Wiping out Trachoma from Nepal – How Nepal eliminated trachoma as a public health problem
WHO - 2018
In 2018, we are celebrating 20 years of progress in eliminating trachoma, the world’s leading infectious cause of blindness. Set up in 1998 by Pfizer Inc. and the Edna McConnell Clark Foundation, the International Trachoma Initiative (ITI) supports Ministries of Health in over 30 countries around ...the world by making Zithromax® available for use in public health campaigns to eliminate trachoma. The 20th anniversary of our founding gives us an opportunity to reflect on the distance we’ve traveled in fighting this disease, and raise the ambition for accelerating to a world where diseases like trachoma are a distant memory. We have not traveled alone these past 20 years – a broad coalition of actors including NGOs, the World Health Organization (WHO), Ministries of Health, health workers, and community members have made these incredible achievements possible. Our 20th anniversary gives us an opportunity to celebrate this coalition of partners, colleagues, and friends
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Contemporary data for causes of vision impairment and blindness form an important basis of recommendations in public health policies. Refreshment of the Global Vision Database with recently published data sources permitted modelling of cause of vision loss data from 1990 to 2015, further disaggregat...ion by cause, and forecasts to 2020.
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The Fifty-first World Health Assembly adopted resolution WHA51.11 in 1998, which targets the
global elimination of trachoma as a public health problem by 2020 (1). The strategy recommended
to achieve that goal is encapsulated by the acronym “SAFE”, which represents: Surgery for
individuals wi...th trachomatous trichiasis (TT; the late blinding stage of trachoma); and Antibiotics,
Facial cleanliness and Environmental improvement (2). The A, F and E interventions are delivered to
entire districts in which active (inflammatory) trachoma is common in order to treat ocular infection
with Chlamydia trachomatis, the causative organism of trachoma, and sustainably reduce its
transmission.
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En 1998, la Cinquante-et-Unième Assemblée mondiale de la Santé a adopté la résolution
WHA51.11 qui vise l’élimination mondiale du trachome en tant que problème de santé publique
à l’horizon 2020 (1). La stratégie recommandée pour atteindre cet objectif est récapitulée dans
le sig...le « CHANCE » qui signifie CHirurgie pour les personnes atteintes de trichiasis
trachomateux (TT – le dernier stade cécitant du trachome) ; Antibiothérapie, Nettoyage du
visage et Changements Environnementaux (2). Les interventions relatives aux volets A, N et CE
sont menées dans des districts entiers dans lesquels les cas de trachome évolutif
(inflammatoire) sont courants, dans le but de traiter les infections oculaires dues à Chlamydia
trachomatis, l’agent pathogène à l’origine du trachome, et de réduire durablement sa
transmission.
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La quincuagésima primera Asamblea de la Salud Mundial aprobó la resolución WHA51.11 en
1998, que busca la eliminación mundial del tracoma como problema de salud pública para el 2020
(1). La estrategia recomendada para lograr ese objetivo está encapsulada por las siglas "SAFE", que
represent...a: La cirugía para los individuos con triquiasis tracomatosa (TT; la última etapa que causa
ceguera por tracoma); y Antibióticos, Limpieza Facial y Mejoramiento ambiental (2). Las
intervenciones A, F y E se llevan a distritos enteros en los que el tracoma activo (inflamatorio) es
común para tratar la infección ocular causada por Chlamydia trachomatis, el agente causal del
tracoma y reduce de manera sustentable su transmisión.
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Trachoma is one of the 17 WHO-defined Neglected Tropical Diseases
(NTDs) that affect over 1 billion of the world’s poorest and most
marginalized people. It is caused by the bacterium chlamydia trachomatis.
International commitment to eliminate trachoma as a public health problem worldwide is supported by resolution WHA51.11 of the World Health Assembly .1 Important progress towards this goal has been made by harnessing the mostly informal relationships that exist between partners including Member Stat...es, the World Health Organization (WHO), academic institutions, donors and nongovernmental organizations. Recognizing that work remains to be done and that the 2020 target2 for elimination is rapidly approaching, in February 2015 the WHO Department of Control of Neglected Tropical Diseases convened a group of academic institutions that had for many years helped WHO to implement its mandate on trachoma and to work towards establishing a Network of WHO collaborating centres (WHOCCs) for Trachoma. The report of that meeting has been published.
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SECOND MEETING REPORT
DECATUR, GA, USA, 26 JUNE 2016
This manual is designed to provide specific information for trachomatous trichiasis (TT) trainers who are training others to undertake surgery for entropion trachomatous trichiasis (TT). Other approaches are not addressed. The manual is divided into two parts. The first part covers specifics designe...d for training TT surgeon candidates, and serves as a resource document. The trainer can elect to have trainees read the material directly, use this manual as a guide for creating a training presentation, or use it in other ways to assist in the training. The manual contains both knowledge that should be imparted during training and a description of the skills that need to be developed and assessed during practice and surgery sessions. The second part is designed only for the trainers of the surgeon trainees and covers selection and final assessment of the trainees.
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A key component of elimination is to reduce the number
of unmanaged trachomatous trichiasis cases to less than
1 per 1,000 population in affected areas. This will require
not only a large increase in the number of surgeries
performed, but also improvements in the quality of surgery
and in the e...fficiency of surgery provision programs. It also
will require that we make special efforts to reach out to
women and the most marginalized populations, who are
disproportionally affected by trichiasis (TT).
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La deuxième édition de ce manuel combine et met à jour les éléments contenus dans les trois manuels
antérieurs consacrés à la rotation bilamellaire du tarse, à la méthode de Trabut et à l’évaluation fi nale des
chirurgiens du trichiasis.
Ce manuel est destiné à fournir des informa...tions spécifi ques aux formateurs dans le domaine du trichiasis
trachomateux (TT) à d’autres personnes pour qu’elles puissent pratiquer la chirurgie de l’entropion trichiasis.
Il ne traite pas des autres approches et se divise en deux parties. La première présente les spécifi cités de la
formation des futurs chirurgiens du trichiasis et sert de document de référence. Le formateur peut préférer
que les stagiaires lisent directement le document, utilisent ce manuel comme guide dans le cadre d’une
présentation didactique ou l’exploitent d’autres manières comme aide à la formation. Le manuel contient
des connaissances devant être transmises lors de la formation et une description des compétences devant
être acquises et évaluées pendant la pratique et les sessions de chirurgie. La seconde partie est destinée
UNIQUEMENT aux formateurs des futurs chirurgiens et porte sur la sélection et l’évaluation fi nale des
participants.
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In order to target resources and drugs to reach trachoma elimination targets by the year 2020, data on the burden of disease are required. Using prevalence data in African countries derived from the Global Atlas of Trachoma (GAT), the distribution of trachoma continues to be focused in East and West... Sub-Saharan Africa, North Africa and a few endemic countries in Central Sub-Saharan Africa. Currently, 129.4 million people are estimated to live in areas that are confirmed to be trachoma endemic and 98 million are known to require access to the SAFE strategy. The maps and information presented in this work highlight the GAT as important open-access planning and advocacy tool for efforts to finalize trachoma mapping and assist national programmes in planning interventions.
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Countries, partners, and donors are committed to
the global elimination of blinding trachoma by 2020.
Achieving this public health milestone requires more
than funding; it requires health personnel with the
right mix of skills, and well supported and managed
health systems. Mass drug administra...tion (MDA)
with Zithromax®, the Pfizer, Inc. donated antibiotic,
is a key component of the SAFE strategy, endorsed
by the World Health Organization. There is growing
recognition that improving all aspects of MDA, from
planning to training, recording to reporting, and
receipt of drug to distribution (the supply chain), will
be necessary if MDA programmes are going to reduce
the community burden of Chlamydia trachomatis, and
eliminate trachoma as a cause of blindness by 2020.
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Trachoma causes more vision loss and blindness than any other infection in the world. This disease is caused by Chlamydia trachomatis bacteria. Other variants or strains of these bacteria can cause a sexually transmitted infection (chlamydia) and disease in lymph nodes.
This is photomicrograph ...of a conjunctival smear that revealed the presence of what are known as, intracytoplasmic inclusions Trachoma is easily spread through direct personal contact such as from fingers, through shared towels and clothes, and through flies that have been in contact with the eyes or nose of an infected person. When left untreated, repeated Chlamydia trachomatis infections in the eye can cause severe scarring on the inside of the eyelid. This can cause the eyelashes to scratch the cornea (trichiasis). In addition to causing pain, trichiasis permanently damages the cornea and can lead to irreversible blindness.
Chlamydia trachomatis infections spread in areas that lack access to safely managed drinking water and sanitation systems. Trachoma affects the most resource-limited communities in the world. Globally, almost 1.9 million people have vision loss because of trachoma, and it causes 1.4% of all blindness worldwide.1 In 2021, 136 million people lived in trachoma-endemic areas and were at risk of trachoma blindness.
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The Fifty-first World Health Assembly,
Recalling resolutions WHA22.29, WHA25.55 and WHA28.54 on the prevention of blindness, and
WHA45.10 on disability prevention and rehabilitation;
Aware of previous efforts and progress made in the global fight against infectious eye diseases, in particular
tr...achoma;
Noting that blinding trachoma still constitutes a serious public health problem amongst the poorest
populations in 46 endemic countries.
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