Trachoma and other neglected tropical diseases

At the African Union Summit in Ethiopia this week [10-11 February], African leaders will be addressing the progress made to fight neglected tropical diseases (NTDs) and other major diseases. NTDs rarely make headline news, yet they affect 1.6 billion people in the poorest parts of the globe – and some 580 million people in Africa – that’s close to 50 per cent of the entire population

The discussion will include the latest data from the African Leaders Malaria Alliance (ALMA) scorecard which tracks progress against malaria and the five most common NTDs. Stemming from this, ALMA’s partners have drawn up a league table, which ranks each country’s performance in the fight against NTDs.

Given its status as one of the poorest countries in Africa, the news that Malawi has been ranked second in this table is particularly significant.

My experience working with the Malawian government over the past four and a half years through The Queen Elizabeth Diamond Jubilee Trust’s Trachoma Initiative stands as testament to the way in which the country is winning the fight against NTDS.

My experience working with the Malawian government over the past four and a half years through The Queen Elizabeth Diamond Jubilee Trust’s Trachoma Initiative stands as testament to the way in which the country is winning the fight against NTDS.

Trachoma is entirely preventable, yet it is the most common infectious cause of blindness in the world. Caused by a bacterial infection that is easily transmitted from person to person, found most commonly in poor, rural communities with limited access to clean water and sanitation, this excruciating disease still affects millions of lives. If left untreated, the infection gradually turns the eyelashes inward, and with every blink, they scratch the surface of the eye, causing not only terrible and constant pain, but irreversible damage to the eye. 1.9 million people around the world are now needlessly without sight because they didn’t receive the treatment they needed.

This preventable disease is responsible for children dropping out of school – either because they suffer from the infection themselves or because they are needed to care for a parent who cannot see. Adults can no longer work, stripping them of their independence and their ability to support their families. As a result, whole communities are trapped into a cycle of poverty.

In 2014, 8 million people were at risk of going blind from trachoma in Malawi. Today, Malawi has accelerated efforts to such an extent that the vast majority of people are no longer at risk of losing their sight to the disease. Government health systems have been strengthened to manage any future cases. As long as the prevalence of the disease remains at this level over the next few years, the country will be able to celebrate the huge achievement of having officially eliminated trachoma as a public health problem, as certified by the World Health Organization.

The Trust’s Trachoma Initiative, which is working towards the elimination of blinding trachoma in 12 Commonwealth countries in honour of Her Majesty The Queen, has been working closely with the Government of Malawi in the battle against trachoma. The huge strides the country has made are the result of a massive collaborative endeavour: The Trust’s Trachoma Initiative is led by Malawi’s Ministry of Health and delivered by a vast network of partners, all of whom are coordinated by Sightsavers on behalf of the International Coalition for Trachoma Control. The Initiative works in tandem with other large-scale trachoma programmes such as the UK Aid-funded DFID SAFE programme, which collectively has halved the number of people at risk of losing their sight to the disease since 2011.

Established as a five-year programme, the Initiative is now entering its final year, and I am in awe at what these combined efforts have achieved in Malawi in such a short amount of time.

Almost 13 million people have been treated with antibiotics to stop the spread of infection, and more than 4,800 people have received surgery to ease their pain and stop further vision loss.

The skills of healthcare professionals have also been strengthened, with multiple sessions held to train, retrain and certify trachoma surgeons. Health services have been brought to the communities that need them the most, with more than 12,500 people trained to find those living with trichiasis, the most severe, blinding form of trachoma, in order to refer them to treatment. That’s thousands of people’s lives transformed for the better.

The skills of healthcare professionals have also been strengthened, with multiple sessions held to train, retrain and certify trachoma surgeons. Health services have been brought to the communities that need them the most, with more than 12,500 people trained to find those living with trichiasis, the most severe, blinding form of trachoma, in order to refer them to treatment. That’s thousands of people’s lives transformed for the better.

Along with the legacy of strengthened health services, access to safe water sources and sanitation has also been increased – at last count, more than 1,600 hand and face washing stations had been set up in Malawian schools alone – alongside awareness about the importance of washing with water and soap.

Because of these efforts, more communities in Malawi are now trachoma-free, allowing people the freedom to work, support their families, access education and interact with the world as they would wish to.

The progress Malawi has made to eliminate trachoma is just one example of the country’s leadership when it comes to improving the health of its people. It shows what can be achieved when communities, governments, and different agencies work together to reach a shared vision. My greatest wish is that the huge strides made by the Trachoma Initiative in Malawi – and the 11 other Commonwealth countries in which we work to eliminate trachoma – will lead to a day when this painful, blinding disease is consigned to history.

As the Trachoma Initiative draws to a close as planned later this year, the efforts of national governments and their partners will be key to ensuring countries that have borne the brunt of trachoma for too long will finally be declared free of trachoma as a public health problem. Malawi shows us all just what is possible.

For more information visit www.endtrachoma.org.

Dr Astrid Bonfield CBE

Dr Astrid Bonfield CBE is Chief Executive of The Queen Elizabeth Diamond Jubilee Trust.
Dr Astrid Bonfield CBE

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