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