The World Health Organization (WHO) has validated Togo as having eliminated trachoma as a public health problem,[1] making it the third country in WHO’s African Region after Ghana (June 2018) and the Gambia (April 2021) to achieve this significant milestone.
In delivering the letter of acknowledgement during a ceremony held today in Geneva, on the margins of the Seventy-fifth World Health Assembly, the Director-General of WHO, Dr Tedros Adhanom Ghebreyesus congratulated Professor Moustafa Mijiyawa, Togo’s Minister of Health, Public Hygiene and Universal Access to Care, on this important achievement. Dr Matshidiso Moeti, WHO Regional Director for Africa and Dr Ren Minghui, WHO Assistant Director-General for Universal Health Coverage / Communicable and Noncommunicable Diseases, also attended the event.
Trachoma control activities started in Togo in 1989 with the establishment of the National Prevention of Blindness Programme (PNLC) by the Ministry of Health, Public Hygiene and Universal Access to Care. In 2009, this was integrated into the activities of the National Programme for Neglected Tropical Diseases (PNMTN). Trachoma was among the priority NTDs selected for the national programme, and control activities included screening for and management of trachomatous trichiasis (TT), which is the late-stage complication of trachoma. The national programme trained community health agents to identify suspected TT cases during integrated mass drug administration conducted door-to-door for onchocerciasis, schistosomiasis and soil-transmitted helminthiases. Suspected TT cases were then examined by ophthalmic nurses and those subsequently confirmed were managed through surgical correction. Additionally, all TT cases identified during outreach activities for eye care and in those people who presented at routine eye care services were also managed.
The Ministry of Health, Public Hygiene and Universal Access to Care also undertook awareness-raising campaigns about the importance of facial cleanliness and personal hygiene in the fight against trachoma. There were also significant improvements in the availability of safe water and access to improved sanitation.
Several population-based trachoma surveys were conducted between 2006 and 2017. The survey conducted in 2017, using the WHO-recommended methodology, found that the prevalence of key indicators was below the thresholds defined by WHO. Moreover, Togo has demonstrated that its health system has the capacity to identify and manage new cases of TT.
Togo and WHO will continue to closely monitor previously endemic populations to ensure there is a rapid and proportionate response to any resurgence of disease.
Globally, Togo joins 12 other countries that have been validated by WHO as having eliminated trachoma as a public health problem. These countries are: Cambodia, China, the Islamic Republic of Iran, the Lao People’s Democratic Republic, the Gambia, Ghana, Mexico, Morocco, Myanmar, Nepal, Oman and Saudi Arabia.
Togo has a remarkable record of success and is the only country acknowledged by WHO as having won its fight against four NTDs: it previously achieved transmission-free status for dracunculiasis in 2011. In 2017 it became the first country in sub-Saharan Africa to eliminate lymphatic filariasis as a public health problem and, in 2020, became the first African country to achieve the same status with regard to human African trypanosomiasis (sleeping sickness).
Disease prevalence
Globally, trachoma remains a public health problem in 43 countries with an estimated 136 million people living in areas endemic for the disease. Trachoma is found mainly in the poorest and most rural areas of Africa, Central and South America, Asia, Australia and the Middle East. The African Region is disproportionately affected by trachoma, with 116 million people living in at-risk areas. This amounts to some 85% of the global trachoma burden.
Significant progress has been made over the past few years and the number of people requiring antibiotic treatment for trachoma infection in the African Region fell by 73 million from 189 million in 2014 to 116 million as of June 2021.
Following Togo’s success, trachoma remains endemic in 26 countries in the WHO African Region, bringing us ever closer to the elimination target for trachoma set in the WHO 2030 NTD road map.
The disease
Trachoma is the leading infectious cause of blindness and is caused by infection with the bacterium Chlamydia trachomatis. The infection spreads from person to person through contaminated fingers, fomites, and flies that have come into contact with discharge from the eyes or nose of an infected person. Environmental risk factors for trachoma transmission include poor hygiene, overcrowded households, inadequate access to water and inadequate access to or use of proper sanitation facilities.
Trachoma is an endemic disease that mostly affects underserved remote rural communities. Infection mainly affects children, becoming less common with increasing age. Repeated infections in early childhood result in late complications years to decades later. In adults, women are up to four times more likely than men to be affected by the blinding complications of trachoma, mainly due to their close contact with infected children.
Repeated infections in childhood lead to scarring of the inner part of the upper eyelids. In some individuals this leads to one or more eyelashes on the upper eyelids touching the eye, a debilitating condition known as trachomatous trichiasis, or TT, which causes extreme pain with each blink of the eyelids. TT can be managed surgically but, if left untreated, may lead to scarring of the cornea resulting in visual impairment and blindness. Trachoma can be eliminated using WHO’s SAFE strategy.[2]
GET2020
In 1996, WHO launched the WHO Alliance for the Global Elimination of Trachoma by the year 2020 (GET2020). Alongside its partners in the Alliance, WHO supports country implementation of the SAFE strategy and the strengthening of national capacity through epidemiological assessment, monitoring, surveillance, project evaluation and resource mobilization, contributing to the elimination of trachoma as a public health problem. The NTD road map 2021–2030, endorsed by the World Health Assembly in 2020 through decision 73 (33), sets 2030 as the new target date for global elimination.
[1] Elimination of trachoma as a public health problem is defined as: (i) a prevalence of trachomatous trichiasis “unknown to the health system” of
[2] The S.A.F.E strategy consists of Surgery to treat the late complication (trachomatous trichiasis); Antibiotics to clear infection, particularly mass drug administration of the antibiotic azithromycin, which is donated by the manufacturer, Pfizer, to elimination programmes, through the International Trachoma Initiative; Facial cleanliness; and Environmental improvement, in particular improving access to water and sanitation in order to reduce transmission.