Eradicating guinea worm without wells: unrealized hopes of the Water Decade.

At the start of the United Nations International Drinking Water Supply and Sanitation Decade in the 1980s, guinea worm disease was targeted as the major indicator of the success of the Decade's efforts to promote safe water. By the late 1980s, most of the guinea worm endemic countries in Africa and South Asia had established guinea worm eradication programmes that included water supply as one of their main technical strategies. By surveying the water supply situation in Ifeloju Local Government Area (LGA) in Oyo State, Nigeria, in June 1996, as a case study, it was possible to determine the role that water supply has played in the eradication effort. Although two major agencies, the former Directorate for Food, Roads and Rural Infrastructure and UNICEF, provided hand dug and bore-hole wells respectively in many parts of the LGA, coverage of the smaller farm hamlets has been minor compared to efforts in the larger towns. This is ironic because the farm hamlets served as a reservoir for the disease in the 1980s, such that when the piped water system in the towns broke down, guinea worm was easily reintroduced into the towns. The survey of 188 ever-endemic hamlets with an estimated population of 23,556 found that 74.3% of the people still drink only pond water. Another 11.3% have wells that have become dysfunctional. Only 14.4% of this rural population has access' to functioning wells. Guinea worm was eliminated from 107 of the hamlets mainly by the use of cloth filters and chemical treatment of ponds. While this proves that it is possible to eradicate guinea worm, it fails to leave behind the legacy of reliable, safe water supplies that was the hope of the Water Decade.

PIP: The 1980s were designated by the UN as the International Drinking Water Supply and Sanitation Decade, and guinea worm disease was targeted as the major indicator of the campaign's success. The campaign conceptualized guinea worm disease as a symbol of the isolation of poor rural residents from national development programs such as water supply, education, and health care. The Nigerian Guinea Worm Eradication Program, launched in 1987, committed to provide drinkable treated water to areas with endemic guinea worm disease. However, less expensive interventions such as monofilament nylon cloth filters were given priority over water supply provision. This article examines the eradication program in Ifeloju Local Government Area in Oyo State, Nigeria. The former Directorate for Food, Roads, and Rural Infrastructure provided hand-dug wells in several settlements, but made no provisions for maintenance and repairs. UNICEF assisted in the drilling of bore-hole wells, but restricted this intervention to settlements with more than 250 people. A 1996 survey of 188 ever-endemic hamlets with an estimated population of 23,556 found that 74.3% of residents drank only pond water. Another 11.3% had wells that had become dysfunctional. Only 14.4% of these rural residents had access to functioning wells. Guinea worm was eliminated from 107 of the hamlets, chiefly through use of cloth filters and chemical treatment of ponds. These results show a striking lack of commitment to the eradication of guinea worm disease through the safe water strategy. In 1995, only 43% of Nigeria's population had access to safe water. There is a need for financial investment in less expensive and more appropriate hamlet-level technologies, as well as community mobilization to dig and maintain hand-dug wells.

Farm land size and onchocerciasis status of peasant farmers in south-western Nigeria.

Concern is being raised about the economic impact of the non-blinding strain of onchocerciasis, since half of those affected with onchocerciasis in Africa live in the forest zones where the non-blinding form is prevalent. WHO's TDR programme has embarked on multi-country studies on the social and economic effects of onchocercal skin disease (OSD). Baseline data from one site, the Ibarapa Local Government Area of Oyo State, Nigeria, is presented here. Farmers were screened for signs and symptoms of onchocerciasis including palpable nodules, reactive skin lesions and self-reported severe itching. Those having two or more of these conditions were classified as having severe OSD. A matching group of farmers without any of the signs or symptoms formed a control group. Women in the area either did not farm or held only one small plot. Land size comparisons were undertaken with 51 pairs of male farmers matched for age and location within 23 small hamlets bordering the Ogun River. Farmers with OSD had significantly less farmland under cultivation (9117 m2) than those with no OSD (13850 m2). The farmers with OSD did not appear to have alternative income strategies to compensate and, consequently, they had a lower value of personal wealth indicators (e.g. iron sheet roofing, motorcycle) than those without OSD. One can conclude that although the effect of forest strain onchocerciasis is less dramatic than of the blinding from, the disease poses an important economic threat in the region.

Ethnic diversity and disease surveillance: Guinea worm among the Fulani in a predominantly Yoruba district of Nigeria.

Guinea-worm eradication has been progressing internationally and efforts at case containment have begun in most endemic countries. Case containment rests on the assumption that in previous phases of eradication most if not all endemic settlements have been identified. Experiences in the predominantly Yoruba communities of Ifeloju Local Government Area (LGA) in Oyo State, Nigeria, however, have shown that the settlements of ethnic minority groups may be overlooked during initial case searches and subsequent programmes of village-based reporting. The migrant cattle-herding Fulani are found throughout the savannah and sahel regions of West Africa. Nearly 3000 live in 60 settlements in Ifeloju. An intensive case search identified 57 cases in 15 settlements. The assumption that village-based health workers (VBHWs) in neighbouring Yoruba farm hamlets would identify cases in the Fulani settlements, known as gaa, proved false. Only 5 endemic gaa were located next to a Yoruba hamlet that had a VBHW, and even then the VBHW did not identify and report the cases in the gaa. Efforts to recruit VBHWs for each endemic gaa are recommended, but only after LGA staff improve the poor relationship between themselves and the Fulani, whom they view as outsiders. The results also imply the need for Guinea worm eradication staff in neighbouring LGAs, states and countries to search actively for the disease among their minority populations.