Fighting Disease:  Ethiopia

Eradicating Guinea Worm Disease

Current status: Endemic
Indigenous cases reported in 2011: 8
Includes two cases reported as imported from South Sudan.

For the most current 2012 Guinea worm case reports, read the Guinea Worm Wrap-Up newsletter >

Dracunculiasis, or Guinea worm disease, is a preventable parasitic infection contracted when a person ingests drinking water from stagnant sources containing copepods (commonly referred to as water fleas) that harbor infective Guinea worm larvae. Inside a person's body, the larvae grow for a year, becoming thin threadlike worms up to 1 meter long. These worms create agonizingly painful blisters in the skin through which they slowly exit the body, preventing the victim from attending school, caring for children, or harvesting crops. Learn more about the historic Carter Center-led campaign to eradicate Guinea worm disease >

The Ethiopia Ministry of Health established its National Dracunculiasis Eradication Program in 1993 with assistance from The Carter Center, and launched a village-by-village nationwide search during which 1,120 cases were found in 99 villages in the southwest part of the country. Transmission of Guinea worm disease in the Southern Nationalities, Nations, and Peoples region (SNNPR) was interrupted in 2001. In 2007, Ethiopia reached a milestone by reporting zero indigenous cases for 12 consecutive months. Unfortunately, transmission of the disease resumed in 2008 when the country reported 41 indigenous cases. The unexpected resurgence of Guinea worm disease in Gambella region during 2008 demonstrates the constant need for vigilance in eradication efforts.

Ethopia reported 8 cases of dracunculiasis in 2011, including two cases imported from South Sudan. In 2010, the nation reported 20 indigenous cases of dracunculiasis plus one case imported from South Sudan.
In collaboration with the Ministry of Health, the strategy for interrupting transmission of Guinea worm disease from Ethiopia relies on an active surveillance system in high-risk areas to detect all cases and prevent each patient from contaminating additional water sources (case containment). One of the goals of the Guinea worm program is to change behavior and mobilize communities to prevent contamination of sources of drinking water. Approaches include: distribution of nylon filters to strain out the water fleas that host the Guinea worm larvae; monthly treatment of stagnant sources of drinking water with ABATE® larvicide (donated by BASF Corporation); and advocacy with water organizations for provision of safe sources of drinking water. Community-elected village volunteers are trained by the program to carry out monthly surveillance and interventions.

In 1995, as part of the effort to provide safe water to communities with Guinea worm disease, 15 hand-dug wells were completed in South Omo, with an additional 40 wells constructed by a partnering nongovernmental organization, Norwegian Church Aid. Later, additional wells were dug in Itang and Gog woredas of the Gambella region. The Ethiopian Water Resources Development offices also have provided training on the use of Vonder drilling rigs to develop a village-level capacity to construct hand-drilled wells.

During the mid-1990s, committees were formed to work with communities to identify factors affecting community participation as well as coordinate efforts to reach people displaced by tribal conflicts from Akobo village. Approximately two-thirds of Akobo's total population were said to have abandoned their homes and resettled in relatively inaccessible woredas (hamlets) of Jikawo and Itang. Following this shift, some 20 volunteers from Akobo were trained on surveillance, health education, and the use of nylon filters. A UNICEF-donated motorboat assisted with reaching some of the most difficult areas.

In 1996, a reward system was established in all endemic areas using resources provided by Health and Development International to improve the detection and reporting of cases. If a case is reported before the worm emerges, both the patient and the person who brings the case to the attention of the health worker receive 100 birr, about $10 USD. The reward system further strengthens eradication efforts by encouraging people with cases to report early and remain at a health facility during the duration of their illness to prevent contamination of water sources. Patients who stay at the health facility receive three meals a day, a place to sleep, and free quality medical care until all worms are removed.

Major constraints on program efforts include maintaining surveillance throughout the Gambella region, including districts that periodically become inaccessible due to insecurities and heavy rains during the peak transmission season. Because South Sudan is the most endemic country in the world, migration of people between South Sudan and Ethiopia is a risk for continued transmission of Guinea worm disease in Ethiopia. Ethiopia must monitor migration across its borders and strengthen surveillance and cross-border collaboration with South Sudan in the final push to eradicate the disease from the world.

Learn more about the Carter Center's Guinea Worm Eradication Program in Ethiopia (in search result
format) >