Health News of Thursday, 7 August 2014


Ghana meets Guinea worm eradication criteria

A World Health Organisation (WHO)-constituted International Certification Team (ICT) has concluded that Ghana has met the criteria for the certification of Guinea worm disease (GWD) eradication.

This means Ghana could soon be certified as a Guinea worm free country.

The team comprised seven international health experts from Burkina Faso, Ethiopia, India, Nigeria, United States of America (USA) and Yemen, five national experts independent of the Ghana Guinea Worm Eradication Programme (GGWEP) and six national facilitators from GGWEP.

The ICT visited all the ten regions of Ghana, 47 districts, 119 communities and 1,320 respondents following a request by the Ministry of Health to the WHO in May this year to certify Ghana free from Guinea worm disease.

The Programme Manager of GGWEP, Dr Asiedu Bekoe, told the Daily Graphic in Accra on July 30 that the ICT observed that there was no active Guinea worm cases in the areas visited.

He said thousands of rumoured and suspected cases were reported and investigated and none was found to be Guinea worm and the last reported case was a 41-year-old female from Diare Village in Savelugu-Nanton, reported in May 2010.

In 2010, he said only eight cases were reported, all in Savelugu-Nanton, compared with 242 cases in 2009, representing a 97 per cent reduction.

He, however, said all eight cases were contained, and since June 2010, no case had been reported.

However, in spite of the new development, Dr Bekoe urged Ghanaians to continue to be on the lookout because visitors come in from countries that are Guinea worm endemic.

The Guinea worm disease (Dracunculiasis) is a crippling parasitic disease caused by Dracunculus medinensis, a long thread-like worm. It is transmitted exclusively when people drink water contaminated with parasite-infected water fleas.

Dracunculiasis is rarely fatal but infected people become non-functional for months. It affects people in rural, deprived and isolated communities who depend mainly on open surface water sources such as ponds for drinking water.

Transmission, life-cycle and incubation

About one year after the infection, a painful blister forms, 90 per cent of the time on the lower leg, and one or more worms emerge accompanied by a burning sensation. To soothe the burning pain, patients often immerse the infected area in water. The worm(s) then releases thousands of larvae (baby worms) into the water. These larvae reach the infective stage after being ingested by tiny crustaceans or copepods, also called water fleas.

People swallow the infected water fleas when drinking contaminated water. The water fleas are killed in the stomach but the infective larvae are liberated. They then penetrate the wall of the intestine and migrate through the body. The fertilized female worm (which measures from 60–100 cm long) migrates under the skin tissues until it reaches the lower limbs, forming a blister or swelling from which it eventually emerges. The worm takes 10-14 months to emerge after infection.

Ghana programme

The disease has a long history in Ghana and infection was widespread in the 1950s. In 1985 when official records began, 4,060 cases were reported and a survey estimated about 70, 000 cases in the Northern Region alone.

By 1989, the number of recorded cases had increased to 179,556 during a nationwide case each conducted by the GGWEP, established in 1988, following a declaration by the 39th World Health Assembly in 1986 urging all countries to eradicate the disease.

From 2000, the Government of Ghana, development partners and the GGWEP had mobilised resources to support the national programme which led to significant reductions in an annual number of reported cases from 2004.

A setback, however, occurred during the 2006-2007 transmission season when the Tamale Municipal water system in the Northern Region broke down, precipitating an outbreak in all the districts served by this system. In the period, the Savelugu-Nanton District reported the greatest number of cases.

After that outbreak, the programme reported 501 cases nationwide in 2008, a reduction from the 3,358 cases reported the previous year, which was the largest one-year reduction in annual cases in its history.

Country certification

To be declared free of dracunculiasis, a country needs to have reported zero transmission and afterwards maintained active surveillance for at least three years.

After this period, an international certification team visits the country to assess the adequacy of the surveillance system and to review records of investigations regarding rumoured cases and subsequent actions taken.

Indicators such as access to improved drinking water sources in infected areas are examined and assessments are carried out in villages to confirm the absence of transmission. Risks of reintroduction of the disease are also assessed. Finally, a report is submitted to the International Commission for the Certification of Dracunculiasis Eradication (ICCDE) for review.

Since 1995, the ICCDE has met nine times and on its recommendation, WHO has certified 197 countries, territories and areas (belonging to 185 member states) as free of dracunculiasis.