“A Historic Public Health Achievement” – Nigeria close to final certification of guinea worm elimination

dscn3245sm.jpgThe International Certification Team (ICT) for Guinea Worm Disease Eradication held a debriefing meeting with the Honorable Minister of Health of Nigeria on Friday 12th July 2013.  The team of over a dozen international and national experts had been working in-country to review the certification report prepared by the Nigerian Guinea Worm Eradication Program (NIGEP) within the Federal Ministry of Health (FMOH) for three weeks to learn if claims that the last case of the disease occurred in 2008 and that measures were in place to detect any imported or locally transmitted case in the interim. (Photo shows Nigeria’s Honorable Minister for Health, Prof. C.O. Onyebuchi Chukwu at right, receiving report from ICT lead by Prof. Molyneux on left, with Nigeria’s WHO representative center.)

nigeria-erad-chart-line-2009-zero-sm.jpgThis ICT visit in 2013 marks 25 years since the launch of NIGEP at a time when there were over 650,000 cases found in over 6,000 villages/communities, the highest burden of the disease in Africa and likely the world at that time.  The leader of the ICT, Prof. David Molyneux, thanked all the partners over the past two and a half decades who made today’s good news briefing possible. Prof. Molyneux is also Chairman of the International Commission for the Certification of Dracunculiasis (guinea-worm disease) Eradication (ICCDE) based in WHO.

dscn3247-sm.jpgThe Commission has certified that two of Nigeria’s neighbors, Benin and Cameroon, are already free of guinea worm. Niger to the north is also in the pre-certification phase, while active transmission is still occurring on a small scale in Chad. Prof. Molyneux explained that the concern about these neighbors to the north and northeast is the potential of imported cases through population migration, hence the need for continued strong surveillance as part of an overall national health surveillance system.

In the process of verifying information in the national report on guinea worm elimination and validating its contents the ICT visited 17 States and the Federal Capital Territory, 60 Local Governments, 136 villages and interviewed 1,630 people using standardized questionnaires. Prof. Molyneux said the team took each State into consideration as a separate entity since some are larger than whole countries that have previously been certified.

nigeria-epid-report-may-2013-gw-sm.jpgSurveillance that helped Nigeria document no new cases since 2008 included 1) regular reporting on multipurpose surveillance forms at all frontline clinics, 2) incorporation of case searches into community and house-to-house health activities such as national immunization days/child health days and ivermectin distribution for onchocerciasis control, and 3) radio advertisements/jingles that describe guinea worm and offer a reward of N25,000 (approximately $160) and subsequent follow-up of rumored reports that this stimulates. These activities need to continue as long as countries in the region may still harbor the disease.

The team also reviewed contributing factors to maintaining a guinea worm free Nigeria, in particular village water supplies. While they noted that access to safe water had increased in many rural villages, there was still a problem of maintaining various kinds of wells and water systems.  At the start of global guinea worm eradication efforts during the United Nations Water Decade (the 1980s) the importance of guinea worm being the main infectious disease transmitted only through poor water supplies was stressed.

dscn3246-sm.jpgThe next steps after this informal briefing of the FMOH is transmission of the ICT report to the ICCDE. The decision of the ICCDE will then be sent to the Director General of WHO, who will then communicate the findings and recommendations to the Nigeria FMOH officially.  Hopefully before the end of 2013, Nigeria will be declared free of guinea worm, and as Prof. Molyneux said, strong vigilance and surveillance will need to stay in place, including cross-border collaboration to prevent reintroduction of the disease. (Photo shows two Nigeria Guinea Worm pioneers, Prof. Eka Braide on right and Prof Luke Edungbola on left who were among the original zonal coordinators for NIGEP)

Eradication of guinea worm will only be achieved once each endemic country is certified free of the disease.  The certification process is lengthy, thorough but absolutely necessary. Similar processes need to be strengthened for other infectious diseases.

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