Category Archives: Trachoma

Mali on Track to Eliminate Trachoma by 2015

 

By Wangechi Thuo and Andrew Carlson 

The Community Eye Health Journal announced in November that the National Blindness Prevention Programme (PNLC) in Mali, established in 1998, is on track to eliminate trachoma as a cause of blindness by 2015.

Trachoma is a bacterial disease that is transmitted through flies that come into contact with infected people or person to person contact. In areas where people live in close proximity, the disease spreads at an alarming rate, and can quickly infect entire communities. Repeated infection causes eyelids to turn inward and scratch the cornea, leaving an infected individual one unbelievably painful step closer to blindness with every blink they take, a process called trachomatous trichiasis. In 2011 the WHO estimated that 7,260,960 people around the world had this form of trichiasis.

Just before PNLC’s inception, Mali bore a generous portion of the global burden: during a national survey conducted in February 1996-May 1997, an estimated 85,700 people needed trichiasis surgery.

Since then, thanks to a strong commitment by the government of Mali, the PNLC has consolidated support from various partners, including The Carter Center, Helen Keller International (HKI), the United Stated Agency for International Development (USAID) managed by RTI international, The END Fund, and the International Trachoma Initiative (ITI). The PNLC has set a high standard in trachoma elimination that similar national initiatives throughout sub-Saharan Africa strive to emulate.

Three important benchmarks help explain how Mali has achieved this success:

  • Distribution of antibiotics: Through district-level mass drug administration, the PNLC has reduced active disease well below the recommended threshold in 84% of the districts in which the disease is present
  • Surgical Efficiency: Since 2009, the PNLC almost halved the surgical backlog throughout the country; in 2011 alone, 8,510 trichiasis surgeries were conducted by only a handful of surgeons
  • Preventive sanitation: Since 2009, 53,090 latrines have been constructed allowing safer disposal of waste

To foster community awareness, the PNLC has developed a primary school curriculum on trachoma, trained community leaders in trachoma prevention and ensured the dissemination of health messages through radio broadcasts with help from HKI.

PNLC’s successes are even more laudable as they were achieved in spite of the military coup d’état in March 2012, which elicited a considerable decrease in financial support to the Malian government.

With support from partners, Mali is less than one year away from achieving the goal of trachoma elimination and is positioned to celebrate this achievement, five years ahead of the global elimination date. Mali’s success story and lessons learned can provide can also be example for more countries throughout the world.

Curing River Blindness with Just One Dose

 

Picture-of-Mabinty-Koroma-2

Mabinty Koroma. Photo courtesy of Helen Keller International.

Reposted with permission from END in Africa

In June 2011, fourteen-year-old Mabinty Koroma was about to take the year-end exam in her middle school. One afternoon whilst in class, Mabinty noticed that she could barely see the writing on the blackboard. She went home that day thinking it was just temporary; but the following morning Mabinty was unable to read her notes and her vision was getting worse. “It became obvious that I couldn’t see well enough to take my exam and would have to drop out of school. My elder brother took me to various traditional healers in many villages in Moyamba district. We went to so many places that I can’t even remember all their names,” said Mabinty.

After a 15-month search for a traditional healer to restore Mabinty’s sight proved fruitless, her family was advised to take her to the eye hospital at Serabu, 40 kilometers from Bo, where Mabinty was attending school. In Serabu, there was no doctor to attend to Mabinty. However, the family decided to stay in Serabu rather than return to Bo.

Shortly thereafter, Sierra Leone’s Ministry of Health and Sanitation (MoHS), with support from Helen Keller International (HKI) and funding from USAID through the END in Africa project, started advocacy and social mobilization efforts to raise awareness about neglected tropical disease (NTD) control activities in the 12 provincial health districts, including Bo.

Using radio discussion programs and promotional jingles on mass drug administration and the use of preventive chemotherapy against NTDs such as lymphatic filariasis, onchocerciasis (“river blindness”) and soil-transmitted helminthes, the MoHS and HKI were working to spread the word that community residents could protect themselves and their children from such diseases just by taking medicine once a year.  With support from its partners, the MoHS distributes millions of doses of ivermectin and albendazole annually in all 14 health districts in Sierra Leone to combat those NTDs.

In addition to the radio promotions, local health workers held a series of community meetings prior to the treatment campaign to further sensitize the public about the benefits of taking treatment, and to encourage community leaders to get the word out to their respective communities.

Over the years, Mabinty and her family had heard some of the radio broadcasts about local NTD control efforts and the national treatment campaign. However, they’d always believed that only people living in the country’s rural areas got NTDs. Since they themselves had always lived in the city, they’d never imagined that they’d be at risk of getting any of those diseases. And so in the past, they’d simply ignored the messages about NTD control efforts, which had started several years earlier in all urban and rural districts of Sierra Leone, and had not gotten any of the annual treatments for lymphatic filariasis and soil transmitted helminthiasis that had been distributed in their community for the past five years.

Now as they tried to cope with her devastating vision loss, however, their attitudes were quickly changing and Mabinty’s family began to open their minds to the possibility that she may indeed be suffering from onchocerciasis, one of the NTDs found in Sierra Leone.  And so, when Mabinty and her father heard that annual NTD control efforts were about to begin again in Serabu, this time they were ready to listen.

“One evening, I was with my father when we heard a town crier saying the drugs for “oncho” and “Bigfut” (as it’s commonly called in the villages) had arrived at the health centre and that distribution would soon start,” she recalled.

After hearing the news, they decided that taking the medicine was worth a shot. Later that week, the community drug distributor visited Mabinty’s house and administered two drug regimens (ivermectin and albendazole) to her.

At first, Mabinty regretted having taken the drugs. “Twenty-four hours after taking the treatment, I felt sick and my eyes began to itch. I started scratching my body and kept on scratching for 3 days,” she said. Fortunately, the peripheral health unit staff in the village health center gave her a medication called Piriton and penicillin eye ointment to stop the itching.

After the initial discomfort from the treatment subsided, however, Mabinty discovered that what seemed to be a miracle had occurred. Her vision had improved and she was able to see clearly again.  So clearly that she was even able to return to her formal school in Bo, St. Andrews Junior Secondary School!

“If I hadn’t gotten my eyesight back, I would never have been able to sit for my Basic Education Certificate Examination,” said Mabinty with a smile. “I say thanks to the CDD and those who made the drugs available to me free of charge, even though I don’t know them personally or their organizations.”

Mabinty’s family is very happy to see her back in school. Her father is now a member of the village health committee and a very strong community organizer. Grateful for the recovery of her eyesight, he now wants to make sure that girls like Mabinty continue to receive annual treatments until the disease has been completely eliminated from the community.

More about END in Africa: Through the work of its END in Africa and END in Asia programs, FHI 360 is advancing USAID’s goal of contributing to the global elimination of NTD by reducing prevalence of seven diseases—lymphatic filariasis (elephantiasis), onchocerciasis (river blindness), schistosomiasis (snail fever), trachoma (blinding eye infection) and three soil-transmitted helminths (hookworm, roundworm, and whipworm). 

SAFEly WASHing away blinding trachoma

 

By Helen Hamilton, Sightsavers and Yael Velleman, WaterAid

Last week, as the global trachoma-community gathered in Geneva for GET2020 (the WHO-led international Alliance for Global Elimination of Trachoma by 2020) there was a significant, and now permanent, addition to the agenda – WASH (water, sanitation and hygiene).  As we move closer to the 2020 elimination goal for this blinding NTD, it was exciting to see water, sanitation and hygiene being given due importance, with its own roundtable session.

So why was this one session such an important milestone? Trachoma is spread where poverty and poor sanitary conditions persist. Despite the fact that two of the four elements of the WHO endorsed SAFE strategy to control and eliminate blinding trachoma (Facial cleanliness and Environmental improvements) rely on successful implementation of WASH interventions, the implementation of the F and E components of SAFE is frequently under-prioritised in planning and implementation of trachoma programmes.

At GET2020 we saw water, sanitation and hygiene come up again and again in all country presentations.  Face washing and environmental improvements are consistently the most challenging action areas within the SAFE strategy implementation.  Although one of the Millennium Development Goals (MDGs) focuses on improving access to clean water and sanitation, with less than three years to go until the MDG deadline there are currently 2.5 billion people with no access to improved sanitationContinue reading

A Minute with NTD expert: Ellen Agler, Chief Executive Officer of the END Fund

END Fund logo

At the recent “Uniting to Combat NTDs: Translating the London Declaration into Action,” we had a chance to catch up with Ellen Agler, Chief Executive Officer of the END Fund. The END Fund is a private philanthropic fund mobilizing resources for neglected tropical diseases in Africa.

Global Network: What does it take for exposed individuals to fight NTDs?

Ellen Agler: When I was in Mali, I also got a chance to see in addition to the mass drug administration other aspects of the program. There is a huge backlog of trichiasis surgery. Blinding trachoma, if it starts advancing, it is incredibly painful… It feels like sand going over your cornea, and you will go blind if you don’t get this surgery in the advanced stages.

And to see how simple of a surgery it was- that it really only took 10 or 15 minutes. [END Fund] do have this incredible message of about 50 cents per person per year can protect you against these seven diseases that cause disability, cause suffering, cause blindness, and really change the trajectory of your life. And that is a simple message, and I think that we’re all rallying to ensure that we can prevent these diseases, we can treat them in the early stage so that no one has to suffer those diseases.

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