Clinical manifestations, disability and use of folk medicine in dracunculus infection in Nigeria

A cross-sectional survey of households was carried out in a dracunculiasis endemic village in Oyo state Nigeria. Data were collected on history of dracunculiasis, occupational and domestic sources of drinking water, clinical manifestations, disability, use of folk medicine, and incorporation of previous dracunculiasis control programmes. The findings indicated that dracunculiasis patients were usually unaware of their infection 3-5 days before the appearance of a bleb; that religious affiliation appeared to be positively related to increasing morbidity; and that ulcers were predominantly in the ankles and feet, particularly among young children. Severe disability was related to age, site and number of ulcers, and the form of selected treatment. Indigenous remedy was the treatment of choice, although traditional healers in the community indicated no knowledge of any efficacious remedy. Mortality from secondary tetanus infection was associated with outbreak of dracunculiasis. The impact of dracunculiasis on agricultural, economic and recreational activities was considerable, with the infected farmers being unable to attend to their farms at the critical farming period. Sixty-one per cent of the residents were opposed on religious and aesthetic grounds to the treatment of the local surface water which contained cyclops species. Sixty-three per cent regarded the boiling and filtration of portions of their domestic water as an additional burden, cumbersome and impracticable. This study suggests the following: the bulk of dracunculiasis goes untreated; folk medicine may pose a significant obstacle to the treatment, prevention, and control of dracunculiasis; local religious leaders may be important adjuncts for dracunculiasis control in endemic areas; due consideration should be given to the development of low-cost improved water supplies which involves the storage of rain-water, surface water, and the development of other water sources in the community.