Update: Dracunculiasis Eradication -- Mali and Niger, 1993

Mali and Niger, countries in West Africa, ranked sixth and eighth in the number of reported cases of dracunculiasis (i.e., Guinea worm disease) in 1992 (1). In March 1993, Global 2000, Inc., and the World Health Organization (WHO) Collaborating Center for Research, Training, and Eradication of Dracunculiasis at CDC began providing direct assistance for the eradication of dracunculiasis in both countries by assigning a resident public health advisor to each country. This report summarizes surveillance data for the two countries during 1991-1993 and describes their progress toward eradication of dracunculiasis. Mali

In 1990, Mali (population: 8.5 million) reported 884 cases of dracunculiasis to WHO (1). During that year, health officials in Mali initiated a pilot project to control dracunculiasis in 68 villages with endemic disease within Douentza District of Mopti Region. This effort employed trained village-based health workers to conduct health education, undertake active surveillance, and distribute nylon cloth to families for filtering drinking water.

From December 1991 through March 1992, national village-by-village searches for cases detected 16,060 cases of dracunculiasis in 1264 villages in five of seven regions of the country (Table_1). Approximately 95% of cases were enumerated in two regions (Mopti and Kayes). By December 1993, Mali's Guinea Worm Eradication Program (GWEP) had trained one village-based health worker in each of 1100 (87%) villages with endemic dracunculiasis and had begun monthly reporting of cases from 433 (34%) such villages. In addition, health education had been initiated in 68% of villages with endemic disease in Mali and use of cloth filters in 34%; improved water supplies already existed or were scheduled to be available by 1994 in 60%. A provisional total of 5779 cases was reported for 1993. Niger

In 1989 (the most recent year for which passive data were available), Niger (population: 8 million) reported 288 cases of dracunculiasis to WHO. In 1991, the Ministry of Health initiated a pilot project to control dracunculiasis in Boubon, Niger (population: approximately 4500), a village in which 2700 cases had been reported that year. Elements of this project included trained village-based health workers, health education, improved water supplies, and use of nylon filters. By 1993, the incidence of dracunculiasis in Boubon had declined to 108 cases.

From October through November 1991, national village-by-village searches detected 32,831 cases of dracunculiasis in 1690 villages. Nearly two thirds of persons with dracunculiasis (21,057) resided in Zinder, one of the country's seven departments; of these, 85% resided in one district (Mirriah).

By December 1993, Niger's GWEP had initiated at least one intervention in 928 (55%) villages with endemic dracunculiasis and had trained health workers for dracunculiasis eradication activities at national, regional, and district levels and in 298 (18%) villages with endemic disease. In addition, health education had been initiated in 49% of villages with endemic disease in Niger and use of cloth filters in 31%; improved water supplies already existed or were scheduled to be available by 1994 in 63%. Completion of training of village-based health workers for all villages in Niger with endemic disease is projected in early 1994. Niger has not yet begun monthly reporting of cases but has recorded a provisional total of 16,231 cases for 1993. Reported by: AT Toure, President, National Intersectorial Committee for Dracunculiasis Eradication; I Degoga, MD, National Program Coordinator, Guinea Worm Eradication Program, Ministry of Public Health, Mali. S Moussa, National Program Coordinator, Guinea Worm Eradication Program, Ministry of Public Health, Niger. Global 2000, Inc, The Carter Center, Atlanta. World Health Organization Collaborating Center for Research, Training, and Eradication of Dracunculiasis, Div of Parasitic Diseases, National Center for Infectious Diseases, CDC.

Editorial Note

Editorial Note: Mali and Niger are part of the core area of West Africa where dracunculiasis is endemic. Although Mali and Niger joined the campaign to eradicate dracunculiasis when fewer than 3 years remained until the target date for eradication (December 1995), both countries were successful in rapidly establishing GWEPs. However, implementation of the interventions described in this report (i.e., health education, cloth filters, and improved supplies of safe drinking water) will probably be insufficient alone to eradicate dracunculiasis before December 1995. To complete eradication of dracunculiasis, in 1994 health officials in Mali and Niger are planning to implement more stringent measures for case containment and begin selective use of temephos (Abate ) * to kill the copepod intermediate host of the parasite in unsafe drinking water sources of selected villages (2).

References

1. World Health Organization. Dracunculiasis: global surveillance summary, 1992. Wkly Epidemiol Rec 1993;68:125-31.

2. Hopkins DR, Ruiz-Tiben E. Strategies for dracunculiasis eradication. Bull World Health Organ 1991;69:533-40.

* Use of trade names and commercial sources is for identification only and does not imply endorsement by the Public Health Service or the U.S. Department of Health and Human Services.
Table_1
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TABLE 1. Numbers of cases of dracunculiasis and villages with endemic disease
detected during national village-by-village searches for cases -- Mali and Niger, 1993
=========================================================================================
                 Mali                  º                 Niger
 ------------------------------------  º  -----------------------------------
              No. affected             º              No. affected
 Region         villages    No. cases  º  Department    villages    No. cases
-----------------------------------------------------------------------------
 Mopti             720        9,154    º  Zinder           808       21,057
 Kayes             379        6,504    º  Tahoua           225        4,696
 Segou              87          277    º  Tillaberi        348        4,442
 Koulikoro          44           89    º  Maradi           224        1,452
 Sikasso            34           36    º  Dosso             83        1,182
 Gao                NA *         NA    º  Diffa              2            2 +
 Timbuktu           NA           NA    º  Agadez             0            0
                                       º
 Total           1,264       16,060    º  Total          1,690       32,831
-----------------------------------------------------------------------------
* Not available; these regions have not been searched yet.
+ Imported dracunculiasis.
=========================================================================================

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