This article is from the source 'guardian' and was first published or seen on . It last changed over 40 days ago and won't be checked again for changes.
You can find the current article at its original source at http://www.guardian.co.uk/global-development-professionals-network/2013/apr/05/eliminating-trachoma-safe-strategy
The article has changed 2 times. There is an RSS feed of changes available.
Previous version
1
Next version
| Version 0 | Version 1 |
|---|---|
| How do we solve a problem like trachoma? | How do we solve a problem like trachoma? |
| (6 months later) | |
| Trachoma is the world's leading cause of infectious preventable blindness, and it is one of the oldest diseases known to man. According to the International Trachoma Initiative (ITI), 110 million people live in areas where trachoma is confirmed to be endemic. Another 210 million people live in districts believed to have trachoma, but where no data is available to guide interventions. | Trachoma is the world's leading cause of infectious preventable blindness, and it is one of the oldest diseases known to man. According to the International Trachoma Initiative (ITI), 110 million people live in areas where trachoma is confirmed to be endemic. Another 210 million people live in districts believed to have trachoma, but where no data is available to guide interventions. |
| As a disease, trachoma mainly affects the most vulnerable members of neglected communities – women and children. Women are more at risk than men simply because women generally spend greater amounts of time in close contact with small children, who are the main source of infection. | As a disease, trachoma mainly affects the most vulnerable members of neglected communities – women and children. Women are more at risk than men simply because women generally spend greater amounts of time in close contact with small children, who are the main source of infection. |
| The infection is caused by a bacteria called chlamydia trachomatis – which spreads through contact with eye discharge on clothing, or by flies that land on the face of the infected person. A simple infection can heal on its own. However, repeated infection leads to progressive scarring of the inside of the eyelid that can turn the eyelid inwards so that the lashes constantly rub on the eyeball, injuring and scarring the cornea. | The infection is caused by a bacteria called chlamydia trachomatis – which spreads through contact with eye discharge on clothing, or by flies that land on the face of the infected person. A simple infection can heal on its own. However, repeated infection leads to progressive scarring of the inside of the eyelid that can turn the eyelid inwards so that the lashes constantly rub on the eyeball, injuring and scarring the cornea. |
| The global burden of trachoma, which accounts for $2.9bn (£1.9bn) in lost productivity per year, in developing countries has not gone unnoticed. The World Health Organisation leads the Global alliance for the elimination of blinding trachoma by 2020 (GET 2020) and in 1998 a non-governmental partnership was set up between pharmaceutical company Pfizer and the Edna McConnell Clark Foundation. The ITI runs the drug donation programme for Pfizer's Zithromax antibiotics. There is also an International Coalition for Trachoma Control (ICTC), who advocate for the global implementation of WHO's Safe strategy (Surgery for trichiasis, Antibiotic therapy, Facial cleanliness, and Environment improvement). | The global burden of trachoma, which accounts for $2.9bn (£1.9bn) in lost productivity per year, in developing countries has not gone unnoticed. The World Health Organisation leads the Global alliance for the elimination of blinding trachoma by 2020 (GET 2020) and in 1998 a non-governmental partnership was set up between pharmaceutical company Pfizer and the Edna McConnell Clark Foundation. The ITI runs the drug donation programme for Pfizer's Zithromax antibiotics. There is also an International Coalition for Trachoma Control (ICTC), who advocate for the global implementation of WHO's Safe strategy (Surgery for trichiasis, Antibiotic therapy, Facial cleanliness, and Environment improvement). |
| But despite the involvement of global and powerful organisations, challenges to eliminating trachoma remain. Successful programmes must treat the entire eligible population for active trachoma consistently for at least three to five years with antibiotics through mass drug administration, made possible through the ITI donations. But there is still a backlog of patients requiring surgery. Communities which play an important role in identifying and following up on these patients, as well as in ensuring adequate geographic and therapeutic coverage, are severely underutilised. | But despite the involvement of global and powerful organisations, challenges to eliminating trachoma remain. Successful programmes must treat the entire eligible population for active trachoma consistently for at least three to five years with antibiotics through mass drug administration, made possible through the ITI donations. But there is still a backlog of patients requiring surgery. Communities which play an important role in identifying and following up on these patients, as well as in ensuring adequate geographic and therapeutic coverage, are severely underutilised. |
| We also need to scale-up the 'f' and 'e' components of the Safe strategy, which are essential for sustainability. Facial cleanliness is the behavioural component, which helps reduce transmission of trachoma through health education. Environmental improvements reduce exposure and reinfection by increasing access to clean water and improving basic sanitation. To achieve the GET 2020 goal of eliminating blinding trachoma by the year 2020 we are faced therefore with the need to scale up all elements of the Safe strategy. | We also need to scale-up the 'f' and 'e' components of the Safe strategy, which are essential for sustainability. Facial cleanliness is the behavioural component, which helps reduce transmission of trachoma through health education. Environmental improvements reduce exposure and reinfection by increasing access to clean water and improving basic sanitation. To achieve the GET 2020 goal of eliminating blinding trachoma by the year 2020 we are faced therefore with the need to scale up all elements of the Safe strategy. |
| Community-based healthcare | Community-based healthcare |
| Human resources are key for the successful integration of sustainable programmes into local health services. This calls for the training and re-training of healthcare professionals at all levels with focus on primary health and eye care. Strong community engagement and ownership, integration into local health services, and reliable support of the community are essential. In this context, well-supported women's groups have proven key, especially in areas of water, sanitation and other basic health and eye care activities. | Human resources are key for the successful integration of sustainable programmes into local health services. This calls for the training and re-training of healthcare professionals at all levels with focus on primary health and eye care. Strong community engagement and ownership, integration into local health services, and reliable support of the community are essential. In this context, well-supported women's groups have proven key, especially in areas of water, sanitation and other basic health and eye care activities. |
| There are different approaches of community engagement that can be viable depending on the context. In community participation, healthcare providers typically establish the needs and facilitate community input. In community direction, the community will identify and prioritise the needs, plan and implement the interventions. They will also monitor and report the outputs and quality of activities, and ensure long-term sustainability. Non-governmental development partners and health workers act as facilitators and communicate benefits to the community. | There are different approaches of community engagement that can be viable depending on the context. In community participation, healthcare providers typically establish the needs and facilitate community input. In community direction, the community will identify and prioritise the needs, plan and implement the interventions. They will also monitor and report the outputs and quality of activities, and ensure long-term sustainability. Non-governmental development partners and health workers act as facilitators and communicate benefits to the community. |
| There is good evidence that communities once fully informed are capable of organising interventions including their own treatment, and once empowered they not only organise but can control and direct the intervention. | There is good evidence that communities once fully informed are capable of organising interventions including their own treatment, and once empowered they not only organise but can control and direct the intervention. |
| So what's next in the fight against trachoma? | So what's next in the fight against trachoma? |
| Based on our experience as an expert organisation, often working in remote areas and difficult environments (including conflict and post-conflict countries), engaging communities and strong partnerships has been essential for the success of development programmes. And while we – the global health community – are making progress, there is a need to urgently scale up interventions at each level. | Based on our experience as an expert organisation, often working in remote areas and difficult environments (including conflict and post-conflict countries), engaging communities and strong partnerships has been essential for the success of development programmes. And while we – the global health community – are making progress, there is a need to urgently scale up interventions at each level. |
| Our focus is on continuing care from prevention, through treatment to rehabilitation. Though diverse in terms of causes and effects, NTDs like trachoma frequently affect the poorest communities causing chronic disability. The GET 2020 goal must further increase output, quality and sustainability of all Safe activities. We must all continue to engage communities and support capacity development and integration into strengthened local health systems. Tackling NTDs is not only an effective way to end poverty – it's crucially important to empower neglected communities. | Our focus is on continuing care from prevention, through treatment to rehabilitation. Though diverse in terms of causes and effects, NTDs like trachoma frequently affect the poorest communities causing chronic disability. The GET 2020 goal must further increase output, quality and sustainability of all Safe activities. We must all continue to engage communities and support capacity development and integration into strengthened local health systems. Tackling NTDs is not only an effective way to end poverty – it's crucially important to empower neglected communities. |
| Dr KH Martin Kollmann is senior adviser for Neglected Tropical Diseases for the charity CBM. He is also currently the vice-chair of the International Coalition of Trachoma Control and lives in Kenya | Dr KH Martin Kollmann is senior adviser for Neglected Tropical Diseases for the charity CBM. He is also currently the vice-chair of the International Coalition of Trachoma Control and lives in Kenya |
| This content is brought to you by Guardian Professional. To get more articles like this direct to your inbox, sign up free to become a member of the Global Development Professionals Network | This content is brought to you by Guardian Professional. To get more articles like this direct to your inbox, sign up free to become a member of the Global Development Professionals Network |
| Our editors' picks for the day's top news and commentary delivered to your inbox each morning. |
Previous version
1
Next version