Surveillance of Human Guinea Worm in Chad, 2010-2018.

The total number of Guinea worm cases has been reduced by 99.9% since the mid-1980s when the eradication campaign began. Today, the greatest number of cases is reported from Chad. In this report, we use surveillance data collected by the Chad Guinea Worm Eradication Program to describe trends in human epidemiology. In total, 114 human cases were reported during the years 2010-2018, with highest rates of containment (i.e., water contamination prevented) in the years 2013, 2014, 2016, and 2017 (P < 0.0001). Approximately half of case-patients were female, and 65.8% of case-patients were aged 30 years or younger (mean: 26.4 years). About 34.2% of case-patients were farmers. Cases were distributed across many ethnicities, with a plurality of individuals being of the Sara Kaba ethnicity (21.3%). Most cases occurred between the end of June and the end of August and were clustered in the Chari Baguirmi (35.9%) and Moyen Chari regions (30.1%). Cases in the northern Chari River area peaked in April and in August, with no clear temporal pattern in the southern Chari River area. History of travel within Chad was reported in 7.0% of cases, and male case-patients (12.5%) were more likely than female case-patients (1.7%) to have reported a history of travel (P = 0.03). Our findings confirm that human Guinea worm is geographically disperse and rare. Although the proportion of case-patients with travel history is relatively small, this finding highlights the challenge of surveillance in mobile populations in the final stages of the global eradication campaign.

Dracunculiasis (guinea worm disease).

Dracunculiasis (guinea worm disease) is a parasitic disease that is limited to remote, rural villages in 13 sub-Saharan African countries that do not have access to safe drinking water. It is one the next diseases targeted for eradication by the World Health Organization. Guinea worm disease is transmitted by drinking water containing copepods (water fleas) that are infected with Dracunculiasis medinensis larvae. One year after human ingestion of infected water a female adult worm emerges, typically from a lower extremity, producing painful ulcers that can impair mobility for up to several weeks. This disease occurs annually when agricultural activities are at their peak. Large proportions of economically productive individuals of a village are usually affected simultaneously, resulting in decreased agricultural productivity and economic hardship. Eradication of guinea worm disease depends on prevention, as there is no effective treatment or vaccine. Since 1986, there has been a 98% reduction in guinea worm disease worldwide, achieved primarily through community-based programs. These programs have educated local populations on how to filter drinking water to remove the parasite and how to prevent those with ulcers from infecting drinking-water sources. Complete eradication will require sustained high-level political, financial and community support.

The impact of dracunculiasis on the nutritional status of children in South Kordofan, Sudan.

This paper assesses the indirect impact of dracunculiasis on the nutritional status of children under 6 years of age in South Kordofan, Sudan. Weight-for-height anthropometric measurement was used as a measure of the nutritional status of 774 children in 428 households. The indirect impact was investigated by comparing the nutritional status in 1988 of children in 'affected' households, where more than half the adult members had suffered from dracunculiasis in 1987, with children in other households. It was anticipated that when the otherwise able adult members of a households had dracunculiasis they were likely to be disabled by the disease and so prevented from fully performing their agricultural activities, so that the nutritional status of children in the same household would deteriorate in the following year. It was found that in 16.9% of the 136 'affected' households the children were wasted (with mean Z-scores of -2 or less), compared with only 6% of the other households.

A survey of predilection sites and degree of disability associated with guineaworm (Dracunculus medinensis).

Of the 1,200 people surveyed for dracontiasis in Ribi and Kanje villages in Awe Local Government Area of Plateau State, Nigeria, 982 (82%) were infected. Most infections (98%) involved the lower limb. Worms emerging from the umbilicus, groin, palm, wrist, and upper arm were also encountered. Of the 982 infected persons 206 (21%) were totally incapacitated, 193 (20%) were seriously disabled, and 431 (44%) suffered mild incapacity, while 152 (16%) were unaffected. Of the 5 species of cyclopoid copepods found in their main water source, only Thermocyclops nigerianus and Mesocyclops aequatorialis harboured guineaworm larvae.

Long-term disability due to guinea worm disease.

The village-based surveillance system for guinea worm disease (dracunculiasis), which has been established in all endemic villages in Ghana, was used to carry out a retrospective study of long-term disability due to the disease. A sample of 195 cases was interviewed and examined, 12-18 months after emergence of the worm. Currently continuing pain when walking or working, attributable by its location and date of onset to the episode of dracunculiasis, was reported by 55 persons (28.2%). Some difficulty in performing at least one of 6 everyday physical activities, attributable after careful interview to the episode, was reported by 66 respondents (34.0%), of whom 10 (5.1%) were unable to carry out one of the activities. In one case, the disease had caused impairment of movement of the joints of the right thumb. The prevalence of serious permanent physical impairment among the cases in the study was thus 0.5%.

Plastic surgery findings in Ethiopian immigrants.

We have encountered infrequent and unfamiliar types of morbid conditions requiring plastic surgery. We present here our clinical experience with five illustrative cases and discuss the typical features of each condition and its treatment.

Dracunculus orchitis: a case report.

The clinical features of dracunculus orchitis as a definite clinical entity are summarized and a case reported.