A study of post emergent guineaworm cases of the year 1994, under RIGEP

Although a National Guineaworm Eradication Programme was launched in India in 1983-4 aimed at achieving zero incidence by 1990, the disease continues to be endemic in some parts of Rajasthan, Kamataka and Madhya Pradesh. Despite a RIGEP Project in 1994 to detect cases in the pre-emergent stage and to perform surgical extraction of the guineaworm to prevent transmission, between January and September of 1994, 135 post-emergent cases were reported. The programme managers therefore found it imperative to conduct an assessment study of post-emergent cases under the RIGEP in 57 villages across Jodhpur, Nagaur, Bikaner and Barmer districts where the 135 post-emergent cases occurred. The study aimed at exploring the causes for not detecting or reporting cases in pre-emergent stages, in order to suggest measures to ensure detection in pre-emergent stages and implementation strategies for 1995 to achieve zero transmission. A questionnaire was developed to gather data on the personal history and socio-economic background of post-emergent cases as well as determinants of their behaviour and knowledge about the disease. Some pre-emergent cases were also interviewed as a control. Village animators and their supervisors were interviewed to test the effectiveness of the community based surveillance system, and programme managers and surgeons were included to gain their perceptions on late reporting. This report presents an analysis (with tables) of information gained through the questionnaires and interviews with each group of respondents. The report summarizes the causes for not reporting guineaworm disease in the pre-emergent stage. Personal factors include failure to detect guineaworm infestation, fear of surgical extraction, and belief that the disease is self-limiting. Project related factors include the failure of the community based surveillance system due to late selection of animators, only 1 animator to 500 population, and uninformed animators, as well as the failure of I.E.C. activities to cover all aspects of the programme. The study calls for programme officers to be centrally located and to develop a mobile team, hospitals to be staffed with experts in surgical extraction of guineaworms, animators to be better trained to make surveillance machinery more effective, the incentive scheme to be vigorously advertised, the time lag between case detection and extraction to be reduced, and I.E.C. activities to be improved.