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In 2006, Ghana ranked second in Guinea worm disease (GWD) incidence and reported a previously undocumented 20% prevalence of worm breakage. A prospective study was conducted in 2007 to validate and describe worm breakage and determinants. Among 221 patients with known outcomes, the worm breakage rate observed was 46%. After controlling for demographics, worm and wound presentation, and treatment course and provision, worm breakage was associated with narrow-diameter worms (< 2 mm) (adjusted odds ratio [AOR] 2.79; 95% confidence interval [CI] = 1.03–7.53). Protective factors against worm breakage included antibiotic ointment use (AOR 0.31; 95% CI = 0.14–0.70), bandage protocol compliance (AOR: 0.38; 95% CI = 0.16–0.89), intact bandages (AOR 0.27; 95% CI = 0.09–0.82), and bloody compared with dry wounds (AOR 0.09; 95% CI = 0.01–0.7). The high worm breakage rate observed warrants improvement in case management and patient care. Adherence to established treatment protocols should be facilitated through improved provider training and supervision to reduce the disabling consequences of broken worms.
Received February 19, 2009. Accepted for publication May 1, 2009.
Acknowledgments: We gratefully acknowledge Andrew Seidu-Korkor, National Coordinator, GGWEP, for his review of this manuscript, as well as the editing, review, and supervision provided by Kris Bisgard, CDC EIS Field Assignments Branch, Jerald Fagliano and Corwin Robertson, New Jersey Department of Health and Senior Services. We especially thank Carter Center Technical Assistants Corey Farrell and Alison Liang, and sincerely thank the data collection staff, treatment providers, and patients for their participation in this evaluation.
Disclaimer: The findings and conclusions in this report are those of the author(s) and do not necessarily represent the views of the Centers for Disease Control and Prevention.
Financial support: This study was supported in part by the Guinea Worm Eradication Program of The Carter Center.
* Address correspondence to Mary T. Glenshaw, Epidemic Intelligence Service, Centers for Disease Control and Prevention, 1600 Clifton Road, NE, MS E-04, Atlanta, GA 30333. E-mail: mglenshaw{at}cdc.gov
Authors’ addresses: Mary T. Glenshaw, Epidemic Intelligence Service, Centers for Disease Control and Prevention, 1600 Clifton Road, NE, MS E-04, Atlanta, GA 30333, Tel: (404) 639-5297, Fax: (404) 639-8105. Sharon Roy, Division of Parasitic Diseases, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, Mailstop F22, Atlanta, GA 30341-3724, Tel: (770) 488-4412, Fax: (770) 488-7761. Ernesto Ruiz-Tiben, Guinea Worm Eradication Program, The Carter Center One Copenhill, 453 Freedom Parkway, Atlanta, GA 30307, Tel: (770) 488-4509, Fax: (770) 488-4532. Philip Downs, Guinea Worm Eradication Program, The Carter Center, One Copenhill, 453 Freedom Parkway, Atlanta, GA 30307, Tel: (770) 488-4507, Fax: (770) 488-4532. John Williamson, Division of Parasitic Diseases, Centers for Disease Control and Prevention 4770 Buford Highway, NE, Mailstop F22, Atlanta, GA 30341-3724, Tel: (770) 488-7746, Fax: (770) 488-7794. Mark Eberhard, Division of Parasitic Diseases, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, Mailstop F22, Atlanta, GA 30341-3724, Tel: (770) 488-7791, Fax: (770) 488-7794.
Reprint requests: Mary T. Glenshaw, Epidemic Intelligence Service, Centers for Disease Control and Prevention, 1600 Clifton Road, NE, MS E-04, Atlanta, GA 30333, E-mail: mglenshaw{at}cdc.gov.
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