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April 29, 2002

The final push against Guinea Worm begins

Emily Howard is coordinator of health programs for the Carter Center.


Last month former President Jimmy Carter and his wife, Rosalynn, participated in the International Conference on the Eradication of Guinea Worm Disease in Khartoum, Sudan.

Representatives of all 13 remaining endemic countries convened in Khartoum for the conference. President of the Republic of Sudan Omar Al Bashir presided over the opening ceremony, which also featured remarks by Carter, Nigerian head of state Yakubu Gowon and Sudanese health minister Amed Bilal.

“Through an international coalition, 98 percent of all Guinea worm cases have been eliminated, but serious challenges remain,” Carter said. “To overcome these obstacles, we need financial support, political will and diplomatic backing so affected countries can finish the job as quickly as possible.”

Carter noted there is no way to separate the suffering due to Guinea worm, AIDS, river blindness or trachoma from that caused by conflict, and that Guinea worm disease cannot be eradicated without peace in Sudan.

Bashir recalled the acceptance of Carter’s proposal for the “Guinea Cease-Fire” in 1995 and said the absence of stability and peace are now the main obstacles to Guinea worm eradication his country. After congratulating the countries already certified as “Guinea worm-free,” as well as those still working hard to become so, Bashir unveiled three commemorative postage stamps in honor of the milestone on the road to eradication.

Sudan remains the greatest challenge to Guinea worm eradication, accounting for 80 percent of the world’s remaining reported cases, and the Sudan civil war is now the single largest obstacle. Last year the Sudan Guinea Worm Eradication Program reported 49,471 cases of Guinea worm in 3,921 villages; however, the civil war prevents health workers from obtaining complete reports and educating people on how to eradicate the disease in about 2,500 now endemic villages.

The areas with the highest incidence of disease are located in the southern part of the country. Low-level transmission still occurs in seven northern states, particularly along their borders with the southern endemic states. These northern states account for less than 1 percent of the total number of cases in Sudan.

Despite 18 years of civil war in Sudan, there have been major steps toward eradication of the disease. In 1995, the Carter Center brokered a humanitarian cease-fire that lasted nearly six months, and last summer all Sudanese parties helped to distribute nearly 9 million pipe filters—one for every man, woman and child at risk for Guinea worm. Use of the pipe filter prevents individuals from consuming contaminated water, thus interrupting disease transmission.

“Using low-tech methods and knowledge gained from eradication efforts, the poorest of the poor have the tools to help themselves and achieve results,” said Ernesto Ruiz-Tiben, technical director of the Carter Center’s Global 2000 Guinea Worm Eradication Program. “However, peace and stability also are essential to the eradication effort.”
Since 1993, Guinea worm disease has been totally eradicated from seven countries: Cameroon, Chad, India, Kenya, Pakistan, Senegal and Yemen. In 12 African countries (excluding Sudan), an estimated 14,000 cases of Guinea worm occurred in 2001.

“The world expects the remaining African countries that are close to eradication to do it soon,” said Donald Hopkins, Carter Center associate executive director for health programs. “When that happens, the eradication of this disease will set a precedent for wiping out other preventable diseases such as polio, measles, river blindness and lymphatic filariasis”

In addition to the center’s fight against Guinea worm, the Carter Center has a number of other programs working to advance both health and peace in Sudan. The Carter Center established offices in the country in 1995 and as a neutral party assists medical personnel on both sides of the civil war. The center expanded its work in fighting disease in Sudan to include river blindness and trachoma control in 1995 and 2000, respectively.

On the peace front, the center continues its work with the governments of Sudan and Uganda to implement the 1999 Nairobi Agreement, aimed at improving relations between the two countries through addressing issues of mutual concern, notably support for rebel groups active in each other’s countries.