In Practice Paper
In Practice: Eliminating Blindness from Trachoma Infection
Dr. Nancy J. Allen analyzes lessons from 15 years of our grantmaking in support of trachoma control and elimination.
The Conrad N. Hilton Foundation began its support for the elimination of blinding trachoma in 1997, immediately following the establishment of the Alliance for the Global Elimination of Blinding Trachoma by 2020 (GET 2020). Now, almost 15 years later, the Foundation has cumulatively contributed more than $40 million toward reducing the spread of trachoma. Great progress has been made in this international effort to combat trachoma, even as significant challenges must be met in order to reach the ultimate goal of global elimination by 2020.
What Is Trachoma?
Trachoma, a highly contagious infection caused by the bacteria Chlamydia trachomatis, is the most common infectious cause of blindness worldwide, presenting initially in young children as an inflammation of the eyelid. The bacteria spread easily from an infected person’s hands or clothing, or can be carried by flies that have come in contact with discharge from the eyes or nose of an infected person. Over many years of repeated infection and chronic inflammation, visible scar tissue forms on the inside of the upper eyelid forcing eyelashes inward (called trichiasis). The combination of abrasion of the cornea as a result of trichiasis and secondary infections causes acute pain, impairs vision, and, if untreated, eventually leads to permanent blindness.
Who Is Affected by Trachoma?
Worldwide, more than 40 million people are estimated to have active trachoma, and approximately 8 million are estimated to be suffering from trichiasis. Although estimates vary, trachoma is responsible for the visual impairment of about 1.8 million people, of whom 1.3 million are irreversibly blind. Trachoma imposes significant economic and personal hardship on the infected individual, and on families and communities. In poor families, the burden of caring for a visually impaired parent falls on family members who are then unable to work or attend school themselves. Estimates of the economic burden of trachoma suggest the total loss of productivity for the vision impaired or blind and their caregivers is between $3 billion and $6 billion every year.
Trachoma declined in developed countries as populations shifted out of poverty and communities benefitted from less crowded and more hygienic living conditions. The last cases of trachoma in North America and Europe were reported in the 1950s. This history leads to a near universal conclusion: “Good hygiene and sanitation are the most powerful prevention tools available for trachoma.” The disease persists among women and children, often the most vulnerable members of society, and occurs where people live in crowded conditions with limited access to water and health care.