Health
Guinea worm cases soaring in Mali and Togo

afrol News, 6 March - Mali and Togo are heading the unpleasant statistics of the return of the Guinea worm, the parasite contracted through drinking stagnant water, causing a painful and debilitating disease. The Guinea worm was close to be wiped off the face of the earth, but has made a strong return in some African countries.

The World Health Organisation (WHO) yesterday made an appeal to intensify the fight against the Guinea worm. WHO's public health experts say they believe that making the final push will free up resources that can then be redirected to other health problems. Falling short of eradication, the disease can rebound. 

According to the latest statistics of the UN agency, cases have already jumped more than 56 percent between 2000 and 2001 in Togo. In that same period, Mali's Guinea worm cases have soared more than 140 percent. 

The Guinea worm was close to eradicated in these two countries by 2000. The countries with the heaviest burden of disease were and are Sudan, Nigeria, and Ghana. Here, 91 percent of the estimated 60,000 cases remaining are located. 

In Togo, a total of 5,045 of Guinea worm were reported in 1994, down from 10,394 cases the year before. Effective campaigning reduced the number of Guinea worm cases to an all-time-bottom of 828 reported cases in 2000. Last year, however, a setback was noted and the prevalence soared to 1292 cases.

In Mali, the decimation and the return of the Guinea worm has been even more dramatic. 16,024 cases were reported in 1991 (5,396 cases in 1993) - a number which was reduced by an incredible 98 percent in nine years, down to 290 reported cases in 2000. The disease seamed close to eradication, but last year, numbers increased by 140 percent to 695 cases.

The relatively low numbers in Togo and Mali throughout the 1990s contrasted the heavy infection in Sudan in 1995 (64,608), Nigeria in 1990 (394,082) and Niger (42,187). In Sudan, prevalence was only reduced by 15 percent between 1995 and 2000, mostly due to the civil war. Nigeria experienced a reduction of 98 percent during the 1990s and Niger by 95 percent.

In 1991, WHO and the UN Children's Fund (UNICEF) launched a campaign aimed at eradicating the worm by providing access to safe drinking water through filtering water and digging new wells. In 1999, UN agencies stated they were close to the eradication of the disease, scattered occurrences only remaining in Benin, Burkina Faso, Central African Republic, Côte d'Ivoire, Ethiopia, Ghana, Mali, Mauritania, Niger, Nigeria, Sudan, Togo and Uganda. Guinea worm cases had been reduced by 87 percent between 1990 and 1998, and the eradication initiative hoped to achieve its goal by the end of 2000. Asia was already completely free of the parasite.

Armed conflict threatens to thwart these eradication efforts, WHO said in a release yesterday. Sudan accounted for 80 per cent of the Guinea worm cases registered last year; almost all the cases occurred in the south, where civil strife has raged for 19 years. 

The largest increase had however been in Togo and Mali, two relatively stable countries. Wavering commitment by governments and donors were preventing the campaign from reaching its final goal, WHO noted. "As the number of worm cases declines, governments and donors may shift their attention to HIV/AIDS and other health emergencies."

- These challenges are not biological, said Maria Neira, Director of the WHO Guinea Worm programme. "In fact, simple eradication tools have proven effective all over the world. Instead the remaining obstacles are all man-made. If we fail to solve these problems, the momentum toward eradication may stall and the disease will rebound."

Guinea worm is a painful and debilitating disease whose effects reach beyond a single victim, crippling agricultural production and school attendance, for example. During one year in the mid-1980s in south-eastern Nigeria, rice farmers lost US$ 20 million due to outbreaks of Guinea worm. 

Guinea worm is contracted when stagnant water, contaminated with microscopic fleas carrying infective larvae, is consumed. Inside a human's abdomen, the larvae mature and grow, some as long as three feet. After a year, the worm slowly emerges through an agonisingly painful blister in the skin. 

Some worms can take up to two months to be completely expunged. The burning sensation caused by the emerging worm leads many victims to immerse their limbs in water, seeking relief, but the cycle of infection only begins again as the worm releases more larvae into the water.

Preventing Guinea worm seems simple: don't enter the water with an emerging Guinea worm and don't drink unfiltered water. But, according to the Carter Center, "the challenge lays in educating villagers to always filter their water and ensuring they have the necessary filters to do so."

Sources: Based on WHO, UNICEF, Carter Center and afrol archives