Careful handling of your face, flies and faeces, holds the key to the elimination of one of the oldest diseases known to man and the leading cause of preventable blindness globally; trachoma.
A dirty face is a reservoir of the disease with studies done in Mali and Tanzania indicating that children with dirty faces were two or three times more likely to have active trachoma.
The disease continues to afflict millions globally including thousands of persons in Kenya in areas like Kajiado, Narok, Baringo, Turkana, Isiolo, Meru North, West Pokot and Samburu despite a global public health strategy to prevent new cases and treatment for already-existing ones.
Described as a disease of the poor especially in rural areas, health experts are now working to implement a combined preventive and curative strategy for a disease that affects the eyelid making the eye lashes turn inwards, damages the eyes and further injures the cornea causing ‘cloudiness’ that leads to blindness.
In the most affected areas, six to nine out of every ten preschool aged children are infected and the family unit including the mother and other siblings become the principal unit for the transmission of the disease.
Prof Jefitha Karimurio, who is an ophthalmologist and lecturer at the Department of Ophthalmology of the University of Nairobi, is calling for the full adoption and implementation of the SAFE strategy (Surgery, Antibiotic Treatment, Facial cleanliness and Environmental Control) in Kenya to prevent new cases and save the sight of those already infected with trachoma.
By developing the ‘segment knockout’ as a new trachoma prevalence survey method, Karimurio has made it more effective and efficient to map the disease in large districts where the population exceeds 200,000 people.
“The main challenge in large districts is the widely scattered survey clusters, which makes it difficult to identify the specific communities that require mass drug administration (MDA) for the treatment of active trachoma,” Karimurio said in an interview with The Standard on Saturday.
He noted that most cases of blindness are caused by Vitamin A deficiency, cataracts and trachoma, especially amongst the young productive persons in the society. But his pet subject is trachoma for which he has gladly taken up the task in research as a mapping and prevention of blindness consultant to international health based organisations, governments in Africa and lead and co researcher on the topic in published works.
“Four out of five of these eye conditions are treatable with a target to prevent blindness but we must be committed by providing the required commitment in terms of staff and resources,” Karimurio said.
Head of the Division of Ophthalmic Services Michael Gichangi, says full implementation of the SAFE strategy is an opportune time to intervene and prevent blindness especially because the disease recurs after the first infection. “Repeated infections cause scars on the upper eyelid causing the eyelashes to turn inward and scratch the cornea, which may slowly and painfully lead to blindness,” he said.
“Trachoma is a community based disease than a district-level disease thus should be dealt within these structures if we expect to eliminate trachoma,” said Karimurio.
Karimurio’s academic journey is evidence of his passion to understand the medical and surgical care of the eyes and the visual system in preventing eye disease and injury.
In 2012, he became the first Kenyan university lecturer to acquire a PhD in Ophthalmology and has continued to receive both national and global recognition for his passion in eye research with the most recent award being in December when he received the 2014 Distinguished Neglected Tropical Disease Researcher Award during the 8th Kemri Annual Scientific and Health in Kisumu. Karimurio stated the importance of the presence of all components of the SAFE strategy in areas that expect to achieve effective control of trachoma.
What is Trachoma?
Trachoma spreads by contact with an infected person’s hands or clothing and is common in areas where hygiene and sanitation are quite poor. In most cases, it is passed from child to child and from child to mother, especially where there is water shortage, flies, and crowded living conditions.
The World Health Organisation (WHO) rates women as the most affected estimating that they are two to three times more likely to become blind than men, probably due to their close contact with infected children.
Karimurio points out factors associated with increased risk of contracting active trachoma include age, gender, dirty face, living with an infected person absence of basic sanitation facilities, eye-seeking flies, over-crowding and poverty.
“Young children are the reservoir of active trachoma whereas adults contribute approximately ten per cent active cases with women more vulnerable than their male counterparts mainly because they are responsible for most of household work and they may not get an opportunity to go for TT surgery,” he said.
He calls for community involvement in the fight against trachoma, citing affected districts like Kajiado where Masai village workers are also trained to screen for active trachoma and record their findings using beads.
“A red bead indicates a household member with trachoma and blue for one with no signs of active trachoma and white for one who was absent at the time of examination. The strings with the diagnostic beads are hang outside the houses for the visiting health worker to enter the information in a register. The health worker provides tetracycline eye ointment for those with the red beads,” said Karimurio in his 2012 PhD research where he studied trachoma endemic areas.
At an annual conference on Neglected Tropical Diseases held in Kisumu last month, health experts expressed concern on the slow rates of treatment and management of trachoma that now leads to irreversible blindness in Kenya of 53,200 people.
In the last one decade, 23,317 surgeries to prevent blindness from the disease have been done leaving a backlog of 34,712 cases expected to be cleared in the next five years.
Flies transmit trachoma by picking up the disease-causing organism as they feed on eye and nose secretions of infected persons and passing it on to others. Kenya is a signatory to a global agreement that seeks to eliminate avoidable blindness by 2020 anchored by WHO.