By SOSTHENES MWITA, 15th October 2011 @ 16:00, Total Comments: 0, Hits: 1192
Tanzania was among the first countries to launch a trachoma control program with support from the International Trachoma Initiative (ITI). The initiative used surgery, antibiotics, facial cleanliness, and environmental improvement (SAFE) strategy with azithromycin.
More than one million children less than 10 years of age in Tanzania have active disease and an estimated 54,000 people have trichiasis. Since 2000, Tanzania has implemented major health sector reform that has been carried out in three phases in 114 districts.
A key aspect of the reform process is the policy of developing locally distributed essential health packages that then serve as the basis of the comprehensive council health plan.
Meanwhile, the government, with support from the World health Organization (WHO) and Alliance for Global Elimination of Trachoma, has also embarked upon an ambitious anti-trachoma crusade that envisages total elimination of the eye ailment by the year 2020.
The campaign involves large-scale distribution of medical drugs and educating victims on how to avoid acceleration to total blindness. Potential victims have been shown what to do to avoid infection.
The campaign will also seek to provide the most affected villages with clean tap water. A former eye specialist with the Dodoma General Hospital, Dr Shaibu Maarifa, says the initiative would initially concentrate on 26 districts that have been determined to have the biggest population of trachoma trichiasis victims.
Trachoma has been detected in all mainland regions and Zanzibar. The 26 districts, where trachoma is most prevalent, are in Dodoma, Singida, Arusha, Mwanza, Shinyanga, Mtwara, Lindi, Coast and Tanga regions. Dr Maarifa says Dodoma Region is the most affected with Dodoma Rural District leading.
The district is home to 44 per cent of all victims. He says a recent survey indicates that over 60 per cent of children in the region aged between one year and 10 years carry the disease. A regional report on the illness also shows that between 2001 and 2003 medical centres received a total of 12,768 victims with varying degrees of attack.
A total of 4,599 eye operations (eyelid corrections) were carried out during the period (2001-2003). The rest of the cases received medical drugs. Dr Maarifa says Kongwa, Kondoa and Mpwapwa districts also harbour numerous cases of trachoma, many of which remain undocumented.
Trachoma is a chronic inflammation that mainly affects the inside of the upper eyelid (tarsal conjuctiva) due to repeated severe infections or attacks by a causative organism or agent called chlomydia trachmatis. These agents are produced by tiny flies (musca sorbient) that are much smaller than the common housefly (musca domestica). The tiny flies breed the agents normally in an open pit latrine, animal dung or human faeces.
People living near animal enclosures risk contracting the ailment. The flies later introduce the agents (chlomydia trachmatis) into human eyes when they settle on the eyelashes to feed on the watery discharge (tongotongo). Gray lumps (follicles) or small swellings appear in the inner side of the eyelids after an incubation period of one month.
A victim who experiences the uncomfortable itchy sensation is likely to rub the infected eye with the back of his hand. He may, unwittingly rub the other eye with the same hand transferring the trachoma causing agents and ending up with a tricky health conundrum. Affected eyes redden and develop an itchy sandy sensation with a continual watery discharge.
The irritation develops into an inflammation that disturbs blood vessels in the area. Later on the swellings disappear as the case advances into an ugly trachoma scar. Both eyelids contract with the insides getting rougher. Repeated infections worsen the eyelids’ condition with the scars developing folds and the itching sensation worsening.
After about 20 years the continual scratching of the eyeballs as a result of callous eyelids damages the cornea. The cornea, which is the transparent protective covering of the eye whose job is to shield the iris and pupil from the elements develops scars as well as impairing vision and finally culminating in total blindness. This final stage ensues after the victim has endured repeated infections.
Nearly all victims of trachoma wander into total blindness between the ages of 20 and 40 years. There is no evidence to show that trachoma blinds young children but the illness is to blame for plunging children into miserly -- having to live with itchy, watering eyes.
The illness is not fatal. Dr Maarifa says trachoma could be avoided by maintaining good personal hygiene. “Washing your face twice a day and improving environmental and sanitary conditions can save you sight,” he says. Like the more serious cholera, trachoma ravages communities that live in overcrowded conditions.
Trachoma can easily pass from one victim to another even through the mundane handshake. If a victim mops his itching eyes with a handkerchief and then passes the kerchief to a
second person, that person might catch a trachoma infection if he mops his eyes too. Most infections occur during the dry season when the trachoma carriers, the tiny flies, find it difficult to find liquids to feed on.
“The flies can be pestering when they discover that your eyes are watery,” says Dr Maarifa. “They keep coming back when you swat them,” he says. Dusty winds that travel in open landscapes without being interrupted by leafy trees also transport trachoma trichiasis causative agents. The agents can easily settle in unprotected eyes.
Tall trees help to break the speed of fast winds and catch the dust that can introduce trachoma infections. Trachoma is mostly prevalent in rural villages where sanitation is poor. Dr Maarifa says the International Trachoma Initiative, an NGO, is helping out in combating the scourge in the 26 most hit districts. The problem is prevalent countrywide.
However, most regions have a negligible number of cases that do not need massive medical intervention,” he says. But this does not mean preventive measures should not be taken. The scourge that is rocking communities in Dodoma Region may have started with only one victim. Efforts are underway to enlighten residents in rural villages on how to avoid trachoma infections.
WaterAid, an NGO, has supplied water to Kibaigwa residents in Kongwa District. Distribution of antibiotics, Zithromax tablets and eye ointment also continues. In 2002, the Tanzania Ministry of Health in collaboration with the ITI, the World Bank, and the office of the President embarked on a program of information for districts where trachoma is endemic but where no control program has been launched.
Clear goals for the trachoma control program have been reviewed and discussed by the districts and as a result trachoma control was integrated into the comprehensive council health plans. This is expected to expand in the coming years.
The Tanzanian effort to eliminate blinding trachoma took shape with the adoption of a national plan for prevention of blindness in 1998. Because Tanzania had played an active
role in the research leading to the formulation of a trachoma control strategy, it was among the first countries to receive support from the International Trachoma Initiative (ITI) to assist with the execution of this plan.
The Tanzania program aims for trachoma control through expanded implementation of the World Health Organization-recommended surgery, antibiotics, facial cleanliness, and environmental improvement (SAFE) strategy.
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