AN EVALUATION ON THE CASE CONTAINMENT STRATEGY FOR GUINEA WORM ERADICATION IN OYO STATE, NIGERIA

Abstract

The World Health Organization has targeted guinea worm as the next disease after smallpox for global eradication. In Nigeria, the case containment strategy (CCS) has been employed since 1996, for the penultimate stage in the eradication process. Between 1996 and 2000, the number of guinea worm cases reported in Oyo State dropped from 1001 to 344, but the percentage contained only fell from 97% to 69%. This poor CCS performance drew unfavorable attention from international organizations and prompted this research to evaluate the implementation of the CCS in Oyo Stale. This evaluation research was descriptive and employed quantitative and qualitative methods. All guinea worm patients from whom worms emerged from October 2000 through March 2001 were interviewed using a pre-tested questionnaire that determined whether the case had been contained and obtained patient's perceptions of CCS. Interviews were held with 113 available VBHWs using structured and semi-structured questions that elicited their knowledge of CCS and the factors that affected the performance of their duties. In-depth interviews were held with 24 available programme staff who were asked to define case implementation. Finally. 16 focus group discussions (FGDs), were conducted in the endemic local government areas (LGAs) to determine community acceptance of CCS. Eight LGAs had 159 guinea worm patients during the six-month period. Only 14 (8.8%) of these cases met CCS criteria, 51(32.1%) cases were reported officially as contained. 61(38.4%) cases were reported as not contained and 47(29.6%) cases had never been reported. This contrasts with the 128 cases officially recorded by the Global 2000 Southwest zone for the same period, of which 77% were reported as contained. VBHWs identified the need to travel out of the village and the fact that some guinea worm patients hide or delay notification as their main problem encountered. Sixteen (36.4%) patients stated that VBHWs were not available or not stable while 16 (36.4%) said they deliberately did not inform VBHWs. Programme staff mentioned lack of transportation to visit the villages and inadequate remuneration as their major problems. They also complained of de-motivation interest because the year targeted for eradication, 1995, had passed. When programme staff asked to define the steps in CCS, they scored an average of only 3.4 out of eight points. Concerning the knowledge of five CCS case management steps that were asked from the villagers, VBHWs averaged a score of 3.8 points compared to 2.4 points for patients. The programme staff knowledge of CCS eight steps had Guinea Worm Coordinators having a median of 3.0 while the Global 2000 field staff had a median of 4.0 (t value=2.4 2 4 , P value =0.024). Programme staff ability to identify containment status of the five Cases studies presented to them showed that Guinea Worm Coordinators had a median of 2.0 while Global 2000 field staff had 2.0 (t value=1.334, p value=0.195). FGD respondents were positive about effort to eradicate guinea worm, though some complained of lack of wells. Most accepted CCS steps but had reservations about bandaging the ulcer. In conlusion, the failure to adhere to CSS was found to be much more serious than indicated in official reports. VBHW high mobility and programme staff lack of transportation contribute to delayed detection and missed cases. These findings suggest the urgent need for a review of CCS implementation.