The Gambia has eliminated trachoma as a public health problem: Challenges and successes

Abstract

Trachoma is the leading infectious cause of blindness in the world and has been known to be a major public health problem in The Gambia for over 60 years. Nationwide blindness surveys, including trachoma, in 1986 and 1996 provided the foundation for a comprehensive plan to implement a trachoma elimination strategy. Impact and pre-validation surveillance surveys in 2011–13 demonstrated that active trachoma was below WHO threshold for elimination but trichiasis remained a public health problem. Trichiasis-only surveys in 2019 demonstrated that trichiasis was below WHO thresholds for elimination and in 2020 the Government of The Gambia completed and submitted its dossier for validation of elimination as a public health problem. Challenges that The Gambia faced on the pathway to elimination included effective use of data for decision making, poor trichiasis surgical outcomes, lack of access to antibiotic treatment for low prevalence districts, high attrition of ophthalmic nurses trained as trichiasis surgeons, unexpected active trachoma in madrassas, the misalignment of elimination of active trachoma and trichiasis, trichiasis in urban settings, and maintaining the quality of surgery post-elimination when trichiasis cases are rare. Elimination of trachoma does not end with the submission of an elimination dossier; The Gambia will need to sustain monitoring and support over the coming years.

Trachoma

“…It has been operationalized in all programs aimed at eliminating trachoma. Elimination has been successfully achieved in hitherto endemic countries such as Gambia, Morocco, Mexico, Laos, and Nepal [47][48][49]. Control programs utilize a four-step approach as follows:…”

The elimination of trachoma as a public health problem in Togo: Successes and challenges

“…Trachoma is the leading infectious cause of blindness in the world [ 1 ]. Caused by Chlamydia trachomatis , the infection can lead to trachomatous follicular inflammation, a clinical sign used to estimate the presence of active trachoma [ 2 ]. Repeated infections lead to the development of scarring on the tarsal conjunctiva of the upper eyelid which, over time, can cause upper eyelid deformity [ 2 ].…”

“…Caused by Chlamydia trachomatis , the infection can lead to trachomatous follicular inflammation, a clinical sign used to estimate the presence of active trachoma [ 2 ]. Repeated infections lead to the development of scarring on the tarsal conjunctiva of the upper eyelid which, over time, can cause upper eyelid deformity [ 2 ]. Deformed upper eyelids may result in trichiasis (the presence of eyelashes touching the front of the eye), the low prevalence of which is a criterion for eliminating trachoma.…”