Guinea Worm – The Disease and its Eradication

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Guinea worm disease (dracunculiasis) is a grotesque illness. Where it exists, guinea worm can permanently cripple people. Research on Guinea worm disease has been completed and “curative prevention” has brought the number people afflicted from 3.5 million in the mid-1980s to 15 people in each of two countries (Chad and Ethiopia) in 2017. The World Health Organization (WHO), UNICEF, UNDP, the World Bank, the US Peace Corps, Sweden’s SIDA, Canada’s CIDA, Norway’s Foreign Ministry, other bilateral agencies, non-governmental groups, businesses, and foundations have joined forces to eradicate this ancient scourge, which has been known to mankind since before the time of the Pharaohs in Egypt.

The eradication effort provides excellent opportunities for “social marketing”. Companies in several nations have found interesting ways to make significant contributions. Companies and organizations whose work in any way deals with water, agriculture, education, or health, will have a particular interest in getting rid of this horrible disease.

Though progress has been great, there is still a real need for more help from businesses working in endemic countries, to help complete the eradication as quickly as possible.

Guinea Worm…

… is an extremely painful, debilitating illness which has been targeted for eradication by the WHO because of the enormous return relative to the effort involved, and the realistic prospects for success.

… afflicted 30 people in 2017, compared with 3.6 million people as recently as 1986. The World Bank estimated $1 billion in annual lost production of marketable goods, in the early 1980s.

… has even been eliminated from South Sudan (last endemic case in 2016) in spite of the civil war prior to its independence and high levels of conflict also after that.

… worsens poverty for individuals and whole villages. It occurs mostly at times that are critical for farming, causing large losses of food production. A farmer with guinea worm has trouble working. Mothers cannot take good care of their children or carry them to clinics for vaccination. Children lose many weeks of schooling, often so many that they drop out of school.

… is a grotesque disease which always debases the victim. People usually stay inside and rarely come to health workers. There is no effective treatment, but simple preventive interventions are dramatically alleviating affliction because people become free of guinea worm unless they are re-infected every year.

… spreads ONLY by drinking infected water, usually from stagnant ponds or step-wells. About a year after the victim drinks such water, one or more worms emerge through the skin. Worms are 1-2 mm thick, up to 1 meter long, and take 3-8 weeks to come out (about 2-3 cm each day). When several worms emerge one after another, people can be sick for over 11 months, completely or partly disabled.

… spreads when persons with a guinea worm emerging from their skin enter a pond or step-well, contaminating the water. The worm pumps hundreds of thousands of larvae into the drinking water as soon as water gets on it, or on the blister where the worm is preparing to come out.

… cannot be treated once the infected water has been drunk, and people develop no immunity, but…

Guinea Worm is Easy to Prevent and Eliminate

The cycle of transmission can easily be broken by filtering drinking water and preventing infected people from entering drinking water sources. Drinking contaminated water is the only way to acquire the disease. When the worm’s one-year life cycle is broken for two years, the disease is permanently eliminated from the area. This is the only disease that can be eradicated by providing clean drinking water.

Eradication Measures – Prevention is the Only Cure:

1. CHOOSING GUINEA WORM VILLAGES FIRST WHEN INSTALLING SAFE WATER SOURCES.

Water projects that use guinea worm elimination as a selection criterion improve their cost-benefit ratio, since villages with guinea worm (often less than 5% of villages, even at the outset) also have all other water-borne diseases.

2. FILTERING ALL UNSAFE DRINKING WATER.

Water contaminated with guinea worm is safe for drinking (as far as this disease is concerned) if the water is filtered through a tightly woven cloth.

Inexpensive, effective cloth is available in most local African markets, and 1 million square meters of special synthetic fabric, for more rapid water filtration, has been donated by DuPont, with additional synthetic cloth donated by the Danish government and others.

Agricultural and school projects, along with company advertising, can teach people about guinea worm and how to protect themselves. Farmers who drink from ponds during the day should have a filter with them. HDI organized the effort to provide 9 million pipe-filters to southern Sudan on both sides of the then ongoing war of liberation, funded by petrochemical workers and their employer Norks Hydro in 2005. Then Norwegian medical students funded the purchase of first aid bandaging kits for every village on both sides of the conflict and a supplemental supply of pipe filters through MedHum-2003, their humanitarian action campaign. (See separate articles here for more details.)

Always using the cloth filter with the same side up, e.g., the one with the printed symbol, avoids rinsing guinea worm larvae into the container when reusing the filter before it dries.

3. KEEPING PEOPLE WITH GUINEA WORM OUT OF THE DRINKING WATER.

Guinea worm disease disappears in 1-2 years where victims are kept out of water. Local leaders have introduced and enforced this principle in thousands of villages, eliminating guinea worm within two years. Neighbors can help guinea worm patients by getting water from the pond or lake. The fiery, burning pain caused by the worm can be relieved by pouring water over the sore. This must be done where water cannot run back into the water source.

Latest News about Guinea Worm Eradication:

While some endemic countries began eliminating guinea worm in 1987, all were not participating until 1994, just one year before the target date for completing the effort, a target which was set by Africa´s Ministers of Health as early as in 1988. The 1991 World Health Assembly endorsed the 1995 eradication goal. Pakistan, India and Iran were all formerly endemic, and are now certified by WHO as free of the disease. In the early ‘80s this disease existed across almost half of India, which has had no cases of guinea worm since 1996.

As of April 2018, all African countries except Ethiopia and Chad have also interrupted transmission. The two countries still reporting cases in Africa in 2017 each reported 15 cases after Ethiopia experienced an outbreak as the result of a single person having gone undetected the year before.

Awareness and activity is also manifest in donor nations. Denmark, Japan, Finland, Luxembourg, The Netherlands, Norway, Spain, Sweden, the UK, and USA, have all supported guinea worm eradication in one or more endemic countries. Former President US Jimmy Carter visited Africa once or more each year to combat guinea worm, for years from 1987. DuPont donated one million sq. meters of filter material. Hydro-Agri, the multinational fertilizer giant, gave t-shirts with guinea worm information for village volunteers. ScanCem paid for training of village volunteers. Daimler-Benz donated bandaging materials. The petrochemicals arm of Norsk Hydro provided 1 740 km of PVC piping for the 9 million pipe filters for what was then southern Sudan, and other companies have contributed similarly, in countries of particular interest to them.

For more information about Guinea Worm Eradication check out Resources.

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