Guinea worm: Mali's most dreadful export

In 1994, authorities in Mali launched a programme to eradicate guinea worm—a parasite that can grow to a length of almost a metre inside the human body, later emerging through a blister in the skin. While the programme was very successful in its first six years, a troubling resurgence of guinea worm was reported last year in the central Mopti region.

This is despite the fact that it is remarkably simple to prevent the parasite’s larvae from entering the body. All that is needed is a water filter.

According to the United Nations Children’s Fund (Unicef) representative in Mali, Frances Turner, guinea worm is “a horrible disease that can be easily prevented by adopting certain hygienic measures, or by just filtering the water [used for drinking]”. Guinea worm larvae are carried by a flea found in standing water.

Complete eradication of the parasite has been difficult, say officials, because it can be nigh impossible to change people’s behaviour—even when it comes to the apparently simple matter of getting them to use filters.

Aminata Ongoiba, a resident of Niagassadiou village in Mopti, believes that guinea worm is the result of a “divine curse”—a fatalism that doubtlessly makes new hygiene procedures appear beside the point.

Rural poverty is also to blame. Many villagers are not able to purchase a new filter when the one they are using no longer works properly.

In addition, the rapid encroachment of the Sahara makes it difficult to drill new boreholes in Mopti—while the three that were established have long been out of order because of mechanical problems.

According to Souleymane Ongoiba, the Mayor of the rural Mondoro town council, which includes Niagassadiou, the delay in repairs is due to negligence on the part of certain authorities. As a result, people have no choice but to use polluted wells.

Niagassadiou appears to have been particularly hard hit by guinea worm. This development has been ascribed by some to the fact that people who fall ill with the parasite refuse to speak about their infections—even though they use the same water points as their neighbours.

To ease the pain caused by the emergence of a worm, people often submerge the affected part of the body in water. This allows the worm to enter the water source, and release millions of new larvae into it: ideal conditions for the spread of guinea worm.

Other villages have adopted the practice of recording and quarantining those infected with guinea worm. They have also been more consistent in filtering their water.

However, Niagassadiou may well set other parts of the country back in the fight to eradicate the parasite.

“The problem with this village is that it exports the disease to other parts of the country—Timbuktu, Gao, Kidal, Bamako—and abroad too, especially to Burkina Faso,” says Issa Degoga, national coordinator of Mali’s guinea worm eradication programme.

Many of Niagassadiou’s young people leave the village in search of work or a better life, with up to 70% heading for neighbouring Burkina Faso, just 26km away. These young migrants take guinea worm with them, infecting the water supplies of other localities.

In 2003 alone, there were 15 recorded instances of guinea worm being “exported” from Niagassadiou. Eleven cases were reported in Burkina Faso, one in a district of the capital, Bamako, two in the region of Gao, and one in Kidal in northern Mali.

As a result, authorities have stepped up eradication efforts in the village.

Free water filters are being distributed to every household in Niagassadiou. Ponds in the area are also being treated with Abate, an insecticide that kills guinea worm larvae, to prevent the parasite from spreading further once the rainy season gets under way.

Eradication efforts prompted the number of guinea worm cases in Mali to drop from 5 581 to 290 between 1994 and 2000, according to Degoga. However, there was a resurgence of the disease in 2003, with 829 cases reported.

In Niagassadiou there were 10 cases in 2002, while in 2003 that number jumped to 23.

The eradication programme receives most of its annual funding (more than $460 000) from Unicef. The Jimmy Carter Foundation, run by the former American president, provides the programme with water filters.

Last May, authorities and development partners organised a day of social action (May 5) to increase awareness of the need to eradicate guinea worm. The government has set itself the goal of having “zero cases by the year 2005”.

As yet, there is no cure for someone who carries the parasite—and no medicine to prevent infection. While the worm can be surgically removed, many people are obliged to wind it around a small stick as it emerges, pulling it out of the body at little bit at a time. This painful process can take weeks or even months, during which the blisters risk becoming infected.

As guinea worms frequently emerge on the legs or feet, the extraction of them can also leave a person crippled. Furthermore, the process can cause children to stay out of school, and keep adults out of the fields during harvest time.—IPS

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