International Notes Update: Dracunculiasis Eradication -- Ghana and Nigeria, 1990

Dracunculiasis (guinea worm disease) is a disabling infection that each year affects an estimated 5 million persons in 17 African countries and parts of India and Pakistan (1-3). This disease is contracted only by persons who drink water contaminated by tiny copepods containing larval stages of the parasite Dracunculus medinensis. The infection can be prevented by providing safe sources of drinking water, teaching populations at risk to boil water or filter it through a fine cloth, or treating the water with temephos (Abate*). Efforts to eradicate dracunculiasis began in 1981, immediately before the start of the International Drinking Water Supply and Sanitation Decade. This report summarizes the progress of guinea worm eradication programs (GWEPs) in Ghana and Nigeria.

Ghana and Nigeria established GWEPs in December 1987 and May 1988, respectively. Of the 17 countries in Africa with endemic dracunculiasis, Ghana and Nigeria have the highest known prevalences of the disease. During the mid-1980s, Ghana and Nigeria each reported approximately 4000 cases of the disease to the World Health Organization (WHO) annually, based on passive reporting. In 1991, both countries began using a system of monthly reporting of dracunculiasis cases by trained villagers who reside in the communities where the disease is endemic. From their inception, the GWEPs in Ghana and Nigeria have emphasized health education, use of cloth filters, and improvements in rural water supplies as the main interventions against dracunculiasis.

The Ghanaian and Nigerian GWEPs set December 1993 and December 1995, respectively, as target dates for eradicating dracunculiasis. These national programs are assisted by the Global 2000 Project of the Carter Center, Inc.; the WHO Collaborating Center for Research, Training, and Eradication of Dracunculiasis at CDC; the United Nations Children's Fund Lagos Office (Nigeria); the U.S. Agency for International Development (Ghana); and the Japanese International Cooperation Agency. Ghana

In June 1988, the Ghanaian head of state made a highly publicized tour of 21 villages with endemic dracunculiasis and instructed inhabitants about the disease and about the proper use of cloth filters. In late 1989, the first national village-by-village search by the Ghanaian GWEP identified 179,483 cases of dracunculiasis in 6515 villages (Figure 1). The search included 19,759 villages (92% of all villages in the country).

In late 1990, Ghana used trained village health workers to conduct house-to-house case counts in all villages known to have endemic dracunculiasis. Endemic dracunculiasis was detected in 351 villages that had not reported any cases in 1989. Nonetheless, for 1990, the provisional number of villages with endemic dracunculiasis declined to 4768, 26.9% fewer than in 1989. The provisional number of cases for 1990 was 117,034, a reduction of 34.8% (Figure 1). Nigeria

The Nigerian GWEP has given priority to a nationwide village-by-village search for cases to ascertain the extent and distribution of dracunculiasis. The first search was conducted from August 1988 through March 1989 (in individual states the village-by-village search lasted 1-3 weeks). In 5879 villages with endemic dracunculiasis, 653,620 cases were identified for July 1987-June 1988 (reported for 1988) (Figure 1). This search, which covered an estimated 80% of the 90,000 villages in Nigeria, was limited by inadequate transportation and lack of access during the rainy season. The second national search identified 640,008 cases in 5932 villages with endemic dracunculiasis for July 1988-June 1989 (reported for 1989) (Figure 1). Together, these two searches covered an estimated 90% of Nigeria's rural population. In March 1989, the Nigerian government announced that it would give priority to dracunculiasis-affected villages in all nationally or externally funded rural water supply projects.

The third and latest search, conducted during October 1990-March 1991, was limited to those villages known to have endemic dracunculiasis; virtually all such villages were visited. This search, which also included health education about dracunculiasis in many villages with endemic disease, identified a provisional 394,082 cases in 5238 villages for July 1989-June 1990, a 38.4% reduction in cases from the previous year (Figure 1). Reported by: Ministry of Health, Ghana. Federal Ministry of Health, Nigeria. Global 2000, Inc, Emory Univ Carter Center, Inc, Atlanta, Georgia. WHO Collaborating Center for Research, Training, and Eradication of Dracunculiasis. Div of Parasitic Diseases, Center for Infectious Diseases, CDC.

Editorial Note

Editorial Note:

This report summarizes the first evidence of a substantial decline in dracunculiasis in Africa since the international eradication campaign began in the early 1980s. The dramatic reduction in the number of cases identified in Ghana and Nigeria probably resulted from increased public awareness, health education efforts, and targeted rural water supply measures. Temephos has been used only in limited areas within both countries. The experience gained from the programs in Ghana and Nigeria and from the eradication effort in Pakistan (4) should benefit other African countries that are beginning eradication efforts.

Information from programs in Ghana and Nigeria, together with the imminent eradication of the disease in India and Pakistan and identification of a provisional total of approximately 40,000 cases during the first national search for cases in Burkina Faso (the only other country where the disease occurs nationwide), provides strong encouragement to other countries with endemic dracunculiasis. In 1986, the World Health Assembly (WHA) chose dracunculiasis as the next disease to be eradicated after smallpox; in 1989, WHA adopted a goal of dracunculiasis eradication during the 1990s. However, in 1988, the African Ministers of Health had resolved to eradicate the disease from that continent by 1995. The progress in reducing the incidence of dracunculiasis in Ghana and Nigeria, the two countries with the highest known prevalences in Africa, supports the goal of dracunculiasis eradication by 1995.

References

1. CDC. Update: dracunculiasis eradication--worldwide, 1989. MMWR 1990;38:882-5.

2. CDC. International Task Force for Disease Eradication. MMWR 1990;39:209-12,217.

3. Hopkins DR, Ruiz-Tiben E. Dracunculiasis eradication: target 1995. Am J Trop Med Hyg 1990;43:296-300.

4. CDC. Update: dracunculiasis eradication--Pakistan, 1990. MMWR 1991;40:5-7.

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