Ghana may break Guinea Worm Disease (Dracunculiasis) transmission at the close of this year. Should that happen the nation can begin the mandatory three-year pre-Certification activities required for final certification of eradication of guinea worm.
The development is seen as a major achievement for the West African nation which was ranked as the second guinea worm endemic destination in the world at the end of 2006. At the time, war torn Sudan was at the head of the rankings.
A massive drive to improve water supply is a major factor for the achievement but the most important catalyst has been the acceptance of ownership of the Ghana Guinea Worm Eradication Programme (GWEP) by local actors, according to a presentation made by the GWEP at Mole XXI.
During January-June 2010, eight cases were reported compared to 228 cases reported over the same period last year. This represents a 96% reduction. A total of 242 cases were recorded at the close of 2009 in 13 districts in the Northern, Brong Ahafo, Ashanti and Eastern regions. Central Gonja, Tamale, Yendi, Tolon-Kumbungu, Kwahu North, Chereponi, East Gonja, Savelugu Nanton, West Gonja, Ejura-Sekyedumasi, Kintampo North and Karaga were the districts in which cases were recorded.
But this year’s cases were limited to only four villages in three districts in the Northern Region. Diare’s four cases make it the most endemic village. There were two cases in Dipali and a case each in Karaga Town and Dipali. The last case was reported on May 11 while the last containment was done on June 2, 2010. As of the time Mole XXI took place, no further cases had been reported, raising hopes that Ghana can break transmission this year.
The most significant change occurred in the Central Gonja District where no case had been recorded as of June. In fact, the district was the most endemic in 2009, recording 148 (about 60%) of the 242 cases recorded for 2009.
The statistics show that six (75%) of this year’s cases were reported by males while two (25%) were reported by females. Two cases affected persons who were 15 years or younger whereas four cases affected those within the age bracket of 30-44 years. A case each was reported for persons between 16-29 years and those above 45 years.
The massive reduction represents 99.8% since the biggest outbreak in recent years in 2006 (4,136 cases) and 99.99% reduction since the inception of the GWEP in I989.
Background of efforts in Ghana
The guinea worm disease is a disease of the poor and a marker of underdevelopment, occurring predominantly in areas that lack access to good drinking water. In Ghana, guinea worm is endemic in the three northern regions and the Brong-Ahafo Region.
The disease occurs when victims drink water containing water fleas that have ingested the infective larvae of guinea worm. The larvae then grows in the small intestine and, over a period of about one year, the females break into the intestine and move around the body, growing up to between one to three metres in length. When the worm reaches maturity, it seeks a way out resulting in a painful blister at the point where the worm emerges, usually on a lower limb.
According to experts, the only available cure is to wind the entire length of the worm on to a stick, inch by inch and this process may take weeks or months, making the victim suffer more. Victims of guinea worm cannot work in the farm, take care of their herds, fetch water, cook or engage in any household chores.
Ghana originally hoped to eradicate the disease by March 2007 just before marking the 50th anniversary of its independence in March. That was derailed by a development in 2005 when out of the 10,674 cases reported worldwide, 90% occurred in just two countries: Ghana and Sudan.
A Public Agenda report of 2007 said as of January 2004, the global guinea worm eradication campaign was fighting the last one percent of Guinea worm disease remaining in the world. Ghana accounted for 27 percent of the approximately 35,000 cases reported at the close of 2003.
Available information from the GWEP have it that the Ghana programme started in 1989 following declarations by the World Health Assembly that all countries should eradicate guinea worm. At the time, Ghana had about 180,000 cases which placed it second in the world behind Nigeria.
In a space of five years, the cases were reduced sharply to 8,432 by 1994 (a reduction rate of 95 percent). But the 1994 ethnic conflict in northern Ghana and subsequent official closure of financial support from the United States Agency for International Development (USAID) stalled progress.
Efforts redoubled afterwards and considerable progress has been made, leading to the current figures.
Driving forces for current success
Apart from efforts at improving drinking water coverage and stakeholder acceptance of the GWEP, better funding and direct (earmarked) funding by the Government of Ghana (GoG) has contributed significantly to the present achievement. Besides, the declaration of guinea worm disease as a disaster in the Northern Region and the free treatment for all cases across the country also played significant roles.
The development and operationalisation of Standard Operating Procedures (SOPs) and strict adherence to the strategies and activities described in it after the outbreak of 2006/07 transmission season also influenced current rates.
Beyond these, improved supply and better utilization of logistics and the deployment of dam guards to police dams also played major roles. Local communities and district assemblies have also enacted bye-laws to control indiscipline and reduce water contamination and improve case reporting and containment.
Looking beyond 2010
Notwithstanding the achievement, there are still challenges. The major challenge, according to the GWEP, is how to ensure a general national awareness and maintain vigilance to recognize and report any suspicious cases to the health authorities for immediate investigation and containment.
This is particularly important because a single undetected case can derail the ongoing process.
Access to and use of potable water is still far from satisfactory and the risk of re-infection always looms until the last case has been detected and contained. Therefore, continuous improvement of water supply for at risk/endemic areas remains a very big challenge in view of perennial underinvestment in the WASH sector.
A document compiled by Dr Andrew Seidu Korkor, National rogramme Manager of GWEP, says that “what needs to be done is to continue and step up surveillance nationwide to detect and report promptly and properly manage all suspected cases (to ensure full containment), continue a nationwide awareness creation among health staff and the general population and continue to advocate for safe drinking water.”
The document rallies people around the cause of eradicating guinea worm, saying, “the time has now come for everyone: health workers, community members, the general population and development partners to join hands and work together to ensure that this happens.”