100 years of living science

Date • Location of Event

Annual Board Meeting 27th June 2013

Donor supported programmes

Dr Giuseppina OrtuSCI Programme Manager

(francophone countries)

SCI programmes

Rwanda

Senegal

Burundi

Mauritania

• Year 2011-2012: Gaps & needs • SCI contribution in year 2012 – 2013 • Current needs / current situation• Next steps / SCI support for year 2013 - 2014

OUTLINE

• Treatment• Disease mapping • M&E• Surveillance & Schistosomiasis elimination• Capacity building

Donor supported programmes

Activities

BURUNDI Year 2011-2012Gaps & needs

PZQ and ALB treatments at national level

PZQ treatment of adults in some areas

Drug coverage surveys for validation of MoH reported treatment

Analysis of disease mapping needs

Capacity building and training needs

Treatments in BURUNDI

Activity Details month/year performed

Reached population

% Drug coverage

National Mass Drug Administration

PZQ - School Age ChildrenJun-12

652,889 104% (tbc)

ALB - age 1-14 years 3,940,280 108%ALB - women 123,115 44%ALB - age 1-14 years

Jan-133,977,190 109% (tbc)

ALB - women  128,455 44% (tbc)

PZQ treatment of adults in some areas Sep-Nov 12 279,405 ( tbc)

• On-going MDA for the administration of ALB to children and mothers

• June PZQ administration postponed to Dec 2013 (PZQ tablets not available)

BURUNDI / SCI contribution / treatments

National drug coverage survey Why do we need this survey?To validate the number of people treated for worm infections reported by the MoH

In Burundi: PZQ and ALB coverage survey was integrated

with vaccination and vitamin coverage surveys to validate the campaign performed in June 2012

Organized in collaboration with: - EPI (Expanded Programme of Immunization)

- MoH- ISTEEBU (Inst. of Statistics in Burundi)

Over 15000 people were interviewed on PZQ and ALB treatment

treated individuals total population requiring treatment

Drug coverage =

BURUNDI / SCI contribution / surveys

Question Mean in %School attendance 68.7%Time to reach distribution site More than 1 hour = 13%Children that swallowed ALB 98% Children that swallowed PZQ 97.8%Site where children received drugs Schools = 53.2 %

Health centre = 36.8%Women pregnant during MDA 11.8%Pregnant women participating to MDA 84.3%Reason for not participating Too sick = 34.7%/ Not informed = 23.8%Pregnant women that took ALB 96%Major reasons for women not to take treatment Drug not available (39%)/ Too sick (16.1%)

Coverage by commune for PZQ – (important information for drug coverage calculation)

Place of PZQ and ALB distribution for children between 5 and 14 years ALB coverage in women – the results are very different from those reported by the

MoH!

Further analysis will be done to assess:

EPI coverage survey report /preliminary results:

BURUNDI / SCI contribution / surveys

Risk map/SCH (2007) Risk map/SCH (2011)

BURUNDI / SCI contribution/ risk maps

Note range of prevalence

BURUNDI – Current needs & next steps

Schistosomiasis/STH Ensure delivery of PZQ in those communes where schistosomiasis is present, but have

never received PZQ Continuous support for PZQ and ALB treatment for the next 2-3 years Re-evaluation of schistosomiasis in areas where more detailed information is needed

Drug Coverage Survey: Further analysis to assess PZQ coverage

Capacity building • Support of a PhD student on Evaluation of health centre capacity in rural areas in

detection and management of schistosomiasis cases (project already started)• Creation of an NTD laboratory reference in Bujumbura?Surveillance & Schistosomiasis elimination• SCORE project ?

Current situation New funding in place for years 2011 - 2015 from a private donor A new contract between SCI and the MoH will be signed in the next few weeks A Programme Manager will be hired for the coordination of activities in Burundi

Nkombo Island

STH: endemic in the whole country

Rwanda

Mapping of schistosomiasis (2008)

Year 2011-2012Gaps & needs

• The MoU between the MoH and SCI was not signed

• A Programme Manager was needed in the country because of lack of human resources at the MoH

• The country needed a comprehensive evaluation of what was done on prevention and control of NTDs to understand the current gaps and needs

Impact survey in 5 districts

NTDs situation analysis

Dec 2007May 2012

12-59mo Lactating women SAC (5-16) ADULTS (>16)

Treated MBZ % Cov. Treated

ALB % Cov. Treated ALB % Cov Treated

PZQTreated

ALB/MBZ/PZQ

Total treated & Min Max

coverage

10,102k 92-116 439k 76-161 19,332k 79-92 577k 251k

RWANDA – SCI contribution/ Situation analysis

Not all districts at risk of schistosomiasis infection were systematically treated every year

It is not possible to calculate PZQ coverage

Not all SAC at risk of infection received the requested treatment

Adult treatment was not done every year

Year 2012Schistosomiasis 450Hookworms 14,751Ascarisis 117,613Trichiuriasis 12,151

Schistosomiasis and STH:

• Impact surveys in 5 districts: positive impact of PZQ treatment (schistosomiasis is now below 10% in those schools where annual surveys were done), but 1.5 million of people still at risk of SCH infection

• Outbreak in the Nkombo Island (2011): 62.1 [56.4-67.5] % of the population assessed (n=311) was infected with

schistosomiasis – this disease is focal and foci can be missed!

• The whole country is still at risk of STH infection as intensity of Ascaris has not decreased as expected in school aged children

Cases of worm infection reported by the health centres in year 2012

RWANDA – SCI contribution/ Situation analysis

Trachoma • In 2 districts of Gatsibo and Nyaruguru - no intervention was initiated • Lack of awareness of this infection and capacity for diagnosis

Lymphatic filariasis and podoconiosis• LF not a public health problem • Risk of LF introduction because of cross-border immigrations (from DRC)

• Non-filarial elephantiasis still exist - no care provided to the affected individuals

Human African trypanosomiasis• Endemic areas along Akagera National Park • Lack of knowledge and understanding on how to detect cases

RWANDA – SCI contribution/ Situation analysis

MDAsSchistosomiasis• Improve drug administration coverage• Ensure treatment in 38 sectors within 9 Districts at risk of infection

> next MDA in August 2013STH Continue drug administration as done before in the whole country

Schistosomiasis MappingRemap districts where as per mapping done in 2008, were cases were reported in areas not targeted for schistosomiasis treatment

> planned for end of the year 2013

M&E and Surveillance Consider to increase surveillance capacity for worm infections, trachoma, LF, and HAT

RWANDA – Current situation & Next steps

Current situation MoU between SCI and MoH has been signed END Fund has pledged support for Rwanda for the next 3 years A Programme Manager in place at the MoH

SENEGAL

Year 2011-2012Gaps & needs

• Epidemiological on schistosomiasis and STH was missing in many districts and mapping was required

• Reassessment of areas at risk of infection in the whole country and possibly, re-evaluation of the treatment strategies, were also needed

Mapping of schistosomiasis in 21 districts

Senegal - SCI contribution / Mapping

Data collected in the field is currently under evaluation

Senegal – Current situation & next steps

Country risk maps• Review all cases of schistosomiasis and investigate the areas where found• Create geo spatial risk maps for schistosomiasis for the whole country to clarify the

endemic areas in the country and reassess the treatment strategy

MDAsSCHISTOSOMIASISPZQ distribution will continue to be supported by Child Fund, and in part by SCI when possible and in those districts currently mapped and at risk of infection, if any

M&E A) impact of mass drug treatment: impact surveys Assessment in 22 schools in the whole country every year for 4 years is needed(The protocol has not been developed as the mapping data has not been analysed yet. Estimated budget: $50k/year)

B) Analysis of snails and schisto hybrids in some schools – WHY?

Current situationSCI has extended the agreement with the MoH for another year

Based on the following study:Research done by Natural History Museum /Imperial College • cercariae from infected B. globosus (host of human schistosomiasis) and

B. truncatus (host of bovine schistosomiasis)• miracidia from human urine samples

Results: 1) Host switching!B. truncatus snails are shedding S. haematobium cercariae.

>>> increase of transmission of S haematobium >>> increase of disease prevalence

2) Miracidia from one patient found to be S. haematobium/S. bovis hybrid

M&E SCI is planning to include in a few schools cercariae and miracidia genotype assessments

SCI is currently looking for funds to support this project in Senegal

Senegal – Current situation & next steps

MauritaniaPopulation3,340,627

OMVS Mapping 2010

MDAs OMVS

Gaps and needs

• Both S. haematobium and S. mansoni are present in the country

• 900,000 SAC at risk of infection

• ~ 200,000 SAC & 80,000 adults in 13 districts treated by OMVS twice. However, for year 2013, the OMVS have not made available financial support for PZQ distribution

• Need for training of nurses in decentralized health centres

Oasis

OMVS = ORGANISATION POUR LA MISE EN VALEUR DU FLEUVE SENEGAL

Mauritania – Current situation and next steps

Next steps Considering that: The MoH needs to improve the PZQ delivery system (= villages as

implementing units instead of entire districts)

Although cases of schistosomiasis were frequently reported in oases, a systematic mapping of schistosomiasis was never done

The OMVS support will be available in year 2014 again; however only for MDA in the Senegal river basin

Current situation SCI offered support for delivering PZQ in these areas plus 8 oases

where schistosomiasis has been reported (between 20 and 80% prevalence)

Support has been made available also for training nurses on NTDs

Schistosomiasis mapping in oasisThe mapping of all the oasis currently inhabited has been considered (possibly 29 oasis?)

Schistosomiasis eliminationThe specific ecosystem and the limited environment of an oases could make elimination of schistosomiasis feasible in some of these oasis

Proposals and Budgets• A proposal and budget for mapping of these oasis and for one treatment of the

estimated affected population are under evaluation ($USA 150 – 200K)(This protocol includes also snail evaluation)

• A proposal and a budget for elimination of schistosomiasis in oases is under development

SCI is currently looking for funds to support this project in Mauritania

Mauritania – Current situation and next steps

THANK YOU FOR YOUR ATTENTION AND YOUR SUPPORT