Dracunculiasis in the Caribbean and South America: a contribution to the history of dracunculiasis eradication.
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Caribbean Region↗
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Dracunculiasis. Fourth Regional Conference on Dracunculiasis in Africa.
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Africa↗
Dracunculiasis (Guinea worm disease) eradication.
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, Côte 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 16026 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 23475 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.
Africa↗
Dracunculiasis eradication: almost a reality.
The idea of a global campaign to eradicate dracunculiasis was first proposed by the Centers for Disease Control and Prevention in 1980, during the advent of the International Drinking Water Supply and Sanitation Decade (IDWSSD) (1981-1990). In 1981, the Steering Committee of the IDWSSD adopted eradication of dracunculiasis as a subgoal of their efforts to provide safe drinking water to unserved populations. In 1988, African ministers of health voted to eradicate dracunculiasis by the end of 1995, a target date that was endorsed by UNICEF in 1989 and the World Health Assembly in 1991. Although nine of 18 endemic countries, India (1980), Pakistan (1987), Nigeria and Cameroon (1988), Ghana (1989), and Mauritania, Benin, Burkina Faso, and Togo (1990) completed national searches for cases of the disease, only four countries, India (1983), Pakistan (1988), Ghana (1989), and Nigeria (1989), actually started eradication programs during the 1980s. The remaining 14 endemic countries began their eradication programs between 1991 and 1995. At the end of 1996, dracunculiasis had not been entirely eradicated, but its incidence had been reduced by 95%, from an estimated 3.2 million cases in 1986 to 152,805 cases in 1996. Sudan reported a total of 118,578 (78%) of the 152,805 cases of dracunculiasis reported during 1996. Insufficient funding and the civil war in Sudan continue to be the major obstacles to overcome. A primary aim of the eradication program in 1997 is to seek to ensure that all cases of dracunculiasis outside of Sudan are contained. In Sudan the challenge is to pursue all appropriate control measures in all accessible areas as vigorously as possible until political circumstances allow access to all of the remaining affected areas.
Africa↗
Progress toward global eradication of dracunculiasis, January 2004-July 2005.
In 1986, an estimated 3.5 million cases of dracunculiasis occurred in 20 countries, and 120 million persons were at risk for the disease. That year, the World Health Assembly adopted a resolution calling for the eradication of dracunculiasis, also known as Guinea worm disease. This report describes the status of the global dracunculiasis eradication program as of July 2005, indicating that, during January-July 2005, a total of 8,191 indigenous cases of dracunculiasis were reported from nine countries, with at least 150 million persons at risk. Despite the substantial reductions in dracunculiasis cases since 1986, eradication of dracunculiasis will require international commitment and ongoing surveillance and intensified interventions at national, state, and local levels.
Dracunculiasis↗
Immunodiagnosis of dracunculiasis by Falcon assay screening test-enzyme-linked immunosorbent assay (FAST-ELISA) and by enzyme-linked immunoelectrotransfer blot (EITB) technique.
The Falcon assay screening test-enzyme-linked immunosorbent assay (FAST-ELISA) and the enzyme-linked immunoelectrotransfer blot (EITB) technique were used to test human sera with Dracunculus medinensis adult worm antigen in order to assess their potential value in the immunodiagnosis of dracunculiasis. The human sera used were from patients with prepatent and patent D. medinensis infections or from patients infected with other nematodes (Onchocerca volvulus and Loa loa) or trematodes (Schistosoma mansoni and S. haematobium), as well as uninfected Nigerian and Puerto Rican normal controls. In the FAST-ELISA, the sera from prepatent and patent dracunculiasis patients gave the highest absorbance values relative to normal human sera. The highest cross-reactivity was observed with onchocerciasis sera; no cross-reactivity was seen with sera from individuals with loiasis or schistosomiasis mansoni or haematobia. By the EITB, sera from dracunculiasis patients specifically recognized a 16 kDa protein (Dm 16) and antibodies to Dm 16 disappeared 2 months after worm extraction. Recognition of Dm 16 occurred from the late prepatent stage. A 17 kDa protein (Dm 17) was also recognized by dracunculiasis sera, but antibodies to Dm 17 disappeared more slowly and were present 1 year after recovery. The 16 kDa and 17 kDa antigens of D. medinensis may be useful in the immunodiagnosis of dracunculiasis.
Animals↗
Progress toward global dracunculiasis eradication, June 2000.
In 1986, an estimated 3 million persons were infected with dracunculiasis (Guinea worm disease) and another 120 million were at risk for infection. That year and in 1991, the World Health Assembly called for the eradication of dracunculiasis, and as a result of the implementation of the Dracunculiasis Eradication Program (DEP), the annual incidence was reduced by approximately 95% by 1995. This report updates the status of the eradication program as of June 2000, which indicates that dracunculiasis has been eliminated from seven of 20 countries where it was endemic in 1995; however, in parts of Africa, particularly Sudan, dracunculiasis remains a serious public health problem.
Dracunculiasis↗
Progress toward global dracunculiasis eradication, June 2002.
In 1986, when the World Health Assembly first adopted a resolution calling for the eradication of dracunculiasis (Guinea worm disease), an estimated 3.5 million persons in 20 countries had the disease, and approximately 120 million persons were at risk for infection. By December 2001, annual incidence of dracunculiasis had decreased approximately 98%, and seven countries (Cameroon, Chad, India, Kenya, Pakistan, Senegal, and Yemen) in which dracunculiasis had been endemic previously had eliminated the disease. This report describes the status of the global Dracunculiasis Eradication Program (DEP) as of June 2002. The findings indicate that DEP has succeeded in reducing incidence of dracunculiasis substantially; the disease can be eradicated if the remaining 13 countries in which it is endemic detect and contain transmission from the final cases.
Dracunculiasis↗
Surveillance for dracunculiasis, 1981-1991.
In 1986 the World Health Organization (WHO) designated dracunculiasis (guinea worm disease) as the next disease scheduled to be eradicated (by 1995) after smallpox. Dramatic improvement in national and international surveillance has played a key role in the global eradication campaign, which was initiated at CDC in 1980. About 3 million persons are still affected by the disease annually, with adverse effects on their health as well as on agricultural production and education. Over 100 million persons are at risk of having the disease in more than 20,000 villages in India, Pakistan, and 17 African countries. At least one nationwide, village-by-village search to detect all villages with endemic dracunculiasis and count cases is recommended at the outset of each national campaign, followed by monthly reporting by village-based health workers in the targeted villages during the implementation phase. Rapid dissemination of the results of the surveillance is critical. Intensive case detection and containment--with rewards for reporting of cases--are most appropriate near the end of each campaign. Cameroon, Ghana, India, Nigeria, and Pakistan have pioneered the various surveillance methods for this disease in recent years. Methods for conducting surveillance of dracunculiasis and other important diseases must continue to be developed and improved as countries now believed to be free of dracunculiasis prepare to apply to WHO for certification of elimination of dracunculiasis.
Africa↗
The Imo State (Nigeria) Drinking Water Supply and Sanitation Project, 2. Impact on dracunculiasis, diarrhoea and nutritional status.
Morbidity due to dracunculiasis (guinea worm disease) and diarrhoea in persons of all ages, and nutritional status of young children, were used as health impact indicators in the evaluation of the Imo State Drinking Water Supply and Sanitation Project in south-eastern Nigeria. Data were collected using repeated cross-sectional surveys and longitudinal follow-up. The study area was found to have a low level of endemicity of dracunculiasis. While no impact could be demonstrated on overall period or point prevalence rates in the cross-sectional surveys, a prospective longitudinal survey showed a significant reduction in the percentage of person-fortnights positive for dracunculiasis in areas served by the project, while the control areas showed no such change. In the cross-sectional surveys it was found that, in the project villages, those persons drinking only borehole water had significantly lower period prevalence rates one year later than others. Moreover, those living further from the nearest borehole had higher rates of dracunculiasis. An impact of the project on diarrhoea morbidity was found only in limited sub-groups of the population. A greater association with water availability rather than quality was suggested for rates in young children. The prevalence of wasting (less than 80% weight-for-height) among children aged less than 3 years decreased significantly over time in all 3 intervention villages; there was no such decline in the control villages.
Child, Preschool↗
The impact of health education to promote cloth filters on dracunculiasis prevalence in the northern region, Ghana.
This paper describes a health education intervention which was conducted during the 1990 dry season in 3 study villages in the Northern Region of Ghana, to reduce dracunculiasis prevalence in that area by promoting the use of cloth filters for drinking water and avoidance of water contact by sufferers. The impact of the intervention in reducing dracunculiasis prevalence was examined by comparing the period prevalence of infection in 1990 and 1991. The findings demonstrate that the intervention had a measurable but limited impact on dracunculiasis prevalence. Face-to-face health education was successful in persuading 56% of households to buy filters. Ownership of at least one filter for every 10 people in the household was associated with a reduction of at least 20% in the risk of dracunculiasis.
Adult↗
The reliability of retrospective studies using a one-year recall period to measure dracunculiasis prevalence in Ghana.
BACKGROUND: Cross-sectional studies are usually adopted to assess the one-year period prevalence of dracunculiasis. They depend upon a recall period of up to one year. This paper aims to examine the degree of accuracy with which villagers in an endemic region recall the occurrence of dracunculiasis during the 12 months prior to a cross-sectional survey. METHODS: Two types of study were conducted in Tolon, a village in Northern Ghana--retrospective and prospective. Data from people interviewed in a bimonthly survey throughout 1990 were compared with the results of a cross-sectional retrospective study conducted in early 1991. RESULTS: The results showed that retrospective studies using a recall period of up to one year to measure dracunculiasis prevalence gave only 59.9% of the actual cases, but there were roughly equal numbers of 'false positive' and 'false negative' cases, so that overall prevalence obtained was very close to the correct figure. CONCLUSIONS: Cross-sectional surveys may be of use to obtain estimates of the one-year period prevalence of dracunculiasis, but are not likely to be reliable enough for more detailed study.
Adult↗
Dracunculiasis in Cameroon at the threshold of elimination.
BACKGROUND: Dracunculiasis is endemic in Mayo Sava Division in the Far North Province of Cameroon. Transmission occurs during the rainy season with a peak in the months of July and August. METHODS: A combination of interventions consisting of active surveillance, social mobilization, health education, distribution of filters, construction of new water sources, chemical treatment of unsafe water sources with temephos, and case containment were applied in Mayo Sava in 1990-1995 by the national Guinea Worm Elimination Programme (GWEP). Dracunculiasis cases were detected by village health workers, confirmed by health outreach teams and reported weekly to the GWEP. RESULTS: A decline in the incidence of dracunculiasis by 98.1% from 778 cases in 1990 to 15 in 1995, and in the number of endemic villages by 92.7% from 82 in 1990 to 6 in 1995 was achieved. The proportion of cases identified < or =24 hours of worm emergence increased from 19% in 1991 to 73.6% in 1993. Over 1500 nylon monofilament filters were distributed yearly to endemic villages lacking safe drinking water sources, while 81 new water sources were constructed (boreholes, wells and dikes), 55% in 1992-1993. The success of GWEP is attributed mainly to: intensive and simultaneous implementation of interventions in highly endemic villages in the first 3 years of the programme, case containment, and cash reward. CONCLUSIONS: Cameroon is on the threshold of eliminating dracunculiasis from Mayo Sava but the major remaining obstacle is the ever increasing threat of re-infestation from neighbouring countries.
Adult↗
Dracunculiasis eradication: a mid-decade status report.
A campaign to eradicate dracunculiasis has been underway from the beginning of the International Drinking Water Supply and Sanitation Decade (1981-1990), since providing safe drinking water is the most effective means to prevent that disease. About 120 million persons are estimated to be at risk of the infection in Africa, and 20 million more in India and Pakistan. Both major endemic countries in Asia have begun efforts to eliminate the disease, and by the end of 1986, national anti-dracunculiasis programs were underway or planned in 8 of the 19 affected African countries. In May 1986, the World Health Assembly adopted a resolution on the elimination of dracunculiasis-the first such resolution since the successful Smallpox Eradication Program. India, which began its Guinea Worm Eradication Program in 1980, has already eliminated the disease from one of seven endemic states, and reduced the total number of cases found through active surveillance by 35% between 1983 and 1985. In Côte d'Ivoire (Ivory Coast), the only African country to conduct active surveillance for dracunculiasis so far, an aggressive combined program of rural water supply, health education, and active surveillance has reduced the disease from 4,971 cases in 1976 to 592 cases in 1985.
Africa↗
Progress toward global eradication of dracunculiasis, January-June 2003.
In 1986, when the World Health Assembly adopted a resolution calling for the eradication of dracunculiasis (Guinea worm disease), an estimated 3.5 million persons in 20 countries had the disease, and approximately 120 million persons were at risk for infection. By the end of 2002, annual incidence of the disease had been reduced >98%; seven countries in which dracunculiasis formerly was endemic (Cameroon, Chad, India, Kenya, Pakistan, Senegal, and Yemen) were free of the disease, and four countries (Central African Republic, Ethiopia, Mauritania, and Uganda) reported <100 cases each. During 1993-2002, the number of villages outside Sudan that reported cases decreased from approximately 23,000 to 2,022. This report describes the status of the global Dracunculiasis Eradication Program (DEP)* as of June 2003. The data indicate that incidence of the disease outside Ghana and Sudan has declined substantially since June 2002. Continuing efforts in all countries in which the disease is endemic, intensified efforts in Ghana, and an end to the ongoing war in Sudan are required for the eradication of dracunculiasis.
Dracunculiasis↗
Strategies for dracunculiasis eradication.
In 1991 the Forty-fourth World Health Assembly declared the goal of eradicating dracunculiasis (guinea worm disease) by the end of 1995. This article summarizes the recommended strategies for surveillance and interventions in national dracunculiasis eradication programmes. It is based on personal experience with dracunculiasis programmes in Ghana, Nigeria and Pakistan. Three phases are described: establishment of a national programme office and conduct of a baseline survey; implementation of interventions; and case containment. The relevance of dracunculiasis eradication activities to strengthening of primary health care in the three countries is discussed briefly. Similar strategies would help eradicate this disease in the remaining endemic countries.
Developing Countries↗
[Current status of the global campaign to eradicate dracunculiasis (guinea worm disease)].
Dracunculiasis is eradicable because it is easy to diagnose, it is only transmitted by drinking water, there is no animal reservoir, and there are three ways to prevent the infection. Global 2000 is assisting guinea worm eradication Programmes in Pakistan, Ghana and Nigeria. The draft criteria for certification of dracunculiasis elimination and the resolutions adopted during the 3rd African Regional Conference on dracunculiasis were described. The progress of Pakistan's guinea worm eradication Programme, which has nearly achieved its goal and the accomplishments of the eradication Programme in Nigeria, which is thought to have the most case of guinea worm in the world were described. Evidence of socio-economic impact of dracunculiasis, vector control, local treatment and case containment were presented during the question and answer period.
Animals↗
Progress toward global eradication of dracunculiasis.
The plan for the global eradication of dracunculiasis (i.e., Guinea worm disease) was developed in October 1980, when dracunculiasis was known to be endemic in 16 African countries, India, and Pakistan. In 1991, the World Health Assembly adopted a resolution to eradicate dracunculiasis by the end of 1995. This report summarizes the substantial progress toward eradication of dracunculiasis since the beginning of this effort.
Dracunculiasis↗