By Sola Ogundipe
FOR several decades, millions of Nigerians have battled Lymphatic filariasis, one of most debilitating Neglected Tropical Disorders, NTDs, and greatest public health problems in the world.
With over 120 million people at risk, Nigeria is the most endemic country in Africa for the disfiguring parasitic disorder and the second most endemic in the world, behind India.
Lymphatic filariasis is a parasitic disease caused by microscopic, thread-like worms. The adult worms only live in the human lymph system. People with the disease suffer from lymphadema, elephantiasis and in men, swelling of the scrotum. one of seven diseases that the International Task Force for Disease Eradication, ITFDE, based at The Carter Center, named potentially eradicable.
The success against the disorder in Plateau and Nasarawa states is the result of a long-term relationship between the Federal government of Nigeria and The Carter Center.
In 1998, at the invitation of the Federal Ministry of Health and the Plateau and Nasarawa States Ministries of Health, the Carter Center helped the establish a Lymphatic Filariasis Elimination Programme.
The goal was to demonstrate that transmission of the disease could be interrupted in one of the world’s most affected areas, and in so doing make the case for elimination of the disease from the rest of Africa.
With support from The Carter Center, the Nigerian’s Federal Ministry of Health and other partners in 2014 issued guidelines (first of their kind in Africa)for a coordinated effort to eliminate both diseases. The guidelines called for shared interventions such as health education, community-based action, distribution of long-lasting insecticidal bed nets, and mass drug administration.
Lately, the burden of the disease has been significantly reduced thanks to a pioneering partnership between the Federal Ministry of Health and The Carter Center. The partnership led to elimination of the disease as a public health problem in Plateau and Nasarawa States.
“This is a great day for the people of Plateau and Nasarawa states, and all of Nigeria,” said Dr. Yisa A. Saka, Director of Neglected Tropical Disease Programmes with the Federal Ministry of Health.
“Together with The Carter Center and our many other valuable partners, we are gaining the advantage over a terrible disease that has plagued good people for far too long.”
In the views of the Director of the Carter Center’s Lymphatic Filariasis Elimination Programme, Dr. Frank O. Richards Jr.,: “Eliminating lymphatic filariasis as a public health problem in Plateau and Nasarawa states is a significant achievement that challenges everyone to broaden their appreciation of what is possible. “Success in these two states not only protects the seven million people who live there, but it also sets a pattern for similar success throughout the rest of Nigeria, as well as in other highly endemic countries.”
Lymphatic filariasis, is caused by parasitic worms transmitted from infected persons to others by mosquito bites. In Nigeria, the disease is transmitted by the same Anopheles mosquito that transmits malaria. The worms impair the lymphatic system, resulting in periodic fevers, fluid collection in the tissues (most commonly the limbs and genitalia), and severe swelling often known as elephantiasis.
In addition to pain and reduced mobility, people disfigured by the disorder often experience crushing social stigma and chronic economic hardship that has a ripple effect across entire families and communities through lost productivity.
To tackle the disease in 30 local government areas of Plateau and Nasarawa States, community-selected volunteers were mobilised to educate their neighbours and annually distributed a combination of free medications — albendazole, donated by GSK, and Mectizan, donated by Merck & Co., Inc., also used in the fight against river blindness, another parasitic disease. In Plateau and Nasarawa alone, more than 36 million drug treatments for lymphatic filariasis were delivered between 2000 and 2012.
Insecticide-Treated bed nets were also a major tool utilised in the battle against the disorder to prevent mosquito bites especially for those not eligible to take the medications, such as children under five years old and pregnant women.
In the two states, Clarke Cares Foundation/Clarke Mosquito Control donated more than 140,000 bed nets.
“The community-directed distributors are the real heroes here. These are regular people stepping up to do the heavy lifting to improve the lives of their families and neighbors. Their commitment and diligence accelerate health programmes’ success,” Richards said.
Work over the years included continuously monitoring the effectiveness of the programme until it reduced the infection level in the two states to the point where community-wide drug treatment could be discontinued in 2012.
The programme then moved into its next phase, called post-treatment surveillance, with financial support from the ENVISION Project, based at RTI International and funded by the U.S. Agency for International Development.
A series of rigorous epidemiological surveys have been conducted throughout the two states to confirm transmission has been interrupted. Researchers examine finger-prick blood samples from children for evidence of the parasites in their blood.
According to Dr. Gregory Noland, Health Programme epidemiologist at The Carter Center, if transmission has been interrupted, those children’s tests should come back negative.
“Over the past two years, we have tested more than 14,000 children ages six and seven throughout the two-state area, and not one of them was found to be infected,” Noland said.
“This definitive outcome is a testament to the foresight of those who launched the programme, believing that elimination was possible in one of the world’s most endemic countries. In human terms, these children will never have to worry about being disabled by lymphatic filariasis.”
Continued surveillance and maximizing bed-net coverage are still required to guard against importation of the infection from surrounding endemic states until Nigeria achieves elimination nationwide, Noland cautioned.
The Hope Group enables lymphatic filariasis patients meet regularly at The Carter Center’s office in Jos, Plateau state, where they learn to care, socialize, give and receive emotional support.
“It’s great that future generations will never know this kind of suffering,” Umaru said. “This unique group helps people understand that although there is no cure for their legs, they don’t have to get worse, and there is hope for living fulfilling and productive lives.”
In partnership with the respective ministries of health, The Carter Center continues to pursue lymphatic filariasis elimination in other parts of Nigeria, as well as Ethiopia, the Dominican Republic, and Haiti. The Carter Center is part of the Global Alliance to Eliminate Lymphatic Filariasis, a diverse group of organizations dedicated to ridding the world of the disease.