Monday April 21 2014

How untreated trachoma can cause permanent blindness

Monika Nandego (Left) has lived with trachoma

Monika Nandego (Left) has lived with trachoma since she was 10 years old. She says the disease has severely affected her left eye and causes her pain. Photos by Paul Menya 


Health experts estimate that 80 per cent of the population in the developing world depends on traditional medicine as their primary source of treatment. Indeed for nearly 25 years, this is what Monika Nandego used to treat her right eye that had been infected with trachoma.

With hindsight now, she regrets that by the time she abandoned the herbs which she usually squeezed into her eyes three years ago for modern medicine, it was too late to cure the illness. “The pain in my right eye started when I was 10 years old. I have grown up with this pain and when it becomes too painful, I do not touch or wash my face,” says the 38-year-old mother of five.

When herbs caused more pain
“I used traditional medicine for a long time but it did not cure my condition so I decided to switch to modern medicine, which I have now used for the last three years. I apply Tetracycline eye ointment whenever I feel the pain and it gives me great relief,” Nandego explains.

She advises all those suffering from eye problems to visit hospitals and not rely on traditional healers or medicine. Nandego lives in Ntafungirwa Village in Buwaya Sub county, Mayuge District in eastern Uganda.

“I do not like to move a lot in the hot season because I feel pain in the eye. I prefer places with less sunshine,” she says. Because Nandego’s case was in the late stage of the disease, doctors at Mayuge Hospital recommended an eye operation, which she hopes to do as soon as her children come home for the holidays.

Free drugs changing lives
Nandego is grateful for the free medicine she gets from the public health facilities through the Village Health Teams. While she admits she does not know what causes trachoma, she hopes her condition will be healed if she gets the right treatment.

On his part, 70-year-old Kefa Misango recalls when he first got trachoma in 1990. “I do not know what caused this illness, but I immediately went to hospital for treatment.”

“It has been on and off. I still get blurred vision. Whenever my eyes are painful, I buy Tetracycline eye ointment and apply,” says Misango who lives in Ntafungirwa Village in Buwaya Sub county, Mayuge District.

The district vector control officer, Juma Nabonge, says while Misango has not been examined by an optician at the district hospital, he may require an eye operation because his condition is in the advanced stages.
According to the World Health Organisation, trachoma is caused by an organism called chlamydia trachomatis. Through the discharge from an infected child’s eyes, trachoma is passed on by hands, through clothing or by flies that land on the face of the infected child.

It is frequently passed from child to child and from child to mother, especially in areas with water shortage, numerous flies, and crowded living conditions.

Infection usually begins during infancy or early childhood, and can become chronic if left untreated. The infection eventually causes the eyelid to turn inwards, which in turn causes the eyelashes to rub on the eyeball, resulting in intense pain and scarring of the front of the eye - a condition called trichiasis. This ultimately leads to irreversible blindness, typically between the ages of 30 to 40, without proper treatment.

According to Dr Patrick Turyaguma who heads the trachoma control programme at the Ministry of Health, people who develop the disease usually experience red and painful irritating eyes, discharge and tears and they tend to fear light (photophobia).

Early treatment crucial
The recommended drugs by the Ministry of Health are zithromax (a trachoma-fighting antibiotic) and Tetracycline eye ointment.
“If the disease is not treated early enough, a person can go blind. Unfortunately, the blindness is permanent,” Dr Turyaguma says.
Trachoma is the world’s leading cause of preventable infectious blindness. The disease is more common in poor rural communities in developing countries. WHO estimates that six million people worldwide are blind due to trachoma and more than 150 million are in need of treatment.

According to latest figures from the Ministry of Health, over 900,000 children under the age of 10 have trachoma, and 10 million people are at risk of being infected. Another 47,000 people are said to be blind from the disease.

The trachoma control programme in Uganda follows the WHO recommended use of the SAFE Strategy (Surgery, Antibiotics, Facial Cleanliness, and Environmental Improvements) to eliminate the disease by 2020.

Trachoma elimination through mass treatment with Zithromax started in seven districts in 2007. Since then, there has been a steady scale up of treatment coverage to more districts with Mass Drug Administration.
Currently, all the 36 districts with high prevalence of trachoma receive Zithromax drugs, and about 20,000 surgeries have been carried out to prevent blindness.

Since 2007, a cumulative total 12.8 million people have received treatments with Zithromax.

According to the Ministry of Health, elimination of blindness from trachoma is possible by treating everyone in areas where the disease is prevalent over a period of three to five years.

This can be achieved by operating all people with in-turned eyelashes and improving hygiene and sanitation. Dr Turyaguma is optimistic that trachoma can be eliminated by 2020 in Uganda, if there is improvement in hygiene and the drugs are made available to all those who require it.
“Trachoma is a disease of poor hygiene and so if you improve hygiene, it can be eliminated,” he adds.

Other ways to eliminate the disease include reducing fly breeding sites, encouraging the washing of children’s faces, improved access to clean and safe water and proper disposal of human and animal.