Gambia has eliminated trachoma, one of the leading causes of blindness worldwide, the government has announced, after almost four decades of work to counter the disease.

The World Health Organisation (WHO) has validated Gambia for having eliminated trachoma as a public health problem, making it the second country in WHO’s African Region after Ghana to achieve this milestone.

A 2018–2019 survey on trachomatous trichiasis (the advanced, blinding stage of trachoma) in Gambia found that the prevalence of this condition among people aged 15 years and above ranged from 0-0.02 per cent – well under the threshold required for elimination of trachoma as a public health problem. 

This is a huge achievement compared to the mid-1980s, when a national survey estimated that trachoma was responsible for almost 1 out of 5 cases of blindness, countrywide.

Despite Gambia’s success, trachoma remains endemic in 29 countries on the African continent.

What is trachoma?

• Trachoma is one of 20 neglected tropical diseases (NTDs) that the WHO says disproportionately affect the world’s poorest people.

• Trachoma is the leading infectious cause of blindness worldwide. It is caused by an obligate intracellular bacterium called Chlamydia trachomatis. 

• The infection is transmitted by direct or indirect transfer of eye and nose discharges of infected people, particularly young children who harbour the principal reservoir of infection. These discharges can be spread by particular species of flies.

• With repeated episodes of infection over many years, the eyelashes may be drawn in so that they rub on the surface of the eye, with pain and discomfort and permanent damage to the cornea.

• Trachoma is hyperendemic in many of the poorest and most rural areas of Africa, Central and South America, Asia, Australia and the Middle East.

• It is responsible for the blindness or visual impairment of about 1.9 million people. It causes about 1.4 per cent of all blindness worldwide.

• Globally, trachoma remains a public health problem in 45 countries, with an estimated 137 million people living in areas endemic for the disease. 

• Overall, Africa remains the most affected continent, and the one with the most intensive control efforts.

• Significant progress has been made over the past few years. The number of people requiring antibiotic treatment for trachoma elimination in the African Region fell by 72 million from 189 million in 2014 to 117 million in 2020.

• The elimination strategy is summarised by the acronym ‘SAFE’, which means Surgery for advanced disease, Antibiotics to clear infection, Facial cleanliness and Environmental improvement to reduce transmission.

• The burden of trachoma on affected individuals and communities is enormous. The economic cost in terms of lost productivity from blindness and visual impairment is estimated at $2.9–5.3 billion annually, increasing to $8 billion when trichiasis is included.

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