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Update: Dracunculiasis Eradication -- Ghana and Nigeria, 1994

The plan for the global eradication of dracunculiasis (i.e., Guinea worm disease) was developed in October 1980 (1). Since 1987- 1988, Global 2000, Inc., the United Nations Children's Fund (UNICEF), and the U.S. Agency for International Development have assisted the Guinea Worm Eradication Programs in Ghana and Nigeria, countries in west Africa. In 1989, Ghana and Nigeria ranked first and second in the number of reported cases of dracunculiasis with 179,556 and 640,008 cases, respectively (2). This report summarizes data for the two countries during 1994 and describes efforts toward eradication of dracunculiasis. Ghana

In 1994, Ghana (1991 population: 16 million) reported to the World Health Organization (WHO) 8432 cases of dracunculiasis in 1347 villages with known endemic disease, representing substantial declines in the numbers of cases (53%) and villages with known endemic disease (42%) from 1993. Since initiation of active surveillance in 1989, the numbers of cases and villages with known endemic disease have been reduced by 95% Figure_1 and 79%, respectively.

In 1994, an average of 74% of villages with known endemic disease submitted surveillance reports on time each month; the rate of timely reporting increased from 30%-45% during January-March (when ethnic disturbances occurred in parts of the northern region, which has high rates of dracunculiasis) to 98% during October- December. During 1994, the northern region reported 69% of all cases in the country. Five of the 10 regions reported no indigenous cases for greater than or equal to 3 consecutive months. Overall, 65% of the reported cases were fully contained (i.e., the case was detected within 24 hours of worm emergence, the worm extracted surgically and/or the lesions bandaged, and the affected person prevented from entering sources of drinking water to prevent transmission); the percentage of contained cases increased steadily during the year, from 30% in January to 93% in December. Nigeria

In 1994, Nigeria (1992 population: 90 million) reported to WHO 35,749 cases of dracunculiasis in 2571 villages with known endemic disease, representing substantial declines in the numbers of cases (53%) and villages with known endemic disease (29%) from 1993 (3). From July 1988 through December 1994, the annual numbers of cases and villages with known endemic disease declined 95% Figure_2 and 56%, respectively.

In 1994, an average of 75% of villages with known endemic disease submitted surveillance reports on time. Five of the 30 states and the Federal Capital Territory reported 66% of the total number of cases; seven states reported no cases. By December 31, approximately 72% of the remaining villages with known endemic disease had begun case-containment measures designed to prevent further transmission. Reported by: S Bugri, MD, Ghana Guinea Worm Eradication Program, Ministry of Health, Ghana. AA Adeyemi, MD, Nigeria Guinea Worm Eradication Program, Federal Ministry of Health and Social Svcs, Nigeria. Global 2000, Inc, The Carter Center, Atlanta. World Health Organization Collaborating Center for Research, Training, and Eradication of Dracunculiasis, Div of Parasitic Diseases, National Center for Infectious Diseases, CDC.

Editorial Note

Editorial Note: This report documents continued progress in Ghana's and Nigeria's efforts to eradicate dracunculiasis. However, the civil disturbances in Nigeria and ethnic fighting in Ghana during 1994 may slow this progress. For example, during January 1995 in Ghana, 1971 cases of dracunculiasis were reported, a 136% increase over the 834 cases reported in January 1994. However, concerted efforts to rapidly reinstitute eradication efforts in Ghana as the ethnic strife subsided resulted in rapid detection and full containment of 97% of the cases. Improvements in surveillance and case containment in Ghana and Nigeria indicate that the two countries may reach the goal of eradicating dracunculiasis by the end of 1995.

References

  1. Hopkins DR, Foege WH. Guinea worm disease {Letter}. Science 1981;212:495.

  2. World Health Organization. Dracunculiasis: global surveillance summary, 1993. Wkly Epidemiol Rec 1994;17:121-8.

  3. CDC. Update: dracunculiasis eradication -- Ghana and Nigeria, 1993. MMWR 1994;43:293-5.


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