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Trachoma is an infectious disease caused by the Chlamydia trachomatic bacterium.
Trachoma is the leading cause of infectious blindness in the world that produces a roughening of the inner surface of the eyelids. Globally, about 40 million people have an active infection and as many as 8 million people are visually impaired as a result of this disease. It is one of the 17 neglected tropical diseases (NTDs).
What causes trachoma and how does it spread?
Infection can occur if an individual comes into direct contact with the discharge produced from the eyes or nose of an infected person, or by contact with contaminated objects, such as towels and clothes. Flies can also transfer the bacteria from the discharge. In the developing world, flies are one of the main ways trachoma is spread.
As a disease, trachoma mainly affects the most vulnerable members of neglected communities – women and children. Women are more at risk than men simply because women generally spend greater amounts of time in close contact with small children, who are the main source of infection.
A simple infection can heal without medical intervention. However, repeated infection leads to progressive scarring of the inside of the eyelid that can turn the eyelid inwards so that the lashes constantly rub on the eyeball, injuring and scarring the cornea.
Trachoma bacteria thrive in environments where there is High levels of overcrowding, Limited access to clean water, Limited access to washing facilities, such as showers or baths, A large fly population and Limited access to healthcare services.
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Trachoma and Poverty
Trachoma is a disease directly linked to poverty. The cycle of poverty and infection caused by Trachoma can limit access to education and prevent individuals from being able to work or care for their families and themselves. Improvements in health and hygiene mean the condition is now rare in the UK and the rest of the developed world.
Trachoma is usually only found in the very poorest communities – typically villages and slums in hot, dusty climates where hygiene levels are poor and access to water and sanitation is limited. The majority of trachoma cases occur in Africa, the Middle East and parts of Asia. Trachoma is most common in children between one and five years old.
Trachoma and Gender
In some more patriarchal societies, women are often responsible for much of the household work leaving them restricted to the household (in many cases). Tasks such as collecting water and firewood, and cooking, place women at disproportionately higher risk for health problems compared to their male counterparts. As already mentioned, the responsibility of caring for the sick, also exposes women to infectious agents more regularly than men. Given this, gender must be considered when looking at intervention programmes and the SAFE strategy (addressed shortly).
Primary interventions backed for preventing trachoma infection include improved sanitation, reduction of fly breeding sites and increased facial cleanliness (with clean water) among children at risk of disease. The scarring and visual change for trachoma can be reversed by a simple surgical procedure performed at village level.
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Good personal and environmental hygiene has been proven to be successful in combating trachoma. Encouraging the washing of children's faces, improved access to water, and proper disposal of human and animal waste has been shown to decrease the number of trachoma infections in communities.
Encouraging the use of water for specific hygiene purposes (face washing) through health education can help prevent cases of trachoma and can be a cheaper alternative to building water supplies.
The WHO, along with a coalition of other interested parties, have adopted the “SAFE” strategy to combat trachoma. The four components of this strategy include:
- Antibiotic treatment (Tetracycline eye ointment new antibiotic, azithromycin has been tested in a number of countries and initial results are very promising)
- Facial cleanliness
- Environmental changes
Without full implementation of these four elements, trachoma programmes cannot be fully achieved. As mentioned earlier, gender is also important to consider within any SAFE strategy.
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There are four reasons why one might expect improvements in water supply to reduce the transmission of trachoma in a community.
- Children's faces are the sources and sites of re-infection with the organism, Chlamydia trachomatis, which causes the disease. Increased water availability means that faces can be cleaned more thoroughly and more frequently.
- It also means that the objects which carry the organism between one person and another (such as fingers and bedclothes) can be kept cleaner and are less likely to be infected.
- Trachoma is transmitted by flies. If there is more water in a dry environment, including water spilt or thrown on the ground, this will provide alternative sources of moisture to flies which would otherwise seek it on children's faces.
- Finally, the water supply helps people to maintain a cleaner domestic environment (for instance, by washing dishes rather than leaving them around with food remains on them). The environment will be less attractive to flies.
How the water is used determines whether it will help to control trachoma. One study in The Gambia found that the total quantity of water used by a household had no effect on the prevalence of active trachoma, but that trachoma-free households used more water for washing children than households with trachoma cases.
LIFESAVER technology can help
By enabling families to gather water nearer to their houses, and by using the clean sterile water that LIFESAVER technology provides, to wash their hands and faces in, children and mothers stay cleaner and are at less risk of contracting Trachoma. Women who work outside the home are also less likely to lose much needed income when using LIFESAVER technology as hygiene levels and cleanliness of the domestic environment will be much improved.
www.who.int/water_sanitation_health/diseases/trachoma/en/> [Accessed 24 April 2013]
www.nhs.uk/Conditions/Trachoma/Pages/Introduction.aspx> [Accessed 24 April 2013]
Cairncross, S., 1999. Trachoma and Water, Community Eye Health Journal, [online] Available at: www.ncbi.nlm.nih.gov/pmc/articles/PMC1706030/> [Accessed 27 April 2013].
The Carter Center, 2009. Women and Trachoma – Achieving Gender Equity in the Implementation of SAFE [pdf] Available at: www.cartercenter.org/resources/pdfs/health/trachoma/women_trachoma.pdf
Wateraid, 2013. WASHING away blinding trachoma [pdf] Available at: www.wateraid.org/~/media/Publications/WASH_trachoma_brief.ashx> [pdf]
West, S., Lynch, M., Turner, V., Munoz, B., Rapoza, P., Mmbaga, B.B.O. and Taylor, H.R., 1989, Water availability and Trachoma, Bulletin of the World Health Organisation www.ncbi.nlm.nih.gov/pmc/articles/PMC2491213/> [Accessed 27 April 2013].
 The Carter Center, 2009. Women and Trachoma – Achieving Gender Equity in the Implementation of SAFE [pdf] Available at: www.cartercenter.org/resources/pdfs/health/trachoma/women_trachoma.pdf> [Accessed 1 May 2013], p. 8.
 Cairncross, 1999.