The eradication of Guinea worm in Africa

Since 1986 former American president Jimmy Carter has worked to eradicate Dracunculiasis – the extremely painful and debilitating Guinea worm disease – from the African continent. Three decades later, the dread disease has almost been eliminated.

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Former US presidnet Jimmy Carter wants to see the eradication of Guinea worm infections in his lifetime. (Image: Carter Center)

Sulaiman Philip

Dracunculiasis. It sounds like a blood sucking monster of nightmares. But the world is close to making the dream of eradicating an incubus parasite cooked up in the dystopian visions of HR Giger come true.

Guinea worm disease, the more common name for dracunculiasis, is a parasitic infection caused by the nematode roundworm parasite Dracunculus medenisis. At the end of the cycle of infection, a metre-long parasite emerges slowly, painfully, from a blister on the skin. The disease is contracted when people drink water from a stagnant source contaminated by Guinea worm larvae. After mating inside a human host, the female worm matures over a year before slowly emerging through a lesion it creates in its host’s skin.

There is no medication to fight infection. The age-old treatment has been to slowly pull or cut the worm out of the body. As the parasite begins burrowing out, villagers wrap it around a stick and slowly wind it out over 20 days.

Ringo Naah Sulley, the district director of Ghana’s Asante Akim South District Health Services, explains: “They put a knife in fire until it is red hot. Then they incise it [the blister]. Usually the pus opens and the Guinea worm emerges. Sometimes the Guinea worm is even cut into pieces.”

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Infection is not a minor inconvenience. Often a patient is host to three or four worms. Infections from incising the blisters are common. Or patients are too weak to care for themselves or their families, work or attend school.

Agitated sufferers seek relief for their burning skin by soaking in pools. But contact with water stimulates the worm to release its larvae into the water. People drinking from this infested pool are infected and the cycle begins all over again.

Jimmy Carter and hope

In one of the greatest medical triumphs of modern history, Guinea worm infections have dropped from 3.2 million in 1986 to just 22 in 2015. Success would mean that Guinea worm would become only the second disease – after smallpox – to be eradicated through human intervention.

In 1991, Guinea worm infections were endemic across 23 735 villages in Asia and Africa. Today there are just 30 villages in four countries – Mali, Chad, Ethiopia and South Sudan – with new infections.

That the world, and Africa, is this close to complete eradication is down to a massive campaign led by former American president Jimmy Carter and the staff of the Carter Center. Working under the motto “Wage peace, fight disease, build hope”, the Nobel Peace Prize winner and a group of scientists, doctors and volunteers have worked to eradicate Guinea worm globally.

Over three decades the campaign has cost R4 218-billion – a cost borne by the Carter Center, governments and global health organisations, including the Bill & Melinda Gates Foundation, the British government, Opec Fund for International Development, the president of the United Arab Emirates, the Children’s Investment Fund Foundation, Unicef and the World Health Organization.

Without a medical cure, the Carter Center programme has highlighted the importance of prevention and education. Its success has, as Carter pointed out recently, helped, “the poorest of all people, but who are as intelligent, ambitious and as hard-working as we are”.

Obsessive response

Carter and his staff have been obsessive about his eradication programme. Success in his lifetime would be for the 91-year-old cancer survivor, his “most satisfying achievement”.

Donald Hopkins, of the Carter Center’s eradication programme, says success can be put down to their engagement with local communities. “Because it would be a disaster for outsiders, and by that I mean people from other countries, or even people from outside the community, to come in and demand that people do one thing or another.”

Hopkins explains that the centre and its partners describe the infection cycle and remind communities the power to stop it is in their hands. This has led to some interesting community-led initiatives. “It’s true that in some communities, the village elders got together and agreed that if anyone knowingly went into a drinking water source with a Guinea worm coming out of their body, they would fine them a goat or something else as a way of punishment. But the important thing is that it must be the community that puts those sanctions in place.”

Prevention is the cure

David Agyemang, who worked on Ghana’s Guinea worm eradication programme, says any successful programme involves getting people to change their behaviour. It is more difficult to get people with a worm dangling from their foot to not seek relief in communal water sources.

Preventative medicine is often the cheapest, most effective and most efficient way to eradicate disease. Beyond outreach, the Carter Center has developed and provided netting to help villages filter their water.

The science is simple. A fine weave net cleans water of the Guinea worm larvae. Nigeria had 656 000 cases of Guinea worm infection in 1988 before 6 million square metres of nylon netting was produced to filter drinking water, now the country is infection free.

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Pipe filters, worn around the neck, has proven to be a cheap and effective way to stop new infections. (Image: Carter Center)

By 2001, 80% of the new cases were in war-torn Sudan. Carter Center volunteers bravely distributed 8.5 million pipe filters, enough for the entire population. Made of a hard plastic encasing the nylon filter, the pipe can be worn around the neck and filters water as you drink.

The biggest challenge for the centre when it began its programme was communication. Carter says: “The people who have Guinea worm live in the most isolated and poverty-stricken villages in the world. They were totally illiterate. And they didn’t have any knowledge of, or much less access to, radio or television. So how do you teach them?”

The center turned to cartoons on posters and books to teach communities about the infection life cycle and the importance of filtering water. The programme has proved to be so successful that images are now printed on cloth that is used to make dresses, shirts and T-shirts.

Dr Hopkins is please by the success of the programme. He says Carter may yet get his wish of seeing the end of infection before his death. “I do feel happy that people are not suffering, but it’s not over until we are at zero.”

Watch: Guinea worm, a painful parasite that once affected millions of people each year, may soon be relegated to the past.