WHO has validated Nepal for having eliminated trachoma as a public health problem
May 23rd, 2018Nepal: first country in South-East Asia validated for eliminating trachoma
21 May 2018 | Kathmandu | New Delhi | Geneva — The World Health Organization (WHO) has validated Nepal for having eliminated trachoma as a public health problem – a milestone, as the country becomes the first in WHO’s South-East Asia Region to defeat the world’s leading infectious cause of blindness.
“Nepal’s achievement is commendable and results from strong political commitment, intense community engagement and impressive leadership demonstrated by civil society,” Dr Khetrapal Singh.
Trachoma was the second leading cause of preventable blindness in Nepal in the 1980s.
“This remarkable achievement demonstrates what political commitment and sustained partner support can do,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “It is a big step towards health for everyone and comes at a time when Nepal accelerates its fight against other neglected tropical diseases.”
A letter acknowledging validation was presented yesterday to Nepal’s Minister of State for Health and Population Ms Padma Kumari Aryal by the WHO South-East Asia Regional Director Dr Poonam Khetrapal Singh and the WHO Director-General Dr Tedros Adhanom Ghebreyesus in Geneva, Switzerland where the World Health Assembly is taking place.
In 2002, the Government of Nepal stepped up efforts to eliminate the disease with the establishment of a national trachoma programme. From 2002 to 2005, following the implementation of sustained control activities, the prevalence of active (inflammatory) trachoma fell by 40%.
“The fight against trachoma gained momentum due to strong government commitment and leadership backed by community engagement and the support of health workers and volunteers” said Ms Padma Kumari Aryal, Minister of State for Health and Population. “Other factors that boosted control and elimination activities included funding from and excellent coordination among key partners1 and donors.”
The Government of Nepal, through the Ministry of Water Supply and Sanitation, provided incentives to local communities and districts to build and maintain latrines – measures that were crucial to improving sanitation and reducing disease-carrying flies.
To increase awareness, the national trachoma programme collaborated with the Ministry of Education to include a module on trachoma in the school curriculum.
“We managed to accelerate awareness about the disease and sanitation through education campaigns involving brochures, posters, flipcharts, radio announcements, and programmes in schools and village health centres,” said Mr Sailesh Mishra, Executive Director, Nepal Netra Jyoti Sangh (NNJS). “These were run by teachers and local health volunteers.”
Approximately 30 000 operations were provided to manage trichiasis, and almost 15 million doses of azithromycin were distributed. Between 2002 and 2014, eye hospitals and dozens of eye centres and clinics with trained staff were established across Nepal.
Azithromycin is donated by the pharmaceutical company Pfizer through the International Trachoma Initiative and was delivered in Nepal by NNJS with support from the United States Agency for International Development-funded ENVISION project, implemented by RTI International.
A series of surveys conducted progressively from 2005 to 2015 showed that active trachoma in children had been brought below the elimination prevalence threshold. Low prevalence was maintained after mass antibiotic treatment was discontinued.
GET 2020
In 1996, WHO launched the WHO Alliance for the Global Elimination of Trachoma by the year 2020 (GET2020). With other partners in the Alliance, WHO supports country implementation of the SAFE strategy (Surgery for trichiasis, Antibiotics to clear infection, Facial cleanliness, and Environmental improvement to limit transmission) and strengthening of national capacity through epidemiological assessment, monitoring, surveillance, project evaluation and resource mobilization.
Elimination of trachoma is inexpensive, simple and highly cost-effective, yielding a high rate of net economic return.
Global progress
In 1998, the World Health Assembly resolved to eliminate trachoma as a public health problem worldwide (WHA 51.11). Since then, significant progress has been made and an increasing number of endemic countries are meeting targets and preparing documentation of national elimination of trachoma as a public health problem.2
In 2014, the WHO South-East Asia Regional Director Dr Poonam Khetrapal Singh identified elimination of neglected tropical diseases as one of the flagship priority programmes. Since then countries in the Region, including Nepal, have been making concerted efforts to eliminate these diseases.
Several criteria are used to assess a country’s claim for having eliminated trachoma as a public health problem. These include:
- less than 5% of children aged 1–9 years have signs of active trachoma (trachomatous inflammation–follicular), which can be treated with antibiotics, in each previously-endemic district;
- less than 0.2% of people aged 15 years and older have trachomatous trichiasis, which requires eyelid surgery, in each previously-endemic district; and
- a health system which can identify and manage new cases of trachomatous trichiasis.
The disease
Trachoma, an eye disease caused by infection with the bacterium Chlamydia trachomatis, is spread through contact with infective eye or nose discharges. Infection is particularly common in young children.
Ocular or nasal discharge can be transmitted directly from person to person, or be mediated by flies which have been in contact with the eyes and noses of infected people. Transmission is associated with poor sanitation and hygiene, which increase the availability of eye discharges and encourage the breeding of flies.
Trachoma puts more than 190 million people at risk of blindness in 41 countries. It is responsible for the blindness or visual impairment of around 1.9 million people worldwide.