Towards Controlling Trachoma in Ghana

Trachoma is a potentially blinding disease caused by Chlamydia trachomatis (serotypes A, B, Ba and C). It is characterized by recurrent conjunctivitis that results in a sequence of scarring, entropion/trichiasis and ultimately corneal blindness. It is found mainly in communities where poverty, lack of water, crowding, and poor hygiene interplay to sustain a transmission cycle that is mediated largely by the common eye-seeking housefly, Muscae sorbens.

The disease has two distinct stages with an active stage affecting mainly children under ten years and a blinding stage that affects adults with predilection towards females. The World Health Organization currently estimates that trachoma accounts for 3.6%1 of global blindness burden and a control programme, the SAFE Strategy2 is being implemented under the tenets of Vision 2020, the Right to Sight initiative.

Ghana signed up to this initiative in October 2000 and has since been working towards eliminating Trachoma as a major cause of avoidable blindness by the year 2020. To achieve this the Ghana Health Service, in collaboration with the World Health Organization, International Trachoma Initiative and other partners initiated in 2000 a National Trachoma Control Programme with the overall goal of eliminating Trachoma as a major cause of blindness by the year 2010, using the SAFE strategy.

Baseline surveys were conducted in the Northern and Upper West regions (2000) and recently in 2007, a similar baseline survey was conducted in the Upper East region (UER). While the UER investigators estimated the region’s active trachoma (TF) prevalence at 0.01% and that of blinding trachoma (TT) at 0.05%3, those in the Upper West and Northern regions estimated active trachoma prevalence of 4.7–16.1% and blinding trachoma in a range of 0.4 to 8.4% resoectively.4 These disparities were expected as clinical reports from the UER had always indicated that trachoma was not of public health importance in the region. This observation throws some challenges to our current understanding of the epidemiology of the disease, as known risk factors such as poor hygiene, lack of water, crowding, low economic status, presence of flies and behavioural attitudes are similar in the three regions. Indeed, the UER has the lowest per capita access to latrines in the country5, a situation that should encourage the breeding of Muscae sorbens, the main transmission vector.

As the end of the ten-year target set by the Ghana Trachoma Control Programme comes to an end, it is encouraging to note that the programme is achieving results as reported in this issue of the journal by Hagan M and collagues.6 The reduction of active trachoma from 15% to 5.6% in the Upper West and 9.1% to 3.5% in the Northern region, two years after the implementation of the SAFE strategy, is quite commendable. The programme has managed to sustain these early gains and improve upon them during the implementation of its second five-year strategic plan (2005–2009). The result is the Ghana Health Service’s declaration in 2008 that active trachoma prevalence in the two regions had fallen below levels considered to be of public health importance.

This success should create the necessary springboard for the programme to improve on the surgical (S) and environmental/education/economic empowerment (E) components of the SAFE strategy. In so doing, the ultimate goal of eliminating Trachoma by the year 2020 shall be realized.

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