Malawi eliminates trachoma as a public health problem

Malawi eliminates trachoma as a public health problem

The World Health Organization (WHO) has recognized that Malawi has eliminated trachoma as a public health problem,1 Making it the fourth country in the WHO African region after Ghana (June 2018), Gambia (April 2021) and Togo (May 2022) to achieve this milestone.

Malawi has been known to be endemic for trachoma since the 1980s. However, it was not until 2008, when surveys were conducted with the support of Save Sight and the World Health Organization in Chikawa and Mishinji counties, that trachoma received due attention. Other baseline surveys confirmed endemicity in 17 of the country’s 28 districts.

Following the launch of the National Trachoma Control Program by the Ministry of Health in 2011, the National Trachoma Task Force stipulated that the program should be integrated into the structure of the Ministry of Health. Malawi received its first donation of azithromycin (Zithromax®, Pfizer, NY) from the International Trachoma Initiative in 2011 to conduct a mass drug administration for antibiotics. Following the development of the Trachoma Action Plan in 2012-2013 and its implementation beginning in 2014, funding for the implementation of the SAFE strategy in all endemic areas was made possible through financial support from the Queen Elizabeth Diamond Jubilee Trust in 2014. Intermediate cadres of ophthalmologists were trained. They are certified TT surgeons. A quality assurance team was formed, and regular national trachoma coordination meetings were held. The Ministry of Health has also conducted awareness campaigns on the importance of facial and personal hygiene in combating trachoma. Moreover, stakeholders already in the districts intensified their work, and the implementation of WASH activities resulted in significant improvements in the availability of potable water and access to improved sanitation.

Malawi and WHO will continue to closely monitor the former endemic population to ensure a rapid and proportionate response to any re-emergence of the disease.

Globally, Malawi joins 14 other countries that have been certified by the World Health Organization to eliminate trachoma as a public health problem. These are Cambodia, China, Islamic Republic of Iran, Lao People’s Democratic Republic, Gambia, Ghana, Mexico, Morocco, Myanmar, Nepal, Oman, Saudi Arabia, Togo and Vanuatu.

spread of disease

Trachoma remains a public health problem in 42 countries with an estimated 125 million people living in endemic areas. Trachoma is found mainly in the poorest rural areas of Africa, Central and South America, Asia, the Western Pacific and the Middle East. The African region is disproportionately affected by trachoma with 105 million people living in high-risk areas, representing 84% of the global burden of trachoma.

Significant progress has been made over the past few years, and the number of people requiring antibiotic treatment for trachoma in the African region has decreased by 84 million from 189 million in 2014 to 105 million as of June 2022.

After Malawi’s success, trachoma is still endemic in 25 countries2 in the WHO African Region, bringing us closer to the trachoma-elimination target set out in the NTD 2021-2030 roadmap.

the disease

Trachoma is the main infectious cause of blindness and is caused by infection with bacteria Chlamydia trachomatis. The infection is spread from person to person through contaminated fingers, tools, and flies that have come into contact with secretions from the eyes or nose of an infected person. Environmental risk factors for transmission of trachoma include poor hygiene, overcrowded households, insufficient access to water, and insufficient access to or use of appropriate sanitation facilities.

Trachoma is an endemic disease that burdens remote, disadvantaged rural communities. The infection mainly affects children, and becomes less common with age. Repeated infections in early childhood lead to later complications years and even decades later. In adults, women are twice as likely to develop blinding complications from trachoma than men, mainly because of their close contact with affected children.

Repeated infections in childhood lead to scarring on the inner side of the upper eyelid. In some people, this leads to TT, in which one or more eyelashes in the upper eyelid touch the eye. TT is a debilitating condition that results in excruciating pain with each blinking movement of the eyelids. TT can be managed surgically, but if left untreated, it can lead to corneal scarring, resulting in visual impairment and blindness. Trachoma can be eliminated using the WHO SAFE strategy.3

GET2020

In 1996, the World Health Organization launched the WHO Alliance for the Global Elimination of Trachoma by 2020 (GET2020). With other coalition partners, WHO supports country implementation of the SAFE strategy and strengthening national capacities through epidemiological assessment, monitoring, surveillance, project evaluation, and resource mobilization that contribute to the elimination of trachoma as a public health problem. The NTD 2021-2030 Roadmap, endorsed by the World Health Assembly in 2020 through Resolution 73 (33), sets 2030 as a new target date for global elimination.

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1. Elimination of trachoma as a public health problem is defined as: (1) the prevalence of trichomoniasis “unknown to the health system” trachoma less than 0.2% in adults aged 15 to 15 years (about 1 case per 1000 population), and (ii) the prevalence of tracheo-follicular inflammation in children aged 1-9 years of <5%, persisting for at least 2 years in the absence of systemic antibiotic therapy, in every previously endemic area; In addition to (3) having a system capable of identifying and managing cases of Trichotillomania, using specific strategies, with evidence of appropriate financial resources to implement those strategies.

2 – Algeria, Angola, Benin, Burkina Faso, Cameroon, Central African Republic, Chad, Côte d’Ivoire, Democratic Republic of the Congo, Eritrea, Ethiopia, Guinea, Guinea-Bissau, Kenya, Mali, Mauritania, Mozambique, Niger, Nigeria, Senegal, South Sudan, United Republic of Tanzania, Uganda, Zambia, and Zimbabwe.

3. The SAFE strategy consists of surgery to treat a late complication (Trichia matica). Antibiotics to clear infection, particularly administering bulk medications to the antibiotic azithromycin, donated by the manufacturer, Pfizer, to infection clearance programs through the International Trachoma Initiative; Facial hygiene and environmental improvement, especially improving access to water and sanitation, to reduce transmission of infection.

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