Trachoma : preventing the most prevalent infectious blinding disease in the world.
Video produced by "The Fred Hollows Foundation" in collaboration with "International Coalition for Trachoma Control". Music by Sigur Rós- ’Glósóli’, album ’Takk...’ (2005).
The OPC is a member of the ICTC (International Coalition for Trachoma control)
Trachoma is one of the oldest diseases known to man. It is caused by chlamydia trachomatis, a microorganism that is spread from person to person via physical contact (hands, towels etc.) and by flies.
It is easily transmitted between members of the same family and those living in close proximity to one another, and small children are susceptible to contracting the disease from a young age. People who contract the disease suffer from chronic conjunctivitis which is aggravated by other microbial infections.
Image courtesy of the International Trachoma Initiative
By adulthood, most have suffered repeated reinfections, each time causing scarring which leads to the upper eye lid becoming deformed and turning inward (entropion) resulting in the eye lashes rubbing against the cornea (trichiasis). If this entropion trichiasis is not operated upon, it leads to the appearance of corneal opacities and irreversible blindness.
Women have a much higher risk than men in developing complications linked to the disease. This can be explained by the fact that women tend to spend more time than their male counterparts do in raising and caring for young children, who are one of the main sources of infection.
Illness and Poverty
21.4 million people are affected by trachoma, of which 1.2 million are blind.
Trachoma has been completely wiped out in Europe and North America for around fifty years. Yet the disease continues to be hyper-endemic in the poorest and most isolated rural regions of Africa, South-east Asia and the Middle-East. It is estimated that there are 84 millions cases of active trachoma in need of treatment.
But thanks to socio-economic development and programmes which fight the disease, the number of trachoma cases over the past 15 years has decreased globally.
A Public Health Problem
In hyper endemic areas, the active disease is common and may affect 60-90% of preschool children.
Almost 11 million people, the majority of whom are women, suffer from trichiasis (a complication of trachoma) which requires medical intervention in order to prevent them from going blind. Almost 6 million adults are irreversibly partially sighted due to the corneal opacities which have been caused by trachoma.
Trachoma is caused by poor personal and collective hygiene as well as by promiscuity. It is associated with poor living conditions : lack of clean water, poor sanitation and an inadequate health system. The presence of trachoma acts as a poverty indicator.
Two recent studies have confirmed the extent of trachoma and of trichiasis in Chad and the Central African Republic (CAR) :
Between 28.6% and 34.5% of children aged under 10 are affected by trachoma in Chad ; 1.5% of women suffer from a degree of trichiasis which risks blinding them.
Between 10% and 54.3% of children aged under 10 are affected by trachoma in CAR ; 1.5% to 2.1% of women suffer from trichiasis.
Trachoma is more than an eye illness, or even a medical problem. It is first and foremost a serious socio-economic and public health problem.
Prevention and Treatment
The real challenge remains the fight against poverty. The current strategy revolves around community development (increasing villager’s access to water, improving the communities’ hygiene) and improving the current health system. A global initiative for the elimination of trachoma which leads to blindness has been called for by 2020 by the GET (Alliance for Global Elimination of Trachoma) in 1997. It is coordinated by the World Health Organization. Thanks to this initiative a primary public health strategy has been developed which aims to eliminate trachoma by 2020, which is known by the acronym “SAFE”.
- (S) stands for "surgery" : performing trichiasis operations to correct eye lid deformities.
- (A) stands for "antibiotics" (azithromycin or oral drops, tetracycline ointment 1%) : mass treatment should be implemented if the active disease is present in more than 20% of children aged 0 to 10 years in a community.
- (F) stands for "facial cleanliness" : an essential part of personal and collective hygiene which is needed to stop the spread of the disease.
- (E) stands for “environmental improvement" : promoting community hygiene, particularly through waste management and water supply.
Image courtesy of the International Trachoma Initiative
The OPC first in line for the fight against trachoma
Implementation of a Programme for the fight against trachoma in Chad and CAR
Nation Programmes for Trachoma Control in Central African Republic and Chad
The OPC is helping to implement national programs to eliminate trachoma in Chad and CAR, where we have already been present in order to combat the disease. These countries are the worst affected by this disease, as in certain regions, between 20% and 50% of children are infected.
The Programme simultaneously involves :
The training of specialist nurses in ophthalmology, already developed by the OPC in Chad for over ten years and more recently in CAR ;
The systematic distribution of an antibiotic treatment in areas where more than 20% of children suffer from trachoma, particularly thanks to the community network of health workers developed by the OPC. 910,000 people in the worst affected areas are concerned (more than 11 million by 2016) ;
Raising villagers’ awareness of good hygiene practices via the same community network ;
Operating on patients suffering from trichiasis ; already more than 600 patients have been operated on in 2011 thanks to the OPC, in both Chad and CAR.
This programme has started this year in one region of Chad and two in CAR, where the prevalence of trachoma is particularly high, before being gradually extended to all of the regions concerned.
The Important Stages in the Worldwide Fight against Trachoma
1st Stage (January-June 2012) : Defining the National Program for the Fight against Trachoma
Drawing on extensive experience, the OPC organised several workshops in both the Central African Republic and in Chad, joining with its main partners with the aim of developing an individual national program to combat trachoma (PNLT) for each country. It precisely defines the number of people who will receive operations and treatment, as well as the means of implementation for obtaining our goal of eliminating trachoma in Chad and CAR by 2020.
2nd Stage (July-December 2012) : Audit by an independent committee of experts
An independent committee of experts verified whether all the conditions were met for each programme with the aim of guaranteeing that very important quantities of antibiotic medicines (almost 1.5 million doses in 5 years) quickly passed through customs, the storage of this medecine, their delivery to each region then to each community agent, their distribution to the population at risk of trachoma…
The positive response that we have received for our work in the two countries makes the donation of medicines by PFIZER, the medical company, and the effective start of the Programmes possible.
3rd Stage (2013) : Beginning training and the programmes themselves
From the first half of 2013 for CAR and the second half for Chad, the OPC and its partners are organising the training of the first voluntary community agents, in charge of screening and of distributing antibiotics in their village, and specialised health agents who are capable of operating on those who suffer from trichiasis.
Community Agents : 3317 in CAR and 5649 in Chad
Specialised health agents : 35 in CAR and 53 in Chad
At the same time, the Programmes will begin to take place in 2 regions in CAR and 1 in Chad.
People receiving treatment : 4 900 000 in CAR and 405 000 in Chad
People receiving operations : 900 in RCA and 2 500 in Chad
The villagers are progressively being made aware of hygiene measures in order to prevent trachoma.
4th Stage (2014-2017) : Extending the Programmes throughout each country
When the programme is successfully completed :
12 600 community agents and 52 specialised health agents will be trained in CAR, and respectively 22 600 and 200 in Chad.
50 000 patients suffering from trichiasis will receive operations in CAR and 64 000 in Chad (supposing that is 100% of diagnosed cases).
13 000 000 people will receive treatment in CAR (95% of the population at risk of trachoma) and 6 750 000 in Tchad (80% of the population at risk).
90% to 95% of children will know and use the hygiene measures that will help prevent Trachoma.
65% of the population will have access to safe drinking water in CAR (currently 30% have access) and 60% in Chad (currently 46% have access).
At the end of these 5 years, Trachoma will have completely disappeared in these two countries.
Drinking water (Photo WHO)