor6, representing the WHO Regional Director for Africa, referred toOCP as a programme of which Africa could be proud. It was achieving its objectiveafter more that 25 years of control operations.
The Programme Director, Dr Boakye Boatin, asked the Committee for guidance on anumber of issues of prime interest to OCP activities during the last 1 % years of itslife, including the efficacy of ground larviciding; future control activities in SierraLeone; Community-directed Treatment with Ivermectin (CDTI); cross-bordercollaboration; the attitude to take faced with the possibility of ivermectin (Mectizan@
) resistance; the DEC patch test; and the closure of OCP.
Dr Boatin informed the Committee that practically all its recommendations adoptedat its session in 2000 had been followed by the Programme.
The Chair then summarised her report to the December 2000 session of the JointProgramme Committee flPC) on the proceedings of last yeay's EAC session.
Hydrobiolog.v
The Ecological Group recommended that a search be made for historicalenvironmental data from the pre-OCP era for use in determining the currentecological state in the onchocerciasis-freed zones. It was further recommended thatthe non-technicalbrochure on the work of the Ecological Group be published by OCPand that a steering Committee to plan for the writting up of synopses of scientificresults from monitoring activities be established. The Group concluded that large-scale treatment with ivermectin had no detrimental impact on the environment anddid not pose a risk to terrestrial organisms. It was decided to continue monitoringactivities along the same lines as those carried out in 2000 until the end of 2002.
Visits of EAC Members to the Programme area
Dr Bernard Philippon, reporting on a visit to Mali, expressed doubt as to the efficacyof ground larviciding for vector control in large and long stretches of rivers. Dr YoichiYamagata reported on his visit to Togo indicating that on the whole there was goodaccePtance of CDTI by the communities after an initial skepticism. Dr Andr6Yebakima had visited COte d'lvoire and Guinea. He stressed the importance ofcommunity participation in, and ownership of CDTI and insisted on increasedentomological surveillance in "Special Intervention Zones"
Professor Detlef Prozesky presented his findings of a study on the motivation ofhealth centre nurses in CDTI areas carried out in Benin and made a plea that themotivation of CDTI workers be tackled systematically through operational research.
a
c
d
e,
t
a
8.
h.
lPC22.3Page 6
k.
m.
n
Vector control
EAC was informed that the findings of entomological surveillance were, on the
whole, satisfactory. Operations had been intensified in the "special interventionzones" with good results. Field studies and investigations focused on the
characteristics of vector and parasite populations to determine the risk, if any, oftransmission after the end of OCP operations. Susceptibility testing continued and
national teams were involved in these research activities. Additional nationalentomologists would be trained so as to ensure proper entomological surveillance inthe post-OCP era.
Planninq, evaluation and transfer
The activities during the period under review focused on support to countries in theirimplementation of transferred activities which included strengthened collaboration inthe fields of Community-directed Treatment with Ivermectin (CDTI), epidemiologicaland ophthalmological evaluation and data collection and analysis. CDTI operationswere on the whole satisfactory with good geographical and therapeutic coverage as
demonstrated by an external evaluation. All countries, with the exception of two,now ordered ivermectin supplies directly from the Mectizan Donation Program(MDP). The results of epidemiological, entomological and ophthalmologicalsurveillance/evaluation were satisfactory although certain "special interventionzones" required particular attention. In this connection EAC recommended a
proposal for continued aerial larviciding beyond closure of OCP, and withoutadditional Donor financing, in four such zones, two in the east of the Programme area
and two in the West. Retraining of national staff took place during surveillance and
evaluation exercises thus allowing for effective transfer of data to the field level.
The Committee heard a statement by Dr Hans Remme on intervention research byTDR. A multi-country study of drug delivery methods for lymphatic filariasis haddemonstrated the effectiveness of community-directed treatment (achieving 77% -88% treatment coverage) as compared to mass treatment by the regular healthservices (with only 447o - 47% coverage).
Priority actions to be taken durinq the last lrh years OCP operations
This agenda item was considered in three working groups which reported to Plenary:" Vector control" , " Community-directed Treatment with laermectin" and " Epidemiological
Surueillance".Macrofil
The Committee was informed about the progress being made in the fields of clinicalstudies; pre-clinical activities; and drug discovery. Moxidectin studies were in the
final stage for investigation in humans. A special investigation was being carried outto determine the reasons for non-response to ivermectin in a small grouP of people.
The search for an ivermectin resistance detection tool continued as did the
development of the DEC Path Test.
Closure of OCP
a
t.
?
o EAC was informed about recent developments in the preparation for the closure ofOCP.
P.
IPC22.3PageT
Progress of APOC
Dr Azodoga S6k6t6li, Director of APOC, informed the Committee about thepreparations for Phase II and the Phasing-out Period of the Programme.
Report on TDR Operational Research
A summary description of recent modifications in the TDR structure and of plannedTDR operational research in support to OCP and APOC operations was provided byDr Hans Remme.
Cochrane Library review
The Committee decided to respond to the review by a letter to a scientific journal.
Other matters
A presentation on integrated data analysis was made by Dr N. Nagelkerke of theRotterdam University.
q
ar
s
t
'.22.3
ie8
OPENING OF THE SESSION
Therwenry-SecondsessionoftheExpertAdvisoryCommittee.heJdattherdquarters of oCP, was oPened by the Chair of tt'" Committee' Professor Adenike Abiose'
: welcomed Professor Oit Uabbema as a new Member of the Committee' and Dr Antoine
bor6, Director, Communicable Diseases Control in the wHo Regional office for Africa'
ro is also a Member of the oCP-APOC Committee of sponsoring Agencies (CSA)' she also
lcomed Dr M Hacen, WHO Representative in Burkini Faso, Drs Hans Remme and Marc
ram from wHO heaiquarte.r, th" National onchocerciasis Coordinators and Dr Azodoga
(6t61i, Director of APOC'
Professor Abiose stressed the importance of this EAC session which was the last but
e before the closure of oCP and on which the Programme depended fo-r advice on the
naining 18 months or op"*ions, on the closure of the Programme' as well as on guidance
the participating Countries concerning the post-oCP suiveillance and control activities
luired for maintiining the achievements of the Programme'
DrAntoineKabor6,representingthewHoRegionalDirectorforAfricawhop."r*J his regrets for being unable to ittend the session' referred to OCP as a Programme
which Africa could u" p.oia. It had managed to transfer methodologies and tools to the
rrticipating Countries ir, ti^" for them to te ready to undertake effective detection and
rntrol of any localis"d .".r,.rd"scence of onchocerciasis transmission that might arise after
CPcametoanend.TheProgra[unewassucceedinginachievingitsobjectivetoeliminate," di,u,," as a problem of public health and socio-economic importance.
TheDirectorofOCP,DrBoakyeBoatin,inwelcomingEAC.Membersandotherarticipants to OCP and Ouagadougou, underlined the importance of the annual sessions of
AC for the programme, occisionr-*h..t OCP staff obtained solid scientific knowledge and
perational .*p.ri.n.", essential for the work of the Programme' H: *u:-particularly
leased that Dr Kabor6 had been able to attend the session uJt"pt"s"tttative of Dr Samba'
. He particularly looked forward to the Committee's recommendations regarding
;suesofprimeinteresttothefinalstagesofoCPi.I:ll"twhichincludedguidanceonontinuing larviciding in some specific.'u."u, beyond 2002 and', in this connection' on the
:asibility and efficacy of ground larvicjding. fhl Ptgg-tlT-e Director also referred to the
ituation in Sierra Llone and solicited thJ view of gaC ott the possible impact of the
uspension of treatment in that country on Guinea and Mali'
,. As regards Community-directed Treatment with Ivermectin (CDTI)' Dr Boatin
eferred to the implementation of previous EAC recommendations and encouraged the
rommittee to come up with further iuggestions to ensure viabre CDTI in the Participating
lountries. He also invited suggestion, oi ho* to enhance cross-border common issues and
nter-country collaboration and activities'
z. The possibility of ivermectin (Mectizan @ ) resistance should not be dismissed and
;uggestionswouldbewelcomedastohowtodealwithsuchresistance.Difficultieshadlrisen in regard to the signing of a Memorandum of Understanding with a commercial firm
for the development of -the bgC patcn Test and, again, any suggestions for solving the
problem would be welcomed'
g. Preparations for the closure of oCP were well underway with the help of a committee
appointed by the n"gi"."r Director of wHo/AFRO and chaired by Dr Kabor6' should any
o
I
C
IPC22.3Page 9
EAC Member have had experience with the closure of a project or programme of similarmagnitude, that experience might be useful for the future work of Dr Kabor€'s committee
B. ADOPTION OF THE AGENDA
g. The provisional agenda, Revision 2, as reflected in the list of contents of the present
report, was adopted.
FOLLOW.UP TO THE RECOMMENDATIONS OF THE TWENTY-FIRSTSESSION OF THE EXPERT ADVISORY COMMITTEE
10. Dr Boatin, in referring to Annex 2 to the EAC21 report ("List of EAC21
Recommendations") informed the Committee that practically all its recommendations had
been implemented.
D MATTERS ARISING FROM THE TWENTY-FIRST SESSION OF THE
IOINT PROGRAMME COMMITTEE
11. The following points came up during IPC21. and the Joint JPC-JAF6 Session inconnection with Professor Abiose's report to JPC21 on the EAC21 proceedings:
satisfaction was expressed about the progress of OCP and its preparation for closure;there was a call for strengthened ownership by communities of their CDTI projects and for astudy on the impact of ivermectin treatment on transmission;a decision regarding a proposed " soft" loan by the World Bank for vector control andlarviciding in Sierra Leone would be taken in the light of the findings of a special study byOCP concerning the risk of re-invasion from Sierra Leone to neighbouring countries;the plans for establishing an AFRO Multidisease Surveillance Centre (MDSC) with the helpof OCP facilities and its means of communication was welcomed by JPC ;
JPC supported the FAO initiative for support to socio-economic development in oncho-freedzones and agreed to the planned West African Freshwater and Management Projectestablishing its headquarters in the AFRO Multidisease Surveillance Centre;the Joint JPC2L-JAF6 Session agreed to JPC and APOC collaborating with the LymphaticFilariasis Elimination Programme in co-endemic zones, excluding hypo-endemic areas;the |oint Programme Committee approved the OCP Plan of Action for 200L and thecorresponding budget in the order of US$ 1,4770 000.
***Administrative briefing
12. As in previous years, the Administrative and Finance Unit provided, in addition to itssupport of OCP operations, services to APOC in respect to Personnel, Finance, transport andpurchase of equipment. The Unit had been strengthened by a Translation Section and aSection responsible for the organization of Statutory Meetings.
13. With the scrapping of old vehicles and no purchase of new ones, the reduction in thefleet continued. The Garage activities were directed to more efficient maintenance of thevehicles and increased training for the drivers in order to reduce breakdowns.
I
a
IPC22.3Page 10
'14. The OCP radio network, connecting all the Participating Countries, facilitatedcommunications with, and among,, National Coordinators as did the Codan radios equippedwith cc-mail facilities.
15. Arrangements had been made at OCP Headquarters for increased efficiency inconsultation on the Web and exchange of e-mail and other information.
16. As the Programme is nearing its end, the purchase of equipment is steadilydecreasing.
17. The number of staff in OCP had been reduced to 278 of whom 92 were on WHOstatus and the remainder employed under different arrangements (e.9. Special Service
Agreement). The Programme continued to provide certain benefits to 279 nationallyemployed staff working in their own countries under OCP technical and administrativesupervision.
18. Special efforts continued to prepare OCP staff for their departure from the
Programme at its end of operations. Training was provided in such fields as secretariat,
documentation, informatics, vehicle mechanics, finance and laboratory work to qualify the
staff for new activities after the closure of OCP.
E. REVIEW OF THE REPORT OF THE TWENTY.SECOND SESSION OF THEECOLOGICAL GROUP
I
19. The report was introduced by Professor Vincent Resh, Chair of the Ecological Group,who pointed out that six of the eight recommendations made by the Group at its session in2000 had been implemented. As to last year/s recorrunendation conceming "Land-use
Changes as Part of Environmental Monitoring in Oncho-freed Zones", the Ecological Grouprecommended at its recent session that a search should be made for historical data on the
occupational and ecological state in zones later freed from onchocerciasis, before
determining the ecological state of oncho-freed zones at the end of the Programme. Inquiriesshould therefore be made regarding the availability of remote sensing information on studysites and related areas.
20. As regards the preparation of synopses of scientific results from monitoring activities,also recommended by the Ecological Group a year ago, the Group now recommended, that a
non-technical brochure prepared by a team be published by OCP, and that a Steering
Committee to plan the preparation of a technical volume should be established during the
current year.
21,. On the specific issue of the impact of ivermectin on the environment, it was pointed
out that as the molecule was strongly bounded to the soil with rapid degradation, the risk ofcontamination of the aquatic environment, for which the drug is highly toxic, was almostnon-existent. As emissions occurred during two to three days only after the treatment and
was limited to areas immediately surrounding the villages, the risk to terrestrial organismswas also limited.
22. A Member of the Ecological Group had undertaken a cost-benefit analysis of the
Group's contribution to OCP which concluded that the consequences of acceptance of the
recommendations of the Ecological Group could be estimated at an Internal Rate of Return ofat least 31% which is extremely high.
t
a
IPC22.3Page 11
?3. The Group expressed, once again, its satisfaction with the results of vector controlduring the preceding year when the Annual Transmission Potential (ATP) of savannaspecies, with only one or two exceptions, fell well below 100. The Group also noted thesatisfactory performance of B.f. H-14 which was being increasingly applied in preference tochemical larvicides.
24. Regarding monitoring activities until the end of OCP operations, it was recommended
that they should centre on the same watercourses and at the same frequency as in 2000.
25. It was finally recommended that OCP should collaborate with the West AfricanFreshwater Biodiversity and conservation Project ready for implementation once financingby the Global Environmental Fund had been secured.
REPORTS ON THE VISITS OF EAC MEMBERS TO THE PROGRAMMEAREA
26. Dr Bernard Philippon in reporting on his visit in Mali to Baguineda and S6lingu6,stated that both foci were situated in previously hyper-endemic areas with considerableimportance for socio-economic development. They were both under ivermectin treatmentand would qualify for nuisance control by ground larviciding.
27. In the Niger area near Bamako, ground larviciding had shown good results but aftercessation in 2002 the nuisance factor was likely to retum and larviciding might need tocontinue.
28. As to post-OCP surveillance and control of onchocerciasis and blackfly nuisance,activity plans should be developed even now.
EAC comments
29. Dr Philippon expressed as his opinion that ground larviciding could be an effectivemeans of nuisance control in restricted and isolated foci but not for the control oftransmission on large river basins, Iong stretches of rivers, high discharge rates and difficultaccessible terrains. After the end of OCP operations the control, wherever needed, wouldrely on intensified Community-directed Treatment with Ivermectin (CDTI). In thisconnection, the question was posed if after 2002, there would be a need for aerial larvicidingin certain foci where transmission was still ongoing.
30. A report on a visit to Togo was provided by Dr Yoichi Yamagata. The purposes of hisvisit were to evaluate entomological achievements in the Upper Keran and Lower Karabasins; to evaluate CDTI implementation; and to make suggestions for post-OCP activities.His impressions can be summarised as follows:
ground larviciding on the Kara and Keran would be sporadically possible during the dryseason but almost impossible during the rainy season;sporadic ivermectin distribution by mobile teams started in 1988 while CDTI started in 1997followed by twice yearly applications only since 2000;problems in the implementation of CDTI included lack of motivation of Community-directedDistributors (CDDs); failure of updating of community census and heighu and registers notavailable;good acceptance of CDTI after a couple of years of refusal and skepticism;
F
t
lPc22.3Page12
there was a great deal of misinterpretation of the onchocerciasis-related vocabulary and
many questions apparently unrelated to the treatment were asked at the community level;
they showed, however keen interest and deserved serious consideration and answers by the
CDDs and health centre staff.
He made the following suggestions and recommendations :
there was a need to improve the format of registers;in some villages, the number of CDDs should be increased;all possible means of motivation of CDDs should be explored; they should be provided withbicycles and a stock of pamphlets;health centre nurses should ensure that CDTI periods conform with the prospect ofmaximum therapeutical coverage; they should consider CDDs as equal partners and returnto them registers u'ithout delay;Regional Onchocerciasis Teams should promote the Bamako Initiative; ensure oncho
information through radio broadcasts; and arrange for refresher courses foi CDDs;
31. The National Onchocerciasis Teams should budget for bicycles, advocate for funds,
draft teaching material for CDDs and update oncho pamphlets.EAC nts:
32. In reply to a question regarding the justification for twice yearly ivermectin treatment
in the Upper Keran valley, it was explained that the purpose was to intensify the reductionof transmission even if the possibility of increased selection for resistance could not be
excluded.
33. It was suggested that consistenry of reviews and reporting should be attempted forfuture country visits by EAC Members.
34. Dr Andr6 Yebakima reported on his visits to C6te d'Ivoire and Guinea. As toivermectin distribution, he stressed in conclusion, that the efficienry of CDTI depended notonly on the effectiveness of ivermectin but also on a satisfactory supply of the drug, on thequality and involvement of CDDs as well as on an ongoing evaluation. More specifically, he
had observed that although a great deal of treatment data and other information existed theywere not always being used by the CDDs for the organisation of their work.
35. Dr Yebakima made a series of recommendations relating to specific situationsregarding CDTI in the villages visited, including:
the need for the CDDs and health centre nurses to acquaint themselves with the mostimportant social data of the village populations;to promote community participation and ownership through information sessions forcommunity leaders.
36. In respect to vector control, Dr Yebakima underlined the importance of increased
entomologicaI evaluation in "Special Intervention Zones" under larviciding.
37. In referring to the breeding sites on the Mafou river (Yalawa, Guinea), he did notbelieve that ground treatment would be possible during the rainy season (although feasible
during the dry season) due to difficulties in accessibility. He called for intensive discussionon future vector control and entomological evaluation in this, as in other zones with similarproblems.
t
t
J
IPC22.3Page L3
38. Dr Yebakima did not have the necessary information allowing him to pronounce onthe situation in C6te d'Ivoire regarding Transfer of OCP activities and preparedness for post-OCP surveillance and control. His impression in Guinea was that the structure and staffwere in place to en'sure effective operations. All possible efforts should be made to maintainthe "OCP dynamic" after the Programme came to an end. Both in COte d'Ivoire and inGuinea, did he observe experienced and motivated teams at work.
EAC comments
39. On the question of motivation of CDDs, it was pointed out that lack of commitmentcould, among other consequences, result in poor filling out of records. In this connection itwas suggested that a satisfactory level of motivation did not necessarily result from financialincentives, other aspects like "satisfaction to serve" might be equally important. However,there was a need for those responsible for national CDTI programmes to consult with otherprogrammes providing incentives to their health workers in order to avoid competition forrecruitment of field workers.
40. The question was raised whether or not the CDTI mode of distribution was the onlymethod to be applied or if other means of ensuring ivermectin reaching people in thecommunities should be explored.
41,. Prof. Detlef Prozesky made a presentation on the research he had done in Benin,conceming the level of motivation of health centre nurses in CDTI areas, and the factorsinfluencing that. This followed on the previous year's similar presentation on the motivationof CDDs. The research was done in partnership with the National Coordinator in Benin, Dr]ulius Gaba, and his deputy Dr Franck Sintondji.
42. It was found that, out of 14 nurses, only 6 were highly motivated for CDTI activities,and 3 had low motivation. The factors that facilitated motivation, or were obstacles to it, hadfirst and foremost to do with the support the nurses received from the health service, andtheir relationship with the communities in which they worked. Prof. Prozesky made a pleathat the question of motivation of CDTI workers be tackled systematically,by clarifying theirmotivational state through research; making interventions based on findings; and evaluatingthe result.
EAC comments
43. Governments in newly independent countries had originally assumed responsibilityfor health care, a responsibility which people were only now beginning to take over,resulting in community-directed treatment. It was important that communities assumed fullownership of such treatment and ensured the appointment of capable and effectiveCommunity-directed Drug Distributors (CDDs).
44. It was also important to note that motivation correlated with the performance level,which was the visible result of energy spent by health staff.
45. Onchocerciasis control would not be a priority concem for health centre staff(nurses) and would therefore need to be integrated with other health developmentprogrammes ensuring, however, that sufficient attention and support be given to CDTIactivities when carried out once, or twice, a year.
{
JPC22.3Page1.4
46. Consideration also needed to be given to the duration of ivermectin treatment - 20
years or more while nurses frequently moved from one health centre to another every five
years or so.
G. REVIEW OF SCIENTIFIC, OPERATIONAL AND TECHNICAL ISSUES
47. EAC noted the generally satisfactory epidemiological and entomological situation
within the Programme area.
VECTOR CONTROLProsramme report
48. During the period under review the entomological results were satisfactory with
declining transmission trends throughout the Programme area. All catches in a total of 1'07
catchhgfpoints showed Annual Transmission Potentials (ATPs) below 100 when limiting the
counts to savanna species transmittin g Onchocerca aoluulus with the exception of two points:
Vialadougou on the Sassandra in the Western Zone (ATP 147) and Djabata on the Okpara in
the Eastern Zone close to the border with Nigeria (ATP 2aa)'
49. Larviciding during 2000 remained practically unchanged from that of-the preceding
year. How"*r"., op"rutions were disturbed in the basins of the Kolent6 and Kaba-Mongo
iiu"., due to rebel incursions from Sierra Leone. Operations were intensified in the "specific
intervention areas". Pilots were frequently accompanied by OCP staff; ground or aerial
prospections were also intensified; ground treatments were largely carried out by the
fp.r"tio.,rl bases to complement aerial larviciding; and new access roads to the breeding
sites were identified.
50. The aerial fleet stood at 5 helicopters to be reduc6d to three during 2002, the last year
of OCP operations. In the year 2000, Iarvicide consumption rose by 12% from that of 1999
due to the proportional increase in the use of biological insecticides to minimise the risk of
resistance to chemical insecticides.
51. Field studies and investigations focused on the characteristics of vector and parasite
populations with a view to determining the risk of such populations transmitting
inihocerciasis after the cessation of OCP control. The main emphasis has been on the
characteristics of Simulium sirbanum and the possibiliry of it being involved in transmitting
through its seasonal migration from Sierra Leone to Guinea and Mali.
SZ. The Programme continued susceptibility testing of Simulium larvae to
organophosphorous compounds as well as field and laboratory studies designed to improve
the formula[ions of Bacillus thurengiensisH14 compounds (Vetobac and Teknar). Much of the
research activities rvere conducted with the participation of the national teams which were
thus familiarised rvith field research and investigation methodologies and techniques in
preparation for their involvement in such activities after OCP came to an end.
53. The Vector Control Unit has strengthened the involvement of the national
entomologists in its activities through a) studies of the level of infectivity of the vector, b)
their participation in the daily activities of the operational bases, and c) the writing up of
synthlsis documents on the activities of the Programme in the main river basins. Former
drcp rtuff members have also contributed to this last mentioned exercise.
t
..
j
JPC22.3Page 15
54. Additional national entomologists would be trained during the current year toincrease the national capability to address entomological issues. Training modules had been
finalised to support this training at the national level.
PLANNING, EVALUATION AND TRANSFER
Proeramme report+
55. During the period under review, the Programme concentrated its efforts to ensure theeffective implementation by national health authorities of transferred activities. The supportto ivermectin distribution was strengthened as was the collaboration with ParticipatingCountries in the fields of epidemiological and ophthalmological surveillance and evaluationwith particular emphasis on data gathering, processing and analysis.
56. Distribution of ivermectin through the mode of Community-directed Treatment withIvermectin (CDTI), adopted by all OCP countries, covered 7.3 million people out of 9.8
million registered (mean therapeutic coverage of 7a%) in 20 441, villages (mean geographiccoverage: 97% in six countries Benin, Burkina Faso, Guinea, Mali, Senegal and Togo). InGhana the annual treatment began at the end of 2000 and during the first quarter of 2001
with a few treatments carried out in C6te d'lvoire. In Sierra Leone, training and communitytreatment were conducted in the south of the country with financial support by OCP andSight Savers Intemational. Epidemiological evaluation was planned in Guinea-Bissau todecide on the advisability of resuming CDTI after three years suspension in the Rio Gebaand the River Corubal basins.
57. The findings of an external evaluation carried out in Benin, Ghana, Guinea and Maliwere presented by the Coordinator of Mali, Dr Mamadou O Traor6 who reported that theCDTI approach was well established in the four countries visited. The mean geographicalcoverage was found to be 85.8% and the mean therapeutic coverage 75.7%. However,additional efforts were required in the field of sensitisation of the communities.
58. The communities paid particular attention to the choice of CDDs, their motivationand a regular and sufficient supply of ivermectin. Monitoring and supervision at the level ofthe communities and the health centre staff should be reinforced. Support by "Health andSocial Services" workers should be solicited for strengthening community involvement.
59. With the exception of Guinea-Bissau and Niger, all OCP countries now ordered theirsupplies of ivermectin directly from the Mectizan Donation Program (MDP). Monitoring wasstrengthened in areas with unacceptable levels of transmission as well as in areas whereivermectin treatment might possibly cease as the epidemiological situation was highlysatisfactory.
60. Epidemiological surveillance in the Original Programme Area was conducted inalmost 90 villages in Benin, Burkina Faso, C6te d'Ivoire, Ghana and Niger. The findingsranged from satisfactory to excellent with the majority of the river basins showing zeroprevalence. However, an investigation into the incidence of more than 1%, observed in twovillages in the N'Zi basin in C6te d'lvoire, seemed to indicate that it was a localphenomenon. Ivermectin treatment would be implemented in these areas. Also, in the riverbasins of Sissili in Ghana and of Oti and its tributaries in Benin, Togo and Ghana underivermectin treatment, the epidemiological situation remained unsatisfactory and called for a
special study.
a
IPC22.3Page1.6
61,. In the Extension Areas, epidemiological evaluation was undertaken in 242 villages in
Benin Ghana, Guinea, Mali, Senegal and Togo under combined vector control/ivermectintreatment or exclusive ivermectin treatment. In those basins where vector control would
cease end-2001 (Sankarani, Dion, Milo and Kaba in Guinea; Amou, Anie, Asukawkaw/Dayiand Mono in Togo; and tributaries of Lake Volta East to the Dayi and Asukawkaw river
basins in Ghana) the evaluation results were on the whole satisfactory. In those zones in
Guinea, Mali and Senegal where ivermectin distribution was the only means of
onchocerciasis control, the results of evaluation were excellent with more than 40% reduction
in prevalence of infection, which reached 80% in some villages before the start of large-scale
ivermectin treatment.
62. To determine the impact of vector control in the Original Programme Area,
ophthalmological evaluation was carried out in seven villages in Burkina Faso, three in COte
d'lvoire and three villages in Ghana. Preliminary results showe d total absence of
microfilariae and ocular lesions in most of the villages while new ocular lesions were
detected in the villages of Mouvielo in the Bougouriba basin in Burkina Faso and the village
of Kayoro in the Sisili basin in Ghana. Apart from villages in Asubende on the Pru and
Kayoro on the Sisili, no new evolutionary lesions were found in the Extension Areas in
Ghana, Guinea and Mali.
63. A rapid test for the detection of IgG4 antibodies of. O. oolaulus was carried out in 12
villages of six countries where transmission had been intemrpted, in areas where
transmission had resumed, as in Burkina Faso, and in forest zones in COte d'Ivoire. The
analysis of the results in ongoing.
64. Integrated analysis of the entomo-epidemiological OCP data continued in
collaboration with the Erasmus University of Rotterdam in order to improve epidemiologicalpredictions made by the ONCHOSIM model and with a view to making the model a useful
tool for the Participating Countries. Work also continued on the use of integrated analysis to
study the impact of long-term ivermectin treatment on kansmission.
s
65. Retraining of national field staff was reinforced during the
implementation of epidemiological evaluations in consonance withParticipating Countries to ensure transfer of data to the peripheral level.
planning andthe interest of
j
t
EAC comments and ations
66. In response to a suggestion by the OCP Management that it miSht be necessary to
continue aerial larviciding beyond 2002 in the Oti tributaries (Kara, Keram-Mo) in Togo, the
river Pru in Ghana, and Tinkisso (village Fifa) and Mafou in Guinea , Members of the
Committee posed questions concerning the duration of the proposed aerial larviciding and
its cost.
67. The Committee was informed that the aerial larviciding, combined with ivermectin
treatment, would be required for 3 to 5 years and that the cost would be in the order of US$
2.5 million per year, except for 2003 when the larvicide reserve from 2002 would be used,
reducing the cost for that year to US$ 1.5 million.
68. This estimate included a minimum of staff to monitor and evaluate the impact of the
vector control/CDTI activities. It was suggested in this connection that economist advice be
sought to establish cost-efficiency of CDTI alone versus combined aerial larviciding/CDTIoperations.
t
lPC22.3Page17
69. Given the little time left before OCP comes to an end, it was suggested that EAC TaskForce(s) be established to look into specific matters of priority importance and makerecommendations for dealing with connected problems. Also, the joint vector control/CDTIactivities should be reinforced.
70. The coverage of CDTI remained essential for model predictions and it was pointedout that the omission of treatment of one village could have serious repercussions on otherwell-covered communities. It was explained, however, that the ONCHOSIM predictionswere based on the therapeutic minimal coverage of.65%.
71,. The Committee was informed by the APOC Director that the situation in Sierra Leonehad been a major concern expressed recently during visits to Donors in Europe. He hoped itwould soon be possible to collect blackflies in the northern part of the country to determinetheir capacity of transmitting the parasite. This would be more so important as it would be acritical element in the decision-making concerning the World Bank proposal to financeonchocerciasis control in Sierra Leone. In the meantime ivermectin distribution had beenorganised where conditions so allowed, and in refugee camps.
72. In response to a concern expressed regarding the exclusion of Liberia from OCPcontrol, it was explained that the blackflies were of the forest type and did therefore not posea risk of transmission of the blinding form of the disease into neighbouring countries.
73. A question was posed why it took so long for the results of the laboratoryinvestigation of community collected blackflies for post-conkol studies to reach the offices ofthe National Coordinators. The answer given was that the OCP Molecular Laboratoryrequired several thousands blackflies for DNA testing which it could very well take time tocollect. National Coordinators should investigate the matter of how village fly catchers wereto be motivated after 2002 and take steps to ensure sustainability of this activity.
74. Suggestions were made for expanding the predictive capacity of ONCHOSIM byincluding parameters on drug resistance and refining simulations to take into consideration avariety of operational conditions. It was pointed out that preliminary studies had been doneand that the current updating of the model would take some time.
UPDATE ON FILARIASIS INTERVENTION RESEARCH BY TDR
75. Dr. Hans Remme provided an update of the activities of the TDR Task Force onFilariasis Intervention Research. A multi-country study on the implementation andsustainability of CDTI had been completed. Key baseline findings identified that before theintroduction of CDTI there was poor communication and interaction between communitymembers and health workers. An enhanced approach to CDTI was tested with as mainenhancement local stakeholders meetings of community representatives and health workers.Treatment coverage was similar for enhanced and regular CDTI. The attitude of healthworkers to CDTI improved over time with both approaches but most significantly with theenhanced approach. It was recommended that control programmes consider the use of localstakeholder meetings to encourage ownership of CDTI by the community and to improveinvolvement of district health services.
76. A multi-country study of drug delivery methods for lymphatic filariasis haddemonstrated the effectiveness of community-directed treatment (achieving 77%-88%treatment coverage) as compared to mass treatment by the regular health services (with only44%-477, coverage). In this study, CDTI was introduced to the communities by the District
a
a
lPC22.3Page L8
Health Management Team (DHMT) and the process was effectively managed by the regular
health services. A study had also been undertaken of a simple and rapid method for
monitoring treatment coverage through questionnaires administered by school teachers to
schoolchildren. Coverage estimates obtained by the school survey method proved much
inore reliable than those reported using the regular method based on the village register.
Follow-up studies were planned to validate the school-based rapid assessment method
under large scale application at district level.
EAC comments
77. Responding to a concern that the communities involved in the study had benefited
from the availability of resources, not available under normal field conditions, it was pointed
out that routine CDTI activities in APOC communities had shown no tendency to decrease inefficiency.
78. The matter of "overloadi.g" Community-directed Drug Distributors (CDDs) withactivities additional to that of ivermectin distribution had been discussed in various fora,
recently in Uganda with the participation of staff from other health development
prograrnmes. The overall conclusion was that any decision on additional tasks for the CDDs
inouta be taken by the communities which should also ensure that the burden of work didnot exceed their capacity.
Zg. As to stakeholders meetings, Dr Remme explained that in many cases the firstmeeting was an opportunity for the various partners to establish contact and that it was onlyfrom the second meeting that operational issues and problers were considered. The
initiative of calling stakeholders' meetings would mostly come from health centre staff whowould see their status increase and at the same time their workload reduced by CDDs taking
on certain health-related tasks. The communities would decide on the attendance at
stakeholders' meethgs.
80. Some scepticism was expressed regarding the current system of preparation and
keeping of records which often lacked direct correlation between the reports and the
activities actually performed. There tended to be a great deal of over-reporting.
81. On the question of whether, or not, lack of incentives would result in low-level
sustainability, it was emphasised that the communities would decide on the
appropriateness/nature of incentives.
82. The importance of community ownership was again emphasised and it was pointed
out that instead of "imposing" elements of the CDTI process on the communities, they
would need to "find out" themselves.
83. Although the CDTI approach was considered the most appropriate for ivermectin
distribution, it needed improvement in its application in several countries as demonstrated
by National Coordinators in their reports to OCP. Generally, communities were capable ofimplementing CDTI in a satisfactory manner if the process was explained to them correctly
and introduced in a manner which conformed with true ownership. Also, communities
should have full controlover the timing of distribution.
84. Although CDTI was introduced in APOC countries from the beginning of
Programme operations, ivermectin distribution had been carried out several years before,
supported by Non-governmental Development Organizations (NGDOs) using more
a
t
IPC22.3Page L9
"vertical" approaches, a situation similar to OCP where the Programme also applied such
approaches before shifting over to CDTI.
85. The CDTI concept was based on stable community structures which might even be
maintained in refugee camps. Absenteeism should not be a serious problem insofar as the
CDDs could ensure that those absent at a particular time were "recuperated" later.
86. The Committee was informed that any deviation from height-determined dosing to a
standard treatment (say four tablets to all) would require a change in the registration of
ivermectin.
BZ. The Director of APOC informed the Committee that the Programme was in the
process of publishing in "The Annals of Tropical Medicine" a series of papers on the
different aspects of APOC operations.
H. PRIORITY ACTIONS TO BE TAKEN DURING THE LAST 71/Z YEARS OF
OCP OPERATIONS
88. This agenda item was considered in three working groups for presentation and
comments in Plenary. The groups' reports are summarised in this report while their full text
can be found in Annexes 3-5.
"Vector control"
89. As regards the "special Intervention Zones" (Oti & Pru in Zone East and Tinkisso &
Mafou in thsWest) the entomological situation had improved over the past few years, while
the prevalence and incidence remained high. This situation called for the continuation ofcontrol activities in these river basins after closure of OCP operation by the end of 2002.
90. The working group recommended that updated ONCHOSIM data and predictionsconcerning the four zones be made available within the next 15 days and that the duration ofcombined vector and ivermectin control be determined. It was also recommended that an
analysis be made within the next 45 days of the reasons for the unsatisfactory situation inthe four zones. The group finally recommended that steps be taken to constitute and trainnational teams in vector control which, after cessation of OCP operations by the end of 2002,
would take the form of aerial larviciding in the four special intervention zones.
91,. In respect to the situation in Sierra Leone, it was recommended that CDTI be applied as
the sole means of onchocerciasis control.
92. The group furthermore suggested that a vector control/ivermectin treatment workinggroup be established and that an ad hoc session of EAC be held early during2002.
93. In order to obtain support from CSA and the ]oint Programme Committee [PC), itwould be necessan'to convince the two bodies of the existing problems, the conditions formaintaining the achievements of OCP, including the need for post-OCP control inexceptional cases, and the need to approach the countries involved.
a
lPc22.3Page 20
EAC ts and recommendations
94. It was pointed out in a response to a question that the working group did not
consider the structure to support posI-OCP aerial larviciding (see following paragraph).
95. The Committee approved in principle the recommendation to continue aerial
larviciding for a few years beyond 2002 with the understanding that this be not considered
an extension of OCP operations and that the larviciding could be financed by the OCP
Contingency Fund, should the Donors so agree, without seeking additional Donor financing.
The final decision regarding the continuation of aerial larviciding in the four "Special
Intervention Zones" should, however, await the outcome of the ONCHOSIM predictions.
96. Once the finaldecision was taken to go ahead with combined aerial larviciding/CDTIcontrol in the four "special Intervention Zones", a convincing and well argumented
document would need to be presented to CSA and eventually to JPC in December 2001. To
strengthen the argument, reference could be made to the deplorable situation that existed
before OCP operations started and to the fact that any post-OCP control resulting in the finalsuccess would have cost implications in the order of only 1-2 % of the total amount whichwould have been invested in OCP by end-2002. A document of this nature was already
under preparation by the OCP Management. Also it should be stressed that it was not a
question to extend OCP beyond end-2002 but that it was a "mopping-up" action to ensure
that the zones in question would not become sources of recrudescence.
97. Efforts should be made to strengthen the CDTI process particularly in the four zones
and it was recommended that small "special intervention teams" be established to spend timewith CDDs, the communities and health staff to provide support and strengthen the
ivermectin distribution efforts, the communities retaining full responsibility and direction(see also paragraph 108 below).
"Community-directed Treatment with Ivermectin"
98. The group analysed the causes of persistent problems in CDTI, and found that mostproblems were related to the extent of the lack of integration of onchocerciasis control intothe national health system, which varied from country to country. The group thus presented
a set of practical recommendations, understanding that they could be selectively adoptedaccording to the specific situation of each country.
99. While the therapeutical coverage had generally met the target, geographical coverage
varied and was low in certain zones. This was mainly because of difficult access to some
scattered hamlets, in which it was also difficult to find literate persons willing to work forivermectin distribution. The group recommended that ivermectin treatment should have
flexibility in such cases by adopting both passive treatment of clinic attendees and active
treatment by health workers. Where needed, appropriate means of transportation might be
provided to CDDs by the communities at their discretion. It was further recommended thatlists of eligible villages be established before the end of 2002 on the basis of maps updated by
the district health staff. OCP should accelerate the development of the pictorial data
reporting form to assist CDDs without formal education.
100. Motivation remained a persistent problem at various levels of the health system.
National Coordinators should arrange stakeholders' meetings to advocate harmonisation ofmotivational schemes, while maintaining community directedness.
a
I
a
t
lPC22.3Page 21
101. It was emphasized that non-monetary incentives were the most important. Otherincentives could include refresher training courses; promoting experienced CDDs assistanceto training; providing CDDs with quality Information Education Communication (IEC)materials; acknowledging good performance by rewarding the communities, health centres,and districts with the "best practice"; and acknowledging and responding to reports andqueries. District Health Management Teams (DHMT) should also raise the issue of usinglocal sustainable financial resources (e.9. cost recovery for the provision of ivermectin,agricultural co-operative funds and Bamako Initiative funds).
102. National budget for onchocerciasis control existed in most countries, but not easilyaccessible. District budget also existed but onchocerciasis control was not given priority insome cases. OCP and National Coordinators should prepare advocacy packages forsensitisation of DHMTs on the importance of continued onchocerciasis control to preventrecrudescence. The Director of OCP should continue sensitising governments on theimportance of devolution, and urge governments to facilitate the early release of funds foronchocerciasis control activities. OCP should address this issue during the next JPC inWashington. National Coordinators should also mobilise extemal resources for national anddistrict control activities.
103. To ask the community to come twice to the health centre, first to fetch ivermectin andthen to bring the register, was unpractical in some cases. During the training of CDDs,agreement should be reached between health workers and CDDs on how the drugs andregister were to be transported. Health workers should use the CDD registers while onsupervisory visits and not keep them in the health centres. Countries should make their owndecisions on the most practical approach to ensure availability of registers. NationalCoordinators should help ensure smooth flow of ivermectin.
1,04. Supervision was poorly practised in most countries mainly because onchocerciasiswas not integrated into the national disease control planning. AFRO should therefore urgegovemments to integrate supervision guidelines to cover all prograrrunes, includingonchocerciasis control. National Coordinators should initiate actions to establish anintegrated supervision check list; the example of COte d'lvoire and Guinea-Bissau could betransferred. National Coordinators should work with relevant departments to include CDTIdata in the health information system.
105. Training/retraining needs were high because of weak performance, high staff turnover, newly recruited CDDs and the new ivermectin tablet size. Using the existing manualsand guidelines, front line health workers should be trained/retrained where the needexisted. Priorities should be on community entry/re-entry, IEC, management of ivermectin,data reporting, and supervision and monitoring. Basic curricula in onchocerciasis for doctorsand nurses were deficient or old-fashioned. Up-to-date training modules should be preparedin English and French for tutors in all under-graduate health care training institutions. Sincea variety of IEC materials relevant to onchocerciasis control already existed, NationalCoordinators should assemble/adapt their own country-specific IEC materials incollaboration with the national IEC officers. National Coordinators should ensure that allCDDs receive an onchocerciasis IEC package before the end of 2002.
106. Northern border regions of Sierra Leone were inaccessible because of persisting civilunrest. No definite plan of operations for onchocerciasis control could be drawn up untilsecurity in the area was assured. The National Coordinator should document the situationand guide OCP on the plan of action, especially on when to start training and CDTI. Specialentomological studies were to be conducted during the next dry season. Meanwhile the
a
I
lPc22.3Page22
National Coordinator should continue with CDTI in the southern part of the country and
pursue other options for financial support.
lO7. There was a need for a better understanding of the cross-border problem. It was
iecommended that OCP, with collaboration of relevant countries and APOC, establish a task
force to address the technical issues in the cross border areas such as human movement,
synchronisation of ivermectin treatment as well as the feasibility of involving commando
type of mobile support to CDTI. The Director of APOC would invite Benin to the next
seision of the Technical Consultative Committee (TCC) and provide the participants from
Benin with the opportunity of field visits in the border area on the Nigerian side'
108. As a matter of urgency countries should consider intervention in areas where the
epidemiological situation was unsatisfactory,by putting together crack teams of health
workers to work for a few months at village level, to optimise CDTI in all the villages
involved. This concerned Guinea, Ghana, Togo and Benin.
109. Indicators were suggested to track the implementation and accomplishment of all the
key strategies recommended by the group (see Annex 4). It was suggested that OCP should
support the countries' efforts to monitor the situation by means of these indicators.
EAC comments and recommendations
110. It was explained that the recorunendations made by the group did not necessarily
apply to all situations so that those responsible for CDTI activities would need to consider
those which conformed with their needs. Several of the recommendations would be
applicable to the "special InterventionZones" -
111. The list of indicators was intended to be used for trend analysis and their use woulddepend on the feasibility of data collection. Also, the list might usefully be compared withthat in use by APOC. It was emphasised that the criteria would be in use, not only for OCP
but also for the Participating Countries after the end of Programme operations. The
applicability of the indicators would be tested over the coming 18 months.
112. In response to a query as to what would be the criteria for cessation of CDTI
activities, the Committee was informed that this matter would be taken up during the
forthcoming study on the impact of ivermectin treatment on transmission.
113. As regards the concern expressed that some Participating Countries levied customs
duties on ivermectin consignments, it was recommended that contacts should be made withMinistries of Finance and that the WHO Regional Director for Africa might be requested to
intervene.
11,4. In respect to the expressed intention for Sierra Leone to be included in APOC
operations, it was pointed out that this would require a request from the Government to be
considered by the APOC Joint Action Forum-
"Epidemiological surveillance"
115. The group dealt with parasitological and entomological surveillance and how this
would be affected by the Lymphatic Filariasis (LF) Elimination Programme; the occurrence
of ivermectin resistance; and the use of moxidectin. The use of ONCHOSIM modelling and
the specific case of Guinea-Bissau were also discussed-
a
a
t
a
JPC22.3Page23
116. As to surveillance methods, the group recommended that skin snipping, for the timebeing, remain the main tool, with entomological surveillance as an additional tool, and thatthe DEC Patch Test replace skin snipping as soon as possible. The Group furtherrecommended that epidemiological surveillance be reconsidered in areas covered by the LF
Elimination Programme and that surveillance systems be developed for both onchocerciasis
and LF when the latter came to an end.
1,17. Another recommendation was that national programmes should reinforce monitoringof non-response to ivermectin and that the AFRO Multidisease Surveillance Centre (MDSC)
should be capable of detecting drug resistance. It was further recommended that nationalprogrammes prepare for monitoring of failure of moxidectin when available; that NationalCoordinators be trained to understand the concept of the ONCHOSIM model; and that theAFRO MDSC should develop expertise for the use of ONCHOSIM.
118. The group looked forward to the results of a study which would determine whetherGuinea-Bissau should undertake large-scale ivermectin treatment or confine the control tocase management.
179. Professor Dik Habbema summarised the future development of the ONCHOSIMmodel as follows:
DTI with ivermectin in integrated analysis ofOCP epidemiological and entomological data in order to learn more on the effectiveness ofCDTI and improving ONCHOSIM in this respect; simulations for both expected coverageand for higher/lower coverage figures; comparison of annual and half-yearly treatment;consideration of different levels of transmission; role of immigration of infected flies andhumans; criteria for when to stop CDTI.
Surveillance: simulation of possible development of recrudescence in onchocerciasis-freedzones; determination of sensitivity and specificity of differentepidemiological/ entomological surveillance strategies.
Larviciding beyond 2002: simulation of effectiveness of control strategies in "specialintervention zones" based on a combination of aerial larviciding with CDTI, compared tocontrol strategies based on CDTI alone.
Macrofilaricide: simulation of the use of a macrofilaricide under different assumptions ofeffectiveness of the drug.
Resistance: simulation of the possible emergence of resistance to ivermectin and its detectionby surveillance methods.
Dissemination: development of an ONCHOSIM demo-package; exploring the possibility ofbuilding up ONCHOSIM expertise in the AFRO Multidisease Surveillance Centre; helping inpreparing a workshop for familiarising National Coordinators and data managers withONCHOSIM.
EAC comments and recommendations
1,20. In considering the problem of epidemiological surveillance in areas under lymphaticfilariasis control, EAC recommended that negotiations take place between the coordinators ofthe two Programmes (in some cases one coordinator would be responsible for both) to agree
a
a
IPC22.3Page24
on the timing of lymphatic filariasis treatment so as to allow effective onchocerciasis
epidemiological evaluation to be carried out.
121. The Committee was informed that lymphatic filariasis (LF)was found to be highlyprevalent in those areas in the Original Programme areas where no ivermectin treatment had
teen carried out, while the prevalence in Extension areas with a long history of ivermectin
distribution was considerably lower. It was expected that LF mapping would be completed
in most West African countries early next year.
I. MACROFIL
122. This agenda item was introduced by Dr Janis Lazdins, Manager of Macrofil.
Clinical studies
123. Drug combinations: the Onchocerciasis Chemotherapy Research Centre (OCRC) inHohoe examined drug combinations (ivermectin + albendazole and levamisole +
albendazole or ivermectin) in the control of onchocercasis, revealing that there was no
advantage in using these combinations compared to using ivermectin alone. For lymphatic
filariasis, efficacy, safety of albendazole + ivermectin or DEC was studied in India and
Tanzania. Results were expected for the 4th quarter of 2002. They would guide the Lymphatic
Filariasis Elimination Programme and the integration with the onchocerciasis control
proSrarnmes.
124. htermectin 'non responders": a collaborative study (OCRC, Ghana National
Onchocerciasis Control Programme and Noguchi Memorial Institute for Medical Research inGhana) to define if the parasites of "non-responders" (more than 10 skin microfilariae per
snip after multiple keatments with ivermectin) from Asubende and Bui (Ghana) were
resistant to ivermectin had been initiated. The results would be available during the 4tr'
Quarter of 2002 (4Q02) and might determine the need to implement key changes in the
strategies for control and surveillance of onchocerciasis.
125. Moxidectin: in filarial animal models moxidectin has a better profile than ivermectin(including macrofilaricidal effect). It was promoted for drug development 4Q00. Activitiesrequired to be completed before evaluating the effect of this drug in patients withonchocerciasis had been initiated. It was expected to study the drug in infected patients
under strict clinical monitoring starting 1Q02 in OCRC. Before further field clinical studies
could be initiated, the Onchocerciasis Control Programmes should provide an indication on
how a new product such as this would be introduced and used in the field so as to providean idea on the type and amount of studies that would be required to achieve registration inthe most rapid wa1'.
126. Wolbachia: a clinical study to determine if eliminating this endosymbiont of filarialparasites with antibiotics (rifampicin-used in the context of DOTS in tuberculosis patients co-
infected with lymphatic filariasis) would kill adult worms, will be started in India (3Q01).
This should help to decide the relevance in public health of this approach.
Pre-clinical research activities
127. laermectin resistance detection tool: the product development team was addressing the
discovery of molecular marker indicative of ivermectin resistance in Onchocerca aolaulus; the
experts indicated that while there was no evidence of resistance in O. uolaulus there was also
a
a
a
IPC22.3Page 25
no reason to expect that this may not occur - in many animal parasites exposed to this drugresistance has developed; the team required close interaction with the members of controlprogrammes to have access to parasitological material from different geographical areas thathad been exposed to ivermectin treatment.
"128. Optimisation of DEC skin patch test; development of a standardised pre-packaged formof this test at an affordable price was feasible; a German company experienced in developingtransdermal delivery of drugs had been contacted; while strong initial interest wasdemonstrated, the progress in reaching an agreement (Memorandum of Understanding) has
been slow; active intervention of CSA would be desirable to transmit a message requestingmediation through the representative of the German government in the World Bank with theconlpany in question; furthermore, if such product were to be developed, a consultation todefine tl-re national requirements for product release for use should be conducted for whichthe input of the control programmes would be important; also defining the extent of use byAPOC countries would be relevant to establish a negotiating position with the potentialmanufacturer.
Drug discovery activities
129. The emphasis of drug discovery had shifted from evaluating existing drugs in theveterinarian field in animal models to that of identifying specific filarial targets fordiscovering novel, specific and potent drugs. This was mainly because most of the existingmolecules from animal health had been examined with poor results. Specific focus wasdirected to: inhibitors against aminoacyl-tRNA synthetases; assay for screening novel tubulinligands; and genetic research (reoerse genetics of C elegans to aalidate nat antiflaial drugtargets) with the scope of identifying novel drug discovery targets. Pursuing these activitieswas of key relevance since the only candidate for clinical testing currently available wasmoxidectin.
130. On the subject of resistance to ivermectin, Professor Roger Prichard informed theCommittee that resistance had occurred in nematode parasites in animals and could occur inOnchocerca aolaulus .Should this happen, it could be a serious threat to OCP and APOCoperations and could result in recrudescence.
131. Based on experience of nematode parasites in animals, moxidectin should it beregistered for use in humans, was likely to be very useful in reducing the threat of controlbreakdown due to resistance.
732. Any ivermectin resistance should be detected rapidly, before it spreads. A diagnostictest for this would be needed. Progress had been made on developing a tool for detectingivermectin resistance in O. uoluulus. However, the test needed optimisation
EAC comments and recommendations
133. As to the use of moxidectin, it was explained that it might be applied in large-scalecontrol operations.
734. The DEC Patch Test, once ready for application on a large scale, would be of use notonly by OCP and APOC, but also by the Participating Countries for measuring prevalencetrends.
a
a
lPc22.3Page26
135. In response to a question regarding the risk of more than once a year ivermectin
treatment selecting for resistance, the Committee was informed that bi-annual treatment was
acceptable as long as no cases of resistance were detected.
136. The Committee made the followingrecommendations;
a the development of moxidectin for use in humans against Onchocerca uolaulus to be
given the highest PrioritY;
b. the effects of moxidectin against microfilariae, adult worms, reproduction in adult
worms, in t3 and L4, in humans, and on the development of microfilariae to [3 in the
vector to be assessed during its developmen|c. following successful development of moxidectin, it be employed against O. oolaulus
as soon as possible;
d. the development of a diagnostic tool for the detection of ivermectin resistance to be
accorded the highest PrioritY;
e. surveillance for ivermectin resistance within the OCP/APOC areas to be established
as soon as the tool is available; this surveillance is likely to be carried out inassociation with either entomological surveillance for microfilaria or epidemiological
surveillance (skin snips) and will involve samples (e.g. flies) being sent for DNA
analysis in the AFRO MDSC;
f. to facilitate the development of the ivermectin resistance diagnostic tool, the
provision of O. aolaulus material by OCP to the Diagnostic Tool Development Team
to be accorded a high priority by OCP.
L CLOSURE OF OCP
137. In view of the closure of OCP on31./L2/2002 the Regional Director of WHO/AFRO
had set up a working $oup chaired by Dr A. Kabor6 (DDC/AFRO) and comprising staff
members of AFRO Regional Office, OCP and APOC. The working group had to make
recommendations on redeployment, whenever possible, of staff and on disposal of the assets.
138. Staff assistance would consist in training to facilitate employment search after
closure of OCP, forwarding of CV's to all possible organisations of the United System, WHO,
ApOC, WRs and NGDOs. The Programme would also authorise staff members to leave theprogramme before 31,/12/2OOZ without losing their rights, in case employment opportunity
arisis. The disposal of Programme property would be conditioned by the Memorandum of
Understanding signed between the Programme and the eleven OCP countries in September
1997.
l3g. The two operational Units of OCP, Vector Control Unit and Planning, Evaluation and
Transfer Unit will progressively end their operations during2002. Nevertheless the Vector
Control Unit would hive to extend its activities beyond 2002 for a few months in order to
definitely close all field activities, larviciding treatments, dismantling of telebeacons,
computerisation of Iast records etc
140. Finally, the Programme would have to retain a small administration team after
31,/1,2/ZOOZior a short period (2 to 3 months) to close all financial and pending matters of
staff members.
a
a
t
JPC22.3Page27
L41,. The Director of OCP informed the Committee that modules, and training manualswere now available at the country level and plans were underway to publish a book on the
OCP experience intended for readers interested in health development programmes, as wellas an update of the scientific document covering OCP operations.
142. Dr Antoine Kabor€ informed EAC that a first report on all aspects of the closure ofOCP had been submitted to the WHO Regional Director by the committee of which he is the
Chair, and that the committee would meet during the following week. The committee paidparticular attention to making the best possible arrangements for the staff and tried,whenever it was possible, to retain them by giving them priority, as appropriate, in fillingposts in APOC, the AFRO Multidisease Surveillance Centre and even within the AFROstructure.
143. The OCP telecommunication system and the library were among the facilities thatwould continue to serve the Participating Countries.
1,44. As to the AFRO Multidisease Surveillance Centre, Dr Kabor6 informed EAC that the
basic document for the Centre was now ready and that a small team would gradually moveto the Centre (the interinz responsible officer was already in place). The Centre wouldconcentrate its efforts on the control of onchocerciasis, meningitis, malaria and HIVinfections. A Plan of Action for the work of the Centre during the last 6 months of 2001 was
being prepared. The Centre would develop and utilise its own public health laboratory and
discussions would take place regarding the future of the Hohoe OCRC laboratory.
K. REPORT ON THE PROGRESS MADE BY APOC, ITS PREPARATIONSFOR PHASE II AND THE PHASING.OUT PERIOD OF THEPROGRAMME (2002-2010)
L45. Dr Azodoga ftketeli, Director of APOC, informed the Committee that a draft of a
Programme Document (corresponding in OCP to a Plan of Operations) for Phase II of APOCoperations (2002-2007) had been developed in consultation with all partners (includingParticipating Countries, NGDOs, TCC, and CSA). The Programme Document covered inaddition operations during a Phasing-out Period (2008-2010). Contacts had already beentaken with Donors who had all accepted the principle of the need for a Phasing-out Period.
1,46. The estimated financial requirements were in the order of US$ 68 million for Phase IIand US$ 11 million for the "Phasing-out Period". By 2007,45 million people would be underivermectin treatment in the APOC area and by the end of the Programme (20L0) in all 50
million people.
EAC comments and recommendations
1,47. To a question whether Loa-loa was a problem in Nigeria, Dr S6k6t6li stressed that so
far severe adverse reactions to ivermectin had only been reported from one country,Cameroon, within the Programme area. The Committee was reminded of last year'srecommendation that the situation in Cameroon be investigated.
L. REPORT ON TDR OPERATIONAL RESEARCH
749. Dr Hans Remme informed EAC about TDR's new overall strategy and relatedchanges in the organisation of work. The disease portfolio of TDR was now flexible with twonew diseases added recently. There would be greater emphasis on implementation research
a
a
JPC22.3Page28
and TDR now operated under a matrix management structure in which disease-specific
planning and budgeting received greater attention.
150. The research strategy for onchocerciasis control had been updated in consultation
with OCp and ApOC. The ievised strategy focused on i) sustained control using available
interventions, and ii) improved tools for treatment and surveillance.
151. TDR had not yet decided if research on post-oCP surveillance and recrudescence
control should be included in its research strategy for onchocerciasis, and the opinion of EAC
was sought on this issue.
EAC ts and
1.S2. Although the work plan of the AFRO Multidisease Surveillance Centre was still to be
elaborated, it was likely thit the Centre would support operational research on surveillance.
The Centre would consult with TDR in further developing its plans in this resPect.
M. CONSIDERATION OF THE COCHRANE LIBRARY REVIEW ON,IVERMECTIN FOR ONCHOCERCAL EYE DISEASE" BY H EIERE, F
SCHWARTZ AND R WORMALD
153. The Committee questioned the relevance and validity of the review and decided to
respond to the review by a letter to a scientific journal (e.9. Lancet).
N. OTHER MATTERS : "Integrated Data Analysis"
154. Dr Nico Nagelkerke of the University of Rotterdam, The Netherlands, informed the
Committee that ONCHO simulations suggested that annual, or more frequent, large-scale
application of ivermectin as sole means of control had the potential for elimination of
onchoce.ciasis given a sufficiently high level of coverage. This was, as a matter of fact, the
strategy adopted by the Onchocerciasis Elimination Programme for the Americas (OEPA).
155. In order to establish an empirical basis for this elimination hypothesis, simulations
were carried out using data from OCP areas where large-scale ivermectin treatment had
been carried out, eitheialone or in combination with vector control. The interpretation of the
data was complicated by a difference between epidemiological and entomological results,
the latter sometime suggesting ongoing transmission in the presence of excellent
epidemiological findings. The results would be presented to a Joint OCP/TDR workshop in
October 2001 where conclusions regarding the potential for elimination was expected to be
arrived at.
156. Another ONCHOSIM simulation study compared the potential for onchocerciasis
elimination by means of a "hypothetical" macrofilaricide combined with ivermectin
treatment. The comparison yielded favourable predictions for elimination by the
macrofilaricide under tircumstances (coverage, frequency) that could not apply to exclusive
ivermectin control.
O. DATES AND VENUES OF FUTURE SESSIONS OF EAC
1S7. The Committee decided to hold its next regular session on23-27 September 2002 and
an ad hoc session on L1-15 March 2002, both in Ouagadougou'
,
a
I
IPC22.3Page29
1.57. The Committee decided to hold its next regular session on 23-27 September 2002 and
an ad hoc session on 11-15 March 2002, both in OuagadouSou.
.158. A Task Force with membership of Adenike Abiose, Andre Yebakima, Bemhard
Philippon, Detlef Prozesky and Fatu Yumkella or Mamadou S. Traor6 would meet on L-2
Octo^blr 2001, venue still to be decided. The meeting took place as scheduled, in Geneva. The
report is attached in annex 7.
P. APPROVAL OF THE DRAF"T REPORT
:r5g. A draft of the report was approved by the Committee with the understanding thatmodifications agreed upon during its consideration would be incorporated.
o. cLosuRE oF THE SESSION
160. After statements by the Chair, the Director of the Programme and Dr AntoineKabor6, Professor Abiose declared the session closed.
I
t
IPC22.3Page 30
ANNEX 1
LIST OF EAC 22 RECOMMENDATIONS
The Committee recommended
Ecological Group
1. That search should be made for historical data on the occupational and ecological
state in zones later freed from onchocerciasis (paragraph 19).
2. That monitoring activities continue until the end of 2002 on the same watercourses
and at the same frequency as in 2000 (paragraph 24).
Vector control
3. That updated ONCHOSIM data and predictions concerning the four "special
intervention zones" (Oti & Pru in Zone East and Tinkisso & Mafou in the West) be made
available within the 15 days following the closure of the EAC22 session (paragraph 90).
4. That an analysis be made within 45 days of the reasons for the unsatisfactorysituation in the four "special intervention zones" (paragraph 90).
5. That national teams be constituted and trained to participate in vector controlactivities in the four "special intervention zones" (see following recorunendation)(paragraph 90).
6. That aerial larviciding be continued for a few years beyond 2002 in the four "special
intervention zones" with the understanding that this be not considered an extension of OCP(paragraph 95).
7. That CDTI be applied as the sole method of onchocerciasis control in Sierra Leone(paragraph 91).
Plannine. evaluation and transfer
8. That small "special intervention teams" be fielded to support the CDTI process
(paragraph 97).
9. That ivermectin treatment should have flexibility in areas with scattered hamlets byadopting both active and passive approaches (paragraph 99).
10. That lists of eligible villages be established before the end of 2002 on the basis of maPS
updated by district health staff (paragraph 99).
11. That OCP, with collaboration of the countries concerned and APOC, establish a taskforce to address cross-border problems (paragraph 107).
12. That contact be made with Ministries of Finance in countries which levy customs
duties on ivermectin consignments (paragraph 113). - Comprehensive lists ofrecommendations can be found in Annex 4.
,
t
a
JPC22.3
Page 3 IAnnex I
13. That skin snipping remains, for the time being, the main tool for epidemiologicalsurveillance, with entomological surveillance as an additional tool, and that the DEC Patch
Test replace skin-snipping as soon as possible (paragraph 116).
1.4. That epidemiological surveillance be re-considered in areas covered by the
Lymphatic Filariasis (LF) Elimination Programme and that surveillance systems be
developed for the two Programmes when the LF activities come to an end (paragraph 116);
and that negotiations take place between the Coordinators of the two Programmes to agree
on the timing of LF treatment to allow for effective onchocerciasis epidemiologicalsurveillance (paragraph 120).
15. That national programmes reinforce monitoring of non-response to ivermectin andprepare for monitoring of failure of moxidectin when available (paragraph 1,17). - A list ofrecommendations regarding Macrofil can be found in paragraph 136.
a
a
I
JPC22.3Page32ANNEX 2
RECOMMENDATIONS OF THE APRIL 2OO1 OCP OPERATIONAL RESEARCH ANDSTRATEGY MEETING
1. Given the need to pool all the epidemiological and entomological data as well as all the
data on treatment with ivermectin in order to help make a decision, the meeting
recommends that a document (statistical yearbook) gathering all this data should be
prepared for each basin and for each country before December 2001 (OCP, NC ).
Z. The meeting took note of the proposal to stop larviciding in 2001 and to suspend
ivermectin distribution at the same date on the Dienkoa, Milo, Dion and Sankarani basins
that have been subjected to combined control for 1,2 consecutive years. To that effect, itrecommends the validation in 2002 of the ONCHOSIM model for these basins whilerespecting the protocol for stopping larviciding and undertaking a "post-treatment" typeentomological study (OCP, NC).
3. To study the impact of ivermectin on transmission, the meeting recommends the
following:
a) collect, enter and analyze existing data by late May 2001 (OCP, NC);b) use infectivity rates, prevalence, CMFL and incidence as indicators to analyze the
data of the selected basins (OCP, NC)c) set up in June 200L a catching network at Mako (Senegal) in order to compare the
1998 blackfly densities with those of 200L (OCP, NC).
4. In order to guarantee the delivery of ivermectin in the countries while minimizingproblems of custom duties in the recipient countries, it is recommended to involve the
WHO representatives in the countries in the reception of order for mectizan made by the
countries (OCP, CN).
5. The meeting recorrunends that stakeholders' meetings should be organized in the
countries in order to strengthen sensitization and advocacy of the opinion leaders,
partners, health staff and the communities to ensure their effective participation in CDTI(NC, OCP)
I
,
?
a
t
IPC22.3Page 33
ANNEX 3
REPORT OF WORKING GROUP A
Members
EAC: Vincent Resh (Pdt) - B. Philippon - A. Yebakima
National Coordinators: B6nin - Togo
wHo staff : L. Yamdogo (vCU) - H. Agoua (CAT/Est) - M. Sarr (CAT/West)- A. Ak6
(Aerops) - Y. Bissan (Rech.) - V. Ket6 (Hydro) - M' Karam (WHO/HQ)
Speci fic issues
Specific recommendations on the "black spots" areas
If extension of operations beyond 2002 (larviciding, cost figures) - concrete scientific
evidence to support suggestions.Specific recommendations on xenodiagnostics in Sierra Leone
Implication of closure of OCP (contract with Evergreen, Staff...)Update of schedule on pages 23 & 24 - EAC21 report - ref. table A of National
Coordinators Meeting report.
Specific issues : what priority ?
The "black spot" areas - Where are the black spot areas ?
Eastern Znne; Oti & PruWestern Zone: Tinkisso & Mafou
Observations
Entomo-Epidemiological indicators show that the situation in the 4 areas has greatlyimproved (especially transmission potentials) ever since the implementation of specific
actions. However, prevalence levels and incidence still remain too high. This situation can
cause a great harm to the achievements of the Programme and therefore calls for a continuedcombined action of vector control and ivermectin treatments beyond2002.
In this regard, the Group recommends
Situation : 2levelsEastern Zone:. Oti/Pru
Total agreement of the Group for the continuation of combined VC-IVM action af.ter 2002.
Western Zone : Tinkisso/ Mafou
The need to gather epidemiological data for Tinkisso. Thus the urgency to have this data.
t
,
lPc22.3Page 34
Annex 3
1. The Group urgently recommends that all efforts be made to update, within the
shortest possible time (15 days), data on the ONCHOSIM Model for the four basins in order
to have a better perception of the simulation (differtent hypotheses : IVM alone; IVM-VC, at
several levels of IMvI coverage) and to determine the duration of these actions.
2. The Group recommends that (within 45 days) a study be carried out on the causes of
the persistence of this situation in the four areas, mainly CDTI, so that the necessary
measures to ensure maximum and sustainable (therapeutic and geograhic) coverage could be
taken.
3. That emphasis be placed on the formation and training of national teams in Vector
control.
Concerning aerial larviciding
The different working Groups recognised the need for aerial larviciding to guarantee the
efficiency of intervention. This procedure must therefore be continued.
- Sierra Leone
After discussion the Group recommends that efforts being made for this country should be
centred solely on CDTI.
Suggestiott
To be able to say anything worthwhile on this issue vital for the post-OCP period, the group
suggests:
- the creation of a working Group/Task Force(lVM-VC)- an adhoc EAC meeting before the October 2001 CSA meeting. This EAC meeting could
also examine other issues.
SensitizationCSA October 2001 - )PC December 2001
The Group recognises the importance of sensitizng these two bodies with the aim ofinforming them as clearly as possible and convincing them about :
o
the pfgblelqg that still remainthe conditions for saveguarding the achievements of OCP
the need for an "exceptional" extension of some activitiesthe need for a common and strong "lobblring" towards some countries
The need for an adhoc EAC meeting
,
a
a
Recommendations
I
lPC22.3Page 35
ANNEX 4
REPORT OF WORKING GROUP B
The group analyzed the causes of persistent problems and found that the extent of
integration of onchocerciasis control into the national health system varies from country to
.o.rr,try. The group thus presented a set of practical recommendations, understanding that
they could be selectively adopted according to its specific situation.
Low
ProblemsWhile the therapeutical coverage has generally satisfied the goal, geographical coverage
is alarmingly low. This is mainly because of difficult access to some scattered hamlets;
where finding Iiterate/ willing persons is also difficult. List of eligible villages is lacking.
P ractical r ecomnrcn da tions :
- Adapt CDTI in difficult situations, and then return to the ideal as soon as possible.
- Provide one or two bicycles per health centre, for CDDs to use on rotation.
- Passive treatment of all eligible health centre attendees from these hamlets.
- Actively make links with hamlets through clinic attendees - even find possible CDDs.
- Use health workers (e.g. nurse aides) as active distributors - as an interim measure,
while continuing to motivate the community.- District level staff must update maps of their districts, showing all villages (and
including hamlets and their names).- List of eligible villages to be established by OCP and NOCs before the end of.2002,
which should contain Criteria of the villages in terms of oncho importance, together
with latitude and longitude.- OCP to accelerate the development of the pictorial form (which can be used by
literate persons).
Motivation
Motivation is one of the most serious and widespread problems which persist at differentlevels of health system.
1. CDD level
. ProblemsDifferent programmes (NGDO, State, WHO related) offer different incentives, whichharm other programmes and may contradict the'community directed'approach..
Practical recommendations
- NCs to arrange programme stakeholders' meeting to advocate communitydirectedness.
- Communities may be informed about possibilities for raising funds for their CDDssuch as cost recovery capitation for the ivermectin, funds raised by the community:agricultural co-operatives, Bamako initiative, etc.
- Refresher training courses should be utilized as an opportunity of motivating CDDs.
The courses should be combined with a package of good quality IEC materials,recruitment of some experienced CDDs as facilitators, and certificates.
\
i
IPC22.3Page36Annex 4
2 Community level
Problems
Some communities were wrongly approached and see CDTI as someone else'sresponsibility. Some communities have had bad experiences from health service staff,like having to pay for'free' services.
P ractical r ecomnt en dations- Promote collaboration between the nurses and social workers and other extension
workers, in meeting and negotiating with communities.- Health workers should be reoriented on community entry skills for CDTI, using
existing OCP or APOC training materials.- District health managers may consider a'best community award' - e.g. a bicycle.- If available, districts may donate useful items to communities - e.g. empty insecticide
containers (provided this is done fairly).
3. Health centre nurses
Problems
Some nurses resist the extra effort and change of approach involved in CDTI. It is crucialthat the nurses at peripheral stations do not feel they are marginalized from the higherlevel of health system.
P r actical r e commendations- Provide each health facility with a CDD trainer's manual and a durable'job aid' in
the form of a wall chart.- Acknowledge receipt of reports and queries quickly and politely.- Send a yearly letter of thanks to the nurses, signed by the directors of disease control
programmes.- Institute a yearly'best district' award.
Finance
Problems
A national budget exists in most counkies, but not easily accessible. District budget alsoexists but onchocerciasis control is not given priority in some cases.
P r actical r ecomnrenda tionsOCP and NCs should prepare the advocacy packages for sensitization of DHMTs on theimportance of continued oncho control to prevent recrudescence.OCP Director should continue sensitizing governments on the importance of devolution,and urge governments to facilitate the release of funds for oncho at the earliest timewhen the fund is available.OCP should address this issue during the next JPC in WashingtonNCs should also mobilize resources from donor agencies, i.e. HKI, Sight Savers, WorldVision, Unicef, OPC, etc.NCs to sensitize DHMTs.District plans should include activities and budgets for onchocerciasis control.DHMT should mobilize external financial resources of NGDOs, bilateral, multilateral,etc.
t
,
t,I
JPC22Page37
Annex 4
Logistics
1. Ivermectin
, Problems
2. Registers
. Problems
Supervision
. Problems
Ivermectin and register are two essential materials of CDTI. The original idea of
community ."rpo.,Jibility on the movement of these materials between community and
the healttr faciiity is not practical for isolated communities. In addition, the flow of
Ivermectin is disrupted at several levels of health system. \ trhile the community
ownership of register should be respected for the distribution of ivermectin to those who
were not treated
P r a ctical r ecomnrendations- Ivermectin should be shipped through tax free agencies such as WHO and UNICEF.
- NCs to lobby MoF for budget to clear tax.
- NCs should facilitate orientation of pharmacists at central, regional and district level
on relevance of smooth flow of ivermectin.- The orientation package to health workers should include population census and
drug order procedures.- During the training of CDDs, agreement should be reached between health workers
and CDDs on how the drugs are to be supplied from health centre to the community.
t
l
According to CDTI policy, community should supply its register. The format of the
register is not standardized. Registers are kept long time in the health centres.
P ractical recommendations- Countries should make their own decisions on the most practical approach to ensure
availability of standardized registers.- During the orientation of CDDs, agreement should be reached between health
workers and CDDs on how the registers can be accessed for data extraction.
Supervision is planned vertically mainly because the external budgets are not integratedinto the national disease control planning. CDTI data are not included in the healthinformation system.
Practical r ecommendations- AFRO shoutd urge governments to validate as soon as possible the supervision
guidelines for multi-disease surveillance.- NCs should initiate actions to establish an integrated supervision check lisU the
examples of C.l. and Sierra Leone can be transferred.- NCs should work with relevant departments to include CDTI data in the health
information system.
?
-t
!
IPC22.3Page 38
Annex 4
- NCs should plan and execute training of the front line health workers on data
rePorting of oncho control'
Training
. ProblemsTrainingneedshavebeenidentifiedbecauseof:weakperformance;highstaffturnover;newly r"ecruited CDDs; newly recommended dosing'
P r ac tical r econtmendations
Using the existing *u.rrut, and guidetines, the training and re-training for the front line
healih workers u.,d COOs should give emphasis to:
- Community re-entry and problem solving'
- IEC- Management of ivermectin'- Supervision and monitoring'
Pre-service training
. ProblemsBasic curricula in onchocerciasis for doctors and nurses is deficient or old-fashioned'
I
I
Recommenilations- up-to-date training modules must be prepared,- in French and English' for tutors of
medical ,,,r.rir,g 6oth levels) "rra
p,iUti. he-a1-th students. These must be attractive
and user-fri".,ar"y;'.r"rrly describe the role of the nurse/ doctor/ health inspector in
CDTI and surveillance; contain visual aids; and contain questions for student
assessment (withmodel answers)' , , --:-:-- :-^d+.,+,.NOCS must deliver the modules personally to every relevant training institution in
the 11 countries.
IEC materials
. ProblemsAlthough a lot of work has been done regarding development of IEC materials' it has not
been well coordinated between countries] and as a result many districts do not have any
available.
. Practicalrecommendations-NCsshoulddeveloptheirowncountryspecificlECmaterialsincollaborationwith
the national IEC officers.
NCs should make sure that every CD receive an
the end of2002.
onchocerciasis IEC package before
t
J
lPCzzPage 39
Annex 4
Specific areas
1. Sierra Leone
. Situation
I
Although most of the Northern districts are occupied by government soldiers, 2
districts in the North are still under rebel control.Border regions are oncho endemic areas; inaccessible because of persisting rebel
force.However, the government and rebels established collaboration for EPI.
No definite plan of operations for oncho control can be made until security in the area
is assured.CDTI South is rebel-free; CDTI fully installed in 5 southern districts.
Recommendations
- Southern part:continue with CDTI.- Northern part:
* NC to document the situation in the North and guide OCP on the plan of action;
when to start training; when and how to start CDTI.* To conduct special entomological studies (collection of flies in Nov. 2001-May
2002).* Sierra Leone to obtain a commitment from |AF and JPC for inclusion of S.L. as
part of APOC.* NC to pursue other options for financial assistance e.g. World Bank and NGDOs.
2. Cross border problem
SituationThere is a need for a better understanding of the cross border problem.
Recommendations
- OCP, with collaboration of relevant countries and APOC, should establish a technical
task force to address the technical needs in the cross border areas. The issues to be
addressed by the task force should include at least:* human movement* synchronization of ivermectin treatment* feasibility of involving one health worker each from the district health and
peripheral levels and CDDs to assist the less experienced countries.- That APOC invite Benin to the next TCC Meeting in Nigeria and provide the
participants from Benin with the opportunity of field visits in Nigeria.- Benin (OCP) and Nigeria (APOC):
* That each country establish lists of the eligible villages under CDTI and share
them.* That the national coordinators of both countries meet regularly.* That APOC and OCP coordinate the cross border meeting.* Simultaneous implementation of CDTI in relation to the start of high transmission
seasons.* APOC to provide OCP with Nigerian information.
I
I
t
lPC22.3Page 40
Annex 4
Cross border technical meeting to share the experience in one country with otherless experienced countries.
3. Critical areas
SituationCoverage in critical areas remains low
RecommendationsAs a matter of urgency countries should intervene in areas where the epidemiologicalsituation is unsatisfactory, by putting together crack teams of health workers to work fora few months at village level, to optimise CDTI with all the villages involved. This
concerns Guinea, Ghana, Togo and Benin.
Indicators
For low geographical coaerage:
- % of villages covered
For low CDD motiaation:- % of village population treated- "/o of. villages with incentive package in place- % of CDDs satisfied with incentive package
For community entry:- % of target communities satisfied with CDTI implementation
For motioation of health workers:- % of. health centers from which health workers visit all CDDs at least twice a year
For finance:- % of districts with oncho budgets- o/o of districts have and used oncho budgets- proportion of oncho recurrent budget supplied by govemments and other donors
For logistics - iaermectin supply:- % of health facitities reporting no stock out of ivermectin in the past during CDTI- % of target villages received ivermectin during the year
For logistics - records:
- % of villages returning records of CDTI- % of villages with accurate records of CDTI
For superuision:- % of CDDs who received supervision visit at least twice annually as per standard
For training:- o/o of heatth workers competent in estimating ivermectin requirement correctly- % of. health CDDs competent in performing the population census
*
t
I
I
I
n
lPC22Page 41
Annex 4
% of regions, districts with who have identified health workers and CDDs in need oftraining/ re-training% of regions, districts who have carried out necessary training/ re-training
For IEC:% of communities and health facilities with at least one IEC material package
Reco mmenda tions ab out in dica to r s
- NCs in collaboration with OCP to implement evaluation using the above listedindicators.
- NCs and OCP to study the feasibility of the collection of above listed indicators, andto consider including other indicators developed by APOC.a
t
a
-i
l.Whatactionsneedtobetakenduringthenextl|/zyearsforaneffectiveepidemiological
2.'Jiftlil::J:fiH.. system will be affected by the LF Erimination Programme in oCP
3. ff;tiffi::urveillance system wilr be affected by ivermectin resistance should it occur?
4. How this surveillance system will be affectea uy the use of moxidectin when it becomes
lPc22.3Page 42
ANNEX 5
REPORT OF WORKING GROUP C
The Group addressed issues relating to Epidemiological surveillance' It tried to provide
some answers to 4 main questions:
available ?
Finally the group further discussed the specific case of Guinea Bissau and the use of
Onchosim.
general.
Epidemiological surveillance is done in oCP areas where there are no interventions with the
objective of detecting any recrudescence. parasitorogical surve,rance using skin snip should
be the priority ".,i;;,; t. .ut".t "ffu""ifn
pi'f,itt.health staff shouid be trained and
equipped to perfori.r tnl turt p.op".rf. rniomological surveillance should be used as an
additional tool because of the io* 'u'{'itiuiry
of tile skh snip method' It has proven on
several occasions t" b" "
useful.o*pf"ttt"tti"'i' !""f to confirm rectudescence' Following the
recommendations oigeCZf u .,r*b"t of t"u'* have been formed and trained' but the bulk
of the work is done by the national t"uttts' The Entomological surveillance is always done by
the national teams with some assistance from the community' DEC Patch test has not been
implemented during ,tt" pur, y"u. b"tu'^'u of technical difiilulties' These should be solved
when the Mono *;! ;;J;"s'available' In future this Patch test could be used as a more
,".,ri,i*r" tool for the confirmation of recrudescence'
MappingofLFhasbeencompletedinTogo,Benin,G|anllndBurkinaFaso.MaliandNigerare plarrning their "r*"vr.
ir.e results ,3 iu, show that LF covers a wider area than oCP'
including urban settings. The implication of the LF elimination programme would be the use
of Ivermectin in are-as where the treatment had ceased u^i *n..e epidemiorogical
surveillance is in place. At the ,tu.t oi-ttt" ptogt-ul"^3.this surveillance witl probably no
longer be necessary. 8.,,o*ological ,t"itiiru"teif feasible could still be useful' In any case'
bytheendoftheLFeliminationp,ogt^t"*e'asurveillancesystemforbothonchocerciasisuna lf should be worked out'
Ivermectin resistance has occurred in veterinarian medicine and is very likely to happen in
oCp areas sooner o. 1u,".. But this is just a speculation at this stage. Molecular markers are
being developed, and the ongoing studies on Ivetmettin non-relsponders should provide
some answers to the existence of resista**"ly it " *d of the year 20bt. The group thinks that
Control programme Managers srrgr,{{fe equipp"a to propeily monitor all non-responses to
Ivermectin *"u,-".,i- g"site tn" MDsc:r-,;,rr'i u" ,t.".,g[n"r,Ld to detect drug resistance in
i
t
Moxidectin will hopefully be available in 5 - 6 years. similar type of surveillance system
would be required ,1"n"" i, comes to be used. But most importanily there is a need to clearly
t
JPC22.3Page 43
Annex 5
define the context in which it will be launched. Whether it will be launched in places whereIvermectin has (or never) been used, for case management or control management.
Onchosim is a management as well as an advocacy tool. It is not intended for a routine use atdistrict or even national level at this stage of its development. However, nationalcoordinators should get acquainted to the concept. Training workshops are planned for thenational teams and it is important that expertise be developed under the MDSC for the use ofOnchosim.
A survey conducted in Guinea Bissau in 1997 revealed that the endemicity was very low.Mass treatment with ivermectin was not recommended. The strategy has so far been case
management. A survey is been completed and the result will be available by the end of themonth. If the results show a still low endemicity, case management will continue. If on the
other hand a higher level of prevalence is observed there will be a need to take a decision onthe transfer of Guinea Bissau to APOC.
RECOMMENDATIONS
1. The decentralisation of the epidemiological surveillance should be pursued by theprovision of equipment, training of district health staff in the collection and analysis of data.The entomological surveillance should remain a responsibility of the national teams
2. The surveillance system for both LF and onchocerciasis should be developed before theend of LF elimination programme tfuough the MDSC.
3. National control progranunes should reinforce surveillance system to monitor failure oftreatment for early detection of ivermectin resistance through MDSC
4. National control programmes should set up surveillance system to monitor failure oftreatment with moxidectin when it becomes available through MDSC
i) National coordinators should be trained to understand the concept of Onchosimmodelii) Expertise should be developed under the MDSC for the use of Onchosim
I
,5
IPC22.3Page 44
ANNEX 6
REPORT OF THE TWENTY-SECOND SESSION OF THE ECOLOGICAL GROUP
Accra, 7-9 March 2001
TABLE OF CONTENTS
SUMMARY OF RECOMMENDATIONS...
A. INTRODUCTION....
B. ADOPTION OF THE AGENDA.
C. FOLLOW UP OF RECOMMENDATIONS OF THE 215T SESSION OF THE
ECOLOGICAL GROUP .......
D. VECTOR CONTROL UNIT ACTIVITIES IN 2000....
E. AQUATIC ENVIRONMENTAL MONITORING ACTIVITIES..
F. ECOLOGICAL MONITORING AS PART OF THE SOCIO-ECONOMIC
DEVELOPMENT OF ONCHO-FREED ZONES
G. WORK PROGRAMME FOR 2001./2002
H. ARRANGEMENTS FOR THE NEXT MEETING.........
I. READING OF MEETING REPORT FOR APPROVAL..
I CLOSURE OF THE SESSION..
Appendix L : List of participants ..........
Appendix 2 : List of documents ...........
Appendix 3 : Work Programme for 2001
Page
J
45
46
51
t
.......52
55
52
64
64
65
I
65
65
66
68
69
IPC22.3Page 45
Annex 6
SUMMARY OF RECOMMENDATIONS
Summary of recommendations made by the Ecotogical Group during the session are presented
below
Moni AS tal n zones
1. Members of the Ecologicat Group and OCP should inquire about availability of remote
sensing information on study sites and related areas (Para 80).
valorisation
2. Appropriate actions should be taken by OCP to publish the manuscript of the brochure
presented to the session, highlighting environmental activities of the Programme (Para 8L).
3. A steering committee should be set up to draw a detailed plan for the preparation and
publication of synopsis of scientific results of environmental monitoring and related activities
(Para 82).
4. OCP should through a member of the Ecological Group organise a one-day workshop on
the organisation of manuscripts for national hydrobiological teams. (Para 83).
Aquatic monitoring -Work Programme
5. Monitoring activities during 2001-2002 should be on the same watercourses and at the
same frequencies as in 2000 (Para 83).
monr AS
6. OCP should closely cooperate with the WAFEM project in fulfilment of its objectives
(Para 16).
d-
a
t
IPC22.3Page 46
Annex 6
A. INTRODUCTION
1. The twenty-second session of the Ecological Group was held from 7th to the 9th March,
2001 in Accra, Ghana, under the chairmanship of Professor V.H. Resh, Chair of the Ecological
Group. Present at the session were four members of the five-member Ecological Group, the
Director of the Onchocerciasis Control Programme (OCP), Dr Boakye A. Boatin, the Chief of the
Vector Control Unit (VCU) of the Programme, Dr L. Yameogo, invited Experts and the FAO. The
FAO as focal point of the OCP Sponsoring Agencies for Socio-economic development of the
Oncho freed zones was represented by Mr M. Sonou. (See appendixes L and 2 for lists of
participants and documents respectively).
Opening Session
Z. The opening ceremony was presided over by the Chairman of the Ecological Group, Prof.
V.H. Resh. He opened the session by welcoming all members of the Ecological Group and invited
persons to the meeting. He especiatty welcomed Dr C.A. Biney as the Director of Water Research
institute (WRI) which was providing facilities for the meeting. He then gave the floor to the Chief
of VCU for his opening remarks.
3. The Chief of VCU, Dr L. Yam6ogo, expressed his pleasure in welcoming participants to
the session. He indicated that for VCU, the session was as important as previous ones. This is
because VCU expects to learn from it, especially as the Programme approaches its end in less
than two years. ttl" Cni"f of VCU was pleased to announce that Mr M.E. Diop, member of the
national hydrobiological team of Guinea, had recently earned his Doctorate degree from the
University of Mali. Ae indicated that Dr Diop's success was pleasing to VCU and OCP because
the Programme supported his efforts towards that end. Finally, he wished to Put on record that
the meJting was thl second in less than five years to be held at the Water Research Institute
(WRI). He fherefore thanked WRI on behalf of the Programme Director and the Chief VCU's
Office for WRI's available support.
4. Prof Resh, as Chairman of the Ecological Group made his opening remarks. He briefly
indicated that the Ecological Group had over the years contributed significantly to the resolution
of problematic issues of tnu OCP. As examples, he cited the documentation of criteria for
monitoring, selection of monitoring stations, approaches for the avoidance of resistance of target
organismJto insecticides operationally used by OCP, provision of monitoring strategies to assess
loig-term impacts of insecticides on non-target fauna and issues related to human settlements in
oncho-freed zones. He indicated that the current issue at stake was to provide an overview
evaluation of the status of non-target aquatic fauna in the various countries and river systems
after the many years of larviciding. He therefore called on members, to put their minds to the
issue, especiaily, the experiences of two former chairmen of the Ecological Group still serving.
Then heiaid the hydrobiologists had worked out an approach of presenting the overall status of
fauna during their meeting two days earlier, but this could be refined. The Chair concluded his
opening rernarks by requeiting members to also talk on possible collaborations hydrobiologists
could J.rgug. in aiter OCP. Having made the above remarks, Prof. Resh then called on the
Director of the Programme for his opening remarks.
5. On taking the floor, the Director of the Programme echoed the welcome of previous
speakers to partiiipants of the 22na session of the Ecological Group and thanked the WRI for its
t
IPC22.3Page 47
Annex 6
support to the meeting. He then commented briefly on various issues raised for consideration by
the Chief of VCU and the Chairman of the Ecological Group.
6. On the significance of the session, the Director said for those in OCP, the Ecological Grouphas been a very important body for various reasons. These included the Group's independentadvice to the Programme, the Group being the link between OCP and the rest of the world and
being part of the Expert Advisory Committee (EAC) to the Programme. Therefore, he said, the
session was as important to the OCP as previous ones.
7. With respect to hydrobiologists and the imminent end of the OCP, the Director brieflyindicated that, the Programme had provided several training opportunities to hydrobiologists to
be able to function in relation to the environment at the end of OCP in December, 2002. He citedfor example, that the EAC had already suggested that an evaluation be carried out about three
years after the cessation of OCP operations, to assess the extent to which the achievements of the
Programme had been maintained, suggesting that the activity could use some of the
hydrobiologists.
8. With hindsight of the value of various recommendations of the Ecological Group to the
OCP, the Director called for advice from the Group on ground-larviciding and the
implementation of the project aimed at monitoring aquatic and related ecosystems associated
with oncho-freed zones, the West African Freshwater Biodiversity Conservation and Ecosystem
Management (WAFEM) project.
9. On the issue of collaboration among those who have been linked by OCP after theProgramme, the Director said all must find ways and modalities to continue collaborationswherever possible. The OCP Director concluded his remarks by thanking participants for theiranticipated involvement in the heavy agenda set for the meeting and wished all fruitfuldeliberations with expectation that, we shall all learn from the outcome of the session.
)oint Hydrobiologists/Ecological Group meeting
L0. This session received and commented on brief presentations and reports on
i) Issues related to OCP's ending and the future from the Programme Director andChief of VCU;
ii) Summary results of hydrobiological monitoring from national teams (see Section E);
and
iii) Special subjects from members of the Ecological Group (EG), invited expertsor participants.
Prior to the presentations however, the chairman announced that a member of thehydrobiological team Mr M.E. Diop had earned his Doctrate degree, Dr C. Lev€que (member ofthe EG) had been awarded the Naumann Thienemann medal of the International Society ofLimnology, and Prof. D. Calamari (member of the EG), had received the EnvironmentalEducation Award attributed by the Society of Environmental Toxicology and Chemistry. Allthree accreditations had occurred during 2000. The Chair considered those of Ecological Groupmembers as evidence of the quality of the Group.
I
lPC22.3Page 48
Annex 6
a) General information on OCP and APOC
11. The OCP Director summarised the status of the Programme with reference to itsimminent end, in December 2002. He indicated that towards the Programme's end, various
actions which would facilitate decommissioning activities, human and material resources of OCP
have been planned and a meeting scheduled for about the end of March 2001, would initiate
actions o., th" plans. Among the plans to implement, the Director said that the African Regional
Office (AFRO) 6f WUO is to set up a multi-disease surveillance centre at the OCP's main building
in Ouagadougou.
1,2. With reference to staff, the Director indicated that efforts to assist individuals to manage
the change have been planned. For example, staff who would require reasonable training to be
gainfullliengaged elsewhere would be offered the training. Also, appropriate recommendations
iould U" p-"iaud on behalf of staff seeking engagements in various agencies, while personnel
would be encouraged to seek available positions in \AIHO at large. The Director also indicated
that, plans made to assist staff manage the change included psychological counselling for those
who may need it.
13. In relation to onchocerciasis control which has been the central agenda over the pasl27
years, the Director said the Programme was on course. The subject, he said, puts OCP close to the
African programme for Onchoierciasis Control (APOC) which is also involved in the control of
onchocerciuiir Uy a different approach from that of OCP. Thus APOC could be considered to be
continuing the control of the disease after OCP. However, APOC's first phase ends in December
2001, after which a phase of winding down, to end in2007 will have to start'
1,4. The Director then referred to the Ecological Group's input to the successes of OCP. He
said the JPC has appreciated the contributions of the Ecological Group to the OCP to resolve very
crucial issues of the Programme and wanted the Group to know it.
15. To end his brief, the Programme Director announced that the ]PC meeting for 2002 willtake place in Ouagadougou to end the Programme where it started.
b) General Information on the WAFEM proiect
1,6. The Chairman, in introducing the subject for the Chief of VCU, announced that the
WAFEM project proposal had been submitted and was going through approval processes. Also,
he explained that OCP's assistance and the involvement of the Ecological Group to bring
WAFEM proposal to its present status was not a coincidence. This was because the mandate of
the Ecological Panel, the precursor of the Ecological Group, included aspects of human
settlements in oncho-freed zones. Therefore OCP should closely cooPerate with the WAFEM
project for the achievement of its objectives.
17. The VCU Chiel Dr L. Yam6ogo, then took the floor and informed the meeting of the
following : first, the WAFEM project had received the support of )PC. Second, a draft protocol for
the projeit had been prepared and would be circulated in due course for comments which must
be communicated to his office in Ouagadougou. Third, if and when the project becomes
approved, it may have to be launched and information on the issue would be communicated.
Finally, the meeting was informed that overall supervision of WAFEM could be provided by the
multi-disease centre after OCP.
t,
I
t
lPC22.3Page 49
Annex 6
18. The Chief VCU then reminded the meeting of some central features of WAFEM as
including:
i) The partnership spirit of the project,ii) The community centred approach, andiii) The need to entourage early community ownership of the project to ensure
sustainability.The reminders were perhaps, directed mainly at the hydrobiologists as they have been expected
to maintain contact with project community representatives after the project finalisation
workshop until the anticipated approval of the project for implementation.
c) Eaaluation of the impact of iaermectin on the enaironment in the OCP area
19. A presentation on the above subject was made by Prof. Davide Calamari, member of
Ecologicaf Group. The data he showed were collected through an extensive review of the
literature on physico-chemical properties, environmental distribution and degradation of the
drug.
20. Ecotoxicological data were also reviewed and a preliminary evaluation of the risk for the
environment made in relation to the type of immissions of ivermectin in relation to its use in the
Programme area.
21,. It was stated that as emissions are concentrated in time and space because ivermectin is
eliminated by humans mainly on soil where the molecule is strongly bounded, it was also
considered that degradation occurs rapidly (photo and biodegradation) in tropical conditions.
Under these conditions, the substance has a very low potential to contaminate the aquatic
environment. Therefore the risk is almost non-existent despite the high toxicity for aquatic
environment. For terrestrial organisms, the risk is limited due to the fact that emissions occur
during a short period of two-to-three days after the treatment and in limited areas around the
village.
d) lnfluence of hydraulic conditions of riaer on impacts of lanticides
22. Dr Berhnard Statzner made a presentation on how hydraulic conditions in a river stretch
may modify the impact of insecticides on the vector and non-target invertebrate fauna. He
related discharge stages to river morphology to demonstrate how these two factors influence the
velocity close to river bottom. It was indicated that for most insecticides and given
concentrations, their impact on insects increases with increasing bottom velocity and the
phenomenon could be scaled in the field using the Froude Number (= velocity/ [depth x 9]o's;.
23. In discussions after the presentation, hydrobiologists confirmed the general view and
statement of Dr Statzner from their field observations. It was therefore considered that includinga better assessment of hydraulics could contribute to explaining unusual observations ofinsecticide effect (on both target and non-target invertebrates). Also, an appreciation of the
hydraulics and its consideration could reduce quantities of insecticides needed for groundtreatment.
I
IPC22.3Page 50
Annex 6
e) Potential inryact of Pennethrin impregnated bed nets on enuironment
24. Prof. Calarirari made the meeting aware that the above subject was being investigated and
indicated that the results should be of interest to members of the Ecological Group since the
product is one of the insecticides the Group has had to deal with in relation to its use by the OCP.
0 The economic benefts of managing ecological impacts of laruiciding.
ZS. Prof D. Colman, member of the EG presented the following on the above subject. The key
task of the Ecological Group has been to control the larviciding process of OCP to ensure that :
The vector control activities should not reduce the number of invertebrate species; or cause
a marked shift in the relative abundance of species ; temporary and seasonal variations in
non-target invertebrate populations were acceptable ;
The pesticides applied shoutd have neither a direct impact on fish, nor effect on the life
cycle of fish species;
Bio-accumulation of insecticides and bio-magnification through food webs should be
avoided;Human activities in the control area should not be impaired.
Ia
a
a
26. Many reports indicate that these objectives have been handsomely met, but would not
have been so without the timely intervention and planned research based on reconunendations
of the Ecological Group (EG). In consequence the EG can claim to have delivered substantial
benefits. Many of these benefits are non-market ones, that is, benefits not connected with things
which are traded and have a price on the market. These benefits arise from the fact that bio-
diversity in the aquatic fauna has been maintained throughout the OCP area, whereas it would
almost iertainly hive been diminished had improvements to the dosage rate not been made or
additional insecticides not been identified, tested and selected for application with appropriate
protocols.
27. Indeed the preceding sections of the report have not chosen to speculate on what might
have happened had key recommendations of the EG not been made, and implemented. These
recommendations and the resulting actions prevented widespread resistance to insecticides
devetoping in the blackfly populations, something which would have resulted in considerable
cost (in the form of reduction in health benefits and smaller increases in agricultural output). Itcan also be confidently asserted that, had the EG's recommendations about larviciding not been
implemented, the production and saleable value of fish would have been reduced. On the most
conservative assumptions about the value of fish which would have been lost, and the costs
attributable to the decisions of the EG, it can be shown that the economic returns to the EG's
recommendations have been high.
28. Following extensive review by regional experts, the percentage of marketed fish in the
OCP area which would have been lost has been estimated for every year from 1980 to 1997 '
Conservatively at its maximum this is assumed to be only 1O% of the total catch (FAO data) in the
OCp area, o.3,8 % of the totat fish catch of the OCP countries in L988. This fish has been valued
at the river-side price of Tilapia paid to producers around Mopti in Mali; there is a continuous
published price series for this and evidence for later years that fish prices are similar across West
JPC22.3Page 51
Annex 6
Africa. Valuing in this way is an underestimate, since additional value is generated in marketing
fish
t
29. The costs which have been attributed to the EG in the economic analysis are (i) all the
costs of the monitoring programme plus the costs of convening the EG, and (ii) a high ProPortionof the costs of the larviiides, since the additional insecticides introduced have been more costly.
(The whole point of the tarviciding programme has been effectiveness with environmental
protection, rather that cost minimisation).
30. Even with what is seen as the conservative estimates of the additional fish marketings
attributable to the EG, and a high assessment of the costs to be charged, the returns to the EG are
estimated at an internal rate of return of 31.o/o. This is high, and almost certainly an under-
estimate. It therefore seerns entirely reasonable to conclude that the environmental protection
component of the OCp has had large positive economic benefits of a tangible market nature. In
addition there are very important non-marked benefits, which in themselves would justify any
additional costs incurred.
g) Major issues raised by the thesis of M. E. Diop
31. Dr. M.E. Diop presented the major subject discussed by his thesis as temporal and spacial
factors or characteriitics of river systems and fish that influence the reproduction of some West
Africa river fishes. Among other things the thesis concluded that reproduction and recruitment
periods of fishes studied were close in time and space. With reference to OCP activities, the thesis
indicated that the period of recruitment apparently coincided with the period during which OCP
uses "stronger" anii-Simulium larvicides in the river systems to control populations of Simulium.
Dr. Diop indicated that the effect of the larvicides on fish recruits may be noticed and was an
issue that called for attention.
32. The discussion which took place after the presentation suggested that lethal impacts of
anti-Simulium larvicides on small fish could occur rarely as accidents but not as a routine.
However, the issue was recognised and would further be discussed in the future.
h) Freshwater Fish Biodioersity Gradients inWest Africa
33. Mr. George Ganda, formerly a member of the national hydrobiological monitoring team
of Sierra Leone and now a doctorate student in the United Kingdom, presented the above as the
subject of investigations of his study. The goal of his study, he said, was to develop a Rapid Fish
Biodiversity Assessment formula based on status of various environmental parameters and
known fish fauna of freshwater systems. The aim of the presentation was to expose the subject
and ask for assistance in the form of ideas and sources of possibly useful information for the
work. Thus he indicated the approaches already being adopted.
34. The discussions which foltowed the presentation mainly calted on the presenter to be
aware of existing approaches to fish biodiversity estimations.
B. ADOPTION OF THE AGENDA
35. The agenda as presented in the table of contents was proposed to participants and was
adopted.
a
lPC22.3Page52Annex 6
C. FOLLOW UP OF RECOMMENDATIONS OF THE 21ST SESSION OF THEECOLOGICAL GROUP
36. Six of the eight recommendations made by the Ecological Group during its 2L't session
were implemented. Those related to land-use changes monitoring and preparation of synopsis of
scientific results from monitoring activities needed further discussions (see section
D. VECTOR CONTROL UNIT ACTIVITIES IN 2OOO
General overview of VCU activities
g7. The Chief of VCU indicated that vector control activities had a few problems in C6te
d'lvoire and Guinea. However, all the components of the Unit (aerial operations, entomological
evaluation, operational research, hydrology, hydrobiology) have continued to be operational.
a. Larviciding coverage (both from the air and from the ground) remained close to 11700
km of rivers treated in 2000.
b. Blackfly susceptibility to the operational insecticides being a critical factor for the success
of vector control opeiations, particular emphasis was placed on evaluating the situation withrespect to such susceptibility in order to better adjust insecticide rotation strategy.
38. Due to the presence of resistant populations or populations showing an intermediate
susceptibility to the organophosphorous compounds, the use of these insecticides was reduced in
1999 ind 20b0, giving greater preference to B.f. H-14, a biological insecticide (see para.48 to 52
below). This was intended to provide better control over resistance and a lower impact on the
aquatic environment.
Atl this was achieved due to the good performance of the present formulations of B.f' H-
14 whose effective carry is now competitive with that of the chemical insecticides even if itsdosage still remains at least 3 times that of the organophosphorous compounds.
The results were on the whole satisfactory in the areas under larviciding if we take into
account the savanna form of onchocerciasis which is considered to be the most blinding type.
Indeed, for the first time, the annual transmission potential (ATP) of savanna species of
Simulium damnosum was below L00 at all catching points in the Oti basin. It was also below 100 in
most of the basins with trouble spots. Only two points out of L07 regularly visited had an ATP
above 100 (Vialadougou and Djabata).
The Unit also put special emphasis on the transferable entomological activities. Thus, the
national entomologists trained by the Programme conducted a number of studies in 2000 aimed
at:
t
the early detection of any possible recrudescence,
assessing the impact of ivermectin on transmission,the control of blackfly nuisance.
i)ii)iii)
t
JPC22.3Page 53
Annex 6
Regarding the last point, it should be noted that some initiatives were taken in the socio-
economic development areas by the companies involved to assume responsibility of the nuisancecontrol activities in collaboration with the national teams of C0te d'Ivoire and Mali.
Generally, activities were centred around attempts to solve the problems encountered inthe special intervention areas or black spots as well as preparing for the post-OCP period.
Aerial Operations and Larviciding
a) Introduction
39. The year 2000 was the second and thus 2001 is the third of the last four year contract with"Evergreen". Area covered in operations during 2000 was the same as in 1999. However, in thewestern zone, treatments were suspended in the upper Mongo-Kaba and Kolente basins due toactivities of rebels.
40. The overalihydrological situation during 2000 showed a slight deficit compared to that of1999. In the western zone a 25% and 1,2% def.icits were recorded in the Tinkisso and Kolentebasins respectively. However, other basins in the zone showed slight increases. In the easternzone, increased discharges were recorded on the Pru and Mono basins due to higherprecipitations. Yet all other rivers in the zone recorded deficits in precipitations.
41,. Intensification of ground larviciding, exhaustive prospections in problematic basinshelped in optimising treatments and to reduce supplementary flight hours. During the year,more biological, compared to chemical larvicides was used.
42. Combined action of VCU teams and local populations helped to reduce product lossduring 2000. For types of larvicides, materials in store and procurements were managed to resultin minimum residual stock by December 2002 when the programme comes to an end.
b) Utilisation of laraicides in the East Zone
43. Treatment was maximum during week 31 (ie 31st ]uly to 6th August), minimum duringweeks lL,12 and 13 (ie from 13 to 3Lst of March) and treatment was suspended during weeks L4
to 17 (ie 4 weeks of April). On the Oti, six cycles of experimental treatments were effected duringJanuary and February 2000.
44. To ensure effectiveness of the larviciding activity, actions taken included rotation oflarvicides used, confirmation of susceptibility of target organism to product and have goodknowledge of river discharge. Also, the advice of Ecological Group on larvicides usage wasstrictly adhered to. For example, temephos was used at a maximum of three consecutive cycleswhile Permethrin and Carbosulfan were used at a maximum of six cycles per year.
45. Entomological evaluation results were good. Out of 51 points evaluated, only one, atDajabata, on the Okpara river near the Benin border with Nigeria, had an ATP above'100 (244).
Actions are being taken to improve the situation.
lPc22.3Page54Annex 6
c) lLtilization of laroicides in theWestern zone
46. The westem zone of the Programme covers C6te d'Ivoire from the river Sassandra to Mali
on river Niger and its tributaries lncluding Sankarani, Milo, Niandan, the Upper Niger' the
Mafou, and lhe Tinkisso in Guinea, Kolente ind the Kaba-Mongo also in Guinea. In this zone, the
longest circuit of treatmen t (4507 km) occured during the 8th week and the shortest (436 km) in
the 35,r,week. Treatment was susPended during the 36th week'
42. Larvicides used were rotated. Temephos was not used on the Sassandra and its effluents
for fear of enhancing resistance of vectoi to the product. Temephos was also utilised with
precaution on tl-re tirikisso and the Kaba but without restriction on the Kolente and the Mongo
because susceptibitity of vector larvae is good'
Entomological research and insecticides
a) Monitoring of the suscEtibitity of blackfly lantae to the operational insecticides
4g. During 1999 and.2000, susceptibility tests carried out especially during the low water
period (Noveirber to March) and spaie period (June, JuIy and August) made it possible to closely
monitor the evolution of susceptibility bf btackfly larval populations to the organophosphorous
compounds in river basins under larviciding.
49. During the low water period of 1999, the tests revealed the presence of some blackfly
populations riesistant to temephos in certain river basins of the Westem Zones (Niandan, main
Sankarani, Dion and uPPer Niger) and Eastern Zone (Sio and Ani6)' The phenomenon of
resistance detected was eifectiv"iy ^u.ugud
tfuough adequate implementation of the insecticide
rotation strategy recommended to limit the impact of the treatments on non-target aquatic fauna'
It should be noted that on the upper Sassandra, where temephos has for many years been
excluded from Iarvicides used for treatments because of resistance, a clear improvement in the
susceptibility of larval populations to the product was observed during the high water period
(July) of 2000.
50. In the two operational Zones of the Programme, the susceptibility of the larvae to
pyraclofos was normal or intermediate on all the sites visited. The blackfly populations least
susceptibte to this product were encountered in the Westem Zone on the Milo, Niandan and
Niger, and in the Eastern Zone on the Oti and Sio.
51. With reference to phoxim, the susceptibility of larvae to the product was generally
satisfactory. Indeed, in the basins under larviciding treatments, blackfly populations resistant or
not very susceptible to this product were observed only on the upper Kaba and certain stretches
of the Milo in Guinea.
52. Considering the trends shown by the results presented above, it has been considered
advisable to contiriue the implementation of all actions initiated to improve the efficiency of the.
larviciding treatments. These include, closer supervision of aerial treatments, the monitoring of
specific composition of blackfly populations, and the adequate use of pyrethrinoids and Teknar
to acceleratelhe decline in the resistance to temephos of some black-fly populations'
I
t
IPC22.3Page 55
Annex 6
b) Blackfly population mouements and possible threats to the achieuements of the Programme
53. The movement of blackflies from Sierra Leone towards Guinea and Mali had led the
Programme to extend its vector control activities to Sierra Leone. These activities have been
suspended since 1994. Since then, increases in densities of Simulium sirbanum have been observed
in the north of Sierra Leone. It is still impossible to undertake any studies in the north of Sierra
Leone. Therefore some samples of larvae and adult blackflies were collected at the beginning ofthe rainy season in some catching points located within the corridor of re-invasion in Guinea(starting from the border with Sierra Leone) and in Mali to assess the possible impact of the
apparent invasion of Mali by flies from north of Sierra Leone.
54. Part of the samples were subjected to cytotaxonomic and microsatellites approaches ofpopulation studies. The preliminary results indicated that one of the two cytotypes of S. sirbanum
living on the border of Sierra Leone and Guinea is also present in Mali. It could thus be that this
cytotype moved from the border of Sierra Leone into Mali bome by the monsoon winds.However, currently available entomological results do not show any obvious impact of these
possible movements on the transmission in Guinea.
55. S. sirbanum being a poor vector in the north of Sierra Leone, studies of experimentaltransmission (xenodiagnosis) which will be carried out soon should make it possible to ascertain
whether the cytotype in Guinea is also a poor vector when put in contact with patients fromvarious origins.
Discussion
56. The ecological Group congratulated the Programme on the excellent results recorded andthe excellent presentations made of it. It was recognised that the excellent results were achievedin part, due to an efficient management of the resistance through the continuation of an increased
use of B.t H-14 to replace the less selective chemical insecticides. This increased use of B.t. H-1,4
was made possible following the improvement of current formulations which allow their use at% of the normal amount and at discharges above 70 m3/s. More generally, the other actions
taken to achieve the current satisfactory entomological results (reinforcement of both thelarviciding treatments and ivermectin distribution) were also the subject of exchanges withmembers of the ecological Group.
57. The availability and significant amount of data on the status of blackfly susceptibility tothe organophosphorous compounds caught the attention of the Group which expressed itsinterest in similar data being collected on the larvae of the non-target benthic invertebrates.Finally, the Group noted with satisfaction the efficient management of the logistics andcongratulated the Programme for the expertise it has developed in this matter.
E. AQUATICENVIRONMENTALMONITORINGACTIVITIES
Introduction
58. The principal activities of aquatic monitoring teams during 2000 were the monitoring ofimpacts of larviciding on invertebrates and fish fauna of treated rivers, evaluation ofrecolonisation trends where treatment has stopped, assessment of river and land environments at
monitoring stations and various involvements to contribute to finalizing a proposal for a project
IPC22.3Page 56
Annex 6
to manage ecosystems in order to conserve biodiversity in oncho-freed zones (ie the WAFEM
project). Comprehensive reports on the issues have been submitted and only summaries ofessentials are presented here.
59. In addition to the summaries of fish and invertebrate results, a format which attempts to
cristalize overall observations on fauna in relation to larviciding at stations is also presented.
Fish monitoring
60. Fish teams in all countries involved continued to monitor four characteristics of fish
communities and populations at their stations in relation to OCP larviciding. These were :
i)ii)iii)i'r)
Continuous occurrence of fish species known at a station,Catch Per Unit Effort (CPUE) of fishing trends,Species richness of catch, andCoefficient of condition of principal species per station.
a
a) COte d'laoire
61,. Three stations (Pont frontiOre on river Leraba ; Ganse on the Como6 and Niaka on White
Bandama) were monitored during 2000. Treatments on all the rivers were terminated at least
seven years ago.
- Species occurrence : The number of fish species encountered at the stations during 2000
were 36, i+ and 32 for Pont frontiEre, Ganse and Niaka respectively. The number and kinds ofspecies encountered at the respective stations during the year were comParable to the range and
species known for the individual stations. At Pont fronti0re on Leraba, a specimen of. Heterotis
iiloticus (fm. Osteoglossidae) was encountered in a monitoring net for the first time. No
indication of a species being persistently absent can be reported.
- Species richness of catch : Species richness at all stations in Cdte d'Ivoire during 2000
was more comparable to records of 1997 which were slightly higher compared to other years.
- CPUE : CPUEs recorded on Leraba and Como€ during 2000 were slightly higher
compared to records of recent years. On the Bandama however, a decline in CPUE was recorded
during 2000 compared to recent catches.
- Coefficient of condition : Average "condition" values of principal species per station
remained stable and comparable to previous years.
b) Ghana
62. One station, Asubende on the River Pru was monitored during 2000. The river is still
under treatment.
- Species occurrence : Number of species encountered at the Asubende station during 2000
were 52. Att tn" species have been previously encountered and there was no species persistently
absent taking previous records into account.
IPC22.3Page 57
Annex 6
- Species richness of catch : Fifty two species per year as recorded in 2000 was the second
highest species-rich year in 23 years of monitoring the station. Species richness observed during2000 was comparable to that obtained in 1988 and only lower than the record high richness of1989 for any year since 1978.
- CPUE : The CPUE recorded for 2000 was comparable to records of 1991/92 and higher
compared to records of 1992 till present. Steady decrease observed since 1987 seem to have
stopped during 799.8/99 and a definite increasing trend recorded in 2000.
- Coefficient of condition : Mean "condition" factor of species monitored at Asubende
remained stable and comparable to estimates of previous years.
c) Guinea
63. Three stations (Mandiana on Sankarani, Boussoul6 on Milo and Baranama on the Dion)
were monitored during 2000. All three rivers are still under treatment.
- Species occurrence : Species occurring at all stations have been encountered before at the
stations and no durable absence of any species could be reported as at the end of 2000.
- Species richness of catch : Species richness recorded in 2000 was comparable to the
relatively higher levels obtained since L997 in relation to earlier years.
- CPUE : In Guinea, CPUE recorded during 2000 was higher compared to previous years
Thus an increasing trend of catch apparently continue at all stations in Guinea.
- Coefficient of condition : Mean "condition"of principal species at all stations were stable
and comparable to estimates of all previous years.
d) C-onclusions
64. The follorving conclusions on characteristics of fish communities and populationsmonitored at all station could be made.
- Species occurrence : With the exception of a specimen of. Heterotis niloticus encounteredon the Leraba river in COte d'Ivoire, species occurring at all stations have been recorded therebefore. There was also no indication of a species being persistently absent at any station to be
attributed to larviciding.
- Species richness of catch : Annual species richness of catch continue to increase slightlysince 1994/ 95 at all stations. The situation is attributed first, to relatively persistent conducivehydrological situation in the sub region. This factor has also generally increased catch persampling event and annually and the increased CPUE has contributed to increased species
richness of catch. However, as indicated above, the species being recorded have previously beenknown for the individual stations.
- CPUE : Considering all station, the major change in trend of recorded CPUEs was the
change of study decreasing catches on the Pru river at Asubende. Evidence of "recovery" was
recorded during 2000. In C6te d'lvoire the slight decline in CPUE on the Bandama was within
a
IPC22.3Page 58
Annex 6
acceptable range. All other stations continue to record higher CPUEs since1994/95. Considering
that alt rivers in C6te d'lvoire have not been treated for more than five years each, the decline on
the Bandama, where treatment was terminated in 1993 could not be attributed to larviciding. The
situation is confirmed by the obvious increase in CPUE on the Pru which is still under treatment.
- Coefficient of condition : No detectable change in mean condition of principal species
has been observed at any of the stations monitored since the beginning of larviciding in the
programme area. Thus lirviciding could not be influencing the well being of fishes (which is
expressed by the "condition").
Entomological monitoring
65. As initiated in1998/99, the emphasis of entomological monitoring since then has been on
the study of recolonisation of water courses where Iarviciding has stopped. However, impact
assessment of treatments on fauna continued where treatment is being maintained.
Results of recolonisation studies
Marahoui
66. River Marahoud monitored at two stations, Danangoro and Entomokro, has not been
treated for three and a half years (ie since June 1997).
- At Danangoro re-occurrence of Tricorythidae, Leptophleiidae and Neoperla spp. during
post-treatment years indicate re-colonisation of river by invertebrate fauna. AIso, observed
increased frequlncy of occurrence of Ephemeroptera, Tricorythidae and Leptophleiidae may
support the considered re-colonisation.
- At Entomokro only Neoperlahas reoccurred in samples to suggest re-colonisation.
Nazinon, Ldraba andlMite Bandama
67. A station each on the Nazion, Leraba and White Bandama have been under study for
indications of re-colonisation by invertebrate fauna-
- The Nazion river at Pont de P6 has not been treated for more than nine years. During the
post-treatment period, Neoperla spp, Sericostomatidae and Pyralidae have reoccurred in samples
ind at higher frequencies indicating re-colonisation of river by invertebrate fauna.
- The Leraba has not been treated for more than nine years. During the period after
treatment, 33 out of 35 taxa known for the station have been encountered with Pyralidae being
encountered for the first time in 2000. The re-occurrence of Pyralidae especially, has been
considered as indication of re-colonisation. Also, increasing frequency of occurrence of majority
of taxa (currently 23) during post treatment period has been considered as indication of re-
colonisation.
- The White Bandama has not been treated for eight years. During the period, Neoperla spp
have re-occurred together with a general stability in occurrence of majority of taxa. The situation
is considered as indication of re-colonisation by invertebrate fauna.
a
a)
a
a
IPC22.3Page 59
Annex 6
Red Volta at Nangodi
68. The Red Volta has not been treated for seven years (since 1994). During the period the
taxonomic richness of the river has increased by the reoccurrence of four of five "sensitive" taxa.
These include Heptageniidae, Oligoneuriidae, Tricorythidae and Neoperla spp. Tricoythidae were
encountered only during 2000. The other "sensitive" taxa of the station awaited is Caridina. Thesituation indicates very fair re-colonisation of river by invertebrate fauna.
Conclusions on re-colonisation study data
69. Indications of re-colonisation of rivers by invertebrate taxa after river treatment continueto improve. "sensitive" taxa eg. Neoperla spp, Pyralidae, Tricorythidae and Oligoneuriidae whichwere affected during treatment years, in the same or different rivers have re-occurred. Also,
reports of stability of the majority of taxa and increased frequency of occurrence of identifiedones also support the re-colonisation indications.
Discussion
70. Discussion following the reports on re-colonisation studies among the Ecological Groupmembers indicated that the Group was satisfied with the widespread re-colonisation indications.The Ecological Group also considered that continued absence of a total of six taxa, consideringindividual stations in the monitored area, had been anticipated and thus acceptable.
b) Results of entomological monitoring at treated stations
Ghana: Riuers Pru at Asubende and Oti at Sabari
71. During 2000, drift indices on the Pru which had been considered to have shown minimumimpact of larviciding since L992 further improved. However, increased densities was notaccompanied by taxonomic richness. Among sensitive taxa at the station Neoperla spp. andOligoneuriidae have not been encountered since 1993 and L997 respectively.
72. At Sabari on the Oti, which has been subjected only to a few cycles of experimentaltreatment per year since L998, densities of entomological fauna increased in 2000 compared toL998 and 1999 data. Taxanomic richness was also recorded by the re-occurrence of Tricorythidaeand Heptageniidae which had not been encountered for several years.
Guinea : Riaers Milo at Boussoull, Niandan at Sansambaya and Dion at Tire
79. At Boussoul€ improvements in taxa composition and densities were recorded in 2000. The
improvements were attributed to better epifaunal substrate during the year.
- At Sansambaya, taxanomic richness increased by five taxa during 2000 compared to resultof 1998 and 1999. However densities of samples reduced, due to lower representation ofHydropsychidae and Orthocladiinae.
- At Tdre, taxanomic richness increased to 24 from L9 in 1998 and22 in 1999. Also, althoughnight drift samples recorded taxonomic richness of 27, this was still lower and the taxa less stable
compared to the 33 and 36 taxa richness of pretreatment years.
IPC22.3Page 60
Annex 6
Surumary conclusion on obseraations at treated stations
24. At majority of treated stations increased taxonomic richness and densities were recorded'
The situation was attributed to improve ecological factors (e.g. increased epifaunal substrates)
and reduced impact of treatment on fauna due to the rotation strategy'
of f.a
75. In anticipation of summarising the status of monitored fauna after OCP, the following
formats were presented for comments of the Ecological Group.
a) For summary of fish status
76. Basically, a number of tables, each dealing with a parameter monitored is proposed' Each
table would have columns indicating the relativJtrend of the parameter with reference to before-
treatment, during-treatment and after-treatment periods of monitoring (see example below)'
The subjects for the tables would include eg:
a) Trend of total CPUE,
b) Trend of CPUE of Principal species,
.j General trend of species richness of catch'
d; G".,".rI trend of coefficient of condition of species'
Etc.
b) For Summary of lnaertebrates status
72. Again, a number of tables each presenting the trend of a characteristic of invertebrates
monitored with reference to before-treatment, during-treatment and after-ffeatment periods of a
station. (See examPle below).
Subjects for the tables will include :
a) Taxonomic richness (Drift and Surber samples)'
b) Response of sensitive taxa in Drift,c) Response of sensitive taxa in Surber'
Discussions
78. The discussions which went on among the Ecological Group members after the
presentation of the summary tables indicated thit the format was acceptable' They however'
suggested that wherever figures could be put to indicate level of decrease or increase, it should
bel-one. For example, decreasing trend up to 30%'
Their comment on the contents of tables was that, they were pleased with the indications of
recovery of sensitive taxa which had been a real worry about ten years ago' Also' because the
data showed that reduction of number of taxa per station was maximum six' the results were
acceptable because that level of effect had been anticipated.
a
I
a
lPc22.3Page 61
Annex 6
Example of Fish table
Table - General trend of total CPUE
Example of Invertebrateltable
Table - Taxonomic Richness of Surber and Drift
Habitat Assessment parameters extension to accommodate WAFEM
79. Habitat assessment study reports of various monitoring stations, hcorporatingamendments made on the study format at the 2000 meeting, were submitted. It was encouragingto observe use of habitat status in the interpretations of aquatic fauna monitoring results. Nomore amendments on the study format was proposed. However, in anticipation of the WAFEMproject, which would cover aquatic habitat, gallery areas and beyond galleries, parameters toassess the gallery and area beyond were necessary. Therefore, the following points wereconsidered by the meeting for addition to the present habitat assessment protocol :
First, it was considered that an estimation of the length, mean width and depth of riverstretch should be included in the aquatic habitat assessment.
River station Before-treatment (BT) During-treatment (DT) After-treatment (AT)
Leraba/Pontfrontidre
19xx to L9xx
No data
1975 to 1989
Decreasing trend to about50%
1989 to2002
Decreasing trend continuefor 4 year then increasing
Pru/Asubende 1978 tofluctuating
1987 1987 to 2002 presentdecreasing trend for 11
years then increasing about7992level in 2000
Not available
Milo/Boussoul6 Not available 1988 - 2000 presentlystable, initially increasingsince 1994
Not available
RIVER STATIONPRE.TREATMENT
PERIODTREATMENT PERIOD POST TREATMENT
Marahou6/Danangoro Surber 27Drift 38
Richness decrease to 23
Decrease to 35
Increase to 27
Continue to decrease to 33
a
JPC22.3Page 62
Annex 6
Second, status of gallery and the area beyond should be assessed as optimum,
suboptimum, marginal or poor on the following criteria'For the gallery zone :
For the area beyond gallery
Discussion on land-use changes as part of environmental monitoring in Oncho-freed zones.
80. The subject continued to be discussed by the Ecological Group to identify limited
approaches thaiwoutd ensure sound basis for the monitoring. Several suggestions were made by
^e^U".s. Finally the Group decided to follow two lines of action; first to search for historical
perspective of occupationil and ecological state of oncho-freed zones; second to find the
pomiUitify of having the ecological state of oncho-freed zones recorded at the end of the
b.og.u- e. Membeis of the EG and OCP were therefore requested to inquire about availability
of remote sensing information on study sites and related areas.
ac the fifth
81. Dr. Leveque presented to the meeting, a manuscript of a brochure prepared by a team.
The intended brochure highlighted environmental activities of the Programme as previously
recommended. With a few ii.,irhi.,g items to be added, the meeting accepted the manuscript and
recommended to OCP to take necessary steps to have the manuscript published in English and
French.
82. Referring to preparation and publication of synopsis of scientific results from monitoring
activities, Dr. Leveque said the subject had only been discussed briefly during the last meeting.
However, he presented a preliminary consideration of unit parts as shown below for further
deliberation by members as the recommendation to publish a synopsis was retained.
Unit parts considered were :
The strategy of Vector Control - Former C-VCUs
Concerns for the Environment - Ex. Chairs of E.G.
The EG: history, mandate & objectives - L6v€que & Calamari
t
Optimum Suboptimum Marginal Poor
Gallery forest width> 25% of river meanwidth. Gallery has
old trees on galleryfloor.
Gallery forest width < 1,0%
of river mean width.Numerous old trees,
shrubs and grass near riverbank.
Few old trees close toriver bank. Shrubsand grass present inarea.
Some Brass andopen soil.
Optimum Suboptimum Marginal Poor
Natural vegetationof area (to be
stated)
Degraded naturalvegetation throughdeforestation, bumingand/or cattle grazing.
Subsistence farm landwith annual crops.
Area covered by largeindustrial type plantation.
IPC22.3Page 63
Annex 6
History of Aquatic Monitoring - L. Yam6ogoEconomic importance of EG recommendations - D. ColmanLarvicide screening on the vector- ).M. Hougard & Y. Bissan
Screening of larvicides & non-target fauna - B. Statzner & L. Yam6ogoLong term impact assessment on invertebrates - V. Resh f Statzner / NationalhydrobiologissLong term impact assessment on fish - Paugy / National hydrobiologistsSustainable development in oncho-freed zones - Sonou & OCP
The discussion which took place after Dr. Leveque's brief centred on the approach to the
organisation of work. Generally it was thought that a steering committee which should do some
detail planning of the work should first be established. The first meeting of the committee should
be held in Ouagadougou in 2001 at a date to be agreed on by the members.
For the purpos€ of continuing with the eventual publication of the two documents, the Chief
of VCU indicated that there was some resources available for the purpose during 2001.
Response of the Ecological Group to recommendations of the hydrobiologists
83. Work done by groups of hydrobiologists taking into account the results of the monitoringduring 2000lead to the following recommendations:
o Monitoring activities during 2Cf],-2002 for both invertebrate and fish teams, should be
at the same stations and frequencies as they were during 2000. However, monitoringteams ltould take necessary extra samples during their usual visits to obtain any othercrucial information.
o Habitat assessment reports should be accompanied by photographic documentation.
. Common approaches to data handling and presentation in reporting shall be adoptedor adhered to by the fish and invertebrate monitoring teams.
o National teams should endeavour to prepare, preferable joint manuscripts based onmonitoring data aimed at publishing them and submit to VCU. Meanwhile OCP shall,through a member of the Ecological Group organise a one-day workshop on theorganisation of manuscripts for national hydrobiological monitoring teams.
. OCP to assist national teams to train younger hydrobiologists by augmenting missioncost of regular monitoring.
84. The Ecological Group appreciated and endorsed recommendations made by thehydrobiologist and recommended to the Programme to respond positively by supporting thehydrobiologists to achieve them. The Group also appreciated the current level of reporting by thehydrobiologists.
F
IPC22.3Page 64
Annex 6
ECOLOGICAL MONITORING AS PART OF THE SOCIO-ECONOMICDEVELOPMENT OF ONCHO-FREED ZONES
The chief of VCU had earlier briefed the meeting on the status of the WAFEM project and
reminded participants of some central characteristics of the project. On collaboration, and the
Ecological Group's call on FAO to support WAFEM, Mr Sonou of FAO briefed the meeting as
below.
Recent developments in Socio-Economic Development activities of FAO for Oncho-freed zones
and possible relationships with the WAFEM project
85. FAO's focal point person for OCP's Committee of Sponsoring Agencies (CSA), Mr. M.
Sonou briefed the meeting on FAO's activities towards sustainable socio-economic development
of oncho-freed zones. He said, FAO has since 1998 focused on mobilizing resources for the said
development through the designing of national pilot investment projects in almost all countries
participating in OCP. This activity is expected to be completed by end of March 2001. As a
iollow-up, FAO initiated the development of a concept and proposal for a regional socio-
economic development programme for oncho-freed zones in 2000.
86. The Programme's goal is to ensure that rural services, food security and household
income in oncho-freed areas equal or exceed that of other areas in West Africa, while ensuring
that the oncho-freed areas contributed to the food fibre and feeding requirement in the region.
An objective of the programme is to achieve more rational management of natural resources. In
the process, the programme will maximize complementarity with ongoing projects and
encourage involvement of communities and non-govemmental organisations. Thus FAO's
programme for the oncho-freed zones will build synergy with WAFEM in many respects such as
I puiti.iputory conununity Planning, management of shared river basins, establishment of local
fora for resource access and use rights together with environmental monitoring and itsassessment. In the latter field FAO intends to use GIS and Satellite Imagery Interpretation (SII).
87. As presently envisaged, the programme would start with a two-year launching phase,
followed by a seven-to-nine year operational stage, and then, a two-to-three year consolidation
and devolution period.
Discussiott
88. Mr Sonou's brief was followed by discussion which centered on FAO's considered role in
orderly settlement in oncho-freed areas, encouragement of communities in ecosystems
management and conservation of biodiversity. Mr Sonou explained that while FAO does not get
directly involved with who or how many people immigrate into an area, it functions through
district and traditional administrative structures to organise distribution of immigrants and
supports their socio-economic development.
)
G. WORK PROGRAMME FOR 200V2002
89. Aquatic monitoring activities during 2OO1 - 2002 were recommended by the Ecological
Group to iontinue on the same watercourses and frequencies as in 2000.
- OCP would, through a member of the Ecological Group organise a one-day workshopon organisation of manuscript for national hydrobiological teams.
I
a
lPC22.3Page 65
Annex 6
Finalisation of the economic importance of Ecological Group decisions would be
completed during the year.
If and when WAFEM is approved the project may have to launched with theinvolvement of several of members Present.
At the appropriate time a draft of a protocol for WAFEM would be circulated for the
comments by participants.
OCP is to closely cooperate with WAFEM in fulfilling its objectives.
H. ARRANGEMENTS FOR THE NEXT MEETING
90. The twenty-third session of the Ecological Group is planned to be held in OuagadouSou,
Burkina Faso, tentatively, on the 7tn and 8,n of March 2002. The meeting would be preceded by
the joint Hydrobiologists - Ecological Group meeting on the 6th March and the Hydrobiologists
meeting on the 4tt and 5th of March 2002.
I. READING OF MEETING REPORT FOR APPROVAL
91.. The main points of the Ecological Group meeting as recorded during the meeting were
presented for correction and approval. The discussion after the presentation concluded that parts
of the report had to be restructured and presented for preliminary approval prior to the
finalisation of the report. Minutes of the meeting to be written after the preliminary aPProval willbe submitted to the chairman of the Ecological Group for approval before presentation to the
Expert Advisory Committee in June.
l. cLosuRE oF THE SESSION
92. The meeting was closed on the 9th of March 2001 by the Chairman of the Ecological
Group. As closing remarks the chair thanked his colleagues, Director of the Programme, the chief
of VCU, invited experts and participants for attending the meeting and for their contributions.He also thanked the WRI and its personnel for the facilities and organisational support given to
the meeting. He invited members of the Ecological Group who could make it, to a field trip toAsubende on the Pru river the next day. The session was then closed with an invitation tomembers for the 2002 meeting.
a
IPC22.3Page 66
Annex 6
APPENDIX 1
LIST OF PARTICIPANTS
Ecolo Group Members
Professor Davide Calamari, Environmental Research Group, D-epartmt-"j. ol Structural and
Functional Biology, U.riu".tity of Insubria, Via ].H. Dunant 3,21L00 Varese VA' Italy
Tel: 00 39-0332-421546 - Fax: OO gq-oggz- 421554, E-Mail: davide-calamari@uninsubria'it
professor David Colman, Schoot of Economic Studies, University of Manchester, Manchester
M13 9PL, United KingdomFax: 0161 z7s 4g2g - rlt. OrOr 275 4804,E-mail: david.colman@man'ac'uk
Dr Christian L6v€que, Programme Environnement, Centre national de Ia Recherche scientifique'
Vie et soci6t6s, 1 Place Aris-tide Briand, 92195 Meudon cedex, France
Tel. 01 45 07 5045 - Fax 01 45 07 5124- E-mail: Christian.Leveque@cnrs-bellevue'fr
professor vincent H. Resh, Department of Environmental science, Policy and Management'
u"J".s i ty of Calif orn ia, 207 Weliman Hall, Berkeley, Ca tif orn ia 9 47 20, US A
i"f. 1SfOl O 42-3327 - Fax (510) 642-7428 - E-mail: vresh@nature'berkeley'edu
Invited ExPert
Dr Bernhard Statzner, CNRS, Ecologie des Eaux douces et de9 8ry11F191Ye's' Universit6 Lyon 1'
6g622Villeurbanne Cedex, France --Fax: +33 4724317 41- Tel: +33 472448034
E-mail: [email protected]'fr
Other oarticipant
Mr Moise sonou, senior water development officer, FAO Regio"4-9!qt9j:r Africa'
p.O. Box 1628, Accra, Ghu.ru -Tel:233'21 675000 or 70L0930 - Fax: 233 21' 668427 or 7010943 -E-mail: [email protected]
OCP Secretariat
Dr B.A. Boatin, Directeur du Programme,0l 8.P.549, Ouagadougou 01, Burkina Faso
E-mail: boa [email protected]
DrL.Yam6ogo,VCU/oCP,0].B.P.s4gOuagadougou0l,BurkinaFasoE-mail: [email protected]
Dr H. Agoua, VCU/OCP,8.P.36 Kara, Togo
E-mail: [email protected]
M. A. Ak6, VCU/OCP, B.P.504 Odienn6, C6te d'Ivoire
E-mail: [email protected]
M. M. Sarr, VCU/OCP, B.P. 504 Odienn6, C6te d'Ivoire
E-mail : [email protected]
M.].M.Tapsoba, VCU/OCP,0L B'P' 549 OuagadouSou 01' Burkina Faso
I
I
a
IPC22.3Page 67
Annex 6
M. L. Bakon6, VCU/OCP,01 8.P.549 Ouagadougou 01, Burkina Faso
M. P.R. B6lemgoab ga, CoM/ o, 01 B.P. 549 Ouagadougou 01, Burkina Faso
Dr E. K. Abban, Council for Scientific and Industrial Research, Water Research Institute
(CSIR/WRI), P.O. Box AH.38, Achimota, Ghana -
Fax: (233) 2177 7170 - Tel.: (233)2176831.0 - E-mail [email protected]
t
a
a
lPC22.3Page 68
Annex 6
APPENDIX 2
LIST OF DOCUMENTS
OCP/VCU/HYBIO/01.01 - Monitoring of the aquatic environment in Guinea - IchtyofaunaMoussa Elimane Diop
OCP/VCU /HYBIO/01..02- Fish monitoring in relation to OCP larviciding in Ghana
E.K. Abban & K. Kwarfo-Apegyah
OCP/VCU/HYBIO/01.03 - Monitoring of the non target aquatic entomofauna in Guinea
K6l6tigui Nab6
OCP/VCU /HYBIO/0L.04 - Summary of the annual report of C6te d'Ivoire - IchtyofaunaKouassi N'Gouan Cyrille
OCP/VCU/HYBIO/01.05 - Ghana invertebrate monitoring report - 2000
J. Samman & A. Ampofo-Yeboah
OCP/VCU /HYBIO/01.06 - Aquatic monitoring and progress report of the OCP team in 2000
L. Robert Bakon6 & Joseph-Marie Tapsoba
OCP/VCU /HyBIO/01,.07 - Annual report of C6te d'Ivoire - Entomology (2000)
Bihoum Moussa, Ayekoue Patrice & Kouassi N'Gouan Cyrille
a
a.
a
t
a
I
lPC22.3Page 69
Annex 6
APPENDIX 3
WORK PROGRAMME FOR 2OO1
a
a.
PERIOD OF SAMPLING /FREQUENCY
FISHINVERTEBRATE
January to DecemberJanuary to April, Novemberand December
COUNTRY/ RIVER/ SITE
Once every 2 months (2 nights)
Once every 2 months (2 nights)
Once every 2 months (2 nights)
Once every 2 months (2 nights)
Once every 2 months (2 nights)
Once every 2 months (2 nights)
Once every 2 months (2 nights)
Once a month (1 daY)
Once a month (1 day)
Jan., Feb., Nov. & Dec(recolonisation)
Jan., Feb. And Oct. to Dec.(recolonisation)
Sept. to Dec. (recolonisation)
Jan., Feb., Nov. And Dec.
Once a month (1 day)
Aug. To Oct. (recolonisation)
)uly to Nov. (recolonisation)
Once a month (1 day)
Once a month (1 day)
Once a month (1 day)
COTE D'IVOIRE
Marahou6/Danangoro
Marahou6/Entomokro
L€raba/Pont Frontidre
Bandama/Niaka
Como6/Gans6
GHANA
Oti/Sabari
Pru/Asubende
Red Volta/Nangodi
BURKINA FASO
Nanzinon/Pont Po
GUINEE
Niandan/Sassambaya
Dion/Baranama
Dion/TErd
Milo/Boussoul6
Sankarani/Mandiana
a
NB: The drift samples are taken only to follow taxonomic ichness of riaers
a
a
,
JPC22.3Page70ANNEX 7
EXPERT ADVISORY COMMITTEE
Rqport of an EAC Task Force
Geneva. I and 2 October 2001
,
q
t
JPC22.3Page77
Annex 7
a
t
c
A. OPENING OF THE SESSION
1' Professor Adenike Abiose, current Chair of EAC, in opening the session referred to thedecision of the June 2001, session to appoint a Task Force that would consider therecommendation of EAC to continue onchocerciasis control (including the possibility of aeriallarviciding) in the four "special Intervention Zones" (map) beyond th"e end of OCp lperationsand make specific recorunendations for the implementation of such control. The Task Forcewould have at its disposal up-to-date entomological, epidemiological and socio-demographicinformation concerning the zones in question, reports on vector control, ivermectin distributionand the predictions of ONCHOSIM simulations on the effects of post-Ocp interventions. TheTask Force report would be submitted first to CSA at its Octobe. s"siio., before being consideredby IPC at its session in December 2001. (List of participants in the Appendix).
2' The Programme Director, Dr Boakye Boatin, summarized the findings of recent socio-demographic, migration and CDTI compliance studies.
3' Dr Laurent Yameogo, Chief of the Vector Control Unit, informed the participants aboutthe results of up-to-date entomological surveys.
4' Details were Provided by Dr Soumbey Altey, formerly acting Chief of the planningEvaluation and Transfer Unit, regarding the methodology oi recent"ONCHOSIM simulationstudies using data from the "special Intervention Zones", *a tfr" predictions arrived at.
B. DETERMINATION OF POST.OCP ACTTVITIES TO BE UNDERTAKEN INTHE SpECrFrc TNTERVENTTON ZONES (StZ)
5' The four SIZ show widely differing characteristics - both in the nature of the controlproblems they are experiencing and i" the socio-demographic characteristics of theirpopulations.
PRU RTVER BASIN
Characteristics
Population:85 000
Prevalence : 7 .5o/o (September 2001)
Incidence: 1.4
Community Micro filarial Load (CMFL):
Annual Biting Rate (ABR):18250 (2000)
Annual Transmission Potential (ATp): 15g (2000)
Vector control since: March 1989
CDTI since: 1987
O uolaulus adjusted ATP: 91
coverage: 65.1,%
JPC22.3Page72Annex 7
6. In summa Although this zone has taken longer than expected to respond to combinedrvtreatment, the situation is becoming satisfactory. The focus experiencing the problem is fairlysmal[.
Recommendation
Annual ivermectin treatment at a high level of therapeutic coverage (85%) and maximumgeographical coverage, continued until 20L2 (10 years) without vector control.
Close monitoring of the control situation to decide whether, at any stage, the frequency ofivermectin treatment should become bi-annual and whether the coverage is being
achieved.
)ustification
7. The latest series of Onchosim simulations predicts that annual, intensified ivermectin
treatment will reduce the danger of recrudescence in the zone to zero.
Prerequisites
8. To ensure a high level of ivermectin treatment coverage, arrangements must be made forintensive support to those responsible for implementing CDTI:. The principle of treatment undertaken and directed by the community remains.
' The Ministry of Heatth remairu in charge of operations, but is given additional suPPort
by OCP during its remaining life. Such support should be directed at health service staff
(at national, district and sub-district/ health centre levet) and at community distributors.. Such support would include ensuring that all communities that need treatment are
known and located; providing further sensitisation and training where needed;
intensifying supervisiory encouragement and guidance; and making arrangements forthese improvements to be sustained after the end of 2002.
' Additional staff and resources such as transport will be required to put these measures
into effect.
MAFOURIYER BASIN
I
,a
Characteristics
Population: 844L9
Prevalence : 27 .5o/o (1999)
Incidence: 7.7% (1999)
CMFL:0.49
ABR:21452 (2000)
ATP:74 (2000)
Vector control since: March 1990
Ivermectirr treatment since: 1990
O.aolaulus ATP:25
Mean coverage:62%
t
a
o
IPC22.3Page73
Annex 7
g. In summary: The area is at the end of the first twelve year period of control. The results of
control were initially satisfactory, but there was later incomplete coverage of certain breeding
sites. This probably contributed to the control problems which developed later.
Recommendation
. Ivermectin treatment at a high level of coverage (80%) twice yearly, continued until 2012
(10 years), without vector control., Close monitoring.
fustification
10. The latest series of Onchosim simulations predicts that bi-annual, intensified ivermectin
treatment will reduce the danger of recrudescence in the zone to zero.
L7. However, adding vector control would have the additional benefit of protecting the free
areas in Guinea and beyond.
Prerequisites
72. To ensure a high level of ivermectin treatment coverage, the steps previously outlined
(see paragraph 8 above) should be taken in this zone as well.
TINICSSO BASIN
No current epidemiotogical data is available: however, the basin is socially similar to the Mafou
basin and the recommendations for that basin would apply here too.
UPPER OTI RIVER BASIN
Characteristics
Population:18'1. 422
Prevalence of onchocerciasis: Titira: 21.7% (year 2001) - 88.5% (1976)
Tapounde: 24.6% (2000) - 30.5% (7992)
Incidence of onchocerciasis: not available
CMFL: Titira: 0.9 microfitariae per skinsnip (2001) - 36.62 (1976)
Tapounde: 0.7 (2000) -2.44 (1976)
ABR: Titia: 24072(1976) - 9 426 (2000)
Tapounde: 131,47 (7977) - 7 889 (2000)
ATP: Titira: 1 339 (1976) - 101 (2000)
Tapounde: 1,096 (L977) - 29 (2000)
O. aoloulus ATP:77O.oolaulus ATP: 7
lPC22.3Page74Annex 7
Vector control since: 1977, interrupted in certain parts of the basin in1992 and resumed llr:.1997
Ivermectin treatment stnce1997, but the area was under re-invasion until L987
Mean coverage: 79.26o/, (2001)
13. In summary: This basin was part of the initial Programme area, and vector control started
there in 1977. lJnsatisfactory results were already noted after its first fourteen year period of
larviciding. Aerial larviciding was resum ed in 1997.In spite of efforts that optimized larviciding
and ivermectin treatment, the situation remained unsatisfactory.
Recommendation
. Ivermectin treatment at a high level of coverage (85%) twice yearly, continued until 20L2.
This is the prioritY activitY.
. Aerial larviciding, continue for 5 years after the closure of OCP at the end of 2002. This is
considered essential.
]ustification
14. The latest series of Onchosim simulations predicts that bi-annual, intensified ivermectin
treatment will reduce the danger of recrudescence in the zone to a very low level. Bi-annual
treatment will have the double effect of enhancing coverage and maintaining the CMFL at a low
level.
15. The same simulations predict a zero danger of recrudescence if the intensified ivermectin
treatment is combined with vector control. Ivermectin treatment alone will eliminate
onchocerciasis as a public health problem (probably with some impact on transmission), while
adding vector conkol virtually eliminates transmission.
L6. Adding vector control to ivermectin treatment will prevent re-invasion by infected black
flies from the zone, into surrounding areas where the onchocercal prevalence has been reduced to
zeroby previous OCP vector control.
L7. A combined treatment (ivermectin and vector conhol) ought to reduce the risk ofresistance to ivermectin developing.
L8. The situation will be closely studied to see how it develops. In the meantime it is essential
to keep the epidemiological and entomological situations as well controlled as possible, while
awaiting the development of further control options and new tools.
Prerequisites
19. To ensure a high level of ivermectin treatment coverage, the steps previously outlined
(see paragraph 8) should be taken in this zone as well.
'
t
(
JPC22.3Page75
Annex 7
20. For postOCP control to be maintained at a satisfactory level, the necessary technical
know-how and management capacity to conduct larviciding, without interruption, to be
hvailable at the closure of OCP.
ADDITIONAL RECOMMENDATIONS
Z1^. The possibility should be considered of treating (on a case basis) infected patients with
compounds of poteniial macrofilaricidal effect such as doxycycline, and research undertaken in
this respect.
22. Budgets should be prepared for intensified support to CDTI in the four zones.
Zg. Special research efforts are urgently needed, to find out what the reasons could be for
control measures not having had the same results in the fours zones, as in other parts of the
Programme area.
,
I
a
t
JPC22.3Page76Annex 7
Members of EAC:
Secretarial and specially invited:
APPENDIX
List of participants
Professor Adenike Abiose (Chair)Dr Bemard PhilipponProfessor Detlef R ProzeskyDr Andr€ Yebakima
Dr Soumbey AlleyDr Anarfi Asamoa-BaahDr Boakye A. BoatinDr Ole Worm Christensen (Secretary)Mr Abdulai DaribiDr Marc KaramDr Janis LazdinsDr Hans RemmeDr Laurent Yam6ogo
t
a
L
I
lPC22.3Page77Annex 7
U)(c-ol<okatr
p<
1
I
I
/
/
-\-
(hC)
l-{(d
-ok
U)cdpt<(D
l-.oV)U'
,51
F
trv,d.ol-ot{
€cl
Eo)o0
zl-.oaAD
/
\;(r,t\
Ll/1.
Tl
@
0i()c6
()€o)L<
d6
ad.OaG)
CS
o\(DqaatroHC)t(.)
G
'(,aC)
oI(.)L{cc
()
COo)l-{
o<QcC)
)-{
aC)L{oNtro{-)l-{G)
rC)
t-{
CC
oC)q
UC)
O.CO
=a
a
,
,
t