WHO Certifies Nigeria, South Africa and 3 others free of Guinea worm disease.

UPDATES ON THE GWD CERTIFICATION EXERCISE IN NIGERIA

photo by Nigeria Guinea worm Eradication Programme (NIGEP)

The Scourge

Guinea worm disease (GWD) is one of a group of diseases classified as Neglected Tropical Diseases (NTD) because they are indeed neglected so also are the poorest persons in the society who are most commonly afflicted by the NTDs. GWD is caused by a parasitic nematode worm which emerges from the skin after about one year following ingestion of water from unsafe, contaminated sources (usually ponds).

Nigeria was the world’s most endemic country in the 1980s with over 650,000 cases reported. The country however interrupted disease transmission and reported its last case on the 11^th of November 2008 as claimed in the Nigeria country report presented to the International Certification Commission on Disease Eradication (ICCDE) of the WHO by the Federal Ministry of Health.

The Forensic Exercise

Verification and validation of records at the local level by Dr Dankoli and the Red Cross team. Photo by Uzoma Nwankwo for NIGEP

The Red Cross team in Borno State; North East Nigeria stuck in traffic due to a security check point mounted by soldiers due to the security challenges in the region. photo by Uzoma Nwankwo for NIGEP

Following the request of the Nigerian government to the ICCDE to certify Nigeria free of Guinea worm disease having maintained zero case status for GWD for five years, the ICCDE sent an International Certification Team (ICT) to the country in June 2013 to validate the claim that Nigeria had indeed interrupted transmission, and has a national disease surveillance system that is sensitive enough to detect imported cases, or any on-going local transmission of the disease.

The team explaining its mission to a Sarkin (tribal head). This was critical to successfully interacting with community dwellers. Photo by Uzoma Nwankwo for NIGEP

The ICT in discharging this very important responsibility, visited 17 states and the FCT, 60 LGAs, 136 villages and health facilities, and interviewed 1360 persons in what the team leader; Prof. David Molyneux described as, ‘a very large forensic exercise of significant public health importance’. They examined the records and reports of diseases surveillance activities at all levels of government, verified the existence of safe water sources, examined and tested the public knowledge of GWD and the cash reward for reporting suspected cases.

The debriefing

Photo by Uzoma Nwankwo for NIGEP

Hon Minister of Health Prof Onyebuchi Chukwu and NIGEP Coordinator Mrs Ifeoma Anagbogu listening to leader of the ICT Prof. David Molyneux in the midst of reporters as Drs Biswas and Maiga look on. Photo by Uzoma Nwankwo for NIGEP

At the end of the three week exercise Prof David Molyneux debriefed the Hon. Minister of Health Prof. Onyebuchi Chukwu of their findings and made recommendation to the Government and people of Nigeria. He informed a very attentive Hon Minister that evidence found in the field showed that Nigeria Guinea worm eradication Programme had met the minimum required criteria for certification. His team found that there was no on-going transmission of GWD; there was a sensitive national surveillance system that could detect imported cases and any local transmission, especially with the complementary use of polio vaccinators for GWD case searches during national immunisation days; there was evidence of provision of portable water supply to rural communities at risk of the disease. Prof David Molyneux and his team were also impressed with the level of public knowledge of the GWD and the cash reward scheme for reporting a confirmed case.

The ICT team however reminded the Federal Ministry of Health that his team can only make recommendations which are subject to the final decision of the ICCDE and the Director General of the WHO in December 2013.

He also added that there is now the need for even further strengthening of the surveillance system and cross border collaboration with countries like Chad and Niger that are yet to be certified free of GWD. He commended water providing agencies for the good work they had done but insisted they needed to do more to ensure that such water sources are maintained to continue to deliver safe water to the people. He also stressed the importance of record-keeping , archiving and the need to ensure that publicity activities through the print and electronic media continue. The need to also ensure that all rumours of GWD must be investigated within 24 hours and properly documented.

The Hon Minister thanked the ICT members and for the good job they had done especially considering the size of the country , its difficult terrain and the current security challenges in some States. He said the ministry will immediately begin to implement the recommendations of the ICT while the country awaits the official pronouncement from the ICCDE and the DG WHO in December 2013.

End of year gift

On the 6^th of December 2013, the WHO announced on its website that it had certified five countries as free of GWD. The list included the world’s formerly most endemic country; Nigeria and its neighbour; Niger. Others were Ivory Coast, South Africa and Somalia. Click here

This achievement is significant as the world again marches closer to the eradication of another disease after small pox. It is also exciting for the Nigeria NTD Programme which has by this WHO pronouncement achieved a milestone set in its strategic NTD Master Plan.

This momentum will carry us into 2014; a year in which the NTD programme plans to scale up ongoing intervention activities and conclude all epidemiological mapping to determine disease prevalence.

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