Trachoma control strategies

A trachoma patient recruitment and treatment campaign. ETHIOPIA. ICEH/LSHTM

Developing strategies and testing practical approaches to prevent blinding trachoma in the African context

Trachoma is the leading infectious cause of blindness. It is a disease of poverty afflicting some of the world’s poorest people, particularly in Africa. Trachoma has disastrous consequences for affected individuals and communities, frequently compounding health problems and poverty. Prevention of blindness from trachoma is a major public health priority internationally.

In trachoma the cornea becomes irreversibly scarred from the abrasive effect of inturned eyelashes (trichiasis). To prevent trachomatous blindness, eyelid surgery is performed to correct the inturned lashes. However, this treatment is only partially effective as the trichiasis frequently returns.

Research aims

A collaborative research programme conducted a series of complementary studies to develop strategies and test practical approaches to prevent blinding trachoma in the African context.

The programme was implemented through a partnership between the Ethiopian Government Trachoma Control Programme, an NGO providing eye care in the district and the Trachoma Research Group at the London School of Hygiene & Tropical Medicine (LSHTM) and the Institute of Ophthalmology.

The programme had five main aims:

  1. Improve the long-term outcome of eyelid surgery.
  2. Establish the optimal treatment for the earlier stages of the disease.
  3. Characterise the some of the pathological processes involved in the development of blinding trachoma, to provide a rational basis for future interventions against the disease.
  4. Produce and test material to enhance the training of eyelid surgeons.
  5. Develop and test mechanisms to audit and improve the surgical outcomes of individual surgeons.

Acknowledgements

We gratefully acknowledge the funders of this research programme:

  • Band Aid

Trachomatous trichiasis surgery training DVDTrachomatous trichiasis surgery training DVD

The programme published and distributed  more than 16,000 copies of the Trachomatous trichiasis surgery training DVD to African eye care workers. The DVD has step-by-step teaching videos both bilamellar tarsal rotation (BLTR) and posterior lamellar tarsal rotation (PLTR) procedures.  In addition, there is extensive supporting material, such as the assessment and counselling of patients, setting up an operating theatre, sterilising instruments and post-operative care.

Watch the DVD online or order copies for distribution in low and middle-income countries.

Selected publications

  • Rajak SN, Habtamu E, Weiss HA, Kello AB, Abera B, Zerihun M, Gebre T, Gilbert CE, Khaw PT, Emerson PM, Burton MJ. The outcome of trachomatous trichiasis surgery in Ethiopia: risk factors for recurrence. PLoS Negl Trop Dis. 2013 Aug 22;7(8):e2392. Article
  • Burton MJ, Rajak SN, Ramadhani A, Weiss HA, Habtamu E, Abera B, Emerson PM, Khaw PT, Mabey DCW, Holland MJ, Bailey RL. Post-operative recurrent trachomatous trichiasis is associated with increased conjunctival expression of S100A7 (Psoriasin). PLoS Negl Trop Dis. 2012 December; 6(12): e1985. Article
  • Rajak SN, Habtamu E, Weiss HA, Bedri A, Zerihun M, Gebre T, Gilbert CE, Emerson PM, Burton MJ. Why do people not attend for treatment for trachomatous trichiasis in Ethiopia? A study of barriers to surgery PLoS Negl Trop Dis. 2012 Aug;6(8):e1766. Article 
  • Rajak SN, Collin JR, Burton MJ. Trachomatous trichiasis and its management in endemic countries. Surv Ophthalmol. 2012 Mar-Apr;57(2):105-35. Article
  • Rajak SN, Habtamu E, Weiss HA, Bedri A, Gebre T, Genet A, Khaw PT, Bailey RL, Mabey DC, Gilbert CE, Emerson PM, Burton MJ. Epilation for trachomatous trichiasis and the risk of corneal opacification. Ophthalmology. 2012 Jan;119(1):84-9. Abstract
  • Rajak SN, Habtamu E, Weiss HA, Kello AB, Gebre T, Genet A, Bailey RL, Mabey DC, Khaw PT, Gilbert CE, Emerson PM, Burton MJ. Absorbable versus silk sutures for surgical treatment of trachomatous trichiasis in Ethiopia: a randomised controlled trial. PLoS Med. 2011 Dec;8(12):e1001137. 13. Article 
  • Rajak SN, Habtamu E, Weiss HA, Kello AB, Gebre T, Genet A, Bailey RL, Mabey DC, Khaw PT, Gilbert CE, Emerson PM, Burton MJ. Surgery versus epilation for the treatment of minor trichiasis in Ethiopia: a randomised controlled noninferiority trial. PLoS Med. 2011 Dec;8(12):e1001136. Article
  • Rajak SN, Habtamu E, Weiss HA, Bedri A, Gebre T, Bailey RL, Mabey DC, Khaw PT, Gilbert CE, Emerson PM, Burton MJ. The clinical phenotype of trachomatous trichiasis in Ethiopia: not all trichiasis is due to entropion. Invest Ophthalmol Vis Sci. 2011 Oct 10;52(11):7974-80. Print 2011. Abstract
  • Burton MJ, Rajak SN, Bauer J, Weiss HA, Tolbert SB, Shoo A, Habtamu E, Manjurano A, Emerson PM, Mabey DC, Holland MJ, Bailey RL. The conjunctival transcriptome in scarring trachoma. Infect Immun. 2011 Jan;79(1):499-511. Article
  • Habtamu E, Rajak SN, Gebre T, Zerihun M, Genet A, Emerson PM, Burton MJ. Clearing the backlog: trichiasis surgeon retention and productivity in Northern Ethiopia. PLoS Negl Trop Dis. 2011 Apr 5;5(4):e1014. Article

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Image credit: A trachoma patient recruitment and treatment campaign. ETHIOPIA. ICEH /LSHTM

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