Fighting Disease: Ghana
Eradicating Guinea Worm Disease
Current status: Transmission stopped, May 2010 (read the announcement)
Certification of Dracunculiasis Eradication: Pending
For the most current 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 Carter Center began leading the international Guinea worm eradication campaign in 1986. The following year, Ghana became one of the Carter Center Guinea Worm Eradication Program's first country partners (in addition to Pakistan). The Carter Center's relationship with the Ghanaian Ministry of Health has remained strong as the international eradication campaign has grown to include other partners, such as the U.S. Centers for Disease Control and Prevention, the World Health Organization, and UNICEF.
The last indigenous case in Ghana was reported and contained in May 2010. In July 2011, after completing 14 consecutive months reporting zero indigenous cases of Guinea worm disease, Ghana Vice President John Mahama officially announced that the country had stopped disease transmission after a 23-year nationwide battle.
Over the years, Guinea worm disease had been entwined in Ghana's history, economy, traditional beliefs, and modern politics. The peak transmission season in Ghana was from November to June, coinciding with the end of the rainy season when water sources become stagnant and susceptible to Guinea worm transmission.
Nearly 180,000 cases of Guinea worm disease were reported during the country's first national case search in 1989. This ranked Ghana second in the world in cases at the time, and suffering was widespread.
Guinea worm closed schools in endemic communities, because it prevented so many young students from being able to walk. Farmers suffering from the disease were unable to tend their fields, causing their families to be further entrenched in dire poverty.
The Ghana Guinea Worm Eradication Program introduced the following approaches in local communities: health education; the distribution of nylon household filters and pipe filters to strain out water fleas with infected larvae; safe, monthly treatment of stagnant water sources with ABATE® larvicide, donated by the BASF Corporation; direct advocacy with water organizations; and increased efforts to build safer hand-dug wells. Village volunteers, who were trained, supplied, and supervised by the program, carried out monthly surveillance and interventions.
Some of these interventions were tailored to meet the unique needs of migratory farming populations such as the Nanumba, Konkomba, and Dagomba ethnic groups. Because migratory groups rarely gather water from the same permanent water sources, simply digging a well or holding health education sessions at the local school was not enough. To fit the unique needs of these populations, the program created alternative approaches to Guinea worm health education such as: targeted radio messages, continued community volunteer recruitment, and the development of additional educational materials.
For instance, young men, usually farmers and cattle herders,found themselves at greater risk for the disease because they often are away for weeks from the community base where household filtered water should be available. Instead they drink from numerous unprotected water sources while working in the field. The use of pipe filters has been one solution to this problem. The Guinea worm pipe filter – a hard plastic straw covered at one end by a filter material – is used to strain out the microscopic water fleas from the water, preventing people from contracting Guinea worm disease when away from the community. In 2005, approximately 144,000 new pipe filters were distributed to every eligible person over 5 years of age in each household in the seven most endemic districts in Ghana.
Those who are responsible for water-related activities, such as gathering drinking water, washing, and cooking – often women and children – bore an additional risk. Recognizing women's role and responsibility for water, The Carter Center engaged the women of the Ghana Red Cross Society in 2001 to work with and support village volunteers in the most affected districts. The Red Cross Society women — who, at one point, numbered more than 5,000 — played an important role in the fight against Guinea worm disease. The eyes and ears of the community, these women reported cases,ensured proper use of filters, and prevented worm contamination in water sources.
Ghana's Guinea Worm Eradication Program, in partnership with The Carter Center, sponsored performances by local drama groups to increase health education among at-risk populations. The plays were one more avenue for spreading the word about how to prevent the disease.
In the play "Let's Eradicate Guinea Worm," performed by the Suhuyini Drama Group, emphasis was placed on filtering water to prevent Guinea worm disease and stopping people with Guinea worm from entering and contaminating water sources.
Read: Laughter Is the Best Medicine – Group's Humor Aids in Guinea Worm Education >
During Ghana's peak transmission season, case containment centers were opened in strategic endemic areas. At these care centers, people with Guinea worm disease were treated and given health education. Patients stayed free of charge until their Guinea worms had fully emerged to ensure they would not inadvertently infect community water supplies.
Addressing stigma associated with Guinea worm disease was yet another difficulty. Through a public awareness campaign, the Ghana Guinea Worm Eradication Program publicized the importance of immediately reporting all cases of Guinea worm disease and emphasized that infection is not necessarily the fault of the individual. To help educate the public and raise awareness about Guinea worm disease, The Carter Center enlisted U. N. Secretary-General and Ghanaian Kofi Annan to record Guinea worm public service announcements for radio and television aired in Ghana and throughout Africa.
After winning the crown of Miss Ghana in 2005, Lamisi Mbillah brought attention to the efforts of Ghana's Guinea Worm Eradication Program. In 2006, she visited dozens of endemic villages to provide health education and participate in community mobilization activities to prevent the disease, continuing her active involvement in eradication activities into 2008.
Despite the many challenges the program faced from the beginning, Ghana's Guinea worm eradication campaign made significant progress early, reporting only 8,432 cases in 1994. However, ethnic fighting that year in the highest endemic area – the eastern part of the Northern region – disrupted health efforts, creating programmatic instability and safety concerns that prolonged the fight against the so-called "fiery serpent" in Ghana and West Africa.
While the program in Ghana's south successfully eliminated Guinea worm disease, the northern regions continued to report the majority of the disease, particularly among marginalized and migratory populations. During the 2006-2007 peak transmission season, the town of Savelugu in the district of Savelugu-Nanton reported a large outbreak of cases due to a breakdown in the main water supply in 2005-2006. Despite this setback, in May 2008 Ghana reported its 14th consecutive month of reduced cases, exceeding 70 percent reduction each month since October 2007 and suppressing the upsurge in cases normally expected at the beginning of the annual peak transmission season. By the end of 2008, cases had been reduced by 85 percent, the greatest single-year reduction of any moderately endemic country in the history of the campaign.
And in 2011, after more than 500,000 cases since its inception; thousands of village volunteers; more than 4 million cloth filters; more than 1 million pipe filters; 72,000 liters of ABATE; at least nine ministers of health and nine missed target dates; Ghana's Guinea Worm Eradication Program achieved the demise of the worm.
The Carter Center ended its in-country activities in Ghana in August 2011.
Ghana's success at eliminating Guinea worm inspires other nations struggling with the disease as well as the Ghanaian people.
Watch/Listen to the Secretary-General's Guinea worm public service announcement >
Read the TIME magazine story: "A Village Woman's Legacy" >
Learn about Sadia Mesuna's struggle to overcome a devastating Guinea worm disease infection:
View Slideshow: Sadia's Story >
Sadia's Story Revisited: Triumph Over Guinea Worm >
Watch: Ghana Declares Victory Over Guinea Worm >
Print
This Page
E-Mail
This Page
Carter Center Blog
RSS
iTunes
Facebook
Twitter
YouTube