ONCHOCERCIASIS CONTROL PROGRAUME IN IIEST AFRICA
PROGRAMI{E DE LUTTE CONTRE LTONCHOCERCOSE EN AFRIQIIE DE L'OUEST
NATIONAL ONCHOCERCIASIS COUI.TITTEES
Twelfth meetlng
NOC12.2
ORIGINAL : FRENCII
Conakry, 31 Uay-2 June 1988
DEVOLUTION
With a vLew to devolutLon, the Programne DLreetor has the honour to subnlt herewlth a propoasal for a Uanual on Onchocereiasl.s Surveillanee and Treatment.
l{arch 1988
INTRODUCTION
1.1. POLITICAL WILL
1.2. HUMAN RNSOURCES
1.3. COMMUNITY MOBILIZATION
2. EPIDEMIOLOGICAL SURVEILLANCE
2.L. INFORMATION
2.2. EVALUATION
CONTENTS
1
3 IVERMECTIN TREATMENT
3.1. INFORMATION
3.2. PRELIMINARY MEDICAL EXA},IINATION
3.3. DISTRIBUTION
3.4. POST-TREATMENT SURVEILLANCE
4. ENTOMOLOGICAL SURVEILLANCE
Sec.ond column: Name of the person
. Write the surname and first name of the family head on the flrst line;
. Wrlte, one after the other, the surname and first names of the other members of the famlly in the following order:
. Identify the wives in relatlon to their husband, the ehildren ln relation to their parents, the c,ollaterals in relatlon to the fanlly head. To thls end:
- Write against each name, the position of the person ln the famlly, uslng the
following legend:
- flrst wlfe
- chlldren of the first wife - sec.ond wife
- children of the seeond wife - ete...
- collaterals of the farully head, i
grandson, granddaughter, cousln, f any: brother, sister, nephew, niee.e,
father, mother, widower, widow, etc.
Meanlng
Family head
Wlfe of No1
Son of Nol and No2
Wife of No3
Daughter of No3 and No4
Son of No3 and No4
Son of Nol and No2 Wife of No1
Daughter of Nol and No8 Brother of Nol
Wife of NolO
Son of NolO and No1l Mother of No1
Nlece of Nol Cousin of Nol Wldower
etc. . .
.wi
.FH. .ch
sib . "FR".I.I.EN .Pa
Farnily head
Wl fe
Son or daughter Brother or sister cousin
Nephew, nlec.e, grandson, granddaughter Widower or widow
Father or mother
Name of the rson
- Specify the identiEy of the person by using the sequence numbers ln the first
eolumn of the form named : PROVISIONAL NUMBER.
Example
Provlsional number
1 2 3 4 5 6 7
I
9 10 11 L2 13
Gado Takpara FH
Ouattara Oumou Wll
Gado Koffi Ch 1x2
Akossia Ygan Wi3 Gado Ama-vi Ch 3x4 Gado Yao Ch 3x4 Gado Kouakou Ch 1x2
Nignan Afoua Wil
Gado Yawa Ch 1x8 Gado Amegan Sib
NrGuessan Essane WilO Gado Komlan Ch 1oxl1 Kao Bernadette Pa
Tossou Pya-Halo EN
Ossei Koffl "FR"
Kpatoba Kornla-vi W
etc....
t4
15 16
ete. . .
Third column: Sex
. Assign e.ode 1 for mascullne subjects
1. INTRODUCTION
The control of onchocerciasis in West Africa is based mainly on the use of lnsee.tleldes to destroy the larvae of the blackfly, the disease's vec.tor. However,
ivermectln, an effective mlcrofilarielde whieh does not present serious side-effects, has been the subjec.t of field trlals sine.e 1987 and ls likely to change the control strategy slgnlflcantly and facllitate the devolution process.
In the near future, onchocerciasls should no longer eonstitute a publlc- health problem or an obstae.le to the socloeconomle. development of the protected valleys.
However a mlnimum entomologic.al and epidemlologlcal surveillane.e would be necessary
in order to prevent any rec,rudescence of the disease.
1.1. POLITICAL WILL
Politlcal wl11 exists and has been demonstrated on several occaslons by the
Partlclpating Countries who, moreover, have become arrrare of thelr collectlve responsibility to make this noble undertaking a success.
1.2. HUMAN RESOURCES
OCP has c.ontributed to the training of more than 3O0 natlonals of the Participatlng Countries ln discipllnes related to onc.hocerciasis control. Thls training will be eontinued and c.arried out ln the field.
Human resources are avallable. Thanks to an appropriate methodology and wlth the
help of OCP and WIIO, all the devolutlon aetlvltles ean be c.arrled out by the natlonal health services.
1.3. COMMUNITY MOBILIZATION
No health development activity c.an suce.eed these days without full e.ommunity
partleipatlon in lts planning, organizatlon, operatlon and control.
This manual has been written wlthin the framework of devolutlon for the naElonal teams and ls intended to be a simple tool adaptable to dlfferent situatlon.
2. EPIDEMIOLOGICAL SURVEILLANCE
2.L. INFORMATION
The Minister of Health will pass the information on to the administratlve and
health authorlties.
The administratlve authoritles wl11 in turn inform the
there will be a rouElne evaluation (census, biopsy, etc). village communities that
2.2. EVALUATION 2.2.1. Census
Carry out a c.ensus of the village, family by family. For that, use the family form e.opy of which ls attached (Forn 5602 - see Annex I).
. Asslgn code 2 for N.B.: Be careful not Fourth eolumn:
feminine subjects
to put M for masc.uline and F for feminine as done usually.
Asg
Present and examlned
Present but refused to be examined
Present but not examined for various reasons (old age, sickness , occ.upat 1on, etc . )
Absent for less than one year
Has moved to another village since the last evaluation
Dead slnce the last evaluaEion Absent for more than one year
codes 5 and 6 are used only during the seeond and subsequent
Write Ehe ages ln full years
Code 00 for age of subjec.ts less than 6 months old
Code OX for age of subjects between 6 uonths and 1 year old.
N.B.: Be c.areful not to put the year of birth.
Fifth c,olumn: Examination status
Write the following eodes acc.ording to the sltuation:
Meanlng Code
N.B.: NoEe that evaluatlons.
1 2 3 4 5 6 7
2.2.2. Blopsy and parasitol oglcal examlnation
Make a rough estlmate of the prevalenc.e in the village. In order to do this:
Make a list of the famlly heads, numbered from 1 to...
write eaeh number on a piece of paper and mix all in any contalner;
Select half of the numbers at random, not puttlng any back;
Using a Holth punc.h, take a bloodless skin snip on eaeh iliac crest of each member of the familles corresponding to the numbers selected at random;
Plac.e the snlps ln the rlngs of a sllde for a VDRL serologleal analysis, in the presence of a physiological serum;
Using sunllght read the skin snlps with a mieroscope, magnified 4Ox, after thlrty (30) minutesr incubation in a physiologlcal serum and wrlte the number
of 0. volvulus microfilarae that have emerged;
rstim-i-tffiprevalence of onc.hoeerciasls in the village:
Number of posltlve subjects
x 1OO
Number of subjects from whom
skin snip taken
The microscope reading result sheet is slmple. It eomprises:
d d d
-a
heading
lineline line
Mlc.roscope reading results
Number of positlve subjeets 60 Number of negaEive subjects 4O
Nuuber of subjec.ts from whom skln snip taken lOO
- An arrow from the prevalence calculaElon formula, shows the prevalene.e found in thls village whic.h is presented as follows:
PREVALENCE IN THE VILLAGE = 6O x 100 = 60%
100
3 IVERMECTIN TREATMENT
3.1. INFORMATION
Just as for the epldemiologie-al surveillanc.e, the Minister of Health will pass
the lnformation on to the health and adminisErative authoritles who, ln turn, will lnform the village communitles that Ehere would be a drug distribution (ivermectin).
3.2. PRELIMINARY MEDICAL EXAMINATION
3.2.L. Weigh eac.h subjec t
. Write the weight In kilogram, in the sixth column entitled trIeight ln Kg.
3.2.2. Subjec-ts Eo be excluded from Ehe treatment Carry out a medlcal examinatlon of each subjeet
Exclude from the treatment subjects presentlng the following situatlons and Code them acc-ordlngly ln the elghth column enrirled REASON FOR NoN TREATMENT.
Excluslon criterla Code
. Child of LESS THAN FIVE YEARS I
. PREGNANT woman 2
. I,rloman BREAST FEEDING since at least ONE MONTH 3 . subject with a SEVERE AFFECTIoN 4
. Subject wirh an AFFECTION 0F THE CENTRAL NERVOUS SYSTEM (partlc.ularly epilepsyr ldiocy, meningltis) 5 . Subject presentlng an ICTERUS 6
. Subject having REFUSED TREATMENT 7
. Other reasons (particularly: OEDEMA, SEVERE
ANAEMIA, CACHEXIA, ere.. ) g
N.B.: In case of exclusion from treatment for "OTHER REASONS" (Code 8), specify the E-son for this exc.luslon in the ninth column entitled "OBSERVATIONS".
3.3. DISTRIBUTION
3.3.1. Prescribe the Mectlzan dose
. Write the MecEizan dose that the patient should take in the seventh eolumn
entitled IVERMECTIN DOSAGE. The number of Mectizan tablets to be taken depends on Ehe
patlentrs weight.
. Refer to the following table for the prescrlptlon:
I.Ielght (KG) Number of tablets
<15
15
to
2930 ro 44
45
to
640.0 o.5
1.O 1.5
65+ 2.O
Treat the patient
. Give the number of Meetizan tablets prescribed to each paElent;
. Record in the ninth eolumn "OBSERVATIONS" the time when the prescribed dose was
taken.
N.B.
3.4
: Every patient should take his Mectizan tableEs on the spot.
POST-TREATMENT SURVEILLANCE
the treated patients for three (3) days
patients presentlng reaetions to come to you and not you to them.
indivldual "P0ST-TREATMENT" form per patient (Annex 2).
Monltor Wait for Fi1l an
. For a child, if the temperature is equal to (50O mg tablets): 1 tablet morning, afternoon and
- Make a list of symptoms
- Record the result of your medieal examination - Record your treaEment
- Slgn the Post-Treatment form.
3 .4.1. Ree.ord the f ollowing
Pulse (taken for 30 seconds), the patient sEanding;
Blood pressure (BP), patient standlng;
Axlllary temperature (taken after 2 mlnutes), patient standing;
Respiratory Movements (R) per minute and
Quality of Respiratory Murmur (RM).
N.B.: Pulse, BP, R, and RM should be taken with the patlent lying down if he cannot stand.
3.4.2. Fever
. For an adult, if the temperature is equal to or above 39oC, give PARRACETAMOL
(50O mg tablets): 2 tablets mornlng, afternoon and evening for three (3) days.
or above 38oC, give PARACETAMOL
evening for three (3) days.
.Ifat tablets): 2
c,hildren.
the end of three days the fever continues, give CHLOROQUINE (100 mg
Eablets morning and evening for three days for adult; half (Glz) dose for 3.4.3. Convulsions
. For an adult, give an intramuseular PHENOBARBITOL injeetion (O.2Og arnpoule): 1
amp. in two (2) minutes. If four (4) hours after this lnjec.tlon there is no notable- remlssion of the convulsion,
. Give a second ampoule and evacuate Ehe patient to the nearest hospital.
. For a child, glve 0.O4g and observe the same recommendations as for adults.
3.4.4. Hypotention. patient standing
Prescribe stricE rest in bed, in a lying position.
3.4.5. Hypotenslon. patient 1ylng down
For an adult, give HYDRoCoRTISoNE HEMISUCCINATE (1OO ug bottle): 2 borrles
intravenously plus perfuslon of 5OO mI of ISOTONIC SERUM if necessary,or ADRENALINE.
. eheck BP every 1/2 hour
.lf after four (4) hours the BP does not rlse . evacuate patient to the nearest hospltal.
For children, give half the adult dose and observe the same recommendations.
In e,ase of fever ln addition, glve PARACETAMOL (5O0 mg tablets)z 2 tablets morning, afternoon and evening for 3 days; l/2 dose for children.
3.4.6. Tachycardia
Prescribe STRICT REST in bed, in a lylng position.
3 .4 .7 . Rashes
No Ereatment
3.4.8. Itching lesions
Look for evident signs of se.ratching: seratches, exeorlations, with notlon of lnsomnia and restlessness.
Treat wlrh PHENERGAN (25 mg): 1 morning and evenlng for three (3) days; Llz dose for ehildren.
3.4.9. Respiratory dlfficulties ( Dyspnoea)
carry out a eompleEe medical examination of the respiratory organ
Treat wlth ADRENALTN (lmg/mt ampoule): 1 m1 subeutaneously
Give a second ampoule if after 30 minutes Ehere is no notable remission and
Evaeuate the patient to the nearest hospital;
For a child, gi've ll2 dose and observe Ehe same recommendations as for adults.
3.4.10. Pains
The pains are articular and/or muscular andfor ganglionic. and/or general.
. Look for evident signs of functional, partial or complete impotence: (i)
partlal or complete impossiblllty of ralsing the arm; (ii) patient supportlng the arm
with one hand; (iii) limping; (iv) patient movlng abour wlth walking srlck; (v) patient rooted to the spot or confined to bed.
. Treat with PARACETAMOL (50O ng): 2 tableEs morning, afrernoon and evening for three (3) days for adults; 7/2 dose for ehildren.
3.4.11. Headache
. Note if the patlent ls holding his head with his hands or if he has tied his head wlth a scarfl
. Look for meningeal stiffness . Look for signs of obnubtlation . Take the temperature
. TreaE with PARACETAI'{OL (500 ng tablets): 2 tablets morning, afternoon and
evening for three (3) days i l/2 dose for ehildren.
3.4.12. Adenopathies
They are generally axillary and/or ingulnal
. Try to stir up palns by means of intense palpation
. Look for evident signs of functional, partial or complete regional impotene.e:
(i) irnposslbility of raising arm or limitation of arm movement; (il) patlent
supporting the arm; (iii) liruping; (iv) patient moving about with walking stlck; (v) patient rooted to the spot or confined to bed.
. Treat with PARACETAI'IoL (5OO mg tablets): 2 tablets mornlng, afternoon and
evening for 3 days; 1/2 dose for children.
3.4.13 . Oedemas
They generally c.over the l1mbs and/or face.
. Try to stir up a possible pain by an intense palpation
. Look for evident signs of functional, partial or eomplete regional impotence:
(1) impossibillty of raising arm or limitaEion of arm movement; (ii) patient supporting arm; (iii) limping; (iv) patient moving about with walking stick; (v) patient rooted to the spot or confined to bed; (vi) partial or complete impossibility of gestic.ulatlon.
. Treat with PARACETAMOL (5O0 mg tablets): 2 tablets rnorning, afrernoon and
evening for 3 days; L/2 d,ose for children.
3.4.\4. Red eyes
. Assess the ocular tonus by palpation of the eyeball and at the least suspicion of glauc.oma evacuate the patient to the nearesE hospital.
Treat with DACRINE: 2 drops in each eye 4 to 6 times per day.
3.4.15. Dlzziness. cold feell ng, anorexi.a
. If lsolated, these symptoms disappear with STRICT REST ln bed, in a lying position.
4. ENTOMOLOGICAL SURVEILLANCE
Entomologleal monitoring ean be summarized as follows:
(a) follow the dynamic.s of the veetor populations of s. damnosum s.1.
(b) lnform OCP if their number is increasing.
Village Number :.... ...Famlly Number...
Date : Time
Provi s lona1 number
16
t7
0bserva- vatlon
1 2 3 4 5 6 7
8
10 11
13
1
Name of person Sex Age Examination
s tatus Ivermectlndosage
Reason for
non
treatment
I I
INDIVIDUAL R-ECORD FORM
(Monltoring )
Individual number : .... ...
Form No : .... ...Family No.:. ....Vi11age No.:...
Treatment Reae t ion Date
Time
Symptoms
Pulse, standing Blood pressure
s t anding
Temperature
Dysnoea
0bservations Treatment
