39.1.5  Prevention and control of trachoma

Surgical treatment

A simple surgical procedure can save a patient from becoming blind. Surgery can be carried out at the health centre by trained nurses and may simply involve turning out the eyelashes that are scarring the cornea. Your role is to reassure and refer patients with Grades 3 to 5 (i.e. trachomatous scarring, trachomatous trichiasis, or corneal opacity) for immediate surgery. Explain that the operation is very simple, quick and safe, and it will greatly reduce the discomfort in their eyes and prevent further damage from occurring.

Antibiotic treatment

You are expected to treat grade 1 and grade 2 active trachoma (i.e. people with trachomatous follicles and trachomatous inflammation in at least one eye) in the community. You should show parents how to administer tetracycline 1% ointment onto the conjunctiva inside the eyelids twice every day for six weeks (Figure 39.9a and b). If you identify two or more family members with trachoma, treat the whole family.

Figure 39.9  (a) Positioning a child to apply tetracycline eye ointment. (b) Placing the ointment inside the lower eyelid. (Diagrams: Dr Radmila Mileusnic)

If you are informed by the District Health Office that trachoma is a major concern, you may be advised to treat all the children in your community as a preventive measure. If this is the case, treat all children with tetracycline eye ointment for five consecutive days in a month, and repeat the same procedure for six consecutive months. Alternatively, a doctor may prescribe the oral antibiotic azithromycine (20 mg/kg bodyweight) as a single dose in place of tetracycline to treat the whole community.

Face washing

Educate all families, particularly mothers of children (Figure 39.10), by going house to house to teach them the importance of regular washing of face and hands, ideally using soap. Go to schools to teach children there in a large group that washing regularly prevents the transmission of trachoma from person to person. Everyone should learn the habit of washing their hands with soap and water in the early morning before they touch their eyes, before and after eating or preparing food, and after using the latrine.

Figure 39.10  Women teaching children how to wash their hands and faces in Wonji, Ethiopia. (Photo: WHO TDR Image Library, image 9400962/Martel)

Environmental sanitation

Educate every family to dispose of their household rubbish in a pit dug away from their home (Figure 39.11). Garbage and other dirty materials can be buried using spades or other locally made tools. The waste materials should be covered with soil or burnt inside the pit. Educate adults and children to keep their surrounding environment clean and free from rubbish and animal dung, to avoid encouraging the breeding of flies. Animals should be penned away from the house at night. Encourage everyone to use latrines and a safe water supply to prevent disease transmission by flies and dirty hands. Latrines should be properly covered after use.

Figure 39.11  Waste disposal in a pit away from the house. (Source: WHO, 1993, Primary Healthcare Level Management of Trachoma)

Now read Case Study 39.1 and then answer the question that follows it.