Kristen K Renneker1, Mariamo Abdala2, James Addy3, Tawfik Al-Khatib4, Khaled Amer5, Mouctar Dieng Badiane6, Wilfrid Batcho7, Lucienne Bella8, Clarisse Bougouma9, Victor Bucumi10, Tina Chisenga11, Tran Minh Dat12, Djore Dézoumbé13, Balgesa Elshafie14, Mackline Garae15, André Goepogui16, Jaouad Hammou17, George Kabona18, Boubacar Kadri19, Khumbo Kalua20, Sarjo Kanyi21, Asad Aslam Khan22, Benjamin Marfo3, Sultani Matendechero23, Aboulaye Meite24, Abdellahi Minnih25, Francis Mugume26, Nicholas Olobio27, Fatma Juma Omar28, Isaac Phiri29, Salimato Sanha30, Shekhar Sharma31, Fikre Seife32, Oliver Sokana33, Raebwebwe Taoaba34, Andeberhan Tesfazion35, Lamine Traoré36, Naomi Uvon37, Georges Yaya38, Makoy Yibi Logora39, P J Hooper40, Paul M Emerson40, Jeremiah M Ngondi41. 1. International Trachoma Initiative, The Task Force for Global Health, Decatur, GA, USA. Electronic address: krenneker@taskforce.org. 2. Mozambique Ministry of Health, Maputo, Mozambique. 3. Ghana Ministry of Health, Accra, Ghana. 4. Yemen Ministry of Health, Sana'a, Yemen. 5. Egypt Ministry of Health, Cairo, Egypt. 6. Senegal Ministry of Health, Dakar, Senegal. 7. Benin Ministry of Health, Porto Nova, Benin. 8. Cameroon Ministry of Health, Yaounde, Cameroon. 9. Burkina Faso Ministry of Health, Ouagadougou, Burkina Faso. 10. Burundi Ministry of Health, Bujumbura, Burundi. 11. Zambia Ministry of Health, Lusaka, Zambia. 12. Vietnam Ministry of Health, Hanoi, Vietnam. 13. Chad Ministry of Health, N'Djamena, Chad. 14. Sudan Ministry of Health, Khartoum, Sudan. 15. Vanuatu Ministry of Health, Port Vila, Vanuatu. 16. Guinea Ministry of Health, Conakry, Guinea. 17. Morocco Ministry of Health, Rabat, Morocco. 18. Tanzania Ministry of Health, Dodoma, Tanzania. 19. Niger Ministry of Health, Niamey, Niger. 20. Malawi Ministry of Health, Lilongwe, Malawi. 21. The Gambia Ministry of Health, Banjul, The Gambia. 22. Pakistan Ministry of Health, Islamabad, Pakistan. 23. Kenya Ministry of Health, Nairobi, Kenya. 24. Côte d'Ivoire Ministry of Health, Abidjan, Côte d'Ivoire. 25. Mauritania Ministry of Health, Nouakchott, Mauritania. 26. Uganda Ministry of Health, Kampala, Uganda. 27. Nigeria Ministry of Health, Abuja, Nigeria. 28. Zanzibar Ministry of Health, Zanzibar Town, Zanzibar. 29. Zimbabwe Ministry of Health, Harare, Zimbabwe. 30. Guinea-Bissau Ministry of Health, Bissau, Guinea-Bissau. 31. Nepal Ministry of Health, Kathmandu, Nepal. 32. Ethiopia Ministry of Health, Addis Ababa, Ethiopia. 33. Solomon Islands Ministry of Health, Honiara, Solomon Islands. 34. Kiribati Ministry of Health, Tarawa, Kiribati. 35. Eritrea Ministry of Health, Asmara, Eritrea. 36. Mali Ministry of Health, Bamako, Mali. 37. DR Congo Ministry of Health, Kinshasa, DR Congo. 38. Central African Republic Ministry of Health, Bangui, Central African Republic. 39. South Sudan Ministry of Health, Juba, South Sudan. 40. International Trachoma Initiative, The Task Force for Global Health, Decatur, GA, USA. 41. RTI International, Washington, DC, USA.
Abstract
BACKGROUND: Global elimination of trachoma as a public health problem was targeted for 2020. We reviewed progress towards the elimination of active trachoma by country and geographical group. METHODS: In this retrospective analysis of national survey and implementation data, all countries ever known to be endemic for trachoma that had either implemented at least one trachoma impact survey shown in the publicly available Trachoma Atlas, or are in Africa were invited to participate in this study. Scale-up was described according to the number of known endemic implementation units and mass drug administration implementation over time. The prevalence of active trachoma-follicular among children aged 1-9 years (TF1-9) from baseline, impact, and surveillance surveys was categorised and used to show programme progress towards reaching the elimination threshold (TF1-9 <5%) using dot maps, spaghetti plots, and boxplots. FINDINGS: We included data until Nov 10, 2021, for 38 countries, representing 2097 ever-endemic implementation units. Of these, 1923 (91·7%) have had mass drug administration. Of 1731 implementation units with a trachoma impact survey, the prevalence of TF1-9 had reduced by at least 50% in 1465 (84·6%) implementation units and 1182 (56·4%) of 2097 ever-endemic implementation units had reached the elimination threshold. 2 years after reaching a TF1-9 prevalence below 5%, most implementation units sustained this target; however, 58 (56·3%) of 103 implementation units in Ethiopia showed recrudescence. INTERPRETATION: Global elimination of trachoma as a public health problem by 2020 was not possible, but this finding masks the great progress achieved. Implementation units in high baseline categories and recrudescent TF1-9 might prolong the attainment of elimination of active trachoma. Elimination is delayed but, with an understanding of the patterns and timelines to reaching elimination targets and a commitment toward meeting future targets, global elimination can still be achieved by 2030. FUNDING: None.
BACKGROUND: Global elimination of trachoma as a public health problem was targeted for 2020. We reviewed progress towards the elimination of active trachoma by country and geographical group. METHODS: In this retrospective analysis of national survey and implementation data, all countries ever known to be endemic for trachoma that had either implemented at least one trachoma impact survey shown in the publicly available Trachoma Atlas, or are in Africa were invited to participate in this study. Scale-up was described according to the number of known endemic implementation units and mass drug administration implementation over time. The prevalence of active trachoma-follicular among children aged 1-9 years (TF1-9) from baseline, impact, and surveillance surveys was categorised and used to show programme progress towards reaching the elimination threshold (TF1-9 <5%) using dot maps, spaghetti plots, and boxplots. FINDINGS: We included data until Nov 10, 2021, for 38 countries, representing 2097 ever-endemic implementation units. Of these, 1923 (91·7%) have had mass drug administration. Of 1731 implementation units with a trachoma impact survey, the prevalence of TF1-9 had reduced by at least 50% in 1465 (84·6%) implementation units and 1182 (56·4%) of 2097 ever-endemic implementation units had reached the elimination threshold. 2 years after reaching a TF1-9 prevalence below 5%, most implementation units sustained this target; however, 58 (56·3%) of 103 implementation units in Ethiopia showed recrudescence. INTERPRETATION: Global elimination of trachoma as a public health problem by 2020 was not possible, but this finding masks the great progress achieved. Implementation units in high baseline categories and recrudescent TF1-9 might prolong the attainment of elimination of active trachoma. Elimination is delayed but, with an understanding of the patterns and timelines to reaching elimination targets and a commitment toward meeting future targets, global elimination can still be achieved by 2030. FUNDING: None.