Trachoma Prevention Toolkit for Face Washing and Environmental Improvement (F&E)

Trachoma Global Overview

Trachoma, an infection of the eye caused by Chlamydia trachomatis, ranks worldwide as the most common preventable cause of blindness and the second most common cause of blindness after cataract. It has been estimated to cause 15% of the world's blindness. The disease is endemic in 48 countries in Latin America, Africa, the Middle East, Asia, and Australasia and is most prevalent in poor, rural communities with lower standards of hygiene and sanitation.

In 2003, the WHO estimated that 84 million people were suffering from active trachoma, and 7.6 million were severely visually impaired or blind as a result of trachoma. When visual impairment occurs during the productive years of life, it results in economic hardship for families and communities: it has been estimated that in countries ranked with a low Human Development Index (http://hdr.undp.org/en/data) the morbidity arising from trachoma is estimated to cost US $2.9 billion per year in lost workforce productivity.

The world's leading cause of preventable blindness, trachoma spreads easily from person to person. Of the people at risk for trachoma, most are children. Women are almost twice as likely as men to develop the advanced stage of the disease, which can lead to painful disability or blindness.

Trachoma is prevalent in poor, rural communities that lack the tools for basic hygiene, clean water, and adequate sanitation. Infections are spread via contact with dirty clothes, hands, and flies that are attracted to people's eyes. In the advanced stage of the disease, called trichiasis, a person's eyelashes turn inward, scraping the cornea with every excruciating blink, causing scarring, diminished vision, and, eventually, blindness.

In 1997, the WHO organized the Alliance for Global Elimination of Trachoma by 2020 (GET 2020) and recommended the 'SAFE' strategy as a basic framework for dealing with trachoma. This strategy involves the use of Surgery to treat advanced stages of disease, Antibiotic treatment with azithromycin, and the promotion of Facial cleanliness and Environmental change.

Trachoma Global Statistics

Globally, 1.2 billion people live in endemic areas, 40.6 million people are suffering from active trachoma, and 8.2 million have trichiasis; 48.5% of the global burden of active trachoma is concentrated in five countries: Ethiopia, India, Nigeria, Sudan and Guinea. On the other hand, 50% of the global burden of trichiasis is concentrated in only three countries: China, Ethiopia and Sudan.

Overall, Africa is the most affected continent; 27.8 million cases of active trachoma (68.5% of all) and 3.8 million cases of trichiasis (46.6% of all) are located in 28 of the 46 countries in the WHO African Region, with an estimated population of 279 million living in endemic areas. The disease is still prevalent in some countries or areas of countries of four other WHO regions: the Eastern-Mediterranean (12 countries, population in endemic areas 144 million), the Western Pacific (11 countries, population in endemic areas 400 million), South-East Asia (three countries, population in endemic areas 362 million) and the Americas (three countries, population in endemic areas 58 million). The European region is the only WHO region to be free of trachoma. According to these estimates, the ultimate intervention goals require antibiotic treatment for some 340 million people and trichiasis surgeries for 8.2. Trichiasis, however, continues to occur in adults exposed to trachoma in the past: the UIG for trichiasis surgery determined in this paper does not make projections on the incident cases and is therefore an underestimate.

Trachoma: Situation and Trends

Blinding trachoma is hyper endemic in many of the poorest and most remote rural areas in 57 countries of Africa, Asia, Central and South America, Australia and the Middle-East. Roughly half of the global burden of active trachoma is concentrated in 5 countries (Ethiopia, India, Nigeria, Uganda and Sudan), and that of trichiasis in 4 countries (China, Ethiopia, Nigeria and Uganda). Overall, Africa is the most affected continent: 27.8 million cases of active trachoma (68.5% of all cases globally) and 3.8 million cases of trichiasis (46.6% of all) occur in 28/46 countries in the African Region. The highest prevalence of active trachoma have been reported from Ethiopia and Sudan, where the infection often occurs in more than 50% of children younger than 10 years; trichiasis is found in up to 19% of adults. Implementation of the SAFE strategy will lead to the elimination of blinding trachoma by 2020. In 2008, about 60% of the population in need received preventive chemotherapy using antibiotics and about 45% received surgical care. Ghana, the Islamic Republic of Iran, Morocco and Oman have reported reaching their elimination targets.

Toolkit last updated: May 12, 2014