Abstract

SA.22.03

Trachoma

Karimurio J.
Nairobi, Kenya

Trachoma is a disease of poverty and the number one infectious cause of blindness in the world, contributing to about 5.9 million blind people. It is commonly found in areas with hot, dry and dusty climates; especially in Africa¹. In May 1998, the 51^st World Health Assembly adopted a resolution calling for the elimination of trachoma as a cause of blindness and recommended that Ministries of Health should pursue the “SAFE strategy” to do so. “SAFE” stands for surgery for trichiasis/entropion, antibiotics for active disease, facial cleanliness, and environmental change to reduce transmission. It targets all key elements believed to be necessary for a short and long-term intervention program. Implementation of “SAFE” is expensive and calls for broad partnership between governments and eye care partners. Due to the focal nature of the disease, it is difficult to start a control project without baseline survey results. Surveys (plus SAFE) are ongoing in known trachoma endemic countries of Africa². Established projects are evaluated to document, report on and share the experiences, accomplishments and lessons learnt among the implementing partners and sponsors³. Extrapolation of the results of one district survey to the entire country or region is not justifiable; all the known and suspected endemic districts are to be surveyed. Nomadic lifestyle poses a major challenge. Country specific data collection tools are based on the standardized protocol developed by the International Trachoma Initiative and endorsed by WHO. The WHO simplified trachoma grading is used in recording of clinical findings. TF (active trachoma) prevalence ³10% at district and ³5% community levels in children 1-9 years old and TT ³1% in adults ³15 years are considered a public health problem. The ultimate intervention goal (UIG) for trachoma control is to reduce the prevalence of active trachoma to less than 5% at community level and that of TT (potentially blinding trachoma) to less than 1 case per 1,000 in people aged 15 years and older. One of the pioneer “SAFE” pilot projects in Africa is the African Medical and Research Foundation (AMREF) Shompole trachoma project of Kenya. It was initiated in 2002 and evaluated in 2006 after 3 years of joint control activities (Health education, two mass distribution of Zithromax and provision of water/sanitation) by AMREF, government of Kenya and partners^3,4. The evaluation revealed that: the prevalence of active trachoma (TF) in children has dropped from 46.4% in 2002 to 16.0% in 2006 and that of potentially blinding trachoma (TT) from 4.5% to 1.7% in the same period. The proportion of children with clean faces has not changed but that of children with many (>5) flies on the face has drastically reduced from 48.0% in 2002 to 6.0% in 2006. The project was found to be sustainable. The findings of this project have lead to the listing of Kenya as a trachoma endemic country by the WHO. Trachoma mapping in the entire country is ongoing. By August 2007, seven endemic districts of Kenya had been surveyed and a national trachoma task force (government and a consortium of trachoma partners) created.
References
1. Karimurio J, VISION2020 “The Right to Sight Global Initiative”, Editorial article, East Afr. Ophthalmol. J 2006; 12: 1-3
2. Karimurio J. Ilako F, Gichangi M. Trachoma control using SAFE with azithromycin: Experiences from a Kenyan pilot project. Afr. Med. J. 2007; 84: 127-135
3. Karimurio J, Gichangi M, Ilako D, Kilima P, Adala H. Prevalence of Trachoma in six districts of Kenya East Afr. Med. J. 2006; 83: 63-68
4. Matende I, Kollman M, Karimurio J, Gaeckle M, (2003) The Prevalence and Pattern of Trachoma in Shompole location, Magadi Division of Kajiado District, Kenya. Department of Ophthalmology; University of Nairobi postgraduate thesis. (not published)

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