Lindsay Rakers is a senior program associate for The Carter Center.

Eight years ago, the urine of 12-year-old Jude Ogwu was consistently red from blood. His father, chief of Aboh, a village in southeast Nigeria, took him to the hospital for treatment but received none. The hospital lacked medicine and the resources needed to treat Ogwu, who was suffering from schistosomiasis, a parasitic disease that damages internal organs.

Ogwu and his friends are particularly susceptible to schistosomiasis because they swim and play in a nearby stream where disease transmission occurs via snails.

With assistance from The Carter Center, Ogwu took his first dose of praziquantel, the medicine that treats and prevents schistosomiasis, when he entered primary school in 2005. Seven years later, when I visited Aboh last summer, I saw Ogwu take his annual dose. He said he feels better and no longer has bloody urine.

Patience Odogwu scrubs beans for her family using water from a muddy stream in central Nigeria that harbors the parasite that causes schistosomiasis. (Photos: The Carter Center/L. Rakers)

I have been traveling to Nigeria since 2005 and was there to witness schistosomiasis program implementation. Health education and drug distribution were to occur outside the local community center. As people gathered under tents, the police officers who had escorted us ran their sirens for several minutes. My Nigerian colleagues told me that this was to arouse curiosity and increase attendance. We keep careful records of who receives treatment; community members not attending the drug distribution would have to be visited in their homes or schools later.

A child is measured to determine correct dosing and then provided with Mectizan® (ivermectin, donated by Merck) to prevent river blindness and praziquantel to prevent and treat schistosomiasis (donated by Merck KGaA and distributed with support from Izumi Foundation).

We walked to the slow-moving, muddy stream that harbors schistosomiasis year-round. Local resident Patience Odogwu was cleaning beans when we arrived, scrubbing them with sand, then swirling them in the water. Children like Jude Ogwu are not the only ones at risk — the stream plays a role in the daily chores of all villagers. Aboh is fortunate in that it has a water pump in town that delivers clean, safe water. While a valuable resource, the pump’s capacity does not alleviate the need for people to go to the stream for chores like washing clothes, bathing, or scrubbing beans.

It was a privilege to watch the Aboh community take strides toward healthier lives during my visit. And I was reminded that we’ve accomplished much, but we still have more to do.

Carter Center Malaria Control Program Assistant Director Amy Patterson reflects in the blog below on the challenges and opportunities for increasing the use of bed nets in communities in Nigeria.

Adamu Sallau, director of the Carter Center’s malaria program in Nigeria, uses a flip-chart to teach a group of women in Plateau State, Nigeria how to use a bed net to prevent malaria. (Photos: A. Patterson/The Carter Center)

During a recent field visit to Nigeria, I visited some villages in Plateau State with several members of our Nigeria office to talk to people about the things that make it hard to use bed nets as well as the things that encourage use. The purpose of these conversations was to get ideas about what else we might be able to do to increase the use of the more than1.4 million long-lasting insecticidal bed nets that The Carter Center has helped to distribute in the state, in partnership with the Federal Ministry of Health. In particular, we wanted to get ideas about the kinds of messages we should emphasize in our health education and communication activities–a project that I have been working on with Adamu Sallau, director of the Carter Center’s malaria program in Nigeria. We hope communicating these additional messages will result in behavioral change.

Often, just telling people that malaria is a dangerous disease, that it is transmitted by mosquitoes, and that it can be prevented by sleeping under a net is not enough to bring about behavior change. Some people aren’t motivated by that argument, but could be persuaded by different messages. Others might really want to use nets but are prevented from doing so by things like lack of access to a net, lack of empowerment to make decisions in their household, or lack of the skills to hang and use a net properly in the place where they usually sleep.

When trying to help people to understand this, Adamu likes to use the example of exercise: How many of us know that exercise is good for our health? And yet how many still don’t exercise regularly? What are the things that keep us from exercising even when we know it’s important?

When we talked with villagers in Plateau State, people mentioned numerous things that make it hard to use nets. Many were the ‘usual suspects,’ such as finding nets too hot to sleep under or worrying about the safety of insecticides. However, they also said many things I hadn’t heard before.

For example, young boys said they got home when it already was too dark to see well enough to pull down the sides of their nets to tuck them in (especially when they don’t have electricity in their house, or due to the frequent power outages). They said using a net wasn’t “cool” and that young men often think they are invincible, or that they are protected from malaria by drinking beer.

This page from a health education flip chart shows people that they can prevent malaria by sleeping under a long-lasting insecticidal bed net. Recent focus group discussions are helping to inform revisions and improvements to these flip charts, so community volunteers can use them during house-to-house behavior change activities.

Some young women said they had trouble convincing their husbands to use nets and thus were not able to use them. Many people said that they didn’t know how to hang a net if they sleep on a mat instead of a bed, or when they sleep outside, as is common during the hot season. Others said the shape and size of the nets makes them hard to hang in the small rooms that students and young couples often rent in peri-urban neighborhoods. These are all things that The Carter Center can find ways to address.

People also talked about what motivates them–or would make it easier–to use nets, many of which were not directly related to malaria. Young women said that nets are “fashionable,” and that using a net keeps their skin beautiful by protecting them from mosquito bites.

Men and boys were particularly motivated to use nets when they learned that nets could protect them from the swollen genitals and legs that commonly result from lymphatic filariasis. As one boy said, “Now that I know that, I will definitely start using my net. You should tell everyone that!”

Carter Center Malaria Control Program Assistant Director Amy Patterson (above) in Nigeria earlier this summer, evaluates how freely provided bed nets are being used. Since 2004, The Carter Center, in partnership with the Nigerian government and endemic communities, has supported the distribution of more than 4 million bed nets in areas where the Center works. In 2012, the Center expects to assist with the distribution of at least 4.6 million more.

People said peer pressure and reminders from family members encourage them to use nets, and that it was easier for men and boys who come home late to use a net if another family member already had hung it and tucked in the sides for them. Emphasizing some of these other benefits and strategies in the Carter Center’s communications can persuade even more people to use nets.

Adamu and the other members of the Nigeria team are passionately committed to the project of increasing net use to prevent more of the millions of potentially fatal cases of malaria that Nigerians suffer from each year. In the coming months, they will be training community volunteers to address various barriers to using nets during house-to-house visits in Plateau.

These volunteers are trusted and reliable people, selected by the communities they serve. They already work with The Carter Center to deliver treatments for other diseases at the household and community levels, dedicating their time, without pay, to improve directly the lives of their neighbors and indirectly contribute to the economic health of their entire country by reducing school and work absences.

I am incredibly impressed by–and grateful to–these volunteers as well as to our extremely dedicated Nigerian staff who constantly work to expand and improve the Center’s work to control malaria in Nigeria.

However, with help from The Carter Center–and in partnership with the national malaria programs in Nigeria and Ethiopia–millions of families are getting the chance to significantly improve their own lives.

Carter Center Photo: F. Richards

The Carter Center’s new Malaria Control Program in Nigeria—which works in partnership with the national program and is integrated into the Center’s other neglected disease control efforts—is helping children like these live to “know tomorrow.” In this village in Plateau State, Nigeria, bed nets hang outside a home, waiting to be used by these two children when they go to sleep. The bed nets are distributed free of charge and paired with health education on how to use them.

Building on decades of community-level “grassroots” experience fighting neglected diseases like Guinea worm, river blindness, lymphatic filariasis (elephantiasis), and trachoma, The Carter Center and its partners are helping to demonstrate that large-scale malaria prevention is possible in the largest malaria-endemic countries in Africa. Efforts have focused mainly on providing two important tools to every household: health education on malaria prevention and long-lasting insecticidal bed nets (LLINs) that offer protection from the night-biting mosquitoes that spread both malaria and lymphatic filariasis.

In the spring of 2011, the Center and its partners achieved an important milestone by reaching a cumulative total of 10 million bed nets distributed where they are needed most in Ethiopian and Nigerian communities (since late 2006 and late 2010, respectively). The Center also is helping measure the impact these nets are having against malaria.

Graphics Source: UNICEF Malaria and Children – Progress in Intervention and Coverage (2007) and the World Health Organization’s World Malaria Report (2009)

When the Carter Center’s Malaria Control Program began in Ethiopia in 2006 – at the invitation of the Ethiopian Ministry of Health – the government sought to dramatically improve bed net protection to cover all 50 million Ethiopians at risk for the potentially deadly parasitic infection. In only one year, with Carter Center support, more than 20 million long-lasting insecticide-treated bed nets (LLINs) were distributed, dramatically increasing the country’s protection against malaria. The Center’s work in Nigeria aims to accomplish a similar goal of blanketing the entire nation with bed nets that can help curb the spread of malaria and potentially save millions of lives. Nigeria has launched a nationwide 2010-2011 campaign to deliver 63 million nets, with about one-half already distributed.

Resources:
• Watch the video on the Center’s new malaria program in Nigeria >
• Read the blog about the pioneering MALTRA weeks in Ethiopia to combat malaria and trachoma >
• Learn more about the Carter Center’s Malaria Control Program >

The two countries, which share a border, join 14 other nations that have wiped out Guinea worm disease since The Carter Center spearheaded the international eradication campaign in 1986. Nigeria—formerly the most Guinea worm-endemic country in the world— and Niger both interrupted transmission in late 2008 and have reported zero indigenous cases for more than 12 months, the incubation period of the parasite.

Click image below to watch video.

During the awards ceremony, former U.S. President Jimmy Carter, Carter Center Health Programs Vice President Donald R. Hopkins and Guinea Worm Eradication Program Director Ernesto Ruiz-Tiben presented representatives from Nigeria and Niger with hand-crafted mahogany and enamel statues representing this historic achievement.

An ancient and horrible affliction, Guinea worm disease is poised to become only the second disease to be eradicated from the earth, and the first without the use of vaccines or medicines, due to a 24-year international campaign led by The Carter Center. Three remaining countries are fighting the fewer than 1,800 cases of the disease.

Press Release: Former U.S. President Jimmy Carter Announces Three Countries Left in Guinea Worm Eradication Campaign >

Find out more about the disease and the progress of the eradication campaign at www.cartercenter.org/guinea-worm.

It’s a historic moment for David, his community, and all of Nigeria, as David recently became the first in his country to receive the Pfizer-donated medicine.

All Photos: Carter Center/ E. Cromwell
Aloshi village in eastern Nigeria was the first village in the country to receive Pfizer-donated antibiotic treatments for trachoma through a partnership between The Carter Center and the Nigeria Ministry of Health.

Children bear the highest burden of infections with trachoma, and may pass their infections on to their caretakers, traditionally women.

After being exposed repeatedly to trachoma infections over many years, women are especially vulnerable to the excruciating advanced stage of the disease called trichiasis, which causes permanent vision damage and even blindness. Although preventable, without access to health education, prevention tools, and treatment, women with trichiasis often become a burden to their families, and are sometimes disowned from them entirely.

However, there is hope. Since 1999, in partnership with the Nigeria Ministry of Health, The Carter Center has been integrating trachoma prevention into lymphatic filariasis, schistosomiasis, river blindness, and most recently, malaria control, among other programs in Plateau and Nasarawa states. When efforts began, trachoma control activities focused on two of the four ways to prevent blinding trachoma: encouraging face and hand washing and improving environmental sanitation.

David Nuhu, 4, receives help from his mother to take the antibiotic Zithromax (donated by Pfizer Inc.) before she receives her dose as tablets. Annual treatments will help everyone in the community have a future free from trachoma.

In October 2010, the Carter Center-assisted trachoma control program was able to expand its activities to include mass drug administration to fight trachoma in targeted areas.

So, after David and his mother receive health education, David takes a quick swallow of the banana-flavored antibiotic, and Nigeria takes a major step toward a future free from trachoma.

Learn more about the Carter Center’s Trachoma Control Program >

Carter Center Vice President for Peace Programs John Stremlau addressed a recent conference on electoral reform in Nigeria convened by Chinua Achebe at Brown University.  The conference, which highlighted the relevance of international election principles and standards for improving Nigeria’s upcoming state and national elections, drew on lessons from the Center’s successful partnership with Nigerians to advance public health in local communities throughout the nation.  Watch his remarks here (17:15): http://www.brown.edu/web/achebe-colloquium/videos2009/02.html