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Water is at a premium for most Niger, located on the edge of the Sahara Desert, and waterborne diseases threaten many people, who have no option but to drink from unsafe sources such as stagnant ponds. The government of Niger invited The Carter Center to assist with efforts to combat two painful and debilitating waterborne illnesses, Guinea worm disease and, later, trachoma.
Current Status: Transmission stopped, October 2008 (Read the announcement)
Certification of Dracunculiasis Elimination: 2013
Current Guinea worm case reports >
Since 1986, the Carter Center's Guinea Worm Eradication Program has led a worldwide coalition to wipe out this devastating disease. In 1993, when the Center began working in five of Niger's six endemic regions — Dosso, Maradi, Tahoua, Tillaberi, and Diffa — there were approximately 33,000 cases of Guinea worm disease in 1,700 villages of the country.
In collaboration with the Ministry of Health, The Carter Center implemented health education strategies aimed at changing behavior in order to prevent Guinea worm disease and mobilized communities to improve the safety of their local water sources.
Efforts were focused on collaboration between village volunteers, who were trained to detect and quickly report cases, and medical facilities, where worms could be safely removed to avoid contaminating sources of drinking water.
Niger reported its last three indigenous cases in October 2008, and after 13 consecutive months without an indigenous case, Niger was determined to have broken Guinea worm transmission. However, neighboring Mali, which remains endemic, exported three cases to Niger in 2012.
Migratory groups (such as the Tuareg and Peule) in the tri-border area of Burkina Faso, Mali, and Niger pose a challenge to the global eradication program. Often marginalized, migrant populations must be given the necessary tools, such as portable pipe filters used for drinking water from stagnant ponds in the desert, and health education, to prevent the disease from traveling with them.
To help avoid further case importation and ensure successful regional elimination, Mali and Niger have collaborated to standardize their monetary rewards for reporting cases and guidelines for hospitalizing Guinea worm patients.
Starting in 1998, The Carter Center used the experience and knowledge gained from the Guinea Worm Eradication Program to work with the government of Niger and partner organizations to fight trachoma. Surveys conducted in Niger from 1997 through 1999 found that trachoma was a major public health problem in Niger; the burden of trachoma was concentrated in Diffa, Maradi, and Zinder regions. A high prevalence of trachomatous inflammation-follicular (TF) was found in children, the standard to assess disease prevalence. A high prevalence of the advanced stage of the disease, known as trachomatous trichiasis (TT), was found in adults; TT can lead to permanent blindness if left untreated.
From 1999 through 2008, the Center focused exclusively on health and hygiene education and environmental sanitation activities. In late 2008, the Niger Ministry of Health and the National Prevention of Blindness Program asked partner organizations to support the full SAFE strategy nationwide. SAFE is a multipronged approach endorsed by the World Health Organization (WHO) that includes Surgery to turn eyelashes back outward; Antibiotics to treat trachoma infection; Facial cleanliness through the provision of health education messages to communities; and Environmental improvement by promoting the construction of household latrines and maintenance to reduce fly populations that may carry the disease from person to person.
With support from the Conrad N. Hilton Foundation, The Carter Center expanded its assistance throughout the Diffa, Maradi, and Zinder regions to include corrective eyelid surgeries for those at risk of blindness from TT. The 20-minute surgery halts further corneal abrasions, eases the pain caused with each blink, halts further damage to the cornea, and reduces the threat of blindness. In 2023, a total of 1,633 TT surgeries were conducted with Carter Center assistance; from 2008 to 2023, The Carter Center assisted the Niger program in providing more than 91,000 people with TT surgery. The numbers decline as the country nears the thresholds for trachoma elimination.
The mass administration of Zithromax® (azithromycin, donated by Pfizer Inc) to treat active trachoma infection has been assisted by Helen Keller International as part of an integrated neglected tropical disease program supported by the Ministry of Health. From 2008 to 2011, The Carter Center supported the distribution of 3,780,384 doses of azithromycin and 100,973 doses of tetracycline eye ointment (TEO) in Niger. Additionally, from 2018 through 2022, The Carter Center supported the distribution of 450,000 doses of TEO for those who are unable to take azithromycin.
Again with the Conrad N. Hilton Foundation’s support, The Carter Center has assisted the national program in Niger to train schoolteachers to educate their students about trachoma control. The national program broadened the educational campaign’s reach throughout Niger with messages broadcast in local languages on community radio stations. Since 2008, The Carter Center has broadcast 420,566 health education messages and promoted the messages through listening clubs. To reach people without access to radio, artists and health educators perform theatrical dramas in large villages and weekly markets, and religious and community leaders are trained to act as advocates.
Household latrine building and promotion has been a cornerstone of the Carter Center program in Niger. From 2002 through 2023, with the Center's support, at least 193,090 household latrines have been built by over 4,350 trained masons.
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