Category Archives: Trachoma

Water is Crucial to Ending Blinding Trachoma

 

Photo from International Trachoma Initiative

Photo from International Trachoma Initiative

By Elizabeth Kurylo
Communications manager, International Trachoma Initiative

Every morning and every night, I turn on the hot and cold water taps, adjusting them so the temperature is just warm enough to wash my face. I take for granted that the water will flow. I would be shocked if it didn’t. This easy access to water is a luxury not enjoyed by hundreds of millions of people around the world.

As we mark World Water Day, it is worth noting that 748 million people do not have access to an improved source of drinking water and 2.5 billion do not use an improved sanitation facility. For them, the lack of water can mean poor health, disability and even death.

Water and sanitation is especially important in the prevention and control of trachoma and other neglected tropical diseases (NTDs). Trachoma is an ancient eye disease caused by a bacterial infection. Left untreated, it can lead to blindness. But we can stop it with the World Health Organization-endorsed SAFE strategy – Surgery, Antibiotics, Facial cleanliness and Environmental improvement.

Water is crucial to facial cleanliness, and key to ending blinding trachoma.  But in many places where trachoma is endemic, water is scarce, and rationed for uses other than hygiene, such as cooking. Face washing is not a priority.

The global trachoma community has made much progress since 1998, when Pfizer began donating the antibiotic Zithromax®, which treats and prevents trachoma. More than 444 million doses of Zithromax® have been shipped to trachoma endemic countries to date. And seven countries have reported reaching their elimination goals.

Under the leadership of WHO and the Alliance for the Global Elimination of Blinding Trachoma by the year 2020 (GET 2020), national trachoma programs have steadily scaled up implementation. In 2014, WHO’s Weekly Epidemiological Report (WER) said trichiasis surgeries and antibiotic distribution were tenfold higher in 2013 compared to 2004.

The International Coalition for Trachoma Control (ICTC) has galvanized the global trachoma community’s commitment to reaching elimination by 2020.  Collaboration on game-changing initiatives with governments, health officials and trachoma endemic communities has led to the mobilization of more than 150 million dollars of new funding from DFID, USAID and the Queen Elizabeth Diamond Jubilee Trust.  That is in addition to the national government domestic budget allocations and support already provided by many non-governmental development organizations as well as other donors such as the Lions Clubs International Foundation, Conrad N Hilton Foundation and the Bill & Melinda Gates Foundation.  The WASH sector also is collaborating with the NTD sector to achieve shared goals of improving health and eliminating disease.

Still, there is much work to do. An estimated 232 million people in 51 countries live in trachoma endemic areas. Globally, 31 countries are implementing the SAFE strategy to eliminate trachoma, which signifies that 20 countries are still in need of help.

In 2015, ITI plans to ship 115 million doses of Zithromax®, donated by Pfizer. That is more than twice the amount approved for shipment in 2014.  ”We are doing everything we can to accelerate access to Zithromax® needed by people who are at risk of blindness from trachoma,” said Dr. Paul Emerson, Director of ITI. “We are empowering national programs so that those at risk of going blind from trachoma can be treated.”

Empowering people in trachoma endemic communities to prioritize water for hygiene also has lasting benefits. I saw this in Ethiopia, where I met Amarech Haluka, the mother of three young girls, one of whom had experienced the pain of trachoma. Health workers introduced the SAFE strategy to Amarech’s community, which received donated Zithromax® and education about the importance of using latrines and keeping their faces clean to avoid trachoma. Amarech and her husband got a loan to install a water pump in their back yard, and she now routinely washes her children’s faces twice a day. Even though she cannot adjust the temperature of the water that flows from her pump, her children’s faces are clean, and her family is free of trachoma.

Bill and Melinda Gates Bet on the Elimination of Guinea Worm, Elephantiasis, Trachoma and Onchocerciasis

 

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In their Annual Letter, Bill and Melinda Gates have one big bet: The lives of people in poor countries will improve faster in the next 15 years than at any other time in history. And their lives will improve more than anyone else’s.

Considering the tremendous progress made in the fight against neglected tropical diseases (NTDs), we couldn’t agree more. By advocating for the control and elimination of NTDs, the international community is making big strides to improve the lives of the world’s poorest people.

Just last year, 800 million people were treated for NTDs, and the U.S. Agency for International Development (USAID)’s NTD Program successfully delivered its one billionth NTD treatment. Echoing this momentum, NTD treatment continues to be recognized as a key tool for cutting extreme poverty. For example, the G7 and BRICS countries (Brazil, Russia, India, China and South Africa) recently made commitments to accelerate progress toward the global fight against NTDs.

NTDs are the most common affliction of the world’s poorest people, contributing to debilitating blindness, disfiguration and a number of harmful outcomes including school absenteeism, malnutrition and poor maternal and child health. This group of parasitic and bacterial infections is notorious for perpetuating poverty and undermining broader global development efforts. In order to end poverty and improve the lives of the poor, we must prioritize the control and elimination of NTDs.

In their annual letter, Bill and Melinda Gates specifically call for the end of four NTDs: Guinea worm, elephantiasis, trachoma and onchocerciasis. They write:

“Destroying a disease utterly is a very difficult thing to do—so difficult, in fact, that it’s only happened once in history, when smallpox was eradicated in 1980. But if we keep working hard, we can eradicate four diseases by 2030. We can get polio out of Africa this year and out of every country in the world in the next several years. Guinea Worm, an incredibly painful disease whose sufferers spend months incapacitated while worms that can be several feet long burst out of their legs, will also be gone soon, thanks in large part to the leadership of President Carter and the Carter Center. We’ll also see the last of diseases like Elephantiasis, River Blindness, and Blinding Trachoma, which disable tens of millions of people in poor countries. The drugs that can stop these scourges are now being donated in huge numbers by pharmaceutical companies, and they’re being used more strategically thanks to advances in digital maps that show where diseases are most prevalent. Last year these free medicines were distributed to 800 million people.”

Bill and Melinda Gates’ important message injects new energy into the fight against NTDs. Their message is timely, following the recent appropriation by Congress of $100 million toward USAID’s NTD Program for FY 2015 and the launch of India’s ambitious campaign to treat more than 400 million people for elephantiasis, which if successful, could help India eliminate elephantiasis within the next few years and set a bold example for the world.

To read the full letter, click here. To read a statement from Dr. Neeraj Mistry, Managing Director of the Global Network for Neglected Tropical Diseases, click here.

Al Jazeera’s Documentary Series Highlights Neglected Tropical Diseases

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In a fight between the world’s worst diseases and the human population, there are those that dream of a world free of diseases and poverty. Lifelines, a global health television series produced by Al Jazeera with support from the Bill & Melinda Gates Foundation, highlights the efforts of global health workers and professionals who are vigorously working to end neglected tropical diseases (NTDs).

Lifelines’ “River of Hope” documentary highlights the devastating effects of schistosomiasis on poor, rural communities in Senegal. The health crisis started when the Diama dam was built across the Senegal River in 1986. Construction of the dam stopped the river’s flow and created a growing population of infected snails, which left 90 percent of the population living near the river basin infected with schistosomiasis. Schisosomiasis is a water-borne parasite that affects 240 million people in mostly Sub-Saharan Africa and is linked to deadly chronic diseases such as cancer and organ failure.

Lifelines also covered the innovative work of Alassane Ndiaye and Elizabeth Huttinger who are working together on “Project Crevette,” a novel experiment to restore prawns — natural predators of the disease carrying snails — in the lower Senegal River basin to control the spread of schistosomiasis. They plan on convincing political leaders responsible for the Diama dam to build a fish ladder in the dam to allow prawns to maintain their migration upstream where the snails harboring schistosomiasis are heavily populated.

Lifelines also highlighted blinding trachoma and river blindness (onchocerciasis) in the “The End is in Sight” documentary. In Part One of “The End is in Sight,” Lifelines takes us into the Amhara province in Ethiopia, a region that has the highest prevalence of trachoma in the world. Trachoma is an infectious bacterial disease of the eye that blinds approximately half a million people annually. The documentary follows Aba Wolde, an 85-year old citizen of the Amhara region, and his daughter, Amalda. They both have advanced trachoma and must walk over 20 kilometers to a health clinic to receive surgical treatment.

Part Two of “The End is in Sight” takes place in the rural areas of Uganda with a high prevalence of river blindness. River blindness is transmitted by infected black flies and causes severe itching and visual impairment. In 1987, Merck declared that they would donate a medication called Mectizan to treat river blindness for as long as needed through the Mectizan Donation Program (MDP). In Uganda, where about 3.5 million people are infected with river blindness, Dr. Moses Katabarwa introduced an innovative administrative system of mobilizing, educating and providing communities in endemic areas with Mectizan. This approach of mass drug administration (MDA), along with environmental control measures for controlling fly larvae, has produced successful results for eliminating river blindness in multiple regions in Uganda.

Whether you’re an expert in the field of NTDs or someone who is curious to learn more about diseases that keep communities in poverty, we highly recommend that you watch these impactful stories from Aljazeera’s ‘Lifelines’ series.

SAFEly Combatting Trachoma across Africa

 

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By Anna Massey, Head of Strategic Government Partnerships at Sightsavers

When it comes to tackling the largest infectious cause of blindness in the world – trachoma – it is widely agreed that the SAFE strategy is key in moving towards elimination. Recommended by the World Health organization (WHO), the strategy aims to reduce the burden of the disease, especially in Africa where it is highest, by addressing: Surgery (lid surgery to correct trichiasis); Antibiotics (Zithromax® donated by Pfizer to treat and prevent active infection); Facial cleanliness (to prevent disease transmission); and Environmental change (such as the construction and use of latrines to control flies, and provision of accessible water to allow face washing).

Excitingly, the situation will now change dramatically in six Sub-Saharan countries over the coming five years with the UK government announcing an investment of £39 million to help support the elimination of trachoma in countries like Ethiopia, Zambia and Tanzania through the SAFE strategy. Being implemented by a consortium of International Coalition for Trachoma Control (ICTC) members and managed by NGO Sightsavers, programme work will begin on the ground in Autumn.

The burden of the disease has already largely been surveyed in these countries, through the UK government supported Global Trachoma Mapping Programme (GTMP). For example Ethiopia, where the GTMP has supported the Ministry of Health to examine 430,000 people across seven regions, has approximately 30 per cent of the known global trachoma burden, so this support is much needed.

For countries such as Chad this crucial investment will see a rapid expansion of the nascent trachoma programmes and will hopefully be a catalyst for further support in fighting trachoma and stopping people needlessly living in pain and ultimately losing their sight.

Whilst this project will see 165,000 trichiasis surgeries performed and almost 10 million people treated with antibiotics, in addition to increasing access to water and instigating behavioural changes to reduce transmission of the disease, there is further good news for the broader NTD community. The implementation of the SAFE strategy and particularly the F&E components will also yield broader benefits including potential reductions in the burden of other infectious diseases, including cholera, typhoid and other NTDs (schistosomiasis, STH, Guinea worm), plus other diarrheal illnesses.

Through the programme, links will be made with other NTD projects in these countries to ensure a holistic push to make a dent in the significant and debilitating burden placed on these poor communities by NTDs such as trachoma. The provision of infrastructure around this planned scale-up of SAFE activities will support control of trachoma and provide a platform for strengthening other NTDs and health interventions.

The ICTC programme Advisory Committee will be providing technical and quality assurance guidance for the programme, which will include support from a series of structured working groups on technical programmatic practices.

Sightsavers itself will be drawing on its expertise of working with partners and Ministries of Health in African nations through other trachoma-related projects such as GTMP, The Queen Elizabeth Diamond Jubilee Trust Trachoma Initiative and a DFID-funded UNITED programme to tackle NTDs in Nigeria to ensure efficiencies, collaborations and ultimately success!