Blinding trachoma almost eliminated from Morocco

BMJ 2001; 323 doi: (Published 15 December 2001) Cite this as: BMJ 2001;323:1387

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  1. Annabel Ferriman
  1. BMJ

    Trachoma, the world's leading cause of preventable blindness, is expected to be eliminated from Morocco by 2005, the International Trachoma Initiative announced this week.

    The initiative, founded in 1998 by the Edna McConnell Clark Foundation and Pfizer, is currently working in six countries where trachoma is endemic. It is shortly going to extend its work to another three countries in Africa and Asia. Six million people worldwide are blind as a result of the disease, which is caused by the bacterium Chlamydia trachomatis.

    Since the organisation became active in Morocco in 1999, the prevalence of trachoma has decreased by about 75% (from 28% to 6.5%).

    The initiative uses a four pronged strategy, known by the acronym SAFE: “S” for surgery to treat complications that may cause blindness if left untreated; “A” for antibiotics (azithromycin) to treat active trachoma infections; “F” for face washing (encouragement of more face washing to reduce disease transmission); and “E” for environmental changes to increase access to clean water and improved sanitation.

    Trachoma is easily transmitted from person to person, particularly in families with small children. It occurs first in children, who often transmit the disease to others through frequent contact. Blindness occurs only after multiple infections, usually when individuals are in their 40s or 50s. Women's close contact with children may be the factor that makes them two to three times more likely than men to be blinded by it.

    Without adequate treatment, the inner eyelid becomes scarred. After repeated infection and scarring, a condition known as trichiasis arises, which ultimately causes the eyelid to turn inwards, causing the eyelashes to rub against and damage the cornea, which leads to blindness. An estimated 6780 Moroccans still have trichiasis and need corrective surgery to prevent blindness.

    The initiative, which has just been given an extra $200m (£143m) by Pfizer, which manufactures the drug azithromycin, has worked in Morocco in partnership with the country's national programme for blindness control. It has involved working with local teachers, health professionals, and volunteers in five targeted provinces. Local health workers have been trained to conduct trichiasis surgery.

    The initiative, which currently operates in Morocco, Ghana, Mali, Tanzania, Sudan, and Vietnam, is to be extended to Ethiopia, Nepal, and Niger.

    Embedded Image

    Dr Khakid Salmi applies an antibiotic to a patient's eye following surgery in Morocco

    (Credit: BETSY K FRAMPTON)

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