Water, they say is life but in the absence of clean accessible water, what is supposed to be a sustainer of life is now turned into an agent of destruction.

As the world mark its first NTDs day we at everythingpublichealth.com has taken it upon ourselves to enlighten the public on this agent of destruction found in water; Guinea worm disease.        

Guinea worm disease a neglected tropical disease (NTD) also known as Dracunculiasis, is a parasitic disease caused by the Nematode called Dracunculus Medinensis. Guinea worm disease is mostly common in some rural part of Africa, where there is no available safe drinking water.

BRIEF HISTORY OF THE DISEASE

Guinea worm disease, also known as dracunculiasis goes a long way as an established infection of humans, which was clearly referred to by various authors from India, Greece, and the Middle East. During ancient times, the presence of dracunculiasis can be inferred by the universally recognized symbol of medicine, the Greek asklepios (i.e, Roman aesculapius), which consists of a one-headed snake wrapped around a stick. Dead female worms have also been found in Egyptian mummies older than 3000 years. Female worms have been seen in Egyptian mummies. A curious monograph by Velschius discussed real and imagined references in ancient writings and sculptures, including a supposed relationship with the caduceus motif. James Africanus Horton, the first West African to be trained in Europe as a medical doctor, wrote a book about the disease, mistakenly supposing that it was transmitted through the soles of the feet.

MODE OF TRANSMISSION

Humans get infected with Guinea worm disease when they drink an unfiltered water containing cyclops (cyclops are tiny water fleas which are infected with the larvae of Dracunculus Medinensis). Following the ingestion, the gastric juice in the intestinal tract of the human host kills the cyclops thereby freeing the larvae to migrate and bore from the intestinal tract into the tissue of the abdomen, where they grow and become mature.

SIGNS AND SYMPTOMS OF GUINEA WORM DISEASE

Guinea worm disease takes about a year before the infected person begins to shows sign of having the infection. The symptoms associated with the Guinea worm disease are:

Fever.

Swelling and pains in the area housing the worm.

Nausea.

Diarrhea.

Dizziness.

Formation of blisters around the area where the worm is located. The blister eventually ruptures, exposing the worm. The infected person may put the affected body part in cool water to ease the symptoms.

BURDEN OF THE DISEASE IN DIFFERENT PARTS OF THE WORLD

During the mid 1980s an estimated 3.5 million cases of dracunculiasis occurred in 20 countries worldwide. 17 countries of which were in Africa, the number of reported cases fell to fewer than 10,000 cases in 2007, dropping further to 543 cases in 2012, 126 in 2014, 22 in 2015, 25 in 2016, 20 in 2017.

And recent World Health organization (WHO) report from October 2018, state that only a few cases have been reported in Chad, South Sudan, and Angola.  And 199 countries have been certified by WHO as free from guinea worm disease.

PREVENTION AND TREATMENT

Though, there are no vaccines to prevent the disease nor is there any medication to treat patients with the disease. People infected with the disease can be given Anti inflammatory agent like aspirin, ibuprofen to help reduce the pain and swelling.

Diphenhydramine drug can help treat itching.

Topical antibiotic cream or ointment is an option to prevent secondary bacteria infection at the site where the worm emerges.

Prevention is always the first line of action against guinea worm disease. Some of the ways of preventing guinea worm disease are;

Provision of safe drinking water in community that lacks good water source in other to prevent the infection.

Disallowing patient with blisters, swellings, wounds or visible worm from entering into any source of water body in other to avoid contaminating the water with the parasites.

Filtration of water from open water bodies before drinking

Implementing vector control by using larvicide tamephos to kill the cyclops and minimize the risk of Dracunculus Medinensis transmission.

Health education and community mobilization in villages on Guinea worm disease.

CHALLENGES ON THE PREVENTION, CONTROL AND TREATMENT OF THE DISEASE

Difficulty in accessing some remote villages due to bad roads.

Insecurity in some disease endemic areas has been a great obstacle in the fight against guinea worm disease.

No vaccine or direct drug treatment.

Weak health care system.

Inadequate access to safe portable water.

ROLES STAKEHOLDERS CAN PLAY IN PREVENTING/CONTROL/TREATMENT OF THE DISEASE

Since the disease is mainly associated with water, stakeholders can help combat it by providing a good portable source of water like boreholes, good hand dug well that is protected with barricade.

Open water bodies can be sprayed with the approved chemical; tamephos, to kill the cyclops and reduce the risk of contamination.

Rural Community that lack health centers should be provided with one in order to assist patient suffering from guinea worm disease which can be painful during the emergence of the worm.

Educate the community about Guinea worm disease and ways to prevent it.

THE WAY FORWARD FOR A WORLD FREE GUINEA WORM DISEASE

The fight for a complete elimination of guinea worm disease is on, with only few countries left to be certified free from the disease by WHO. Since water remains the source for the transmission of Guinea worm disease (GWD). I will recommend that all government agencies, private stakeholders and individuals who are concerned about health matters help out by devising order means to get safe portable water in affected communities in other to discourage people from visiting the open water body like ponds, stream and rivers to get water. They can also collaborate with other ministries e.g. ministry of works and housing for provision of safe and portable water source.

There might be difficulty in preventing people from visiting the main water source in their community without alternative provision therefore; the available water body should be sprayed with larvicide to eliminate the disease vector.

The problem associated with poor health care system, absence of vaccine, and treatment for guinea worm disease can be address through public – private partnership, which can be of great help in building a better health care infrastructure in the disease endemic areas, with the availability of a good health system people suffering from GWD will be encouraged to make an early report in the hospital and in return be assisted with medical help throughout the process to complete healing.

The worsening state of insecurity in some endemic areas are major source of concern. Though dialogue has been effective in granting health care worker immunity in accessing those region. However, much works still need to be done to ensure the safety of health care personnel and their facilities by providing adequate security presence in such community and the government of those state should provide adequate incentives, insurance and opportunities for the personnel  and their dependents in the event of displacement, death, and disability.

Reviewed on 16/04/2020

REFERENCES
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