Guinea worm is a debilitating disease caused by the consumption of contaminated water. Uganda and Ghana are the two most endemic areas in the world. Ghana's economy suffers because men, women, and children are unable to attend school and work for months at a time. There also has been ethnic fighting going on in Ghana for the past 25 years which has thwarted many programs that have been put in place to eradicate Guinea worm. There is no cure for Guinea worm disease and so the only way to really eradicate it is through education and cost-productive filtration systems
Considerations
Economic
Dracunculiasis is debilitating and with any disabling disease, a community’s economy will suffer as the sick are restricted in their ability to produce for the other members of the village. Dracunculiasis, also known as guinea worm disease, has deprived Ghanaian villages of flourishing socio-economic status as it limits the work force and prevents attendance to school in order to obtain a future job (Oyibo et al 2007) Therefore, it is apparent that the guinea worm inflicts much more than physical pain on one individual it deprives families of food, clothing, and proper shelter. Currently, the World Bank is working to involve local entrepreneurs in simple, inexpensive ways to jump start the eradication process of dracunculiasis and to revive endemic communities failing economies—killing two birds with one stone so to speak. One way of doing this is by starting a barter system that involves local business owners being trained to deliver information about eradicating the disease along with water filters, larvicde, and other treatment services in return for a needed commodity like gum Arabic which can be used to make many products for selling (Voelker 2007). If the World Bank is successful in implementing these innovative programs, guinea worm, has a higher chance of being eradicated in Ghana.
Political
Many public health experts have asked themselves why Ghana has not been eradicated from guinea worm when so many other African countries have reached eradication. In fact, Sudan and Ghana each reported 45% of all reported cases in 2004 (Oyibo et al 2007). The answer to this question lies in Ghana’s political history and current political landscape. Due to ethnic fighting eradication efforts have been stunted. Ghana was formerly under British rule and received its independence in 1957. Since achieving their ‘independence’, Ghana has been through six different governments up until 1981 and now is ruled democratically by Jerry Rawlings. However, stability has not yet been reached as a destructive cycle of military interventions and thwarted democratic elections ensues. Ghana Red Cross and Government of Ghana Society Mothers Clubs along with health education groups have been reaching endemic regions to curb the negative effects of the ongoing ethnic fighting. With efforts of these various groups, a more conducive environment to eradicating guinea worm is likely within the next few years (Oyibo et al 2007). It is extremely critical that the ethnic fighting must stop so that eradication can occur because if not other eradicated communities may be infected as infected refugees seek safety and likely increase the risk of transmission of guinea worm.
Social/Cultural
There is no effective vaccine for dracunculiasis and so Ghanaians living in rural areas are exposed to a disease that has no immunity due to their limited access to clean water sources. Clean water sources are very rare in dessert communities and many locals dig man made water holes that quickly become infected when one person who has guinea worm places their body in a water source and other members of the community drink from that water source. During the dry season, about 60% of villages in Northern Ghana use dams for drinking water (Tayeh et al 1998). These dams are full of filthy, stagnant water that have no outlet well or fence around them where people and animals wade in making them perfect breeding grounds for the guinea worm’s larvae.
Placing an infected limb or body part in water offers some relief; however; with this one act of seeking relief, the infected individual can plagued an entire village in no time. Infection can only be prevented by giving the local people proper education about guinea worm, keeping infected individuals form entering water sources, filtering the drinking water with fine woven cloth or boiling it, and treating open, stagnant ponds with Abate larvicide (temephos; BASF, Mount Olive, NJ) (Oyibo et al 2007).
Health Service
Public health experts are working hard to eradicate guinea worm but are not receiving the needed financial support from NGO’s and the government. Diseases such as HIV/AIDS and Malaria take priority, as millions die each year from their effects, where as guinea worm are not fatal. Agencies that donate money to Ghana allocate given funds for health services to HIV/AIDS and Malaria initiatives. Those on the path to eradicating guinea worm will not let the slim budget stop the fight against guinea worm. Since the early 1980’s, guinea worm has been operated on a low dollar budget, costing nearly $225 million; which is relatively nothing in a 26 year span. With such little means to fight the disease the money has to be used to fight guinea worm and boost the endemic community’s economy in order to get the most out of each dollar. In fact, experts have found that for every $1 spent on guinea worm eradication a $1.29 was produced in increased agriculture production for the local communities (Voelker, 2007). Northern Ghana, where most guinea worm cases occur, has kept the entire country from reaching eradication due to health service programs not receiving adequate distribution of funding from the allocated budget as well as poor transfer of staff and resources between ministries and between departments (WHO 2005). To eliminate dracunculiasis from Ghana, health services must distribute funds equally to each village’s clinic and staff it with proper supplies and trained professionals otherwise Ghana will continue to be in an endemic state.
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