Guinea worm has been known in Ghana for decades and most endemic communities have some myths about it. In some communities where people usually suffer from the disease, they attribute it to evil spirits and other unexplained circumstances. In the northern parts of the country, it is able to keep farmers away from their farms for a whole planting season. It has also been established that there is a significant loss to agriculture production when there is high level of infection in these communities. The disease Guinea worm is caused by a nematode parasite with a simple transmission cycle but usually involves an intermediate host, the water flea or cyclops which abounds in stagnant ponds and puddles. Man, who is the final host becomes infected when he drinks water containing the cyclops, causing ingested larvae to undergo a series of development processes in the human host. At that point, the larvae becomes an adult worm within approximately nine to twelve months, ready to discharge its eggs. For the worm to be able to discharge its eggs, it has to migrate towards the surface of the body where it forms a blister, which most often becomes increasingly itchy and finally bursts to form an ulcer. Once the ulcer is formed and the worm starts to emerge, it is now ready to discharge its eggs into water, which is said to provide a soothing remedy for the discomfort of the ulcer, as well as a suitable stimulus for the egg-discharge process to take place. This means that when the affected ulcer is immersed in water, eggs can be seen being discharged and the patient may get a lot of comfort from the process. These eggs once discharged into water (such as when an infected person wades into any stagnant water) readily enter the intermediate cyclops hosts, to undergo preliminary developmental stages to become larva, which are then discharged into the water. The current situation According to the National Programme Manager of the Ghana Guinea Worm Eradication Programme, Dr Andrew Seidu Korkor, Ghana accounts for 14 per cent of all global cases today whiles Sudan accounts for 85 per cent. The good news is that the cases in Ghana have been significantly reduced by 98 per cent but the reduction cannot be said of all the areas. The Northern Region reported 90 per cent of all cases during January to December 2006, with Savelugu-Nanton, Tolon-Kumbugu, Tamale, Yendi, East Gonja being the top five endemic districts. They had 3,188 cases, or 77 per cent of all cases reported in the country. At a recent workshop in Accra on guinea worm eradication, Dr Korkor said it was possible to interrupt the cycle of transmission of the worm which the programme was making efforts to check. Risks Primarily, the disease affects people who do not have access to potable water and have to drink from unsafe surface sources such as dams, ponds and puddles. It is interesting to note that all are equally vulnerable, however people of certain occupational groups are more vulnerable, for example, farmers, hunters and traders who usually work out in the fields, where there is no potable water. Again, at social gatherings or events such as markets, funerals and weddings when potable water is not available, there is the risks of infection. Even though guinea worm disease is endemic in Ghana and occurs all year round, the peak transmission season is the dry season when most of the flowing streams and rivers become stagnant ponds. The intermediate host, the cyclops, thrives in stagnant water. Management and control The measures for the eradication of guinea worm are based on the recommendations of the World Health Organisation (WHO). The recommendations include the provision of adequate safe water, including water supply systems, to replace the dependence of affected people on stagnant ponds and dams. In the wake of unavailability of potable water, people should be educated on the causes and transmission of diseases and how to prevent infection. Since water sources become infested when an infected person steps in, water sources should be protected from contamination. In fact, in some areas, traditional rulers have imposed sanctions and fines on infected individuals who contaminate water sources. Community-based surveillance for guinea worm should be encouraged and village volunteers who are also well-trained must be encouraged to search and identify cases for treatment on a daily basis. The success of the guinea worm eradication programme is challenged by inadequate safe water and poor attitudinal change. Actions by government The government has always been committed to eradicating the disease because it plays a significant part in meeting the Millennium Development Goals (MDGs). In line with that the Ministry of Health (MOH) and the Ghana Health Service (GHS) is focusing its efforts in the remaining endemic foci in the Northern Region. New initiatives being put in place include the re-organisation and re-orientation of field staff to ensure more productivity through better management of time and more targeting for better efficiency. The MOH has earmarked ¢5 billion to support field operations, community education and advocacy, as well as a marketing campaign. Apart from these initiatives, the government has declared that guinea worm is a medical emergency requiring immediate reporting, prompt action to contain cases, provision of free medical care to all patients preferably in a public or Case Containment Centre and a release of ¢500 million for the free treatment of guinea worm cases. The government has also endorsed a special European Union (EU) project in collaboration with UNICEF to bring water to endemic communities in the Northern Region. Expansion works are going on at the Tamale Water system, which when completed will significantly improve water supply to Tamale and its environs. Conclusion Guinea worm eradication is a national priority and must be included in the development process of all development agencies and partners. For the MOH, it is as important as polio, cholera and meningitis which are treated as a medical emergencies. This means that, every person with guinea worm must be detected and treated immediately and each case must be prevented from contaminating water. This calls for the support of district assemblies to make guinea worm a priority and assist the activities of the guinea worm eradication programme by involving NADMO, Health officers and others in all the districts’ activities as well as the need to enforce bye-laws in order to confine cases. Proactive community leaders who have successfully eradicated guinea worm from their communities should be involved in advocacy work in the remaining endemic communities, while water development agencies should accelerate the provision of water to these communities. Obviously as a nation committed to providing social security and good health care delivery in order to boost development, we need to reposition ourselves, think back and find a lasting solution to the problem. As Ghana prepares to celebrate an eventful and remarkable day in the history of the country – its 50th Anniversary, it is justifiable for some people, or, concerned members of society to pose the question, Why are we still battling with guinea worm at a time when technology and science had advanced? By Hilda Owusu