The 2nd meeting of the EMR Alliance for Trachoma Control 26th - 27th April 2014 in Addis Ababa, Ethiopia

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1 Kingdom of Morocco Ministery of Health Epidemiology and Disease Control Directorate المملكة المغربية وزارة الصحة مديرية علم األوبئة و محاربة األمراض The 2nd meeting of the EMR Alliance for Trachoma Control 26th - 27th April 2014 in Addis Ababa, Ethiopia Surveillance system of trachoma in the Kingdom of Morocco Dr Jaouad HAMMOU Head of Eye and Otological Diseases National Blindness Control Program Ministry of Health

2 Situation in early 1990 Extent of known problem endemic blinding trachoma in five provinces in South Eastern Morocco: Prevalence of active trachoma in children under 10 years ranged between 6% in Figuig and 70% in Zagora. Trichiasis prevalence ranges from 1% in Tata and 3% in Zagora. 0.8% had visual impairment from trachoma. Population : (5,3%) Figuig : 54% Nomad Zagora : 87% Rural Aerea : km² (31%) Villages/localitis : 1866

3 Elimination of blinding trachoma in the South East of Morocco Step 1 : Implementation SAFE stratégy Step 3 : Process of elimination Step 4 : Post- certification Step 2 : Action Plan (Consolidation + SSE) Reached UIG Zagora Errachidia Tata Ouarzazate Figuig

4 Epidemiological surveillance system Sentinel Surveillance (SS): Trachoma Follicular ACTIVE PASSIVE Exhaustive screening (ES): Trichiasis Surveys and studies: Community Survey March 2009 Investigations around cases

5 Epidemiological surveillance Follicular Trachoma (TF): SS active and SS passive 2 crossing (October / March) Investigations around the case Gradually (child and his school friends and neighbors at home) Declaration of negative cases Exhaustive Screening (TT): Door to door 1 pass / year Notify incident cases Monitoring - evaluation: National Technical Committee Committee of experts Study / survey School children: Preschool First 3 years of Primary School Children not in school: Primary Health Care (medical visit) Systematic screening If child TF: TT child or/and TT family All villages / localities 5 provinces: 1866 The passage can: Identify incident cases Control of surgical patients Awareness cases who refuse surgery identify cases of refusal (after 3 reminders and before a witness) Meetings CTNT Experts Committee - February September 2010 Supervision Community Survey - March 2009

6 Organization of epidemiological surveillance at Community level District Locality/ Village PHC (1 à <3 years) Preschool (3 à <5 years) School (5 à 9 years) Passive screening Active screening Epidemiological investigation School Family Locality Community Therapeutic decision

7 Data collection Registry data collection. Individual record of a case of follicular trachoma. Sheet epidemiological investigation on a case. Half-yearly rapport.

8 Registry data collection TF N d ordre commune localité Nom et Prénom Age Sexe Type de dépistage diagnostic Date de diagnostic TTT Reçu

9 Individual record of the investigation about a case TF Province :. Circ.Sanitaire : Date :.. Commune :.. Localité :.. N maison : # habitants dans la localité :. # habitants maison : Nom et Prénom du malade : N d ordre (du registre) : Age : Sexe : Nom/Prénom Age S e x e DIAGNOSTIC Traitement Refus ou Absent Azithromycine Œil Droit Œil Gauche Pde 1% TT CO TF TI TS TT CO TF TI TS Susp. Cp. Nombre Visage propre Lavage des mains Existence eau : oui /_/ Non /_/ Existence latrine : oui /_/ Non /_/ Utilisation : Oui /_/ Non /_/ Déchet liquide/solide : Ecole oui /_/ Non /_/ Maison Oui /_/ Non /_/ Localité Oui /_/ Non /_/

10 Exhaustive screening TT Door to door exhaustive list Targeted actions Have an additional information Register for reporting cases of TT Notification register of refusals

11 Register case reporting TT

12 Notification register of refusals Province : Code province :/ / / Formation sanitaire:. Diagnosis Witnesses people Number and date of relfation name / first name Age Sex Adress Doctor Health worker Family member (to clarify) Orthers (to clarify) 1 2 3

13 Model report

14 Evaluation Epidemiological Surveillance System of blinding trachoma 1st Evaluation meeting ESS 26 et 27 february 2008 in Rabat 2 nd Evaluation meeting ESS 28 et 29 september 2010 in Rabat

15 Conclusions of the Experts Committee Roadmap

16 Community Study Certification Make sure that blinding trachoma is not a public health problem at the most disadvantaged population in the communities of the five target provinces. Assess the epidemiological surveillance system

17 % of cases of TF detected by the system of SS in children 1-9 years by province, year and passing UNDER 2,5% Epidemiological Surveillance Errachidia Figuig Ouarzazate Tata Zagora Community Survey - March 2009

18 Commentary Coverage rate of the population aged 1 to 9 examined more than 90% + rotation system between the villages Positivity rate among the population aged 1 to 9 <2.5% at the community level in each province Each case of TF: Treatment case + environment investigation Epidemiological investigation Absence rates in schools varied between 0.4% and 0.8% Declaration of negative cases NEGATIVE case

19 Trichiasis surgery New cases Reached UIG

20 Documentation of the Moroccan experience Recommandation of the 13 ème GET 2020 : The World Health Organization will support the countries of Morocco, Oman and Ghana to analyze and draw lessons learned from their programs against trachoma.

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