• Pre-Collegiate Global Health Review

Sight for the Future: Eliminating Trachoma's Prevalence in Impoverished Areas

Debbie Mojekwu, Jones College Prep, Chicago, Illinois, USA

“It is so painful: I don’t know where to put my head. Everything stops: I can't see,” says Orou, a former traditional dancer in Benin who lost her vision from trachoma.

According to the World Health Organization, "trachoma is the leading infectious cause of blindness worldwide" (WHO, 2022). With its contagious nature, trachoma has blinded or visually impaired 1.9 million people worldwide, declaring this the most devastating, but preventable blinding infectious disease in the world. Dating all the way back to 2600 BC, trachoma landmarks as one of the oldest infectious diseases known to man (Yaghoobi, 2018).

Trachoma is caused by the bacterium Chlamydia trachomatis and is spread through personal contact such as contaminated hands, shared clothing, and has even been found to be transmitted by moisture-seeking flies that carry bacteria from a person's eyes or nose. Once transmitted, this disease causes a variety of eye-related symptoms including eye discharge, pain, scarring of the eyelids, and vision loss.

Environmental factors that contribute to the disease’s spread are “poor hygiene, overcrowded households, inadequate access to water, and inadequate access to, or use of, proper sanitation facilities” (Moloo, 2021). Trachoma poses a very significant concern on a global scale, with 4.2 billion people living without safely managed sanitation services and 3 billion people lacking access to basic hand washing facilities (WHO, 2019). These environmental risks are usually found in the homes of some of the most remote areas in the world resulting in its prevalence in 51 countries that are clustered in the rural areas of Africa, Asia, Central and South America, Australia, and the Middle East.

Amongst these countries, there are notable gender disparities in trachoma infection rates. Former US President, Jimmy Carter, visited Ethiopia to see their trachoma control efforts and found that one of the main causes of this gender disparity is trachoma-infected children putting their primary caretaker, their mother, at a higher risk of exposure than their father. Because of the brutality of the disease, it usually results in trichiasis which is when eyelashes scratch the cornea and can lead to blindness. When a mother develops trichiasis, the young women of the household tend to take over the mother’s house duties and drop out of school, setting them on a path of inevitable poverty (Carter Center, 2009). In this manner, trachoma negatively affects women more than men, by increasing their chances of staying in poor areas where trachoma remains endemic. This trend is not limited to Ethiopia; it can be found in many trachoma-endemic countries. In Tanzania, girls in preschool had an elevated chance of having active trachoma than boys, and amongst adults, “female patients had a twofold excess risk for active trachoma compared to male patients” (Courtright, 2004).

Arguably, trachoma’s continuous gender disparities are directly linked to its status as a neglected tropical disease (NTD), or communicable diseases that affects the world’s poorest nations. NTDs affecting women at greater rates than men is a feat that has persisted since its existence. Women’s assigned gender roles are among the most prominent factors that contribute to this disparity. Globally, women who suffer from NTDs also face stigma, a lack of economic power, and a lack of autonomy, all of which lead to poor “health-seeking behavior”. As a result of this behavior, women are reportedly “two to three times more likely to be permanently blinded from trachoma than men” making them even more susceptible to their disease overcoming them (National Center for Biotechnology Information, 2021). A direct consequence of gender roles is death for women who are forced to suffer from the burden of NTDs.

Unfortunately, very few developing countries have successfully eliminated this threat, with a staggering 136 million people living in areas at risk of this infection (WHO, 2022). Its lack of attention, combined with its threatening nature, makes it just another overlooked disease that causes preventable disabilities.

Despite the enormous threats that trachoma poses to community health and well-being, there has been a 90 percent reduction in risk since the early 2000s. (Ababa, 2021). Most of this success can be attributed to the SAFE strategy designed by the World Health Organization (WHO) in 1993. This strategy consists of Surgery to treat the blinding stage, Antibiotics to treat and prevent active infection, Facial cleanliness to prevent disease transmission, and Environmental improvement to increase access to water and sanitation. The SAFE strategy has demonstrated promise in many countries, most notably in the Gambia and South Sudan.

Gambia’s efforts in defeating trachoma lasted about four decades before it was eliminated in 2021 using the WHO’s recommended strategy (WHO, 2021). The creation of a trachoma task force, supported by the nation’s people, was able to implement preventative health measures by educating the public about the importance of washing hands, and building latrines and boreholes for communities to avoid the effects of open defecation. Additionally, Gambia took the initiative to hire clinical staff to carry out the necessary procedures to treat the disease, while its citizens volunteered to go door to door to diagnose and treat trachoma-infected people with antibiotics donated by Pfizer (Mutali, 2021). Through these measures, the Gambia was able to not only prevent further disease spread but also save money to allocate to other health crises that may ravage the nation.

South Sudan used these same steps by offering trachoma education in schools, antibiotics, and surgery when diagnosed (National Center for Biotechnology Information, 2019). Even whilst in the midst of a civil conflict, South Sudan managed to reduce active trachoma rates by 92% in only three years (Ngondi, 2006). The success of these simple measures has given hope to many poor rural areas that this disease can be eliminated worldwide. By following this program and other safety measures, numerous countries can make this disease a thing of the past and end the suffering of millions.

As of March 2022, the following twelve countries have been validated by WHO as having eliminated trachoma as a public health problem: Cambodia, China, Gambia, Islamic Republic of Iran, Lao People’s Democratic Republic, Ghana, Mexico, Morocco, Myanmar, Nepal, Oman and Saudi Arabia. Unfortunately, South Sudan did not meet elimination standards due to the rise in trachoma rates that ensued after years of conflict. However, there is still hope for them as the Ministry of Health is currently aiding their most endemic counties, in hopes of eliminating trachoma indefinitely with the SAFE strategy.

Elimination efforts made by the world’s most trachoma endemic nations have sparked many more to do so. So much so that the WHO has set a target date for global elimination of trachoma in 2030. Hopefully with the SAFE program, this goal becomes a reality.