Ethnic diversity and disease surveillance: Guinea worm among the Fulani in a predominantly Yoruba district of Nigeria.

Guinea-worm eradication has been progressing internationally and efforts at case containment have begun in most endemic countries. Case containment rests on the assumption that in previous phases of eradication most if not all endemic settlements have been identified. Experiences in the predominantly Yoruba communities of Ifeloju Local Government Area (LGA) in Oyo State, Nigeria, however, have shown that the settlements of ethnic minority groups may be overlooked during initial case searches and subsequent programmes of village-based reporting. The migrant cattle-herding Fulani are found throughout the savannah and sahel regions of West Africa. Nearly 3000 live in 60 settlements in Ifeloju. An intensive case search identified 57 cases in 15 settlements. The assumption that village-based health workers (VBHWs) in neighbouring Yoruba farm hamlets would identify cases in the Fulani settlements, known as gaa, proved false. Only 5 endemic gaa were located next to a Yoruba hamlet that had a VBHW, and even then the VBHW did not identify and report the cases in the gaa. Efforts to recruit VBHWs for each endemic gaa are recommended, but only after LGA staff improve the poor relationship between themselves and the Fulani, whom they view as outsiders. The results also imply the need for Guinea worm eradication staff in neighbouring LGAs, states and countries to search actively for the disease among their minority populations.