July 2002
Ansumana Sillah
E-mail: eyecaredosh@qanet.gm
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July 2002
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Ansumana Sillah E-mail: eyecaredosh@qanet.gm |
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Trachoma which accounted for 17% of blindness in The Gambia (1986), was reduced to 5% in 1996 through the efforts of the National Eye Care Programme (NECP). Subsequently, based on operational research, a trachoma control programme with the ultimate aim of eliminating trachoma through the SAFE strategy was established as a major component of the NECP. Several factors in combination have led to this remarkable achievement, among which are:
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Trachoma is still the leading cause of preventable blindness in The Gambia, and the Department of State for Health and Social Welfare has adopted the SAFE strategy for its elimination. This forms the cornerstone of the trachoma prevention activity in the region. The overall programme is described below. Community Screening Nationwide screening for active trachoma and trichiasis was conducted from January to March 2002. Forms were printed out from the Trachoma Management Information System (M IS) and Geographical Information System (GIS), and through these some 316 villages that were not screened during the GET 2020 exercise were identified. This enabled us to reach communities that had been overlooked in mass screening. A total of 193,360 people were screened; 111,473 are children under 15 years of age. The rest are adults, comprising 48,993 females and 31,904 males. Of these 3,833 had active trachoma (mainly children), and 362 had entropion trichiasis with females being the most affected. The data collected was recorded on the MIS/GIS forms in the field, and subsequently sent down to Banjul at the National Eye Care Programme Secretariat where all the information was punched into the MIS/GIS computer. Today we have an updated MIS/GIS giving us the current Trachoma status of the country. One hundred and two (102) of those screened had cataract, 22 of them had no vision in both eyes and Eighty-six (86) have benefited from surgery. Trichiasis Surgery Camps In addition to treating Trachoma cases, other conditions were seen and given appropriate treatment/ advice. Remarkably, a large number of Cataract and Trichiasis cases were identified and booked for surgery. Trichiasis camps were conducted in each Health Division of the country. Cataract cases were operated upon at the secondary eye centres or out reach surgery points. |
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Sanitary Kits The screening exercise enabled us to identify at-risk communities. Sanitary kits were distributed to motivate them to carry out cleaning exercises to reduce fly breeding sites. Public Sensitisation The main area of focus here was on Trachoma messages to the general public. The activity included:
The SAFE strategy All the components are being implemented throughout the country. Surgery: A manual for training community ophthalmic nurses in community lid surgery has been developed. So far 25 community ophthalmic nurses have been trained and certified in community lid surgery. Almost all the districts have easy access to a trained lid surgeon. Antibiotic: Tetracycline eye ointment was used for active cases. The treatment policy for active cases is now Azithromycin. Plans are underway to include The Gambia in the ITI donation programme. Face washing and Environmental Improvement: Many communities have been empowered through community sensitisation and mobilisation in environmental sanitation. Villages with more than 50% prevalence of active trachoma were given sanitary equipment to facilitate a village-cleaning exercise and over 300 families also benefited from latrine construction under the "flies and eye" project. Although access to adequate water is not a major problem in The Gambia, there are cultural barriers to face washing among children. A school eye health manual has been developed to facilitate the child-to-child strategy in the promotion of good hygiene. 2500 posters were developed on the SAFE strategy. Television and radio messages have been created and are being broadcast nationwide. |
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Traditional communicators and traditional practitioners are being used to disseminate eye health messages. The concept of "NYATEROS" (Friends of the Eye) is being exploited in the promotion of eye health messages.
Urban Eye Health Programme Studies (1996, 1998, 1999) in the urban and semi-urban areas have shown an increase in the prevalence of active trachoma. Risk factors include lack of Primary Health Care services, making access to eye care services difficult for the poor. This is compounded by poor environmental sanitation associated with the high increase in the urban population due to rural-urban migration and refugee influx from the sub region which has been experiencing some instability. Five community ophthalmic nurses have been deployed to the urban clinics; they are actively involved in training community-based workers, sensitisation of women, and youth groups on importance of environmental sanitation, collaboration with traditional healers, and community screening in formal and non-formal schools. Health for Peace Initiative The Gambia National Eye Care Programme strongly emphasises a collaborative approach. Health Ministers of Senegal, Guinea Conakry, Guinea Bissau and The Gambia met in Banjul (16 - 17 August 2001) and agreed to include Prevention of Blindness in the Health for Peace Initiative to be coordinated by The Gambia. A Declaration was signed by the four Ministers and is called The 'Banjul Declaration'. Subsequently the NECP and Senegal conducted a trichiasis surgery camp in Nyoro (Senegal). The two countries also developed a project proposal for a joint programme for trachoma control activities. However, this is yet to be accepted by ITI, which has been approached for funding. Research The Gambia National Eye Care Programme, Medical Research Council, The International Centre for Eye Health, London, and The London School of Hygiene and Tropical Medicine are working together on a number of operational research projects in trachoma designed to help improve service delivery in The Gambia, and strengthen the scientific evidence for trachoma control and management strategies. a. The Gambia National Eye Care Programme, and the Medical Research Council have recently completed a large scale, community-based, clusterrandomised, controlled trial as a definitive study into the role of eyeseeking flies as vectors of trachoma, and to test the provision of latrines as a sustainable method of fly control suitable for inclusion in trachoma control programme. Field work for the project started in 1999 and finished in October 2001. During the course of the work 8,500 people were enrolled from 36 separate communities; conducted almost 20,000 eye examinations; conducted 82 village-based Trichiasis surgeries; controlled flies with insecticide spray; and constructed 677 pit latrines - one for every participating household Insecticide spraying reduced the number of eye-seeking flies (Musca sorbens) caught from children's eyes by 88%, and latrine provision reduced this by 30%. Analysis of age-standardised trachoma prevalence rates at the village level showed that spraying was associated with a reduction in trachoma prevalence of 56% (95% C1, 19-93%; P=0.01) and 30% with latrines (81 % reduction - 22% increase; P=0.210) compared to controls. Fly control with insecticide was effective in reducing the number of flies caught from children's eyes and was associated with substantially lower trachoma prevalence compared to controls, confirming that flies are important trachoma vectors. The effect of latrine provision was encouraging and has programmatic significance. b. A longitudinal study looks at the impact of community-wide treatment with azithromycin to control trachoma in order to help determine how this drug should be used in control programmes. Specifically, how frequently and to which members of the affected communities should it be given? We are working in a group of 14 villages. Prior to treatment and subsequently at 2,6,12, and 18 months, each participant is examined for signs of trachoma and a conjunctival swab is collected for a quantitative PCR test for Chlamydia trachomatis. This study will provide information on the relationships between the clinical signs, various risk factors and the burden of infection Some individuals have a considerable load of infection. This was strongly associated with signs of severe inflammatory trachoma (TI). Additionally, living in a compound without a latrine was a risk factor for infection. The amount of infection declined after treatment. However, two villages had a prevalence of infection two months later, which was probably due to more frequent contact with communities in Senegal where the prevalence of disease is known to be high. c. We are also conducting a prospective randomised controlled trial of the use of azithromycin in patients undergoing trichiasis surgery, to assess whether this intervention improves the long-term outcome of the surgery. A total of 450 trichiasis patients have been enrolled in this study, which will be reported next year. Mr. Ansumana F.S. Sillah National Eye Care Programme Manager Box 950, Medical Health Quarters Banjul, THE GAMBIA Tel: +220-972020 I 222463 Fax: +220-222580 |