Neglected tropical diseases

Morocco defeats trachoma

After more than six decades of sustained control activities, Morocco has defeated trachoma – a leading infectious cause of blindness – and today joins Oman on the list of countries that have been validated to have eliminated the disease as a public health problem.

Formal acknowledgement letter - Dr Abdelali Alaoui Belghiti, Secretary General, Moroccan Ministry of Health with Dr Margaret Chan
© WHO/EMRO

Morocco’s fight against trachoma dates back as early as 1953, when the Ministry of Health together with the World Health Organization and the United Nations Children’s Fund trained medical and nursing staff at the National Ophthalmology Center in Rabat-Salé for deployment to the field to serve its poorest and most disadvantaged populations.

In the 1990s, a high prevalence of the disease was discovered in some regions of the south-east. In response, Morocco mobilized relevant sectors such as health, education, and water and sanitation to ensure implementation of the WHO-endorsed SAFE strategy.1

Morocco has implemented the SAFE strategy since 1997, allowing thousands of seriously affected people to undergo surgery and receive treatment with azithromycin, donated by Pfizer through the International Trachoma Initiative.

By the end of 2005, Morocco had achieved the epidemiological end-points defined by WHO for elimination of trachoma as a public health problem. The epidemiological surveillance system that was developed and implemented continues to this day.

Morocco’s achievement in context

The WHO Alliance for the Global Elimination of Trachoma by the year 2020 (GET2020) supports countries endemic for trachoma to accelerate implementation of the SAFE strategy in order to achieve their elimination targets by 2020.

In 2015, more than 185 000 people with trichiasis received corrective surgery worldwide, and 56 million were treated with azithromycin.

The trachoma community estimates that funding of up to US$1 billion is required to extend activities until the 2020 target.

Trachoma

Trachoma is known to be a public health problem in 42 countries and is responsible for blinding or visually impairing about 1.9 million people.

Slightly more than 200 million people live in trachoma-endemic areas worldwide and are at risk of blindness. Human transmission occurs through contact with infective discharge from the eyes and nose, particularly in young children who harbour the main reservoir of infection. It is also spread by flies which have been in contact with the eyes and noses of infected people.

The immune system can clear a single episode of infection, but in endemic communities the organism is frequently reacquired. After years of repeated infection, the inside of the eyelid can become so severely scarred (trachomatous conjunctival scarring) that it turns inwards and causes the eyelashes to rub against the eyeball (trachomatous trichiasis), resulting in constant pain and light intolerance. This and other alterations of the eye can lead to scarring of the cornea. Left untreated, this condition leads to the formation of irreversible opacities, with resulting visual impairment or blindness.


1Surgery for the late, blinding stage of trachoma, Antibiotics to treat infection, Facial cleanliness and Environmental improvement to limit transmission.