| Opportunities for Control of Dracunculiasis (1982) |
|Overview of Dracunculiasis|
Dracunculiasis primarily affects families of subsistence farmers, with peak transmission often coinciding with heavy demands for agricultural labor. Because the worm's incubation period is approximately 1 year, farmers and their families tend to suffer the greatest number of cases during the same season each year.
Data from village studies in West Africa and India show dracunculiasis attack rates ranging from 10-40 percent or more in a single season. Some families are affected more heavily than others, with virtually all the victims incapacitated at the same time, each with one or more emerging worms. Approximately 40 percent of dracunculiasis victims are completely disabled for periods lasting 1-3 months. Villages affected by the disease experience significant losses in agricultural productivity. Families with high rates of infection may suffer during the remainder of the year from lost agricultural earnings, inadequate food supplies for home consumption, and many missed days of school. Responsibilities for working in the fields may have to be given to other members of the family, often to the detriment of adequate child care. The psychological stress of worms emerging from the leg, chest, or even genitals can also be considerable.
The adverse impact of this disease on school attendance was recently documented in Anambra State of Nigeria. In a 1979 study, Nwosu and colleagues (1982) found that the mean percentage of absenteeism attributed to dracunculiasis in 13 schools increased from an average of 13.2 + 4.6 percent to a peak of 60 percent at the height of the guinea worm season. Two schools were virtually closed for 2 weeks (Figure 7).
Unlike many other infectious diseases in developing countries that carry high mortality rates, the impact of dracunculiasis on public health is a function of length of disability, severity of illness, village attack rates, and its seasonality (Belcher et al. 1975, Kale 1977). These indicators can be related to days of work lost among the most productive age groups within the population, along with nutritional or income deficits suffered by affected families.