Fighting Disease: The Republic of Sudan and The Republic of South Sudan
Eradicating Guinea Worm Disease
Current status: Endemic
Indigenous cases reported in 2011: 1,028
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 >
Since 1995, The Carter Center has worked to reduce the cases of Guinea worm disease in Sudan and South Sudan through its Guinea Worm Eradication Program. Harboring the vast majority of the world's remaining cases in 2011, Southern Sudan has become the last frontier on the difficult path to eradicating this debilitating parasitic disease. However, despite the severe conditions the Southern Sudanese people experienced as a result of the civil war, both the northern and southern regions have made great progress overall in reducing their number of cases. Since 2002, no indigenous cases have been reported in northern Sudan. The incidence of Guinea worm disease has been reduced in Sudan from 118,578 cases in 1996 to a total of 1,028 cases reported in Southern Sudan in 2011.
Smallpox, the first disease to be eradicated in human history, was eliminated from the former nation of Sudan during the 10-year cease-fire (1973-1983). Some experts believe that without this window of peace in Sudan, smallpox would not have been eliminated from the country in 1977, or globally in 1980.
Smallpox's eradication led experts to believe other diseases are eradicable, and in 1980, Guinea worm disease became the second disease in history to be targeted for eradication. The Carter Center's leadership of the Guinea worm effort began in 1986, following the inauguration of the International Drinking Water Supply and Sanitation Decade and a commitment by the Centers for Disease Control and Prevention to target Guinea worm disease.
The "Guinea worm cease-fire," brokered by President Carter in 1995, lasted for almost six months, suspending fighting to treat Guinea worm and other diseases, like river blindness, and to immunize children. The cease-fire is one of many examples of how The Carter Center is actively and neutrally involved in the areas of peace and health in Sudan and South Sudan despite many challenges.
The war made the southern areas uninviting, or worse, inaccessible, to foreign aid workers, such as those with the Guinea Worm Eradication Program, who endangered their lives by working in the war zone. Since the comprehensive peace agreement was signed in 2005, there has been relative stability in the area; however, the possibility of future conflict is still very real.
While more endemic villages are benefiting from regular water treatments in South Sudan, transportation of ABATE® larvicide (donated by BASF Corporation) in the area is difficult and expensive, and the four-month rainy season renders makeshift roads impassable, creating such vast swamps that proper application is nearly impossible.
Although the program has been severely handicapped by war and the nature of the terrain, village-based volunteers remain dedicated to preventing their neighbors from suffering. These "Guinea worm warriors" will need the continued support and political will of South Sudan's leaders and external partners to fully eradicate Guinea worm from South Sudan.
Read about the Carter Center's "Guinea worm warriors" >
In 2001, the Center's Guinea Worm Eradication Program and partners such as Health and Development International, the Hydro Polymers of Norsk Hydro, and Norwegian Church Aid spearheaded the Sudan Pipe Filter Project. In only a few months, the project manufactured for distribution more than 9.3 million Guinea worm pipe filters – hard plastic straws equipped with nylon cloth for straining microscopic water fleas out of drinking water – to every man, woman, and child at risk for the disease in Sudan. In conjunction with the pipe filter distribution, a targeted health education campaign was launched, including flip charts, radio public service announcements, and community demonstrations.
Read the feature: Pipe Filters Renew Hope (PDF) >
Even the most basic medical supplies are hard to come by in rural South Sudan. In 2003, the Humanitarian Action Campaign, an initiative of the Norwegian Medical Students Association, chose to support the Center's Guinea worm program in Sudan by raising funds to purchase 7,000 much-needed medical bags filled with gauze, antiseptics, scissors, and pain relievers. The students also purchased 3,000 replenishment medical kit supplies.
Improved reporting, surveillance, and Guinea worm filter cloth and pipe filter distribution – in conjunction with many other interventions – have enabled the Sudanese and South Sudanese people to dramatically reduce incidences of Guinea worm disease. During 2006, the program began surveillance activities in previously inaccessible areas of Sudan. The data collected from these newly reached areas revealed a clearer picture of the prevalence of Guinea worm in Southern Sudan. As predicted, with a gain in access due to the negotiated peace settlement, Guinea worm cases have risen as surveillance and case searches reveal the extent of this painful disease. Guinea worm eradication must continue to be a priority in South Sudan.
Read the Lancet article: "Sudan's War and Eradication of Dracunculiasis" >
The program has witnessed that when people are given the proper tools and health education, there is a dramatic drop in cases. It remains vital that South Sudan continue to expand its social mobilization while aggressively intensifying health education. Effectiveness of case containment must also be improved by making surveillance active and complete, with the goal of case detection and containment within 24 hours of the worm's emergence. This basis of public health education, built by efforts against Guinea worm, has made it possible for the Center's fight against disease in Southern Sudan to extend into other illnesses, such as trachoma.
With efforts such as the pipe filter project, increased health education, and the possibility for sustained peace, cases of Guinea worm disease continue to dwindle, indicating that Guinea worm disease eradication is truly on the horizon.
The Carter Center is currently fighting Guinea worm disease in the following South Sudanese states: Jonglei, Upper Nile, Central Equatoria, East Equatoria, North Bahr Al Gazal, West Bahr Al Gazal, Lakes, and Warab.
Until Guinea worm disease is eradicated in South Sudan, all countries bordering this nation will be at risk, especially Uganda, Kenya, and Ethiopia. Therefore it is imperative to monitor and report the importation/exportation of Guinea worm cases from South Sudan to its neighbors. The international Guinea worm coalition believes sustained peace will be required to eradicate the disease. South Sudan must continue the momentum.
Watch the video: Guinea Worm's Last Stand – Southern Sudan >
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