trachoma

UNIVERSITY OF GONDAR
COLLEGE
OF MEDICINE & HEALTH SCIENCE
Department of optometry
Seminar presentation
Tittle: Epidemiology of trachoma in Ethiopia
Prepared by Yohannes B. (BSc, MSc student in clinical
optometry)
January 18, 2021

OUTLINE
 Introduction
 Transmission and risk factor
 Epidemiology trachoma in global and Africa
 Epidemiology of trachoma in Ethiopia
Prevalence in Urban and rural
Prevalence in Gender
Prevalence In Ethiopian region
The burden of trachoma in Ethiopia
Control and treatment of trachoma
National policy or program for trachoma elimination
Recommendation for Government of Ethiopia
2
Yohannes B. (MSc student in clinical optometry) bizualemyohannes@gmail.com
3/29/2021

OBJECTIVE
 At the end of this seminar we will able
 Understand what is trachoma
 Know distribution of trachoma in geography, gender and sex in
Ethiopia
 Burden of trachoma in Ethiopia
 Identify the area where it have high prevalence of trachoma
 List national program that involve in elimination of trachoma
3
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INTRODUCTION
 Definition: Trachoma is a chronic
keratoconjunctivitis caused by the obligate
intracellular bacterium Chlamydia trachomatis
 at least 2 of the following to say trachoma
1. Conjunctival follicles
2. tarsal conjunctval scarring( Arlt’s line)
3. (Herbert’s pit)
4. Vascular pannus /the superior limbus
4
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CONT.……
 WHO classification:
 Trachomatous follicular(TF) 5 or more follicles of > 0.5mm on upper
tarsus, deep Conjunctival vessels seen
 Trachoma intense(TI) diffuse involvement of the tarsal conjunctiva,
obscuring 50% or more of the normal deep tarsal vessels; papillae are
present
 Trachomatous scarring(TS) -
 Trachomatous trichiasis(TT) at least one lash touching the globe
 Corneal opacity(CO) sufficient to blur details of at least part of the
pupillary margin 5
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TRANSMISSION AND RISK FACTOR
Discharge
Hands (fingers),
On clothes, or
By flies
It occurs in areas
Poor personal and community hygiene
Hot, dry, and dusty climate)
Typically affects the most marginalized, deprived members of
a community 6
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EPIDEMIOLOGY IN THE WORLD AND AFRICA
 Trachoma is a disease of the eye and the leading
infectious cause of preventable irreversible blindness
worldwide. It is caused by an obligate intracellular
bacterium called Chlamydia trachomatis.
 The World Health Organization (WHO) reports trachoma
is endemic to more than 50 countries, with most blinding
trachoma in Africa.
 2.5 million people of all ages with trachomatous trichiasis
in 2019 globally
7
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CONT….
Trachoma is endemic in more than 50 countries,
predominantly in sub-Saharan Africa, the Middle East, and
Asia
approximately 1.3 million people are blind and probably a
further 1.8 million have low vision due to trachoma.
(Organization 2003)(Pascolini, Mariotti et al. 2004)
8
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CONT.….
 Africa is the most affected continent, but it also
has the most widespread control efforts.
In 2019 alone,
o 92 622 people surgical treatment for advanced
trachoma
o 95.2 million were treated with antibiotics. But the
disease remains a serious public health concern,
o due to this US$ 8 billion annual loss in
productivity
9
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CONT.…
More than 80% of the global burden of active trachoma is
concentrated in 14 countries, all of which are in Africa(Haddad
2012).
Click this the distribution
10
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EPIDEMIOLOGY IN ETHIOPIA
 Ethiopia is the second most populous country in Africa and has a very
high burden of trachoma.
 The prevalence of active trachoma among children and trachomatous
trichiasis among 15 years and above is very high in Ethiopia.
 Rural/urban differences in active trachoma and gender differences in
trachomatous trichiasis
 (Berhane, Worku et al. 2007).
11
population of
Ethiopia in 2006
over 1.2 million
people 15 years and
above -TT
over 9 million
children - active
trachoma
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PREVALENCE IN URBAN AND RURAL
 The prevalence of active trachoma is
four-fold in the rural population compared
to the urban
 poor sanitation
 Poor water supply(safe water is 25.2%
Vs. 91.7%
 improper human waste disposal
coverage
12
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PREVALENCE IN GENDER
 The prevalence TT among females is also over twofold as compared
to males
 This according to the Health Status Indicators published by the
Federal Ministry of Health for the year 2004/5.
13
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PREVALENCE IN ETHIOPIAN REGION
PREVALENCE OF TRACHOMATOUS TRICHIASIS (TT) FOR THE 15 YEARS AND ABOVE
POPULATION. NATIONAL SURVEY ON BLINDNESS, LOW VISION AND TRACHOMA IN ETHIOPIA
(2005-6)
14
Region TT Prevalence
Tigray 2.3
Afar 1.0
Amhara 5.2
Oromia 2.8
Somali 4.2
B-Gumz 0.1
SNNP 2.0
Gambella 2.5
Harari 1.2
Addis Ababa 0.9
Dire Dawa 0.7
National (weighted) 3.1
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THE BURDEN OF TRACHOMA IN ETHIOPIA
 In Ethiopia, trachoma remains a major public health problem
 Ethiopia is the most affected country in the world
 1/3rd of the global burden is in Ethiopia
 Trachoma is a huge public health problem in Ethiopia
 Trachoma is a major socio-economic development issue for Ethiopia
and should be treated as such (loss of productivity)
15
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CONT.……
 Of the 650 known endemic districts, 256 of them are with hyper-endemic
trachoma (TF > 30%), only 25 have TF between 5 and 9.9%
 Trachoma is a gender issue (women make up about 2/3rd of the trachoma
cases)
 Ethiopia receives more than 50% of the global Zithromax supply (the
largest recipient of the drug donation program)
16
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CONT.….
 The Ethiopian National Survey on Blindness, Low Vision, and Trachoma,
carried out from 2005 to 2006 estimated that the national prevalence of
active trachoma was 40.14%, with some regional variation; the highest
prevalence being in the Amhara region (62.60%)
 The prevalence rate of active trachoma in various districts in Ethiopia
were; 22% in Goro zone, 22.8% in Gurage zone, and 24.10% in east
Gojjam zone 17
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CONT.…
 256 districts have active trachoma (TF) above 30% (requiring at least 5
years of SAFE interventions) and 301 districts with TF between 10 and
29.9% from 650 endemic districts.
 93 districts with TF between 5 – 9.9%
 693,000 trichiasis cases requiring surgical treatment; again the largest in
the world (WHO GET2020 Alliance Database).
 Trachoma burden in Ethiopia: Prevalence and the need for intervention in 2012 and 2016 (Source: WHO
Alliance for GET2020, 2016)
18
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CONT….
 There are more than 75 million people living in trachoma-endemic
areas in Ethiopia, the largest number of any country in the world.
 The backlog of people who urgently need eyelid surgery to prevent
blindness stands at over 693,000 – again, the largest number of any
country in the world. (Source: WHO GET2020 Database)
19
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HIGH PREVALENCE OF TRACHOMA IN ETHIOPIA. WHY?
 Poor access to water supply
 Lack of latrine and garbage disposal facilities
 Poor indoor air quality
 The presence of animals inside a residential house have been
reported
 Low literacy rate and poor face washing habits have been
associated with development of trichiasis.
20
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TRACHOMA IMPACT EVALUATIONS, ETHIOPIA VERSUS OTHER
COUNTRIES, 2015
21
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THE COMMON FEATURES OF WOREDA NOT
APPARENTLY ACHIEVING REDUCTIONS IN TT AND TF
PREVALENCE INCLUDED:
 Lower rainfall
 More widespread unwillingness among the population to accept
offered antibiotics
 Lower reported antibiotic MDA coverage
 Fewer health extension workers and fewer supervisors
 Fewer kebeles free of open defecations
22
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CONT.…
 Less active identification of TT cases
 Higher incidence of post-surgical TT
 Incentives for surgical staff linked to the number of TT patients
identified (not managed)
 Reported lack of reduction in TF prevalence following MDA leading to
community disillusionment
23
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CONTROL AND TREATMENT OF TRACHOMA
 Endemic countries are being implemented through the WHO-
recommended SAFE strategy.
24
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CONT.…
 Ethiopia has made important progress in the elimination of
trachoma on SAFE strategies
 The annual number of azithromycin treatments administered has
increased from 400 000 in 2006 to 22 497 883 in 2013.
 Surgery: By 2013, a cumulative total of 855 491 trichiasis surgeries
had been done; an additional 133 940 surgeries were done in 2013
alone.
 Antibiotics: Since the inception of mass drug administration (MDA) in
2006 with 400 000 antibiotic treatments, a cumulative total of 119 697
067 treatments have been administered.
25
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CONT.…
 Facial cleanliness: Of the population living in known endemic areas,
75% have received hygiene and sanitation education by 38 000
health educators trained for this purpose
 Environmental improvement: Some 7 915 949 latrines have been
built; an estimated 6 million remain to be constructed. However,
current latrine utilization is low (20%). Access to potable water has
increased
26
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PRIMARY PREVENTION
 Good Face washing practice
 Avoid touching of the eyes with Fingers
 Avoid sharing of Fomite
 Avoid Flys (Musca Sorben)
 Environmental hygiene(latrine construction, water
supply)
 Mass treatment (TF 20% TT 1% and more, TI 5%
and more)
 Prevention of recurrent infections
 Early detection and rx
27
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NATIONAL POLICY OR PROGRAM FOR TRACHOMA ELIMINATION
 World Health Organization’s
 Neglected Tropical Diseases was launched in 2015, NTD Master Plan
Launch in 2013 in Ethiopia
 inclusion of trachoma elimination in the national Health Sector
Transformation Plan
 Global Trachoma Mapping Project
 mass drug administration
 The Carter Center
 SNV in Ethiopia develops a Trachoma Programming Strategy
28
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RECOMMENDED FOR GOVERNMENT OF ETHIOPIA
 Federal Government of Ethiopia and the regional governments
need to enhance their commitment to eliminate the unnecessary
loss of sight by:
 Increasing resources allocation
 Improving health services capacity at all levels to effectively and
timely provide preventive and curative eye care services.
 Supporting development of basic infrastructure and human capacity
for prevention, treatment and rehabilitation services at all levels
29
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CONT.…
 Putting emphasis on comprehensive and integrated prevention and
treatment eye care programs is essential to reduce the disease
burden in the long term.
 Improvement in one component of trachoma control intervention
 improving water supply
health education about trachoma
30
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WHY OPTOMETRY INVOLVED IN THE SURVEY?????
31
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REFERENCE
 National Survey on Blindness, Low Vision and Trachoma in Ethiopia:
Methods and Study Clusters Profile
 Global Elimination of Blinding Trachoma by 2020:
 NATIONAL PROGRAMME FOR CONTROL OF BLINDNESS
 Haddad D. Trachoma: the beginning of the end? Community eye health.
2012;25(77):18.
 Oswald WE, Stewart AE, Kramer MR, Endeshaw T, Zerihun M, Melak B, et
al. Active trachoma and community use of sanitation, Ethiopia. Bulletin of
the World Health Organization. 2017;95(4):250.
 Ferede AT, Dadi AF, Tariku A, Adane AA. Prevalence and determinants of
active trachoma among preschool-aged children in Dembia District,
Northwest Ethiopia. Infectious diseases of poverty. 2017;6(1):128.
 Berhane Y, Worku A, Bejiga A, Adamu L, Alemayehu W, Bedri A, et al.
Prevalence of trachoma in Ethiopia. The Ethiopian Journal of Health
Development (EJHD). 2007;21(3) 32
3/29/2021

3/29/2021
Yohannes
B.
(MSc
student
in
clinical
optometry)
bizualemyohannes@gmail.com
33

3/29/2021
Yohannes
B.
(MSc
student
in
clinical
optometry)
bizualemyohannes@gmail.com
34

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