Elimination of trachoma as public health problem in Gambia

Gambia Elimination of trachoma as public health problem in Gambia

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On 20 April 2021, Gambia was validated by WHO for having eliminated trachoma as a public health problem, making it the second country in WHO’s African Region to achieve this milestone.

Trachoma was recognized as a major public health problem in Gambia for a long time. A survey conducted in a rural village in the country in 1959 showed that trachoma was present in 91% of children aged five to nine years. A population-based survey of blindness and eye diseases conducted throughout the country in 1986 further revealed that trachoma was responsible for 17% of blindness.

The WHO Country Office in Gambia provided support to the country to conduct a nationwide blindness survey, establish a National Eye Care Programme, develop a National Plan for Trachoma Elimination, build partner coordination, and build programme capacity. Gambia’s Trachoma Elimination Programme implemented the WHO-recommended “SAFE” strategy, which comprises of surgery for advanced disease, antibiotics to clear C. trachomatis infection, facial cleanliness, and environmental improvement to reduce transmission. The fight against trachoma was decades long, but in 2021, it ended with the WHO declaration of Gambia as having achieved the status of eliminating trachoma as a public health problem.

How did Gambia do it, and how did the WHO Secretariat support Gambia?

Nationwide blindness survey – In order to establish baseline data on the prevalence of the major blinding diseases, the WHO Country Office provided support for a national survey of blindness and low vision. Gambia was one of the first countries in sub-Saharan Africa to undertake a nationwide blindness survey in 1986. The survey was undertaken as part of the first phase in the development of a National Eye Care Programme in the country.

Creation of a National Eye Care Programme – Based on the results of the national survey, the WHO Country Office response included support for the establishment of a National Eye Care Programme (NECP) in 1986. The aim was to provide an integrated approach to reducing the national burden of blindness and low vision in the country.
National Plan for Trachoma Elimination – The WHO Country Office supported the National Eye Care Programme to develop a National Plan of Action for elimination of trachoma as a public health problem using the WHO SAFE strategy for trachoma. The implementation of five-year plans successfully led to the elimination of trachoma in the country.
Coordination – Through the establishment of a national multisectoral taskforce, the WHO Country Office engaged several partners to implement the SAFE strategy at country level, which included Sightsavers International, Medical Research Council, the International Center for Eye Health, the Department of Water Resources, the Ministry of Basic and Secondary Education, and the Department of Community Development. Significant support and funding were provided by the WHO Country Office, Sightsavers International, International Trachoma Initiative, London School of Hygiene & Tropical Medicine, Medical Research Council, and the British Council for Prevention of Blindness.
Developing capacity to deliver trachoma interventions – Regular training and capacity building for National Eye Care Programme staff was provided by the WHO Country Office. In addition, standard training for community field workers, ophthalmic nurses and trichiasis surgeons were ensured by the use of WHO training guidelines and the WHO manual for trichiasis surgery for trachoma.
Facilitating the process for validation of elimination of trachoma as a public health problem – In order to assess the impact of the SAFE strategy, the WHO Country Office in Gambia provided support for several surveys including pre-validation surveillance surveys. Subsequently, when the prevalence estimates fell below the WHO threshold for elimination, the country was encouraged and facilitated to submit a trachoma elimination dossier. The country office supported external review of the dossier by WHO/AFRO that convened a Regional Ad-hoc Trachoma Dossier Review Group. Based on the evidence provided in the dossier and the recommendations of the Dossier Review Group, the country was validated as having achieved elimination of trachoma as a public health problem.

Photo Credit: ©WHO/Gambia

Photo Caption: Development of the Trachoma Elimination Dossier. Shown are Mr Sarjo Kanyi (National Eye Care Programme), Dr Sharmila Lareef-Jah (WHO Country Office), Dr Desta Tiruneh (WHO Representative in Gambia) and Dr Agatha Aboe (Sightsavers, Ghana)

Currently, in the post-elimination period, the WHO Country Office continues to provide support to the country to ensure that the results achieved are sustained. Importantly, the country has been encouraged to use the trachoma experience in the elimination of other neglected tropical diseases and health problems.

Photo Caption: WHO Representative of Gambia handing over WHO certification to the Honourable Minister of Health in an official ceremony to mark the elimination of trachoma in the country.

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