Public Health Service
Centers for Disease Control
and Prevention (CDC)
DEPARTMENT OF HEALTH & HUMAN SERVICES
Memorandum
Date:
June 14, 1999
From:
WHO Collaborating Center for
Research, Training and Eradication of Dracunculiasis
Subject:
GUINEA WORM WRAP-UP #91
To:
Addressees
Detect Every Case, Contain Every Worm!
COUNTRIES OUTSIDE OF SUDAN, NIGERIA, AND GHANA REDUCE DRACUNCULIASIS
BY 69% IN JANUARY-APRIL 1999
The ten endemic countries outside of Sudan, Nigeria and Ghana (Benin, Burkina Faso, Chad, Côte
d’Ivoire, Ethiopia, Mali, Mauritania, Niger, Togo, and Uganda) have dramatically resumed their collective
march to dracunculiasis eradication. As illustrated in Figure 1, the ten countries reduced their reported
cases of the disease from 2,121 in January-April 1998, to 654 cases during the same period of 1999, a
reduction of 69.2. The individual rates of reduction in the ten countries during the 4 month period are:
Chad, 100%; Mauritania, 100%; Burkina Faso, 82%; Uganda, 86%; Cote d’Ivoire, 79%; Niger, 81%;
Mali, 77%; Ethiopia, 74%; Togo, 52%; and Benin, 20%. This four month period includes part of the peak
transmission season in Chad, Uganda, Cote d’Ivoire, Ethiopia, Togo, And Benin. Table 1 and figure 2
show the latest update of cases reported and percent changes in cases by country.
The status of
surveillance in Burkina Faso, however, is still uncertain.
Figure 1
Percent change in reported cases of Dracunculaisis
from all endemic countries, excluding Ghana, Nigeria, Sudan
during January - April 1995 - 1999
YEAR
CASES REPORTED
20
1995
7535
1996
3889
1997
1898
1998
2121
1999
654
total % change
from 1995 to1999
% CHANGE
% INCREASE
0
-20
% REDUCTION
-40
-60
-80
-100
-48
-51
+ 12
-69
-91
Table 1
Number of cases contained and number reported by month during 1999*
(Countries arranged in descending order of cases in 1998)
COUNTRY
NUMBER OF CASES CONTAINED / NUMBER OF CASES REPORTED
%
JANUARY
FEBRUARY
MARCH
1066
1375
352
SUDAN
NIGERIA
/
/
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/
/
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/
/
/
/
48
23
30
319
75
201
86
111
92
139
93
9
89
/
71
173
/
/
39
65
102
/
/
70
129
/
8
/
2
0
0
/
0
38
/
5
0
/
0
14
0
57
15
/
42
62
0
/
0
92
0
/
0
/
0
0
0
1
89
240
36
0
/
53
/
9
/
0
C.A.R. **
/
3
/
0
/
/
63
/
41
/
5
0
1
/
4050
47
2
0
0
CAMEROON
/
21
/
/
/
/
/
0
0
0
/
9
2
0
CHAD
/
15
/
/
/
28
/
0
0
/
/
3
2
ETHIOPIA
/
66
/
35
7
/
/
/
6410
2533
34
/
2
0
/
20
27
88
MAURITANIA
/
33
/
/
/
/
14
22
1
/
16
7
6
MALI
/
16
/
/
/
/
/
1369
/
7
7
84
/
28
43
58
BENIN
/
5
/
/
/
/
33
31
32
3
UGANDA
/
7
84
102
/
/
771
/
/
CONT.
6321
/
/
15
57
58
COTE D'IVOIRE
/
TOTAL*
7
0
0
/
/
/
/
/
/
87
TOGO
/
7
0
/
/
/
2
3
2
0
BURKINA FASO
/
/
/
1114
/
/
DECEMBER
4251
/
5
2
3
/
NOVEMBER
/
1000
1139
1140
2
NIGER
OCTOBER
1112
/
/
/
SEPTEMBER
450
546
616
/
AUGUST
3475
1143
1433
1351
921
GHANA
/
/
/
/
/
/
JULY
1157
887
914
754
584
JUNE
/
641
2438
2085
MAY
682
/
/
/
APRIL
1
/
0
/
0
1
100
4
0
17698
62
0
/
/
/
4
2806
TOTAL*
2868
/
1896
/
4834
% CONTAINED
58
2118
/
5176
55
1334
/
2884
66
0
/
3172
67
0
/
1632
0
/
0
0
/
0
0
/
0
0
/
0
0
/
0
11022
/
0
82
* provisional
** Central African Republic reported 4 alleged (unconfirmed) cases of dracunculiasis for the period January - April, 1999. These cases are not included in the totals.
/
0
62
Figure 2
Percentage of Endemic Villages Reporting
and Percentage Change in Number of Indigenous Cases of Dracunculiasis
During 1998 and 1999 *, by Country
COUNTRY
ENDEMIC VILLAGES: 1999
NUMBER % REPORTING
% REDUCTION
CASES REPORTED
1998
% CHANGE : 1998 - 1999
% INCREASE
1999
-100
-50
0
1
100
2
0
-100
57
100
4
0
-100
BURKINA FASO (4)
236
NR
129
23
UGANDA (5)
166
100
516
109
COTE D'IVOIRE (5)
161
98
949
200
NIGER (5)
282
100
229
53
MALI (4)
175
61
39
9
46
100
149
62
TOGO (5)
210
100
566
317
BENIN (4)
191
86
172
137
SUDAN (4)
6531
29
6755
6321
NIGERIA (5)
1414
97
6276
6410
GHANA (4)
907
86
2923
4050
10354
53
18709
17691
-5
3823
91
11954
11370
-5
CHAD (4)
MAURITANIA(4)
ETHIOPIA (5)
TOTAL*
TOTAL (without Sudan )*
* Provisional. Totals do not include imported cases.
(2) Denotes number of months for which reports were received, e.g., Jan. - Feb., 1999
NR Countries with unknown or low rate of reporting.
50
-82
-79
-79
-77
-77
-58
-44
-20
-6
2+
39+
100
JAPAN GRANTS $150,000 TO CARTER CENTER FOR SUDAN
In an impressive ceremony recorded by print, radio and television media at the
Embassy of Japan in Khartoum on June 10th, the Ambassador of Japan, Mr. Junnosuke
Kage, and Mr. Elvin Hilyer of The Carter Center (Global 2000), signed an agreement
under which the Government of Japan will provide approximately US$150,000 to The
JAPAN
Carter Center for the Guinea Worm Eradication Program in Sudan. The grant, made
under Japan’s Grant Assistance for Grassroots Projects (GGP, formerly Small Scale Grant Assistance), is
the first such GGP grant to a Non-Governmental Organization in Sudan. Funding from this grant, which
will be divided between activities in northern and southern areas of Sudan, will be used mainly to purchase
over 36,000 square meters of nylon filter material, which will be distributed to between 150,000 and
200,000 households in endemic villages. Also participating in the signing ceremony were the Deputy to the
Ambassador, the Second Secretary, and the Director of Humanitarian Assistance of the Embassy of Japan;
Dr. Nabil Aziz, National Coordinator of the Sudan Guinea Worm Eradication Program (SGWEP); Mr.
Hashim Elkhalifa, Deputy National Coordinator, SGWEP; and Nancy Hilyer and Ayman El Sheikh of
Global 2000’s office in Khartoum. This grant, as well as grants totaling $305,000 which were awarded in
March for use in Nigeria, were made in follow-up to the Government of Japan’s pledge to provide $2.5
million to The Carter Center for the global Guinea Worm Eradication Program.
NIGERIA: GENERAL GOWON VISITS SW, NE, AND NW ZONES
Former Nigerian Head of State General Dr. Yakubu Gowon has completed his first round of advocacy and
community mobilization visits to authorities in the highest-endemic state in each of the four zones of the
country. On April 12th-14th, he visited Oyo State in Southwest Zone, including Igangan community in
Ibarapa North LGA, and Daodu village in Orire Local Government Area (LGA). He met with the military
administrator of the state as well as the chairman of the traditional rulers council. General Gowon was
accompanied on this visit by the NIGEP National Coordinator, Dr. K. A. Ojodu; Global 2000/Carter
Center Country Representative Dr. Emmanuel S. Miri; S.W. Zonal Consultant Dr. Fola Osibogun, and by
Ambassador Morris Ekpang, Executive Director of the Gowon Center. On April 23rd-25th, General Gowon
visited Borno State in Northeast Zone, including Borwashe, Morodo and Cha-chile villages in Bama LGA.
In addition to visiting the military administrator of Borno State and two traditional rulers (the Shehu of
Borno and the Shehu of Dikwa), General Gowon also met the governor-elect of Borno State during the visit
to the military administrator. The Global 2000 country representative; Mr. Joshua Ologe, the NIGEP
Zonal Facilitator for Northeast Zone; and Ambassador Ekpang accompanied General Gowon on this visit.
On May 19th-21st, General Gowon and his party (including the national coordinator, Dr. Ojodu; Global
2000 country representative, Dr. Miri; NIGEP Zonal Facilitator for the NW Zone, Prof. Luke Edungbola;
and Ms. Mairo Zakari, Program Officer for the Yakubu Gowon Center) visited Yankaba village in Kaura
Namoda LGA, and Nassarawa Mailayi village in Birnin Magaji LGA; both in Zamfara State. As in
previous visits, General Gowon met with the military administrator, commissioners, and traditional rulers,
and spoke directly to populations in the affected communities themselves. General Gowon visited endemic
villages in Izzi and Ebonyi LGAs of Ebonyi State in March.
General Gowon’s advocacy efforts were warmly received wherever he went, and effective follow-up actions
have already been taken by the Shehu of Dikwa, who has begun conducting advocacy tours of his own, and
in Orire LGA of Oyo State, where authorities have stepped up efforts to provide new safe water sources
and to rehabilitate broken pumps in endemic villages. Paraphrasing the popular theme he developed while
leading the country during and after the Nigerian Civil War, General Gowon repeatedly exhorted his
audiences that “Eradicating Guinea worm by 2000 is a task that must be done!”
The status of monthly incidence in the six highest endemic states of Nigeria are given in Figures 3A & 3B.
Nigeria marked National Guinea Worm Eradication Day on March 18th, when the Federal Minister of
Health, the Honorable Prof. Adebo S. Adeyemi, held a ministerial press briefing in Abuja. General Gowon
was a special guest of honor at the briefing. Dr. Donald Hopkins of The Carter Center, and Dr. Nevio
Zagaria of the World Health Organization were among the external participants in a meeting of NIGEP’s
steering committee, which was held in Jos on May 25th-26th. The Yakubu Gowon Center was also
represented at this steering committee meeting for the first time, by Ms. Mairo Zakari. In follow-up to the
previous steering committee meeting, Southwest and Northeast Zones have begun pilot experiments with
offering small cash rewards to encourage reporting of cases of dracunculiasis. A new shipment of 15,000
square meters of nylon filter material purchased by Global 2000/The Carter Center (~$60,000) arrived in
Nigeria in mid-May and is being distributed, with priority to Northeast and Northwest Zones, which are
entering their peak transmission periods.
NIGER CELEBRATES WORM WEEK ’99 IN ZINDER
Fifty teams, each including one of forty-two American Peace Corps Volunteers or one or
two of thirteen Japan Overseas Cooperation Volunteers, and with one Nigerian “animator”
counterpart on each team, spent one week visiting villages in the most endemic areas of
Zinder and Tillabery Departments. In Zinder, thirty teams, which worked mainly in the
cantons of Tirmini, Ouame and Albarkaram, in late May, traveled on foot, from household
to household, hamlet to hamlet talking to villagers about how to prevent Guinea worm disease, and
distributing cloth filters. In Tera Arrondissement of Tillabery Department, twenty teams visited the 20
most endemic villages and their 94 hamlets, and distributed almost 5,000 filters from May 1 - 7, working
mainly in the canton of Dargol and the area around the village of Bankilare (Gorouol Canton). U.S. Peace
Corps is also supporting two theater troupes, which have performed skits in 18 villages so far in Bankalare
and Zarma/Fulfulde regions, also conveying messages about Guinea worm prevention.
Mr. Harry Godfrey and Mr. Christopher Duggar, consultants provided by Global 2000/The Carter Center,
have arrived in Niger to assist during the peak transmission season in Tillabery and Tera Districts, and in
Tahoua District, respectively. Niger has reported a total of 41 cases in May 1999, 35 of them contained,
for a reduction of 76% from the 168 cases reported in May 1998.
IN BRIEF
Benin: Funding from the Government of Benin and from UNICEF have been released to the program. A
consultant, Mr. Daniel Frank, is assisting this program at present, with support provided by Global
2000/The Carter Center.
Burkina Faso: Dr. Maxime Drabo reports that the Guinea Worm Eradication Program has appointed 14
agent renforts, who will be deployed to the highest endemic regions of the country. Emergency funding for
these additional health workers, including purchase of 14 motorcycles for their use, has been provided by
Global 2000 in a grant of $50,000 through the WHO office in Ouagadougou. The agents are being trained
in two simultaneous sessions in Ouagadougou and Bobo-Dioulasso.
Togo: WHO has purchased 2,000 square meters of filter material for delivery to this GWEP.
Figure 3A
Nigeria Guinea Worm Eradication Program
Number of cases of dracunculiasis reported from Ebonyi State during 1998-1999*
1,000
944
1999 1998
900
800
Number of cases
700
642
662
600
500
529
584
536
438
400
325
300
252
171
200
125
100
60
93
36
28
35
42
JUL
AUG
SEPT
OCT
0
JAN
FEB
MAR
APR
MAY
JUN
NOV
DEC
Number of cases of dracunculiasis reported from Benue State during 1998-1999*
400
Number of cases
1999 1998
300
260
232
208
200
168
186
155
117
90
100
68
43
48
57
45
33
15
20
SEPT
OCT
18
0
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
NOV
DEC
Number of cases of dracunculiasis reported from Oyo State during 1998-1999*
400
1999 1998
302
Number of cases
300
200
149
163
88
100
167
170
180
151
99
81
82
27
57
43
44
22
19
0
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEPT
OCT
NOV
DEC
*Provisional
Figure 3B
Nigeria Guinea Worm Eradication Program
Number of cases of dracunculiasis reported from Borno State during 1998-1999*
800
731
1999 1998
700
Number of cases
600
500
386
400
346
300
229
198
200
100
100
9
0
0
0
6
0
JAN
FEB
MAR
0
1
0
11
11
52
APR
MAY
JUN
JUL
AUG
SEPT
OCT
NOV
DEC
Number of cases of dracunculiasis reported from Zamfara State during 1998-1999*
800
1999 1998
700
Number of cases
600
500
452
404
400
349
300
244
272
200
100
0
0
0
15
5
26
18
JAN
FEB
MAR
85
77
26
16
APR
MAY
JUN
JUL
AUG
SEPT
OCT
4
0
NOV
DEC
Number of cases of dracunculiasis reported from Gombe State during 1998-1999*
300
Number of cases
267
1999 1998
197
200
149
125
110
112
99
100
104
68
34
12
2
14
25
6
2
NOV
DEC
3
0
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEPT
OCT
*Provisional
HEALTH AND DEVELOPMENT INTERNATIONAL PROVIDES MORE SUPPORT FOR
FRANCOPHONE COUNTRIES
Dr. Anders Seim of Health and Development International (HDI) has announced new
support for seven francophone countries in follow-up to discussions held at the Program
Review in Dakar, Senegal last March. The seven countries are Benin, Cameroon, Chad,
Côte d’Ivoire, Niger, Senegal and Togo. The total amount of additional support to be
provided is $500,000. This support is intended to help meet shortfalls in funding for the seven countries,
particularly for surveillance and case containment, strengthening of supervision, fuel and maintenance of
vehicles, and health education materials. The funding for Chad and Senegal is intended to help maintain
the program office and support field activities through 1999 (Chad), as well as to support offering of
rewards for reporting a case (both).
HDI
RECENT PUBLICATIONS
Hall FM., 1999. Guinea worms [letter]. Radiology, 210(3); 881.
Sam-Abbenyi A., Dama M., Graham S., Obate Z.. 1999. Dracunculiasis in Cameroon at the threshold of
elimination. International Journal of Epidemiology. Feb. 28 (1):163-8.
World Health Organization, 1999. Dracunculiasis surveillance, 1998. Weekly Epidemiological Record
74: 145-152.
Inclusion of information in the Guinea Worm Wrap-Up does not
constitute “publication” of that information.
In memory of BOB KAISER.
For information about the GW wrap up, contact Trenton K. Ruebush, MD, Director, WHO Collaborating Center for
Research, Training, and Eradication of Dracunculiasis, NCID, Centers for Disease Control and Prevention, F-22,
4770 Buford Highway, NE, Atlanta, GA 30341-3724, U.S.A. FAX: (770) 488-4532.
The GW Wrap-Up is also available on the web at http://www.cdc.gov/ncidod/dpd/list_drc.htm.
CDC is the WHO Collaborating Center for Research, Training, and Eradication of
Dracunculiasis.