Notions and treatment of guinea worm in northern Ghana.

Dracunculiasis, infection with Dracunculus medinensis or guinea worm, is widespread in the Northern Region of Ghana, where rural people drink from unprotected water sources such as ponds and small-scale dams. This paper discusses the results of an anthropological study of beliefs and practices concerning commonly occurring illnesses, such as infection with guinea worm (nierifu), in two rural Dagomba communities in the Northern Region of Ghana. The importance of knowing about local perceptions and treatment of guinea worm is stressed. Guinea worm is not attributed to water. The general understanding is that guinea worm is an innate part of human anatomy. It is not seen as an alien presence in the body. Guinea worm is rather said to be 'in people's blood', and sooner or later to 'stand up'. Guinea worm is considered an 'inevitable' feature of living. After a description of the background to the study, the methods are characterized. Brief background information on the people, their environment and their water sources are given. The central portion of the paper focuses on local perceptions of illness and notions of guinea worm ('guinea worm is in the human blood'), which are very different from those of biomedicine ('guinea worm is a disease'). Attention is also given to perceptions of water ('bitter' vs 'sweet') and the prevention of guinea worm. The social limitations to the filter technology are addressed. People's choice of therapy and the role of medicines (herbs and Western pharmaceuticals) in treatment of guinea worm are also considered. The paper concludes with a discussion of health education and stresses the importance of showing respect for the local view of guinea worm, which is said to be 'in the blood'. It is suggested that, since people are not adverse to the use of Western pharmaceuticals, the use of Western medicines to treat guinea worm should be further promoted. The social constraints on filtering must also be appreciated. These relate to the organization of labour within the household and the dominant role of the 'senior wife'.

[Dracunculosis: beliefs and attitudes of populations in the endemic zone of the savannah (Burkina-Faso)]. / Dracunculose: étude des croyances et attitudes des populations en zone endémique de savane (Burkina-Faso).

For years, most of the authors propose the sinking of wells as the only method of dracunculiasis control. However, this measure did not lead to the eradication of this very vulnerable endemic scourge in West Africa. Our research has concerned the collection of epidemiologic and socio-medical data close to the housewives. The research has been carried out into six endemic villages in Burkina-Faso, North-Western savannah before the setting up of a control project through health education and chemical water supply points treatment. The global dracunculiasis incidence rate is about 20.3%, setting the six villages in hyperendemic zone. The family incidence rates are from 5.3% to 100% with an attack of 72% of families. The majority of patients are taken into account in case of disability by the village community. Causes of the illness are unknown for 68% of persons, but 30% of people associate it to the water. Ignorance and lack of treatment concern 63.5% of answers. Traditional treatment (32.8% of answers) is very diversified and based on plant extracts. As for the prevention of disease, there is no solution in 83% of cases. A part from the 35% of answers concerning modern well water, the other proposed methods are ineffective. Ponds are finally the mainly water supply source during the raining seasons in spite of the presence of modern wells. The reasons of that situation are mainly the taste of ponds water and the remoteness of wells. The understanding of those beliefs and attitudes lead to thing of several complementary strategies as sinking of modern wells and health education for dracunculiasis control.

Guineaworm, maternal morbidity, and child health.

Studies have documented the effect of guineaworm concerning days lost to agricultural work and drops in school attendance, but little is known about how the disease disables mothers and impairs their ability to care for their children and families. A pilot case study of 42 women in two rural Nigerian communities has been conducted to fill that gap. Guineaworm was responsible for half of child immunization defaulting and deterred women from using maternity services. Guineaworm kept women from their jobs and trades, costing an average of approximately $50 in lost income, a sizable chunk of a family's support considering the annual per capita income for the area is just over $100. Other problems experienced included loss of appetite and reduced food intake, unattended child illnesses, and disabling secondary infections resulting from unhygienic self-treatment. The ill women and her dependent children put great strain on the support network of family friends, a network already weakened in many cases when several other members were also afflicted with guineaworm. While further research is needed to learn more about this disabling disease, there is no excuse not to implement known guineaworm control interventions. The experience with mothers and children in Nigeria has shown that guineaworm control through water supply improvement should be a major child survival and development initiative.

Learning from local knowledge to improve disease surveillance: perceptions of the guinea worm illness experience.

Surveillance is an essential tool in any campaign to eradicate disease; guinea worm (dracunculiasis), which is targeted for eradication before the year 2000, is no exception. One criterion of an eradicable disease is that it be easy to recognize as the program advances. Few experts doubt that the experience of a meter-long subcutaneous worm protruding through a painful ulcer can be missed or confused with another disease, thus ensuring that guinea worm meets this criterion. Field experiences of anthropologists and health educators have shown that one should never assume that community perceptions of illness experience coincide fully with medical case definitions of disease. This paper describes efforts to learn how the Yoruba people of southwestern Nigeria perceive sobia, the local name for guinea worm. Qualitative methods including informal interview, village discussion and participant observation were used to discern a pattern of illness presentation and progression. Interestingly, local perceptions were found to include a variety of illness manifestations beyond the common clinical case definition of an emergent worm, thus creating the potential for a high level of false positive reports. Local knowledge was then used to design a pilot project that trained volunteers to become part of the surveillance network for the national eradication program. The volunteers, who were largely illiterate, were able to distinguish between cultural and clinical definitions, and submit quite accurate reports on the guinea worm status of their villages. Among the 164 volunteers, only two submitted false reports due to incorrect disease definition. In contrast local government health workers who were conducting village searches during the same period were significantly more likely to register false positive reports. The culturally sensitive training based on local knowledge received by the village volunteers is thought to have contributed to their superior performance.

Behavioural aspects and their possible uses in the control of dracontiasis (guinea-worm) in Igwun river basin area of Imo State, Nigeria.

Individuals suffering from dracontiasis from Igwun river basin area of Imo State Nigeria were randomly chosen, examined and interviewed between December 1988 and March 1989 with a view to ascertain some of the behavioural aspects that could be of help in the control/eradication of this disease as well as to ascertain whether local medication was of any chemotherapeutic significance. Of 100 guinea-worm patients males were significantly higher (P < 0.05) in number (63.0%). In the age-related distribution, children less than 10 years old and the members of the villages more than 60 years old accounted for only 5.0% of the patients whilst those in their productive years (10-60 year old) accounted for 95.0%. Only 10.5% of the respondents associated guinea-worm infection with the drinking of "polluted" water while most believed it was a familial trait (36.8%) or implicated their enemies (35.1%). As a result medications against the disease were mainly directed towards consulting the oracle and herbalists, and appeasing the gods. Most (98.0%) of them kept their dressing dry by refraining from immersing them in water. The concomitant behavioural aspects of these results are discussed in relation to their uses in the control/eradication of guinea-worm.

PIP: Between December 1988 and March 1989 in the Igwun river basin of Imo State, Nigeria, health workers randomly chose, examined, and interviewed 100 people with dracontiasis (Guinea-worm infection) living in the villages of Isi Ugwu, Ndi Okorie, Ndi Agwu, Ndi Oji, and Ndi Okereke in the Arochukwu/Ohafia local government area. Males were significantly more likely to be infected with guinea-worm than were females (63% vs. 37%; p .05). Guinea-worm infection was significantly associated with age (95% of cases were between 10-60 years old; p .05). 93% of the 228 villagers who completed a questionnaire about local disease perception, treatment/control, and sociocultural factors were familiar with Akwara (the local term for guinea-worm infection). 84.2% believed infants and the very old, who had low rate of guinea-worm infection, tended to not do farm work, which was indeed the case. 85.5% knew about the damaging effects of the infection. 36.8% believed Akwara was inherited. 35.1% thought enemies or gods caused Akwara. Just 10.5% made the connection between guinea-worm infection and drinking water from contaminated streams, ponds, and lakes. Most guinea-worm infected patients (42%) either just used the time-honored method of winding the emergent female worm around a small stick or the time-honored method in combination with other methods, such as herbalist treatment, consulting an oracle, and receiving Western medical treatment. 21% sought an oracle and received treatment from herbalists. 17% sought an oracle and appeased the gods to achieve relief from guinea-worm. 15% just received herbalist treatments. 5% only sought treatment at the hospital. Just 2 (3.8%) of the 53 patients with dressed guinea-worm blisters and ulcers immersed the dressing into a water source while retrieving water. This low number helped reduce the transmission of the larvae from the blisters/ulcers to the water. Guinea-worm was most devastating in Isi Ugwu, where people believed that drinking potable water separated them from their gods.