GUINEA WORM ERADICATION PROGRAMME (GWEP)

Introduction
  • Dracunculosis or Guinea Worm (GW) disease is caused by the nematode Dracunculus medinensis. The adult female guinea worm, measuring 60-100 cm in length, emerges through the skin, usually lower limbs, causing swelling, ulceration and discomfort to the patients. The GW infection is transmitted to a person when an active GW patient with the ulcer enters into unsafe drinking water - source the anterior end of the emerging guinea worm is ruptured. The contact with water bursts a loop of the uterus discharges its thousand of embryos into water. Cyclops present in the water ingests these embryos. When a person drinks water containing infected Cyclops, the gastric juice of man kills the Cyclops and activates the larvae which then penetrate the gut wall and migrate, usually to the retro peritoneal connective tissues, when they mature into male and female adult worms in about six months after entering into human body. The male worm is smaller in size, dies immediately after copulation and gets absorbed in the body. The female then, migrate to those part of the body which are likely to come in contact with water.

  • The disease causes incapacitation to the patient who is unable to perform his regular work, resulting in economics and production loss to the family. Presently it is prevalent in the African continent as well as India, viz. Andhra Pradesh, Gujarat, Karnataka, Madhya Pradesh, Maharashtra, Rajasthan, and Tamil Nadu. The disease was mostly confined to rural areas with inadequate safe drinking water supply. Peak incidence used to occur in the summer season when there is scarcity of water, except in the desert areas of Western Rajasthan where the incidence was more in post-monsoon season.

  • India is the first country in the world to establish the National Guinea Worm Eradication Programme in 983-84 as a centrally sponsored scheme on 50-50 sharing between Centre and States with the objective of eradicating guinea worm disease from the country. The National Institute of Communicable Diseases (NICD), Delhi worked as the nodal agency for planning, coordination, guidance and evaluation of NGWEP in the country.

  • The important strategy adopted to eradicate the GW is:

    1. GW case detection and continuous surveillance through active case search operations and regular monthly reporting
    2. GW case management
    3. Vector Control by the application of Tempos in unsafe water sources eight times a year and use of fine nylon mesh/double layered cloth strainers by the community to filter Cyclops in all the affected villages
    4. Health education
    5. Trained manpower development and
    6. Provision and maintenance of safe drinking water supply on priority in GW endemic villages
    7. Concurrent evaluation and operational research
Implementation

The endemic State Health Directorate through Primary Health Care system implemented the programme. The Ministry of Rural Development, Govt. of India and State Public Health Engineering Departments (Rural Water Supply) assist the Programme in provision and maintenance of safe drinking water supplies and conversion of unsafe drinking water sources, like step wells, and ponds on priority in the guinea worm affected areas. District Medical Officer and PHC medical Officer were responsible for planning, implementation, monitoring and supervision of the GWEP. Annually the Task Force Group under the chairmanship of Director General of Health Services, Govt. of India, reviewed the GWEP in depth. This task Force Group was constituted by: a) Director and Deputy Director (Helminthology) of NICD Delhi as convener and coordinator of the work, b) Directors of Health and Medical Services, GWEP-officers, chief engineers (Rural Water Supply) of GW endemic states, c) Director/Advisor of National Water Mission as members, and d) Experts from WHO, UNICEF, Centre Health Education Bureau (CHEB), Planning Commission and related organisations.

Achievement

At the beginning of the programme i.e. in 1984, there were around 40,000 GW cases in 12840 villages in 89 districts of 7 endemic states. During 1996 only 9 guinea worm cases have been recorded in three villages from Jodhpur (Rajasthan), rest of the country continued to remain free from GW. Banwari Lal 25 years old from Jodhpur in Rajasthan was the last case in India in 1996 (Lancet 2000). "Zero" incidence has been maintained since August 1996 through active surveillance and intensified field monitoring in the endemic areas.

In the Meeting of WHO in February 2000 the India has been certified for the elimination of Guinea Worm Disease and on 15th February 2001 declared India as "Guinea Worm Disease Free".