Cover Image
close this book Opportunities for Control of Dracunculiasis (1982)
close this folder Recommendations
View the document For Government Authorities In Endemic Countries
View the document For International Or Bilateral Assistance Agencies

For Government Authorities In Endemic Countries

- It is recommended that public health authorities in all countries with any reported (or suspected) cases of dracunculiasis assess the extent of the dracunculiasis problem at the national level. Such an assessment can be based on analysis of reported cases and/or responses to a questionnaire sent to district or provincial health officers and to other appropriate officials in the country.

- In each endemic country, appropriate steps should be taken to facilitate the reporting of cases of dracunculiasis.

- Each endemic country should select strategies for controlling dracunculiasis and should prepare a written plan of action that includes a pilot-project phase and a training component. The plan of action should specify the collaborative roles of health, water, education, administrative, agriculture, and finance sectors, where appropriate, in implementing the program. The ministry of health should probably be responsible for identifying endemic regions and villages within regions and for making that information known to water works authorities and other relevant agencies. Water works authorities should give priority to dracunculiasis-affected areas wherever feasible.

- Endemic countries should take maximum advantage of resources mobilized for the International Drinking Water Supply and Sanitation Decade to provide dracunculiasis-endemic villages with protected water sources on a priority basis. When all endemic villages have been identified, the proportion of those that can be provided safe drinking water as a part of already planned activities should be determined, after which other national or international resources should be sought to support provision of safe water to the remaining endemic villages and to support other program activities designed to reduce the incidence of dracunculiasis. Relevant donor activities should be coordinated systematically within a countrywide plan.

- Control efforts should include health education of people living in endemic areas. The goal of these efforts is to mobilize members of affected communities to act against dracunculiasis, including local efforts for improving and maintaining water supplies, preventing people with patent dracunculiasis from contaminating water sources, adopting personal protective measures, reporting cases, and cooperating with other aspects of the program.

- A standardized treatment protocol should be developed for health clinic personnel, specifying the appropriate care for patent dracunculiasis cases and emphasizing that preventive measures should receive first priority. Because of its rural distribution, dracunculiasis patients are likely to make initial contact with the primary health care system.

-The school system of affected countries should help extend the program throughout the country by reporting cases and disseminating information about personal protective measures. Some endemic countries may wish to encourage university researchers to address applied research issues identified during the national control program.

- Endemic countries may wish to designate the elimination of dracunculiasis as a national goal. Progress can be monitored and achieved through effective control efforts in affected villages, leading to elimination of the disease at the village, provincial, and district, and then national, levels.

- It is recommended that priority be given to applied research in the following areas:

- Development and evaluation of prototype health education materials for use in affected communities

- Development and standardization of field methods for species identification and quantification of cyclops vectors and D. medinensis larvae

- Comparison of the efficacy and cost of different intervention methods

- Evaluation of techniques for analysis of patterns of community water use.

-It is recommended that priority be given to biomedical research in the following areas:

- Development of therapeutic (e.g., chemotherapy) or preventive (e.g., chemoprophylaxis) measures that either are capable of destroying or sterilizing female D. medinensis worms to prevent subsequent patency and/or release of,viable larvae or are capable of destroying early stages of the worms soon after infection. Controlled clinical trials of antihelminthic drugs to find one that will kill D. medinensis larvae before the worms mature and emerge, with no harm to the human host, should be strongly encouraged.

- Ecologic studies of conditions in surface waters favorable or unfavorable to infestation of cyclops, should be conducted.