The Carter Center currently works with national ministries of health to eliminate the debilitating parasitic disease of lymphatic filariasis - a leading cause of permanent and long-term disability worldwide - from areas of Ethiopia, Nigeria, and the island of Hispaniola.
Lymphatic filariasis is caused by thin worms transmitted to humans by the bites of mosquitoes in tropical and subtropical regions.
These worms live in, and cause blockage of, the lymphatic system that normally returns fluids in our extremities to the circulatory system. This blockage results in fluid collection in the tissues (most commonly the legs and genitalia), severe swellings, and periodic fevers from bacterial infections of the collected fluids.
A long-standing infection with lymphatic filariasis results in an irreversible condition called elephantiasis, in which there is a marked enlargement and hardening of the limbs so that they resemble those of an elephant.
Approximately 120 million people are infected by lymphatic filariasis, and 1.1 billion are at risk of infection. In endemic communities, as many as 10 percent of women and men can be affected with swollen limbs and 50 percent of men can suffer from the mutilating disease of their genitals.
These conditions have a devastating effect on the quality of life of victims, impacting them not only physically but also emotionally and economically. Two of the countries where the Center has fought lymphatic filariasis — Nigeria and Ethiopia — are among the most endemic worldwide.
The Center assists countries to distribute the drugs Mectizan®, donated by Merck, albendazole, donated by GlaxoSmithKline, and DEC, donated by Essai. These medicines are taken in combination (Mectizan and albendazole in Africa; DEC and albendazole in Hispaniola) to stop mosquitoes from transmitting the parasite from infected to uninfected people.
The Center also has assisted in the distribution of long-lasting insecticidal bed nets (LLINs) to protect pregnant women and children who cannot take drug treatment. LLINs have the added benefit of protecting against other mosquito-borne diseases, such as malaria.
The success of the joint programs has demonstrated that one community-based health education and drug distribution system can support the control and elimination of multiple diseases.
In Nigeria: Between 2000 and 2011, The Carter Center and the Nigeria Federal Ministry of Health worked together to protect 4 million people from lymphatic filariasis in Plateau and Nasarawa states through community health education, delivery of LLINs and 33 million drug treatments for lymphatic filariasis and river blindness between 2000 and 2011. In 2012, it was confirmed that lymphatic filariasis transmission had stopped. Post-treatment surveillance is currently underway to assure that the parasite is not reintroduced into the area.
In 2014, with support from The Carter Center, the Nigeria Federal Ministry of Health and other partners 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 eighteen districts, and delivered more than 1.1 million treatments in 2015.
In Hispaniola: The Carter Center is working to encourage cooperation between health agencies in Haiti and the Dominican Republic to eliminate both lymphatic filariasis and malaria from the island the nations share.
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The Carter Center's pioneering use of integrated drug treatments for lymphatic filariasis, schistosomiasis, and river blindness saves approximately 40 percent of program costs, such as gasoline and training expenses as well as time for community members who distribute the drugs.