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  • Title: Eradication of dracunculiasis from Pakistan.
    Author: Hopkins DR, Azam M, Ruiz-Tiben E, Kappus KD.
    Journal: Lancet; 1995 Sep 02; 346(8975):621-4. PubMed ID: 7651010.
    Abstract:
    In 1986 the World Health Organization targeted dracunculiasis (Guinea-worm disease), which seriously impairs socioeconomic development in 16 African countries, India, Pakistan, and Yemen, to be eradicated globally. The target date for eradication by the end of 1995 was established in 1991. Pakistan eradicated dracunculiasis from the country in October, 1993, after a national campaign which began in 1987 with a nationwide village-by-village search for cases. The infection, which is transmitted by drinking water from ponds containing infected water fleas, was eradicated by using health education, cloth filters, and the cyclopsicide, temephos; and in the later stages, by case containment. Methods pioneered in Pakistan's National Guinea Worm Eradication Program are now being applied in remaining endemic countries. Dracunculus medinensis larvae expelled into drinking water may be ingested by water fleas, copepods, in which they undergo two moults before becoming infectious to humans. A person consuming unboiled or unfiltered water infested with larvae-ridden copepods will contract dracunculiasis. The disease is manifest one year later by the emergence from the human host of one-meter-long adult worms of Dracunculus medinensis. Infected people are often incapacitated for several weeks by secondary infections associated with the emergence of the worm, although less than 1% of victims suffer permanent disability. The disease is rarely fatal, but it prevents large numbers of people from farming or attending school. Dracunculiasis, Guinea-worm disease, can be prevented by boiling drinking water or filtering it through a cloth to remove the larvae's copepod hosts, by educating villagers not to contaminate their sources, by providing clean drinking water from underground sources such as borehole wells which cannot be contaminated, or by using a larvicide, temephos, to kill the copepods while leaving the water safe for human consumption. In 1986, the World Health Organization targeted dracunculiasis for global eradication. From an estimated total of more than three million cases in 1986, only 165,000 cases were reported worldwide in 1994. Pakistan, however, is the first country endemic for dracunculiasis to eradicate the disease during the ongoing global campaign. The goal of countrywide eradication was reached in October 1993 after a national campaign which began in 1987 with a nationwide village-by-village search for cases. Health education, cloth filters, temephos, and case containment were used together to achieve success. Methods pioneered in Pakistan's guinea-worm eradication program are being applied in the remaining endemic countries.
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