News & Publications

River Blindness Program - Articles By Carter Center Experts

5 September 2009
Sustainability of Ivermectin Distribution Programmes
This article was published in the Sept. 5, 2009 issue of The Lancet, Volume 374, Issue 9692,and is reprinted with permission. 
Lindsay J Rakers, Emmanuel Emukah, Jude Onyenama d, Grace Amah, Nnenna Ukairo, Uche Enyinnaya, Emmanuel Miri, Frank Richards, Sustainability of ivermectin distribution programmes, pgs. 785 - 786.

31 March 2009
Successful Interruption of Transmission of Onchocerca volvulus in the Escuintla-Guatemala Focus, Guatemala (PDF)
This article was published in the March 2009 issue of PLoS Journal of Neglected Tropical Diseases and is reprinted with permission. 
PLoS Negl Trop Dis 3(3): e404. doi:10.1371/journal.pntd.0000404. Rodrigo J. Gonzalez, Nancy Cruz-Ortiz, Nidia Rizzo, Jane Richards, Guillermo Zea-Flores, Alfredo Domı´nguez, Mauricio Sauerbrey, Eduardo Catu´ , Orlando Oliva, Frank O. Richards Jr, Kim A. Lindblade. Elimination of onchocerciasis (river blindness) through mass administration of ivermectin in the six countries in Latin America where it is endemic is considered feasible due to the relatively small size and geographic isolation of endemic foci. We evaluated whether transmission of onchocerciasis has been interrupted in the endemic focus of Escuintla- Guatemala in Guatemala, based on World Health Organization criteria for the certification of elimination of onchocerciasis.  Read the press release>

1 September 2008
After a Decade of Annual Dose of Mass Ivermectin Treatment in Cameroon and Uganda, Onchocerciasis Transmission Continues (PDF)
Tropical Medicine and International Health, Volume 13, no. 9, pp 1–8. © 2008 Blackwell Publishing Ltd.  Authors: Moses Katabarwa, Albert Eyamba, Peace Habomugisha, Tom Lakwo, Same Ekobo, Joseph Kamgno, Thomas Kuete, Richard Ndyomugyenyi, Ambrose Onapa, Mkpouwoueiko Salifou, Marcelline Ntep and Frank O. Richards.  Objective: To evaluate the effectiveness of 10 years' annual single dose ivermectin treatment on onchocerciasis transmission in hyperendemic areas of Cameroon and Uganda.

1 June 2008
Dracunculiasis, Onchocerciasis, Schistosomiasis, and Trachoma (PDF)
Annals of the New York Academy of Sciences, 1136: 45-52 (2008), Issue - Reducing the Impact of Poverty on Health and Human Development: Scientific Approaches,
Donald R. Hopkins, Frank O. Richards, Jr, Ernesto Ruiz-Tiben, Paul Emerson, P. Craig Withers, Jr. Published Online: 25 Jul 2008. The definitive version is available at www.wileyinterscience.com.

1 March 2008
Short Report: Could Neurocysticercosis Be the Cause of "Onchocerciasis-Associated" Epileptic Seizures? (PDF)
Am. J. Trop. Med. Hyg., 78(3), 2008, pp. 400–401. Copyright © 2008 by The American Society of Tropical Medicine and Hygiene. Moses Katabarwa,* Tom Lakwo, Peace Habumogisha, Frank Richards, and Mark Eberhard. Abstract. We conducted a nodule prevalence survey in four onchocerciasis sentinel communities in Moyo and two in Kanungu districts of Uganda. Seven (33.3%) out of 21 excised "onchocercomas" (nodules) in Moyo District and excised onchocercomas from four of six persons in Kanungu District turned out to be cysts of Taenia solium.

1 January 2008
Evidence for Suppression of Onchocerca volvulus Transmission in the Oaxaca Focus in Mexico (PDF)
Am. J. Trop. Med. Hyg., 78(1), 2008, pp. 147–152, Copyright © 2008 by The American Society of Tropical Medicine and Hygiene. Authors: Mario A. Rodríguez-Pérez,* Cristian Lizarazo-Ortega, Hassan K. Hassan, Alfredo Domínguez-Vásquez, Jorge Méndez-Galván, Patricia Lugo-Moreno, Mauricio Sauerbrey, Frank Richards Jr., and Thomas R. Unnasch.

1 October 2006
Successful integration of insecticide-treated bed net distribution with mass drug administration in Central Nigeria (PDF) 
Am J Trop Med Hyg; 75: 4: 650-5. Copyright © 2006 by The American Society of Tropical Medicine and Hygiene Blackburn BG, Eigege A, Gotau H, Gerlong G, Miri E, Hawley WA, Mathieu E, Richards F.

1 January 2005
Significant Decrease in the Prevalence of Wuchereria Bancrofti Infection in Anopheline Mosquitoes Following the Addition of Albendazole to Annual, Ivermectin-Based, Mass Treatments in Nigeria (PDF)
Annals of Tropical Medicine and Parasitology; 99: 155-64. Richards, F., Pam, D., Kal, A., Gerlong, G., Oneyka, J., Sambo, Y., Danboyi, J., Ibrahim, B., Terranella, A., Kumbak, D., Dakul, A., Lenhart, A., Rakers, L., Umaru, J., Mafuyai, H., Jinadu, M., Miri, E., and Eigege, A. 

1 April 2005
Community-directed interventions strategy enhances efficient and effective integration of health care delivery and development activities in rural disadvantaged communities of Uganda
Tropical Medicine & International Health Volume 10 Issue 4 Page 312 - April 2005 By M. N. Katabarwa, P. Habomugisha, F. O. Richards Jr and D. Hopkins, The Carter Center, Atlanta GA, USA.

1 January 2005
Editorial: Whither Onchocerciasis Control in Africa? (PDF)
Editorial: Whither Onchocerciasis Control in Africa? By D. R. Hopkins, F.O. Richards, and M. Katabarwa, The Carter Center, Atlanta, Georgia; Centers for Disease Control and Prevention, Atlanta, Georgia. (Am. J. Trop. Med. Hyg., 2005 Jan;72(1):1-2. No abstract available.) PMID: 15728857

26 June 2004
Kinship Structure and Health-Care Improvement in Sub-Saharan Africa
The following was originally published in The Lancet, Volume 363, Number 9427, as a letter to the editor. 

1 January 2004
A Longitudinal Study of Impact of Repeated Mass Ivermectin Treatment on Clinical Manifestations of Onchocerciasis in Imo State, Nigeria (PDF)
Authors: E.C. Emukah, E. Osuoha, E.S. Miri, J. Onyenama, U. Amazigo, C. Obijuru, N. Osuji, J. Ekeanyanwu, S. Amadiegwu, K. Korve, F. Richards. Published in American Journal of Tropical Medicine and Hygiene 2004; 70:556-61. Abstract: We conducted a cohort study on impact of effects of eight years of annual ivermectin mass treatment administered in eight villages in Imo State, Nigeria. Physical and visual acuity examinations carried out in 462 persons in 1995, prior to the launching of mass drug administration with ivermectin, were compared with re-examinations of 411 (89%) of these same individuals in 2002. We found that gross visual impairment decreased from 16% to 1%, nodult prevalence decreased from 59% to 18%, and papular dermatitis was reduced from 15% to 2%. No change was seen in leopard skin rates (14%). the only incident lesions were three subjects from a single community having the appearance of new nodules (e.g., nodules not identified in the 1995 examinations). Differences in community coverage did not appear to influence the benefit from treatment of individual residents.    

1 January 2002
Involvement and Performance of Women in Community-Directed Treatment With Ivermectin for Onchocerciasis Control in Rukungiri District, Uganda (PDF)
Authors: Katabarwa, M.N., Habomugisha, P., Ndyomugyenyi, R., and Agunyo, S. Published in Annals of Tropical Medicine & Parasitology, Vol. 95, No. 5, 485-494 (2001).  

1 January 2002
Lymphatic Filariasis Elimination and Schistosomiasis Control in Combination with Onchocerciasis Control in Nigeria (PDF)
Authors: Hopkins D.R., Eigege A., Miri E.S., Gontor, I., Ogah, G., Umaru, J., Gwomkudu, C.C., Mathai, W., Jinadu, M.Y., Amadiegwu, S., Oyenekan, O.K., Korve, K., Richards, F.O. Published in American Journal of Tropical Medicine and Hygiene. 2002; 67(3):266-72. Abstract: This paper describes a pilot initiative to incorporate lymphatic filariasis (LF) elimination and urinary schistosomiasis (SH) control into a mature onchocerciasis control program bsed on community-directed ivermectin treatment in central Nigeria. In the same districts having onchocerciasis we found LF (as determined by blood antigen testing in adult males) in 90% of 149 villages with a mean prevalence of 22.4% (range 0-67%). Similarly, SH, as a mean prevalence in school age children of 24.4% (range 0-87%). Health education and treatment interventions for SH resulted in 52,480 cumulative praziquantel treatments, and 159,555 combined onchocerciasis and LF treatments (with ivermectin and albendazole) as of the end of 2000. Treatments for onchocerciasis and LF were separated by at least 1 week from treatments for SH. There was no negative impact on the coverage of the onchocerciasis program by the addition of LF and SH activities. 

1 December 2001
The Carter Center's Assistance to River Blindness Control Programs: Establishing Treatment Objectives and Goals for Monitoring Ivermectin Delivery Systems on Two Continents (PDF)
Authors: F. Richards, E. Miri, M. Katabarwa, A. Eyamba, M. Sauerbrey, G. Zea-Flores, K. Korve, W. Mathai, M. Homeida, I. Mueller, E. Hilyer, and D. Hopkins. Published in the American Journal of Tropical Medicine and Hygiene 2001; 65:108-14. Abstract: Periodic mass treatment with ivermectin in endemic communities prevents eye and dermal disease due to onchocerciasis. As part of an international global partnership to control onchocerciasis, The Carter Center's Global 2000 River Blindness Program (GRBP) assists the ministries of health in ten countries to distribute ivermectin (Mectizan®, donated by Merck & Co.). The GRBP priorities are to maximize ivermectin treatment coverage and related health education and training efforts, and to monitor progress through regular reporting of ivermectin treatments measured against annual treatment objectives and ultimate treatment goals (e.g., full coverage, which is defined as reaching all persons residing in at risk villages who are eligible for treatment). Since the GRBP began in 1996, more than 21.2 million ivermectin treatment encounters have been reported by assisted programs. In 1999, more than 6.6 million eligible persons at risk for onchocerciasis received treatment, which represented 96% of the 1999 annual treatment objective of 6.9 million, and 78% of the ultimate treatment goal in assisted areas. 

1 November 2001
On the Road with President Carter: Targeting River Blindness
During November 2001, former President Jimmy Carter attended the 11th annual InterAmerican Conference on Onchocerciasis in Mexico City, which brought together high-level representatives from the six onchocerciasis- or river blindness-endemic countries in the Americas to discuss recent findings that, under certain conditions, it is feasible to eliminate river blindness in the Americas. Occurring mostly in Africa, the disease also threatens about 540,000 people in Mexico, Guatemala, Venezuela, Colombia, Ecuador, and Brazil. 

1 May 2001
Involvement of Women in Community-Directed Treatment With Ivermectin for the Control of Onchocerciasis in Rukungiri district, Uganda: a knowledge, attitude and practice study (PDF)Authors: Katabarwa, M.N., Habomugisha, P., Ndyomugyenyi, R., and Agunyo, S. Published in Annals of Tropical Medicine & Parasitology, Vol. 95, No. 5, 485-494 (2001). Abstract: A study of knowledge, attitudes and practice was carried out in the Rukungiri district of Uganda, in order to investigate the involvement of women in community-directed treatment with ivermectin (CDTI), for the control of onchocerciasis. The data analysed came from interviews with 260 adult women (one from each of 260 randomly-selected households in 20 onchocerciasis-endemic communities), community informants, and participatory evaluation meetings (PEM) in eight communities. The women who had been treated with ivermectin in 1999 generally had more knowledge of the benefits of taking ivermectin, were more likely to have attended the elevant health-education sessions and were more involved in community decisions on the method of ivermectin distribution than the women who had not received ivermectin in that year. There were fewer female community-directed health workers (CDHW) than male CDHW in the communities investigated. The reasons for not attending health-education sessions, not participating in community meetings concerning the CDTI, and the reluctance of some women to serve as CDHW were investigated. The most common reasons given were domestic chores, a reluctance to express their views in meetings outside their own kinship group, suspicions that other women might take advantage of them, and a lack of interest. Most of the women interviewed (as well as other community members) felt that there were relatively few women CDHW. The women attributed this to a lack of interaction and trust amongst themselves, which resulted in more men than women being selected as CDHW. The rest of the community members were not against women working as CDHW.  

1 February 2001
Community-Directed Health (CDH) Workers Enhance the Performance and Sustainability of CDH Programmes: experience from ivermectin distribution in Uganda (PDF)
Authors: M.N. Katabarwa, F.O. Richards Jr. Published in Annals of Tropical Medicine & Parasitology, Vol. 95, No. 3, 275-286 (2001). 

1 January 2000
In Rural Ugandan Communities the Traditional Kinship/Clan System is Vital to the Success and Sustainment of the African Programme for Onchocerciasis Control [PDF]
Authors: Katabarwa, N. M.; Richards, F.O. Jr.; and Ndyomugyenyi, R. Published in Annals of Tropical Medicine and Parasitology 94, 485-495 Abstract: In rural Ugandan communities where onchocerciasis is meso- or hyper-endemic, conrol of the disease is now being carried out using a strategy of community-directed programmes for the annual distribution of ivermectin to all persons eligible to take the drug. For these programmes to achieve their annual target coverage of at least 90% of the population eligible to take ivermectin, and to continue to sustain themselves for 10-15 years or more, even after external donor funding ceases, it has been found essential to replace the initial community-based strategy, imposed from outside, by a community-directed strategy developed by the community members themselves. Furthermore, it is essential for success that full use be made of the traditional social system, which is very strong in all rural communities in Uganda. This system is based on patrilineal kinships and clans, governed by traditional law, and in it women play an important role. If this system is ignored or by-passed by governmnet health personnel or by the sponsors and promoters of the programme, the communities are likely to fail to reach their targets. When rural communities increase in size and complexity, following development and the arrival of migrant families, they become semi-urbanized. The kinship/clan system is then weakened, community-directed drug distribution is much more difficult to organize, and coverage targets are not often achieved. This effect is of minor importance in a rural disease, such as onchocerciasis, but is likely to be of greater significance in the control of diseases, such as tuberculosis and lymphatic filariasis, which thrive in urban environments.

1 January 1996
Community-Based Ivermectin Distributors: Onchocerciasis Control at the Village Level in Plateau State, Nigeria (PDF)
Authors: F. Richards, C. Gonzales-Peralta, E. Jallah, E. Miri. Published in Acta Tropica 1996; 61:137-44. Abstract: The use of community residents as agents for distributing mass ivermectin therapy for onchocerciasis provides a component of community participation absent from mobile team delivery methods. Community-based distribution, however, presupposes preexisting human resources in the endemic villages capable of fulfilling the essential functions of an ivermectin distribution process: mobilizing and educating the population, dispensing the drug, maintaining records, and monitoring and treating adverse reactions Even when such human resources exist, the comunity workers must continue to receive tangible support from both external (government and donor agencies) and internal (community) sources. Donor and government agencies must accept that their data collection demands will be limited by the literacy standards of the communities being served. Community leaders must agree to set and use their own local standards of payment (including food stuffs or exchange in kind) to compensate the distributors for their time and efforts. The use of locally available human and remunerative resources is a prerequisite for true community ownership of a program.