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The Global 2000 River Blindness Program of the Carter Center September 1996

Table of Contents:

By the end of July, the Global 2000 River Blindness Program (GRBP) in Uganda had assisted in providing Mectizan® treatment to 455,327, or 70%, of the 648,514 at risk persons targeted for treatment in 1996 (Table 1). The Annual Treatment Objective (ATO) of 648,514 (which is the number of eligible at risk persons projected to be treated by the project during the current calendar year) for the GRBP in Uganda covers at risk populations in Apac, Gulu, Kabale, Kasese, Kisoro, Moyo, Nebbi, and Rukungiri Districts, (see map) which include approximately 59% of the estimated 1.1 million Ugandans at risk who require treatment with Mectizan® annually.

At the same time, the Ugandan GRBP provided treatment in 726 (72%) of the 1007 at risk villages it had targeted for treatment in 1996 (Table 1). GRBP activities in 1996 have so far focused on Apac, Kasese, Kisoro, Moyo, and Nebbi districts, where 92% of the ATO has been covered. Community mobilization and/or health education were also conducted in parts of Apac, Moyo, and Nebbi Districts. The mobilization in Moyo was conducted by MSF-CHSwiss and African Humanitarian Action (AHA), agencies providing health services to Sudanese refugees in transit camps and settlements. Over 600 persons from Zaire were treated in Kisoro District in March.

The GRBP country representative, Mr. Moses Katabarwa, is actively assisting in revising the National Plan of Action for Onchocerciasis Control in preparation for a Ugandan proposal to the African Program for Onchocerciasis Control (APOC). The National Plan was reviewed by a team representing APOC and WHO/AFRO, which made a site visit to Uganda between 8 and 13 July. The team was hosted by the coordinator of the national program, Dr. Richard Ndyomugyenyi, and other members of the National Onchocerciasis Task Force.

Mr. Katabarwa leaves the GRBP Uganda program in August to begin studies for the Masters of Public Health degree at Emory University's Rollins School of Public Health, in Atlanta, USA. As the topic of his thesis, he will analyze data collected by the GRBP (formerly River Blindness Foundation) Uganda project since 1993 to address the issue of sustainability of community-based Mectizan® distribution programs. Mr. Dominic Mutabazi will be acting GRBP country representative during Mr. Katabarwa's absence.

Nigeria's National Onchocerciasis Control Programme (NOCP) officially launched a National Onchocerciasis Trust Fund in a ceremony held in Lagos on May 23. In an address read on his behalf at the ceremony, the federal minister of health (who was attending the World Health Assembly in Geneva) stated that the purpose of establishing the fund was to "have a country counterpart funding system to enable the sponsoring and donor agencies to assist the Nigerian program".

He confirmed that funds donated to the Trust Fund for the NOCP will be controlled by a committee which includes representatives of WHO, UNICEF and collaborating NGDOs. Cash donations of approximately 500,000 naira (~US $6,125) were announced at the launching ceremony. In a separate development in late April, Chevron Nigeria Limited forwarded to the Nigerian Global 2000 River Blindness Program office their third annual contribution of 420,000 naira (~US $5,250), to help support GRBP activities in Delta and Imo States.

As of July, the Nigeria GRBP had assisted in treatment of 1,472,674 eligible persons at risk, representing 50% of its annual treatment objective for the year (Table 1). Treatment was carried out in collaboration with the state and local governments, and the Lions SightFirst Program. In June alone, mobilization and health education were conducted in 798 endemic villages in Anambra, Edo, and Delta States. So far this year, 1,429 villages have been assessed, representing 75.2% of the target for the project for the year.

Unfortunately no treatments were conducted in May or June in Anambra, Edo, Delta, and Enugu States due to non-availability of Mectizan® tablets in May or June. In addition, no treatments were distributed in Abia, Delta, and Edo in July. The unfortunate delay in the Mectizan® importation into Nigeria for the GRBP occurred despite intensive efforts by Merck, the Mectizan® Donation Program, UNICEF/Nigeria, and the GRBP. The delayed shipment was finally received in late-July. Steps are being taken to prevent a recurrence of the importation problem.

The national office of GRBP/Nigeria in Jos, Plateau State, assisted the director of the NOCP, Dr. Jonathan Jiya, and other members of an NOCP sub-committee, in hosting the inaugural visit by a team from APOC on June 17-25. The purpose of the visit was to review the Nigerian Onchocerciasis Control Programme, explain APOC's application procedures, and discuss Nigeria's draft proposal for APOC funding.

A summary report of the NOCP was published in the July 12, 1996 issue of WHO's Weekly Epidemiological Record, from which the above map is reproduced (see page 6 for the complete reference). More detailed maps are expected soon as the result of the national REMO exercise. The first in-country management workshop for the NOCP was held at the training center at GRBP/Nigeria headquarters in Jos on August 16-24. The workshop was funded by a grant from Shell Corporation, and was taught in part by consultants from the Centers for Disease Control and Prevention (CDC) Sustainable Management Development Program.

The next meeting of the Nigerian Onchocerciasis Task Force (NOTF) is scheduled to be held in Kano on October 28-29. The Lagos office of GRBP/Nigeria was relocated in June from Victoria Island to Ikeja. The address and phone numbers are: P.O. Box 2382, Lagos, Nigeria, 2341-492-6943 or 492-6944, fax 492-6945.

The GRBP in Cameroon reports that as of the end of June, the project had covered 26.3% of its annual treatment objective for 1996 in North Province, including approximately 79% of the ATO for at risk villages (Table 1). Meanwhile, preparations continue for September-October launchings of Mectizan® treatment by GRBP/Cameroon in West Province, in collaboration with the Lions SightFirst Program. Supervisory Medical Officers in charge of the Primary Health Care System were among the trainers who were trained on June 6-7 for the Western Province ivermectin distribution program.

These trainers are currently training additional health personnel, mainly nurses involved in primary health care. Various preparatory parasitological, entomological and Knowledge, Attitudes, and Practice (KAP) studies have also been completed in the province recently, in cooperation with ORSTOM.

Dr. Christine Godin, the previous country representative of GRBP, and Mr. Jean Marc Macé, administrator, left Cameroon in mid-June after 4 years in residence there. The new GRBP administrator, Mr. Jean Bangob, is also serving as acting GRBP country representative.

Following the decentralization of ministry of health programs in Guatemala last year and consequent disruption of the national onchocerciasis control program, treatment activities declined from biannual treatment in 1993 and 1994 of about 122,000 persons (98%, of the eligible at risk population in the most important "central" focus of the country), to about 22,000 treated in 1995.

The ministry of health now has approved a new national plan of action and appointed a new head of the Onchocerciasis program of Guatemala, Dr. Julio Castro Ramirez. In June, the government held a Launching Program Ceremony in the highly endemic area of Yepocapa, Chimaltenango Department, in the presence of provincial and some central health authorities, to inaugurate the resumed national offensive against onchocerciasis. The director and deputy director of OEPA, Drs. Edmundo Alvarez and Guillermo Zea Flores, were invited as special guests.

A summary of Latin American activities through 1995 will appear in WHO's Weekly Epidemiological Record in early September.

Sudan: As of July 1996, the International Medical Corps (IMC) reported having treated 20,219 persons in Tambura County, Western Equatoria. Medecins Sans Frontiers-Belgium (MSF-B) has not yet reported on the number of persons treated this year with GRBP assistance. In Khartoum, the Higher National Committee for the Control of River Blindness reports that the Government of Sudan's program has treated over 4,600 persons so far this year, although some treatments are on-going in and around Abu Hamad, Aweil, Juba, Raga, Wau, and an area of South Darfur. Insecurity and rains have delayed expanding treatments to areas of Upper Nile as intended, using support provided by the River Blindness Foundation (RBF) and extended by GRBP.

HealthNet International (HNI) assumed as of March 1996 the lead role (formerly held by MSF-B) in assisting and implementing NGDO Mectizan® distribution activities in southern Sudan under the auspices of Operation Lifeline Sudan (OLS). The program manager for this activity at HNI is Dr. Dirk Calcoen (HealthNet International, P.O. Box 40643, Nairobi, Kenya; telephone and fax: 2542-574-452). HNI already has produced two issues (March-April, May-June) of a new bi-monthly "Newsletter for all OV Workers" in southern Sudan.

HNI also has conducted a training workshop, produced and distributed standardized reporting formats based on a consensus of the NGOs, established an onchocerciasis secretariat in conjunction with the Sudanese Relief and Rehabilitation Association (SRRA), and worked with other NGOs to plan a more active treatment program for the rest of 1996.

Chad: With the agreement of all parties concerned, the Chadian Ministry of Health has decided that the ivermectin distribution program (IDP) in the three eastern préfectures of Tandjélé, Moyen Chari, and Salamat will be taken over by the French NGDO, l'Organisation pour la Prévention de la Cécité (OPC), assisted by funds from the French Ministry of Co-operation and Development. Africare will continue in the three western préfectures of Mayo Kebbi, Logone Oriental and Logone Occidental. During 1995, with RBF financial assistance, Africare treated nearly 470,000 persons in 2,093 communities. GRBP has continued its support of the Africare program during 1996. Coverage for the early months of 1996 was approximately 150,000 persons. Chad is expected to submit a proposal for funding to APOC early in 1997.

Central African Republic: During 1996, GRBP continued its financial support to the IDP run by the Programme National de Lutte contre l'Onchocercose et la Cécite and the Christoffel Blindenmission in CAR. Despite political disturbances earlier in the year, ivermectin distribution has continued and the goal of total national coverage is in sight. In 1995, 315,000 persons were treated with Mectizan®. Treatment figures for 1996 are not yet available. It is likely that a funding proposal to APOC will be submitted in October 1996 by the Ministry of Health of Central African Republic and the Christoffel Blindenmission.

Tanzania: GRBP has continued to support the IDPs in Morogoro, Ruvuma, Iringa and Mbeya Regions, which are now being managed by the Interchurch Medical Assistance (IMA) River Blindness Program.

Congo: The IDP in the Congo, formerly funded by RBF and directed by Dr. A. Stanghellini, was taken over in 1996 by the OPC using funds provided by the French Ministry of Co-operation and Development. The IDP now is directed by Dr. J.M. Sicard and has extended coverage to virtually the entire nation.

Malawi: The IDP, conducted by the International Eye Foundation (IEF) and formerly funded by RBF has continued in 1996. The Ministry of Health of Malawi, in co-operation with the IEF and the major Tea Companies, will apply in October 1996 to APOC for further funding.

APOC: The next meeting of the Technical Coordinating Committee (TCC) of APOC is scheduled for October 1-4 in Ouagadougou, Burkina Faso. Applications for the first round of APOC funding will be considered during that meeting. An NGDO Coalition meeting led by the new chairperson, Dr. Katheryn Cross of SightSavers, also will be held in Ouagadougou immediately before the TCC meeting.

The second session of the Joint Action Forum (JAF) of APOC will be convened in Cotonou, Benin on 5-6 December, 1996.

Dadzie K.Y., 1996. Criterion for inclusion in onchocerciasis control programmes. Transactions of the Royal Society of Tropical Medicine & Hygiene, 90(2):206.

Desole G., 1996. Criterion for inclusion in onchocerciasis control programmes (reply). Transactions of the Royal Society of Tropical Medicine & Hygiene, 90(2):206.

Gardon J., Mace J.M., Cadot E., Ogil C., Godin C., Boussinesq M., 1996. Ivermectin based control of onchocerciasis in northern Cameroon. Transactions of the Royal Society of Tropical Medicine and Hygiene, 90(3): 218-222.

Hewlett B.S., Kollo B., Cline B.L., 1996. Ivermectin distribution and the cultural context of forest onchocerciasis in South Province, Cameroon. American Journal of Tropical Medicine and Hygiene, 54:517-22.

Kipp W., Burnham G., Bamuhiiga J., Leichsenring M., 1996. The Nakalanga syndrome in Kabarole District, Western Uganda. American Journal of Tropical Medicine and Hygiene, 54(1):80-3.

Resnikoff, S., 1995. L'ivermectine: les problemes poses par la donation et la distribution [Ivermectin: problems with donation and distribution]. Medecine Tropicale, 55:28-9.

Richards F.O. Jr., Gonzales-Peralta C., Jallah E., Miri E., 1996. Community-based ivermectin distributors: onchocerciasis control at the village level in Plateau State, Nigeria. Acta Tropica, 61:137-44.

Umeh R.E., Chijoke C.P., Okonkwo P.O., 1996. Eye disease in an onchocerciasis endemic area of the forest savannah mosaic. Bulletin of the World Health Organization, 74(1):95-100.

World Health Organization, 1996. Onchcocerciasis - Nigeria. Weekly Epidemiological Record, 71:213-5.

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