Guinea Worm (GW) disease, also known as Dracunculiasis, is an infection that is caused by the parasite Dracunculus medinensis. GW disease affects poor communities in parts of Africa that do not have safe drinking water. Individuals become infected with the GW when drinking water from a pond or stagnant water that contains water fleas. These water fleas carry the GW larvae as the larvae are eaten by the water fleas. Once the individual drinks the contaminated water, the larvae are released in the stomach and will penetrate the digestive track into the body. Female larvae will grow into an adult (approximately 2 or 3 feet long), over a 10-14 months period. The female worm creates a blister on the skin of the body, and burst within 24-72 hours as the worm slowly emerges from the body. Individuals immerse their body parts into the water as it helps relieve pain. However, it also causes the GW to come out of the wound and release new larvae into the water, thus contaminating the water supply and continuing the cycle. Persons are not symptomatic for about a year after they are initially infected. Symptoms will develop a few days prior to the worm coming out of the skin and include fever, swelling and pain in the area. Individuals who have GW disease typically do not have health insurance or even access to health care. There is no drug treatment for GW disease and no vaccine. It can take days to remove the worm as it can only be removed a few centimeters per day, however, the worm can also be removed by a physician before the blister forms (CDC, 2015).
Globally, GW disease is considered by health officials to be a neglected tropical disease and is the first parasitic disease on the board to be eradicated. As of 2014, only four countries (Chad, Ethiopia, Mali, and South Sudan) had GW disease and agencies worldwide are helping them decrease active cases. GW disease can be avoided by drinking safe water. The citizens of these countries need to be educated about drinking water from protected sources, preventing individuals with GW disease from entering ponds that are used for drinking water. It is important to ensure citizens can filter drinking water from unsafe sources, treat unsafe sources with larvicides, and provide communities with new safe sources of water (CDC, 2015).
Ecological Model
The Ecological Model (EM) of health considers the social and physical environment determinants that affect health as well as how we respond to those determinants (Fielding, Teutsch, & Breslow, 2010). Furthermore, stating that models help with organizing thinking, establishing interventions, and measuring effectiveness. Fielding, Teutsch & Breslow (2010) provide a list of determinants that assemble the EM. Among these determinants are biological factors, individual behaviors, social, family and community networks, social and environmental conditions and policies. The EM is often referred to as the Social- EM (SEM). The concept of EM is based on the belief that no single factor is the cause of health issues and population health, but a variety of social and physical determinants are root causes of population health (Ruderman, 2013)
According to Fielding, Teutsch & Breslow (2010), the social and physical environmental elements that comprise the EM are among the following: biologic factors (such as genetics), individual behaviors (diets, tobacco use), social, family and community networks (social capital, schools), living and working conditions. The overall social, economic, political, and culture forces spanning from a global aspect to national, state, and local levels that focus on concerns such as climate control, Medical care systems, air pollution and discrimination.
The EM assists in identifying the social and physical environmental factors that contribute to an unhealthy community. Fielding, Teutsch & Breslow (2010), states that all sectors have to be engaged in creating healthier communities by addressing social and environmental issues that deter population health. According to John Hopkin Bloomberg School of Public Health (nd) the EM consist of (1) public policy (national, state, and local laws and regulations) (2) community (relationship between organizations), (3) organization, (4) interpersonal, networks that consist of family, friend’s social networks, and (5) individual knowledge, skills, and attitudes. These characteristics are consistent with those provided by Fielding, Teutsch & Breslow and Ruderman.
Population Health Surveillance and Communication Network
Population health surveillance is a central component of GW eradication efforts to aid planning and its importance of intensifying surveillance efforts in monitoring and eliminating the disease (Thacker & Berkelman, 1988). The surveillance of GW disease ensures that the discovery of the disease and the accuracy of reported cases have a positive impact on the disease.
Communication network makes provisions for a community-based approach, which involves and encourages the engagement of community participants to receive training and education— enabling them to let health care staff know about possible cases of diseases in a well-timed manner. Reasonable quantities of social capital in conjunction with health campaigns supporting a community-based approach can significantly enhance the level of effective surveillance. The community takes ownership as community members carried out the eradication effort. Polio prevention campaigns, on the other hand, are often carried out by visiting health workers administering vaccines (Carter Center, 2015). Nevertheless, a community-based surveillance alone cannot improve the surveillance process without the support of well trained and dedicated health care staff which, includes epidemiologists. Minimum logistics are needed to ensure communications between community members and district epidemiologists (Awofeso, 2013). Another preventative measure currently being tested uses chlorination to rid the parasite from bodies of water using both fixed and non-fixed chlorination in the research. (Smith, Cloutier, Harrison & Desforges, 2012) The use of water treatment in this model showed to be promising but requires more research with various stages of the GWD. Although, this method is beneficial, the most promising and preventive approach is community outreach. An alternative model to eradicating GW disease is a logistics model that utilizes a filtration system with multiple stages, to ensure clean water. Using community-based surveillance and the filtration intervention model, members can assist in the creation, and maintenance of the system outbreak in prevention the disease (Jones et al, 2014)
Systems Thinking Approach
The strength of the System Thinking Approach (STA) understands GW as a preventable disease with access to safe drinking water, adequate health care. System thinking approach guides in educating community members (Awofeso, 2013). Likewise, there have been a lot of changes during the past two decades. The GW has been successfully eradicated, which draw attention to the dominance of intensive community effort in combating and eliminating the GW disease. The collaboration between surveillance and response officers remains weak in South Sudan. The STP is evidenced by inadequate follow-up concerning patients diagnosed with the GW disease in the region of South Sudan. Reports of case detection, containment trends and capacity building efforts for GW eradication, South Sudan is more likely to eradicate GW by 2020, rather than by 2015(Awofeso, 2013).
The application of a STA to eradicate GW is to define a common technique or a system that interrelates to specific consequences, parts and outputs (The Institute for Systemic Leadership, n.d.). However, not all specific parts of such system can work in a defined approach and if not accurately predicted, it will fail (Sarriot et al., 2008). Therefore, there can be variations in a system method whereby its application may not display a fit-all-approach and can be predictable (The Institute for Systemic Leadership, n.d.). For example, one of the only ways to prevent the infection of GW is to drink water that is free from contaminated bacteria or from underground sources or prevent contaminated persons from infecting filtered or clean water sources (Ballantyne, 2008). If proper education is not provided to the local residents or water filters are not supplied sufficiently, the system approach will fail.
If all parts are given and outputs are provided but local residents do not intentionally or unintentionally follow the system due to their culture or religious belief, the system will fail. If children do not follow proper procedures due to their ways of thinking, the system will fail. If disables are not properly trained to follow procedures, the system will fail. If the pattern of behaviors and underlying structures are not properly developed and centralized, the system will fail. Therefore, there are many parts of the system that can cause other parts to malfunction due to external factors such as leadership aspects, or other intentional or unintentional consequences, leading to the failure of the whole system (The Institute for Systemic Leadership, n.d.).
Summary
GW disease, through a STP, is a disease that is preventable and has almost been eradicated. It is important, though, to remember that the system will fail if behaviors of the citizens are not changed and structures are not properly developed.
References
Awofeso, N. (2013). Towards global GW eradication in 2015: The
Experience of South Sudan
Ballantyne, C. (2008). What is GW Disease? Scientific American. Retrieved from http://www.scientificamerican.com/article/what-is-guinea-worm-disease/
Carter Center. (n.d.). Waging Peace. Fighting Diseases. Building Hope. Retrieved from http://www.cartercenter.org/health/guinea_worm/index.htlm
Fielding, I. E., Teutsch, S., & Breslow, L. (2010). A framework for public health in the United States. Public Health Review, 32, 174-189.
GW Disease. (2015). Retrieved December 22, 2015 from www.cdc.gov
John Hopkin Bloomburg School of Public Health Ecological model of public healthJohn Hopkin Bloomberg School of Public Health. (n.d.). Ecological model of public health. Retrieved from http://www.jhsphedu/…heal. 201512282014481552400947
Jones, A. H., Becknell, S., Withers, P. C., Ruiz-Tiben, E., Hopkins, D. R., Stobbelaar, D., & Makoy, S. Y. (2014). Logistics of GW Disease Eradication in South Sudan. The American journal of tropical medicine and hygiene, 90(3), 393-401.
Ruderman, M. (2013,). An introduction to the Ecological Model in Public Health. Retrieved from http://www.jsph.edu/research/centers-and-institutes/womens-childerns-health-policy-center/eco-model/eco-model.html
Sarriot, E. G., Kouletio, M., Jahan, D. S., Rasul, I., & Musha, A. (2014). Advancing the application of systems thinking in health: Sustainability evaluation as learning and sense-making in a complex urban health system in northern Bangladesh. Health Research Policy and Systems, 12, 45. doi:http://dx.doi.org/10.1186/1478-4505-12-45
Smith, R. J., Cloutier, P., Harrison, J., & Desforges, A. (2012). 6. A mathematical model for the eradication of GW Disease. Understanding the Dynamics of Emerging and Re-Emerging Infectious Diseases Using Mathematical Models, 133-156.
Thacker, S.B., & Berkelman, R.L. (1988). Public Health Surveillance in the United States. Epidemiology Rev.1988; 10:164–190.
The Institute for Systemic Leadership (n.d.). Basic principles of systems thinking as applied to management and leadership. Retrieved from http://www.systemicleadershipinstitute.org/systemic-leadership/theories/basic-principles-of-systems-thinking-as-applied-to-management-and-leadership-2/
