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Prevention of Blindness: Trachoma Control

Trachoma is estimated to affect approximately 500 million people, primarily in rural communities of the developing world and in the arid areas of tropical and subtropical zones. Approximately 6-9 million* people are blind from trachoma, and many more have suffered partial loss of vision.

Trachoma can be controlled, and blindness and visual loss can be prevented by appropriate application of relatively simple and inexpensive measures. Therefore, communities with uncontrolled trachoma should be identified so that appropriate control measures can be implemented. Such communities are likely to be found in countries where blindness rates are above the range of 0.5%-1%, and where more than 1%-2% of the population are blind from all causes.

In recent years, preventable and easily curable blindness has been recognized as a combatible public health problem. The need for blindness prevention has led to a renewed interest in trachoma and associated infections, which are still the most important causes of preventable blindness in the world.

In 1975, the Twenty-Eighth World Health Assembly, in a resolution on the prevention of blindness, requested the Director General of the World Health Organization "to encourage member countries to develop national programmes for the prevention of blindness, especially aimed at the control of trachoma, xerophthalmia, onchocerciasis, and other causes, and to introduce adequate measures for the early detection and treatment for other potentially blinding conditions such as cataract and glaucoma."

Trachoma-control programs must be aimed primarily at those severely affected communities where the disease leads to blindness. In planning and implementing control programs, consideration must be given to the simultaneous introduction of other specific measures for dealing with all causes of avoidable blindness. In recent years, knowledge about the causative agent of trachoma and about the epidemiologic patterns that determine the intensity of inflammation and the gravity of disease has increased substantially. This new information has led to a clearer definition of risk for the individual and for the community and has made it possible to distinguish communities with "blinding trachoma" from those with "non-blinding trachoma." In view of these developments and the importance of trachoma control in the prevention of blindness, a revised guide to trachoma control has been prepared (1).

This new field guide presents simple and effective methods suitable for widespread implementation in underserved communities with blinding trachoma. It stresses the importance of maximum participation of the people themselves in promotion of health care for the prevention and cure of blinding trachoma. This approach makes the best possible use of available but limited resources and is in accord with the defined health objectives and reorientation of health activities found in the Declaration of Alma-Ata on Primary Health Care.

The guide also outlines basic principles for the organization of trachoma-control programs. It summarizes present knowledge on the epidemiologic and clinical aspects of the disease, explains the most commonly used approach of large-scale trachoma treatment through control of infection transmission, and describes the more intensive treatment of individual cases. It also contains recommendations on training activities, health education, evaluation of results, and monitoring of programs. The basic methods described can be suitably adapted to local conditions and should allow the swift and effective implementation of trachoma-control programs. Reported by WHO Weekly Epidemiological Record 1982;57:189-90.

Reference

  1. World Health Organization. Guide to trachoma control. Geneva: World Health Organization 1981. *Estimate endorsed by the WHO Programme Advisory Group on the Prevention of Blindness in February 1982.

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