By: Chioma Umeha
“We are staring history in the face as the public health system of Nigeria is about to make a bold statement of eradicating Guinea worm disease in Nigeria after many years–over two decades of hard fought battle against Guinea worm, we have now succeeded in defeating it.” Thus quipped General Yakubu Gowon, former Head of State, on the verge of the struggle against eradication of guinea worm infection in Nigeria. This remarks of Gowon may come true barely 17 days from today if there is no report of fresh guinea worm infection in the country.
This is because Nigeria will be officially certified free of the disease by the World Health Organization (WHO), this month. Precisely, the International Certification Team (ICT) for Guinea Worm disease eradication, from the world health body will be in the country between June 24 and July 14, to assess her for certification. Nigeria was the most guinea-worm-endemic country in the world, between 1988 and1989, as it reported more than 650,000 cases in 36 states, according to the first nationwide survey for the disease. In 1988, the disease affected 5,879 persons. Popularly identified in local parlance as “the impoverisher,” between 2002 and 2004, UNICEF spent about US $ 3.8 million (500 million naira) for guinea worm eradication. In the mid-1990s, guinea worm infections in parts of the heavily populated region of southeast Nigeria caused an estimated USD $20 million in lost income to rice farmers alone.
The Carter Center’s Guinea Worm Eradication Programme confirmed that the disease cost rice farmers an estimated US $20 annually in the late 1980s, in the south-east alone. In collaboration with Nigeria’s Ministry of Health, the strategy for elimination consisted of several components, driven by health education. The goal was to change the behaviour and mobilize communities to improve the safety of their local water sources. Most endemic communities lacked access to quality health education, social and educational facilities among others. The period when the worm normally emerges on the skin of people tends to coincide with the peak farming season, therefore, guinea worm infection not only renders the victim immobile, it causes poverty and hunger.
Consequently, it is often referred to as ‘masiyaci’ in Hausa, meaning ‘the troublesome one’ and ‘sobia’ in Yoruba meaning ‘poverty’. As most guinea worm endemic communities lacked health clinics, infected school children couldn’t attend classes, either temporarily or sometimes permanently. Infected individuals are unable to attend to their means of livelihoods and to fend for their families. Infected mothers are unable to provide adequate care especially to infants resulting in conditions such as diarrhoea, malnutrition and skin infections. They are unable to walk any great distance to immunise their babies against childhood killer diseases. Nigeria reported its last case in a 58-year-old woman in south-eastern Nigeria in November 2008. Since the past three years, the country has been in surveillance of guinea worm disease in preparation for the official certification by the World Health Organization as free of the disease, experts are focusing on how to repeat Nigeria’s success in the last strongholds of the disease in southern Sudan, northern Ghana, and eastern Mali.
Meanwhile, Ethiopia is fighting just a few remaining cases. However, some have said that the expected certification programme may be a fluke, insisting that the disease is still occurring in the villages, therefore, the country cannot claim to have eradicated the disease. Those who belong to this school of thought insinuate that those who claim that the disease has been eradicated are living in the city, not in the village where the disease mostly occurs. For instance, Mr. Soni Uwachue, a chartered accountant, an indigene of Nsukka, Enugu, who works in Lagos, said; “nobody can say that guinea worm diseases has been eradicated. You cannot stay in Lagos and be talking about certifying the country free from guinea worm by the World Health body, because the disease is still occurring in the villages.” Similarly, Sam Idiga, a lawyer, practising in Lagos, asked rhetorically; “Is this not one of the government’s gimmicks? That was how the government said that leprosy and polio diseases have been eradicated, yet there are still reports of the disease in some parts of the country.
However, Tony Ufoma, from Ezza Nkwubor village, Enugu; one of the guinea-worm-endemic states in 1988, said that the thinking that guinea worm has not been contained is the figment of some people’s imagination, especially those who do not appreciate that the world today, including Nigeria is a global village. Ufoma, who spoke to Daily Newswatch, reasoned that if reports of the disease in 1988 came to the public domain before the era of global communication network, then, any report of new infection since the last case in November 2008, would have become public knowledge. Further investigations confirmed that there has not been any report of new infections since 2008 in Izamgbo, Ezza both in Ebonyi State and Ezeagu in Udi Local Government Area, Enugu State, among other areas which were affected by the disease between 1988 and 2008. In a telephone conversation, Joe Nwagbo, from Izamgbo, in Ebonyi State, said there has not been any report of new infections in the state. Nwagbo said he often visits neigbouring cities like, Aba, Onitsha, Enugu, Port Harcourt, even Lagos on business trips. There has been no confirmed case of the disease in the country since the reported 38 cases in 2008, down from over 653,000 cases at the start of Guinea Worm Disease eradication campaign in 1987.
Guinea worm eradication efforts have been pushed by the Nigeria Guinea Worm Eradication Programme (NIGEP) focusing on surveillance, integrating guinea worm watch into other immunisation programmes and conscious efforts to improve water and sanitation in the 5,879 affected villages identified by NIGEP in 1998. However, through persistent, leadership from individuals like General Gowon, and Nigeria’s contribution of US $2 million of its own funding to the Carter Center for the campaign. Between 2009 to date there have been 545 rumoured cases of guinea worm out of which 21 were recorded between January and March 2013. Since the country reported its last case in November 2008, there has not been any confirmed report of fresh infection from any part of the country. During a roundtable on media and advocacy for guinea worm disease eradication pre-certification activities, in Lagos, recently, Assistant National Coordinator of the National Steering Committee of NIGEP, Mr. Babatunde Tokoya, highlighted of the criteria for the certification.
Tokoya explained; “Before Nigeria can be certified guinea worm free, we must meet four distinct criteria. We must have at least 85 per cent timely monthly reporting from all health facilities, public and private primary, secondary and tertiary health facilities in the 774 LGAs across the country. Currently we have attained 57 per cent. Further, he said there must be at least 80 per cent monthly reporting from all 774 LGAs in the states. “Currently we are at 83 per cent completeness but 51 per cent reported timely. “We must have at least 80 per cent monthly reporting from all 774 LGAs and at least 80 per cent of the general public in rural and urban areas knowing about the reward, and all health facilities staff at national, State, LGA levels must know about the case definition of guinea worm and appropriate response to the cases. Currently we have attained 32 per cent. “All guinea worm disease rumours must be investigated immediately, within 24 hours of receiving the verbal or written report. Currently we are at 82 per cent. Further, Tokoya said adequate safe water supply and management in villages at risk must be maintained. “Currently we are at 97 per cent. The government appears ready to spare no effort in the preparation to be officially certified as a guinea worm disease free country in the next 17 days. Confirming the proposed visit by the ICT recently, the Minister of State for Health, Dr.Ali Mohammad Pate, expressed optimism that the visit will yield positive results, insisting that Nigeria will qualify to be certified free of Guinea worm disease this year. To this end, the country is trying to tighten every loose end to avoid the re-emergence of the disease.
Already, Nigeria has increased surveillance on border posts to avert new infections in the country, even as experts are focusing on how to repeat her success in the last strongholds of the disease in southern Sudan, northern Ghana, and eastern Mali. The government has also promised a cash reward of N25,000 to any reporter of authentic, new guinea worm cases from any part of the country. In 2011, a N10,000 reward was offered for a similar report. Speaking, recently, in Kaduna, the Communication Officer, NIGEP, Dorcas Mernyi, elaborated on the measures being adopted to avoid cross-border infections and ensure that Nigeria remains guinea worm free. Ms. Mernyi emphasised on the need to sensitise Nigerians to be more vigilant so as to avert contracting the disease from neighbouring countries where it had not been contained. “We are keeping surveillance over our borders because some countries are still reporting and Nigeria is bordering some of the countries. So our surveillance structure has to be very sensitive so that no case will be imported into Nigeria,” she said.
According to her, cases of guinea worm diseases were still prevalent in Sudan, Ethiopia, Chad and other border countries, hence the collaboration between the Federal Government and the neighbouring countries, to eradicate the disease. “We are fighting this together; we don’t want any re-bounce of guinea worm case in the country. We are intensifying surveillance at the borders, screening people that come in. It is a collaborative effort; we cannot do it alone. What Nigeria is doing is collaborating with other countries,” she said. She said that villages bordering other countries had been engaged in community participatory surveillance, to assist government in checking the spread of the disease into the country. “People in the communities are helping us to look out. If we see a stranger, we find out who the person is, if we don’t understand, we report immediately. “We are not pursuing them out of the country, but we want to know who they are, where they are coming from and to make sure they are not bringing guinea worm disease into Nigeria,” she said. Guinea worm disease 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.
The disease is common in communities with low level of hygiene practice. It is mostly found in very poor communities, hard to access, uninformed and neglected areas with no safe sources of drinking water. Infection occurs when a person drinks water contaminated with water flea or Cyclops which contains the worm larvae. The water flea is digested while the guinea worm larvae is set free; it penetrates the digestive tract and moves through the body between nine to 12 months until it emerges from any part of the body. All age groups are susceptible to guinea worm infection. There is no treatment for Guinea worm disease; the only prevention is to avoid contaminated water.
This story was published in Newswatch Times on June 6, 2013.