Case Scenario 06

Combating a hidden threat: cystic echinococcosis in Morocco

In Morocco, high prevalence rates of cystic echinococcosis (CE) have been reported both in the definitive and in the intermediate hosts, including humans. Comparable prevalence rates have been reported in other countries of North Africa and in the Middle East. To date, there has not been any programme to control this zoonotic disease in the region. However, there are considerable barriers to the designing and implementation of a control programme, not just the lack of human and financial resources but also a failure to prioritize and a lack of awareness of the magnitude of the losses associated with the disease. Conducting robust field trials is also difficult.

To deal with these problems, firstly, data from sporadic prevalence surveys was compiled, showing alarming prevalence figures: rates of 56% in stray dogs and 80% in cattle and 26% in sheep in convenience samples taken at abattoirs – while in the human population the overall prevalence was 1%, rising to 14% in children aged one to 15 years. A programme of sensitization of relevant government departments and holding workshops followed, with the creation of an inter-sectoral commission for zoonoses control and involvement of international organizations and pharmaceutical companies.

A pilot control programme was then implemented based on: health education; control and treatment of dog populations; abattoir upgrading, prevalence surveys, inspection and regulation; ultrasound surveys, treatment of infected people and public education. Surveys of knowledge, attitude and practices (KAP) and the cost of the disease were also conducted.

The programme included a number of unique and novel features. It targeted dogs for more than one disease by making use of the existing rabies control programme. It used novel health education methods, such as plays and meetings to target diverse audiences and ultrasound surveys as an opportunity for public education. Non-invasive treatments were promoted, to reduce the costs and trauma associated with surgery.

This pilot programme has had a considerable impact on the affected populations, the local authorities and the health and agricultural structures, both at the regional and central level. It has made it possible to establish the protocol for a control programme and thus paved the way for control on a larger scale. It was successful in attracting and combining local and international sources of funding and fostering collaboration between veterinarians and physicians. There is a strong need to implement a control programme at the national level and this will make a more significant impact on the whole country. Meanwhile, the lessons learnt will be of great relevance to other countries in the region in dealing with their problem of CE.