Transcript Document

Dr Giuseppina Ortu
100 years of SCI
livingProgramme
science
Manager
(francophone countries)
Donor supported programmes
Annual Board Meeting 27th June 2013
Date • Location of Event
SCI programmes
Burundi
Rwanda
Mauritania
Senegal
Donor supported programmes
OUTLINE
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Year 2011-2012: Gaps & needs
SCI contribution in year 2012 – 2013
Current needs / current situation
Next steps / SCI support for year 2013 - 2014
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Activities •
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Treatment
Disease mapping
M&E
Surveillance & Schistosomiasis elimination
Capacity building
BURUNDI
Year 2011-2012
Gaps & 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
BURUNDI / SCI contribution / treatments
Treatments in BURUNDI
Activity
Details
month/year
performed
PZQ - School Age Children
ALB - age 1-14 years
National Mass ALB - women
Drug
ALB - age 1-14 years
Administration
ALB - women
PZQ treatment of adults in some
areas
Jun-12
Jan-13
Sep-Nov 12
Reached
population
% Drug
coverage
652,889
104% (tbc)
3,940,280
123,115
3,977,190
128,455
108%
44%
109% (tbc)
44% (tbc)
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 / surveys
National drug coverage survey
Why do we need this survey?
To validate the number of people treated for
worm infections reported by the MoH
Drug coverage =
treated individuals
total population requiring treatment
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
BURUNDI / SCI contribution / surveys
EPI coverage survey report /preliminary results:
Question
School attendance
Time to reach distribution site
Children that swallowed ALB
Children that swallowed PZQ
Site where children received drugs
Women pregnant during MDA
Pregnant women participating to MDA
Reason for not participating
Pregnant women that took ALB
Major reasons for women not to take treatment
Mean in %
68.7%
More than 1 hour = 13%
98%
97.8%
Schools = 53.2 %
Health centre = 36.8%
11.8%
84.3%
Too sick = 34.7%/ Not informed = 23.8%
96%
Drug not available (39%)/ Too sick (16.1%)
Further analysis will be done to assess:
 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!
BURUNDI / SCI contribution/ risk maps
Risk map/SCH (2007)
Risk map/SCH (2011)
Note range of prevalence
BURUNDI – Current needs & next steps
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
Drug Coverage Survey: Further analysis to assess PZQ coverage
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
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 ?
Rwanda
Impact survey in 5 districts
Year 2011-2012
Gaps & 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
Nkombo
Island
• The country needed a
Mapping of schistosomiasis (2008)
comprehensive evaluation of what
STH: endemic in the whole country
was done on prevention and
control of NTDs to understand the
current gaps and needs
NTDs situation analysis
RWANDA – SCI contribution/ Situation analysis
12-59mo
Dec 2007
May 2012
Total
treated &
Min Max
coverage
Treated
MBZ
% Cov.
10,102k
92-116
Lactating women
SAC (5-16)
Treated
ALB
% Cov.
Treated
ALB
% Cov
Treated
PZQ
439k
76-161
19,332k
79-92
577k
ADULTS
(>16)
Treated
ALB/MBZ/
PZQ
 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
251k
RWANDA – SCI contribution/ Situation analysis
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
Year 2012
Schistosomiasis
450
Hookworms
14,751
Ascarisis
117,613
Trichiuriasis
12,151
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 – 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
MDAs
Schistosomiasis
• Improve drug administration coverage
• Ensure treatment in 38 sectors within 9 Districts at risk of infection
> next MDA in August 2013
STH Continue drug administration as done before in the whole country
Schistosomiasis Mapping
Remap 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
SENEGAL
Year 2011-2012
Gaps & 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, reevaluation of the treatment
strategies, were also needed
Senegal - SCI contribution / Mapping
Mapping of schistosomiasis in 21 districts
Data collected in the field is currently under evaluation
Senegal – Current situation & next steps
Current situation
SCI has extended the agreement with the MoH for another year
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
MDAs
SCHISTOSOMIASIS
PZQ 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?
Senegal – Current situation & next steps
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
Mauritania
Population
3,340,627
Gaps and needs
• Both S. haematobium and S.
mansoni are present in the country
Oasis
• 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
MDAs OMVS
OMVS Mapping 2010
OMVS = ORGANISATION POUR LA MISE EN VALEUR DU FLEUVE SENEGAL
Mauritania – Current situation and next steps
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
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
Mauritania – Current situation and next steps
Schistosomiasis mapping in oasis
The mapping of all the oasis currently inhabited has been considered
(possibly 29 oasis?)
Schistosomiasis elimination
The 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
THANK YOU FOR YOUR ATTENTION
AND YOUR SUPPORT