Current Status: Transmission stopped, November 2008
Certification of Dracunculiasis Eradication: Pending
Since 1988, the Carter Center's Guinea Worm Eradication Program has worked with the Nigeria Ministry of Health to spare thousands of people from suffering from this devastating disease. Dracunculiasis or Guinea worm disease is contracted when a person drinks stagnant water that is contaminated with microscopic water fleas carrying infective larvae. Inside a person's body, the larvae grow for a year, becoming thin thread-like worms, up to 1 meter long. These worms create agonizingly painful blisters in the skin through which they slowly exit the body, preventing the victim from attending school, caring for children, or harvesting crops. In the mid-1990s, Guinea worm infections in part of the heavily populated region of southeast Nigeria caused an estimated USD $20 million in lost income to rice farmers alone.
In 1988-89, Nigeria was the most Guinea-worm-endemic country in the world, reporting more than 650,000 cases in 36 states. By November 2008, incidence of the disease had been reduced by more than 99 percent, with 38 indigenous cases reported and all cases were contained. In November 2009, with 12 consecutive months of zero cases, Nigeria was determined to have once and for all broken Guinea worm transmission.
In collaboration with Nigeria's Ministry of Health, the strategy for elimination consisted of several components, driven by health education. The goal was to change behavior and mobilize communities to improve the safety of their local water sources.
Approaches introduced to communities included: health education and nylon filter distribution; treating stagnant ponds monthly with safe ABATE® larvicide (donated by BASF); direct advocacy with water organizations; and increased efforts to build safer hand-dug wells. The program also trained and supervised village volunteers to carry out monthly surveillance and interventions.
In addition to these sweeping efforts, other activities to stamp out Guinea worm were initiated. For example, in 2000, Nigeria held a national symposium on Guinea worm eradication in Abuja with the theme "Guinea Worm Eradication: Let's End It Now!" In an address read on his behalf by the permanent secretary of the Ministry of Health, Vice President Atiku Abubakar announced that the head of state had released more than 5 billion naira – approximately USD 50 million – for safe water to rural communities, and that Guinea worm-endemic villages would be given priority attention. He highlighted the impoverishing nature of the disease – hence the Kanuri term for Guinea worm disease, Ngudi, "the impoverisher."
Nigeria's success at eliminating Guinea worm inspires other nations struggling with the disease as well as the Nigerian people. Now that Guinea worm has been defeated, perhaps other problems may be solved with the same dedication. The Carter Center hopes Guinea worm's elimination will represent empowerment and achievement for the Nigerian people.
Guinea Worm Feature Stories:
Volunteers, diplomats assemble medical kits
In the thick of Atlanta's steamy summer of 2004, more than 500 corporate and diplomatic community volunteers joined Carter Center staff to assemble crucial medial supplies necessary to eradicate the last fraction of a percent of Guinea worm disease in the world. After three weeks of bundling gloves, stuffing bags, and counting gauze packets in an unair-conditioned warehouse, 30,000 medical kits were successfully assembled. The kits are being distributed to village-based volunteer health workers in Sudan, Ghana, and Nigeria, the three countries with the most cases of Guinea worm disease. Supplies are reaching rural areas where medical attention is often unavailable. Each medical kit gives volunteers the tools they need to care for 10 people who suffer from Guinea worm disease, allowing children to return to school and parents to work. Nigeria received 1,500 in early 2005. Read more about the medical kit assembly project >
Updated December 2009
River blindness is a parasitic disease transmitted by the bite of small black flies that breed in rapidly flowing streams and rivers. The disease causes severe itching, eye damage, and often blindness.
River blindness is transmitted by black flies, which deposit the larvae of the Onchocerca volvulus worm into the body. Over the course of a year, these larvae mature within the human host at which point the adult worms mate and the female worms release their embryonic microfilariae. These microfilariae cause debilitating itching and inflammation and may eventually infiltrate the eye where they cause damage and diminished eyesight. If left untreated, the infected person can become permanently blind.
Nigeria is the most endemic country in the world for river blindness, accounting for as much as 40 percent of the global disease burden. It is estimated that up to 27 million Nigerans living in 32 endemic states need treatment for river blindness.
The drug Mectizan® (ivermectin), donated by Merck & Co., Inc., is the only medication that treats river blindness without major side effects. Mectizan kills microfilariae in a single, yearly oral dose, thereby eliminating the risk of blindness in the treated individuals.
Since 1989, the Nigeria National Onchocerciasis Control Program has grown from treating 49,566 people with Mectizan its first year in operation, to the world's largest Mectizan distribution program. In 2008, The Carter Center-assisted program in Nigeria provided Mectizan and health education to more than 5.7 million people in 7,874 villages.
With headquarters in Jos and Plateau states, and with supporting sub-offices in Lagos, Owerri, Benin City, and Enugu, the Carter Center's River Blindness Program provides direct assistance to the national program in treatment activities in nine states in Nigeria: Abia, Anambra, Delta, Ebonyi, Edo, Enugu, Imo, Nasarawa, and Plateau states. The nine states assisted by The Carter Center conducted training or retraining for 52,314 health workers involved in Mectizan® distribution in 2008. This is more than double the number trained in 2007. A major Carter Center partner in Nigeria has been the Lions Clubs International Foundation SightFirst Initiative. Lions Clubs District 404, with Lions Clubs International Foundation support, is actively involved in promoting public awareness of the disease by advocating for onchocerciasis control, meeting with high-ranking officials to solicit support, and visiting communities where mass treatment is provided.
The Carter Center's activities in Plateau and Nasarawa States are unique. Using an integrated approach, The Carter Center has targeted three diseases that can be controlled by community-wide treatment: onchocerciasis, lymphatic filariasis, and schistosomiasis. This approach makes it possible to provide medicine distribution and health education for more than one disease using the same program structure. This initiative has proven to be a successful strategy and is inspiring other programs, within The Carter Center and in other organizations, to integrate efforts.
Learn more about the Carter Center's River Blindness Program >
Updated September 2009
Nigeria is the third-most endemic country in the world for lymphatic filariasis, with an estimated 22 million cases. The federal Ministry of Health of Nigeria, and the state ministries of health of Plateau and Nasarawa states, first invited The Carter Center to help establish a Lymphatic Filariasis Elimination Program in 1998. Since, The Carter Center, GlaxoSmithKline, and Merck & Co. Inc. have been working to fight lymphatic filariasis, with support from the Bill & Melinda Gates Foundation. The aim of the program is to eliminate the disease as a health problem in the two states by 2010.
Lymphatic filariasis (LF) is a debilitating and deforming disease caused by infection from a parasitic worm called Wuchereria bancrofti that lives in the victim's lymphatic system. The infection is transmitted from person to person by mosquitoes. In its severest form, lymphatic filariasis causes elephantiasis, or dramatic swelling of limbs (usually the leg) and male genitals (called "hydrocele" of the scrotum).These conditions have a devastating effect on the quality of life of those affected, impacting them not only physically but also emotionally and economically.The World Health Organization ranks lymphatic filariasis as a leading cause of permanent and long-term disability worldwide. Annual, communitywide treatment with the medicines Mectizan® and albendazole reduces or eliminates transmission of the parasite, thus saving the new generation from the fate of many of their parents and grandparents.
Using the same community-based distribution strategies The Carter Center helped pioneer for fighting river blindness in Africa and the volunteers and logistics in place in the Plateau and Nasarawa states in Nigeria, the Lymphatic Filariasis Program is helping to eliminate the disease through health education and mass distribution of the combined drug therapy of albendazole, donated by GlaxoSmithKline, and Mectizan, donated by Merck.
Lymphatic filariasis, also known as elephantiasis, is widespread in Plateau and Nasarawa states, with all cities and villages (encompassing a population of approximately 4 million people) needing health education and combined Mectizan/albendazole treatments. The program began in 2000, and in 2008, alone, more than 3.7 million persons received health education and treatment, 99.8 percent of the treatment goal. Health education messages are aired in radio messages in Hausa and English, as is a television documentary as part of the program's efforts to educate the population about the disease.
As a result of the program's interventions, many Nigerians are being protected from contracting lymphatic filariasis, and those seriously infected with the crippling disease are learning how to better care for themselves.
With support from the Conrad N. Hilton Foundation, The Carter Center and the Nigeria Ministry of Health began working with state and local health authorities to implement trachoma control programs in Plateau and Nasarawa states in 2000. Since these states already supported Guinea worm eradication and river blindness, lymphatic filariasis, and schistosomiasis control efforts, the integration of trachoma control was a logical next step. In 2009, the Center, with support from the Bill & Melinda Gates Foundation, began assisting the Ministry of Health to integrate trachoma control with the control of lymphatic filariasis, schistosomiasis, river blindness, soil transmitted helminths, and malaria. This integration of different disease interventions will be monitored for effectiveness, reproducibility, and cost savings.
The Carter Center supports trachoma control in six African countries in partnership with trachoma-endemic communities, ministries of health, the Lions Clubs International Foundation, Pfizer Inc., and the Conrad N. Hilton Foundation.
The leading cause of preventable blindness in the world, trachoma is an excruciating bacterial disease endemic to the poorest countries of the world. Over time and through repeated infections, trachoma leads to the permanent scarring of the inner eyelid, deforming the lid and causing the lashes to turn inward and press painfully against the sensitive eye. Although not typically a fatal disease, severe trachoma is disabling, debilitating, and eventually leads to blindness.
The World Health Organizations recommends the implementation of the SAFE strategy for trachoma control: Surgery to correct scarring from advanced trachoma, Antibiotics to treat early trachoma infections, Facial cleanliness to prevent disease transmission, and Environmental changes to improve hygiene and sanitation.
The Carter Center's Trachoma Control Program focuses on preventing trachoma through health education, targeted to children and women in rural communities, and the promotion of household latrines.
In Carter Center intervention areas, health education sessions are conducted in communities using flip charts that are provided to trained community health workers. Community health educators are trained to communicate key messages about trachoma prevention and encourage adoption of latrine construction. T-shirts and baseball caps with health education messages also are produced and distributed to help promote trachoma prevention.
To increase the coverage of household sanitation, The Carter Center assists the Ministry of Health to promote household latrine construction in rural communities. Since 1999, the program has built more than 29,000 household latrines and has trained more than 1,900 community masons.
Learn more about the Carter Center's Trachoma Control Program >Updated September 2009In terms of socio-economic and public health impact, schistosomiasis, or "snail fever," is second only to malaria as the most devastating parasitic disease in tropical countries. An estimated 200 million people in 74 countries are infected with the disease: 100 million of these people are in Africa.
Schistosomiasis is a parasitic disease, and its life cycle involves snails and fresh water such as ponds, dams, and rivers. There are two forms of schistosomiasis in Nigeria and a number of other African countries: Schistosoma haematobium (urinary schistosomiasis) and Schistosoma mansoni (intestinal schistosomiasis). Both can severely impact its victims.
During transmission, larval stages of the parasite emerge from infected snails and swim in water until they can penetrate the skin of people coming into contact with contaminated water. Once in the body, the larvae develop into adult male and female parasites that pair and live together in human blood vessels for years. The female parasites release thousands of spiny eggs, some of which are passed out in the urine (in the case of urinary schistosomiasis) or feces (in the case of intestinal schistosomiasis) to hatch in water and invade snails, thus continuing the life cycle.
School-age children, 10 to 14 years old, are usually the most affected by this silent, debilitating disease. Stunted growth, poor school performance, and anemia are all part of schistosomiasis, making it a great hindrance to the youth, the lifeblood of any civilization.
Although schistosomiasis is not considered eradicable, it can be controlled by
one of the great miracle medical discoveries of the 1980s: the oral medicine
called praziquantel. A single annual dose of this medicine will prevent a child
from suffering from schistosomiasis. Now that costs of the medicine have
dropped from more than $2 USD per dose to $0.18, something can be done
for schistosomiasis.
In partnership with Nigerian health authorities, using the same community-based tablet distribution system pioneered for fighting river blindness in Africa and Latin America, the Carter Center's Schistosomiasis Control Program works to control schistosomiasis through distribution of the praziquantel, with health education. Health education is a key element of the schistosomiasis effort, because the disease will not be eradicated until better water and sanitation reach these communities. For now, the message is not to urinate or defecate in water and to take praziquantel annually when offered. In May 2007, The Carter Center and the Nigeria Ministry of Health celebrated the delivery of 1 million praziquantel treatments for schistosomiasis in Nigeria's Delta, Nasarawa, and Plateau states since the schistosomiasis program's inception in 1999.In 2008, due to a large donation of Praziquantel from Merck KGaA ®, administered through the World Health Organization, The Carter Center-assisted Schistosomiasis Program was able to treat more than 1 million persons, mostly children, in just one year.
Read: The Carter Center Celebrates 1 Million Treatments for Schistosomiasis in Nigeria >
Updated September 2009
Working hand in hand with Nigeria's Ministry of Agriculture, the Carter Center's Agriculture Program has assisted farmers in Nigeria with agricultural production since 1993. The program has been active in the states of Kano, Kaduna, Jigawa, and Katsina. The Carter Center, in partnership with the Sasakawa Africa Association and led by Nobel Prize Peace winner Dr. Norman Borlaug, is part of a larger joint initiative, SG 2000, which has helped more than 4 million sub-Saharan farmers improve food security.
In Nigeria, not only has the democratically elected government – headed by President Olusegun Obasanjo – commended the partnerships' efforts in extending crop-based technologies to small-scale farmers, but it has requested a blueprint on how to expand, consolidate, and sustain the program nationwide.
The prescription is simple: Farmers are provided with credit for fertilizers and seeds to grow production test plots. Different crops are tried to see which will be most productive for farmers. Following successful harvests, which usually exceed previous harvests by 200 to 400 percent, farmers teach their neighbors about the new technologies, creating a ripple effect to stimulate food self-sufficiency in the nation.
Recognizing the achievements of the program over the past four years, the federal Department of Agriculture directed the 33 other states of Nigeria to adopt the management training plot approach demonstrated by SG 2000.
One emphasis of the program has been to teach farmers to use the fertilizers more efficiently. For example, farmers learn to reduce the amount of compound and urea fertilizer applied from 20 bags per hectare to around nine bags of compound and two bags of urea. Farmers also are taught how to incorporate fertilizer in the soil to keep nutrients from being washed away by heavy rainfall. These methods have become more critical now that the fertilizer subsidy offered by the government has been removed.
For example, when the 2003 wet season arrived in Nigeria, farmers were faced with an acute shortage of fertilizer due to poor planning by both the federal and state governments. Bauchi was the only state that procured its fertilizer equipment ahead of the season. Having predicted the impending shortage, SG 2000 forewarned its farmers, who purchased sufficient fertilizer in time for the wet season. The season came with the heaviest rains recorded in more than three decades. In several areas, the rainstorms caused havoc in terms of flooding, which washed away several hundred thousand hectares of cropped farmland, houses, and livestock.
Yet, thanks to the assistance of SG 2000, participant farmers were still able to get a significant yield of QPM (4.9 tilled per hectare compared to the national average of 1.6 tilled per hectare). The average cost of production was USD$354 per hectare with a net income of USD$307 per hectare. For maize conservation tillage plots, the average yield was 3.6 tilled per hectare with the cost of production at USD$285 and net income of USD$191 per hectare.
"An important objective of the SG 2000 program is to provide hands-on skills training for extension staff and farmers," says Dr. Ahmed Falaki, SG 2000 project coordinator for Nigeria. "During the 2004 wet season, some 1,230 extension staff and no less than 32,500 farmers were trained with the support of the state and local governments."
Another innovative approach has been to establish demonstration plots in selected schools and prisons in Bauchi, Gombe, Jigawa, and Kaduna states. Dr. Falaki explains, "The aim is to supplement the food that students eat while staying in hostels. We hope that prison inmates will take away new agricultural skills when they leave prison – and perhaps not offend again!" The pilot demonstrations have been encouraging, and requests have been received for the program to be established at other prisons and schools.
The process of accelerating extension outreach is gaining rapid momentum. The program is receiving renewed and increased support for the consolidation and expansion of activities and in laying a foundation for sustainability.
Governor Ahmadu Adamu Mu'azu of Bauchi state has been so dedicated to the issue that the state sponsored the training of 10,000 farmers and program supervisors. He also distributed 80 new motorcycles to supervisors. In addition, all trained farmers were provided with loan packages of seed, fertilizer, and agrochemicals to establish small management training plots in maize, rice, millet, sorghum, cowpea, and soybean. The governor intends to sponsor another 20,000 management test plots during the 2004 wet season. Having set the ball rolling, the governments of Kano, Zamfara, and Gombe states have invited SG 2000 representatives for discussions on support and expansion of the project in their states for the benefit of small-scale, resource-poor farmers.
Adopting new technologies to improve crop yields is only half the battle as farmers then must find ways to sell their surplus crops. The program also helps identify local markets for these surpluses, because transporting them can be costly and inefficient. In addition, the program focuses on post-harvest technologies, including methods for processing and storing. As a result of these combined efforts, farmers are able to get a better price for their crops, meaning they can later expand their farms or buy livestock. Overall, Nigerian farmers in this program are making a better living, allowing them to improve their quality of life. For instance, the average participant farmer's costs were USD$410 per hectare, whereas the average net income per hectare ranged between USD$1,300-$1,512. This is a tremendous achievement in a nation where the average annual income is only USD$300.
The shadow of starvation and famine looms less ominously over Nigeria thanks to these on-going efforts. It is the program's hope that fewer children will be sick or die from malnutrition, allowing them more opportunities to grow into healthier adults. Consequently, more adults will be able to join the struggle to increase food security in the nation and the region. With continued hard work like this, the future is indeed full of hope.
Learn more about the Carter Center's Agriculture Program >
Updated June 2005
Although Nigeria is one of the largest petroleum exporters in the world, Africa's most populous nation has failed to capitalize on this natural resource. Decades of unfettered corruption, ethnic violence, and military rule stunted Nigeria's economic development. Since its independence from Great Britain in 1960 until its historic presidential election in 1999, Nigeria was under military rule for all but 10 years.
In 1993, a civilian-led government was installed, but again, the military seized power after three months. Nigeria was returned to a dictatorship, this time under General Sani Abacha, who strengthened his power by jailing and executing his dissenters. He also allowed only five political parties to exist, but all of them had to nominate him for the presidency.
After Abacha died of a heart attack in June 1998, General Abdulsalami Abubakar rose to power and instituted democratic reforms. He legalized political parties, political prisoners were released, and the press operated unhindered. Elections were called for February 1999.
Voter registration began in October 1998, just four months before the election – a huge feat considering Nigeria's vast size and population. Registration was further hampered by the poor communications system, frequent fuel shortages that hampered transportation of voters lists, and a run-down infrastructure.
The Carter Center and its partner, the National Democratic Institute for International Affairs, observed voting Feb. 20 for National Assembly members. Observers, led by former U.S. President Carter, saw a low turnout and serious irregularities nationwide, including ballot stuffing, inflation of results, and voter intimidation.
President Carter was joined by retired U.S. General Colin Powell and former Niger President Mahamane Ousmane to lead a 66-member delegation to observe the Feb. 27 presidential election. The Center and NDI again found serious irregularities. Many sites recorded all 500 registered voters had cast ballots when observers saw fewer than 100 people on election day at those sites. One ballot box contained 500 ballots all folded the same way and all marked for retired General Olusegun Obasanjo. President Carter sent a letter to the election commission asserting the Center could not verify the outcome of the election because of the seriousness of the flaws observed. Nevertheless, Obasanjo was later sworn in as president.
The Center and NDI again called for significant changes in electoral preparations for the 2003 presidential election. After a pre-election mission in March 2003, NDI and the Center called on Nigeria's election commission to put the voter register out for public review, publicize the number of registered voters, inform citizens how to acquire a voter card, and simplify the process for accrediting election observers. In addition, the government was urged to establish a national security plan for the elections. Nigeria's pre-election period was marked by violence, including the assassination of candidates and political activists.
"Such a plan could serve as a deterrent to violence and provide a framework for resolving any conflicts as they erupt," said Dr. David Carroll, associate director of the Center's Democracy Program. "We were encouraged, though, by the signing of a code of conduct by the major political parties and urged that it be distributed and widely publicized." The Center, though, did not observe election day, April 19, 2003. Because of world events, it decided not to send staff from Atlanta overseas.
Because a free press is vital to a strong democracy, The Carter Center helped arrange professional training workshops in 1999 for print and broadcast reporters in Nigeria covering the elections and political issues. Workshops focused on such topics as story structure, the media's role in free and fair elections, and how to deal with censorship and government interference. The project has been a collaborative effort of the U.S. Information Service's Democracy and Governance Program, the Nigerian nongovernmental organization Media Rights Agenda, The Carter Center, and the DeWitt Wallace Center at Duke University in North Carolina. To promote peace and democracy, The Carter Center often speaks out against human rights violations. Such was the case in November 1995, when President Carter wrote to Nigerian head of state General Sani Abacha to express his "profound dismay and shock" at the execution of nine environmental and minority rights advocates, including Ken Saro-Wiwa. President Carter called on General Abacha to "release all other prisoners detained or convicted on the basis of the peaceful expression of their beliefs, to commute the sentences of other detainees facing capital punishment on politically inspired grounds, and to give full effect to the rule of law in Nigeria."
A letter also was sent to the secretary-general of the Commonwealth of Nations stating that the executions raised "serious questions as to Nigeria's continued good standing with the international community." Both letters were sent on behalf of the Carter Center's International Human Rights Council, comprised of leaders from around the world.
President Carter visited the Niger River delta in February 1999 to meet with activists, who had grown more confrontational in protesting policies and practices of the government and major oil companies operating in the area. "There is almost unanimous agreement that the people in this oil-producing region have suffered from severe environmental degradation and a lack of fair allocation of funds for schools, hospitals, housing, and other necessities," he said. "Unless resolved, the disputes could degenerate into an all-out war."
After meetings with Ijaw Youth Council representatives and elders from the Ijaw, Urhobo, Isoko, Ogoni, and Itsekiri peoples, President Carter recommended consideration of several options. They included initiating a dialogue with representatives chosen by the Delta people themselves and establishing a clearer federal oil revenue-sharing formula to allow local and state officials in the Delta region to administer oil revenues for new roads and other projects. He also suggested that a social development trust fund be administered privately with local participation to support more such projects.
Learn more about the Carter Center's Conflict Resolution Program > Pre-election Statement on Nigeria Elections, Nov. 22, 2002 (PDF)This statement is the product of the National Democratic Institute and The Carter Center pre-election assessment mission that visited Nigeria Nov. 17-22, 2002. To support the work of the delegation, a 13-person advanced team of observers visited nine states in all six geopolitical zones Nov. 7-15 and conducted more than 100 meetings and interviews. The statement details the delegation's observations and respectfully includes specific recommendations to stakeholders for ways to improve the conduct of the elections. Pre-election Statement on Nigeria Elections, March 28, 2003This report is the product of a pre-election assessment team organized by the National Democratic Institute for International Affairs (NDI) and The Carter Center that visited Nigeria March 16-21, 2003.
Final Report: Observing the 1998-99 Nigeria
Elections (PDF), released June 1, 1999At the invitation of all key political figures in Nigeria, The Carter Center and the National Democratic Institute for International Affairs (NDI) organized election assessment and observation missions for each round of the transition process, including a 66- member international delegation to observe the Feb. 27 presidential election.
Observing the 1998-99 Nigeria Elections (Summer 1999 PDF) The sudden death of military dictator Gen. Sani Abacha in June 1998 and the positive steps taken toward democracy by his successor, Gen. Abdulsalami Abubakar, raised the hopes that Nigeria might end a 15-year period of nondemocratic rule. The Carter Center monitored all stages of the transition, culminating in the Feb. 27 presidential election. The report details Nigeria's troubled past, transition issues, and the monitoring of the elections (pdf format). Postelection Statement on Nigeria Elections, March 1, 1999 The Carter Center and the National Democratic Institute (NDI) offer this statement on the Feb. 27 presidential election in Nigeria, to supplement the preliminary statement of Feb. 28. Postelection Statement on Nigeria Elections, Feb. 28, 1999 The Carter Center and the National Democratic Institute (NDI) offer this preliminary statement on the Feb. 27 presidential election in Nigeria.
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