IT was a fight that begun in 1989 with little hope as to whether the country would succeed or not. Today, one would be apt to conclude that Ghana is winning the fight against guinea worm.
With the number of cases recorded annually reduced by over 99 per cent in 2010, Ghana is at the brink of being declared a guinea worm free country. One may wonder how the country achieved this feat and what is the way forward?
This feature takes a closer look at guinea worm and how far Ghana has come with the fight.
So, what is Guinea Worm?
Guinea Worm, known in medical language as Dracunculiasis is a parasitic infection, caused by the agent called Dracunculus medinensis. It is also called the Medina worm.
It gained the popular name “Guinea worm” in the 17th century, when Europeans first saw the disease on the Guinea coast of West Africa.
One acquires the disease when one drinks water contaminated by the larvae of the worm. The larva takes about a year to develop into an adult worm.
The male worm is much smaller than the female adult worm. The latter can grow up to two-three feet long and be as thick as a spaghetti noodle.
During the growth period, the worm roams through the body and, when fully matured, the female adult worm looks for an avenue to lay its eggs into water. It therefore migrates towards the surface of the body of its host and forms a blister waiting to burst. Immediately the person hosting this worm comes into contact with water, such as through swimming or stepping into a dam to fetch water, the blister ruptures and several larvae are released into the water.
In the water, are other hosts – water flea or Cyclops – that immediately ingests the eggs; the larvae continue to develop in this intermediate host and become infective within two weeks.
After then, anyone who drinks the water containing these infected hosts also gets infected and the cycle continues.
These intermediate hosts thrive in stagnant and polluted water bodies, such as ponds and dams, and this is why people in rural communities are more prone to guinea worm, because they rely on these contaminated water bodies for water.
Whiles some infected persons have been lucky with their worms protruding from the leg, others have had their worms appearing on the stomachs, backs and on and around the reproductive organs.
The Guinea worm infection season usually begins in November, with the onset of the dry season. It gains momentum in January, February and March, when most of the water bodies have broken into stagnant ponds and puddles because that is the period with a heavy density of the copepod intermediate host.
People, who have no access to potable water and rely heavily on such unsafe water sources, stand a higher risk of infection. After this period, the infection rate begins to subside as the rains set in and the water sources are flowing with few or no intermediate host.
The ‘fiery serpent’
Fortunately, guinea worm rarely kills. However, it can cause severe pain to its victim.In fact, the painful and burning sensation experienced by infected persons has led to the disease being called “the fiery serpent.”
Even though guinea worm does not kill directly, it kills indirectly. It inflicts so much pain on its host to the extent that it incapacitates the host for several months.
Poor management of the disease could also cause it to degenerate into other conditions, such as tetanus. Again, it prevents energetic people from engaging in their farming and other income-generating activities and this worsens rural poverty and also impacts negatively on food security.
Aside these, school children, who are infected with the disease, are also incapacitated and this affects school enrolment and endangers the future of the children.
Any cure?
In actual fact, there is no cure for guinea worm and no vaccine to prevent it, except that, when it appears, health professionals can pull it out over a period of time.
The best cure for guinea worm is prevention or early detention and treatment.
The Guinea Worm Eradication Programme (GWEP)
Before 1989, there was no consistent and co-ordinated effort towards tackling the guinea worm pandemic.
In 1989, however, the Guinea Worm Eradication Programme (GWEP) was introduced following a declaration by the World Health Assembly urging all guinea worm endemic countries to eradicate the disease.
At that time, the number of detected guinea worm cases in the country stood at 180,000, placing Ghana as the second most endemic country in the world.
The efforts of GWEP led to sharp reductions in the number of cases recorded for the first four to five years of the commencement of the programme.
In 1994, when the number of cases had reduced to 8,432, major conflicts in the northern sector destabilised the guinea worm eradication efforts and this lasted for sometime until 2000, when the programme was restructured and revamped.
By 2005, the GWEP had regained its momentum and the number of cases begun to reduce consistently.
The biggest success ever recorded since the commencement of the eradication programme was in 2008 when the number of cases reduced from 3,358 to 501, representing an 85.1 per cent reduction.
In spite of this success, Ghana emerged as the second most guinea worm prevalent country in the world that year, coming only after Sudan, which recorded 3591 cases. This meant that more needed to be done.
Measures Instituted
To ensure clearer understanding of the measures instituted to eradicate guinea worm in Ghana, it is prudent to segregate the measures into four categories.
They are: measures that prevent the contamination of water sources; measures that protect consumers of unsafe water sources; measures that bring relief to victims; and measures that improve water supply.
On measures that prevent the infection of water bodies, the GWEP has employed guards to police dams and ensure that people suspected to be infected with the disease do not come into contact with the water.
In cases where a particular water source is suspected to have been contaminated with the disease, safe chemicals (larvicide) are applied to treat the water by killing the infected hosts.
The GWEP has field personnel who move from house to house nosing for suspected cases, alongside educating the people on the disease.
The second group of measures, which protect people who source water from dams and ponds, involves the provision of water filters to community folk.
It also entails the sensitisation of community folk on how to treat contaminated water, such as filtering and boiling. Community sensitisation methods used by GWEP include durbars, drama, radio messages and group discussions.
The third category involves the containment and care for people infected with guinea worm. In order to promote proper and absolute containment, containment centres have been established in selected communities or health facilities, where both suspected and confirmed cases of guinea worm are admitted, properly managed and contained where applicable.
To encourage patients to stay until the worms are completely expelled, persons infected with guinea worm are sometimes put on a daily stipend, since the worm has incapacitated them from engaging in income-generating activities.
The last, and most important, is the measures undertaken to make potable water available to community folk. Indeed, Ghana would say goodbye to guinea worm if every community had potable water.
The GWEP has undertaken the construction of several boreholes and mechanised water systems in guinea worm endemic communities in collaboration with UNICEF and the European Union under the Integrated Water and Sanitation (I-WASH) project.
It has also worked with the Ghana Water Company Limited to ensure that pipe-borne water is extended to communities in urban areas, such as the peri-urban communities of Tamale.
Apart from the efforts of GWEP, rural water projects that have been undertaken by organisations and institutions, such as the Community Water and Sanitation Agency, World Vision, UNICEF and CIDA, have all contributed to the reduction in the guinea worm pandemic.
Funding
Funding remains the critical element in the drive to eradicate guinea worm. According to the National Programme Manager of GWEP, Dr Andrew Seidu Korkor, the annual budget for these interventions is about GH¢3 million, about half of this spent on water provision.
The GWEP is currently being supported by several partners, with the main funders being the Government of Ghana (GoG), The Carter Centre, United Nations Children’s Fund (UNICEF), The World Health Organization (WHO) and Japan International Co-operation Agency (JICA).
Where are we today?
As at December 2009, the country recorded 242 cases, a 52 per cent reduction from the 2008 caseload.
In November 2009, Ghana recorded no case of guinea worm disease and this was the first time ever that no case had been reported in a particular month within the infection season.
Essentially, guinea worm has been limited to the Northern Region, since all the recent cases have been recorded in communities in the region, particularly in the Central Gonja district.
There is optimism that the year 2010 has better prospects for the eradication programme. At the close of October 2010, only 8 cases have been reported compared with 240 reported during the same period last year. No case has been reported since June this year!
The main challenge, in my opinion, to the guinea worm eradication programme is how to prevent re-infection. This is because, the risk of re-infection is always there until the last case has been detected and contained.
Even the containment of the last case is not a guarantee against further infection, due to the risk posed by migratory groups and travellers from Mali and Niger, which are still endemic. A cut in funding towards the GWEP could also derail progress.
Way Forward
Rural water provision needs to be boosted drastically if the fight against guinea worm is to succeed. The country must move beyond the current 57 per cent rural water supply penetration to about 85 to 100 per cent.
Also, the GWEP implementers, namely the Ministry of Health and Ghana Health Service, need to strengthen their efforts, particularly surveillance monitoring, since the programme is in its most challenging time.
All Ghanaians must be alert and immediately report anything condition that they suspect to be guinea worm to the nearest volunteer, health worker or health facility for immediate investigation and containment.
In fact, the Ghana Health Service and the GWEP have announced a reward of GH¢50 to anybody who will help to identify a guinea worm patient.
There is the need for consistent and timely provision of funds to the GWEP secretariat to sustain its work.
More partnership needs to be forged between the various agencies, which are into water provision, health delivery, local and traditional governance, social welfare and other development sectors.
If all things work well, hopefully, Ghana could break the transmission of Dracunculiasis this year and prepare itself for certification of eradication in the next few years to come.
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