Dracunculiasis Eradication -- Ghana and Nigeria, 1993

In 1989, Ghana and Nigeria, countries in west Africa, ranked first and second in the number of reported cases of dracunculiasis (i.e., Guinea worm disease) with 179,556 cases and 640,008 cases respectively (1). During 1987-1988, Global 2000 and the World Health Organization (WHO) Collaborating Center for Research, Training, and Eradication of Dracunculiasis at CDC initiated direct, onsite assistance for the eradication of dracunculiasis in Ghana and Nigeria. This report summarizes surveillance data for the two countries during 1993 and describes efforts toward eradication of dracunculiasis. Ghana

In 1993, Ghana (1991 population: 16 million) reported to WHO 17,918 cases of dracunculiasis from 2306 villages, representing substantial declines in the numbers of cases (46.5%) and villages with endemic disease (25.6%) from 1992 (2). The number of villages included 520 that did not report any cases in 1992 but had at least one case in 1993. Since initiation of active surveillance in 1989, the numbers of cases and villages with endemic disease have decreased by 90.0% (Figure_1) and 64.6%, respectively. During 1993, the Northern Region reported 69.0% of all cases in the country, compared with 51.2% of all cases in 1992.

By the end of 1993, health education and nylon filters had been provided to all known villages with endemic disease, 40% of villages had at least one safe source of drinking water, and temephos (Abate{Registered} *) was being used in 20% of such villages. Emerging Guinea worms were removed surgically in 8% of persons with detected cases in Ghana in 1993. Nigeria

In 1993, Nigeria (1992 population: 90 million) reported to WHO 75,752 cases of dracunculiasis from 3614 villages with endemic disease, representing substantial declines in the numbers of cases (58.6%) and known villages with endemic disease (21.0%) from 1992 (3). From January 1993 to December 1993, the number of villages reporting some or no cases increased from 2485 to 4159. From the epidemiolgic year July 1987-June 1988 to December 1993, the numbers of cases and villages with endemic disease declined 88.4% (Figure_2) and 38.5%, respectively. Of all cases reported in 1993, 65.5% occurred in five of the 30 states and the Federal Capital Territory: Sokoto (17.0%), Ondo (17.0%), Enugu (16.8%), Katsina (11.3%), and Benue (11.1%). Three states (Akwa Ibom, Anambra, and Kaduna) reported no cases. Four states (Abuja, Imo, Kogi, and Rivers) reported 10 or fewer cases; all of the eight cases reported in Lagos state were imported from other parts of Nigeria.

By the end of 1993, health education had been initiated in all villages with endemic disease, nylon filters had been distributed in 89%, at least one safe source of drinking water already existed or was targeted to be placed by 1996 in 37%, and temephos (Abate{Registered}) was being used in 9% of such villages. Health workers from seven states had been trained in case-containment measures to be implemented in all areas with endemic disease by 1995.

Reported by: Ministry of Health, Ghana. Federal Ministry of Health and Social Svcs, Nigeria. Global 2000, Inc, The Carter Center, Atlanta. World Health Organization Collaborating Center for Research, Training, and Eradication of Dracunculiasis, Div of Parasitic Diseases, National Center for Infectious Diseases, CDC.

Editorial Note

Editorial Note: The reductions in the incidence of reported dracunculiasis of at least 90% in Ghana and Nigeria since 1989 are important achievements in the global campaign to eradicate dracunculiasis. Despite the known underreporting in Nigeria in 1993, the findings in this report indicate that both programs have substantially reduced the occurrence of dracunculiasis. Continued reduction of dracunculiasis will require implementation of intensive case-containment measures, health-education efforts, and campaigns to increase public awareness of dracunculiasis prevention.

References

1. World Health Organization. Dracunculiasis: global surveillance summary, 1992. Wkly Epidemiol Rec 1993;68:125-31.

2. CDC. Update: dracunculiasis eradication -- Ghana, 1992. MMWR 1993;42:93-4.

3. CDC. Update: dracunculiasis eradication -- Nigeria, 1992. MMWR 1993;42:310-1.

* Use of trade names and commercial sources is for identification only and does not imply endorsement by the Public Health Service of the U.S. Department of Health and Human Services.
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