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Dracunculiasis (Guinea worm disease) is a preventable waterborne parasitic disease that affects the poorest people living in remote rural areas in sub-Saharan African countries, who do not have access to safe drinking water. The Guinea Worm Eradication Program, a 25-year old campaign to rid the world of Guinea Worm disease has now reached its final stage accelerating to zero cases in all endemic countries. During the 19th and 20th centuries, dracunculiasis was common in much of Southern Asia and the African continent. The overall number of cases has been reduced tremendously by ≥99%, from the 3.32 million cases estimated to have occurred in 1986 in Africa to only 1,797 cases reported in 2010 reported in only five countries (Sudan, Mali, Ethiopia, Chad and Ghana) and Asia free of the disease. This achievement is unique in its kind--the only previously eradicated disease is smallpox, a viral infection for which vaccination was possible--and it has been achieved through primary community-based prevention and health education programs. Most efforts need to be taken in two countries, South Sudan (comprising 94% or 1,698 out of 1,797 of the cases reported world-wide in 2010) and Mali because of frequent movements of nomads in a vast area inside and outside Mali's borders. All factors favourable to dracunculiasis eradication are available including adequate financial resources, community and political support and high levels of advocacy. Thus there is no reason that this disabling parasitic disease cannot be eradicated soon before surprises arise such as new civil conflicts in currently endemic countries., (Copyright © 2012 Hainan Medical College. Published by Elsevier B.V. All rights reserved.)

Parasitic infestation is common in developing countries especially in Africa. Children are often more vulnerable to these infections. Many health problems result from these infestations, including malnutrition, iron-deficiency anemia, surgical morbidities, and even impaired cognitive function and educational achievement. Surgical intervention may be needed to treat serious complications caused by some of these parasites. Amoebic colitis and liver abscess caused by protozoan infections; intestinal obstruction, biliary infestation with cholangitis and liver abscess, and pancreatitis caused by Ascaris lumbricoides; biliary obstruction caused by Faschiola; hepatic and pulmonary hydatid cysts caused by Echinococcus granulosus and multilocularis are examples. Expenditure of medical care of affected children may cause a great burden on many African governments, which are already suffering from economic instability. The clinical presentation, investigation, and management of some parasitic infestations of surgical relevance in African children are discussed in this article., (Copyright © 2012 Elsevier Inc. All rights reserved.)

In 2006, Ghana ranked second in Guinea worm disease (GWD) incidence and reported a previously undocumented 20% prevalence of worm breakage. A prospective study was conducted in 2007 to validate and describe worm breakage and determinants. Among 221 patients with known outcomes, the worm breakage rate observed was 46%. After controlling for demographics, worm and wound presentation, and treatment course and provision, worm breakage was associated with narrow-diameter worms (< 2 mm) (adjusted odds ratio [AOR] 2.79; 95% confidence interval [CI] = 1.03-7.53). Protective factors against worm breakage included antibiotic ointment use (AOR 0.31; 95% CI = 0.14-0.70), bandage protocol compliance (AOR: 0.38; 95% CI = 0.16-0.89), intact bandages (AOR 0.27; 95% CI = 0.09-0.82), and bloody compared with dry wounds (AOR 0.09; 95% CI = 0.01-0.7). The high worm breakage rate observed warrants improvement in case management and patient care. Adherence to established treatment protocols should be facilitated through improved provider training and supervision to reduce the disabling consequences of broken worms.

We have encountered infrequent and unfamiliar types of morbid conditions requiring plastic surgery. We present here our clinical experience with five illustrative cases and discuss the typical features of each condition and its treatment.

Twenty patients with Guinea worm disease having a total of 29 emerging worms in a rural village of North West Frontier Province, were put on a 5-day course of antibiotics and antiinflammatory drugs and compared with age-matched control patients. The ulcer sites of emerging worms were kept continuously moist, and 18 worms were extracted from 14 patients during the above mentioned period. The average time taken for the entire worm to be expelled in these patients was considerably shorter (13.6 days) than in controls (89 days). Seven (39%) of these worms were expelled spontaneously whereas the remaining 11 (61%) were pulled out manually with relative ease. Fifteen (75%) patients in this study had a single emerging worm, three (15%) had two emerging worms and two (10%) patients had four or more emerging worms.

A cross-sectional survey of households was carried out in a dracunculiasis endemic village in Oyo state Nigeria. Data were collected on history of dracunculiasis, occupational and domestic sources of drinking water, clinical manifestations, disability, use of folk medicine, and incorporation of previous dracunculiasis control programmes. The findings indicated that dracunculiasis patients were usually unaware of their infection 3-5 days before the appearance of a bleb; that religious affiliation appeared to be positively related to increasing morbidity; and that ulcers were predominantly in the ankles and feet, particularly among young children. Severe disability was related to age, site and number of ulcers, and the form of selected treatment. Indigenous remedy was the treatment of choice, although traditional healers in the community indicated no knowledge of any efficacious remedy. Mortality from secondary tetanus infection was associated with outbreak of dracunculiasis. The impact of dracunculiasis on agricultural, economic and recreational activities was considerable, with the infected farmers being unable to attend to their farms at the critical farming period. Sixty-one per cent of the residents were opposed on religious and aesthetic grounds to the treatment of the local surface water which contained cyclops species. Sixty-three per cent regarded the boiling and filtration of portions of their domestic water as an additional burden, cumbersome and impracticable.(ABSTRACT TRUNCATED AT 250 WORDS)

Dracunculiasis is an ancient disease which international organizations are working to eradicate. It has been suggested that the caduceus and Aesculap's staff may be based on the treatment of dracunculiasis from the time of Hippocrates, which is still the most modern treatment available. The article discusses dracunculiasis with emphasis on the historical aspects and the possible connection with the symbol of medicine--a snake wound around a staff.

We studied 18 cases of dracunculosis treated in our department of Internal Medicine in Paris. The mean duration of the hospital stay is 38 days (15 to 90). The cost of this stay, calculated on the basis of the daily charge, accounts for 93.3 % of the total cost. The longest stays are due to serious subcutaneous infections at the site of the worm and to multiple or complex associated diseases. Average charge for laboratory test, roentgenograms or other investigations amounts to 4.4 % of the cost of the hospital stay. A significant part of these investigations is warranted by cellulitis and the diagnosis of associated conditions. Antibodies prescribed for subcutaneous infections account for almost all of the drug expense (2.3 % of the total cost). Thus, investigations and treatment together amount to only 6.7 % of the daily charge. Traditional treatment of dracunculosis is based on manual extraction of the worm. Thiabendazole was added in 12 of the 18 patients. The average duration of hospitalization (34 days) and average charge for investigations and drug treatment (FF 611) were less in these 12 patients than in the 6 others (47 days, FF 1286). However, this result is to be considered with caution as the number of patients in each group is small, treatments were assigned without any statistical rule, subcutaneous infections were more or less serious and associated diseases may have had a bearing on results.

A survey, resulted from the immediate need to understand the health behaviour of Southern Ghanaian villagers during an epidemic of guinea worm disease. While such problems are usually studied at a time when the epidemic has abated, this study emphasized getting into the field quickly to obtain data before the epidemic passed. If behaviour models are to have value for programme planning in the developing world, they should be amenable to such quick sample approaches. The study involved a survey on attitudes, beliefs and practices related to gent. Results showed distinctive and somewhat differing perceptions of susceptibility, seriousness, curability and preventability for the two ethnic groups within a single geographic area. The analysis of the survey results permitted suggestion of various educational strategies for both of the groups. This quick survey approach must be more refined before it has wide applicability. There appears to be a significant potential for developing a simplified checklist to be used by health workers in carrying a rapid educational diagnosis of a specific health problem for a given population.

Epidemiological survey was carried out for prevalence of guinea worm infection in 12 villages having a total population of 10281 persons in Jhabua district of M.P. The prevalence of 2.85 percent. Infection was more common in males. A paste of leaves of carica papya with opium and common salt applied for 3 days was helpful in relief of symptoms and easy extraction of worm from the body.