Focus on the war against Guinea worm disease

A painful blister just beneath his right knee, accompanied by fever, were the first signs for 15-year-old Akunne Egwa that something was wrong with his health. When the blister ruptured two days later and a worm the thickness of a match stick emerged, he had no doubt he was a victim of Guinea worm disease, or dracunculiasis. "I was not alone," he told IRIN. "There were three of us, including my mother and my elder brother, in our family of six who were infected about the same time. And it was the same in most of the households in my village." With the worm emerging at the rate of a few centimetres a day, it could take between a few days and one month for an infected person to be rid of its full length of up to one metre. The wounds take an average of two months to heal completely. Invariably, a victim is incapacitated for at least three months. Egwa's home district of Ohaozara, in the southeastern state of Ebonyi State, is one of the areas of Nigeria where Guinea worm disease is endemic. Ebonyi State has the highest incidence of the disease among the 16 of Nigeria's 36 states affected, and where a total of 2,438 cases were reported between January and August this year. The latest infection figures represent a significant worsening of the situation from the 635,620 cases reported in 1987, when an intensive effort was launched by a coalition of international and local partners aimed at eliminating the disease by 2004. Spearheading this partnership was the Global 2000 organisation, set up by the Carter Center of former US President Jimmy Carter, with support from the World Health Organization (WHO), the United Nations Children's Fund (UNICEF) and the ministries of health of affected states. The main strategies in this effort have been to interrupt the process by which infection is spread and to provide treatment for infected people. Guinea worm is caused by a parasite known as dracunculus medinensis. People become infected when they drink water, usually from streams or ponds, containing the dracunculus larvae. The infected person feels no symptoms while the larvae grows to adult size, achieving a length of about one metre, in the first year or so. Then the worm begins to migrate to the body surface, causing a blister on the skin through which it emerges. In more than 90 percent of cases, the worms emerge through the legs or the feet, rarely using other parts of the body. Due to the burning pain that comes with the worm's emergence, victims often immerse their legs in water for relief. With the sudden drop in temperature that follows, the blisters usually rupture, letting out the worms. Female worms use this opportunity to release millions of larvae into the water, further contaminating the supply. If the affected water source is a stream, other users are exposed to a high risk of infection. Those most susceptible to the disease are people who live in remote, rural areas that lack potable water. The incidence of Guinea worm disease is directly linked to the lack of access to safe water, and rural areas in Nigeria are particularly disadvantaged in this respect. A 1999 study by Nigeria's National Planning Commission showed that 80 percent of the urban population had access to what could be considered safe water, against 39 percent in rural communities. The national average was found to be 50 percent. The southwest presented the highest average access to safe water at 69 percent, while the lowest access rate (34 percent) was found in the southeast. This, in turn, is the region with the highest incidence of Guinea worm infection. Though fatalities from the disease are rare, usually resulting from complications due to secondary infections, Guinea worm disease is debilitating and often leaves victims crippled for life. Some of its worst effects are measurable in man-hours of labour lost, when large numbers of people are incapacitated by the disease. The areas of Nigeria where Guinea worm disease is endemic include the most agriculturally productive areas in the north, central and southern regions. With the disease often at its worst during planting and harvest periods, sizeable yields may be lost, leaving a huge economic toll. Guinea worm infection caused rice farmers an annual loss of about US $20 million in parts of southeastern Nigeria in the mid-1990s, according to Global 2000. The main thrust of the Guinea Worm Eradication Project (GWEP) run by Global 2000 is to curb the disease by using health education to bring about changes in individual behaviour and encourage communities to improve safety of their water sources. With the assistance of local health authorities, communities are being taught to use nylon or cloth filters to eliminate water fleas which are the intermediate hosts for the dracunculus medinensis parasite. Local volunteers are also being trained to carry out surveillance and regular interventions through the chemical treatments of stagnant ponds and streams. State and local governments, and communities, are also being encouraged to devote resources to building boreholes and wells which produce safer water. In Ebonyi State, 46 new boreholes sunk in affected areas by Nigeria's federal government were commissioned for use in September. A total of 150 boreholes are planned for the state in the next two years. Similar efforts are being undertaken in other affected areas. General Yakubu Gowon, a former Nigerian military ruler and chairman of Global 2000, is upbeat that Guinea worm disease can be eradicated in the country by the end of 2003. He told a recent review meeting of the Guinea Worm Eradication Programme that the number of cases fell from 13,247 to 5,355 in the three years from 1998, before dropping under 3,000 this year. "We must resolve to be courageous and unrelenting in our attack against Guinea worm disease," he exhorted field workers in the campaign. "The consolation is that the final victory will surely be ours, and is already in the horizon."