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Businga – Salomon Kosoma, a fisherman and farmer in the north-west of the Democratic Republic of the Congo (DRC), is also a community mobilizer with a strong commitment to the prevention and control of Guinea-worm disease also known as dracunculiasis. In his fifties, Salomon decided to be part of the control effort when he realized the harmful health consequences of this neglected tropical disease. “I first heard about this disease during a polio vaccination campaign. That was in 2016,” explains Salomon. In Businga District and across the DRC, Guinea-worm disease control is integrated into broader community health initiatives.
After receiving initial information about the disease, Salomon gained additional knowledge through radio broadcasts detailing its symptoms, such as swollen feet and how to extract the worm, which can grow up to a meter long. Intrigued and concerned, Salomon decided to get involved in active case finding in his community, after completing a community health training course.
One day, in the course of his daily work as a community health volunteer, he encountered a man with a swollen leg and immediately took him to the health centre. Upon examination, it turned out to be a case of elephantiasis. “It wasn’t Guinea-worm disease. After receiving treatment, he was able to resume his life as a fisherman. I was very proud to have helped him.”
In the DRC, the elimination of guinea worm marks a major achievement in the prevention and control of neglected tropical diseases. In 2022, World Health Organization (WHO) certified the country as having eliminated the disease as a public health problem, a significant step toward achieving the 2030 Sustainable Development Goals.
Despite the achievement, DRC remains vulnerable to a resurgence of this parasitic disease due to frequent cross-border population movements with countries where transmission is still active and has passed from humans to animals. To mitigate this risk, WHO, with support from partners including the Carter Centre and CDC Atlanta, has strengthened post-elimination efforts that include active surveillance, particularly community-based monitoring system.
To permanently break the cycle of transmission, the Ministry of Health, with WHO’s support has trained over 500 community health volunteers to detect symptoms of the disease and raise public awareness. Thousands of posters have been displayed in hospitals and health centres, while local radio stations continue to broadcast targeted messages to reach isolated populations.
Milekana Maboki Bébé, a social mobilizer for the past 10 years in Businga, works with Salomon. “Every day, with the support of community mobilizers, I raise awareness in at-risk areas about good hygiene practices,” she says. “I am greatly encouraged by the community involvement in case finding and the adoption of simple actions, such as avoiding bathing in contaminated water.”
Nicknamed “Mpika” (hook), “Mutchopi” (earthworm) or “Nkusu ya Mulayi” (maggot), depending on the community, guinea worm disease mainly affects rural populations using stagnant water contaminated by water fleas carrying Guinea-worm larvae. The disease causes painful sores and inflammation of the joints, which can lead to disability. Its transmission peak coincides with the farming season, which also has repercussions on food production.
To encourage case reporting, a US$ 400 incentive was introduced in 2016 for confirmation of a suspected cases, increasing to US$ 1000 in 2021. The incentive is distributed as follows: US$ 250 each to the informant, nurse, health zone, and provincial health division (DPS). Since its introduction, suspected cases have been frequently reported within communities, though none have been laboratory-confirmed as positive.
“The commitment of Salomon and other community relays attests to the effectiveness of this incentive,” says Dr Renée Nsamba, epidemiologist in charge of neglected tropical diseases at the WHO Country Office in the DRC. “With rapid reporting of suspected cases, we are confident that we can respond quickly to a positive case.” One of the strategies implemented by the DRC to maintain its dracunculiasis-free status is the integrated approach. “Integrated surveillance, implemented during polio vaccination campaigns, enables us to reach a wider audience and also affords us the opportunity to address public health issues, such as active dracunculiasis case finding,” adds Dr Nsamba. “Community involvement remains crucial. It ensures the sustainability of initiatives.
In addition to community surveillance, the introduction of sustainable initiatives such as water supply, hygiene and sanitation measures, and the strengthening of cross-border surveillance, have been crucial. “We welcome all strategies that will preserve our elimination status,” says Dr Nkoy Mbilo Serge, Director of the National Dracunculiasis Eradication Programme (PNED). “If a drinking water source is suspected of being contaminated, it must be treated immediately,” he explains. “In addition, we continue to place a premium on intersectoral collaboration, integration with other programmes and strengthening the ‘One Health’ approach.”
In Businga, Salomon continues his community surveillance activities with the same resolve. “I will continue to search for cases throughout my province. By joining this effort, I am protecting myself, protecting the people around me and protecting my environment.”
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