The Guinea Worm Eradication Programme

Contributing to my previous blog about diseases in sub-Saharan Africa, this blog looks at the Guinea Worm Disease, a disease that can easily be eradicated by providing access to safe and protected drinking water. As the Guinea Worm Disease is mostly found in remote villages, there is often not scope for boreholes or wells, therefore changing behaviour towards water sources is the most appropriate way to provide safe water.

The Guinea Worm Disease, also known as Dracunculiasis, is a water-borne disease caused by the parasite Dracunculus medinensis.  In the 1980s the Carter Centre, a charitable organisation founded by the former US President Carter, alongside other supranational bodies, campaigned to eradicate the Guinea Worm Disease globally by 1995 (Ciantia et al, 2013). Before the eradication programme, Guinea Worm was a largely unreported disease, Nigeria estimated that it annually only had around 3000 cases in the 1980s, however, in 1989 Nigeria carried out a nationwide survey which returned with an actual figure of 650,000 cases annually (Hopkins and Ruiz-Tiben, 2011). The 1995 goal of eradication was not achieved and was therefore extended to 2009, again there were still isolated cases of Guinea Worm and the eradication date was set in line with the Millennium Development Goals (Ciantia et al, 2013).

Causes:

Eradicating the Guinea Worm Disease directly relies on the provision of safe drinking water (Hopkins, 1981). Humans can become infected with the Guinea Worm Disease by drinking stagnant surface water. This water has been infected as a result of copepods eating the young of the parasite, thus infesting the water. Figure 1 below shows an illustration of how a water source can become contaminated.

Figure 1

Source: http://edition.cnn.com/2010/WORLD/africa/10/08/guinea.worm.eradication/index.html 

Once infected the parasite remains in the body for over a year, growing up to 1 metre long. Towards the end of the year, the worm begins to slowly and painfully exit the human body through a ruptured blister on the skin, usually found on the legs or feet. The Guinea Worm Disease is not usually fatal but can have great consequences on villages, due to the painful way the worm exits the body this can result in the infected person being temporarily disabled for around 1 to 2 months, leaving the infected unable to work or attend school (Hopkins and Ruiz-Tiben, 2011). The Guinea Worm Disease commonly has no long-term effects, however, some cases report early onset arthritis, and 0.5% of cases result in permanent disability (Hopkins, 1981). 

Solutions:

There is no medical cure for the Guinea Worm Disease. Providing water from boreholes and wells would be the ideal way of preventing this parasitic disease, however, this is often a very slow and expensive approach, and often not suitable for remote villages (Hopkins and Ruiz-Tiben, 2011), and therefore other approaches are required to tackle the disease.

Through the Guinea Worm Eradication Programme (GWEP), numerous approaches were taken to make the water supply free from Guinea Worm. A vital aspect of the eradication programme involved sending village volunteers to villages impacted by Guinea Worm. The role of the village volunteers was: to educate about disease prevention, record and report cases of Guinea Worm, distribute cloth filters among villagers, and finally administer first aid to those suffering from the disease (Ciantia et al, 2013).

The programme began with educating the villages susceptible to the disease. Many did not understand that the reason behind their illness, was due to water they had drunk a year ago, many blamed bad spirits (Ciantia et al, 2013), the programme was able to change the villager's perception by magnifying a glass of the contaminated water showing the parasites inside, this was met with disgust from many villagers. This education focused on teaching the infected individuals to stay out of the water and taught the villagers how to effectively filter water, with a special emphasis on educating females, as they are the primary water collectors (Hopkins and Ruiz-Tiben, 2011).

Alongside this education, the programme provided finely woven cloths to villages to use as water filters (Hopkins and Ruiz-Tiben, 2011). The programme also provided portable 'pipe filters', a straw that could be hung around one's neck which allowed water to be filtered immediately, this meant that those who were travelling on long journeys were able to filter water effectively (Hopkins and Ruiz-Tiben, 2011).

The success of the Guinea Worm eradication programme:

The Guinea Worm Eradication Programme was an extremely successful way of combating water-borne disease through introducing behavioural changes and low-cost filtering techniques. Figure 2 illustrates the huge success of the Guinea Worm Eradication Programme, the disease which was originally found in 20 countries is now only found in four, Chad, Ethiopia, Mali and South Sudan.

Figure 2 

Source: https://www.cdc.gov/globalhealth/infographics/guinea_worm.htm

The Guinea Worm disease is the perfect example of an illness that does not need to exist, the only way one can get the disease is through drinking contaminated water. By providing the world access to a safe water source, the Guinea Worm disease would be completely eradicated and would help to further eradicate other diseases.