, OCTOBER 30 - DECEMBER 13,2OOO

NATION ^_ WIDE RAPID EPIDEMIOLOGICAL MAPPING

oF ONCHOCERCTASIS (REMO) REF,TNEMENT OF NIGERIA,

, OCTOBER 30 - ^{DECEMBER 13,2OOO}

. MISSION _REPORT FOR

woru,o HEALTH ORGAI\TZATION (WHO) _AFRTCAN PROGRAMME _FOR ONCHOCERCIASTS CONTROL (APOC)

OUAGADOUGOU, BI'RKINA FASO.

BY

DR B. E. B. NWOKE OYHO Temporary adviser)

Professor of Medicawubtic Heau! rarasuotogt & Eniomologt

School of Biological _Sciences Imo Stote University, Nigeria PMB 2000 Owerri, Nlgeria

Tel: (234)

_E3

230

69E

DECEMBER _I2,2OOO

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SUMMARY

l.Onchoceiciasis in all the refined zones/areas of

Sokoto,Zamfara,

Adamawa,Kntsina, JigawnrNnsflrawa, Kaduna,Knno, Rnd ogun

States

is not

a

serious public health problem to warrant

CDTI

strategy,

2.Of the

four

outstanding

LGAs in Imo

State(Obowo,Ezinihitte,Ngor Okpala,Ahiazu and Abor),only the zone of

Ngor

Okpala

LGA

is

CDTI

area.

3.Only the

northern

part of Ovia south west

and

Ovia north west LGAs of

Edo State(bordering Ondo State) is a

CDTI

area.

4In Ondo

State,Irele,Okitipupa,Idanre

and odrgbo LGAs wcre outstaldilg.'r5e

present result showed that only Idnre

LGA

rone

*ai GDTI

area.

S.The

two LGAs

refined in

Ekiti

state(Ikole _and

oye)

are all

GDTI

area

6'Eight LGAS were refined

in osun

State. onchocerciasis

is

serious

within

the zones

of

Ayeda Ade,Irepodun _and Egbeofe LGAs.

7'Of the six

outstanding

LGAs in oyo State,the

zones

of the

northern

LGAs of

Irepo,olorunsogo,and

oriri

as wefl as Ido

LGA

are

CDTI

area.

9-91

th.e

Hadeji River Basin of Yobe State,lg community were

examined and 12(63%) of them had no onchocercal nodule.Five(72%)

of

the communities who were

positive for onchocercal nodule had l-9% nodie prevarece and onry

one.

community,Dagona

had

2OYo

nodule rate.This result will be made

clearer when integrated

into

the Atlas GIS.

'9.A total of 43 communities were refined from six LGfu in

Gombe State :Balanga,Akko,Billiri,Nafada,Dukkil and Funakaya.Except in the zones

of Akko

and

Dukku LcAs,'onchocerciasis is a

serious

probl.* in a[ the other

LGAs examined.

I2'REMO

exercise

was

refined

in 4l comminities in,2l LGAS in Borno state.of

this,only the zones

of

Bama and Kala Balge

LGAs

_are

CDTI

area.onchocerciasis is apparently absent or of low endemicity in ti'e other 19

LGAs in

this Sahefian ,egion

of

Lake Chad basin.

l3.The'REMO

_exercise

was conducted in Alkaleri,Kirfi,Bpuchi,

Bogoro,Tafawa Balewa,Dass,Toro,Ganjuwa communities were rgfi.ned

tl and Duazo LGAs _JHt

study.The result showed

of iauchi that state.A

onchocerciasis was

total of

³⁵

absent n-16(46%) of them.onty _{the zone}

of

Toro

LGA

has the disease endemicity

to

warrant

CDTI

approach.

LIST OF CONTENT

1.0

2.0

3.0

4.0

5.0

6.0

7.0 31

3.2 3.3

7.1

SUMMARY ---

2

INTRODUCTION

Study Area

MATERIALS AND

METHODS

4

6 ()

Training ₆

RESULTS

AND

DISCUSSION ₈

REFERENCES 44

ACKNOWLEDGEMENT --.---. -45

APPENDTX

^{____-_ _} ₄₆

Mission

Schedule

46

7.2

List

of NOCP Participants 47

7.3

List

of National ScientistVConsultants

---'-

47

7.4 Refined REMO

Data --- ^---

^{- 49}

il

L+

2.O

INTRODUCTION

Human onchocerciasis is a serious public health problem in Nigeria _{and other}

west

African _countries

(prost,l986;Nwoke,ileo; od;iiy-;;;;g

the..people at the end

of

the road"

-

^the farmi'F.p^9P^YluJion who produce the

urr[ oiou,

food and industrial raw materials (Nwoke _et at

ilsl;. It

is estimut.d thut about

I I

nrlilion

Nrg;rt.;, .r;

infected by the parasite and more than 100,000 are blinded by

it *i,r, or".40 million

at risk.

with

this picture, onchocerciasis is no long". _{a disease tnut}

,touta

be taken for granted

in

^'

Fortunately, the advent

of

ivermectin (Mectizan) _{as an} effective _drug of choice

for

large

-

scale treatmeltt

of

onchocel'ciasis _Itas revolutioniz-ed the

Jir.ur.

,la,agenrent _an4 given great hope for the contror. And with the

wuo/apoC;;gy

put in prace in the continent, there is greater.hope at sight for

the.m"rtir.

una successful control

of

this cluonic and debilitating _disease.

APOC is committed,through partnership

with.Ministry

_{of Health}

(MoH)

and various Non all endemic

-

Governmental

African

countries through'mass DevJopment organizations

iue.m".ti, airiiii"uiSr. fNcporl

to control onchocerciasis

j,'tTrro"o,i"n,,o

_in

point out here that there is general alreement that the drug should be distributed

first

to communities whose members are atiisk_of aereloping ihE

r"u..e

and disabling ocular _or dermal complication

of

onchocerciasis lTaylor.et ir,-

i,g;;

This risk is accepted to be directly related to the intensity of infection in

the;;;;ity

_{(Remme et al, r989).}

Furthermore, the demonstration of good correration

bd;;,

the prevarence

of

onchocercal nodules and the skin m-icrofilariae

i,

^u

"onr*rnity

^(Nwok

e, r992b,wHo,

1992;1995) provideda.bre-akthrough in_the.upia

.pia..ioiogi"ut

_mapping

of

onchocerciasis

@EMO)

(Ngoumou-&

Wulrh,'1993).-- --

Informed by the advantage supported the

first

nation

-

of REMO ^wide REMO exercise in the country in onchocerciasis control,

with uNICEF by wHo providing

1993

- ^lgg4

technical guidance and logistic support. This pionee,

*o.k

hu, played a significant _{role in} ourunderstanding

ofthe

disease puit"rn in

the;r*" _Gmade

_et

_{al, l99g) (Fig. I)}

The

APoc

strategy is.community _ownership of the contror efforts through _mass treatment of

a!

high risk areavzones

- _lsing

^the

community oirected

_Treatment

with

Ivermectin

(CDTI)

approach. However

r"iJr."tir. pi.rr*g

and implementation

of

the CDTI'

APoc

as a

mitter of

priority_requires

*;p;.'d;ir.

epidemiorogicar data generated using the

wHo

deveropid,na.

upprorfi n i!;or;;i;i;-e;? Muiping or

onchocerciasis

(REMO)

from aliendemic cbuntries.

rn. nbnao

results help to delineate the main onchocerciasis endemit ur.ur/rone-s tlrat

."quirc ibrr priority

and at the same time ensure adequate coverage of all the high risk areas.

Informed by this,

wyglApoc,

June ^g

- ^I0,l99g

^{organized a} national workshop _at

wHo

office, Lagos, on

REMO/GIS

_{on the}

definition;i46il'ffi.ty

_areas in Nigeria.

with

Dr'

Nutral

(crD/Hearth

_{Map, Geneva) and Dr.}

No,,l B'giilepocr

in attendance, _a1

5

14. REMO was refrned in 60 communities

from

16

LGAs

of Kebbi State. Onchocerciasis is not a major public _health pioblem in the state except at Danko Wasogun

LGA

(bordering southern Zamfara state)

15.

Thirty communities were examined from 9 LGAs _in

Kogi

State. Only

Omalaz;lne

showed definite

CpU

communities.

I6.

By the present ex€rcise, REMO was relined in 29 communities

of

8

LGAs

in

Kwara

State. Onchocerciasis is endemic in

allthe LGfu

examined to warrant

CDTI

except Edu LGA.

17.

Atotal

of

83 communities from 8 LGAs in Tarabastatewere refined. The zones

of

Ibi, Gassol,

Laq Karim

Lamido, Jalingo and

yorro

_{LGAs were not}

_CDTI

_areas.

Only the area of Ardokola was CDTI zone. The

REMO

exercise in southern part

of

Sarduana

LGA

showed that the lowland areas, especially

within

the Donga

river

basin are definite

CDTI

as recorded in the lgg3lg4

ngUO.

On the other hand the present result showed that the cold higtrland communities around Gembu zone

which

hitherto were mapped definite CDTI

by

1993t94 are not GDTI zone.

18

In Plateau State,

3l

communities were refined

in l0 LGAs.

Only communities

within

the zones of Bassa, Jos East and Pankshin LGAs are

CDTI

ureai. The other 7 LGAS are

within

the less endemic lowland zone of the State.

19. Akwa Ibom results showed that 1.0

b

the available REMO data were reviewed, analyzedand

finally

integrated

with

the

existing epidemiological data. At.the

*i.ortrrl *o[rr,"p,lr,.

refined map

of GDTI

areas in Nigeria (based on the current REMO data then)

*.r J[r.rrped

and agreed upon

by

all the _as participating members

of NorF

as a true representative of the disease,s

distribution

at June 10, 1998 (Fig. 2)

Furthermore the workshop observed that

with

the available data, there were areas/zones in the country where

nrMo

_{was not}

conducteJ,;;;;;s

_{which needed to be refined}

and/or areavzones where trre data were

inconrirt.ri

_*itr-,

k;;*"

epidemiologicauentomological

information Th;;;rkffiin.r.rore

recommended that

for

effective coverag-e,

plTl1.s

ana

imptementation;i;il

_ongoing

_CDTI

in the country, there was need to refine

REMd

in

Nig.iia -

^{to create a}

"t..,

^{picture of} the disease.

It

was in recognition of this necd that cricouraged

Afoc

ur,i1,o,t,.,.,-in tlie

cllT.t

srrategy to sponsor this mission. So the objectives

oiry *irrion

u,.1'

To train Nigerian

N0TF

scientists/consultants _in

^Rapid Epidemiological Mapping

of

onchocerciasis

(REMo) - ^to

^enable them successfully carry out independent

REM9

exercise.

To assist the national team conduct nation

-

^{wide REMO} refinement in the country

-

^to

delineate the main onchocerciasis endemi"

u..*

,t

*;.il;

definite

CDTI

approacrr, _and where clinic

-

^{based strategy are} to be

adopted

^-

--r-" -

3.0

MATERIALS AND METHODS

3.1 Study

Area

Fig.2

shows the areas/zones in the country for the REMO refinement 3.2

Training

The

first

objective

of

this mission was capacity b_uilding Two different _groups were trained:

(l)

National Scientists ana

rvoci, stunuio tzilcn ^Sraff

The detailed REMO training-war

eir.nio th.

Natiornar Scientisil and

Nocp staffwho

#ffi::"ed

^the

^rcn

hearth"uunin

ihe

fiera

whire.orau.ting

_the

REM,

It

is a statement of fact that alr the National scientists and

Nocp staffare

experienced and have at one time or the other been invqlved in onchocerciasis control in _the country. This fact not withstanding,

th..r*u,

need for this training sinib

REMo

is a new _and

rr...ni

Jiusnostic toor. Again,

it

is significant _{that the} global standard of the procedure is ma]ntained

for oulio*

epidemiorogicar reasons. The eight

-

man national

,"i.ntirt, un;;ffi'iloH

staffred _{by the} National

coordinator

_{(see appendix)}

weretherefor"

"*porra

^{to a 3}

-

^{day intensive}

and detailed training

aithe

_ionat

;6r;ln

Kaduna.

rr,ilir"iiirg

covered a1 the aspects of the

wHoiREMo

documents 6Ngoumou

t ^w;r;h,

rg93;

wHO, _I995)

Inaddition,thebiologyandecologvoi.r,.Vector,theepidemiology,

5

Tt 61

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_u.:

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39

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d=

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clininopathological manifestations and socioeconomic impact of the disease, _as

well

as the need and current control strategy, thb

CDTI

stiategy

*er. disrursJ.'

3.3 Implementation

At

theend

"{t.!..

^training

^it

^was clear that every member had acquired the appropriate

pkill

and procedure necessary to carry out successfuliy independent REMO exercise, Each national scientist

*ur usig*a

an area or states for REMO refinement'

B.!1.

leavirig for the field exercis.,"sarple villages were seiected and the states,

NGDos

and LGAs were inflormed and senstized for the exercise

-

to enable them _{adequate logistic} be ready

with

staffand logistic _suirport.

with

_{the time}

-

^table,

and material support and efficient conrmunication, the national scierttists wcrtt.altead

lbr

the field bxercisc. Thc

wiro

adviser particrpated _{rn t5e} exercise and also plaved both supervisory and facilitating _role.

At

the end of the .exercise, jhe REMO results generated were impressive and consistent. Not withstanding the inherent difficulties _and risks'associated with extensive and intensive vilrage studies, the

REMo

refinement

i,

trrc country was a huge success.

4.0

RESULTS AND

DISCUSSION 4.1 TARABA STATE (Tabte 2

)

a)

LGAs

mapped as Definite

CDTI by

1998

l.

Part of Yorro 2. Zing

3

Bali 4. Gashaka

5. Sarduana 6. Kurmi

7

Ussa 8. Tukum b)

LGAs

mapped as NO CDTI area

l. Wukari 2 ^partoflbi

c) LGAs where REMO refine was conducted

l.

Part of

Ibi

2. Gassol

3. Part of

fudokola

4. Jalingo

9. Donga

10. Part of Karirn Lamido I ¹ . Part of fudokola

5. Lau

6. Part of

Karim

Lamido 7. Part of

Yorro

8. Southern _Sarduana to validate the 199311994

RAM

exercise

A total

of

83 commu.nilie; from the

-eight

LGfu

in Taraba were refined (Table ₂₎ The results showed

rTl["

^zones of I6i, Gassor,

r,*, i..i,

Lamido, Jaringo,and Yorro LGAs are not

.DTI.

Two areas in ardokora

L'cA ;;;

definite GDTI. The

REMo

exercise in Southern part

of

Sarduana

LGA

showed that the low land

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yeas.(wr]h ^a lot of breeding sites), especially

within

the Donga

river

basin are definite

CDTI

as recorded in the 1993194 REMO exercise.

fhis

is not uncommon becapse the same river, Donga river, and enviromental factors

which

are

favoi[able

_to the breeding

oIthe r""torc

and transmission of the disease in Donga and

Kurmi

LGAs are also prevalent in _{this part}

of

Sarduana

LGA.

On the

other-

hand, the present result showed that the highland communities around the Gembu zone which hitherto were mapped definite

CDTI by

lgg3lg4 are not

cDTI

zone.

This result is consistent-with known

epidemiologicll

and entomological facts.

Aq1in, Gembu highland, or rather the Mambila Flateau, is perhaps 6ne of the coldest areas in Nigeria. And such very cord weather conditions are known to inhibit _breeding of flies and development of parasite in the

flies.

Similar results have been observed at gther very cold highlands such as on the

Nyika

highlands of

Malawi

(Nwoke _et al, 1995)

4.2 KIYARA

STATE

(Iahte

3)

a.

LGAs

mapped as Definite CDTI

by

1998

l. Baruten _Z.pategi

b. LGAS mapped as NO

CDTI

area None

c. LGAs where REMO refine was conducted

1

2 3 4

Ifelodun Kaiama

n Edu

oyu

5

Moro 6.

Ekiti

7. Oke

-

^ero

8.

Ilorin

East

9

Irepodun

l0

Osin I

l.Asa

f(wara ^state is one of the foremost states in the country where

distribution of

ivermectin was carried out by Africarel

A

lot of

oth.r'pr.vui"nce

_{surveys have}

been carried out in this area. By the present exercise

nBMo,

was refined _{in 29} communities in the state(Tablb 3). While we await the

intejration of

this result into.the Atlas GIS, we wish to observe that onchocerciasis is endemic in the LGAs _examined to warrant definite

CDTI

stiategy,

.*."pi

in trr" area of Edu LGA.

4.3 KEBBI STATE'(Table g'

a.

LGi{s

mapped as Definite CDTI

by l99g

l.

Part of Danko Wasagun

2.

Part of Zuru

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t+

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=

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-a

tv

o o o

a!

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ft ,6

ru1L

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ft

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b. LGAs mapped as NO

CDTI

area 1. Birnin

Kebbi

2. Argungu c.

LGfu

where REMO refine was conducted

3. Gwandu

13. Part of Danko Wasagun 14.'Yauri

15. Suru 16. Koko Besse

I,

Aliero

2.

Arewa 3. Bunza 4. Bagudo

5

Dandi 6. Kalgo 7. Maiyama 8. Shanga

9. Ngaski 10. Part of Zuru I

L

Fakai 12. Sakaba

REMO refine was conducted in 60 communities

of

16 LGAs _of Kebbi state (Table 4) and the results showed that onchocerciasis is not a major public _health problem in the state- Except at Danko wasagun

LGA o;.ring.ni.*ic

^areas

^or

Zamfara)

which

is drained by Culbin river, i-he othdr

ti

LGAs studied were _not CDTI definite areas. These other less endemic _{areas are} drained mainly by the sandy, fl9od

-

^plain

-like,

sluggish Sokoto river (whictr empties into wigLr

iiver

at Gwamba). The Kebbi

REMo

result is not uncommon because this major

river .tysl:.*

in.the state (sokoto river) like most other river systems in this type

of

bioclimatic _zone of the coun_try and indeed continent

*.

t"tnporury, and have shallow,

lmdy

^valleys _3na

_!9w

through the saherian zone. As a result they do not favourably support the breeding of vec-tor flies

- t.n.. "".y

^{limited disease}

transmission' The same

similairesults

have been recordedin

rh;;;;;i.ii.uti"

zone of nearby Niger, Chad and Cameroon.

4.4

KOGI

STATE (Iabte

S)

LGAs _where

REMO

refine was conducted

l.

^Omala

2.

Bassa

3.

Okehi

4.

Ijumu

5.

Kalla - Buru

6.

Mopa - Muro

7.

Yagba East

8.

Lokoja

9.

Kogi

lhere

^was

difticulty.in

getting at th9 appropriate maps of

Kogi

state. This obscures our discussion on

thi

results notn.

uo*rvei

a total of 30 communities were examined in the study.

of

the 9 LGAS studied,

onif o^uta

area showed definite

CDTI

communities_(Table 5). The'results

will

be made clearer when integrated into _the Atlas

GIS. '

^-

tl _lr

II

ft tI

I

fi

tL

rl f! It

I

n ti

ft n U

ru

U

II

4.5

GOMBE

STATE

(Tahte 6)

a. LGAs _{mapped as Definite}

CDTI by l99g

l.

Shongom

2. Eastern Yamaltu

-

^beba

b.

LGAs

mapped as NO CDTI area

l.

Western Yamaltu

-

^Deba

2.

Western Funakaye

3.

Kwami

3. Eastern Nafada 4. Eastern Funakaye

4.

Eastern

i{kko

5. Kaltungo

5.

Eastern Damboa

6.

Gwoza

7.

Chibok c. LGAs _where REMO refine was conducted

5. Western Nafada 6. Western Funakaye The results on Table 6 showed that six LGAS were refined in Gombe state in this exercise' This covered 43 communities.

It

is clear from these results that western Nafada, western Funakaye,

Billiri

and Balanga as

well

u. rrr. north eastern area

of

Dukku

LGAs

are definite CDTI zones.

ekkJlcn i, noi"na.ri,

to attract definite

CDTI

strategy.

4.6

BORNO

STATE (tabte

7)

a. LGAs _{mapped as} Definite CDTI

by l99g L

Balanga

2.

Billiri

1.

Eastern

Biu

2.

Shani

3.

Hawul

4.

Askira _Uba

l.

Abadam

2.

Mobbar

3.

Kukawa

4.

Guzamala

5.

Gubio

6.

Nganzai

7.

Monguno

3 Akko

4. Dukku

8. Marte 9. Mafa

10. Ngala

Ll.

Kala

-

^Balge

12. Dikwa

13. Bama 14. Magumeri

15. Jere 16. Konduga 17. Kaga

18. Western Damboa 19. Western Bui 20. Kwaya Kusar 21. Bayo

b. For obvious roasons, apart ftom _{the above}

LGAs,

REMO was conducted in the remaining

LGA'.

This was designed to create u

,t"*

"orprehensive. ^picture

of

_onchocerciasis preevalence./endJmicity in the state.

rhe l6ns

studied were 21,

vtz.

I

u

tl]

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N)

a z { o

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