Fighting Disease: Pakistan

Eradicating Guinea Worm

Current Status:Transmission stopped, 1993
Certification of Dracunculiasis Eradication: 1996

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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 >

At the personal urging of former U.S. President Jimmy Carter and through the help of The Carter Center and the U.S. Centers for Disease Control and Prevention, Pakistan became one of the first nations to establish a Guinea Worm Eradication Program in 1986. A nationwide survey conducted the following year, in 1987, estimated a total of 2,400 cases of Guinea worm disease in 408 villages in the North West Frontier, Punjab, and Sindh provinces. Within seven years – with hard work and commitment from the endemic communities – Pakistan had stopped Guinea worm disease transmission.

Studies show reducing a community's parasitic burden improves school attendance, as victims of the Guinea worm are incapacitated for several weeks. Villagers suffer food shortages when they are unable to work. Eradicating Guinea worm disease has benefited whole communities in Pakistan, allowing villagers to achieve a better quality of life.

Since there is no vaccine or medication for Guinea worm disease, it will be the first disease in history to have been eradicated largely through preventive measures such as education and empowering people to take action.

In Pakistan, volunteer community health workers were recruited and trained to detect, record, and report cases. The volunteers also learned to use and care for nylon filters as well as how to replace and distribute them. In turn, the health workers taught people in their communities about the need to filter all unsafe drinking water while also providing first aid care to any individuals with skin lesions caused by emerging Guinea worms.

In the endemic areas of the North West Frontier province, safe drinking water from underground sources was not an easy option as water from these sources was brackish and undrinkable. Residents in this province prefer the use of household cisterns, which are rectangular tanks at ground level that harvest rainwater throughout the residential compound.

Lined with cinder blocks or cement, cisterns are covered for protection from dust and sand and extend below ground level. If one family member has Guinea worm disease, the whole family's water supply is at risk, as members must often travel down a set of steps to reach water level, invariably getting their wounds wet and thus unknowingly recontaminating the whole cistern.

In 1991, a cash reward system was implemented and publicized, offering 1,000 rupees – USD $40 approximately – for those who reported the first case in a village. By 1993, 3,000 rupees for each patient who followed case containment procedures and 500 rupees for the person reporting the case were added to the reward system. The program also established a national registry of potential cases and ensured that program staff promptly investigated all claims of cases of the disease.

By 1993, Pakistan made history by becoming the first nation to stop Guinea worm disease transmission since the campaign started in 1986. The Carter Center held a special ceremony in Atlanta in 2000 to honor Pakistan, Chad, Senegal, Cameroon, Yemen, India, and Kenya as becoming the first among the endemic nations to stop transmission of Guinea worm disease. Read more about the eradication of Guinea worm in Pakistan (PDF) >

The World Health Organization certified Pakistan free of Guinea worm disease in 1997.

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