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Dracunculiasis

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Dracunculiasis eradication program

 

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Patient with Dracunculiasis: Gambella region, Ethiopia

Guinea worm, which is also known as Dracunculiasis is now endemic in only 12 countries, all of which are found in sub-Saharan Africa. Dracunculiasis is a disease caused by the parasitic worm Dracunculus medinensis or "Guinea worm". This worm is the largest of the tissue parasite-affecting human. The adult female, which carries about 3 million embryos, can measure 600 to 800 mm in length and 2 mm in diameter. The parasite migrates through the victim's subcutaneous tissues causing severe pain especially when it occurs in the joints. The worm eventually emerges (from the feet in 90% of the cases), causing an intensely painful oedema, a blister and an ulcer accompanied by fever, nausea and vomiting. For further development, they need to be ingested by suitable species of voracious predatory crustacean, Cyclops or water fleas.

 

When a person drinks contaminated water from ponds or shallow open wells, the Cyclops is dissolved by the gastric acid of the stomach and the larvae are released and migrate through the intestinal wall. After 100 days, the male and female meet and mate. The male becomes encapsulated and dies in the tissues while the female move down the muscle planes. After about one year of the infection, the female worm with the uterus filled with larvae emerges usually from the feet repeating the life cycle.

 

 

Eradication program in Ethiopia

1.1. Epidemiology

The Ethiopian Dracunculiasis Eradication Program was established in 1992. After its establishment, a case search was conducted throughout the country in 1993. In this survey, it was confirmed that the disease is endemic in six districts of Gambella Regional State namely: Abobo, Akobo, Gambella, Gog, Itang and Jikawo. The survey also indicated that one Woreda of Southern Nations Peoples Region (SNNPR) namely Kuraz, in South Omo Zone was also endemic for Dracunclusiasis (see map below)

 

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Guinea worm current and former endemic areas in Ethiopia

 

1.2. Disease trends

Following the establishment of an Ethiopian Dracunculiasis Eradication Program in 1992 and its implementation in 1994, there has been a decreasing trend of the disease in the country as shown in fig 2 below.

 

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Trends of Dracunculiasis cases from 1993 -September 2004

 

1.3. Interventions

In 1994, a number of interventions were initiated in endemic areas. These include case control, vector control, provision of safe water, health education, provision of filters, training of Village Based Volunteers and monthly reporting. As a result of these efforts, a great success has been achieved in the eradication process. The number of cases has been reduced by more than 97% between 1994 and 2003 and indigenous transmission has been interrupted from South Omo since 2001and zero indigenous case report is maintained so far.

By the end of July 2004, a total number of 12 cases were reported out of 4,722 reported at the same time in the African region. Few reports were received due to the insecurity in Gambella.

1.4. Eradication efforts

A number of eradication efforts are being done in order to achieve eradication certification. These efforts include intervention intensification by strengthening the existing Case Containment Centres, straw filter distribution to nomadic populations, use of the reward system, abate application in all endemic and high-risk villages, provision of safe portable water in affected villages through UNICEF support which spends about USD 60,000-100,000 per year and health education.

Other strategies are strengthening active supervision by maintaining regular visits jointly with pre-certification members and strengthening active surveillance and house to house search, cross border surveillance with Sudan, community mobilisation, refresher training of Village Based Volunteers and Use of IDSR strategy.

1.5. Major constraints and challenges.

  1. Continued cross border cases from Sudan especially in South OMO.
  2. Inadequate supervision at Woreda, Zonal and Regional levels
  3. Weak infrastructure (Communication, transportation, health, safe water schemes).
  4. Social cultural aspect of affected communities.
  5. Insecurity in Gambella Region.

1.6. Way forward

  1. Intensifying case surveillance, detection and containment activities by use of cash reward system and strengthening supervision at all levels
  2. Construction of new safe water supply schemes in endemic villages and rehabilitation of the existing ones.
  3. Intensifying health education through mass media and strengthening public awareness by inclusion of messages on Dracunculiasis control in IDSR/EPI bulletins.
  4. Training of teachers and Development Agents in all woredas under surveillance
  5. Continued sensitisation of WHO surveillance officers and close collaboration with the IDSR team at all levels in order to ensure surveillance in non-endemic areas.
  6. Ensure all villages reporting only imported cases are equally treated as the endemic ones
  7. Strengthening measures that will promptly detect and contain imported cases by publicising cash reward system, strengthening surveillance in refugee camps and providing training to all health workers and Community Health Agents of refugee camps.
  8. Strengthening cross boarder collaboration

Conclusions and recommendations

The Ethiopian Dracunculiasis Eradication Program has so far been very successful by dramatically reducing the number of cases. This is due to the integrated nature of implementation involving various partners, international agencies, non-governmental organisations, Government sectors at all levels and the community at large.

It is recommended that this partnership should be strengthened in order to scale up eradication activities of the disease in the country. Special attention should be directed to Akobo zone where implementation of the program has been weak due to inaccessibility and insecurity.

References

Ethiopian Dracunculiasis Eradication Program-Annual report 2003 and 2004 (FMOH)

Weekly epidemiological record-No 19, 2004, 79, 181-192.