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Dr Giuseppina Ortu SCI Programme Manager (francophone countries). Donor supported programmes. Annual Board Meeting 27 th June 2013. SCI programmes. Burundi. Rwanda. Mauritania. Senegal. Donor supported programmes. OUTLINE. Year 2011-2012: Gaps & needs - PowerPoint PPT Presentation
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100 years of living science
Date • Location of Event
Annual Board Meeting 27th June 2013
Donor supported programmes
Dr Giuseppina OrtuSCI Programme Manager
(francophone countries)
SCI programmes
Rwanda
Senegal
Burundi
Mauritania
• Year 2011-2012: Gaps & needs • SCI contribution in year 2012 – 2013 • Current needs / current situation• Next steps / SCI support for year 2013 - 2014
OUTLINE
• Treatment• Disease mapping • M&E• Surveillance & Schistosomiasis elimination• Capacity building
Donor supported programmes
Activities
BURUNDI Year 2011-2012Gaps & needs
PZQ and ALB treatments at national level
PZQ treatment of adults in some areas
Drug coverage surveys for validation of MoH reported treatment
Analysis of disease mapping needs
Capacity building and training needs
Treatments in BURUNDI
Activity Details month/year performed
Reached population
% Drug coverage
National Mass Drug Administration
PZQ - School Age ChildrenJun-12
652,889 104% (tbc)
ALB - age 1-14 years 3,940,280 108%ALB - women 123,115 44%ALB - age 1-14 years
Jan-133,977,190 109% (tbc)
ALB - women 128,455 44% (tbc)
PZQ treatment of adults in some areas Sep-Nov 12 279,405 ( tbc)
• On-going MDA for the administration of ALB to children and mothers
• June PZQ administration postponed to Dec 2013 (PZQ tablets not available)
BURUNDI / SCI contribution / treatments
National drug coverage survey Why do we need this survey?To validate the number of people treated for worm infections reported by the MoH
In Burundi: PZQ and ALB coverage survey was integrated
with vaccination and vitamin coverage surveys to validate the campaign performed in June 2012
Organized in collaboration with: - EPI (Expanded Programme of Immunization)
- MoH- ISTEEBU (Inst. of Statistics in Burundi)
Over 15000 people were interviewed on PZQ and ALB treatment
treated individuals total population requiring treatment
Drug coverage =
BURUNDI / SCI contribution / surveys
Question Mean in %School attendance 68.7%Time to reach distribution site More than 1 hour = 13%Children that swallowed ALB 98% Children that swallowed PZQ 97.8%Site where children received drugs Schools = 53.2 %
Health centre = 36.8%Women pregnant during MDA 11.8%Pregnant women participating to MDA 84.3%Reason for not participating Too sick = 34.7%/ Not informed = 23.8%Pregnant women that took ALB 96%Major reasons for women not to take treatment Drug not available (39%)/ Too sick (16.1%)
Coverage by commune for PZQ – (important information for drug coverage calculation)
Place of PZQ and ALB distribution for children between 5 and 14 years ALB coverage in women – the results are very different from those reported by the
MoH!
Further analysis will be done to assess:
EPI coverage survey report /preliminary results:
BURUNDI / SCI contribution / surveys
Risk map/SCH (2007) Risk map/SCH (2011)
BURUNDI / SCI contribution/ risk maps
Note range of prevalence
BURUNDI – Current needs & next steps
Schistosomiasis/STH Ensure delivery of PZQ in those communes where schistosomiasis is present, but have
never received PZQ Continuous support for PZQ and ALB treatment for the next 2-3 years Re-evaluation of schistosomiasis in areas where more detailed information is needed
Drug Coverage Survey: Further analysis to assess PZQ coverage
Capacity building • Support of a PhD student on Evaluation of health centre capacity in rural areas in
detection and management of schistosomiasis cases (project already started)• Creation of an NTD laboratory reference in Bujumbura?Surveillance & Schistosomiasis elimination• SCORE project ?
Current situation New funding in place for years 2011 - 2015 from a private donor A new contract between SCI and the MoH will be signed in the next few weeks A Programme Manager will be hired for the coordination of activities in Burundi
Nkombo Island
STH: endemic in the whole country
Rwanda
Mapping of schistosomiasis (2008)
Year 2011-2012Gaps & needs
• The MoU between the MoH and SCI was not signed
• A Programme Manager was needed in the country because of lack of human resources at the MoH
• The country needed a comprehensive evaluation of what was done on prevention and control of NTDs to understand the current gaps and needs
Impact survey in 5 districts
NTDs situation analysis
Dec 2007May 2012
12-59mo Lactating women SAC (5-16) ADULTS (>16)
Treated MBZ % Cov. Treated
ALB % Cov. Treated ALB % Cov Treated
PZQTreated
ALB/MBZ/PZQ
Total treated & Min Max
coverage
10,102k 92-116 439k 76-161 19,332k 79-92 577k 251k
RWANDA – SCI contribution/ Situation analysis
Not all districts at risk of schistosomiasis infection were systematically treated every year
It is not possible to calculate PZQ coverage
Not all SAC at risk of infection received the requested treatment
Adult treatment was not done every year
Year 2012Schistosomiasis 450Hookworms 14,751Ascarisis 117,613Trichiuriasis 12,151
Schistosomiasis and STH:
• Impact surveys in 5 districts: positive impact of PZQ treatment (schistosomiasis is now below 10% in those schools where annual surveys were done), but 1.5 million of people still at risk of SCH infection
• Outbreak in the Nkombo Island (2011): 62.1 [56.4-67.5] % of the population assessed (n=311) was infected with
schistosomiasis – this disease is focal and foci can be missed!
• The whole country is still at risk of STH infection as intensity of Ascaris has not decreased as expected in school aged children
Cases of worm infection reported by the health centres in year 2012
RWANDA – SCI contribution/ Situation analysis
Trachoma • In 2 districts of Gatsibo and Nyaruguru - no intervention was initiated • Lack of awareness of this infection and capacity for diagnosis
Lymphatic filariasis and podoconiosis• LF not a public health problem • Risk of LF introduction because of cross-border immigrations (from DRC)
• Non-filarial elephantiasis still exist - no care provided to the affected individuals
Human African trypanosomiasis• Endemic areas along Akagera National Park • Lack of knowledge and understanding on how to detect cases
RWANDA – SCI contribution/ Situation analysis
MDAsSchistosomiasis• Improve drug administration coverage• Ensure treatment in 38 sectors within 9 Districts at risk of infection
> next MDA in August 2013STH Continue drug administration as done before in the whole country
Schistosomiasis MappingRemap districts where as per mapping done in 2008, were cases were reported in areas not targeted for schistosomiasis treatment
> planned for end of the year 2013
M&E and Surveillance Consider to increase surveillance capacity for worm infections, trachoma, LF, and HAT
RWANDA – Current situation & Next steps
Current situation MoU between SCI and MoH has been signed END Fund has pledged support for Rwanda for the next 3 years A Programme Manager in place at the MoH
SENEGAL
Year 2011-2012Gaps & needs
• Epidemiological on schistosomiasis and STH was missing in many districts and mapping was required
• Reassessment of areas at risk of infection in the whole country and possibly, re-evaluation of the treatment strategies, were also needed
Mapping of schistosomiasis in 21 districts
Senegal - SCI contribution / Mapping
Data collected in the field is currently under evaluation
Senegal – Current situation & next steps
Country risk maps• Review all cases of schistosomiasis and investigate the areas where found• Create geo spatial risk maps for schistosomiasis for the whole country to clarify the
endemic areas in the country and reassess the treatment strategy
MDAsSCHISTOSOMIASISPZQ distribution will continue to be supported by Child Fund, and in part by SCI when possible and in those districts currently mapped and at risk of infection, if any
M&E A) impact of mass drug treatment: impact surveys Assessment in 22 schools in the whole country every year for 4 years is needed(The protocol has not been developed as the mapping data has not been analysed yet. Estimated budget: $50k/year)
B) Analysis of snails and schisto hybrids in some schools – WHY?
Current situationSCI has extended the agreement with the MoH for another year
Based on the following study:Research done by Natural History Museum /Imperial College • cercariae from infected B. globosus (host of human schistosomiasis) and
B. truncatus (host of bovine schistosomiasis)• miracidia from human urine samples
Results: 1) Host switching!B. truncatus snails are shedding S. haematobium cercariae.
>>> increase of transmission of S haematobium >>> increase of disease prevalence
2) Miracidia from one patient found to be S. haematobium/S. bovis hybrid
M&E SCI is planning to include in a few schools cercariae and miracidia genotype assessments
SCI is currently looking for funds to support this project in Senegal
Senegal – Current situation & next steps
MauritaniaPopulation3,340,627
OMVS Mapping 2010
MDAs OMVS
Gaps and needs
• Both S. haematobium and S. mansoni are present in the country
• 900,000 SAC at risk of infection
• ~ 200,000 SAC & 80,000 adults in 13 districts treated by OMVS twice. However, for year 2013, the OMVS have not made available financial support for PZQ distribution
• Need for training of nurses in decentralized health centres
Oasis
OMVS = ORGANISATION POUR LA MISE EN VALEUR DU FLEUVE SENEGAL
Mauritania – Current situation and next steps
Next steps Considering that: The MoH needs to improve the PZQ delivery system (= villages as
implementing units instead of entire districts)
Although cases of schistosomiasis were frequently reported in oases, a systematic mapping of schistosomiasis was never done
The OMVS support will be available in year 2014 again; however only for MDA in the Senegal river basin
Current situation SCI offered support for delivering PZQ in these areas plus 8 oases
where schistosomiasis has been reported (between 20 and 80% prevalence)
Support has been made available also for training nurses on NTDs
Schistosomiasis mapping in oasisThe mapping of all the oasis currently inhabited has been considered (possibly 29 oasis?)
Schistosomiasis eliminationThe specific ecosystem and the limited environment of an oases could make elimination of schistosomiasis feasible in some of these oasis
Proposals and Budgets• A proposal and budget for mapping of these oasis and for one treatment of the
estimated affected population are under evaluation ($USA 150 – 200K)(This protocol includes also snail evaluation)
• A proposal and a budget for elimination of schistosomiasis in oases is under development
SCI is currently looking for funds to support this project in Mauritania
Mauritania – Current situation and next steps
THANK YOU FOR YOUR ATTENTION AND YOUR SUPPORT