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The Carter Center - River Blindness Program

This page is part of our report on The Carter Center.

Published: 2009

What do they do?

The Carter Center's River Blindness Program provides health education and distributes ivermectin to control or eliminate river blindness, also known as onchocerciasis (more information about onchocerciasis).1 The program aims to eliminate the disease six countries in the Americas as well as parts of Uganda and Sudan.2 It also aims to control the disease in Nigeria, Ethiopia, Cameroon, and Sudan.3 The Carter Center receives donated ivermectin from Merck, and then follows the "Community-Directed Treatment with Ivermectin Process" outlined in our report on controlling onchocerciasis.4

Evidence of effectiveness

General evidence on this program type

There appears to be no debate that ivermectin effectively reduces the prevalence of river blindness as measured by various diagnostic tests. However, there is little rigorous evidence that ivermectin, alone, reduces rates of blindness or skin disease (the debilitating conditions caused by river blindness). For more, see our full report on the use of ivermectin to control onchocerciasis.

Monitoring provided by The Carter Center

The Carter Center tracks several different indicators to evaluate the presence of river blindness in each region. In the Americas, The Carter Center provides consistent monitoring in all areas in which they work. In Africa, monitoring is much less consistent. The Carter Center provides: multiple data points for its programs in Uganda and Cameroon, none for either Ethiopia or Sudan, and one survey for Nigeria, reporting that prevalence fell significantly (from 51% to 3%) between 1992 and 1999.5 For explanations of the terms used in these charts, see our glossary of terms. The Americas: The charts below provide different measurements that The Carter Center uses to monitor progress in eliminating river blindness from the Americas.6 All show significant decreases in prevalence after the time The Carter Center entered into those areas. Africa The following charts present the data The Carter Center provides for its impact in Cameroon7 and Uganda.8 In both countries, prevalence of river blindness has fallen substantially.

What do you get for your dollar?

The Carter Center does not appear to make information available on how much this program spends. In general, independent estimates imply that this type of program is highly cost-effective: $7-$40 per disability-adjusted life-year (DALY), or $100 to avert a total of 10-50 years of serious debilitation (blindness, low vision, or irritating skin disease). Additional information on these figures can be found at our full report on onchocerciasis control. In addition, see our discussion of the DALY metric.

Sources

  • 1. "The Carter Center's RBP is dedicated to safe and sustainable distribution of Mectizan® [a brand name for ivermectin] with health education to control or eliminate onchocerciasis." Carter Center, "Program review for the Lions-Carter Center SightFirst river blindness programs (2008)," Pg 2.
  • 2. "Trying to eliminate onchocerciasis where feasible is an important goal of the RBP, and current RBP elimination efforts include all six countries in the Americas and designated foci in Uganda and Sudan." Carter Center, "Program review for the Lions-Carter Center SightFirst river blindness programs (2008)," Pg 2.
  • 3. "Through the Lions SightFirst I Initiative, LCIF and The Carter Center expanded their partnership to encompass controlling RB in five countries in Africa (Cameroon, Ethiopia, Nigeria, Sudan, and, until 2005, Uganda)." Carter Center, "Program review for the Lions-Carter Center SightFirst river blindness programs (2008)," Pg 2.
  • 4. "Studies in the 1980s showed that the drug Mectizan®, made by Merck & Co. Inc., could effectively and safely treat and prevent river blindness by killing the microfilariae in the human body. Merck decided in the late 1980s to donate the drug to all who needed it for as long as needed. This donation was an important stimulus for the current initiative to globally control onchocerciasis using a strategy of community-based treatment." Carter Center, "River Blindness (Onchocerciasis) Program."
  • 5. "Onchocerciasis nodule data was first collected in 1992 by RBF, prior to the launching of Mectizan® treatment, and repeated in 1999 in 23 of the originally surveyed villages. Thirty to fifty males were sampled. The nodule rate prior to treatment was 51%, and 7 years later had dropped to 3%." Carter Center, "Program review for the Lions-Carter Center SightFirst river blindness programs (2005)," Pg 37.
  • 6. We went through each Carter Center River Blindness Program Report and gathered this data from any page on which it was available. The primary pages we used (that account for most of the data) are listed below:
    • Carter Center, "Program review for the Lions-Carter Center SightFirst river blindness programs (2005)," Pg 26.
    • Carter Center, "Program review for the Lions-Carter Center SightFirst river blindness programs (2006)," Pg 34, Table 4.
    • Carter Center, "Program review for the Lions-Carter Center SightFirst river blindness programs (2007)," Pg 24.
    • Carter Center, "Program review for the Lions-Carter Center SightFirst river blindness programs (2008)," Pg 22.
  • 7. Carter Center, "Program review for the Lions-Carter Center SightFirst river blindness programs (2006)," Pg iii, Figure A.
  • 8. Data for areas within Moyo comes from Carter Center, "Program review for the Lions-Carter Center SightFirst river blindness programs (2005)," Pg 65. Five districts data comes from Carter Center, "Program review for the Lions-Carter Center SightFirst river blindness programs (2006)," Pg iii, Figure A.