Monitoring and evaluation of Guinea Worm Eradication

Abstract

Dracunculiasis, or guinea worm disease is well-known for a number of reasons: its spectacular clinical manifestations (the emergence of a near-meter long worm from a painful cutaneous blister), the severe disease outbreaks which paralyze entire villages, and the striking traditional treatment which consists of laboriously rolling out inch after inch of the worm round a wooden stick. In the early 1980s, following the success of smallpox eradication, dracunculiasis was identified as the next candidate for eradication, since it could be tackled through simple preventive measures. Today, a successful global programme of eradication is underway in several countries. To appreciate the challenges of monitoring and evaluating the interventions, an understanding of the disease, the epidemiological situation and programme interventions is necessary; these aspects are therefore discussed. Then, based on the West and Central African experience, this article goes on to examine programme planning approaches and the monitoring and evaluation systems that were developed to track progress towards the global goal of eradication, notably community surveillance systems, formative evaluations, geo-reference database and mapping tools. Such monitoring and evaluation systems have several innovative elements unique to guinea worm eradication programmes and adapted to the requirements imposed by disease transmission patterns. There is evidence that the final efforts to eradicate guinea worm will be more costly, will take much longer than expected, and will require adequate and timely support in order to deal with the setbacks.