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
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 : 1 600 000 (5,3%) Figuig : 54% Nomad Zagora : 87% Rural Aerea : 219 154 km² (31%) Villages/localitis : 1866
Elimination of blinding trachoma in the South East of Morocco 80 70 Step 1 : Implementation SAFE stratégy 60 50 Step 3 : Process of elimination Step 4 : Post- certification 40 30 20 Step 2 : Action Plan (Consolidation + SSE) 2006-2009 Reached UIG 10 0 1997 1999 2001 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Zagora Errachidia Tata Ouarzazate Figuig
Epidemiological surveillance system Sentinel Surveillance (SS): Trachoma Follicular ACTIVE PASSIVE Exhaustive screening (ES): Trichiasis Surveys and studies: Community Survey March 2009 Investigations around cases
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 2008 - September 2010 Supervision Community Survey - March 2009
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
Data collection Registry data collection. Individual record of a case of follicular trachoma. Sheet epidemiological investigation on a case. Half-yearly rapport.
Registry data collection TF N d ordre commune localité Nom et Prénom Age Sexe Type de dépistage diagnostic Date de diagnostic TTT Reçu
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 /_/
Exhaustive screening TT Door to door exhaustive list Targeted actions Have an additional information Register for reporting cases of TT Notification register of refusals
Register case reporting TT
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
Model report
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
Conclusions of the Experts Committee Roadmap
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
% of cases of TF detected by the system of SS in children 1-9 years by province, year and passing 5 4.5 4 3.5 UNDER 2,5% 3 2.5 2 1.5 1 0.5 0 2007 2008 2009 2010 2011 2012 2013 2009 Epidemiological Surveillance Errachidia Figuig Ouarzazate Tata Zagora Community Survey - March 2009
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
Trichiasis surgery 10000 7944 5000 3840 4557 5383 5420 6409 New cases 3134 2964 0 340 480 642 2376 2017 2394 Reached UIG 469 1122 522 656 590 158 115 120
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.