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The Role of Case Containment Centers in the Eradication of Dracunculiasis in Togo and Ghana

As part of the global effort to eradicate dracunculiasis (Guinea worm disease), several endemic countries established case containment centers to provide treatment and support to patients with emerging Guinea worms to keep them from contaminating water sources. To assess the functioning, effectiveness, and public perception of this intervention, we visited eight centers and conducted surveys in 32 villages in Togo and Ghana. In the areas served by these centers, incidence dropped by 71% in Togo and 42% in Ghana from 2003 to 2004. Among persons with emerging worms, admission to the centers was associated with younger age (P value = 0.04) after controlling for occupation and gender. Overall, the centers functioned well and were regarded favorably: 99% of the 152 center-attendees expressed satisfaction with their stay. Strategically-located case containment centers in conjunction with other interventions appear to play an important role in the final effort to eradicate dracunculiasis.

Received October 21, 2007. Accepted for publication July 12, 2008.

Acknowledgments: The authors thank the numerous persons who participated in this program evaluation; Etse Gilles and Jim Ting for their valuable assistance with administering the surveys; Daniel Abbott, Emily Howard, and the volunteers at the Carter Center for their help with data entry; and Donald Hopkins and Sharon Roy for reviewing the manuscript. We also thank Mr. Ignace Komi Amegbo and Dr. Andrew Seidu Korkor, National Guinea Worm Eradication Program Managers of Togo and Ghana, respectively, and the Togolese and Ghanaian Ministries of Health for their support.

Financial support: Funding for this project was provided by the Carter Center.

Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.

^* Address correspondence to Natasha Hochberg, Division of Infectious Diseases, Emory University, 69 Jesse Hill Junior Drive, SE, Atlanta, GA 30303. E-mail: natasha_hochberg{at}post.harvard.edu

Authors’ addresses: Natasha Hochberg, Division of Infectious Diseases, Emory University, 69 Jesse Hill Junior Drive, SE, Atlanta, GA 30303, Tel: 404-616-3603, Fax: 404-880-9305, E-mail: natasha_hochberg{at}post.harvard.edu. Ernesto Ruiz-Tiben and Philip Downs, Dracunculiasis Eradication, The Carter Center, 453 Freedom Parkway, Atlanta, GA 30307, Tel: 770-488-4509, Fax: 770-488-4532, E-mail: exr1{at}cdc.gov. Jennifer Fagan, Division of HIV AIDS Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, NE, MS E-46-4030, Atlanta, GA 30333, Tel: 404-639-8396, Fax: 404-639-8640, E-mail: jfagan{at}cdc.gov. James H. Maguire, University of Maryland, 660 West Redwood Street, Howard Hall Suite 100, Rm. 102B, Baltimore, MD 21201, Tel: 410-706-0206, E-mail: jmaguire{at}epi.umaryland.edu.

Reprint requests: Natasha Hochberg, Division of Infectious Diseases, Emory University, 69 Jesse Hill Junior Drive, SE, Atlanta, GA 30303, E-mail: natasha_hochberg{at}post.harvard.edu.