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TRACHOMA IN ETHIOPIA

Team ETIE
(Eliminating Trachoma In Ethiopia)
Kendra Miller, Brennen Jaquint, Bryan Erspamer, Katie Dzedzie

IMAGES FROM HTTP://CECOPTOMETRY.COM/OURSERVICES_INDV.PHP?SID=28 AND HTTP://WWW.GOODWP.COM/GIRLS/19863-WOMANEYE-EYELASH-LASH.HTML

TRACHOMA THE DISEASE


Neglected Tropical Disease (Polack et al., 2005; International Trachoma Initiative [ITI], 2012). Preventable (Polack et al., 2005; ITI, 2012). Blindness (Polack et al., 2005; ITI, 2012). Caused by Chlamydia trachomatis (BIO Ventures for Global Health [BVGH], 2013). Multiple forms of transmission (Despommier et al., 2004; ITI, 2012). Composed of 5 stages

STAGES OF TRACHOMA
Trachomatous Follicular inflammation (TF) and Trachomatous Intense inflammation (TI) Trachomatous Scarring (TS)

Trachomatous Trichiasis (TT)


Corneal Opacity (CO)

(BVGH, 2013; WHO, 2013b)

GLOBAL OVERVIEW

Image from http://gamapserver.who.int/mapLibrary/app/searchResults.aspx

ETHIOPIAN OVERVIEW
The most endemic country (ICTC, 2011) Up to 75.6 million people at risk (ITI, 2012; Smith et al.,
2013)

1 million people have trichiasis (ITI, 2012; Smith et al., 2013) Almost 140,000 people blind (Carter Center, 2013) Elimination has been set for 2020 (ITI, 2012)

Image from http://www.trachomaatlas.org/maps/search/all?country=65&map_&infection=All

CULTURAL
Living conditions are poor and unhealthy
et al 211-215)
(Berhane, Worku, and

No means of proper human waste disposal Poor bathing habits Lack of clean water Women twice as likely to develop trichiasis than men
(International Trachoma initiative, 2012)

ECONOMIC
Ethiopia is one of the poorest countries per GDP in the world
211 out of 229 in the world
(The World Factbook)

Nearly 85% of GDP comes from agriculture


(The World Factbook)

Nearly 10% of persons yearly income can be used on treatment of a loved one
(Burton and Mabey)

As of 2011 over $430,000,000 has been spent on trachoma interventions


(ICTC, 2011)

Image found at: (ICTC, 2011)

ENVIRONMENTAL
-

Water Shortage

-Flies

-Overcrowded Households

-Poor Hygiene Conditions

http://www.trachomacoalition.org/node/410

http://crisisboom.com/2011/07/26/the-geopolitics-of-water-in-the-nile-riverbasin/

HISTORY
Prevalent throughout known written history
(Mabey and Bailey)

A common disease in Europe well into the 20 th century


(Al-Rifai 9-14)

Immigrants checked at Ellis Island upon arrival to U.S.


(Mabey, and Bailey)

Has been eradicated from almost all developed countries

Image found at: http//chlamydiae.comtwikibinviewHuman_Inf ectionsOcularTrachomaPrevalence

POLITICAL
Children's health is the main concern of the government due to high numbers of child mortality (Trachoma control program, 2013) Government commitment to the MGDs (Admasu, D.K.M.O.H. 2013, January) Invited WHO to work on the problem, government works with the Global Alliance to Eliminate Blinding Trachoma by 2020
(Haddard, D. 2010)

Government asked for help from The Carter Center (Trachoma control
program)

DESIGN

Photos from: ethiopia.limbo13.com/index.php/trachoma/

http://www.cartercenter.org/health/trachoma_education/Manuals%20and%20Te chnical%20Resources/Manuals%20Full%20Media%20to%20Link%20P/15%20 P.pdf

WE CAN END TRACHOMA

http://www.youtube.com/watch?v=ra3O1elj9cw&feature=player_embedded

SCIENTIFIC METHOD
Studies were completed on the Chlamydia Trachomati s bacteria itself (Despommier et al., 2004) Found that the infection was strongly correlated with a lack of facial cleanliness, presence of nasal discharge, living in crowded spaces, lack of proper waste disposal and child care Transmitted by flies which seek mucous secretions from the eyes and nose and spread from person to person (Despommier et al., 2004) Created insecticide intervention which proved to decrease fly population and new cases of trachoma but due to cost it isnt used much (Despommier et al., 2004)

INTERVENTIONS
In 1997, the World Health Organization (WHO) formed the Alliance for Global Elimination of Trachoma by 2020 (GET2020) (Polack et al., 2005) International Trachoma Initiative (ITI, 2012) Non-governmental organizations (NGOs ) (BVGH, 2013) The Carter Center (Carter Center, 2013) Bilateral and multilateral governmental agencies (WHO, 2013a) United States Agency for International Development Australian Government Overseas Aid Program Lions Club International Foundation Volunteer, Education, Water and Sanitation programs (Hamilton and Veleman, 2013;
WHO, 2013a)

URGERY
BTRP (Despommier et al., 2004)

Ethiopian surgeons provide 40 surgeries a day (Carter Center, 2013)


Currently only at 50% desired goals

Taping or removing eyelashes (BVGH,


2013; WHO, 2013a)

New strategies are needed (BVGH, 2013; ICTC,


2011; WHO, 2013a)

Image from http://www.medicalecology.org/water/trachoma/trachoma.htm

A
(ITI, 2012)

NTIBIOTICS

Most are donated by drug companies Distributions are determined by the Trachoma Expert Committee
(Despommier et al)

Most common are Zithromax and Tetracycline

Topical, oral and intraocular


Treatment rates are nearly 80% in some areas
Image found at: http://www.medicalecology.org/water/tr achoma/trachoma.htm

ACIAL CLEANLINESS

Facial cleanliness to prevent trachoma Stops the spread Proper hygiene and sanitation is mediated in public spaces, villages, community health centers and schools (Carter Center, 2013)
(google Images)

NVIRONMENTAL CHANGE

The main goal of these changes is to reduce transmission by contact and by decreasing the fly population. Changes include access to water, cleaning clothes and home surfaces, building and using latrines, moving domestic animals out of villages, and even use of insecticides. Can be done in an inexpensive manner. (Despommier et al., 2004; Hamilton and Veleman, 2013)

Image from http://www.cartercenter.org/health/Trachoma/index.html/

ALTERNATIVES
MALTRA
The malaria and trachoma (MALTRA) program, takes place during two weeks of the year, intensely promoting SAFE strategy and malaria prevention through the use of thousands of local, regional, and national volunteers that travel by foot to provide information, antibiotics, testing, and other treatments via door to door visits (Carter Center, 2013). This capacity building program provides locals with knowledge and tools to help themselves, leading to empowerment.
http://endtheneglect.org/2012/12/more-than-7-million-treated-for-trachoma-inmassive-mda-in-ethiopia/

ALTERNATIVES CONTINUED
Vaccine Six studies are being currently being conducted worldwide to create a vaccine, so far mixed results have been recorded. (BVGH, 2013) Insecticide

Chemical control with sprays is possible and known to be effective for controlling flies. Spraying requires specialist equipment, training, and planning to be effective. (Frost, 2010)

http://www.medicalecology.org/water/trachoma/trachoma.htm

TOGETHER WE CAN

Eliminate Trachoma
Image from: http://trachoma.org/safe-strategy

SOURCES
Admasu, D. K. M. O. H. (2013, January ). Remarks by the hon. minister . african leadership for child survival-a promise renewed meeting, Addis Ababa, Ethiopia. Retrieved from http://www.moh.gov.et/English/Information/Pages/DrKeseteRemarks.aspx

Al-Rifai, Kassim. "Trachoma Through History `." International Opthamology . 12. (1988): 9-14. Print.
Ayele, B., Gebre, T., House, J. I., Zhou, Z., McCulloch, C. E., Porco, T. C., Gaynor, B. D., Emerson, P. M., Lietman, T. M., and Keenan J. D. (May 2011). Adverse Events after Mass Azithromycin Treatments for Trachoma in Ethiopia. Am. J. Trop. Med. Hyg., 85(2), 291-294. Retrieved from http://www.ajtmh.org/ content/85/2/291.long Berhane, Y, A Worku , et al. Prevalence of Trachoma in Ethiopia" 21.3 (2007): 211 -215. Web. 22 Oct. 2013. <http://ejhd.uib.no/ejhd-v21-n3/211Prevalence of Trachoma in Ethiopia.pdf>. (Berhane, Worku, and et al 211-215) BIO Ventures for Global Health. (2013). What is Trachoma? Retrieved from http://www.bvgh.org/Biopharmaceutical-Solutions/Global-Health-Primer/Diseases/ci d/ViewDetails/ItemID/24.aspx Burton, Matthew , and David Mabey. "The Global Burden of Trachoma: A Review ." PLOS Neglected Topical Diseases . n. page. Print. The Carter Center. (2013). Waging Peace. Fighting Disease. Building Hope . Retrieved from http://www.cartercenter.org/index.html Despommier, D., Chen, S. X., and Tan T. M. (2004). Medical Ecology. Retrieved from http://www.medicalecology.org/water/trachoma/trachoma.htm Gasahw, G. (2012, September 21). Ethiopia: Expanding urban, rural healthcare services. Ethiopian Press Agency . Retrieved from http://allafrica.com/stories/201209210871.html?page=2 Haddard, D. (2010). Ten years left to eliminate blinding trachoma. Community eye health , 23(72), Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2975121/ Hamilton, H., and Veleman, Y. (Apr. 2013). WASHing away blinding trachoma. Sightsavers and WaterAid, 1-4. Web. Retrieved from http://trachoma.org/sites/ default/files/19621_J0552_Trachoma%20Policy%20Brief%20v%205.pdf Heinlein, Peter, and Addis Ababa. N.d. Photograph. Abbay MediaWeb. 4 Nov 2013. <http://abbaymedia.com/2010/02/05/scientists-donors-blast-ethiopias-bio-safety-law/>. ICTC, . "The End in Sight." 2020 Insight. (2011): 1-38. Web.

SOURCES CONT.
International Trachoma Initiative. (2012). The Worlds Leading Cause of Preventable Blindness . Retrieved from http://trachoma.org/world%E2%80%99 s-leading-cause-preventableblindness Kifle, E. (27 Nov. 2009). Amhara Region Ground Zero for Trachoma in Ethiopia Ethiopian Review . Retrieved from http://www.ethiopianreview.us/11488 Lakew, T, J House, and et al. "Reduction and Return of Infectious Trachoma in Severely Affected Communities in Ethiopia ." Neglected Topical Disease . N.p.. Web. 22 Oct 2013. <http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0000376>. (Lakew, House, and et al) Mabey, B, and R Bailey. "Eradication of trachoma worldwide." Br J Ophthalmol . 83. (1999): 1261-1263. Print. <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1722859/pdf/v083p01261.pdf>. (Mabey, and Bailey 1261-1263) "Medical Examination ." Ellis Island . N.p., n.d. Web. 30 Oct. 2013. <http://www.ellisisland.se/english/ellisisland_immigration3.asp>. (Medical Examination) Polack, S., Brooker, S., Kuper, H., Mariotti, S., Mabey, D., and Foster, A. (Dec. 2005). Mapping the global distribution of trachoma. Bulletin of the World Health Organization, 83(12), 913919. Retrieved from http://www.who.int/bulletin/volumes/83/12/913.pdf "Rural population (% of total population) in Ethiopia." Trading Economics . N.p., 2013. Web. 30 Oct. 2013. (Trading Economics) Smith, J., Mann, R., Haddad, D., Polack, S., Kurylo, E., and Brooker, S. (2013). Global Atlas of Trachoma. Trachoma Atlas. Retrieved from http://www.trachomaatlas. org/maps/search/all?country=65&map_&infection=All "The World Factbook: Ethiopia ." Central Intelligence Agency . N.p., 09 September 2013. Web. 22 Oct 2013. <https://www.cia.gov/library/publications/the -world-factbook/geos/et.html>. (The World Factbook: Ethiopia )

"Trachoma control program." In (2013). The Carter Center . Atlanta, GA: One Copenhill. Retrieved from http://www.cartercenter.org/health/trachoma/index.html (Trachoma control program)
Weinstock, Frank J. Trachoma . Ed. Andrew A. Dahl. N.p., 2013. Web. 22 Oct. 2013. http://www.medicinenet.com/trachoma/page2.htm. (Weinstock) World Health Organization. (2013a). Global Alliance for the Elimination of Blinding Trachoma by 2020. Weekly epidemiological record, 88(24), 241-256. Retrieved from http://www.who.int/wer/2013/wer8824.pdf World Health Organization. (2013b). Priority eye diseases. Prevention of Blindness and Visual Impairment. Retrieved from http://www.who.int/blindness/causes/priority/en/index2.html