Peter Mark Jourdan, MD PhD - World Health Organization · Peter Mark Jourdan, MD PhD Sylvia...

The control of cysticercosis in Madagascar

Peter Mark Jourdan, MD PhD

Sylvia Noromanana Ramiandrisoa, MD

Samuel Hermas Andrianarisoa, MD

Wendy Harrison, BVetMed MPH PhD

Stakeholder meeting on T. solium taeniasis/cysticercosis diagnostic tools

WHO Geneva, 17-18 December 2015

Contents

• Country overview

• Survey design

• Scientific skills base

• Diagnostic challenges

• Logistical challenges

• Targets and opportunities

• Key points

One health in Madagascar

Humans:

• 60% have access to basic health care

• 12% have access to sanitation facilities

Pigs:

• 1.4 million pigs, mostly smallholder farms

• Cysticercosis-infected pigs -50% in value

• Limited access to veterinary services

World Bank, 2015 WHO Madagascar, 2015

Photo: P Jourdan/SCI 2015

Cysticercosis and schistosomiasis in Madagascar

• Scarce data: prevalence range 7-21% (human cysticercosis)

• MDA of PZQ to children in schistosomiasis-endemic areas

Rasamoelina-Andriamanivo, 2013 MOH/SCI Madagascar, 2015

Survey design

T. solium prevalence survey Stool microscopy; CoproAg

n = 950

Humans Pigs

Social mobilisation, PZQ distribution n = 75,668

Cysticercosis prevalence survey ELISA (Western blot)

n = 900

T. solium prevalence survey Stool microscopy; CoproAg

n = 950

Cysticercosis prevalence data ELISA (Western blot)

n = 900

Antanifotsy

Scientific skills base

Central level

Regional level

District level

Peripheral level

Planning

Commune level

Implementation M&E

Public health programmes vs research

Other NTDs

Veterinary vs human health

Other IDs

Photo: P Jourdan/SCI 2015

Diagnostic challenges

• Only central, costly laboratory for diagnosis of NCC in humans;

• Certain taboos regarding human stool collection;

• No standardisation of diagnosis of cysticercosis in humans and pigs;

• Lack of field-friendly, highly sens/spec tests in humans and pigs;

• Integration of data collection with other NTD surveys.

Logistical challenges

• Poor infrastructure;

• Varying accessibility due to rains;

• Vast distances;

• Limited cellular network;

• Limited financial resources.

Photo: P Jourdan/SCI 2015

Targets and opportunities

• Eliminate human taeniasis (from the district of Antanifotsy);

• Integration with other NTD control programmes (schistosomiasis) • Appropriate diagnostic tools?

• Different MDA thresholds?

• Cost-effective intervention?

Key points

• Cysticercosis is a one health problem in Madagascar;

• Data collection, including diagnostics still cumbersome;

• Evidence needed to inform programme development;

• Growing opportunities for integration with other NTD PC programmes

Acknowledgments

• Service de Lutte contre les Maladies Endémiques et Négligées (SLMEN), Ministry of Public Health, Madagascar;

• Health district of Antanifotsy;

• World Health Organization (WHO);

• Schistosomiasis Control Initiative (SCI), Imperial College London

Thank you for your attention

Photo: P Jourdan/SCI 2015