Trachoma, a public health problem in 42 countries which is responsible for the blindness or visual impairment of about 1.9 million people globally is a disease of the eye caused by infection with the bacterium Chlamydia trachoma- tis. Blindness from trachoma is irreversible and based on a June 2022 data, 125 million people liv- ing in trachoma endemic areas are at risk of trachoma blind- ness, according to the World Health Organisation (WHO).
The good news is that the WHO has validated Benin and Mali as having eliminated trachoma as a public health problem, making them the fifth and sixth countries in WHO’s African Region to achieve this significant milestone. The number of people with the disease and blindness due to the disease has drastically reduced. Trachoma is now only responsible for about four per cent of blindness worldwide down from 12 per cent some few decades ago. Countries that previously re- ceived WHO validation for tracho- ma elimination are Ghana (June 2018), Gambia (April 2021), Togo (May 2022) and Malawi (September 2022). “WHO congratulates the health authorities of Benin and Mali and their network of global and local partners for these milestones,” said Dr. Tedros Adhanom Ghebr- eyesus, WHO Director-General. “Following Benin’s and Mali’s success, trachoma remains endemic in 23 countries in WHO’s African Region, bringing us a step closer towards the elimination target for trachoma set in the road map for neglected tropical diseases (NTDs) 2021–2030.” Globally, Benin and Mali join 15 other countries that have been validated by WHO for having eliminated trachoma as a public health problem. These are Cambodia, China, the Gambia, Ghana, Islamic Republic of Iran, Lao People’s Democratic Republic, Malawi, Mexico, Morocco, Myanmar, Nepal, Oman, Saudi Arabia, Togo and Vanuatu.
Against the background of eliminating the disease from Benin and Mali, trachoma control in Nigeria is currently facing numerous challenges. Survey challenges According to data from Middle East African Journal of Opthalmology, many districts (local government areas) of northern Nigeria have some data on trachoma, which is based on either trachoma rapid assessment or an epidemiological survey.
However, other districts of the region are yet to be mapped. “This is probably because the trachoma belt of northern Nigeria is vast. More than half of the 774 districts of Nigeria are in northern Nigeria, covering over 500,000 km, with a population of over 80 million people. As such under- taking district by district population- based surveys to cover this vast area will require enormous resources and time.” And NGOs as the main advocates and implementers of trachoma control in the country, are unable to provide such resources. A dearth of this comprehensive data had been a constraint for national trachoma control planning and resource utilisation in Nigeria. SAFE strategy Some states have a trachoma control programme but most of them are not implementing the full SAFE strategy as recommended by WHO. “Some states like Sokoto, Zamfara, and Kebbi have initiatives based mostly on the interest of the partnering NGO to provide community-based lid sur- gery only, while other states like Plateau and Nassarawa implement the personal and environmental hygiene components only.
According to the data, local/federal governments and NGOs need to mobilise resources to complete the mapping of the entire trachoma belt of northern Nigeria. “For optimal effect of the tra- choma control programme service providers, especially NGOs, should collaborate with other agencies and organisations to implement a full scale SAFE strategy.” Both Benin and Mali implemented the WHO-recommended SAFE strat- egy to eliminate trachoma with the support of WHO and partners. The SAFE strategy consists of surgery to treat late trachoma complications; antibiotics to clear infection; facial cleanliness; and environmental improvement, particularly improving access to water and sanitation, to reduce transmission. Through the International Trachoma Initiative, the antibiotic azithromycin is donated by Pfizer to elimination programmes implementing the SAFE strategy. “These are impressive public health achievements,” said Dr. Ibrahima Socé Fall, Director of the WHO Global NTD Programme.
“Benin and Mali demonstrate how strong political will, cross-sector integration, surveillance and community engagement can work in concert to achieve disease elimination.” Significant progress has been made in the fight against trachoma over the past few years. The number of people requiring antibiotic treatment for trachoma in the WHO African Region fell by 84 million, from 189 million in 2014 to 105 million as of June 2022. Mode of transmission Infection is transmitted from person to person through contaminated fingers, fomites and flies that have come into contact with discharge from the eyes or nose of an infected person. Environmental risk factors for trachoma transmission include poor hygiene, overcrowded house- holds, inadequate access to water or use of proper sanitation facilities. In 1996, WHO launched the WHO Alliance for the Global Elimina- tion of Trachoma by the year 2020 (GET2020). However, the new road map, en- dorsed by the World Health Assem- bly in 2020 through its decision 73(33), sets 2030 as the new target date for global elimination.