100 years of living science Date Location of Event Annual Board Meeting 27 th June 2013 Donor supported programmes Dr Giuseppina Ortu SCI Programme Manager (francophone countries)

SCI programmes Rwanda Senegal Burundi Mauritania

Year : Gaps & needs SCI contribution in year 2012 – 2013 Current needs / current situation Next steps / SCI support for year OUTLINE TreatmentTreatment Disease mappingDisease mapping M&EM&E Surveillance & Schistosomiasis eliminationSurveillance & Schistosomiasis elimination Capacity buildingCapacity building Donor supported programmes Activities

BURUNDI Year Gaps & needs  PZQ and ALB treatments at national level  PZQ treatment of adults in some areas  Drug coverage surveys for validation of MoH reported treatment  Analysis of disease mapping needs  Capacity building and training needs

Treatments in BURUNDI ActivityDetails month/year performed Reached population % Drug coverage National Mass Drug Administration PZQ - School Age Children Jun ,889104% (tbc) ALB - age 1-14 years3,940,280108% ALB - women123,11544% ALB - age 1-14 years Jan-13 3,977,190109% (tbc) ALB - women 128,45544% (tbc) PZQ treatment of adults in some areas Sep-Nov 12279,405 ( tbc) On-going MDA for the administration of ALB to children and mothers June PZQ administration postponed to Dec 2013 (PZQ tablets not available) BURUNDI / SCI contribution / treatments

National drug coverage survey Why do we need this survey? To validate the number of people treated for worm infections reported by the MoH In Burundi:  PZQ and ALB coverage survey was integrated with vaccination and vitamin coverage surveys to validate the campaign performed in June 2012  Organized in collaboration with: - EPI (Expanded Programme of Immunization) - MoH - ISTEEBU (Inst. of Statistics in Burundi)  Over people were interviewed on PZQ and ALB treatment treated individuals total population requiring treatment Drug coverage = BURUNDI / SCI contribution / surveys

QuestionMean in % School attendance68.7% Time to reach distribution siteMore than 1 hour = 13% Children that swallowed ALB98% Children that swallowed PZQ97.8% Site where children received drugs Schools = 53.2 % Health centre = 36.8% Women pregnant during MDA11.8% Pregnant women participating to MDA84.3% Reason for not participatingToo sick = 34.7%/ Not informed = 23.8% Pregnant women that took ALB96% Major reasons for women not to take treatmentDrug not available (39%)/ Too sick (16.1%)  Coverage by commune for PZQ – (important information for drug coverage calculation)  Place of PZQ and ALB distribution for children between 5 and 14 years  ALB coverage in women – the results are very different from those reported by the MoH! Further analysis will be done to assess: EPI coverage survey report /preliminary results: BURUNDI / SCI contribution / surveys

Risk map/SCH (2007) Risk map/SCH (2011) BURUNDI / SCI contribution/ risk maps Note range of prevalence

BURUNDI – Current needs & next steps Schistosomiasis/STH  Ensure delivery of PZQ in those communes where schistosomiasis is present, but have never received PZQ  Continuous support for PZQ and ALB treatment for the next 2-3 years  Re-evaluation of schistosomiasis in areas where more detailed information is needed Drug Coverage Survey: Further analysis to assess PZQ coverage Capacity building Support of a PhD student on Evaluation of health centre capacity in rural areas in detection and management of schistosomiasis cases (project already started) Creation of an NTD laboratory reference in Bujumbura? Surveillance & Schistosomiasis elimination SCORE project ? Current situation  New funding in place for years from a private donor  A new contract between SCI and the MoH will be signed in the next few weeks  A Programme Manager will be hired for the coordination of activities in Burundi

NkomboIsland STH: endemic in the whole country Rwanda Mapping of schistosomiasis (2008) Year Gaps & needs The MoU between the MoH and SCI was not signed A Programme Manager was needed in the country because of lack of human resources at the MoH The country needed a comprehensive evaluation of what was done on prevention and control of NTDs to understand the current gaps and needs Impact survey in 5 districts NTDs situation analysis

Dec 2007 May moLactating womenSAC (5-16) ADULTS (>16) Treated MBZ % Cov. Treated ALB % Cov. Treated ALB % Cov Treated PZQ Treated ALB/MBZ/ PZQ Total treated & Min Max coverage 10,102k k ,332k k251k RWANDA – SCI contribution/ Situation analysis  Not all districts at risk of schistosomiasis infection were systematically treated every year  It is not possible to calculate PZQ coverage  Not all SAC at risk of infection received the requested treatment  Adult treatment was not done every year

Year 2012 Schistosomiasis450 Hookworms14,751 Ascarisis117,613 Trichiuriasis12,151 Schistosomiasis and STH: Impact surveys in 5 districts: positive impact of PZQ treatment (schistosomiasis is now below 10% in those schools where annual surveys were done), but 1.5 million of people still at risk of SCH infection Outbreak in the Nkombo Island (2011): 62.1 [ ] % of the population assessed (n=311) was infected with schistosomiasis – this disease is focal and foci can be missed! The whole country is still at risk of STH infection as intensity of Ascaris has not decreased as expected in school aged children Cases of worm infection reported by the health centres in year 2012 RWANDA – SCI contribution/ Situation analysis

Trachoma In 2 districts of Gatsibo and Nyaruguru - no intervention was initiated Lack of awareness of this infection and capacity for diagnosis Lymphatic filariasis and podoconiosis LF not a public health problem Risk of LF introduction because of cross-border immigrations (from DRC) Non-filarial elephantiasis still exist - no care provided to the affected individuals Human African trypanosomiasis Endemic areas along Akagera National Park Lack of knowledge and understanding on how to detect cases RWANDA – SCI contribution/ Situation analysis

MDAsSchistosomiasis Improve drug administration coverage Ensure treatment in 38 sectors within 9 Districts at risk of infection > next MDA in August 2013 STH STH Continue drug administration as done before in the whole country Schistosomiasis Mapping Remap districts where as per mapping done in 2008, were cases were reported in areas not targeted for schistosomiasis treatment > planned for end of the year 2013 M&E and Surveillance Consider to increase surveillance capacity for worm infections, trachoma, LF, and HAT RWANDA – Current situation & Next steps Current situation  MoU between SCI and MoH has been signed  END Fund has pledged support for Rwanda for the next 3 years  A Programme Manager in place at the MoH

SENEGAL Year Gaps & needs Epidemiological on schistosomiasis and STH was missing in many districts and mapping was required Reassessment of areas at risk of infection in the whole country and possibly, re- evaluation of the treatment strategies, were also needed

Mapping of schistosomiasis in 21 districts Senegal - SCI contribution / Mapping Data collected in the field is currently under evaluation

Senegal – Current situation & next steps Country risk maps Review all cases of schistosomiasis and investigate the areas where found Create geo spatial risk maps for schistosomiasis for the whole country to clarify the endemic areas in the country and reassess the treatment strategyMDAs SCHISTOSOMIASIS PZQ distribution will continue to be supported by Child Fund, and in part by SCI when possible and in those districts currently mapped and at risk of infection, if anyM&E A) impact of mass drug treatment: impact surveys Assessment in 22 schools in the whole country every year for 4 years is needed (The protocol has not been developed as the mapping data has not been analysed yet. Estimated budget: $50k/year) B) Analysis of snails and schisto hybrids in some schools – WHY? Current situation SCI has extended the agreement with the MoH for another year

Based on the following study: Research done by Natural History Museum /Imperial College cercariae from infected B. globosus (host of human schistosomiasis) and B. truncatus (host of bovine schistosomiasis) miracidia from human urine samples Results: 1) Host switching! B. truncatus snails are shedding S. haematobium cercariae. >>> increase of transmission of S haematobium >>> increase of disease prevalence S. haematobium/S. bovis hybrid 2) Miracidia from one patient found to be S. haematobium/S. bovis hybrid M&E SCI is planning to include in a few schools cercariae and miracidia genotype assessments SCI is currently looking for funds to support this project in Senegal Senegal – Current situation & next steps

Mauritania Population 3,340,627 OMVS Mapping 2010 MDAs OMVS Gaps and needs Both S. haematobium and S. mansoni are present in the country 900,000 SAC at risk of infection ~ 200,000 SAC & 80,000 adults in 13 districts treated by OMVS twice. However, for year 2013, the OMVS have not made available financial support for PZQ distribution Need for training of nurses in decentralized health centres Oasis OMVS = ORGANISATION POUR LA MISE EN VALEUR DU FLEUVE SENEGAL

Mauritania – Current situation and next steps Next steps Considering that:  The MoH needs to improve the PZQ delivery system (= villages as implementing units instead of entire districts)  Although cases of schistosomiasis were frequently reported in oases, a systematic mapping of schistosomiasis was never done  The OMVS support will be available in year 2014 again; however only for MDA in the Senegal river basin Current situation  SCI offered support for delivering PZQ in these areas plus 8 oases where schistosomiasis has been reported (between 20 and 80% prevalence)  Support has been made available also for training nurses on NTDs

Schistosomiasis mapping in oasis The mapping of all the oasis currently inhabited has been considered (possibly 29 oasis?) Schistosomiasis elimination The specific ecosystem and the limited environment of an oases could make elimination of schistosomiasis feasible in some of these oasis Proposals and Budgets A proposal and budget for mapping of these oasis and for one treatment of the estimated affected population are under evaluation ($USA 150 – 200K) (This protocol includes also snail evaluation) A proposal and a budget for elimination of schistosomiasis in oases is under development SCI is currently looking for funds to support this project in Mauritania Mauritania – Current situation and next steps

THANK YOU FOR YOUR ATTENTION AND YOUR SUPPORT