Neglected tropical diseases

Eradicating dracunculiasis: Ethiopia’s Gambela region announces new measures to stop transmission

26 February 2019 | Geneva −− Health and rural development officials in the Gambela region of Ethiopia will act decisively to stop transmission of dracunculiasis (guinea-worm disease) in the region, including in “investment farms” where migrant workers are employed. In 2017, an outbreak of the disease from commercial farms resulted in 15 human cases.

The point source of infection in 2017 involved a commercial farm in Abobo where seasonal migrant workers were infected,” said Dr Amir Aman, Federal Minister of Health of Ethiopia. “We want to make sure that all workers are provided with a safe and adequate water supply.

In 2018, Ethiopia reported zero human cases of dracunculiasis after decades of low-level transmission; however, 17 Dracunculus medinensis infections were reported in animals.

If transmission of animal infections is interrupted in 2019, Ethiopia can request the World Health Organization (WHO) to verify the country as free of dracunculiasis transmission after three consecutive years of surveillance and zero reporting of cases in humans or animals.

Advocacy mission

On 19 February 2019, a high-level advocacy mission, led by the Federal Minister of Health of Ethiopia and the Gambela Regional President to Abobo district of Gambela region, assessed the situation of safe water on at least three commercial farms that employ seasonal farm workers from throughout Ethiopia.

As part of its plan for development, the Government of Ethiopia has introduced incentives allowing private firms to lease swathes of agricultural land to boost commercialized farming, generate employment and promote agro-industries.

Other senior officials involved in the mission included the cabinet of the Regional President, the Director General and Deputy Director General of the Ethiopian Public Health Institute, the WHO representative, The Carter Center Ethiopia team and representatives of federal and regional investment agencies.

We conducted field visits to Goyi, Mulat and Sisay investment farms and were able to assess the supply and distribution of water on these farms” said Mr Ojulu Omod, President of Gambela Regional State. “We now need to sustain strong political commitment, particularly with the announcement of a board to oversee the functioning of the Guinea-worm Eradication Programme in the region.”

After the visit, discussions were held in Abobo on achievements, major challenges and possible solutions with representatives of the regional water bureau, the regional health bureau, federal and regional investment agencies, officials of the Bureau of Labour and social affairs, and representatives of companies that have invested in commercial farming.

Ethiopia and dracunculiasis eradication

The Federal Ministry of Health of Ethiopia established a national dracunculiasis eradication programme in 1994, when the country reported more than 1200 human cases. In 2000, only 60 cases were reported. Since 2001, fewer than 50 cases have been reported annually, mostly from Gambela region.

Major challenges in the region include weak surveillance; inaccessibility due to flooding during the peak transmission seasons; and inadequate collaboration with South Sudan, as movement of people across the shared border area poses additional risk of reintroducing D. medinensis in areas declared free of transmission. To increase the sensitivity of the surveillance system, the authorities have introduced a cash reward for the voluntary reporting of dracunculiasis cases.


Dracunculiasis is a crippling parasitic disease caused by D. medinensis, a long thread-like worm. The disease, which has afflicted humanity for centuries, is transmitted exclusively when people drink water contaminated with parasite-infected water fleas.

During the 1980s, dracunculiasis was endemic in 20 countries. In 2018, transmission was limited to two countries: Chad and South Sudan; both countries reported a total of 28 human cases that year.

Mali has reported zero human cases since 2016; the last case was reported in November 2015. Ethiopia reported its last human case in December 2017. Surprisingly, however, in Angola (a country in which cases had never been reported) the first human case was detected in April 2018 while preparing the national dossier for submission to WHO to verify the absence of transmission.

WHO is advocating for stronger surveillance, even by national eradication programmes in countries already certified free of dracunculiasis transmission by the Organization.

Ashok Moloo
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