The provision of potable water in eradication of Guinea worm infection in Ezza North, Southeastern, Nigeria.

Guinea worm is a parasite found in unprotected drinking water sources, causes considerable morbidity and loss of agricultural production among rural people. The study was to determine the current status of Guinea worm infection in Ezza North and to evaluate the impact of control measures on guinea worm infection. A total of 200 individuals in Ezza North Southeastern, Nigeria were examined for guinea worm infection. A standardized questionnaire was used to determine the effect of potable water on guinea worm eradication/control, the source of drinking water, information on the knowledge, attitude, symptom management practices, availability of health facilities and boreholes installation status. The instrument for data collection was well constructed, validated and reliable tested questionnaire by an expert. Data obtained was analyzed using Epi-Info model 3.4 versions. Results of a study indicated majority of the respondents 195 (97.5 %) have access to safe drinking water supply which indicated no case of Guinea worm infection. The active use of potable water supply was found among the age group of 20-30 years 71 (35.5 %) and higher in male (57.5 %) than females (42.5 %). The drastic reduction of Guinea worm infection to zero (0) level in Ezza North were due to multiple factors as health education, availability of functional boreholes, presence of health centers for immediate treatment if any case discovered.

Dracunculiasis, onchocerciasis, schistosomiasis, and trachoma.

The four diseases discussed in this chapter (dracunculiasis, onchocerciasis, schistosomiasis, and trachoma) are among the officially designated "Neglected Tropical Diseases," and each is also both the result of and a contributor to the poverty of many rural populations. To various degrees, they all have adverse effects on health, agricultural productivity, and education. The Carter Center decided to work on these health problems because of their adverse effect on the lives of poor people and the opportunity to help implement effective interventions. As a result of the global campaign spearheaded by the Carter Center since 1986, the extent of dracunculiasis has been reduced from 20 to five endemic countries and the number of cases reduced by more than 99%. We have helped administer nearly 20% of the 530 million Mectizan (ivermectin) doses for onchocerciasis, which is now being controlled throughout most of Africa, and is progressing toward elimination in the Americas. Since 1999, two Nigerian states have been using village-based health workers originally recruited to work on onchocerciasis to also deliver mass treatment and health education for schistosomiasis and lymphatic filariasis. They now also distribute vitamin A supplements and bed nets to prevent malaria and lymphatic filariasis. Ethiopia aims to eliminate blinding trachoma in the Amhara Region of that highest-endemicity country by 2012, already constructing more than 300,000 latrines and other complementary interventions. Because of the synergy between these diseases and poverty, controlling or eliminating the disease also reduces poverty and increases self-reliance.

Control of endemic dracunculiasis in Ebonyi state, south-eastern Nigeria.

A field study was carried out in Ozibo and the Ebonyi local government area of Ebonyi state, south-eastern Nigeria to determine the effectiveness of several intervention strategies in the control of endemic dracunculiasis in that area. During the initial study prior to the application of such measures, 14,421 subjects were examined. A total of 8,688 (60.2%) persons had either Dracunculus ulcers or emergent worms. Sex-related prevalence rates were 56.1% and 63.9% for males and females respectively. Age specific prevalence rates increased with age in males, whereas highest infection rates were found in females younger than 20 years. Twenty-eight months after the introduction of intervention strategies the prevalence rate fell by 85.1% to 9% (males: by 88.2% to 6.6%, females: by 83.0% to 10.8%). Reduction rates of more than 90% were observed in males aged 10 to 19 and in females aged 0 to 9 years. Intervention measures included systematic pond treatment, distribution or replacement of filters, intensive health education, provision of hand-dug wells, regular bore-hole installation/rehabilitation as well as active case detection, containment, management, and prompt reporting. Active involvement of the endemic communities, governments and the Global 2000 staff regarding the control efforts is a necessity towards the final eradication of the disease in the near future. The relationship between some of these intervention strategies and community development are highlighted.

[Water contacts in dracunculiasis-infected patients in Mali: transmission risk activities]. / Contacts homme-eau chez des malades atteints de dracunculose au Mali: activités à risque de transmission.

The aim of this study lies in the identification of human activities responsible for the transmission of the Guinea worm in an endemic village in Diema Region in Mali. Human water contacts observations started after a census followed by the implementation of a bi-monthly notification system, carried out from May to November 1993. Water contacts were noticed and observed from the mid-July to the end of November of the same year. The first case of dracunculiasis observed was randomly drawn out of a list of the families with obvious cases. The patent case activities involving either surface water, traditional wells or bore-hole water were recorded for 10 consecutive days. During this observation period, contacts made by other patients with the same water sources were also recorded. After 14 days, the case list was updated and a new case selected out of families previously selected. This cycle was repeated until the end of the study period. A "contact at risk for transmission" was defined by a close correspondence between the location of the worm's emergence and the surface of the skin exposed to water, within two weeks following emergence. Contacts were described according to water sources, activities in relation to water, date, gender and age. Observations were made on 103 patients who had 2506 activities in relation with a water body: 1132 of these activities implied a skin contact with the water. Only 133 (9%) of these water contacts were at risk for transmission, 75% took place during the months of August and September, 80% were related to surface waters and 20% to traditional wells. Woman household activities and boys games were the major activities at risk, in contrast to economic activities (watering cattle). The low proportion of "at risk activities" evaluated in this study suggests that a small number of water contacts is sufficient to maintain the transmission. The case implications of the current eradication strategy might not be sufficient alone to break the transmission and should therefore be associated with a reinforcement of the use of filters for drinking water together with an health education.

[Endemic dracunculiasis in new villages: re-emergence of the disease or failure of the surveillance system]. / Les nouveaux villages d'endémie de la dracunculose: réémergence de la maladie ou dysfonctionnement du système de surveillance.

According to data sent to Bamako in March 1998 for the annual review of National Programs for the Eradication of the Guinea Worm (NPEGV), dracunculiasis was observed in 211 villages in Burkina Faso in 1997. Of this total, 110 (52 p. 100) were new villages not previously reporting dracunculiasis. A study focusing on these new villages was carried out in June 1998. The aim of the study was to evaluate the quality of the disease monitoring system and determine if endemicity was spreading to new villages. A twofold method was used first to analyze the data used in the geographic information section of the disease monitoring system and second to test the validity of this data in field surveys. Findings showed the actual number of new villages showing endemicity could be reduced from 46 p. 100 to 12 p. 100 since 67 p. 100 of the new villages had in fact previously reported endemicity but had been wrongly eliminated from monitoring records. This probably long-standing problem has been uncovered with a decrease in the number of villages showing endemicity and an increase in prevention activities. In addition this study identified several confounding factors and defects in disease monitoring and data reporting techniques. Based on this study, several recommendations were made to improve the quality of the disease monitoring system.

Epidemiology of dracunculiasis and its socio-economic impact in a village in south-west Nigeria.

An epidemiological survey of dracunculiasis conducted in a village in Oluyole Government Area of Oyo State, Nigeria, from January to June 1985 revealed that of a sample of 851 subjects interviewed and examined 52.2% had had infection at one time or the other while 28.7% were females (30.3%) than males (27.0%) were infected, the difference was not statistically significant. The prevalence increased with age and infection was found to be uncommon in children below one year of age. Reinfection after infancy is a common feature and all the infected people regularly drank untreated pond water. 85.8% claimed they knew that they were infected before the formation of the characteristics guineaworm bleb; of these 56.6% became aware of infection two to five days prior to the formation of the bleb. 70% had had more than one worm emerging at a time, mainly in the lower parts of the body. Most of the infected people (76.0%) became clinically ill in the dry season and 93.4% of these were incapacitated for an average of 26 days from each infection.

Dracunculus insignis in ferrets: comparison of inoculation routes.

Three routes of inoculation were compared to determine the best method to infect ferrets with Dracunculus insignis. The traditional method of administering infected cyclops containing L3s through gavage was compared to intraperitoneal (i.p.) and subcutaneous (s.c.) inoculation of L3s. Ten of 18 (56%) gavaged ferrets became infected after receiving copepods containing approximately 100 L3s each; 44 adult worms were recovered from these 10 animals. Twenty-one of 28 (75%) animals inoculated with 50 L3s each became infected i.p.; 92 adult worms were recovered from the positive animals. Four of 5 (80%) ferrets given subcutaneous inoculations of 50 L3s became infected; only 6 worms were recovered from these 4 animals. Inoculation of larvae via the i.p. or s.c. route greatly simplifies the infection procedure and produces more consistent results. A simple procedure is described, which permits rapid recovery of L3s to be used in the i.p. or s.c. inoculations.

Guinea worm disease in Northern Uganda: a major public health problem controllable through an effective water programme.

A modified cluster survey was conducted in northwestern Uganda in 1984 to provide descriptive epidemiological data on dracunculiasis in a water programme target area. A total of 2014 people participated from 58 randomly selected clusters. Interviewers elicited information on age and sex of household members, number, date of emergence and location of Guinea worms, and type of and distance from water source in an endemic area. The survey yielded an incidence rate of 193 cases/1000 people per year, and a prevalence rate of 43 active cases/1000. Respondents who reported using ponds, reservoirs, valley tanks or rivers as their primary water source had the highest attack rates; those using boreholes, the lowest. Adolescents and adults differed little in risk, but the disease was less common among young children. Guinea worm disease displayed a bimodal seasonal pattern. We concluded that the survey method used for determining dracunculiasis incidence was appropriate in this setting. The incidence of this disease may be significantly reduced in Uganda through the country's commitment to the International Drinking Water Supply and Sanitation Decade.

Dracontiasis in Rajasthan. VI. Epidemiology of dracontiasis in Barmer district, Western Rajasthan, India.

Epidemiology of guinea worm disease was studied in relation to sex, age, community and drinking water of inhabitants of 12 desert villages in Barmer district, Western Rajasthan, India. Data were also stratified with respect to first infection and reinfection. Infection was significantly (p less than 0.001) more prevalent in males (7.5%) than females (4.1%). Among all age groups peak infection (9.9%) occurred in those aged 30-39 years. Non-vegetarian communities had a higher incidence than vegetarian communities. Between-community difference was significant (p less than 0.01). First infection cases (11.0%) peaked in those aged 20-29 years while people aged 30-39 years were most susceptible to reinfection (84.6%). Between-age differences with respect to first and reinfection were insignificant (p greater then 0.05). Of various water sources reported pond water was a major source of contamination. 82.7% of the population examined was at risk of developing guinea worm infection at any time. No effective treatment is yet available.

Guinea worm infection in a Nigerian village.

An epidemiological study of Wawa village near Kainji Lake in Kwara State of Nigeria led to the source of guinea worm infection, a man-made cattle pond by the village. The people acquired the infection mainly during the dry season by drinking cyclops-infested water of the pond known to be the best and coolest for the rural people through the water was dearer and more difficult to get than the water from the wells. It is suggested that an interdisciplinary approach should replace the usual fractional and departmental planning the provision of water for men and livestock.

Guinea worm disease: epidemiology, control, and treatment.

Guinea worm infection is one of the most easily prevented parasitic diseases, but it is nevertheless a common cause of disability in rural areas of Africa, south-west Asia, and India. Infection occurs when drinking water is infested with infected Cyclops, a microcrustacean. Worms up to 70-80 cm in length develop in the subcutaneous tissues of the feet or legs and larvae are liberated to renew the cycle when an infected individual steps into a well or pond from which others draw drinking water. Infection is markedly seasonal because of (a) the influence of the climate on the types of water source used and (b) the developmental cycle of the parasite. The disability may be economically very important if the period of infection coincides with busy periods in the agricultural year. Sieving water through a cloth is sufficient to remove the Cyclops, but on a public health scale improved water supplies are required for control. Once the cycle of reinfection can be broken in any district the disease disappears. Chemical treatment of water bodies with temephos is also an effective and safe way of controlling transmission. Treatment consists of rolling out each emerging worm onto a small stick, a few centimetres each day, and certain drugs reduce the pain and pruritus and enable the worm to be removed more quickly.