Guinea worm wrap-up ; # 169, January 26, 2007
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Guinea worm wrap-up ; # 169, January 26, 2007

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  • Journal Article:
    Guinea worm wrap-up
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    The Golden Anniversary of Ghana’s epochal achievement of political independence on March 6, 1957 is fast approaching. That 50 year milestone in March 2007 is also the date by which Ghana now aims to finally stop transmission of dracunculiasis by containing all subsequent cases of the disease that occur in Ghana, and thus expecting no more cases of the “Fiery Serpent” after March 2008. In escalating its efforts, Ghana is focusing to achieve the promise first made when its Guinea Worm Eradication Program began in December 1987—a promise that has seen no sustained national reduction in cases over the past 12 years.

    Since the Program Review of Ghana’s Guinea Worm Eradication Program in Atlanta in August 2006 however, the Government of Ghana has announced free treatment for persons with Guinea worm disease at all public hospitals and clinics, declared the disease to be a public health emergency in the Northern Region, replaced 10 of 12 under-performing district and regional supervisors, opened ten case containment centers to complement existing health facilities, kicked off a major public awareness offensive that includes radio, television, newspapers, billboards, durbars, appearances by Miss Ghana 2005, and a ministerial press conference on January 22, released 5 billion cedis (~$500,000) to the Ghana Health Service for the program, begun distributing 372,000 pipe filters, and introduced improved water supply in the highest endemic community (Savelugu: 411 cases in 2006), with improved water supply for the second-highest village (Diare: 298 cases) to follow in January 2007. During a visit to Brong Ahafo Region on January 16, President J.A. Kufuor expressed his surprise that Guinea worm disease is reportedly increasing in Ghana and directed minister of health Maj (Rtd) Courage E.K. Quashigah to submit a report to him on the situation.

    Ghana reported 4,132 cases of dracunculiasis from 605 communities in 2006, but only 346 communities reported indigenous cases. This is a 4% increase from the 3,981 cases Ghana reported in 2005 (Table 1, Figure 5). Ghana is now by far the main remaining focus of this disease in West Africa (Figure 1), having assumed the role formerly held by Nigeria (Figure 2), despite having already consumed one-third more donated ABATE® Larvicide than Nigeria (62,800 liters, vs. 47,160 liters). Ghana’s immediate neighbor Cote d’Ivoire reported only 6 cases in 2006, Burkina Faso reported 5 cases, and Togo reported 29 cases, including 4 cases exported to Togo from Ghana (Table 1, Figures 5 and 6). Two Malian nationals were reported as cases of dracunculiasis by Ghana during November 2006. (Burkina Faso reports that three cases of dracunculiasis were imported from Ghana in early January 2007). 90% of Ghana’s cases in 2006 were in the Northern Region, which lags all other endemic regions in reducing the disease in recent years (Figure 3). 77% of Ghana’s cases were reported from only five districts, all of which are in the Northern Region: Savelugu-Nanton, Tolon-Kumbungu, Tamale, Yendi, and East Gonja.

    Case containment rates have risen significantly in recent months with the re-introduction of case containment centers and adjustment for adherence to the strict definition of case containment, so that the percentage of cases reportedly contained in 2006 rose to 75% (vs. 62% in 2005) (Figure 4). The share of Ghana’s cases reported monthly that was isolated in case containment centers rose from 1% in October to 10% in November to 14% in December 2006 (Ghana’s overall case containment rates for those months were 78%, 94%, 85%). As of December 2006, 98% of endemic villages had received health education, 95% had cloth filters in each household, 47% had at least one source of safe water, and 27% had water sources treated with ABATE® Larvicide.

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