India: A Momentous Achievement - India Now Free Of ‘Infective Trachoma' Declares Union Health Minister Of India

On December 08, 2017, Shri J P Nadda, Union Minister of Health and Family Welfare released the National Trachoma Survey Report (2014-17)1. He declared that India is now free from 'infective trachoma', and termed this as a momentous achievement. Shri J P Nadda stated that the survey findings indicate that the active trachoma infection has been eliminated among children in all the survey districts with overall prevalence of only 0.7%. This is much below the elimination criteria of infective trachoma as defined by the WHO; active trachoma is considered eliminated if the prevalence of active infection among children below 10 years is less than 5%, he added.

The Union Health Minister stated that the survey results indicate that active trachoma is no longer a public health problem in India. "We have met the goal of trachoma elimination as specified by the WHO under its GET2020 program", he said."This has been possible due to decades of inter-sectoral interventions and efforts that included provision of antibiotic eye drops, personal hygiene, availability of safe water, improved environmental sanitation, availability of surgical facilities for chronic trachoma, and a general improvement in the socio-economic status in the country", he added. Shri Nadda emphasized the need for constant surveillance by the states to report any fresh cases of trachoma and trachoma sequelae (TT cases) and to treat them promptly to finally be completely free of trachoma.

At the release of the Survey Report, the minister emphasized, "it is our aim to eliminate trachomatoustrichiasis from the country. States which still report cases of active trachoma need to develop a strategy for community- based case finding of patients of trachomatoustrichiasis (TT)". "These cases must be provided free entropion surgery/ treatment in local hospitals", he stated. Shri Nadda further said that a careful record of each identified case and its management status must be maintained as per the WHO Guidelines. Also, adequate surveillance of the disease must be done all over the country in order to certify India as trachoma free (eliminated). Monthly data on indicators of trachoma surveillance as per WHO guidelines must be regularly sent to the NPCB, he urged the states.

The National Trachoma Prevalence Surveys and the Trachoma Rapid Assessment Surveys were conducted by Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, in collaboration with National Program for Control of Blindness & Visual Impairment, Union Ministry of Health and Family Welfare from 2014 to 2017. This was conducted in 27 high-risk districts across 23 states and union territories. Trachoma Prevalence Surveys were carried out in 10 districts selected from the previously hyper-endemic states. Under the survey, 19662 children in 1-9 years age group were examined by trained ophthalmologists. As many as 44135 persons were examined among the 15yr+ age group. The Trachoma Rapid Assessment Surveys (TRA) was done in 17 other districts from other parts of the country in places where trachoma cases have been reported, which were not previously hyper-endemic.

Trachoma is a chronic infective disease of the eye and is the leading cause of infective blindness globally. Trachoma results from poor environmental and personal hygiene and inadequate access to water and sanitation. It affects the conjunctiva under the eyelids. Repeated infections cause scarring leading to in-turning of the eyelashes and eyelids. This further causes damage to the cornea and blindness. It is found affecting the population in certain pockets of the States of North India like Gujarat, Rajasthan, Punjab, Haryana, Uttar Pradesh and Nicobar Islands. Trachoma infection of the eyes was the most important cause of blindness in India in 1950s and over 50% population was affected in Gujarat, Rajasthan, Punjab, and Uttar Pradesh. It was the most important cause of corneal blindness in India, affecting young children.

According to the World Health Organization (WHO), Trachoma is hyperendemic in many of the poorest and most backward rural areas in 41 countries of Africa, Central and South America, Asia, Australia and the Middle East. It is responsible for blindness or visual impairment of about 1.9 million people. It causes about 1.4% of all blindness worldwide2. Overall, Africa remains the most affected continent.

For Prevention and Control, WHO recommends elimination programmes in endemic countries using SAFE strategy which consists of:

  • Surgery to treat the blinding stage of the disease (trachomatous trichiasis);
  • Antibiotics to clear infection, particularly mass drug administration of the antibiotic azithromycin, which is donated by the manufacturer to elimination programmes, through the International Trachoma Initiative;
  • Facial cleanliness; and
  • Environmental improvement, particularly improving access to water and sanitation.

The World Health Organization leads an international alliance of interested parties to work for the global elimination of trachoma, named as the Alliance for Global Elimination of Trachoma by the year 2020 (GET 2020).

Footnotes

1. http://pib.nic.in/newsite/erelease.aspx?relid=174210

2. http://www.who.int/mediacentre/factsheets/fs382/en/

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