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International Notes Dracunculiasis Surveillance--India

The Indian Guinea Worm Eradication Program, conceived in early 1979, began in 1980 when India endorsed the recommendation of a Task Force on Eradication of Guinea Worm Disease in India. The National Institute of Communicable Disease (NICD) was asked to provide national leadership, planning, monitoring, and assistance in eradication efforts.

Before the first meeting of the task force in Delhi in November 1980, a preliminary assessment of the geographic extent of dracunculiasis was made through a questionnaire circulated to directors of each State's and Union territory's Health Services. Subsequent meetings of the task force* were held at Jaipur in March 1981 and at Bhopal in July 1981. The fourth meeting was conducted in conjunction with a World Health Organization (WHO) Workshop on Guinea Worm Eradication at Aurangabad (Maharashtra) April 27-30, 1982.

Preliminary assessment revealed that approximately 726 villages/hamlets in seven States and one Union territory, with a total population of 1.8 million, were affected. To delineate the affected areas more accurately, paramedical workers from Primary Health Centers in the endemic areas undertook a village-by-village search in May-June 1981. This active search, which also collected information on each village's drinking water, found that at least 7,533 villages/hamlets** in the seven States were affected, with a population of 5.9 million at risk. Investigation of the affected villages in the previously identified Union territory revealed no indigenous cases; the only reported case had been imported from an adjacent State in 1978. In October/November 1981, a second search of the seven endemic States reported 10,582 villages/ hamlets affected, with a population of 12.2 million at risk.

During the most recent active search in June 1982, 11,736 villages/hamlets were identified as affected by guinea worm, with a population of 12.6 million at risk. The increase in the number of affected villages revealed by the active searches undoubtedly reflects improved efficacy of the later searches, as well as the known seasonal variation in the incidence of the disease. Any village with a new case identified during 1980, 1981, or to June 1982 has been considered affected, even if no new case was reported in one or more of those years. In addition to determining the number of affected villages and the nature of their water sources, persons suffering from the disease were counted for the first time during the June 1982 search. The most variation in the incidence of the disease. Any village with a new case identified during 1980, 1981, or to June 1982 has been considered affected, even if no new case was reported in one or more of those years. In addition to determining the number of affected villages and the nature of their water sources, persons suffering from the disease were counted for the first time during the June 1982 search. The most extensively affected state was Rajasthan, where 14,905 persons residing in 6,104 villages harbored the infection to June 1982.

An indirect benefit of the searches was confirmation of the efficacy of anti-dracunculiasis efforts already in progress for many years in Tamil Nadu State. No cases were reported there from January to June 1982. However, the June 1982 search identified for the first time the presence of guinea worm disease in 423 villages of the known endemic States. A report on the nature of cases in these apparently newly affected areas is pending. An assessment of the quality of this latest search--by follow-up visits to two or three districts in each State--suggests the actual number of cases in the visited districts may have been underestimated by 10%-50%. Thus, dracunculiasis has been revealed to be endemic in slightly more than 2% of India's villages, including 18% of the villages in Rajasthan.

India has set a goal of eradicating dracunculiasis from the entire country within 5 years and is committing eight million rupees (approximately $1.2 million) as central assistance to the seven affected States. Steps for eradicating the disease include: 1) semi-annual searches of all 82 affected districts; 2) surveys of water sources in the affected villages to determine priorities for their improvement and means for providing safe water sources; 3) education of communities on the mode of dracunculiasis transmission and personal prophylaxis; 4) chemical disinfection of unsafe water sources with temophos (Abate), and 5) training of district level health officers, environmental engineers, and other staff involved in the program.

The most important features of India's Guinea Worm Eradication Program are: each of the affected States retains primary responsibility for all program activities in its areas (NICD provides only technical guidance and training); implementation of the program is conducted within the country's primary health care system by the existing health manpower in addition to their other responsibilities; and strategy for eradicating guinea worm disease is completely coordinated with the country's program of providing safe drinking water to all its rural population by the end of the International Drinking Water Supply and Sanitation Decade (1981-1990). The latter program is planned by the Central Public Health Environmental Engineering Organization at the national level and operated by the State Public Health Engineering Departments.

Other important accomplishments to date include development, publication, and distribution to local workers of an Operational Manual on Guinea Worm Eradication; development of prototype health education materials for adaptation and use by the States; and organization of 4-day courses for training district level staff (physicians and engineers).*** Reported in WHO Weekly Epidemiologic Record 1983;58:(4):21-3.

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