Guinea Worm Eradication Program
The Carter Center reported just 54 human cases in 2019, along with 1,994 infections in animals, mostly dogs in Chad. (Figures are provisional.) Intensified surveillance and interventions are taking place, particularly in Chad, which had 49 of the human cases. A single case reported in Cameroon is believed to have been imported from Chad. The Carter Center is now working in Angola, which had one case in 2019. When the Center started leading the global eradication program in 1986, there were an estimated 3.5 million cases in 21 countries in Africa and Asia. Progress has been achieved entirely through behavioral change, as there is no medication to treat the parasitic disease nor vaccine to prevent it. The Carter Center board of trustees in 2019 launched a two-year, $40 million campaign to support the challenging final stages of eradicating Guinea worm disease. The Carter Center Challenge Fund will match donations of $100,000 or more to the Guinea Worm Eradication Program, up to $10 million per year in 2019 and 2020, for a total of $20 million in matching funds.
River Blindness Elimination Program
The Carter Center assists six countries in delivering Mectizan® (donated by Merck & Co., Inc.) to populations at risk for this parasitic disease, also called onchocerciasis. Over 20 million treatments (provisional figure) were provided in 2019 in Center-assisted mass drug administration programs. The largest effort is in Nigeria, followed by Ethiopia. The goal of the program is to reach a point where transmission of the disease is interrupted and treatments can safely be stopped; a total of 6.8 million treatments have been halted in accordance with World Health Organization guidelines. The Carter Center-assisted country closest to elimination in Africa is Uganda, where treatments have been stopped in 15 of 17 transmission zones. In the Americas, four countries have eliminated river blindness and 94% of Mectizan treatments are no longer needed. About 30,000 Yanomami indigenous people living in the areas bordering Brazil and Venezuela remain at risk; Yanomami health agents are helping deliver Mectizan and other health services to their communities.
Several countries are on track to eliminate blinding trachoma, a bacterial eye disease, as a public health problem. Mali may be able to eliminate blinding trachoma as a public health problem by the end of 2020. In Niger, the program is expected to clear the remaining surgical backlog by 2023 and eliminate trachoma as a public health problem by 2025. In Ethiopia’s hyperendemic Amhara region, the program relies on a network of over 7,000 government health extension workers and about 30,000 village-based volunteers to reach nearly 20 million at-risk people. Since 2001, The Carter Center has supported more than 708,000 surgeries in the region to correct eyelids damaged by the disease. Despite ongoing conflict throughout South Sudan, The Carter Center remains committed to supporting the National Trachoma Program as it works toward elimination of trachoma as a public health problem by 2030. In Sudan, periodic unrest impacted activities in certain areas, but the Center supported the delivery of medication and surgery as security allowed. The Carter Center concluded its work in Uganda in 2019.
The Carter Center works with the ministries of health in Haiti and the Dominican Republic to eliminate malaria and lymphatic filariasis (LF) from the countries’ shared island, Hispaniola. Malaria cases decreased 93% islandwide between 2010 and 2019. The reduction is greatest in Haiti, where approximately 6,500 cases occurred in 2019, representing a 94% decrease compared to the more than 84,000 cases reported in 2010. Burden of disease is lower in the Dominican Republic, where only 1,244 cases were reported in 2019. Similar progress has been achieved against LF. In Haiti, 118 (84%) of the 140 communes have met the criteria for stopping annual mass drug administration for LF. In the Dominican Republic, all previously endemic areas qualified to stop mass drug administration for LF in 2018 and are conducting post-treatment surveillance. Surveillance is ongoing in other parts of the country to confirm the absence of LF transmission nationwide.
Public Health Training Initiative
Through this initiative, The Carter Center aims to improve the training of frontline health professionals who treat mothers, infants, and children in Nigeria and Sudan. The Carter Center partners with the federal and state ministries of health in the two countries to produce a more skilled workforce by enhancing teaching and learning environments through the provision of classroom equipment; updating preservice training curricula to ensure high-quality instruction; conducting in-service training with health workers to refresh and advance their skills; providing pedagogical training to faculty; and strengthening monitoring, evaluation, and reporting systems to measure impact. Through these efforts, more than 700 Nigerian and Sudanese instructors are now better equipped to train nurses, midwives, and other frontline health workers; over 10,000 classroom equipment items have been distributed; and training curricula reflecting global standards in community health are utilized at institutions across Nigeria and Sudan.
Mental Health Program
Working with the Liberian government, The Carter Center has helped to create a corps of more than 340 locally trained mental health clinicians, 120 of them child and adolescent specialists. The Center is also working with London-based United for Global Mental Health to create greater awareness of mental health and a mental health financing mechanism within Liberia. In 2019, the Center launched a pilot program to assess the impact of mental health interventions for people living with lymphatic filariasis in Haiti. Since the Rosalynn Carter Fellowships for Mental Health Journalism were established in 1996, fellows have produced more than 1,500 stories, documentaries, books, and other works on mental health topics. In May, the 24th Rosalynn Carter Georgia Mental Health Forum convened leaders and experts on parity for mental health insurance coverage, school-based behavioral health services, and behavioral health in older adults. The Center also worked with the Georgia Appleseed Center for Law and Justice and with Voices for Georgia’s Children to launch a series of six School-Based Behavioral Health Forums in Georgia.
Lymphatic Filariasis Elimination Program
The Carter Center assisted in providing mass drug administration to over 11 million people in 2019 to prevent this devastating mosquito-borne parasitic illness. Lymphatic filariasis obstructs lymphatic vessels, resulting in painful, irreversibly swollen limbs and sometimes hydrocele, a swelling of the scrotum. Those who are most seriously afflicted develop elephantiasis, resulting in disfigurement, disability, and social stigma. In Africa, The Carter Center helps distribute Mectizan® (donated by Merck & Co., Inc.) and albendazole (donated by GSK), which, taken in combination, stop mosquitoes from transmitting the parasite from infected to uninfected people.
Schistosomiasis Control Program
People who bathe in natural water sources risk contracting schistosomiasis, which is spread by small freshwater snails. Schistosomiasis causes bloody urine, anemia, organ injury, and stunted growth. Working in Nigeria, The Carter Center assisted in providing over 1 million treatments to schoolchildren in 2019 to treat and prevent this disease. Praziquantel tablets were donated by Merck KGaA.
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