Fighting Disease: Ethiopia
Eradicating Guinea Worm Disease
Current status: Endemic
Indigenous cases reported in 2015: 3* (provisional)
With assistance from The Carter Center, the Ethiopia Ministry of Health established its National Dracunculiasis Eradication Program in 1991, launching a village-by-village nationwide search, which found 1,120 cases in 99 villages in two regions of the southwest part of the country. Transmission of Guinea worm disease (dracunculiasis) in the Southern Nationalities, Nations, and Peoples Region (SNNPR) was interrupted in 2001, but continued in the Gambella Region. In 2007, Gambella Region reported zero indigenous cases for 12 consecutive months.
In 2008, Gambella reported 41 indigenous cases, and by 2014, only three cases of dracunculiasis were reported. The strategy for interrupting transmission of Guinea worm disease in Ethiopia relies on active surveillance systems in high-risk areas to detect all cases and contain them by preventing patients from contaminating water sources. Approaches for changing behavior and mobilizing communities to protect their drinking water 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); voluntary isolation of patients in case containment centers; 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.
As part of the effort to provide safe water to communities with Guinea worm disease, the Carter Center-supported program and a partnering nongovernmental organization, Norwegian Church Aid, have constructed hand-dug wells in the Gambella Region. The Ethiopian Federal 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.
Committees were formed to stimulate community participation and to reach villagers displaced from Akobo by tribal conflicts to the relatively inaccessible woredas (hamlets) of Jikawo and Itang. Some 20 resettled Akobo volunteers were trained on surveillance, health education, and the use of nylon filters, and a UNICEF-donated motorboat assisted with reaching some of the most difficult areas.
A reward system provided by Health and Development International was established in all endemic areas to improve the detection and reporting of cases. A monetary reward induces people with cases to report early and, for the duration of their illness, to remain at a health facility, where they receive three meals a day, a place to sleep, and free medical care until all worms are removed.
Major constraints on program efforts include: maintaining surveillance throughout Guinea worm-free districts in the Gambella Region, where health extension workers are not engaged in support of the national Guinea worm program, and where districts are periodically inaccessible due to insecurity and heavy rains during the peak transmission season; and migration of people from South Sudan to Ethiopia.