A brighter future

by Vicky Blagbrough,
WaterAid's Programme Learning Facilitator

One of the many, and often unmentioned, benefits of clean water, effective sanitation and hygiene promotion is that they can help stop the largest cause of preventable blindness in the developing world, trachoma. Vicky Blagbrough explains.

The disease

Trachoma is a highly infectious eye disease commonly found in poor rural areas where there is a lack of clean water, the climate is dry and dusty and where flies are common. Almost six million people in the world are blind or visually impaired due to the disease, with 150 million infected and requiring treatment.

The infection by the organism Chlamydia trachomatis causes a sticky discharge from the eye, with soreness and swelling of the eyelids.

After repeated infections, scarring of the inner lining of the eyelids occurs which, if severe, leads to the eyelashes turning inwards (trichiasis). The inturned eyelashes rub on the eye and this scars the cornea which causes blindness.

Trachoma is easily spread, especially among young children, by flies, fingers or clothes coming in contact with the sticky eye discharge and then passing the infection on to other people's eyes. Because of their close contact with children, women are between two and three times more likely than men to be infected.

Trachoma debilitates families and communities. When mothers become blind, they are often unable to care for their children. Children with painful eye infections don't learn well in school. Blind adults may not be able to fully participate in the economy or earn a living for their families, and so the cycle of poverty continues.

Children with painful eye infections don't learn well in school. Blind adults may not be able to fully participate in the economy or earn a living for their families, and so the cycle of poverty continues.

Control of the disease

Trachoma infections can be treated with antibiotics, and trichiasis surgery will correct the inturned eyelashes. But it is good hygiene practices which prevent trachoma occurring and recurring. Because of this, the World Health Organisation (WHO) recommends an integrated trachoma control strategy known as SAFE:

• Surgery for correction of trichiasis
• Antibiotic treatment of infected people
• Face washing to prevent the disease spreading
• Environmental improvement in water and sanitation.

Since 1997, the SAFE strategy has been adopted by a worldwide alliance of governments, research institutions, medical personnel, non governmental organisations and donors. This alliance is known as GET 2020 - The Alliance for the Global Elimination of Trachoma by the Year 2020.

WaterAid and trachoma control

There is a clear overlap between WaterAid's aims and those of GET 2020:
Trachoma is a disease of the poor, especially women and children and WaterAid targets the most vulnerable poor people in developing countries

Trachoma is a disease of people without access to adequate water and sanitation facilities and WaterAid focuses exclusively on water, sanitation and hygiene promotion

WaterAid promotes improvements in personal hygiene practices; the SAFE strategy encourages face washing, especially of children

WaterAid promotes safe disposal of faeces and, to a lesser extent, refuse; the SAFE strategy encourages the control of flies through use of latrines, refuse pits, and fly traps

Six of the countries where WaterAid works have been identified by WHO as priority for trachoma control - that is, Ethiopia, Ghana, Mali, Nepal, Pakistan and Tanzania. Trachoma control programmes are also currently underway in Nigeria, Malawi, Uganda, Burkina Faso and India.

What is WaterAid doing?

WaterAid has joined GET 2020 and in doing so has gained the opportunity to learn from others working in similar environments, with comparable target groups.

WaterAid benefits from the opportunity to access research findings regarding water use, fly control and latrine design as well as bringing WaterAid's expertise to an important group of health care professionals and organisations internationally.

WaterAid is collaborating on some initial joint project work with trachoma control organisations in Tanzania and Ethiopia. This provides opportunities for both increasing mutual effectiveness (by complementing one another's work and sharing resources) and accessing funding from sources new to WaterAid.

WaterAid has accepted an invitation to join the Trachoma Expert Committee of ITI (the International Trachoma Initiative, a US based organisation which supports trachoma control programmes in Africa and Asia), thus gaining the opportunity to influence the way that hygiene and sanitation is promoted in countries both within and outside WaterAid programme areas.

It is hoped that these partnerships will develop to ensure a brighter future, without trachoma, for poor communities throughout the world.