Long-term disability due to guinea worm disease

Slaying little dragons: the impact of the Guinea Worm Eradication Program on dracunculiasis disability averted from 1990 to 2016

Background: The objective of this study was to document the worldwide decline of dracunculiasis (Guinea worm disease, GWD) burden, expressed as disability-adjusted life years (DALYs), from 1990 to 2016, as estimated in the Global Burden of Disease study 2016 (GBD 2016). While the annual number of cases of GWD have been consistently reported by WHO since the 1990s, the burden of disability due to GWD has not previously been quantified in GBD. Methods: The incidence of GWD was modeled for each endemic country using annual national case reports. A literature search was conducted to characterize the presentation of GWD, translate the clinical symptoms into health sequelae, and then assign an average duration to the infection. Prevalence measures by sequelae were multiplied by disability weights to estimate DALYs. Results: The total DALYs attributed to GWD across all endemic countries (n=21) in 1990 was 50,725 (95% UI: 35,265-69,197) and decreased to 0.9 (95% UI: 0.5-1.4) in 2016. A cumulative total of 12,900 DALYs were attributable to GWD from 1990 to 2016. Conclusions: Using 1990 estimates of burden propagated forward, this analysis suggests that between 990,000 to 1.9 million DALYs have been averted as a result of the eradication program over the past 27 years.

What It Means to Be Guinea Worm Free: An Insider's Account from Ghana's Northern Region

Despite several periods of stagnating guinea worm disease (GWD) incidence in Ghana during its national eradication campaign in the 1990s and early 2000s, the last reported case of GWD was in May 2010. In July 2011, Ghana celebrated the interruption of guinea worm (GW) transmission. Although it has been established that GWD causes disability, pain, and socioeconomic hardship, there is a dearth of population-based evidence collected in post-GW-endemic countries to document the value attributed to GWD eradication by residents in formerly endemic communities. Given Ghana's recent history of GWD and a concentrated burden of the disease in its Northern Region, a pattern which remained true through to the final stage of the eradication campaign, seven villages in the Northern Region were targeted for a retrospective, cross-sectional study to detail the perceptions, attitudes, and beliefs about the impact of eradication of GWD in northern Ghana. The study revealed that respondents from the sampled communities felt GW eradication improved their socioeconomic conditions, as the impact of infection prohibited the pursuit of individual and social advancement. The value residents placed on the absence of GWD highlights both the impact infection had on the pursuit of social and economic advancement and the newfound ability to be disease-free and productive. Of the 143 respondents, 133 had GWD in the past and were incapacitated for an average of 6 weeks annually per GW infection, with each infected person affected nearly four times in his or her lifetime.

Guinea worm infection in northern Nigeria: reflections on a disease approaching eradication

Global eradication of the guinea worm (Dracunculus medinensis) is near, although perhaps delayed a little by the discovery of a transmission cycle in dogs. It is therefore an appropriate time to reflect on the severe impact of this infection on the life of the communities where it was endemic prior to the start of the global eradication programme in 1981. From 1971 to 1974, we conducted a series of unpublished studies on guinea worm in a group of villages in Katsina State, northern Nigeria, where the infection was highly endemic. These studies demonstrated the high rate of infection in affected communities, the frequent recurrence of the infection in some subjects and the long‐standing disability that remained in some infected individuals. Immunological studies showed a high level of immediate hypersensitivity to adult worm and larval antigens but a downregulation of Th1‐type T‐cell responses to worm antigens. Freeing communities such as those described in this article from the scourge of guinea worm infection for good will be an important public health triumph.

Global eradication of Guinea worm

Little more than a decade ago, it was estimated that over three million cases of dracunculiasis occurred worldwide. Since then, the numbers have fallen dramatically, thanks to the water supply initiatives of the 1980s and, more recently, the national guinea worm eradication programmes implemented in a score of endemic countries. Hervé Periès and Sandy Cairncross discuss how eradication will require the containment of cases in the remaining endemic areas, together with the simultaneous strengthening of surveillance to permit the certification of eradication. This aim requires existing strategies to be adapted to maintain their efficacy and also to improve their sustainability and cost-effectiveness. Sudan with its civil war, and more than a hundred thousand reported cases, remains a major obstacle to rapid achievement of the goal.

Dracunculiasis (Guinea worm disease) and the eradication initiative

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.

Disinfectants/antiseptics in the management of guinea worm ulcers in the rural areas

The effectiveness of trichlorophenol (TCP), chlorhexidine gluconate plus cetrimide (Savlon) and Izal in inhibiting the growth of bacterial isolates from guinea worm ulcers was investigated. Using an adaptation of the method of Russell and Furr (Russell, A.D., Furr, J.R., 1977. The antibacterial activity of a new chloroxylenol preparation containing ethylenediamine tetraacetic acid. J. Appl. Bacteriol. 43, 253-260) the minimum inhibitory concentration (MIC) values of the three anti-microbial agents for each of the isolated bacteria was determined. Water drawn from the rural guinea worm endemic sites was autoclaved and used for the various dilutions of the anti-microbial agents. At the manufactures' recommended use-dilutions in cases of wounds/cuts/sores, Savlon showed greater effectiveness than Izal and TCP in this order. Probable organic and inorganic inhibitors in water that is usually employed in diluting anti-microbial agents in the rural areas for the dressing of guinea worm ulcers very likely had greatest effect(s) on TCP and least effect(s) on Savlon.

Community participation in the eradication of guinea worm disease

As Guinea worm eradication programmes have got under way in endemic countries over the last decade, there has been a shift towards more participatory methods. The approach to surveillance has changed from periodic cross-sectional surveys to monthly village-based reporting of cases by a volunteer village health worker. At the same time, the emphasis regarding control interventions has moved from the provision of safe water supplies to health education. The new approach has proved very effective. The village health volunteers who carry out both surveillance and health education seem to be motivated largely by the social status of their role; still more commitment will be required of them in the final stages of eradication. It is to be hoped that the networks of village health workers established for Guinea worm eradication will find a useful role in health promotion after the worms have gone.

Guinea worm disease in Ayod, Upper Nile Province, southern Sudan: a cross-sectional study

Upper Nile Province is one of the four main endemic areas for Guinea worm disease in the Sudan. In December 1994, a survey was conducted in the village of Ayod where the disease is endemic, to investigate morbidity and local knowledge of transmission and prevention. Interviews were conducted in households selected by standard cluster sampling procedures and of the 759 people examined, 156 (20.6%) had Guinea worm lesions. Adjusted odds ratios were used to estimate the relative risk for people with different personal or household characteristics in a multivariate analysis. After controlling for the possible confounding effects of other study variables, having a filter in the household, gender, and lack of knowledge about transmission and about prevention, were not associated with lesions. Only two variables were significantly associated with Guinea worm disease: getting water from a source other than a well increased the risk by a factor of 2.3, and being aged 5 years or more increased the risk by a factor of 31.1. This study demonstrates the clear association between the source of water for drinking and Guinea worm disease found elsewhere. We suggest the provision of reliable sources of pure drinking water and health education are the most suitable long-term preventive measures. The Sudan now represents the greatest challenge to the goal of global eradication of Guinea worm disease, following the reduction in cases in Nigeria. The continuing civil war and insecurity in southern Sudan hinder the implementation of an effective water programme and other control measures, but the potential benefits through reduced incapacity and improved agricultural productivity are considerable.