Abstract

Dracunculosis, an incapacitating, essentially rural, water-borne parasitic disease is considered a high priority public health problem in Mali given the extent of its socioeconomic repercussions. Despite a rural water policy that regulates the drinking water supply with a view to controlling water-borne diseases, the main water sources, namely the surface waters, continue to carry cyclopides infested with Dracunculus medinensis larvae. The disease could be eradicated by filtering water through an inexpensive screen filter. However, the acceptability of the technology must be tested before it is introduced in nomadic communities. This project will examine the epidemiology of dracunculosis in a population of nomads. Researchers will survey existing knowledge of water treatment methods; investigate the socioeconomic consequences of dracunculosis in the research area; and ascertain people's opinion on the introduction of the screen filter.

Post-Project Summary

The researchers developed a questionnaire including a socio-demographic survey (one to a family), an opinion survey, a clinical survey and an economic survey. They surveyed a total of 1,356 people in 13 villages or encampments near watering places. The proportion of the population surveyed at each site varied from 1.8% to 15.9%. More than half (55.4%) of those questioned were familiar with the typical signs of dracunculiasis or Guinea worm disease; 22.5% had had the disease at least once. Only 29.4% of them identified surface water as the source of the disease; 58.5% admitted they did not know its source. With regard to prevention, 57.1% thought it was impossible, and a further 34.1% had no idea. However, 93.6% recognized the seriousness of the disease, particularly as it incapacitates the sufferer. The age group most affected was 20-29, followed by those 30 or older. Of the 36 patients examined, 26 were totally incapacitated for an average of 47.62 days, with a standard deviation of 38.72 days. The economic repercussions were felt in losses of livestock by families in nomadic and semi-nomadic encampments: on average, 16 sheep and 19 goats for each infected family, compared with fewer than 10 for each uninfected family. Only 16 people received treatment, 13 by traditional methods and three by modern methods.

The researchers' recommendations included: mandatory reporting of every case of dracunculiasis; initiating active epidemiological monitoring of the disease by mobilizing community leaders, public service providers, health workers and the like; incorporating drinking water supply into an integrated water and primary health care policy at the village level; a public education campaign on transmission of the disease; promoting the use of filter screens as a simple and effective prevention method; treating sufferers with anti-inflammatory drugs, antibiotics, antipyretics, wound dressings and tetanus shots to shorten the period of incapacity and thus reduce the social and economic repercussions; and drawing up an inventory of all existing traditional remedies with a view to promoting the use of those that appear beneficial and discouraging the use of those that may cause complications.

Recipient Institution(s)