Onchoccrciasis Control Programmc in the Volta Rivcr Basin arca

Programme de Lutte contre I'Onchocercose dans la R6gion du Bassin de la Volta

JOIN'T PROCRAMME COMMITTEE

Officc of the Chuirrrran

JOINT PROGRAII"IE COMMITTEE

Third session

JPC.CCPCOMITE CONJOINT DU PROCRAMME

Bureau du Prdsident

L

JPC3.6ORIGINAL: ENGLISHOctober 1982Bamako 7-10 December 1982

Provisional Agenda item 8

The document entitled t'Proposals for a Western Extension of the Prograncne in Mali,Guinea, Guinea-Bissau, Ssnegal and Sierra Leone" was reviewed by the Corrrittee ofSponsoring Agencies (CSA) and is now transmitted for the consideration of the JointPrograurne Conrnittee (JPC) at its third sessior:.

The CSA recalls that the JPC, at its second session, following its review of theFeasibility Study of the Senegal River Basin area entitled "Senegambia Project :Onchocerciasis Control in Guinea, Guinea-Bissau, l,la1i, Senegal and Sierra Leone", hadasked the Prograrrne to prepare a Plan of Operations for implementing activities in thisarea. It notes that the Expert Advisory Conrnittee (EAC) recormnended an alternativestrategy, emphasizing the need to focus, in the first instance, on those areas whereonchocerciasis was hyperendemic and on those rivers which were sources of reinvasion ofthe present OCP area (Document JPC3.3).

The CSA endorses the need for onchocerciasis control in the Western extension area.However, following informal consultations, and bearing in mind the prevailing financialsituation, the CSA reconrnends that activities be implemented in the area on a scale thatcan be managed by the Prograrmne and at a pace concomitant with the availability offunds, in order to obtain the basic data which have been identified as missing by theproposed plan of operations.

, Furthermore, the CSA recournends the JPC to dpprove this action and to requestthe Executing Agency to negotiate the appropriate agreements with the countries concerned

@WORLD HEALTH ORGANIZATION

ORGANISATION MONDIALE DE LA SANTE

ocP82.3

ORIGINAL: ENGLISH

ONCHOCERCIASIS COMROL PROGRAMME

PROPOSALS FOR A WXSTERN EXTENSION OF

THE PROGRAI,II,IE rN MALI, cUlMA, GUINEA-BTSSAUSENEGAL AND SIERRA LEONE

ocP 82.3Page 2

SI]MMARY

Chapter I. IIfIRODUCTION

Chapter

CONIENTS

PART IINIRODUCTION TO ONCHOCERCIASIS IN TIIE PROPOSED

OCP WESTERN EXTENSION AREA AND TIIE BASICPRINCIPLES FOR ITS CONIROL:

PART IIPI.AN OF OPERATIONS FOR TIIE FIRST SIX YEARS

OF ONCHOCERCIASIS COMROL IN THE I,IESTERN

EXTENSION AREA:

Page

5

Background . .

New approaches and developmentsThe proposed Western Extension area

LimitsPhysical geography

Mali .

SenegalGuinea

3.3 Social and economic geography3.4 LogisEical aspects of the area

The need for onchocerciasis control

Health considerations .

Socioeconomic considerations

THE PRINCIPLES OF ONCHOCERCIASIS COMROL

Introduction .

Vector control . .

2.L Vector species in need of control . .

2.2 Vector control techniques . .

2 .2 .1, Environmental rnethods2.2.2 Chemical control techniques

2.2.2.1 Adulticiding2 .2 .2 .2 Larviciding

2.3 The evaluation of vector control operations

Entomological evaluationsEpidemiological evaluat ionsEnvironmental monitoring .

REFERENCES CITED IN PART I

1

2

3

7

7

8

9

9

103.13.2

4.t4.2

3.2.t3,2.23 .2.3

loL2

13

t415

4 l616

19

II'.t.)

20

2020

2T

22

2222

22

23

25

252626

)7

2.3.L2 .3.22.3.3

Chapter III. RESPONSIBILITIES

1

2

3

Introduction.Responsibilities of the OCP

National responsibilities

29

2929

30

ocP82 .3Page 3

Page

31chaprer rV. PHASTNG OF EXIENSTON ACTTVTTTES

Introduction.Spatial phasingTimeEable for phasing of activities

In the northern subregionIn the southern subregion

PREPARATORY ACTIVIT]ES

Introduction.OCP activities

In the Phase I zoneIn the Phase II zoneIn the Phase III zone . .

National activities

3.I In the Phase I and II zones . .

3.2 In the Phase III zone . .

Activities conducted jointly by the ocP and national authoriEiesocP requirements for addirional hydrological stations and roads in

Phase I and fI zones . .

5.1 Requirements for hydrological stations5.2 Requirements for additional roads

Other considerations

VECTOR COMROL OPERATIONS IN THE PHASE I AND ]I ZONES

Operational bases

I2

3

313233

33

34

Chapter V.

Primary operational' baseSecondary operational basesOCP helipadsLogistic support

2. Aerial operations logisEics and costs

Aircraft requirements .

Deployment of aircraft .

Basic aircraft costsFlight hour requirements and costs

3. Insecticide requirements

Temephos requirements for the Phase I zoneTemephos requirements for the Phase II zoneTotal temephos requirements and costs . .

Managerial staffApplied research

chaprer vII. ENIOMOLOGICAL EVALUATIONS IN TI{E PHASE I AND 11 ZONES

Introduction .

Entomological evaluation sub-unit

Sectors and subsectorsStaffing of sectors and subsectorsResponsibilities of sector and subsector chiefsTimetable of sector activities

1

2

3.13.2

2.L))2.3

35

3535

353636

36

3637

37

3

the37

3739

40

45

6.

Chapter VI.

l.

4t

4L

42

4l4t4L42

2.L??2.32.4

1.1L.21.3r.4

3.13.23.3

2.t,)2.32.4

4242

4242

45

42

434343

43

44

45

4545

I2

454647

48

ocP82.3Page 4

Sector requirements for vehiclesSector requirements for equipmentRequirements for radio stations

Cytotaxonomy sub-unit .

Duration of pre-control evaluations

chapter vrrr. EPrDEMroLocrcAL EVALUATTONS rN THE PHASE r AND rr zoMs

Page

2.52.62.7

4.L4.2

5.15.25.3

3

4

2.\aa

2.3

3.13,2

3

4

484849

4949

50

1

2

3

4

IntroductionSelection of indicator viltagesPopulation covered by evaluationsEvaluation teams

ENVIRONMENTAL MONITORING IN TIIE PHASE

Introduct ionIntercountry monitoring Eeam

2.1 Staff requirements2 .2 Equipnrent requirement s .

Monitoring procedures

3. t Methods3.2 Recording and analysis of data .

oPERATIONAL BASE, BAI,IAKO

Int roduc E ionStaff..

in indicator villages

5050

5151

For parasitological eval-uationsFor ophthalmoLogical evaluations

5. Capabilities of national health authorities

AND

51

51

5354

54

54

55

5555

5657

57

Simple evaluations .

Detailed evaluations .Options for ophthalmological evaluations .

52

525252

53

56

s656

Chapter IX

Chapter X.

chaprer xI. BUDGET

Tables 1-9

Vector Control UnitEpidemiological Evaluat ionAdministration Unit

1

2

1I ZONES

3

1

2

Unit

Vehicle requirementsRequirements for equipment and supplies

57

57

58

585858

61

I2

3

Introduction

International- contributionsGuidelines for the preparation of the budgetBudget . .

5960

Maps 1-7 73

ocP82.3

Page 5

SLII"{MARY

i^Ihen proposals for a Senegambia Onchocerciasis Control Project were reviewed by the JointPrograrnme Committee in December 1981 it was acknowledged that there r^7as a serious onchocerciasisproblem in the region to the west of the onchocerciasis control programme in the Volta RiverBasin area and that for both health and socioeconomic reasons there \^ras justification for a WIIO

control activity. In addition iE was agreed that any such control activity in that regionshould be implemented as an extension of Ehe OCP and not as a seParate and multi-disease project.

Accordingly the OCP was charged with appraising and studying the original feasibilityreport, with collecting additional information from the region, and with the preparation ofa revised plau of operations.

lnvestigations conducted during 1982 both in the existing OCP area and in the proposedtr'Jestern Extension area brought to light information which was either not available at the timeof the original feasibility survey or was not fully apparent at that time, but which is nowconsidered of such importance that a completely different approach to onchocerciasis controlin the Western Extension area has to be adopted. This new informaEion relates primarily toan incomplete picture of vect.or distribution, to the insecticide resistance problem in theIvory Coast, to infrastructural and logistic constraints in the extension zone, and totopographical and climatic constraints in the southern part of the extension zone.

Although the vector species of the VJestern Extension area are the same as those in theOCP, precise information is not yet available on the distribution of all the species.Similarly the vectorial capacity of at least some species has not yet been fully assessed.However, what is kno\^m with some certainEy is that S. soubrense is widely distributed in theupper basin of the River Niger and that the zone of distribution is contiguous with infestationsin the OCP which are now double resistant to the larvicides temephos and chlorphoxim. Thusuntil such time that Ehe present resistance problem is satisfactorily resolved, an extensionof vector control operations into the upper Niger basin would involve unjustifiabl-e risks and

could have serious repercussions.

With regard to infrastructural and logistic constraints the main problems relate to theinadequacy of road networks in many technically critical parts of the extension area, and,to the generally poor condition of many existing roads. Because of the higher rainfall inthe southern part of the area (annual means of 15OO-280O rprn compared to 7OO-1500 mm in thenorth) road conditions are generally poorer in the southern subregion than in the northernsubregion, especially during the r^7et season. The implication of these situations is thateven if vector control was technically justified in the southern subregion there would be

many logisEic problems and it would not be possible to conduct entomological evaluations on a

sufficiently large scale to meet OCP requirements.

The remaining constrainEs to an early extension of operations in the southern subregionare imposed by topographical, vegetational and climatic factors. More specifically theconstraining factors are combinations of mountainous terrain, very lush riverine fringingforesEs (which conceal many of the rivers when viewed from Ehe air), and much low cloud whichwould make 1ow-level flying by larviciding aircraft impossible in some localities andextremely dangerous in others.

These constraints require much more detailed study in order to identify the aPProPriatemeasures to be taken to remove, reduce or circumnavigate them. In the meantime it has been

necessary Eo make a decision on those parts of the extension area which could receive earlyonchocerciasis control action, and those which, contrar)Mise, cannot be considered until suchtime that constraints to effective conErol have been diminished to accePtable levels.Accordingly it has been assessed that an early extension of OCP activities is feasible in thenorthern subregion, which is a generally low-lying, dry savanna area containing only thetruly savanna vectors of onchocerciasis, S. sirbanum and !!ryg s.s. Conversely, forthe time being an early extension cannot be envisaged for the southern subregion which containsmuch humid savanna, rain forest, and rugged upland terrain, and which provides habitats for a

ocP82 .3Page 6

Sreater number of vector sPecies. The northern subregion includes r{estern Mali, much ofeastern Senegal and a narroi^7 frontier zone of Guinea, while the southern subregion includesmost of Guinea, a smal1 part of eastern Senegal, all of Guinea-Bissau and the affected areasof Sierra Leone.

The strategy ProPosed for the implementation of the extension is to subdivide the northernsubregion into two phase zones designated I (the R. Senegal basin, mainly involving westernMali) and II (Ehe R. Gambia basin, mainly involving eastern Senegal), and to consider for thetime being, the southern subregion as the phase III zone.

Depending on when the starting date is set for the commencement of OCp activities in thePhase I zone, activities will commence in the Phase II zone one year later. In both phasezones vector control operations will normally not coutrnence until a two-year preparatoryactivities period has been completed. During these preparaEory periods logistic problemswill be resolved as far as possible and the necessary evaluation units will be created inorder to ensure at least one ful1 year of pre-control data are available before vector conErolsEarts.

During both the Preparatory activities period logistic and technical investigations willbe intensified in the Phase III zone with a view to defining an appropriate control strategy(ies)and a tentative starting date for vector control in that zone.

It is envisaged that in all phase zones aerial spraying operations for vector control willbe implemented through an appropriate extension of the present OCp aerial operati-ons contract.

With regard to the responsibilities for and the staffing of the various activities necessaryfor an effective extension, these will be shared between the OCp and participating governments.The OCP will have overall directorial and managerial responsibility, will conduct all vectorcontrol operations, and \^7ilt also be responsible for entomological evaluations. Epidemiologicalevaluations and environmental monitoring activities will be conducted by participatinggovernments, either individually or collectivety. tJhichever is the case, these two nationalactivities will be supervised and coordinated by the OCP. Furthermore the OCp will assistin the creation of the epidemiological and environmental teams/services, by providing basicequipment and by training the personnel required. As none of the participati-ng countrieshas an environmental monitoring service the establishment of the appropriate national teamswill be quite an undertaking. It is therefore proposed that the OCp will be responsible foran initial tl^/o-year monitoring contract with a specialized Institute, during the implementationof which staff will be trained and the teams created.

In view of the distance of the Western Extension area from oCp headquarters inouagadougou, it is proposed that extension activities will be conducted from a primaryoperational base located in Bamako, Mali.

If the Ecological Group endorses the strategy proposals contained in this report and ifthe JPC aPProves the early implementation of the extension, preparatory activities couldcoflImence in the Phase r zone in 1983, with vector control operations conunencing approximatelytwo years later in February 1985.

The anticipated cost of the international contribution to the Western Extension has beencalculated in some detail for the first three years of operations, and a more generalizedprediction made of costs for the next three-year period. The resultant six-year budget canbe sununarized as follows:

Year L

US$

(ooos)3 018 5 407

19.:tL

giving a toral of US$ 38 751 OOO.

7 149 7 909 8 391 6 876

oCP62 .3page 7

PART I

]NTRODUCTION TO ONCHOCERCIASIS IN THE PROPOSED

OCP I^IESTERN EXTENSION AREA AND THE BASICPRINCIPLES FOR ITS CONTROL

CHAPTER I

INTRODUCTION

1. BACKGROUND

During the Second Session of the OCP Joint Prograrme Cornlittee, held in Geneva inDecember 1981, the OCP was requested to prepare a Plan of Operations for a prograrme extensioninto Mali, Guinea, Guinea-Bissau, Senegal and Sierra Leone. To facilitate the early executionof this task the JPC approved a budget for L982 of US$ 442 OOO, and accepted the followingTerms of Reference:

l. To sEudy the report of the feasibility study of an onchocerciasis control campaignin the Senegal River Basin area and annexes and have detailed discussions with those whoprepared Ehe report and collect a1l the relevant information available (cf. documentJPC 2.8).

2. To visit the count.ries concerned and determine what personnel is available to mountvector control.

To draw up a Plarr of Action for the implementation of Phase I. This will include:

(a) establishment of staff and logistic network - buildings, transport, radio-comnunication, etc;(b) collection of base-1ine entomological and hydrobiological data;

(c) preparation of insectide application circuits, assessment of insecticiderequired and the number and type of aircraft;(d) drawing up of timetable of events for launching control operations.

4. Collaborate with the Office of the Lega1 Counsel, HQ-WHO to review the legalimplications for extending into Seneganbia countries.

To project the requirements for Phases 1I and IIl with a timetable for implementation.

To prepare the Budget for the Western Extension Programme.

7 . To ensure, in association with the Regional Office for Africa that the structuresare avai.lable within the countries to pursue the epidemiological monitoring activities

8. To prepare a comprehensive report for presentation to the third session of the JPC.

Since January, L982, a Consultant Coordinator has worked in close association with staffof the oCP and of the Project lfx/tCt/VtO/OOl to assist in data collection and to prepare thisreport i-n accordance with clause 8 of the above terms of reference.

The report is presented in t$/o parts. Part I is an introduction to onchocerciasis in theproposed Western Extension area and to the basic principles for its control, while Part IIpresents the Plan of Operations and Budget.

3

5

6

ocP82 .3Page 8

2. NEW APPROACTIES AND DEVELOPMENTS

In collecting data and in considering various scenarios, due attention has been given tovarious options for new approaches to onchocerciasis control and evaluation in the WesternExtension, to recent socioeconomic developments in some of the involved countries, and to newtechnical developments in the existing OCp.

Noting the need for a conservative approach to the Western Extension, and, taking a broadview of national resources and capabilities on the one hand, and the technical know-how andresources of the OCP on the other hand, mush consideration has been given to various optionsfor striking a balance between national and international participation. The option whichhas most to comnend it is that the oCP be responsible for overall administration, for vectorcontrol operations, for entomological evaluations and for the overseeing of epidemiological,hydrobiological and economic development moniEoring. Conversely, nat1onal authorities of theParticipating Countries, either individually or collectively, should be responsible for:

(i) the provision of basic infrastructural facilities and servicesl(ii) the provision of national parasitological and ophthalmological teams for thethe collection of data necessary for accurate long-term epiderriological evaluation (theseteams could be part of a multidisease surveillance service depending upon the particularrequirements of the counEries concerned);

(iii) making available comprehensive networks of hydrological and of meterologicals tat.ions ;

(iv) ensuring adequate lines of cotrEtunication;

(v) surveillance of the possible effects of repeated long-term use of pesticides onaquatic eco-systems.

fhese are ideal objectives, and some nati-onal authorities nay have difficultyin attainingthem. Consequently, "

very flexible approach must be maintained to the apportionment andfunding of the various responsibilities.

In atEempting to define the most appropriate strategy for extending OCP vector controloperations westward, much attention has been given to studying the major technical problemswhich currently plague the OCP: insecticide resistance and reinvasion. Of particularimportance is the critical insecticide resistance problem which affects urany of the valleys ofthe Ivory Coast. The situation is very serious in the present conEext by virtue of the factthat resistant blackfly populations extend to the frontier between Guinea and lvory Coast.Consequently, it is logical to assume that these resistant populations of blackflies havealready spread into eastern Carinea, or, are likely to appear there in the near future. Atpresent the resistance problem priurarily revolves around Simulium soubrense, a species largelyconfined to the rain forest and humid savanna belts. The epidemiological significance of thesetemephos-resistant popu lations of S. soubrense is at present unclear. Experience has shownthat once insecticide resistance appears its spread to other river systems can be very rapid.This is amply illusErated by the following list of dates on which temephos resistance wasdetected in S. soubr ense throughout Ehe lvory Coast:

Date River

Lower BandamaMarahou6N'zi and KanMiddle SassandraLerabaWhite Bandama and Upper SassandraMiddle and lower Como6

lfay 1980August 1980November 1980January 1981February 1981March 1981May

ocP 82.3Page 9

A subsequent serious complication of this resistance \^/as

resistant S. soubrense of double-resistance to ch lorphoxim;the developent by temephos-

the alternative compound firstintroduced in an attempt to control temephos-resistance.

At the Present time every effort is being made to bring the double-resistance problemunder control by the aerial application of a larvicide containing the biological control agent,Baci 1 lus thuringiensis, sero type H-14 @_!. H-14) Unfortunately, the B.t. H-14 formulationavailable to the OCP is not ideally suited to conventional OCP aerial spraying equipment andtechniques. Because of its special formulation characteristics it has to be applied:

(i) after dilution with hTater;

(ii) as a conventional spray, otherwise, because of its high specific gravity itrapidly sinks to the bottom of the rivers to which it is applied;

(iii) at volumetric dosage rates three to ten times those of temephos, depending uponlocal hydrological conditions.

Consequently, it has been, and conti-nues to be necessary to develop and install into oCpaircraft different and more complex types of spraying equipment than have hitherto beennecessary for |trapi-d-releasert applications of Eemephos. Furthermore, in situations whereriver discharge rates have been high, the quantity of B.t. H-14 required to be applied totreat a single S. soubrense breeding site, has exceeded the insecticide reservoir capacity ofthe aircraft. This situation has created new ope-ational and logistic problems which havenot been insurmountable under dry season conditions when ri-ver discharge rates have generallybeen low. However, under wet season conditions the discharge rates of some Ivory Coastrivers, e.8. Como6 and Bandama, have been sufficiently high to sake B.t. H-14 aerial appti-cations impracti-ca1, resulting in a temporary suspension of vector controlmeasures using thisinsecticide in some areas.

This emphasizes the need to accelerate the search for and the evaluation of alternativelarvicides.

The problems of insecticide resistance and of applying B.t. H-14 in the Ivory Coastconfirm the dangers of extending vector control operations into those parts of the humidsavanna and forest zones of the Western Extension area where S. soubrense is knovrn orsuspected to occur, until such time as alternative, back-up larvicides are available. Thisexpression of the situation is in accordance with the constraints introduced into the OCp bythe Ecological Group.

3. IIIE PROPOSED WESTERN E}CTENSION AREA

The region proposed for the Western Extension, which has a human population of at least5.3 million persons, is depicted cartographically in Map l.

3. I Limirs

Bearing in mind that there are stil1 many gaps in our knowledge of the distribution ofthe various Simulium species and of onchocerciasis in the high rain-fall parts of the region,there may eventually be justification for modifying the southern and south-western boundaries.Relocation of these boundaries may be deemed necessary to include areas outside the currentproposed limits; the endemic onchocerciasis area of Liberia is a case in point.

In addition, it must be noted that the Government of Guinea would wish that theRiver Konkour6 basin be included in any Western Extension proposal, in view of current plansto construct two dams (at Souapiti and Amaria) on the R. Konkour6.

0cP 82 .3page 10

The western limit of the Western Extension area would seem to be valid, although theSimulium and onchocerciasis situations in the Gambia are by no means clear. The importanceof clarifying this situation as soon as possible has recently been stressed at ministeriallevel (Anon, 1981).

Although the available evidence suggests that the R. Gambia (within the nationalboundary of the Gambia) is unsuitable for S. damnosum s.1 breeding and that the occasionalcases of onchocerciasis detected are not autochtonous, detailed entomological surveys of theR. Gambia should be conducted before plans are formulated for vector control operations alongthe upstream reaches of this river in south-eastern Senegal.

3.2 Physical geography

A re-examination of the spatial area of the Western Extension zone, according to itsoriginal limits shows that the area u4der consideration is about 365 OOO trl.2 lZlO 0OO km2

according to Orai-n, 1981; 361 7OO krn2 according to this report). The extension of thecontrol operations into the Konkour6 basin (Guinea) would increase the size of the area byca L2 OOO km2. If, to lhe east of Freetown (Sierra Leone) the southern limit is extendedsouthwards to occupy a position g 90 km from the coast and parallel to it, Ehe area would befurther increased by ca 62.OOO k*,.n Including all these possible expansion zones, the finalcontrol zone could reach 440 OOO kmz.

In terms of topography the region is dominated by a crescent-sh,aped highland range(mount.ainous in some areas) which extends westwards from the Guinea/Ivory Coast frontier,northwards through west-central Guinea and Ehen north-eastwards into western Mali. The raincomponents of this highland range are:

the Guinea Highlands and l,Iont Nimba in south-eastern Guinea;

the Guinea Highlands, with their l,rlara l^lara, Loma and Tingi Mountains in Sierra Leone;

the Fouta DjaIon Plateau in west-central Guinea;

Ehe Monts Manding in the extreme west of Mali and the Malinke Plateau more centrallypositioned in western Mali.

Of particular interest is the dramatic influence of this crescent-shaped highland rangeon the drainage system of the region. The crescent cradles the sources of the R. Nigerwhich ramify through the so-called Upper Niger Plains (see Map I). It also forms the water-shed which separates Ehe Niger Basin from other savanna river basins (the Gambia and theSenegal) and from a coast complex of drainage systems (Corubal, Konkour6, Little Scarcies,I"Ioa, Loffa, Cava1ly, etc.). Altogether, the Western ExEension area is much more complexthan the existing OCP both with regard to the patterns and characteristics of the drainagesystem and to their fauna and flora.

The bioclimatic zones of the region, based on the work of Aubreville et al. (1959) areillustrated in Map 2. I,lean annual rainfall patterns of the region are shovm in Map 3.

More specific geographical details of the three countries which constitute the greaterpart of the Western Extension area, Mali, Senegal and Guinea, are Presented be1ow.

3.2.L }(ali

The part of Mali included in the !,iestern Extension has an area of ca l5O OOO 1qn2 and a

population of ca I 150 OOO persons. It includes a small part of the R. Niger valley but isotherwise coincident with the upper basin of the R. Senegal. Within this region three sub-regions can be distinguished, as follows:

ocP82 .3PaSe 11

(a) The upper basin which is dominated by the northern flanks of the Fouta Djalonrange. These uplands look down on the Mandingo plaEeau which stretches as far as the iineformed by the Senegal, Bakoye and Baoul6 rivers. The average height of the pLateau is 5OO m

but it reaches an altitude of 7OO-8OO m and more in its s,ruEhern parts where the Bakoye andBaou16 rivers rise. The average alEitude is 5OO m but it increases to 7OO-8OO m (and more)in southern parts where the Bakoye and Baou16 rise,, Despite its name, the Mandingo pLareauis not a vast and uniform plain but is made up of a series of p1-ateau of unequal heightsfalling in steps not only from south to norLh but also towards the courses of the rivers Lhatdivide it up into sections.

Along iEs western border, the plateau becomes more massive and ends abruptly in a cliffthat rises 2OO m above the flat low-Iying land along the Bambouk and Fal6me rivers. As ageneral rule the plaEeau runs out in gentle siopes. The rivers of the region are permanentwatercourses and in their middle and upper reaches often run through gorges and are punctuatedby waterfalls and rapids. The valleys open out only in their lower reaches, generally wherethey join other rivers.

(b) The Kaarta (or Sarakol16) range is bounded on the south by the combined valleys ofthe Senegal and Bakoye rivers and then by the valley of the River Baou16 as far as theextreme point of its "loop". On the west, it is bounded by the Kolimbin6 river, and on thenorth by the Hodh depression. In the east, the pLateau gradually sinks under a sandy desertof Sreat antiquity. Depending on altitude, relief and soil type, four sectors or naturalmicroregions may be distinguished:

(i) The south-western sector is the highest part of the massif with arr alt.itude of over5OO m and includes the Kaarta's highest point which lies to the north of Bafoulab6.The valleys of the Bakoye and Kolimbin6 rivers are dominated by a 3OO m cliff forming awaIl that runs on towards Ehe North wiEh slightly lower peaks and heights.

Inbetweenthe hilIs, valleys rich in clayey soil run far into the nassif.

(ii) The south-eastern zone, known as the Kaarta-Bagu6 because it is near the Bakoyeriver (Bagu6 in }4alink6), is made up of broad valleys and bottom-Iands with a gentlegradient that keeps its moisture well into the dry season.

(iii) The central zone is the true Kaarta. It is a region of varied topography and theplains and bow-shaped depressions it contains are filled with deep, black, very fertilesoi1.

(iv) The sector to the north and north-east is low in altitude with a fairly shallowrelief. There is some bottom-land with heavy soil, but ocherwise the soils are light.The vaLleys that the Kolimbin6 and its tributaries have cut across the Kaart.a collectthe run-off water and degradation products from schist, limestone and dolerite. Thesedegradation products account for the high fertility of the soil in the va11eys,depresslons and plains within this area and make the Kaarta the "milleE basket'r of theupper Senegal basin.

(c) The higher ground on the plat.eau of the upper basin which varies in detail andchanges from one region to another, is cut up by river valleys of varying width depending onthe nature of the underlyi-ng rock and pierced by enclosed plains that have formed at theconfluence of rivers.

The rivers in the northern part of r^Testern Mali flow through relatively wide, shallowvalleys. Most of them are temporary watercourses, flowing only in the wet season and dryingup for the rest of the year. Only the Kolimbin6 and the Karakoro have water all the yearround in their lower reaches, but it is stagnant during the dry season.

ocP82.3

Page 12

In the South, and unlike the Sahelian regions to the North, water is not a problem, orat least is not the same kind of problem. Although the rdatercourses flow a1l the year round,two factors cancel out the advantages of having a pernanent supply of water in the valleys.One is that most valleys have a V-shaped cross-section and steep sloping side unlikely toretain considerable deposits of alluvium, and the other is that the humidity resulting fromthe heavy rainfall (8OO-15OO mm during five to seven months) is favourable to rnny insectvectors of disease, including onchocerciasis.

3 .2.2 Senegal

The Western Extension area coincides with Eastern Senegal, the largest region of Senegal,with an area of ca 56 ooo krn2 and a human population of g 3oo ooo persons.

Eastern Senegal is composed of the adminisErative departments of Bakel, K6dougou andTambacounda, and is bounded by:

Ehe Fleuve Region to the north,

the frontier with Guinea to the south,

the frontier with Mali to the east,

Ehe regions of Casamnnce and Sin6-Sa1oum, and the frontier with the Gambia.

The pre-Cambrian basement complex outcrops in the south-east of the Region in the formof folded metamorphic series (quartzites, arkoses, schi-sts, micaceous schists, gneiss) andsynklnematic (Saraya and south-east of Kidira) or post-tectonic Birrimian granitic massi-fs(north of K6dougou). The socle is cross-bedded by primary strata forming a north-south bandbetr.Teen Kidira and Gambia, and comprising:

Lower Cambrian sandstones and quartzites making up the northern edge of the Fouta-Dj a lon;

Cambrian, made up of a volcanic complex and conglomerates overlaid with sedimentarystrat.a ending in red clayey sandstones of the Upper Cambrian;

Ordovician: hrhite sandstones cross-bedded with the Cambrian;

Schistose Silurian outcropping west of the north-south band of Cambrian and Ordovicianseries.

Post-Devonian dolerite intrusions appear to the north and west of K6dougou. The northernhalf of the region is a vast peneplain, less than 1OO m above sea leve1, gradually rising to2OO m (the hills of the Bassari country). The only real uplands (4OO-5OO m) are to the south(frontier of Guinea and the loop of the River Gambia) and correspond either to the edge of theGuinean Plateau or to outcroppings of dolerites forming series of terraces along the rivers.

0n the uplands there is Combretum or Andropogon savanna, which may be tree-studded, woodedor shrubby. The vegetation in the hydromorphic soil areas reflects the conditions of hydro-morphism. Inlention may also be urade of two special plant formations - the I'Bow6r' (where thelaterite slab appears bare) and bamboo thickets.

The river basins of imPortance for the area are the following

(i) The River S I basin. with the R. Fal6me, whose catchment area is 28 9OO km2 at theKidira Station. Discharges range from over 3OOO

practically zero at 1ow water.#/s f."r the highest f loods to

(ii) The River Gambia basin. The river has its source in the Fouta Djalon and itscatchment area is Z5SO tmz at K6dougou and 10 45O km2 at },lako. In the K6dougou area itsrrain tributaries are the Koumboutourou, the Tiokoye, the Din Ktra and the Niokolo-Koba.

0cP82 .3

PaSe 13

At Wassadou the River Gambia has a catchment of 20 900 km2. Its low-water bed is well-marked (width 12O m) and its vertical banks lO m high. Ar the height of the flood rhereare extensive innundated areas.

In this area the River Gambia receives the Nieri-Ko, which drains a catchment areaof 1l 946 krr,z. It then receives the Koulountou and just before Gouloumbou the Niaoul6,which has a small catchment area of 1584 km2. At Gouloumbou its catchment area is41 4OO km2, its bed is wider and in the shape of a vast trapezium. After crossing theGuenoto plain it enters Gambia, where it receives the Sandougou, which has a catchmentarea of 9960 kmz. The Sandougou flows sometimes downstream when the runoff from itscatchment area is preponderant, and sometimes upstream (reflux arising from the Gambiaflood which arrives earlier and is larger than that of the Sandougou).

(iii) The Rivers Kayanga and Anambe basins The Kayanga rises to the south of theSenegal-Guinea frontier and enters Senegal south of Patim-Kouta. lt joins the Anambenear Niapo, where its catchment area is about 1755 km2.

The Anambe basin is a vast depression, separated from the River Gambia catchmentarea to the norttr, that of the Casamance to the west and that of the Kayanga to the southand west. Its area is about 11OO km2.

3 .2.3 Guinea

Guinea is one of the coastal States of West Africa. It lies between 7'and 12"latitudenorth and 8'and 15'longitudinal westl it is 246 OOO kn2 in area, and situated in the humidtropical zone of West Africa. The States bordering it are Guinea-Bissau, Senegal and Malito the north, the lvory Coast to the east, and Liberia and Sierra Leone to the south; and ithas a coastline some 3OO km long, which gives it an exceptional geopolitical position.

The major factors of relief, cliunte and vegetation combine to form four natural regions,which make possible the production of a very wide range of different types of agriculturalproduce. These regions are as follows:

(i) Maritime Guinea is a low I.ying coastal region; it has a tropical humid climate ofthe south Guinean type, and annual rainfall is everywhere over 2OO cm, the dry season lastsfive months (December to April), It is a regi-on of mangrove swamps, rainfed rice-growingfields and orchards; it is also the site of substantial mining operaEions (bauxite).

(ii) Middle Guinea corres ponds to the Fouta-Djalon massif, with an altitude ranging from600 to l5OO m (Mount Loura); the dry season lasts five to six months (November t.o April) andmean annualrainfallisabout 18OO mm. Themainriversofthe region rise in the Fouta-Djalon;formerly forest-clad, the massif now has a degraded vegetation anderosionhasassumedalarmingproportions. The region is used for agriculture and stock-raising and has one of the highestpopulation densities in the country (over 40 people per km2). 1t is also, of course, an area ofhigh emigration to the towns and to adjoining countries, parEicularly Senegal.

(iii) Upper Guinea covers the north and east parts of the country and has an area of some97 OOO kn2. The climate is of the south-Sudan type and the mean rainfall is 15OO nrn but thedry season may last eight months and variati-ons are extreme, causing wide fluctuations in thelevel of agricultural production. This is a zone of savanna, where activity is centred onthe river valleys, particularly the Niger valley, and the population is distributed unevenly,mainly along the rivers.

(iv) Forest Guinea, in the south of the country, has a climate of the equatorial type, witha r{et season frequently lasting more than 10 months and a mean annual rainfall of over 2OOO mm.

Basically iE is the zone of deep forest and it has a dense population; iE also contains an ironore deposit of first-class importance (Mount Nimba).

ocP 82 .3Page 14

Area and population estimates of these regions are as follows

Fores tGuinea

97 000

1 140 000

49 000

1 160 000

3.3 Social and eee4omi! €ee€rep y

Historically and culturally, despite the frontiers inherited from the colonial period,the populations of the region display very strong affinities. The great majority of thembelong to one of two main ethno-linguistic groups, the Fulani (Peul) and the Bambara-Malink6,who have shared pre-eminence in the region's history in recent centuries: the Mandingo Empireof Soundjata in the fourteenth century; Ehe heyday of the Fulani of Koli Tenguela in the sixteenthcentury; the kingdoms of Gabou, Boundou, Kaarta and S6gou; the Fulani regimes of Lab6 and Timbo fromthe seventeenth to the nineteenth century; the jihad of El Hadj Ourar which, starting fromDinguiraye in the l85Os, subjected the whole of Western Mali before fading out in the Macina;finally, there was the emergence of the Samori Empire at the end of the nineteenth centuryfrom Upper Guinea and its extension over a large part of central West Africa. Alongsidethese major population groups there are sma11 ethnic groups, linguisEically and culturallydifferent, which at some point in their history were driven back either into the mountainousareas (Bassari, Coniagi, Diakhand6) or to the edge of the forest (Kissi, Toma, Goerz6., etc.)at the border between Liberia and the Ivory Coast.

The peasants of the region mainly grow cereals (sorghum, mi1let, maLze, rice) and alsocowpeas, groundnuts and sometimes cotton. In the southern part of the area fruit crops(mangoes, citrus) are comparatively plentiful, as are tuber crops, especially cassava. Thereis a great deal of livestock raising: not only cattle (mainly in the form of trypano-tolerantvarieties such as Ndama, which appears to originate from Guinea) but also small ruminants,sheep and goats. Itinerant cultivation of burned land with fairly long fallow periods rernainsthe predominant system, despite the introduction of more intensive practices (animal traction,use of fertilizers, bottomland crops) at some places in the area.

From a demographic viewpoint the region can be regarded as underpopulated (about 10inhabitants per kmz on average) but there are some more populated areas and even one area whichcan be regarded as overpopulated. The majority of the region has population densities between5 and 20 inhabitants per icrn': almost all the First Region of Mali, Upper Guinea, Forest Guineaand the Gabu region in Guinea-Bissau. One area i.s distinctly underpopulated: EasEern Senegalwith less Ehan five inhabitants per km2. One area can be regarded as overpopulated: rhecentral part of the Fouta Djalon massif (over 40 inhabitants per km2): on the other hand,some areas can be defined as averagely populated (25-40 inhabitants per km2): the Khassonk6country in Mali, forested subareas of l"lacenta and Nz6r6kor6 in Gui-nea. Senegal is an exampleof inequality in the geographical distribution of population: while the mean national densityis about 25 inhabitants per km2, the population density exceeds l2O per km2 in some rural areasof the Groundnut Basin and drops below four in some parts of Eastern Senegal- (K6dougou area).The reasons for this uneven population distribution are extremely complex and are linked tothe nature of the soil, the environment, the prevailing health conditions in the area, andfinally to history.

From a socioeconomic viewpoint the region can also be regarded as a fairly homogenouswhole; except in certain subareas of Gui-nea, either with diamond deposits (K6rouan6) or atthe fringe of Lhe tropical forest (Nz6r6kor6, Macenta) where some shrub crops are gror,rn (coffee,

Mar i t imeGuinea

Midd 1e

GuineaUpperGuinea

Area (km2)

Population (1978)

45 000

1 300 000

55 000

1 550 000

ocP82 .3page 15

bananas), incomes are extremety low; the region is among the poorest in the world and annualincomes in the rural areas are generally between US$ 5O and iOO; and of course there are al1Ehe diseases, hardships and sufferings which usually accornpany such income levels. Thissituat-ion is found particularly in the northern part of rhe area (between isohyets 7OO and1OOO nun) at the edge of the Sahel where rainfall is lor.r and displays wide variations from yearto year. The decade f97O-1980 saw a series of drought vears which jeopardized the entirefood balance of lhe area and prcduced genuine famines. As a result of this, and the prevalenceof many endemic diseases (particularly malaria) and a very 1ow level of infrastructure and ofsocial and health resources, the mortality rates for children under five are among the highestin the world. Finatly, a characteristic common to almost all parts of Ehe region must bestressed: this is the isolation which hampers the movement of peopLe and goods and inparticular substantially restricts the opportunities for urarketing crops. Because of thelack of any real road network, four-fifths of the region are totally impenetrable during therainy season and three-fifths are very difficult to reach even during the dry season.

3.4 Logistical aspects of the area

As a result of various combinations of topographic, climatic, vegetational and socialfactors, a number of critical logistical problems have been identified. MenEion has alreadybeen made briefly to the deficiencies of the road networks of the Western Extension area whichmake about four-fifths of the area impenetrable during the wet season, and three-fifths verydifficult to reach during the dry season. These situations are largely due to a combinationof rugged mountain terrain, heavy rainfall and dense vegetation in many of the upland areas,and to sandy soils in the drier more northerly parts of the area.

In order to obtain up-to-date first-hand information on these situations road journeys\,rere nade through western }4ali in March 1982 and through eastern Guinea in April 1982. Inboth countries all towns tentatively earmarked as sector or sub-sector headquarters forentomological evaluations and/or aerial operatj-ons, were visited. The findings of the twomissions are suflmarized separately below:

Western Mali

The limited road network in western Mali is not in good condition. In the Monts Mandingand the Malink6 Plateau the roads are rocky and traverse a great many sma1l rarzines which areoften difficult to negotiate. Along the north (right) bank of the Senegal and Baou16 rivers,sandy roads are an ever present problem. In the region of the t'Boucle de La Baoul6" sandyroads so quickly become impassable that they are frequently abandoned and realigned. Ihissituation makes road travel very frustrating and time-consuming for the newcomer, but, mightnot be too much of a problem for regular travellers, e.g. an entomological evaluation team.

A reassuring factor is that work to improve the condition of nany of the roads in theSenegal-Baou16 valley, is in progress. Furthermore, what can only be described as a highway,between Bafoulab6 and Manantali, is nearing completion.

Another factor of appreciable logistic importance is the fact that a very frequent andregular rail service connects most of the towns destined to be sector or sub-sector headquarters,with Bamako (the overall centre of operations for the Western Extension). Consequently, atleast some of the constraints imposed by inadequate roads could be diminished by resorting torail transport.

Eastern Guinea

This area, which involves part of the upper and of the forest regions of Guinea, has twomajor road conununication problems. The first is the lack of roads in the extreme east of thearea, which prevents or restricts accessibility to the headwaters of River Sankarani sub-system, i.e. to the rivers Dion, Limou and Kourai; the second is the condition of the existing

ocP82 . lPage 16

road network, resulting from many broken bridges and generally poor road surfaces. Thegeneral impression gained during the road survey was that the condition of almost all theroads was progressively deteriorating, with virtually no repair work in evidence. Most ofthe diversions around broken bridges were well worn, suggesting that they were of considerablea8e.

Kankan is at the end of the railway from points west but the rail services are neitherfrequent nor regular and so offer no real alternative to road transport in this area.Accordingly, any OCP extension activities in the area will have to face the reality of aninadequate road corurunication system. AIso, with the general absence of electricity,running water, vehicle fuels and lubricating oils, equipment and supplies, food, etc. ineastern Guinea, the region currently lacks the minimal infrastructural and logistic supportfacilities for the introduction of a conventional onchocerciasis control operation.

Climatically there is another potential major problem. In the region of the GuineaHighlands (in eastern Guinea) low cloud which enshrouds the tops of the many mountains andwhich descends far down into many of the valleys, will pose serious threats to the efficientexecution of aerial spraying operat.ions and surveys, and, to the security of aircraft.

Although the region around Beyla (in the Guinea Highlands of eastern Guinea) isclassified as being covered byttmoist savanna woodlandst'the vegetation is much more luxuriantthan one normally associates with this type of woodland. On many of the mountainsides thereare patches of climax forest. I4any of the rivers run through very steeply-sided valleys andunder the protection of dense riverine forest canopies. Thus, apart. from the basic problemsof operating 1ow-flying aircraft in these conditions, specialized aeronautical problems will be

encountered. In many places it will be impossible to conduct aerial surveys of Simuliumbreeding sites, and there will be other places I^rhere it will be impossible to dischargeinsecticide at the required points, because the rivers are concealed by vegetation. Walshet al. (1981) working in this type of situation in the Man region of the Ivory Coast reported,"Among these heavily forested ravines aerial control is difficult to achieve without risk tothe aircrews. Accordingly, larviciding was curtailed where this risk was judged to be

exces s ive.

Although no road survey has yet been conducted in eastern Senegal, it is evident frominformation available that the road network is not very extensive, especially with regard toaccess to the River Faleme valleY.

THE NEED FOR ONGHOCERCIASIS CONTROL

1 Health considerations

The prevalence and severity of onchocerciasis in the Western Extension area have longbeen recognized, and the extent of the problem can be judged from the statistics presentedin the following table.

ENDEMIC ONCHOCERCIASIS: SITUATION IN 1980*

4

4

Population of areas where the disease is endemicNon-exposed populaEionPopulation directly exposed

- at the hyperendemic Ievel- at the mesoendemi-c level- at the hypoendemic leve1

Number of blind persons

5 3902 LgL3 t99

428904

I 86633

oooo00000ooo500500700

*Data from Sierra Leone is not included.

ocP82.3Page 17

I"Iore specific infornation on onchocerciasis in the Participating Countries of the regionare given below.

Guinea

Upper Guinea is a hyperendemic zone where onchocerciasis has very serious consequences inthe form of high percentages of blindness and the abandonment by the population of vast valleyareas even though they are reputed to be very fertile.

Middle Guinea is generally mesoendemic but with serious hyperendemic foci on the Bafing,Bantala-Kornba, Coliba and Koulountou rivers resulting in high Percentages of blindness.However, the disease is hypoendemic in the administrative regions of Lab6 and Pita, situatedon the high ground of the Fouta-Djalon. In Forest Guinea, onchocerciasis is hypoendemic tomesoendemic, with one hyperendemic focus in the Beyla region. The generally low rate ofblindness, however, means that the disease is less serious in this zone.

Finally, in Lower Guinea onchocerciasis does not appear to be endemic and prevalence and

rates of blindness are 1ow.

On the basis of existing data it appears that in Guinea it is UPPer Guinea and MiddleGuinea (with the exception of the Fouta-Djalon highlands) where the serious form of oncho-

cerciasis is rife and which should be included in an onchocerciasis control campaign as a

matter of priority.

It can therefore be concluded that onchocerciasis is Present to varying degrees in most

of Guinea. Some regions are particularly seriously affected, mainly in Upper Guinea (Kankan,

Faranah and Dinguiraye), but in the other regions numerous arrondissements are also stricken.In Middle Guinea the endemiciEy level seems low in the central part of th,e Fouta-Djalonmassif, where population density is relatively high (over 40 inhabitants/kr;rt). In the areassurroundi-ng the Fouta-Djalon, on the other hand, where population is sparse, the level ofendemicity is higher. Onchocerciasis does exist in Forest Guinea (Yomou, N'Z6r6kor6 and

LoIa) but is not as serious as the savanna form.

The area proposed for inclusion in the Western ExEension covers approximately 22O OOO km2,

with a population of ca 3 557 OOO. The population directly exposed Lo onchocerciasis isestigrated at 2 OO9 OOO persons, of whom 254 OOO live in hyperendemic, 545 OOO in mesoendemic,

and 1 210 OOO in hypoendemic, areas. The number of people suffering from onchocerciasis isestimated at 560 OOO and the number of blind persons at 20 OOO, so that of the population atrisk, 287" have the disease and l% are blind.

Guinea- Bis sau

In Guinea-Bissau, onchocerciasis is prevalent only in the two eastern regions of thecountry, Gabu and Bafata, with an area of 13 9OO kmz, a populaEion of 2O4 OOO and a populationdensity of 15 km2. The whole Gabu region is affected, while in the Bafata region only the

Contuboel secEor is affected. The population directly exposed to onchocerciasj-s numbers

132 OOO individuals, 13 OOO of whom are living in hyperendemic zones, 59 OOO in mesoendemic

zones, and 59 OOO in hypoendemic zones. The total number of onchocerciasis sufferers isestiEraEed to be 30 OOO, with I4OO cases of blindness.

Ma 1i

Two administrative regions of Mali are affected by endemic onchocerciasis: the firstRegion (Kayes) and the Second Region (Koulikoro or the former Bamako Region). The Western

Extension area covers 138 94O km2, with a population of I 214 OOO inhabitants and an averaSe

ocP82.3PaSe 18

population density of 8.7 inhabitants per km2. In the First Region (fayes), Y6liman6, Nioro,Di6ma and Kayes Cercles are only slightly affected, while Kita, Bafoulab6 and K6ni6ba Cerclesare areas of medium to high endemicity. In the second Region only three cercles are affected:those of Kangaba and Kati in the case of the arrondissements on the left bank of the Niger andthat of Kolankani in the western part of the Region.

ln l98O it was estiflEted that 860 OOO persons were directly exposed to onchocerciasis(73% of the population of the area), 138 OOO of them living in hyperendemic, 27O OOO in meso-endemic and 455 O0O in hypoendemic areas. The number of people with onchocerciasis in thearea is estimated at 28O OO0 and the number of blind at lO 5OO.

Senega 1

In Senegal- the endemic onchocerciasis area covers the southern part of eastern Senegaland in the north does not extend beyond an imaginary line joining the eastern frontier of theRepublic of Gambia to Kidira. To the west the focus also covers Velingara DepartmenE inUpper Casamance, without, however, extending beyond Baconto arrondissement. The totalpopulation of the endemic area is 418 OOO, while the population directly exposed to the riskof onchocerciasis is estimated to number 198 OOO; 23 OOO of them in hyperendemic, 40 OOO inmesoendemic and 135 OOO in hypoendemic areas. It is estimaEed that there are 44 OOO peoplewith onchocerciasis and 15OO blind persons out of 198 OOO exposed to endemic disease, i.e.22% wi-tt, onchocerciasis and 17" blind.

Existing entomological data suggest Ehat savanna onchocerciasis can exisE in the NorthernProvince of Sierra Leone, although few surveys have been conducted.

The limited epidemiologi.cal surveys undertaken have shown that ocular onchocerciasis ispresent; in two localities blindness rates of O.7-8% and of 4.75-8% have been recorded.

Further detailed parasitological and ophEhalmological surveys are required in theNorthern Province in order to demarcate the focus of savanna onchocerciasis.

The data presented country by country above are collectively summarized in the followingtable:

In conclusion, onchocerciasis control in the proposed Western Extension would benefit atleast 3.2 million persons; approximately 1.2 million in the northern dry savanna Part of theregion, and approximately two million in the southern humid savanna and foresE parts of theregion.

Endemicity level Totalpopulation

exposed

Popu Iat ionnot

exposedHyperendemic Mesoendemic Hypoendemic

Guinea-Bis sau

Gu inea

Mali

Senegal

Region as a whole(except SierraLeone)

13 000

254 000

138 000

23 000

428 000

49 500

545 000

270 000

40 ooo

904 500

69 500

1 210 000

452 000

135 000

132 000

2 009 000

860 000

198 000

I 866 500 3 199 000

72 000

r 548 000

351 000

220 000

2 191 000

Sierra Leone

ocP82.3page 19

4.2 Socioeconomic considerations

In addition Eo the health benefits which would derive from onchocerciasis control in theWestern Extension area there would also be importanr sociucconomi.c benefi-ts, Particularly withregard to:

(i) increased incomes resulting from increases in the quantity and quality of labourand land resources;

(ii) distributional benefits relating to the fact that the beneficiaries are amongstthe poorest in the world.

Between 1978 and 1981, when feasibility surveys were conducted in the Western ExEensionarea, much attention was given to socioeconomic studies in Guinea, Guinea-Bissau, Mali and

Senegal, and appropriate reports were prepared and annexed to the final feasibility rePort.

Those country studies identified 22 development projects in progress, rePresenting a

capital investment of US$ 539 million, and 2O potential developmerrt projects the cost of whichwas estiunted at US$ 685 million. These projects, to a toEal value of US$ L224 r;rillion arebenefiting, or could benefit 3.6 million people.

An important recent socj.oeconomic developmenE. in the proposed Western Extension area was

the awarding by the Organization pour Ia Mise en Valeur du Fleuve Senegal (OMVS), in Yrarch

1982, of a conEract for the constructi-on of a large dam near the village of Manantali on theRiver Bafing in western l,lali. Construction costs are estimated at US$ 8OO million. When

completed, this dam will modify the River Senegal valley to the extent that some 350 OOO

hectares of good agricultural land could be opened up for cultivation.

ocP82.3Page 20

CHAPTER II

THE PRINC]PLES OF ONCHOCERCIASIS CONTROL

1. INTRODUCTION

As in the existing OCP, the objective of the proposed Western Extension is to reduce theimpact of clinical onchocerciasis to a level where it no longer represents either a publichealth problem, an obstacle to socioeconomic development, or a hindrance to the reclamationof good agricultural land that is currently unoccupied.

Similarly, the principles and strategies of control proposed for the Western Extensionwill, as far as possible, be the same as those currently employed by the OCP.

Despite encouraging indications in the field of chemotherapy research, the absence of aspecific drug that can be easily and safely used for mass treatment dictates that oncho-cerciasis control must at present be achieved by reducing or interrupting transmission throughvector control.

In general vector control operations are directed against Simulium larvae, using insecti-cides which do not cause unacceptable hazards to the aquatic environment. However, it mustbe noted that the OCP is intensifying its applied research programne on adulticiding todetermine whether this might offer an alternative and efficient technique (or techniques) forreducing the local impact of the reinvasion problem. It is possible therefore that adulti-ciding activities could play a role in parts of the Western Extension area where theconsequences of reinvasion may be serious.

It is generally acknowledged that the migratory (dispersal) potential of adult Simuliummakes it necessary to undertake simultaneous control action over large areas so as to reducethe risk of reinvasion of the treated areas. This is an ideal objective which it has beenpossible Eo attain in the existing OCP (although reinvasion remains a serious problem on thewestern and eastern flanks). As far as the dry savanna regions of the Western Extension areaare concerned (western Mali, eastern Senegal and the northern fringe of Guinea), this is alsoa valid objective, but there may be some constraints to implementing it totally in the humidsavanna and forested uplands of Guinea and Sierra Leone. Because of the combined problemsof difficult terrain, heavy vegetation, bad weather conditions, inadequate logistic facilitiesand the dangers of the development of insecticide resistance, an alternative modified strategyinvolving much more spatially restricted attacks on the vector might be necessary.

The extended life-span of the parasite (both adult rrorms and microfilariae) dictatesthaE control activities must be conducted continuously for several years. Ihe latest OCP

parasitological findings suggest that the period could be less than the 20 years originallyestimated as being necessary but it is premature to identify how many years less.

If current research should lead to the development of an appropriate drug or of any otheronchocerciasis control technique which meets the requirements of the OCP (see the Final Reportof the Independent Commission), the strategy of control, both within the existing OCP area andthe Western Extension, would have to be revised to incorporate such an important development.However, no such alternative influence will have a major impact on the Progranrne during thesix-year period for which the present report has been prepared, but it may be reflected insubsequent operations.

2. VECTOR CONTROL

In general, the vector control techniques and strategies which will be appropriate forthe Western Extension area are those which are currently employed by the OCP, i.e. aeriallarviciding of Simulium breeding sites employing biodegradable compounds. It is anticipatedthat, altogether, at least 22 OOO km of watercourse in the Western Extension will need to betreated in this way. This compares with the 18 OOO km under control in the present OCP area.

ocP 82 .3

Page 2L

2.L Vector species in need o

Current knowledge of the distribution of the sp ecies of the S. damnosum complex in the

Western Extension area is surmnarized in Map 4. When consulting Map 4 iE must be borne inmind that there is no relationship between the numbers of species symbols and the abundance

of the various species. The Breater number of records shown in the southern half of the

region is due to the fact that:

- anxiety abouE the possible spread of temephos resistance from the existing OCP intothe adjacent southern part of the Western Extension area has inspired much more

intensive sampling,

- there are many more species in the southern half of the region (at least five known

vectors) than in the northern half (on1y two known vectors).

After careful consideration of the geographical distribution of the various species, oftheir bioecological characEeristics, and of their vectorial capacity, certain conclusions can

be drawn concerning the areas which require to be treated.

It is essential that regions occupied by S. damnosum s.s. and S. sirbanum be treated.These two species transmit the savanna strain of Onchocerca that is most Pathogenic to man.

Their range coincides with hyperendemic foci of onchocerciasis. In addition both speciesare highly mobile and capable of covering distances of 3OO-4OO km under appropriate reinvasionweather conditions.

S. soubrense, a species of forest origin, is capable of establishing itself in thegrineaiIZGIia-Ed remaining there throughout the year, although it is not renowned for longdisEance travel. Studies of transmission under natural and experimental condiEions have

given conflicting results which at present make it difficult to judge whether this speciesshould be regarded as a target or a non-target species. Further research is thereforerequired.

S. sancEipauli a species confined to humid zones, has practically no vectorial capacityunder natural condiEions, having regard to its short life span and to the fact that it islargey zoophilic. It is noE usually a mobile species. There is therefore no point intreating zones populated by this species.

S. yahense and S. sjuernerym are species that are excellent forest vecEors, but theOnchocerca strain which they transmit is not especially pa thogenic to man (absence of ocularlesions). Furthermore, they are Poor vecEors of the savanna strain. While S. squamosum isknown to move for distances up to 1OO km, S. yahense is a much more sedentary species. There

seems, therefore, to be no point in treating the breeding places of these species.

To surmnarize, only the range s of S. damnosum s.s., S. sirbanum and possiblY S. soubrense

should be included in the treatment zone.

It follows, therefore, from the data p resented above that S. damnosum s.s. and S. sirbanum

are the species of greatest epidemiological importance with regard to the rei-nvasion problem.However, the 1oca1 importance of ttarrivalrr flies is not geographically uniform. In fact,there appears to be a relationship between vectorial capacity and mean annual rainfall(Dr J. B. Davies, Personal cormnunication).

In the 1250-1500 run mean annual rainfall belt of the OCP area, reinvading flies areusually so numerous that transmission leve1s are unchanged by larviciding operations.(Situation I. )

ocP82 .3Page 22

In the 1OOO-125O nm mean annual rainfall belt of the OCP area, reinvading flies areusually in sufficient numbers to maintai.n transmission. (Situation 2.)

In the 750-1OOO mrn mean annual rainfall belt of the OCP area, reinvading flies are notnormally in sufficient numbers to pose a threat. However, if 1ocal breeding is able to takeplace, a dangerous, but localized disease situation, can develop. (Situation 3.)

By projecting these relationships Eo the Western Extension area it is possible toobtain some foresight of the severity of reinvasion problems which may develop. Thefollowing predictions must however be read with caution:

Situation 1

- The conunon frontier region of Senegal and Gui-nea.

- The extreme southern part of western Mali.

- The northern part of Guinea (below Mati) affecting the valleys of the lower RiverBafing, of the middle and lower River Tinkisso, andoftheheadwatersof the River Bakoye.

Situation 2:

2.2

- The valley of the River Gambia in eastern Senegal.

- In western Mali, most of the River Bafing system, the middle and lower River Bakoye andthe headwaters of the River Baou16.

Situation 3:

- In eastern Senegal the valleys of the River Nieriko and the lower River Faleme.

- In western Mali, the River Senegal and the middle and lower River Baou16.

Vector control techniques

Vector control may take various forms, such as environmental management, the applicationof insecticides to adult insects or larvae, or the use of biological agents. These differentforms of control may be applied by various means. They can be employed separately or incomb ination .

2.2.1 Environmental methods

Although environmental managemenE, environmental modification and environmental manipu-lation might be effective in very special circumstances, these methods cannot be reconrnendedfor large-area control.

2.2.2 Chemical control techniques

Since environmental management will never result in the elimination of all the vectorpopulations, it has been necessary to resort to insecticides, which seem still to be the bestweapon available.

2.2.2.1 Adulticiding

Efforts to control Ehe onchocerciasis vector by killing the adult blackfly cannot atpresent be considered a method of control, because of the great dispersal capacity of theseinsects, which would make necessary the application of treatment over vast areas. LocalizedProtection of certain areas might be considered, however, provided suitable insecticides areavailable and the resting places of the females are accurately known.

octsz. rpage 23

While there is no case for the rouEine use of adulticiding techniques on a large scale,there is an urgent need to develop appropriate adulticiding techniques to assess their effectin controlling reinvasion problems under \,ret season conditions. The endorsement of thisview has been presented in the Final Report of the Independent Cornnission, and in the OCP

Progress Report for 1981 (ocPfPRf8L.4).

Davies eE al. (in press) have reviewed the various tyPes of adulticiding techniquesemployed in different parts of Africa, and together with Baldry et al. have described theresults of trials that were conducted in the OCP area in 1978. Very encouraging resultswere obtained from the latter trials. A single discriminative helicopter application ofdeltamethrin (OMS 1998) at a swath dosage of LZ.S gfl'ra (swath width 30 m) to riverineforests varying in width from 3O-1OO m, was effecEive in controlling S. damnosum for ca

12 days under late dry season conditions. A similar application of endosulfan (OMS 57O)

at a swath dosage of IOO gfha was effecEive for ca 9 days.

Subsequently, and as interest in adulticiding techniques has mounted, the OCP has awarded

a research contract to IRTO, Bouak6, for Ehe screening of insecEicides which would be act.iveagainst Simulium. At the present time Ehe OCP is actively stepping up its own researchprogramme towards the development of some effective and economic adulticiding techniques.In this regard it is reassuring to note that it is now known that the majority of reinvadingSimulium settle very close to watercourses; Eheir numbers decline progressively over a

distance of 3 km from a watercourse. It may Eherefore be possible to develoP adulticidingtechniques which are far more discriminative than was earlier supposed possible.

2,2.2.2 Larviciding

The vector reproduction sites are disEributed irregularly along ri-vers because theyoccur only where Ehere',.s flowing water. The larvae constitute the most vulnerable linkin the development cycle of the blackfly and their destruction seems at Present to be themost appropriate method of controlling t.he vectors of onchocerciasis. The treatmentperiodicity depends on the duration of the vector's larval stage, which averages seven daysin the climatic conditions of the West African savanna.

The larvicidal formulations must be of such a type as to permit easily rePeated and

effective treatments on a weekly basis and must not cause irreversible damage to the aquaticenvironment. The insecticides used must be of low toxicity for man and manrnals. Ihe activesubstance should not persist in the environment, since, otherwi-se, an accumulation in foodchains may result.

The compounds currently in use in the OCP area are

Organopho sphate s :

A 20% (active ingredient) emulsifiable concentrate of temephos is the compound whichhas been used most extensively by Ehe OCP, and at the present time approximately 75% ofthe OCP area i-s under successful temephos treatment.

In I980, unfortunately, temephos resi-stance appea red in the OCP area in S. soubrenseand S. sanctipauli and could not be overcome by increasing the quantities of insecticideused. It is worth noting, however, that no case of resistance has yet been reported inS. damnosum s.s. or S. sirbanum the typical savanna vectors. In view of the conEinuityof distribution of S. soubrense between the south-western part of the Ivory Coast, wherethe resistance appeared, and south-eastern Guinea, it is likely that this sector of theWestern Extension area Eemephos resistance is either already present, or, r,ril1 soondevelop (especially if it is directly exposed to Eemephos treatments).

Chlorphoxim as a special 20% emulsifiable concentrate was introduced into the OCP

area to control temephos-resistant populations of S. soubrense (at less than half thetemephos dosage). This forrmrlation has the drawback of being more toxic to non-targetaquatic fauna than temephos. Its utilization in the OCP was short-lived because temephosresistant populations of S. soubrense quickly developed double-resistance to chlorphoxim.

ocP82.3Page 24

Field trials are now continuing with three other compounds, chlorpyrifos-methyl,pirimiphos-methyl and bromophos.

Bacillus thuringiensis (biological control agent)

Because of its harmlessness for mamnals and non-target aquatic fauna, Bacillusthurin rensrs sero type H-14 was introduced i.nto the OCP to control populations ofS. soubrense which were resistant to both temephos and chlorphoxim

Unfortunately, B.t. H-14 is only effective when applied in high volumetric dosage(up to 10 times that of temephos), and, as a spray (otherwise it rapidly sinks andbecomes ineffective). As these are very largely incompatible parameters many technicaland logistic problems have been and continue to be, experienced by the OCP. During the1982 wet season these problems became unsurmountable with regard to the control ofS. soubrense in parts of the southern Ivory Coast, with the result that the use ofB.t. H-14 has been discontinued in situations where river discharge rates are high.

Evaluations are now being made of BJ. formulations which are two and three timesmore concentrated than the one currently employed by the OCP. Unfortunately, neitherof these formulations is at present being produced in large quantity.

The costs per liEre of the compounds used by the OCP are: temephos US$ 7.80chlorphoxim US$ 7.4O, and B.t. H-14 US$ 5.20.

Taking note that chlorphoxim is applied at approximately one third the dosage oftemephos and that B.t. H-14 is applied at dosages of 3 to lO times those of temephos (dependingon hydrological conditions), the comparative costs, using one litre of temephos as standard,are:

- temephos US$

- chlorphoxim US$

- B. t. H-14 US$

When one takes into account the facts that B.t. H-14 has to be diluted with water, andthat for applying it in large quantities, the flying costs are greatly increased, it is veryclear that this is a very expensive larvicide in its presently available formulation. Itshould be improved or replaced as soon as an alternative compound becomes available.

Various methods can be used to apply larvicides

(i) Ground applications

Ground applications can be reconrnended for the treatment of a single breeding site (dam,ford, broken bridges, etc.) which is fully accessible at aII times of the year, or a seriesof sites situated only a short distance from a road. Ihis method cannot be used, however,for general and continuing treatment of an extensive area including many drainage basins.

(ii) Aerial applications

Ihe most reliable and economic means of reaching all the larval sites in all seasons isto use aircraft. this will be the method of choice for treatment of the breeding sites inthe Western Extension. The type of aircraft will vary according to the type and dischargeof the river to be treated. For the treatment of large watercourses or rivers, where largequanEities of insecticide have to be used, preference will be given to fixed-wing aircraft.It should be noted that the same rivers may only require sma1l quantities of insecticideduring the dry season, and helicopters may then be used. Generally speaking, hohlever,helicopters will be used for treating smal1, winding rivers with a limited discharge to takeadvantage of the greater manoeuvrability of these aircraft, which in any case have a smallerinsecticide capacity. this is the control method used successfully by OCP and it will alsobe used in the Western Extension area.

7.)

15. 52.O

805060 to

ocP 82 .3PaEe 25

The quantities of insecticide used at each treatment point are calculated on the basisof river discharge. In order to avoid either an excessive dose of larvicide, which will beharmful to the non-targeE aquatic fauna, or too sma1l a dose, which will make the applicationineffective, it is necessary, for any onchocerciasis vector control camPaign, to have arelatively dense network of gauging stations.

2.3 The evaluation of vector control operations

2.3.L Entomological evaluations

Because of the cumulative nature of onchocerciasis and the long life span of the parasitein man, the effects of a vector control campaign aimed at eliminating transmissi-on or reducingit to an acceptable level for human conrnunities will not become apparent in the protectedpopulations for several years.

In order to assess the efficacy of larvicide treatments as early as possible, to detectand swiftly remedy any shortcomings, and to adapt the treatments ad hoc to the extremelyfluctuating environmental conditions it is necessary to make provision for detailed entomo-logical evaluations.

The objectives of Ehese evaluations, which should be continuous and have the greaEestpossible geographical spread are as follows:

to establish, prior to the campaign, the blackfly population densities and transmissionpotentials;

to monitor, during the campaign, the results of insecticide applications, which shouldbe adjusted in the light of the data obtained (temporarily suspended, continuedaccording to plan, possibly intensified);

to determine the levels of residual transmission;

to collect the hydrological data needed for the p1-anning and implementation ofinsecticide applications ;

to monitor continuously the susceptibility of the vectors to insecticides.

Ihe simplest way of evaluating the effects of larvicide applications is to observe thed i sapp earance first of the larvae and then of the pupae of S. damnosum s.1. from the breedingsites concerned. In view of the very large number of sites to be examined, the sheer sizeof some of them and Ehe difficulties of access, this purely qualitative method provides onlyan imperfect impression of the real effects of the treatment and can be used only as anoccasional supplementary measure.

The only reliable method for the quantitative measurement of the results of treatmentconsists of capturing female vectors seeking a blood mea1. This is done by staEioning human

insect collectors at specified places, generally adjacent to rivers or villages; thesecollectors catch all r-he S. damnosum s.1. females that settle on them before the b Inview of the daily and seasonal variations in biting activity collection takes place throughoutEhe insect's period of activity (7 a.m. to 6 p.m.); the number of collection days per weekor fortnight is determined according to the importance of the collection point, itsaccessibility and the availabte manpower and transport.

By dissecting these females it is possible to determi-ne the extent to which they areinfected with O. volvulus and their physiological age. A young population indicates theappearance of an active breeding site close to the collection point, while an o1d populationgives a definite indication of reinvasion by females from elsewhere.

ocP 32.3pa9e 26

Since it is now possible to establish a relationship between the number of infectiveO. volvulus larvae received by the individuals in the conrnunity and the endemicity 1eve1(prevalence and incidence) observed in that conununi-ty, it is also essential to be able tomeasure the vectors' transmission potential before and during a control campaign. Ihe methodfor evaluating this transmission potential per unit of time is to take the number of infectivelarvae obtained by regular and periodic collection at a given point and extrapolate this toone month (monthly transmission potential; MTP) or one year (annual transmission potential:ATP). It was concluded at a meeting held in Geneva i,t 1977 that, in the savanna area, anATP of 100 and an annual biting rate (ABR) of 10OO formed the upper threshold of tolerance,above which severe lesions were likely to appear in the long run.

2.3.2 Epidemiological evaluations

As in the existing OCP, the objectives of epidemiological evaluations in the WesternExtension area will be the continuous collection of data in certain indicator villagesselected with a view to following the epidemiological situation before and after t.heintroduction of vector control operations. The aim of the studies is to assess the impactof vector control on the prevalence and incidence of onchocerciasis and to follow theevolution of ocular lesions.

The epidemiological evaluation of onchocerciasis in the Western Extension area must takeinto account the practical experience acquired by OCP in that fie1d. The mode of operation,however, will require to be adapted on the basis of the experience gained. After six years'interruption of transmission it has been found that the O-5 years age-group shows no furtherinfection by O. volvulus or that such infection is exceptional. Moreover, prevalence hasbeen spectacularly reduced in the 5-9 years group. Furthermore the absence of superinfectionmeans that the cumulative process has been interrupted in adults. In this way hyperendemicleve1s are reduced to mesoendemi-c and then to hypoendemic leve1s.

Depending upon the different methods that can be employed, one can distinguish betweensimple and detailed evaluations. Ihese are surtrnarized be1ow.

(a) Simple evaluations

A simple evaluation is designed to study the prevalence of the disease in the wholepopulation of an indicator vi1lage. These evaluations, repeated every three to four years,enable the evaluation of the epidemiological situation to be followed. They involve census-taking of the population of a village by family, clinical examination (for nodules, cutaneouslesions, etc.), parasitological examination (by skin snips), and a test for visual acuity.

(b) Detailed evaluations

Detailed evaluations in a smal1 proportion (ca 1O%) of the indicator villages, involvein-depth clinical and epidemiological studies designed to provide detailed information on theevolution of the disease situation. These studies involve the taking of a census ofindividuals (noting particularly Eheir migration status), brief clinical examination,parasitological examination and detailed ophthalmological examination of both eyes.

2.3.3 Envi-ronmental monitoring

Evaluation of the impact of insecticide applications on the non-target aquatic fauna isa fundamental technique designed to preserve the quality of the environment to the highestdegree possible.

In 1981 the OCP Ecological Group concluded that the use of temephos for controllingS. damnosum at the doses and with the formulations adopted by the Programme, does notconstitute, afEer six years, a major hazard for the aquatic ecosystem. Specifically

ocPS:.3page 27

the irmnediate effect of temephos on the invertebrate fauna is ecologically acceptablesince, although considerable acute mortality may be recorded among ttie i.nvertebrates,there is a proporEion of survivors in almost a1l taxonomic Sroups;

temephos reduces the density of invertebrates in the larval breeding places to an

extent that has never produced an imbalance under normal condiEi-ons of insecticideapplication;

- there is no evidence of any species disappearing;

- no mortality has been recorded among fish and no unstable change in fish populationshas been detected;

- accumulation in the food chain seems slight.

To the extent that Ehe insecticide applications envisaged for the Western Extensionwould be identical with those practised by OCP (temephos in the same formulation, at thesame dosages and applied by the same techniques), it might be considered advisable not torepeat, to no purpose, the monitoring of the environment carried out in the OCP area.However, in view of the fact that other larvicides might have to be elnployed, €.8. to overcomea temephos resistance problem, environmental monitoring activities must be envisaged from theoutset.

Ihe environmental monitoring techniques which have been used very successfully forstudying both aquatic inverEebrates and fish in the OCP area, and which would also be usedin the Western Extension area, have had the following objectives:

- determination of those components of the fauna that are most affected by larviciding;

the drawing up of qualitative and quantitative comparative balance-sheets for Ehe pre-larviciding period and for the periods following the beginning of treatments; and

the forestalling of any deleterious effect that is considered important for establishedbiological equilibria.

RXFERENCES CITED IN PART I

Anon. (1981) Rapport de la 3Eme R6union Minist6rielle de Concertati-on des Etats du Bassin duFleuve S6n6gal (Dakar, Novembre 1981)

Aubreville, Duvigneaud, Hoy1e, Keay, Mandoga, Pichi-Sernolli (1959) Vegetation l"lap of Africa(South of the Sahara), CCTVCSA Oxford University Press

Claude, J. (1980) Donn6es hydrologiques necessaires pour une campagne de lutte contreI'onchocercose dans 1a r6gion du bassin du fleuve S6n6ga1, document OMS/ORSTOM,25 pp.text, 6 annexes and 1 map

Coleman, M. & White, P. T. (L979) Farmer health survey (Sierra Leone)

Baldry, D. A. T., Everts, J.,'Iqoglcal Pest Management,

Roman, B., Boon von Ochssee, G.27, 83-lr)

A. & Laveissiere, C. (1981)

dans larcefr"eofoot

Colussa, B. (1981) SynthEse, par riviEre, des donn6es concernant I'onchocercoseR6publique Populaire R6voluEionaire de Guin6e, au 30 mars 1981, [.IHO document(unpublished), 88 pp. text and 19 maps

Connor, D. H., Cupp, E. W., Ganley, J. P., Gibson, D. W. & Schiller, E. L. (1979) Draft report.Studies on onchocerciasis in northern Liberia, including topical treatment with diethyl-carbamazine: pathology, ophthalmology, parasitology and entomology; and reconunendationsfor control of the disease (26 November - 18 December 1978). Published by the AmericanPublic Health Association, 115 pp.

ocP 82 .3page 28

Crosskey, R. W. & Post, R. J. (1981) A synopsis of present knowledge of the Simulium damnosumcomPlex in the Republic of Sierra Leone, with special emphasis on its geographicaldistribution and relation to onchocerciasis (unpublished report; 35 pp. textr 4 tablesand 4 maps)

Davies, J. B., Gboho, C., Baldry, D. A. T., Bellec, C., Sawadogo, R. & Tiao, P. C. (In press)The effects of nelicopter applied adulticides for riverine tsetse control on Simuliumpopulations in a West African savanna habitat. I. Introduction, methods and theeffect on biting adults and aquatic stage of Simulium damnosum s.1., Tropical PestManagement

Qui116v616, D., Gui11et, P. and 56chan, Y. (1981) Cah. O.R.S.T.O.M. s6r. Ent. med. etParasitol. , 14 (4), 303-309

Vajim6, C. G. & Dunbar, R. W. (1975) Tropenmed. Parasit. 26, 111-138

Walsh, J. F., Davies, J. B. & Garms, R. (1981) Tropenmed. Parasit., 32, 269-273

Garms, R. & Vajim6, C. G. (L975) Tropenmed. Parasit.,26,375-380

Orain, H. L. (198f) Projet d'Etude de Eaisabilit6 d'une Campagne de lutte contre 1'Onchocercosedans la R6gion du Fleuve S6n6ga1, document OuSfrcYfVeOfOfsl , 12 pp. text and 129 annexes

ocP82 .3

Page 29

PART II

PLAN OF OPERATIONS FOR IIIE FIRST SIX YEARS OF

ONCHOCERCIASIS CONTROL IN TIIE WESTERN EXTENSION AREA

CHAPTER III

RESPONSIBILITIES

1. INTRODUCTION

Brief mention has already been made in this report to the respective responsibilities ofthe OCP and of national goverrunent.s in the execution of an OCP Western Extension. However,before proceeding to consider the finer details of the planning, i.mplementaEion and evaluationof such an extension, it is important Eo consider the apportionment of responsibilities inmuch more detail.

2. RESPONSIBILITIES OF TltE OCP

The responsibilities of the OCP, which will be meE from international funds, will, inbroad terms, be as follows:

(i) Ihe overall administration of the Western Extension, in close liaison with NationalOnchocerciasis Corrnittees.

(ii) A11 vector control activities and associated support activities. Al-1 aerialoperations, r^rhether for vector control or for surveillance purposes require the mostperfect coordination and extremely good logistic support facilities. Consequently, it isessential that all these activities are strictly controlled and managed by the OCP.

(iii) The conducting of entomological evaluations. Ihe regrrlar and efficient collectionof entomological data, particularly in relation to the orientation and evaluation ofvector control operations, makes it essential that entomological evaluations are theresponsibility of the OCP.

(iv) Supervising national and/or intercountry epidemiological evaluation teams.

(v) Assistance in the establishment of national and/or intercountry environmentalmonitoring teams or services.

(vi) Assistance in the establishment of additional hydrological stations arrd in therefurbishing of existing stations.

(vii) The training of national staff required for the efficient implementation andevaluati,on of the extension.

(viii) Applied research

(ix) Reporting (through Ehe established OCP reporting system)

At the logistic and operational Ievels the OCP will be responsible for:

(x) The construction of an aircraft hangar with supporting workshop and storage facilitiesfor aviation fuels and insecticides, at the main operational base.

(xi) Ihe construction of helipads and storage depots for aviation fuels and insecticidesat strategically located rural sites.

ocP 82.3Page 30

(xii) The equipment and furnishings of premises used by the ocp.

(xiii) Itre purchase and operation of vehicles, and all other items of supplies.

(xiv) An exEension of the OCp radio network.

(xv) Ihe distribution of all equipmenr and supplies.

(xvi) The recruitment and costs of all- international staff.

3. NATIONAL RESPONSIBILITIES

Activities which will be the responsibility of the govergnents of the countries partici-pating in the Western Extensi,on will be as follows:

(i) Ihe establishment of National Onchocerciasis Committees (Ma1i excluded).

(ii) Ttre appointment of nati.onal liaison officers who will work in close collaborationwith the national and international bodies to ensure Ehe smooth day-to-day execution ofall operations.

(tii) rtre provision of all buildings and premises required to accomodate the mainoPerational base and the teams responsible for entomological, epidemiological and environ-mental monitoring at their respective locations.

(iv) Ihe employment of all staff required for epidemiological evaluations and for environ-mental monitoring activities, and the creation of the services (where appropriate) toaccorunodate them. In connexi.on with these activities, governments will- be responsiblefor assessing training requirements and for submitting candidates to the oCp for appro-priate training.

(v) Ttre operati.on and maintenance of alL existing hydrological stations.

(vi) fhe construction, oPeration and malntenance of any additional hydrological stationsrequired by the oCP (in this respect the oCP will assist in the purchase of essentialequipnent).

(vii) ltre maintenance and repair of all roads needed by national and international teamsto gain access to hydrologicaL stati.ons, helipads, indicator vi1Iages, entomologicalevaluation points (catching stations) and aquatic monitoring sites.

(viii) The construcEi,on of new roads to al1ow access of the various evaluation teams toothendise inaccessible areas. (Ihese activities could require very substantial funding,which may be beyond the means of the appropriate national auEhorities. c,overmnents maytherefore find it necessary to seek the required funds from external sources.)

(ix) Arrangements with the approprlate civil aviation authorities for the construction ofaviation suPPort facilities, for the waiver of duty on aviation equipment, fuels,lubricants, sPare Parts and tools, for the waiver of aircraft landing and parking fees aturban airfields, and for over-flight clearances.

(x) Comprehensive public relations campaigns wtrich will ensure that all ministries,national services, administrators and armed forces, in addition to rural populations, arecompletely familiar with and cooperate with all nationaL and international personnelinvolved in the Western Extension.

oCP requirements for additional hydrological stations and roads (see clauses (vi) and(viii) above) are specified in later sections of this report wtrich deal specifically with thesesubj ects.

ocP82 .3

Page 31

CHAPTER IV

PHASING OF EXIENSION ACTIVITIES

1. INIRODUCTION

The original proposals for the spatial phasing of operations were as follows:

Phase I:Phase I1:Phase III

The River Niger Basin, and some coastal rivers in Sierra Leone.The River Senegal Basin and some coastal rivers in Sierra Leone.411 other river basins in Senegal, Guinea-Bissau and Western Guinea

With regard to temporal phasing it was proposed that once operations cornmenced in thePhase I zone, activities would follow in the Phase 1I and III zones one and th,o years later,respectiveiy. However, in the light of recent additional findings in the Western Extensionarea and of recent developments in the OCP it is no longer considered feasible to adhere tothe original phasing proposals. The most important of these factors are discussed separaEelybe1ow.

(f) Distribution of llackf1y species

The data on Simulium species distribution, presented in Map 4, by no means gives a

complete picture of the distribution of all the species. Much of the information collectedis restrictive both in space and time, especially with regard to many of the upland andforested areas. While the northern half of the Western Extension area appears to be dominatedby a very limited number of savanna species (mainly S s irb anum , with some S . damnosum s. s. )a converse, much more complex and less understood situation exists in the southern half of thearea. In this latter area there are five important species (six if the Konkoure form isconsidered to be separate from the others), knowledge of whose distribution is aE presentscanty, if not non-existent. In this connexion it must be pointed out that, at the presenttime, no information exists on the species of many long stretches of rivers which form what hasbeen referred to earlier as the coastal complex, e.g. Rio Geba, Rio Corubal, Little Scarciesand I"Ioa. This situation applies equally further north in the easternmost hyperendemiconchocerciasis focus associated with the rivers Dion, Limou, Yeremou and Kourai.

(ii) Temephos-resistance and the need for alternaEive larvicides

In the Report of the 2nd Session of the JPC (which met in December, 1981) it was stated:

trAs with the extensions inEo southern Benin, Ghana and Togo, considerable stresswas laid by partic.ipants on the importance of having back-up larvicides availablebefore embarking on vector control in Lhe Senegambia area. At least two andpreferably three larvicides should be kept in reserve, and should all belong todifferent insecticide groups to avoid cross-resistance."

Although Progress has been made in controlling temephos-resistant populations ofS. soubrense in the Ivory Coast, the situation in some forest and hrrmid savanna localitiesis such that, at the moment, the OCP does not have total capability for control under wetseason conditions. Every attempt is being made to improve this situation by using largeraircraft, by spraying a more concentrated formulation of BJ. H-14, and by intensifyingthe search for alEernative larvicides. However, until such time as additional larvicideshave become available and have regularized the resistance problem in the Ivory Coast it wouldbe unwise to extend temephos and BJ. H-14 treatments into the humid savanna and forest regionsof the Western Extension area.

ocP 82.3PaEe 32

( 111' Infrastructural and oq stic support facilities1

Recent field surveys in western Mali and eastern Guinea have revealed that there are many

Parts of the Western Extension area which lack the fundamental infrastructural and logisticsupport facilities which are essential for the introduction of large-scale onchocerciasiscontrol acEivities. This applies particularly to the poor condition of many roads, and tothe inadequacy of the road networks in many regions where al1-season accessibility isessential for the effective execution of vector control and evaluation operations butpresently not possible. The situation is particularly critical in many of the humid savannaand forested regions of the southern part of the Western Extension area.

As sEated earlier in this report the OCP has already conducted some logistic surveys inthe Western Extension area. These studies are continuing and will be continued into thepreparatory activities phases of the extension.

iv) lgpograIlrica1 and climatic factors

The situation referred to in item (iii) above, is in many cases aggravated by extremelyrugged mountainous terrain and by high precipitation rates. These factors, both individuallyand collectively, impose serious constraints to the free movement of vehicles and the technicalpersonnel dependent upon them. Lengthy wet seasons (of up to seven months' duration, andwith each monEh having a minimum of 50-1OO rnm of precipitation) in combination with ruggedterrain at high alEitude, result in much 1ow cloud and ground mist which impose seriousconstraints to the unrestricted and safe operation of low-flying aircraft.

Thus topographical and climatic factors impose two important constraints; a logisticone and a technical one. As part of the continuing logistic surveys referred to insection (iii) above, more information will be collected during the coming months. Withregard to the technical problems of vector control in mountainous and densely vegetatedterrain, it seems unlikely appropriate solutions will be quickly identified. In allprobability the applied research service of the OCP will be required to expand its currentprogramme in order to provide the speciaLized attention that this problem requires.

If all these factors are read in combination with the JPC recormnendation on the need foralternative, back-up larvicides the prospects for early implementation of a Western Extensionare not encouraging, especially with regard to forested, humid savanna and upland areas.However, the fact that the JPC has cornmissioned the OCP to prepare a Planops for the WesternExtension infers that the JPC reconrmendation on back-up larvicides was formulated as a guide-line for the OCP and not as a total embargo on all extension proposals. By accepting thisthesis we can proceed by considering what activities could be implemented in the WesternExtension area, cautiously, flexibly, at the discretion of OCP experts and their professionaladvisers, and without undue de1ay. Furthermore, vre can define those areas and activitieswhich must for the foreseeable future be left in abeyance until such time as the manyconsfraints, discussed above, have been satisfactorily removed, reduced or circumnavigated.

2. SPATIAL PHASING

In the northern hal-f of the Western Extension area which is dominated by generally lowaltitude dry savannas, only the savanna species of the S. darnnosum complex occur, and thevector situation is, therefore, not unlike the northern part of the existing OCP area wherevector control is feasible and has been very successful. Consequently, vector control inthis region, utilizing existing OCP spraying technology and the larvicide temephos, can beconsidered feasible, provided that such a concept meets with the approval of the EcologicalGroup and the Expert Advisory Cormnittee.

(

0cP82 .3

Page 33

Conversely, and in view of the many constraints to effective onchocerciasis control andevaluaLion in the humid savanna and forest regions of the Western Extension area, as discussedearlier in this chapter, OCP operations in the southern part of the region must be posEPonedfor the timebeing. However, the OCP is continuing its studies in this part of the region,and those studies will be considerably expanded when the Western Extension is implemented.

After very careful consideration of the technical and logistical consequences of havingtwo parts of the Western Extensj-on area (northern and southern) with different timetablesfor the commencement of onchocerciasis control activities, it was found that no one parametercould adequately constitute the dividing line between the two subregions. Corrsequently,many parameters were considered in order to derive \,rhat can be called a realisticcompromise. As precipitation patterns constitute a very important factor in distinguishingdry savanna regions from humid savanna and forest regions, much attention was given tothem (see Map 3). Similarly, much attention was given to the delineation of areas in whichonly the savanna species S. sirbanum and S. damnosum s.s. occur (see Map 4). Finally,consideration was also given to drainage patterns, topography and accessibility of \nTater-

cour se s .

thatandmaP

In the final analysis of the different sets of data appraised, the conclusion was derivedthe dividing line should be located between the mean annual rainfal-l isohyets of 13OO

15OO rnm (see Map 3). I'laking allowances for the oEher criteria, it can be defined (see5) as a line which proceeds in a westerly direction:

from the existing OCP western limit on the lower R. Niger, at the Mali-Guineafrontier ;

- along the watershed which separates the Senegal River basin from the R. Tinkissosubsystem (of the R. Niger basin);

- across the upper R. Bafing at the Boureya hydrological station;

along the watershed which separaEes the R. Faleme (Senegal River basin) from theupper R. Gambia;

across the upper R. Gambia at the Madina-Kouta hydrological station;

along the watershed which separates the R. Gambia from Ehe R. Corubal and the R. Geba.

Thus the northern, dry savanna subregion of the Western Extension area embraceswestern Mali, much of eastern Senegal and the northern frontier districts of Guinea.Conversely Ehe southern, humid savanna and forest subregion embraces a sma11 part of easternSenegal (the R. Geba basin), the whole of Guinea-Bissau and Sierra Leone, and the greaterpart of Guinea.

TI},IETABLE FOR PHASING OF ACTIV]TIES

1 In the northern subregion

In formulating phasing proposals for this subregion careful consideration has been givento the following factors:

- the expediency of restricting one phase zone to a whole river basin;

- the need to take over responsibility for and expand any locaiized control operationswhich the O.M.V.S. may have introduced in the R. Bafing subsystem in order to protectthe Manantali Dam site;

the need to give early protection to the expanding populations of the R. Faleme

hyperendemic focus.

3

3

ocP82.3page 34

Thus it is proposed that Phase I will be confined to the Senegal River basin andPhase 1I to the R. Gambia basin (see Map 5).

The main operational base for OCP operations in both phase zones will be Bamako, Mali.

It is proposed that OCP operations will conrmence in the Phase I zone, and will befollowed one year later in the Phase II zone. Unless future developments in the subregionindicate otherwise, vector control operations in each phase zone will not commence until atwo-year Preparatory activities period has been successfully concluded. Thus within thesix-year time frame of this WesEern Extension proposal, vector control operations will beconducted for four and three years in the Phase I and Phase II zones, respectively.

3.2 In the southern subregion

Until such time as much more information is available on the distribution of Simuliumspecies, on log,istic factors and on appropriate strategies for vector control in mountainousand forested areas, it is impossible to say whether the subregion can eventually be consideredas a single spatial phase zone or as a group of smaller phase zones.

For the time being and for the purposes of this report, the southern subregion will bereferred to as the Phase III zone.

2

2

0cP8:) .3

Page 35

CiAPI'Ei. V

PREPARATORY ACTlvil'Iii 5

1. INTRODUCTION

The training of staff, the collection of the additional data essential for planning, thesetting-up and calibration of additional hydrological staLions, the estabLishment of theinfrastructure for the aerial applicacions, the ordering ctf equipment anrl i:upplies, theorgani-zation of conmunications with the operations centres, and the efficient organizationof the extension will require a preliminary period of two yea:s, in most cases '

For each phase zone the first and sc-cond years of preparatory activities are hereafterreferred to as extension year 1 and extension year 2, respectively. Similarly the yearsduri.ng which vector control operations are in progress are referred to as extension year 3 ot 4

or 5 or 6.

In the case of the Phase 1 zone, extension year I could be synonomous with calendaryear 1983.

The various preparatory activities which must be completed in a timely fashion areconsidered separately below according to the proposed apportionment of resPonsibilities.

OCP ACTIVITIES

1 In Ehe Phase I zone

The most important OCP activities to be conducted during extension year I (EY1) in thePhase I zone are:

(i) the recruitment and installation of interrrational personnel at the Bamako mainoperational base and in the entomological evaluation sectors and subsectors;

(ii) construction of an ai-rcraft hangar and support facility at Bamako;

(iii) equipment and furnishing of all bases for operations, and evatuations, includingthe purchase and distribution of vehicles, equipment and supplies ;

(iv) extension of the OCP radio communication network;

(v) conducting of aerial surveys of Simulium breeding sites and coll-ection of samplesfor cytotaxonomic study and for insecticide susceptibility testing;

(vi) awarding of a two-year contract to an independenE institution for the conductingof environmental monitoring activities, and for assistance in the training of nationalstaff;

(vii) assisting in the training of epidemiological evaluation staff;

(viii) comrnencement of entomological evaluations ;

(ix) assisting governments (Ma1i and Senegal) in the establishment of epidemiologicalevaluation teams, and supervising the conrmencement of evaluations;

(x) commencement of applied research on adulticiding.

Needless to say some of these activities will continue into subsequent extension yearsIt is however essential that Ehey be conmenced as early as possible in EYl.

ocP82.3Page 36

Other activities , which can be conducted during EYI and EY2 are:

(xi) assessment of aircraft requirements and the making of arrangements for an expansionof the OCP aerial operations contract;

(xii) construction of helipads and storage facilities for aviation fuel and insecticides;

(xiii) conducting logistic and technical surveys in the Phase 1 and Phase II zones;

(xiv) establishment of, a system of river codings appropriate to larviciding operationsand to the recording/processing of entomological evaluation data;

(xv) reporting.

2.2 In the Phase II zone

Theas thoseto:

preparatory activitles to be conducted in the Phase II zone are essentially the same

listed in sectLon 2.1 above for the Phase I zone. However, it will not be necessary

2

(i) instalL an operational base;

(ii) construct an aircraft hangar and support facility;

(iii-) award a contract for environmental monitoring (the contract referred to insection 2.1 (vi) above will cover both phase zones);

(iv) conduct adulticiding trials.

.3 In the Phase III zone

As stated earlier in this report those staff of the OCP who are directly concerned withthe planning of the Western Extension are continuing their investigations in the proposedphase lII zone, even if they are on a limited scale. However, with the cormnencement ofexEension operations in the Phase I zone and as soon as the initial settling Process has been

completed extension staff will be in a position to conduct much more extensive investigationsin the Phase III zone. Thus during the period EYI to EY3 surveys in the Phase lII zone willconcentrate on logistic factors, but, eventually more attention will be given to technicalaspects of onchocerciasis control. In particular, studies will be made of Simulium speciesdistribution, and insecticide susceptibiLity testing.

3. NATIONAL ACTIVITIES

3 .1 In the Phase and zones

National activities which apply equally to the Phase I and fI zones, but which are fittedto different time scales and which mainly concern the governments of Mali and Senegal, are as

fo1 lows :

(i) establishment of National Onchocerciasis Conrnittees in Senegal and Guinea;

(ii) appointment by the National Onchocerciasis Committees of Ma1i, Senegal and Guineaof a liaison officer in each country who will work in close collaboration with nationaland international bodies and who will assist them in day-to-day problem solving;

(iii.) ensure that all hydrological stations are functioning properly, and that they arereadily accessible at all ti-mes of the year;

(iv) construction of additional hydrological stations in accordance with the requirementsexpressed later in this chapter, ensuring all-season accessibility;

ocP82.3page 37

(rr) improve and maintain the existing road network anrJ construcL and maintain additionalroads in accordance with the requirements expressed laler in this chapter;

(vi) the making available of buildings Eo acconmod;te Lh.r teams that will be responsible

for entomological, epidemiological and environmentaL mcnitoring acEivities;

(vii) the making of arrangements with the appropriate civilconstruction of an aircraft hangar at Bamako internationalof helipads in rural areas (construction costs will be met

duEy on aviation equipment, fuels, lubricants, sPare Partsaircraft landing and parking fees at urban airfields, and,

aviation authorities for theairport , f or the consEruct ioi"lby the OCP), for the waiver ofand tools, for Ehe waiver offor o'ver-flight clearances ;

(viii) the creation of epidemiologicatr- and environmental monitoring units, involving the

early iCentification of personnel who will have to be trained by the OCP;

(ix) the initiation of a comprehensive information campaign.

3.2 In the Phase III zone

Noting that the National Onchocerciasis Conrmittee of Guinea will be created during EYI

in relation to extension activities in the Phase I and II zones, it is anticipated thatsimilar conrmittees for Guinea-Bissau and Sierra Leone will be established during EY2.

In view of the uncertainty about a possible starting date for extension activities inthe phase III zone, it is considered unnecessary to Present here a detailed list of theactiviEies to be conducted during the preparatory period(s); in any case they wi1l, to allintents and purposes, be similar to those which have been described above for the Phase Iand I1 zones.

4. ACTIVITIES CONDUCTED JOINTLY BY TI{E OCP AND NAT]ONAL AU'THORITIES

The most important of these activities can be summarized as folLows:

(i) the selection of indicator villages for epidemiological evaluation purposes and

the collection of baseline, Pre-control data;

(ii) the selection of sites for hydrobiological studies.

5 OCP REQUIREMENIS FOR ADDITIONAL HYDROLOGICAL STATIONS AND ROADS IN THE PHASE I AND I1ZONES

5.1 Requirements for h ro loe 1C a1 stations

A detailed hydrological survey was made of the Western Extension area in L979f8O and

the resultant report it is possible to summarize Ehe situation in the Phase I and II zones

to identify additional requirements for control operations. These are considered on a

national basis be1ow.

fromand

( 1.) Western l'Iali:

T\,renty-nine hydrological stations were in operation in 1980 and an additional fivestations were proposed for the following rivers: Baou16, Badin-Ko, BaLe-Z, Balinn and

Bale-1.

In March 1982, LE was observed that t\^/o new stations, not included in the above list,had been installed to Ehe east of Kayes on the R. Korigon at Segala and on the R. Gari atLambatara. The extent to which these stations could be of use to the OCP has noE yet been

determined.

ocP82.3Page 38

Additional hydrological stations and those existing stations requiring rercalibration areas follows:

Bafing subsystem

New stations on the Bale-1, BaIe-2 and Balinn.

Bakoye subsystem

Recalibration of the Diangola station on the R. Bakoye

Baou16 subsystem

Ne\n7 stations on the R. Baou16 downstream from the Baou16 Loop, and on the R. Badin-Ko.

Recalibration of the stations at the Baoul6 Railway Station (Toukoto) and in the Baoul6Park.

(ii) Senegal:

Twenty-six staEions were in operation in 1980 and an additional two were proposed for therivers Faleme and Niokolo-Koba.

Additional stations are as follows:

Faleme subsysEem

New station at Sansande.

River Gambia system

New station on the lower R. Niokolo-Koba, near Simenti.

(111) Guinea

There were 63 stations in Guinea in 1980 and an additional seven stations were proposedfor the following rivers: Ibulai, Bakoye, Le1e, Niantan, Banie, Bouka and Koulountou. A

more recenE survey indicates that at least 25 of the existing stations are no longer inoperation.

For the implementation of vector control operations in the Phase I and II zones therewill be no dependence on hydrological stations located in Guinea. Partly for this reasonand partly in view of the fact that OCP requirements in Guinea have not yet been fullyassessed full details of the possible hydrological network there cannot be presented here.

It should be emphasized that for OCP PurPoses

- two years' data are required from a new hydrological station or from a recalibratedone before dosages can be calculated with optimum efficiency;

- water 1evel gauges should be fitted with large figures and positioned ir;r open

situations so that they can easily be read by an aircraft pilot.

The estimated basic costs of improving the hydrological networks of Mali,and Senegal tomeet OCP requirements are as follows:

(

ocP82 .3Page 39

Activity

Constructionfrepafi of five stations in MaliCalibration of eight staEions in Mali

Construction of two stations in SenegalCalibration of two stations in Senegal

Sub-total

US dollars

3 50011 200

t4 700

1 4002 800

Sub-tota1: 4 200

Total 18 900

The provision of funds for these activities is the responsibility of the Mali andSenegal governments. However, in order to ensure the timely completion of these activitiesthe OCP may contribute towards the cost of materials.

5.2 Re irements for additional road

Until such time as OCP officials have had detailed discussions with road engineers of theappropriaEe national authorities the lists of roads required by the OCP must be considered as

tentative. Similarly, until the precise a1-ignment of proposed new roads has been agreedupon by al1 parties concerned, it is impossible to esEimate the financial conwritment that willbe required. However, it is safe to assume that substantial funds will be required to extendthe network in Mali and Senegal.

Additional roads that will be required have been identified as follows

In Mali:

(i) westwards from Kolokani to the junction of the rivers Baou16 and Dia;

(ii) westwards from Kita to the R. Bakoye;

(iii) northeastwards from Kita to the R. Baou16, crossing the rivers Badinn-Ko andKenieba-Ko;

(iv) southwards from Manantal-i to Bafing Makana, along the right bank of the R. Bafing;

(v) southeastwards from Koundia, through the R. Balinn valley, to Bafing Makanal

(vi) southeast\^rards from Kenieba to the rivers Kouloun-Ko and Dassabola;

(vii) westwards from Dialafara to the R. Faleme.

In Senegal:

(viii) northwards from the Kedougou-Kenieba road to the R. Faleme;

(ix) southeast\^7ards from the Kedougou-Kenieba road to the rivers Koila-Kabe andBadinn-Ib;

(x) northwards from Salemata to the R. Gambia;

(xi) eastwards from the Tambacounda-Youkounkoun road to the R. Koulountou.

ocP82.3Page 40

6. OTHER CONSIDERATIONS

It must be mentioned here that there are several mineral exploitation activities in thelJestern Extension area (and others are planned), which could have an influence on vectorcontrol operations (see Map 6). In the first place, effluent from certain t)'pes of miningactivity which is discharged into nearby rivers could reduce the efficiency of larvicidingoperations. Secondly, oEher types of mining activity associated with the extraction ofprecious stones, such as diamonds, have very strictly enforced securi-ty regulations; some may

be totally ttrestrictedtt areas. In such situations very complete and well-documentedclearances would have to be granted by the appropriate government authorities before anyvector control andfor eval-uation activities could be planned and implemented. For obviousreasons, all rhe appropriate clearances will have to be secured during the preparatoryactivities phases

ocP82 -1page 41

CHAPIER VI

VECTOR CONTROL CPERATIONS lI'J T}IN P}{.\S'E AIIL 11 ZONES

1. OPERATIONAL BASES

1,1 Primary operat ional base

Since aerial larviciding operations will- be under the sti:ict controL of the OCP, and

anticipating thaE aerial adulticiding operations may also be introdrrced, all aerial operationswill be centralized.

The primary operational base will be,at Bamako, Mali, where it wi.1l be necessary toconstruct an aircraft hangar and workshopfottice complex. It is foreseen that Bamako willnot initially be responsible for major repairs and overhauLing of aircraft (this will continueto be done at Bobo-Dioulasso), but solely for routine and day-to-day servicing activities.

I.2 Secondary operatj,onal bases

As far as possible aircraft will make full use of existing aeronautical facilities towhich the supply of fuel and insecticide does not create a big problem in Mali and Senegal.The airfields identified as being suitable for both helicopters and fixed-wing aircraft arelisted below:

In Mali (Ph499 I):

Kayes: can be supplied by rail from BamakoKenieba: can be supplied by road from KayesBafoulabe: can be supplied by rail from Bamako, through the railway station at I'lahinaManantali (Bingassa): can be supplied by road from BafoulabeKita: can be supplied by rail from BamakoKolokani: can be supplied by road from Bamako.

In Senegal (Phase II)

Tambacounda: can be supplied by rail from DakarKedougou: can be supplied by road from Tambacounda.

1.3 QlP helipeds

Tentative lists of places where it will be necessary to construct OCP helipads are givenbe low :

In l,lali (Phase I)

Bafing Makana: can be supplied by road from Bafoulabe-Mahina, via ManantaliTorodo: can be supplied by road from BamakoToukoto: can be suppli.ed by rail from Bamako, and possibly by road from Kita.

In Senegal (Phase II):

Simenti: can be supplied by road from Tambacounda.

Helipads constructed in remote ar,d,for sandy areas should be made reasonably durableeither by making a 5 m x 5 m concrete plinth surrounded by 4OO ^2 of packed, coarse, gravel,by putting down the gravel without the concrete plinth.

oEt

OCP82.3

PaBe 42

L.4 Logistic support

As far as possible heavy duty lift-trucks and railway services will be used to supplyinsecticide and aviation fuel to the secondary operational bases and helipads.

In the first instances, four trucks will be required in Mali (two at Bamalco, one atBafoulabe and one at Kayes) , and two in Senegal (at Tambacounda).

The safe-keeping of rural stocks of insecticide and aviation fuels will be entrusted to1oca11y-recruited watchmen.

2. AXRIAL OPERATIONS LOGISTICS AND COSTS

2.L Aircraft requirements

For conventional applications of temephos aircraft of the type currently r:mployed by theOCP would be acceptable, i.e. a helicopter capable of carrying 2OO litres of irrsecticide and afixed-wing aircraft capable of carrying 600 litres. From a logistic vie\^7point, aircraftwith greater load carrying capacities would be advantageous.

2.2 Deployment of aircraft

A11 aircraft will normally be based at, and operated from, Bamako. Howe'rer, in order tomake aerial spraying flight circuits as economical as possible, pilots will be required to make

rest-over-night stops at a Iimited number of secondary operational bases, e.B. Kayes andTambacounda.

2.3 Basic aircraft costs

The1983 -8 5

costs presented below are those which will be appli.cable to the OCP drrring the period(both years inclusive) :

Helicopters US$

Basic hourly hiring charge:1oO litres of fuel at $ o.llftitre:

Fixed-wing aircraft

Total hourly cost

42)_

37

45)

(say US$ 460)

44055 .5

Basic hourly hiring charge: ,

150 litres of fuel at $ 0.37/lttre

Total hourly cost: 495.5

(say US$ 5oo)

2.4 Flisht hour requi rements and costs

These data are presented in Table 1.

3. INSECTICIDE REQUIREMENIS

AII calculations for insecticide requirements have been based on the assumption that Ehe

20% emulsifiable concentrate of temephos which is routinely employed in the existing OCP area,or similar, will be used.

OCPg2page

3.1 Temephos requirements for the Phase I zorte

Requirements of temephos for ll months of the first year of treatments have beenestimated on a month-by-month basis and presented in Table 2. The total is 117 498 litres,but no contingency provision has been included.

It would therefore be advisable to allow for 13O OOO litres.

Estimated requirements for three subsequent treatment years are 135 OOO litres annual1y.

If construction work on the Manantali Dam is completed during any one of the years andbreeding sites on part of the R. Bafing are flooded out by the newly created lake, therewould be some savings in temephos. At this stage, it would be premaEure to try and calculatethe magnitude of any such savings.

3.2 Temephos requirements for the Phase II zone

Tentative estimates of temephos requirements and costs for the R. Gambia system are39 OOO litres for the first year and 4l OOO litres annually thereafter.

3.3 Total temephos requirements and costs

In making the following calculations it has been assumed that the first year's supply oftemephos will be purchased in 1984.

Phase, zone and

2

43

treatment vear

Ph.I-Yr 1 (1984)Ph.I-Yr 2

Ph.I-Yr 3

Ph.I-Yr 4

Sub-totals:

Ph.II-Yr 1 (1985)Ph.II-Yr 2

Ph . II-Yr 3

Sub-totals

Tot a ls

Temephos(litres)

130 000135 000135 000135 000

535 000

US dollars

1 170 0001 309 500L 4L4 260r 527 400

5 42r L60

378 300397 700426 400

L 202 400

6 623 560

39 00041 00041 000

12 1 000

656 000

4. MANAGERTAL STAFF

An Assistant Chief of the Vector Control Unit (Bamako) will be appointed withresponsibility for the operations in the Western Extension area. His duties will be asfollows:

permanenE liaison with the Chief, VCU on aIl technical matters;

coordi-nation and supervision of aerial spraying operations and entomologicalevaluations, in direct consultation with subunit chiefs;

supervision of environmental monitoring in consultation with the OCP hydrobiologicalcontractors and national teams;

liaison with the national epidemiological evaluaEion teams;

ocP82.3Page 44

- transmission of resutts to the data recording and analysis service;

- supervision of progress reports of the units;

- participation in the training of national personnel.

TheAssistantChief, VCU will visit the sectors and subsectors as frequently as possiblein order to ensure the best cohesion and the maximum motivation among the teams. He will haveto initiate meetings of the sector chiefs and periodic radio link-ups.

The Aerial Qperations Sub-Unit at Bamako will be headed by an Aerial Opere.tions Officerwho will work direcEly under the AssistanE Chief, VCU. The Aerial Operations Officer will be

responsible for:

organizing and supervising aerial operations in close collaboration wittr the entomologistin charge of the entomological evaluation work, who will also be based i.n Bamako;

arranging, in conjunction with the OCP administration unit, for the orde:ring, takingdelivery and distribution of insecticides and aircraft fuel;

- assisting in working ouL the weekly flight plans, deciding on the amount.s of insecEicideto be applied, and selecting the treatment Points;

arranging with appropriate officials of the entomological evaluation un:-t and of theresearch team, for Ehe conducting of logistic operations, aerial entomol-ogicalevaluations and research activities requiring the use of aircraft (inse<:ticidesusceptibility tests, collection of samples for cytotaxonomic examinati<)n, evaluationtrials of adulticides, etc.);

close liaison with the QCP's overall Chief of Aerial Operations based irr Ouagadougou,

and with the Aerial operations officer based in Bobo-Dioulasso.

The Aerial Operations Officer assigned to Bamako will be assisted by two <leputy aerialoperations officers. Initially they will both be based at Bamako but eventuaLly one may be

outposted. They will be responsible for applying the directives of the AeriaL OperationsOfficer in the Phase I and II zones. They will liaise closely with the Aerial OperationsOfficer located in Bobo-Dioulasso.

5. APPLIED RESEARCH

It is anticipated that the Phase I and II zones will be exposed to a Simulium reinvasionphenomenon similar to, if not identical to, that which occurs annually in the 'axisting OCP

area.

It is therefore important for the Western Extension area, the same as for the existingOCp area, that effective adulticiding techniques be developed as soon as Possible, in order todetermine their effectiveness in countering reinvasion problems, which could have seriousepidemiological repercussions. Accordingly, and in support of the current OCP appliedresearch programme, provision has been made in Table I for addiEional helicopter flight hours

for adulticiding trials.

ocP 82 .3page 45

CII{PTI,R V]I

ENTOMOLOGICAL EVALUAT lONS

IN THE PHASE i AND 1I ZOI{T''I

I. INIRODUCTTON

plans for entomological evaluations in the Western Extension area can be drawn up on the

basis of the methods described in Chapter 1I. As in the existing OCP area. these plans are inlarge measure based on the deployment of teams in the field, so that catching points selected

by the entomologists, in consultation with the national epidemiological evaluation teams, can

be regularlY visited.

However, along many stretches of river in the Phase I and 1I zones, where it is essentialto conduct entomological evaluations, access roads are either in very bad condition, or,totally non-existent. During the Ewo-year PreParatory phase every attemPt will be made toimprove and extend the road networks, but it is extremely unlikely that totally satisfactoryprogress will be made before the comnrencement of Phase I vector control operations. Againstthis background of constraints it is obvious that conventional enEomological evaluationmethods cannot be effectively implemented in al1 areas. In order to overcome this problem

consi-derable ftexibility will have to be exercised boLh wittl regard to the tyPes of ground

transport to be used, and to the arrangement of vector sampling procedures. In some extreme

cases, helicopters may have to be ca11ed in to assist entomological personnel.

2. ENIOMOLOGICAL EVALUATION SUB-UNIT

A1l entomological evaluation activities will be conducted by an Entomological EvatuationSub-Unit (EESU) which, like the Aerial Operations Sub-Unit, will be under the direction ofthe Assistant Chief, VCU.

The EESU, with headquarters in Bamako, will be headed by a senior entomologist and an

entomologist.

The Chief of the EESU will have direct responsibility for the whole evaluation networkwith the following duties:

- selection of catching points in cooperation with the sector chiefs, their assistanEsand technicians, and with the responsible officials of the epidemiological evaluationteams ;

- coordination of evaluation activities by constant liaison, taking t,he form of visitsand radio contacts with the sector chiefs;

- reception of reports from the sector chiefs;

- gtobal weekly and monthly analysis of results on the basis of consolidated data sheetsfrom the sector heads ; correction of these sheets, if required, on the basis of theoriginal data;

- participation in the supervision of envj.ronmental monitoring activities;

- permanent technical Iiaison with the Aerial Operations Officer.

2.1 Sectors and subsectors

Two sectors will be required for the Phase I zone, and one sector for Ehe Phase II zone.lnformation pertinent. to these sectors is given be1ow.

Bamako (Phase I zone): Responsible for the Baou16-Bakoye river subsystem and the lowerR. Niger.

oCPg2. jpage 46

Bamako city, with many facilities and amenities,headquarEers. For the PurPoses of the Phase I zone

to expand the Bamako sector bY:

already the site of an OCP sectorshould be a relatively simple matter

isit

- enlarging the present Bamako subsector so that it has the capability of evaluating thelower R. Niger and the uPPer R. Baou16;

creating a new subsector with headquarters at Kita, and responsible fot the middleR. Baou16 and the R. BakoYe.

Although Ehe town of Kita has no electricity and running water supplies, itsuitable for a subsecEor headquarters because it is on the railway link and has

airfield.

is neverthelessa good

Kayes (Phase I zone): Responsible for the rivers Senegal, Faleme and Bafing

The town of Kayes, is on the railway 1ine, is supplied with electricity zLnd running InTater,

a good airfield, and always has stocks of vehicle fuel. It is thus more than adequateIocation for a sector headquarters.

hasasa

Tambacounda (Pha se II zone): Res ponsible for the rivers Faleme and Gambia

Tambacounda is on the railway line, is supplied with electricity and runrring water, has

a good airfield and usually good stocks of vehicle fuel. It is thus adequat<r for thelocation of a sector headquarters.

The overall sector and subsector network can be sunrmarized as follows:

Sector HQ Sub se ct ors

Phase I zone BamakoKayesKayesKayesKayes

TambacoundaTambacounda

KitaKayesBafoulab6 or ManantaliKeniebaKedougou, Senegal (a temporary measurefor Phase I evaluations).

TambacoundaKedougou.

Phase II zone

The distribution of the sectors and subsectors for the Phase I and II zones, togetherwith predictions for the remaining part of the Western Extension area, are illustrated inI"lap 7 .

2.2 Staffing of sectors and subsectors

In preparing the staff lists of the various sector and subsector units allowance has been

made for the facts that:

some units will be required to use boats for surveillance purposes;

some units will require a small road repair team;

laboratory technicians in some subsectors will have to accomPany the vectorcollecEors to the field and dissect flies on the spot.

The numbers and caEegories of staff required for sectors and subsectors in the Phase Iand 11 zones are Presented in Table 3.

I

I

0cP 82.3Page 47

na Responsibilities of sec tor and subsector chiefs

Under the technical supervision of the Entomological Evaluation Sub-Unit in Bamako,

sector chiefs will:

- organize the catching network in their sector;

- give the chief technicians of the subsectors the necessary instructions for the smooth

running of catching operations and the survey of larval breeding places;

- maintain permanent contact with their technicians through visits and radio contact;

- receive information by radio on insect catches and dissection;

- analyse these results and pass them on to Ehe Chief, EESU;

- check the validity of the catches and dissections recorded on the occasion of frequentvisits;

- receive and verify hydrological data and pass them on to the Aerial OperaEions Officeror one of his assistants;

- supervise sector administrative activities.

In addition to the subsectors which Ehe sector chiefs will have to supervise, each willhave under his supervision:

- an adminisErative nucleus;

- a garage for maintenance and repair of the vehicles of the sectors and subsectors;

- a small catching team that will enable him, should the need arise, to come to theassistance of a subsector chief, or to make periodic checks of the results obtained bythe subsector Eeams.

To carry out all these activities the sector chiefs will have to be constantly on themove, motivating activities and endeavouring to verify the results. Sector assistantentomologists will assist sector chiefs in all their duties. In particular, they willmaintain permanent liaison with the chief technicians of the subsectors.

By virtue of their technical level and their deployment over the area' Ehe chieftechnicians of the subsectors will be the link between the teams engaged in data collectionand the higher levels responsible for their analysis and use. Because of this they willplay a major role in the camPaign.

Under the direcE supervision of their sector chief and his assistant, they will- be

responsible for:

- organizing the catching itineraries in their subsector on the basis of instructionsreceived from their suPeriors;

- supervising the catches;

- ensuring the preservation of the blackflies caught, and their rapid despatch to thedissection points;

- dissecting the blackflies caught to determine their physiological age and infecEionwith O. volvulus ; should the need arise, dissections will have to be performed at thepoint of capture;

ocP82 .3Page 48

- entering the results on record sheets and cornmunicating them to the sector;

- prospecting of larval breeding places;

- collecting of hydrological data and their transmission to the sector;

- ensuring that vehicles are in good running order and innnediately informing the sectorgarage mechanic in the event of a breakdown;

- assisting the crews of the treatment aircraft as necessary.

Depending on Ehe staff complement, between eight and 15 catching days a week should be

worked at from 10 to 15 points. This will provide good overall coverage of the area,i.e. 180-270 catching points.

2.4 Timetable of sector activities

The entomologists, assistant entomologists and technicians for the Phase I sectors and

subsectors should be selected, recruited and sent on a training course (IRTO, Bouak6 and OCP)

so as to Eake up their posts as early as possible during the first year of PreParatoryactivities.

For Mali, one trained entomologist is available (currently employed by the OCCGE atBafoulabe). An assistant entomologist and six Eechnicians (entomology) will have to be

recruited and trained.

For Senegal, one Eechnician (entomology) will have to be recruited and trained.

As soon as they are installed in their respecEive bases the entomologists, assistantsand technicians will select catching points jointly with the EESU in Bamako.

At these catching points they will train their staff in techniques for the catching and

preservation of blackflies and their transPort to the laboratory.

Once the staff have been trained, the subsectors will commence regular catchingoperations in order to obtain Pre-sPray evaluation data (ATP and ABR).

The subsector teams will have to give assistance, in as far as possible, in setting uP

and calibrating the hydrological stations. They will have to learn how to read floodgauges and water-Ievel- recorder curves.

During their field tours they will have to check the location of knovm breeding places

and bring the records uP to date in this connexion'

They witl have to take part in every specialized survey (insecticide susceptibility,cytotaxonomy) needed during the preparation of the treaLment Phase.

2.5 Sector r u rements for 1es

These are listed in Table 4.

2.6 Sector requirements for equipment

These are listed in Table 5.

,l

ocP82.3Page 49

2.7 Requirements for radio stations

In anticipation of extending the existing ocP radio network intoarea, some long distance radio checks (on frequency 10.1.43) irere made

radio links tested, al1 of which gave satisfactory results, were:

the Western Extensionin January 1982. The

Bamako-ParakouBamako-HohoeBamako -N i ameY

Bouak6-NiameY

13OO km

12OO km

1l2O km

1O2O km

)

The OCp has requested an additional radio frequency (12.OOO) and if this is approved,

very good transmissions should be possible throughout the expanded OCP area.

However, anticipating that there may at times be transmission problems, it has been

considered advisable to a1]ow for a more powerful staEion to be installed in Bamako, Eo

replace the present station.

Requirements for radio sLations in the sectors and subsecEors of the Phase I and IIzones have been presented in Table 5. The services of a consultant radio engineer will be

required to install the new stations.

3. CYTOTAXONOMY SUB-UNIT

In view of the taxonomic complexity of the WesEern Extension area, and the need tomonitor very carefully the seasonal movements of different Simulium species, it will be

necessary to form a small cytotaxonomic sub-unit.

This sub-unit will operate from a smal1 laboratory in Bamako and will be staffed by:

a cytotaxonomist (a zoology graduate with postgraduate training and experience intaxonomic techniques) ;

a laboratory assistant (trained by OCP);

a laboratory auxilliary;

a driver.

The sub-unitwillbe equipped with one four-wheel drive-vehic1e, essential laboratoryequipment (ca US$ 600O) and will require an annual budget of ca US$ 10 OOO for supplies and

operating costs.

4, DURATION OF PRE-COMROL EVALUATIONS

It is repeatedly stated that pre-control entomological evaluations should be conductedfor at least one year before the commencement of vector control oPerations, In principle,this is an excellent procedure especially if new techniques are being evaluated, but it may

not be altogether necessary in relation to the extension of a control technique of Provenefficiency from one region to another identical region. The aerial spraying techniquecurrently used successfully over about 75% of the OCP is a proven technique for dry savannasituations. If the same technique (without any variation) is used slightly further west, a

reduced pre-control entomological evaluati-on may be adequate. Post-treatment evaluationsare very important because, on the basis of the results obtained, the next treatment cycle canbe planned; pre-treatment evaluation data Co not influence such planning but are necessarywhen a complete epidemiological evaluation of the control operation is required. In the longterm, the only valid way of evaluating the control operations is by medical means, notentomologi-ca1.

ocP 82 .,lpage 50

C}IAPTER VIII

E P I DEI.IIOLOGI,IAL EVALUAT IONSIN THE PHASE I AND II ZONES

1. INIRODUCTION

It is proposed to make use of national teams and staff to carry out epidemiologicalevaluations. However, considerable OCP inputs will be required, for example:

(i) for the training of personnel;

(ii) for the provision of equipment and supplies;

(iii) to supervise evaluations and to analyse the data collected.

The participation by national teams will constitute a direct contribution by the fivecountries to the Western Extension, supplementary to their other contributions (premises,acconrmodation). However, national participation implies certain constraints:

(a) Correct evaluatj-on of the situation cal1s for a unified basic methodology; thisapplies both to day-to-day and long-term evaluations. The evaluators of the fivecounEries will have to agree to abide by specific protocols which cannot be altered onany account. The only latitude they will have is to add supplementary information theyconsider useful.

(b) The intercountry evaluation activities should be coordinated by the OCP Epidemio-logical Unit. This will bring together and analyse the data collected. It will seethat regular meetings of the team leaders are organized so that they can discuss the waysand means of implementation, the difficulties encountered and the needs. These meetingswill also provide an opportunity for refresher training and for briefing by consultants.

(c) The willingness to participate should be reflected in the establishment of nationalcommittees for onchocerciasis control which will organize ad hoc technical groups.Regular meetings should be organized at the national and intercountry levels.

National teams responsible for the evaluation of endemic onchocerciasis should be set upas soon as the preparatory phase begins. Their training should attemPt to familiarize themwith the techniques developed by OCP for the standardized collection of clinical,parasitological and ophthalmological data. Data collection of this kind is essential forthe implementation of the extension.

2. SELECT]ON OF INDICATOR VILLAGES

The selection of indicator villages in accordance with established OCP cri-teria will be

made as soon as possible (as soon as national reams are up to strength and appropriatelyinstalled) during the preparatory periods.

Initially, in both Mali and Senegal, national teams composed of a sociologist and a

statistician, will be required to:

identify potential indicator villages ;

census the populations ;

establish sociodemographic records of each village.

Once the necessary information has been obtained, national and OCP epidemiologists willjointly select the most representative indicator villages which accord with OCP criteria.

I

ocP82.3Page 51

3. POPULATION COVERED BY EVALUATIONS IN INDICATOR VILLAGES

Table 6 gives the distribution of the population to be evaluated during Phases I and IImaking allowance for inevitable absentees (20%) who will be noted during successive visitsto the indicator villages.

4. EVALUATION TEA},IS

4 .l For paras ilS1ogicql €\/elu4! renq

Parasitological evaluations will be made at both the simple and detailed levels

One parasitological team should be able to examine at least 1OO person"fa^y.

The composition of a parasitology team is:

- 1 clinician/epidemiologist (team leader),

- I census clerk,

- 1 nurse,

- I nurse for measuring visual acuity,

- 3 microscopi-sts,

- 1 laboratory assistant,

- 3 drivers.

One team will be provided with the following vehicle fleet:

- I minibus camper (US$ 10 OOO) ,

- 1 four-wheel-drive vehicle (US$ 13 23O) ,

- 1 rruck - Saviem Cabine (USg f6 3OO),

and scientific/technical equipment to the value of US$ 16 OOO.

4.2 F r thalmo ical tions

oPhthalmological examinations will only be made at the detailed evaluation level

one team should be able to examine approximately 6o peopLefday.

The composition of an ophthalmological team is:

- 1 clinician/ophthalmologist (ream leader) ,

- 1 nurse specialized in ophthalmology,

- 1 census clerk,

- 2 drivers.

One team will be provided with Ehe following vehicle fleet:

- 1 minibus camper (US$ 10 OOO),

- 1 Saviem mobile laborarory (US$ 54 OOO).

5

5

ocP82 .3page 52

CAPABILITIES OF NATIONAL HEALTH AUIHORITIES

.1 Simple evaluations

Because highly specialized personnel are not required for parasitological examinations,it is quite like1y that both national health authorities will be able to provide teams fors imple evaluat ions .

Mali does not have a team aL present which could be charged with epidemiologicalevaluations in the Western Extension area. However the Malian authorities are in favour ofthe formation of such a team, and consider that doing this should not present any graveproblem.

The parasitological unit can probably be formed by staff already available in Bamako(one clinician, one census c1erk, , rr,raa./"aripper, two microscopists and one nurse for visualacuity tests).

Similarly, it seems likely that the Senegal authorities will not have too muchdifficulty in finding the necessary staff.

5.2 Detailed evaluations

A number of nurses have been trained in ophthalmology at the I.O.T.A., Bamako (seeTable 7). In Ma1i, one ophthalmologist, destined for the operation "LumiEre" at Kayes,could be available and if necessary additional staff (mainly nurses) could be drawn fromr .0.T .A.

While it is fairly certain that the Malian health authorities will be able to providerhe ophthalmological expertise required for detailed evaluations, it may not be so easy forthe Senegalese authorities to do so. This does not necessarily mean that qualified personneldo noE exist, it is just that they may not be available for onchocerciasis investigations.

5.3 Options for oph thalmological evaluations

In view of the difficulties which the national health authorities may encounter increating efficient ophthalmological evaluation teams, it is pertinent to consider some

possible alternatives to each government having its own team.

The most obvious options that can be considered are

(i) Creation of national ophthalmological teams which will devote only part of theirtime and energy towards the evaluation of onchocerciasis control operations. However,this might be difficult to achieve and, as equipment would have to be provided by theOCP to enable the teams to meet OCP requirements, and the same equipment would be usedfor other purposes, the cost/benefit ratio would not be very favourable.

(ii) Creation of one intercountry team which would have the capability of making therequired evaluations in both Llali and Senegal. This system would not only al1ownational participation but would also enable equipment costs Eo be kept to a minimum.

(iii) Creation of a new OCP ophthalmological team which would conduct evaluations in each

of the countries. This option would also enable costs to be maintained at a low levelbut lacks appeal on the grounds that it does not al1ow any national involvemenE.

In conclusion, it must be stated that as the OCP epidemiological evaluation unit willhave the responsibility for supervising evaluations in the Western Extension area, and may

from time to time be able to give assistance in the fie1d, oPtion number (ii) above has most

to conrnend it, and is the one which has been used for budget calculations.

If the concept of a single intercountry team is accepted it would be up to the Malian and

Senegalese authorities to suggest where its headquarters should be located. Logistically,Kayes could be a suitable location.

ocP82.3Page 53

CHAPTER IX

ENVIRONMEMAL MONITORTNG

IN THE PHASE I AND II ZONES

1. IMRODUCTION

Assessment of the impact of insecticide treatments on fhe non-targeE aquaticof fundamental importance for maintaining the environment at the highest possiblequality.

fauna islevel of

In this context, the ecological surveillance of treated watercourses will take the form ofcontinuous assessment of the extent of fhe impacE of the treatments.

The study methods used will be those developed in OCP and designed, as regards bothinvertebrates and fish:

to determine the faunal components most affected by the larviciding;

to take qualitative and quantitative stock of the situation during the pre-treatmenEperiod and at regular intervals once larviciding has cournenced;

Eo prevent any adverse effect considered important with regard to the existing biologicalbalances.

The results obtained will have to take into consideration specific taxonomic groups butalso biological conrmunities taken as a representative ecological entity.

It is certain that the conducting of hydrobiological surveillance by Malian and

Senegalese teams will entail onerous and costly infrastrucEures, and will require verycareful and detailed coordination. From the scientific standpoint such intensity ofsurveillance is not entirely justified and it would obviously lead to duplication in thecollection of information.

To avoid this situaEion developing, it would be realistic to envisage a single intercountryteam which would meet the requirements of both Mali and Senegal. Such a team could be based

in Kayes and operate through a substation located at Tambacounda. The monitoringresponsibilities of the two stations would be as follows:

From Kayes

the River Senegal dovinstream from Bafoulabe,

the River Bafing from Bafing-Makana downstream to the junction of the rivers Bafing andBakoye ,

the River Faleme from its junction with the River Koba-Koye to its junction with cheRiver Senegal.

From Tambacounda:

the River Gambia and its main tributaries, the rivers Koulountou, Niokolo-Koba andTiokoye .

At this point it must be stressed that neither Mali nor Senegal has a hydrobiologicalservice; nor do they have suitably qualified and experienced personnel necessary to create a

servi-ce or team.

ocP 82.3

Page 54

Initially, a tr^7o-year contract should be awarded for hydrobiological surveillance to asuitably qualified independent institution. Such a contract would be executed under thesupervision of an OCP hydrobiologist.

During the first year of the contract national candidates for training would be identifiedand awarded scholarships (six months for a graduate and three months for a technician) toundergo training at one or more of the following instiEutions:

the ORSTOM Hydrobiology Laboratory (Bouak6, Ivory Coast);

the Aquatic Biology Institute at Achimota (Ghana) ;

the University of Dakar (Senegal).

Successful trainees would then be assigned to the intercountry team and receive additionalfield training from the hydrobiological monitoring contractor's staff, and from the OCP

hydrobiologist.

During the second year of the contract national hydrobiologists would assume increasingresponsibilities in preparation for the time, on the expiry of the contract, when they wouldhave to assume full responsibiLity.

2

2

INIERCOUNIRY MONITORING TEAM

.1 Staff requirements

The minimal staffing of the intercountry monitoring team is as follows:

2 ichthyologists

2 invertebrate biologists

- 5 technical assistants (national)

- 3 fishermen (national)

- L clerkftypist (national-)

- 3 drivers (national)

The salaries and associated allowances ofof their respective governments.

2.2 Equipment requirements

Contracted expatriates who would be replaced bynationals within two years.

)))

al-l national staff will be the responsibility

The equipment required to establish the intercountry monitoring t.eam is as follows

- 2 four-wheel-drive vehicles,

- 2 PeugeoL 4O4 pickups,

- 4 dissecting microscopes,

- 1 microscope Wild MI1 or equival-ent,

- 4 sets of fish nets (replaced annually),

- 2 light plastic boats,

ocP82.3

Page 55

- 4 outboard engines (9.9 or 20 HP),

- 2 tents,

- 2 office calculators,

- 1 typewriter,

- smal1 items of laboratory and office equipment and supplies.

To ensure the timely commencement of hydrobiologicalmonitoringactivities, the OCP willbe responsible for the purchase of the equipment necessary to establish the intercountry team.Thereafter, the governments of Mali and Senegal will be responsible for the replacement of allitems, other than the standardized sampling equipment, if and when required.

3. MONITORING PROCEDURES

3 .1 Methods

The hydrobiological monitoring methods to'be employed will be the same as those whichhave been approved by the Ecological Group and adopted in the existing OCP area.

3.2 Recordine and lysis of data

Taking into account:

- the existence at WHO headquarters of a data processing and statistical unit working forOCP;

- of the experience accumulated by OCP in the spheres of recording and analysis of results;

the analysis of all hydrobiological data collected by the intercountry monitoring team shouldbe conducted by the OCP data processing team in collaboration with national and OCp hydro-biologists. Should some of the data collected and processed in this lray be difficult tointerpret the OCP will arrange for them to be appraised by an independent authority.

As a branch of the OCP headquarters, Ehe operational base for the Western Extension willbe housed in premises provided by the Government of l"1ali at Koulouba, Bamako. These premisesare currently occupied by staff of the rcefUYOfOoT Projecr.

ocP 82 .3page 56

CHAPTER X

oPERATTONAL BASE, BAI"IAKO

1. IMRODUCTION

The operational base will be composed of a vector control uni-t, an epidemiologicalevaluation unit and an administrative unit, each of them operating under the direction of, andin close liaison with, respective headquarters units in Ouagadougou.

2. STAFF

2.L Vector Control UniL

The professional staff of this unit will include:

- I AssisEant Chief VCU,

- 1 aerial operations officer,

- I senior entomologist ifc evaluations,

- t hydrobiologist,

- 1 entomologist,

- I cytotaxonomist,

- 2 technical officers, Aerial Operations,

- 1 technical officer, Entomological Evaluations,

The minimal requirements for general service staff are:

- 1 administrative assistant,

- 1 secretary,

- 1 clerk,

- I cLerkfstenographer,

- 1 draftsman,

- 4 Iaboratory assistants (entomology, cytotaxonomy and hydrobiology),

- 9 vector collectors,

- 7 drivers,

- I messenger,

- 1 storeman.

ocP82.3Page 57

For technical purposes the unit will be subdivided into an Aerial Operations Sub-Unit,an Entomological Evaluations Sub-UniE and a Cytotaxonomy Sub-Unit.

The Assistant Chief VCU will be the senior officer having overall responsibility for theoperational base.

2.2 Epidemioloeical Eva l-uation Unit

This unit will be composed of one epidemiologist, one clerk/tyPist and one driver.

2.3 Administration Unit

This unit, which will provide the logistic support essential for the implementation ofthe Western Extension, will be responsible for finance, personnel, supplies, transPort and

mai,ntenance.

The professional staff of this unit will include an administrative officer and anassistant administrative officer.

Minimal requirements for general service staff are:

- 4 administrative assistants,

- 4 clerks,

- 4 typists,

- 1 sEorekeeper,

- I senior mechanic,

- 2 mechanics,

- I messenger,

- 10 drivers,

- 3 security guards.

3. VEHICLE PEQUIREMENTS

The vehicle fleet required for the Bamako operational base will include:

- 8 four-wheel-drive station wagons,

- 2 lift-trucks for insecticide and fuet,

- 2 standard trucks for ordinary supplies,

- 2 vanettes/pickups,

- 5 saloon/estate cars.

It is possibl-e that some of these vehicles could be provided from the ICP/MPOfOOI Project.

4. REQUIREMENIS FOR EQUIPMENT AND SUPPLIES

The premises in Bamako available for the operation base will require additional- officefurniture, equipment and supplies.

ocP82.3Page 58

CHAPTER XI

BI]DGET

1. INTRODUCTION

A budget has been prepared for a period of six years. For convenience, it has beenfitted to the 1983-1988 calendar period, covering the last three years of the second OCpfunding cyc1e, and the first three years of the third ocp funding cycle.

Only the first three years of operat.ions have been costed in any detall; the costingsfor the last three years are predictions only.

2. NATIONAL CONTRIBUTIONS

Each of the participating governments will be required to contribute:

(i) the cost of salaries and related allowances for all national staff concerned withepidemiology, hydrology and hydrobiology, according to national salary scales in forcel

(ii) the cost of land and buildings required by the OCP as well as recurrent expenditurefor accormtodation, such as rental and cost of electricity, rdater, postal services andteleconununications (where these exist) ;

(iii) the cost of installing additional hydrological- stations;

(iv) the cost of building additional roads;

(v) Ehe free use by the OCP of national services of aviation, meteorology, hydrologyand cartography;

(vi) an annual cash contribution, in convertible currency, the size of which wilt accordwith those currently received from participating states of the existing OCP.

While it would be useful to prepare a budget of national contributions, such an exerciseis at Present impossible in view of the many unknoum factors which currently exist and whicheven the governments themselves are not yet in a position to quantify.

3. INTERNATIONAL CONTRIBUTIONS

International funds will cover the following items:

(a) the cost of aerial operations including the provision of aircraft, hangar facilities,helipads and insecticides;

(b) the cost of radio communication equipment;

(c) the cost of vehicles and related transport equipment;

(d) the cost of office and laboratory equipmenE and furniture, and other equipment,such as generators, garage tools, camping outfits;

(e) all operating costs;

(f) part of the costs of extending hydrological networks;

(g) the cost of salaries and related allowances for international staff andconsultants;

(h) contracts for hydrobiological evaluaEions for a period of two years;

ocP82.3Page 59

(i) the cost of training and retraining national personnel;

(j) the cost of any meetings that rnay be required;

(k) the cost of data collection surveys in the phase III zone.

3.1 Guidelines for the p reparation of the budget (excluding national component)

The document "lfno/oce/at oct Plan of Action and Budget for 1982rr, has been used as aguideline in the preparation of the budget for phase r and rr operations.

Costs in US dollars have been calculated on the basis of figures seeming to beappropriate for 1983, as follows:

(i) professional staff, $ 64 96O increasing annuaLly by l2%;

(ii) general service staff, $ 44BO increasing annually by l2%;

(iii) consultants, $ 6272 (one man/month, including travel, stipend and per diem)increasing annually by l2%;

(iv) temephos, $ 8.40 per litre increasing annually by g%;

(v) trainees:

- stipend, $ 9OZ p". *"rr/*onth, increasing annually by lZ%;

- tuition, $ 497 increasing annually by g%;

- travel, $ 54o increasing annually by g%.

(vi) vehicles:

- ophthalmology mobile laboratories, $ 54 OOO increasing annuaLly by 8%;

- large heavy duty four-wheel-drive vehicles, $ 2t 527 increasing annuaLLy by g%;

- all other automobiles, $ 14 2gg increasing annualry by g7.;

- bcats with outboard engines, $ 34go increasing annually by g%;

- mobylettes, $ 8oO increasing annually by g%.

(vii) large electric generarors (diesel), $ Z99O increasing annually by g7";

(viii) radio transceivers, $ 5O4O increasing annual_1y by g%;

(ix) aircraft hangars, $ 40 000 increasing annually by approximate:..y g"/".

In making estimates for Ehe six-year budgeting period the following requirements andfactors have been taken into consideration:

(a) only six months' operations have been allowed for during the first year;

(b) radio stations will be required for all sector and subsector headquarters;

(c) larger four-wheel drlve vehicles than currently employed by the ocp will be requiredin all sectors and subsectors;

(d) inaccessible surveillance sites will have to be reached by boat or mobylette;

(e) two professional level staff have been allocated Lo each sector headquarters(eventually some of these could be replaced by general service staff);

/

ocP82.3page 60

(f) provision has been made for a single intercountry ophthalmological Eeam, buttwo nati-ona1 parasitological evaluation Eeams ;

(g) provision has been made for a single intercountry hydrobiological Eeam;

(h) the research provision covers only applied research on adulEiciding techniques I

(i) allowance has been made for the purchase of insecticide during the year before theone in which it is needed;

(j) no i,nsecticide has been purchased during the sixth year.

3 .2 Budget

Estimated costs for the first three years of the Western Extension in the Phase I and IIzones, are presented in Table 8.

Predicted costs for the first six years of the Western Extension in the Phase I and IIzones are presenEed in Table 9.

ocE82 .3Page 61

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TABLE 4. SECTOR AND SUBSECTOR RNQUIREI'IENTS FOR VEHICLES

NECESSARY TO COMMENCE ENTOMOLOGICAL EVALUATIONS

IN THE PHASE I AND II ZONES

I S,rch as the M.B. twin-cabin Unimog.

! S,,r"h as the Landrover.9 Each unit cornposed of one boat and two outboard engines.

LocationLarge4wD

vehicleP

Medium4wD

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Tractortrailerunit s

Mobylettes Boat units9

Bamako

Ki Ea

Kayes

Bafoulabe

Kenieba

Kedougou

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TABLE 8. ESTII',IATED COSTS FOR THE FIRST THREE YEARS OF THN

WESTERN EXTENSION IN THE PHASE I AND II ZONES

(us DoLLARS, C,ALCULATED rN JUNE 1982)

Category Year 1 Year 2 Year 3 Total

1. Professional staff

VCU (Bamako) il*$

^/^$

^/*$

EPI (Bamako)

ADMIN. (Bamako)

EESU sectors:

Phase I ,ry'*$

^/^$

Phase I1

60324 800

6

32 480

L264 960

L264 960

L20727 550

L2

72 755

24145 510

24145 5lO

L272 755

L20814 850

L281 485

24t62 972

24L62 972

24L62 972

300I 867 200

30L85 720

60373 442

60373 442

36235 727

,r/^$

Sub - total 90487 200

L921 164 080

2041 385 251

4863 036 531

2. General Service staff

VCU (Bamako) ,r/^$

,ry'*$

,r/^$

EPI (Bamako)

ADMIN. (Bamako)

EESU sectors

Phase I ^/^$

,"/*$

Phase II

L6260 480

t24 480

18067 200

930347 200

324L35 459

2410 034

360150 510

1 608672 278

396165 561

324151 713

24It 238

408191 046

1 608752 95L

792370 854

810347 652

6025 752

948408 756

4 L46L 772 429

1 188536 4L5

^/^$

Sub - to ta1L 284

479 3602 7r2

L L33 8423 156

L 477 8027 152

3 091 004

3. Consultants

Radio engineer ,r/*$

,d^$

Environmentalist

3

18 8163

2L O726

39 888

,d^$

Sub - to ta13

18 8163

2l o726

39 888

Component,r/^

$

L 377985 376

2 9072 3L8 994

3 3602 863 053

7 6446 167 423

OCP82 .3Page 69

TABLE 8. ESTIMATED COSTS FOR THE FIRST THREE YEARS OF THE

WESTERN EXTENSION IN THE PHASE I AND II ZONES (continued)

Category Year 1 Year 2 Year 3 To ta1

4. Professional tra1n1nq

Entomology ,r/^$

"/^$

,"/^$

Epidemiology

Ilydrobiology

6

6 400

6

6 400

L212 800

6

7 000

6

7 000

L214 000

t213 400

L213 400

2426 800

,"/^$

Sub-tota124

25 60024

28 00048

53 600

5. Technical trainin

EnEomology */^$

,'r/^$

^/^$

Epidemiology

Hydrobiology

6

tL 664

5

9 720

47 776

3

6 402

5

lo 670

2

4 268

9

18 066

1020 390

6

L2 044

*/^$

Sub - to tal 1529 L60

102L 340

25

50 500

*/^$

Component39

54 76034

49 34073

104 100

6. Aerial operations

6.1 Non-spraying: $

6.2 Spraying:

Phase I, helicopters $

Phase I, aeroplanes $

27 600 46 000 46 000

828 000

350 000

119 600

828 000

350 000

Sub-tota1 $ 27 600 46 000 L 224 000 L 297 600

7. Insecticides

7.1 Larvicides:

Phase I: Litres$

Li Ere s

$

$

Phase II

7.2 Experimental

130 0001 170 000

5 000

135 000I 309 500

39 000378 300

7 200

2 479 500

378 300

L2 200

Sub -tota1 $ I 175 000 1 695 000 2 870 000

8. Hydrobiology contract $ 150 000 300 000 150 000 600 000

ocP82.3Page 70

TABLE 8. ESTIMATED COSTS FOR THE FIRST THREE YEARS OF THEWESTERN ExrENsroN rN THE PHASE r AND rr zoNES (continued)

Category Year 1 Year 2 Year 3 Total

$9. Applied research 10 000 5 000 15 000

Component $ L77 600 1 531 000 3 074 000 4 782 600

10. Operational travel $ 195 000 346 000 385 000 926 000

11. Operations andmalntenance $ 295 000 482 000 570 000 1 347 000

Component $ 490 000 828 000 955 000 2 273 000

12. Buildings:

Aircraft hangar

Helipad facilitiesSectors and subsectors

$

$

$

20 000

3 000

35 000

26 000

4 000

40 000

2 000

13 000

46 000

9 000

88 000

Sub - to tal $ 58 000 70 000 15 000 143 000

$13. Furniture 9 000 17 000 6 000 32 000

Others (lorries, pickups,vannettes etc. )

Moby Ie t tes

No.$

No.$

No.$

No.

$

$

No.$

Large 4WD

14. Vehicles

Eye laboratory

Spare parts

Boats

15

4L2 905

54 000

57L 520

30

5 L84

I

40

6

24 000

5 000

118 916

277 758

4

18

6

5 184

10 000

32 LO7

L6 665

1

1

2

1 866

15 000

20563 928

54 000

59865 943

38

5 184

1

6

31 050

30 000

Sub-tota1 $ L O72 609 411 858 65 638 I 550 105

{

15. Equipment

Radlo stations

Diesel generators

Petrol generators

Water pumps

No.$

No.

$

No.

$

No.

$

$

7

4

36 000

33 L52

7

4

8

4

8

4

36 000

33 L52

2 458

3 763

16 000

2 458

3 763

8 000Hydrological 4 000 4 000

ocP82.3Page 71

TABLE 8. ESTIMATED COSTS FOR THE FIRST THREE YEARS OF THEWESTERN EXTENSION IN THE PHASE I AND II ZONES (continued)

Category Year 1 Year 2 Year 3 Total

Laboratory

Camping

Electrical fittingsMisc. smal1 items

$

$

$

$

25 000

6 000

1 000

5 000

10 000

3 000

500

3 000

12 000

2 000

300

2 000

47 000

11 000

1 800

10 000

Sub - to tal $ 110 152 30 72L 20 300 L6t L73

Component $ L 249 76t 529 579 106 938 | 886 278

TOTAL $ 2 9s7 497 s 256 9L3 6 998 99L L5 2L3 40L

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EXPLANATORY NOTES ON THE BIO-CLIMATIC ZONES (I'{AP 2)

I

II

III

IV

VI

Name

Sahel savanna

Sudan savanna

Northern Guinea savanna

Southern Guinea savanna

Forest-savanna Mozaic

Descript ion

Wooded steppe with abundant Acacia andConrniphora

Dry savanna woodlands

Savanna \^Toodlands with abundantIsoberl inia

Moist savanna woodlands

Derived savanna, i.e. savanna derivedfrom forest

v

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EXPLANATORY NOTES ON THE l,llNERAL DEPOSTTS (MAP 6)

Abbreviation Description

Aluminium deposits (Bauxite)

Alluvial gold

Chromite

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Diamonds

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Limestone and marble

Lead

A1

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D

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