lullssloll Iil

AFRIGAII PRoGRAHUE

^FOR

ONGHOGERGIASIS GONTROL

^(APOG)

PROGRATTIE AFRICAIH

^DE

LUTTE GONTRE L'ONGHOGERCOSE

RAPID ASSESSTENT ^OF LOIASIS A]ID ONGHOGERGIASIS Iil

EoUAToRIAREGIoIIoFSoUTHERNSUDA]tl

4th to 24n apfil 2(N5

lullssloll ^REPORT

by Mr Honorat

^{G.M. ZOURE}

Biostatistics and mapping officer, APOC 01 BP 549 Ouagadougou 01, Burikina Faso Tel: +226 50 34 29 53/59i60

E-mail: zoureh@.oncho.oms.bf

Mr Hilary Adie

WHO/APOC TemPorary Advisor

Coordinator, Cross ^River State CDTI project Ministry of Health Calabar, Nigeria

Tet. +234 803706371',l

E-mail : enternilr2002ng@vahoo. ^conri

Dr.

DaddiJima

WHO/APOC ^TemPorary Advisor

N ational Coordinator, Onchocerciasis Control, MOH, Addis Ababa, Ethiopia, Tel- +251 1

150993, mobile: +

2519

4A5722 E-mail: daadhij@Yahoo. com Dr

Innocent Takougang

WHO/APOC TemPorary Advisor Department of Public Health

Faculty of Medicine and Biomedical Sciences P.O. Box: 1364 Yaound6, Cameroon

Tel: +237 9652808

E-mail: itakouga ng@vahoo'com

April

2005

Table of contents

ACRONYMS.

BACKGROUND COUNTRY INT'ORMATION...

IVERMECTIN DISTRIBUTION

CDTI ^pRoJECTS ru SorrnmnN SuoaN...

RATIONALE FOR RAPLOA AND REA IN EQUATORIA REGION...

OBJECTIVE OF

TIM

MISSION Spscmic oBJECTTvES

METHODOLOGY...

REMO/ RAPLOA FIELD DGRCISE...

Phase

I:

Field Preparations. ^(4-6 April ^2005, Nairobi, Kenya)'

Phase II. Searity Clearance. ⁽⁷ April ^2005, Lokichoggio, Kenya)"""

"

Phose

III.

Training on RAPLOA and REMO.

Phase IV. Field ^exercise

Phase V. Report wrifing ^(18-26 April 2005, Nairobi, KEI'|YQ' RESULTS AND DISCUSSIONS

TRAtr{hrG ON RAPLOA ^AXO REA ... ^..

STAruS REPORT ONTHE RAPLOA ^{FIELD DGRCISE...}

SraruS REPORT ON THE REMO FIELD E)(ERCISE ^. ....'' . ...

DIFFICTJLTIES ENCOUNTERED ...

RECOMMENDATIONS ^...

ACKNOWLEDGEMENTS ^...

II

1

I

I

2 4 4 5 5 5 5 5 6 6 6 6 6 7 1 8 8

ANNEX.... 9

SAMPLE PHOTOS 26

ACRONYMS

AAH

ARC

APOC CAR CBM CDD CDTI DRC GIS HNI IMC tRc MEC MHYH MRDA NGDO NPA OV RAPLOA RD REA REMO SAE SIDF SSOTF SU HA TCC TDR

Aktion Afrika Hilfe

American Refugee Committee

African Programme for Onchocerciasis Control Central African RePublic

Christoffel-Blindenmission (German ^NGO) Community-Direded Distributor

Comm u nity-Di rected Treatment with lvermecti n

Democratic RePublic of Congo Geographical lnformation ^SYs{em HealthNet lnternational

lnternational Medical CorPs lntemational Rescue Committee MectizanrM Expert Committee Many Hands of Your Heart

Mundri Relief and Development Association

Non-Governmental Development Organization ^{(see NGO)} Norvegian PeoPle Aid

Onchocerca volvulus

Rapid Assessment Procedure ol Loa loa Restricted definition

Rapid Epidemiological Assessment

Rapid Epidemiological Mapping of Onchocerciasis Serious Adverse Event

Sudan lnland Development ^Foundation Southern Sector Onchocerciasis Task ^Force Sudan Health Association

Technical consultative committee ^(APOC scientiflc advisory group)

Special programme for Research and Training in Tropical Diseases (part of CRD' a

department of CDS, WHO) United Nations Children's Fund World Health Organization UNICEF

WHO

11

Background country information

The Southern Sudan is divided into three administrative levels: regions, counties and payams.

The

"Region"

is the

largest administrative

zone. There are three

administrative regions ⁱⁿ Southem Sudan: Bahr elGhazal, Equatoria, and Upper Nile.

The

"County" is the district within the administrative zone. County boundaries change from ^time to time and new, smaller counties are carved out of larger ones.

The "Payam" is a sub-district of the county, can usually be located on published maps, and have a civiladministrator.

Equatoria region lies in the most southem ^part of Sudan. lt is bordered by five countries, namely Ethiopia, Kenya, Uganda, DRC and CAR in

the

East, Southeast, South, Southwest and West r.espectively. lh tne North it is limited by the southern regions of Bahr El Ghazal and Upper ^Nile- Geographically, the region is divided into Western, Central and Eastem Equatoria, and it has ¹³ adrninistrative counties (Annex ¹ _).

Most of the region has 8 months of rainfall in a year.

The

vegetation ranges from equatorial rain forest in the west and ^southwest to woodland and open savannah towards the north.

The

people practice subsistence agriculture and animal husbandry. Some of the tribes are semi- nomadic.

The ^region is well known for ^{diseases such} as sleeping sickness,

onchocerciasis, draconculiasis, malaria, hydatic disease, leishmaniasis and burulli ulcer.

lvermecti n

d

istri

butio

n

The distribution of ivermectin has been going on in Equatoria region since 1996. However, ^it was

not

really based

on

Community-Directed Treatment

with

lvermectin (CDTI) strategy

and

the treatment coverage was generally low (Table 1).

Several ^NGDOs are involved

in

ivermectin distribution. The lntemational Medical Corps ^(lMC),

Aktion Afrika Hilfe

(AAH), Mundri Relief

and

Development Association (MRDA), ^Samaritan' Purse, Sudan lnland Development Foundation ^(SIDF), OXFAM-GB, Many Hands of Your Heart (MHYH) operate in Western Equatoria.

ln

Eastem Equatoria the distribution

is

made with the

iollaboiatibn of ZOA

Refugee Care,

Sudan

Health Association ^(SUHA), American Refugee Committee (ARC), D. REJAF and Norvegian People Aid (NPA).

Table 1: Treatment figures in Western and Eastern Equatoria

Year COMMUNITIES ^POPULATION

Total Treated ^o/o Total Treated ^o/o

Eastem Equatoria

2002 438 74 17 285,000 61,816 22

2003 18,392

Westem Equatoria

2002 401 240 60 658,000 291,093 43

2003 63,304

CDTI projects in Southern Sudan

The first Rapid Epidemiological Mapping of Onchocerciasis (REMO) exercise was conducted in

Southem Sudan in ^March

^2OO3

^{(Annex 2). As} a result, five (5) CDTI projects

were recommended for approval by

the

^17th session of the Technical Consultative Committee ^(TCC)

of

APOC in September 2003, namely, East Bahr-el-Ghazal, West Bahr-el-Ghazal, Upper Nile, East Equatoria and West Equatoria. The NGDO partner for the Eastem and Western Equatoria

2

cD-Tl

^projects

is

christoffel-Blindenmission

(cBM)r

Field activities

are

conducted

in

westem Equatoria with the

rrpp"rt

oilntemational Medical'Corps

(lMc)

and of AKion Afrika ^{Hilfe (AAH)}

for

^{Eastern Equatoria} CDTI project.

Each cDTl poect

has

a

project coordinator

at

project level, county supervisors at

the

^project supervisory centers level, and payam supervisors'

The western ^Equatoria

cDTl

project @vers the 5 counties of Ezo, Maridi, Mundri, Tambura ^and Yarnbio. lt has a total population at risk of 1,081,035 for 2005'

The first

lefter

of

agreement ^between APOC

and the southem sudan

onchocerciasis ^Task Force (SSSTF) for the implementation of CDTI for

west

Equatoria covers.the. period May 2004 ^-

nprif

^ZbOS.

fn" first

instatlment

was

received

in

September ^2OO4

and CDTI

activities ^were launched in the same month.

The

project coordination office is ^located in Yambio. The county health department of Yambio a*ocated

a

room

toi tne

^{project, but}

the

space

is not

enough

to

a-c-commodate

all the

office equipment. Therefore

tne pioject has been

^forced

to

keep

the office

^{machines (computer'}

pint!r,

photocopieO

i" tn"

WoriO Health Organization's ^(WHO) otfire temporarily'

The project coordination office is composed of the following staff members:

-

Mr David Jacob Bido, project coordinator

-

Mrs Mary Francis, financialclerk

-

^{Mr JosePh} NdukaYo, secretary

-

^{Mr Jackson BabuYa, driver}

-

^{Mr Milton Alfred, assistant driver}

-

^{Mr Santo} Noti, securitY guard

The

Eastern Equatoria

cDTl

^{project covers}

7

counties, namely: ^Budi,

-J-uba Kajo

Keji'

^Magwi Terekeka, Torit ano

iei.

it nas'a total population at risk of 888,380 for 2005'

The retter of agreement for ^the first year of imprementation of cDTr is not yet signed. The project coordination office will be established ⁱⁿ Yei'

Rationale for ^{R^APLOA and REA in} Equatoria region

southern Sudan falls within the ^{Loa loa} belt. some of this information was derived as far back as

the

^{20rh century as} drawn by Angro-Egypti;n

;ndominium

^{maps. The} endemicity

of

Loa loa is

supported

by the

remote ^sensing

r"t'ot

^{Loa loa} (Figure 1) and

the

probability contour map

tr,gure2),bothoevetopeobytheLiverpoolschoolofTropicalMedicine'

Recent studies (Richer, 2OO2\ indicated the existen

e ^or

^{Loa roa}

ⁱⁿ

Equatoria region ^(Mundri, Maridi, Yambio, Yei, Kajo-Keji, Mvolo and lbba counties)'

ln

April 2002 with

the

^support

of

HealthNet lnternational (HNl) and The

carter center'

^blood

survey for

^Loa

roa'wai-Eimeo out in ir*uuru,

^{Ezo, yamb'ro}

^and

Maridi counties

of west

Equatoria.

pretiminarylr*"y

resurts.indicated the ^presence

of

roiasis in

the

region' However, daia on the degree of endemicity of loiasis is fragmentory.

Mass distribution of ivermectin for the contror of onchocerciasis ^has been going on since.1996 ⁱⁿ Tambura, Ezo and yamoio _counties

w;;i iquatoria;.

^{Five (5) cases of sAE were} reported over

the last

six-years. ^f

n iitt

^Equatoria

CVlii.luntYl,

'two

deaths probably ^related

to

SAE were described ^{(Richer, 2OO2).}

'

^{Field mission report}

There is a known relationship between the prevalence of history of eye worm at the community level and the risk of severe adverse events (sAEs) following mass treatment of onchocerciasis

with

ivermectin fl'DR, ^2001).

Since

Southem Sudan

is in the

^process

of

starting CDTI,

it

became imperative

that

Rapid Assessme nt

ol

Loa

iia (nnpuon)

be conducted ^{in order} to determine the level of endemicity of

Loa

loaand the strategy to be used for Mectizan distribution, especially in communities ^starting new CDTI projects.

Based on the

recommendations

of

MEC

and

TCC

for the

treatment

of

onchocerciasis with Mectizan@

in

areas co-endemic for onchocerciasis and loiasis, and on

the

predictive maps of

risk

for SAEs occunence ^(Figures

1

and

2),

the Southem Sudan Onchocerciasis Task Force

t$sorrl

^{with the}

$;& ^{iioi.r Apoc}

Manigement ^decided to conduct RAPLOA exercise with

the

aim of determinind

tn"

level

of

^{Loa loa} endemicity in the CDTI priority areas so as to take precautions during mass distribution of ivermectin'

The

REMO exercise in 2003 was not able to cover some of the areas that vvere inaccessible at

the time of the rr*"y;

^therefore

^{it was}

imperative

to

conduct

REA in

areas

that

needed refinement and which became accessible.

Fiqure 1:

SPOT Vegetation model

map

^(Thomson

et al.,

20012) superposed

with

Southern Sudan counties

Iiur.r"._t llr', .i '; j, !l

,:,

^";

I li*

t:t ;i.: ; ' :1'. * It: fi *€n

- ^{,r.i^}

,

_Thomson M, Obsomer V, Connor SJ ef a/. (2001) Determining the spatial overlap between the distribution of Loa loa and onchocerciasis in APOC countries ^using GIS and Remote Sensing

Technologies: Final n"portto

Apoc

15t1ot2oo1. Liverpool schoolof Tropical ^Medicine, Liverpool,2001 -,

i

;{E n*n

i

'

+..?r

".1 r

lq _4'

^{.r '' -'*l}

{.&-.

.

^s,..;

hAFAETA

FUC.

4

Fiqure ^2: Probability Contour Map3 superposed with Southem ^Sudan counties

Fr ':'t) lkjlr;{ ol lH,lli t'tl'l 0riq-1

f!+ ^. I ^qi ur-J ! lrl-1il f.rF.lI trr rll, Lr! ^,l -i

nr-tt {r;. il l

r, 1.! : Lr!1.f'1

lr - ir ^i1,:

tli f-,11 1

Objective of the mission

1.

^{To buird} the capacity ^of

ssorF

^{in the rapid} assessment of roiasis and onchocerciasis

2.ToassessthelevelofLoa/oaendemicityinEasternandWestemEquatoriaCDTIproject

areas.

3.

^To refine/complete ^{REMO for} the Equatoria ^region'

Specific obiectives

-TotrainpartnersofSSOTF(central,countyandpayamlevels)inrapidassessmentofloiasis

and onchocerciasis.

_

To conduct Rapid Assessment of Loa /oa ^(RAPLOA) in the CDTI priority areas of the East and West Equatoria CDTI _Projects'

_

To conduct Rapid Epidemiorogicar Assessment

of

onchocerciasis (REA)

in the

^accessible

areas of

Equatoria

region wnere REMO results need to be

^refined

or ^{are yet} to

be completed

loa prevalence using the recalibrated 2002

3 Development of an Operational ContourlVlap for ^Loa

il;ifiil;nial

^{Risk l\ilodet} (Draft), Thomson et

al"

.,1.,.

- ^.*-+

.i;:rifi+.,

Methodology

REMO| RAPLOA field exercise

REMO/RAPLOA field exercise was planned in six phases as follows:

Phase

^l:

Field

Preparations.

(46

_April

_2005.

Nairobi. Kenva).

The

first

three days were spent in

Nairobi discussing

and

arranging

all the

administrative processes needed for the field activities-

On

the first day,

the

Head

of

Southern Sudan WHO Coordination office, Dr Abdullahi Ahmed' received and welcomed the team, and assigned ^Mrs Agnes Wanyoike to work with the team to

address

administrative

issues. The team

identified

logistics and ^gathered the

^necessary

information on the East and West Equatoria CDTI project areas.

On

the second and third days, the team together with the SSOTF identified and marked on the rnap the villages to be surveyed for RAPLOA and REA, and started duplicating th'e

surveylo-t- The

selection

of

study villages gave priority

to the

villages that were targeted

for the

REMO exercise

in

2003

"r

ti.r"y w6re lumciLnfly iepresentative and took into account topographical data. Additional villages

*ere

selected in

ireas

were REMO needed to be refined. For RAPLOA,

66

villages were sei-ected in Western Equatoria and

81 in

Eastem Equatoria. REA was

to

be conducted in 31 of the ^villages. Out of these villages, ¹⁴ were in Western Equatoria

while

¹⁷ were in Eastern Equatoria.

fhe

^team took the opportunig

of the

stay

in

Nairobi

to

meet with

the

^national onchocerciasis control coordinator

oi k"ny", br

David

Sing.

^{During the} discussions, Dr Sang emphasized ^on

the

need

for

implementing onchocerciasis surveillance in Western highlands

of

Kenya (on the border

with

Uganda) whe-re onchocerciasis cases are reported

by

different investigators after vector control has been completed in the 50s.

il.s

^to

On

^Thursd

ay

^7r|'

April, the team left

^Nairobi

for

Lockichoggio where the.security briefing for Southem Sudan

was

^provided.

lt

stemmed

out from the

^briefing

that West

Equatoria CDTI

prgect

area was under phase

ll of the

United Nations security system. Similarly, in

the

East

Lquatoria CDTI project area, some

^counties

were

inaccessible

for

security reasons ^(Torit, Magwi, Juba).

Phase lll.

nino

on

RAPLOA REMO

Two

training sessions were organized, the first in Yambio (9-11 April 2005) and the second in

Yei (16-18 April2005).

The

training'

in

yam'bio targeted

the

participants

of

Western Equatoria.

The

participants of Eastem Equatoria were trained in Yei.

The

main components

of the

training were the objectives, procedures and techniques

of

the Rapid Assessment procedure

for

Loiasis ^(RAPLOA). The following support documents were used:

-

TDR/|DE/RP/RAPLtO1.1WHO(2001) ^Rapid Assessment Procedure for Loiasis

-

TDR/|DE/RP/RAPLOA/02.1 WHO(2002) Guidelines for Rapid Assessment of Loa loa

-

TDR/TDE/ONCHO/93.4 WHO(1993)

A ^{manual for Rapid}

Epidemiological

Mapping

^of

Onchocerciasis

The following topics were covered during the training (Annex 3):

-

public health importance of onchocerciasis,

-

overview on APOC,

-

^{severe adverse} events and their impact on sustainability of CDTI,

-

^satellite imaging based on vegetation index,

6

-

RAPLOA procedure and REMO prccedure.

T1,e

^last

day of the

training

was

devoted

to field

exercise.

This field

exercise

gave

the opportunity to 6re APOC

teari to

identify points that were ^not well captured during the training,

and

^{to give further} explanation and guidance'

Phase

lV. Field exercise

Following the training in yambio, participants from West ^Equatoria were organized in eighteen

ira) t".,it

according to their payam ot 6rigin and deadlines for reporting the results were given

to

^{each team}

takinj-into

ac"ouni the number of villages and the difficulty of the tenain ^(Annex 4a). These teams

"6rr"n."d

^{the field} survey on the ^13th of April.

The

RApLOA/REA field exercises in East Equatoria were ^planned from 18-30 April 2005' They

were

planned to eno on tne ^goth of April 2oos:sD,fteen (16) teams were made for the execution of field activities (Annex 4b).

Phase v.

Report

writina

^(18-26

Aoril 2005. Nairobi.

^KENYA).

Report

^writing

was

started

on

^18rh

^April.

^{Briefing yvith}

^{the Head} of

Southem Sudan ^WHO Coordination

oniceloor pr"""

^{on 25rh April. Dr RhmLo stressed the need that}

APoC

involves the

WHO

^office

in

tecnnicat'support

to the

^{projects in}

the

implementation of .CDTI,

in

particular if

sorne

^of

the

^project

areas'were to be'found

co-endemic

for

onchocerciasis

and

loiasis. He thought that this-could be done if APOC strengthened the

wHo

^{office by} appointing temporary advisors for 6 to 11 months. He does not know whether

wHO

^{is member of} the SSOTF since he has never been invited to a SSOTF meeting'

The

members of the ApOC mission left for their respective countries on 25th and ^26th April 2005.

Results and discussions

Training on

RAPLOA

and REA

A total of

110 participants

were

trained. These

were

^county

and

g?yam.onchocercerciasis supervisors, and

Cor;;liy-Directed

Distributors (CDDs). Fifty eight (58) participants were from

west

Equatoria and 52 from East Equatoria (Annexes 5a and 5b).

Status report on the RAPLOAfield ^exercise

out of

the ^{147 villages selected} for RApLOA exercise ⁱⁿ

west

Equatoria and East Equatoria, we have availed data

f-*

^{f S} villages (annex 6). The nece-ssary arrangements have been made for further results to be sent to

Apoc

Management by

sSorF. ^lf

required, the temporary ^advisors remain available to assist in the compilation and analysis ^process'

seventeen ^{(17) of the villages} that were selected for the REMO and RAPLOA exercises ^{in Juba} and Torit couniies were inaccessible at the time of our visit.

Loa

^loa

was

known

in

most areas

of

Westem Equatoria. Several local ^names were used ^to deSignate

the

eye WOrr, "rOrO", "kiri miro",

all

meaning eye

worm' ln

^EaStern EquatOria' the worm was less known in the studied communities'

The

percentage

of eye worm

^(RD)

was higher in western

Equatoria

than in the

Eastern Equatoria.

ln

West Equatoria, the percentage

of

people

repollng

history

of

eye worm ^(RD) was ^greater than 40% in Akorogbodi, Gangura and Nambazia in Yambio county'

ln

East Equatoria, there was no village with RD greater than 40%. Eye worm was poorly known in most of the villages.

The preliminary results agree with the Probability contour ^Map (Figure 3)'

7

Further discussion

of the

results

will be

made when

all the

data

are

received.

We

could not cornplete

the field data

cottection process

due to road

infrastructure difficulties

and

time constraints related to the logistics.

Fiqure 3: Superposition of preliminary RAPLOA results with the Probability Contour Map

f:. l]h !i rliii ;i i I l :ii 1 I t:1 1

f ^::'u"'

_iil.niqi

'- E - .',-{

.- J .:ri

:i-r.

; 4 ^,.'d-,

..tl I ^l

"i , l.! ,:i ..

I

r. :

Sfatus report on the

REMO

field ^exercise

Out of the 31 villages selected for REA exercise in West Equatoria and East Equatoria, we n3y9 availed data for

2lannex

7). The prevalence was 46.70/o in Garia I and 35.0% in Riftenze The remaining results are expeited ^to be forwarded to APOC Management by the SSOTF.

The

Kapoeta County was reported by the ^SSOTF

to

be hypo-endemic

for

onchocerciasis and also the area targeted for REMO refinement was uninhabited.

D ifficu lties encou ntered

Due to difficulties of terrain (bad roads, lack of means of transportation), geographic and ^social accessibility

of

villages,

long

distance between villages

and

^{isolated homestead} distribution within viilages, it

wai

not

polsible for

reduced team

of

^surveyors

to

^{carry out the exercise. ln} consultation with the

sSotF,

^{the team resorted to training}

^a

large number of persons each of whom conducted the exercise in their own ^payam. The implication of this was that the ^direct supervision was difficult. This explains why all the expected results were not available at the time this report was compiled.

. ..: ^:'.:;.,x:,

c.:i

. .:$.

],iF:,Eri

JUBt Ii'FtI

l,lr

8

Recommendations

The

preliminary results indicate that the prevalence

ot

Lo3 /oa varies widely in Equatoria ^region,

and

the complete return of the

RApLoA

survey results from

SSorF

^will be highly important for

fran"t

identiiication of high-risk villages and implementation of CDTI'

The

implementation of CDTI in high risk villages of Mundri, Yambio and other identified counties

(as

rernaining

RApLoA survey results b6come available) should be done following

^the

rccommendations

o{urcncCTorttre

^treatment

^of

onchocercrasis with Meclizan@ rn areas co- endemic for Onchocerciasis and Loiasis'

During the implementation of CDTI, adequate ^means of transportation should be provided ^at the

county (motorbike;t ;J

^payam

ioixes)

^tevels

to

facilitate

the

distribution

and

supervision processes.

Acknowledgemenb

our

^gratitude

^to Dr Azodoga sek6t6li,

^Director

of APOC for giving us the

opportunity ^to participate in its activities.

Wl

wish to thank Dr Abdullahi Ahmed, the Head of Southern Sudan

wHO

Coordination office

for

^their

*rm

^{reception and} assistance throughout the mission'

we are

indebted

to Dr samson p.

_Baba,

_the

coordinator

of the

Southern

sudan

onchocerciasis

iasf

Force, for facilitating ^our field exercise in Southern Sudan.

We

wish to thank the following ^partners of the SSOTF for the logistic assistance: AAH, ^ARC, tMC and

uNlcEF.

We thank all ^the

wHo

^{staff in} Nairobi, Lockichoggio ^and Yambio offices.

we are

indebted

to t#-;;iy

administrative

and medical

authorities

of

Equatoria region ^for facilitating RAPLOA and REMO exercises'

our

^thanks

^to

^Dr Mickey Richer, Dr Jayaprakash Valliakoleri, Dr Ricard

^Lino Laku, Mrs Agnes Wanyoike,

Mr

^{Sinnshaw Tiruneh,}

Mr

Fasil Chane,

Mr

Mike Salla,

Mr

Ceaser Longa

and

^all otheis who assisted ^{us in} our mission'

we

crave the indulgence of everybody omitted erroneously to overlook the omission, may God help you all.

9

ANNEX

Annex ^1: map of southem sudan ^{showing the} regions and counties

L*ger,ld

E: r]

^{e+rintIssEssiurru}

t::. Iii{ia:'l

+

Annex 2: REMO results of Southem Sudan following 2003 exercise

REMO maP Suilen

Southeru sectol Le$end

..'.:'r lto cort Refine

ffio"n,,n.corr

Excluded HHI Rrtuo eenoirxr

Stiltes Re$i0ns

'. ^no(lul€s

o0 o

^1-e

o

^10-19

0) ^{2t- 39} (} 4a-1oo

I---]

0

E[G

Ht{.4

100 200 ,,i..HilAF:':aru 1i't3

i

I

i

!

:

LATJdfl AET'EI

TIVAU

l0

AGIex ^{3: Agenda of} the training sessions in Eastern and

westem

^Equatoria

Dr Baba 8:00

-

^8.15

The Southern Sudan Onchocerciasis Task ^Force

Dr Jima 8:15

-

^8:40

of onchocerciasis Public health im

MrZour6 8:40

-

^9:00

APOC

9:00

-

^9:30 DTT of CDTI

on sustain and their

Severe

9:30

-

^10:00 DrT lntroduction

in the reventio n of SAEs

Mr Adie 10:00

-

^10:15

of Loa loa in the of SAEs : The bi

015

-

^1A.45

Ccffee break.

Dr Takou 10:45

-

^11.15

index based on

Satellite

Clinical _ns RAPLOA

i- tr it r-'l; ^-i 2 {la

-

^1:i.oa

Dr Takou 13:00

-

^13:15

uestionnaire

Clinical The

Dr Tr

13:15

-

^13.30

uestionnaire The individual

Clinical ^NS

of RAPLOA DrT

lm

Dr Takou 13:30

-

^13:45

Selection of communities

a

Dr T;

13.45

-

^14:OO

the communities

a

14:00

-

^14'.15 Dr with chiefs and leaders

a

14:00

-

^15:00 Dr

e

RAPLOA forms

Dr Takou 15:15

-

^16:00

teams of

a

Dr T, 16:00

-

^17:00

Role SaturdaY

selected communities Field exercise in

Sun

11'.15

-

..: :

4CD ^] _.ott, -o:rL

}i'L o oE E

G'o

o

:=L

o

$N

:=_L

o_

o

N

:

_L

o-

N :=_L

o

Nc\t

:=_L

o_

@

:

_L

o-

@ :=_L

o_

o) _-

L

o t- r

:

_L

o-

$ :=_L

o-

o

C\t

Lo-

__

L

o

$!-

o

N :=_g

o- NN

o o(, o .9o

,=tr

EE C'o

oo

lr

=0,

=

q, E'tE

-g E

G,o

F

E(E

F

o r'i_ol

sHl

dt>l_LI

fl * ^r

>l olo

.CI E

.eml

r

(E-cl

t

>

_{r t -c.l}

6lg

_z.

GlcDl*

i

Pl,

^sl

El

=l €l

>t -ot =

gslEl 9:o.-r

EIE

!l

Yl0a oal

o

o Ef

(E

m oo N

Eo oo)

z

*-l(Ei

-lrl cl_ol

<t

NIol YI

-oo

-o

c(E

Eo m o

=o

=

^j

-oE

(U co .v.o

L(U

Lo

-oE

z

(E

j

o)(E L$ (D

L(E

E oL

Eo

(E

=

_o

N r.u

b

o_(U i5

.iE

(E

z

(E

⁼

^(DO)(E (5 N(E

-oE

z

(u

'6(5

o)C

E

(!

E(U

E(E

z

LI_(/)l olo, clol

001

*_(Dl NIcl ol EI lLt

*l(ol

EI -ol$l ZI LIol cl(!l

tl

.-t JI

oL

fo,

C,(g

(,

o)L

q)o,

6

_o

z

.Eo

CD(E

N(U

o,c

(E

m

q, CL(U

v

_(U

z

=

L5 -o

(}

c,(E

=

_o

L(!

-oC,

z

(U

E(U

z

N

(U L5 -oE_(u

F

(E

Eo

l- L

E€ 9

# ₌

^(um

:<d !2

oEE-

d)

c'i?

3 EXEo)

I u3li

(g

E(!

-o

i

c ox

Jo)

_(EF-O

a,EOc

Oo

._E

s5

o

E(D

Eo)

(L

€E

Es) Fcs(u

(U=

lU ]U

L(Uo_o (LN

6.e c-c

CC

oo

-a

.=

(u

gE o-6 6q ^o)

Ss

.Co o

ET o5

E-

EE

_(U:

YIL

'o)cg

]Uo_q)

E(E

a Ifo

(u

.=

o

(Do

(E

(,

L

'(!

m: s8

-e* oo

fs

E'6

L

tN

=,E :lLltJ _E -cXcoo(l) -)J

Lo

tr

E

o)o

.E(o

mo

(E LN tU o)L (E

g

(E

Bo ?3

hul e2

_(D=

(LF

oP U9e d H€

=6a

(l)^o_

aE (E'=

>=il

o

E f

Lq)

ott

o)L

lL

(5

-o

CEE

L

m(U

o

(E

= a

(U

.E

:

J

a

o Eo) (U L

o

oo

E

s

o

F

Eo oo,

c

o

U'(U

mo

6

o)c

.v,(E L

oL

'FiE

Y(E L

o) o)

mo

.v,o

6

(E (l) IUE

'6

(E

-o

2

q)

oo_L

(,

-ooo a(E

o

L

o)

(Lo '6o

c(!

L

LL

=

o)L

Ec

p

o m -oo₍₎ -)(u

o

go

-o

co

.Cc

6

E(u U)

'z_L o

o

.v.(U

z c

.c.o -)

IEo

-oo,

f

L

E_(l)

TL

Eo

(oo- E.E

(5

E.E

(U

=

E(g (o

o o

o)

E(I,

N E.E

(E

=

E(U (E

o

o)N

Yo

(f,

E_'E o

=

E(U (Uo-

(u

-o

o

$

o

L(u

=

E(g (U

o

o_N

tU

oN IU

E(E (Eo-

oN lU c{o

lUN E(E (Uo-

oN ]U

(f)

oN tu

E(o (Eo-

oN UJ

sfo

IUN E(E (Uo-

o

-o E(!

Eo

E(5

E(!

(U

o

E(U

z

N (\t

Eo

E

C,

E(E (Eo-

=

tn(u

o)L

(g (D (o

Eo

E(E

Eo oo-

=o, E(u

t

.t J to

-o E(E

E(!

(!o.

(E

o

o

_o(g

z (, b

o

Eo oL

q)o) E .gE_(u

z

(o

o^

-oE co

_L>\

.(E(U

>o-

(E

Lf -o

E(s

b

oL^

=c

=(5E>

Fo- o(5

o)c

E

o

o

_o

L (U (U 15 Lo o

.EE

(so

E

Ec o

.E(U

o

G

o

=

l'IJ CL

o

aho

=

.Eo E(U

o o

E .9

=

o o

o

Eo O

$lirit

xl(I)l

clcl

<l

H

:=

o-

N o

oc

1'tr

o

o

:

_L

o

@ __

L

o

@

-rLIE.et t-l - ^(El

rl _dol

=l > ^-

ol'=.

I

.;

Q -El

E

EEI

d:<.;

e klg

n:l O

; ^{El= *l}

Srtu<oEl

fi88;l

-(E c-l

g\lf:.J

iEcaBl

.i(UoJl

166 >*i l(DY2=l

o(f,

c

o o,

c

₍₅

z

oL

Y oo) .g(,,

c

L

)

=

,6 -vo)

f

C

o

.E U)

TEE 8'=

-cu.s oo=

5uJco

fE*

o

N(l)

Yc o

.E

a

(5 (E (D

v

6)(E

.E.9

=

oo, .E .EE₍₅ c(o

o

L q) q) TL

L

o)

(Lq)

co

a

E

.E

a

C

J

(E

L

-o= E(E

F

c\l

(E La

€h

='e_E>

Fo-

(ECU (5L

-oE

(g

E_o

o

f

(f,

(!

F(!E>o(E l- ^o- o

o

TJ

o o

.9

t

tr

=E Eo

o

!t

o

.U

-9 E(U

F

o o llo

Eo

=

E(!

F

o cil

o

J (L

t o

C(U

o

]U

tr

Lo

Fo oo)

-(U

*

:t:

.o.

CL(l,

o oE

=

E'6

o

c,

aa

-o -o

gg

zz

(E(5

a aE'

<<E

\tlf, h 616lg

aa

-o -o

'6'6

LL

zz

a

6-='

<<

x lr,lr, h c\tc\tg

AAA,A

-o.o-o-o.cl

coooo

_LLLLL

'6'6'6'6'6

zzzzz

vvvvv LLLLL

ooooo ooooo

(f, (v) (f) (Y, (f)

A-oo_L

'(5

z

<*P

==' NE

6-oo_L

z

(5

-{E

hS

xo

6-oo_L

'(E

z

=='

>(E

aE xE

AA A A

-o -cr -o -o -o -o -a

oo99999

(u(E(E(E(u(E(U

zzzzzzz

vvvvvvv

L L g L L L L.=

o-cLo-o-o-oo(u o++stt$t9 (f)Nc!$lolc{ol-

--: EEE

_(l)(l)o)

LLL

o-oo-

(o (f, (f, c\l ol c!

o oC'

o

.go

.=

=E Eo

o

oL (E

o)= Jo

.c,(!

>(E

'=\ E,

5=

x'(E

_co,

(DY

f(u -cri

9E 6

o.- .Eo FF -Gi

o)

o.- ^(g

.=b=E-

_(EO):C)s

=d=3d

-oic"l+d

.C tDo

o Eo

-,

-

.Y,o

oo :=

6ro9

=d)(!

5>>

-^ic"i

+, _tl

EilHs HE$l -c.i ^c.r+Lridr-

(DE(U(I,

.:Z tu O

o >o

= cE

.Z(L(r Yoo -oici

.A

lt

o o

=

eEE

)

=o= 8aE

(E:= J

rEa

.O(d(U

-5tr= 85€

-oi<"i

5

'EE

6J d)5 tr=

_(l)E

=(E

<a

-

^(ri

-3-f; 8,4 o,

^E

55[:EPs#

EIEEgEEE

-c.i<.i+ddF-d

.v,a

og gE

EO

<> AE -

^o.i

.E Jo

!o

-

Lo

.v.o)

(U-

8H I

g=>

<-Y >

=, .9. 9.

6f;

E

<rL<

-cri

^<a

LL (E

-oc oE

fl= o(u '=

^o) o_a

Je.i

3(D (g

EE 5tP ^g,=

d!iflE

E€

^E

q!

a=iDi->

-c'ic"i+d

t,

o,_(lt

g

EIE

F(l,

o

E(E

lUN

6

J

c

(I, E ]UE

o

E(E

ulN o)

c

(U

E LuE

.E

=o-

:)

(1)

Eo)

$

lJ-

(g

)

o

.co

Lo .9c,,

N

o-.v o EE .c(u U)

.v,=

o

=

o

o oo-

o

L

o

=

'- _j-

Rt

^llJ

O=

S'E

-o _Eo

:A

=<o

.E

(U

=

E_L E(Uo E

(Uo

F

a(E

) -

a

(E

) -

.v(g

Niz

o

'o oP

^ol

-\-

=l-

co J(U

.E

F

o

Yo)

'd

o V

N

\<G)

.6.o Y

(a

Y(D' .o-.o Y

'=

o,o

=

-ooo_L o

=

'6

o)c Eo

o-o

L

oo

o

L

o

o)

.EE oo E

o

c(5

.E(U

oo

o

f lrJ Eo

.t, G' IU ,E

an

Eo o o

Co

.U,

oo- Eo

o iir

_.fl

xlol clcl

<t

co

--

'6'6

LLLL

(Dq)

LLcL o-

(f' (f)

C\l (\l

::

_LL

oo

c{ ^C\l

(() CIN

o{

-

'6

Eo

:

L

o

@c\l

:

_L

o

C\lc\l

:: =:

^LLLL_oocLo-

lolr)l(rro ot c{ (\l ^(\l

L

o

@

:::

LLLL

₌

o-o-oo

1., ro lr, (, GIN(\IOI

:::=:=

LLLLL

o-cLo-oo I-Fl-r\F

---FF

o o(, o o

.g

ca E Eo

o -oE os

_LL

>Y

(!o

-(\i

cc C,,

a._

^g

d.D,F-E

iz E-9 E

o--o

- EE

^E

3_36'5S -C\i(fi+d

(sL

q)o-

Yo

-

-Y,'-(U;i

.9; o-z -oi

=o

J(!

o p Bo

_E-E

EPSg -

^{o,i c.i}

⁺

'=

c_o

t -

(Ul -v= V(E _(!

H

&Ee

: L e.-

E

o 6'6'

o>oY

-

^{oi <tj .+}

6

c

-v,o

E(E

!9=o E 5

L L >\C, -E

a=

gi58?=

-oic.i+d

o llo Eo

=

C(U

E8

E

'o4

c$,

=(u

o)c

_5O

<J -

^c.,i

.9E

(EE(E

6a

=.E U)=

o$

Eg

-

^c.i

(D C'

,

Jo .v

)

J o)

c

_o

-cE

_Oe

>j (s=

EE

OE El -c

3o luo -cri

E(l) Eo

J

(l) C(!

E lrlE

-

or(55

a>

J=

-c ⁽⁹

Bs

s5

-

^c.i

Eg

_a=

aE o< _co

'<= (u

cc oE

>F o-c -

^cli

(U

oc

=g

Eor

E9

=(D

EA -rri

o0)

oc '6

t

o_(U o E_(E

F

o

oL

-o= oc

o

o

p o

(g

=o

=

o

_(E

F

.C

o

q)

oo a

E

o)o o

I o

o)

oo _,

'=_(!

mo o(u

Eo

o

o

-(!

(Eo) Ja

6

_(E

L

.9

'6

)

=o

=

^(E

E(o

CD

)

=

o

Jo Eo

L

o,C

o

I

^.o)

d P.e i

-g Eo o

.o5<N

t-:OII

E Go

F

-ooo_L o N

o) (E '(EC J (9'6

(E

,6c

J

t

(D

=o

(E

J lf,

o)

ofo J (o

o) o)L

F

o N

(l)

-

^(D

@'6 oo)

6

o

o)

o)

(Do '6

L

o)x

o)

E

iI

o)

$

o

J (L

t o

(g

o

TU

t

Lo

tso

q)(,,

(s

I ct

o

EL

E

I

l5

Anr]ex.5a: List of participants in Westem Equatoria

Neh

Joseph Abasi Kotobi DD

Eboul Eluzai Fresser B. Yothoma

John ^{Filbert Su sor}

Mathew Guaso ^M i cou

Gordon Gaba f

Filbert ^{Vic'tor medical}

fficer

Anthony Aboro I

Fzo ^u

Jarnes Elineo

Khar5do Sevenlo Yenqere ^payam

Fra ncis Andrew Su

Elinama John CDD Levi Gershom

Jonathan Ezikia Maridi mSu

Ernmanue! Phelemon f

Su sor

Ezo CDD

Ezo ^D

Titi ^Bakata Grace ^N. Abasi Emilia Diko

Grace Jiraldo mbio

Peter G. Jacob Yambio payam SuPervisor

Martin Musura medical Officer

Lexon H. Abdalla Mam

Silvano Angotua Barnaba Mambe

Charles Suliman Kozi

John Kasara aridi mSu

Mario Berewete ^Ti mSu or

Peter Danahiningo ^M Su or

Fresser Juma Maridi cou ^r

Elia Tabani mSu

Yam CDD

Boniface Timon

Lexon Frezeir ^{B u} Su

Michael Baya Kazimillio Benet

Mundri

Ezo cou sor

Sabino Philipo mbura CDD

Sirnon Peter Tam m CDD

Sirnon Ukes Tambura CDD

Felix A. Unsbofi Tambura CDD

Tambura Sirnon Kesito

Jacob Usumo Su sor

ect

Yambio CDD

Yambio m

Joseph Nalukayo lsaiah Awumbu Martin Samuel John Nakio

John Peter Ezo

Tito M. Amos lbba ^r

Arkanqelo Basonqodo Naandi ^u

John Ziqba Ezo

Peter Thow Yambio CDD

EIisa Angelo

Jackson Abisai Yambio county Supervisor

Titus Enosa Yambio

Fasil Chane CBM, Rumbek

Mike Salla coordinator

Eva Cabatingan rMc e coordinator

Samson P. Baba SSOTFF Coordinator

David Bido a CDTI

Data man SSOTF Rum

coordinator Yambio Ceasar Longa

Bendect Ariwa ^{idi SU sor}

Maridi countv SuPervisor Nagero

Kozi payam Supervisor

Nzara