Category Archives: Trachoma

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!

What Can the Experiences of Sierra Leone and Cambodia Tell Us about How to Fight NTDs?

 

By Romina Rodríguez Pose, independent consultant on international development and lead author for the Health Dimension case studies, Development Progress Project.

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Neglected tropical diseases (NTDs) affect the poorest billion people in the world. They cause number of chronic health conditions that largely limit people’s ability to study and work and consequently have a healthy and productive life. The stigma attached to them can also lead to isolation and fear for those who suffer.

Although they have been long ignored within international and national agendas, in the last decades, there has been an increasing awareness of how NTDs can impede endemic countries from achieving broader development goals. This led to the emergence of global public-private partnerships involving major drug donations from key pharmaceutical companies, the development of inexpensive control strategies and a growing number of donors earmarking funding for integrated NTD control.

These readily available solutions have enabled some endemic countries to fight the five NTDs that bear 90 percent of the global burden: onchocerciasis, also known as river blindness; schistosomiasis, also known as snail fever; lymphatic filariasis, also known as elephantiasis; soil transmitted helminths, also known as intestinal worms; and trachoma.

Image from Cambodia 8To better understand the drivers of progress, ODI’s Development Progress project has taken a closer look at two of the leading performers: Sierra Leone in Africa and Cambodia in Asia. In spite of their different contexts and epidemiological profiles, three drivers have emerged in both case studies:

1. Advances in the fight against NTDs have been driven by the availability of earmarked funds and donated drugs. These have been crucial for both resource-constrained countries, since most endemic countries are faced with several competing, and perhaps more urgent, health issues (such as high mortality rates for mothers and children in Sierra Leone and dengue outbreaks in Cambodia). As a counterpart, political will and local engagement to take advantage of global initiatives have been crucial in bringing NTDs within the national agenda. Both governments, through their Ministries of Health, have proactively looked for partners, secured funds and drugs donations and made important efforts to develop local capacity.

2. There is an important transitional role for development partners in providing access to strategies and guidelines on how to deal with NTDs until local capacity is fully developed. In both countries, this was achieved through bilateral, regional and global partnerships that helped build the local knowledge base for endemic countries to find their own solutions and to implement strategies according to the particular context. These dynamics between development partners and NTD programme managers have gradually led to a ‘transfer of ownership’ of the NTD programmes.

3. The integration of NTD activities within an existing government structure has been vital to set up cost-effective NTD programmes. Both countries have integrated the distribution of drugs within health and education systems. In Cambodia, given the main threat is from intestinal worms which particularly affect school-aged children, progress has been achieved by integrating the distribution of drugs into the school system and turning teachers into twice-yearly doctors/pharmacists. In Sierra Leone, given that the entire population is at risk from at least three NTDs, the main strategy involved the engagement and training of community members as drug distributors. Elected by their communities, their work is divided into catchment areas for which they are responsible, reaching the most remote corners of the country.

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Despite the increasing awareness of their importance, NTDs still loom large in the cycles of poverty, ill-health and under-development that afflict too many developing countries. Yes, as Sierra Leone and Cambodia show, progress can be achieved in the most difficult contexts and with minimal resources, stressing the importance of including NTD control and elimination targets within the post-2015 sustainable development goals.

All photos by Romina Rodríguez Pose. 

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

 

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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).