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