Peter Mark Jourdan, MD PhD - World Health Organization · Peter Mark Jourdan, MD PhD Sylvia...
Transcript of Peter Mark Jourdan, MD PhD - World Health Organization · Peter Mark Jourdan, MD PhD Sylvia...
The control of cysticercosis in Madagascar
Peter Mark Jourdan, MD PhD
Sylvia Noromanana Ramiandrisoa, MD
Samuel Hermas Andrianarisoa, MD
Wendy Harrison, BVetMed MPH PhD
Stakeholder meeting on T. solium taeniasis/cysticercosis diagnostic tools
WHO Geneva, 17-18 December 2015
Contents
• Country overview
• Survey design
• Scientific skills base
• Diagnostic challenges
• Logistical challenges
• Targets and opportunities
• Key points
One health in Madagascar
Humans:
• 60% have access to basic health care
• 12% have access to sanitation facilities
Pigs:
• 1.4 million pigs, mostly smallholder farms
• Cysticercosis-infected pigs -50% in value
• Limited access to veterinary services
World Bank, 2015 WHO Madagascar, 2015
Photo: P Jourdan/SCI 2015
Cysticercosis and schistosomiasis in Madagascar
• Scarce data: prevalence range 7-21% (human cysticercosis)
• MDA of PZQ to children in schistosomiasis-endemic areas
Rasamoelina-Andriamanivo, 2013 MOH/SCI Madagascar, 2015
Survey design
T. solium prevalence survey Stool microscopy; CoproAg
n = 950
Humans Pigs
Social mobilisation, PZQ distribution n = 75,668
Cysticercosis prevalence survey ELISA (Western blot)
n = 900
T. solium prevalence survey Stool microscopy; CoproAg
n = 950
Cysticercosis prevalence data ELISA (Western blot)
n = 900
Antanifotsy
Scientific skills base
Central level
Regional level
District level
Peripheral level
Planning
Commune level
Implementation M&E
Public health programmes vs research
Other NTDs
Veterinary vs human health
Other IDs
Photo: P Jourdan/SCI 2015
Diagnostic challenges
• Only central, costly laboratory for diagnosis of NCC in humans;
• Certain taboos regarding human stool collection;
• No standardisation of diagnosis of cysticercosis in humans and pigs;
• Lack of field-friendly, highly sens/spec tests in humans and pigs;
• Integration of data collection with other NTD surveys.
Logistical challenges
• Poor infrastructure;
• Varying accessibility due to rains;
• Vast distances;
• Limited cellular network;
• Limited financial resources.
Photo: P Jourdan/SCI 2015
Targets and opportunities
• Eliminate human taeniasis (from the district of Antanifotsy);
• Integration with other NTD control programmes (schistosomiasis) • Appropriate diagnostic tools?
• Different MDA thresholds?
• Cost-effective intervention?
Key points
• Cysticercosis is a one health problem in Madagascar;
• Data collection, including diagnostics still cumbersome;
• Evidence needed to inform programme development;
• Growing opportunities for integration with other NTD PC programmes
Acknowledgments
• Service de Lutte contre les Maladies Endémiques et Négligées (SLMEN), Ministry of Public Health, Madagascar;
• Health district of Antanifotsy;
• World Health Organization (WHO);
• Schistosomiasis Control Initiative (SCI), Imperial College London
Thank you for your attention
Photo: P Jourdan/SCI 2015