Follow-on to Eradication of Dracunculiasis in District Dera Ismail Khan, Khyber Pakhtunkhwa, Pakistan

To assess the present status of dracunculiasis in Dera Ismail Khan Khyber Pakhtunkhwa (KP), Pakistan after its declared eradication in 1996, five villages were selected for a cross-sectional household survey based on previous clinical records of dracunculiasis. These villages included Kath Garh, Wanda Dost Ali, Chah Mundar Wala, Ketch and Gara Baloch.

The survey was carried out by random house-to-house visits where household heads were interviewed for any active or past infections of dracunculiasis (preferably backed by clinical examination or in-person examination) among members of their household. Ethics approval for the study was acquired from Ethics committee, Department of Pharmacy, University of Peshawar and informed consent was obtained from participants prior to inclusion.

Additionally, water samples from main drinking water sources including tubewells, Persian wells and hand pumps were also examined for Cyclops vernalis, the vector for parasite, through light microscopy. Water samples were collected from all the reservoirs of drinking water using rectangular dip nets (0.5mm mesh) kindly provided by UNICEP teams doing routine work for water quality assessment in the study area. Each water reservoir was surface sampled three times a day: morning (8 am), afternoon (2 pm) and evening (8 pm). The samples were preserved in sorbex vials containing 30% glycerin, 20% distilled water and 50% to 70% alcohol. The samples were observed under 4X-40X objectives of the microscope for the presence of the Cyclops species.

Table I shows the number of household surveyed and the number of lesion scars in five villages.

No active lesions in the household or Cyclops sp. was detected in the water samples.

The present study to greater extent validated the elimination of dracunculiasis in the studied areas of Dera Ismail Khan District.

Successful eradication of dracunculiasis in Pakistan was possible due to multipronged strategies and involvement of multiple stakeholders. Immediate and committed response of the government, attention by the WHO, various NGOs, proper village-to-village surveillance, mass education by volunteers, provision of safe drinking water and control of the intermediate host proved effective in the prevention and ultimate eradication of the disease from Pakistan. For each calendar year from 1988-1994, the number of villages in Pakistan endemic for dracunculiasis were 156, 146, 56, 35, 07, 01 and 0, respectively, while the number of cases were 1110, 534, 160, 106, 23, 02 and 0, respectively (Azam, 2000). Global success of the control program is apparent since as of June 2014 WHO reported 27 cases compared to 92 cases for previous year in 2013. These cases originated from African countries including Chad, Ethiopia and South Sudan (WHO, 2014).

So far recurrence of any sort has not been observed in any of the Asian countries that eradicated the disease. The present survey also confirmed no recurrence in the study area; however, sporadic cases of recurrence were reported in Chadeven a decade after its transmission was arrested (Tayeh and Cairncross, 2007). Resurgence of any sort is a source of concern to people involved in eradication projects since it is usually not possible to determine whether the resurgence is due to a recent import or low levels of the disease burden that remained undetected during the eradication process, since each of these means would accordingly require particular interventions (Visser, 2012).

The authors are grateful tothe UNICEF and WHO surveillance staff for their technical support during data collection.

Ethics committee, Department of Pharmacy, University of Peshawar.

Authors have declared no conflict of interest.