Social and epidemiological aspects of guinea worm control

Dracunculiasis prevention should be simple: in a population at risk, everyone may be protected by the filtration of drinking water. The research described in this paper allowed the authors to follow the acceptance of new information by villagers in nine localities in Mali. Two strategies were studied: safe water supply (bore-hole or cement lined wells) plus health education on the one hand, and health education alone (based on filtration) on the other. Safe water supply is undoubtedly an effective strategy whereas the success of the health education intervention is uncertain. This experience showed that health education as the only means of control failed due to a lack of social cohesion or of coordinated group-action. Also, when dracunculiasis control is not a population's priority goal, the constraints on systematic filtration are too great and a tendency to discontinue the filtration process occurs. On the other hand, when dracunculiasis is considered to be a serious problem by the population, new information about systematic filtration is better assimilated and leads to behavioural changes. In order that the goal of eradicating dracunculiasis by 1995 should not be an utopic dream, it is necessary to prioritize the allocation of clean rural water supply projects only to those endemic villages where the conditions that allow for health education to be successful are met.