Eradication of Guinea-worm disease

Guinea worm disease was for many years under-reported and neglected. Before the international campaign to eradicate it gained momentum barely one case in 20 was known, although guinea worm disease is a major cause of disability and the third biggest cause of tetanus.

The effect on the economy of endemic countries, including Nigeria and Ghana has been devastating. In Nigeria it is estimated that 50 million working days, in the cultivation of rice, cassava and yams, were lost each year, and that children missed 40 million days a year because of the disease.

The key messages which people needed to know and act on if guinea worm is to be eradicated are:

• guinea worm comes from contaminated drinking water;
• infected individuals should not be allowed to bathe in or contaminate water sources used for drinking;
• guinea worm wounds should be cleaned and bandaged;
• drinking water should be filtered or boiled.

Messages have to be acted on at village level, but they need action national and global level. The campaign needs money to repair wells and pumps, nylon to make filters, training for village health workers, and vehicles and equipment to spread the message. This requires cooperation between donors and government departments.

President Jimmy Carter has been a leading figure internationally in helping to mobilise resources, sometimes able to open doors and gain a hearing when a lower profile approach would have failed. He has been able to act as an ambassador for the campaign, inviting heads of state and government ministers to view a video film outlining the problem and potential for eradication, before discussing what can be done.

At national level the role of Heads of State and Government ministers has been crucial in focusing attention. In Ghana the Head of State visited 21 endemic villages in the Northern Region soon after the national programme began. In Nigeria the Vice President unveiled commemorative stamps and ordered that local government areas allocate 10% of their health budgets to the campaign.

The State Commissioner of Health in Kwarea in Nigeria watched a guinea worm being extracted and then took the worm with him to show to the military governor of the state. The Governor immediately approved the money for a well.

The national effort which laid the groundwork for a successful campaign was a village by village search for cases, which in 1989 identified more than 800,000 cases in the two countries, and showed where they were concentrated. Now village health workers make monthly reports on the number of cases, so that the campaign can be monitored nationally and internationally.

The results have been spectacular. In Nigeria the number of cases fell by 76% in four years, and in Ghana there was an even steeper decline as cases fell by 81% in three years.

Ghana is now on course for eradication by the end of this year, while Nigeria expects to eradicate the disease by 1996. Mobilising the community at village level, Government departments at national level, and agencies and Governments at international level has been a communications success story. Advocacy at Global and national level has been a key element in turning the tide of events.