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’, on the 2005 ’Takk...’ album.

OPC is a member of ICTC (International Coalition for Trachoma control) and a partner of ITI (International Trachoma Initiative) two collaborative efforts to eliminate blinding trachoma.

What is trachoma?

Trachoma is one of the oldest known infectious diseases to affect mankind and it is the world’s leading cause of preventable blindness. Even though trachoma has been completely eradicated in Europe and North America, it is estimated that the disease is still endemic in 53 countries. It remains hyperendemic in the most disadvantaged and isolated regions of Africa, Asia, Central and South America, Australia and the Middle East.
Trachoma causes visual impairment in approximately 2.2 million people and 1.2 million people are irreversibly blind.

This disease is caused by Chlamydia trachomatis – a microorganism – which is transmitted from an infected person to another by contact (hands, towels, etc.) and by flies.
Transmission occurs most often between members of the same family and children are often infected from an early age. A child will suffer from chronic conjunctivitis that will be aggravated by other microbial infections.
After years of repeated infection, the inside of the upper eyelid becomes deformed and turns inwards (entropion) and the eyelashes rub against the cornea (trichiasis). If the entropion trichiasis is not operated on, it causes irreversible corneal opacities and blindness.

Who is at risk?

Copyright International Trachoma Initiative

The poorest populations of the world are threatened by trachoma. Populations living in disadvantaged areas are particularly at risk because access to water is difficult and sanitation is either insufficient or inexistent.
Children are the most affected as they are infected at a young age. In areas where the disease is endemic, the prevalence rate among pre-schoolers is between 60-90%.
Moreover, women are 2 to 3 times more likely than men to develop corneal complications from this disease. This increased risk is due to the fact that women generally spend more time in close contact with small children.

Prevention and Treatment

The current strategy that is in place to combat trachoma is focused around community development actions (increase villagers’ access to safe drinking water, improve community hygiene) and interventions in the field of public health.
A global initiative to eliminate trachoma, GET 2020, was launched in 1997 and is led by the World Health Organisation. Through this initiative, a primary health care strategy, the SAFE strategy, has been developed and aims to eliminate trachoma by 2020. The components of SAFE are:

  • (S)urgery for trichiasis (inturned eyelids)
  • (A)ntibiotics (azithromycin - oral or eye drops, tetracycline 1% ointment)*
  • (F)acial Cleanliness and improved individual and collective hygiene is essential to preventing the transmission of the disease
  • (E)nvironmental improvement to improve living conditions especially in regards to water, sanitation and waste disposal

    *Un traitement de masse doit être mis en œuvre si le trachome actif est présent chez plus de 20% des enfants de 0 à 10 ans dans une communauté

    Copyright International Trachoma Initiative

OPC is at the frontline in the fight against trachoma

Establishment of a programme to combat trachoma in Chad and CAR.

National Programmes to Combat Trachoma in Chad and CAR

OPC helps to introduce a National Programme to Combat Trachoma in each of these two countries.
This programme includes:
- The training of nurses who specialise in ophthalmology, already developed by OPC in Chad for over 10 years and more recently in CAR
- Mass drug administration of antibiotics in areas where more than 20% of children suffer from trachoma, particularly through networks of community health workers developed by OPC. This concerns more than 910,000 people who live in the most affected (more than 1 million by 2016)
- Raising awareness among villagers about effective hygiene by using the same community networks
- The operation of patients with trichiasis: already more than 600 patients have undergone operations in 2011, in Chad and CAR

This programme began in 2013 in one region of Chad and two in CAR where the trachoma prevalence is especially important, before being gradually extended to all affected regions.

Plan for 2014-2017: Extension of the Programme to the whole country

In total:
-  12,600 community agents and 52 specialized health workers will be trained in CAR, and 22,600 community agents and 200 specialized health works will be trained in Chad
-  50,000 patients with trichiasis will be operated in CAR and 64,000 in Chad (100% of diagnosed cases)
-  13 million people will be treated by antibiotics in CAR (95% of the population at risk) and 6.75 million in Chad (80% of the population at risk)
-  90% to 95% of children will use hygiene measures to prevent trachoma
-  65% of the population will have access to drinking water in CAR (currently 30%) and 60% in Chad (currently 46%)

After these 5 years, trachoma will have completely disappeared from these two countries.

Download the World Health Organisation-approved guide that describes the SAFE strategy