Malawi eliminates trachoma as a public health problem

The World Health Organization (WHO) has confirmed that Malawi has eliminated trachoma as a public health problem.¹ It is the fourth country to achieve this milestone, following Ghana (June 2018), Gambia (April 2021) and Togo (May 2022).

Malawi has been known to suffer from trachoma since the 1980s. However, trachoma received due attention in 2011 when surveys were conducted in Chikwawa and Mchinji districts with the support of Sightsavers and WHO. It wasn’t until 2008. Further baseline surveys have confirmed prevalence in 17 of the total 28 districts in the country.

Following the national trachoma control program launched by the Ministry of Health in 2011, the National Trachoma Task Force has established the need to integrate within the structure of the Ministry of Health. Malawi received the first azithromycin (Zithromax®, Pfizer, New York) from the International Trachoma Initiative in 2011 to conduct antibiotic mass drug administration. Development of the Trachoma Action Plan 2012-2013 and implementation of the SafeE strategy in all provinces following rollout in 2014 was funded by a grant from the Queen Elizabeth Diamond Jubilee Trust in 2014. Intermediate cadre ophthalmologists are trained. and certified as trachomatous trichiasis (TT) surgeons. A quality assurance team was established and regular national trachoma coordination meetings were held. The Ministry of Health has conducted awareness campaigns on the importance of facial hygiene and personal hygiene to prevent trachoma. In addition, the stakeholders in the districts continued to strengthen their work by implementing water, sanitation and hygiene activities and recorded significant improvements in the supply of clean water and improved sanitation.

Malawi and the World Health Organization (WHO) said that close monitoring of previously infected people would allow for a rapid and proportionate response to future outbreaks.

Internationally, Malawi has joined 14 countries certified by the World Health Organization as eliminating trachoma as a public health problem. These are Cambodia, China, Islamic Republic of Iran, Lao People’s Democratic Republic, Gambia, Ghana, Mexico, Morocco, Myanmar, Nepal, Oman, Saudi Arabia, Togo and Vanuatu.

Disease spread

Trachoma is still a public health problem in 42 countries, with an estimated 125 million people living in affected areas. Trachoma occurs primarily in rural areas of Africa, Central and South America, Asia, the Western Pacific, and the Middle East. The African region is disproportionately affected by trachoma, with 105 million people living in high-risk areas, accounting for 84% of the global trachoma burden.

Significant progress has been made in the past few years, with the number of people requiring antibiotic treatment for trachoma in the African region falling from 189 million in 2014 by 84 million to 105 million in June 2022.

Following Malawi’s success, trachoma is still widespread in 25 countries.² It brings us closer to the target of trachoma elimination set in the WHO Africa Region NTD Roadmap 2021-2030.

The disease

Trachoma is the leading cause of blindness and is caused by a bacterial infection. Chlamydia trachomatis. Infection is transmitted from person to person through infected fingers, fomites, and flies that come into contact with discharge from the eyes or nose of an infected person. Risk factors for the spread of trachoma include poor sanitation, overcrowded households, inadequate access to water, and poor or inadequate use of sanitation facilities.

Trachoma is a chronic disease that often burdens underserved rural communities. Infection mainly affects children, it decreases with age. Repeated infections in early childhood can cause complications years and even decades later. As adults, women are twice as likely to develop the blinding complications of trachoma as men, largely because of their close proximity to infected children.

Repeated infections in childhood can cause scarring on the inside of the upper eyelids. In some individuals, this leads to trachomatous trichiasis (TT), where one or more eyelashes on the upper eyelids affect the eye. TT is a debilitating disease that causes severe pain with every movement of the eyelids. TT can be treated with surgery, but if left untreated, it can cause corneal scarring, which can lead to visual impairment and blindness. Trachoma can be eliminated using the World Health Organization safety strategy.³

GET2020

In the year In 1996, the World Health Organization established the World Health Organization Trachoma in 2020 (GET2020). Together with other coalition partners, WHO will contribute to the implementation of the SafeE strategy at the national level and build national capacity through epidemic assessment, surveillance, monitoring, project evaluation and resource mobilization to eliminate trachoma as a public health problem. The NTD Roadmap 2021–2030, adopted by the 2020 World Health Assembly in Resolution 73(33), set 2030 as the new target date for global elimination.