What happened to Guinea worm control? An issue of water quality and health improvements

The prevailing emphasis in child survival programs excludes any integrated efforts in water and sanitation. The reason has been the widespread belief that selective primary health care is more cost-effective in lowering child mortality. Yet this is not the case. Studies have clearly shown that rural water projects are not only affordable, but that the community's active involvement in them stimulates greater participation in other child health activities. This article &scribes the debilitating effectsof guinea worm, a waterborne disease that is easily prevented through simple interventions to improve water quality, but nevertheless is allowed to disrupt all aspects of rural social and economic life through much of Africa and Asia. Studies in two Nigerian communities illustrate that the mothers afflicted were so thoroughly disabled and immobilized, over such long periods of time, that they were unable to care for themselves, their businesses, their homes, or even their children. Such incapacity is profoundly threatening to children because, in the study group, immunizations were missed, malarial and diarrheal episodes went untreated or improperly selftreated, breastfeeding became difficult, and food consumption dropped Because the mothers attacked by guinea worm cannotparticipatefully in child survival activities, policiesshould be redefined to include emphasis on clean, convenient water supplies.