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Fighting blindness: trachoma in Ethiopian children

Trachoma is the number one infectious cause of blindness worldwide. Globally it has blinded around six million people and another 150 million people have the disease. Blindness results from repeated episodes of active trachoma, which usually occur in childhood. In some areas of Ethiopia over half of young children have the disease.

Trachoma is linked with poverty as the presence of flies, poor sanitation and a shortage of water in the home all contribute to transmission of the disease. In 1997 the World Health Organisation launched a programme to eliminate trachoma. The programme is based on the SAFE strategy which has four elements - surgery, antibiotics, face washing and environmental sanitation. The Institute of Child Health, London, looked at levels of trachoma in children, aged 3 to 9 years, in 40 communities in Ethiopia in 2002 before the SAFE initiative was due to be launched there.

The study found that 72 percent of children had active trachoma. The number of children with trachoma fell as they grew older but by the age of nine, 20 percent of the children had corneal scarring caused by the disease. Sanitation in many of the homes was poor:

Only 14 percent had a pit latrine while a quarter of families defecated in the back garden close to the home.
Almost half of families brought their animals into the home at night.
40 percent of families took more than an hour to fetch water for household use; for 10 percent of families it took more than two hours to fetch water.
The houses surrounded by the most flies were nine times more likely to have a child suffering from trachoma than the homes with no flies.
Children with clean hair and faces were less likely to have trachoma, while children with discharge and flies in their eyes were more likely to have the disease.

The number of flies around the home is linked to several factors: the way rubbish is disposed of, how close the defecation site is to the home and how close to the home the cows are kept. The study found that keeping the home and the children clean and disposing of faeces in a hygienic way made a significant difference to the likelihood of the children becoming infected with trachoma.

The study recommends that families are educated on the causes of infection so that they take the following steps:

Defecation sites need to be moved away from the home.
Animals need to be moved further away from where the family sleeps.
Rubbish disposal needs to be improved.

In addition:

Basic water supply and sanitation need to be improved to help control all infectious diseases.
In areas with such high levels of disease it may be most effective to give all young children oral antibiotics.
The SAFE campaign to eliminate trachoma needs to be flexible, to adapt to regional differences.

Source(s):
‘Active trachoma in children aged three to nine years in rural communities in Ethiopia: prevalence, indicators and risk factors’, Transactions of the Royal Society of Tropical Medicine and Hygiene 99: 120-127, by P. Cumberland et al, 2005
HINARI subscribers can access the full-text article here. Full document.
Trachoma, Prevention of blindness, World Health Organisation Full document.

Funded by: The International Trachoma Initiative

id21 Research Highlight: 19 October 2005

Further Information:
Phillippa Cumberland
Centre of Paediatric Epidemiology and Biostatistics
Institute of Child Health
30 Guildford Street
London WC1N 1EH
UK

Tel: +44 (0) 20 7813 8396
Fax: +44 (0) 20 7905 2381
Contact the contributor: p.cumberland@ich.ucl.ac.uk

Institute of Child Health, University of London, UK

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