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Roberts JD. Participating in eradication: how Guinea worm redefined eradication, and eradication redefined Guinea worm, 1985-2022. MEDICAL HISTORY 2023; 67:148-171. [PMID: 37525460 PMCID: PMC10404518 DOI: 10.1017/mdh.2023.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
Guinea worm disease (dracunculiasis) is a debilitating waterborne disease. Once widespread, it is now on the brink of eradication. However, the Guinea Worm Eradication Programme (GWEP), like guinea worm itself, has been under-studied by historians. The GWEP demonstrates an unusual model of eradication, one focused on primary healthcare (PHC), community participation, health education and behavioural change (safe drinking). The PHC movement collided with a waterborne disease, which required rapid but straightforward treatment to prevent transmission, creating a historical space for the emergence of village-based volunteer health workers, as local actors realigned global health policy on a local level. These Village Volunteers placed eradication in the hands of residents of endemic areas, epitomising the participation-focused nature of the GWEP. This participatory mode of eradication highlights the agency of those in endemic areas, who, through volunteering, safe drinking and community self-help, have been the driving force behind dracunculiasis eradication. In the twenty-first century, guinea worm has become firstly a problem of human mobility, as global health has struggled to contain cases in refugees and nomads, and latterly a zoonotic disease, as guinea worm has shifted hosts to become primarily a parasite of dogs. This demonstrates both the potential of One Health approaches and the need for One Health to adopt from PHC and the GWEP a focus on the health of humans and animals in isolated and impoverished areas. Guinea worm demonstrates how the biological and the historical interact, with the GWEP and guinea worm shaping each other over the course of the eradication programme.
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Guagliardo SAJ, Thiele E, Unterwegner K, Narcisse Nanguita N, Dossou L, Tchindebet Ouakou P, Zirimwabagabo H, Ruiz-Tiben E, Hopkins DR, Roy SL, Cama V, Bishop H, Sapp S, Yerian S, Weiss AJ. Epidemiological and molecular investigations of a point-source outbreak of Dracunculus medinensis infecting humans and dogs in Chad: a cross-sectional study. THE LANCET MICROBE 2022; 3:e105-e112. [DOI: 10.1016/s2666-5247(21)00209-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 07/21/2021] [Accepted: 07/28/2021] [Indexed: 11/17/2022] Open
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Simpson H, Konan DO, Brahima K, Koffi JD, Kashindi S, Edmiston M, Weiland S, Halliday K, Pullan RL, Meite A, Koudou BG, Timothy J. Effectiveness of community-based burden estimation to achieve elimination of lymphatic filariasis: A comparative cross-sectional investigation in Côte d'Ivoire. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000760. [PMID: 36962795 PMCID: PMC10022321 DOI: 10.1371/journal.pgph.0000760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 07/23/2022] [Indexed: 11/19/2022]
Abstract
For lymphatic filariasis (LF) elimination, endemic countries must document the burden of LF morbidity (LFM). Community-based screening (CBS) is used to collect morbidity data, but evidence demonstrating its reliability is limited. Recent pilots of CBS for LFM alongside mass drug administration (MDA) in Côte d'Ivoire suggested low LFM prevalence (2.1-2.2 per 10,000). We estimated LFM prevalence in Bongouanou District, Côte d'Ivoire, using a comparative cross-sectional design. We compared CBS implemented independently of MDA, adapted from existing Ministry of Health protocols, to a population-based prevalence survey led by formally trained nurses. We evaluated the reliability of case identification, coverage, equity, and cost of CBS. CBS identified 87.4 cases of LFM per 10,000; the survey identified 47.5 (39.4-56.3; prevalence ratio [PR] 1.84; 95% CI 1.64-2.07). CBS identified 39.7 cases of suspect lymphoedema per 10,000; the survey confirmed 35.1 (29.2-41.5) filarial lymphoedema cases per 10,000 (PR 1.13 [0.98-1.31]). CBS identified 96.5 scrotal swellings per 10,000; the survey found 91.3 (83.2-99.8; PR 1.06 [0.93-1.21]); including 33.9 (27.7-38.8) filarial hydrocoele per 10,000 (PR of suspect to confirmed hydrocele 2.93 [2.46-3.55]). Positive predictive values for case identification through CBS were 65.0% (55.8-73.5%) for filarial lymphoedema; 93.7% (89.3-96.7%) for scrotal swellings; and 34.0% (27.3-41.2%) for filarial hydrocoele. Households of lower socioeconomic status and certain minority languages were at risk of exclusion. Direct financial costs were $0.17 per individual targeted and $69.62 per case confirmed. Our community-based approach to LFM burden estimation appears scalable and provided reliable prevalence estimates for LFM, scrotal swellings and LF-lymphoedema. The results represent a step-change improvement on CBS integrated with MDA, whilst remaining at programmatically feasible costs. Filarial hydrocoele cases were overestimated, attributable to the use of case definitions suitable for mass-screening by informal staff. Our findings are broadly applicable to countries aiming for LF elimination using CBS. The abstract is available in French in the S1 File.
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Affiliation(s)
- Hope Simpson
- Department for Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Centre for Global Health Research, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Daniele O Konan
- Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire
| | - Kouma Brahima
- Ministère de la Sante et de l'Hygiène Publique, Programme national de lutte contre les Maladies Tropicales Négligées à Chimiothérapie Préventive (PNLMTN-CP) en Côte d'Ivoire, Abidjan, Côte d'Ivoire
| | - Jeanne d'Arc Koffi
- Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire
| | - Saidi Kashindi
- American Leprosy Missions, Greenville, South Carolina, United States of America
- AIM Initiative, Accra, Ghana
| | - Melissa Edmiston
- American Leprosy Missions, Greenville, South Carolina, United States of America
- AIM Initiative, Accra, Ghana
| | - Stefanie Weiland
- American Leprosy Missions, Greenville, South Carolina, United States of America
- AIM Initiative, Accra, Ghana
| | - Katherine Halliday
- Department for Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Rachel L Pullan
- Department for Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Aboulaye Meite
- Ministère de la Sante et de l'Hygiène Publique, Programme national de lutte contre les Maladies Tropicales Négligées à Chimiothérapie Préventive (PNLMTN-CP) en Côte d'Ivoire, Abidjan, Côte d'Ivoire
| | | | - Joseph Timothy
- Department for Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Karki S, Weiss A, Dcruz J, Hunt D, Haigood B, Ouakou PT, Chop E, Zirimwabagabo H, Rubenstein BL, Yerian S, Roy SL, Kamb ML, Guagliardo SAJ. Assessment of the Chad guinea worm surveillance information system: A pivotal foundation for eradication. PLoS Negl Trop Dis 2021; 15:e0009675. [PMID: 34370746 PMCID: PMC8376011 DOI: 10.1371/journal.pntd.0009675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 08/19/2021] [Accepted: 07/23/2021] [Indexed: 12/02/2022] Open
Abstract
Background In the absence of a vaccine or pharmacological treatment, prevention and control of Guinea worm disease is dependent on timely identification and containment of cases to interrupt transmission. The Chad Guinea Worm Eradication Program (CGWEP) surveillance system detects and monitors Guinea worm disease in both humans and animals. Although Guinea worm cases in humans has declined, the discovery of canine infections in dogs in Chad has posed a significant challenge to eradication efforts. A foundational information system that supports the surveillance activities with modern data management practices is needed to support continued program efficacy. Methods We sought to assess the current CGWEP surveillance and information system to identify gaps and redundancies and propose system improvements. We reviewed documentation, consulted with subject matter experts and stakeholders, inventoried datasets to map data elements and information flow, and mapped data management processes. We used the Information Value Cycle (IVC) and Data-Information System-Context (DISC) frameworks to help understand the information generated and identify gaps. Results Findings from this study identified areas for improvement, including the need for consolidation of forms that capture the same demographic variables, which could be accomplished with an electronic data capture system. Further, the mental models (conceptual frameworks) IVC and DISC highlighted the need for more detailed, standardized workflows specifically related to information management. Conclusions Based on these findings, we proposed a four-phased roadmap for centralizing data systems and transitioning to an electronic data capture system. These included: development of a data governance plan, transition to electronic data entry and centralized data storage, transition to a relational database, and cloud-based integration. The method and outcome of this assessment could be used by other neglected tropical disease programs looking to transition to modern electronic data capture systems. Guinea worm disease has no pharmacological treatment or vaccines, and therefore existing prevention and control strategies (e.g., case containment, health education, chemical treatment of water bodies) are critically dependent on timely, accurate, and actionable data. We conducted informant interviews, used conceptual frameworks, and mapped data flow to evaluate the Chad Guinea Worm Eradication Program’s current information system. We identified areas for improvement including the need to consolidate variables across data collection forms and the need to develop streamlined workflows. We proposed a four-phased roadmap for transitioning to an electronic data capture system and centralizing data storage. Our approach and proposed roadmap could be adopted by other neglected tropical disease control programs looking to modernize data collection and storage procedures.
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Affiliation(s)
- Saugat Karki
- Surveillance and Data Management Branch, Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- * E-mail:
| | - Adam Weiss
- Guinea Worm Eradication Program, The Carter Center, Atlanta, Georgia, United States of America
| | - Jina Dcruz
- Population Health Workforce Branch, Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Dorothy Hunt
- Guinea Worm Eradication Program, The Carter Center, Atlanta, Georgia, United States of America
| | - Brandon Haigood
- Guinea Worm Eradication Program, The Carter Center, Atlanta, Georgia, United States of America
| | - Philip Tchindebet Ouakou
- Guinea Worm Eradication Program, Ministry of Public Health and National Solidarity, N’Djamena, Chad
| | - Elisabeth Chop
- Guinea Worm Eradication Program, The Carter Center, Atlanta, Georgia, United States of America
| | - Hubert Zirimwabagabo
- Guinea Worm Eradication Program, The Carter Center, Atlanta, Georgia, United States of America
| | - Beth L. Rubenstein
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Sarah Yerian
- Guinea Worm Eradication Program, The Carter Center, Atlanta, Georgia, United States of America
| | - Sharon L. Roy
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Mary L. Kamb
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Sarah Anne J. Guagliardo
- Guinea Worm Eradication Program, The Carter Center, Atlanta, Georgia, United States of America
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Guagliardo SAJ, Ruiz-Tiben E, Hopkins DR, Weiss AJ, Ouakou PT, Zirimwabagabo H, Unterwegner K, Tindall D, Cama VA, Bishop H, Sapp SGH, Roy SL. Surveillance of Human Guinea Worm in Chad, 2010-2018. Am J Trop Med Hyg 2021; 105:188-195. [PMID: 34029207 PMCID: PMC8274751 DOI: 10.4269/ajtmh.20-1525] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 03/24/2021] [Indexed: 12/31/2022] Open
Abstract
The total number of Guinea worm cases has been reduced by 99.9% since the mid-1980s when the eradication campaign began. Today, the greatest number of cases is reported from Chad. In this report, we use surveillance data collected by the Chad Guinea Worm Eradication Program to describe trends in human epidemiology. In total, 114 human cases were reported during the years 2010–2018, with highest rates of containment (i.e., water contamination prevented) in the years 2013, 2014, 2016, and 2017 (P < 0.0001). Approximately half of case-patients were female, and 65.8% of case-patients were aged 30 years or younger (mean: 26.4 years). About 34.2% of case-patients were farmers. Cases were distributed across many ethnicities, with a plurality of individuals being of the Sara Kaba ethnicity (21.3%). Most cases occurred between the end of June and the end of August and were clustered in the Chari Baguirmi (35.9%) and Moyen Chari regions (30.1%). Cases in the northern Chari River area peaked in April and in August, with no clear temporal pattern in the southern Chari River area. History of travel within Chad was reported in 7.0% of cases, and male case-patients (12.5%) were more likely than female case-patients (1.7%) to have reported a history of travel (P = 0.03). Our findings confirm that human Guinea worm is geographically disperse and rare. Although the proportion of case-patients with travel history is relatively small, this finding highlights the challenge of surveillance in mobile populations in the final stages of the global eradication campaign.
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Affiliation(s)
- Sarah Anne J Guagliardo
- 1Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia.,2Guinea Worm Eradication Program, The Carter Center, Atlanta, Georgia
| | | | - Donald R Hopkins
- 2Guinea Worm Eradication Program, The Carter Center, Atlanta, Georgia
| | - Adam J Weiss
- 2Guinea Worm Eradication Program, The Carter Center, Atlanta, Georgia
| | | | | | | | - Dillon Tindall
- 2Guinea Worm Eradication Program, The Carter Center, Atlanta, Georgia
| | - Vitaliano A Cama
- 1Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Henry Bishop
- 1Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sarah G H Sapp
- 1Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sharon L Roy
- 1Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
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