| Opportunities for Control of Dracunculiasis (1982) |
Dracunculiasis, or guinea worm disease, is one of the oldest parasitic diseases known to man. It was described in the Old Testament (Numbers 21:6) as the fiery serpent that afflicted the Israelites in their wanderings around the Red Sea. From biblical times to the present day, dracunculiasis has been the cause of human suffering and an impediment to economic development in parts of Africa, India, and the Middle East. Until recently the disease has not been the subject of sustained research or control efforts. It has been neglected because it does not kill, but temporarily disables people in remote, rural areas. Dracunculiasis, like many other tropical diseases, is one of the "forgotten problems of forgotten people."
This report marks a change in that posture. It ItIt the report of the first international meeting on dracunculiasis--a workshop sponsored by the National Research Council in collaboration with the World Health Organization (WHO). It contains the findings and recommendations of a distinguished group of scientists who were brought together to discuss dracunculiasis as an international health problem. Financial support from the Office of the Science Advisor, U.S. Agency for International Development, made the meeting possible.
Members of the steering committee and workshop participants hope that this material will stimulate government agencies in endemic countries to include dracunculiasis control in their national health agendas, primary health care efforts, and water supply and sanitation programs. International agencies also may wish to direct a portion of their health services, biomedical research, or water and sanitation resources toward the application of control technologies that are already known and toward the development of new scientific tools and methodologic approaches for attacking this disease.
All of the workshop participants and the chairman, in particular, are indebted to Karen N. Bell, professional associate, Board on Science and Technology for International Development, National Research Council, who coordinated the workshop and whose sustained effort, erudition, and organizational skills made this meeting possible.
International awareness of dracunculiasis has increased in the last few years as a result of the initiation of an eradication program in India (Rao et al. 1981) and the advent of the International Drinking Water Supply and Sanitation Decade (IDWSSD), whose steering committee endorsed the idea of using dracunculiasis control as an indicator of the Decade's impact on health in endemic regions. In May 1981, the World Health Assembly (WHA) adopted a resolution on the IDWSSD that mentioned dracunculiasis in the following context (WHA Resolution 34.25, May 22, 1981):
The Decade presents an opportunity to eliminate dracunculiasis . . . as a public health problem in affected areas, where the prevalence of the disease could serve as a uniquely visible and measurable indicator of progress for the Decade.
In response to expressions of interest from international and domestic agencies, the National Research Council's Board on Science and Technology for International Development (BOSTID) decided to convene an international workshop on dracunculiasis. A new BOSTID advisory committee on health, biomedical research, and development organized a 4-day workshop on Opportunities for Control of Dracunculiasis." This workshop was held June 16-19, 1982, in Washington, D.C.
Approximately 30 experts in parasitic diseases, vector biology, epidemiology, communicable disease control, health education, and sanitary engineering participated in the workshop. Participants included two WHO staff members from Geneva and one from the WHO regional office in Brazzaville, Congo Republic, a representative from the Organisation Centrale Contre les Grandes Endemies (OCCGE) based in the Ivory Coast, and nationals from Ghana, India, Nigeria, France, Togo, Great Britain, and the United States. Participants were asked to do the following:
- Review current knowledge of dracunculiasis--its epidemiology, surveillance, control, and economic impact
- Assess the economic, social, and administrative feasibility of mounting dracunculiasis control efforts in conjunction with primary health care and water and sanitation projects
- Review alternative methods of control, with special emphasis on their cost-effectiveness
- Identify basic, field, and operational research needed to develop, implement, and evaluate control activities.
The first day and a half of the workshop were devoted to presentations of original papers prepared by workshop participants on the clinical aspects and etiology of dracunculiasis, its global epidemiology, and possible strategies for control. These issues are discussed here in Overview of Dracunculiasis. The papers will be published separately (a list of the papers appears in the appendix).
Participants then divided into three working groups that focused on (1) problem assessment, (2) selection and implementation of surveillance and control strategies, and (3) monitoring and evaluation of control programs. Working papers were drafted by the groups and were presented for discussion in a plenary session. Recommendations were considered by all workshop participants. The workshop report was prepared by the staff under the guidance of the steering committee, drawing on the working papers (see Chapters 1-3) and the papers contributed by workshop participants. The reports of the working groups have been edited to eliminate duplication, but they accurately reflect the discussions of the three groups.
This report is intended for use by international agencies, government leaders, administrators, scientists, engineers, physicians, educators, and other health professionals who are responsible for projects and programs in countries where dracunculiasis is endemic. It suggests ways of gathering information about this disease, planning control efforts, and monitoring program effectiveness.