Dracunculiasis, also known as guinea worm disease, is caused by the large female of the nematode Dracunculus medinensis, which emerges painfully and slowly from the skin, usually on the lower limbs. The disease can infect animals, and sustainable animal cycles occur in North America and Central Asia but do not act as reservoirs of human infection. The disease is endemic across the Sahel belt of Africa from Mauritania to Ethiopia, having been eliminated from Asia and some African countries. It has a significant socioeconomic impact because of the temporary disability that it causes. Dracunculiasis is exclusively caught from drinking water, usually from ponds. A campaign to eradicate the disease was launched in the 1980s and has made significant progress. The strategy of the campaign is discussed, including water supply, health education, case management, and vector control. Current issues including the integration of the campaign into primary health care and the mapping of cases by using geographic information systems are also considered. Finally, some lessons for other disease control and eradication programs are outlined.

Dracunculiasis (Guinea Worm Disease) and the Eradication Initiative

Since the seminal review by Ralph Muller about Dracunculus and dracunculiasis in this serial publication in 1971, the Centers for Disease Control and Prevention and The Carter Center forged, during the 1980s, a coalition of organizations to support a campaign to eradicate dracunculiasis. Eighteen of 20 countries were known in 1986 to have endemic dracunculiasis, i.e., Benin, Burkina Faso, Cameroon, Chad, Cote d’Ivoire, Ethiopia, Ghana, India, Kenya, Mali, Mauritania, Niger, Nigeria, Pakistan, Senegal, Sudan, Togo, and Uganda. Transmission of the disease in Yemen was documented in 1995, and the World Health Organization (WHO) declared Central African Republic endemic in 1995. As of the end of 2004, a total of 16 026 cases of dracunculiasis were reported from 12 endemic countries (91% of these cases were reported from Ghana and Sudan, combined), a reduction greater than 99% from the 3.5 million cases of dracunculiasis estimated in 1986 to occur annually; the number of endemic villages has been reduced by >91%, from the 23 475 endemic villages in 1991; disease transmission has been interrupted in 9 of the 20 endemic countries; and WHO has certified 168 countries free of dracunculiasis, including Pakistan (1996), India (2000), Senegal and Yemen (2004). Asia is now free of dracunculiasis. “ The public interest requires doing today those things that men of intelligence and good will would wish, five or ten years hence, had been done ” Edmund Burke

Dracunculiasis (Guinea worm disease) eradication.

Neglected tropical diseases: equity and social determinants.

Community participation in the eradication of guinea worm disease.

The impact of health education to promote cloth filters on dracunculiasis prevalence in the Northern Region, Ghana

This paper describes a study carried out in a rural area of Ghana on the drinking water sources and other determinants of dracunculiasis (guinea worm disease). The results confirm the association between water source choice and the prevalence of the disease. A logistic regression model was used to show the combined effect of several behavioural, biological, and environmental risk factors. The important behavioural factors were related to the head of household, fetching of water, travelling, and farming. Age was found to be an important biological risk factor for dracunculiasis, but the greatest relative risk applied to those who had suffered from guinea worm disease in the previous year. Although males were significantly more infected than females when analysing the raw data, sex did not prove to be a significant risk factor in this model. Village of residence was an important environmental risk factor for dracunculiasis. Factors related to socio-economic status were not associated with the risk of infection. The paper concludes by presenting the policy implications of the study findings.

G. H. Maude

Papers

Water sources and other determinants of dracunculiasis in the Northern Region of Ghana