Cameroon: an African model for final stages of guinea worm eradication.

The Cameroon Guinea worm eradication program initiated case containment activities in 1991 in the Mayo-Sava Division, the only endemic region in the country. These activities differed from the Pakistan program, the only other operational model for dracunculiasis case containment, in two important ways. In Cameroon, next-level supervisors received reports of new cases from village health workers during routine weekly visits to endemic villages. The Pakistan program established a faster case reporting scheme that allowed higher level personnel (sector supervisors and regional managers) to confirm cases within one week of worm emergence. Second, in Cameroon case containment activities were extended only to villages reporting five or more cases the previous transmission season and villages with recent confirmed cases. In Pakistan, all villages reporting cases during the previous year were included in the program. A village-by-village case search one year after initiation of case containment in the Mayo-Sava indicated decreases of 60% in the number of cases and 51% in the number of villages reporting cases. Based on the apparent success of the efforts in Cameroon, we propose a two-stage scheme for implementation of case containment. Both stages are based on rapid detection and containment of cases, within 24 hr of worm emergence, by village-based health workers. In stage 1, cases are reported and confirmed during routine weekly visits to the endemic villages by next-level supervisors. Weekly reporting should be extended to all villages with recent confirmed cases and to as many villages reporting cases during the previous transmission season as logistically possible.(ABSTRACT TRUNCATED AT 250 WORDS)

Surgical extraction of guinea worm: disability reduction and contribution to disease control.

Surgical extraction of Guinea worm prior to eruption through the skin has long been performed by traditional healers in India. Using modern aseptic techniques under local anesthesia, unerupted worms can be completely and painlessly removed in several minutes. As a result, the average number of working days lost due to a single worm is reduced from three weeks or more to three days. In the field, the procedure results not only in a dramatic decrease in Guinea worm associated disability, but also in an improvement in detecting cases, and appears to reduce disease transmission.

[Social and economic impact of dracunculosis: a longitudinal study carried out in 2 villages in Benin]. / Impact social et économique de la dracunculose: une étude longitudinale effectuée dans deux villages du Bénin.

Dracunculiasis is a severely disabling parasitic disease. In endemic areas it is responsible for heavy economic losses and serious social repercussions. A prospective study in two villages of some 200 inhabitants in Zou Province, central Benin, was carried out over a period of 21 months, which covers two seasons of dracunculiasis transmission. This survey consisted of weekly visits by a medical team and a case study of 30 households conducted by an investigator on 20 days each month. The medical team had the task of detecting and treating all cases of dracunculiasis, and quantifying the duration of each case and the degree of disability of each patient. The investigator noted the number of working days and the distribution of tasks within each household. Days lost on account of dracunculiasis amount to 6.2% of the total number of working days at Lissa and 8.6% at Sozoumé. At certain times of the year as much as 19% of working days may be lost. The reduction in working time leads to a redistribution of tasks among the villagers and, less commonly, to the use of replacement labour. Mutual assistance, very widespread in small communities, makes it possible to maintain income levels. On the other hand, it often involves work by schoolchildren. Young people who stay away from school to replace disabled adults sometimes never return. The annual cost of dracunculiasis has been estimated at 16,000 CFA francs per patient (US$ 60), which corresponds to 15% of a worker's income.

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.

[Dracunculosis--a retreating scourge]. / Dracunculiasis--et uhyre på vikende front.

Guinea worm disease (dracunculiasis) is an easily preventable parasitic illness where one or more worms (Dracunculus medinensis) emerge through the skin about a year after drinking infected water. It is highly debilitating and compromises health, food production and schooling in 19 African nations, and in India. In affected areas it causes more permanent disability than poliomyelitis, and the annual economic cost is estimated to one billion USD. About 120 million poor are at risk. Interventions include providing safe water, teaching people at risk to filter all their drinking water, and chemical treatment of the water. The article discusses the life cycle of the parasite, its socioeconomic consequences, interventions against it and progress toward eradicating guinea worm disease.

Farmers' loss due to Guinea worm disease: a pilot study.

Guinea worm disease has been blamed for much disability and loss of productivity among farmers in Africa and South Asia. Many studies have tried to equate days lost in illness to monetary values. These attempts often overlook the process of disability in relation to farming patterns. This pilot effort uses a qualitative case study approach to learn about how Guinea worm can cause loss to farmers. Twenty in-depth interviews with affected farmers showed that their losses are related to the time of year they are affected by Guinea worm. Some crops with flexible planting times, e.g. cassava, may not be as affected. Duration of disability is another determining factor. Insights from this pilot study can be used to design more appropriate large-scale survey instruments and guide development of longitudinal research.

Guinea worm: an in-depth study of what happens to mothers, families and communities.

This paper reports on the impact of maternal morbidity due to guinea worm, dracunculiasis, on the care and health of children under 24 months old, and the way in which the mothers and the family coped with the often extended periods of disability. This qualitative study is based on observation and in-depth interviewing, supplemented by focus group discussions. Of 42 mothers with guinea worm in two hyperendemic areas of Oyo and Kwara States, 28 were either bedridden or only able to hobble short distances with the help of a stick; the average period of incapacity was almost 9 weeks. Of the four maternal roles identified (child care, self care, domestic tasks, income generation), the women gave priority to child care; 34 of the 42 mothers needed help in child care. Coping networks operated principally within the extended family, but also included women in other households, and women from beyond the community. Thus the impact of a mother's illness extended beyond her children and family to the wider community. This qualitative study thus reveals the multifaceted impact of a disease on individuals and on the community. The study stresses the need for, and availability of, effective methods for controlling guinea worm by utilizing community cooperation to provide protected water sources and other preventive measures against the disease.

[Therapeutic and economic aspects of dracunculosis in a Parisian hospital]. / Aspects thérapeutique et économique de la dracunculose dans un hôpital parisien.

We studied 18 cases of dracunculosis treated in our department of Internal Medicine in Paris. The mean duration of the hospital stay is 38 days (15 to 90). The cost of this stay, calculated on the basis of the daily charge, accounts for 93.3 % of the total cost. The longest stays are due to serious subcutaneous infections at the site of the worm and to multiple or complex associated diseases. Average charge for laboratory test, roentgenograms or other investigations amounts to 4.4 % of the cost of the hospital stay. A significant part of these investigations is warranted by cellulitis and the diagnosis of associated conditions. Antibodies prescribed for subcutaneous infections account for almost all of the drug expense (2.3 % of the total cost). Thus, investigations and treatment together amount to only 6.7 % of the daily charge. Traditional treatment of dracunculosis is based on manual extraction of the worm. Thiabendazole was added in 12 of the 18 patients. The average duration of hospitalization (34 days) and average charge for investigations and drug treatment (FF 611) were less in these 12 patients than in the 6 others (47 days, FF 1286). However, this result is to be considered with caution as the number of patients in each group is small, treatments were assigned without any statistical rule, subcutaneous infections were more or less serious and associated diseases may have had a bearing on results.

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.