Guinea worm disease outcomes in Ghana: determinants of broken worms.

[dracunculiasis]

In 2006 , Ghana ranked second in Guinea worm disease (GWD ) incidence and reported a previously undocumented 20 % prevalence of worm breakage . A prospective study was conducted in 2007 to validate and describe worm breakage and determinants . Among 221 patients with known outcomes , the worm breakage rate observed was 46 %. After controlling for demographics , worm and wound presentation , and treatment course and provision , worm breakage was associated with narrow -diameter worms (< 2 mm ) (adjusted odds ratio [AOR ] 2 .79 ; 95 % confidence interval [CI ] = 1 .03 -7 .53 ). Protective factors against worm breakage included antibiotic ointment use (AOR 0 .31 ; 95 % CI = 0 .14 -0 .70 ), bandage protocol compliance (AOR : 0 .38 ; 95 % CI = 0 .16 -0 .89 ), intact bandages (AOR 0 .27 ; 95 % CI = 0 .09 -0 .82 ), and bloody compared with dry wounds (AOR 0 .09 ; 95 % CI = 0 .01 -0 .7 ). The high worm breakage rate observed warrants improvement in case management and patient care . Adherence to established treatment protocols should be facilitated through improved provider training and supervision to reduce the disabling consequences of broken worms .