Dracunculiasis in Cameroon at the threshold of elimination.

Abstract

Dracunculiasis is endemic in Mayo Sava Division in the Far North Province of Cameroon. Transmission occurs during the rainy season with a peak in the months of July and August. A combination of interventions consisting of active surveillance, social mobilization, health education, distribution of filters, construction of new water sources, chemical treatment of unsafe water sources with temephos, and case containment were applied in Mayo Sava in 1990-1995 by the national Guinea Worm Elimination Programme (GWEP). Dracunculiasis cases were detected by village health workers, confirmed by health outreach teams and reported weekly to the GWEP. A decline in the incidence of dracunculiasis by 98.1% from 778 cases in 1990 to 15 in 1995, and in the number of endemic villages by 92.7% from 82 in 1990 to 6 in 1995 was achieved. The proportion of cases identified < or =24 hours of worm emergence increased from 19% in 1991 to 73.6% in 1993. Over 1500 nylon monofilament filters were distributed yearly to endemic villages lacking safe drinking water sources, while 81 new water sources were constructed (boreholes, wells and dikes), 55% in 1992-1993. The success of GWEP is attributed mainly to: intensive and simultaneous implementation of interventions in highly endemic villages in the first 3 years of the programme, case containment, and cash reward. Cameroon is on the threshold of eliminating dracunculiasis from Mayo Sava but the major remaining obstacle is the ever increasing threat of re-infestation from neighbouring countries.