IN EQUATORIAL

11

REPORT ^ON APOC MISSION IN EQUATORIAL GUINEA:

FEASIBILITY ^OF INTEGRATED MAPPING ^OF NEGLECTED TROPICAL ^DISEASES (onchocerciasis, lymphatique filariasis, ^loiasis',

schistosomiasis and soil-transmitted hetminthiasis)

Period: ¹⁴

-

23 JulY 2007

By

Prof. Louis-Albert TCHUEM TCHUENTE Dr.

Samuel

WANJI

0$ ^nrtut

^ZttRi

ITINERARY / SUMMARY

July 13 2007: Departure Yaounde to Douala July 15 2007: Departure Douala

Julv 152QQ7:

Arrival

^Malabo

July

l6

2Q07: - Prof. Tchuem Tchuent6 and Dr. Wanji met

with WHO

WR (Dr. Pierre

lrfp.t"l

NOTF Coordinator (Dr. Sima Anacleto), Mrs. Julie Akame and

Mr.

Patrice

Nkwelle'

Presentation of the objectives of the mission ^and discussion on various points

/

aspects and organisation.

- participation to the opening ceremony of the meeting on harmonization

of

common pharmaceutical

politic in CEMAC

countries, presided by the

Minister

of Health.

July 17 2007: - Participation to the Meeting of the Equatorial

GuineaNOTF,

presided by the Minister of Health,

with

the participation of key partners.

- Prof. Tchuetn Tchuentd gave ^a power point presentatioir ou the situation

of

neglected tropical diseases in Equatorial Guinea,

with

emphasis on the importance of diseases mapping and the aims and prospects of our visit.

- Meeting and discussion

with

medical Chiefs

of

3 health districts (Riaba, Luba

and Baney) who attended the NOTF meeting.

-

Working

session

with

Dr. Sima Anacleto, and teleconference

with

the National Coordinator

of

schistosomiasis control, Dr. Pedro, who is based

in

Bata.

Julv 18

2007:

-

W

orking session of the consultants ^at the

WHO office

-

Visit

to

Ministry

^of Health ^as appointment

with

the General Director

of

Health (GDH). However, due to unforeseen last minute commitment of the GDH, the meeting was postponed for the

following

day.

-

Visit

to the

Ministry

of Education: discussion

with

General Director and the General Inspector of primary education. Presentation of the purpose of disease mapping and request of

rilevant

data on school system (school map). However, the

MOE

responsible highlighted the need to obtain an authorisation from their hierarchy prior to providing ^any information.

-

Visit

to the health district of Baney: discussion

with

the medical chief' July 19

2007:

-

Visit

to the

Ministry

of Health:

working

session

with

the General Director

of

Health, Dr. Gregorio

Gori

Momolu.

-

Visit

to the

Ministry of

Education: meeting

with

the

Vice-Minister of

Education,

Mr.

Carlos Nsu6 Otong, who provided authorization to obtain school map.

- Meeting

with

the General Director of primary education. But the data were not ready and the GD promised to provide these data to

Dr.

Sima

within

one week.

-

Visit

to the health district of Luba: discussion

with

the medical chief.

- Debriefing meeting

with

the WR WHO.

JuJy 20 2007: Departure Malabo.

July

2l-222007: Working

session and reporting of consultants.

JuJv 23 2007:

Arrival in

Yaound6.

{PAGEQ}

I. INTRODUCTION AI\D OBJECTTIVES

The

African

Programme

for

Onchocerciasis Control (APOC),

in

collaboration

with

George Washington

University

and

Exxon-Mobil,

envisages conducting an integrated campaign

for

the

control of

some major Neglected Tropical Diseases

(NTD) in

Equatorial _Guinea.

Th"s"

NTDs include onchocerciasis, lymphatic filariasis, loiasis, schiitosomiasis and

soil- transmitted helminthiasis.

Prior

to

the implementation

of

the integrated control activities, there

is

a need

to

define the

distribution

and

infection

prevalence levels

of the different

diseases

in

order

to

determine treatment needs and strategies.

Therefore,

APOC

has requested

Prof. L.A.

Tchuem Tchuenr6 and

Dr.

S.

Wanji to

provide advice and supervise

the

integrated mapping

of the

targeted neglected

tropical

diseises in Equatorial Guinea.

Within this framework, a first trip

was conducted

in

Equatorial Guinea

from

14

- ²³

^July

2007 by Prof. Tchuem Tchuentd and Dr. Wanji.

The main objectives of this assignment were:

. To plan in

collaboration

with

the

NOTF, MoH

and

WHO office in

Malabo the

NTD

mapping activities in Equatorial Guinea.

o

To def,rne

with

local relevant authorities the best period

of

the year and the appropriate zones for the study.

II. MEETINGS WITH NOTF, WHO WR, MOH AND MOE AUTHORITIES

In order

to

gather

all

relevant information necessary for the situation analysis, the assessment

of

the needs,

the

elaboration

of the

methodologies, and the

planning of the NTD

mapping surveys, several meetings were organised

with

key stakeholders, including:

o WHO

WR (Dr. Pierre Mpele)

o NOTF

Coordinator

(Dr.

Sima Anacleto)

o

Medical Chiefs

of

3 health districts (Riaba, Luba and Baney)

o Minister

of health and social well-being

o

General

Director of Health, ministry of

health and

social well-being (Dr.

Gregorio

Gori Momolu)

o Vice-Minister

of Education, Sciences and Sport

(Mr.

Carlos Nsu6 Otong)

o

General Director of primary education, ministry of education, sciences and sport

o

General Inspector of primary education, ministry of education, sciences and sport In addition, the

following

activities were achieved:

o

Participation to the Meeting of the National Onchocerciasis Task Force (NOTF).

o

Teleconference

with

the National Coordinator

of

schistosomiasis control, Dr. Pedro

{PAGE3}

Field visits in

two

health districts (Baney and Luba) and discussion

with

the respective medical chiefs and health staff.

Search of documentation in libraries, bookshops and purchase

of

relevant books.

II.1. Meetings

with WHO, NOTF

and

health authorities

Several

meetings and working

sessions

were held with the Equatorial Guinea

WHO Representative, Dr. Pierre Mpele, and the NOTF National Coordinator,

Dr.

Sima Anacleto.

The presentation

of

the rationale and objectives

of

the assignment

in

Equatorial Guinea were made

by the WHO

consultants

(Prof.

Tchuem Tchuent6 and

Dr. Wanji), highlighting

^the opportunity

for

eradication

of

onchocerciasis and other

NTDs in Bioko in

particular, taking advantage

of its

island situation,

the

successful

elimination of black flies,

and the multiple opportunities of partnership and support from the private sector.

This was

followed by

constructive exchanges

of

vier,l's and discussions on various aspects

of

neglected tropical diseases, the situation

of

disease control, the health system, the availability

of

required

information, and the

organisation

of our working plan in

Equatorial Guinea, including key authorities and persons to meet.

Dr. Sima Anacleto facilitated the

meeting

with the different

authorities/persons, and his collaboration and

availability

during our stay were very helpful and

well

appreciated.

The

WHO

Representative very much welcomed the project

of

integrated control for

NTDs

in Equatorial Guinea, and highlighted his wish to develop a partnership

with

^private sector,

with a pilot project in some

selected schools

including regular deworming, health

^education, construction

of

latrines, supplying

of

safe water and other basic health needs. This project is in preparation and recommendations and advices

from

the consultants may be provided once detailed school map/information is obtained.

Following the presentation on the negative impact and high burden of

NTDs,

and the fact that

simple solutions do exist to

^prevent

them

and

alleviate the suffering of

populations, the Minister

of

Health and social well-being, as

well

^as the General Director

of

health, expressed their interest

for

the

control

and promised

to

^provide

all their

support

for

the success

of

^the

control programme.

The General Director

of

health expressed the

will to

set up at the

MoH

a steering committee

/

task force for the coordination of

NTD

control.

II.2.

Meetings

with ministry of

education

authorities

In order to obtained detailed information about the school organisation, including the number of schools and pupils per district, province, etc. visits were made to the

ministry of

education.

At a first meeting with the

General

Director and the Inspector of primary

education, a presentation

of

the purpose

of

disease mapping and the requirement

of

school map data were made. However, these

MoE

authorities requested from us a formal authorisation signed by the Minister prior to provide any information. This was obtained the

following

day from the Vice-

Minister of Education. However, the

requested

data were apparently not ^available /

assembled, and the General Director of primary education therefore promised to provide them to the

NOTF

coordinator

within

one week.

a

a

{PAGEQ}

II.3. Visit

to

health districts

Field

visit

was made

to

the districts

of

Baney and Luba.

In

each

of

these districts we visited the hospital and had a

working

session

with

the hospital director. Information was gathered on

health

system,

health

personnel, equipment

and logistics available. Also, information

on

ongoing

disease

control

programme

was

collected.

The lack of logistics was

particularly highlighted by the directors.

II.4. Participation to

the

NOTF

meeting and Advocacy

for NTDs

The meeting

of

the Equatorial Guinea

NOTF

was organised on

the

17th July 2007

in

Malabo,

while

we there,

which

gave us an opportunity

to

attend.

This

meeting was presided over by the Minister of Health,

with

the participation of several partners.

At this

occasion,

Prof.

Tchuem Tchuentd made a power

point

presentation

on the

situation neglected

tropical

diseases

in Equatorial

Guinea,

the

^progress

achievetl such as

vector

elimination in the island of Bioko

and the challenges

for NTD control.

Emphasis was also made

on the

importance

of

disease mapping and

the

aims and prospects

of our visit.

This meeting provided an opportunity to advocate for

NTD

control to important stakeholders.

III. IMPORTANT CONSIDERATIONS

FOR

THE INTEGRATED NTD

SURVEYS

III.1.

Generalities on the

Equatorial

Guinea: geography, geomorphology,

hydrology, climate

The Equatorial Guinea is made up of

two

main regions: The continental region and the insular region.

The

insular region has

two

islands:

Bioko

and Annobon. The

city

capital

is

Malabo and is situated in the

Bioko

Island.

Bioko

Island

The

Bioko

Island

is

an

old

volcano,

with

three important picks (Caldera-2260

m,

Biao-2009 m, Basile-3O11

m).

The

Bioko

Island

is

also characterised

by

numerous streams which have

their

springs at higher

altitude

and

which flow on

stormy

soil.

These meandering rivers are fast

flowing with

numerous cascades which are excellent breeding sites

for

Simulium, vectors of onchocerciasis. The feet of the mountain are occupied by beaches

with

steeps.

The climate of the

Bioko

Island has a double influence of ocean and mountain,

with

important

rainfall

in the south-west

flank

and on the summits of the mountain. The

locality of

Ureka can register 6000 mm of rain

fall

per year.

On the

Bioko

Island, there are

two

seasons: the

dry

season goes from November

to

February and the rainy season

from

March to October.

Continental region

The continental region, also known as Rio

Muni

is characterised

by

a varied landscape, going from the coastal region in the west, to the

hilly

area in the centre region of the country and the

{PAGE5}

swampy

valley in

the eastern

part of

the country. The country stretch

out from

latitudes ^-3o south

(Bio

campo) to -6o south (Asobio). In the coastal area there are several estuaries where the rivers from inland

flow

into the ^sea.

The inland is characterised by mountains

with

altitudes varying

from

600

to

1000m. The most important summits are:

Alen, Mitra,

Bere and Nzas. These

hills

are at the

origin of

^cascades on

the rivers.

Cascades are

found in the following rivers: river

Campo,

river Wele,

river Mitemele. These fast

flowing

rivers can be potential breeding sites for Simulium.

The southern parts

of the country

have numerous swampy valleys,

which

can be potential breeding sites

for

mosquitoes, vectors

of

malaria and

lymphatic filariasis.

One should also take note of the presence in the south

-west

^{coastal region of the small islands} of Mbelobi and Corisco.

The climate

of

the continental region

is

characterised

by four

seasons as evidenced

by

the records

of

the

rain fall

at Bata. There are

two dry

seasons and

two rainy

seasons. The main dry season goes

from

December

to

February and the smaller one

from July to

Aug,ust. The

main rainy

season

goes from March to June and the smaller one from

September to November.

III.2. Administrative

divisions

The country has two regions: the continental and the insular regions.

The insular region has three provinces: _the province

of

Annobon,

which

covers the island

of

Annabon; the provinces of

Bioko

south and Bioko north, situated in the

Bioko

island.

The continental region has four provinces: the centre south province, the

Nki6

Ntem province, the

littoral

province and the Wele Nzas province.

The Provinces are

further divided into

districts.

In total

there

are

18

districts in

Equatorial Guinea.

III.3. Population

(1994 census)

The

total

population

of

Equatorial Guinea is estimate d

at

406 I 5 1 inhabitants ( 1 994 census) :

315 625 in the continental region and

90

526

inthe

insular region. The population distribution is summarized

inTable l.

The

littoral province, in the

continental region

is

the most densely populated

with

100047.

The less populated province is Annobon

with

2820 inhabitants,

followed

by

Bioko

south

with

12 569 inhabitants.

61%

of

the populations

of

the Equatorial Guinea

live in rural

areas.

The

average population density

is

14.5 inhabitants

lkrrZ.

{PAGrtr}

ADMINISTRATIVE

UNITS TOTAL URBAN

POPULATION

RURAL POPULATION

INSULAR REGION

^{90526 73376 17150}

Province

ANNOBON

2820 2820

-District

Annobon 2820 2820

Province

BIOKO

NORD

75t37

66676

846t

-District

Baney I 4698 66t

I

⁴⁰⁸⁷

-District

Malabo 64439 6006s 4374

Province

BIOKO

SUD 12569 3880 8689

-District

Luba 9242 ^{JJZJaa^1} 5919

-District

Riaba ³ 327 557 2770

CONTINENTAL REGION

Province CENTRE SUD

315625 84372 231253

60341 9632 50709

-District

Akurenam ^r 1631 1921 ^{97 10}

-District

Evinayong 21353 5181 16172

-District

Niefnng 27357 ²⁵ 30 24827

Province

KIE NTEM

92779

t1724

^{8 1055}

-District

Ebebiyin 45557 8075 37482

-District

Milomeseng 29953 2723 27230

-District

Nsoc Nsomo 17269 926 ^I 6343

Province

LITORAL

^{100047 53762 46285}

-District

Bata 71406 50023 21383

-District

Cogo 14607 ^I s09 ^I 3298

-District Mbini

^{14034 2430 I 1604}

Province WELE

NZAS

^{62458 9254 53204}

-District

Aconibe 9065 ¹⁷⁵

I

⁷³¹⁴

-District

Anisok 22613 2105 20s08

-District

Mongomo

2i756

4639 19117

-District

Nsork ^{7024 759 6265}

TOTAL

^{406151 157748 248403}

Table 1.

Population

of

Equatorial

Guinea per region,

province and district.

III.4. The health

system

The organisation

of

the health system

follows

the pattem

of

the administrative divisions

with

notably:

o

the health centres or post ^at the village levels

o

the district hospital at the headquarters of districts ⁽¹⁸ district hospitals)

.

Provincial hospital ^at the headquarters of provinces (7 provincial hospitals)

o

Regional hospitals ^at the headquarters of regions (situated at Malabo and Bata)

{PAGE+

III.5.

The

Education

system

The education system in the Equatorial Guinea is organised into primary education, secondary education and higher education.

The

primary

education comprises

848

schools,

including 600

government

primary

schools and 248 private

primary

schools. Overall, there are 1440 teachers.

In the

1999-2000 school years, 73310 children attended primary schools representingS6% of school ^age children.

The secondary education consists

of

51 secondary schools (27

public

colleges and24 private colleges),

with

920 secondary school teachers. In

the

1999-2000 school years, 20671children attended secondary schools in Equatorial Guinea.

The national

university of

Equatorial Guinea was created

in

1995,

with

one campus

in

Bata and another one

in

Malabo. The university has 15 departments,

with

16 specialties including health sciences, agriculture, engineering, administration, education, arts, literature etc.

In

the 1999-2000

academic years, overall 1328 students were registered at the

university, irrespective

of

levels, programmes and departments.

III.6.

The

situation

of

current NTDs control

programmes

Presently, among the targeted neglected tropical diseases

in

Equatorial Guinea, there exists ^a control programme

for

some.

However, only the control

prograrnme

for

onchocerciasis is somewhat operational.

Community

directed treatment

with ivermectin

was implemented in Equatorial Guinea

since

1992.

During the first

years (1992-1997)

this

mass distribution

of

ivermectin was conducted

with

the support from the

NGO

"Universidad de Barcelona". CDTI

was implemented only in the Bioko Island, no control is conducted in the

mainland.

Currently,

the

onchocerciasis

control is not well

implemented, apparently due

to lack of

funding, absence of

NGO,

etc.

The control plan for lymphatic filariasis was

elaborated

in 2001, including island

and mainland.

Apparently some

baseline surveys

were

conducted

in 2003 (data

available at NOTF); however control activities are not implemented yet.

The schistosomiasis control programme is ^part of the national programme for

trypanosomiasis.

The

coordinator

of this

programme

Dr

Pedro)

is

based

in

Bata; however almost

nothing

has been achieved

so far,

and due

to lack of funding, the

schistosomiasis control programme is not operational in Equatorial Guinea.

There is no STH control programme

(it

is mentioned by

Dr

Sima that the Director of Hospital, Dr Andres may take care

of

STH control).

{PAGE8}

IV. SURVEY METHODOLOGIES

In

order

to

assess

the levels of infections

and

the distribution of the different

species

of

helminths

in the Equatorial

Guinea, parasitological and

rapid

assessment surveys

will

^be

conducted in selected villages/communities and schools all over the country.

Though the surveys

for

the different parasitic infections

will

be conducted simultaneously in

an integrated approach, specific sampling, specimen collection and

parasitological methodologies

will

be conducted for the different helminthiasis.

IV.l. FILARTASIS (LF, ONCHOCERCIASIS, LOIASIS)

Study area and

sampling

Cross-sectional

survey will be

conducted

in rural and semi-rural communities

^(villages) representing potential intervention units

for

filariasis

in

both the insular and continental ^areas of the Equatorial Guinea.

The

first

step in the sampling process

will

be to define the intervention

tinit (IU).

This

will

^be

the

district.

l0o/o

of

communities

within

each

IU will

be selected

for

the survey. Selection

will

be made such that the

IU

is entirely covered spatially. In the second step, the available data on filariasis in each

IU will

be reviewed. New data therefore

will

be collected from each IU.

Data

collection for Lymphatic filariasis

In

each sampled

village

at least 50 resident adults (aged

>

_{15 years)}

_will

be tested

for

day- time

filarial

antigenaemia, using commercial immunochromatographic tests

(ICT;

Wetl et

al', lggT). A 100-pl

sample

of finger prick blood will

be collected

from

each subject,

with

^a

micropipette, and then dropped on an ICT ^{card (AMRAD} lCT, Richmond,

Victoria,

Austrilia).

^The reading

will

be done

within

3-5 minutes. Sample

will

be deemed negative

if

the card indicate a negative result after 15 min. Resident adult

will

be defined as a person who has been resident

in the village for at

least 10 years and

who

had

not

been absent

for >

6 months during that

period.

Testing

will

be stopped

if

more

than l0 (20%) of

the 50 adults tested are found positive, since

this

gave sufficient precision. Otherwise, testing

will

continue

until

a

total of

100 adults had been examined.

If all

100

ICT for

^{a randomly selected village}

are negative, then a check

village

^(i;e. any community in the same

IU

where local health

staff

thought, or old survey data indicated, that LF might be present)

will

be selected for validation'

All

the surveys

will

be conducted

by

a country team that

will

be trained at the national level.

The work

wilt

be done under the supervision of international experts.

An

independent team

will validate a

selected number

of

communities.

The validation will

include a comparison

of the

results

of ICT with

those

of the

microscopical examination

of

smears

of "night" blood for microfilariae. The correlation

between

the two

measures

of

infection

will

be tested.

The geographical co-ordinates

of

each

of

the sampie viilages

will

be recorded

with

a global posltioning system (GPS).

A

geographical

information

system

(GIS will

be used

to plot

the prevalences

of

antigenaemia

for

each sample community

on

a map, and the prevalence data

will be

recorded

using the

HealthMapper software package

(World Health

Organisation, Geneva).

Spatiat analysis

will be

^based

on

geostatistical methods (Isaaks

and

Srivastava, 1989) ^as

pieviously

applied

to

studies

of LF distribution

^(Gyapong and Remme, 2001). Prediction

of

ihe distribution of prevalence across the country

will

be based on the observations made in the

{PAGE9}

sample villages. This approach

will

consist

of four

steps that are described

in

Gyapong et al.

2002.

Data

collection for

Onchocerciasis and Loiasis Study

population

A

census

will

be conducted

in

each

of

the villages surveyed

to

estimate the population size.

The study population

will

consist

of

males and females aged 15 years and above who have been resident

in

the

village for

a

minimum of

ten consecutive years

(for

onchocerciasis) ^and

five

consecutive

years (for loiasis) and who have not taken antifilarial

treatment

for

^a

minimum period

of

one year.

All eligible

members

of the community who will

consent to participate

will

be enrolled into the study.

Conduct of the rapid

assessment

procedures for loiasis and

onchocerciasis

(RAPLOA

and

REA)

Organization

ofwork

A form

will

be designed to collect data and

will

be divided into three sections: the

first

section

will

be for the identification of participants, the second and

third

sections

for

the collection

of

RAPLOA and REA.

In each community surveyed, a team

of

three technicians

will

^move

from

one household to another to register eligible participants, administer the

RAPLOA

questionnaire and carried out a Rapid epidemiological assessment (REA) by nodule palpation.

Administration

of

RAPLOA questionnaire

The Rapid Assessment Procedure

for

loiasis

will be

based on the restricted

definition of

the eye wonn; the past experience

of

eye

wonn,

confirmed by a photograph

of L.

loa adult worm in the white part

of

the eye and

with

the duration

of

the most recent episode being between ¹

to 7

days

(Wanji et al

2005).

The

questionnaires

will be

administered

to 80

adults

in

the Spanish language

and where required,

interpreters

from the community will

assist

in

the interview process according to the

RAPLOA

guidelines

(WHO/TDR,

Geneva,2002)

Nodule

palpation (REA)

The

REA will

be based on nodule palpation.

After

undergoing the

RAPLOA

interview, male patients

(30 in number), above twenty years, and who have been in the

community continuously

for

the past ten years,

will

be examined by the same technician

for

the ^presence

of

Onchocerca nodules according

to

^previous studies

(

Ngoumou et

al.

1994,

Taylor et

al.

ree2)

The geographical co-ordinates

of

each

of

the sample villages

will

be recorded

with

a global positioning _system (GPS).

A

geographical

information

system

(GIS will

be used

to plot

the prevalence

of

antigenaemia

for

each sample community

on

a map, and the prevalence data

will be

recorded

using the

HealthMapper software package

(World Health

Organisation, Geneva).

Spatial analysis

will be

based

on

geostatistical methods (Isaaks

and

Srivastava, 1989) as

previously applied to

studies

of

Onchocerciasis

and loiasis distribution. Prediction of

the distribution

of

prevalence across the country

will

be based on the observations made

in

the sample villages.

{PAGE40

IV.2. SCHISTOSOMIASIS AI\D INTETINAL WORMS

Study area and

population

The distribution

of

schistosomiasis and soil-transmitted hetminthiasis

will

be evaluated

with

regard

to

geographical and administrative sub-divisions. Studies

will

be conducted

in

schools and the current parasitological infections

will

be assessed.

About l0% of

the total number

of primary

schools

in

the

different

districts province

will

be selected.

It is

estimated

that

approximately

80-90

schools,

over the total 848

nationwide primary schools,

will

be investigated.

Sampling and

parasitological

assessment

In

each

of

the selected scf,ool, 50 children

from

the 5th grade

will

be selected. Study

will

be conducted

with

the approvai

ui

the administrative authorities, school inspectors, directors and teachers. The

schoolihildr.r, will

be invited to participate

in

the study, and

will

be registered only after explanation

of

the objectives

of

the study to them and

to

their parents

or

guardian, and after

full

informed consent has been obtained'

From each

of the children

selected randomly

in the

studied schools,

child, urine

and stool samples

will

be collected.

Urine

samples

will

be collected

in

60

mL ^plastic

screw-cap vials, between 11.00

and

13.00

hours. Each urine

sample

will be

agitated

to

^{ensure adequate}

dispersal

of

eggs, 10

mL of

urine

will

be filtered through ^a Nucleopore@

filtet,

and the filters

wiit

be

"*ur.ri*d ^by

microscopy

for

the presence

of

^{eggs. Stool samples}

will

be collected in similar screw-cap vials, and

will

be examined

by

a single

thick

smear technique using ^a 41.7 mg Kato-Katz template.

Importantly, the

same

Kato

slides

will allow

^detecting

both intestinal

schistosomiasis and intestinal helminth infections in the study populations.

Data analysis

The diffeient parasitological data will be

analysed

using appropriate statistical test

^and methods. This

will allowlo

^assess the disease distribution and prevalence, and to recommend the most appropriated control strategies, accordingly.

V. LOGISTICS AND HUMAN

RESOURCES V.1.

Human

resources

Filariasis

survey

A

typical surveyteam

will

be made up

of

5 members, divided as

follows:

. I rr*"yor for

REA (Rapid Epidemiological Mapping

of

Onchocerciasis)

o

2 surveyors for R,APLOA (R.apid Assessment Procedure

for

Loiasis)

.

2 suryeyors for

RAGFIL

^(Rapid geographical assessment of bancroftian filariasis).

We may need three such teams; making a total number

of

15 surveyors

with

3

for

REA, 6

for RAPLOA,6 for RAGFIL.

The

work will

be carried

out

under the supervision

of

an expert on

filariasis,

assisted by the Equatorial Guinea national coordinator of onchocerciasis and other filariasis control.

{PAGE.tt

It will be

important

that

surveyors

be

recruited amongst health personnels

working at

the district levels.

The

15 surveyors should be recruited across

country

and trained

at

Malabo.

When

the

research team

is working in

a given health

district, it

should be envisaged that a local

facilitator

be recruited

to

assist the team during the survey. Such

facilitator

may be ^a medical doctor

in

service at the

district

hospital, or a senior nurse designated by the medical doctor.

Validation of

RAGFIL

results

Two

independent

laboratory

technicians

(not

members

of the rapid

survey

team) will

be required to conduct the

"night

survey" for the microscopical validation

of RAGFIL.

Schistosomiasis and

Soil-Transmitted Helminthiasis

survey

A

basic survey team

for

schistosomiasis and STH

will

be made up

of

5 members, constituted

as follows:

o

1 surveyor

o

2 laboratory

I

microscopist technicians

o

2 supporting technieians

(l

driver)

In total, and

for

integrated investigation

with

filariasis assessment,

it will

be necessary to have a schistosomiasis and

STH

team

working

together

with filariasis

team. Complementarity

of

team members

will

be

worked out for

cost-effectiveness. Nevertheless,

it is

anticipated that

we may

need

three

teams

as

described above,

making a total number of 3

surveyors, 6 laboratory technicians and 6 supporting technicians.

The

work will

be carried out under the supervision

of

an expert on schistosomiasis, assisted by

the

Equatorial Guinea national coordinator

of

schistosomiasis and./or onchocerciasis and other filariasis control.

It will be

important

that

surveyors and technicians be recruited amongst health personnels working at the

district

levels. They should be recruited across country and trained at Malabo.

When the research team

is working in

a given health

district, it

should be envisaged that a

local

facilitator

be recruited

to

assist the team during

the

survey. Such

facilitator may

be a medical doctor

in

service at the

district

hospital,

or

a senior nurse designated

by

the medical doctor.

Data processing and

Analysis

We

will

need

a bio-statistician to

develop

the

template

for the

data

entry in Epi-Info

and supervise

the data entry. Two

computer

clerks will be

required

to enter the

data.

After

cleaning, data

will

be forwarded to the epidemiological unit of APOC for analysis.

{PAGE4g

V.2.

Logistics: important

considerations

Filariasis

survey

Schistosomiasis and

STH

surveY

Items

Quantity

Four wheel drive car ^a3

ICT test for

RAGFIL

¹⁰⁰⁰⁰

Various consumables (gloves, slides, reagents,

etc.

Microscopes ²

Computer* printer ¹

Photocopy machine

I

Fuel

Country

Map

1/500,000 ⁵

GPS ⁵

S tationeries/training materials

Items

Quantity

Four wheel drive car ^aJ 60 mL plastic screw-cap

vials

10 000

Nucteopore*

filter

^{5 000}

41.7

mgKato-Katz

(kits of 250 units each)

20 Fuel

Country

Map

1/500.000 5 (shared)

GPS 5 (shared)

Stationeries / Training materials

Microscopes 6 (shared)

Haemastix strips (50 units per box)

100

Various consumables (gloves, slides, reagents,

etc.

{PAGE

13

VI. TIME FRAME

Steps

Activities

By who?

Duration

1 -Logistic preparation -Recruitment and training

of

surveyors, laboratory technicians/microscopists, supporting technicians

2Intemational

expert (1

for

filariasis and I

for

schistosomiasis

and STH), assisted by the

national coordinators

for

filariasis and schistosimiasis

control

Two weeks

2 Field surveys

+RAPLOA +REA/REMO +RAGFIL

+SCHISTO +STH

Two district covered /team/week, a total

of

six districts covered per weeks)

Survey teams under the supervision

of

the2

International and national

experts

Three weeks

J

-Data entry,

^processing

and cleaning)

(Development

of

template

in Epi-Info, Data

entry, Data cleaning

Computer clerk, under the supervision of a

biostaticien

Two weeks

4 Data analysis

Development of country maps

for

onchocerciasis,

schistosomiasis, soil- transmitted helminthiasis,

loiasis and lymphatic

fi lariasis for Equatorial Guinea

Epidemiologic UNit Of APOC

Two weeks

{PAGE.f +

YII. BUDGET:

N.B.: In

order

to

avoid duplication,

it is

necessary

to

have a

working

session between the ² consultants to define sharing costs, logistics, etc.

Activities FILARIASIS SURVEY

Costs (USD)

SCHISTOSOMIASIS AND STH

SURVEYS

Costs (USD)

l.Personnel

Training ^{5000 6000}

-Field work ^{25200 24000}

-Data entry and Processing 6000 5000

International Expertise -Travel

-Out

of

station allowance -Honorarium

1 3000 ¹ 5000

3.Field

Transportation

-Fuel

&

lubricant

for

vehicles

4000 4000

- Maintenance of vehicles 1500 ¹⁵⁰⁰

-Hiring

of vehicle (eoo0) Provided by WHO?

3.Stationeries ^{2000 2500}

4.Consumable

Country Maps To be given by

AEQC?_

^?

ICT

cards To be given by APOC? ^?

RAPLOA

^pictures To be given by

TDR

^?

5.Equipment

Vehicles To be given by GTNO

and WR or to be hired?

Provided by WHO?

GPS To be Given by APOC? ^?

Computer

*

Printer To be given by

GEQ?

^?

Photocopy machine To be given by

GTNO?_

^?

Total (Provisory)

⁶⁵⁷⁰⁰

56700

(If

vehicle given

by GTNO

and

WR)

58 000

V[I. SUGGESTED PERIOD FOR THE SURVEY

Taking into account the date of the start of the new academic year, the

dry

season, the national feast and

the

date

of the JAF

meeting, the appropriate

period for

conducting

the

study was suggested between ¹⁵ October and ¹⁶ November 2007.

{PAGE

45