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Objectives: To quantify conflict events and access across countries that remain to be certified free of transmission of Dracunculus medinensis (Guinea worm disease) or require postcertification surveillance as part of the Guinea Worm Eradication Programme (GWEP)., Setting and Participants: Populations living in Guinea worm affected areas across seven precertification countries and 13 postcertification sub-Saharan African countries., Outcome Measures: The number of conflict events and rates per 100 000 population, the main types of conflict and actors reported to be responsible for events were summarised and mapped across all countries. Chad and Mali were presented as case studies. Guinea worm information was based on GWEP reports. Conflict data were obtained from the Armed Conflict Location and Event Data Project. Maps were created using ArcGIS V.10.7 and access was measured as regional distance and time to cities., Results: More than 980 000 conflict events were reported between 2000 and 2020, with a significant increase since 2018. The highest number and rates were reported in precertification Mali (n=2556; 13.0 per 100 000), South Sudan (n=2143; 19.4), Democratic Republic of Congo (n=7016; 8.1) and postcertification Nigeria (n=6903; 3.4), Central Africa Republic (n=1251; 26.4), Burkina Faso (n=2004; 9.7). Violence against civilians, protests and battles were most frequently reported with several different actors involved including Unidentified Armed Groups and Boko Haram. Chad and Mali had contracting epidemiological and conflict situations with affected regions up to 700 km from the capital or 10 hours to the nearest city., Conclusions: Understanding the spatial-temporal patterns of conflict events, identifying hotspots, the actors responsible and their sphere of influence is critical for the GWEP and other public health programmes to develop practical risk assessments, deliver essential health interventions, implement innovative surveillance, determine certification and meet the goals of eradication., Competing Interests: Competing interests: LK-H declares no competing interests. DM is a member of the International Commission for the Certification of Dracunculiasis Eradication., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

The authors report for the first time, in the south of Algeria, four imported cases of dracunculiasis in Malian Touaregs. The patients came from Mali. They remained two months in Tamanrasset before settling in Illizi where they have been working illegally for more than nine months. In August 2007, because of infected lesions appearing on their legs a month earlier, the patients decided to go to the Illizi hospital for treatment The diagnosis of dracunculiasis was made by direct observation of worms emerging from lesions and by microscopic examination of larvae. The patients were then isolated and treated. The Ministry of Health immediately took measures to avoid local transmission of the disease, never seen in the region. The measures consisted in increasing awareness campaign among medical and paramedical staff about dracunculiasis and in pointing out the importance of detection of new cases among nomadic populations. The risk of emergence of a new dracunculiasis indigenous focus in the south of Algeria should be seriously considered, especially as the number of immigrants from endemic countries is increasing considerably

The authors report a case of knee acute arthritis with intra-articular presence of microfilariae D. medinensis observed in a black African worker immigrated in France. It is a classical manifestion of dracunculosis articular complications which are however less frequent than intra-articular reaction arthritis without microfilariae, or than pyogenes arthritis due to neibourhood superinfections. The authors emphasize the significance of a double clinical and immunological supervision in the course of a convenient treatment including antibiotics, anti-inflammatory agents, local treatment, and rehabilitation.