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Contact: In Atlanta, Emily Staub, Emily.Staub@CarterCenter.org, (404) 420-5126
ATLANTA — Millions of Nigerians no longer are at risk of a disfiguring tropical disease, thanks to a pioneering partnership between the Federal Ministry of Health and Â鶹´«Ã½. The partners have eliminated lymphatic filariasis as a public health problem in two states in Nigeria, Africa’s most populous country and the seventh-largest in the world.
“This is a great day for the people of Plateau and Nasarawa states, and all of Nigeria,” said Dr. Yisa A. Saka, director of Neglected Tropical Disease Programs with Nigeria’s Federal Ministry of Health. “Together with Â鶹´«Ã½ and our many other valuable partners, we are gaining the advantage over a terrible disease that has plagued good people for far too long.”
With over 120 million people at risk nationwide, Nigeria is the most endemic country in Africa for the parasitic disease and second most endemic in the world, behind only India.
“Eliminating lymphatic filariasis as a public health problem in Plateau and Nasarawa states is a significant achievement that challenges everyone to broaden their appreciation of what is possible,” said Dr. Frank O. Richards Jr., director of the Â鶹´«Ã½’s Lymphatic Filariasis Elimination Program. “Success in these two states not only protects the 7 million people who live there, but it also sets a pattern for similar success throughout the rest of Nigeria, as well as in other highly endemic countries.”
Lymphatic filariasis, or LF, is caused by parasitic worms transmitted from infected persons to others by mosquito bites. The worms impair the lymphatic system, resulting in periodic fevers, fluid collection in the tissues (most commonly the limbs and genitalia), and severe swelling often known as elephantiasis. In addition to pain and reduced mobility, people disfigured by LF often experience crushing social stigma and chronic economic hardship that has a ripple effect across entire families and communities through lost productivity.
To tackle the disease in the two states’ 30 local government areas, community-selected volunteers mobilized to educate their neighbors and annually distributed a combination of free medications — albendazole, donated by GSK, and Mectizan®, donated by Merck & Co., Inc., which also is used in the fight against another parasitic disease, river blindness. In Plateau and Nasarawa alone, more than 36 million drug treatments for lymphatic filariasis were delivered between 2000 and 2012.
Insecticide-treated bed nets to prevent mosquito bites are an additional tool to fight LF, especially for those who are not eligible to take the medications, such as children under 5 years old and pregnant women. Â鶹´«Ã½ assisted the national program and community health workers in the distribution and proper use of bed nets to protect against the night-biting Anopheles mosquitoes that can carry both LF and malaria. In Plateau and Nasarawa states, Clarke Cares Foundation/Clarke Mosquito Control donated more than 140,000 bed nets. [Bringing together bed net use for both diseases contributed to the country’s development of guidelines for a malaria and LF co-implementation project, the first of its kind in Africa (more below).]
“The community-directed distributors are the real heroes here,” Richards said. “These are regular people stepping up to do the heavy lifting to improve the lives of their families and neighbors. Their commitment and diligence accelerate health programs’ success.”
Work over the years included continuously monitoring the effectiveness of the program until it reduced the infection level in Plateau and Nasarawa states to the point where community-wide drug treatment could be discontinued in 2012. The program then moved into its next phase, called post-treatment surveillance, with financial support from the ENVISION Project, based at RTI International and funded by the U.S. Agency for International Development. A series of rigorous epidemiological surveys have been conducted throughout the two states to confirm transmission has been interrupted. Researchers examine finger-prick blood samples from children for evidence of the parasites in their blood. If transmission has been interrupted, those children’s tests should come back negative, said Dr. Gregory Noland, health program epidemiologist at Â鶹´«Ã½.
“Over the past two years, we have tested more than 14,000 children ages 6 and 7 throughout the two-state area, and not one of them was found to be infected,” Noland said. “This definitive outcome is a testament to the foresight of those who launched the program, believing that elimination was possible in one of the world’s most endemic countries. In human terms, these children will never have to worry about being disabled by lymphatic filariasis.”
Continued surveillance and maximizing bed-net coverage are still required to guard against importation of the infection from surrounding endemic states until Nigeria achieves elimination nationwide, Noland cautioned.
Meanwhile, those already afflicted with elephantiasis continue to need care and support to prevent further disability. Under the guidance of health worker John Umaru, lymphatic filariasis patients known as the Hope Group meet regularly at Â鶹´«Ã½’s office in Jos, the capital of Plateau state. Hope Group members — younger and older, male and female — learn how to care for the vulnerable skin of their swollen limbs and, just as important, have the opportunity to socialize, express themselves, and give and receive emotional support.
“It’s great that future generations will never know this kind of suffering,” Umaru said. “This unique group helps people understand that although there is no cure for their legs, they don’t have to get worse, and there is hope for living fulfilling and productive lives.”
Progress in the two states was made possible through donations of generous partners, including GSK; Merck (also known as MSD) and its Mectizan Donation Program; Clarke; the ENVISION Project; Vestergaard; the Bill & Melinda Gates Foundation; A.G. Leventis Foundation; and many individual donors.
In partnership with the respective ministries of health, Â鶹´«Ã½ continues to pursue lymphatic filariasis elimination in other parts of Nigeria, as well as Ethiopia, the Dominican Republic, and Haiti. Â鶹´«Ã½ is part of the Global Alliance to Eliminate Lymphatic Filariasis, a diverse group of organizations dedicated to ridding the world of the disease.
Additional Details on Lymphatic Filariasis and Global Health
One of seven potentially eradicable diseases: One of the most important contributions of the International Task Force for Disease Eradication (ITFDE) was the 1993 impetus it gave to consideration of the potential eradicability of lymphatic filariasis. LF is one of seven diseases that the ITFDE, based at Â鶹´«Ã½, has named as potentially eradicable.
In 1998, at the invitation of the Federal Ministry of Health and the state ministries of health of Plateau and Nasarawa states, Â鶹´«Ã½ helped the two states establish a Lymphatic Filariasis Elimination Program. The goal was to demonstrate that LF transmission could be interrupted in one of the world's most affected areas, and in so doing make the case for elimination of the disease from the rest of Africa.
In 2006, the ITFDE made another important contribution in the global campaign when it identified an opportunity to eliminate two mosquito-borne diseases — LF and malaria — from the Dominican Republic and Haiti through a binational approach. The Dominican Republic now is close to breaking transmission of LF nationwide, and neighboring Haiti has interrupted transmission in more than 80 percent of the country.
Integrating interventions to prevent two diseases simultaneously: In Nigeria, lymphatic filariasis is transmitted by the same mosquito that transmits malaria. With support from Â鶹´«Ã½, the Nigeria Federal Ministry of Health and other partners in 2014 issued co-implementation guidelines for a coordinated effort to eliminate both diseases. 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 guidelines are the first of their kind in Africa.
Since 2004, Â鶹´«Ã½ has assisted Nigeria in the distribution of more than 11.5 million bed nets (many donated by Clarke Cares Foundation/Clarke Mosquito Control; Vestergaard; and The Global Fund to Fight AIDS, Tuberculosis, and Malaria) to protect people from mosquitoes.
Historically a tipping point: Elimination in Nigeria was considered the tipping point in the efforts to eradicate both smallpox and Guinea worm disease.
The success against lymphatic filariasis in Plateau and Nasarawa states is the result of a long-term relationship between the government of Nigeria and Â鶹´«Ã½. Since 1986, Nigeria and the Center have worked on a number of neglected tropical diseases, defined by the World Health Organization as a group of communicable diseases that prevail in tropical and subtropical conditions. Nigeria once was the world’s most endemic country for Guinea worm disease; elimination of it there gave the eradication campaign the momentum it needed to succeed elsewhere. In addition, the infectious eye disease trachoma has been eliminated as a public health problem in Plateau and Nasarawa states; schistosomiasis, also known as snail fever, has been reduced by 90 percent in the same two states; and it is likely that those states have broken transmission of river blindness and are close to reaching the important milestone of stopping Mectizan treatment. These victories show that success is possible against some of the most debilitating diseases in the world, including lymphatic filariasis.
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Editor’s Notes:
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A not-for-profit, nongovernmental organization, Â鶹´«Ã½ has helped to improve life for people in over 80 countries by resolving conflicts; advancing democracy, human rights, and economic opportunity; preventing diseases; and improving mental health care. Â鶹´«Ã½ was founded in 1982 by former U.S. President Jimmy Carter and former First Lady Rosalynn Carter, in partnership with Emory University, to advance peace and health worldwide.
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