National Trachoma control programme : India as having eliminated trachoma as a public health problem

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National Trachoma control programme :

It sets out, step-by-step, what is needed to assess the magnitude and extent of the trachoma problem in the area and how to plan, implement, monitor and evaluate a programme to control, and ultimately eliminate, trachoma

 The World Health Organization (WHO) has validated India as having eliminated trachoma as a public health problem. It is the third country in WHO’s South-East Asia Region to achieve this milestone, following Nepal in 2018 and Myanmar in 2020.

Trachoma prevalence surveys were first conducted by the Indian Council of Medical Research from 1959–1963. They revealed that in several states in northern India, >50% of those examined had active (inflammatory) trachoma. Within these states, over 90% prevalence was observed in some villages, where there was also high rates of overcrowding as well as poor personal hygiene and environmental conditions.

To address the national burden of trachoma, the Union Ministry of Health established India’s National Trachoma Control Program in 1963. The program sought to scale up trachoma interventions in areas where it had been identified as a public health problem. In 1976, India also launched its National Program for Control of Blindness, into which the National Trachoma Control Program was integrated. Trachoma remained a priority under the Vision 2020: The Right to Sight India initiative.

Since its inception, the National Trachoma Control Program has primarily implemented surgical and antibiotic interventions through the health sector. Surgical interventions are typically available at district hospitals, medical colleges and regional centers of ophthalmology, while azithromycin and tetracycline eye ointment were included under the national list of essential medicines and made available in the routine public health system.

Additionally, in 2019, India established a Trachoma Elimination Task Force to: plan interventions focusing on identifying trachomatous trichiasis (TT) cases; coordinate the training of ophthalmologists on TT surgery; strengthen TT surgical facilities across the country; and coordinate the provision of TT surgeries. To ensure that trachoma elimination is sustained, India also established a national register to monitor case detection and document interventions provided at public health facilities.

India has also prioritized facial cleanliness, implementing health promotion activities in collaboration with community leaders, teachers, women's groups, and multi-purpose workers (community health workers), and other well-known and respected community members. Provision of safe drinking water, sanitary latrines and facial cleanliness interventions were integrated into routine school health work.

“The elimination of trachoma as a public health problem in India is a testament to the country’s dedication to strengthening its eye health systems,” said PJ Hooper, Chair of the International Coalition for Trachoma Control. “India’s longstanding investment in building human resources for eye health and robust trachoma surveillance systems has ensured that new cases are identified and treated. This milestone reflects India’s leadership in public health, and we extend our congratulations to the Government of India on this significant achievement.”

In April 2024, WHO’s trachoma elimination update reported that 103 million people are known to require interventions for trachoma globally, a 93% reduction from the number of people thought to be at risk in 2002. India is the 20th country to achieve elimination of trachoma as a public health problem. Other countries that have reached this milestone are: Benin, Cambodia, China, Gambia, Ghana, the Islamic Republic of Iran, Iraq, the Lao People’s Democratic Republic, Malawi, Mali, Mexico, Morocco, Myanmar, Nepal, Oman, Pakistan, Saudi Arabia, Togo, and Vanuatu.

Introduction :

 Clear eyesight is one of life's most precious gifts, essential for daily activities, education, and overall well-being. However, several diseases, such as trachoma, pose serious threats to eyesight, potentially leading to irreversible blindness if left untreated. Trachoma, a highly contagious bacterial infection, has been a major cause of preventable blindness worldwide. According to WHO estimated 150 million people worldwide are affected by Trachoma and 6 million of them are blind or at risk of visually disabling complications.1 Among them the infective stages of trachoma are usually found in children.

In a significant public health achievement, India has been officially declared free from trachoma by the World Health Organization (WHO). This milestone comes after years of dedicated efforts by the government to protect the vision of millions, emphasizing the importance of healthy eyesight for every individual.

What is Trachoma? 

Trachoma is a devastating eye disease caused by infection with the bacterium Chlamydia trachomatis. The primary source of trachoma infection is the eye secretions of infected individuals, it can be transmitted through several routes, including:

 • Close physical contact, such as playing together or sharing a bed, especially among mothers and affected children.

 • Sharing towels, handkerchiefs, pillows, and other personal items. • Houseflies, which can carry the infection. 

• Coughing and sneezing. 

Environmental risk factors that promote the transmission of trachoma include: 

• Poor hygiene practices.

 • Overcrowded living conditions.

 • Water scarcity.

 • Inadequate latrines and sanitation facilities. Addressing these risk factors is crucial to breaking the cycle of transmission and preventing the further spread of the disease.

 Children are more vulnerable to trachoma: 

As children experience repeated infections, scarring can occur on the inner surface of their upper eyelids. This scarring leads to a painful condition known as trachomatous trichiasis, where the eyelid margin turns inward, causing the eyelashes to constantly rub against the eyeball, but the hazards don’t end there. If left untreated, this condition can lead to visual impairment. Research shows that individuals may need to endure more than 150 infections over their lifetime to develop severe complications associated with blinding trachoma.

India’s Victory Against Trachoma :

 During the 1950s and 1960s trachoma was a significant public health concern in India. States like Gujarat, Rajasthan, Punjab, Haryana, Uttar Pradesh, and the Nicobar Islands were heavily impacted, with over 50% of their populations affected during that period. By 1971, trachoma was responsible for 5% of all blindness cases in the country. In response to this pressing issue, India implemented a series of measures aimed at eradicating the problem

Initiatives to Combat Trachoma 

Recognizing the urgent need to combat the trachoma health crisis, India implemented several key interventions under the National Programme for Control of Blindness and Visual Impairment (NPCBVI). A pivotal moment in this effort was the adoption of the WHO SAFE strategy, which aimed not only to treat existing cases but also to prevent future infections through improved