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Fighting Disease

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.

+Eradicating Guinea Worm Disease

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.

+Controlling Trachoma

In 1998, The Carter Center capitalized on experience and knowledge gained from the Guinea Worm Eradication Program to work with the government of Niger and partner organizations on trachoma control. Surveys conducted in Niger from 1997 through 1999 found the burden of trachoma to be concentrated in Diffa, Maradi, and Zinder regions. In children, a high prevalence of trachomatous inflammation-follicular (TF) was found, 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. The advanced stage of the disease can lead to permanent blindness if not addressed. These findings indicated that trachoma was a major public health problem in Niger.

In response to these data, the Niger Ministries of Health, Education, Water, and Social Development established a Trachoma Task Force and invited The Carter Center and other partner organizations to serve as members.

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 comprises Surgery, Antibiotics, Facial cleanliness, and Environmental improvement.

With support from the Conrad N. Hilton Foundation, The Carter Center expanded its assistance throughout Diffa, Maradi, and Zinder regions to include corrective eyelid surgeries for those at risk of blindness from TT. Through both health center-based care and outreach strategies, The Carter Center has assisted in providing TT services in targeted districts within the three regions. In 2019, a total of 5,316 TT surgeries were conducted; from 2008 to early 2020, The Carter Center assisted the Niger program in performing more than 84,000 TT surgeries.

The mass drug administration of Zithromax® (azithromycin, donated by Pfizer Inc) used to treat active trachoma infection, was taken over by Helen Keller International in 2011 as part as 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 in Niger. The Carter Center continues to support the distribution of tetracycline ointment for those who are unable to take azithromycin; since 2008, more than 350,000 doses of TEO have been distributed in Niger.

With support from the Conrad N. Hilton Foundation, The Carter Center and its partner organization, Helen Keller International, have assisted national school health programs to train schoolteachers to educate their students about trachoma control. To reach children not in the secular school systems, the program also has trained traditional Koranic schoolteachers about trachoma prevention. In 2019, 441 people were trained to provide health education and assist with the ongoing health education in over 600 villages supported by The Carter Center in Niger.

To broaden the reach of the program's educational campaign throughout Niger, health education messages on the SAFE strategy are produced and broadcast in local languages on community radio stations. Since 2008, The Carter Center has broadcast more than 279,000 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 for change.

Household latrine promotion has been a cornerstone of the Carter Center program in Niger. As of the end of 2019, with the Center's support, more than 151,600 household latrines have been built by over 4,000 trained masons since 2002.

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