Two Countries Eliminate Trachoma

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Benin and Mali have eliminated trachoma—the leading infectious cause of blindness in the world—as a pub­lic health problem, the World Health Organization (WHO) reported.¹ The two nations in West Africa join 15 other countries that have reached this milestone. The WHO seeks to eliminate trachoma worldwide by 2030.

BENIN OPERATING ROOM. Surgeon Raphael Agbotchotcho and physician Ruth Houngnihin perform posterior lamellar tarsal rotation on a patient with trachoma.

WHO’s SAFE strategy. Benin and Mali implemented the WHO-recommended SAFE strategy with the support of the WHO and other part­ners. The strategy focuses on surgery to treat late complications and to limit the progression of corneal scarring and reduce the need for corneal trans­plants; antibiotics to clear the infection; facial cleanliness; and environmental improvement, such as better access to clean water and sanitation to reduce transmission. Through the Interna­tional Trachoma Initiative, Pfizer has donated over 1 billion doses of the antibiotic azithromycin to programs implementing the SAFE strategy.

The disease, which can lead to severe scarring on the inside of the eyelid, causes vision loss and blindness in nearly 2 million people across the globe and is responsible for 1.4% of all blindness worldwide.

The 15 other countries that have eliminated trachoma as a public health problem include: Cambodia, China, the Gambia, Ghana, Iran, Laos, Malawi, Mexico, Morocco, Myanmar, Nepal, Oman, Saudi Arabia, Togo, and Vanuatu. But the disease remains a public health issue in 41 countries.

The power of political will. While more work needs to be done to eliminate trachoma worldwide by WHO’s 2030 deadline, the current progress is an impressive public health achievement and provides hope for the future, Ibrahima Socé Fall, DrMed, MPH, MSc, PhD, director of the WHO Global NTD Programme, said in a press statement. He added, “Benin and Mali demonstrate how strong political will, cross-sector integration, surveillance, and community engagement can work in concert to achieve disease elimination.”

“It’s really exciting news how many countries are either approaching elimination or reaching elimination in recent times,” said Lloyd B. Williams, MD, PhD, at Duke University. “Unfortunately, it doesn’t mean that there’s nobody in these countries affected by trachoma, but it means that moving forward, there are fewer and fewer people who are going to be affected by it in the future.”

Dr. Williams works with the Himalayan Cataract Project and Carter Center to perform trachoma surgeries in Africa. (In some instances, he has hand carried donor corneas on ice overseas, sometimes the safest way to transport them.)

Trachoma transmission. Deemed a neglected tropical disease by the WHO, trachoma is caused by infection with the bacterium Chlamydia trachomatis, which is transmitted by direct or indirect contact with discharge from the eyes or nose of infected individuals. It can also be spread by particular species of flies—including Musca sorbens, also called bazaar flies and eye-seeking flies—that live in tropical and subtropical regions. They feed from mucous membranes, particularly ocular and nasal.² Poor hygiene, overcrowded housing, and inadequate access to clean water and proper sanitation contribute to widespread transmission.

Long-term, repeated trachoma infections that are left untreated can cause scarring of the inner eyelids that becomes so severe it causes entropion.

Global impact and stigma. Trachoma is hyperendemic in many rural and poverty-stricken areas of Africa, Asia, Central and South America, the Western Pacific, and the Middle East. Africa is disproportionately affected with 105 million people living in at-risk areas, accounting for 84% of the global trachoma burden.

In many of these regions, the disease also comes with a social stigma and little hope for treatment or support. “In my interactions with people who are blind overseas, in places like Sierra Leone and South Sudan, it’s really a soul crushing disease,” said Dr. Williams. In small villages, where there are no services, he said it’s especially devastating.

Boubacar Dicko, country director for Mali for the nonprofit organization Sightsavers, which is working globally to end preventable blindness and which partners with WHO, said, “Eliminating trachoma will have a huge impact for people in Mali and have a ripple effect on our society in so many different ways.”

One Sightsavers patient from Benin, 60-year-old Fousseni, had trachoma for 15 years before he underwent surgery. Before developing the disease, the father of six worked as an upholsterer, a farmer, and a security guard, and he sold mustard. But he had to reduce his work as the eye condition progressed. He kept razor blades on hand to cut away his eyelashes to reduce the pain caused by his turned-in lids. Surgery has restored his sight and he is working again.

Mr. Dicko said that ending the disease will break the vicious cycle of pain, disability, and stigma for many patients, and it will increase productivity, improve school attendance, and help empower women.  

—Ashley Welch

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1 who.int/news/item/16-05-2023-who-congratulates-benin-and-mali-for-eliminating-trachoma-as-a-public-health-problem. Accessed June 12, 2023.

2 Solomon AW et al. Nat Rev Dis Primers. 2022;8(32):1-20.

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Relevant financial disclosures: Mr. Dicko—None. Dr. Williams—None.

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