"Interruption of dracunculiasis (commonly known as guinea worm disease) -- appears to have occurred in Nigeria" a team of independent international expert evaluators said in a report issued in February in Abuja, the Nigerian capital.

The report was authored by a team which had just concluded an evaluation of the Nigerian Guinea Worm Eradication Programme (NIGEP), at the request of the Nigerian Federal Government.

The 13- member team of evaluators comprised seven international evaluators including from the US Centers for Disease Control, UNICEF and WHO, complemented by six national experts on guinea worm disease (GWD).

Following the last reported indigenous guinea worm case in November 2008, the Nigerian Government requested WHO to carry out an evaluation.

The objectives of the evaluation were to:

  1. Confirm interruption of local transmission of GWD in Nigeria;
  2. Assess the quality and extent of integrated GWD surveillance within the national disease surveillance and response system;
  3. Assess the capacity of affected communities and the surveillance system in place to detect and contain any case, if it occurred;
  4. Assess the quality and extent of documentation of all pre-certification activities;
  5. Evaluate safe water supply coverage in the target areas and other villages at risk;
  6. Formulate relevant recommendations to improve pre-certification activities.

After an in-depth review of NIGEP's strategies and progress as reported by the Programme's coordinator, the evaluators broke up into seven teams which visited 15 of the country's 36 states, 40 Local Government Areas (LGAs) and 136 villages.

Out of the 50 villages identified by NIGEP as being at-risk and under active surveillance, Fifteen of the villages were selected for visits. Field reviews were carried out using standardized questionnaires, and review of records and reports. Based on the assessment, the evaluation team reached five conclusions:

  1. Although active searches and interviews in the selected villages suggested that no confirmed GWD cases were recorded in 2009, the team came across rumours (not reported or investigated) that in that year GWD occurred in villages not under active surveillance in four LGAs in three States. While the possibility of missed cases in the previous 12 -24 months needed to be ruled out in such foci, NIGEP, in collaboration with the Integrated Disease Surveillance and Response (IDSR) officials needed to strengthen ongoing nation-wide surveillance to confirm the absence of transmission.
  2. The sensitivity of the current IDSR system was not considered satisfactory for the detection and containment of GWD especially in villages which were not formally endemic.
  3. Among the general public awareness of the reward for reporting GWD cases, was low and the response mechanism to rumours was deficient. In formerly endemic villages, GWD surveillance was satisfactory, and communities, village volunteers and health staff demonstrated awareness of the need to report GWD cases. However the sensitivity of the surveillance system to detect GWD within 24 hours across all formerly endemic villages needed to be improved upon. Also, supervision by GW coordinators was deficient and not regularly conducted, and even during the infrequent visits the quality of supervisory visits was not optimal.
  4. Until eradication of GWD in Nigeria is finally certified, NIGEP needs to continue undertaking action in the following areas which have so far been satisfactory: documentation of pre-certification activities, ensuring security and retrievability of data in formerly endemic areas, elaboration of reports on interventions and revision of existing guidelines for meeting the elimination goal.
  5. With regard to safe drinking water supply coverage -- one of the criteria for certifying a country as GWD–free -- the gap in drinking water supply needed immediate and urgent attention. The evaluation revealed that 36 (72%) of the 50 villages under active surveillance have inadequate water sources, and eight (16%) have no single source of safe water.

The evaluators made a number of recommendations, including strengthening and extending the IDSR mechanism to at least 80% of health facilities; regular review of IDSR reports by State and Local Government GWD focal persons and their IDSR counterparts; the transformation of the IDSR system into an electronic data based system; the institution of public communication in local languages and of cash rewards for reporting GWD cases.

Other recommendations include providing physical access by healthcare workers to vulnerable communities; placing such communities under active surveillance; prioritizing and accelerating access to safe drinking water to 50 at-risk villages in 2010 (targeting the eight villages with no safe water supply and the 28 others with inadequate water supply) , and budgeting at the three tiers of government to ensure the achievement of pre-certification requirements.

"We believe that Guinea worm transmission has been interrupted in our land and we are confident that Nigeria will be struck off the list of Guinea-worm-endemic countries in a short while", commented a former Minister of Health of Nigeria, Prof. Babatunde Osotimehin.

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