Geographical patterns of guinea worm infestation in Ghana: An historical contribution

Guinea worm disease (dracunculiasis) is caused by a parasitic worm, some 2–3 ft in length. Its victims suffer prolonged pain, physical incapacitation, and social and economic disruption. This study identifies geographical patterns of guinea worm disease in Ghana in 1989, just before a national eradication campaign was launched. The broadest belts of disease correspond with long dry seasons, water shortages, and deep water tables over Voltaian sandstone formations. A major “disease hearth” is located in the Northern Region savanna woodland, with rates rising to about 200 per 1000 population. In the rain forest, rates drop below 1 per 1000. Cyclical and seasonal labor migrations result in regional spread of dracunculiasis. The Upper Regions enjoy low rates of infestation, despite constant disease assault by returning migrants. This outcome is based on favorable geology, and hand-pump tube well programs. Village water security in the Upper West Region is associated with a reversal of the seasonal incidence of dracunculiasis. The dry coastal plains are associated with elevated dracunculiasis, but irrigation projects appear to be a compounding influence in the creation of “hot spots” or foci of disease. Notorious in the transtlantic slave trade, and historically long entrenched in rural areas, guinea worm now faces global extinction.