The World Health Organization (WHO) has validated Gambia for having eliminated trachoma as a public health problem, making it the second country in WHO’s African Region to achieve this milestone.
“This is a great step towards the 2030 goals set by the recently launched 2021–2030 road map for neglected tropical diseases,” said Dr Ren Minghui, WHO Assistant Director-General for Universal Health Coverage/Communicable and Noncommunicable Diseases. “Gambia has become the second country this year, after Côte d’Ivoire1,to eliminate a neglected tropical disease.”
Gambia’s success in eliminating trachoma is largely attributed to strong collaboration with partner organizations to implement WHO’s SAFE strategy.2
“This is a remarkable achievement that has saved children, mothers and families from preventable visual impairment or blindness, and improved their quality of life and well-being,” said Dr Matshidiso Moeti, WHO Regional Director for Africa. “It is also a clear sign that we can achieve significant milestones through dedicated efforts in tackling health challenges in the region.”
At the heart of the efforts against trachoma are Gambian community volunteers, who have played a crucial role in mobilizing communities and promoting behaviour change.
A 2018–2019 survey on trachomatous trichiasis (the advanced, blinding stage of trachoma) in Gambia found that the prevalence of this condition among people aged 15 years and above ranged from 0% to 0.02% – well under the threshold required for elimination of trachoma as a public health problem3. This is a huge achievement compared to the mid-1980s, when a national survey estimated that trachoma was responsible for almost 1 out of 5 cases of blindness, countrywide.
Trachoma is a neglected tropical eye disease. Infection mainly affects children, becoming less common with increasing age. The long-term consequences of infection develop years or even decades later. In adults, women are up to 4 times more likely than men to be affected by the blinding complications of trachoma, mainly due to their close contact with infected children.
Gambia and WHO will continue to closely monitor previously endemic populations to ensure there is a rapid, proportionate response to any resurgence of the disease.
Despite Gambia’s success, trachoma remains endemic in 27 countries in WHO’s African Region, and 29 countries on the African continent overall. Progress against neglected tropical diseases has alleviated the human and economic burden they impose on the world’s most disadvantaged communities. The 2021–2030 road map for neglected tropical diseases seeks to prevent, control, eliminate or eradicate 20 diseases by 2030.
Globally, trachoma remains a public health problem in 45 countries, with an estimated 137 million people living in areas endemic for the disease. Significant progress has been made over the past few years – the number of people requiring antibiotic treatment for trachoma elimination in the African Region fell by 72 million from 189 million in 2014 to 117 million in 2020.
Trachoma is a devastating eye disease caused by infection with the bacterium Chlamydia trachomatis. The infection spreads from person to person through contaminated fingers, fomites and flies that have come into contact with discharge from the eyes or nose of an infected person.
Environmental risk factors for trachoma transmission include poor hygiene, overcrowded households, inadequate access to water, and inadequate access to, or use of, proper sanitation facilities.
Repeated infections in childhood lead to scarring of the inner side of the upper eyelids, resulting in inward turning of the eyelid margin, with the lashes touching the globe. This is a painful condition known as trachomatous trichiasis – if left untreated, this condition can result in visual impairment and blindness.
In 1996, WHO launched the WHO Alliance for the Global Elimination of Trachoma by 2020 (GET2020). With other partners in the Alliance, WHO supports country implementation of the SAFE strategy and the strengthening of national capacity through epidemiological assessment, monitoring, surveillance, project evaluation and resource mobilization.
Elimination of trachoma is inexpensive, simple and extremely cost-effective, yielding a high rate of net economic return.
2The SAFE strategy consists of:
Surgery to treat the blinding stage (trachomatous trichiasis); Antibiotics to clear the infection, particularly mass drug administration of the antibiotic azithromycin, which is donated by the manufacturer, Pfizer, to elimination programmes, through the International Trachoma Initiative; Facial cleanliness; and Environmental improvement, particularly improving access to water and sanitation.
3Elimination of trachoma as a public health problem is defined as:
- (i) a prevalence of trachomatous trichiasis “unknown to the health system” of <0.2% in adults aged ≥15 years (approximately 1 case per 1000 total population);
- (ii) a prevalence of trachomatous inflammation—follicular in children aged 1–9 years of <5%, sustained for at least 2 years in the absence of ongoing antibiotic mass treatment, in each formerly endemic district; and
- (iii) the existence of a system able to identify and manage incident trachomatous trichiasis cases, using defined strategies, with evidence of appropriate financial resources to implement those strategies.