Emory Report
October 23, 2006
Volume 59, Number 8


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October 23, 2006
Trachoma study in Sudan shows SAFE strategy works

BY meryl bailey

Children in the United States may not give grape-flavored cough syrup a second thought, but in Eastern Equatoria, Sudan, children look forward to their yearly dose of an antibiotic that tastes like bananas. The medicine, azithromycin, is one part of a strategy designed to prevent blinding trachoma, a bacterial eye disease and leading cause of preventable blindness in the world.

A recent program evaluation by the Carter Center Trachoma Control Program showed that simple measures applied at the community level can nearly eliminate the devastating disease in one of the most neglected regions of the world.

The evaluation results, published in the August 2006 issue of the medical journal The Lancet, centered on the SAFE strategy – surgery, antibiotics, facial cleanliness and environmental improvement – the four-pronged approach to controlling trachoma endorsed by the World Health Organization. After three years of intervention using the SAFE strategy in communities in southern Sudan, prevalence of active trachoma and unclean faces was reduced by up to 92 percent and 87 percent, respectively. The program was implemented with support of the Lions Clubs International Foundation in four districts with a combined population of almost 250,000 people.

“The evaluation data provide hope that if the strategy can be implemented with such success in southern Sudan, an area with limited resources, little infrastructure, and difficulties in access and insecurity, the strategy can be used to effectively wipe out the disease in all countries where it is found,” said Paul Emerson, technical director of the Carter Center Trachoma Control Program and co-author of the Lancet paper.

Caused by bacteria, trachoma is prevalent in poor, rural communities that lack access to basic hygiene, clean water and adequate sanitation. The disease is easily spread throughout a community via contact with dirty clothes, hands and flies that are attracted to eyes.

“These disease factors have been aggravated by the prolonged civil conflict in Sudan. In fact, the trachoma situation in southern Sudan is dire, with one of the highest prevalence rates of blinding trachoma in the world,” said Jeremiah Ngondi, co-author of the paper and Carter Center consultant.

The path to blindness from trachoma is slow and painful as repeated infections cause the eyelid to scar and turn inward allowing the eyelashes to scrape against the cornea. If left untreated, eyelashes constantly scratch the surface of the cornea leading to scarring and irreversible blindness.

For millions of people tortured by the end stages of the preventable disease, the world permanently fades from view, one painful blink at a time. Young children who rub their eyes with unclean hands and whose faces are constantly wiped by their mothers’ skirts, bear the heaviest burden of active trachoma infections and are the main source of infection for other people.

The study raises opportunity for future research on the collateral health benefits that the SAFE strategy can provide for children in trachoma-endemic areas of southern Sudan and elsewhere around the world.

“Just imagine how useful it is for people to have a yearly dose of a systemic antibiotic, plus hygiene promotion, plus access to water and sanitation, and imagine what effect that also is having on diarrheal diseases, infection with worms, pneumonia and other communicable diseases. We can have a powerful effect on health and development through the vehicle of trachoma control,” said Emerson.