Evaluation of the dracunculiasis surveillance system in 4 districts in Ghana

Overview

The Guinea Worm Eradication Programme (GWEP) of Ghana was launched in 1988, the third such national programme in Africa. Although the number of reported cases fell from 179 556 in 1989 to only 8894 in 1995 (Fig. 1), GWEP’s progress then stalled for the next 10 years, and the number of cases was hardly changed at 7275 in 2004. Ghana now has more reported cases of dracunculiasis (guinea-worm disease) than any other country in Africa, and nearly half the total worldwide.

Various reasons have been suggested for the poor performance of the Programme during the past decade. These include the ethnic conflict that broke out in Northern Region in 1994, cuts in funding from major Programme partners and the change to the sector-wide approach under which prevention programmes such as GWEP did not receive the desired priority in the allocation of health sector funds. The focus on GWEP was reduced as a result of the pooling of vehicles for all health programms by health managers following the health sector reforms aiming at integration and decentralization and the transfer of environmental health staff, which included most district coordinators, from the Ministry of Health to the Ministry of Local Government and Rural Development.

An important step in turning the tide, in early 2002, was the establishment of collaboration with the Ghanaian Red Cross, whereby up to 10 members of the Red Cross mothers’ clubs support village volunteers (VVs) in the 15 most endemic districts. This in turn attracts coaches, who supervise VVs at zonal level, and their district supervisors, who thus join the district-level dracunculiasis team. From 2001, national service personnel have also been trained and assigned to the most endemic districts.

The Programme has at last begun to show signs of progress. The overall drop in the number of cases from 2003 to 2004 was only 12% (from 8290 to 7275), despite an increase of intensified surveillance leading to detection of nearly 1500 cases in just 4 districts (Kete Krachi, Savelugu-Nanton, Tolon-Kumbungu and Wa). The reductions in the other endemic districts are correspondingly greater. Even in those districts, such as Nkwanta, where the reduction is limited, month-by-month comparison of reported cases shows that greater reductions have occurred in more recent months, compared with the corresponding months of the preceding year.