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 Carter urges Sudan ceasefire to eradicate Guinea worm
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Carter urges Sudan ceasefire to eradicate worm
KHARTOUM, Feb 4 (Reuters) - Former U.S. president Jimmy Carter urged the warring parties in Sudan on Monday to declare a nationwide ceasefire to back a project to eradicate the debilitating Guinea worm disease.
Sudan has around 50,000 sufferers from about 80 percent of all the world's cases, but experts say eradication would be a matter of a few years if health workers were given proper access.
In 1995, Carter negotiated a similar ceasefire which lasted several months, allowing health teams into affected areas. But fighting in Africa's largest country flared again afterwards.
"In my prayers to God, I appeal to the government and the SPLM/SPLA (rebel group) to show wisdom and generosity, and as a first step to eradicating Guinea worm, they should announce a nationwide and complete ceasefire," he said at the start of a four-day conference in Khartoum on wiping out the infestation.
Sudan's President Omar Hassan al-Bashir said his government backed the idea of a ceasefire to help health workers, and urged the international community to put pressure on the rebel movement to do the same.
Carter said he would be travelling to the rebel-held town of Rumbek in southern Sudan to meet Sudan People's Liberation Army (SPLA) leaders to discuss peace efforts and health issues.
Rebels have been fighting since 1983 for greater autonomy for the mostly Christian and animist south from successive governments in the Muslim north. Some two million people have died as a result of the conflict.
U.S. special envoy John Danforth recently secured a ceasefire deal in the Nuba Mountains of southern Sudan, but there have been reports of violations, and fighting continues elsewhere in the country. Carter now ######### the U.S.-based Carter Center, which leads a project to stamp out Guinea worm disease.
Sudan's national coordinator for Guinea worm eradication, Nabil Aziz, said that of the more than 49,000 cases reported in Sudan, 99 percent were in the south.
People catch the disease by drinking water infested with the larvae. The worm, which is about as thick as a spaghetti noodle, can grow to about three feet (over a metre) long inside the body. After a year, it emerges through an agonisingly painful blister in the skin.
Carter told Reuters last week that even if he could arrange a ceasefire throughout Sudan, it would take at least three years to stamp out every last case of the disease. All other countries hoped to wipe out the illness by 2004, he said.
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Re: Carter urges Sudan ceasefire to eradicate Guinea worm (Re: Kostawi)
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Disease status
Burden in figures
Recent epidemiological data
Geographical distribution
Control activities
Policy and Strategy
Progress
Ongoing collaborations
Specific information
The Disease
Relevant WHO documents
Important dates
DRACERAD discussion list
General information and related links
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The Disease
Nine out of ten people living in the depressed areas of Africa south of the Sahara still have nothing else to drink but meagre quantities of impure water, thus exposing themselves to serious diseases such as the appalling dracunculiasis.
This parasitic disease causes dreadful suffering and disability among the world's most deprived people. The disease reappears each year during the agricultural season, handicapping farmers, mothers and schoolchildren already weighed down by harsh living conditions and often existing just above survival level. Families affected by the disease experience great loss: their food stocks and savings gradually dwindle away, they are no longer able to participate in vaccination campaigns and the children's schooling increasingly suffers. Gradually worn down by penury, these underprivileged people find themselves trapped in a vicious circle of poverty and disease.
 Dracunculiasis is a disease caused by the parasitic worm Dracunculus medinensis or "Guinea worm". This worm is the largest of the tissue parasite affecting human. The adult female, which carries about 3 million embryos, can measure 600 to 800 mm in length and 2 mm in diameter. The parasite migrates through the victim's subcutaneous tissues causing severe pain especially when it occurs in the joints. The worm eventually emerges (from the feet in 90% of the cases), causing an intensely painful oedema, a blister and the an ulcer accompanied by fever, nausea and vomiting.
Infected persons try to relieve the burning sensation by immersing the infected part of their body in local water sources, usually ponds water. This also induce a contraction of the female worm at the base of the ulcer causing the sudden expulsion of hundreds of thousands of first stage larvae into the water. They move actively in the water and can live for a few days in water.
For further development, they need to be ingested by suitable species of voracious predatory crustacean, Cyclops or water fleas which measure 1 - 2 mm and widely abundant worldwide. In the cyclops, larvae develop to infective third-stage in 14 days at 26°C.
When a person drink contaminated water from ponds or shallow open wells, the cyclops is dissolved by the gastric acid of the stomach and the larvae are released and migrate through the intestinal wall. After 100 days, the male and female meet and mate. The male become encapsulated and die in the tissues while the female move down the muscle planes. After about one year of the infection, the female worm with the uterus filled with larvae, emerges usually from the feet repeating the life cycle.
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An emerged Guinea worm is being pulled out from a small girl in Tamale, Ghana |
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A Guinea worm emerging form a foot of a person in Sudan |
No drugs are currently available to prevent or heal this parasitic disease - the only disease exclusively associated with unsafe drinking water. Dracunculiasis is, however, extremely easy to combat and should no longer be prevalent.
Dracunculiasis is rarely fatal. Frequently, however, the patient remain sick for several months, mainly because:
- Several worms are expelled successfully,
- The migration and emergence of the worms occur in sensitive parts of the body, e.g. the sole of the feet,
- Serious secondary bacterial infection frequently sets in subsequent to the accidental rupture of the worm.
 Temporary disability can leave 58% unable to leave their beds for a month during and after the emergence of the worm, as found by a longitudinal study in Nigeria. This usually occurs during the peak agricultural activities and labour is in a great demand, this can effect the nutritional status of their children. In Sudan, households where more than half the adult members had suffered from Guinea worm in one year, their under 6 year children were three times as likely to be malnourished, as indicated by wasting. For that reason, considering only the benefit of reducing incidence, the WB estimated 29% economic rate of return for the global Guinea worm campaign which has cost US$ 90 millions todate. However, this is only part of the cost as Guinea worm cause other negative social and educational impact such as preventing infected people from engaging into social activities and prohibit children from attending schools.
 The epidemiology of the diseases is determined largely by the use of open water sources such as ponds and sometimes shallow or step wells. Man-made ponds such as hafirs in Sudan and small scale dams in West Africa are the main source of transmission. The disease is seasonal occurring with two broad patterns found in endemic areas of Africa depending upon climatic factors. In the Sahelian zone, transmission generally occurs in the rainy season (May to August). In the humid savanna and forst zone, the peak occurs in the dry season (September to January). However, there are local variations in these patterns. Other risk factors are mobility and infection the previous year.
Dracunculiasis is a vulnerable disease: man alone is responsible for maintaining its fragile transmission cycle. It is therefore possible to permanently curtail transmission by applying simple measures. Some elementary steps include:
- systematic filtering of drinking water derived from ponds and shallow unprotected wells or from surface water. Finely-meshed cloth or, better still, a filter made from a 0.15 mm nylon mesh, is all that is needed to filter out the cyclops from the drinking water.
- the construction of copings around well ######### or the installation of boreholes with handpumps. This would prevent not only dracunculiasis but also diarrhoeal diseases.
If these measures are accepted and then administrated by village communities, the ultimate goal will be achieved: the eradication of dracunculiasis . |
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Re: Carter urges Sudan ceasefire to eradicate Guinea worm (Re: Kostawi)
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Press Release WHO/13
4 March 2002 |
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FINANCIAL AND POLITICAL COMMITMENT NEEDED TO FINALLY ERADICATE DEVASTATING GUINEA WORM DISEASE
Armed conflict and wavering commitment are threatening the eradication of one of the world's most devastating diseases. While the number of people infected by Guinea worm has dropped by 98% over the past 12 years, war and lack of financial backing in the 12 countries still plagued with this debilitating disease have led the number of cases to increase again.
In 1989, one million people fell victim to Guinea worm. When the worms spewed a blistering acid from beneath the skin, victims were disabled by pain, fever and vomiting for several months. Often this meant farms would go untended and Guinea worm (dracunculiasis) became known as the "empty granary disease." But by then, an inspirational group of partners had begun battling the disease by providing access to safe drinking water through water filtering, digging wells and other interventions.
These efforts proved that eradication, which means freeing the globe of the disease as was done with smallpox, was possible. In 1991, the World Health Assembly resolved to eradicate Guinea worm and a campaign was launched by WHO, UNICEF, the Carter Centre and others. To date, public health workers have made enormous progress. During the last few years, WHO certified Pakistan and India as Guinea worm disease-free and several countries, including Yemen, Kenya, Senegal, Chad and Cameroon are on the verge of doing the same. In fact, only 13 nations still have the disease. Combined, they reported last year a total of 60,000 cases.
"We are at a critical and dangerous juncture," says Dr Gro Harlem Brundtland, Director-General of the World Health Organization. "Now, just as global eradication of this disease is within reach, we face the most difficult issues of all."
"These challenges are not biological", adds Dr Maria Neira, Director of the WHO Guinea Worm programme. "In fact, simple eradication tools have proven effective all over the world. Instead, the remaining obstacles are all man-made. If we fail to solve these problems, the momentum toward eradication may stall and the disease will rebound."
"Through an international coalition, 98 percent of all Guinea worm cases have been eliminated, but serious challenges remain," said former President Carter. "To overcome these obstacles, we need financial support, political will, and diplomatic backing so affected countries can finish the job as quickly as possible."
These challenges are being addressed at a Guinea worm meeting in Khartoum, Sudan, March 4-7 involving former U.S. President Jimmy Carter, two other former ######### of state, eight ministers of health and public health leaders from all countries where Guinea worm exists.
Armed conflict is the greatest barrier to all eradication programs. Take Sudan. Of the 60,000 cases of Guinea worm identified in 2001, 80% were from Sudan and 99% of Sudan's cases were from southern Sudan, where civil conflict has raged for 19 years. There, 3,000 of the region's 5,000 Guinea worm endemic villages remain inaccessible to either government health workers or to NGO eradication workers.
War does not necessarily have to block eradication. In many parts of the world, fighting factions have agreed to negotiated days of cease fire for polio, lymphatic filariasis and other public health campaigns.
Wavering commitment by governments and donors also threatens eradication programs making their final push. Twelve nations have, on average, less than 1,000 cases each. Consequently, efforts to eliminate Guinea worm in the remaining countries have been delayed while public health officials confront AIDS and other health emergencies.
Donors, who have supplied the funds for the eradication work, are also confronted with competing demands from these same health emergencies. Also, donors can become fatigued with the amount of time it takes to complete eradication.
WHO's public health experts believe that making the final push will free up resources that can then be redirected to other health problems. Falling short of eradication, the disease can rebound. Cases have already jumped more than 56% between 2000 and 2001 in Togo; and in that same period, Mali's Guinea worm cases have soared more than 140%.
Background: The source of Guinea worm is found in polluted drinking water. Once ingested, the larval form of the worm grows, reproduces and migrates, often to the leg. After a year inside the body, when it may have grown to meter in length, it moves to surface of the skin where it emits a chemical that causes a hot, blistering sensation. Victims often plunge their legs in water for relief, but this simply allows the parasite to emerge and release millions of baby parasites -- and the cycle continues. Pain from the ulcer and attendant complications can leave a victim completely debilitated for as along as two months.
Several intervention efforts have proven successful. The easiest method is to identify patients early and warn them of the dangers to the community of soaking their legs in ponds or streams. In Uganda and Ethiopia, a bounty is paid to those infected if they go to "Guinea worm houses" for early treatment. This keep victims away from ponds and thus breaks the cycle of transmission. Controlling the parasites with mild insecticides and filtering water have also eliminated the worm in many countries, as has building deep water wells which are unlikely to become contaminated. Since the lifecycle of the worm is one year, if new infections can be stopped for a year the worm can be eliminated.
Eradication deadlines have been missed repeatedly. The first was set for 1995, then 2000. WHO now hopes to certify eradication by 2005.
WHO's role is to provide technical advice and to certify countries have eliminated the disease. Surveillance and a reward program to identify victims are the primary tools used to confirm disease elimination. Three years without the identification of one case of Guinea worm are required to certify a nation is free of guinea worm. Five countries are in this pre-certification phase now. They are Kenya, Yemen, Chad, Senegal and Cameroon. Most cases in Kenya, which shares a border with Sudan, are imported from Sudan.
WHO GUINEA WORM CONTACTS:
Dr Maria Neira, Director, Communicable Disease Prevention, Control and Eradication, Telephone (+41 22) 791 3977 or E-mail: [email protected]; Dr Nevio Zagaria, Coordinator, Communicable Disease, Eradication and Elimination, Telephone (+41 22) 791 2534 or E-mail: [email protected]; Iain Simpson, Information Officer, Communicable Diseases Programme, Telephone (+41 22) 791 3215, Mobile (+41 79) 475 5534 or E-mail: [email protected]; or ######## Thompson, Information Officer, Communicable Diseases Programme, telephone (+41 22) 791 2095 or E-mail: [email protected]
Information on Guinea worm can be found at the following sites:
http://www.who.int/ctd/dracun/disease.htm
http://www.who.int/inf-pr-1998/en/pr98-28.html
http://www.cdc.gov/ncidod/dpd/parasites/guineaworm/default.htm
http://www.cartercenter.org/guineaworm.html |
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Re: Carter urges Sudan ceasefire to eradicate Guinea worm (Re: Kostawi)
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Sudan opens guinea worm conference with call for peace
KHARTOUM, Sudan, Mar 04, 2002 (AP) -- Former U.S. President Jimmy Carter and Sudan's leader stood side-by-side Monday to open a health conference with a plea for peace in Sudan after 19 years of civil war.
"We say: 'The war imposed on us is the main impediment to the eradication of this disease,"' President Lt. Gen. Omar el-Bashir said at the four-day conference on the eradication of guinea worms, which bore their way under human skin and can lead to pain, ulcers, fever, and joint deformities.
"We cannot eradicate guinea worm without peace in the Sudan," said Carter, who in 1995 brokered a six-month cease-fire to allow aid workers to take the guinea worm eradication campaign for the first time to parts of southern Sudan.
According to UNICEF, 78 percent of the world's guinea worm cases are in Sudan. Experts say 99 percent of Sudan's 49,583 guinea worm cases are in the war-affected south.
Sudan's civil war pits rebels fighting for autonomy for the south, where most people follow traditional beliefs, against the Sudanese government, which enforces Islamic law where it is in control. Fighting and war-induced famine have killed more than 2 million people.
According to the Carter Center, the former president's development and peace think tank, the war in southern Sudan has prevented aid workers from providing water filters, medicine, vitamins and vaccinations for children.
Guinea worms can grow up to one meter (yard) in the bodies of humans who consumed water infested with their larvae. Guinea worms are sometimes known as fiery serpents because of the burning pain they cause as they emerge slowly from the human body to lay their eggs. They often emerge from the feet or ankles, making it impossible for the victim to walk, and dangerous infections can result when they break through the skin.
Sudan's University of Juba awarded Carter an honorary doctorate Monday for his humanitarian work.
As president, Carter brokered the 1978 Camp David Accords between Egypt and Israel that produced the Middle East's first peace treaty. Since leaving office in 1980, he has devoted himself to helping settle several international conflicts, building homes for the poor and tackling health issues in the developing world.
On the Web:
http://www.cartercenter.org
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Kostawi
فيس بوك
تويتر
انستقرام
يوتيوب
بنتيريست