Neglected tropical diseases

High-level mission reiterates need for enhanced dracunculiasis surveillance and case-containment in Ethiopia’s Gambela region

© Biswas Gautam/WHO
People from an affected community carefully following tips on how to avoid dracunculiasis infection
Geneva | 17 June 2013

Heightened surveillance, prompt implementation of case-containment measures and rigorous reporting are crucial to interrupting transmission of dracunculiasis (also known as guinea-worm disease) cases in Ethiopia’s Gambela region.

This is the assessment of a high-level delegation, which visited two endemic districts (Abobo and Gog) in Gambela from 16 to 17 June 2013.

A first-hand account of difficulties and challenges puts in real perspective the need for more interaction with inhabitants as well as implementation of a more stringent surveillance system in Gambela” said Dr Lorenzo Savioli, Director of the Department of Control of Neglected Tropical Diseases. “We are committed to working closely with the authorities of the Regional State, the Federal Ministry of Health in Addis Ababa and The Carter Center to support surveillance and case containment activities.”

The delegation comprised Dr Kesetebirhan Admassu, Minister of the Federal Ministry of Health, Dr Lorenzo Savioli, Director of the Department of Control of Neglected Tropical Diseases, other WHO officials as well representatives from The Carter Center and the Bill & Melinda Gates Foundation.

Low intensity transmission of dracunculiasis has continued for over a decade in a few villages in Gambela. In 2008, an outbreak resulted in more than 40 confirmed cases. From 1 January to date, 6 cases have been reported from Abobo and Gog districts (woredas) in Gambela.

The high-level delegation also met with the President of Gambela Regional State, Mr Ato Gatluak Tut Khot, who expressed the determination of his Government to own and provide the needed support to strengthen eradication activities and oversee implementation progress.

Discussions also focused on lesson learnt from past experiences, the need for increased political commitment and a strengthened health system to overcome the challenges in eradicating dracunculiasis.

During visits to villages in Abobo and Gog districts, the delegation met inhabitants to get a better understanding of their perception and noted their concerns for access to improved drinking-water sources.

We need to engage villagers in order to increase their awareness of the current reward scheme for the reporting of any suspected case in their community” said Dr Gautam Biswas, Team Leader , Dracunculiasis Eradication, at WHO in Geneva, Switzerland. “This will encourage prompt reporting and containment of cases.

The delegation also heard from villagers that people often get infected by drinking unsafe water in neighbouring forests where they frequently go to collect firewood or honey.

Ethiopia and dracunculiasis eradication

The Ministry of Health of Ethiopia established a full-scale national dracunculiasis eradication programme in 1993 when 1120 cases were reported in the country.

In 2000, only 60 cases were reported and since 2001 less than 50 cases have been reported annually, the majority from the Gambela region.

Major challenges include maintaining surveillance in the Gambela region, including accessibility to districts due to flooding during the peak transmission season. Cross-border collaboration with South Sudan is important , as movement of people poses a risk for ‘imported cases’ from South Sudan into Ethiopia’s Gambela and Southern Nations, Nationalities, and Peoples' Regions.

To increase the sensitivity of the surveillance system, a reward of about US$ 58 (1000 Birr) is offered for self-reporting of dracunculiasis cases.


Dracunculiasis is a crippling parasitic disease caused by Dracunculus medinensis, a long thread-like worm. The disease, which has afflicted humanity for centuries, is transmitted exclusively when people drink water contaminated with parasite-infected water fleas.

The disease was endemic in 20 countries in the 1980s. In 2012, transmission was limited to only four countries: Chad, Ethiopia, Mali and South Sudan.

Dracunculiasis eradication strategies include:

  • detecting each case within 24 hours of worm emergence;
  • preventing transmission from each worm by cleaning and bandaging the affected skin area regularly until the worm is completely expelled from the body;
  • educating people with an emerging worm to avoid wading in any surface water source, as this releases larvae, which contaminate the water;
  • ensuring wider access to safe drinking water to prevent infection;
  • filtering water from open water bodies through a cloth or nylon mesh before drinking;
  • implementing vector control by using the larvicide temephos (Abate) in potential transmission sources; and
  • conducting health education and bringing about behavioural change.