River Blindness, Lymphatic Filariasis, and Schistosomiasis Programs

Wednesday, March 8 - Friday, March 10, 2023

 

Agenda

River Blindness Elimination Program

 

Our Goal

 

The Carter Center works with national ministries of health in Latin America and Africa to eliminate river blindness, one of the leading causes of preventable blindness worldwide.

Lymphatic Filariasis Elimination Program

 

Our Goal

 

The Carter Center works with national ministries of health to eliminate the debilitating parasitic disease lymphatic filariasis — a leading cause of permanent and long-term disability worldwide — from areas of Ethiopia, Nigeria, and Sudan.

Schistosomiasis (Bilharziasis) Control Program

 

Our Goal

 

The Carter Center undertakes one of the longest-running initiatives in providing health education and treatment for schistosomiasis in Nigeria, the world's most endemic country for this preventable but devastating disease. Praziquantel for schistosomiasis is donated by E-Merck (Germany).  Together with praziquantel, intestinal deworming tablets using albendazole (GSK) or mebendazole (Johnson & Johnson) are provided for added health benefits to the children.

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Results & Impact

 

Since 1996, The Carter Center has assisted ministries of health in the distribution of more than 500 million treatments of Mectizan® (donated by Merck & Co). Treatments have been provided in 11 countries of Africa and Latin America through community-based mass drug administration (MDA) programs.  

Uganda has eliminated river blindness in fourteen foci and stopped Mectizan distribution in one focus. The last focus with “ongoing transmission” was reclassified from “ongoing transmission” to “interruption of transmission suspected,” bringing the number of foci with suspected transmission interruption to two. It is believed that there is no longer onchocerciasis transmission in Uganda. 

In 2021, Plateau and Nasarawa states became the first in Nigeria to meet the WHO criteria for elimination of onchocerciasis transmission, protecting about 2 million residents. Delta state interrupted transmission of river blindness, allowing it to stop MDA for another 2 million residents; Delta will now conduct the required three years of post-treatment surveillance that will conclude with an entomology assessment to determine if it too can move to "transmission eliminated" status. 

In the Americas, the last focus of onchocerciasis is the Yanomami Focus Area, shared by Brazil and Venezuela. In 2013, Colombia became the first country in the world to be granted formal verification of elimination of river blindness by WHO. Ecuador, Mexico, and Guatemala followed in Colombia's steps, receiving official verification of elimination in 2014, 2015, and 2016, respectively. 

In Sudan, transmission was eliminated in the Abu Hamad focus (River Nile state) in 2015 and interrupted in the Galabat subfocus (Gedaref state) in 2018. 

In Ethiopia, transmission was interrupted in Metema Subfocus (Amhara Region) in 2018 and in parts of Jimma zone (Oromia Region) in 2021. 

 

Volunteer community-directed distributor Abeje Ulondimu delivers health education to Gambella Town’s Kebele 5 neighborhood during a mass drug administration event in Ethiopia. (Photo: The Carter Center / Ryan Youngblood) 

 

Dr. Nabil Aziz (center, seated) oversaw the interruption of river blindness transmission in Sudan’s vast and remote Abu Hamad area in 2012. (Photo: The Carter Center / M. Katabarwa) 

 

Health workers in the Amazon Rainforest must travel on foot to treat and prevent river blindness in indigenous Yanomami communities. (Photo: CAICET / Oscar Noya Alarcón)

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Results & Impact

 

In Nigeria: Millions of Nigerians are no longer at risk of lymphatic filariasis since a pioneering partnership between Nigeria’s Federal Ministry of Health and The Carter Center succeeded in 2017 in eliminating the disease as a public health problem in Plateau and Nasarawa states. Community-selected volunteers mobilized to educate their neighbors and annually distributed a combination of free medications — albendazole and Mectizan®. In Plateau and Nasarawa alone, more than 36 million drug treatments for lymphatic filariasis were delivered to bring about this success. Insecticide-treated bed nets, donated by Clarke Cares Foundation/Clarke Mosquito Control, were also widely distributed. Drug treatment was discontinued, followed by several years of post-treatment surveillance involving blood-testing for signs of infection. No new infections were found in Plateau and Nasarawa, proving that transmission had been eliminated in those two states in the center of the country. 

The seven other states we assist in Nigeria continue to focus on mass drug administration (MDA), while more and more districts within those states, after five or more years of good treatment coverage, conduct assessments to determine whether transmission of lymphatic filariasis has been interrupted. 

With support from The Carter Center, the Nigeria Federal Ministry of Health and other partners developed and issued co-implementation guidelines for a coordinated effort to eliminate malaria and lymphatic filariasis. The guidelines called for shared interventions such as health education, community-based action, distribution of long-lasting insecticidal bed nets, and mass drug administration. These are the first of their kind in Africa. 

In Ethiopia: In 2009, The Carter Center began integrating mass drug administration to prevent lymphatic filariasis with river blindness and malaria control in the Gambella region. Subsequently, the program expanded to parts of Amhara, Beneshangul Gumuz, Southern Nations Nationalities and Peoples, and Oromia regions. Significant portions of program have now achieved their goals and are stopping treatment.  

 

In Sudan: Thanks to recent support from the Reaching the Last Mile Fund housed at the END Fund, in 2022 The Carter Center began assisting the Sudan Federal Ministry of Health with the goal of eliminating lymphatic filariasis. The disease is endemic in 14 of the country’s 18 states. Efforts are underway to finalize mapping, expand MDA to all endemic districts, and build capacity for morbidity management and disease prevention in the health care system. 

 

Sama’ila Simon (right) of Nigeria lives with an extremely enlarged right leg due to the parasitic disease lymphatic filariasis. He lives with his brother’s family and has never married, common for those with the disease due to the severe social stigma that accompanies it. (Photo: The Carter Center / Ruth McDowall)

Watch the video to learn more:

 

Results & Impact

 

Blood in schoolchildren's urine — a telltale sign of schistosomiasis infection — has been reduced by approximately 50 percent in Plateau and Nasarawa states. Particularly high-risk areas in Plateau and Nasarawa states saw infection drop from 31% to 10% between 2013 and 2018. 

 

Because schistosomiasis—a parasitic infection that damages internal organs—mainly affects children, Nigeria’s strategy is to distribute treatment through schools. (Photo: The Carter Center / Ruth McDowall)

 

Paul Nnamchi, the principal and CDD for his school in Amagunze, Enugu State, Nigeria, records treatments in his log book. (Photo: The Carter Center / Ruth McDowall)

 

A single annual dose of donated praziquantel is sufficient to keep the tropical parasitic infection under control.(Photo: The Carter Center /
Ruth McDowall)