1988 to 2013: Nigeria’s guinea worm eradication journey

What Chukwu relies on, however, is a recommendation by the verification team. The country still has to wait till later in the year, December precisely, to know from WHO through the presentation of a certificate affirming that Nigeria, which recorded its last transmission in 2008, is truly now free of guinea worm.From most to naughtNigeria […]

What Chukwu relies on, however, is a recommendation by the verification team. The country still has to wait till later in the year, December precisely, to know from WHO through the presentation of a certificate affirming that Nigeria, which recorded its last transmission in 2008, is truly now free of guinea worm.
From most to naught
Nigeria topped the list of guinea worm endemic countries in 1988, recording 653,620 cases at a time when the global total was 3.5 million and reported in 21 countries. Working with speed however, Nigeria reduced the cases by the year 1995 to 13,000. And today, the country has zero transmission of the disease. It has been so since 2008, the fact which gave Nigeria the courage to invite the global health monitor, World Health Organisation (WHO), to come and take a look.
Nigeria began the move to have its zero guinea worm transmission claim verified last year, four years after the last reported case, because the investigation for the certification of any country as guinea worm-free can only begin after the country has not recorded any guinea worm transmission in at least three years.
The guinea worm disease, so called because it is particularly common in the coast of Guinea, and less commonly known as Dracunculiasis, is a disease from water contaminated with flea which contains the worm larvae. As the water flea is digested, the worm moves through the body over a period of nine to twelve months when it manifests through the formation of blisters in any part of the body, but most frequently in the leg, causing pain and immobilizing the victim.
Guinea worm was mandated for eradication globally by WHO, the Organisation does the investigation through a body of experts, the Guinea Worm Eradication Certification Committee, which was in Nigeria between June 24 and July 12 to do the field work.
The committee which toured Plateau State, as it did all other states and the Federal Capital Territory; spent a good while at the Nigeria Office of the Carter Center in Jos; an international NGO in the forefront from the beginning of the struggle to stamp out the guinea worm disease.
“I’m leading a team of nine external consultants and nine Nigerian consultants.” Chairman of the Committee, Professor David Molynonx, said.  Molynonx stated further, “We’re operating on the basis of strict independence, because the team must be totally independent in its review of documentation provided by the Nigeria Guinea Worm Eradication Programme.
Nine teams are distributed all over the country examining the information and documentation which governments at state level provide. The effort is to bring evidence to bare that guinea worm transmission no longer exist in Nigeria.”
The Nigeria Guinea Worm Eradication Programme (NIGEP) has been the organ constituted by the Federal Government to steer the required concerted efforts to fight the disease.
Turning point for guinea worm in Nigeria
When one 58-year-old Grace Otubo made history in November 2008 of becoming the last Nigerian to be a victim of guinea worm, it was a national achievement for a country that had recorded thousands of cases and working consistently at reducing the incidence and waiting expectantly to see the last case go.
That achievement nearly five years ago prompted these words from Nigeria’s former Head of State, founder of the Yakubu Gown Foundation, and the individual who has done much in Nigeria’s anti-guinea worm fight, Retired General Yakubu Gowon:  “We are staring history in the face as the public health system of Nigeria is about to make a bold statement of eradicating guinea worm disease in Nigeria after many years.”
Guinea worm was common in communities with low level of hygiene practice and inadequate sources of safe drinking water. Organisations like the UNICEF became interested when infected school children could not attend classes, infected mothers were unable to provide care especially to infants, resulting in diarrhoea, malnutrition, and skin infections, even as affected mothers were unable to walk long distances to immunise their babies against childhood killer diseases.
Guinea worm which affects people of all ages and sexes has one redeeming feature: it does not kill. But because it could render sufferers unable to carry out socio-economic activities, it could impoverish families and harm the economies of endemic communities.
The Carter Center has been in Nigeria (with Jos as its administrative base) since 1988 when the guinea worm eradication programme started. Country Representative of the Center, Dr. Emmanuel Miri has taken time to explain the role of the Center on guinea Worm eradication and how the eradication drive had faired, including the personal contribution of Yakubu Gowon.
 Miri said during an interview with Daily Trust when the work against guinea worm experienced a lull, Jimmy Carter (former US president and founder of the Carter Foundation) invited General Gowon. He elaborated, “Getting on board, General Gowon made numerous trips to the various states of this country to do advocacy and mobilisation for guinea worm eradication. It is largely the result of his efforts that we can be here today talking about guinea worm eradication certification.”
Miri also singled out two other former heads of state who did their own parts while in office. He recalled, “General Ibrahim Babangida donated $1 million on behalf of the country to the Carter Center to support the push; so also was General Abubakar Abdulsalam when he was the military head of state, who similarly donated $1 dollars. This is in addition to  the donations by UNICEF, the WHO and many international donors and government at the three levels in Nigeria.”
Awaiting the certification from WHO
Explaining the course of the certification, Molynonx said: “The context of the mission is that a week or two after we leave Nigeria; we will do a report to the World Health Organisation. That report is scrutinized by the International Commission for the Certification of Dracunculiasis Eradication. It is not up to me what happens to that report. It is left to the commission which is made up of technical experts.
The certification is an intensive process and the responsibility of the team is significant because we have to first investigate the claim by Nigeria’s Ministry of Health that there is no more guinea worm in Nigeria and then to make a presentation of its findings to the International Commission for the Certification of Dracunculiasis Eradication, which is likely to meet in December this year and consider, among other countries, the Nigeria report. The commission will then recommend to the Director General of WHO whether Nigeria should be certified or not. The meeting will take place in Geneva in December.”