Guinea Worm Disease: Overview, Economic Impact, Treatment
Introduction
A crippling infection is sweeping across Africa and Asia, inflicting agony upon its victims and leaving them incapacitated for months on end. When asked, those who have suffered through its symptoms view the memory with the pain they endured through. “The wound burned like a fire,” recalls a 52-year-old man, John Jal Youl, his hand motioning towards a faded scar on his ankle. He brushes his fingers over the light pink circle contrasting against the rest of his skin, recollecting the memory. “In the beginning, it started like a fever… after that, my body started to swell. Then I had pain around the hips and legs. It took about one month for the whole thing to come out. ” (unicef. org) Victims of this disease often speak in this way, as if exorcising demons once present in their body. Millions affected each year, huge amounts of money have been lost, and it’s all to a single disease. What kind of infection could cause results so catastrophic? The answer is simple. It’s all due to a single nematode parasite, no more than 2 millimeters thick: the guinea worm.
What is Guinea Worm Disease?
The guinea worm disease is not a fatal condition, but there is a reason that the name given to it by its victims is “the fiery serpent. ” The people living in rural villages in Africa often tell tales of this horrible disease, speaking of how it is caused by witchcraft, that it is a curse inflicted by the gods upon the sinners, or other such misconceptions. But what causes the pain, and why is it so catastrophic? What is guinea worm disease, and how is it affecting people all around the world?
The guinea worm, also known as Dracunculiasis medinensis, belongs to Spirurida. These are tissue parasites that either produce eggs containing larvae, or release free larvae that use arthropods as intermediate hosts (such as how the guinea worm remains inside of a water flea until it is digested). An example of this species would be the filariae, including important human parasites Wuchereria bancrofti and Brugia malayi, which are the causes of elephantiasis. Mature female guinea worms are one of the longest nematodes (roundworms), as they can grow up to 1 meter in length; however, they are only 1–2 millimeters thick. There is no known animal reservoir of infection, though this has not been conclusively disproved, which makes eradication of the disease much more likely if safe drinking water be ensured. People become infected with GWD when they drink water containing copepods (water fleas) that host guinea worm larvae. Once ingested, the copepods are then killed by stomach acid, which releases the larvae. Upon moving to the small intestine, the larvae penetrate the intestinal wall, and travel to the connective tissues of the abdominal wall and the thorax. The male and female larvae grow and mate 60–90 days after infection; while the male worm dies shortly after mating, the female lives and over the following 10–14 months it matures, slowly migrating to the surface of the body and eventually emerging through a searingly painful lesion on the body (usually towards lower appendages, such as the legs and feet). Seeking relief from the agony caused by the guinea worm emerging, victims often submerge affected body part(s) in water. Upon contact with the water, the guinea worm releases a milky white fluid containing millions of immature guinea worm larvae.
These larvae are then ingested by copepods, contaminating the water. When the next person who comes along drinks this water and ingests the water fleas with the guinea worm larvae inside, the whole cycle begins all over again; in this way, the guinea worm disease continues to spread. Once the worm begins to emerge after the 10-14 months are over, people have difficulty moving, and disability can occur. This prevents people from working in the fields, going to school, tending animals, and caring for their families. This disability usually lasts 8. 5 weeks on average, but it sometimes may be permanent. In some villages where there were high infection rates, more than 60% of children had to miss school. Some children are disabled by infection, while others are needed to work in place of disabled family members. In some cases, permanent damage happens if a person’s joint is infected and then becomes locked. A disease born from poverty, guinea worm disease only continues to make the poor conditions it comes from even poorer. It is a cycle that never ends.
Economic Impact
Take a moment and think for a bit. With the information you’ve received, make an educated guess on roughly how much money has to be shelled out to compensate for the damage inflicted by the guinea worm in its path. What do you think? First, let's take a look at how much money on average is lost when one person is (typically temporarily) disabled by the disease. Stop, make your guess. Want to know the real answer? For just one person, the average annual cost is estimated to be 16,000 CFA francs per patient (US$60). More than you thought, huh? Remember, it was mentioned earlier that there were 3. 5 million cases in 1986. How much do you think that cost? Evidently, the economic impact of guinea worm disease is much more than you thought. Guinea worm has been devastating for the countries it has affected, and most people don’t even realize just how much it has hurt the economy of these countries.
There are six main countries in Africa where guinea worm disease was endemic: Sudan, Ghana, Mali, Ethiopia, Nigeria, and Niger. It has been estimated that in Nigeria, infected people lose roughly 100 days of work per year, and that for most children, for 25% of the school year, they cannot attend school. Based on a survey conducted using 87 households in southern Nigeria, in 3 rice-growing states in southern Nigeria, the annual loss is already US $20 million. These rates have been based on several very conservative estimates of the average amount of time workers are disabled after infection. Evidently, the cost in lost revenue caused by this disease can be very high; so high, in fact, that the Dogon people of Mali have often referred to this disease as “the disease of the empty granary. ” If guinea worm disease is to be eradicated, the benefit of this will be limited nearly exclusively to villages and countries in which the disease is endemic.
However, benefit of guinea worm eradication for the global community will be the knowledge that it has participated in reducing the suffering of some of the world’s most underprivileged populations, and that these populations will be provided safe drinking water and community-based health volunteers capable of delivering other basic health services. The World Bank has estimated that the economic rate of return on investment in guinea worm eradication will be about 29% per year once the disease has been eradicated; people just have to make the effort, to make guinea worm disease the second disease that has ever been completely eradicated (after smallpox). It will be the first disease ever wiped off the earth without the use of drugs or medication, and the first parasitic infection to be eliminated as well. This dream is not completely unattainable; it may even be just beyond our fingertips.
Treatment and Eradication
Unfortunately, there is no known medicinal treatment or vaccine to treat guinea worm disease. There are only the traditional treatments that have been used for millennia. People can work with government health agencies to give health education, slowing the spread of guinea worm disease, maybe even stopping it. This dream is not as far off as you might think, either. From the 3. 5 million cases of the disease reported in 1986, thanks to the work of several organizations working towards this cause such as UNICEF and The Carter Center, the number of cases of guinea worm disease annually has been reduced by 99. 99% to merely 30 cases in 2017. One major setback to this cause, however, is guinea worm infection in dogs. The first detections of infection in dogs in Chad was in 2012. In 2016, there were 14 dogs reported to be infected in Ethiopia, along with 11 in Mali, and merely one case in South Sudan in 2015.
One of the traditional treatments often used to treat guinea worm disease is twisting the worm around a twig or a piece of gauze and slowly pulling it out. This often can take weeks, and peripheral bacterial infections from skin lesions can follow, worsening the pain and extending the period of disability. Guinea worm disease can also be prevented through community-based efforts to change behavior, such as learning to filter water before drinking and keeping infected people out of water sources. The infection of dogs can be linked to the consumption of infected fish and fish entrails. People can bury fish entrails to stop this, along with keeping the dogs away from stagnant water sources. In order to hold these measures, a cash reward to report the infected was created. In addition to all this, researchers are looking for a canine remedy, including the use of veterinarian drugs that have already been established. Traditional beliefs have also sustained the disease, as people continue to spread the disease without accurate knowledge of how they are doing so.
As John Jal Youl puts it, "There are two beliefs about how you get it… The first is that if someone has it and you step on his urine, you will contract it. The second is that if someone has guinea worm and you touch them, you can get it. " When people follow beliefs like this, they continue to transmit the disease because they do not realize that their stories are wrong and do not know how the disease is actually passed on to people. "I also go to schools and talk to children about the danger of guinea worm, and I go to talk to people in church,” he says. “In the beginning, people don't usually believe me. But after seeing how people who use the filter are not affected by the disease, they begin to ask questions. " Teams of health workers educate villagers about where the disease really comes from; they teach people about using safe sources of drinking water, and distribute simple filters (metal or clay tubes with cloth screens over one end) that can strain out insects that are carrying larvae. People have also received instructions for those infected not to bathe in common water sources, so that the disease doesn’t spread. There is another measure for stopping guinea worm disease, one just as powerful as all the others, perhaps even more: peace. UNICEF has connected its guinea worm eradication efforts in Sudan to local peace building initiatives.
In 2001, the organization helped broker a peace agreement in the states of Jonglei and Upper Nile between two ethnic Nuer groups that have been warring for years, at the cost of thousands of lives. The mediators offered the warring parties a universally appealing incentive to make peace: promise of boreholes, which meant, among other things, that guinea worm disease might vanish from area. Dr. Emmanuel Baya, the UNICEF Resident Project Officer in Malakal, has seen proof that this will work firsthand, "In East Equatoria State [in Sudan] there was a village where almost everyone had guinea worm," he recalls. During a lull in fighting, "UNICEF sank one borehole that delivered clean water to the community. In one year, all the guinea worm cases were gone. " Evidently, clean water can be provided, and as it is what everyone wants, it can be used to create peace. In 2001, the peace contract was signed, and the worm, hopefully, "is in retreat. "
