5.2 Falling trends in guinea worm disease

Recognition of the seriousness of the guinea worm problem led the Indian government to initiate the first national dracunculiasis-elimination programme in 1982.

Similar programmes began later in Pakistan, Cameroon, Ghana and Nigeria, and in 1989 the WHO launched the global eradication campaign. The features of the campaigns will be described shortly but, for the moment, we will concentrate on the evidence of their success. The reduction in transmission of guinea worm disease in the first decade of the global campaign is illustrated by Figure 19.

Figure 19 Number of reported cases of guinea worm disease in various endemic countries, 1989–2001. Note that the vertical axis has a logarithmic scale.

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Data are plotted for six countries in which guinea worm disease is endemic: Sudan, Nigeria, Ghana, Uganda, India and Pakistan. The horizontal axis is labelled year and marked from 1989 to 2001 at one-year intervals. The vertical axis is labelled reported case and is marked on a log scale from 0–10 up to 1 000 000. Both Nigeria and Ghana had several hundred thousand reported cases in 1989, and by 2001 case numbers in both countries had fallen to the thousands. Uganda had 100 000 cases in 1992 but by the year 2000, case numbers had dropped to below 10. Both Pakistan and India had relatively small numbers of reported cases in 1989, of the order of 1000 and 10 000 respectively; and in both counties case numbers fell to below 10 in the 1990s: by 1993 in Pakistan, and by 1996 in India. In contrast, numbers of reported cases in Sudan did not decline appreciably over the period of measurement: numbers fluctuated around 100 000 until 1999, and in 2001 were still many tens of thousands.

Figure 19 Number of reported cases of guinea worm disease in various endemic countries, 1989–2001. Note that the vertical axis has a ...

Eradication in Pakistan was certified by the WHO in 1993, and India followed in 1996. It took several more years before it was eradicated in Uganda (2003), Nigeria (2008) and Ghana (2010) – bringing the total to 187 previously endemic regions and territories certified as free of dracunculiasis by the end of 2010.

In the whole of 2010 there were 1797 reported cases of the disease worldwide, and the number fell to just 1058 cases in the whole of 2011 in only four countries – Chad, Ethiopia, Mali and South Sudan (WHO, 2012j).

The community actions that have interrupted guinea worm transmission so successfully can only be understood by first describing its complex life cycle.