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TRACHOMA CONTROL IN THE GAMBIA

TRACHOMA CONTROL IN THE GAMBIA. Progress Report Ansumana Sillah Manager The Gambia National Eye Care Program & Coordinator, Health for Peace Initiative – PBL West Africa sub-region Dakar, Senegal: 21- 25 th may 2007.

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TRACHOMA CONTROL IN THE GAMBIA

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  1. TRACHOMA CONTROL IN THE GAMBIA Progress Report Ansumana Sillah Manager The Gambia National Eye Care Program & Coordinator, Health for Peace Initiative – PBL West Africa sub-region Dakar, Senegal: 21- 25th may 2007

  2. Population is 1.41 million with annual growth of 3.5%: however, the pattern is uneven, with very high growth rates in the coastal parts of Western Division, and stable or declining populations in Banjul itself and some rural areas

  3. The Gambia has five administrative divisions plus the city of Banjul • The six Health Divisions are coterminous with the administrative divisions except for the North Bank which is divided into two to facilitate supervision • These divisions are further divided into 37 districts

  4. NECP • The Gambia established a National Eye Care Programme (NECP) following a Prevalence Survey of Blindness and Eye Diseases in 1986. The leading causes of blindness were Cataract47%, Trachoma 17%, and other corneal Opacities mainly associated with childhood measles or harmful traditional eye medicines 11%.

  5. NECP CTD • Based on the fact that these conditions are either Preventable and or curable, and faced with shortage of trained personnel the NECP focused on the PHC approach: i.e. making services affordable, accessible and appropriate.Emphasis was on:

  6. Human Resource Development – e.g. Training of Paramedics to handle cataracts, Community Ophthalmic Nurses, Village Health Workers and Traditional Birth Attendants to function at community level. • Cataract campaign • Trachoma control activities- “SAFE” strategy is being fully implemented • Information, Education & Communication • Appropriate Technology – construction and equipping secondary eye care centres, and Local Production of Eye Drops.

  7. A resurvey 10 years later in 1996 revealed 40 % reduction in the prevalence of blindness. Trachoma which was the leading cause of preventable blindness was reduced from 17% down to 5%.

  8. These achievements have been attained through Government commitment, Partnership with a committed NGO – Sight Savers International, MRC/LSHTM,ICEH and very importantly focus on Community based eye care services including TT surgery in homes.

  9. Current situation • Active Trachoma (TF/TI) continues to be a problem and ranks the fifth cause of blindness in the country. • The last national prevalence survey of eye diseases and blindness in 1996 showed the prevalence of active trachoma to be 4.9% in children under 14 years of age, but was 11.5% in Lower River Division (LRD) and 7.7% in North Bank Division (NBD) .

  10. 2006 Survey • Revealed a modest decline in prevalence since 1996: from 14.6% to 11.9% in LRD and from 10.8% to 9.6% in NBD

  11. However, the results are not comparable because the 1996 survey looked at children under 15 years of age rather than under 10years.

  12. Summary of epidemiology of active trachoma in The Gambia • The prevalence of active trachoma in The Gambia is declining, except in the periurban area where rates doubled between 1986-1996 • However the 2006 survey showed that substantial parts of LRD and NBD still had >10% prevalence of TF/TI in children under 10. • Active trachoma persists at potentially blinding levels in foci particularly in Foni, Jarra, North Bank East, CRD North and in the periurban area

  13. Risk Factors • Poor personal hygiene (2006) – Clean Face among 2996 children in 60 enumeration areas varied from 38-100%. The 38% =Kohel village near Cassamance border. Overall National = 75% • Refugee influx • Trans border travel

  14. Risk Factors ctd

  15. Activities • Routine community screening by CONs, “Nyateros”(Friends of the Eye) • Case finding for TT & surgery when detected/applicable – total surgeries= 297 • IEC • Proposal for Zithromax donation developed & submitted to ITI- Approved • Plan for Zx. Distribution developed with Partners & discussed possibility to integrate distribution with immunization campaigns (measles) in selected areas

  16. Plan for SAFE with Zithromax • To mass treat all the 11 districts with (2006, or extrapolated from 1996 Survey) 10% TF prevalence or more in 1-9yr. olds. Annually x 3 yrs. – “A” districts. • “B” districts = 5 -10% mass treat all villages with prevalence > 10 % in 2006 survey + any found at >10% prevalence by subsequent screening

  17. Plan ctd. • The remainder of settlements with <5% prevalence will be treated according to national policy- a single treatment for active cases and their household members.

  18. “A” Districts for mass treatment

  19. “B” Districts Village based mass treatment

  20. Conclusion We believe: • that the main criterion for success in trachoma control is the non- occurrence of new cases of TT. This is achievable when new cases of trachomatous scarring do not occur, or when they do not progress to TT/sight threathening lesions. • The prevalence of active trachoma still appears sufficient to support the progression to blinding lesions

  21. the programme has not been able to secure donation of adequate Azithromycin and had to use tetracycline most of the time ?? Compliance/effectiveness Our intention is to improve on the implementation of SAFE with Azithromycin according to WHO recommendations when we receive the donation from ITI this year.

  22. Thank you

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