Nigeria crosses final hurdle to emerge Guinea worm-free

[Mirror]

Nigeria is on the path to receiving World Health Organization's (WHO) certification on elimination of Guinea worm, as the team of the global health's body is currently touring states of the federation to ascertain Nigeria's claim of riddance of the pandemic.

The struggle began over two decades ago against the syndrome which has left over a million people affected till date in the country.

In 1988, according to WHO, the first national case search recorded 653,620 cases in almost all states throughout Nigeria, the highest worldwide.

Nigeria has however not recorded a case since 2008, given both local and international interventions that have spanned over two decades.

Guinea worm, otherwise known as dracunculiasis is a water-borne disease which affects human beings. It has an incubation period of about 12 months and manifests through the formation of blisters on any part of the body, inflicting pain on its victims who are in most cases, immobilized during the peak period of attack.

Dracunculiasis, The Carter Centre says, is contracted when people ingest drinking water from stagnant sources containing copepods (commonly referred to as water fleas) that harbour infective Guinea worm larvae. Inside a human's abdomen, Guinea worm larvae mate and female worms mature and grow, some as long as three feet or one meter. After a year of incubation, the female Guinea worm creates an agonizingly painful lesion on the skin and slowly emerges from the body. The contamination cycle begins when victims, seeking relief from the burning sensation caused by the emerging Guinea worm, immerse their limbs in sources of drinking water, which stimulates the emerging worm to release larvae into the water and begin the cycle all over again.

There is no medication for Guinea worm but it can be managed. Centre for Disease Control, CDC, says "When the Guinea worm is ready to come out of the body, it creates a painful burning blister on the skin. When the infected person immerses the blister in cool water to ease the symptoms, the Guinea worm breaks through the blister and part of the worm is exposed.

Management of GWD involves removing the whole worm and caring for the wound in general. There is no specific drug to treat or prevent the disease. There is also no vaccine to prevent it. The only way to avoid infection is to prevent exposure to the Guinea worm larvae in contaminated drinking water sources." The disease is best prevented through the provision of safe drinking water and adequate sanitation.

Joint report by Emmanuel S. Miri et al, titled "Nigeria's Triumph: Dracunculiasis Eradicated" and published by the American Journal of Tropical Medicine and Hygiene on August 5, 2010, says Nigeria and its partners had spent $37.5 million on the disease, and that medical geographer Susan Watts estimated, in 1986, that Nigeria accounted for approximately two-thirds of the world's dracunculiasis cases.

Sporadic reports of Guinea worm, the report says, was first discovered by a Swiss traveler who gave the name Guinea worm to the parasite Dracunculus medinensis after visiting the West African coast in approximately 1611. He was said to have referred to what he saw "in areas bordering Gulf of Guinea, including the area that is now Southeastern Nigeria," as Guinea worm.

Grace Otubo, an indigene of Ezza Nkwubor village near Enugu, Enugu State, has been recorded as the last victim of Guinea worm in Nigeria. Pointing to her right foot that was affected, Otubo, 58 in 2008 when she was afflicted, said in a video that she used to stay in her home for eight or nine months when she contracted the disease. She later went to the containment centre where she got treated. This is the general experience of all victims; which makes poverty further ravages the mainly poor sufferers.

WHO's team is on three-week verification in Nigeria. Speaking on Nigeria's efforts, leader of the delegation, Prof David Molyveux told journalists in Abuja that: "What is remarkable is that between 1970 and 1972 that I was here in Nigeria, guinea worm, during our study, was never mentioned. Yet, then you'd had about 650,000 cases. I think this is remarkable; irrespective of the conclusion which we never wish to preempt done well. What I want to do is just to say that we've read most of the documentation you provided. We look forward as a team over the next three weeks to work very closely with you on this credibly important mission. I just want to contextualise that we are looking at a very significant study team.

"As you are aware, only two diseases are currently slated for eradication; guinea worm and polio and yours is now on the map. And, we are looking at the country which has had the most cases in the highest number of people in terms of population in the largest cities and environment. And, with the information you'd given us, it is extremely exciting and thorough; it addresses the issue in many settings in a very novel way and we look forward very much to having the opportunity to validate the conclusions of the country report," he stated.

He added that the team was in Nigeria to validate the report already prepared by the Independent Verification Team on Guinea Worm in the country and that the team's report would go to the International Commission for the Certification on Eradication which might be issued the country this December.

The team leader continued: "It is something we cannot anticipate what the Commission will do with our report. My job is one responsibility to report to the Commission the findings of this mission. I see this activity as a mission and the report we make will be one of considerable responsibilities given the importance of being here to say that Guinea worm must be eliminated in Nigeria." He promised that the team would be objective in its duties.

A member of the team, Dr Gnatam Bisual said: "We are going to move round the different parts of the country. We would write our report and present it before the WHO and from there it would be forwarded to the Secretary General of the UN."

The team said it would rely on the assistance of the WHO officials who had been working in Nigeria and also understand the current standing of the country regarding the disease in troubled states of Yobe and Borno. The team, Bisual said, would not go to the two states.

The Federal Government responded to the challenges posed by the disease by setting up the Nigeria Guinea Worm Eradication Programme, NIGEP.

Addressing the WHO's team, NIGEP's Coordinator, Mrs. Ifeoma Anagbolu, said NIGEP had ensured execution of needed programmes to include case management, provision of potable water for communities in the country; dissemination of requisite information and sustenance of zero-case since 2008. The list according to her, includes programme activities surveillance for guinea worm disease, communication for behavioural impact; including health education, advocacy and social mobilisation, safe water provision, maintenance and use.

She noted that NIGEP was established in 1988 in tandem with global call for the eradication of guinea worm disease and in line with the recommendation of International Drinking Water Supply and Sanitation Decade to combat water and sanitationrelated diseases, particularly in developing countries.

NIGEP, she said, works in partnership with government of Nigeria, United Nations Children Fund, UNICEF, Yakubu Gowon Centre, The Carter Centre and the endemic communities. Others are government of Japan and United Nation's Development Programme, UNDP.

Anagbolu added: "Guinea worm disease surveys were conducted during the epidemiological years through June 1987 to July 1988 until 1991. In 1987 to 1988, we have 653,620 cases reported. The number of cases declined until 2008 when Nigeria reported the last 38 cases. The 38 cases occurred in five villages. But, at the inception of NIGEP, we had 5,879 villages affected. Altogether, we had 393 local government areas affected by Guinea worm disease in the country between 1987 and 1988. For the precertification period, a year after the case was reported, Nigeria adopted minimum pre-certification target. This includes that all health staff must know case existence for Guinea worm disease and appropriate response to a suspected case or rumour. All guinea worm disease or rumour must be reported within 24 hours, regardless of how the rumours were received.

"At least, 80 percent of the public must be aware of message on Guinea worm disease and the cash reward for Guinea worm disease reporting. This means that any suspected case must be reported to the nearest health facilities of health workers and that there is a cash reward of N25, 000 on any confirmed case. From 2009 to 2010, we have received several rumour reports which were investigated and found not to be Guinea worm disease. Altogether, we have 680 rumour reports," she stressed.

National Mirror