Countdown to wipe out guinea-worm in Ghana by vwt15444



Countdown to wipe out guinea-worm in Ghana
Ghana could be one of the next African countries to say goodbye to guinea worm. Mawusi Afele reports from Tamale.

Amamata Sumani is on the front line                      A teacher by profession, Yakubu                 staying out of reservoirs. At least most
in the war against guinea-worm disease              has for the past 15 years been a vol-                people are, but there is still one group
(dracunculiasis) in Ghana – a front line            unteer for the Ghana Guinea Worm                     that is not getting the message: young
that shrinks every year as the parasitic            Eradication Programme, and one of the                boys. Boys like four-year-old Moham-
nematode retreats into its last remain-             biggest obstacles he has had to over-                med Tahidu. He was brought from
ing strongholds in the north of the                 come is the entrenched belief that at-               Gunsi to the guinea-worm contain-
country. Dracunculiasis transmission                tributes guinea-worm disease to the will             ment centre in Tamale, the capital of
can be interrupted at two places in the             of the gods or witchcraft. “It took some             the Northern Region, after he was
parasites’ life-cycle – by preventing               time before I was able to erase these                diagnosed with the disease.
people with open sores from contami-                gods, curses and superstitions from their                  “These boys hang around all sorts
nating water sources, and by filtering              minds,” Yakubu says. Like Sumani,                    of places and swim in ponds that
drinking water.                                     Yakubu has enlisted the help of chiefs               their parents are not even aware of,”
      “People’s behaviour is part of the            and elders to educate the community.                 says Jim Niquette, the Carter Center
problem,” explains Sumani, district                                                                      Resident Technical Adviser in Ghana.
director of health services for Central                                                                  The Carter Center is an international
Gonja, in the Northern Region. Gonja                                                                     nongovernmental organization that
                                                                    This is the                          was founded in 1982 by former US
has vast tracts of arable land traversed
by migrant farmers. “When measures                           biggest percentage                          President Jimmy Carter and his wife
were put into place to control the farm-                     reduction in cases                          Rosalynn Carter, and this centre has
ers, they refused to filter their water                    for a one-year period                         been at the forefront of the campaign
and waded through dams and ponds                               in any country                            to eradicate guinea worm worldwide.
with open sores,” says Sumani. Some                                                                            Niquette and the guinea-worm
                                                           with over 1000 cases                          team are encouraging communities
refuse to filter water because they are
too busy trying to make a living; some                     since the programme                           to find out where these children have
forget their filter nets; others believe                         started.                                been swimming or playing and then
that witchcraft – rather than contami-                     Andrew Seidu Korkor                           treat the water with chemicals that kill
nated water – causes the disease. These                                                                  the intermediate hosts of guinea worm.
reasons are why the Northern Region                                                                      The disease is caused by drinking water
accounted for slightly more than half of                 The approach is working. “Kpanvo                containing water fleas that have in-
the 229 cases reported in Ghana in the              used to be one of the worst affected vil-            gested dracunculus larvae. This is why
first six months of 2009.                           lages, but this year it has yet to report a          filtering the water to remove the water
      Since the drinking of infected                case,” says Yakubu. Attitudes are chang-             fleas is important. In the human body,
water and release of larvae from                    ing all over the country, including                  the larvae are released and develop into
guinea-worm sores are key phases of                 among the migrant farmers of Central                 adult worms. The worms eventually
the parasite’s transmission cycle, the              Gonja. People are filtering water and                emerge through the skin, usually at the
migrant farmers are inadvertently as-
sisting the spread of guinea worm. The
situation is frustrating because humans
are the only known reservoir for the
parasite, and denying the worm access
to water is a matter of changing human
      Sumani is attempting to bring
about change by calling on chiefs to
impose sanctions, focusing on those
who refuse to bandage their wounds or
who wade through dams and ponds at
the risk of polluting the water.
      Sumani and her team have also
                                                                                                                                                    WHO/Gautam Biswas

made use of dramatic role play to
educate people about the dangers of
the disease. Getting people to change
their behaviour is not easy, as can be
attested by Joseph Yakubu in Kpanvo,
a community of some 500 people, also
located in the Northern Region.                     A health worker rolls out an emerging guinea worm.

Bull World Health Organ 2009;87:649–650 | doi:10.2471/BLT.09.010909                                                                          649

                   feet. If they come into contact with
                   water as they are emerging, the female
                   worms discharge their larvae, setting in
                   motion a new life-cycle.
                        Locating and treating infected
                   water has become a core element of
                   the National Programme’s campaign,
                   which is also focused on improving
                   water supplies. “This year alone, the
                   Carter Center has fixed 125 water
                   pumps, although this was not part of
                   our original job description,” Niquette

                                                                                                                                                                                WHO/Gautam Biswas
                   says, adding that the work is essential
                   because it is when water supplies break
                   down that people go back to unsafe
                   drinking sources.
                        All the evidence suggests that the
                   efforts of the programme are paying                Stagnant bodies of water are a source of transmission for guinea worm.
                   off. Despite trouble spots like Fufulso-
                   Junction, Ghana seems to have the
                   disease on the run, having posted an               villages with at least one safe water                         “Some people confuse breaking
                   85% reduction in cases from 3358 in                source increasing from 45% at the end                    transmission with eradication,” says
                   2007 to 501 in 2008. “This is the big-             of 2008 to 63% during the first half                     Korkor. “Eradication can be declared
                   gest percentage reduction in cases for             of this year,” he says. “The emergency                   only after at least three years of zero case
                   a one-year period in any country with              response system for water was imple-                     reporting, after having broken transmis-
                   over 1000 cases since the programme                mented and a rapid response team                         sion, and when other conditions have
                   started,” says Andrew Seidu Korkor,                from the secretariat is in place to access               been satisfied.”
                   national programme manager, add-                   and promptly repair broken-down                               In 2004, governments pledged to
                   ing that the number of villages that               boreholes.”                                              interrupt transmission of guinea worm
                   reported the disease has also dropped                                                                       by the end of 2009. That goal may not
                   significantly. Meanwhile, reported cases                                                                    be achieved, but it is not far off. The
                                                                                                                               only disease to be eradicated by human
                   for the first six months of this year fell                      We are on the                               effort to date is smallpox in 1979. Polio
                   to 229 from 416 for the same period                       brink of winning the
                   last year. The disease is now limited to                                                                    eradication seems tantalizingly close in
                   the Northern Region, and the hope is
                                                                             battle against guinea-                            the last endemic countries: Afghanistan,
                   that once this area is cleared Ghana will                  worm disease.                                    India, Nigeria and Pakistan.
                   be free of the disease.                                   Gautam Biswas
                                                                                                                                    “We are on the brink of win-
                                                                                                                               ning the battle against guinea-worm
                        Like Niquette, Korkor believes
                                                                                                                               disease,” says Gautam Biswas, pro-
                   clean water is crucial to continued
                                                                           But groundwater is not always                       gramme manager of WHO’s enhanced
                   improvement and stresses the National
                                                                      available. The United Nations Chil-                      guinea-worm eradication programme.
                   Programme’s commitment in this
                                                                      dren’s Fund (UNICEF) drilled three                       “In principle, interruption of transmis-
                   area. “There was an overall improve-
                                                                      such boreholes earlier this year for                     sion of guinea worm could be achieved
                   ment from the proportion of endemic
                                                                      the Fufulso-Junction community but                       within one transmission cycle,” he says,
                                                                      all were dry. Now a water filtration                     explaining that it is “largely feasible” to
                                                                      plant has been brought in to treat the                   interrupt transmission of guinea worm
                                                                      surface water to the great satisfaction                  by the end of 2009 outside Sudan.
                                                                      of Sumani, who is also pleased to re-                         Sudan has faced problems in
                                                                      port that guards are now policing the                    the past due to the conflict and the
                                                                      dams in the district. “These measures                    guinea-worm eradication programme
                                                                      are working,” she says, “and so far                      in southern Sudan has only been fully
                                                                      this year almost all cases have been                     operative since 2006. That said, Biswas
                                                                      contained.”                                              is cautious about declaring victory
                                                                           And what of the rest of Africa,                     quite yet for Ghana or any of the other
                                                                      the only continent now where guinea                      countries, pointing out that laxity in
WHO/Mawusi Afele

                                                                      worm is still endemic? Efforts are con-                  surveillance or case containment and
                                                                      centrated on six remaining endemic                       mobile populations could still thwart
                                                                      countries. Niger and Nigeria reported                    their efforts.
                                                                      the last cases in 2008. Ethiopia, Ghana                       “We’re working very hard to make
                                                                      and Mali look ready to interrupt trans-                  one last effort,” says Korkor. “We be-
                   Four-year old Mohammed Tahiru is recovering from   mission soon, with Sudan likely to be                    lieve we can interrupt the transmission
                   a guinea-worm infection.                           the last to cut transmission.                            of this disease in the coming year.” ■

                   650                                                                                    Bull World Health Organ 2009;87:649–650 | doi:10.2471/BLT.09.010909

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