Togo eliminates trachoma as a public health problem

The World Health Organization (WHO) has confirmed that Togo has eliminated trachoma as a public health problem, [1] making it the third country in the WHO African region after Ghana (June 2018) and The Gambia (April 2021) to achieve this important milestone.

Presenting the letter of thanks at a ceremony held today in Geneva, on the margins of the 75th World Health Assembly, WHO Director General Dr Tedros Adhanom Ghebreyesus congratulated Professor Moustafa Mijiyawa, Togo’s Minister of Health, Public Hygiene and Universal Access to Care, on this important achievement. dr. Matshidiso Moeti, WHO Regional Director for Africa and Dr Ren Minghui, WHO Deputy Director General for Universal Health Coverage/Communicable and Non-Communicable Diseases also attended the event.

Trachoma control activities started in Togo in 1989 with the establishment of the National Program for the Prevention of Blindness (PNLC) by the Ministry of Health, Public Hygiene and Universal Access to Care. In 2009 this was integrated into the activities of the National Program for Neglected Tropical Diseases (PNMTN). Trachoma was one of the priority NTDs selected for the national program and monitoring activities included screening for and treatment of trachomatous trichiasis (TT), the late-stage complication of trachoma. The national program trained community health officers to identify suspected TT cases during integrated mass drug delivery performed door-to-door for onchocerciasis, schistosomiasis, and soil-borne helminthiases. Suspected TT cases were then examined by ophthalmologists and the later confirmed cases treated by surgical correction. In addition, all TT cases identified during eye care outreach activities and in those people who presented to routine eye care were also managed.

The Ministry of Health, Public Hygiene and Universal Access to Care also ran awareness campaigns on the importance of facial and personal hygiene in the fight against trachoma. There were also significant improvements in the availability of safe water and access to improved sanitation.

Several population-based trachomic surveys were conducted between 2006 and 2017. The survey conducted in 2017, using the methodology recommended by the WHO, found that the prevalence of key indicators was below the thresholds set by the WHO. In addition, Togo has demonstrated that its health system has the capacity to identify and manage new cases of TT.

Togo and the WHO will continue to closely monitor previously endemic populations to ensure there is a rapid and proportionate response to any recurrence of the disease.

Globally, Togo joins 12 other countries that the WHO has confirmed have eliminated trachoma as a public health problem. These countries are: Cambodia, China, Islamic Republic of Iran, Lao People’s Democratic Republic, Gambia, Ghana, Mexico, Morocco, Myanmar, Nepal, Oman and Saudi Arabia.

Togo has a remarkable track record of being the only country recognized by the WHO as having won the battle against four NTDs, achieving transmission-free status for dracunculiasis earlier in 2011. In 2017, it became the first country in sub-Saharan Africa to identify lymphatic filariasis as a public health problem and in 2020 became the first African country to achieve the same status with regard to human African trypanosomiasis (sleeping sickness).

Disease prevalence

Globally, trachoma remains a public health problem in 43 countries, affecting an estimated 136 million people in areas endemic to the disease. Trachoma occurs mainly in the poorest and most rural areas of Africa, Central and South America, Asia, Australia and the Middle East. The African region is disproportionately affected by trachoma, with 116 million people living in high-risk areas. This amounts to about 85% of the global trachoma burden.

Significant progress has been made in recent years and the number of people requiring antibiotic treatment for trachoma infection in the African region has fallen by 73 million from 189 million in 2014 to 116 million in June 2021.

Following the success of Togo, trachoma remains endemic in 26 countries in the WHO’s African Region, bringing us closer and closer to the trachoma elimination target set in the WHO 2030 NTD Roadmap.

The sickness

Trachoma is the leading infectious cause of blindness and is caused by an infection with the bacteria Chlamydia trachomatis† The infection spreads from person to person through infected fingers, fomites and flies that have come into contact with secretions from the eyes or nose of an infected person. Environmental risk factors for trachoma transmission include poor hygiene, overcrowded households, inadequate access to water, and inadequate access to or use of proper sanitation.

Trachoma is an endemic disease that mainly affects disadvantaged remote rural communities. Infection mainly affects children and becomes less common with age. Repeated infections in early childhood lead to late complications years to decades later. In adults, women are up to four times more likely than men to be affected by the blinding complications of trachoma, mainly because of their close contact with infected children.

Repeated infections in childhood lead to scarring of the inner part of the upper eyelids. In some individuals, this leads to one or more eyelashes on the upper lids touching the eye, a debilitating condition known as trachomatous trichiasis, or TT, which causes extreme pain with each blink of the eyelids. TT can be treated surgically but, if left untreated, can lead to scarring of the cornea, which can lead to visual impairment and blindness. Trachoma can be eliminated using the WHO SAFE strategy.
[2]

GET2020

In 1996, the WHO launched the WHO Alliance for the Global Elimination of Trachoma by the year 2020 (GET2020). Together with its partners in the Alliance, WHO supports the implementation of the SAFE strategy in countries and the strengthening of national capacity through epidemiological assessment, monitoring, surveillance, project evaluation and resource mobilization, contributing to the elimination of trachoma as a public health problem. The NTD Roadmap 2021-2030, approved by the World Health Assembly in 2020 by decision 73 (33), sets 2030 as the new target date for global elimination.

[2] The SAFE strategy consists of: Surgery to treat the late complication (trachomatous trichiasis); antibiotics to cure infection, especially mass drug administration of the antibiotic azithromycin, which is donated to elimination programs by its manufacturer, Pfizer, through the International Trachoma Initiative; facial cleanliness† and Environmental improvementin particular, improving access to water and sanitation to reduce transmission.