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About the Author

Bart Knols
Medical Entomologist (Dodewaard, Netherlands)

Bart G.J. Knols (1965) is the Managing Director of MalariaWorld, the world's first scientific and social network for malaria professionals. He is a malariologist with a Masters degree in Biology and a PhD in Medical Entomology from Wageningen University, the Netherlands. He also obtained an MBA degree from the Open University (UK) in 2006, for which he won the prestigious international ‘MBA Student of the Year 2007 Award’ as well as the Alumnus of the Year Award from the Open University. With 11 years of working experience in Africa he has managed large-scale research and vector control programmes on malaria for ministries, international or national research institutions. He has worked for the UN (IAEA) as a programme manager for three years, has served as a consultant for the World Health Organization, and is currently a Board Member of the UBS Optimus Foundation, the second largest charity in Switzerland. He has published over 130 peer-reviewed research articles, has written 16 book chapters, and has served as senior editor on a WHO/IAEA sponsored book on implementation research. In 2007 he co-edited a best-selling book titled 'Emerging Pests and Vector-Borne Diseases in Europe'. He received an Ig Nobel Prize (2006), an IAEA Special Service Award (2006), and in 2007 he became a laureate of the Eijkman medal (the highest award in the field of tropical medicine in the Netherlands). He has been a member of the Royal Dutch Academy of Arts and Sciences since 2004. Bart held an Assistant Professorship at Wageningen University until April '09 with projects across Africa. He currently directs K&S Consulting, a firm he founded in the beginning of 2007.


Victory: Nigeria no longer needs matches!

Published 04th August 2010 - 27 comments - 14313 views -

guinea wormHealth remains, undoubtedly, one of the cornerstones of development. So often though, we read about poor health and misery in impoverished nations around the world, and look the other way. We despair, and chunks of society in the West have given up. ‘No hope for Africa’ is what you hear time and again.

Well, read on. This story is all about victory and glorious success. Against a debilitating and painful disease called Dracunculiasis (no relation to Dracula mind you). Also called Guinea Worm, it’s a disease you get by drinking contaminated water that contains miniscule copepods that in turn got infected by larvae from a nematode worm called Dracunculus medinensis. A year after becoming infected, the female worm has grown in size up to a miraculous 1 meter in length, when it creates a blister, usually on the lower extremities. When submerged in water, from the blister, the worm releases thousands of new larvae in the water that in turn infect the copepods and complete the life-cycle.

And this is where matches come into play. It has been common practice to tie the end of the worm around a matchstick [see video below], and slowly pull it out from the leg by twisting it bit by bit, every day, until the entire worm is removed. Although this can work, secondary infections often occur at the site of the blister, or worse, the worm gets killed when it snaps, causing leg infections. Although the infection is not lethal, its painful presence prevents people from working or attending schools. A Nigerian study showed that losses in rice farming accrued to 20 million $ due to Guinea Worm disease.

Guinea Worm can be prevented quite easily. Water can be filtered through fine mesh cloth to avoid drinking copepods. Water from underground sources (wells, boreholes) is not contaminated. And preventing people with open blisters from contacting water sources interrupts transmission. 

These simple measures inspired former US President Jimmy Carter and the Carter Center back in 1985 to tackle Guinea Worm. Together with the CDC, UNICEF, WHO, and backed with stacks of cash from the Gates Foundation, the battle has been hugely successful. 

In 1986, there were still 3,5 million cases in 20 countries in Africa and Asia. In 2009 only 3,190 remained in the four countries still afflicted: Sudan, Ghana, Mali and Ethiopia.

Nigeria was the worst affected country, with more than 270 thousand cases in the early 1990s. Only 495 cases were reported in 2004, then 38 in 2008, and victory over the disease was declared in 2010. This victory cost some 37,5 million $.

Guinea Worm is now listed by WHO as a disease that will be wiped from the face of the planet over the next few years. Sudan is the remaining hotspot, but after signing the peace declaration in 2005 the eradication programme was intensified. Were there more than 15 thousand cases in 2006, last year there were only 2,733 left. Sudan will succeed.

Resources, will, and political backing. Key ingredients for successful disease elimination programmes.

If in the near future anyone in your surroundings is cynical about development and Africa, tell them about Guinea Worm and the glorious victory over this disease. Tell them that Nigeria no longer needs matchsticks…


  • Carmen Paun on 04th August 2010:

    Didn’t have any idea about this nasty disease Bart. Even though I visited Nigeria I never heard of it. That is maybe because Nigeria no longer needs matchsticks. smile
    Happy to read successful stories about development. Even though sometimes I sound hopeless I am sure hope has not been lost for Africa or other parts of the world!

  • Bart Knols on 04th August 2010:

    @Carmen - thanks for quick response! Guinea worm is typically a disease of the rural poor, without access to clean drinking water.

    What this story shows is that the world can be successful and solve major diseases. After smallpox, it is likely that Guinea worm will be the second disease to be eradicated once and for all.

    After my ‘Good rats’ story I really wanted to bring another good news story and came across the publication in the American Journal of Tropical Medicine and Hygiene this morning. I smiled and sat down to write the blog…

  • Clare Herbert on 04th August 2010:

    Harrowing story, but I was delighted to see a positive ending. Great as always, Bart.

  • Andrea Arzaba on 04th August 2010:

    This seems so surreal! One meter long! Ahhhhh. I am eagerly waıtıng to hear that thıs dısease does not exıst anymore! Lets make clean water a human right!

  • Bart Knols on 04th August 2010:

    @Clare and @Andrea - if you think this is bad, have you heard about Buruli ulcer? It is a completely neglected disease, see: and perhaps worse than Guinea Worm…

  • Ian Sullivan on 04th August 2010:

    Makes me feel queasy. Interesting article though. On some comments you’ve left on my posts you seem sceptical about the value of internatinal aid - but this is a clear example of how aid money (in this case from Gates) can have a significant impact on the lives of the people (I’d be interested to see which socio-economic groups were most effected by this horrible worm!).

  • Bart Knols on 04th August 2010:

    @Ian - if I left you in doubt of whether or not I value international aid I can tell you that investments like these are surely positive and good. Control of Guinea Worm was considered doable and the massive amounts of funding needed to do it were obviously worthwhile. If my doubt came through to you it was because of unconditional monetary donations directly to governments, which is very different from the disease elimination programme shown here…

    People most affected by Guinea Worm were mostly the rural poor that lack access to good sanitation and safe drinking water [see the video].

  • Ian Sullivan on 05th August 2010:

    @bart - I don’t think anyone is pushing for ‘unconditional aid’. but people are calling for budget support for health and education systems - giving governments freedom within that to prioritise. That way you build up the state, which I would argue is the most realsitic way that you will get vital services to the poorest people…

    The type of giving in your atricle is also open to the potential failings that budget support aid is - people just feel more comfortable with this type of support.

  • Bart Knols on 05th August 2010:

    @Ian - perhaps the words ‘giving governments freedom within that to prioritise’ is precisely where I have my doubts. There is no such thing in the ‘developed’ world, and it is surely not working in the developing world. Nobody is coming to the Dutch government with a bag of money and giving us the freedom to do with it as we like.  Alternative mechanisms are much better at stimulating economic development (e.g. microfinancing systems). The amount of aid money going down the drain because of this is horrendous and I believe that we should do a much better job at determining what receives money and how it is spent. Alas, in line with Obama’s recent policy on attaining the MDGs…

  • Ian Sullivan on 05th August 2010:

    @bart - I don’t understnd your developed world comment - the Dutch government, for instance, does prioritise how it spends it’s health budget. Why shouldn’t developing countries do that with the support they are given - this doesn’t mean that there’s no accountablility - they have to show how it’s been spent. But ‘we’ determinnig how it’s spent - well, that has many issues attached to. Look at spending under Bush for instance. I liked a lot of elements of Obama’s speech and it had elements that acknowledged that the state has to play a key role in development.

    No argument with you on micro-financing and ways of stimulating economic growth - happy to deabte trade etc but that is not the same as using aid money for service provision - and there are many, many examples of how that money has been spent well and made a difference to people’s lives.

  • Clare Herbert on 05th August 2010:

    @Bart: Thanks for that. Making us queasy is a sign that your writing is having an impact.

  • Bart Knols on 05th August 2010:

    @Ian - well, looking back only at the way we dealt with swine flu there is much that goes wrong with prioritising health even in the Netherlands… We’va wasted millions on vaccines that are now being destroyed.

    ‘Accountability’ is the key word here, and that’s exactly where the problem lies with much of aid that is directly channeled to governments. I also don’t see the ‘we determining what is happening with aid money’ as a real issue. Of course govts needed to buy into the idea of Guinea Worm elimination (you cannot and should not bypass them), but setting up such programmes was very much determined by ‘us’.

    The world has become a village, and I don’t see development aid any longer as ‘us’ and ‘them’. We’re all in the same boat. Sixty years of development aid should have told us that apparently large aid organisations remain far from effective (sorry to say this) and that new and novel approaches are warranted.

  • Ian Sullivan on 05th August 2010:

    Not them and us…so what did “we should do a much better job at determining what receives money and how it is spent” - who is the ‘we’.

  • Ian Sullivan on 05th August 2010:

    And development aid (in terms of government) doesn’t really go through development organisations (on the whole). I’d like to see your evidence of development organisations (like the one I work for) failing.

  • Bart Knols on 05th August 2010:

    @Ian - we’re back to the fundamental issues surrounding development aid. Regarding your one but last comment ‘we’ is us, developed nations spending on development aid. But this is completely different from my statement ref ‘we’re all in the same boat’. Even in the UK money is in the hands of some, who give it others - control over how that money is spent is logical and considered normal. I am arguing that the same counts for the world as a whole.

    Evidence for dev organisations failing (I did not refer to Oxfam specifically btw): look at the billions and billions that have been spent over the last six decades. Looking at the state of Africa alone, it is hard to argue that we have all (‘them’ and ‘us’) done a great job, right? Far from that I would say…

  • Ian Sullivan on 05th August 2010:

    I know you didn’t refer to Oxfam but as I work for them if I’m in this kind of debate want to be upfront about it for other readers….I think the 6 decades argument is problematic. It assumes that aid money has been concerned with poverty reduction, whereas the reality is quite different, it also ignores many of the successes of aid (Rwanda, Zambia etc) and tars the whole of ‘Africa’....

    there is still a lot of poverty (clearly) but blaming that on aid is like blaming fires on the fire brigade - the reasons for that poverty are massively complex - but that doesn’t mean that aid can’t be a positive force in the world.

  • Bart Knols on 05th August 2010:

    @Ian - sure, I agree with you. But besides Rwanda and Zambia I can place Sudan, Somalia, Chad, CAR, Niger, Sierra Leone, Liberia, Guinea, just to stay in the north of Africa. The successes you mention are small compared to the problems still out there. Mind you, I don’t argue to stop with what you’re doing (on the contrary), I merely argue that it can be done much better and should be much more business-like.

    I assume that meanwhile you have read Moyo’s ‘Dead Aid’. It is very hard to argue against her views on how little has been accomplished in six decades. It is simply looking at the state of current affairs in Africa that tells you that our collective approach may not have been all that good…

  • Ian Sullivan on 05th August 2010:

    There have been successes but I don’t think anyone doubts that the countries you outline have massive problems (although I don’t think your suggestgint hat is the fault of government aid policies).no one is saying development aid will save the world (except maybe Bono) but what I am saying is that it can make a significant difference to the lives of the poorest people.

    The issue with Moyo’s book is that she looks at the last 60 years and makes a broad statement that blames aid for the problems. In the list you site I don’t think you can say that aid is responsible for thier issues - and to take 1 of the countries, Sierra Leone, they have just introduced free healthcare for pregnant women, lactating mothers and children under 5, thanks to increased aid spending by the UK.

    I agree with the idea of being business like but in your article you site the Gates Foundation (an NGO much like Oxfam in a lot of practices and approaches) so I think that is already happening and increasingly so. But we should look at improving how we do things and try new approaches - although again, I would say organisations like Oxfam do have a very varied approach to our work…

    As for Moyo’s conclusions about aid, simplistic an innaccurate would be my synopsis…

  • Clare Herbert on 06th August 2010:

    I agree with you Bart. Moyo presents a compelling case and while there may be spots where she is too simplistic or generalist, overall it’s a strong argument. ODA hasn’t worked, or hasn’t worked sufficiently well to be worthwhile. Time to try something new. Trade is worth a go IMO.

  • Bart Knols on 06th August 2010:

    @Ian - oh well, I guess it is a bit hard for us to find common ground… wink

    I appreciate the views towards your employer but please accept that others tend to have different opinions (like Clare below your comment). I have been directly involved with three Gates projects and boy - that’s a business-like approach you have not seen before. They have learnt some good lessons from large NGOs not doing it the right way…

    My synopsis of Moyo’s book: thought-provoking, insightful, refreshing perspective.

    @Clare - agree entirely with what you are saying. Thanks for comment.

  • Ian Sullivan on 06th August 2010:

    @clare - but that’s the point. it’s not either or with trade and aid. By stopping aid you won’t suddenly get the trade that can (potentially) lift people out of pvoerty.  I agree that trade and access to technology are vital but so is support to develop health and education systems. So, yes let’s miprove aid and make it work better for the poorest people. And I even think anything that can be done to improve accountability can only be a positive.

    But @bart and @clare - ‘insightful’ and ‘strong argument’ - did you leave your critical faculties at the door? In the policy world (not always supporters of ODA) most thinkers have basically dismissed the book. Owen Barder writes a good review:

  • Bart Knols on 06th August 2010:

    @Ian - no, I did not leave them at the door and have read the critiques of the book. But if the majority of people look one way, do you blindly follow them or maintain your own opinion based on the pros and cons of the book. I’d prefer the latter…

    I have just reviewed a book on malaria, which is highly critical of the role played by the UN (WHO, UNICEF) and the Global Fund. No doubt that it will be dismissed by the masses - that’s the way it goes in this business. Lash out to anything that is not in line with your own approach… and that is a big, big mistake. As long as we don’t take in both sides of the story, we are not learning.

    Give me three things from Moyo’s book that you should consider in your work, even if you don’t agree with them. Just consider. Curious to see how long it will take to see your response…

  • Ian Sullivan on 06th August 2010:

    I don’t know about consider in my work?? As I don’t provide government to government development aid which is what her book is concerned with. She also doesn’t alk about NGO work, so she doesn’t attack what I actually do/who I work for but I campaign on the issue so I’ll assume you mean 3 things about my view on aid:

    1. There needs to be a long-term vision for aid - and the idea of exit strategies (her 5 year one is nonsense but I agree there should be one)
    2. Finding alternative forms of finance rather than just having ODA - again her alternative forms need some consideration.
    3. Being open about where aid has failed and what it’s limitations are. Then debate why it hasn’t achieved what you set out to do etc.

    That OK for you?

  • Bart Knols on 06th August 2010:

    @ My dear Ian - I am impressed and we’ve reached common ground, at long last wink

  • Clare Herbert on 07th August 2010:

    @ Ian: My point is that aid is stifling trade. Why work for a living if you’re getting aid for free? Both governments and citizens have little incentive to be entrepreurial when they’re getting hand outs.

    And I think I read Moyo’s book with my critiquing hat on. I definetly see some holes in her argument (as I mentionned about) but overall, she makes a compelling case.

  • Bart Knols on 07th August 2010:

    @Clare @Ian - a good example of what Clare is saying is the story (in Moyo’s book) of a small bednet manufacturer somewhere in Africa. He produced enough nets to maintain extended families numbering more than 150 people in total. But then UNICEF moved in and flooded the area with a million nets. He went out of business… Would UNICEF have supported this man’s business and help him to expand it, a much better outcome would have been achieved…

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