Gates Open Research Open Peer Review Discuss this article (0) Comments RESEARCH ARTICLE Slaying little dragons: the impact of the Guinea Worm Eradication Program on dracunculiasis disability averted from 1990 to 2016 [version 1; referees: 3 approved] Elizabeth A. Cromwell , Sharon Roy , Dieudonne P. Sankara , Adam Weiss , Jeffrey Stanaway , Ellen Goldberg , David M. Pigott , Heidi Larson , Stein Emil Vollset , Kristopher Krohn , Kyle Foreman , Peter Hotez , Zulfiqar Bhutta , Bayu Begashaw Bekele , Dumessa Edessa , Nicholas Kassembaum , Ali Mokdad , Christopher J. L. Murray , Simon I. Hay 1,9 Institute for Health Metrics and Evaluation, University of Washington, Seattle, Seattle, WA, USA Centers for Disease Controls and Prevention, Atlanta, GA, USA World Health Organization, Geneva, Switzerland The Carter Center, Atlanta, GA, USA College of Medicine, Baylor University, Houston, TX, USA Aga Khan University, Karachi, Pakistan University of Gondar, Gondar, Ethiopia Haramaya Univerisity, Dire Dawa, Ethiopia Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK Abstract The objective of this study was to document the worldwide Background: decline of dracunculiasis (Guinea worm disease, GWD) burden, expressed as disability-adjusted life years (DALYs), from 1990 to 2016, as estimated in the Global Burden of Disease study 2016 (GBD 2016). While the annual number of cases of GWD have been consistently reported by WHO since the 1990s, the burden of disability due to GWD has not previously been quantified in GBD. The incidence of GWD was modeled for each endemic country using Methods: annual national case reports. A literature search was conducted to characterize the presentation of GWD, translate the clinical symptoms into health sequelae, and then assign an average duration to the infection. Prevalence measures by sequelae were multiplied by disability weights to estimate DALYs. The total DALYs attributed to GWD across all endemic countries Results: (n=21) in 1990 was 50,725 (95% UI: 35,265–69,197) and decreased to 0.9 (95% UI: 0.5–1.4) in 2016. A cumulative total of 12,900 DALYs were attributable to GWD from 1990 to 2016. Using 1990 estimates of burden propagated forward, this Conclusions: analysis suggests that between 990,000 to 1.9 million DALYs have been averted as a result of the eradication program over the past 27 years. Keywords Guinea Worm, dracunculiasis, disability adjusted life years, DALYs, eradication, prevalence, GBD, Global burden of disease, neglected tropical 1 2 3 4 1 1 1 1 1 1 1 5 6 7 8 1 1 1 1,9 1 2 3 4 5 6 7 8 9 Referee Status: Invited Referees version 1 published 18 Jun 2018 1 2 3 report report report , International Trachoma Teshome Gebre Initiative, Ethiopia 1 , Institute for Guillaume Chabot-Couture Disease Modeling, USA 2 , Sightsavers, USA Philip Downs 3 18 Jun 2018, :30 (doi: ) First published: 2 10.12688/gatesopenres.12827.1 18 Jun 2018, :30 (doi: ) Latest published: 2 10.12688/gatesopenres.12827.1 v1 Page 1 of 14 Gates Open Research 2018, 2:30 Last updated: 30 JUL 2018