Trachoma

Trachoma found in :
Poor living
Rapid economic development <<
Rural area (African, Eastern
Mediterania, Central & South America,
Asian)
Severity & degree varies
Evolution of the disease typically
presents 2 stages

1. Inflamatory (active) trachoma

2. Cicatricial (scarring) trachoma
Cause of Trachoma
Clinical Presentation of
Trachoma
Trachoma : grading system
TF = Trachomatous Inflammation
(Follicles)
TI = Trachomatous Inflammation
(Intense)
TS = Trachomatous Scarring (Fibrosis)
TT = Trachomatous Trichiasis
CO = Corneal Opacity
Trachoma Inflamatory - Follicles
Trachoma Inflamatory - Intense
Trachoma Scarring (TS)
Trachoma Trichiasis (TT)
Corneal Opacity (CO)
Risk factors for severe trachoma :
Lack of facial cleanliness
Crowding
Insufficient environmental sanitation
Cattle
SAFE Strategy
Surgery of upper eyelid
What causes trachoma ?
How to prevent trachoma : hand
washing
When assessing trachoma, important to
consider

Inflamatory disease in children

Potentially blinding complication in adults
Hyperendemic area
Active trachoma in children &
trichiasis trachoma related visual
impairment
Mass intervention (AB distribution &
health promotion) & trihiasis surgery
Mild & non blinding trachoma with very
few trichiasis

No need mass intervention

Treated individually
When assessing trachoma, important to
Assess

Not only active disease, but

Degree of severity
Existing risk factors
Rapid Assessment

Identify the communities most in

need of intervention
Necessary to determine where most
severe blinding trachoma
Rapid & low cost methods
Rapid Assessment

Reviw the existing records

Interview key informants
Direct observation

Rapid :
Time spent to collecting & analysis
the data
Rapid Assessment

RA based on community participants

An operational tool determine the
most highly endemic communities for
treatment
Practical way of determining rapidly
Ranking of communities
Rapid Assessment

Basic principles

Collect maximum information, minimum

time, lowest cost

To build an information pyramid

Rapid Assessment

Information directly extracted from

Existing written documents
Interview or group discussion
Direct observations
field visits or
Eye examination in specific age groups
Methods for Collecting the
Information
The following steps
1. First phase (static/passive)
Reviewing all existing documentation
Trachoma & its complication
Socio-economic
Confirming & analysing
What additional information is still
required
Methods for Collecting the
Information
2. Second phase (dynamic/active)
Trichiasis will be assessed simple
questions, eye examination
At least 50 children (1-9 y.o)
Facial cleanliness should be recorded
Risk factors : latrine, availability of
water, etc.
Methods for Collecting the
Information

3. Summarised in a table in order of

priority

Reminder :
Involve the community
Do not collect too much data
What can be Axpected
from RA

Number of communitie & population

sizes which will require active public
health intervention
Rank the district or communities
Distribution pattern of trachoma for
each province/district/community
What RA is Not

Not a detailed household survey

Not based on an accurate
epidemiological methodology
Not & never replace surveys
Not suitable for monitoring,
evaluation of intervention
Conclusions

RA indicated only what the trachoma-

related problems are in a given
community, at a specific point in time
Beginning of the process for
collecting information prepare a
plan of action against trachoma
Further field work need to be
undertaken and reviewed
Age and Trachoma
Rapid Assessment

The minimum acceptable time to gather

current information to develop a plan
of action :
Quick & cost effective approach
Getting information in short period &
finance
This assessment should determine

Presence or absence trachoma as a public

health problem and intervention in
community to eliminate the problem of
blinding trachoma