WHO/CDS/CPE/CEE/2002.30 Distribution : GeneraVGenerale Bilingual: Enghsh/French Bilingue: anglals!francais

REPORT ON THE STATUS OF THE DRACUNCULIASIS ERADICATION CAMPAIGN IN 2001

RAPPORT SUR LA CAMPAGNE D'ERADICATION DE LA DRACUNCULOSE EN 2001

ORGANISATION MONDIALE DE LA SANTE WORLD HEALTII ORGANIZATION

L This document was developed by the Strategy Ce document a ete developpe par !'unite de Development and Monitoring for Eradication and !'Elaboration et Suivi des Strategies d'Eradication Elimination Team and the Public HealthMapping Team, et d'Elimination et l'Unite de Cartographie sanitaire, Programme of Communicable Diseases, Groupe des Maladies transmissibles, World Health Organization. Organisation mondiale de la Sante.

Acknowledgements Remerciements

Special thanks to the Guinea Worm Eradication Un remerciement particulier aux Gestionnaires de Programme Managers and Data Managers for the data Programmes et de donnees des Programmes nationaux provided and their tremendous contribution to d'Eradication du Ver de Guinee, pour les donnees Dracunculiasis eradication. fournies et pour leur formidable contribution dans ]'eradication de la dracunculose.

This document was printed with the support of Ce document a ete produit et imprime the Bill and Melinda Gates Foundation. grace au soutien de la Fondation Bill et Melinda Gates.

This document is available on the Internet at: Ce document peut etre consulte sur internet : www.who.int/globalatlas www. who.int/globalatlas

Copies may be requested from: Des copies de ce document soot disponibles aupres de : World Health Organization Organisation mondiale de la Sante Information Resource Centre Centre d'Information et de Documentation Communicable Diseases Groupe des Maladies transmissibles CH-1211 Geneva27,Switzerland CH-1211 Geneve 27, Suisse Fax: + 41 022 791 4285 - E-mail: [email protected] Fax: + 41 022 791 4285 - E-mail: [email protected]

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©WORLD HEALTH ORGANIZATION 2002 ©ORGANISATION MONDIALE DE LA SANJ"E 2002 This document is not a formal publication of the Wortd Ce document n'est pas une publication officielle de Health Organization (WHO), and all rights are reserved !'Organisation Mondiale de la Santa (OMS) et taus by the Organization. The document may, however, be les droits y afferents sont reserves par freely reviewed, abstracted, reproduced or translated, !'Organisation. S'il peut etre commente, resume ou in part or in whole, but not for sale or for use in conjunc­ cite sans aucune restriction, il ne saurait cependant tion with commen::ial pU!poses. etre reproduit ni traduit, partiellement ou en totalite, pour la vente ou a des fins commerciales.

Photo cover: WHO/A. Tayeh WHO/CDS/CPE/CEE/2002.30 Distribution: Generai/Generale Bilingual: English/French Bilingue: anglais/franQais

REPORT ON THE STATUS OF THE DRACUNCULIASIS ERADICATION CAMPAIGN IN 2001

RAPPORT SUR LA CAMPAGNE D' ERADICATION DE LA DRACUNCULOSE EN 2001 TABLE OF CONTENTS

1. Global status of dracunculiasis eradication 4 1 .1 . Global overview 4 1.2. The decline in dracunculiasis cases 4 1.3. Containment of cases 9 1.4. Seasonality of dracunculiasis 10 1.5. Villages under surveillance and currently endemic villages 11 1 .6. Imported cases 13

2. Situation in highly endemic countries 15 2.1. Overview of highly endemic countries 15 2.2. Ghana 15 2.3. Nigeria 19 2.4. Sudan 21

3. Countries with moderated levels of endemicity 24 3.1. Overview of endemic countries reporting 100 to 1500 cases in 2001 24 3.2. Benin 25 3.3. Burkina Faso 26 3.4. Cote d'lvoire 30 3.5. Mali 33 3.6. Niger 38 3.7. Toga 40

4. Countries approaching interruption of transmission 4 7 4.1 . Overview of endemic countries approaching interruption of transmission 4 7 4.2. Central African Republic (CAR) 48 4.3. Ethiopia 50 4.4. Mauritania 53 4.5. Uganda 57

5. Countries that interrupted transmission and in pre-certification phase 61 5.1. Overview of countries in pre-certification phase 61 5.2. Cameroon 62 5.3. Chad 62 5.4. Kenya ______64 5.5. Senegal 65 5.6. Yemen 66

Annex I ______68 TABLE DES MATIERES

1. Situation mondiale de !'eradication de la dracunculose 4 1.1. Vue d'ensemble 4 1.2. La diminution du nombre de cas de dracunculose 4 1 .3. L' isolement des cas 9 1.4. Le caractere saisonnier de la dracunculose 10 1.5. Villages sous surveillance et villages actuellement endemiques_ 11 1 .6. Cas importes 13

2. Situation dans les pays fortement endemiques 15 2.1. Vue d'ensemble des pays fortement endemiques 15 2.2. Ghana 15 2.3. Nigeria 19 2.4. Soudan 21

3. Pays d'endemie moderee (entre 100 et 1500 cas par an) 24 3.1. Vue d'ensemble des pays endemiques rapportant de 100 a 1500 cas en 2001 25 3.2. Benin 25 3.3. Burkina Faso 26 3.4. Cote d'lvoire 30 3.5. Mali 33 3.6. Niger 38 3.7. Toga 40

4. Pays approchant de !'interruption de la transmission 47 4.1. Vue d'ensemble des pays approchant de !'interruption de la transmission 47 4.2. Republique Centrafricaine (RCA) 48 4.3. Ethiopie 50 4.4. Mauritania 53 4.5. Ouganda 57

5. Pays qui ant interrompu la transmission et qui sont dans la phase de pre-certification 61 5.1. Vue d'ensemble des pays dans la phase de pre-certification __ 61 5.2. Cameroun 62 5.3. Tchad 62 5.4. Kenya------64 5.5. Senegal 65 5.6. Yemen 66

Annexe I ______69 REPORT ON THE STATUS OF THE DRACUNCULIASIS GLOBAL ERADICATION CAMPAIGN IN 2001

1. GLOBAL STATUS OF 1. SITUATION MONDIALE DE DRACUNCULIASIS L'ERADICATION DE LA ERADICATION DRACUNCULOSE

1.1. Global overview 1.1. Vue d'ensemble The dracunculiasis eradication initiative started in Bien que le programme d'eradication de la 1982. However it is only from 1989 that surveillance dracunculose ait ete lance en 1982, la majorite des systems for few countries including Ghana and Ni­ pays n'ont etabli leur systeme de surveillance qu'en geria were effective. As a result 892,055 dracuncu­ 1989, y compris le Ghana et le Nigeria, pourtant for­ liasis cases were reported in that year. The tement endemiques. Par consequent, environ programme was strengthened in 1991 , when the 900 000 cas de dracunculose ant ete enregistres World Health Assembly declared its goal to eradi­ en 1998. L'initiative d'eradication de la dracunculose cate the disease by 1995. In the following years, more a ete renforcee en 1991, quand I'Assemblee mon­ endemic countries established their eradication pro­ diale de la Sante a declare que son but etait d'eradi­ grammes. Pakistan interrupted transmission in 1993 quer la maladie. Les pays les plus endemiques ant and India in 1996 and 3 years later were respectively etabli leurs programmes d'eradication dans les an­ certified as disease free. Civil war in the worst af­ nees suivantes. Le Pakistan et l'lnde avaient inter­ fected countries, combined with the inaccessibility rompu la transmission en 1993 et 1997 to endemic areas and other factors, delayed com­ respectivement et avaient ete certifies comme plete achievement of the eradication goal. Neverthe­ exempts de dracunculose en 1997 et 2000 respec­ less, endemic countries have shown a determination tivement. La guerre civile dans les pays les plus af­ to be rid of this painful and disabling disease. Cur­ fectes, combinee avec l'inaccessibilite des zones rently, only 13 countries, all in Africa, are endemic endemiques et d'autres facteurs ant cependant re­ with the disease and 5 countries are in there tarde !'eradication. Neanmoins, les pays endemiques precertification phase. There is heightened interest ant montre une determination a se debarrasser de in eradication among endemic countries, countries cette maladie douloureuse et invalidante, et tant les in precertification stage, donors and supporting or­ bailleurs de fonds que les organisations parrainantes ganizations including The Carter Center/Giobal telles que le Carter Center, I'Unicef et I'OMS ant fait 2000, UNICEF and WHO. This commitment was preuve d'un tres grand inten~t pour !'eradication de expressed during the seventh meeting of dracuncu­ la dracunculose. Actuellement, seuls 13 pays sont liasis eradication programme managers held in Khar­ encore endemiques, et 5 pays sont dans la phase toum, Sudan, from 4 to 7 March 2002. Ministers de pre-certification. from several countries reaffirmed their commitment to dracunculiasis eradication in a Round Table and 1.2. La diminution du nombre de cas issued a declaration to publicize this commitment de dracunculose (Annex 1). La forte diminution du nombre de cas enregistres dans le monde pendant les 13 dernieres annees, 1.2. The decline in dracunculiasis cases temoigne de cet engagement a eradiquer la mala­ This commitment to eradicate the disease had die. Get engagement a ete renouvele pendant la 8 8 been demonstrated clearly through the sharp de­ 7 "' reunion des coordonnateurs de programmes qui crease of the number of reported cases worldwide a eu lieu a Khartoum du 4 au 7 mars 2002. Des during the last 13 years. Figure 1.1. shows the de­ Ministres de la Sante de plusieurs pays ant reaffirme clining trend of reported cases of dracunculiasis from !'engagement de leur pays pour !'eradication de la 1989 to 2001 . Cases declined sharply from 1989 to dracunculose a !'occasion d'une table ronde, et ant 1995, from 892,055 to 129,852 cases. After that fait une declaration a ce sujet (annexe 1). La figure year, the number of reported cases fluctuated but 1 . 1 montre la tendance a la diminution des cas de eventually declined to 63,717 cases in 2001. The 1989 a 2001. De 1989 a 1995, cette diminution etait still high number of reported cases for 2001 com­ tres marquee, passant de 892 055 a 129 852 cas. pared with 2000 is due to high number of reported Apres 1 995, le nombre de cas de dracunculose a cases from Sudan where civil unrest in the southern fluctue mais a diminue a 63 717 cas en 2001. Le part of that country, prevents implementation of eradi­ nombre toujours eleve de cas notifies en 2001, com­ cation measures. pare a l'an 2000, est dO a !'augmentation des cas

4 RAPPORT SUR LA CAMP,lGNE M(lNDII',LE D'ERi\OICATION DE LA DRACUNCULOSE EN 2001 - - -

Figure 1.1 . Declining trend in dracunculiasis prevalence

100,000 892,055 90,000 0 Other countries 0 Sudan 80,000 70,000 623,&14 60,000 547,575 50,000 40,000 374Zl2 30,000 229,773 20,000 10,000 0 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001

Table 1.1 shows the monthly distribution of dra­ Le tableau 1.1 montre la repartition mensuelle des cunculiasis cases reported from 13 endemic African cas de dracunculose dans 13 pays africains ende­ countries and 5 countries in their precertification stage miques et dans 5 pays en phase de pre-certification during 2001. The total number of dracunculiasis en 2001. Le nombre mondial de cas de dracunculose cases reported worldwide during 2001 were 63,717. en 2001 etait 63 717. Le Soudan representait envi­ Sudan accounted for about 78% of all cases reported. ron 78% des cas rapportes.

Table 1 .1 . Dracunculiasis, monthly reporting of cases, 2001"

Country Total Number of cases reported in 2001 % cases 2000b Jan I Feb Mar Apr May Jun Jul Aug Sep IOct Nov I Dec Total Contained 2001 Countries endemic with dracunculiasis Ben in 186 17 14 7 1 0 1 1 6 70 44 172 3 8 - 95 Burkina Faso 1,956 20 29 37 61 189 197 126 75 108 116 62 12 1,032 73 CAR 35 1 2 4 4 3 5 4 2 3 2 0 6 36 63 Cote d'lvoire 297 40 60 39 6 10 8 4 9 8 0 14 33 231 55 Ethiopia 60 0 0 0 1 5 7 2 3 5 4 2 0 29 72 Ghana 7,402 906 954 543 474 380 208 105 63 39 134 438 495 4739 68 Mali 290 6 0 0 0 2 2 55 193 134 181 74 71 718 51 Mauritania 136 1 0 1 0 1 3 25 21 29 8 2 3 94 52 Niger 1,166 -- 2 2 0 2 13 12 62 101 105 66 33 19 417 - 57 Nigeria 7,869 1 ,043 1 ,032 730 271 250 323 382 331 195 147 285 366 5355 65 Sudan 54,890 2,423 2,296 2,321 3,278 5,488 7,200 7,606 5,535 6,929 3,098 2,066 1,231 49,471 49 To go I 828 125 89 81 48 24 57 51 55 45 308 278 193 1,354 62 Uganda 96 0 0 0 3 19 17 9 1 4 1 1 0 55 64 Countries in pre-certification stagesd - - Cameroon 5 0 0 1 0 0 1 0 0 5 100 Chad 3 0 0 0 ~ o1 0 oi 00- r0 0 0 0 0 0 Kenya i 4 0 0 0 1 0 1 11 0 1 0 0 8 100 Senegal i - 0 0 oi 0 0 0 0 0 1 ~ I 0 1 0 0 1 0 Yemen 0 0 0 0 0 0 0 0 ·-l o oj o o o o o Total I 75,223 4,584 4,478 3, 764 4,152 i 6,385 8,040 8,434, 6,394 7,612 4,076 3,325 12,473. 63,717 53

' Data for 2001 were provided by programme managers during a meeting in Khartoum (Sudan) on 4-7 March 2002 " See No 18, 4 May 2001 PP - 133-139 c In addition 27 cases were alleged to have occurred in CAR during November 2001 detected by NID. • All reported cases in 2001 were imported from endemic countries.

5 REPORT ON THE STATUS OF THE DRACUNCULIASIS GLOBAL ERADICATION CAMPAIGN IN 2001

Although dracunculiasis cases declined rapidly enregistres au Soudan ou le conflit qui affecte le sud from about 892,055 cases in 1989 to 63,717 cases du pays empeche la mise en ceuvre des mesures in 2001, the decline was sharper if we consider that d'eradication. La figure 1.1. montre la diminution des not all countries started their dracunculiasis eradi­ cas enregistres de 1991 a 2001. Bien que le nom­ cation programmes in 1989 but in the following bre de cas ait rapidement diminue entre 1989 years. Figure 1.2 shows the number of reported (892 055 cas) et 2001 (63 717 cas), cette reduction cases in endemic countries from 1989 to 2001 (con­ etait en realite plus marquee car taus les pays n'ont tinuous line) and extrapolation of the data if all en­ pas debuts leur programme d'eradication en 1989 demic countries had established their surveillance mais dans les annees suivantes. La figure 1 .2 mon­ system in 1989 (broken line). Several countries re­ tre le nombre de cas notifies entre 1889 et 2001 ported zero cases or few cases in 1989 but when (ligne continue) et une extrapolation des donnees their national eradication programme was estab­ assumant que taus les pays endemiques aient com­ lished, they reported high number of cases because mence leur programme en 1989 (ligne pointillee). of improved surveillance. Burkina Faso, Ghana and Plusieurs pays ont notifie zero cas ou quelques cas Nigeria established their effective surveillance sys­ en 1989 mais lorsque leur programme fut etabli par tem in 1989. Benin, Cote d'lvoire, Mali, Niger and la suite un plus grand nombre de cas etait notifie Senegal started their programmes in 1991. Chad, grace a une surveillance epidemiologique amelioree. Mauritania and Togo followed in 1993. Kenya, Le Burkina Faso, le Ghana et le Nigeria ont etabli Uganda and Yemen reported significant number of leur surveillance epidemiologique en 1989. cases in 1994. And finally Sudan reported about 120,000 cases in 1996 when their programme was Dans les pays endemiques, Soudan exclu, la re­ established. If we consider that the cases were con­ duction du nombre de cas etait de 30% en 2001 par stant from 1989 till the year these countries estab­ rapport a 2000. L'Ethiopie, le Niger, le Burkina Faso lished their surveillance systems and reported their et I'Ouganda ont reduit le nombre de cas de plus de cases, we will get more impressive decline like the 45% en 2001 par rapport a 2000 (figure 1.3). En broken line in Figure 1 .2. Mauritania, au Ghana et au Nigeria, la reduction en nombre de cas a varie de 32% a 36% et en Cote There was 30% reduction of the number of cases d'lvoire elle etait de 21%. Au Soudan, pays avec le in countries outside Sudan in 2001 compared with plus grand nombre de cas, la reduction etait de 10% 2000. Ethiopia, Niger, Burkina Faso and Uganda en 2001 par rapport a 2002. 11 est cependant difficile each reduced their yearly cases by more than 45% d'apprecier la tendance epidemiologique au Soudan in 2001 compared with 2000 (Figure 1 .3). The de­ de maniere realiste car plus de 50% des villages en­ cline of cases in Mauritania, Ghana and Nigeria demiques dans le sud du pays restent inaccessibles ranged from 31% to 36%. Cote d'lvoire reduced its a tout systeme de surveillance. Au Benin, la reduc­ cases by 21 %. Sudan, the country with the highest tion n'etait que de 6%. En Republique Centrafricaine, number of cases reported a reduction of 10% in les rapports rec;:us font etat d'une augmentation de 2001 compared with 2000. However, no realistic 3% du nombre de cas et au Toga et au Mali il y a eu statement on epidemiological trends in Sudan could une augmentation en nombre de cas de 65% et 151% be concluded, as around 50% of the known en­ respectivement. demic villages remain inaccessible to surveillance in the south of the country. The reduction in Benin was only 6%. Central African Republic reported an increase in the number of cases by 3%. Toga and Mali reported increase in the number of cases (65% and 151% respectively).

6 RAPf>ORT SUR LA CAMPAGNE MONDI1\LE D'ER;\DIC. .n.TJON DE L.n. DRACUNCULOSE El~ 2001 - -

Figure 1.2. Reported dracunculiasis cases and extrapolation for estimation of dracunculiasis cases (Countries name appear vertical to year when their national programme started)

140,000

en 120,000 Q) en s 100,000 en 'iii - ~ 80,000 3 u c ::J u 60,000 ~ '0 0 40,000 0 z 20,000

1989 1990 1991 1992 1993 1994 19951996 1997 1998 1999 2000 2001

Figure 1 .3 shows the percentage of decrease/in­ La figure 1.3 montre le pourcentage d'augmen­ crease of the number of indigenous cases (a) and tation/diminution du nombre de cas autochtones the number of endemic villages (b) during 2001 com­ (a) et du nombre de villages endemiques (b) en 2001 pared with 2000 for different endemic countries. par rapport a 2000. Plusieurs pays tels que I'Ethio­ Several countries such as Ethiopia, Niger, Burkina pie, le Niger, Le Burkina Faso, I'Ouganda, le Ghana, Faso, Uganda, Ghana and Mauritania succeeded in et la Mauritanie ont reussi a realiser une reduction achieving a greater reduction than the remaining plus importante que celles des autres pays. La com­ countries. Comparing the decline in reported cases paraison de la diminution des cas dans differents of dracunculiasis between endemic countries can pays peut apporter une explication quant aux rai­ be useful for understanding why some countries sons qui ont permit une reduction plus rapide. 11 n'est were able to reduce cases faster than others. lt is pas utile de comparer le niveau de reduction dans not interesting to compare the degree of decline of des pays eloignes l'un de I' autre tels que le Pakistan cases between countries in different continents or ou l'lnde avec des pays tel que le Ghana et le Nigeria far from each other such as comparing Pakistan and a cause des differences de climat, de statut India with other endemic countries like Ghana and epidemiologique, des interventions menses, et des Nigeria because of differences in climate, epidemio­ autres facteurs influenc;:ant la transmission. Cepen­ logical status, interventions used and other factors dant, il est approprie de comparer la diminution des influencing the transmission. However, it will be ap­ cas dans des pays voisins tels que le Benin et le Togo propriate to compare the decline in endemic coun­ qui ont des facteurs epidemiologiques similaires. tries that have similar epidemiological factors, such as Benin and Togo, two neighbouring countries.

7 f1EPORT ON THE STATUS OF THE DRACUNCULIASIS GLOBAL ERADICATION CAMPAIGN IN 2001

Figure 1 .3. Percentage reduction/increase in the number of cases (a) and number of currently endemic villages (b) in 2001 compared with 2000.

%Reduction %Increase Ethiopia .------.., -81 Niger -65 Burkina Faso -48 Uganda -45 Ghana -36 Nigeria -32 (a) Cases Mauritania -31 Cote d'lvoire C:=J -21 Sudan D-10 Benin 0-6 +3D CAR +65 c:======:J Toga +151 c:======::::=J Mali

Ethiopia -44 Niger -47 Burkina Faso -43 Uganda -81 Ghana c::::J -21 Nigeria c::=J -1 9 (b) Currently endemic villages 14 Cl Mauritania Cote d'lvoire -48 Sudan c::::J -18 Benin -36 0 CAR 22 c::::::::J T og o 200 c::======:=J Mali

8 Rl\f'PORT SUR l /1 Ct\MPAGNE MOND/t\LE D'En ;\ D I C.".T/0 ~! DE Lll, DRACUNCULOSE El" 2001 - . - -- -

Figure 1.4. Comparison the decline in cases between Benin and Togo (1992-2001)

100,000 en enQ) eO 16,334 () en 'Uj 10,000 -~ 5,044 3 () c 2,073 . 2 128 ::J 1,626 '·?.?~...... 1 589 () 2!273 ...... ·····!.,,, 828 .!;~54 eO 1,000 .••...... Toga -o"- '+- 0 0 z Ben in

1992 1993 1994 1995 1996 1997 1998 1999 2000 2001

Figure 1.4 shows reported cases of dracunculia­ La figure 1.4 compare !'evolution de la sis between these two countries during the period dracunculose entre ces deux pays de 1992 a 2001 . 1992 and 2001. Although the two countries reported Bien que les deux pays aient enregistre le meme similar number of cases during 1994 to 1996, re­ nombre de cas de 1994 a 1996, le Benin a reussi a ported cases declined sharply in Benin to 171 in ramener ce nombre a 171 cas en 2001 , tandis que 2001 while it remained l1igh in Toga and was 1 ,319 le Toga enregistrait 1319 cas la meme annee. 11 sera cases in the same year. lt will be interesting to iden­ interessant d'identifier les facteurs ou interventions tify tile factors or inte1ventions yielding a better per­ qui conduisent a une meilleure performance et ceux formance and factors or interventions which have a qui ant un moindre impact sur !'eradication. Une less marked impact on eradication. Such analysis telle analyse pourrait reveler la meilleure strategie pour may bring the evidence for the best strategy for a une eradication acceleree. rapid eradication.

1.3. L'isolement des cas 1.3. Containment of cases La clef de voGte de !'eradication de la The corner stone of dracunculiasis eradication is dracunculose est l'isolement des cas. Les pays ant containment of cases. Endemic countries have re­ enregistre un pourcentage eleve de cas isoles en ported high percentage of case containment in 1997 1997 et 1998, mais la reduction enregistree les an­ and 1998 but decrease in the number of cases in nees suivantes a ete moderee, et ne correspondait the subsequent years was modest and below ex­ pas au niveau attendu compte tenu du degre d'iso­ pectations considering the degree of reported con­ lement rapporte. Ceci peut etre vu sur la figure 1 .5, tainment. This can be seen in Figure 1.5 where the ou la correlation entre le taux d'isolement de 1997 correlation between reported containment in 1997 et la reduction de 1998 etait negative, indiquant la and reduction in 1998 was negative indicating over­ surestimation du nombre de cas isoles. Un resultat estimation of containment of cases. Similar result semblable a ete trouve les annees suivantes. Seul le was found in the following year. Only the percent­ pourcentage des cas isoles en 1999 a montre une age of case containment in 1999 showed a positive correlation positive avec la reduction de l'annee 2000. correlation. Criteria for case containment reporting Des criteres convenus pour l'isolement des cas de­ should be adhered to allow thus a better estimation vraient etre suivis de fac;:on plus stricte pour perm et­ of the number of cases in the following year or a tre une meilleure estimation du nombre de cas better understanding of the factors favouring recru­ attendus durant l'annee suivante ou pour mieux descence of transmission. No positive correlation comprendre les facteurs qui influencent la recrudes­ was found between the percentage of contained cence de la transmission. Aucune correlation posi­ cases in 2000 compared with reduction of reported tive n'a ete trouvee entre le pourcentage des cas cases in 2001. isoles en 2000 et celui rapporte pour 2001.

9 REPORT ON THE STATUS OF THE DRACUNCULIASIS GLOBAL ERADIGATIO~I CAMPAIGN IN 2001

Figure 1.5. Containment of cases compared with dracunculiasis for four years

Containment in 1997 and reduction in1998 Containment in 1998 and reduction in 1999 100r------, 100r------~ 90 80 80 Cote d'lvoire. Uganda. CO 70 60 8l 60 §l Niger Ethiopia ~50 • Benin• • ,!; 40 Mali G~ana ,!; c c g 30 Uganda 0 0 . g 20 Nioer • EthiOP.i~ ·g Burkina Faso -o -20 ~ 10r-----~~~.~---1~~----~~~B~e~ni~nJ ~ ?.'i?. o Burkina Faso Mauritania • ~ -40 -10 Nigeria • • -60 -20 Cote d'lvoire -30 - 80~~------~~--,---~----~~--~ 0 1 0 20 30 40 50 60 70 80 90 1 00 0 10 20 30 40 50 60 70 80 90 100 % containment in 1997 % containment in 1998 Countries weighted by cases in 1997 Countries weighted by cases in 1998

Containment In 1999 and reduction in 2000 Containment in 2000 and reduction in 2001 100r------, 100r------~. 90 Ethiopia 80 § 70 Bepin 0 COte d'lvoire N 60 ~ .!; ,!; To no § 50 . . • ~ To_go Ma ritan .§ 40 u la ~~1geria"'' • 13 u:J :J aJ-100 ~ 30 Niger .... ~ 20 ~ • Ghana 10 • Burkina Faso 0~~----~~~----~~~--~--~~ 0 10 20 30 40 50 60 70 80 90 100 -200~------.---~50 60 70 80 90 100 % containment in 1999 % containment in 2000 Countries weighted by cases in 1999 Cases weighted by cases in 2001

1.4. Seasonality of dracunculiasis 1.4. Le caractere saisonnier de la Dracunculiasis is a seasonal disease which is usu­ dracunculose ally represented by the monthly distribution of inci­ La dracunculose est une maladie saisonniere ce dence through the year, when guinea worm emerges qui est habituellement represents par la distribution from the infected persons. Dracunculiasis seasonality mensuelle de !'incidence des cas tout au long de depends upon the availability of water sources, l'annee. Le caractere saisonnier de la dracunculose mainly rain. The peak of dracunculiasis incidence depend de la disponibilite de l'eau, principalement varies between different regions in Africa. Figure 1 .6 de l'eau de pluie. Le pie de !'incidence de la maladie shows the different seasonal pattern of the incidence varie entre les differentes regions d'Afrique. La figure of the disease in endemic countries. The countries 1.6 montre les differentes configurations de !'incidence can be grouped into four different categories accord­ saisonniere de la maladie dans les pays endemiques. ing to their similar seasonal pattern. Les pays avec une configuration saisonniere sem­ blable peuvent etre groupes dans quatre categories • The first category includes Mauritania, Chad, differentes. Mali, Niger, Burkina Faso, Cameroon. Dracun­ culiasis occurs usually in those countries from • La premiere categorie comprend la Mauritania, le May to October. Tchad, le Mali, le Niger, le Burkina Faso, le Cameroun.

10 RI\Pf"'RT SUR U1 CAMPI\GI~E MONO/ALE D'En;\0/C.".TIO~! DEL". DRACUNCULOSE EN 2001 - -

• The second category includes Sudan, Uganda and La dracunculose se produit habituellement dans Ethiopia, all in east Africa, and the season of peak ces pays entre mai et octobre. incidence of dracunculiasis takes place from April • Le Soudan, I'Ouganda et I'Ethiopie sont taus si­ to October. tues en Afrique de I'Est, et pour eux la saison de • The third category includes Cote d'lvoire, Ghana, !'incidence maximale va d'avril a octobre. Benin and Toga that have the peaks of incidence • La troisieme categorie comprend la Cote d'lvoire, stretching from the last few months to the few le Ghana, le Benin et le Togo ou la saison maxi­ months at the beginning of the following year. male d'infection se situe au debut et a la fin de • The fourth category includes Nigeria, that has two l'annee. peaks, one during mid year (May to August) and • Au Nigeria, il y a deux pies, un au milieu de !'an­ another that stretches from November of one year nee (mai a aout), et un autre durant le premier et to February the following year. In the north-east and les deux derniers mois de l'annee. Dans le sud­ north-west, the peak appeared to occur during May est et le sud-ouest ou la majorite de cas se decla­ to August In the South-east and south-west where rent, !'incidence maximale se produit a partir de the majority of cases occurred, the peak infection novembre jusque fevrier de l'annee suivante. Dans occurs from November to February. le nord-est et le nord-ouest, le pie a semble se produire de mai a aout (figure 1.6). Le caractere saisonnier de !'infection, et de la transmission peut aider a se focaliser et intensifier les interventions pendant cette periode de l'annee.

Figure 1 .6. Dracunculiasis seasonality in endemic countries

Country Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

Mauritania - -- --L- - Chad I Mali - 1- l Niger Burkina Faso I Cameroon -! Sudan Uganda Ethiopia

Cote d'lvoire Ghana Ben in Togo

Nigeria

1.5. Villages under surveillance and 1.5. Villages sous surveillance et currently endemic villages villages actuellement There were 6,118 villages that were defined as endemiques "currently endemic villages" which had one ore more En 2001, 6 118 villages etaient infectes avec au dracunculiasis cases in 2001. The highest number mains 1 cas de dracunculose. Le plus grand nom­ of "currently endemic villages" was reported by Su­ bre de villages infectes etait rapporte par le Soudan, dan (3,921) followed by Ghana (779) and Nigeria (3 921) suivi par le Ghana (779) et le Nigeria (733). (733). Table 1 .2 shows the number of villages under Le tableau 1 .2 montre le nombre de villages infectes surveillance and "currently endemic villages in 2001 ". sous surveillance en 2001.

11 REPORT ON THE STATUS OF THE DRACUNCULIASIS GLOBAL ERADICATION CAMPAIGN IN 2001

Table 1.2. Villages under surveillance and endemic and reported cases in 2001

Country No of Villages in 2001 Reported cases in 2001 cases in 2000 under Currently Indigenous Imported Total surveillance endemic Endemic countries Ben in 186 158 39 156 16 172 Burkina Faso 1,956 389 202 1,021 11 1,032 CAR 35 22 34 2 36 Cote d'lvoire 297 28 226 5 231 Ethiopia 60 83 10 10 19 29 Ghana 7,402 1,237 779 4,738 4,739 Mali 290 158 120 708 10 718 Mauritania 136 335 25 94 0 94 "!!_g_er 1,166 622 50 405 12 417 Nigeria 7,869 1 '116 733 5,355 0 5,355 Sudan 54,890 6,11 o_ 3,921 49,471 0 49,471 Toga 828 1,214 180 1,340 14 1,354 Uganda 96 55 9 51 4 55 Countries in pre-certification stage Cameroon 5 117 0 0 5 5 Chad 3 94 0 0 0 0 Kenya 4 0 0 8 8 Senegal 0 0 0 1 Yemen 0 0 0 0 0 Total 75,223 11,688 6,118 63,609 108 63,717

... no data

Table 1.3. Imported cases in 2001

Country of Country of origin To go importation Ben in Burkina I Cote I Ghana Mali Nlge< j Nigeria Sudan Total Faso d'lvoire 1 Ben in 1 15 16 . I- ______, . ~ Burkina Faso 4 2 2 3 11 Cameroon 5 5 -r-· - --- CAR* 2 2 --1- ! I I Cote d'lvoire 1 3 1 5 -~ - - Ethiopia 19 19 •· I I Ghana 1 1 - - r Kenya 8 8 I I Mali 5 I 5 10 ------· - t--- 1- Mauritania - I T Niger 2 - 3 3 4 12 Nigeria ! - - f-- l - Senegal ' 1 1 I - I Sudan - -- r Togo 1 11 2 14 - - -- j ..J:!_ganda - r 4 4 Total 3 5 4 19 5 11 11 33 I 17 108

12 F1o\PPOfiT SUF1 U1 CAMPI\G I~E MONDI!\LE D'EFl;\DICi\Tim! DEL'\ DRACUNCULOSE EN 2001

1.6. Imported cases 1.6. Cas importes In 2001 , there were 108 imported cases reported En 2001 , il y avait 108 cas importes enregistres by several countries, endemic or in their pre-certifi­ par differents pays, endemiques ou en phase de pre­ cation phase. Ethiopia had the highest number of certification. L'Ethiopie avait le plus grand nombre imported cases (19) followed by Benin(16), Togo (14), de cas importes (19) suivi par le Benin (16), le Togo Niger (12), Burkina Faso, (11) and Mali (1 0). Table (14), le Niger (12), le Burkina Faso(11) et le Mali (1 0). 1 .2 and 1 .3 show in detail the origin and place of detection of imported cases in 2001. Figure 1. 7 and 1 .8 shows importation of cases in West African and West African countries respectively.

Figure 1. 7. Cases exported from Sudan to neighbouring countries, 2001

Masindi KakumaO

UGANDA ) KENYA

13 REPORT ON THE STATUS OF THE DRACUNCULIASIS GLOBAL ERADICATIOI'I CAMPAIC:oN IN 2001

Figure 1 .8. Cases exported from several endemic countries in West Africa to neighbouring countries, 2001.

14 Fli\Pf'ORT SUR U1 C•\MPI\GNE MUNDI•\LE D'En;\DIC.".TION DE LP. DRACUNCULOSE El-l 2001

2. SITUATION IN HIGHLY 2. SITUATION DANS LES PAYS ENDEMIC COUNTRIES FORTEMENT ENDEMIQUES 2.1. Overview of highly endemic countries 2.1. Vue d'ensemble des pays There are three countries that have been highly fortement endemiques endemic for dracunculiasis during the last few year. Trois pays ont ete fortement endemiques pendant Ghana and Nigeria reported the highest number of la derniere annee : le Soudan, le Ghana et le Nigeria. cases at the start of the programme in 1989 (179,556 Le Ghana et le Nigeria ont rapporte le nombre le plus and 653,492 respectively). Sudan reported 118,578 eleve de cas au debut de leur programme en 1989 cases in 1996 when the national dracunculiasis eradi­ (179 556 et 653 492 respectivement). Le Soudan a cation programme was established. rapporte 118 578 cas en 1996 lorsque le programme national d'eradication de dracunculose a ete etabli. In 2001 , dracunculiasis cases in these three coun­ tries reached 59,565 and accounted for about 93% En 2001, les cas de dracunculose dans ces trois (59,565/63, 717) of the total number of cases world­ pays ont atteint 59 565 et ont represents environ wide [fable 2.1). Ghana and Nigeria reported 4,739 93% (59 565/63 717) du nombre de cas dans le and 5,355 cases respectively. Sudan reported 49,471 monde (tableau 2.1). Le Ghana et le Nigeria ont rap­ cases, representing 83% of the cases in the three parte 4 739 et 5 355 cas respectivement. Le Sou­ countries. Total number of villages under surveillance dan a rapporte 49 471 cas, representant 83% des during 2001 were 8,393. Out of those, 65% reported cas dans les trois pays. En 2001, 8 393 villages one or more cases in 2001. etaient sous surveillance. Parmi eux, 65% ont notifie un ou plusieurs cas. The decrease of the number of cases in 2001 compared with 2000 was small and have not ex­ La diminution du nombre de cas de 2001 com­ ceeded 15% for the three countries. Whilst the per­ pare a 2000 etait faible et n'a pas excede 15% pour centage of decrease was 36% and 32% for Ghana les trois pays. Alors que le pourcentage de la dimi­ and Nigeria respectively, it was only 10% for Sudan. nution etait de 36% et 32% pour le Ghana et le Nigeria respectivement, il etait de seulement 10% pour le Soudan.

Table 2.1 . Villages under surveillance and endemic and reported cases in 2001

Country No of Villages in 2001 Reported cases in 2001 cases in 2000 under Currently Indigenous Imported Total surveillance endemic I Ghana ---7,402 1,237 779-- -- 4738 b-t 4EQ__ (8L Nigeria 7,869 1 '116 733 5355 j 0 5,355 (9) Sudan 54,890 6,040 3,921 49,471 I 0 49,471 (83) Total 70,161 8,393 5,433 57,913 • 1 I 59,565 (100,-

2.2. Ghana 2.2. Ghana From 1992 to 1994 dracunculiasis cases de­ De 1992 a 1994 les cas de dracunculose ont di­ clined rapidly from 66,697 cases to 8,432 cases. minue rapidement de 66 697 a 8 432. De 1994 a From 1994 to 2000 cases fluctuated with a maxi­ 2000, le nombre de cas a fluctue avec un maximum mum of 9,027 cases in 1999 and a minimum of de 9 027 cas en 1999 et un minimum de 4 877 cas 4,877 cases in 1996. In 2000, a total of 7,402 en 1996. En 2000, un total de 7 402 cas ont ete cases were reported, a reduction of 18% compared notifi8s, representant une reduction de 18% com­ to 1999 (Figure 2.1 ). pare a 1999 (figure 2.1 ). En 2001 , le programme a

15 nEPORT ON THE STATUS OF THE DRACUNCULIASIS GLOBAL ERADICATION CAMPAIC.oN IN 2001

The Programme reported only 4,738 indigenous notifie seulement 4 738 cas autochtones (en plus du cases (in addition to 1 imported case) during 2001 , seul cas imports) ce qui represents une reduction de which is a reduction of 36% when compared to the 36% une fois compare aux 7 401 cas autochtones 7,401 indigenous cases reported in 2000 (Figure rapportes en 2000 (figure 2.1 ). Soixante huit pour cent 2.1 ). 68% of cases were reported as contained. Cases des cas ant ete notifies comme isoles. Des cas ant were reported from Northern Region (60%). Brong ete rapportes dans les Regions du Nord (60%), du Ahafo (17%) and Volta (15%) Regions (Map 2.1 and Brong Ahafo (17%) et les Regions de la Volta (15%) 2.2). Three of Ghana's ten Regions (Greater Accra, (carte 2.1 et 2.2). Trois des dix regions du Ghana (le Upper East, Western) have reported zero indigenous Greater Accra, Upper East, Western) ant notifie zero cases for over a year. Dracunculiasis transmission/ cas autochtone pendant plus d'une annee. La saison infection season occurred from January to May and de transmission de la dracunculose s'est produite from November to December. de janvier a mai et de novembre a decembre.

Figure 2.1 . Annual number of dracunculiasis cases in Ghana in 1991 -2001

60,000

(f) Q) 50,000 (f) CO (.) ·cn(f) 40,000 - ~ '3 (.) c 30,000 ::J (.) ~ '0 20,000 0 0 z 10,000

0 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001

There were a constant number of new highly en­ Le nombre de nouveaux villages fortement ende­ demic villages every year in Ghana. miques a ete constamment eleve au Ghana durant les dernieres annees. La recherche de cas est ne­ Case search is needed in highly endemic area to cessaire dans les secteurs fortement endemiques determine the reason for the phenomena of yearly pour elucider les phenomenes de recurrence des recurrence of new infected villages (42%) as well as nouveaux villages infectes (42%) ainsi que des villa­ villages with one case only (30%). In fact, 68 out of ges avec un cas unique (30%). En fait, 68 districts 11 0 district in Ghana reported dracunculiasis cases sur 11 0 au Ghana ant notifie des cas de in 2001. There is an increase of 13 infected districts dracunculose en 2001 . Par rapport a 2000, il y a 13 in 2001 compared with 2000. districts infectes de plus en 2001 .

16 RI\Pf'ORT SUR LJ\ CAMPI\GI~E MONDI1\LE D'EHADICATIO~J DEL". DRACUNCULOSE El~ 2001

Figure 2.2. Monthly number of dracunculiasis cases in Ghana in 2000-2001

2,000 __,._ 2001 ~ -·- 2000 (/) 1,800 (j) (/) ' ro 1,600 ' () ... (/) 1,400 'iij ' .g! 1,200 ' -su 954 ' c 1,000 ... ::J u 800 ~ '"0 600 • 0 / 495 z0 400 200 63 0 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

Map 2.1. Dracunculiasis reported cases by in Ghana

2001

Number of cases D o 0 1-50 51 - 500 • 501 - 1,000 • > 1,000

17 f"lEPORT ON THE STATUS OF THE DRACUNCULIASIS GLOBAL ER.ADICATIOI'I CAMPAIGN IN 2001

a- Dracunculiasis indicators for Ghana Name Ghana Guinaa \1/orm Programma lnlormation

1'391 3575 1725• 33•356 1992 3575 1402 17544 1993 3575 1221 11569 1!l'34 5328 047 7146 1995 3636 726 7583 1996 3741 502 4582 0 0 0 0 19971 351 0 462 7087 1998 00! 282 2610 1999 490 275 2582 2088 19458 2000 853 350 3934 1919 :6109 0 2001 1255 811 4742 431 •I I

b- Dracunculiasis indicators for Ho District Name Ho

1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 0 0 0 0 4 2 I) I) 22 6 a 990 6 6 4

Percentage of endemic villages under acceptable surveillance, by district.

Do% D 21-50% D 51%-84% 85%-99% • 100%

Table 2.1.1 Dracunculiasis indicators for Ghana Tableau 2.1.1: lndicateurs de dracunculose pour (a) and for Ho District (b). le Ghana (a) et pour le district de Ho (b).

Map 2.1 .1 Dracunculiasis endemic villages in Carte 2.1.1: Villages d'endemie dracunculienne Ghana with percentage of villages under acceptable au Ghana, avec le pourcentage de villages sous sur­ surveillance in each districts during 2001 (villages sub­ veillance acceptable par district, en 2001 (villages mitting at least 9 reports out of 12 reports per year). soumettant au mains 9 rapports sur 12, par an).

Table 2.1.1 a and Map 2.1.1 show the percentage Tableau 2.1.1 a et carte 2.1.1: montrent le pour­ of villages under surveillance in each district in 2001. centage de villages sous surveillance, par district, Few districts such as Ho District were not under en 2001. Quelques districts, tel que celui de Ho, acceptable surveillance during 2001. Ho District n'etaient pas sous surveillance acceptable en 2001. submitted 49 out of 72 reports due for 2001 (12 Le disctrict de Ho a soumis 49 rapports sur les 79 reports per year for each of the 6 villages under sur­ requis en 2001 (12 rapports par an pour chacun des veillance, Table 2.1.1 b). 6 villages sous surveillance, tableau 2.1.1 b).

18 R1\PPORT SUR U1 CM;1PI\GI~E MONDI,\LE D'En;\DIC.".TION DE U\ DRACUNCULOSE El~ 2001

2.3. Nigeria 2.3. Nigeria Dracunculiasis cases have been declining from Les cas de Dracunculose ont diminue de 1991 a 1991 to 1995 in Nigeria. From 1995 to 1999, 1995 au Nigeria. De 1995 a 1999, le nombre de cas monthly dracunculiasis cases were nearly the same mensuels de dracunculose etait presque identique each year ranging from 12,282 to 13,237 cases. d'une annee a I' autre, variant entre 12 282 et 13 237 Only in 2000 that a significant decline took place cas . C'est seulement en 2000 qu'une diminution when cases fell to 7,869 cases. (Figure 2.3). significative a eu lieu quand le nombre de cas est tombe a 7 869 (figure 2.3). Le Nigeria est reste le Nigeria remained the second country after Sudan deuxieme pays, apres le Soudan, qui ait notifie le in the number of cases reported in 2001. The pro­ plus grand nombre de cas en 2001. Le programme gramme reported 5,355 dracunculiasis cases dur­ a notifie 5 355 cas de dracunculose en 2001 repre­ ing 2001 representing a reduction of 32% compared sentant une reduction de 32% compare a 2000. with 2000. 65% (3,503/5,355) of the reported cases Soixante cinq pour cent (3 503/5 355) des cas rap­ were contained. Case occurred throughout the year partes ont ete isoles. Les cas sont distribues sur but the incidence was higher during January to April, toute l'annee mais !'incidence etait plus elevee de May to October and November to December. The janvier a avril, et de mai a decembre. La saison maxi­ peak infection season in the south-east and south­ male d'infection dans le sud-est et le sud-ouest a west was during January to April and November to eu lieu entre janvier et avril et de novembre a de­ December. In the north-east and north-west, the cembre. Dans le nord-est et le nord-ouest, le pie de peak appeared to occur during May to October !'incidence se situait durant la periode de mai a oc­ (Figure 2.4). tobre (figure 2.4).

Figure 2.3. Annual number of dracunculiasis cases in Nigeria in 1991-2001

300,000 281,937

en 250,000 (])en CO u ·u;en 200,000 .\!! "5 u c 150,000 ::J ~ -o 100,000 0 0 z 50,000 16374 ' 12,28212,500 13,42013,237 7,869 5,355 0 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001

Figure 2.4. Monthly number of dracunculiasis cases in Nigeria in 2000-2001

2,000 ----- 2000 .....,._ 2001 1,600

1,200

800

400

04---~~~~--~--~--~--r-~~~~~--,-~ Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

19 REPORT O~l THE STATUS uF THE DRACUNCULIASIS GLOBAL EnADIGATION CAMPAIGN IN 2001

In 2001 , dracunculiasis cases were reported from En 2001 , des cas de dracunculose ont ete rappor­ 17 out of the 36 states and the Federal Capital Terri­ tes de 17 sur les 36 Etats et le territoire de la capitale tory of Nigeria. There was a drop in the number of federale du Nigeria. Entre 2000 et 2001 , le nombre endemic villages reporting cases from 907 in the de villages infectes a baisse de 907 a 733 (soit 19%). year 2000 to 733 in 2001 (19%). High percentage or Un pourcentage eleve (33%) des villages infectes en 33% of the endemic villages in 2001 were newly in­ 2001 , representait des villages nouvellement infectes fected and reported 29% of the total number of cases et ont contribue a29% du nombre total de cas. Trente while 34% of villages that were endemic in 2000 quatre pour-cent des villages qui etaient infectes en reported zero cases in 2001 . Three states (Ebonyi, 2000 ont notifie zero cas en 2001. Trois etats (Ebonyi, Benue and Engu) all from South-Eastern Zone (Map Benue et Engu) tous de la zone du Sud-Est (carte 2.3 2.3 and 2.4) reported 4,051 cases or 76% of the et 2.4) ont notifie 4 051 cas soit 76% des cas de reported cases in 2001 compared with 4510 or 57% 2001 compares a 4 510 (57%) du nombre de cas de of the number of cases reported in 2000. Thus, the 2000. Ainsi, la reduction du nombre total de cas etait total reduction in the number of cases was mainly principalement le fait de la reduction dans les autres from the remaining endemic states of Nigeria. Ebonyi etats endemiques du Nigeria. L'Etat d'Ebonyi etait l'etat State was the most highly endemic state with 299 le plus fortement endemique avec 299 villages infec­ endemic villages and 2092 cases in 2001 represent­ tes et 2 092 cas en 2001 (soit 39% du nombre total ing (39%) of the total number of cases. Table 2.2 de cas) . Le tableau 2.2 montre qu'un nombre eleve shows that a high number of villages reported 12 de villages a soumis 12 rapports mensuels de sur­ reports in 2000. veillance en 2000.

Table 2.2. Report received from the villages according to number of cases per village in Nigeria, 2000

Report received Villages reporting according to per year their dracunculiasis cases in 2000 0 cases_ 1 case > 1 cases I Total villag~s <9 5 33 88 126 9 to 11 9__ 24 124 1 157 12 474 143 489 1,106 Total 488 I 200 701 1,389

20 RAPf>ORT SUR U1 CI\MP,l..GNE MONDif,LE D'Eni\DICArlm! DE LJ'. DRACUNCULOSE El-l 2001

Map 2.3. Dracunculiasis reported cases by State in Nigeria

2000 2001

Number of cases D 0 D 1 - 50 0 51 - 500 501 - 1,000 • > 1,000

2.4. Sudan 2.4. Soudan Sudan is the highest endemic country for dracun­ Le Soudan est le pays le plus endemique pour la culiasis accounting for 78% of the global cases. Of dracunculose et compte 78% des cas dans le all Sudanese cases, nearly 99% were reported from monde. Presque 99% des cas soudanais ont ete the southern part. recenses dans le sud du pays.

The reported cases were relatively low in the early Les cas notifies etaient relativement peu nombreux 90' with less than 3000 cases in each of 1992 and dans les annees 90, avec mains de 3000 cas en 1993. Due to improved surveillance, reported cases 1992 et en 1993. En raison de la mise en place d'un increased year by year and in 1996, 118,578 cases systeme de surveillance ameliore, le nombre de cas were reported. Cases fluctuated after that year to rapporte a augments d' an nee en annee et, en 1996, reach around 49,471 cases in 2001. However, these 118 578 cas ont ete notifies. Le nombre de cas a reported cases surely underestimate the actual dra­ ensuite fluctue pour se stabiliser autour de 49 471 cunculiasis cases because many areas were inac­ en 2001 . Cependant, il y a surement une sous-esti­ cessible in the southern part of the country due to mation du nombre reel des cas car beaucoup de the civil conflict. 48% of the cases were reported as regions restent inaccessibles dans le sud du pays a contained. Figure 2.5 and 2.6 show the status of cause du conflit. Ouarante huit pour-cent des cas dracunculiasis cases during the last ten years and ont ete notifies comme isoles. Les figures 2.5 et 2.6 the monthly distribution of cases in 2000-2001 re­ montrent !'evolution des cas de dracunculose pen­ spectively. dant les dix dernieres annees et la distribution men­ suelle des cas en 2000-2001 respectivement. The northern states reported only 132 cases out of which 4 7 cases were imported by displaced per­ Les Etats du Nord ont notifi8 seulement 132 cas sons from endemic areas in the southern States. dont 4 7 ont ete importes par les personnes depla­ The remaining 85 cases were indigenous cases re­ cees des secteurs endemiques dans les Etats meri­ ported from 10 villages. About one third of indig­ dionaux. Les 85 cas restants etaient des cas enous cases were reported from White Nile State autochtones recenses dans 10 villages. Environ un

21 REPORT ON THE STATUS OF THE DRACUNCULIASIS GLOBAL ERADICATION CAMPAIGN IN 2001

and one-fourth from South Darfur State. 79% (1 04/ tiers des cas autochtones ant ete rapportes de I'Etat 132) of the cases in the northern states were reported du White Nile et un quart de I'Etat du Darfur Sud. as contained. 79% (1 04/132) des cas dans les Etats du Nord ant ete notifies comme cas isoles. In the southern states 49,339 dracunculiasis cases were reported. The highest concentration of Dans les Etats du Sud, 49 339 cas de dracunculose reported cases was in Jonglei State with 34% ant ete rapportes. L' Etat de Jonglei avec 34% (17 025/ (17,025/49,471) and Warab State with 29% (14,454/ 49 471) et I'Etat de Warab avec 29% (14 454/49 471) 49,471). The remaining 37% was reported from other avaient le plus grand nombre de cas. Les 37% res­ southern states. Although there was a decrease of tants ant ete rapportes des autres etats du sud. Bien 10% compared with the number of cases reported qu'il ait y eu une diminution de 10% compare au in 2000, this cannot be considered as real reduction nombre de cas rapportes en 2000, ceci ne peut pas as many endemic villages in the south are not ac­ etre considers comme une vraie reduction car de nom­ cessible and the status of dracunculiasis remains breux villages du sud restent inaccessibles a la sur­ unknown. Of the total number of 6 040 villages which veillance de la dracunculose. Des 6 040 villages qui are known to be endemic, 65% reported one or more sont connus pour etre infectes, 65% ant rapporte un cases, 22 % reported zero cases and 36% submit­ ou plusieurs cas, 22 % ant rapporte zero cas et 36% ted no report in 2001 since they were not accessi­ n'ont soumis aucun rapport en 2001 puisqu'ils ble. The peak occurrence of cases was during May n'etaient pas accessibles. L'incidence maximale des to October. cas a eu lieu entre mai et octobre.

Figure 2.5. Annual number of dracunculiasis cases in Sudan in 1991-2001

140,000 m Q) m 120,000 ro (.) m '(jj 100,000 .5!1 '5 80,000 (.) c ~ (.) 60,000 ~ '0 40,000 0 z0 20,000 0 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001

Figure 2.6. Monthly number of dracunculiasis cases in Sudan in 2000-2001

12,000 -·- 2000 -2001

10,000

~ 8,000 .':!l -~ 6,000 '5 g ~ ~ 4,000 0 2,000 ·--·-·---· 0+---~~~~--~~~--~--~~~~--~--~~ Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

22 R1\Pf'ORT SUR U1 CAMPAGI-JE MCNDII\LE D'ER;\OIC."J'ION DEL". D RACUNCULOSE EN 2001 . -

Table 2.2. Report received from the villages according to number of cases per village in Sudan, 2001

Report received Dracunculiasis cases Total per year per village number of 0 cases 1 case >1 cases villages <9 1,438 330 1,365 3,133 I 9 to 11 784 201 1,343 439 12 144 66 439 649 ' Total 2,366 597 · 3,147 6,110

Table 2.3 shows that, about 10% of the villages Le tableau 2.3 montre qu'environ 10% des villa­ reported one case only and about 52% reported more ges ant rapporte un cas seulement et environ 52% than one case. The remaining 38% of the villages ant soumis mains de 12 rapports mensuels de sur­ reported zero cases. 58% (3,572/6, 11 0) of villages veillance par an. Cependant, environ, 62% des villa­ submitted less than 12 report per year. However, ges qui ant soumis mains de 9 rapports par an about, 62% of the villages that submitted less than n'avaient pas de cas. 9 report per year were reporting zero cases.

... / '· _ _ \ r-.... -1 r' I \ / \.. .-/ ..... _ .· J ,' / \ ·-'·"\. \

I r ·"', 7--- , I f _ i'/

Map 2.5. Dracunculiasis reported ~ -- \' cases by Province in ' 1,_ ·:·"' ;; ..

southern Sudan in 2000 '· '·1 i, ~>-

\' I I ·.\.:'/ \ f"•. Number of cases ''--...,;" ·-, . 0 1 -50 51 - 500 • 501 - 1000 • > 1,000

Map 2.6. Dracunculiasis reported cases by Province in southern Sudan in 2001

23 REPORT ON THE STATUS OF THE DRACUNCULIASIS GLOBAL ERADICATION CAMf"'AiloN IN 2001

3. COUNTRIES WITH 3. PAYS D'ENDEMIE MODEREE MODERATED LEVELS OF (entre 100 et 1500 cas par an) ENDEMICITY (100 to 1500 cases per year)

3.1. Overview of endemic countries 3.1. Vue d'ensemble des pays endemi· reporting 1 00 to 1500 cases in ques rapportant de 1 00 a 1500 2001 cas en 2001 There were six countries that can be classified as Six pays on ete classes dans le groupe des pays having reported moderate number of dracunculiasis d'endemie moderee en 2001 (de 1oo a 1500 cas). cases in 2001 (from 100 to 1 ,500 cases). A sum­ Un recapitulatif du statut de ces pays est presents mary of the status of those countries is shown in dans le tableau 3.1 . Par ordre decroissant du nom­ Table 3.1. They were according to their reporting bre de cas, on retrouve le Toga (1 354), le Burkina cases in descending order: Toga (1 ,354), Burkina Faso (1 032), le Mali (718), le Niger (417), la Cote Faso (1 ,032), Mali (718), Niger (417), Cote d'lvoire d'lvoire (231) et le Benin (172). La reduction moyenne (231) and Benin (172). The average reduction in the du nombre de cas notiMs pour les six pays en 2001 number of reported cases for the six countries in compare a 2000 etait seulement de 18%. Le Niger 2001 compared with 2000 was only 18%. Niger was etait le seul de ces pays a realiser une reduction ele­ the only moderately endemic country to achieve high vee du nombre de cas notifies (65%) suivi du Bur­ reduction of reported cases of 65% followed by kina Faso (48%), de la Cote d'lvoire (21 %) et du Benin Burkina Faso (48%), Cote d'lvoire (21 %) and Benin (6%). Le Toga et le Mali ont rapporte une augmenta­ (6%). Toga and Mali reported an increase of the tion du nombre de cas de 65% et de 151% respec­ number of cases of 65% and 151% respectively in tivement en 2001 compare a 2000, due 2001 compared with 2000. This was mainly due to principalement a une explosion des cas dans quel­ outbreaks of cases in a few number of villages in ques villages. Des 3 232 villages qui etaient sous each countries. Of the 3,232 villages that were un­ suNeillance en 2001, 619 etaient infectes avec un der suNeillance in 2001, 619 were endemic with one ou plusieurs cas. or more cases.

Table 3.1. Summary of villages and cases in 2001 in moderately Infected countries

Country No of Villages currently Reported cases in 2001 cases in ' ~ 2000 under surveillance endemic Indigenous Imported Total - ' Ben in I 186 158 39 I 156 16 172 Burkina Faso 1,956 389 202 1R21 11 1,o:g_ COte d'lvoire 297 691 28 226 5 231 Mali 290 158 120 708 10 718 - - Niger 1,1661 622 -- 50 405 12 417 Togo 828 1,214 l 180 1,340 14 1,354 Total 4,723 3,232 I 619 3,856 68 3,924

24 RAP!"'RT SUR L-'1 CAMPAGNE MCNDI1\LE D'Ert;\DIC.".TION DEL'\ DRACUNCULOSE El~ 2001

3.2. Benin 3.2. Benin During the last eleven years the highest number Pendant les onze dernieres annees, c'est en 1993 of cases of dracunculiasis in Benin were reported in qu'il y a eu le nombre le plus eleve de cas de 1993 (Figure 3.1 ). After that year, dracunculiasis dracunculose au Benin (Figure 3. 1.). Par la suite, le cases declined rapidly and was as low as 172 cases nombre de cas de dracunculose a diminue rapidement in 2001 . Those comprised 156 indigenous and 16 jusqu'a 172 cas en 2001 dont 156 cas autochtones imported cases. lt was reported that 95% ofthe cases et 16 cas importes. 95% des cas avaient ete isoles. had been contained. There was a modest reduction En 2001, on observe une reduction moderee de 6% of 6% of dracunculiasis cases in 2001 compared du nombre de cas de dracunculose compare a celui with that of 2000. Figure 3.2 shows the monthly de 2000. La figure 3.2 montre la distribution mensuelle distribution of cases during 2000-2001. Cases of des cas en 2000-2001 . Les cas de dracunculose dracunculiasis were scattered in most areas in Benin etaient distribues dans la plupart des regions au but more than half were concentrated in Djidja and Benin mais plus de la moiti8 d'entre eux ant ete Savalou Districts (Map 3.1 ). Peaks of transmission concentres dans les regions de Djidja et de Savalou are from February to April and from September to (carte 3.1 ). Les pies de transmission ant lieu de fe­ December (Figure 3.2). vrier a avril et de septembre a decembre (figure 3.2).

Figure 3.1. Annual number of dracunculiasis cases in Benin in 1991 -2001

18,000 (/) Q) (/) 16,000 ro u 14,000 (/) ·u; 12,000 .!!! 3 u 10,000 c :::J 8,000 6,000 u~ 0 4,000 4,302 2,273 z0 2,000 1 27 .4 855 695 492 186 172 0 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001

Figure 3.2. Monthly number of dracunculiasis cases in Benin in 2000-2001

100 --- 2000 -2001

80 70 Sl r3 60 -~

~ \ 40 "' \ \ j \ .. 20 17 14 ' ,._ 7'~ 0 0 .... Jan Feb Mar Apr May Jun--- Jul Aug Sep Oct Nov Dec

25 REPORT ON THE STATUS OF THE DRACUNCULIASIS GLOBAL ERADICATION CAMPAIGN IN 2001

Map 3.1. Endemic villages according to number of cases in three different years, Benin

,, \ .. ; ~· I ( .. ; ,, I " " '.' ~ '~ ' \ ) ... ____ . } l r- --~-- •. • ' • ' " ,r--" I ; • r - \ I L • ' ~ '· ./' ( I j '• ., • . .. ,

1 •. l 'I - 1 ' I. ; l ~. , (~ I I -~ " ,-t . 1995 1998 2001 e 1 cas I 1 case • 2 a 10 cas I 2-10 cases e 11 a 100 cas I 11-100 cases • >a 100 cas I> 100 cases

3.3. Burkina Faso 3.3. Burkina Faso From 1992 to 1997, the National Guinea Worm De 1992 a 1997, le programme national d'eradi­ Eradication Programme in Burkina Faso reduced cation du ver de Guinee au Burkina Faso a reduit le dracunculiasis cases more than four-folds, from nombre des cas de dracunculose de 11 784 a 2 4 77 11,784 to 2,477 cases. However, during 1997 to cas. Cependant, de 1997 a 2000, le nombre de cas 2000, the number of cases did not decrease dra­ n'a pas diminue de fac;:on si marquee, allant de 2 477 matically and ranged from 2,477 to 1,956 (Figure a 1 956 cas (figure 3.3). En 2001 , le programme na­ 3.3). In 2001, the national Guinea worm eradication tional d'eradication du ver de Guinee a notifie 1 021 programme reported 1,021 cases in addition to 11 cas autochtones et 11 cas importes, soit une reduc­ imported cases, a 48% reduction in the number of tion de 48% du nombre de cas compare a 2000. La cases when compared to 2000. Figure 3.4 shows figure 3.4 montre la distribution mensuelle des cas the monthly distribution of cases during 2000 and en 2000 et 2001 . Le Burkina Faso est en cinquieme 2001 . Burkina Faso was the fifth highest country in position parmi les pays ayant le plus grand nombre the number of dracunculiasis cases after Sudan, de cas de dracunculose, apres le Soudan, le Nigeria, Nigeria, Ghana and Toga. 73% of the cases were le Ghana et le Toga. Le programme a mentionne que reported to have been contained. The majority of 73% des cas notifies ant ete isoles. La majorite des dracunculiasis cases were found in the northern­ cas de dracunculose ant ete trouves dans la partie central part of the country. A small area in the south­ Centre-Nord du pays. Une petite region du sud-ouest west, bordering Cote d'lvoire and Ghana, has a la frontiers du Ghana et de la Cote d'lvoire a rap­ reported 15% of the cases (Map 3.2). The program parte 15% des cas (carte 3.2). Le programme a ame­ improved 15 wells in four of the most endemic vil­ liore l'etat de 15 puits dans quatre des villages les lages of Ouahigouya District, which reported the plus endemiques de la zone de Ouahigouya, placee second highest number of cases (143) of all dis- en deuxieme position pour le nombre le plus eleve

26 R1\Pi'ORT SUR LA CAMPAGf~E MCNDft\LE D'ER;\DICAriON DE U\ DRACUNCULOSE Ef~ 2001

tricts in the country in 2000, and has started to im­ de cas (143) de toutes les zones dans le pays en prove 16 wells in the village of Gorgare in Tougan 2000. Le programme a egalement commence a District, which reported 83 cases last year. Filters ameliorer l'etat de 16 puits dans le village de have been distributed in "all" endemic villages. Gorgare dans la zone de Tougan, qui a rapporte 83 cas l'annee derniere. Des filtres ont ete distribues dans les villages endemiques.

Figure 3.3. Annual number of dracunculiasis cases in Burkina in 1991-2001

14,000 m Q) 11,784 m 12,000 ro (.) m ·u; 10,000 .\!l -s 8,000 (.) c :::J (.) 6,000 ~ "0 4,000 3,241 0 2,477 2,227 2,184 1 956 z0 2,000 1,032 0 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001

Figure 3.4. Monthly number of dracunculiasis cases in Burkina in 2000-2001

-.- 2000 - 2001 400

m~ ro u m ·u; .\!l -s (.) c :::J 200 u ~ 0

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

Table 3.2 . Report received from the villages according to number of cases per village in Burkina Faso, 2000-2001

Report Vill~ges reporting according to their dracunculiasis cases received 2000 2001 per year 0 cases 1 case >1 cases Total No 0 cases 1 case >1 cases Total No. _L _ of villages__ of vill'!_ges <9 2 34 67 103 54 27 82 9 to 11 3 30 61 94 ~ 7 8 17 12 1-- 1 2 182 44 64 290 Total 6 129 199 185 105 99 r 389

27 REPOf

Table 3.2 shows low level of reporting in 2000. Le tableau 3.2 montre le niveau relativement bas only 2 out of 199 villages submitted 12 reports each des rapports mensuels de surveillance en 2000. Sur per year, 94 villages submitted 9 to 11 reports and 199 villages sous surveillance, seuls 2 ant soumis 103 villages submitted less than 9 reports. In 2001, les 12 rapports mensuels requis, 94 villages ant the percentage of villages submitting report monthly sou m is 9 a 11 rapports et 103 villages ant soumis increased. 389 villages submitted reports during mains de 9 rapports. En 2001, le pourcentage des 2001. Three quarters of them (75%; 290/389) sub­ villages soumettant des rapports mensuels a aug­ mitted 12 reports. Although 182 of those villages ments. Sur les 389 villages sous surveillance, 290 reported zero cases, nevertheless, they submitted (75%) ont soumis 12 rapports. A noter que 182 de reports every month in 2001 . Sixty six percents of ces villages ant notifie zero cas. Parmi les villages villages that submitted less than 9 reports had one qui ant soumis mains de 9 rapports, 66% avaient case only and 33% had more than one cases. seulement un cas et 33% avaient plus d'un cas.

Map 3.2 shows the location of endemic villages Les cartes 3.2 montrent la localisation geogra­ according to the number of cases in three different phique des villages infectes dans le pays (taille pro­ years for three selected years. Map 3.3 shows the portionnelle au nombre de cas) pour trois annees concentration of endemic villages in Burkina Faso differentes. La carte 3.3 montre les zones de con­ during 2001 . Map 3.4 shows the origin of 11 im~ centration des villages endemiques au Burkina Faso parted cases to Burkina Faso from Mali, Niger Ghana en 2001. La carte 3.4 montre l'origine de 11 cas and Cote d'lvoire. importes au Burkina Faso du Mali, du Niger, du Ghana et de Cote d'lvoire.

Map 3.2. Location of endemic villages according to the number of cases in three different years, Burkina Faso

• 1 casl1 case • 2 a 10 cas I 2-10 cases • 11 a100casl11-100cases e >a 100 cas I> 100 cases

28 RAPPORT- SUR U1 CAMPA.Gf~E MONDI,\LE D'EfV\DIC.t•.TION DE LP. DRACUNCULOSE EN -2001

Map 3.3. Endemic villages In Burkina Faso, 2001 (number of cases is between brackets.)

Koui (24) Yabo (13)

Mekpa (20)

Zindi (2)

Douloumba (2) Batie (15) Takbo (11)

• 1 cas/ 1 case • 2a 10cas/2-10cases • 11 a100cas/11-100cases • >a100cas/>100

29 REPORT ON THE STATUS OF THE DRACUNCULIASIS GLOBAL ERADICATION GAMPAIGN IN 2001

Map 3.4. Imported cases to Burkina Faso from neighbouring countries in 2001

Ghana

3.4. Cote d'lvoire 3.4. Cote d'lvoire Figure 3.5 shows the rapid decline in the number La figure 3.5 montre la decroissance rapide du of reported dracunculiasis cases in Cote d'lvoire nombre de cas de dracunculose notifies en Cote during the last eleven years. Only in 1998, reported d'lvoire pendant les onze dernieres annees. On ob­ cases increased compared with 1997 (1 A 14 and serve une remontee du nombre de cas en 1998, par 1,254 respectively). Cote d'lvoire reported 231 cases rapport au nombre de 1997 (1 414 et 1 254 respecti­ in 2001 (including 5 imported cases), a reduction of vement). La Cote d'lvoire a notifie 231 cas en 2001 21% compared with 2000 when 285 indigenous (dont 5 importes), ce qui correspond a une reduction cases were reported (Figure 3.6). The endemic ar­ de 21% compare a 2000 ou 285 cas autochtones eas were mainly in the east of the country (Bouna, ont ete rapportes (figure 3.6). Les zones endemiques Tanda, Mbahiakro) and in Diva in the south and in etaient principalement localisees dans a I'Est du pays Seguela in the centre-west of the country (Map 3.5). (Bouna, Tanda, Mbahiakro), dans la region de Diva Dracunculiasis cases occurred mainly during the first dans le Sud et dans la region de Seguela au centre­ half of the year (from January to May). Cote d'lvoire ouest du pays (carte 3.5). Les cas de dracunculose has 28 endemic villages and 71% of them sent 9 or se sont produits principalement pendant le premier more reports to national level in 2001. Only one vil­ semestre (de janvier a mai). La Cote d'lvoire a 28 villa­ lage was a re-infected (Yaobilekro). ges endemiques et 71% d'entre eux ant envoys 9 rapports mensuels de surveillance ou plus, au niveau From 23 May to 4 June 2001 WHO staff member national en 2001 . Seulement un village etait re-in­ visited the Cote d'lvoire Programme. Discussions fects (Yaobilekro). Du 23 mai au 4 juin 2001, un mem­ were held with the Ministry of Health officials and bre du personnel de I'OMS a visite le programme de representatives of principal partners in a way to im­ Cote d'lvoire. Des discussions ont ete tenues avec prove the eradication measures, surveillance and case des fonctionnaires du Ministere de la Sante et des containment and visited four sanitary districts and representants des principaux partenaires, sur la ma­ villages. Evaluation is planned to take place in early niere d'ameliorer les mesures d'eradication, la sur­ 2002. veillance et l'isolement des cas. Une evaluation externe du programme est prevue en mai 2002.

30 nAr>PORT sun U1 CAMPAGI~E M()NDIALE D'Eilr\DICATION DE LA DRACUNCULOSE El~ 2001

Figure 3.6. Monthly number of dracunculiasis cases in Cote d'lvoire 2000-2001

1~~ 1 -·- 2000 -2001 80 (/J Ql (/J ro 70 0 (/J 'iii .!!! "S ] 40 1 0 :~ c 40 I ::J 0 fA-, ~ I "\. 0 I '-- ...- ..-., 3020 l•l I r '- 9 '\ 8 10 0 -.--""T --,-- -, Jan Feb Jul Aug Sep Oct Nov Dec

Table 3.3. Report received from the villages according to number of cases per village in Cote d'lvoire, 2000-2001

Report Villages reporting according to their dracunculiasis cases received 2000 2001 per year 0 cases 1 case >1 cases Total No 0 cases 1 case >1 cases Total No. of villages of villages <9 5 2 7 5 3 8 9 to 11 3 2 5 1 2 3 12 22 18 40 6 11 17 Total I * I 30 22 52 12 16 28

Data for 2000 and 2001 presented to WHO by Les donnees pour 2000 et 2001 envoyees aI'OMS Cote d'lvoire represented only villages with 1 case or par la Cote d'lvoire concernent seulement les villa­ more and excluded the villages that had zero cases ges ayant au mains un cas de dracunculose et ant as seen in Table 3.3. exclu les villages qui ant eu zero cas (tableau 3.3).

Map 3.5. Endemic villages according to number of cases in three different years, Cote d'lvoire

1995 1998 2001

• 1 cas/1 case • 2 a 1o cas I 2-10 cases e 11 a 100 cas I 11-100 cases • >a 100 cas/> 100

31 REPORT ON THE STATUS OF THE DRACUNCULIASIS GLOBAL ERADICATION CAMPAIGN IN 2001

Map 3.6. Currently endemic villages according to dracunculiasis cases in Cote d'lvoire (villages with high infection rates are indicated with the number of cases in brackets)

Map 3.6 shows villages with high infection rates La carte 3.6 montre les villages ayant un taux d'in­ in the north-western part of the country (number of fection eleve dans la partie nord-ouest du pays (le cases is between brackets). Map 3. 7 shows 5 im­ nombre de cas est entre parentheses). La carte 3.7 ported cases to Cote d'lvoire from neighbouring montre 5 cas importes en Cote d'lvoire des pays countries. voisins.

32 R•\Pi>ORT SUR U1 CAMPAGNE- MONDIALE-- D'Efv\DIC.ATION DEL~. DRACUNCULOSE El~ 2001

Map 3.7. Imported cases to Cote d'lvoire in 2001

Niger

' Ghana

3.5. Mali 3.5. Mali Figure 3.7 shows the consistent decline in the La figure 3.7 montre la diminution constants du number of dracunculiasis cases during the last nine nombre de cas de dracunculose pendant les neuf years (1993-2001 ). Contrary to this sharp decline, a dernieres annees (1993-2001 ). En contrasts avec considerable increase occurred in 2001 compared cette reduction, une augmentation considerable du with 2000. 708 indigenous cases were reported from nombre de cas s'est produite en 2001 . En effet, 708 120 villages during 2001 (in addition to 10 imported cas autochtones et 10 cas importes ant ete notifies cases) while 282 indigenous cases were reported in dans 120 villages correspondant a une augmenta­ 2000, an increase of 151%. This increase is mainly tion de 151 % par rapport aux 282 cas autochtones due to surges in cases in two Districts: Gao (190 recenses en 2000. Cette augmentation est principa­ cases in 2001 versus 11 cases in 2000) and Ansongo lement due a des flambees dans deux zones : Gao (178 cases in 2001 versus 73 cases in 2000). 51% (190 cas en 2001 contre 11 cas en 2000) et Ansongo of the total number of cases were reported as con­ (178 cas en 2001 contre 73 cas en 2000). La moiti8 tained. Figure 3.8 shows the monthly distribution of des cas notifies ant ete isoles. La figure 3.8 montre cases during 2000-2001. la distribution mensuelle des cas en 2000-2001 .

Figure 3. 7. Annual number of dracunculiasis cases in Mali in 1991 -2001

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001

33 REPORT 0N THE STATUS OF THE DRACUNCULIASIS GLOBAL ERADICATION CAMPAIGN IN 2001

Only 6 villages were accounting for 320 cases Seulement 6 villages comptaient 320 cas (soit (45% of the total cases of the Country): lntillit 90 45% de tousles cas du pays): lntillit 90 cas, Ansongo cases, Ansongo 88, Ouatagouna 51, Tessit 32, 88, Ouatagouna 51, Tessit 32, Gassi-Est 30, Gossi Est 30, Gourma-Rharous 29. Gourma-Rharous 29.

Table 3.4. shows that villages that submitted less Le tableau 3.4 montre que les villages qui ont sou­ than 9 reports in 2000 and 2001 had high percent­ mis mains de 9 rapports mensuels de surveillance age of villages reporting 1 case and more compared en 2001 sont en grande majorite des villages noti­ with villages submitting 9 to 12 reports in 2001 (72% fiant 1 cas ou plus de dracunculose. Les villages qui and 54% respectively). ont soumis 9 rapports mensuels ou plus sont en majorite des villages ou il n'y a pas eu de cas. The locations of endemic villages in Mali accord­ ing to the number of cases in three different years is La carte 3.9 montre la localisation geographique shown in Map 3.8. Concentration of endemic vil­ des villages endemiques au Mali sur trois annees lages in 2001 is shown in Map 3.9. In 2001, Mali differentes. En 2001, le Mali a eu 6 villages re-infec­ had 6 re-infected villages and 9 villages infected for tes et 9 villages infectes pour la premiere fois (voir the first time (see Table 3.5 and 3.6 and Map 3.1 0). tableau 3.5 et 3.6 et carte 3.1 0).

Figure 3.8. Monthly number of dracunculiasis cases in Mali in 2000-2001

-·- 2000 - 2001 193 200 180 160 Ulw Ul 140 ~ Ul "(ij 120 .m 3 100 (.)c ::l 80 ,...., 71 ~ / ...... 0 60 / ' 40 / ' 20 / 6 0 0 ------0 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

Map 3.8. Endemic villages according to number of cases in three different years, Mali

1995 1998 2000

• 1 cas/1 case • 2a 10cas/2-10cases e 11 a 100cas/1H00cases e >a 100 cas 1 > 100 cases

34 R1\Pf'ORT SUR U1 CAMPt\OI~E tv10 NDII'·LE D'ER!\DICliTION DE LJI. DRACUNCULOSE Er~ 2001

Map 3.9. Villages endemic with dracunculiasis in Mali (filled circles) and villages under surveillance (empty circles), 2001.

Gourma- Rharous (29)

\

Gossi-est (30) , c/ Djebock (4) /Tin Ferere (3) Ebang-lmalen (4) • • "L • ~l 1 Gassel Diama (7) ~ ~ I Nlangassa)oJ.I (5) ~ Douari ( ~ "~ "- • • \ '\~ (•) ·•

0 0 ' ~~ _:~ lnkiliwi (12) (!) ~~I ------/ ----- (~ , ;:::,.,_.-- / <;!) 1.-- 0/ ro' . --' .. !) € '..- .. t ; i (.'\ (!) (! ) • \.! ) '.;./ ...

lntillit (90) Tessit (32)

35 REPORT ON THE STATUS OF THE DRACUNCULIASIS GLOBAL ERADICATIOI'I CAMPAIGN IN 2001

Table 3.4. Report received from the villages according to number of cases per village in Mali, 2000-2001

Report Villages reporting according to their dracunculiasis cases received 2000 2001 per year 0 cases 1 case >1 cases Total No 0 cases case >1 cases Total No. of villages of villages <9 2 19 18 39 20 21 33 74 9 to 11 0 0 0 0 19 8 26 53 12 46 5 8 59 19 6 5 30 Total 48 24 26 98 58 35 64 157

Table 3.5. Villages reinfected with dracunculiasis in Mali, 2001

Re-infected villages N. of cases Last cases N. of reports in 2001 in 2001 before 2001 in 2000 Gao 10 1991 0 Bakal 4 1998 0 Djebock 4 1998 0 Douari 2 1999 12 Nene 1999 12 Tere 1994 0

Table 3.6. Villages newly infected in Mali , 2001

NEWLY INFECTED VILLAGES Cases in 2001 Gourma Rharous 29 Haoussa Foulane 4 Kaban 2 Segala Maguiragacounda Sissahi Bore Marsi Men aka

36 rll\f'f'ORT t.!JR G~ CAMPI\GNE MC1NDIALE D'ERADIC.I\TION DE LP. DRACUNCULOSE EN 2001

Map 3.10 . Newly infected villages ad re-infected villages in Mali, 2001

Bore Sissahi Kaban Maguiragacounda

Segala

* Newly infected villages

Djebock

e Re-infected villages

37 REPORT ON THE STATUS OF THE DRACUNCULIASIS GLOBAL ERADICATION CAMPAIC:•N IN 2001

3.6. Niger 3.6. Niger There was a sharp decline in the number of cases Durant les 11 dernieres annees, le nombre de cas during the last eleven years in Niger (Figure 3.9, for de dracunculose au Niger a fortement diminue (figure 1992, the data was not complete). However, the 3.9 -a noter que pour 1992, les donnees etaient decrease during the last six years period (1996-2001) incompletes). Cependant, la diminution pendant les was slow and not considerable (from 2956 to 417 six dernieres annees de cette periode (1996-2001) cases respectively) although it was consistent. etait relativement faible (de 2 956 a 417 cas respec­ tivement) mais continue. Niger reported 405 indigenous cases (in addition to 12 imported cases) from 50 villages during 2001, En 2001, 405 cas autochtones (et 12 cas impor­ a 65% reduction compared to 2000. Only 57% (237 I tes) on ete notifies dans 50 villages, ce qui corres­ 417) of the cases reported were contained. The area pond a une reduction de 65% par rapport a 2000. of high incidence were Zinder, Tillaberi and Tahoua, Seulement 57% (237 /417) des cas notifies ont ete Maradi and Dosso Department in the south-west­ isoles. Les zones de forte incidence comprenaient ern part of the country (Map 3.11 and 3.12). The les regions de Zinder, Tillaberi et les departements peak number of cases occurred from June to Octo­ de Tahoua, de Maradi et de Dosso dans la partie du ber (Figure 3.1 0). Imported cases in 2001 from coun­ sud-ouest du pays (carte 3.11 et 3.12). L'incidence tries neighboring Niger Togo to the districts where maxi male se produit entre juin et octobre (figure 3.1 0). the imported cases were identified in 2001 are seen Les cas importes en 2001 proviennent du Togo voisin. in Map 3.13. La carte 3.13 montre les districts ou les cas impor­ tes ont ete detectes.

Figure 3.9. Annual number of dracunculiasis cases in Niger in 1991-2001

35,000 32,829 30,000 g) CO 25,000 (.)"' ·m 20,000 .!ll '5 (.)c 15,000 ::J (.) fE 10,000 0 5,000 3,030 2,7001,920 1,166 417 0 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001

Rgure 3.9. Annual number of dracunculiasis cases in Niger in 1991-2001

400 - • - 2000 ----- 2001 350 ,., I \ "'Q) 300 CO I \ "'(.) 250 I \ '(ij"' .!ll / .. '5 200 c(.) ', ::J 150 / . .. ~ / 101 105 ' 'lJ 100 0 /.. 66' / _ z0 50 ... 2 2 0 2 ...... 13 12 33 .. 1 9 0 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

38 RAPPORT SUR LA CAMPAGI~E MONDI,\LE D'EFti\DilATION DEL". DRACUNCULOSE El~ 2001 - -

Map 3.11 . Endemic villages according to number of cases in three different years, Niger

' ,'\ 2001 . I t

/ I -t .- --( I -- ,/' / / /

• 1 cas I 1 case • 2 a 10 cas I 2-10 cases e 11 a 100 cas I 11-100 cases e >a 100 cas I> 100 cases

Table 3.7 . Report received from the villages according to number of cases per village in Niger, 2000-2001

Report Villages reporting according to their dracunculiasis cases received 2000 2001 per year 0 cases 1 case >1 cases Total No 0 cases 1 case >1 cases Total No. of villages of villages <9 128 33 44 205 0 0 0 0 9 to 11 5 0 1 6 0 0 0 0 12 184 37 107 328 -- 452 94 76 622 Total [ 317 70 152 539 452 94 ,- 76 I 622

Table 3.7 shows that all622 villages in Niger sub­ Le tableau 3.7 montre que chacun des 622 villa­ mitted each 12 reports in 2001 . ges sous surveillance au Niger a soumis 12 rap­ ports mensuels en 2001 . Ceci correspond a une grande amelioration par rapport a 2000 ou un fort pourcentage de villages avait soumis moins de 9 rapports par an .

Map 3.12. Villages endemic with dracunculiasis (filled circle) and village under surveillance (empty circle) in Niger, 2001 J l AGADEZ

39 RErORT ON THE STATUS OF THE DRACUNCULIASIS GLOBAL ERADICATION CAMf>AIGN IN 2001

Map 3.13. Imported cases to Niger in 2001

BEN IN

3.7. Togo 3.7. Togo During the last eleven years dracunculiasis case L' evolution du nombre de cas de dracunculose peaked in 1993 in Togo when the cases reached au Togo durant les 11 dernieres annees montre une 10,349 cases, as seen in figure 3.11. After that year, recrudescence en 1993 culminant a 1 0 349 cas there was a sharp decline to 1,626 cases in 1996. (figure 3.11) suivie d'une diminution tres marquee a There was fluctuation after that period but case de­ 1 626 cas en 1 996 puis d'une fluctuation avec clined again after 1998 and reached less than 828 diminution a 828 cas en 2000 (figure 3.11 et carte cases in 2000 (Figure 3.11 and Map 3.14). 3.14). En 2001, 1 340 cas autochtones et 14 cas importes ont ete notifies dans 180 villages. Ceci repre­ In 2001 , 1 ,340 indigenous cases were reported sents une augmentation de 65% du nombre de cas (in addition to 14 imported cases) from 180 villages. compares a 2000 ou 811 cas autochtones ont ete This was an increase of 65% in the number of cases notifies. L'augmentation en 2001 etait due a une compared with 2000 when 811 indigenous cases flambee dans le village de Kpatala, la zone d'Ogou, were reported. The increase in 2001 was due to an qui a rapporte 304 cas (carte 3.15). Le programme a outbreak in Kpatala village, Ogou District, that re­ signals que 62% (838/1 354) des cas avaient ete ported 304 cases (Map 3.15). The programme re­ isoles. L'incidence des cas de dracunculose est re­ ported that 62% (838/1 ,354) of the cases had been partie sur toute l'annee mais est plus marquee en contained. Dracunculiasis cases occurred during the debut et en fin d'annee Oanvier a mars et octobre a whole year with more cases in the beginning and decembre, figure 3.12). La carte 3.16 montre que les the end of the year (January to March and October 14 cas importes au Toga en 2001 viennent du Benin, to December, Figure 3.12). Map 3.16 shows that 14 du Ghana et du Nigeria. cases were imported to Togo from Benin, Ghana and Nigeria during 2001 .

40 R1\PPORT SUR U1 CAMPfi.Gf~E MONDIALE D'ERr\DII_.ATION DE LP. DRACUNCULOSE El~ 2001

Figure 3.11. Annual number of dracunculiasis cases in Togo in 1991-2001

12000 en (]) 10349 (/) Cll 10000 () rJl ·en 8000 :s.\Jl () § 6000 () -o~ 4000 0 1762 2128 z0 2000 1626 0 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001

Figure 3.12. Monthly number of dracunculiasis cases in Toga in 2000-2001

500 ----2000 -2001

400

~ rJl 308 Cll () 300 rJl (ij .\Jl 3 () c ::J 200 193 ~ 0

100

Table 3.8. Report received from the villages according to number of cases in Toga, 2001

Report Villages reporting according to their dracunculiasis cases received 2000 2001 per year 0 cases 1 case >1 cases Total No 0 cases 1 case-' > 1 cases 1Total No. of villages of villages 1 <9 I 8 12 11 31 1 0 0 1 I .J. 9 to 11 0 1 2 8 1 r 0 9 12 I 419 28- - - 93 540 1,021 65 118 1,204 Total I 428 40 105 573 1,030 66 118 1,214

Table 3.8 shows that almost all villages in Toga Le tableau 3.8 montre que presque taus les villa­ submitted 12 report each in 2001 except 9 villages ges au Toga ant soumis 12 rapports mensuels de that submitted 9 to 11 reports. Large number of the surveillance a !'exception de 9 villages qui ant sou­ reports recoded zero cases. mis 9 a 11 rapports. Le plus grand nombre de ces rapports mentionnait zero cas.

41 REPORT 0~1 THE STATUS OF THE DRACUNCULIASIS GLOBAL ERADICATIOJ'i Ct'.MPAIGN IN 2001

Ogou district had the higher number of dracun­ Le district d'Ogou a eu le nombre le plus eleve de culiasis cases during 2001 . In that district, there were cas de dracunculose en 2001 . Dans cette zone, sur 150 villages under surveillance with 52 reporting 528 les 150 villages sous surveillance, 52 ont notifi8 528 cases in 2001 . The situation in 2000 was not sig ­ cas en 2001. La situation en 2000 n'etait pas sensi­ nificantly different. 134 villages were under surveil­ blement differente : des 134 villages sous sur­ lance of which 48 villages reported 384 cases (Map veillance, 48 ont rapporte 384 cas (carte 3.17). Les 3.17).Dracunculiasis indicators for Kpatala village, indicateurs de dracunculose du village de Kpatala, in Ogou District, that have the highest number of dans la zone d'Ogou qui a le plus grand nombre de cases in 2001 are seen in Table 3.9. Kpatala was cas en 2001 sont mentionnes dans le tableau 3.9. endemic for the last 5 years and the cases were in­ Kpatala etait endemique pendant les 5 dernieres creasing gradually annees durant lesquelles, le nombre de cas a gra­ duellement augments.

Map 3.14. Endemic villages according to number of cases in three different years, Togo

1995 1998 2001

• 1cas/1case • 2 a 10 cas /2-10 cases e 11a100cas/11-100cases e >a100cas/>100cases

42 RAPPORT SUR LA CAMP/IGI-JE M(1NOI1\LE D'Efi.:\D I CII.TIO~J DE U\ DRACUNCULOSE Er-J 2001

Map 3. 15. Villages endemic with dracunculiasis (in filled circle) and villages under surveillance (empty circle) in Togo, 2001 , showing the village where an outbreak occurred and the number of cases

Kpatala (304)

Tchebou (!?L_ _

SOTOUBOUA

Legueda (25)

43 REPOnT ON THE STATUS OF THE DRACUNCULIASIS GLOBAL ER.ADICATION CAMPAIGN IN 2001

Map 3.16. Imported cases to Togo in 2001 from Benin, Ghana and Nigeria

NIGERIA

GHANA

Maps 3.17. Maps of highly endemic areas Ogou in Togo with villages re-infected in 2001

EST EST L- - --(_ ~.J AfokpaAko Kaoura Kondo ------• Kpalamedji • OGOU Gabri Kobe Atchou Onougbo l OGOU ** Atakpame • Ago una Deve Abi Akpare -· Datcha Akakai TogboAyiho ) *** Adanba J. Abotchi

HAHO HAHO

Maps 3.1 7. Maps of highly endemic areas Ogou La carte 3.17. Carte des secteurs fortement en­ in Togo with villages re-infected in 2001 (filled circle) demiques d'Ogou, au Togo, avec des villages and villages infected for the first time in 2001 (stars) reinfectes en 2001 (cercle rempli) et des villages in­ and villages endemic per number of cases. fectes pour la premiere fois en 2001 (etoiles), ainsi que les villages endemiques, par nombre de cas.

44 fl,\Pi'ORT SUR L/\ CAMPAGNE M{)NDIALE D'EJli\DilATIO~! DE Lh, DRACUNCULOSE El~ 2001

Table 3.9. dracunculiasis indicators for Kpatala village during 1997 to 2001

Year Dracunculiasis Cases Filter Abate cases contained distributed application 1997 7 7 0 0 1998 24 24 0 0 1999 17 13 321 1 2000 52 32 364 146 2001 304 175 911 13

Map 3.18. Villages endemic per number of cases in highly Infected district of Ogou, 2001, with names and number of cases between brackets.

__\7 • - . Djiniohui (12) Kpatala (304) ~ .. Tele Kope (17)

OGOU AMOU . ~. •

45 REPORT ON THE STATUS OF TH[ DRACUNCULIASIS GLOBAL ERADICATION GAMPAIGN IN 2001

Table 3.10.

1 0 1 0 12 0 0 22 0 0 32 0 0 20~ 0 658 244 'l91 ?08 2~-~ 1 Map 3.19. 1010 273 591 :€.6 ss,.;821 1 829 780 5907

2000 2001 a- Dracunculiasis indicators for Togo

N~WM:KLOTO

0 4 5 3 o. 0 37 16 4 5181 0 12 3 4 7 0 0 0 1 16~! 0 0

b- Dracunculiasis indicators for Kloto District

Percentage of endemic villages under acceptable surveillance, by district. 0 0% D 21 -50% D 51 %-84% 85%-99% 100% Kloto Department • Tableau 3.10 . lndicateurs de dracunculose pour Table 3.10 . Dracunculiasis indicators for Togo (a) le Togo (a) et pour le departement de Kloto (b). and for Kloto Department (b). Carte 3.1 9. Cartes du Togo avec le pourcentage Map 3.1 9. Maps of Togo with percentage of vil­ de villages sous surveillance acceptable en 2000 lages under acceptable surveillance in 2000 and et 2001 , par district (villages soumettant au mains 2001 , by district (Villages submitting at least 9 re­ 9 rapports sur 12, par an). ports out of 12 report per year). Le tableau 3.1 0 et la carte 3.19 montre la grande Table 3.1 0 and Map 3.1 9 show the great improve­ amelioration, au cours des annees, de l'efficacite de ment in the effectiveness of surveillance with years. la surveillance. En 2000, les villages sous surveillance In 2000, villages under surveillance in 8 out of 30 de 8, sur les 30 departements du Toga, ont soumis departments in Togo submitted each at least 9 re­ au mains 9 rapports chacun. En 2001 , ce nombre ports. In 2001, this number increased to 24 out of est passe a 24 sur les 30 departements. Seul le de­ 30 departments. Only Kloto Department submitted partement de Kloto a soumis 6 rapports sur 12 en 6 out of 12 report in 2001 but this village lack coor­ 2001 mais ce village n'ayant pas de coordonnees, il dinates as it did not appear in Map 3.19. That de­ n'apparalt pas sur la carte 3.1 0. Ce departement a partment reported 4 villages under surveillance in rapporte 4 villages sous surveillance en 1999 mais 1999 but were not followed up in 2000, thus did n'a pas ete suivi en 2000, par consequent, il n'a pas not submit any report in that year (Table 3.1 Ob) . soumis de rapport durant cette annee (tableau 3.1 Ob).

46 RI\F'f>ORT SUR l../1 CAMP,\GI~E MONDIAL[ D'En,\01( .".TION DEL". DRACUNCULOSE El-l 2001

4. COUNTRIES 4. PAYS APPROCHANT APPROACHING DE L'INTERRUPTION INTERRUPTION OF DE LA TRANSMISSION TRANSMISSION

4.1. Overview of endemic countries 4.1. Vue d'ensemble des pays approaching interruption of approchant de l'interruption transmission de la transmission Although only 189 indigenous dracunculiasis Bien que seulement 189 cas autochtones de cases were reported from 65 villages in the four coun­ dracunculose aient ete notifies dans 65 villages des tries that belong to this group, there was a tremen­ quatre pays qui appartiennent a ce groupe, il y a eu dous decrease (60%) in the number of cases in 2001 une diminution tres importante (60%) du nombre de as compared to 2000 (Table 4.1). Ethiopia, Uganda cas en 2001 par rapport a2000 (tableau 4.1 ). L'Ethio­ and Mauritania are approaching interruption of trans­ pie, I'Ouganda et la Mauritania approchent !'inter­ mission. Ethiopia reported only 10 indigenous cases ruption de la transmission. L' Ethiopie a notifie in 2001. Uganda reported 51 indigenous cases and seulement 10 cas autochtones en 2001 . L'Ouganda Mauritania reported 89 cases. lt is expected that a notifie 51 cas autochtones et la Mauritanie 89 cas. soon those countries will be free of the disease. The On s'attend a ce que, bientot, ces pays soient epidemiological situation in Central African Repub­ exempts de la maladie. La situation epidemiologique lic is not very clear. 36 cases were reported in addi­ en Republique Centrafricaine n'est pas tres claire, tion to 27 cases alleged to have occurred during 36 cas y ant ete notifies en plus de 27 cas allegues November 2001 that were detected by National Im­ qui auraient ete rapportes durant les journees natio­ munization Day. nales de vaccination en novembre 2000.

Countries that will come next to the group of dra­ Le Niger a reduit le nombre de ses cas de 65% en cunculiasis-free countries are Niger which reduced 2001 par rapport a 2000 et est passe en dessous it cases by 65% in 2001 compared with 2000 and de la barriers des 1000 cas. 11 compte a present seu­ jumped below the 1000 cases barrier to have only lement 405 cas autochtones. Le Benin et la Cote 405 indigenous cases. Benin and Cote d'lvoire have d'lvoire ant un nombre relativement bas de cas low number of indigenous cases ( 156 and 226 re­ autochtones (156 et 226 respectivement) mais la spectively) but the decline was not very substantial reduction n'est pas tres marquee compare a 2000. compared with 2000. The decline in the number of Au Toga et au Mali, la diminution du nombre de cas cases in Toga and Mali was substantial prior to 2001 . etait bien marquee mais, en 2001, la tendance a ete However, in 2001 this decline was reversed and the inversee et le nombre de cas notifies a augments de number of cases reported increased by 65% and 65% et de 151% respectivement. 151 % respectively.

Table 4.1. Villages under surveillance and endemic and reported cases in 2001

Country No of Villages in 2001 I Reported cases in 2001

cases - in 2000 Under Currently Indigenous Imported Total - surveillance endemic CAR' 35 NA I 22 34 2 36 Ethiopia 60 83 10 10 19 29 Mauritania 136 335 25 i 94 0 94 - - - - - I U anda 96 _ 55 - --8 - 51-- - --4 -- 55 Total 327 473 l 65 189 25 214

* Villages under surveillance are not known in CAR

47 REPORT ON THE STA1US OF THE DRACUNCULIASIS GLOBAL ERADICATION GAMPAIGN IN 2001

4.2. Central African Republic (CAR) 4.2. Republique Centrafricaine (RCA) After being considered free of dracunculiasis Apres avoir ete consideree exempte de la trans­ transmission, the Central African Republic is now mission de dracunculose, la Republique Centrafri­ reporting indigenous cases since 1997. During the caine notifie des cas autochtones depuis 1997. last six years dracunculiasis cases in CAR fluctu­ Pendant les six dernieres annees, le nombre de cas ated but were small with a maximum of 35 in 2000 de dracunculose en RCA a fluctue avec un maximum and a minimum of 5 in 1997 (Figure 4.1 ). No cases de 35 cas en 2000 et un minimum de 5 en 1997 were reported contained. WHO supported an exter­ (figure 4.1). Aucun cas n'a ete isole. En 2000, I'OMS nal evaluation mission in 2000 which surveyed 150 a soutenu une mission d'evaluation externe qui a villages in the south-eastern border area of the coun­ examine 150 villages dans la zone frontaliere du sud­ try that reported 50 cases in 33 endemic villages in est du pays et qui a mentionne !'existence de 50 cas south-eastern border area of the country. qui seraient survenus dans 33 villages endemiques dans la zone frontaliere du sud-est du pays. For the year 2001 , the CAR reported 36 dracun­ culiasis cases occurring in 22 villages. Surveillance En 2001 , la RCA a notifie 36 cas de dracunculose is still weak and the villages that are reporting cases dans 22 villages. La surveillance est encore faible et in the year 2001 submitted only 1 to 3 reports per les villages qui ont notifie des cas en 2001 n'ont year. Three new districts, Ouham-Pende, Name­ soumis que 2 a 3 rapports de surveillance par an. Trois Gribingui and Ouaka, were reporting cases in 2001 . nouvelles zones, Ouham-Pende, Name-Gribingui et The low number of cases recorded by village could Ouaka, ont notifie des cas en 2001 . Le petit nombre de be a sign for imported cases. Map 4.1 shows en­ cas enregistres par village peut etre une indication demic villages according to number of cases in three qu'il s'agit de cas importes. La carte 4.1 montre la lo­ different years and 4.2. shows infected villages in calisation des villages infectes pour trois annees diff8- 2001 . rentes. La carte 4.2 montre les village infectes en 2001.

The National Guinea Worm Eradication Pro­ Le programme national d'eradication du ver de gramme carried out surveillance activities during the Guinee a conduit des activites de surveillance pen­ National Immunization Day in 2001 . 34 out of 65 dant les journees nationales de vaccination de 2001. reported rumours were investigated. As a result the Sur 65 rumeurs mentionnees, 34 on ete investiguees National Programme reported 27 cases from 18 vil­ et le programme n'a retenu que 27 cas hypotheti­ lages. This 27 cases were not included in this report ques, issus de 18 villages . Ces 27 cas ne sont pas as the National Programme failed to describe clear pris en compte dans ce rapport car le programme inclusion criteria for case confirmation. 34 indig­ national n'a pas ete en mesure de nous donner les enous cases (in addition to 2 imported cases) were criteres sur lesquels il s'est fonde pour confirmer ces reported from 22 villages in 2001. Surveillance ac­ cas. Trente quatre cas autochtones et 2 cas importes tivities should be strengthened more effectively and ont ete notifies dans 22 villages en 2001. Les activi­ be focused on the endemic communities. tes de surveillance devraient etre renforcees et etre concentrees sur les communautes endemiques.

Rgure 4.1. Annual number of dracunculiasis cases in Central African Republic, 1991-2001

100 90 80 en~ Cll 70 (.) en 'Ki 60 '3 (.) 50 c ::J (.) 40 ~ 35 36 "0 40 0 30 z0 20 10 0 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001

48 R1\Pf">ORT SUR l../1 CI\MPA.Gl-JE MONDJ,\LE D'Ef"li\DICATION DE L..'l DRACUNCULOSE El-J 2001

Map 4. 1. Endemic villages according to number of cases in three different years, Central African Republic

• 1 cas/ 1 case • 2a10cas/2-10cases • 11a100cas/11-100cases e > a 100cas/> 100cases

Map 4.2. Villages reported endemic with dracunculiasis in Central African Republic, 2001

49 REPORT ON THE STATUS OF THE DRACUNCULIASIS GLOBAL ERADICATION CAMPAIGN IN 2001

4.3. Ethiopia 4.3. Ethiopie During the last ten years, dracunculiasis cases Au cours des dix dernieres annees, c'est en 1993- were at its highest in Ethiopia from 1993 to 1994. it 1994 que I'Ethiopie a eu le plus grand nombre de declined after that but fluctuated with a small peak cas de dracunculose. Ce nombre a par la suite dimi­ in 1997 (Figure 4.2) . After 1997, cases decreased nue avec cependant un petit pie en 1997 (figure 4.2). gradually to reach 60 cases in 2000 and only 29 Apres 1997, les cas ont diminue graduellement pour cases during 2001 . atteindre 60 cas en 2000 et seulement 29 en 2001.

Out of the 29 cases of 2001 , only 10 cases were Sur les 29 cas de 2001, seuls 10 cas etaient indigenous. There was a remarkable reduction of autochtones. 11 y avait une reduction remarquable 81% in 2001 compared with 2000 (Figure 4.2). 69% du nombre de cas (81 %) en 2001 par rapport a 2000 of the cases were contained. Ethiopia reported 19 (figure 4.2). Soixante neuf pour cent des cas ont ete cases imported from Sudan. The cases were reported isoles. L' Ethiopie a notifie 19 cas importes du Sou­ from six woredas of Gambella Region (!tang, dan. Les cas ant ete notifies dans six woredas de la Gambella, Jikawo, Akobo, Abobo and Gog Woredas) region de Gambella (!tang, Gambella, Jikawo, Akobo, are known to be endemic. South Omo was declared Abobo et Gag) qui sont connus pour etre endemi­ as free from the disease as no cases indigenous ques. Le Sud Omo a aussi ete declare indemne de cases were reported from that region in 2001. This la maladie et aucun cas autochtone n'a ete notifie was due to concentrated efforts in the 2000 trans­ dans cette region en 2001 . Ces bon resultats sont mission season and the use of Guinea Worm Sta­ dus aux efforts faits durant la saison 2000 de trans­ tions to hospitalize and contain the dracunculiasis mission et a !'utilisation des stations d'hospitalisa­ patients. Transmission season occurred from April tion et d'isolement des patients. La saison de to August (Figure 4.3) . transmission a eu lieu d'avril a aoat (figure 4.3).

WHO started its extensive support to Ethiopia L'OMS a commence son appui au programme Dracunculiasis Eradication Programme in early 2001 Ethiopien d'eradication de la Dracunculose debut when the number of cases decreased to below the 2001 lorsque le nombre de cas a diminue au-des­ threshold of 100 cases in the year 2000 (60 cases) sous du seuil de 100 cas (60 cas), et que Global and when Global 2000 withdraw its assistance. WHO 2000 ait arrete son assistance. L'OMS soutient les supported dracunculiasis surveillance and interven­ activites de surveillance et les interventions visant a tion activities raising awareness about the disease ameliorer la connaissance de la maladie, par l'inter­ with the help of Village-Based Volunteers (VBV) in mediaire des volontaires villageois de la sante des the two endemic districts of South Omo and deux zones endemiques d'Omo et de Gambella du Gambella. Support was provided to assist the Na­ sud . L'appui a ete fourni pour aider le coordonna­ tional Programme Coordinator overseeing the im­ teur national de programme a surveiller !'execution plementation of eradication activities. In early 2001 des activites d'eradication. En 2001, un epide­ and in July 2001 , a WHO epidemiologist visited the miologists de I'OMS a visite par 2 fois le programme Programme to review the eradication activities and pour passer en revue les activites d'eradication et faire suggest recommendations to improve the pro­ des recommandations pour ameliorer !'execution de gramme implementation. programme.

Rgure 4.2. Annual number of dracunculiasis cases in Ethiopia in 1991-2001)

1,400 1,252 1,200 CO~ u

50 RAf'f>ORT SUF1 U1 CAMPAGI~ E MONDI1\LE D'ER;\DIC.".T IO~J DE LA DRACUNCULOSE El~ 2001

Figure 4.3. Monthly number of dracunculiasis cases in Ethiopia in 2000-2001

30 - · - 2000 - 2001

25 • 20

15 \ • 10 \ 5• 5

0 0 0 0

Table 4.2. Report received from the villages according to number of cases in Ethiopia, 2001

Report Villages reporting according to their dracunculiasis cases received 2000 2001 per year 0 cases 1 case >1 cases Total No 0 cases I 1 case >1 cases Total No. of villages of villages <9 0 0 0 0 0 0 0 0 9 to 11 0 0 0 0 1 0 1 2 12 68 10 6 84 67 13- 1 81 Total 68 10 6 84 68 13 2 I 83

Table 4.2 shows that out of 83 villages that were Le tableau 4.2 montre que sur 83 villages qui under surveillance, only 2 reported less than 12 etaient sous surveillance, seulement 2 ont notifie reports per year. Only two villages reported more moins de 12 rapports par an. Seuls 2 villages ont than one case (mostly refugee camps for imported notifie plus d'un cas (cas importes dans les camps cases). de refugies).

51 REPORT 0~ 1 THE STATUS OF THE DRACUNCULIASIS GLOBAL ERADICATION CAMPAIGN IN 2001

Maps 4.3. Comparison of the epidemiological status of Guinea Worm villages for three years, 1994, 1998 and 2001, Ethiopia.

1995

2001

1 cas I 1 case • 2a 10casl2-10cases • 11 a 100 cas I 11-100 cases e >a 100 cas I> 100 cases

Map 4.4. Villages endemic with dracunculiasis in Ethiopia, 2001 (with one guinea worm case in each endemic villages and the remaining in Refugee camps)

ID'~ Cl () 0 ,I () (j JIKAWO \ ITANG ~ Tumserra AKOBO ~~ ... I () ---- ~ \?. AB~BO Dum bang / ' \_;)-- " • I ' r"-- o;i ------­ Chinak • Inaccessible Woreda ,() .;;q .~ ------­ Awkoy / / Metage! Depach Kudbudi Akumed Refugee Camps GOG & JOR (13 imported cases) Wichini

52 RI\Pf'ORT SUR l../1 CAMPA.GI~E MUNDIP,L.E D'En;\DICI\TI

4.4. Mauritania 4.4. Mauritanie Figure 4.4 shows that the highest number of dra­ La figure 4.4 montre que c'est en 1993 qu'il y a cunculiasis cases were reported in 1993 (5882 eu le plus grand nombre de cas de dracunculose cases). After 1993 there was a striking decline to (5 882 cas). Apres 1993 il y eut une decroissance 5,029, 1,762 and 562 cases in 1994, 1995 and marquee, a 5 029, 1 762 et 562 cas en 1994, 1995 1996 respectively. From that year onward, there was et 1996 respectivement. A partir de cette annee, la a gradual decline in the number of cases which diminution a ete progressive pour atteindre 136 cas reached 136 cases in 2000. The programme re­ en 2000. Le programme a notifie 94 cas autochto­ ported 94 indigenous cases in 2001, a reduction of nes en 2001, une reduction de 31% compare a2000, 31% compared to 2000, when 136 cases were re­ quand 136 cas ont ete notifies. Seulement 52% des ported. Only 52% of the cases were reported as con­ cas ant ete isoles. Ceux-ci etaient principalement tained. Those were mainly in the southern part of localises dans la partie meridionale du pays (Hodh the country in Hodh Chargui, Assaba, Gorgol, Chargui, Assaba, Gorgol, localite de Guidimaka). Guidimaka locality. Peak infection season was from L'incidence maximale a eu lieu de juillet a novembre July to November (Figure 4.5). Map 4.5 show the (figure 4.5). La carte 4.5 montre la localisation des endemic villages in the country. villages endemiques dans le pays. Le tableau 4.3 montre le rapport entre le nombre de cas notifies Table 4.3 shows the relationship between the par les villages sous suNeillance et le nombre de number of cases reported by the villages under sur­ rapports regus. Taus les villages endemiques ant un veillance and the number of report received. All the tres bon systeme de suNeillance (plus de 9 rapports endemic villages have a very good suNeillance sys­ mensuels de suNeillance). D'autre part, la grande tem (all more than 9 reports). On the other hand the majorite de villages sous suNeillance notifiant zero great majority of villages under suNeillance report­ cas ont un systeme de suNeillance faible (69% mains ing 0 cases have a weak suNeillance system (69% de 9 rapports). Sur 22 villages infectes en 2001, 11 less than 9 reports). sont re-infectes (voir le tableau 4.4 et la carte 4.7). Ceci souligne !'importance de continuer une sur­ Between the 22 endemic villages reported in 2001, veillance intense pendant quelques annees suivant 11 are re-infected. (See table 4.4 and map 4.7). This !'arret presume de la transmission. important phenomenon underline the importance to continue an intense suNeillance for some years af­ ter the first year reporting 0 cases.

Rgure 4.4. Annual number of dracunculiasis cases in Mauritania in 1991-2001

7000

6000 5882

5000

4000

3000

2000 1557 1000

0 ---T---r---r---.--,-~::::::3:7:8~25~5~1g3~6~9~4~ l1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001

53 nEPORT ON THE STATUS OF THE DRACUNCULIASIS GLOBAL ERADICATION CAMPAIGN IN 2001

Figure 4.5. Mauritania dracunculiasis cases 2000-2001

50 -·-2000 2001 45 Ill, 40 I ~ m Q) m I \ Cll 35 () I \ m 1 29 \ 'Cii 30 . ~ :5 25 I 21 ~ () c \ ::J 20 () \ Cll 15 \ 0 \ 10 .. 5 0 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

Table 4.3. Report received from the villages according to number of cases in the villages in Mauritania, 2001

Report Villages reporting according to their dracunculiasis cases received 2000 2001 per year 0 cases 1 case >1 cases Total No 0 cases 1 case >1 cases Total No. of villages of villages <9 31 0 0 31 225 0 0 225 9 to 11 5 2 2 9 0 1 1 62 12 368 7 11 386 0 9 11 48 Total I 404 ·rr- 13 426 225 10 12 I 335

Table 4.3 shows that villages that submitted less Le tableau 4.3 montre que les villages qui ant sou­ than 9 reports had higher number of zero cases 71% mis mains de 9 rapports par an etaient plus nombreux (225/313) compared with villages reporting 9 to 12 a declarer recenser zero cas, 71% (225/313) compare reports per year. aux villages soumettant 9 a 12 rapports par an.

Table 4.4. Village re-infected with dracunculiasis in 2001

Re-infected village N. of cases Last cases N. of reports in 2001 in 2001 before 2001 in 2000 I NABAME 3 1999 12 WOIDAMOUR . 2 1999 12 DABER 2 1997 ' 12 TOUN GADE 1 1997 12 -- . ' OULD MOILID P. 1 ? ? GUERROU 1 1992 not under surv. ------BOULLY 1 1996 not under surv. - - GUEMOU SONINKE 1 1999 - --12 HASSIVOULANE 1 1996 12 KANKOU 1996 12 1 - -- YOWGUI 1 1999 12

54 RI\F'f'Ofn SUR L/1 CJ\t>lPAGI~E M()NDI,\LE D'En;\DIC!\TION DEL~. DRACUNCULOSE EN 2001

Maps 4.5. Comparison of the epidemiological status of Guinea Worm villages for three years, Mauritania.

1995 1998 2001

• 1cas/1case • 2 a 10 cas I 2-10 cases • 11a100cas/11-100cases e >a 100 cas I> 100 cases

Map 4.6. Village endemic with dracunculiasis (filled circle, names shown with cases in brackets) and villages under suNeillance (empty circle) in Mauritania, 2001

'.____ , -r~ I MOUOJEAIA( 'BOUMD E ;· MAGTA-LAHJAR " . ' \ ~J -- a • • ' ~ \t -----7~J__ 1 l~~ AroUN~Amous J~ ~--· NEMA " I r. . , J //- / / /

Hassi Atila (12)

55 REPORT ON THE STATUS OF THE DRACUNCULIASIS GLOBAL ERADICATION CAMPAIGN IN 2001

Map 4. 7. re-infected (filled circle) and newly infected (Star) villages in Mauritania

1------J ~~

Toun Gade •

/'"'

Guerrou

Ould Moilid _!( e-- Dab~ Nabame ~.:c.: e - ~ -L { Woidamour Boully Yowgui \- /-!-'\. . r---...... ~-'--L--- • Yassi Voulane ~ """""""""'""

I / I

56 fli\Pf'OR r SUR U1 CAMF'I\GNE MUNDif,LE D'En;\DIC.'\TIO~J DEL". DRACUNCULOSE Ef~ 2001

4.5. Uganda 4.5. Ouganda Dracunculiasis cases decreased rapidly during the Les cas de Dracunculose ant diminue rapidement first half of the last ten years from 126,369 cases in pendant la premiere moiti8 des dix dernieres annees 1992 to 1 ,455 cases in 1996 . From 1996 to 1998 de 126 369 cas en 1992 a 1 455 cas en 1996. De the decrease was slow and the number of cases 1996 a 1998 la diminution etait plus lente et le nom­ reached 1061 in 1998 (Figure 4.6). There was a sharp bre de cas a atteint 1 061 en 1998 (figure 4.6). 11 y a decrease in 1999 and 2000 when cases fell to 321 eu une diminution marquee en 1999 et 2000, ou and 96 respectively. 51 indigenous cases were re­ les cas sont tombes a 321 et a 96 respectivement. ported in 2001 . This is a reduction of 45% of the 51 cas autochtones ant ete rap partes en 2001 , ce number of cases reported in 2000. In addition, four qui correspond a une reduction de 45% du nombre cases were reported as imported from Sudan, 3 were de cas notifies en 2000. En outre, quatre cas ant found in Agago refugee camp in Kitgum district and ete notifies comme importes du Soudan, 3 ant ete one in Moroto District. 64% (35/55) of the cases trouves dans le camp de refugies d'Agago dans la were reported as had been contained. The highest zone de Kitgum et un dans la zone de Moroto. number of cases occurred during April to August Soixante quatre pour-cent (35/55) des cas ant ete (Figure 4. 7). isoles. C'est d'avril a aoOt que l'on a recense le plus grand nombre de cas (figure 4.7). Kotido district accounted for 78% (43 cases) of the total cases reported in 2001. They were mainly Le district de Kotido a represente 78% (43 cas) de reported from two village, Rikitae (31 cases) and Ilia/ taus les cas notifies en 2001. lis ant ete principale­ Nawapoet (12 cases). The remaining 22% of the ment notifies dans deux villages, Rikitae (31 cas) et cases were reported from Moroto district 9% (5 llla/Nawapoet (12 cas) . Les 22% de cas restants ant cases), Gulu district 5% (3 cases), Kitgum 2% (1 ete notifies dans le district de Moroto 9% (5 cas), le case) . Seven percent (4 cases) cases were imported district de Gulu 5% (3 cas), et a Kitgum 2% (1 cas). from the Sudan. 76% (39/51) of the dracunculiasis Quatre cas (7%), ont ete importes du Soudan. indigenous cases were females and 24% (12/51) Soixante seize pour-cent (39/51) des cas autochto­ were males and 87% of them were 11 to 40 year nes de dracunculose etaient des femmes et 24% old. (12/51), etaient des hommes, et 87% d'entre eux etaient ages de 11 a 40 ans. In the month of December 2001, Kotido and Moroto districts reported a total of 100 and 21 func­ En decembre 2001 , les zones de Kotido et de tioning boreholes in the endemic villages respec­ Moroto ant respectivement rapporte que 100 et 21 tively. Furthermore, in the same month Kotido forages etaient en fonctionnement dans les villages targeted 3 ponds in diffeent endemic villages and endemiques. En outre, durant le meme mois, Kotido treated all with Abate. Re-training village volunteers a traits avec I'Abate 3 mares dans 3 villages diffe­ and sub-county supervisors from Soroti, Kumi and rents. Le recyclage des volontaires villageois de Katakwi was carried out in Katakwi district. Soroti, de Kumi et de Katakwi a eu lieu dans la zone de Katakwi.

Figure 4.6. Annual number of dracunculiasis cases in Uganda in 1991 -2001

140,CXXJ 126,369 en 120,CXXJ ~u en 100,CXXJ : ~ :; OO,CXXJ u c :::J u 60,CXXJ -o~ 0 40,CXXJ 0 z 20,CXXJ 321 96 55 0 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001

57 nEPORT ON THE STATUS OF THE DRACUNCULIASIS GLOBAL ERADICATION CAMPAIGN IN 2001

Figure 4.7. Monthly number of dracunculiasis cases in Uganda in 2000-2001

50 -·- 2000 -2001

40 (/) Q) (/) lll u (/) 30 '.mUi "5 u c ::l 20 ~ 0 10 • . -~ 0 0 o---o-.-o Jan Feb Mar Apr Nov Dec

WHO increased its support to the Ugandan Guinea L'OMS a augmente son appui au programme Worm Eradication Programme in early 2001 after the d'eradication du ver de Guinee d'Ouganda debut dracunculiasis prevalence declined to less than 100 2001 , apres que le nombre total de cas dans le pays cases in the year 2000 (96 cases) and Global 2000 soit passe en dessous de 100 cas en 2000 (96 cas), terminated its support. UNICEF is still supporting et que Global 2000 ait cesse son soutien. L'UNICEF the major part of the programme. WHO assistance soutient toujours la majeure partie du programme. focused on improving the knowledge of health per­ L'aide de I'OMS s'est concentree sur !'amelioration sonnel about Guinea worm disease, strengthening des connaissances du personnel de sante au sujet communications between UGWEP in the secretariat de la dracunculose, le renforcement des communi­ and district level, reactivating the Guinea Worm Steer­ cations entre les differents niveaux du programme, ing Committee and establishing National Commit­ la reactivation du comite de coordination du ver de tee for Certification of dracunculiasis Eradication. In Guinee et l'etablissement de la commission natio­ May 2001 , WHO visited the country to support the nals pour la certification de !'eradication de la Programme by reviewing the eradication activities and dracunculose. En mai 2001, I'OMS a visits le pays suggesting recommendations to accelerate the pour soutenir le programme en passant en revue les progress of implementation measures. activites d'eradication et en faisant des recomman­ dations pour accelerer la mise en reuvre des mesu­ res d'eradication.

58 f1Af'f'ORT SUf1 U1 CA Mf'A.GI~E MONDIALE D' E Fv\ D I (.;,ii.TJ O~J DE LA DRACUNCULOSE EN 2001

Maps 4.8. Comparison of the epidemiological status of Guinea Worm villages for three years, Uganda.

2001 . /\

~"'--~\ \

• 1casl1case • 2 a 10 cas I 2-1 o cases • 11 a100casl11-100cases e >a 100 cas I> 100 cases

59 REPORT ON THE STATUS OF THE DRACUNCULIASIS GLOBAL ERADICATION CAMPAIGN IN 2001

Map 4.9. Villages endemic with dracunculiasis in (filled circle) and villages under surveillance (empty circle) Uganda, 2001 (One village, Rikitea with the majority of cases, in brackets)

Table 4.5. Report received from t11e villages according to number of cases in Uganda, 2001

Report Villages reporting according to their dracunculiasis cases received 2000 2001 per year 0 cases 1 case >1 cases Total No 0 cases 1 case >1 cases Total No. of villages j of villages <9 0 0 0 0 0 0 0 0 9 to 11 0 0 0 4 0 5 - 12 90 12 134 34 12 47 Total 90 ~32 ~ 12 134 T 38 12 I 2 52

Table 4.5 shows that only about 10% of the vil ­ Le tableau 4.5 montre qu'environ 10% des villa­ lages submitted less than 12 reports in 2001. How­ ges seulement ont soumis mains de 12 rapports en ever, the number of villages reporting only one case 2001 . Cependant, le nombre de villages rapportant was very noticeable (86%; 12/14) compared with seulement un cas etait tres consequent, (86%; 12/14) villages reporting more than one case compare aux villages rapportant plus d'un cas.

60 RI\PPORT SUR U1 CAMPAGI-IE MONDI,\LE D'En;\DIC.''.TIO~J DE U'. DRACUNCULOSE El-l 2001 . - -

5. COUNTRIES THAT 5. PAYS QUI ONT INTERRUPTED INTERROMPU TRANSMISSION AND IN LA TRANSMISSION ET PRE-CERTIFICATION PHASE QUI SONT DANS LA PHASE DE PRE-CERTIFICATION

5.1. Overview of countries in pre­ 5.1. Vue d'ensemble des pays dans la certification phase phase de pre-certification The International Commission for the Certifica­ La Commission lnternationale pour la Certifica­ tion of Dracunculiasis Eradication (ICCDE) was es­ tion de !'Eradication de la Dracunculose (CICED) a tablished in 1995 and is made up of 12 independent ete etablie en 1995 et se compose de 12 experts public health experts from all regions of the world. it independants de toutes les regions du monde. Elle is responsible for evaluating evidence presented by est responsable d'evaluer les donnees presentees countries claiming to be dracunculiasis-free and par les pays candidats a la certification de !'interrup­ seeking WHO certification of eradication. By Febru­ tion de la transmission. En fevrier 2000, I'OMS a ary 2000, WHO certified 152 countries as free of ports a 152 le nombre de pays certifies exempts de transmission of the parasite. transmission du parasite. Cinq pays (Cameroun, Tchad, Kenya, Senegal et Yemen) ont interrompu la Five countries (Cameroon, Chad, Kenya, Senegal transmission et n'ont notifi8 aucun cas autochtone and Yemen) have interrupted transmission and have en 2001 . Le Cameroun a notifi8 5 cas, le Kenya 8 reported no indigenous cases in 2001 . Cameroon cas et le Senegal 1 cas, tous importes. Ces pays reported 5 imported cases, Kenya 8 and Senegal 1 . continuent leur surveillance et d'autres activites. Le These countries are continuing their surveillance and Yemen et le Senegal seront passes en revue par la other activities. Yemen and Senegal will be reviewed CICED en 2003 et le Cameroun et le Tchad en 2004. by the ICCDE in 2003 and Cameroon and Chad in Les pays voisin du Soudan tel que le Kenya devront 2004. Countries neighbouring Sudan such as Kenya attendre quelques annees supplementaires et de­ will have to wait few extra years but should be vigi­ vraient etre vigilants, renforcer leur programme et lant and strengthen its programme and guard for prevenir la reintroduction possible de la maladie a possible re-introduction of the disease from Sudan. partir du Soudan.

61 nE PORT ON THE STATUS OF THE DRACUNCULIASIS GLOBAL ERADICATIO~I CAMPAIGN IN 2001

5.2. Cameroon 5.2. Cameroun During the last ten years Cameroon reduced its Pendant les dix dernieres annees, le Cameroun a dracunculiasis cases from 393 cases in 1991 to a ramene ses cas de dracunculose de 393 cas en less than 10 cases after 1998, mostly imported from 1991 a mains de 10 cas, pour la piu part importes neighbouring countries (Figure 5.1.). No indigenous des pays voisins, apres 1998, (figure 5.1 ). Aucun dracunculiasis cases were reported in Cameroon cas autochtone de dracunculose n'a ete notifi8 au during 2000. Five cases were declared as imported Cameroun en 2000. Cinq cas ont ete declares from Borno State in Nigeria during 2001. All cases comme importes de l'etat de Borno au Nigeria en were contained as stated by the health authority. 2001. Tous les cas ont ete isoles comme indique par le service d'hygiene. For HealthMap 2: Identify village were GW cases were recorded, Do a map showing Nigeria and Cameron one single map. An arrow coming from Bonou state towards the villages in Cameron with imported cases.

Figure 5.1. Annual number of dracunculiasis cases in Cameroun in 1991-2001

500

U) 450 Q) U) ro 400 0 U) 350 'Cii .~ 300 ::; 0 c 250 :::J 0 200 ~ '0 150 0 100 z0 50 15 19 23 17 8 5 5 0 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001

5.3. Chad 5.3. Tchad The highest number of dracunculiasis cases re­ Le nombre le plus eleve de cas de dracunculose ported during the last 10 years was in 1993 when rapportes pendant Jes 1o dernieres annees etait en 1231 cases were documented. The number of cases 1993 ou 1 231 cas ont ete documentes. Le nombre declined rapidly after that year and reached 25 cases de cas a diminue rapidement ensuite, et a atteint 25 in 1997 and only 3 cases in 1998 (Figure 5.2). Chad cas en 1997 et seulement 3 cas en 1998 (figure 5.2). has consistently reported zero incidence of Guinea Le Tchad a constamment rapporte une incidence worm since October 1998 and was considered to nulle du ver de Guinee depuis octobre 1998 et est be in the three-years precertification period. An ex­ entre dans la periode de pre-certification de trois ans. ternal evaluation, which took place in February 2001 Une evaluation externa, qui a eu lieu en fevrier 2001 showed that three cases of dracunculiasis had oc­ a montre que trois cas de dracunculose s'etaient curred in the village of Oueleye, prefecture of Guera, produits dans le village d'Oueleye, prefecture de during August and September 2000. All three cases Guera, pendant les mois d'aoCJt et de septembre were recorded by the village health worker and con­ 2000. Chacun des trois cas a ete enregistre par firmed by his supervisor and were contained. Be­ !'agent de sante du village et confirme par son su­ cause the area was isolated during the rainy season, perviseur. Tous les cas ont ete isoles. Du fait de the cases were only reported to the district respon­ l'impraticabilite des routes durant la saison des sible officer in October 2000. In 2001 a total of 125 pluies, les cas n'ont pu etre notifies au responsable former endemic villages were under surveillance. No de zone qu'en octobre 2000.

62 RAPr>ORT SUR l../1 CAMPAGI-JE MUNDI/\l..E D'ERADICATION DELl'. DRACUNCULOSE Ef-J 2001

cases were reported for 2001 . Chad reported hav­ En 2001 , un total de 125 villages anciennement ing 250 village health volunteers and distributed endemiques etait sous surveillance. Aucun nouveau 1695 filter. Map 5.1 shows villages under surveil­ cas n'a ete notifie pour 2001. Le Tchad a rapporte lance in 2001 . avoir 250 volontaires de sante de village impliques dans la surveillance, et avoir distribue 1 695 filtres en 2001.

La carte 5.1 montre les villages sous surveillance en 2001.

Figure 5.2. Annual number of dracunculiasis cases in Chad in 1991-2001

1,400 1,231 1,200 (/) Q) m(/) (.) 1,000 (/) ii5 ~ 800 '5 (.) c ::l (.) 600 -om 0 400 z0 156 200

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001

Map 5.1. Vrllages under surveillance in Chad, 2001

63 REPORT ON THE STATUS OF THE DRACUNCULIASIS GLOBAL ERADICATION GAMPAIC:.N IN 2001

5.4. Kenya 5.4. Kenya Kenya reported the last indigenous cases in Oc­ Le Kenya a rapporte les derniers cas autochtones tober 1994 that were confined to the north west of en octobre 1994. Ceux-ci etaient confines au nord - the country in West Pokot and Turkana Districts bor­ ouest du pays dans les districts du Pokot acciden­ dering Uganda and Sudan respectively. In the fol­ tal et de Turkana, respectivement a la frontiere de lowing years, only imported cases were reported, I'Ouganda et du Soudan. Les annees suivantes, mainly from Sudan. Kenya was supposed to be con­ seuls des cas importes ont ete signales, tous en sidered for certification but because of the influx provenance du Soudan. Le Kenya etait cense etre about 1000 refugees per month from southern Su­ eligible pour la certification, mais, en raison de l'af­ dan and the continuous population movement from flux d'environ 1000 refugies du Sud-Soudan par neighbouring endemic countries, Uganda and Ethio­ mois, et du mouvement continu de population des pia, the country is vulnerable to reintroduction of the pays endemiques voisins, (Ouganda et Ethiopie), le disease. Figure 5.3 shows the reported cases dur­ pays est vulnerable a la reintroduction de la maladie. ing the last ten years. Kenya reported 8 cases in 2001, La figure 5.3 montre les cas notifies pendant les all imported from southern Sudan. 5 of these cases dix dernieres annees. Le Kenya a rapporte 8 cas en were reported in Lokichokio and 3 in Kakuma camp 2001, tous importes du sud Soudan. Cinq de ces (table 5.1 ). cas ont ete notifies a Lokichokio et 3 dans le camp de Kakuma (tableau 5.1 ). In May 2001 , a WHO epidemiologist visited Kenya to review dracunculiasis activities. During the visit, 3 En mai 2001, un epidemiologists de I'OMS a vi­ dracunculiasis cases, all imported from south Su­ site le Kenya pour passer en revue des activites d'era­ dan were identified in Turkana District. As a response dication de la dracunculose. Pendant la visite, 3 cas to this situation, several activities have been planned de dracunculose, taus importes du sud Soudan ant to reactivate surveillance, train of 45 Trainers and ete identifies dans la zone de Turkana. Comma re­ 1810 Health Workers, motivate the village based ponse a cette situation, plusieurs activites ant ete volunteers to conduct surveillance and publicizing prevues pour reactiver la surveillance, la formation the reward, integrate dracunculiasis surveillance with de 45 formateurs, du personnel sanitaire et de 1 810 National Immunization Day, and investigate the pos­ volontaires villageois. La formation a ete axee sur sibility of local transmission of dracunculiasis in !'amelioration de la surveillance, la publicite concer­ Turkana District in the areas near the border with nant la recompense mise en place, !'integration de Sudan and Ethiopia. To support surveillance activi­ la surveillance de la dracunculose aux journees na­ ties, WHO provided in 2001 computer equipment tionales de vaccination et, pour evaluer la possibilite to the programme. de transmission locale de dracunculose dans la zone de Turkana dans les secteurs proches de la frontiere In December 2001 , West Pokot District was vis­ avec le Soudan et I'Ethiopie. Pour soutenir des acti­ ited by a WHO Team together with the National vites de surveillance, I'OMS a fourni le materiel infor­ Guinea Worm Eradication Programme, and 39 vil- matique au programme.

Table 5.1. Guinea worm imported cases to Kenya in 2001

Case J Age Sex I Place, date of guinea Place of origin ,. worm emergence Town Date Villag~ Town District State Case no1 M L ockichokio r 04.04.01 Ayod Malakal Kwac Deng Phow Case no2 F Lockichokio 24.07.01 Pakam Panyagor Pakam Jonglei Case no3 F Lockichokio 07.08.01 Jiach Case no4 F Lockichokio 21.08.G1 Theutok Jiech Ayod __ ~ Case no5 25 M Lockichokio ??.06.01 Biong Wau Uet Noom B. Ghazal Case no6 r14o ... F Kakuma 26.08.01 --!---'K...:.:u::c.m:.:..:e:c..l _ +--- Noai Case no7 1*9 ,. ~ , ~akuma 29.08.01 ! Narus Kapoeta Kapoeta E/Equatoria Case nos 28 October * * SoJth Sudan

• Data not available

64 fll\f'f'ORT SUR- U1 CAMPAGI~E- MllNDif,LE- D'EnADICI'.TIO~J DE U\ DRACUNCULOSE EN 2001

lage Health Workers were trained. Similar training En decembre 2001 , la zone du Pokot accidental will be conducted for an extra 21 village Health Work­ a ete visitee par une equipe de I'OMS accompagnee ers in West Pokot. Plans to conduct training for 60 par le programme national d'eradication de ver de village Health Workers to take place in trans Nzoia Guinee. 39 agents de sante de village ont ete for­ and Turkana are under way. mes. Une formation semblable sera conduite pour 21 autres agents de sante dans le Pokot accidental. 11 est aussi prevu de faire la formation pour 60 agents de sante de village dans le trans-Nzoia et le Turkana.

Figure 5.3. Annual number of dracunculiasis cases in Kenya in 1991-2001

100 en Q) en CO 80 (.) en 'ii) .!'!1 60 53 "3 (.) c :::1 (.) CO 40 35 '- "0 0 0 20 z 6 7 4 8

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001

5.5. Senegal 5.5. Senegal Senegal reported the last indigenous dracuncu­ Le Senegal a rapporte les demiers cas autochtones liasis cases in 1997 (Figure 5.4) and entered its de dracunculose en 1997 (figure 5.4) et est entre dans precertification stage. Only one imported case from la phase de pre-certification. Seul un cas importe , Ghana was reported in 2001. probablement du Ghana, a ete notifi8 en 2001 .

WHO supported the National Guinea Worm Eradi­ L'OMS a soutenu le programme national d'eradi­ cation Programme in Senegal in May 2001 in im- cation de ver de Guinee au Senegal en mai 2001

Figure 5.4. Annual number of dracunculiasis cases in Senegal in 1991-2001

1,600

1,400 1,341 m Q) m 1,200 CO (.) m 1i) 1,000 .!:!! "3 (.) c 800 :::1 (.) -aCO 600 0 400 z0 200 19 4 0 0 0 0 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001

65 REPORT ON THE STATUS OF THE DRACUNCULIASIS GLOBAL ERADICATION GAMPAIGN IN 2001

proving dracunculiasis surveillance and raising pour ameliorer la surveillance de la dracunculose. awareness about the disease. Hardware computer Le materiel informatique aussi bien que des program­ equipment as well as software programmes includ­ mes de logiciel comprenant HealthMap ont ete four­ ing HealthMap have been provided in 2001 to assist nis en 2001 pour aider le programme dans la the programme in collection and management of collection et la gestion des donnees, et pour prepa­ dracunculiasis data required for review by the ICC DE rer la revue par la CICED.

5.6. Yemen 5.6. Yemen Although the last indigenous case was reported Bien que le dernier cas autochtone ait ete notifie in October 1997, the subsequent rumours of cases en octobre 1997, les rumeurs de cas dans certaines in part of the country which were not previously en­ regions du pays, qui n'etaient pas precedemment demic has shed some doubt on the assertion that endemiques, ont jete un certain doute sur I' affirma­ Guinea worm transmission has been interrupted and tion que la transmission de ver de Guinee a ete in­ on the strength of the surveillance network. In 2000, terrompue et sur la solidite du reseau de surveillance. one rumour was alleged to be dracunculiasis that En 2000, une rumeur alleguee a AI-Mahweet (WER, occurred in October 2000 in AI-Mahweet Governorate No 3, 19 janvier 2001) n'a pu etre confirmee. (WER, No 3., 19 January 2001).

Figure 5.5. Annual number of dracunculiasis cases in Yemen in 1994-2001

100 94 90 rJ) Q) rJ) 80 tO (.) 70 ·u;rJ) .£9 60 '5 (.) c 50 ::l (.) 40 ~ "0 0 30 z0 20 10 0 0 0 0 0 1991 1992 1993 1994 1995 19961997 1998 1999 2000 2001

66 RAPPORT SUR LA CAMPAGI-JE MONDif,L.E D'ER;\DICI'.TIO~J DE L'l. DRACUNCULOSE El~ 2001

Map 5.2. Rumours of Guinea worm in Yemen and villages investigated, 2000

In 2001, WHO agreed to support the following En 2001, I'OMS a accepts de soutenir les activi­ activities: tes suivantes :

• Development and production of Information, Edu­ • Developpement et production de materiels d'in­ cation and Communication (IEC) materials. Ex­ formation, d'education et de communication. Uti­ tensive use of mass media to improve community lisation etendue des medias pour ameliorer la awareness and to announce a reward of US$ 200 connaissance de la maladie par les communautes for reporting a case. Village Health Workers (VHWs) et pour annoncer une recompense de US$ 200 will supplement this effort by organizing informa­ pour la notification d'un cas. Les agents de sante tion sessions for village people, displaying post­ villageois completeront cet effort en organisant des ers, distributing pamphlets and communicating sessions d'information pour les villageois, en mon­ face-to-face. trant des affiches, distribuant des brochures et en discutant en tete a tete. • Training of 600 VHW in villages throughout the country is planned for January and February 2001 . • La formation de 600 volontaires de sante villageois The VHWs will be active in case detection, sur­ (VSV) dans tout le pays a ete faite en janvier et veillance and health education activities. fevrier 2001. Les VSV seront tres actifs dans la detection des cas. la surveillance et les activites • Strengthening the surveillance of dracunculiasis d'education sanitaire. using various approaches, such as routine data collection through health facilities and VHWs. • Le renforcement de la surveillance de la dracun­ culose en utilisant diverses approches, telles que la • GWEP will monitor quarterly all dracunculiasis collecte de donnees par l'intermediaire des struc­ eradication activities. tures de sante, et par les VSV.

• No cases were reported during 2001 . Yemen will • Le programme fera un suivi trimestriel des activites. be eligible for review by the ICCDE in 2003. • La Commission lnternationale pour la Certifica­ tion de !'Eradication de la Dracunculose passera en revue le dossier du Yemen en 2003.

67 REPORT ON THE STATUS OF THE DRACUNCULIASIS GLOBAL ERADIGATION CAMPAIGN IN 2001

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ANNEX I

The Khartoum Declaration on Guinea worm eradication

4 March 2002, Khartoum, Sudan

The Ministerial Round Table on eradication of interruption of transmission. This will permit the Guinea worm took place in Khartoum in Sudan on eradication of the disease once and for all; 4 March 2002. Ministers of Health or their repre­ d. as there is a high risk of re-introduction of the sentatives from countries where Guinea worm trans­ disease. it is necessary to maintain the eradica­ mission continues to occur, namely: Benin, Burkina tion efforts until the last country is certified free of Faso, Central African Republic, Cote d'lvoire, Ethio­ the disease. pia, Ghana, Niger, Sudan, Uganda and those which have recently interrupted transmission, namely: Ill. We commit ourselves to provide leadership and Cameroon, Chad and Yemen, participated in the to continue maximum focused political and technical Round Table. The Ministers reiterated their commit­ efforts toward the eradication in our countries by: ment to achieve eradication of the disease as soon a. providing additional national resources for eradi­ as possible and adopted the following Declaration: cation interventions and timely release of funds; b. strengthening inter-sectoral collaboration to im­ We, Ministers of countries still endemic for Guinea prove health education programmes and increase worm and of countries in the pre-certification stage, access to safe drinking water; c. implementing effective surveillance and monitor­ I. recognize that: ing before and after interruption of transmission much has been achieved to eradicate Guinea worm within the standards required by WHO for certifi­ disease: more than 95% reduction in cases reported cation; world-wide between 1989 and 2001, with about 64,000 d. increasing social mobilization advocacy, capacity cases reported in 2001, and over 150 countries and building and empowerment; territories already certified free of parasite transmission. e. adopting an integrated approach within the Pri­ mary Health Care system; 11. Nevertheless, we must acknowledge that: f. ensuring dedication and commitment of all person­ a. the disease continues to affect the poorest nel involved in the assault against guinea worm; populations deprived of access to basic health g. collaborating with neighbouring countries to tackle care provision, safe water supply and health edu­ trans-border foci; cation; h. promoting peace to allow health interventions to b. in the last areas where the disease is present, it take place in all affected areas. remains a barrier to development as it affects the workforce of the society and prevents children IV. We call on our partners to: from attending school; a. Support the promotion of effective peace proc­ c. the interest in combating the disease reduces esses where needed; when the number of cases approaches zero. We b. Provide the additional financial resources needed must resist the tendency to shift resources and to complete the Guinea worm eradication cam­ attention when it is crucial to consolidate the paign .

68 Ri\PPORT SUR l../1 Ci\MPA.GNE MONDI1\LE D'Erv\DIGATION DE Ul, DRACUNCULOSE Ef-1 2001

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ANNEXE 1

Declaration de Khartoum pour l'eradication du ver de Guinee

4 mars 2002, Khartoum, Soudan

Une table ronde ministerielle sur !'eradication du d) le risque de reintroduction de la maladie ver de Guinee a eu lieu a Khartoum, au Soudan, le 4 etant eleve, il est indispensable de poursuivre les mars 2002. Y ont participe ou s'y sont fait represen­ efforts d'eradication jusqu'a la disparition du der­ ter les Ministres de la Sante des pays d'endemie (le nier ver et jusqu'a la certification de taus les pays. Benin, le Burkina Faso, la Cote d'lvoire, I'Ethiopie, le Ghana, le Mali, la Mauritania, le Niger, le Nigeria, Ill. Nous nous engageons a maintenir le cap et a I'Ouganda, la Republique centrafricaine, le Soudan continuer de concentrer au maximum l'action et le Toga) et de ceux qui ont recemment interrompu politique et technique jusqu'a l'objectif final la transmission (le Cameroun, le Kenya, le Senegal, dans nos pays en: le Tchad et le Yemen). Ceux-ci ont reaffirms leur vo­ a) fournissant des ressources nationales addition­ lonte d'eradiquer la maladie le plus rapidement pos­ nelles aux interventions liees a !'eradication en sible et ont adopte la declaration suivante : nous assurant que les fonds soient disponibles en temps utile ; Nous soussignes, Ministres de la Sante des b) renfon;ant la collaboration inter-sectorielle pour pays d'endemie dracunculienne et des pays en ameliorer les programmes d'education sanitaire phase de pre-certification, et augmenter l'acces a !'eau potable; c) assurant une surveillance efficace, qui sera main­ I. Reconnaissons que : tenus apres !'interruption de la transmission, con­ de nombreux efforts ont ete faits pour eradiquer formement aux normes de certification etablies le ver de guinee: reduction de plus de 95% de par I'OMS; !'ensemble des cas declares entre 1989 et 2001, d) multipliant les activites de mobilisation sociale, avec seulement 62 000 cas notifies en 2001 et de developpement des competences et de ren­ plus de 150 pays et territoires deja certifies forcement de l'autonomie. exempts de transmission. e) adoptant une approche integree au systeme des soins de sante primaires ; 11. mais constatons cependant que: n s'assurant du devouement et de !'engagement a) la maladie continue d'affecter les populations les plus de taus les personnels impliques dans la lutte pauvres, privees d'acces aux soins de sante ele­ contre le ver de Guinee ; mentaires, a I' eau potable et a l'ooucation sanitaire; g) collaborant avec les pays voisins pour combat­ b) dans les dernieres regions d'endemie, la mala­ tre les foyers transfrontaliers ; die reste un obstacle au developpement puis­ h) pr6nant la paix pour etendre la mise en oouvre qu'elle touche les forces vives de la societe et des interventions sanitaires a toutes les regions. entrave la scolarite des enfants. c) l'interet a combattre la maladie decrolt lorsque le IV. Nous appelons nos partenaires a : nombre de cas tend vers zero. Nous devons nous a) soutenir la promotion des efforts de paix la ou ils garder de re-affecter prematurement les ressources sont necessaires ; et continuer a nous mobiliser au moment ou il est b) fournir les ressources financieres supplementai­ crucial d'interrompre definitivement la transmission res indispensables pour mener a bien !'eradica­ pour eradiquer la maladie une fois pour toutes ; tion du ver de Guinee.

69

REPORT ON THE STATUS OF THE DRACUNCULIASIS ERADICATION CAMPAIGN IN 2001

RAPPORT SUR LA CAMPAGNE D'ERADICATION DE. LA DRACUNCULOSE EN 2001

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