Contributions of the Guinea Worm Disease Eradication Campaign
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Contributions of the Guinea Worm Disease Eradication Campaign toward Achievement of the Millennium Development Goals Kelly Callahan, The Carter Center Birgit Bolton, Emory University Donald Roswell Hopkins, Emory University Ernesto Ruiz Tiben, Emory University P. Craig Withers, The Carter Center Kathryn Meagley, Emory University Journal Title: PLoS Neglected Tropical Diseases Volume: Volume 7, Number 5 Publisher: Public Library of Science | 2013-05-30, Pages e2160-1-e2160-7 Type of Work: Article | Final Publisher PDF Publisher DOI: 10.1371/journal.pntd.0002160 Permanent URL: http://pid.emory.edu/ark:/25593/f3v9g Final published version: http://www.plosntds.org/article/info%3Adoi%2F10.1371%2Fjournal.pntd.0002160 Copyright information: © 2013 Callahan et al. This is an Open Access work distributed under the terms of the Creative Commons Attribution 2.5 Generic License (http://creativecommons.org/licenses/by/2.5/). Accessed September 27, 2021 12:32 AM EDT Review Contributions of the Guinea Worm Disease Eradication Campaign toward Achievement of the Millennium Development Goals Kelly Callahan1*, Birgit Bolton2, Donald R. Hopkins1, Ernesto Ruiz-Tiben1, P. Craig Withers1, Kathryn Meagley2 1 The Carter Center, Atlanta, Georgia, United States of America, 2 Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America Introduction Other symptoms include nausea, vomiting, diarrhea, and dizzi- ness; secondary bacterial infections can also occur and can lead to Infectious diseases have influenced the biological, historical, and arthritis, tetanus, and permanent crippling [8]. political development of the human species more than any other There is no cure, vaccine, or immunity after infection [11]. factor: from the outcome of wars to the success of empires, from Since there is no evidence that animals are reservoir hosts, the the pace of technological advance to the structure of society [1]. disease is deemed a good candidate for eradication [8]. The global Dracunculiasis (Guinea worm disease) was considered a mild eradication campaign began at the United States Centers for affliction not warranting a widespread public health campaign. Disease Control and Prevention (CDC) in 1980 and was then However, examination of the benefits of eradicating Guinea worm adopted as a subgoal of the United Nations International disease (GWD) reveals the effort is contributing to development, Drinking-Water Supply and Sanitation Decade (1981–1990). In including contributions to certain Millennium Development Goals that same year, the decision-making body of the World Health (MDGs) [2]. Organization (WHO) adopted a resolution (WHA 34.25) recog- Given the use of the MDGs in the development of global health nizing the decade could be an opportunity to eliminate GWD. agendas, it is timely to consider the contributions of neglected Since 1986, The Carter Center (TCC) has led the effort, with the tropical disease (NTD) programs, such as the Guinea Worm help of the CDC, WHO, United Nations Children’s Fund Eradication Program (GWEP), toward the achievement of the (UNICEF), and many other donors and nongovernmental MDGs. The prevention of NTDs, and their cost-effective organizations, to assist national eradication efforts by governments interventions, fuels long-term economic growth and development, of the countries where GWD is endemic [11]. The GWEP assists and human advancement [3]. The effort to eradicate GWD is ministries of health (MOH) in each endemic country to provide considered one of the most cost-effective health interventions GWD interventions. The GWEP is an eradication effort that relies available [2,4,5]. The authors provide evidence that concentrated heavily on behavioral change via health education and interven- efforts on eradication, elimination, and control of some NTDs can tions. The GWEP has demonstrated that when people are given yield far-reaching results, and given these results, stimulate the proper tools and health education, cases decrease dramatically increased efforts toward NTD eradication, elimination, and [16]. The most effective and cost-efficient way to prevent GWD is control among public health advocates, global health entities, the promotion of its health campaign coupled with proper and and donors. consistent use of filters to remove the copepods from drinking GWD is a disease of the poor, debilitating many in the most water, case containment, and the application of ABATE, a safe remote and disadvantaged communities in parts of sub-Saharan chemical larvicide, to control the copepods [4,17–19]. Africa, where potable water is limited and health care and GWD is an infectious disease categorized as a neglected tropical education are lacking [6]. Endemic GWD transmission is an disease (NTD) [20]. NTDs are among the most common infectious indicator of extreme poverty [6,7]. GWD is a preventable, painful, diseases of the world’s poorest people [21,22]. An estimated 1.2 and incapacitating waterborne helminthic disease, which harms billion people are infected with one or more NTDs [23]. These health, agriculture, school attendance, and overall quality of life individuals are among the billion people living on less than $1 per for individuals and communities [7–9]. GWD is transmitted when day, a population identified as the ‘‘bottom billion’’ [23]. NTDs humans drink water, usually from stagnant water sources, are a group of parasitic, bacterial, and viral diseases that cause containing tiny copepods that have ingested larvae of the parasite. Once consumed, the digestive juices in the human stomach kill the Citation: Callahan K, Bolton B, Hopkins DR, Ruiz-Tiben E, Withers PC, copepods, allowing the larvae to be released and move to the et al. (2013) Contributions of the Guinea Worm Disease Eradication Campaign intestinal wall where they migrate to connective tissues of the toward Achievement of the Millennium Development Goals. PLoS Negl Trop thorax. Male and female larvae mature and mate 60–90 days after Dis 7(5): e2160. doi:10.1371/journal.pntd.0002160 infection. Symptoms appear 10–14 months later when the gravid Editor: Jeremiah M. Ngondi (University of Cambridge, United Kingdom) adult female(s), measuring up to 70–100 cm long, emerges from Published May 30, 2013 the skin, causing a painful lesion [10]. When the emerging worm is Copyright: ß 2013 Callahan et al. This is an open-access article distributed exposed to water, she ejects hundreds of thousands of larvae into under the terms of the Creative Commons Attribution License, which permits the water to continue the cycle. During emergence, an infected unrestricted use, distribution, and reproduction in any medium, provided the person can be incapacitated for an average of 8.5 weeks [10,11]. original author and source are credited. Although rarely fatal, GWD inflicts devastating pain and infection Funding: No specific funding was received for this study. resulting in immobility [8,12]. The pain is so long-lasting that Competing Interests: The authors have declared that no competing interests infected individuals may be incapacitated for up to three months exist. during and after the Guinea worm (GW) emerges [11,13–15]. * E-mail: [email protected] PLOS Neglected Tropical Diseases | www.plosntds.org 1 May 2013 | Volume 7 | Issue 5 | e2160 substantial illness and are a major cause of disease burden that can $63 billion for a new Global Health Initiative, which included last decades, impairing children’s growth, development, physical support for NTDs [37]. In December 2011, the U.S. Congress fitness, and causing disability and disfigurement [3,20,24,25]. The allocated $89 million for the USAID NTD control efforts in most common NTDs have relatively high morbidity and low FY2012, which was a $12 million increase over the FY2011 mortality [3,25]. There are 17 diseases recognized by the CDC as budget for NTDs [38]. Despite the higher burden, new funding, NTDs, of which four (onchocerciasis, schistosomiasis, soil-trans- and cost-effectiveness of preventing NTDs, donors and the mitted helminths, and trachoma) can be controlled, or potentially international health community still direct more resources, funds, eliminated, and three eradicated through mass administration of and effort to combating the ‘‘big three’’—HIV/AIDs, tuberculo- safe and effective medicines complemented with effective inter- sis, and malaria [3,21,26] —than to combating NTDs. ventions, such as behavior change programs (dracunculiasis (Guinea worm), lymphatic filariasis, and taeniasis/cysticercosis) Contribution of the Guinea Worm Eradication [20,26]. NTDs are considered ‘‘low-hanging fruit’’ with benefits Program toward Achievement of the Millennium beyond disease-specific effects, given marked disease burden Development Goals reduction through cost-effective interventions, mass drug admin- istration, and community-based delivery strategies [4,27]. The toll Here we describe specific ways the GWEP contributes to of NTDs on individuals, communities, and societies extends achieving certain MDGs: beyond physical suffering to significant economic, social, and political consequences, hampering development and trapping the MDG 1: Eradicate Extreme Hunger and Poverty poor in a cycle of poverty and disease [3,23]. Affected individuals Poverty is not defined by the MDGs; however, an indicator of often suffer from multiple NTDs, compounding their individual poverty is a person whose income is less than $1 a day, and burden, including disability [3,26]. This impedes a country’s extreme hunger