Guinea Worm Eradication Program - Articles By Carter Center Experts

Jan. 3, 2013
Disease Eradication
New England Journal of Medicine, Vol 368 No. 1.pp. 53-64. Doi:10.1056/NEJMra1200391
Author: Donald R. Hopkins. Since the last case of naturally-occurring smallpox in 1977, there have been three major international conferences devoted to the concept of disease eradication. Several other diseases have been considered as potential candidates for eradication, but the World Health Organization (WHO) has targeted only two other diseases for global eradication after smallpox.  In 1986, WHO's policy-making body, the World Health Assembly, adopted the elimination of dracunculiasis (Guinea worm disease) as a global goal, and it declared eradication of poliomyelitis a global goal in 1988. Although both diseases now appear to be close to eradication, the fact that neither goal has been achieved after more than two decades, and several years beyond the initial target dates for their eradication, underscores the daunting challenge of such efforts, as does the failure of previous attempts to eradicate malaria, hookworm, yaws and other diseases. "Disease Eradication" was published as part one of "A Global View of Health – An Unfolding Series." Read the overview of the series >

Oct. 26, 2012
Progress Toward Global Eradication of Dracunculiasis, January 2011 – June 2012
Centers for Disease Control and Prevention, Morbidity and Mortality Weekly Report, Vol.61 No. 42.
Dracunculiasis (Guinea worm disease) is caused by Dracunculus medinensis, a parasitic worm. Approximately 1 year after initial infection from contaminated drinking water, the worm emerges through the skin of the infected person, usually on the lower limb. Pain and secondary bacterial wound infection can cause temporary or permanent disability that disrupts work and schooling for the entire family.

Dec. 18, 2011
Dracunculiasis Eradication and the Legacy of the Smallpox Campaign: What's New and Innovative? What's Old and Principled? [Presented at the Symposium on Smallpox Eradication: Lessons, Legacies & Innovations]
This article was online on Dec. 18, 2011 in Vaccine. Online signup is required to read the full article.
Coming on the heels the declaration of smallpox eradication in 1980 was the launch of the dracunculiasis (Guinea worm) eradication program, as a key outcome indicator of the success of the United Nations 1981-1990 International Drinking Water Supply and Sanitation Decade (IDWSSD). The dracunculiasis eradication campaign has carried on well beyond the close of the IDWSSD largely due to the efforts of President Jimmy Carter and The Carter Center, to assist the national Guinea Worm Eradication Programs in collaboration with partner organizations, including the Centers for Disease Control and Prevention (CDC), UNICEF, and the World Health Organization. Dracunculiasis eradication efforts have as primary tools health education, filter distribution for drinking water filtration, and case containment, all guided by rigorous village based surveillance.

Oct. 28, 2011
Progress Toward Global Eradication of Dracunculiasis, January 2010 - June 2011
Centers for Disease Control and Prevention, Morbidity and Mortality Weekly Report, Vol. 60 / No. 42.
In 1986, the World Health Assembly (WHA) called for the elimination of dracunculiasis (Guinea worm disease), a parasitic infection in humans caused by Dracunculus medinensis (1). At the time, an estimated 3.5 million cases were occurring annually in 20 countries in Africa and Asia, and 120 million persons were at risk for the disease (1,2).

Jan. 15, 2011
Looking to the Future in Sudan: Dr. Donald R. Hopkins' Letter to the Editor, The New York Times
This letter sent Jan. 11, 2011, by Carter Center Health Programs Vice President Donald R. Hopkins, M.D., M.P.H., is in response to an editorial published Jan. 8, 2011, by The New York Times.
"Southern Sudan Votes" (editorial, Jan. 8) rightly notes that the government of southern Sudan has "set up more than two dozen ministries and built schools and roads" since the signing of the comprehensive peace agreement in 2005.

Nov. 1, 2010                                                                                       
Emergence of Onchocerca Volvulus From Skin Mimicking Dracunculiasis Medinensis (PDF)
Reprinted with permission from the American Journal of Tropical Medicine and Hygiene, 83(6), 2010, pp. 1348-1351.
Authors: Mark L. Eberhard, Ernesto Ruiz-Tiben, Andrew S. Korkor, Sharon L. Roy, and Philip Downs. We describe 11 cases of suspected Dracunculus medinensis infection in which the worm recovered was identified as Onchocerca volvulus. Identification was based on morphology of the examined specimen.

Oct. 1, 2010
Progress Toward Global Eradication of Dracunculiasis, January 2009–June 2010
Centers for Disease Control and Prevention, Morbidity and Mortality Weekly Report, Vol. 59 / No. 38. Reported by Dr. Hopkins, M.D., E. Ruiz-Tiben, Ph.D., The Carter Center, Atlanta, Ga. ML Eberhard, Div. of Parasitic Diseases and Malaria, Center for Global Health; SL Roy, Div. of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC.

Aug. 4, 2010
Nigeria's Triumph: Dracunculiasis Eradicated (PDF)
Copyright © 2010 by The American Society of Tropical Medicine and Hygiene. Reprinted with permission. Am. J. Trop. Med. Hyg., 83(2), 2010, pp. 215-225. doi:10.4269/ajtmh.2010.10-0140.
Emmanuel S. Miri, Donald R. Hopkins*, Ernesto Ruiz-Tiben, Adamu S. Keana, P. Craig Withers, Jr., Ifeoma N. Anagbogu, Lola K. Sadiq,Oladele O. Kale, Luke D. Edungbola, Eka I. Braide, Joshua O. Ologe, and Cephas Ityonzughul. Read the media advisory "Carter Center Experts and Partners Chronicle "Nigeria's Triumph" Over Ancient Guinea Worm Disease in American Journal of Tropical Medicine and Hygiene Article."

Oct. 30, 2009
Monthly Report on Dracunculiasis Cases, January–August 2009 (PDF)
Published in Weekly Epidemiological Record, No. 44, 2009, 84, 453–468. © World Health Organization. Number of dracunculiasis cases reported worldwide.

Oct. 16, 2009
Progress Toward Global Eradication of Dracunculiasis, January 2008-June 2009
Centers for Disease Control and Prevention. MMWR 2009; 58(40);1123-1125.
Reported by: DR Hopkins, MD, E Ruiz-Tiben, PhD, the Carter Center, Atlanta, Georgia. ML Eberhard, S Roy, Div of Parasitic Diseases, National Center for Zoonotic, Vector-Borne, and Enteric Diseases, CDC.

July 1, 2009
Atlas of Pediatrics in the Tropics: Dracunculiasis Chapter (PDF)
Published in the June 2009 edition of "American Academy of Pediatrics' Atlas of Pediatrics in the Tropics and Resource-limited Settings."
Edited by: Jonathan M. Spector, MD, MPH, FAAP and Timothy E. Gibson, MD, FAAP.  Donald R. Hopkins, M.D., M.P.H, vice president of the Carter Center's Health Programs, contributor.  The dracunculiasis chapter is part of the AAP's take-along guide to more than 80 pediatric tropical diseases and conditions. © AAP. Reprinted with permission. ISBN 13: 978-1-58110-303-8. American Academy of Pediatrics.

May 1, 2009
Nigeria's War on Terror: Fighting Dracunculiasis, Onchocerciasis, Lymphatic Filariasis, and Schistosomiasis at the Grassroots (PDF)
This article was published in the May 2009 issue of American Journal of Tropical Medicine and Hygiene and is reprinted with permission.
Am. J. Trop. Med. Hyg., 80(5), 2009, pp. 691–698. Ngozi A. Njepuome, Donald R. Hopkins,* Frank O. Richards Jr, Ifeoma N. Anagbogu, Patricia Ogbu Pearce, Mustapha Muhammed Jibril, Chukwu Okoronkwo, Olayemi T. Sofola, P. Craig Withers Jr, Ernesto Ruiz-Tiben, Emmanuel S. Miri, Abel Eigege, Emmanuel C. Emukah, Ben C. Nwobi, and Jonathan Y. Jiya. Africa's populous country, Nigeria, contains or contained more cases of dracunculiasis, onchocerciasis, lymphatic filariasis, and schistosomiasis than any other African nation and ranks or ranked first (dracunculiasis, onchocerciasis, schistosomiasis) or third (lymphatic filariasis) in the world for the same diseases.

Feb. 24, 2009
Teaching Module:  Eradication & Control Programs – Guinea Worm
Guinea worm eradication teaching module #109 by Sharon Roy, M.D., M.P.H., Centers for Disease Control and Prevention, and Ernesto Ruiz-Tiben, Ph.D., The Carter Center.  Prepared as part of an educational project of the Global Health Education Consortium, University of California (San Francisco) School of Medicine and collaborating partners.
 

Oct. 31, 2008
Update: Progress Toward Global Eradication of Dracunculiasis, January 2007-June 2008
Morbidity and Mortality Weekly Report, Centers for Disease Control and Prevention. Reported by: DR Hopkins, MD, E Ruiz-Tiben, PhD, The Carter Center, Atlanta, Georgia. ML Eberhard, S Roy, Div of Parasitic Diseases, National Center for Zoonotic, Vector-Borne, and Enteric Diseases, CDC.

Oct. 1,  2008
Dracunculiasis Eradication: Neglected No Longer (PDF)
Am. J. Trop. Med. Hyg., 79(4), 2008, pp. 474–479. Copyright © 2008 by The American Society of Tropical Medicine and Hygiene. Donald R. Hopkins, Ernesto Ruiz-Tiben, Philip Downs, P. Craig Withers, Jr., and Sharon Roy. Abstract: This report summarizes the status of the global Dracunculiasis Eradication Program as of early 2008. By the end of 2007, dracunculiasis (Guinea worm disease) transmission had been eliminated from 15 of the 20 countries where the disease was endemic in 1986, only 9,585 cases were reported worldwide, and 2,016 villages still had indigenous cases of the disease. Two of the remaining affected countries (Nigeria and Niger) reported < 100 cases in 2007 and are on the verge of eliminating dracunculiasis if they have not stopped transmission already. Sudan, Ghana, and Mali are addressing their final challenges to interrupting all remaining transmission by the end of 2009.

June 1, 2008
Dracunculiasis, Onchocerciasis, Schistosomiasis, and Trachoma (PDF)
Annals of the New York Academy of Sciences, 1136: 45-52 (2008), Issue - Reducing the Impact of Poverty on Health and Human Development: Scientific Approaches, Donald R. Hopkins, Frank O. Richards, Jr, Ernesto Ruiz-Tiben, Paul Emerson, P. Craig Withers, Jr. Published Online: 25 Jul 2008. The definitive version is available at wiley.com.

March 1, 2008
Within Reach: Guinea Worm Eradication in Ghana (PDF)
Published March 2008 by The Carter Center.
A painful and debilitating condition, Guinea worm disease has plagued Ghana since ancient times. In 1988, Ghana joined an international effort to eradicate the disease and has made remarkable progress over the past 20 years. Guinea worm has been found in the most forgotten communities, where there is little or no access to safe water.

Aug. 17, 2007
Progress Toward Global Eradication of Dracunculiasis, January 2005--May 2007
Morbidity and Mortality Weekly Report, Centers for Disease Control and Prevention. Reported by: DR Hopkins, MD, E Ruiz-Tiben, PhD, The Carter Center, Atlanta, Georgia. ML Eberhard, S Roy, Div of Parasitic Diseases, National Center for Zoonotic, Vector-Borne, and Enteric Diseases, CDC.

July 1, 2006
Uganda's Successful Guinea Worm Eradication Program (PDF) 
Am. J. Trop. Med. Hyg., 75(1), 2006, pp. 3-8. Copyright © 2006 by The American Society of Tropical Medicine and Hygiene. JOHN B. RAWKIMARI, DONALD R. HOPKINS, and ERNESTO RUIZ-TIBEN; Ministry of Health, Entebbe, Uganda; The Carter Center, Atlanta, Georgia. Abstract. Having begun its national Guinea Worm Eradication Program (UGWEP) in 1991 (1991 population, 16.6 million) with the third-highest number of cases reported by any endemic country, and ranked as the second-highest endemic country in the world in 1993, by 2004, Uganda celebrated it first full calendar year with no indigenous cases of the disease. Systematic interventions began in 1992 and were gradually intensified until the final indigenous case occurred in July 2003. The favorable concentration of most cases in relatively few northern districts of the country was partly offset by chronic insecurity in much of the endemic area by repeated importation of cases from neighboring Sudan. Strong support and dedicated leadership by government officials and external partners were keys to this program's dramatic success. The program cost approximately US$5.6 million.

Oct. 28, 2005
Progress Toward Global Eradication of Dracunculiasis, January 2004 - July 1005
Morbidity and Mortality Weekly Report, Centers for Disease Control and Prevention. Reported by: The Carter Center, Atlanta, Georgia; World Health Organization Collaborating Center for Research, Training, and Eradication of Dracunculiasis; Div of Parasitic Diseases, National Center for Infectious Diseases, CDC.   

Oct. 1, 2005
Dracunculiasis Eradication: The Final Inch (PDF)
Am. J. Trop. Med. Hyg., 73(4), 2005, pp. 669–675 Copyright © 2005 by The American Society of Tropical Medicine and Hygiene. DONALD R. HOPKINS,* ERNESTO RUIZ-TIBEN, PHILIP DOWNS, P. CRAIG WITHERS, JR., AND JAMES H. MAGUIRE; The Carter Center, Atlanta, Georgia; Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia. Abstract. This report summarizes the status of the Dracunculiasis Eradication Program as of early 2005. Nine of the 20 countries that were endemic for this disease when the program began have already interrupted transmission, Asia is free of Guinea worm, and five of the remaining disease-endemic countries reported less than 50 cases each in 2004. Ghana and Sudan each reported 45% of the 16,026 cases in 2004. Except for Sudan, whose reports are delayed, cases in the remaining disease-endemic countries were reduced by 61% during the first quarter of 2005 compared with the same period of 2004. With accelerating momentum towards zero cases in all countries, the recent settlement of Sudan's north-south civil war, and a new challenge grant from the Bill & Melinda Gates Foundation, the way now seems clear to finish eradicating dracunculiasis by 2009 in Sudan and earlier elsewhere. "The rule of the final inch . . . The work has been almost completed, the goal almost attained . . . In that moment of fatigue and self-satisfaction it is especially tempting to leave the work without having attained the apex of quality . . . In fact, the rule of the Final Inch consists in this: not to shirk this crucial work. Not to postpone it . . . And not to mind the time spent on it, knowing that one's purpose lies . . . in the attainment of perfection." —Alexander Solzhenitzyn, The First Circle

May 10, 2005
Differentiating Dracunculus medinesis from D. insignis, by the sequence analysis of the 18S rRNA gene (PDF)
Published in the Annals of Tropical Medicine & Parasitology, Vol. 99, No. 5, 511-517 (2005). Authors: L. BIMI*, A. R. FREEMAN*, M. L. EBERHARD*, E. RUIZ-TIBEN (The Carter Center) and N. J. PIENIAZEK* (all others, Parasitic Diseases Branch, Division of Parasitic Diseases, Centers for Disease Control and Prevention). Received 15 February 2005, Revised 9 May 2005, Accepted 10 May 2005. ABSTRACT: This study, undertaken as a component of the global Dracunculiasis Eradication Program (DEP), was designed to provide molecular tools to distinguish Dracunculus medinensis, the nematode causing human dracunculiasis, from other tissue-dwelling nematodes, including other Dracunculus species that infect humans and other animals. DNA was extracted from D. medinensis and from a closely related species that infects North American carnivores, D.insignis, so that the genes coding for the small-subunit ribosomal RNA (18S rRNA) of the parasites could be amplified, sequenced and compared. Sequences were obtained for 20 specimens of D. medinensis (from humans in Pakistan, Yemen and six African countries endemic for dracunculiasis) and three of D. insignis (from raccoons trapped in the state of Georgia in the southern U.S.A.).  

Feb. 9, 2004
Final Reflections From Africa: Web Log (Blog) Update
Former U.S. President Jimmy Carter and his wife, Rosalynn, are traveling in West Africa Feb. 2-7, 2004, on behalf of The Carter Center. The purpose of their trip is two-fold: to call international attention to the need to eliminate the last 1 percent of Guinea worm disease remaining in the world and to launch the Development and Cooperation Initiative, a multiyear effort to help reduce poverty in Mali.

Dec. 1, 2002

Guinea Worm and Sudan: Center Experts Featured in The Lancet
Feature article by Dr. Donald R. Hopkins and P. Craig Withers, Jr., originally published in the Dec. 2002 supplement to The Lancet.

Oct. 1, 2002 

DRACUNCULIASIS ERADICATION: AND NOW, SUDAN (PDF)
Am. J. Trop. Med. Hyg., 67(4), 2002, pp. 415-422. Copyright © 2002 by The American Society of Tropical Medicine and Hygiene. DONALD R. HOPKINS, ERNESTO RUIZ-TIBEN, NWANDO DIALLO, P. CRAIG WITHERS, JR., and JAMES H. MAGUIRE; Global 2000 Program of The Carter Center, Atlanta, Georgia; Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia. ABSTRACT: This paper summarizes the status of the global dracunculiasis eradication campaign as of early 2002. Of the 20 countries that were endemic when the campaign began, seven have already interrupted transmission, four countries reported less than 100 cases each, and only five countries reported more than 1,000 cases each in 2001. Only 14,000 cases remained outside Sudan in 2001. Sudan reported 78% of all cases of dracunculiasis in 2001, and virtually all of Sudan's cases were in the southern states, where the long-standing civil war limits accessibility to endemic areas. A political settlement of the waris now urgently needed, since it will be impossible to complete the eradication of dracunculiasis without peace in Sudan.

Feb. 1, 2000
Dracunculiasis Eradication: Delayed, Not Denied (PDF)
Am. J. Trop. Med. Hyg., 62(2), pp. 163-168. Copyright © 2000 by The American Society of Tropical Medicine and Hygiene. DONALD R. HOPKINS, ERNESTO RUIZ-TIBEN, TRENTON K. RUEBUSH NWANDO DIALLO, ANDREW AGLE, and P. CRAIG WITHERS JR.; Global 2000 Program of The Carter Center, Atlanta, Georgia; Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia. ABSTRACT: By the end of 1998, Asia was free of dracunculiasis (Guinea worm disease), with Pakistan, India, and Yemen having interrupted transmission in 1993, 1996, and 1997, respectively. Transmission of the disease was also interrupted in Cameroon and Senegal during 1997.

Sept. 1, 1997
Dracunculiasis Eradication: Almost a Reality (PDF)
Am. J. Trop. Med. Hyg., 57(3), pp. 252-259. Copyright © 1997 by The American Society of Tropical Medicine and Hygiene. DONALD R. HOPKINS, ERNESTO RUIZ-TIBEN, and TRENTON K. RUEBUSH; Global 2000 Program, The Carter Center, Atlanta, Georgia; Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia. ABSTRACT: The idea of a global campaign to eradicate dracunculiasis was first proposed by the Centers for Disease Control and Prevention in 1980, during the advent of the International Drinking Water Supply and Sanitation Decade (IDWSSD) (1981-1990). In 1981, the Steering Committee of the IDWSSD adopted eradication of dracunculiasis as a subgoal of their efforts to provide safe drinking water to unserved populations.

July 1, 1997
Cost-Benefit Analysis of the Global Dracunculiasis Eradication Campaign (PDF)
An analysis prepared by the Africa Human Development Department at the World Bank. By Aehyung Kim and Ajay Tandon, The World Bank, and Ernesto Ruiz-Tiben, The Carter Center. July 1997. ABSTRACT This paper is a cost-benefit analysis of the Global Dracunculiasis Eradication Campaign (GDEC). Dracunculiasis (or Guinea worm disease) has been endemic in several African countries as well as in Yemen, Pakistan, and India. In the past decade, the incidence of dracunculiasis has seen a remarkable decline as a result of GDEC. This paper compares expenditure on GDEC activities with estimates of increased agricultural production due to reductions in infection-related morbidity resulting from the eradication program. Using a project horizon of 1987-1998, the Economic Rate of Return (ERR) is 29%, under conservative assumptions regarding the average degree of incapacitation caused by Guinea worm infection (5 weeks). In addition, our results indicate that eradication must be achieved in Sudan -- which is projected to be the sole endemic country after 1998 -- at the very latest by the year 2001 in order for economic returns there to be consistent with those obtained in other endemic countries.

Sept. 2, 1995
Eradication of dracunculiasis from Pakistan (PDF)
Lancet Sept 1995 issue 346 vol 8975 pp. 621-624. Hopkins, D.R.; Azam, M; Ruiz-tiben, E; Kappus, KD. Summary: In 1986 the World Health Organization targeted dracunculiasis (Guinea-worm disease), which seriously impairs socioeconomic development in 16 African countries, India, Pakistan, and Yemen, to be eradicated globally. The target date for eradication by the end of 1995 was established in 1991. Pakistan eradicated dracunculiasis from the country in October, 1993, after a national campaign which began in 1987 with a nationwide village-by-village search for cases. The infection, which is transmitted by drinking water from ponds containing infected water fleas, was eradicated by using health education, cloth filters, and the cyclopsicide, temephos; and in the later stages, by case containment. Methods pioneered in Pakistan's National Guinea Worm Eradication Program are now being applied in remaining endemic countries.


March 1, 1994
Dracunculiasis Eradication: March 1994 Update (PDF)
Am. J. Trop. Med. Hyg., 52(1), pp. 14-20. Copyright © 1995 by The American Society of Tropical Medicine and Hygiene. DONALD R. HOPKINS, ERNESTO RUIZ-TIBEN, TRENTON RUEBUSH II, ANDREW N. AGLE, and P. CRAIG WITHERS, JR; Global 2000, Inc., The Carter Center, Atlanta, Georgia; World Health Organization Collaborating Center for Research, Training and Eradication of Dracunculiasis, Centers for Disease Control and Prevention, Atlanta, Georgia. ABSTRACT: Substantial progress has been realized in the global campaign to eradicate dracunculiasis by the end of 1995 since a previous review of the subject was published in this journal a year ago. All known endemic countries are now engaged in the eradication effort, and one or more control measures are now in place in 93% of endemic villages.

Sept. 1, 1993
Dracunculiasis Eradication: Beginning of the End (PDF)
Am. J. Trop. Med. Hyg., 49(3), pp. 281-289. Copyright © 1993 by The American Society of Tropical Medicine and Hygiene. DONALD R. HOPKINS, ERNESTO RUIZ-TIBEN, ROBERT L. KAISER, ANDREW N. AGLE, and P. CRAIG WITHERS, JR; Global 2000, Inc., The Carter Center, Atlanta, Georgia; World Health Organization Collaborating Center for Research, Training and Eradication of Dracunculiasis, Centers for Disease Control and Prevention, Atlanta, Georgia. ABSTRACT:  Beginning with the International Drinking Water Supply and Sanitation Decade (1981-1990), an increasingly broad coalition of international and bilateral agencies, organizations, private companies, and other institutions have joined forces to eradicate draculiasis (Guinea worm disease).

June 1, 1992
Homing In On Helminths (PDF)
Am. J. Trop. Med. Hyg., 46(6), pp. 626-634. Copyright © 1992 by The American Society of Tropical Medicine and Hygiene. DONALD R. HOPKINS; Global 2000, Inc., The Carter Center, Atlanta, Georgia

Jan. 1, 1992
Guinea Worm No One Should Suffer (PDF)
Encyclopaedia Britannica Inc., Copyright  © 1991.  In this article Dr. Donald Hopkins and Dr. Ernestine Hopkins present a history of Guinea worm disease.  The article highlights both early and more recent eradication efforts, focusing on the successful approaches of the early 1980s through 1991, which resulted in dramatic declines in the incidence of Guinea worm disease.  The piece also recognizes many of the initial donors who supported the campaign in its earliest days.  The article includes a forward by former U.S. President Jimmy Carter.

Dec. 12, 1991
Strategies for Dracunculiasis Eradication (PDF)
Bulletin of the World Health Organization, Vol 69 No. 5.
In 1991 the Forty-fourth World Health Assembly declared the goal of eradicating dracunculiasis (Guinea worm disease) by the end of 1995. This article summarizes the recommended strategies for surveillance and interventions in national dracunculiasis eradication programmes. It is based on personal experience with dracunculiasis programmes in Ghana, Nigeria and Pakistan. Three phases are described: establishment of a national programme office and conduct of a baseline survey; implementation of interventions; and case containment. The relevance of dracunculiasis eradication activities to strengthening of primary health care in the three countries is discussed briefly. Similar strategies would help eradicate this disease in the remaining endemic countries.