Countdown to wipe out guinea-worm in Ghana.

Amamata Sumani is on the front line in the war against guinea-worm disease (dracunculiasis) in Ghana--a front line that shrinks every year as the parasitic nematode retreats into its last remaining strongholds in the north of the country. Dracunculiasis transmission can be interrupted at two places in the parasites' life-cycle--by preventing people with open sores from contaminating water sources, and by filtering drinking water. "People's behaviour is part of the problem," explains Sumani, district director of health services for Central Gonja, in the Northern Region. Gonja has vast tracts of arable land traversed by migrant farmers. "When measures were put into place to control the farmers, they refused to filter their water and waded through dams and ponds with open sores," says Sumani. Some refuse to filter water because they are too busy trying to make a living; some forget their filter nets; others believe that witchcraft--rather than contaminated water--causes the disease. These reasons are why the Northern Region accounted for slightly more than half of the 229 cases reported in Ghana in the first six months of 2009. Since the drinking of infected water and release of larvae from guinea-worm sores are key phases of the parasite's transmission cycle, the migrant farmers are inadvertently assisting the spread of guinea worm. The situation is frustrating because humans are the only known reservoir for the parasite, and denying the worm access to water is a matter of changing human behaviour. Sumani is attempting to bring about change by calling on chiefs to impose sanctions, focusing on those who refuse to bandage their wounds or who wade through dams and ponds at the risk of polluting the water. Sumani and her team have also made use of dramatic role play to educate people about the dangers of the disease. Getting people to change their behaviour is not easy, as can be attested by Joseph Yakubu in Kpanvo, a community of some 500 people, also located in the Northern Region. A teacher by profession, Yakubu has for the past 15 years been a volunteer for the Ghana Guinea Worm Eradication Programme, and one of the biggest obstacles he has had to overcome is the entrenched belief that attributes guinea-worm disease to the will of the gods or witchcraft. "It took some time before I was able to erase these gods, curses and superstitions from their minds," Yakubu says. Like Sumani, Yakubu has enlisted the help of chiefs and elders to educate the community. The approach is working. "Kpanvo used to be one of the worst affected villages, but this year it has yet to report a case," says Yakubu. Attitudes are changing all over the country, including among the migrant farmers of Central Gonja. People are filtering water and staying out of reservoirs. At least most people are, but there is still one group that is not getting the message: young boys. Boys like four-year-old Mohammed Tahidu. He was brought from Gunsi to the guinea-worm containment centre in Tamale, the capital of the Northern Region, after he was diagnosed with the disease. [ILLUSTRATION OMITTED] "These boys hang around all sorts of places and swim in ponds that their parents are not even aware of," says Jim Niquette, the Carter Center Resident Technical Adviser in Ghana. The Carter Center is an international nongovernmental organization that was founded in 1982 by former US President Jimmy Carter and his wife Rosalynn Carter, and this centre has been at the forefront of the campaign to eradicate guinea worm worldwide. Niquette and the guinea-worm team are encouraging communities to find out where these children have been swimming or playing and then treat the water with chemicals that kill the intermediate hosts of guinea worm. The disease is caused by drinking water containing water fleas that have ingested dracunculus larvae. This is why filtering the water to remove the water fleas is important. …