Guinea worm eradication: Nigeria risks WHO’s certification without surveillance

By: Chioma Umeha

If Nigerians go to sleep and watch neighbouring countries like Sudan, Ethiopia, Chad, among others, where guinea worm diseases is still prevalent transmit the disease to the country, it may not be certified as a guinea worm free nation by the World Health Organisation, (WHO), come June 2013. 

For two decades, beginning from 1988, thousands of volunteers laboured to document every case of the disease and providing the tools and education necessary to defeat it. Nigeria had from December 2008 till date maintained a zero Guinea worm disease case status that is over four years. However, there are indications that some countries are still reporting Guinea worm disease and Nigeria is bordering some of the countries. Last month, the country celebrated her success in the eradication of the disease during the National Guinea Worm Disease Eradication Day. During the occasion, the Minister of State for Health, Dr.Ali Mohammad Pate, announced the proposed visit by the International Certification Team (ICT) for Guinea Worm disease eradication in June 24 to July 14, to assess Nigeria for consideration for certification. He expressed optimism that the visit of the international Certification Team will yield positive results pointing out 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 offered a cash reward of N25,000 for every report of authentic new guinea worm cases in any part of the country. In 2011, a N10, 000 rewards was offered for a similar report. The government seems not to leave any stone unturned in the preparation to be officially certified a guinea worm disease free country. Speaking, last week in Kaduna, the Communication Officer, Nigeria Guinea Worm Eradication Programme, (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. 

Drinking water containing water fleas habouring Dracunculus larvae cause guinea worm infection
 According to her, cases of guinea worm diseases were prevalent in Sudan, Ethiopia, Chad and other border countries, hence the collaboration between the Federal Government and the neighbouring countries, to eradicate the disease. “It is a collaborative effort; we cannot do it alone. What Nigeria is doing is collaborating with other countries,” she said. “Recently, the National Coordinator for guinea worm diseases went for a cross border meeting with the countries bordering Nigeria. “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.” 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. According to her, the Federal Government with the support from the World Health Organisation, (WHO), and other partners had built an information network from the national level through the states, local governments down to the villages. 

Also, during a roundtable on Media and Advocacy for guinea worm disease eradication pre-certification activities, Assistant National Co-ordinator of the National Steering Committee of the Nigeria Guinea Worm Eradication Programme, (NIGEP), Mr. Babatunde Tokoya, explained the essence of the financial incentives of N25, 000 to volunteers of information on fresh cases of the disease. Tokyo said the incentive was to sensitise the entire populace about the importance of guinea worm certification. “Any suspected case of guineaworm disease is to be reported to the nearest health facility and if it is confirmed, the reporter will be given a cash reward of N25,000. All suspected cases can be reported through a toll free line 08001001000,” Tokoya confirmed. The Assistant National Co-ordinator observed that between 2009 to date there have been 545 rumour cases of guineaworm out of which 21 were recorded between January and March 2013. “Before Nigeria can be certified guineaworm 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 the 774 LGAs across the country. Currently we have attained 57 per cent. He said there must be at least 80 per cent monthly reporting from all 774 LGAs in the states, adding; “currently we are at 83 per cent completeness but 51 per cent reported timely. “We must have at least 80 percent  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 facility staff at national, State, LGA and health facility level must know about the case definition of guinea worm and appropriate response to the cases. Currently we have attained 32 percent. “All guinea worm disease rumours must be investigated immediately, within 24 hours of receiving the verbal or written report. Currently we are at 82 percent. Also, Tokoya said adequate safe water supply and management in villages at risk must be maintained, noting; “currently we are at 97 percent.” 

There has been no confirmed case of the disease in Nigeria since the reported 38 cases in 2008, down from over 653,000 cases at the start of Guinea Worm Disease eradication campaign in 1987. NIGEP has been championing guinea worm eradication efforts, focusing on surveillance, integrating guinea worm watch into other immunisation programmes with conscious efforts to improve water and sanitation in the identified 5,879 affected villages in 1998. Member of the Steering Committee, Mr. Buki Ponle, said the roundtable was to discuss, among others, specific roles expected of the media and also to unfold plans for a Media Merit Award which will climax media activities on guinea worm eradication. Guineaworm is infection with Dracunculus medinensis, a nematode worm. It is caused by drinking water containing water fleas harbouring Dracunculus larvae. There are no drugs for treatment but it can be prevented by protecting water sources and filtering potentially contaminated water.

This story was published in Daily Newswatch on May 9, 2013.


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