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The Gambia has been validated by the World Health Organization (WHO) for eliminating trachoma as a public health problem.
The announcement follows the submission of a dossier to WHO demonstrating The Gambia has achieved WHO elimination thresholds, which are: 1) a prevalence of trachomatous trichiasis of less than 0.2% in adults aged over 15 years (approximately 1 case per 1000 people); and 2) a prevalence of less than 5% of trachomatous inflammation follicular in children aged 1–9 years.
The Gambia has a long history of trachoma. In 1959, the prevalence of trachoma was estimated to be as high as 65.7% among children in high burden villages. Evidence of trachoma was further verified in 1986, when the Ministry of Health conducted its first nationwide population-based survey which revealed trachoma as the second leading cause of blindness in the country after cataract.
Since then, government leadership, including the integration of trachoma into the National Eye Care Programme of The Gambia resulted in the scale up of all pillars of the WHO-endorsed SAFE strategy (surgery to correct trachomatous trichiasis, antibiotics for Chlamydia trachomatis infection, facial cleanliness and environmental improvements to reduce transmission).
The Gambia has shown leadership to integrate WASH interventions, with its national trachoma task force expanded to include the Ministry of Water Resources, Environment and Education. This facilitated the national trachoma task force to liaise with the Ministry of Water Resources to choose villages for their well digging programme based on the prevalence of trachoma infection determined by the geographical information system.
Collaboration with the Ministry of Education also resulted in the inclusion of trachoma in the WHO School Eye Health Activity Book, which aimed to improve facial cleanliness and sensitise communities to trachoma interventions. It also supported The Gambia’s innovative child-to-child strategy, which was introduced to support children to identify trachomatous trichiasis cases in their homes and encourage the adults to accept surgery.
“The Gambia has long applied the principles embodied in the new WHO Global NTD road map”, said Angelia Sanders, Chair of the International Coalition for Trachoma Control. “From innovative research to integration with the National Eye Health Programme, inter-ministerial and cross-sectoral collaboration and a focus on equitable access to services, The Gambia can be viewed as a model of what can be achieved with strong government leadership and collaboration with all stakeholders”.
The Gambia is the second country in the WHO Africa region and 11th country to achieve elimination as a public health problem worldwide.
Image: Giving-AZT-syrup-for-trachoma/Solomon Gadisa