Distribution and Incidence

In the 1980s and 1990s, Dracunculiasis is found mainly in India, in Pakistan, and in a band of 19 African countries between the Sahara Desert and the equator, from Senegal in the west to Ethiopia in the east (see Map VIII.38.1). Formerly this disease was much more widespread in the Middle East and Africa, and it occurred for some years in the Americas after it was introduced there by infected Africans during the slave trade.

In general, the incidence of dracunculiasis is significantly higher in endemic rural Africa communities than in endemic Asian villages. In West Africa especially, for example, rates of infection in affected areas often reach 20 to 40 percent, and sometimes exceed 50 percent, whereas in Asia, the rates usually are below 20 percent. In rural areas, the disease occurs sporadically, with adjacent villages sometimes differing greatly in the percentage of those infected. Susan Watts (1987), a medical geographer, has estimated that the number of persons at risk of this infection in Africa is about 120 million, with

Map VIII.38.1. Areas in which dracunculiasis is reported or probably exists.

another 20 million at risk in India and Pakistan, based on the assumption that everyone is at risk who is living in a rural district where a minimum of one case of dracunculiasis has occurred.

The number of persons affected annually by this infection is not known. Although diseases are often underreported in the countries affected, the reporting of dracunculiasis is especially poor because the infection generally is found only in impoverished rural communities where medical facilities are rare, and where many victims cannot walk and have little incentive to seek treatment because there is no drug that can cure the infection. The best estimate is that probably between 5 and 15 million persons contract dracunculiasis each year.

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