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Grassroots public health initiatives eliminate dreaded guinea worm disease

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Grassroots public health initiatives eliminate dreaded guinea worm disease

A global campaign to eliminate the dreaded scourge of guinea worm disease or dracunculiasis — Latin for "affliction with little dragons" — that has been accomplished through grassroots public health initiatives involving thousands of village volunteers is now in its final stages. The unprecedented accomplishment (the only disease previously eradicated was smallpox, not a parasitic disease) has been successful on a modest budget of about $225 million for the entire 20-year campaign, because it has been achieved through grassroots public health initiatives involving thousands of village volunteers. Its disappearance is proof that people can be persuaded to change their behaviour through innovative health education.

Globally, guinea worm disease has fallen from an estimated 3.5 million cases in 1986 to 25,217 in 2006, and the number of countries with endemic dracunculiasis has fallen from 20 in 1986 to 9 in 2006 (with 5 of the 9 having reported fewer than 30 cases each). The World Health Organization (WHO) has now certified 180 countries as free of the disease.

Dracunculiasis is transmitted to humans through drinking water contaminated with microscopic water fleas infected with larvae of the worm. About a year after a person has become infected, adult female worms emerge from the skin. If the emerging worms make contact with water, they expel larvae, beginning the cycle anew. The worms can be more than two feet long and their emergence is painful, often incapacitating people for 2 to 3 months. There is no effective anthelmintic agent or vaccine. Infection can be prevented by filtering drinking water; killing the fleas and larvae in open ponds; not entering sources of drinking water; and providing clean drinking water from safe sources such as borehole wells or hand-dug wells. Where guinea worm is endemic, it often predominantly infects women, who wash clothes and gather water for households. During planting or harvest season, more than half a village's population can be suffering from guinea worm disease.

The campaign began at the Centers for Disease Control (CDC) in 1980 and was adopted as part of the United Nations International Drinking-Water Supply and Sanitation Decade (1981–1990). Since 1986, the Carter Center has led the effort with the help of the CDC, the WHO, the United Nations Children's Fund (UNICEF), the Bill and Melinda Gates Foundation, and many other donors and nongovernmental organizations, as well as governments of the affected countries and thousands of village volunteers.

The Carter Center provides financial and technical assistance to national guinea worm programs that include participants from ministries and from nongovernmental organizations, traditional leadership, political leadership, and village volunteers. Working with this public–private coalition, the Carter Center has been able to initiate village-based surveillance, health education, and distribution of cloth filters and to provide larvicides and solicit operational support for the digging of wells. The WHO has convened an International Commission for the Certification of Dracunculiasis Eradication to certify countries that have eradicated the parasite.

Health care initiatives have had to be linked with diplomatic efforts to overcome such challenges as inadequate security, inadequate political will on the part of national leaders, and the absence of a "magic bullet" treatment. Carter negotiated a 4-month "guinea worm ceasefire" in 1995 during the civil war in southern Sudan, which also allowed public health officials to kick-start Sudan's onchocerciasis control program.

The Dracunculiasis Eradication Program has helped to improve the quality of water sources for communities that previously lacked access to clean and safe water, created jobs for the (often elderly) unemployed, and empowered volunteers, frequently inspiring them to pursue health-related employment. In communities where guinea worm was endemic, networks of women have been created for education campaigns. School absenteeism has decreased as fewer children have become infected, and agricultural productivity has improved.

This story is told in "The Tail End of Guinea Worm - Global Eradication without a Drug or a Vaccine", by Michele Barry, professor of medicine and global health at Yale University School of Medicine in New Haven, Connecticut, published in The New England Journal of Medicine, Volume 356:2561-2564, June 21, 2007, Number 25. For an update on the fight to eradicate Guinea worm, see Nick Kristof's column entitled Winning the Worm War, posted from Dor, Sudan, April 28, 2010, in the New York Times.


UPDATE: In The Power Of One: A Village Woman's Legacy, by Jimmy Carter, published in the March 20, 2008 edition of Time Magazine, Carter tells of meeting a young woman in a Ghana village in 1988 whose agony personalized guinea worm disease and poverty for him. “Having seen her that day in 1988, I came to examine life differently--in a micro way. I now believe that the vitality of one person's life has an impact on the health and harmony of the surrounding world.” He never learned what had happened to her, but the next year, the painful disease was almost gone from her village, thanks to the efforts of The Carter Center, other organizations and the villagers themselves.


For other stories about practical health care solutions in Africa, see:

Acupuncturists bring healing, relief, local training across the globe

Benin is an ongoing success story in eliminating endemic river blindness

Bicycle ambulance provides practical health care transportation in Africa

Coping with the grief and loss of AIDS: memory projects bring hope to Africa

Ending slum deadlock to bring health to Mali slums

Innovative South Africa pill reminder idea spreads globally

Motorbike ambulances save lives of mothers, babies, in remote areas of Africa

New therapeutic food is miracle for starving children

Personal Digital Assistants, and open source software, save lives in Africa

Recycled phones and free software revolutionize health care for Malawi hospital

Successful Tanzanian trachoma treatment offers hope for nomadic communities

Using mobile phones to monitor child malnutrition in Malawi wins award for UNICEF



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