Ministry of Health Kenya Guinea Worm Eradication Programme Laico Regency Hotel - 26 th August 2015 Guinea worm disease1

White Worm Emerging from the skin Guinea Worm - a white worm emerging from a skin lesion. Its length is between 60cm-120cm (≈1m) Infection occurs when a person drinks contaminated water containing water fleas (Cyclops) infected with guinea worm larvae Guinea Worm Disease (Dracunculus medinensis) Guinea worm disease2

Life Cycle Guinea worm disease3 Water fleas (cyclops) with GW larvae Contaminated pond/dam 1 2

Life Cycle cont.  The worm emerges from the skin after one year  This is accompanied by a lot of pain that forces the infected person to immerse the affected part in water  The worm in turn releases larvae into the water - thus continuing the cycle Guinea worm disease4

Prevention and Control  There is no drug or vaccine to prevent guinea worm  Prevention of GWD is through  Environmental management – protecting water sources using vectorcides such as temephos (Abate™)  Preventing infected persons from contaminating water sources  Health education  Active & passive surveillance Guinea worm disease5

Prevention and Control cont. Water obtained from dams & ponds should be boiled or filtered before drinking The infected person should not step into water dams and ponds to avoid infecting the water fleas with larvae of GWD Contaminated sources of water – ponds & dams should be disinfected with temephos (Abate™) Guinea worm disease6

Treatment & management of cases There is no drug to cure guinea worm On suspicion of guinea worm infection the patient should be CONTAINED – i.e. The worm should not be allowed to enter water in ponds or dams The part of the body from where the worm is emerging should be bandaged to prevent damage to the worm until it has been completely removed Guinea worm disease7

Treatment & management of cases When the worm emerges, it should be slowly rolled onto a small stick or piece of gauze by a health worker. NB: this is the main way of removing the worm but it is very painful to the patient so it is done slowly in phases Complete removal of the worm can take days or weeks If the worm breaks before it has been fully removed – the remaining worm will have to be removed surgically! Guinea worm disease8

GLOBAL SITUATION Guinea worm disease9

10 Status of certification of dracunculiasis eradication worldwide, countries, areas and territories certified free of dracunculiasis 4 endemic countries 3 countries in precertification stage 2 countries not known to have dracunculiasis 9 countries yet to be certified 5

Status of endemicity and number of cases reported by country in the WHO Africa Region* Guinea worm disease11 (11) ( (2) (31) (81) (81) 4 ENDEMIC countries with 125 reported cases Jan-Oct PRE-CERTIFICATION country 1 PRE-CERTIFICATION country with ICT visit 39 Certified GWD-free countries 2 Countries to be VERIFIED Ethiopia South Sudan Chad Mali Ghana DRC Angola Kenya *At October

GWD GLOBAL No. of cases  ,600,000 cases  cases  cases  cases (in Mali, Chad, S. Sudan & Ethiopia)  (January to May) Guinea worm disease12

Distribution of remaining cases Reported Cases by Country in 2014  Chad: 13  Ethiopia: 3  Mali: 40  South Sudan: 70 Jan 2015 to Date - 5 cases discovered so far  4 in Chad &  1 in Ethiopia Guinea worm disease13

Guinea worm about to become the second disease to be eradicated from the world – 37 years after small pox was eradicated in 1978 Guinea worm disease14

Kenyan Situation  Kenya is in precertification phase of dracunculiasis eradication  The last indigenous and imported cases were reported in 1994 and 2005 respectively  Main Activities towards certification are active surveillance, reporting and documentation  Main Focus- formerly endemic Counties of Turkana, West Pokot and Trans Nzoia Guinea worm disease15

Risk of Importation into Kenya  Risk of importation exists due to proximity to endemic countries of South Sudan and Ethiopia  Current civil strife in South Sudan poses a major risk due to influx of refugees to Kakuma camp, Turkana county  Cross border interactions between the Turkana and Toposa communities also increases risk of importation Guinea worm disease16

Guinea worm disease17 Surveillance for GWD  During and after the communication campaign, Health workers will be expected to ask for GWD cases in during health talks at health facilities – esp. in Turkana County  Community Health Workers will also sensitize their Units on GWD and follow up any suspected cases  ALL suspected cases must be reported immediately to the nearest health facility

Surveillance for GWD cont.  Details of suspected cases are to be entered into a special investigation form at the health facility as soon as a case is reported  ALL SUSPECTED CASES MUST BE PHOTOGRAPHED – even with a phone camera Guinea worm disease18

REWARD FOR FINDING A CASE OF GUINEA WORM DISEASE  KShs.100,000/= From the Ministry of Health Guinea worm disease19

WHY we need you to spread the message of guinea worm disease  We want Kenya certified as a guinea worm free country by 2016  Therefore we need all Kenyans to  Have heard of the disease  Have an idea of what it looks like & look out for it  Know that it must be reported to a health facility  Know that there is a reward of ksh.100,000 for every case found Guinea worm disease20

Guinea worm disease21

Mass media communication campaign on GWD  Starts today 26th August 2015, intensively for three months  Information on GWD will be disseminated nationwide to all social strata and especially through primary schools in Turkana County Guinea worm disease22

Counting on all of us to spread the word & Guinea worm disease23