EPIDEMIOLOGICAL STUDIES ON DRACUNCULIASIS IN OYO STATE,
NIGERIA
BY
OLUWASEYI ADEGBOYEGA ADEYEBA 
M. Sc., M. Phil. (Ibadan), AIMLS (London), F.l.M.L.S.(Nigeria) AMNIM
THESIS IN THE DEPARTMENT OF VETERINARY MICROBIOLOGY
AND PARASITOLOGY
SUBMITTED TO THE FACULTY OF VETERINARY MEDICINE 
IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE
DEGREE OF
DOCTOR OF PHILOSOPHY 
UNIVERSITY OF IBADAN
FEBRUARY, 1995
11
DEDICATION
DEDICATED TO
The Glory of the Living and Everlasting 
God through Jesus Christ our Lord.
For from Him and through Him and to Him
I l l
ABSTRACT
The studies were designed to collect baseline information to form 
essential data base for effective planning and s-ubsequent evaluation of 
guineaworm control Jprogramme in Oyo State. In order to establish the 
epidemiology of dracunculiasis and assess the impact of the disease on the 
economic life of the affected population, pretested questionnaire data 
sheets were administered to 2,415 individuals and 257 heads of household 
in eight different villages in Oyo State. The data analysis was done by 
using analysis of variance and coefficient of determination and multiple 
range tests, using the IBM computer, utilizing the SPSSH package. The 
survey of concurrent parasitic diseases was carried out in one village by 
examining faecal and blood samples of 287 individuals. The antibiogram 
and profile of bacteria associated with secondary infection was determined. 
Simple methods of chemical, biological and physical control of 
guineaworm vector under laboratory conditions were described.
Of 2,415 individuals examined in eight villages of Oyo State in 1988,
76.9 per cent had history of dracunculiasis while the infection rate at the 
time of study was 47.9 per cent. There was no significant difference in the 
infection rate between the sexes. However, the risk of infection increased 
with age. Infection occurs at any age above 1 year and reinfection is 
common, indicating that on clinical grounds, no protective immunity is 
developed after infection.
I V
There was a general awareness by individuals that they were infected 
before the formation of the guineaworm bleb. Mean percentage of 18.9 ± 1 
had the sympoms in 1 day. The sites of guineaworm emergence differ 
significantly for each victim (P < 0.05), and no anatomical part of the body 
was apparently exempted with regard to worm emergence. Majority of the 
affected people (a mean per cent of 54 ± 6.7) became clinically ill in the dry 
season; and also a mean per cent of 54.3 ± 2.3 suffered severe infection. 5 - 
8 weeks was the most frequently occuring period of incapacitation. 54.5% 
of the victims had no form of assistance on the farm during the period of 
incapacitation.
Majority of the heads of household held various wrong beliefs of 
causes and prevention of the diesease. 82 ± 3.6 per cent attributed the 
cause of guineaworm to the act of God and that there was no remedy for it. 
Only 6.53 per cent treated the drinking water before consumption. The 
disease has an adverse impact on agriculture, while an average of 20 - 41 
per cent of the pupils were absent from school with attendant poor 
academic performances.
Of 487 samples examined for concurrent parasitic disease 278 (57.1 
per cent) were infected with one parasitic disease or the other: Ascariasis 
(43.7%), hook-worm disease (27.1%), strongyloidiasis (2.5%), trichuriasis 
(31%), Entamoeba histolvtical infection (3.9%) and plasmodiasis (43.7%). 
The haematocrit value of the individuals in the community was generally 
low (26 - 30%) whilst eosinophilia was a common feature. The health 
implication was discussed.
V
Klebsiella sp., Streptococcus sp., Proteus sp. and Staphylococcus 
aureus were common bacterial agents isolated from guinea worm ulcers. 
The phage types of Staph, aureus (the commonest agents) isolated were 
resistant to both penicilline and tetracycline. The epidemiological 
importance of the various phage types was discussed. A
The ecology of the environment where the copepod intermediate hosts 
breed and transmit dracunculiasis was described and discussed. Cyclopoid 
copepods died within 60 minutes when the ironment was 
manipulated to 24.6mg/l. oxidizable organic matter concentration from 
the natural average va~ue of 12.5mg/l. It was shown that cyclopoid 
copepods became inactive at 4 - 6°C in 4 hours and later regained activity
in 15 minutes at room temperature.,^^^
The study showed that ponds in a study area had the highest density 
of cylops in November/December (1988) and lowest density in 
July/August (1988) with natural cyclops infection rate of 6.5% at the peak 
of transmission. It was also shown that the concentration of cyclops was 
greatest when water was drawn at the time the pond water was still and 
undisturbed, especially with the first caller at the pond, with attendant 
higher risk of infection.
The study also revealed that population mobility occasioned by 
marriage, socio-cultural and economic life of the people contributed to the 
diffusion and control of the disease.
A variety of chemicals found in natrual waters, or used in the 
treatment of water were added to pond water and their effects on the
V 1
survival of the cyclopoid copepods were assessed. The possible use of such 
chemicals as calcium hypochlorite, potassium permanganate, lime, etc., in 
individual houses as a preventive measure against the transmission of 
the disease was discussed.
Furthermore, the study revealed that indigenous fishes like 
Hemicromis fasciatus. Barbus occidentalis. Tilapia nilotica and T. galilea; 
were very useful biological control agents of the vector of Dracunculus.
It is believed that provision of safe drinking water and good health 
education with active case search to monitor the intervention programme 
will reduce the disease prevalence.
&
VI I
ACKNOWLEDGEMENT
I am greatly indebted to my supervisors, Professor Oladele O. Kale, 
the former head, Department of Preventive and Social Medicine, College 
of Medicine and a Senior Consultant and National Facilitator of the
very useful services at every stage of the course of this study. I thank them 
for their keen interest, guidance and encouragement.
allowing me the use of his laboratory and other facilities and critically 
going through the work. His technical assistance has contributed in no 
small measure to the success of my laboratory work.
Ogunrinde, the former Acting Head, Department of Veterinary 
Microbiology and Parasitology, Dr. Clement K. Ojeh, Professor Aderemi 
Kuku, Dean, Post Graduate School; Professor E. O. Ogunba, Professor 
Olowookorun and Professor O. O. Kale. I thank Professor Yemi Adetosoye 
for his support during my trying period.
V I I 1
My sincere appreciation goes to Dr. Akinmumi Akinyemi, the former 
Chief Medical Officer of Oyo State and pioneer chairman, Oyo State Task 
Force on Guineaworm Eradication and Dr. Olu Alabi, the then Oyo State 
Commissioner for Health for appointing me the (pioneer) Secretary and 
Co-Ordinator of the State Task Force on Guineaworm Eradication. I 
benefited immensely from their co-operation and support. I also wish to 
thank Mr. Isola, the Government Photographer who produced most of the 
photographs used in this thesis.
I must not forget to thank all the Local Government Authority 
Health Officials especially those from Irewole, Oluyole and Akinyele 
L.G.As who assisted during the epidemiological survey for their kindness. 
My appreciation also goes to Messrs Lekan Akinlabi and Dotun Adeyeba 
for assisting me throughout the period of water sampling and collection of 
cyclops for the study.
I am also profoundly indebted to Dr. Gabriel O. Adegoke of 
Department of Food Technology, University of Ibadan and Dr. C. Godard 
of Institut Pasteur du Brabant, Belgium for assisting in phage typing the
Staphylococcus strains.
I must also thank Rev. Okeremi, the Director of Fisheries, Oyo State 
Ministry of Agriculture for supplying free of charge all the fishes used for 
my experiments. My special thank goes to Prince Adetogun of the same 
Ministry who introduced me to him.
I must place on record the various supports received from my friends 
especially Brother Yemi Obakin (who gave monetary support), Brother
IX
Ranti Orioke (for supplying reams of photocopy papers), Brother Jide 
Soetan (for all the duplication), Dr. Oyewole Adeyeye (for arranging and 
paying for the computer analysis of my data and development of all 
figures and illiustrations), Prof. M. B. Ogunniyi, formerly of the 
Department of Teacher's Education (for his critical review of the 
questionnare), K&K Bookshop ( for donating typing sheets for this work) 
and Mrs . R . O . Akindiya (for typing this thesis). I am greatly indebted to 
all the members of the Mobile Fellowship for their prayer support.
I am very grateful for the co-operation received from the members 
of staff and students of all the community schools in Mele, Ejitolu and 
Seriki villages and indeed all the Chiefs and elders of the entire study area, 
who literaly stood by us throughout the course of the study. Occasionally, 
they gave to us part of thier farm produce as gift.
I want to express my gratitude to members of my family for bearing 
with me during the period of this study.
ALL GLORY BE TO GOD through my Lord and Saviour Jesus Christ 
whose amazing grace I enjoy always.
X
CERTIFICATION
n
..........W...e.. .  certify that this work was carried out by 0,. 5A. Adeyeba 
in the Departments of Preventive and Social Medicine, and 
Veterinary Microbiology and Parasitology, University of Ibadan.
c u .
Professoi^O.O. Kale, B.A. (T.C.D) Dr. B.O. Fagbemi, D.V.M. (Ibadan)
M.B., B.C.H., B.A.O. (Dublin) D.T.M M.Sc., Ph.D (Ibadan) 
and H (Liverpool) D.P.H. (Bristol), Reader'. r,
F.M.C.P.H., F.W.A.C.P. (Nigeria), Department of Veterinary 
Department of Preventive and Social; Microbiology and Parasitology, 
Medicine, University of Ibadan. ^University of Ibadan.
XI
TABLE OF CONTENTS
PAGE
Format.......................... .....................................
Dedication....................................... ................. n
Abstract............................................................. iii
Acknowledgement.......................................... ..4 iv 
Certification..................................................... r x 
Table of Content.......................  ................................................. xi
List of Figures.................................................. ............ xviii
List of Tables.................................................... xx
.............
CHAPTER ONE
1.0 GENERAL INTRODUCTION...... 1
1.1 Rationale and objective of the study..................... 4
1.2 About Oyo State and the Study areas at a glance 5
CHAPTER
2.0 Literature; reviieew.................................................................. 14
2.1 The Parasite Dracunculus medinensis ........................ 14
2.2 Transmission of dracunculiasis......................................... 16
2.3 Clinical features of the disease........................................... 18
2.4 Sequale and impact of dracunculiasis.............................. 20
2.5 Secondary bacterial and concurrent parasitic infection 22
2.6 Epidemiology of dracunculiasis.......................................... 24
Xl l
PAGE
2.7 General characteristics of the vector...................... 26
2.8 Global distribution of dracunculiasis................... . 29
2.9 Prevention, control and prospect for eradication
of dracunculiasis........................................................
CHAPTER THREE
3.0 DRACUNCULIASIS IN OYO STATE: EPIDEMI
OLOGY, SOCIO-ECONOMIC AND CULTURAL 
IMPACT..................................................... ................. 34
3.1 INTRODUCTION........................... 34
3.2 Materials and Methods......... 35
3.2.1 Method of data analysis 36 
3.3 Results o* 36
3.3.1 Distribution of persons with dracunculiasis in 8
villages of Akinyele and Irewole LGAS...................................  36
3.3.2 Percent>age of reinfected patients by age and sex ....................  41
3.3.3 Distribution by number of times of infection ........................  41
3.3.4 Prodromal symptoms.....................................................................  46
3.3.5 Anatomical sites of guinea worm emergence........................  46
3.3.6 Seasonality of dracunculiasis......................................................  51
3.3.7 The degree of severity of dra,cunculiasis.................................  51
3.3.8 Period of disability......................................................................... 51
3.3.9 Effect of dracunculiasis on school attendance......................... 55
XII I
PAGE
3.3.10 Assistance during absence from w ork.................... 55
3.3.11 Perception of causes of guineaworm by heads of
household...................................................................... 60
3.3.12 Belief on prevention of guineaworm by heads of
household...................................................................... 60
3.3.13 Extent of water treatment among household heads.......... 60
3.3.14 Methods of water treatment by heads of househ! old .... 64
3.4 DISCUSSION ........... 64
CHAPTER FOUR
4.0 SECONDARY BACTERIAL INFECTICON IN
DRACUNCULIASIS: BACTERIAL ISCOLATES, 
ANTIBIOTIC SUSCEPTIBILITY PATTERNS AND 
PHAGE TYPES OF STAPPIYLOCOCUS AUREUS ... 77
4.1 Introduction..................................................................... 77
4.2 Materials and methods.................................................. 78 
4.2.1 Sample collection and isolation of bacterial 78
4.2.2 Strains................................................................. 78
4.2.3 Antibiotic susceptibility test........................... 79 
4.2.4 Minimum Inhibitory concentration (MIC) .. 79 
4.2.5 Phage typing...................................................... 81 
4.2 Result.................................................................. 82 
4.3.1 Bacterial agents isolated from guineaworm ulcers 82
X I V
PAGE
4.3.2 Phage types of Staph aureus isolated from
guineaworm ulcers ................................................ 82
4.3.3 Antibiotic susceptibility pattern of staph-aureus
strains isolated from guineaworm ulcers............ 82
4.4 DISCUSSION.............................................................. 85
CH PTER FIVE
5.0 CONCURRENT PARASITIC DISEASES K &
DRACUNCULIASIS ENDEMIC AREA OF OYO
STATE, NIGERIA...... 88
5.1 Introduction............... 88
5.2 Materials and Method s 89
5.3 Results......................... :: 90
5.4 DISCUSSION............... 91
CHAPTER SIX &
6.0 VECTOR ECOLOGY AND POPULATION
MOBILITY: ESSENTIAL FACTORS IN THE DIFFUSION 
AND CONTROL OF DRACUNCULIASIS .......................... 97
6.1 Introduction................................................................................. 97
6.2 Materials and Method............................................................... 99
6.2.1 Estimation of Biochemical Oxygen Demand........................ 99
6.2.2 Dissolved Oxygen (DO) Estimation........................................ 100
PAGE
6.2.3 Total alkalinity Estimation.................................................. 100 
6.2.4 Total hardness Estimation................................................... 100 
6.2.5 Chloride Estimation.............................................................. 101 
6.2.6 Calcium Estimation.............................. ................................ 101
6.2.7 Oxidizable organic matter Estimation using 4 hr
permanganate value (4hr - P - V ) ........ .g .. 101
6.2.8 Effect of organic matter on cyclops...... $ ) ........ 102
6.2.9 Storage of cyclops at low temperatures 102
6.2.10 Monthly cyclops distribution............... 102
6.2.11 Disturbance effect on cyclops concentration............... 103
6.2.12 Socio-economic activities and population mobility .. 103
6.3 Result................................................................................... 104 
6.3.1 Characteristics of the vector habitat.............................. 104 
6.3.2 Effect of low temperature on the survival of cyclops 104 
6.3.3 Effect of organic matter on survival of cyclops.......... 104
6.3.4 Seasonal and monthly distribution of cyclops
in Folarin ponds................................................................ 108
6.3.5 Effect of disturbances on cyclops density..................... 108
6.3.6 Socio-economic activities and population mobility .. 111
6.4 Discussion........................................................................... 111
XVI
PAGE
CHAPTER SEVEN
7.0 INFLUENCE OF SOME WATER TREATMENT 
CHEMICALS ON SURVIVAL OF CYCLOPS IN
POND WATER................................................ 120
7.1 Introduction...................................................... * •< p  120
7.2 Materials and Method.................................... 121
7.2.1 Effect of PH on cyclopid copepods (cyclops) 0 122
7.2.2 Effect of aluminium sulphate (Alum) .......... 122
7.2.3 Effect of potassium permanganate on 123
7.2.4 Effect of calcium hypochlorite (CL2) on cyclops........ 123
7.2.5 Effect of some water treatment chemicals on cyclops 123
7.3 Results.......  ......................................................................... 124 
7.3.1 Effect of PH on the survival of cyclops........................ 124 
7.3.2 Effect of aluminium sulphate on cyclops survival ... 124 
7.3.3 Effect of potassium permanganate on cyclops survival 124 
7.3.4 Effect of calcium hypochlorite on cyclops survival....... 127 
7.3.5 Effect ooffs soonm e)water treatment chemicals or cyclops 127 
7.4 Di^^ajian 130
CHAPTER EIGHT
8.0 EFFECT OF FISHES AS BIOLOGICAL CONTROL
AGENTS OF VECTOR OF DRACUNCULIASIS UNDER 
LABORATORY CONDITIONS.............................................. 134
xvu
PAGE
8.1 Introduction......................................... 134
8.2 Materials and method........................ 135 
8.2.1 Study with Fishes......... ...................... 135
8.2.1.1 Pilot study......................................... 135
8.2.2.2 Experimental studies...................... a* 136
8.3 Results.................................................. 137 
8.3.1 Effect of predating fishes on cyclops p 137 
8.4 Discussion............................................ 143
...............
CHAPTER NINE
9.0 CONCLUSION 146
REFERENCES . 150
APPENDIX ..... 167
..........
....................
X V U I
LIST OF FIGURES
FIGURES PAGE
1.1 Oyo State showing 24 LGA .................................... 8
1.2 Akinyele Local Government Area showing the
study areas ............................................................... 10
1.3 Map of Irewole Local Government A rea............ 3 ^ 11
1.4 Oluyole Local Government M ap........................... 12
1.5 A typical pond in Seriki Village in Akinyele L G A ..... 13
3.1 History of dracunculiasis in Oyo State Distribution
by age and sex..................................................... 38
3.2 Distribution of patient by number of times of infection 43
3.3 Dracunculiasis and prodromal symptoms 44
3.4 Guineaworms emerging from 5 sites on both legs
of a house w ife............................................................... 45
3.5 Guineaworms from the foot of an incapacitated 
teenage school boy in Mele Village........................... 48
3.6 Guineaworms emerging from the penis of a 60 years
old Head of a household........................ 49
3.7 Guineaworm on the wrist of a woman 50
3.8 Guineaworm victims of a household
(PapanlaVillage)....................................... 54
3.9 Period of "lay off from work"................ 58
XI X
PAGE
3.10 Impact of dracunculiasis on school attendance in
Oyo State (Jan. '86 - July, '89)................................................ 59
3.11 A thirsty farmer in Asani village in Akinyele
LGA drinking directly from pond in the vicinity 
of the farm ................................................................................ 67
3.12 School children with mild guineaworm infection........ 73
3
3.13 Guineaworm extraction with string cord tied round.... 75
6.1 Monthly distribution of cyclopoid copepods in a pond 
in Folarin village (March 1988 May, 1988)........................ 109
6.2 Effect of frequency of pond patronage disturbance 
on cyclops density.................................................................. 110
6.3 The villagers returning from the pond after collecting 
water......................................................................................... 115
6.4 A woman collecting water from the pond with legs
inside........................................................................................ 119
7.1 Effect of chlorination on the survival of cyclops............ 128
8.1 Effect of predating fish (Tilapia Sp) on cvclops densitv 
in pond water under Laboratory condition...................... 138
8.2 Effect of predating fish (Hemicromis fasciatus) on 
laboratory condition............................................................... 139
8.3 Effect of predatinv fish (Tilapia nilotica. T.galileal on 
cyclops density in pond water under laboratory 
condition.................................................................................. 141
8.4 Effect of predating fish (Barbus occidentalism on cvclops 
density in pond water under laboratory condition........ 142
XX
LIST OF TABLES
TABLE PAGE
3.1a Prevalence of dracunculiasis in 8 villages, Oyo State 39
3.1b Distribution of dracunculiasis in 8 villages at time
of study (Feb. - April, 1988)............................................ 40 
3.2 Percentage of reinfected patients by age and sex ....... 42 
3.3 Anatomical sites of guineaworm emergence .. 47
£ ? .........
3.4 Distribution of guineaworm patients by seas ons
of infection............  ........................................' ........... 52
3.5 Distribution of victims by degree of severity of
dracunculiasis..................... 53 
3.6 Assistance during lay-off from  ̂ ork 57
3.7 Perception of causes of guineaworm by household
heads......... 61
3.8 Belief on prevention of guineaworm by household 
heads......... 62
3.9 Extent of- water treatment before drinking by
household heads......................................................... 63 
3.10 Methods of water treatment by household heads 65
4.1 Symbols and concentrations of antibiotics used
for sensitivity testing of Staph, aureus strains..... 81
4.2 Phage types of S.aureus strains isolated from
guineaworm u lcers.......................................................... 83
4.3 Antibiotic susceptibility pattern of phage type..... 84
XXI
PAGE
5.1 Prevalence of gastrointestinal parasitic infections
in Area of endemic dracunculiasis.......................... 92
5.2 Distribution of intestinal parasitic infection by
age group....................................................................... 93
5.3 Malaria parasite distribution by age group ....
and packed cell volume...................................... 94
6.1 Characteristics and properties of pond water in 
which cyclops breed and transmit dracunculiasis
100 105
6.2 Effect of low temperature on the survival of
cyclopoid copepods........... 106 
6.3 Effect of organic matter (sewage)o on survival of cyclops 107
7.1 Effect of potassium permanganate on the
survival of cyclops............................................... 125
7.2 Effect of organic matter and potassium
permanganate on the survival of cyclops...... 126 
7.3 Effect of some water treatment chemicals on
the survival of cyclopoid copepods 129
CHAPTER ONE
GENERAL INTRODUCTION
Dracunculiasis (guineaworm disease) the infection with 
Dracunculus medinensis has been recognised since antiquity (Linnaeucs 
1758). This infection is caused by a large unsegmented cylindrical worm of 
the phylum nemathelminthes, class nematoda, sub-class phasmidia, order 
spirurida, sub - order camallanata, super family dracunculoidea, family 
dracunculidae genus Dracunculus and species medinensis. It is one of the 
oldest parasitic diseases ever known to man.
The disease had been described by many early Greek, Arabic and 
Persian authors who called it by many vernacular names: guinea worm, 
medina worm, "irk al medina", filaire de medine, le dragonneau 
phyraonswurm. The disease was first named and described as occuring 
around the Red Sea by Agatharcides of Chidus while Plutarch said it was 
common in Egypt and Mesopotamia ( Hoeppli, 1959). The controversy on 
the origin of the disease as started by an early author Avicehna, who 
thought that it was of nervous origin was laid to rest by Velsichius (1674) 
and Bartet (1909) who also prepared a monograph containing other lists of 
historical references.
Many names have been coined for the worm all over the world in 
modern time depending, of course, on the part concerned. For instance, in 
Nigeria, it is called "Sobiya", "Zuba", "Bulutu", "Kunukuni", Ari ikwere"
9
and "Odrogo" in Yoruba, Boko, Fulani, Hausa, Igbo and Idoma lands 
respectively. Other known names include "irkon" in New Guinea and 
"rishta" in Iran. '
Dracunculiasis, by any assessment, is a terrible disease. It is 
primarily a rural problem. This fact partially explains the relative 
obscurity of the disease as weli as its continued prevalence and increase in 
magnitude. Until recently, the disease has not been the subject of 
sustained research or control efforts. It has been neglected because it rarely 
kills, but temporarily cripples people in rural communities located far 
from modern institutions. Hence, the notion that the disease is "a 
forgotten problem of the forgo
There are no accurate some measure of the
extent of distress caused by the disease can be gauged from various small 
scale epidemiological surveys carried out by a few authors (especially in 
Nigeria) like Kale (1977), in Ibarapa area; Nwosu £t a] (1982) in Anambra 
State; Edungbola (1983, 1984) in some parts of Kwara State and Udonsi
(1987a, b) in Imo State. In the early fifties, Onabamiro reported many cases
in some parts of the old Western Region now within Oyo and Ogun states 
of Nigeria (Onabamiro, 1952). Information on the distribution and 
prevalence of the disease is scanty. Therefore, precise numbers and 
locations of contaminated water sources, as well as the specific villages, 
towns and sizes of the populations which are affected by dracunculiasis are 
known.
3
In some countries, such as Uganda (WHO, 1984) the disease is 
thought to be restricted to specific regions, while in Nigera it is now 
known to exist in all but one of the 21 States (at the time of this study) of 
the federation as a result of a nationwide active search conducted in 1988. 
Prior to this data on disease prevalence in the country was based on 
sporadic reports from part of Anambra, Kwara, Ogun and Oyo States.
Up to the 1988 active case search in Nigeria it was estimated that 
about 2.5 million cases per year occur in Nigeria which would account for 
one-fourth of all the disease which occurs in the world. Thirty million 
Nigerians are thought to be at risk from the infection and this represent 
about 7596 of the annual African cases (Watt, 1987). The first active case 
search however revealed about 700,000 cases, although the (1988) active 
coverage was less than complete. Estimates of the magnitude of impact of 
dracunculiasis on the agricultural sector are relatively scarce, but those 
that exist either estimate lost workdays or the value of lost production in 
some parts of the world. The estimates of W.H.O. (1986) places the annual 
loss of workdays in India caused by dracunculiasis at 10.6 million. The 
average period of absenteeism from farms in South Ghana was about 15 
weeks (Belcher et ah, 1975). Current research assisted by UNICEF on the 
socioeconomic impact of dracunculiasis on rice out-put in Cross River, 
Anambra and Benue States is expected to reveal a more correct assessment 
in Nigeria, (Kale - personal communication). Dracunculiasis is the ma jor 
cause of absenteeism from sc hool in endemic areas of Anambra State and 
Idere in Oyo State (Nwosu gt aL 1982; llegbodu gt aju 1986).
4
1.1 RATIONALE AND OBJECTIVE OF THE STUDY
From ancient times to the present and in spite of technological 
advancement, dracunculiasis still represents a serious health risk, social 
indignity, psychological distress and economic loss for several millions of 
rural villagers in parts of Africa especially, Nigeria, the Middle East and
India.
< P
The purpose of this present study was Oto vcollect baseline 
information 'from households in a small representative sample of 
villages in Oyo State especially during the peak transmission season as 
essential data base for effective planning and subsequent evaluation of a 
control programme as well as case treatment and management. In 
addition, the study was designed to evaluate simple methods of chemical,
biological and physical cont r ol of tlhe vector of Dracunculiasis.
The specific objectives of the studies are:
(a) To describe the prevalence of dracunculiasis in a sample of
rural agricultural communities in Oyo State of Nigeria by
*
specified demographic ecological variables viz. sex, age,
religion; sources of drinking water; site of lesion; freqency of
infection and seasonal variations.
(b) To ascertain or assess the health beliefs/and knowledge 
regarding dracunculiasis and water use behaviour in the 
communities .
5
(c) To describe the effect of the disease on daily routine of work 
and school attendance and academic performance of school 
children.
(d) To determine the pattern and level of concurrent parasitic
infections in a guinea worm endemic area A
(e) To determine the antibiogram pattern and phage types of the 
predominant microbial agent responsible for secondary 
infection of the guinea worm ulcers.
(f.) To investigate the water supplies for monthly variations in the 
density of the vector, the cvclops, and physical and 
environmental factors affecting the survival and breeding of 
the vector. o ! r  ■
(g) To determine the effects of some common chemicals found in 
water on the survival of the vector under laboratory
conditions.
(h) To determine the effect of varied environmental factors on the 
survival of cyclopoid vectors under laboratory conditions;
(i) To examine the effectiveness of biological methods of
controlling the vector using locally available species.
ABOUT OYO STATE AND THE STUDY AREAS AT A 
GLANCE
Oyo State is one of the twenty one States that constitute Nigeria (as 
at the time of this study). It lies between latitude 7° and 9°30’ North of the
6
Equator and between 2°30' east of the Prime Meridian. It covers a land 
area of 35,743 sq. km. It is bounded in the North by Kwara State, in the 
West by the Republic of Benin, in the south by Ogun State and in the east 
by Ondo State.
Within the national setting, Oyo State represents the core of a 
homogenous Yoruba speaking people. It is one of the most densely 
populated States in Nigeria. With an estimated 1989 population of 
11,909,039 projected from 1963 census figures at the rate of 3.3 per cent 
growth rate; it is the second largest state in the Federation. The State was 
divided into 24 Local Government Areas (LGA) at the time of this study 
(Fig.1.1). The state experiences two major seasons viz rainy and dry 
seasons with rainfall varying between 1500mm to 2000mm per annum.
Farming or agriculture is the predominant occupation in the state, 
being practised by over 70% of the citizens. Women are more involved in 
the distributive trade and food preparation while men are involved ui!n 
the crop production and some of the retail trade. Farming in most parts of 
the States is^still done in very crude forms and it is a labour intensive. 
This calls for the combined input of both the head of household as well as 
wives and children .
This study was conducted in nine villages selected by random 
sampling from among 3 LGAs. The villages are Abaepo/Asani, Ejitolu, 
Folarin, Mele and Seriki Okegbemi in Akinyele Local Government Area 
(Fig. 1.2); Igiidu, Mowooba and Papanla in Irewole Local Government
7
Area (Fig. 1.3); and Sanusi village in Oluyole Local Government Area (Fig. 
1.4).
Mele village is situated about 8km, west of Moniya the Local 
Government Area Headquarters and north-west of Ibadan, the State 
Capital. The other villages viz Aba-epo/Asani, Ejitolu, Folarin and Seriki 
are situated west of Mele at an approximate distance of 2 to 5 km. each to 
one another (Fig. 1.2). A primary school is located in each of the following
villages - Mele, Eij itolu and Seriki Okegbemi. Each school draws its 
pupils from other contiguous communities. Aba--eeipo/Asani, Ejitolu, 
Folarin, Mele and Seriki have de facto population of 72, 176, 202, 228 and 
138 respectively.

9
Papanla village with population of 125 is located about 10km west of 
Ikire, the Headquarter, Irewole Local Government Area along Apomu- 
Orileowu road and 41km. south east of Ibadan has a primary school. 
Igiidu with 938 inhabitants is located in the eastern part of Ikire about 
64km. to Ibadan. Mowooba village is located about 80km. near Oranran 
Road south eastern Ibadan. It has a de facto population of 536.
Sanusi village located about 20km. south east Ibadan in Oluyole 
Local Government Area has a de facto population of 1, 000.
Most of the villages lack basic amenities for comfort, such as health
centres, potable water, electricity and good roads. Of all the villages
_ y *
surveyed, only Mele has a maternity and dispensary which is meant to 
serve no fewer than 12 other communities. The only source of drinking 
water in all the villages is pond (Fig. 1.5) and roof collection during the 
rains. Effort to sink wells in most of the villages have been frustrated by 
the topography. Hard rock prevented the sinking of well by the 
inhabitants of Igiidu while the walls of the well kept collapsing in Sanusi 
village.
,< Z r
oco
AR7.A
CL!JVC!_£ LOCAL
ST U D Y  AREA *
Fig. 1*b A typical pond in seriki village in Akinyele L.G. Area
CHAPTER TWO
LITERATURE REVIEW
2.1 THE PARASITE: DRACUNCULUS MEDINENSIS
Dracunculus medinensis is monoecious. The female Dracunculus is 
one of the largest nematodes known to man. In 1938, Moorthy and Sweet 
recorded a mean value of 690mm. long, 2.0mm. broad from specimens 
they surgically removed from patients in Pakistan when worms were 
about to emerge. Females removed from the dog measured 280 - 530mm 
long by 1 .0mm broad, an indication that parasites from experimentally
infected animals are often smalle
There are many report: detailed description of the
morphology and structure of adult female and male worms from human 
sources (Charles, 1892; Chitale, 1912; Mirza, 1929; Moorthy and Sweet, 
1936; Moorthy 1937). The male is usually smaller (12 - 29mm by 0.4mm 
broad) in siz^and the tail is curved into a spiral. However, the description 
has been based on worms mostly recorvered from animal sources (Leiper, 
1906; Moorthy and Sweet, 1938; Muller, 1971).
Although nothing is known about the nutritional requirement of 
the Dracunculus and its physiology Bueding and Oliver Gonzalez (1950) 
felt that in D. insignis. the species of the parasite most common in lower 
animals, the main end-products of carbohydrate metabolism is lactic acid 
and the rate of its formation, or of glucose utilization is not affected by the
presence or absence of oxygen. Histochemistry has revealed that glycogen 
stores in the mature female are mainly in the amoeboid portion of the 
musculo-cutaneous cells, in basement membranes, the wall of the uterus
and in the cells of the intestine.
Detailed description of embryogenesis of Drac
undertaken in 1970 by Muller. The uterus of the female 
months is filled with developing eggs and whereas poly spermy 
sometimes occurs, only one sperm fertilizes the ovum. The embryos 
break free of the egg shells and are usually fully formed by 10 to 14 
months.
Many authors have described in detail the larvae of Dracunculus 
(Blacklock and O’Farrell, 1919; Moorthy, 1938; Muller, 1970b, 1971). The 
tail is long and pointed and the cuticle is characteristically striated with 
lateral ridges in the first stage larvae (Li). Although the gut is fully formed 
with mouth and anus and a pharynx, the first stage larvae do not feed. 
The number of embryos released by the female worm usualiy decreases on 
each immersion in water (Muller, 1971). The total number of embryos 
contained on one female worm was estimated at 3 million in 1919 by 
Turkhud. While Muller (1971) gave an estimate of about 2 million in two 
worms dissected from rhesus monkeys just before emergence.
Despite the fact that the larvae remain active in pond water for 4 - 7 
days (Moorthy, 1932; Southwell and Kirshner, 1938), there was reduction 
in the subsequent percentage infection rate in cyclops after 3 days of
existence in pond water and more often than not nil after 6 days (Muller, 
1971).
The subsequent third stage larvae (L3) was described in detail by 
Leiper (1907) and Moorthy (1938). The tail of the third stage larvae usually 
appears bifid (Brug, 1930 and Muller, 1971) or conical Roubard (1913). 
According to Moorthy (1938) the third stage larva measures 240 - 608pm 
long by 12 - 23pm broad at 21 days. The pharynx has an anterior glandular 
portion, the intestine contains transparent and brown globules. The anus 
opens from the short tail, the feature of which is variable depending on 
the observer.
2.2 TRANSMISSION OF DRACUNCULIASIS
Larvae from adult female worms protruding from the lesions on 
man's skin are washed into water in which they can survive for two or 
three days awaiting ingestion by the cyclops, a microcrustacean, in pond. In 
this intermediate host the larvae undergo powerful bending movements 
and penetrate the cyclops gut wall. There they move to the body cavity, 
where they develop, over a period of about fourteen days into the 
infective third stage larvae (L3) (Leiper, 1907; Moorthy, 1938). Man 
becomes infected when he swallows the infected Cyclops while drinking 
from previously contaminated surface water. The gastric juice in the 
stomach destroys the Cyclops but do not kill the larvae, which penetrate 
the gut wall and proceed to wander in the tissue till they become adult. 
Copulation occurs at about the sixth month after ingestion. The male
worm dies thereafter and is either absorbed by the body or become encysted 
or calcified. The greatest clinical problems are caused by the female worms 
which usually migrate down to the subcutaneous'tissue. After an 
incubation period of about ten to fourteen months in the host the 
fertilized female worm which measures up to 70cm long is ready to 
emerge and discharge larvae. To do so it migrates to tissues beneath the 
skin where it secretes a toxic substance that produces localized swelling, 
accompanied by intense burning and itching (Fairley and Liston, 1924) 
usually at a spot which is likely to come in contact with water.
In the gravid female, the uteri are packed with coiled up embryos 
which may be up to three million. Within a few days, a painful blister 
develops and rupture leaving a shallow ulcer on the skin from which a 
loop of uterus prolapses through the anterior end of the worm. When the 
ulcer comes in contract with water, a milky fluid containing Dracunculus 
larvae is discharged. The larvae are then intermittently discharged on 
subsequent contracts with water over a period of two to three weeks, until 
all larvae have been evacuated. The worm then dies or emerges 
spontaneously. If the larvae are not taken up by the cyclops, they can live 
for about a week in non-turbid water and from two or three weeks in 
muddy water.
The Cycle of the disease is continued with individuals immerse the 
affected parts of the body in water either in the course of normal activities 
such as collecting drinking water, bathing or washing clothes, or to get 
relief from deep-seated stinging and excruciating pain and other
symptoms of the disease. Thus, a single individual can contaminate the 
water supply for an entire village. About two weeks after the larvae are 
ingested by cyclopoid copepods they develop into the infective third stage 
which in turn develop to dracunculiasis when consume^
2.3 CLINICAL FEATURES OF THE DISEASE
It has been noted that Dracunculus lesions ocecu ominantly in
the foot, leg and around the ankle of humans, (Blacklock and O'farrel, 
1919; Adeyeba and Kale, 1988). The appearance of worms in the lower and 
upper extremities is about 97 and 15 per cent respectively. On a few 
occasions however, the sites of blister have been on the hips, abdomen, 
genitals and chest ( Putta Bhatta, 1954). Examples of relatively less 
common sites where adult worms have been found are in the inguinal 
region and scrotum (Ray, 1920\. Osoba and Oyediran, 1977, Adeyeba and 
Kale, 1988), upper eyelid (Wright, 1924), suprapubic region, (Makel and 
Devault, 1930) and tongue (Moorthy, 1932).
Infection is ususally asymptomatic until a few days before the 
emergence of the female worms. About 85 per cent of infected individuals 
had prodromal symptoms in Sanusi village in Oyo State of Nigeria 
(Adeyeba, 1986a). The patient exhibits some allergic manifestations like 
transient generalized pruritus (later localised) and urticarial rash 
culminating in a painful irritation and inflammation at the site where the 
worm eventually form a blister before its emergence (Kale, 1977; Adeyeba 
1986a). Although a generalised urticaria has been found to be the first
indication of Dracunculus infection in 30 - 80% of cases, Duke (1985), 
Fairley (1924) and Carayon et a! (1961) observed that that this is sometimes 
accompanied by fever, giddiness, gastro intesinial symptoms and dyspoea. 
It was also observed that the urticarial eruption, may be accomipannie d by
transient infra-orbital oedema (Carayon gt aL 1961). Hodgson and IBarret 
(1964) noted that an allergic pruritis may occasionally result from chronic 
infection with non emergent worm.
In many cases, 61 per cent (Fairley, 1924), or 63 per cent ( Reddy gt ah 
1970) the local blister is the first sign of infection. The formation of the 
blister which is accompanied by local itching and often an intense burning 
pain may be relieved by immersion of the infected portion in cold water. 
All these disturbances in the host's body metabolism are believed to be 
dfo”rm a”ti on of• t“he bleb.“  “ b" “  " ‘” " d * •
Worms that fail to oemeirge eventually gradually disintegrate and 
subsequently fluid from the worm's uterus produces a sterile abscess,
which may later become secondarily infected by tetanus and other bacteria. 
Where this occurs near the synovial cavity of a joint, septic arthritis may 
result (Fairley and Liston, 1924). In some cases the dead worm becomes 
calcified and if not too deep seated, it may sometimes be palpable. 
Dracunculus are mostly found calcified in the lower limbs. Calcifications 
have been observed radiologically in other parts of the body, including the 
perineal tissue, the scrotum, the spinal muscles and the chest wall. The 
presence of calcified worm often elicits no clinical symptoms.
2 0
2.4 SEQUALE AND IMPACT OF DRACUNCUUASIS
Dracunculiasis is primarily a rural problem and this probably 
accounts for the relative obscurity of the disease and its continued and 
increased prevalence especially in Nigeria. Hitherto, there had been little 
or no attention given to the study or control of the disease because it rarely 
kills but tempararily incapacitates the victim in the rural communities. 
This explains why there is paucity of information on the disease as regard 
the impact of the disease on the socio-economic life of the endemic 
community.
The infection is usually followed by spontaneous recovery. 
However, in the course of the disease the patients may suffer to varying 
degrees from painful uclers and abscesses, which usually occur on the feet 
and legs, and which can last over a period of several months. A few 
patients are left with permanent locomotOry disabilities usually resulting 
from involvement of the joints. A case of complication of dracunculiasis 
occasioned by paraplegia was reported by Lawrie (1987). Patnaik and 
Kapoor (1967) have estimated that permanent disability occurs in 0.5% and 
fatality in 0.03% cases.
In as much as the period of peak Dracunculus infection coincides 
with the period of peak agricultural activities, immediate economic 
impact of the disease is in the form of lost agricultural production. The 
degree of impact depends on the prevalence of the disease; whether the 
disability is total or partial; the duration of the disability; the agricultural
activities which are prevented, the degree of involvement in agricultural 
activities and the extent to which other members of the household or 
village can compensate for diminished productivity of those who are 
disabled (Ward, 1982).
It is very difficult to quantify the impact of dracunculiasis on the 
economy of a disabled self employed farmer. Judging from the seasonality 
of crop production, its effect on agricultural input may be considerable 
Estimates of the magnitude of impact of dracunculiasis on the agricultural 
sector are relatively scarce, but those that exist either estimate lost 
workdays or the value of lost production. In 1986, the World Health 
Organisation estimated the annual loss of workdays attributable to the 
disease in I ndia at 10,6 million.
Earlier on, Datta e ia i  (1964) found in India that guinea worms took 
one to three months to emerge fully and this led to an average loss of 119.8 
working days by males and 78.1 days by females. The average period of 
complete disability in untreated patients in Southern Ghana was about 15 
weeks with the peak infection rate coinciding with the planting or
harvesting period (Belcher gt aL. 1975). There was a similar situation in a 
part of South Western Nigeria where up to 25 per cent of the working 
population aged from 15 to 40 years may be incapacitated for at least 10 
weeks in each year (Kale, 1977). The impact of the disease on the nomadic 
cattle Fulani in Babana District of Kwara State is adverse (Edungbola, 1983). 
The infected and incapacitated are confronted with threats of poverty and
misery for thier most valuable cattle die of starvation and dehydration in 
significant numbers.
In addition to costs of lost productivity occasioned by dracunculiasis, 
costs of treatment can be significant and usually bey,ond what the disabled 
poor farmer can cope with despite the fact that modern medicine has little 
or nothing to offer but merely offer a palliative measure. The dignity of 
the disabled farmer is lost, his psychological distress increased as well as 
his socio-economic status diminished.
Dracunculiasis among school children is reported to be the cause of 
missed school in endemic areas of Anambra state and a principal 
contributing factor for 90% of the students who dropped out of school in 
the area (Nwosu et aL 1982).
2.5 SECONDARY BACTERIAL AND CONCURRENT
PARASITIC INFECTION
Bacteria are responsible for the severe tissue inflam mation 
associated with secondary infection (Fairley and Liston, 1924; Garayon et 
al, 1965; Muller, 1971). A list of the complications observed in cases of 
dracunculiasis as given by Fairley and Liston (1924) included acute abscess, 
cellulitis, arthritis, synovitis, epididvmo-orchitis, chronic ulcerations, 
fibrous ankylosis of joints and contractures of tendons.
Streptococcus species, Staphylococcus aureus. Escherichia coli and 
Enterobacter species were commonly cultured from lesions occasioned by 
D racunculus emergence (Fairley and Liston, 1924) described how the
female worm withdrew into its connective tissue sheath if it is broken 
during extraction thereby drawing bacteria into the host tissues. Muller 
(1871) found that 50% of cases showed evidence of sepsis. Not 
surprisingly, lesions on the feet and ankles were much more likely to 
become secondary infected.
However, the role of bacteria in secondary Dracunculus infection 
has been a subject of controversy among authors. Kothari et ah, 1969; 
Muller, 1970 and Muller £t ah 1970 challenged the role of bacteria as the 
aetiologic agent in secondary infection on the ground that there had been 
no success in antibiotic therapy and that spontaneous quick healing of a 
secondarily infected ulcer or abscess has always been preceeded by removal 
of worms. However, it is imperative to carry out more detailed studies on 
the role of bacteria in secondary guineaworm infection and the 
antibiogram pattern.
Cases of tetanus following D ra cu n cu lu s  infection have been 
reported (Lauckner et ah, 1961; Pirame and Becquet, 1963; Labegorre et
a].,1969). #  '
Gemade and Dipeolu (1982) have reported some cases of 
concomitant parasitic disease in area endemic of onchocerciasis in Benue 
State of Nigeria, no similar studies have been reported with respect to 
dracunculiasis .
2.6 EPIDEMIOLOGY OF DRACUNCULIASIS
People between the ages of about 10 and 60 years are usually most 
frequently infected, Peak infection is usually found in the 41 to 50 years 
age group. Nevertheless a considerable proportion of children below 10 
years may also be affected. Children below 1 year seldom acquire the
between sexes. However, in both sexes the incidence of first infection was
significantly highest in the first dec* The risk.of reinfection
increases with age (Adeyeba, 1986a).
The prevalence of dracuncuMasis shows marked variation with the 
season. This is determined by the mode of transmission of the parasite 
(Muller, 1982). An important factor that reinforces the seasonal nature of 
infection is that the female worm in the human body takes approximatelv 
one year to mature and release larvae into water to initiate the following 
year's infection. The larvae require a period of development of about a 
fortnight in fresh water cyclops before the disease can be transmitted to a 
new host.
Suitable conditions for infection occur only where water for 
drinking is taken from stagnat bodies of surface water such as ponds, large 
open wells with steps leading down to the water as found particularly in 
India, or the type of covered rainfilled cisterns that provide the only 
source of drinking water in rural areas of southern Iran. Infection is not
associated with running water or with draw-wells with a circumference of 
less than 3 metres. Infection is also limited to tropical and sub-tropical 
regions because the larvae develop best in cyclops between 25 and 30°G and 
will not develop at all below 19°C (Muller, 1979).
The transmission season in different regions depends on the 
pattern of rainfall. In Sahel Savannah areas of Africa where the rainfall is 
less than 75cm per year, the ponds dry up for much of the year, as in desert 
areas. This occurs in Northern Nigeria (Ramsay, 1935; Onabamiro, 1952) 
and most of Burkina Faso (Steib and Mayer, 1988) Niger, Chad, 
Mauritania, Sudan and Senegal. This results in transmission being 
confined to the rainy season and the months immediately following until 
ponds dry up. In the Guinea Savannah areas of West Africa, with an 
annual rainfall of more than 150cm as in Benin, Ghana, Cote D'voire, 
Southern Nigeria, Guinea and Togo, the ponds have water all the year. 
There is a close correclation between the incidence of dracunculias in a
community in a given year and the amount of rainfall in the preceeding 
year (Kale,1982)'.
For instance, in the rain forest belt, heavy, prolonged precipitation 
in one year, resulting in a relatively abundance of surface water, often 
presages a lower incidence of infection in the following season. Hence, 
during the raining season there is little or no transmission as there is so 
much surface water that many ponds turn into small streams (Adeyeba 
1986a). The water becomes very turbid and the concentration of cyclops is 
low. Besides, there are many alternative sources of drinking water. For
2 6
instance, in the village of Iwoye (Onabamiro 1952), as well as Igbon and 
Sanusi village in Oyo State of Nigeria (Edungbola, 1984; Adeyeba 1986a), 
infection was found to be confined to the dry season when the volume of 
pond water is low and the concentration of cyclops in pond water is high. 
It has also been demonstrated that infected cyclops sink to the bottom of a 
pond (Onabamiro, 1954), and so are more likely to be picked up when the 
level is low.
Generally, in the savannah regions infection ^is <confined to areas 
which are away from rivers, and which rely on shallow ponds for 
drinking water (Onabamiro, 1954 and Scott, 1960).
In endemic areas draw wells app/ eSar 'to be of little importance as 
regard transmission since the risk of contamination by Dracunculus larvae 
is very low (Lindberg, 1946; Onabamiro, 1952; Scott, 1960; Ansari and 
Nasir, 1963), as they are usually protected by apron and Parapet fitted with 
a lid to cover. However, step wells which provide the main sources of
drinking water in many rural areas in India are ideally situated for the
, . 
tran sm iss io n ^  Dracunculus medinensis because with steps leading down
into the water, the affected parts of the body especially the limbs are often
immersed in the process of dipping a water container into the well
(Lindberg, 1946).
2.7 GENERAL CHARACTERISTICS OF THE VECTOR
The cyclops, the intermediate host is a semi-transparent fresh water 
crustacean, rarely exceeding one millimeter in length. It has a symmetrical
2 7
pear shaped body, a tail which is forked, two pairs of antennae, five pairs 
of shinning legs and one eye (Onabamiro, 1954).
Cyclops are common and ubiquitous inhabitants of most fresh 
water bodies in both tropical and temperate regions. Some species of the 
genus Cyclops which exclusively transmit Dracunculus. are confined to 
large bodies of water, but those likely to be of importance in transmission 
exist also, or sometimes principally, in small ponds, tanks, or open wells. 
These are often seasonal in nature and in Sahara and savannah areas of 
Africa are present only in the rainy season. When ponds refill at the 
beginning of the rain, cyclops populations build up over a matter of weeks. 
In humid guinea savannah areas, like Western Nigeria, with abundant 
rainfall cyclops population builds in the early dry season, and are reduced 
greatly during the rains because of the lower temperature, and the large 
volume and turbidity of the water (Muller, 1985).
C yclops can be broadly divided into two, viz, carnivorous and 
herbivorous species: The carnivorous live on other microcrustaceans, 
annelids, inasect larvae, protozoa and aquatic nematodes while the
:< ?
herbivorous cyclops live on algae and diatoms (Fryer, 1957). Examples of 
herbivorous genera and Sub-genera are M icrocvclop s Eucvclops and 
certain species of Acanthocyclops. In general, it is only the larger 
carnivorous genera which will ingest Dracunculus. larvae or free living 
nematodes, etc.
The most important factor determining whether a particular 
cyclopoid copepods will transmit Dracunculus rests on the mode of life;
2 8
unless it is a predatory species it will not ingest embryos or larvae in the 
water. Many species of cyclops are cosmopolitan in distribution. An easily 
recognised species, important for transmission of Dracunculus; cyclops 
(M esocvclops) leukarti. can live in both large and small bodies of water 
(Miller, 1970) in Africa and India.
Some specific species of Cyclops found naturally infected with 
Dracunculus in various parts of the world are listed in the monograph by 
Muller (1970). They include Cyclops (M esocvclops) leuckarti (Benin and
Ghana); C (M. leuckarti equatorialis (Guinea Bissau): C (M. leuckarti. C 
(M . verm ifer and C (M . iranicus (Middle East); C (M) T h erm o cv clo p s 
inopinus (Cote D'Voire); while in Burkina Faso, according to Steib and 
Mayer (1988), the species responsible for active transmission of 
Dracunculus are Thermocvclops inopinus (Kiefer, 1926), I. incisus (Kiefer, 
1932) M e s o c v c lo p s  K ieferi (Van de Velde, 1984) and M e ta c v c lo p s  
Margaretae ( Linberg, 1938).
The species of Cyclops which have been found naturally to act as 
intermediate hpst in Western Nigeria include Cyclops leuckarti (claus), Q. 
le u c k a r t i  e q u ito r ia lis  (Kiefer), C in o p in u s  Kiefer), T h e r m o c v c lo p s  
n igerianu s ( Kiefer), Q. Vericans subaequalis ( Kiefer) and C. hvalinus 
(Rehberg). They are capable of harbouring Dracunculus larvae for about 
fourteen days, by which time the larvae will have moulted twice and 
become infective to man (Onabamiro, 1956).
Uninfected T. nigerianus undergo vertical diurnal migration in 
ponds (Onabamiro, 1952). After about six days of infection the amplitude
2 9
of the migration is reduced and by the 14th day the Cyclops are confined to 
the bottom few inches of a pond (Onabamiro, 1954). This effect is probably 
a result of the physiological action of the larval moults and it may be of 
importahce in confining transmission to man to the months when the 
water level is low. .......................
Infection takes place more readily when the cyclops are immature 
than when they are adults (Moorthy and Sweet, 1936). Development of 
larvae in the Cyclops ceases at a temperature below 19°C .
Although in the laboratory as many as twenty larvae can be seen in 
one cyclops, in nature more than one is not generally observed (Moorthy, 
1938). Cyclops infected with more than one or at the most two guinea
worm larvae tend to die (Muller,
2.8 GLOBAL DISTRIBUTION OF DRACUNCULIASIS
Dracunculiasis occurs only in the third world mainly India, 
Pakistan, Africa and Middle East (Watts, 1987). The disease is scattered 
throughout Jjae rural communities of the affected state where there are no 
safe or protected source of drinking water. In India the disease is limited 
to six States in the Western part of the country; about half of the cases are 
reported from Rajasthan State (Patnaik and Kapoor, 1967). Transmission 
in a State appears to have been interrupted recently by long standing 
control measures (Datta et al., 1964; Reddy et aN 1969: WHO, 1983. 
Another state Gujarat will probably become dracunculiasis free soon 
(Hopkins, 1987).
30
Dracunculiasis has been a bane of economic development in 
Pakistan (Ausari and Nasir, 1963 and Belcher, 1982); and parts of Africa 
(Stoll, 1947; Scott, 1960; Lyons, 1973; Belcher, £ t a L  1975; Kale, 1977; 
Muller, 1979; Edungbola, 1983; Udonsi, 1987a, Adeyeba and Kale, 1988), and 
Middle East (Sahba et a], 1973 and Belcher, 1982). It is estimated that 10 to 
48 millions - cases occur annually, affecting one to six per cent of the total 
rural population (Centres for Disease Control, 1987).
In West Africa, where probably less than 10 per cent of cases are 
routinely reported, the zone of highest endemicity includes Cote D'voire 
Raffier, 1965); Ghana (Scott, 1960 and Belcher et ah, 1982); Togo, Mali 
(Schneider, 1964); Niger and Chad (Simmon et al., 1951); Burkina Faso, 
Guinea and Senegal (Carayon et al; 1961, Schneider, 1964; Gretillat, 1965; 
Steib and Mayer, 1988). For West Africa as a whole, Hopkins (1983) 
estimated that only 1% to 5% of the actual cases were reported. Watts 
(1987) estimated the total at-risk population in Africa to be 120 million, 
about 4296 of the total population of affected countries. The estimated 
annual incidence is 3.32 million, 2.7% of the population at risk
2.9 4PREVENTION. CONTROL AND PROSPECT FOR
ERADICATION OF DRACUNCULIASIS 
Personal protection can be achieved by the simple measure of 
sieving drinking water through a fine mesh cloth. This will filter out any 
infected cyclops. Boiling of drinking water would destroy infected cyclops 
and Dracunculus larvae and thus prevent infection.
For control at community level, there are three possible lines of 
approach:
(a) the improvement of the water supply by providing alternate 
sources;
(b) treatment of existing water supply to render it free of 
infection and
(c) by well articulated health education programme. (Brieger gt 
aL 1985).
The provision of treated piped water results in the elimination of 
dracunculiasis within a couple of years. Examples where this has been 
achieved included the towns of Fiditi, Igboora (Muller, 1971) and Igbo 
Elerin (Kale unpublished data) in Oyo State . In Fiditi and Igboora, the 
incidence of the disease was 20 per cent and over 60 per cent respectively 
prior to the introduction of piped water system In 1963 and 1965. Within 
two years no cases of infection were reported although the disease was still 
endemic in the surrounding villages (Muller, 1971).
Where their construction is technically feasible, bore wells and tube
wells can also provide a c*onsctan-t sAupply of pure water. The water is not 
liable to the contamination that can occur in draw-wells when full and, if 
used with an elevated tank, can provide the convenience of water on tap. 
Example of where this has been of tremendous benefit were the group of 
villages making up Igbo-Elerin in Lagelu EGA of Oyo State (Kale - 
unpublished); Sanusi village in Oluyole Local Government Area of Oyo 
State where the incidence was over 23 per cent in 1985 (Adeyeba, 1986)
prior to the siting of deep well in Sanusi in 1986, by Federal Government 
of Nigeria's Directorate of Food and Rural Infrastructure (DFRRI). By 
1988, the disease has virtually vanished from the village with only one 
case reported (Adeyeba - unpublished observation).
The impact of a UNICEF - assisted rural water project on the 
prevalence of dracunculiasis in Asa, Kwara State, Nigeria has been 
reported by Edungbola £t aL (1988). "Protected water supplies, in the form 
of boreholes, can reduce the prevalence of dracunculiasis in affected 
communities from a point prevalence of > 50% to O or near 0% within 3 
years of intervention".
/ N \
Provision of safe water supplies has also caused a decline in 
prevalence of dracunculiasis in some rural areas of Imo State (Udonsi,
1987b). Improved water supplies havve2 benefits, far greater than the control 
of dracunculiasis since this helps to reduce other water borne diseases such 
as cholera, typhoid fever, gastro-enteritis, hepatitis, poliomyelitis and 
schistosomiasis.
Chemical control of dracunculiasis by treatment of water sources 
has been advocated many times in the past but very few practical control 
schemes based on this alternative have been attempted. This is partly 
because of cost but also because of a lack of the basic epidemiological 
knowledge necessary to make such treatment effective. Various organic 
chemical compounds have been widely used - potassium permanganate 
(Turkhud, 1919); quick lime and slaked lime (Pradhan, 1930, Davis, 1931); 
temephos (Muller, 1970; Belcher, 1982), DDT ( Ramakrishnan and
3 3
Rathnaswamy, 1953; Nugent etaJL 1955). The molluscide zinc dimethy 
dithio carbamate ("Zirame") was reported to be effective against Cyclops 
(Gretillat, 1965 and Raffier 1966,1969).
Biological methods of control have also been advocated in certain 
parts of the world. Successful field experiments using small fishes 
(G a m b u sia ,  and B arbus species and R asbora d o n ico n iu s  have been 
reported (Moorthy and Sweet, 1936; Gideon, 1942).
—  ■«. — tF
&
t  ^
f
# !
34
CHAPTER THREE
DRACUNCULIASIS IN OYO STATE: EPIDEMIOLOGY, SOCIO-
ECOMOMIC AND CULTURIAL IMPACT
3.1 INTRODUCTION
Many parts of Nigeria have been show o be endemic for
dracunculiasis (Stoll, 1947; Ramsay, 1935; Onabamiro, 1952; Kale, 1977;
Muller, 1979; Abolarin, 1981; Nwosu Adekolujohn, 1983;
Edungbola, 1984; Daniel and Osisanya, donsi, 1988). Most of
the literature on the status of the disease are restricted to reports from a 
few States, notably, south eastern parts of the country (Anambra and Imo 
States) and Kwara, Oyo and Ogun States. Very often, some of these 
literatures are either of scanty in terms/epidemiologic information or 
have gone out of date.
It is apparent that there is a dearth of information on the 
epidemiological status and impact of the disease in many parts of Oyo 
State. Since the knowledge and the impact of the disease will not only
„
enhance effective control plan, it will be an asset in the evaluation and 
monitoring of any control efforts. It is this understanding that stimulated 
this study. Hence this study is designed to provide the base line 
epidemiological information on the disease caused by guineaworm and 
identifying the factors affecting the effective control in the locality.
3.2 MATERIALS AND METHODS
The survey was conducted between February and April, 1988 in 
eight villages randomly selected by balloting from among two Local 
Government Areas ( LGAs) of Oyo State. The LGAs were randomly 
selected by lottery method. The villages are A baepo/Asani, Ejitolu, 
Folarin, Igiidu, Mele, Mowooba and Seriki Okegbemi, ( Fig. 1.2 and 1.3). 
Manpower support was provided by Local Government Area health 
officials and members of Oyo State Task Force on Guineaworm Control 
Programme. During this period guinea worm ulcers were dressed,
haematinics and analgesic drug tamol and aspirin were
administered at no cost to the victi
The interview was conducted from house to house with two 
different questionnaire sheets directed at Heads of household and 
individuals members of the household respectively. In order to determine 
the prevalence of dracuncuiiasis, the questionnaire record sheets 
(Appendix 3.1) were completed for all 2415 subjects in the sample villages. 
Parents or guardians of toddlers/younger children provided relevant 
informations required in respect of their wards. The data so collected 
included the name, sex, occupation, religion, period of residency and 
source of drinking water. Where an individual was not able to give the 
correct age, major contemporary historical events were used as guides. 
Information on the season when disease became apparent was obtained as 
well as water treatment technique, duration of "lay-off from work" and 
degree of morbidity. The 257 heads of household were interviewed on the
36
nature of assistance received during period of incapacitation and their 
perception of causes and prevention of dracunculiasis (Appendix 3.2). In 
effect, the administration of questionnaire applied to all individual 
subjects inrespective of whether they were infected or not, while clinical 
examination was made of subjects with patent infection (active cases) at 
the time of the study.
The attendance registers of three schools in Akin yele Local
Government Area (located in Mele, Ejitolu and Serriiki) were examined in 
order to determine the percentage of absenteeism due to guinea worm 
infection between January, 1986 and July, 1989.
3.2.1 Method of data analysis; The analysis of variance and 
coefficient of determination were obtained by using the IBM 
computer (1976 version) utilizing the SPSSH package. Where 
significant effects were obtained, treatment means were compaired 
using a multiple range test, the least significant Difference (LSD) 
proceedure (Steel and Torrie, 1960).
3.3 RESULTS
Distribution of Persons with Dracunculiasis In Eight Villages 
of Akinvele. Irewole EGAs:
Data for all the people of all ages in both sexes who have infection and 
who had previous history of infection in eight rural communities in Oyo 
State are shown in Figure 3.1 and Tables 3. la and 3.1b. Data indicate that
co-efficient of variation is low (CV% = 19.94) and coefficent of 
determination is relatively high (r2 = 0.66). Of 2,415 individuals 
interviewed, 1,857 (76.9 per cent) had history of infection with 
guineaworm. There was no significant difference in the infection rate 
between the male and female sexes (P > 0.05) but there existed significant 
variation in the infection rate among the age groups and villages (P > 
0.05). Multiple range comparison test shows that the peak infection rate 
was among 61 - 70 years (93.7 per cent), this is not significantly different 
from 90.3 per cent and 83.6 per cent, respectively recorded from 71+ years 
and 51 - 60 years age cohort. The lowest infection rate was recorded among 
31 - 40 years age cohort.
Analysis shows that Papanla village had the highest infection rate 
(92.05 per cent), followed by Igiidu (91.99 per cent) and Mowooba (84.07 per 
cent). The difference among the three villages is not significant (P > 0.05). 
But there is significant difference between the three and the remaining 5 
villages ( P < 0. 05) which had no significant variation as regards infection 
distribution. Ejitolu (55.97 per cent) had the lowest infection rate.
Table 3.1 b shows the results on the incidence of dracunculiasis at 
the time of this study. 47.7 per cent had the infection with no significant 
difference between male and female sexes (P > 0.05). Papanla had the 
highest rate with 69.64 per cent while Seriki Okegbemi had the lowest with 
25.68 per cent.
100 FEMALE
MALE
0-10 11-20 21-30 31-40 41-50 51-60 61-70
Age (years)
FIG. 3.1 HISTORY OF DRACUNCULIASIS IN OYO STATE. 
DISTRIBUTION BY SEX AND AGE.
o
INFECTION (mean + SEM)
-  39
Tab le  3.1a: Prevalence of Dracunculiasis in 8 Villages, Oyo S ta te , by sex
M e 1 e Abaepo E jrtofu Folarin Serik i Papanla Mowooba Ig iidu T O T A L
9
Sex No No % No No % No No % No No % No No % No No % No No % No No % No No o
Exam In f In f Exam In f In f Exam In f In f Exam In f In f Exam In f In f Exami In f  In f Exam In f In f Exam In f In f Exam In f In f
Male 101 57 56.9 29 19 65.5 83 91 99.9 90 47 52.2 60 32 53.3 60 59 90.0 228 199 85.1 390 359 92.1 1041 803 77.1
Female 127 77 60.6 93 25 58.1 93 51 59.8 112 67 593 78 99 59.9 65 57 87.7 308 239 77.6 598 989 892 1874 1059 76.7
TOTAL 228 139 58.8 72 44 61.1 176 92 523 202 114 56.9 138 81 58.7 125 111 88.8 536 933 80.8 938 8 9 8 90.9 2915 1857 76.9
-  40
Table  3 .1 b :  D i s t r i b u t i o n  o f  D ra c u n c u l i a s is  in 8 V i l lages  a t  t ime o f  S t u d y  (F e b .  - A p r i l ,  1988)
M e 1 Abaepo E jito lu Folarin S erik i Pa pan la Mowooba Ig i id u TOTAL
S ex No No % No No % No No % No No % No No % No No % No No % No No % No No %Exam In f I n f Exam In f  In f Exam In f  In f Exam In f In f Exam In f  In f Exam In f  In f Exam In f 1 n f Exam In f  In f Exam In f In f
Male 101 33 32.7 29 8 27.6 83 19 22.9 90 22 24.4 60 12 20.0 60 47 79.3 228 119 52.2 3 9 0 2 4 5 62.8 1041 505 48.5
Female 127 37 29.1 43 17 39.5 93 25 26.9 112 34 30 78 25 65 45 69.2 308 139 45.1 548 326 59.5 1374 648 47.2
TOTAL 228 70 30.7 72 25 34.7 176 44 25.0 202 56 27.7 138 37 26.8 125 92 73.6 536 258 48.1 938 571 60.9 2415 1153 47.7
No. exam ined  = To ta l  p o p u la t i o n  in the  V i l lage  
(P > 0 .05)
3.3.2 Percentage of Reinfected Patients by age and sex: The result of 
the percentage of reinfected patients by age and sex is presented in Table 
3.2. The data show that there were significant differences in the ages oi 
patients that were reinfected (P < 0.05). The percentage reinfectio~ 
increases with age. The difference in distribution of percent reinfection 
was significant among the villages (P < 0.05). There was no significant 
difference between mean of male and female sexes (P > 0.05).
3.3.3 Distribution by number of times of infection: Figure 3.2 
shows the result in respect of distribution of victims by number of times of 
infection. Data show that the distribution of frequency differ significantly 
among the villages (P C 0.05). There were significant differences in the 
number of times victims were infected (P < 0.05). The percentage of the 
number of people infected once is significantly higher than those infected 
multiple number of times. The percentage of victims affected reduces 
with the number of times of infection.
&  '
Tab le  3 .2 :  Percen tage  o f  R e in fe c te d  Pat ien ts  b y  Age and Sex
1 i
M e 1 e Abaepo Eji to lu Folarir} S e r i k i Papanla Mowooba Ig i id u Mean i  SEM
Age o6 o6 o6 o6 o6 oo I^O • o oG ro u p S e x 6 6 o
( Y e a r ) R e i n f . R e in f . Re in f . Re in f . R e i n f . R e in f . Re in f . R e i n f . Re in fec t ion
bed
M 30.7 100 47.1 81 .1 75.8 81 .7 78.8 100 74.4 * 8.5 
0 - 5 F 18.1 52 53.4 100 41.6 49.0 59 9 2 . 5 582 * 9 .4 d
M 51 .7 40 65 93.4 80.7 50 80 90 68.9 « 7 .1 d
6 - 1 0 F 65.2 50.4 93.6 44 53.5 80 100 100 73.3 • 8 . 2 bcd
M 78.5 64 37.9 86.1 80.0 52 96.7 77.8 71 .6 b .8 Cd
11 - 15 F 66.7 37.5 65.8 77.7 44.4 96.7 91.6 57.2 67 2 ■ 7 .4 cd
M 100 79 73.1 97.5 +75.5 84.6 75 84.5
16 -  20 F 100 49.9 68.7 81.9 76.5 66.6 88.2 100 79 * b . r ,bcd
M 100 86.4 85.6 8 5 ^ 73.8 78.7 59.1 85.7 81 .2 .
21 -  25 F 100 65.7 77.1 56.0 65.2 65 81.9 85.7 75.9 • s V bcd
M 73.3 92.7 91.8 92.7 81 .9 84.2 100.0 57.9 84.3 4 4 . 8a bcd
26 30 F 100.0 89.0 54.5 52.4 93.4 86.9 100.0 98 84.3 6 .9 dbCd
M 100.00 82.7 88.3 84.2 83.3 100.0 100.0 100.0 93.5 ; 3 . i ab
31 -  35 F 56.5 - 92.0 85.7 60 100.0 100.0 95.9 83.0 • 8 . 1 abC
M 100.0 100.0 81.8 100.0 ' 100.0 99 100.00 100.0 99.8 - 0 .2 a
36 -  40 F 100.0 97.5 66.7 100.0 too. 0 100.0 100.00 100.0 95.5 * 5 .6 ab
M 100.0 100.0 100.0 86.1 84.6 100.0 75.7 92.7 91.3 • 3 .6 abC
41 - 45 F 100.0 100.0 100.0 100.0 99.1 100.0 55.5 100.0 95.3 4 . 5ab
M 100.0 50.9 100.0 50.0 100.0 100.0 100.0 87.5 a ^  ^abed
46 - 50 F 100.0 100.0 100.0 100.0 - 100.0 100.0 100 " oa
M 100.0 100.0 . - 90.9 97.0 100.0 100.0 99.3 0 .8 d
51 - F - 100.0 100.0 100.0 100.0 100.0 100.0 1 100 0a
1 A
Mean i  SEM w i th  d i f f e r e n t  s u p e r s c r i p t d i f f e r  s ig n i f i c a n t l y  (P<0.05)
SEM SMt arn d a rd  e r r o r  o f mean
3 0
No of times of Infection
FIG. 3.2 DISTRIBUTION OF PATIENTS BY NUMBER OF TIMES OF INFECTION.
20
15
10
5
— i-------- I_________ I________ i________ i________ J_________I________ l_________I_________I_________i
<1 I 2 3 4 5  6 7  8 9  10
No.  of days before appearance of bleb
FIG. 33DRACUNCULIASIS AND PRODROMAL SYMPTOMS.
% POPULATI ON OF VI CTI M (mean + SEM)
Guinea worms emerging from 5 sites on 
both legs of a housewife
4 6#
3.3.4 Prodromal Sym ptom s: The population of the victims who
were aware of being infected with guineaworm before the appearance of 
the bleb is shown in Fig. 3.3. This awareness took the form of palpating 
the worm or feeling of movement of the worm around the body or 
experience of allergic manifestations. The percentage of victims that had 
the symptoms in 1 day is highest (18.9 ± 1) followed by the mean 
percentage of 16.9 ± 3.1 that had the symptoms in 2 days while the lowest 
percentage had it in 9 days (3 ± 0.7). Generally the percentage of victims 
reduces with the number of days of prodromal symptoms.
3.3.5 Anatomical Site of Guineaworm Emergence: Table 3.3 shows
the result of the anatomical site of guineaworm emergence. The data 
indicate that the sites of guineaworm emergence differ significantly for 
each victim (P < 0.05). Most of the victims had the guineaworm emerging 
from their foot (80.3%) followed by the leg (52.3%) and knee (26.8%), all in 
the lower limb (Fig.3.4, 3.5, 3.8). Conversely, the upper limbs (13.2%) - Fig.
3.7 followedJ?y head and neck regions (1.5%) were least preferred sites as 
regards worm emergence. The Multiple Range Test revealed that the 
pattern from one village to the other was not significantly different(P > 
0.05).
Table 3 .3 :  Anatomical Site of Cuineaworm Emergence
M e 1 e Abaepo Ejitolu Folarin Seriki Papanla Mowooba Igi idu r A L M EA N lS E M
o i i e
No of1 No o f1 o No of o No of1 O No of1 o No of1 9 No o f 5 No o fo % No o f oo %
V ie t . o Viet . o V ie t . o V ie t . 6 Viet . o Viet . o Viet .
o V ie t . V i e t .
[
Head/ - -  : - - -  ' - 1 0.9 - - 2 1.8 5 1 .2 19 2.0 27 1 .5 1.5 ± 0 .2 6 e
N eck
B a c k / p
A bdom en 3 2.2 1 2 . 3 - 3 3.6 — — 2 1 .8 7 1 .6 51 6.0 67 3.6 2.8  ± 0 .7
A r m  / de10 7.5 4 9 . 1 7 7.6 17 14.9 9 11.1 1 3 11.7 29 6.7 159 18.5 246 13.2 10.9 ± 1.5Hand
B ut tock 2 1.5 - - - - - - • -  4 5 4.5 3 0 .7 95 11.2 105 5.7 4 .5  ± 2 . 4 e
S cro tum / 7 5.2 - - 2 2.2 3 2.6 2 2.5 5 4 .5 12 2.8 74 8.7 105 5.7 4.1 ± 0 .9 eVu lva
T h ig h 45 33.6 11 25.0 8 8.7 21 18.4 5 6.2 11 9.9 35 8.1 129 15.2 265 14.3 15.6 ± 3 . 4 d
Knee 64 47.8 18 40.9 14 15.0 15 13.2 19 23.5 18 16.2 49 11.3 301 35.5 498 20.4 25 .4  ± 5°
Leg 106 79.1 25 56.8 52 46.5 56 73.0 57 70.4 44 39.6 221 51.0 411 48.5 972 52.3 59 .4  t4. 8 b
Foot 121 90.3 36 81 .8 69 75.0 75 97.0 71 87.7 74 66.7 397 91.7 648 76.4 1491 80.3 83 .3  ±  3 .6 a
1857
Mean f  SFM w i th  d i f f e r e n t  s u p e r c r i p t  d i f f e r  s i g n i f i c a n t l y  (FK0.05) 
SEM -  S ta n d a r d  e r r o r  o f  mean
o
1-
■ V > 4 -  . ' . *
Fig , C Guinea worm from the foot of an incapacitated teenage Vschool boy in Mele village
■ M
Guineaworm emerging from the penis of a 60-year old 
Head of a household

3.3.6 Seasonality of Dracunculiasis: Table 3.4 shows the result in 
respect of the distribution of infection by seasons of the year. There was a 
significant variation in the season the infection become apparent. The 
mean infection rate of 53.98 ± 6.65 during the dry season was significantly 
higher than the infection rate of 14.68 ± 2.17 that occured during the wet
season (P < 0.05).
3.3.7 The Degree of severity of dracunculiasis: The result of the 
severity of infection is presented in table 3.5. An infection is said to be 
mild where the victim is mobile and suffers little or no discom fort; 
moderate when the victim is mobile but suffers considerable discomfort; 
and severe when the victim is immobile or unable to use the affected part 
and suffers considerable discomfort. There was significant difference 
among the per cent of the population affected and the severity (P < 0.05). 
But the difference among the villages as regards distribution of severity of 
infection and percentage of the population affected were not significant (P 
> 0.05). A multiple range comparison of the severity shows that victims 
with severe infection (54.3 ± 2.3) were significantly higher than those with 
mild (16.7 ± 1.2) and moderate infection (29.0 ± 1.6). The population that 
sufferd moderate infection was significantly higher than those with mild 
infection (P < 0.05).
3.3.8 Period of disability. The result of the study into the period of
incapacitation is presented in Figure 3.9. The data show that coefficient of
Table  3 .4 :  D is tr ibut ion  of  Guineaworm patients by Seasons of Infection
Mean ± SEM with d i f fe rent  superscr ip t  d i f fe r  s ignif icantly (FK0.05)
-  53
Table 3.5 :  D is tr ibut ion of Vctinrrs by Degree of Severity  of Dracunculiasis
Moderate - disabi li ty is where the victim is mobile but suf fers  considerable discomfort.
Severe -  Where the victim is immobile or is unable to use the a ffected par t  and suffers  considerable  
discomfort .
Mean t SEM with d i f fe re n t  superscr ip t  d i f fe r  s ignif icantly  (FK0.05)
SEM -  S tandard  E r r o r  of  Mean.
Fig.^.c Guineaworm victims of a household (P^panla village)
variation (CV%) is 44.96% and coefficient of determination is high (r2 = 
0.71). There was significant variation in the period of lay off from work 
among the population affected (P < 0.05). Multiple Range Comparison 
showed that 5 - 8  weeks followed by 9 - 12 weeks was the most frequently 
occuring period of incapacitation. Lowest percentage of the population (1.8 
± 0.5) were incapacitated for 25 - 28 weeks. Similar pattern was recorded in 
each village (P < 0.05) but there was no significant difference when 
grouped by village (P > 0.05).
3.3.9 Effect of dracunculiasis on school attendance: Fig . 3 .10
shows the result of the effect of dracunculiasis on the school attendance.
>
The data indicate that about 20 per cent to 41 per cent of the pupils were 
absent in the course of the year due largely to dracunculiasis. 10 pupils 
were reported to have withdrawn from Seriki Community School due 
exclusively to dracunculiasis since the beginning of second term of 1989 
school year alone. Results show that most of the pupils that were absent 
from school^had multiple infection which had been com plicated by 
secondary bacterial agents. Results also revealed that about 60 per cent of 
the pupils present in class in Seriki Community School had mild infection 
(Fig. 3.12).
3 3 10 Assistance during absence from work: Table 3.6 shows the
results of the interview on the assistance victims received during the 
period of "lay off from work". The nature of assistance received by victims
differs significantly among the population (P< 0.05). The data show that 
majority, 54.5 ± 2.3 per cent had nobody to assist during absence from 
work, while a few 22.9 ± 24 per cent depends on relatives. 31.6 ± 3.1 per 
cent of the victims were able to employ the service of labourers while 26.6 
± 2.3 per cent depended on their children.
&
5 7 -
Table  3 .5 :  A s s is tan c e  D u r in g  " L a y  O f f  From W o rk *'
i
M e l e Abaepo Ej i to lu Folarin Seriki Papanla Mowooba Ig n d u T O T A L MEANiSEM
Assist­
No of] 0 No of* No of No of' No o f1 No oP No of’ No of' No of' 
ance Benef  ° Benef Benef Benef Benef Benef Benef Benef Benef
Relat ives  27 24.5  5 13.5  28 34.6 25 25.8 10 15.4 17 [19.8 81 22.3 197 27.1 390 21 . 0 22 .9 ± 2 .4  
be
Chi ldren  32 29.1 12 32.4  31 38.3 21 21.6 17 26.2 21 24.4 72 19.8 151 2 0 . 8 357 19 .2 26 .6 ± 2 .3  
Labourer  31 28 2 9 24.3  34 42.0 35 36.1 25 38.5 89 24.5 293 40.3 532 28 .6 31 .6 ± 3 . I 1 
1 6 i1r8
No Body 70 63.6 19 51 .4) 45 55.0 52 53.6 27 41.5 59.3 191 52.5 427 58.7 882 47 .5 54 .5 ± 2 .3 a
1857
o
4
Mean ± SEM with d i f fe rent  superscr ip t  d i f fe r  signif icantly (P  < 0 .05 )
% TOTAL NUMBER OF VICTIM (mean ± SEM)
1986
1987
1988
1989
5 0
4 0  -
30  -
20 -
10
JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC
FIG. 3. ItoMPACT OF D^CUNCULIASIS ON SCHOOL ATTENDANCE IN OYO STATE (JAN '8 6 - JUL 89)
&
s/o OF PUPILS ABSENT FROM SCHOOL 
(mean + SEM , N = 3)
3.3.11 Perception of causes of guineaworm by Heads of household:
The results of the interview of 257 Heads is presented in Table 3.7. Data 
show that there was no significant difference in perception of causes 
among the different villages (P > 0.05).
Multiple Range Test shows that 82 ± 4.0 per cent attributed the cause 
of guinea worm to act of God while 73.8 ± 3.6 per cent that felt that the 
disease was caused by work of an enemy. Those who attributed the cause 
to drinking of "bad" water accounted for 70.8 ± 3.9 per cent.
3.3.12 Belief on prevention of guineaworm bv Heads of household:
Table 3.8 shows the resutls of the interview of Heads of household as 
regards their belief on prevention s ?  e disease. Data indicate that the
beliefs vary significantly from one subject to the other (P < 0.05). Majority 
(76.2 ± 4.1 per cent) believed that offering of prayers to God was the remedy 
while 53.4 ± 6.7 per cent believed that there was no remedy at all. 4.0 ±1.1 
per cent of the household Heads believed that guineaworm disease could 
be prevented^ by avoiding contact with victims. There was a similar 
pattern among the villages (P < 0.05).
3.3.13 Extent of water treatment among the household Heads: The
results of the assessment of the attitude of household Heads to water 
treatment is shown in Table 3.9 The extent of water treatment varies 
significantly (P < 0.05). Data show that majority of the population (68.7 ± 
5.3 per cent) did not treat water at all times before drinking while only
-  61
-  62
Tab le  3.8 :  Be l ie f  on P re v e n t io n  of  Gu ineaworm by  Household Heads
f f
M e e Abaepo Ejitolu Folarin Seriki Papanla Mowooba , Igi idu T O T A L M E A N iS E M
R E M E D Y No of' No of' o No of t Q No o f ’ —6 No of' o
No of' O No of' No of ’ o No of ’ 9o o- %
Heads % moHeads o Head; 6Heads * Heads Heads Heads Heads Heads
Performing ITS
Rituals 11 52.4 2 33.3 6 90.0 13 72.2 9 69.2 56.0 31 55.9 56 54.4 192 55.3 59.1 ± 9 . 6 b>
Offer ing  
prayers  to 16 7 6 . 2 4 66.7 10 66.7 19 77.8 13 )  f 6 8 . 0 39 69.6 87 84.5 200 77.8 76 .2  ± 9 . 1 3
Cod ">0
Avoiding
contact
with 1 4.8 - - - - - - - j j - 3 5 .9 2 1.9 6 2 .3 9 .0  ± 1 . l d
Victim
Using Pro­
tective  7 33.3 1 16.7 3 20 5 .6 - - 12 48 8 19.3 25 24.3 57 22.2 23 .2  ± 5 . 3 C
medicine
No Remedy 13 61 .9 4 66.7 9 60 38.9 11 84.6 11 44 13 23.2 99 47.6 117 95.5 53 .9  ± 6 . 7 fc
T O T A L 2 1 6 M S 1 8 1 3 25 56 1 0 3 257
;_______ i — k-------------- ______i1_____________ i
Means ± SEM with d i f fe re n t  superscr ip t  d i f fe r  signif icantly (P  < 0 .05 )  
SEM -  Standard  mean of E r ro r

32.1 ± 4.2 per cent occasionally treated their water before drinking. 6.5 ± 0.9 
per cent of the population treated their water at all times. The extent of 
water treatment varies significantly among the villages (P < 0.05).
3 3.14 Methods of water treatment by Heads of household: Table
3.10 shows the result of the assessment of methods of water treatment
among the Heads of household. Data revealed that methods of water 
treatment vary significantly among the population and the villages (P < 
0.01). Majority (35.1 ± 3.6 per cent) who claimed to have treated their water 
did so with alum while only 14.0 ± 2.8 per cent boiled their water before 
consumption. None chose filtration as a method of treatment.
3.4 DISCUSSION s T
Dracunculiasis is a household name in the State especially in the 
rural areas where there is no safe water supply for drinking. This is so 
because this study had shown that in a total population of 2,415 in eight 
different villages located in two Local Government Areas, 76.9 per cent 
had been victims of dracunculiasis. The prevalence at the time of study 
was 47.7 per cent and this is higher than the rate reported from certain 
parts of the State like 17 villages north of Ibadan, 1971 - 1975 (Kale, 1977) 
and Sanusi (Adeyeba 1986), where 13.5 per cent and 28.7 per cent 
prevalence were recorded respectively; and in Egbejila near llorin with 45 
per cent (Edungbola and Watts, 1984b). The rate recorded in this study is 
significantly lower than those reported in most parts of Kwara State like
65
Asa with 53 per cent (Edungbola and Watts, 1984a), Babana District with
54.7 per cent (Edungbola, 1983) and Igbon in Oyo State with 75.0 per cent 
(Edungbola, 1984).
The absence of a significant difference in infection rates between the 
female and male sexes (P > 0.05) in the eight communities is similar to 
those obtained in Egbegila, a peri- urban community of Ilorin (Edungbola 
and Watts, 1984b), Babana District (Edungbola, 1983), Sanusi village 
(Adeyeba, 1986) and in Anambra State (Nwosu et aL, 1982). By contrast 
Scott (1960), Lyons (1972) and Sahba £taL, (1975) reported that more 
females than males were infected in their studies in Chana and Iran while 
the reverse was the case in the studies of Reddy et ah (1969), Belcher et a],, 
(1975) and Kale, (1977) in India, Southern Ghana and Ibadan District, 
Nigeria respectively.
The occurrence of significant difference in prevalence rate among the 
age groups (P < 0.05) conforms with reports from other suthors (Rao, 1942; 
Lindberg, 1946, 1948, Belcher et ah, 1975, Kale, 1977; Nwosu et all 1982; 
Edungbola and Watts, 1984a, b; Edungbola,1983 1984). Infection in infants 
is uncommon. This is partly because of the long incubation of the 
infection (10 - 14 months) and also because water meant for infants 
consumption is often boiled. Adults who spent most of their time on the 
farms, and the older children who assisted them have the greatest 
exposure to infection, since they would quench their thirst directly from 
contaminated ponds in the vicinity of the farms (Fig. 3.11).
Fig . 3 .11  A th ir s ty  farmer in  Asani V illa g e  .in Akinyele LGA 
drinking d ir e c t ly  frcm pond in the v ic in i t y  o f the 
farm.
The water consumption habit of individuals is a principal factor in 
susceptibility to infection. The extent and method of water treatment 
differ significantly among the populations (P < 0.05). That 68.66 per cent of 
the population had never bothered to treat water before drinking by any 
method is not surprising in view of the input to be made which only 6.53 
per cent could afford at all time. It is quite clear from this study that 
method of water treatment employed include boiling and addition of 
alum. It has been shown from another study that mere addition of alum 
in the form of aluminium sulphate in the quantity used by the villagers 
certainly can not kill the cyclopoid copepod vectors of the disease. 
Therefore this practice does not amount to effective treatment of water. 
Although boiling of water is an effective means of rendering water safe for 
human consumption, the practice could not be sustained. This is partly 
because of fuel requirement like firewood and kerosine which many 
peasant farmers could not afford and partly because the rural dwellers did 
not have the patience and perseverance that it is required at all time in 
boiling and cooling down of the water before consumption. Therefore, it 
is not surprising that only 14.04 per cent treated water by boiling. This 
meant that only a minority would drink less contaminated water. Since 
the volume of contaminated water consumed is directly related to 
susceptibility to infection (Kale, 1977) the majority of the rural dwellers are 
at risk of contacting the disease.
However, it is obvious from this study that not all that drink from 
contaminated pond water become infected. The reason for this is still a
subject of debate. The suggestion by Scott (1960) that the gastric acid status 
of individual ( hypochlorhydria) was an important factor in refractoriness 
to infection has been disputed by Gilles and Ball (1964). Other factors 
which protect some individuals from infection have been suggested 
(Onabamiro, 1958; George, 1975; Kale,1977 and Edungbola, 1983).
In this study, it has been shown that repeated infections were found 
to be very common in all the villages. The rate of reinfection increases 
with age. This conforms with observations from other studies (Scott, 1960; 
Belcher e h a l ,  1975; Kale, 1977), and this indicates that guineaworm 
infection does not confer any tangible protective immunity on the 
patients. S > '
The results in respect of the site of emergence of guinea worm in 
the different anatomical parts of the body among the villagers is not 
different from those reported by previous authors (Lindberg, 1946; 
Onabamiro, 1952; Muller, 1971; Kale, 1977; Edungbola, 1983, 1984) with 
foot and leg being the most frequetly affected parts while the trunk and 
abdomen, scrotum and vulva were least affected sites of guineaworm 
emergence.
The findings of this study that infection is common in the area of 
study during the dry season and usually coincides with the time of 
harvesting and preparation of the land for the following planting season 
are similar to those of Scott (1960), Belcher et ah, (1975), Kale (1977), Nwosu 
et al., (1982), Edungbola (1984) and Daniel and Osisanya (1985), The period 
of disability or "lay off from work" is the time patients are unable to
perform their normal routine duties like farming, active trading and 
schooling. It is alarming to note in the study area that those with severe 
infection accounted for the highest percentage of 54.3 ± 2.3 which is 
significantly higher than the percentages of those with either mild or 
moderate disabilities. Any assumption that those with mild or moderate 
disability would not be adversely affected in terms of productivity would 
not be right as the input would be reduced in terms of coverage and scope. 
This meant in a sense that the coverage of guineaworm would be felt no
matter the degree.
The average period of "lay off" is between 5 to 8 weeks and this as 
was found out in this study could extend to over 33 weeks in extreme 
cases. This finding is similar to those of Reddy et aL (1969). Because the 
period of disability usually coincides with the planting and harvesting 
seasons, the agricultural input is adversely affected compellfng the victim 
to seek assistance during the period of disability. Generally, the options 
opened to the disabled farmer are the services of relatives, or children or 
labourers and sadly enough no assistance. None of the options available is 
reliable as those that remain are few and more often than not they too 
soon become victims of the disease. Although 54.5 ± 2.3 per cent are 
unable to secure any form of assistance which meant a very serious and 
added sorrow. The 31.6 ± 3.1 per cent who could afford to employ the 
services of labourers had to pay heavily.
The wage bill is very high at least for a peasant farmer. It is 
estimated that a sum of about N600.00 to N960.Q0 would be required to
engage the services of labourers for between 5 - 8  weeks, since a minimum 
of N20.00 is the fee chargeable per day per male labourer who assist in 
clearing or preparing the land for planting. The female labourer who 
helps in the cocoa and palm oil processing normally charges a minimum 
of N15.00 per working day depending on the prevailing circumstances. As 
it is expected in an endemic area the number of labourers and/or any 
other assistance dwindles as a result of infection since all are at risk from 
the disease. When this happens the remaining who are free of infection 
would charge exhorbitant fees for their services.
More often than not, the services of these emergency assistants were 
not promptly secured, they are unreliable and on many occasions this has 
led to a delay of work on the farm. Atimes the work is unfinished and 
usually not thorough. Consequently, the harvesting and/or planting is 
delayed which may contribute more to the frustration af the farmer who 
may have to contend with poor yield/harvest with the corresponding 
economic implication.
The adverse impact of this disease on the school attendance in three 
different primary schools over a period of about four years gives a pathetic 
picture. It was found out that about 20 per cent to 41 per cent of the 
student population were absent from school in the course of the year as a 
result of dracunculiasis. It is apparent from this study that dracunculiasis 
is increasing both in prevalence and magnitude with every passage of each 
year at least since 1986 using school absenteeism as an index of 
determination (Fig. 3.10). In a situation where over 60 per cent of the
72
pupils present in a class were infected (Fig. 3.12) beside the number that 
were absent calls for an urgent attention. Although most of the infected 
pupils present in the school at the time of this study had mild infections, 
their fortnight academic performances were poor. A total of 10 pupils 
were reported to have withdrawn from school since the beginning of 
second term of 1989 school year in the community primary school in 
Seriki Okegbemi village. Investigation then revealed that the pupils who 
were residents of Seriki and Folarin villages had multiple infections that 
were complicated by secondary bacterial infection. Their academic 
performance would undoubtedly be adversely affected. Nwosu et ah (1982) 
and llegbodu etaL (1984) gave similar pathetic report in Anambra State 
and Idere village, Oyo State, respectively.
3 .12  School ch ild ren  with mild Guinea worm infection
Apart from the adverse socio-economic effect and the psychological 
torture, the disabled farmer is not sure of his future as the available 
medicare is not within his reach. Although modern medicine has little or 
nothing to offer in terms fo cure of guineaworm disease, it is sad to note 
that the only village (Mele) of the eight that has a dispensary and 
maternity centre did not stock enough essential palliative drugs that may 
be administered to patients at affordable prices. It is normal behaviour to 
seek pleasure and to avoid pain. In man, where emotional life is of the 
greatest importance, pleasure and pain are as much concerned with 
psychology as with physical well-being. Based on the importance of 
pleasure-pain principle as shown by Tinbergen (1953) and Barnett (1955) 
the victims attempted to discharge their emotional tensions by a special 
behaviour pattern. Therefore, since most of the victims can not afford the 
cost of medication, they resorted to local treatment of their guineaworm 
ulcer by applying palm oil and a local herb called "Oluganbe" while the 
extraction of the guineaworm is done with cord tied round the affected 
part ( Fig. 3T3). This indigenous approach has exposed the guineaworm 
ulcer to secondary bacterial agents which actually complicate the ulcer and 
prolong the period of incapacitation.
The future of the disabled farmers for a long time to come will 
remain bleak in view of their wrong perception and belief of causes and 
prevention of the disease unless they are given a new orientation.
Fig• y»] 3 Guineaworm extraction with string cord 
tied round.
It is unfortunate that towards the end of 20th Century, a section of 
Oyo State still believe that guineaworm is caused by act of God or an 
enemy and that it could only be prevented b~ offering prayers to God.
However, it is believed that only the improvement of water 
supplies like provision of draw well, deep well or piped water backed up 
with a well articulated health education programme, will reduce, if not 
completely eradicate the disease in the State. Meanwhile at individual 
personal level, boiling or filtering the water before drinking, will go a long 
way in controlling the spread of the disease.
77
CHAPTER FOUR
SECONDARY BACTERIAL INFECTION IN DRACUNCULIASIS: 
BACTERIAL ISOLATES, ANTIBIOTIC SUSCEPTIBILITY PATTERNS 
AND PHAGE TYPES OF STAPHYLOCOCCUS UREUS
4.1 INTRODUCTION
Guinea worm ulcers when left untreated become infected
with secondary bacterial agents which usually result in prolonged period 
of incapacitation. Studies have shown that certain bacterial agents are 
associated with secondary guinea worm ulcer (Muller, 1971). There has 
been no adequate report on the profile of bacterial agents isolated from 
guinea worm ulcers or the various phages and antibiotic susceptibility 
pattern of Staphylococcus aureus which is most frequetly associated with 
guinea worm ulcers
Generally, there are differences between staphyloccocci isolated 
from lesions^and those from carrier sites in the production of toxins and 
other extracellular products (Williams, 1963). The relationships between 
these micro-organisms and their hosts have been greatly influenced by the 
introduction of antibiotics into medicine (Adegoke, 1984) especially in the 
area of resistance to antibiotics.
Applying knowledge derived from isolation and sensitivity testing 
of the infecting strains of staphylococci to the choice of antimicrobial 
chemotherapeutic agents enhances response to treatment and reduces the
emergence of resistant strains associated with indiscriminate use of 
antibiotics. There is paucity of information on the characteristics and 
importance of secondary bacterial infections associated with dracunculiasis 
in the world at large and in Nigeria in particular.
The present work reports specific bacterial agents as
secondary guinea worm ulcers and highlights the epidemiological
importance of Staphylococcus aureus, a dc um associated
with septic guinea worm ulcers in the areas :
4.2 MATERIALS AND METHODS
4.2.1 Sample Collection And ion Of Bacteria: Swabs were
collected aseptically from the ulcer han 75 guinea worm patients
with bad ulcers irrespective of their ages and sex in villages in Akinyele 
LGA of Oyo State of Nigeria. In essence, only those patients with bad 
septic ulcers were targeted in the study area. The swabs were examined 
immediately in the laboratories using the methods described by 
Cruickshank^ £ i  ah (1975). All bacterial isolates thus obtained were 
characterised by using the standard methods described by Cowan and Steel
4.2.2 Strains: Only coagulase - positive staphylococci isolated from
the guinea worm ulcers were tested further.
4. 2. 3 Antibiotic Susceptibility Test: Disc sensitivity tests were
performed with all the strains of coagulase-positive staphylococci using 
the method of Kirby-Bauer (Bauer, e la L ,  1986). From the previously 
grown strains on trypticase Soya agar five similar colonies were 
transferred into 5ml. of trypticase soya broth ( BAL). The broth was 
incubated at 30°C for 2 - 8 hours after which the turbidity was adjusted to 
correspond to that of 0.5% McFarlared standard barium sulphate solution. 
A sterile swab dipped into each dilution was used, to streak Mueller 
Hinton agar in 140mm petri dish. Each plate was then allowed to air-dry 
for 3 to 5 minutes before applying the following antibiotics; penicillin, 
oxaciillin, tetracycline, minocycline, gentamycin, oxcacillin (merieux, 
France); amykacin, erythromydin, clindamydin, ampicillin, fusidic acid 
and rifampicin Table 4.1 shows the symbols and concentrations of the 
antibiotic used in this study.
The plates were later incubated at 37°C for 15 - 24 hours after being 
left for 15 to 30 minutes at room temperature. The zone diameters were 
measured with sliding calipers and the meter rule. Staph, aureus ATCC 
25293 was employed as a control. Sensitivity to each antibiotic was 
interpreted as recommended by Lorian (1980).
Minimum Inhibitory Concentration (MIC): The minimum 
inhibitory concentration (MIC) of tetracycline and penicillin for strains 
resistant by disc-diffusion method was determined as described by 
Adegoke (1984).
HO
5ml of broth culture of isolates were incubated for 5 hours at 37°C 
after which they were thoroughly mixed. 2.3.5 triphenyl tetrazolium 
chloride (sigma Co., St. Louis, U.S.A.) was dissolved in sterile distilled 
water to give a concentration of 0.1 per cent. 0.05ml. of nutrient broth was 
delivered into each of 8 wells in a row in a sterile WHO microtiter plate. 
0.05ml of the antibiotic under test was then added to the first well and 
serial dilutions were made using a sterile graduated Pasteur pipette (Morse 
guage No. 55) and 0.05ml of the antibiotic solution was transfered at each 
dillution. This was followed by the addition of 0.025ml of 2.3.5 triphenyl 
tetrazolium chloride. Later, 0.025ml of each suspension was added. This 
gave an initial antibiotic concentraction of 5.0 m cg/m l, 2.5m cg/m l in the 
first and the second wells respectively, and 1.25mcg/ml in the third well 
and so forth. The procedure was repeated for the control Staph , aureus 
(ATCC 25293). The microtitre plates were then covered and incubated at 
37°C for 18 - 24 hours and the results were recorded. The minimum 
inhibitory concentration (MIC) of each antibiotic was taken as the 
minimum amount of the antibiotic needed to inhibit the growth of the 
Staphvloccocus strain under test and it was indicated by no change in the 
colour of the indicator.
Table 4.1 Symbols And Concentrations of Antibiotics Used for 
Sensitivity Testing of Staph - aureus Strains
Symbols Antibiotics Concentration
PlO Penicillin 10  units
DP5 (Rosco) Oxacillin 5 microgromme
TE30 Tetracycline 30 microgramme (meg)
MI30 Minocycline 30 m e g )
GM 10 Gentamycin 10 meg
OXi (Merieux France) Oxacillin
AN0 Anikacin O "
E15 Erythomycin 15 "
OC2 Clindamycin 2 "
AMP30 Ampicillin 30 "
FA10 Fusidic acid 10 "
RA30 Rifampicin 30 "
4.2.5 Thage Typing: Lysotyping agar plates were flooded with 4 - 6
hours broth cultures of the strains under test. Excess fluid was removed 
and the plates were allowed to air-dry. One drop of each of the typing 
phages diluted to 100 times the routine test dilution (RTD x 100) wras 
placed on the seeded plate with a sterile graduated pasteur pipette 
(l/50m l). A template was held underneath the plate after which each 
plate was allowed to air-dry again and then incubated at 30°C over night. 
Lytic reactions were read as described by Blair and Williams (1961).
4.3 RESULTS
4.3.1 Bacterial agents isolated from Guineaworm Ulcers: All the
ulcers of the seventy five patients with secondary guinea worm infection 
were infected with one or more bacterial agents either singly or in 
combination of two or even three. The isolates were S tap h y lo co ccu s  
au reu s. S ta p h , ep id erm id is ; S trep to cco cu s s p e c ie s: E sch erich ia  coli: 
K lebsiella  species: Proteus sp e c ie s . P se u d o m o n as  species were not 
ilolated. Of all the bacteria isolated, staphyloccoci had the highest 
occurence rate either as a single aetiologic agent or in association with any
other bacteria.
4.3.2 Phage Types of Stap)h,. aureus Isolated from Guinea worm
u lc e rs :  The S t a p h . a u r e u s  strains isolated from septic ulcers of 
dracunculiasis were generally susceptible to human phages as only three 
strains were found to be untypable even at 100 x RTD concentration (Table 
4.2). Four strains were susceptible to phage 52, three strains were refractory
pectivlely.
Antibiotic susceptibility Pattern of Staph, aureus strains 
om guineaworm ulcers: Of the fourteen strains of Staph, aureus 
examined in this study, only one strain was susceptible to penicillin. 
Isolates were also commonly resistant to tetracycline The other antibiotics 
used were found to be effective against the strains of Staph, au re u s  
examined in this study (Table 4.3).
Table 4.2 Phage types of S. aureus strains isolated from Guinea Worm 
Ulcers
N.T. = Could not be typed.
84
TABLE 4.3
A N T IB IO T IC  SUSCEPTIB IL ITY PATTERN OF PHAGE TYP
Antibiotic dose
(meg) 1------------ ----------- 1
------ 1----------- 1i------------1-------------------------
P10 DP5 ’ TE 30 M130 CM10 o x 1 E15 CC2 C 30 FA 10 RA 30
SA 1 13r 27s 1°R 20s 21s 19s 22s 26s 25S 2“ s 30 S 34s
SA 3 17r 30s 12r 29s 20s 22s 20s 26S ^ ’ *S 25s 28s 36s
SA 4 15r 28s 29s 30s 20s 20s 21s 25s 24s 28s 31 s
SA 5 n R 25s 13R 30s 21s 17s 19s 25s 29s 29s 34 s
* SA 6 18r 28s 12r 29s 21s 21s 2 ,s 28s 24s 25s 3Us 36s
SA 8 15r 27s 29s 29S 2°S 20s 22s 24s 25s 24s 28s 33s
SA 9 13r 27s 13r 28S 2°S 18s 20s 26s 2<s 25s 28s 33s
SA 10 12r 26s 11R 22S 20s 18s 21s 27s 24s 29s 28s 39s
SA 11 17r 28s 12r 29s 20s 21s 21s 25s 25s 24s 28s 35s
SA 12 U R 27s 12r 28s 20s 20s 20s 26s 2“ s 24$ 29s 34s
SA 13 13R 26s 8r 20s 21s 19s 21s 25s 25s 20s 29s 34s
SA 14 15R 27s 12r 28s 2°S 18s 20 26 25 25 30 36
ATCC
2593 35s 29s 30s 31s
231s 23s 23s 26s 26s 2Us 30s 34s
425/81 11 1«trF
— 12r 23s 11R , 3 t r R 20s °RR 26trR 10R 32s 36s
K E Y : - t r  = trouble
Sensi ti ve x x  = zone of in h ib it io n .
Resistent
o
Z
<
4.4 DISCUSSION
Infection with Dracunculus m edinensis is usually asymptomatic 
until a few days before the emergence of the female worms. Thereafter, 
the victim exhibits some allergic manifestations and other generalised 
disturbances in the body, all of which are believed to be due to the effect of 
toxic substances released at the time of the formation of the bleb. Worms
J
that fail to emerge eventually gradually disintegraattee  and subsequently
fluid from the worm's uterus produces a sterile abscess, which may later 
become secondarily infected by tetanus and other bacterial agents. This 
study has shown that staphylococci E sch . coli. Klebsiella species and 
Proteus species were frequently isolated from secondary guinea worm 
ulcer. However, staphylococci infection had the highest occurence rate.
Several new antibiotics are now available for therapeutic use. 
Adegoke (1984) reported that vancom ycin, ristocetin and the 
cephalosporins are amongst the active antibiotics against staphyloccoci. 
Marked resistance to these antibiotics are not common. Although minor 
and localised^superficial infections usually respond to therapy as indicated 
by adequate testing procudures is often necessary where evidence of spread
of the infection is apparent.
According to Kryaski and Becla (1981), strains of S ta p h , au reu s 
belonging to phage types 94/96, 96 and 71/96  have been linked with 
epidemics. Also epidemic strains of Staph, aureus are known to be often 
associated with phage 80/81 complex (Poole and Baher, 1966). Thus, the 
isolation of some strains susceptible to phage 71 and 80 is of
epidemiological importance as patients from whom the isolates were got 
could spread S ta p h , aureus amongst the populace exposed to wound 
infections associated with dracunculiasis.
Staphylococcal resistance to penicillin is generally coded for on a 
plasmid and only rarely on the chromosome ( Dyke and Richmond, 1967; 
Peyru Wexler and Movick, 1969). Asheshov (1966), Poston (1966) and 
Sawai, £t al. (1968) have reported the occurence of chromosomally located 
penicillinase gene in some strains of Staph, aureus. Although screening 
for Plasmids in the strains was not undertaken in this present study, the 
development of resistance to penicillin by Staph aureus is of clinical 
importance as some rare strains of staphylococci possess an inheritable 
resistance to penicillin G. (Dyke, Jerons and Parker, 1966; Smith, 
HamittonMiller and Knox, 1969).
In a survey of staphyloccocal infections in some of the hospitals in 
Lyon, France and Nigeria, (Fleurette, Forey and Gontheir (1981); and 
Adegoke and Adeyeba (1986) respectively found that hospital-isolated 
staphylococci had a greater resistance to antibiotics. The apparent 
resistance to penicillin and tetracycline in this study could confirm the 
indiscriminate use of these antibiotics which often results in resistance of 
S ta p h .aureus strains to them. Furthermore, these antibiotic - resistant 
Staph, aureus may be capable of prolonged carriage by patients (Boyce et al., 
1981).
Although, dracunculiasis is rarely a disease that kills and the 
infection is usually followed by spontaneous recovery (Muller, 1971), in
the course of the disease the victim may suffer varying degrees of 
discomfort like painful ulcers and abscesses in relation to complications 
arising from secondary bacterial infection. These may result in varying 
degree of incapacitations.
Economically, it is relatively difficult to accurately quiantif\y the 
impact of dracunculiasis in Nigeria, However, there is 0loss in work forceoccasioned by prolonged absenteeism from work, decreas-e5d agricultural
productivity and the patient is constantly exposed to ha iemoparasitic and
'
other enteric parasitic diseases. Hence now that attention is being focused 
on the eradication of guinea worm infection globally, especially in Nigeria, 
considerable efforts need be directed towards taking care of disabled 
patients who can be foci for disseminating strains of Staph, aureus which 
clinically are of epidemiological importance.
&
CHAPTER FIVE
CONCURRENT PARASITIC DISE SES IN A DRACUNCULI SIS 
ENDEMIC AREA OF OYO STATE, NIGERIA
5.1 INTRODUCTION
Guinea worm disease alone has been shown to dterrrible disease
as it causes a major set back on the socio-economic development of the 
afftected population (Kale, 1977). Similarly, blood and gastro-intestinal 
parasitic diseases have also been shown to constitute a major threat to 
public health in certain parts of Nigeria (Okpala, 1975; Ejezie, 1981). These 
parasitic diseases especially those caused by hookworm and Plasmodium 
falciparum have been incriminated with marked eosinophilia and severe 
anaemia resulting in iron store depletion and raised ferritin in man 
(Usanga, 1989). It has been shown that certain broad spectrums anti- 
thelmintic drugs like thiobendazole, mebendazole and niridazole that are 
active against many worms also effectively aid the extraction of guinea 
worms ( Kale - personal communication).
Although Gemade and Dipeolu (1983) reported a high prevalence 
rate of concurrent parasitic infections in an onchocerciasisendemic area of 
Benue State, Nigeria, there had not been a similar report on the status of 
concurrent parasitic diseases in a guineaworm endemic area in Nigeria. 
Since chronic parasitism in synergy with the crippling dracunculiasis in a 
farming population could jeopardise their health and increase their
mental distress with adverse effect on their agricultural productivity, it is 
considered necessary to report the status of concurrent parasitic diseases in 
an area endemic of dracunculiasis with a view of planning a control
programme.
5.2 MATERIALS AND METHODS AS*
This study was conducted in Sanusi village, a rural agricultural 
community known to be endemic of dracunculiasis in Oluyole Local 
Government Area of Oyo State (Fig. 1.4). The village was selected 
randomly by balloting from guinea worm endemic areas in the state. For 
the purpose of sample collection, all the houses in the village were
numbered and those houses bearing even numbers were selected. Faecal 
samples were collected from 48? individual subjects of age 1 to age 60 and 
above and of both sexes irrespective of whether they were infected with 
guineaworm or not. The faecal samples were collected into stool carton 
with tight fitting lid which were promptly treated
Samples were subjected to formol-ether concentration method 
(Riddle and Hawgood, 1956) for the presence of helminth over and 
protozoa cysts. Cysts were stained with 1% solution of iodine to facilitate 
identification. Those found containing strongyle ova were cultured for 
larvae, and for the purpose of distinguishing between larvae of 
Ancvlostom e duodenale and N ecator am ericanus. the criteria of Muller 
(1975) were employed
9 0
Blood samples were collected from the fingers of 160 individuals 
resident in the houses already selected as stated above. Individual subjects 
of all ages and sexes were targeted, irrespective of their state of health. A 
major constrait here is the low level of co-operation received from the 
people, majority of who were not willing to be sampled for superstitious 
reasons. The thick and thin blood films were stained with Giemlsa and 
Leishman stains respectively to screen for malaria parasites. The blood for 
P. C. V. was taken in heparinised capillary tubes and was processed using 
the micro method described by Dacie ana Lewis (SJ.9
5.3. RESULTS
Of the 487 faecal samples examined, z/» p / . l% )  contained helminth 
ova and protozoa in cysts. The ova and cysts of parasites encountered as 
per cent infection in males and females are shown in Table 5.1. Ascariasis 
(43.7%) was highest followed by trichuriasis (31%) and hookworm 
infection (27.1%). Incidence of infections in males and females were 
similar in alHhe parasitisms (P > 0.05). The culture of all the 132 faecal 
samples containing hookworm ova yielded larvae of N. a m e r ica n u s . 
Table 5.2 shows that incidence of A . Ium bricoides. hookworm and T. 
t r ic h iu r a was lowest in the young kids. While A sca r is  incidence, 
however, was at its peak among the 1 - 10 years cohort, peak incidence was 
recorded in the case of Trichuris, hookworm and Strongvloides in the 11 -
20 years cohort. In these parasitism, per cent infections in the age group of
21 - 30 years and above were similar (P > 0.05).
Table 5.3 shows the result of the blood film examination and P.C.V. 
of all the 160 individuals screened. 43.7% of the people were infected with 
Plasmodium falciparum with the highest prevalence rate of 61.9% in 11 - 
20 years age groups. The packed cell volume was found to be generaly low 
in all the age groups. The blood picture showed marked eosinophilia in 
most sub jects.
5.4 DISCUSSION
It is evident that many parasitic diseases are rampant in the study 
area. The situation is aggravated by the fact that there were many cases of 
polyparasitisms where the same individual has been infected by 
lumbricoides, hookworm, T. trichiura, D. medinensis and P. falciparum.
The study revealed that Ascaris, hookworm and Trichuris were the 
commonest human gastrointestinal parasitic infections in the study area, a 
situation that is not different from what obtains in some other parts of the 
country from where guinea worm cases have not been reported (Ejezie,
Table 5.1 Prevalence of Gastrointestinal Parasitic Infections in Area of 
Endemic Dracunculiasis
9 3
Table 5.2:  Distribution of Intestinal Parasitic Infection by Age Croup
Parasitic 1 y r .  1-10 yrs  11-20 yrs 21-30 yrs  31-40 yrs  41-50 yrs  51-60 yrs  61 yrs .  
Egg/Cysts *(50) * (91) *(75) * (56) *(80) *(35) * (60) * (42)
No. No. No. No. No. No. No. No.
Pos. Pos. Pos. Pos. Pos. Pos. Pos. Pos.
(%) (%) (%) (%) (%) (%) (%) (%)
A.lumbricoides 5(10) 52(57.1) 36(49.3) 25(44.6) 36(45.0) 15(42.9) 26(43.3) 18(42.9)
Hookworm 4 (8) 52(57.1) 27(37.0) 20(35.7) 29(36.3) 12(34.3) 19(31.7) 10(23.8)
T. trichiura 7(14) 16(17.6) 29(39.3) 22(39.3) 31(38.8) 12(34.3) 21(35.0) 13(31.0)
S.stercoralis 2 (4) 3 (3 .3 ) 4(5 .5) 2 (3 .6 ) 1(1.3) 0 (0) 0 (0) 0 (0)
E. histolytica 0 (0) 0 (0) 4(5 .5) 13(23.2) 1(1 .3) 1 . (2 .9 ) 0 (0) 0 (0)
E.coli 0 (0) 0 (0) 1(1.4) 10(17.9) 1 (1 .3) 2 (5 .7 ) 0 (0) 0 (0)
*  Number examined 
( ) Per cent infection
t
Table 5.3. Malaria parasites distribution by age group and packed cell 
volum e.
9 5
The per cent Ascaris infection (43.7%) fell within the 30 - 60 
incidence rate estimated for Africa twenty-two years ago (W.H.O. 1967). 
Though, the infection rate is higher than 39.9% in Iwo ( Adeyeba and 
Dipeolu, 1984) it is significantly lower than the 74.2% infection rate 
amongst Lagos school children (Ejezie,1981). Although this investigation 
also reveals that there was significant fall in prevalence rate as the age 
increases. The level of hygiene was still very low in the area of study.
The percent infections of T rich u ris  and hookworm in Sanusi 
village as well as the distribution by age groups are similar to early report 
by Adeyeba and Dipeolu (1984) who also reported that only N e ca to r 
americanus were reported in a LGA of south western Nigeria. It is shown 
that the incidence of 2.5% of strongyloidiasis is not significantly different 
from 2.2% in Lagos (Marsden, 1960) but marginally higher than 1.4% in 
Iwo (Adeyeba and Dipeolu, 1984).
This study has shown an over all malaria parasite infection rate of 
43.7%, with the infection almost evenly distributed amongst all age groups 
except th o s^ in  the 1 1 - 2 0  years age cohort which have a very high 
prevalence rate of 61.9%. The over all figure is slightly higher than 37.7% 
reported by Ejezie (1981) but marginally lower 65.9% reported by Fasan in 
1969. There is ample evidence available from this work to show that 
people in Sanusi and other rural agricultural communities with similar 
situation are generally anaemic probably largely due to heavy burden of 
parasites, especially hookworm and malaria parasites which often result in 
iron store depletion and raised ferritin (Usanga, 1989). The problem is
further compounded by the crippling dracunculiasis which accounts for an 
average work loss of 3 - 6 months amongst 52.296 of the entire population 
in 1986 (Adeyeba, 1986) and consequently the disabled farmer will have to 
experience hunger as a result of poverty. It is obvious that the high 
infection rate with gastro intestinal and blood parasites in synergy with 
dracunculiasis has deleterious effects on the health, mental well being and 
socio-economic life in the community. Due to the infection with 
parasites, and occurence of anaemia in this area, that is seemingly teeming 
with parasites. It is evident that the people will not be able to perform 
their normal farming activities.
Since the use of drugs cannaot boe efttfe ctively monitored by any agency
to check abuse, the only option l1eft whichl  is even more reliable is a well
organised and articulated health oerdl  u11cation programme on personal 
hygiene and community health. Essentially, indiscriminate defaecation 
should be discouraged while encouragement is to be given to clean 
surroundings devoid of broken containers and tins which could serve as 
breeding sites for mosquitoes.
97
CHAPTER SIX
VECTOR ECOLOGY AND POPULATION MOBILITY: ESSENTIAL 
FACTORS IN THE DIFFUSION AND CON'
6.1 INTRODUCTION
Dracunculiasis belongs to a group
includes Malaria, onchocerciasis; and schistosomiasis. All of these 
diseases depend in some way on water as the natural habitat of an 
intermediate host. Unlike the others, however, dracunculiasis is 
transmitted only through drinking cyclopoid copepods contaminated 
water and does not have any alternate pathways.
Although there are^Some reports on the epidemiology of 
dracunculiasis in Nigeria (Nwosu et aL 1982; Edungbola, 1983; 
Romsay,1947) and fewer reports in Oyo State (Kale, 1977; Adeyeba, 1986), 
there is scanty information on its control. Sridhar et al; (1985) 
recommended the use of sand-filter while Brieger et al (1985) advocated 
health education along with other interventions. Certainly there is a 
dearth of information on the ecology of the vector cyclopoid copepods.
In order to enhance effective control plan and implementation, the 
need for ecological studies of the vector has become more urgent than 
ever before. The need for ecological studies on the vector stems from the 
fact that both the vector and biocontrol agents are components of the same 
ecosystem and have to interact. It has been found that biological control
requires much detailed information on the biology and ecology of vectors 
as well as on their environment, Besides, the knowledge of the ecology of 
cyclopoid copepods and their breeding habits are also very essential tools 
in chemical control programme. Essentially, a high level of physical 
control is enhanced by manipulation of the environment. Therefore, 
since the efficiency of any vector control method is dependent on the 
particular biological and physical environmental conditions prevailing in 
each habitat it has become imperative in developing effective vector 
control programme to carry out studies on such variables like life tables 
and population dynamics, distribution dispersal and movement of vector 
in a habitat, and physical and biological characteristics of the habitat.
Human mobility has been identified as part of the disease diffusion 
process which occur when people who move around acquire a disease to 
which they may not have been exposed previously, or spread an infection 
to a new area ( Protherto, 1977). In the case of dracunculiasis, Watts (1985) 
described population movements as very important with regard to the 
understanding of the dynamics of how the disease spreads locally from 
community to community in endemic areas as well as how it is 
transmitted over long distances.
Essentially, knowledge of human behaviour associated with 
contamination of water sources is relevant to control strategies since it 
takes only one visit by an infected person to the pond for the entire 
community to be exposed to infection.
Therefore this study is designed to highlight the effect of vector 
ecology, environmental manipulation and human behaviour in the 
process of disease diffusion and control.
62 MATERIAIS AND METHODS
The ecological community of the pond was carefully 5obse^rved. In 
order to determine the biological and physical characteristics and peculiar
chemical composition of the pond water where cyclopoid copepods breed 
and transmit Dracunculus Standard methods for water analysis described 
by the American Public Health Association (1976) was employed. The 
water obtained from pond was filtered through a net made up of 
monofilamentous polyester with of 75pm which retained all
the cyclops and other biological mates. The parameters determined in the 
water include the temperature (°C), pH, suspended matter (mg/1); colour 
(co-pt scale) oxidizable organic matter (mg/1); Biochemical oxygen 
Demand (BOD) (mg/1); Dissolved oxygen, DO (mg/1); Total alkalinity 
(mg/1 as CaC03); Total hardness (mg/1 as CaC03); Calcium (mg/1); 
Magnessium (mg/1); and Chloride (mg/1).
6.2.1 Estimation of Biochemical Oxygen Demand (BOD): A narrow
mouth 250ml reagent bottle was filled to the brim with 50% filtered pond 
water diluted with normal supplements pure wTater, covered with a 
stopper and left on the bench at 20°C for 5 days. The water was filtered in 
order to remove all biologicals thereby reducing theorganic content which
might interfere with the true value of BOD. 1ml each of manganese 
sulphate solution and alkaline potassium iodide solution were added 
respectively and mixed thoroughly before adding another 1ml of 
concentrated sulphuric acid. This was mixed until a clear yellow solution 
was formed. 100ml of the liquid was titrated against N /80 thiosulphate 
using starch indicator. The end point was colourless. The control value 
was also determined using distiled water instead of pond water. The 
value of BOD was calculated thus: the blank (control) reading minus the 
test reading multiplied by 100 and divided by % sample liquid for dilution. 
(Blank titre - test titre) x 2 = xmg/1. BOD.
6.2.2 Dissolved Oxygen (DO) Estimation: The procedure is similar 
to that of BOD estimation and the only difference is that the waterwas 
fresh and undiluted. The test titre was expressed as mg/1.
6 23 Total Alkalinity Estimation: A few drops of mixed indicator
(see appendix 6.1) was added to 100ml of fresh pond water in a conical flask 
and titrated against 0. 02N sulphuric acid. The end point was orange 
colour. Calculation: titre reading X 10 = ymg/1 as CaC03.
6.2.4 Total Hardness Estimation: To 100 pond water in a conical
flask was added 1ml ammonia buffer (Appendix 6.1) and a pinch of 
Eriochrome Black T indicator and titrated against EDTA solution to reach
end point of blue coloration. Calculation: titre reading X 10 = zmg/1 as 
CaC03.
6.2.5 Chloride Estimation: To 100ml pond water in a conical flask
was added 0.5ml potassium chromate solution and titrated agaisnt silver 
nitrate solution until the end point of flesh colour was reached. 
Calculation: titre reading X S = tmg/1.
N?
6.2.6 Calcium Estim ation: A pinch of murexide indicator
(Appendix 6.1) was added to 100ml pond water with 1 ml 1 N NaOH in a 
conical flask and titrated with EDTA solution to reach an end point of
pink coloration. Calculation: Titre X 4 = fmg/1.
6.2.7 Oxidizable Orgamniec Matter Estimation using 4hr. Permanga­
nate value (4hr. - P-V): 4hr-PV was used to determine the oxidizable 
organic matter. To 25ml pond water in conical flask 5ml each of 1 : 3 
sulphuric acid solution and N/80 potassium permanganate solution was 
added consecutively, and this was left on the bench at a room temperature 
for 4 hours in dark. Thereafter, 2 drops of potassium iodide solution and 
starch solution (indicator) were added to give a blue coloration. Titration 
with thiosulphate solution was followed until the colourless end point 
was reached. The control blank was done with distiled water.
Calculation: [control blank titre - test titre] X 10 = tmg/1 oxidizable 
organic matter.
6.2.8 Effect of Organic Matter on Cyclops: Varying concentrations
of sewage i.e. organic matter in pond water was prepared as follows: 0% 
(Omg/1); 10% (4.1m g/l); 2096 (8.2m g/l); 50% (20.5m g/l); 75%
(24.6mg/l); 10096 (41mg/l). The value in parenthesis represents the 4hr- 
PV (the oxidizable organic matter) in the various sewage concentration, as 
determined. 200 active cyclops were introduced into each concentration in 
the conical flask. The flasks were left on the bench at room temperature. 
The survival rate (per unit time)of the cyclops in each concentration was 
followed by examining a sample at regular intervals under the compound 
microscope. The chlorine demand of each concentration was also 
estimated. The whole experiment: was caarried out in replicate.
6.2.9 Storage of Cyclops at Low TemDeratures: A series of 200ml
pond water containing 200 active cyclops in conical flasks were kept in a 
refrigerator at a temperature of 4-6°C. At regular intervals, a flask was 
taken out and examined under the compound microscope for active 
cyclopoid copepods. The same flask was kept on a laboratory bench at 26°C 
till the contents attained room temperature was carried out in replicate.
Monthly Cyclops Distribution: Study on monthly and
seasonal distribution of Cyclops in ponds was carried out by examining 
pond water twice a month right from the month of March, 1988 through 
+May, 1989 in Folarin village where guinea worm was hyperendemic. 10
litres of pond water was filtered through a net made of monofilamentous 
polyester writh a mesh size of 75|am attached to a plain tube which retained 
all the Cyclops in 10ml volume of water. The 10ml pond water Cyclops 
concentrate was counted under a compound microscope. Drops of 10% 
formalin or alcohol was added to the plastic cuvette containing the filtered 
pond water in order to inactivate the Cyclops to ease the counttiingg exercise.
6.2.11 Effect of Disturbance of pond water on .Cycdlojps Concentration:
A vigil was kept on the pond in Folarin village from 06.30hr to 19.16hr 
each day for two consecutive days in order to sample pond water after a 
villager had drawn water for use. 10 litres of pond water was thus 
collected and examined after every visit by the villagers. This was done in 
replicate. The time of the day and frequency of visit were noted against 
each sample. The count of the Cyclops was done under the compound 
microscope.
6.2.12 Socio-economic activities and population mobility: Investi­
gations were carried out on the effect social and economic activities had in 
the communities on the population mobility and the spread (or 
otherwise) of guineaworm in the study areas. The individual subjects of 
both sexes and school age and above were interviewed on the effect their 
vocational and social activities had on their movements wdthin and 
outside their villages. Notes were also made of.residents who were non­
natives and their places of origin.
6.3 RESULTS
6.3.1 Characteristics of the Vector Habitat: Physically, the pond in
Folarin village like in most other rural communities in the State under 
survey are situated under tree shades and roots of these trees were seen to 
be projecting into the ponds (Fig. 1.5). Leaves of the trees were usually 
dropping into the pond. Physical and chemical properties of the pond 
water are presented in Table 6.1. Tadpoles, fishes, dragon fly, crabs,, 
mosquito larvae, rotifers were common aquatic mates observed in most 
ponds. It was a common site to see falling woods on the surface of water.
6.3.2 Effect of Low Temper*aatture on the Survival of Cyclops:
Cyclops became inactive at 4 - 6°C but become revived and active again 
when the medium attain higher temperature of 15 - 20°C. (Table 6.2). The 
Cyclops never regained activity when kept at 4 - 6°C beyond 48 hours and 
at -4°C ( freezing point) for any length of time.
&
6.3.3 Effect of Organic Matter on Survival of Cyclops: Table 6.3
shows that Cyclops can not survive for more than 15 minutes in any 
medium, including water, whose organic matter concentration is above 41 
mg/litre. The chlorine demand of the various concentration is Omg/1.
Table 6.1. Characteristic and properties of pond water in which Cyclops 
breed and transmit dracunculiasis.
Characteristics Value
PH value 
Temperature °C < ^  
Suspended matter, mg/1 32.0
Color, co-pt scale 3.2 
Oxidizable organic matter (4-hr permanganate value, 12.5
mg/1
Biochemical Oxygen demand, mg/1 5.7
Total alkalinity, mg/1 as CaC0 3  94.0 
Total hardness, mg/1 as CaCo3 199.3
Calcium, mg/1 69.2
Magnesium, mg/1 42.0
Chloride, mg/1 A 74.0
V
t
Table 6.2 Effect of low temperature on the survival of Cyclopoid 
Copepods.
revived and active at higher temperatures of 15-20°C. They did not 
become reactivated after being kept in the deep freezer.
Table 6.3. EFFECT OF ORGANIC MATTER (SEWAGE) ON SURVIVAL OF CYCLOPS.
108
6.3.4 Seasonal and monthly Distribution of Cyclops in Folarin 
Ponds: The highest concentration of Cyclops was recorded in the dry 
months of December, 1988 to February, 1989. There was a slight drop in 
the months of March and April, 1989 probably because of early rains. 
There was a significant drop in May and it is estimated that further drop 
will be recorded to a great extent during the rest of the year. Whereas a 
sharp drop was recorded in March the previous year by July and 
September, 1988 the volume of the pond had increased significantly with 
resultant low density of Cyclops ( Fig. 6.1). The pond did not turn into a 
stream at any point in the year. The concentration of Cyclops increased 
with every passing month from Octob
6.3.5 Effect of Disturbances on Cyclops Density: Fig . 6.2 shows that 
there is little patronage of the pond before 6.30hr ( i . e 6.30 am . ) each day, 
whereas there is increased activity with respect to water fetching during 
the evening time starting from 17.00hr. When many came to draw water 
at the same tirn  e M J ?  first caller at the pond collected more Cyclops with 
her bucket or container than the one who came in to draw after the pond 
has been disturbed by a number of immediate drawers.
J
!20
o:
LU
110
1
Q 100
c/) 9Q
CL
oO 80
o>N
70
QC ll
LaU.  o£
>  — 6 0
co 5 0
I
QLU
CO 4 0
oCL
o—I>- 30i o
20
10
_L
J
MONTHS OF THE YEAR
FIG. 6.1: MONTHLY DISTRIBUTION OF CYL0P0ID C0PEP0DS IN POND IN F0LARIN VILLAGE. ( March 1988-May 1989)
)
17
'/
-  8
- 7
-  6
-  5
-  4
-  3
-  2 
-  I
CYCLOPS COUNT (Mean va lue /10 It pond water) (A )
FREQUENCY OF POND PATRONAGE
6.3.6 Socio-economic Activities and population mobility: The
results of investigation revealed that socio-economic activities had effect 
on the population circulation and consequently on the diffusion of 
dracunculiasis in the study areas. Social activities such as marriage, 
naming ceremonies, festivals, family meetings; and economic endeavours 
like periodic marketing, village hawking of wares, coperative movement 
activities, job seeking (itinerant labourers) and schooling contributed to 
short and long distance transmission of guineaworrfl in association with 
movements of the people. The investigation also revealed migrant 
labourers from other states of the Federation and some West African 
countries who were temporary residents in the study areas.
6.4 DISCUSSION
The improvement of t:he environment, both in urban and in rural 
areas should be the first priority in all development programmes. The 
elimination or control of the intermdediate host of the Dracunculus or 
any vector borne disease for that matter is an important component of 
disease control. Whereas chemical and biological methods may provide 
only temporary control of vectors, environmental (physical) 
improvements may lead to more permanent control.
Knowledge of the ecology of the Cyclops and their breeding habits 
will in many instances make a high level of control possible by 
manipulation of the environment. Since such measures are likely to
produce definitive and permanent results they should be the basic 
approach to effective control of the vector.
It has been observed that most ponds in the study area (presumably, 
the same situation in other rural communities in the State) are situated 
under tree shades, and usually, the roots of these trees project into the 
pond. This situation provides conducive environmental conditions for 
the cyclops to breed and transmit the infection in the area. The 
characteristics and properties of the pond whose factors favoured cyclops 
breeding and transmission of guinea worm as elucidated in Table 6.1 has 
been subjected to experimental study in the laboratory. This present study 
has shown that cyclops can not survive beyond 15 minutes in a pond 
water or any water at all in which the concentration of oxidizable organic
matter is high beyond 41mg per litre. It is concluded therefore that any 
water containing more than 41mg/litre of oxidisable organic matter will 
not support the breeding of Cyclops and therefore transmission of the 
disease.
It hasjaeen observed that some ponds do not contain or harbour 
Cyclops in certain parts of the State. However, it was discovered that the 
pond water in these communities have high concentration of organic 
matter which is inimical to the existence of Cyclops. Observation also 
Revealed that this type of situation occurs in areas where certain local fruit 
called "Afon" in the local language is preponderant. These fruits often fall 
into the pond and decompose or disintegrate in there.
The current study revealed that when Cyclops are kept in the 
refrigerator at 4-6°C they become inactive. However, they are reactivated 
when the temperature reaches 15°C and above. These Cyclops are killed 
when kept or stored in the freezer at -4°C. It is not yet certain whether 
larvae inside the inactive Cyclops could stimulate an infection in a subject 
if consumed. This could be investigated. However, it is known that 
development of larvae inside the Cyclops ceases at any temperature below 
19°C (Muller, 1979). The normal temperature of pond water (as it occurs 
in nature) where Cyclops breeds and transmits dracunculiasis is between 
25-27°C. It therefore follows that any deviation from this condition might 
be deleterious to Cyclops activities in respect to disease transmission. The 
attainment of such low temperature may be difficult in nature especially
in this part of the world, but privileged individuals in the society could 
store their drinking water at 4-6°C for at least 48 hours for personal 
protection.
It has been shown that density of Cyclops goes up in the dry months 
of October through February and early March of the following year with 
the peak at around December to February (Fig . 6.1). This is the time the 
community is at greatest risk of infection more so that there is no alternate 
source of drinking water beside the pond. The water level in most ponds 
in the area had gone down considerably at this particular time. In-fact 
most ponds had dried up at the peak of dry season resulting in acute water 
shortage compelling the villagers in the contiguous communities around 
Folarin to travel on foot many kilometres in search of water (Fig. 6.3).
This is a very effective means of disease diffusion. More often than not 
the water is not fit for human consumption as it is very turbid and heavily 
contaminated with infected Cyclops. This has to be so since infected 
Cyclops are said to undergo a vertical diurnal migration (Onabamiro, 1952) 
and the infected Cyclops are confined to the bottom few inches of a pond 
(Onabamiro, 1954). Therefore the risk of getting infection increases with
every drop in water level.
In the rural environment, Cyclops density may often be increased by 
such agricultural and industrial activities as the construction of dams, 
large scale irrigation projects and deforestation (WHO, 1975). Examples of 
these human activities are apparent in Nigeria espcecially in Kwara State 
(Edungbola, 1983; Edungbola and Watts, 1984; 1985).
r i g
This study has shown that very few villagers draw water from the 
pond in the early hours of the day (06.30Hr.) and those who come early to 
draw are likely to catch more Cyclops than those following immediately. 
The heavier the traffic to the pond (which means that pond water has 
been disturbed) the less number of Cyclops that will be caught along with 
the water drawn. The level of pond patronage is usually very low in the 
early morning and tends toward nil in mid-day. Conversely, there is 
usually unprecedented heavy traffic and patronage to the pond in the late 
afternoon towards evening time at around 17.00 htW;*This is the time the 
villagers especially women fectch water for domestic use after the day's 
farming and trading activities. The water is usually stored overnight and 
might last till the evening of the following day. Since the volume of 
contaminated water consumed is directly related to acquisition of infection 
(Adeyeba, 1986) a consumer of water drawn when the traffic was heavier is 
less likely to acquire infection. It could be inferred therefore, that 
disturbance of pond water occasioned by heavy traffic and patronage of 
pond is inversely related to level of contamination i.e, C y clo p s 
contaminated water drawn for drinking.
The introduction of guinea worm into new communities in rural 
parts of Oyo State is frequently associated with short distance movement 
by school children, local women, schooling, trading and visiting kin for 
family, social and religious festivals. Villagers in some highly endemic 
areas usually claim to know the origins of the infection in their 
communities.
This study has shown that very few villagers draw water from the 
pond in the early hours of the day (06.30Hr.) and those who come early to 
draw are likely to catch more Cyclops than those following immediately. 
The heavier the traffic to the pond (which means that pond water has 
been disturbed) the less number of Cyclops that will be caught along with 
the water drawn. The level of pond patronage is usually very low in the 
early morning and tends toward nil in mid-day. Conversely, there is 
usually unprecedented heavy traffic and patronage to the pond in the late 
afternoon towards evening time at around 17.00 i hr. This is the time the 
villagers especially women fectch water for domestic use after the day's 
farming and trading activities. The water is usually stored overnight and 
might last till the evening of the following day. Since the volume of 
contaminated water consumed is directly related to acquisition of infection 
(Adeyeba, 1986) a consumer of water drawn when the traffic was heavier is 
less likely to acquire infection. It could be inferred therefore, that 
disturbance of pond water occasioned by heavy traffic and patronage of 
pond is inversely related to level of contamination i.e, C y clo p s 
contaminated water drawn for drinking.
The introduction of guinea worm into new communities in rural 
parts of Oyo State is frequently associated with short distance movement 
by .school children, local women, schooling, trading and visiting kin for 
family, social and religious festivals. Villagers in some highly endemic 
areas usually claim to know the origins of the infection in their 
communities.
In Papanla village, one of the study areas, the villagers claimed that 
infection was first introduced to the area by an unknown person who 
visited from the surrounding endemic settlements in the year 1985. 
Similarly, the settlers in Folarin village blamed their calamity on the 
villagers from neighbouring villages like Oloyin, Seriki, Okegbemi, etc. 
who came especially during the dry season to fetch water from their own 
ponds. There was information that women from the neighbouring 
villages who engage in palm oil processing often draw water from the 
pond during the time especially those who have their local oil mills close 
to the ponds.
Most schools in the endemic areas draw their students from the 
surrounding villages usually as close as 5 to 6 km. For example the 
primary school in Papanla village draw her students from six other 
neighbouring villages while students from Folarin village in Akinyele 
L.G.A. have to travel 2 to 3 km each day to schools in either Ejitolu or 
Seriki Okegbemi both of which are also known to be endemic for
dracunculiasii ar Tfhis scenario is very efficient in the diffusion of the
disease.
It was discovered that there is a high level of mobility both by local 
residents and by indigenes visiting other areas during festivals and social 
ceremonies like funeral outings, naming and wedding. These women are 
usually engaged in the fetching of drinking water during which process 
they wade into the pond.
The network of periodic markets in the study areas provided for 
women migration a useful instrument of guinea worm spread. Some 
married women in the study area moved in and out (just like students on 
vacation) of their settlement.s to join their kitt and kins though some 
moved relatively short distances . Watts (1984) made similar observation
in llorin.
Long - distance transmission of dracunculiasiis^ min association with
the movements of migrant labourers and their famuilies iinto the area is a 
possibility. Migrant labourers move into th^Weas from the Northern 
States like Kano, Sokoto and Benue; some Eastern States and even outside
the country. For example an investigation has shown that two palm wine 
tappers who claimed to be citizens of Ghana were incapacitated in the 
month of April, 1988 in Seriki Village. Several reports have shown that
dracunculiasis is found in those areas earlier on mentioned (Scott, 1960; 
Belcher, et aL, 1975, Nwosu gt §1., 1982; Daniel and Osisanya, 1986).
It is apparent that every effort must be geared towards reducing the 
exposure of man to contaminated pond water. This could be achieved by 
constructing a barrier round the pond leaving only one point of entry into 
the pond through a platform hanging over the pond on one side. To 
achieve any reasonable success there is need to direct a well articulated 
health education measure to all concerned most especially women, and 
also school children, who are the main contaminators of pond water.
/ !
4 -
1 2 0
CHAPTER SEVEN
INFLUENCE OF SOME WATER TREATMENT CHEMICALS ON 
SURVIVAL OF CYLOPS IN POND WATER
7.1 INTRODUCTION
Species of Cyclops which act as intermediate vectors in the 
transmission of the infection of Dracunculus medinensis from man to 
man have been reported by Onabamiro (1954) and Sridhar and Kale (1985). 
While potable water supply is the surest way and means of avoiding the 
consumption of cyclops contaminated water, many countries in Africa 
especially Nigeria are not yet able to provide it despite the increase in 
prevalence and magnitude of guinea worm disease due to limited social 
and economic resources. An alternative approach is to break the 
transmission cycle by eliminating Cyclops from the waters either at the 
community level or at an individual or household level. The use of a 
variety of chemicals, plant extracts (Singh and Raghavan, 1957; 
McCullo1 ugh, 19 '83), filtration (Sridhar- e ia i, 1985) and a combination of 
physical and chemical treatment of waters, and health education to the 
community (Brieger £taL  1985; Olajide eiaX  1987) have yielded some 
encouraging results over the years.
However, there has been a dearth of information on the influence 
of some of the chemicals commonly present in waters on the survival of 
cyclops under laboratory conditions. Even though such studies may have
limited application in poorer communities scattered far apart, an 
understanding of Cyclops will be useful in the control of the disease under 
certain situations especially at the household level.
This work reports some of the laboratory studies carried out on the 
influence of a variety of common chemicals on the survival of cyclopoid 
copepods.
7.2 MATERIALS AND METHODS 
Large quantities of pond water were obtained from Folarin village
near Ibadan in Akinyele Local Government Area of Oyo State where 
guinea worm is endemic. The analysis of the pond water was carried out 
according to the standard methods described by American Public Health 
Association (1976). The water samples from the pond were filtered 
through a net made of monofilamentous polyester with a mesh size of 
75pm which retained all the cyclopoid copepods. The cyclopoid copepods 
were recovered and preserved separately for survival studies in the 
laboratory. The filtered pond water was used in all the experiments by 
adding a variety of chemicals: aluminum sulphate, potassium 
permanganate, calcium hypochlorite, calcium hydroxide, calcium 
carbonate, ferrous sulphate, ammonium chloride, and copper sulphate. 
All the chemicals used except aluminum sulphate (alum) and calcium 
hypochlorite were of analytical grade.
In some experiments, pH was adjusted by using standard sulphuric 
acid or sodium hydroxide.
The Cyclops were counted under the compound microscope after 
concentrating them in a polyester filter net and keeping in a plastic 
cuvette. The Cyclops used were those commonly found in this part of the 
country and consisted of T h erm o cy clo p s n eg lectu s d e c ip ie n s , 
Thermocvclops crassus, Afrocvclops gibsoni, Microcvclops varican, 
Mesocvclops major and Tropocvclops sp. No effort was made in singling 
out any species as all these species were involved in the transmission of 
the disease (Sridhar and Kale, 1985) .
All the experiments were carried out in 250ml beakers or conical 
flasks at 23-26°C in replicates.
7.2.1 Effect of pH on Cvclopoid Copepods (Cyclops): The pond
water of 200ml in each beaker was adjusted to varying pH values: 4, 5, 6 , 7, 
8 , 9, 10 and 11 . To each of them were added 200 active live Cyclops and 
kept on the laboratory bench at 23-26°C in order to observe the survival 
rate at various intervals.
*
7.2.2 Effect of aluminum sulphate ( Alum): A 5 per cent solution 
of aluminum sulphate was added drop by drop to the pond water while
stirring to reach an alum dosage of 160ml when the floculation was 
formed. In this case, 0.65ml of 5% aluminum sulphate solution was added 
to 200ml pond water. The contents were examined for active Cyclops.
7.2.3 Effect of potassium permanganate on cvclops: Potassium
permanganate was added to pond water at concentrations (mg/1): O, 10, 
20, 30 and 50 respectively. It was prepared by adding respectively to a set of 
flask countaining 100ml pond water, 0.1ml, 0.2ml, 0.5ml, l.Oml, 2.5ml of
N/80 kmN04. .........................................
In another experiment the various concentrations of organic matter 
in the form of domestic sewage were added to the pond water to reach 
concentrations 7, 11, 15, 28, 32 and 49m g/l. To each of them were added 
potassium permanganate at 50m g/l and introduces 200  active live 
Cyclops. The contents were examined for active Cyclops for varying 
periods.
7.2.4 Effect of calcium hypochlorite on Cyclops: Varying amount
of calcium hypochlorite was added to 200ml pond water to reach a residual 
chlorine level of 0.5, 1.0, 2.0, 3.0, 4.0 and 5.0 mg/1. This was achieved by 
dissolving 2 0 0mg CaOCl2 in 100ml distilled water to form stock solution 
(200m g/100ml or lOOOpg or 2m g/l chlorine i.e, 4m g/l CaOCl2). 0ml, 0.1ml, 
0 .2ml, 0.4, 0 .6 , 0 .8 , 2 .5 ml of the stock was added in series to give the 
concentrations. To each of them were added 200 active Cyclops and their 
survival was followed.
7.2.5 Effect of some water treatment chemicals on Cyclops: Some
chemicals occasionally used in the water treatment operations or 
commonly present in the waters were examined for their effect on the
Cyclops. Varying concentrations of the chemicals: calcium hydroxide 
(lime), calcium carbonate, ferrous sulphate, ammonium chloride and 
copper sulphate were added to pond water and the survival of cyclops was 
followed.
7.3 RESULTS
7.3.1 Effect of pH on the survival of Cyclops: I observed that
within 30 minutes, all the Cyclops were dead at H values 4, 10, 11 
respectively. But at pH 5 they died in 4 hours. At the other pH values 6 , 7, 
8 and 9, the cyclops remained active for seven days. There was a slight but 
insignificant decrease in pH values when rechecked after 24 hours.
7.3.2 Effect of aluminum sulphate on Cyclops survival: It was
observed that for up to the end of 30 minutes, the cyclops were still active 
and moving. Between 30 minutes and one hour, they were seen in the 
floes settling from the centre of the beaker to the bottom. At the end of 
two hours they became less mobile and restricted to the alum sludge at the 
bottom of the beaker. At the end of three hours, all the Cyclops were 
found dead and the pH value reached 5.4.
7.3.3 Effect of potassium permanganate on Cyclops survival: It
was observed that a concentration of 50m g/l inactivated the Cyclops 
within 30 minutes and lowering the concentration to 10m g/l increased 
the survival period up to 100 minutes (Table 7.1) .
125
Table 7.1 Effect of potassium permanganate on the survival of 
Cyclops.
1 2 6
Table 7.2. Effect of organic matter on the survival of cyclops
The results as shown in Table 7.2 indicate that organic matter above 
30m g/l has a toxic effect on the survival of Cyclops and it affords some 
protective effect against potassium permanganate at low concentration.
7.3.4 Effect of calcium hypochlorite on Cyclops survival: The 
results as shown in Fig. 7.1 indicate that lmg/1 residual chlorine 
inactivated the Cyclops in thirty minutes contact time.
7.3.5 Effect of some water treatment chemicals on Cyclops: The 
results as shown in Table 7.3 indicate that the various chemicals 
inactivated Cyclops at different concentrations which were rather high as 
compared to the guidelines set by WHO for drinking water (World Health 
Organisation, 1971). Ammonium chloride at 200m g/l concentration 
inactivated Cyclops in 30 minutes while 200mg/l CaOH killed the Cyclops 
in 3.5hr. The Cyclops were inactivated in 5 minutes in 500m g/l CaOH. 
10m g/l and 20m g/l CUSO4 respectively inactivated the Cyclops in 3hr and 
2hr whereas the Cyclops became inactivated after 18hr in 500m g/l. 
Ferrous sulphate and sodium chloride at 200m g/l did not affect the 
Cyclops even at the end of 14 days.
% ACTIVE CYCLOPS
1 29
Table 7.3 Effect of some Water Treatment Chemicals on the Survival 
of Cyclops
Sodium Chloride at 2000 mg/1 did not inactivate the cyclopoid copepoid 
even at the end of 14 days.
130
7.4 DISCUSSION
A careful review and analysis of the impediment to progress in 
vector control as practised currently or even in the past are pre-requisites 
for the consideration and testing of new developments in the future. 
During the early period of work on the control of dracunculiasis some 
experiments were carried out on the effect of chemicals on the 
intermediate host, Cyclops and the worm Dracun cuius medinensis. 
Turkhud (1919) reviewed the earlier work on the effect of water treatment 
on the Cyclops. It was recorded that steaming the water to 43°C or addition 
of 0.15 per cent potassium hydroxide to water killed all the Cyclops. He 
further conducted experiments in India and reported that addition of 
potassium permanganate to a well tilDthe water turned pink (0.395g/l) 
resulted in the complete destruction of Cyclops in one hour. However, 
longer periods were required when the chemical was added in lesser 
concentrations. He also recorded that the Cyclops reappeared after some 
time. This study has revealed that the concentration of 50m g/l potassium 
permanganate had resulted in the complete destruction of cyclops in less 
than 30 minutes. The low level of acceptability of colour in drinking 
water would however be a disadvantage. However, the colour disappears 
with time.
>
Various other chemicals such as lime, perchlorite, copper sulphate, 
rock salt, bleaching powder, asafoetida (a common spice) and tender 
bamboo leaf extracts were added to water which showed varying 
cyclopscidal effects (Moorthy, 1932; Singh and Raghavan, 1957). As was
also observed in this study, most of those chemicals killed the adult 
cvclops. The water source would be kept safe but for a short periods. This 
has to be so since the chemicals are suspected to have no lethal effect on 
the eggs of Cyclops which developed into adult after a few; week.s. 
Essentially, periodic application of the chemicals is necessary in order to 
achieve the desirable result.
Another study by Khanna and Saraswet (1985) fit India indicated
that Pot chlorination of step wells in Rajasthan to a residual chlorine level
of 0.18mg/l at 30°C and 0.15mg/l at V *20°C resulted in complete destruction 
of Cyclops in 12 hours. In the present study, higher concentrations of 
chlorine were required as the pond water showed higher organic matter 
content and the number of cyclopoid copepods used in the experiments 
were high. The required time was indeed less than one hour and the 
chlorine demand depends on the quality of water. In all the studies so far 
made none of the chemicals were found to have any application for singki 
dose treatment under field conditions.
It has been shown in this present study that any treatment of water 
which might result in a condition whereby the pH values of the water is 
reduced or adjusted to 4, 10 and 11 would be valuable in the control of the
vector, since this has resulted in the destruction^ cyclops within a short
Xx\ \  X\>\ >
period. However, the water may have sharp taste which might render it 
less acceptable for drinking.
Abate (Temephous) an organophosphorous compound has 
however been used in different areas by treating the ponds at frequent
1 3 2
intervals (Law eiaL 1968; Olajide et aL 1987). Even though it is reported to 
have no adverse effects on human beings and other acquatic flora and 
fauna, the long range effects are still not ruled out when ingested in low 
concentrations.
The appearance of second order problems of steadily increasing 
severity in vector control, such as vector resistance, environmental 
contamination, and increasing costs has seriously jeopardized successful 
vector control operation in large areas, which are inhabited by many 
people. These setbacks make it imperative to re-examine strategies for the 
use of chemicals in vector control in general and cyclops control in 
particular. Refinements of techniques are required in order to ensure 
more efficient and economic utilization of these chemicals.
In view of the foregoing discussion, use of the milder chemicals 
normally used in water treatment may be of value in small water supplies 
or in the individual houses. They may be applied to water collected for 
use immediately or within a short period. Among the various chemicals 
tested, calciuWm hypochlorite, potassium permanganate, lime and copper
sulphate see«m to hiave cyclopscidal effect which may be used in practice in
the storaige pots  for individual households. Presence of organic matter in 
water beyond 30m g/l also seems to promote unfavourable conditions for 
the survival of cyclops even though such higher levels are not commonly 
found in nature. However, the waters may receive periodic organic 
shocks due to storm run-off. Normal tropical water temperatures (25°C) 
are favourable for the longer survival of cyclops but lower temperatures
1 3 3
(4-6°C) seem to promote faster death. This study seems to throw some 
light on the behaviour of cyclops in waters of varying chemical quality 
which may pave way for possible control of dracunculiasis at the 
individual's level.
&
CHAPTER EIGHT
EFFECT OF FISHES AS BIOLOGICAL CONTROL AGENTS OF VECTOR
OF DRACUNCULIASIS UNDER LABORATORY CONDITIONS
8.1 INTRODUCTION <03
The use of certain common chemicals in water treatment by 
individual households had been recommended in chapter seven of this 
dissertation. Although the use of certain small fishes (Gambusia spp. 
Barbus spp and Rasbora doniconius) as biological control agents had been 
recommended in India by Moorthy and Sweet (1936) and Gideon (1942),
there is no record of the use of indigenous species of fish as biocontrol 
agents of dracunculias is in Nigeria. Therefore there is a need to search for 
new biological control agents to be used under the local condition by the 
afflicted communities to control and possibly eradicate the disease.
This study was stimulated by an observation made at a village in 
the State which indicate that the common indigenous fishes may act as 
biological control agents by predating on the intermediate host, cyclopoid 
copepods. This observation was further substantiated with a series of
laboratory experiments preceeded by pilot studies on the efficiency of
>
predating biological agents.
1 3 5
8.2 MATERIALS AND METHOD
Samples of water were periodically collected and filtered through a 
plankton net made up of monofilamentous nylon gauze with mesh size - 
75um attached to a plastic tube. Adult and nauplii stages of different 
species of Cyclops retained on the filter and collected in the tube were 
transferred to a glass container, their numbers were counted under the
low power of a compound microscope and use i0n 3the  ,lcaboratory
experiments. The dominant species in this part of Nliger ia were shown by
Sridhar and Kale (1985) to be: Thermocvclops neglectus decipiens: T 
crassus: Afrocvclops gibroni; Mesocvclops major; Tropocyclops prasinus; 
Microcvclops varicans: Thermocvclops species: Cryptocvclops linjanticus 
and Tropocvclops onabamiroi.
8.2.1 STUDY WITH FISHES
8.2.1.1 Pilot Study: A pilot study on the role of fish as biological 
control agents of cyclopoid copepods was first carried out. Four active 
fishes were caught from a pond in the course of water sampling. Into a jar 
containing 500 ml pond water and 50 live cyclops were introduced the 4 
live and active small fishes identified as Tilapia species (courtesy of 5tate
Fishery Department). A jar containing onl>y 50 live cyclops and 500ml
pond water was also set up as control. The cyclops count was followed at 
various time intervals.
The possibility of the use of the species of fish obtained in the area 
as a biocontrol agent was confirmed.
8 .2.1.2 Experimental Study: In order to determine the predating capability 
of indigenous species in Western Nigeria, the following species of fish 
obtained from the Oyo State Fishery Department at Agodi, Ibadan were 
used for the experiments. Hemicromis fasciatus; Barbus occidentalis; 
Tilapia nilotica and T. galilea. The physical characteristics 6$ the pond 
water used in these experiments was determined before the start of the 
experiments in order to ascertain the prevailing ecological characteristics 
(Table 6.1).
Samples of pond water were collected . anvd f,iltered as described 
earlier on. Into each 15 litre plastic aquarium containing 10 litres of 
Cyclops free pond water and 16,000 active Cyclops were introduced 10
active young fish of the same spec Iies (thait is H . fasciatus B. occidentalis
and Tilapia species). The experiment was done in replicate with a control 
tank which contained only pond water and Cyclops but no fish. The 
experiment was maintained at room temprature (26°C - 28°C). The 
Cyclops counts were recorded over a period of hours and days. The cyclops 
density per ^unit time was determined in the system and expressed in 
percentage.
In another experiment, alternate food was provided for the fish in
order to assess the predating effectiveness of >the fish on the Cyclops in the
presence of alternate food. Into each 15 litre capacity plastic aquarium 
containing 10 litres of Cyclops free pond water, 16,000 active Cyclops and 10 
active fish of the same species were introduced 4 gramme of fish meal 
(brewery waste used in feeding fish in Oyo State fish ponds at Agodi) as an
1 3 7
alternate food supply to Cyclops. The experiment was carried out in
Jf
replicate with a control aquarium which contained only pond water, 
cyclops and fish meal but no fish. The experiment was similarly 
maintained at room temperature 26° - 28°C and observed over a period of 
hours and days. The cyclops density per unit time was determined and 
expressed in percentage.
8.3 RESULTS
8.3.2 Effect of predating fishes on Cyclops: Results from the pilot
experiment shows that the Cyclops population was reduced by 75 per cent 
in 7 days and by 90 per cent in 14 days. observed that 2 of the 4 fishes
died on day 7 (Fig. 8.1). There were no drop in Cyclops counts in the 
control beaker.
The result of the experiment involving Hemicromis fasciatus is 
shown in Fig. 8.2. Data indicate that these relatively big fishes of about 
4cm long reduced the Cyclops population by 50 per cent in 60 hours and by 
75 per cent, 90 per cent in 72 hours and 84 hours respectively. The Cyclops 
counts in the control tank did not drop throughout the duration of the 
experiment.
%  CYCLOPS DENSITY
100
90
80
70
60
50
40
30
20
10-
24 36 48 60 72 84
PERIOD (Hours)
FIG 8.2: EFFECT OF PREDATING FISH (Hemicromis Fascidtus)ON CYLOPOID DENSITY
IN POND WATER UNDER LABORATORY CONDITION. (2cm = 12 h rs )
140
Fig . 8.3 shows the result of the experiment involving the Tilapia 
species. Data indicate that the Cyclops count droped by 45 per cent and 90 
per cent in 4 days and 9 days respectively when the fish were kept on pure 
Cyclops diet whereas the fish caused a drop in Cyclops population by 33 per 
cent and 84 per cent in 4 days and 9 days respectively when there was an 
alternate food supply. There were no drop in Cyclops count in the control 
tank. This result shows that the presence of alternate food supply had 
very little influence on the feeding habit of the fish on Cyclops.
The results of the experiment involving Barbus occidentalis is 
shown in fig. 8.4. The result shows that B. occidentalis reduced the 
population of Cyclops by 48 per cent and 90 per cent in 3 days and 6 days 
respectively when there was no alternate food supply in the medium 
whereas there was a drop of ent and 52 per cent in Cyclops count
when there was an alternate food supply. There was no drop in Cyclops 
count in the control tank. Barbus lived longer than 3 weeks.
CYCLOPS DENSITY
% CYLOPS DENSITY
8.4 DISCUSSION
The observations reported here seem to be applicable in the control 
of dracunculiasis in the tropicaL areas. In most of these areas the ponds 
are seasonal, with excess water in rainy season which gradually recede and
finally dry up. ............................................................^
This present study has shown that certain fishes are efficient 
biological control agents of the vector of dracunculiasis. Earlier on 
successful field experiment using small fishes (Gambusia, and Barbus 
species and Rasbora domiconius'l reported in India by Moorthy and Sweet 
(1936) and Gideon (1942) agree with the present findings. This is 
significant in the sense that fo: '' " ' "  11 * has been a report of
indigenous species of fishes biological agents of
cyclopoid copepods in Nigeria.
This method of using biological control agents if employed, may 
save money for the country. Of all the species of fish used in this 
experiment, Barbus occidentalis was the most enduring fish, followed by 
Tilapia nilotica and T. galilea as they were able to withstand the adverse 
laboratory conditions which left Hemicromis fasciatus dead within 4 days. 
Despite the inadequate facility for aeration in the course of the experiment 
Barbus and Tilapia species survived as long as the experiments lasted; and 
even beyond. This is an indication that these small fishes would be 
invaluable tools in the biological control of Cyclops in the field where the 
conditions are more natural. Hemicromis fasciatus. though a vet} 
voracious predator of Cyclops could not be regarded as a good
experimental model animal as it could not withstand the laboratory stress. 
Besides, it was discovered that the fish did not only prey on cyclopoid 
copepods but predated also on the other small fishes like Tilapia species 
within the same enclosure, a situation that does not augur well for the 
other mates that are expected to be more efficient biocontrol agents.
Tilapia fish could be safely regarded as the most reliable of the 
indigenous fish as it is found to be naturally occuring in most ponds in 
villages South Western Nigeria. The fish could also endure to a large 
extent the adverse conditions occasioned by dry season. It has also been 
demonstrated that the presence of alternate food supply in the ecosystem 
had very little negative effect on the predating ability of Barbus and Tilapia 
fishes on cyclopoid copepods. This further supports the adoption of fish as 
biological control agents of cyclops.
Although field trials have not yet been undertaken, the prospect is 
very bright. It was discovered from an unpublished observation that those 
ponds in which fishes were more preponderant had lower density of 
cyclopoid copepods than others in some villages South Western part of 
the country. In addition, it was observed that the level of acceptability of 
presence of fishes in drinking water supply is very high among all the 
household heads interviewed ( Adeyeba, 1989 - unpublished observation). 
Infact the fishes are given maximum protection possible by the villagers. 
It is a general belief of Yoruba people that the presence of fishes in pond 
water meant for drinking is an indicator or index of water fit for drinking. 
The water is deemed to be free of all undesirable elements such as poison,
14 5
etc. In addition, fishing activity in the pond is strictly forbidden because of 
the belief that the pond might dry up as a result.
Although certain fishes had been recommended for biological 
control in India (Moorthy and Sweet, 1936; Gideon, 1942), it is believed 
that this report has made a landmark in the search for new biological 
control agents of vector of dracunculiasis in Nigeria. Therefore, during 
this hard time of economic recession in the country, indigenous 
biocontrol agents like fishes could be adopted as an alternative to the 
expensive imported chemical used for water treatments in the country.
146
CHAPTER NINE
CONCLUSION
A
Dracunculiasis is the only communicable desease that is transmitted 
exclusively by contaminated drinking water. It is easy to prevent. Despite 
the fact that the disease is a serious impediment to development with 
severe impact on health, agricultural production and school attendance, 
until recently it has not received any serious attention by the various 
levels and succeeding governments in the country. Majority of the 
victims of the disease reside in remote and seemingly neglected rural 
communities where basic amenities like safe water supply are absent.
In recent years, efforts have been increased in the global attempt to 
control dracunculiasis as a result of the advent of the International 
Drinking Water Supply and Sanitation Decade (IDWSSD) (1981 - 1990). 
Barely a year to 1990, the end of IDWSSD this study shows that the impact 
of its activities is yet to be felt in the study area where a prevalence rate of
47.7 per cent was recorded in 1988. Although, demographic variables like 
sex or religions had no differential bearing on infection rate, infection 
rates increased with age. Worm burden and risk infection are very 
important parameters that suggest that the study area is endemic for 
dracunculiasis. The rural dwellers of the State had been victims of the 
infection for many years. It is apparent that the infection occurs at any age 
above one year and reinfection is not uncommon indicating that on
clinical groups no protective immunity is developed after an infection just 
like any other helminthic diseases.
Basically, this study showed that the level of awareness of the 
danger inherent in drinking untreated water is very low in the study area. 
Where the poeple are aware of the danger, they are not able to do anything 
about it. This is demonstrated in the lackadaisical attitude to water 
treatment before drinking. Over 68 per cent of the househeads did not 
treat their water before drinking while 6.5 per cent treated their water at all 
times by either boiling or adding alum. This study has shown that mere 
addition of alum to drinking water at the concentration used by 
individuals had no lethal effect on the cyclops. The taste of water becomes 
objectionable and unbearable when a lethal dose of alum is added to the 
water and so such dosage is never used by the people. Therefore, an 
individual who drank such water that is not properly treated is still at risk 
of infection. The populace is also at the risk of other water borne diseases 
like gastro-enteritis, typhoid fever and schistosomiasis. The problem is 
further heightened by the wrong perception of the causes and prevention 
of the disease and might probably account for the high prevalence rate of 
the disease in the study area.
Since bacteria were isolated from ulcers of varying degree of 
morbidity, it is concluded that bacteria play an important role in secondary 
guinea worm infection. The phage types of the coagulase positive 
staphylococcus strains, the most common bacterial agents, are commonly 
resistant to penicillin and tetracyclines. Therefore, both penicillin and
148
tetracycline based drugs are most unhelpful in case treatment of secondary 
guinea worm ulcers. This study shows that the drug of choice for case 
treatment include amikacin, oxacillin, fusidic acid and erythromycin.
Concurrent parasitic diseases like ascariasis, hookworm diseases, 
strongyloidiasis, trichuriasis and malaria have been shown to contribute
more to the health problem of the victims. This study has confirmed that
malaria and hookworm disease have contributec w haematocrit
values (anaemia), that plagued infected individuals in the study area.
It was observed during this study that conducive conditions 
naturally exist in ponds located under tree shades for Cyclops to breed and 
transmit guinea worm. However, when these conditions were 
manipulated from the natural estate, they become lethal to Cyclops 
existence. Factors which effect the density of the Cyclops include pond 
water level which is greatly influenced by the season of the year. The 
populace is at great risk when water is drawn from still and undisturbed 
pond during which time there is high concentration of Cyclops. This 
meant that early callers at the pond stand more risk of infection as more 
Cyclops would be collected in the water meant for drinking.
The population mobility of the people occassioned by such socio­
cultural economic ventures as marriage, periodic market, village/street 
trading, festivals, schooling holidaying or even search for water appear to 
be principal factors affecting the disease diffusion.
Various chemicals such as potassium permanganate, lime, 
perchlorite, copper sulphate, rocks salt, and bleaching powder were shown
to be cyclopscidal when used in correct dosage/concentration and so are 
recommended to individual household for prevention.
In view of the identification of some indigenous fishes like 
Hemicromis occidentalis. Barbus fasciatus, Tilapia nilotica and T. galilea as 
biological control agents of dracunculiasis, it would be commendable to 
rear such fishes in the village ponds with the additional advantage of 
providing protein supplement to the community and individuals.
In the light of the above, it is quite certain that the disease can be 
controlled and indeed eradicated within a reasonable time scale. It is 
obvious that the combination of health education and epidemiological 
surveillance are essential components of any strategy to eradicate the 
disease. Therefore, there are essentially three basic options which can be 
followed to control or eliminate the disease: preventive measures, case 
treatment, vector control based on chemical treatment of drinking water, 
and use of biocontrol agents, development of protected and safe sources of
water. <5
In order to achieve the set goals, it would be desirable to incorporate 
guinea worm control programme into special programmes of the Federal 
Government, such as MAMSER, Better Life for Rural Women, and 
Directorate for Food, Road and Rural Infrastructures ( DFRRI ) in addition 
to the services being provided by Water Corporation, and Health 
Education Unit of the Ministry of Health.
1 5 0
REFERENCES
Abolarin, M O. (1981): Guine worm infection in Nigeria villaae. Tropical 
and Geographical Medicine, 23: 83-88.
Adegoke, G . O. (1984): Characterisation of Staphylococci isolated from 
man and animals in Nigeria. Ph.D. Thesis, University of 
Ibadan, p. 163. . N X
Adegoke, G . O. and Adeyeba, O. A . (1986): Antibiogram and Phage types 
of S. aureus isolated from man and animals. African Tournal 
of Applied micrQbiplogy.(in press).
Adekolu-John, E. O . (1983): The impact of Lake creation on Guinea worm 
transmission in Nigeria on the Eastern side of Kainji Lake,
International Tournal of Parasitology 13: 472 - 452.
Adeyeba, O. A. and Dipeolu, O. O. (1984): A survey of gastrointestinal
parasi in a Local Government Area of South Western
Nigeria. International Tournal of Zoonoses. 11: 105 - 110.
Adeyeba, (1985a): Secondary infections in dracunculiasis: Bacteria
ind morbidity: International Tournal of Zoonoses. 12: 147 - 
^  149.
Adeyeba, O. A. (1985b): Hyperproteniaemia in dracunculiasis.
International lournal of Zoonoses. 12: 150.
Adeyeba, O. A. (1986): Studies in Dracunculiasis in Western Nigeria. M. 
Phill. Thesis. University of Ibadan.
Adeyeba, O. A. and Kale, O. O. (1988): Epidemiology of dracunculiasis and 
its Social Economic Impact in a Village in South-West 
Nigeria. West African Tournal of Medicine ( In Press) .
American Public Health Association: 14th Edition (1976) Standard Method 
for the Examination of Water and Waste Water. 
Washington D. C.
Anon (1983): Opportunities for Control of Draiccunculiasis Report of
Workshop. National Academy Press, Washington D. C.
Ansari, A. R. and Nasir, A. S. (1963): A survey of Guinea worm Disease in 
the Sind Desert (Tharparkar District) of West Pakistan. 
Pakistan lournal of Health 13: 152 - 167.
Asheshov, E. H. (1966): Chromosomal Location of the Genetic elements 
controlling Penicillinase Production in a Strain of 
Staphylococcus arueus. Nature 210: 802 - 804.
Barnett, S. A. (1955): "Displacement” Behaviour and "Psychosomatic" 
Disorder: Lancet. 2,1203.
Bartet, A. J. A. L, (1909): "Le Dragonneau (Ver de Guinee Filaire de
Medine)" A. Maloine, Paris.
Bauer ., Sherris, W. M. M.; Sherris, J. C. and Turck, M. (1966):
Antibiotic susceptibility testing by a standardise single disc 
method. Acta of American Tournal of Clinical Pathology. 493 
-496.
Belcher, D. W.; Wurapa, F. K.; Ward, W. B.; and Lourie, I. M. (1975): 
Guinea worm in Southern Ghana; Its Epidemiology and
1 5 2
impact on agricultural productivity. American Tournal of 
Tropical Medicine and Hygiene. 24. (2): 243 - 249.
Belcher, D. W. (1982): Opportunity for Control of Dracunculiasis 
transmission and epidemiology. Contributed paper to 
Workshop on Opportunity for Control of Dracunculiasis, p. 1 
- 9. National Academy Press, Washington . C. 1985.
Boyce, J . M. ; Laudry, M. ; T. R. and Dupout, H. L. (1981): Epidemiological 
Studies of an Outbreak of Nosocomia (Methicillin Resistant 
Staphyiococus aureus) infections. Infect Control 110 -116.
Blacklock, B. and O. 'Farrell, W. R. (1919): Note on a case of Multiple 
Infection by Dracunculus medinensis Annals of Tropical 
Medicine and Parasitology 13 .189 - 194.
Blair, J. E. and Williams, R. E. O. (1961): Phage Typing of Staphylococcus, 
Bulleting of World Health Organisation, 771 - 884.
Brieger, W. R.; Ramakrishna, J. and Adpovi, S. U. (1985): Selecting 
alternative strategies for community health education in 
0^uineaworm control. Conference Proceedings of First lational Conference on dracunculiasis in Nigeria. P. 82 - 88. 
Brug, S. L. (1 9;30): Dracunculus medinensis in the Dutch East Indies. 
Mededeel Dienst, Volksgezondheid Nederl Indie, 19: 153 - 
157.
Bueding E. and Oliver-Gonzalez, J. (1950): Aerobic and anaerobic 
production of lactic acid by the filarial worm, Dracunculus
insignis British Journal of Pharmacology and Chemotherapy.
5, 62 - 64.
Carayon, A.; Camain, R.; Guirand, R. and Havret, P. (1961): Aspects 
Chirurgicaux des helminthiasis en Afrique de louest 
(ascaridiose, dracunculose, Filariose, bilharziose) 11. 
Pathologie de migrations habituelles, aberrantes on 
manquees de la filaire de medine (A propose de 25 
localisations chirurgicales) Medicine Tropicale 21. 538 - 549.
Charles, R. H. (1892): "A contribution on the life history of the Male Filaria 
m edineusis removed from abdominal cavity of man." 
Scientific Memoirs by medical officers of the army of India, 
Calcutta (quoted by Mirza, 1929).
Chitale, P. K. (1912): Observations on three hundred cases of guineaworm, 
Indian Medical Gazzet. 47: 318 - 320.
Cowan, S . T. and Steel, K. J. (1974): In : Manual for the identification of 
medical bacteria. 3rd edition, University Press Cambridge. 
Cruickshank^R.; Duguid, J. P.; Marmion, B. P. and Swain, R. H. A. (1975): 
i: Medical Microbiology. The practice of medical 
licrobiology, 12th Edition. Churchill, Livingstone.
Dac:iiee, J, V. and Lewis, S. M. (1977): In: Practical Haematology", 5th Edition, 
Churchill, Livingstone, p. 39 - 40.
Daniel, S. Ola and Osisanya, J. O. S. (1986): Dracunculiasis in Sub-Saharan 
Zone, Sokoto State Nigeria. Proceedings of First National 
Conference on Dracunculiasis in Nigeria, p. 77 - 81.
154
Datta, S. P.; Stanislas, L. and Veeraraghavan, M. (1964): Dracontiasis in 
Pondicherry Settlement. Bull Indian Soc. Mai. I: 11 -18.
Davis, J. L. (1931): A note on some experiments with agents Lethal to 
Cyclops. Transactions of the Royal Society of Tropical 
Medicine and Hygiene, 24. 631 - 633.
Dipeolu, O. O. (1983): Studies on aids of efficient diagnosis of strongyle 
infection in Ruminant in Nigeria and investigations on 
suitable preservations for helminth eggs in tropical 
environment. Bulleting of Animal Health and Production. 
31
Duke, J. (1895): Notes on the symptoms of Filaria m edinensis or 
guineaworm. Indian Medical Gazzet. 30: 64 - 65.
Dyke, K. G. H. and Richmond, M. H. (1967): Occurrence of various types of 
penicillinase phasmid among a hospital staphyloeoccus. L 
Clin.,F.ath.Qh2fl: 75-79.
Dyke, K. G. H.; Jevons, M. P, and Parker, M. T. (1960): Penicillinase and 
intrinsic resistance to penicillins in Staphylococcus aureus 
lancet I: 835-838.
Edungbola, L. D. (1983): Babana Parasitic Diseases Project II. Prevalence
and impact of dracontiasis in Babana District Kwara State 
Nigeria. Trans. Roy. Soc. Trop. Med. Hvg. 77(3): 310 - 315.
Edungbola, L. D. and Watts, S. J. (1984): An outbreak of dracunculiasis in a 
peri-urban community of llorin, Kwara State, Nigeria. Acta 
Tropica 4L 155 - 163.
Edungbola, L. D. and Watts, S. J. (1985): Epidemiological assessment of the 
distribution and endemicity of guineaworm infection in Asa, 
Kwara State, Nigeria, Trop. Geog. Med. 37: 22 - 28.
Edugbola, L. D. Watts, S.J.; Alabi, T. O. and Bello, A.B. (1988): The Impact 
of a UNICEF - assisted rural water project on the prevalence 
of guineaworm disease in Asa, Kwara State,. Nigeria . Am. T. 
Trop. Med. Hvg. 39(1): 79 -85. ( f y
Ejezie, G. C. (1981): The parasitic diseases of school children in Lagos State, 
Nigeria. Acta. Tropica 32; 79 - 84.
Fasan, P. O. (1969): Malaria in the school of Lagos City. Lagos State. West 
African Medical Tournal. 1 8 ,176 - 180.
Fairley, N. H. (1924): Studies in dracontiasis, IV: The clinical picture - 
analysis of 140 cases. Indian Tournal of Medical Research, 12, 
351 - 367.
Fairley, N. H. and Liston, W. G. (1924): Studies in the pathology of 
dracontiasis. Indian Tournal of Medical Research. 11. 915 -
Fryer, G. (1957): The Food of some fresh water cyclopoid copepods and its 
ecological significance. Tournal of Animal Ecology. 26. 236 - 
263.
Gemade, E. I. and Dipeolu, O. O. (1983): Prevalence of Castro Intestinal
parasites and urinary schistosomiasis in Benue State of 
Nigeria. International Tournal of Zoonoses, 10: 53 - 58.
Gideon, P. W. (1942): Experiments in the control of guineaworm 
infections in step wells by means of carnivorous fish, Rasbora 
doniconius and chlorogen (abstract). Proceedings of 28th 
Indian Science Congress, p. 225.
Gretillat, S. (1965): Le dimethyldithiocarbanate de zinc dans la prophylaxie 
de la dracuncuiose. Med. Afrique Noire. Dakar 12: 93 - 96.
Hoeppli, R. (1959): In "Parasites and parasitic infection in early medicine 
and science." University of Malaya Press.
Hodgson, C. and Barret, D. F. (1964): Chronic Dracunculosis British 
Journal pf Dermatology, 7&. 211 - 217.
Hopkins, D. B. (1982): "Guineaworm disease - a chance of eradication?" 
World Health Forum 3(4): 434 - 435.
Hopkins, D. R. (1987): Dracunculiasis eradication: a mid-decade status
report. Am. T. Trop. Med. Hvg. 37(1): 115-118.
Hopkins, D. R. (1988): Dracunculiasis eradication: the tide has turned. 
Lancet 2 (8603); 148 - 150.
llegbodu, V.A.; Kale, O. O.; Wise, R. A.; Christensen, B. L.; Steele, J. H.; Jr.
Chambers, L. A. (1986): Impact of guineaworm disease 
on children in Nigeria. Am. I. Trop. Med. Hyg. 35: 962 - 964 
Kale, O. O. (1977): The Clinico-epidemiological profile of guineaworm in
the Ibadan District of Nigeria. American lournal of Medicine 
and Hygiene. 208 - 214.
Kale, O. O. (1982): "Fall in incidence of guineaworm infection in Western 
Nigeria after periodic treatment of infected persons." Bull- 
World Health Ore. 60. 951 - 957.
Khanna, P.; Sarraswat, N. (1985): Lair of the guinea worm World Water:
31 - 32.
Kiefer, F. (1981): Beitrag Zur Kenntnis von Morphologic, Taxonomie and 
Geographischer Verbreitung Von Mesocvclops leuckarti
auctorum. Archiv fur Hydrobiologie, S>uppll-.  £62. 148 - 190.
Kryaski, S. and E. Becla (1981): Staphylococus aureus strains isolated in 
poland. ZbI. Bakt, Mikrobiol. Hygl Abt. Supply. 925-929.
Laws, E. R.; Sedhak, V, A.; Miles, J.W.; Jeseph, C. R.; Lacomba, J. R.; Dias 
Rivera, A. (1968): Field study of the safety of Abate for 
treating potable water and observations on the effectiveness 
of a control programme involving both Abate and 
Malathion. Bull. Wrld. Hlth. Org.. 38: 439 - 445.
Lawrie, J. (1987): Paraplegia complicating dracontiasis (letter) T. R. Coll. 
Surg. Edinb. 32(4): 259- 260.
Leiper, R. T. (1906): Some results of the infection of monkeys with 
guineaworm. Rep. Br. Ass. Adv. Sci. 76: 600.
Leiper, R. T. (1907): The etiology and prophylaxis of dracontiasis. Br. Med. 
l b  129 - 132.
Lidberg, K. (1946): Enquete epidemioligique sur les dracunculose dans un
village du Deccan (Inde) Bull. Soc. Path. Exot. 29. 303 - 318.
Lorian, V. (1980): Antibiotics in Laboratory medicine, Williams and 
Wilkin Baltimore.
Lyons, G. R. L. (1972): Guinea worm in the WA District of North West 
Ghana. Bull. Wrld HIth Org. 47: 601 - 610.
Marsden, P. O. (1960): Clinical trials with Entamide Furorate, piperazine 
sulphate and emetine bismulth iodide. Trans. Rov. Soc. Trop. 
Med. Hvg. 5414): 396 - 399.
Manson-Bajr. P. (1966): In: Manson's Tropical Diseases, 6th Ed. Bailliere 
Tindall and Cassel London, p. 712.
McCullough, P. S. (1982): Cyclopid copepods: Their role in the 
transmission and control of dracunculiasis: in Opportunities 
for Control of dracunculiasis. Report of Workshop, 
Washington D. C., 46 - 49.
Mirza, M. B. (1929): Beitroige zur Kenntms des Baues Von Dracunculus 
medinensis. Velsch Z . Parasitenkde 2 129 - 156.
Moorthy, V. M. (1932a): An epidemiological and experimental study of 
da raconit iasis in Ochitaldrug district. Indian Medical Gazett. 
£ :  498■ -504.
Moorthy, V. M. (1932b): Treatment and prophylaxis of dracontiasis.
Indian Medical Gazett. 6 617 - 619.
Moorthy, V. M. (1937): A redescription of Dracunculus medineusis
Tournal of Parasitology: 23, 220 - 224.
1 5 9
Moorthy, V. M. (1938): Observations on the development of Dracunculus 
medinensis larvae in cyclops. American Tournal of Hygiene. 
27: 437-460.
Moorthy, V. M. and Sweet, W. C. (1936a): A bioogical method for control 
of Dracontiasis. Indian Medical Gazzet. 71: 565-568.
Moorthy, V. N. and Sweet W. C. (1936b): Guineaworm infection of cyclops 
in nature. Indian Medical Gazzet, 71: 568 - 570.
Moorthy, V. N. and Sweet, W. C. (1938): Further notes on the 
experimental infection of dogs with dracontiasis. American 
Tournal of Hvgiene, 27, 301.
Muller, R. (1970a): Laboratory experiments on the control of cyclops, 
transmitting Dracunculus. Bull. Wrld. Hlth. Org. 42: 563 - 
567.
Muller, R. (1970b): In "Disease&s of Children in the sub-tropics and tropics" 
2nd Ed. (D. B. Jelliffe ed.). p. 893 - 898. Edward Arnold, 
London.
Muller, R .^(1970c): Egg Division in Dracunculus medinensis 
(demonstration) Trans. Rov. Soc. Trop. Med. Hvg. 64. 473.
M u lle r ^ ^  (1971): D racunculus and dracunculiasis Advances in 
Parasitology. 73 - 151.
Muller, R. (1975): In "Worms and Diseases" A manual of medical 
Helminthology, p. 68 - 85, Heinemann.
Muller, R. (1979): Guineaworm Desease: Epidemiology, control and 
treatment. Bulletin of World Health Organisation, 5Z(5): 683 
-689.
Muller, R.; Ellis, D. S. and Bird, R. G. (1970): Election Microscope studies of 
the phasmids in D racunculus m edinensis hla rvae
(Demonstration). Trans . Roy. Soc. Trop. Med. Hyg . 64- 24.
Nugent, D. A. W.; Scott, D. and Waddy, B. B. (1955): Effect of water point 
treatment.with DDT on the incidence of guineaworm 
infection. Trans. Roy. Soc. Trop. Med. Hvg. 49: 476.
Nwosu, A. B. C.; Ifezulike, E. O. and Anya, A. O. (1982): Endemic 
dracontiasis in Anambra State of Nigeria: Geographical
distribution, clinic ures, epidemiology and socio­
economic impact of the disease. Annal of Tropical Medicine 
and Parasitology. 76:187 - 200.
Okpala, I. (1975): The incidence of malaria in school children in Western 
and East Central States of Nigeria. Paper Read at the 
Scientific Conference on Malaria in Nigeria, p. 27 - 28.
Olajide, I; Sridhar, M. K. C,; Kale, O. O. (1987): Guineaworm control in an 
endemic area in Western Nigeria. Aqua. 6: 333 - 339.
Onabamiro, S. D, (1952): The Geographical distribution and clinical feature 
of Dracunculus medinensis in South-west Nigeria. W es t 
African Medical lournal. 1: 159.
Onabamiro, S. D. (1954): The diurnal migration of cyclops infected with 
the larvae of D racunculus medinensis ( Linnaeus), with
some observations on the development of the larval worms. 
W . Afr. Med. I.. 3: 189 194.
Osoba, A. O. and Oyediran, A. B. (1977): Guinea worm and inguinal 
adenopathy. British lournal of Venereal Disease, 53: 63 - 64.
Peyru, G.; Wexler, L. F. and Novick, R. P. (1969): Naturally occuring 
penicillinase phasmids in $. aureus. T. Bacteriology, 98: 215 - 
! ! i
Poole, P. M. and Bacher, J. R. (1966): An outbreak of infection due to 
Staphylococcus aureus phage type 80/81 in a Veterinary 
School Bull. Min. Hlth fU. K. ). 116-123.
Position, S. M (1966): Cellular location of the genes controlling 
penicillinase production and resistance to Streptomycin and 
Tetracycline in a strain of S. aureus. Nature 210: 802 - 804.
Pradhan, Y. M. (1930): Observations on experiment designed to combat 
dracontiasis in an endemi area by Col. Morision's Method of 
"liming wells". Indian 1. Med. Res.. 18 443-465.
Patnaik, K, C. and Kapoor, P. M. (1967): Incidence and endemicitv of 
guineaworm in India. Indian T. Med. Res.. 55, 1231-1242
Protherto, R. M. (1977): Disease and Morbidity a neglected factor in 
epidemiology. Int. T. Epid 6: 259.
Raffier, G. (1965): .Note Preliminaire sur l'activite du CIBA 32644 Ba dans 
la dracunculose Acta Tropica 22 350.
Raffier, G. (1966): Preliminary note on the activity of a new antihelminthic 
agent in dracunculosis. Med. Trop.. 26: 29-46.
6 2
Raffier, G. (1969a): Efficiency of thiabendazole in the treatment of 
dracunculiasis. Texas Report on Biology and Medicine, 27 
(Suppl. 2) 601 - 609.
Raffier, G. (1969b): Activity of Niridazole in dracontiasis Ami . N. Y. Acad.
Sci.. 160: 720 - 28.
5 - _
Ramakrishnan, N. R. and Rathnaswamy, G. A. (1953): Use of DDT for 
control of cylops breeding and as an anti-dracontiasis 
measure. Indian Med. Gaz. 88: 386 - 3908. ?
Ramsay, G. W. St. C. (1935): Observation on intradermal test for 
dracontiasis. Trans. Rov. Soc. Trop. Med. Hg. 28: 399-404.
Rao, C. K. Paul, R. O.; Sharma, M. D. and Sharad Kumar (1981): 
Guineaworm disease in India: Current status and strategy of 
its eradication. I. Comm. Pis. (Delhi) 13: 1 -7 .
Reddy, C. R. R. M.; Narasaiah, I, L. and Parvathi, G. (1969): Epidemioogical 
studies on guineaworm infection. Bull. Wrld. Org.. 40. 521 - 
529.
Reddy, C. R. Prasautha Murthy, D. sita Devi, C. Lakshmi, S. and
Sivaramappa, M. (1970): Pathology of acute guineaworm 
synovitis. 1. Trop. Med. Hvg.. 73: 28 - 32.
Roubard, E. '(1913): Observation sur la biologie du verde Gurnee infection 
intestinale des cyclops. Bull. Soc. Path. Exot. 6: 281 - 288.
Riddle, D. S. and Hawgood, B. C. (1956): Conservative and quantitative
methods for ova and larval stages of helminths. I. Clin. 
Path.. 9; 74.
63
Sawai, T.; Mitsuhashi. S. and Yamagishi, S. (1968): Comparison of the 
chromosomal and extrachromosomal genetic determinants 
controlling staphylococcal penicillinase production. Tapan I. 
Microbiol. 12: 521 - 533.
Schneider, J. (1964): Probleme diagnostique et therapeutique de medecine 
tropicale daus la pratique medicale courante en France. Bull. 
Soc. Path. Exot. 57: 669 - 715. ^  ...................
Scott, D. (1960): An epidemiological note on guineaworm infection in 
north-west Ashanti, Ghana. Ann. Trop. Med, Parasit.. 54: 32 - 
43
Singh, J.; Raghavan, K. C. S. (1952): Dracontiasis in: Public health 
importance and control. Bull. Nat. Soc. Ind. Mai. Mosq. Pis.. 
5 :141 - 160.
Simmons, J. S.; Whayne, T. F.; Anderson, G. W. and Horack, H. M. (1951): 
In "Global epidemiology" Vol. 2, Lippineott, Philadelphia.
Smith, J. T.; Hamilton-Miler, J. M. T. and Knox (1969): Bacterial resistance 
to penicilline and cephalosporins. J. Pharm. Pharmacol, 21: 
337 - 358.
Southwell, T. and Kirshner, A. (1938): Some observations on guineaworm 
larvae. Ann Trop. Med. Parasit. 32: 193-196.
Sridhar, M. K. C.; Kale, O, O.; Adeniyi, J. D. (1985): A simple method and
filter to reduce guineaworm disease in Nigeria. VVaterlines. 
4 :16-19.
Sridhar, M. K. C.; Kale, O. O. (1985): Some observations on the control of
guineaworm in Oyo State. Proceedings of the First National 
Conference on Dracunculiasis in Nigeria. 136 - 140.
Steel, R. D. and Torrie, J. H. (1960): Principle and Procedure of statistics 
with special reference to biological science. McGraw-Flill 
Book Co., Inc. New York, pp. 106 - 107.
Steib, K. and Meyer, P. (1988): Epidemiology and vectors of Dracunculus 
medinaisis in northwest Burkina Faso, West Africa. Ann. 
Trop. Med. Parasit. 82(2): 189 - 199.
Stoll, N. R. (1947): This wormy world. I. Parasit. 22: 1 -18.
Tinbergen, N.(1953): The herring Guell's world, London: Collins.
Turkhud, O. A. (1919): Prophylaxis of Dracontiasis. India I. Med. Res.. 6:
217 - 225.
LJdonsi, J. K. (1987a): Draco^n^tiasis in Igwum River Basin, Nigeria: Its 
distribution, epidemiologgy and transmission dynamics. 
Trop. Med. Parasitol, 38(4) 304 - 308. •
Udonsi, J. (1987b): Control of endemic dracontiasis by provision of 
wai«ter supply in rural communities of Imo State, Nigeria. 
Public Health. 101 63 - 90.
Usanga, E. A. (1989): Iron status of Nigeria in health and disease. A paper 
presented at the 14th Annual Scientific Conference of 
Association of Medical Laboratory Scientists of Nigeria at 
University of Benin, October, 11 - 14th.
16 5
Velschius, G. H. (1674): "Exercitationes de vena medinensis et de 
vermiculis capillaribus infantium." Augsburgh.
Van De Velde, I . (1984): Revision of the African species of the genus 
Mesocyclops SARS, 1914 (Copepoda: Cyclopidae), 
Hvdrobiologia.
Watts, S. J. (1984a): Marriage migration, a neglected form of long term 
mobility; a Case Study from llorin, Nigeria. International 
Migration Rev . 17: 682 - 698.
Watts, S. J. (1984b): Population Mobility, urban development and 
dracunculiasis in Kwara State, Nigeria. Soc. Sci. Med.. 19: 471 
-472.
Watts, S. J. (1986): Human Behaviour and disease control: The 
implication of population mobility for the control of 
dracunculiasis. Conference proceedings of First National 
Conference on dracunculiasis in Nigeria, p. 97.
Watts Susan J. (1987)S Dracunculiasis in Africa in 1986: Its geographic 
^extent, incidence, and at risk population. Am. I. Trop. Med. 
Hvg. 2Z(1): 119-125.
Ward, W. B. (1982): The Impact of dracunculiasis on the household: The 
challenge of measurements. Paper Presented at Workshop 
on Opportunites for control of Dracunculiasis, National 
Research Council, Washington, D. C. (June 16 - 19).
World Health Organisation (1967): Control of Ascariasia, WHO, Technical 
Report Series, No. 379.
World Health Organisation (1975): Ecology and control of vector in Public 
Health. WHO Technical Report Series, No. 561.
World Health Organisation (1983): Dracunculiasis Surveillance. Wklv. 
Epidem. Rec. 58(4): 21 - 23.
World Health Organisation (1986): Dracunculiasis in Africa. Final Report 
on Workshop held in Niamey, Niger, 1 - 3 .
APPENDIX 3.1
EPIDEMIOLOGICAL STUDIES ON DRACUNCULIASIS - 
QUESTIONNAIRE
PERSONAL DATA
Name................................................................. v .................................
Address...................................................................................................
A ge..........................................................................................................
Sex 52
Household size
Religion................
Occupation...........
Period of Residency in the Area
HISTO)RY OF INFECTION
(Indicate with 'YES' or 'NO' with respect to the 9 and 10).
1 am currently infected with guinea worm (YES/NO).
I have been previously infected with guinea worm (YES/NO). 
How many times have you been infected before......................
1 6 8
12. Indicate the sites on your body where the worms are Emerging:
(a) Head and neck region ( )
(b) Back and abdomenal region 
(c) Arm and hand 
(d) Buttock
(e) Scrota or vulral areas 
(0 Thigh 
(g) Knee 
' 0 ^ -
(h ) Leg 
(i) Foot
>
13. What season of the year do you notice an infection?
(a) Any season ( )
(b) Wet season ( )
(c) All season Cr< >
14. Did you feel any sign before the emergence of the worms ( Yes /  No)
15. If ’Yes' in (14), for how many days?.........................
16. State whether or not you experienced the following sympoms:
(a) Feeling of movement of worms around the body (Yes/No)
(b) Feeling queer all over (Yes/No)
(c) Sudden fever and high temperature (Yes/No)
(d) Loss of appetite and sleep (Yes/No)
(e) Generalised urticarial rash later localised (Yes/No) 
<0 Painful blister (Yes /  No)
17. How long have you been incapacitated ( in weeks)
6 9
18. State the degree of incapacitation: tick appropriately.
(a) Mild - mobile but suffers little or no discomfort. ( )
(b) Moderate: mobile but suffers considerable discomfort. ( )
(c) Severe: immobile or is unable to use the affected part and
suffers considerable discomfort. ( )
19. What is your average monthly earnings from the proceeds of you r
occupation ? ......... . ...................................  &
20. Who assisted you to look after your business during your absence ?
(a) Relatives ( ) (c) Labourer ( )
(b) Children ( ) (d) Nobody ( )
21. If labourers are engaged, how much do you pay per day?
22. Is the service of the labour ers/children prompt? 
(Yes/No/ Not Always)
170
EPIDEMIOLOGICAL STUDIES ON DRACUNCULIASIS - 
QUESTIONNAIRE 11
FOR HOUSEHOLD HEADS ONLY
A. Express your candid opinion about the following by ticking 
appropriately in terms of agreement or disagreement. Guinea
worm is caused by/or acquired through the following:
Agree/Disagree
■ /
(a) Evil spirit ............
(b) An act of God ...........
(c) The work of the e nemy ...........
(d) Heredity ..........
(e) Drinking bad water 
(f) Poorly cooked vegetable/food 
(g) Contact with an infected person
B. Guinea worm can be prevented by doing the following:
Agree/Disagree
(a) Performing rituals 
(b) Offering prayer to God 
(c) Running away from a victim 
(d) Using a protective medicine 
(e) No remedy
C Water utilization - indicate with Yes or No
(a) I drink from a village pond (Yes/No)
(b) I drink from a well (Yes/No)
(c) I drink pipe-borne water (Yes/No)
( d ) I drink from pond while working on the farm (Yes/No)
(e) I drink boiled water (Yes/No)
(0 I drink filtered water (Yes/No)
(g) Alum is added to the water I drink (Yes/No)
( h ) I always drink treated water (Yes/No)
I drink treated water sometimes (Yes/No)
I drink untreated water (Yes/No)
1 7 2
APPENDIX 6.1
MUREXIDE INDICATOR SOLUTION FOR CALCIUM
It is prepared by mixing 200 mg of murexide with lOOg of solid NaCI 
and grinding the mixture to 40 to 50 mesh. A pinch of it is added to the 
sample and titrated against standard EDTA till the indicator changed from 
pink to purple.
MIXED (BROMOCRESOL GREEN METHYL RED) INDICATOR
SOLUTION
Dissolve 20 mg methyl red and 100 mg bromocresol green in 100 ml 
95% ethyl alcohol or isopropyl alcohol.
AMMONIUM BUFFER SOLUTION PH 10.1
Dissolve 6.75g NH4CL in 500ml distilled water. Add 57ml Cone 
NH4OH and dilute to 1 litre with distilled water. Adjust PH to 1C 1 arc 
store in a poallvyethylene bottle.