Case study: Challenges and approaches to managing trachoma in Morocco
- Between 1953 and 1971 the Kingdom undertook prevention strategies in partnership with WHO and UNICEF. Education on hygiene and methods of self care were delivered to the most disadvantaged and poorest communities. School eye health was introduced along with other health programmes
- 1971: Medication for trachoma self-treatment was made available in local tobacco shops
- 1975: A programme was introduced to give 1% oxytetracycline ointment to all students in schools twice each day for 3 days.
- 1984: Decision taken to expand antibiotic ointment distribution to 13 Saharan provinces.
- 360 000 Moroccans had signs of trachomatous inflammation—follicular (TF)
- 25,000 had severe visual impairment from trachoma
- 35,000 – 40,000 required TT surgery to prevent blindness.
- Prevalence of TF/TI in this age group was found to be 5.6% in Figuig and 30.5% in Ouarzazate
- Twice as many women were affected by TT and corneal opacities than men
- Trachoma was a significant cause of corneal blindness.
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- Family members living in close quarters
- Lack of water
- Accumulation of animal waste
- House fly populations.
Introduction of SAFEIn 1997, the SAFE strategy was introduced in 5 provinces of Morocco. Local political will and global partnerships were central to organised action taken across multiple levels and agencies.
SurgeryTT surgery was provided after active screening through static and mobile units.
AntibioticsIn 1996, the programme conducted a community test of trachoma treatment. Oral azithromycin was compared with topical 1% chlortetracycline ointment. Mass drug administration using the one-dose treatment with azithromycin was adopted following this study.
Facial cleanliness and environmental improvementsThe programme began by providing information, education and communication on hygiene. Advocacy for rural development, improved water and sanitation, electrification, and literacy programmes for women were also established.
From 1994 to 2000200 health professionals were trained to operate on trachomatous trichiasis (TT) and 200 surgical kits were obtained.In addition, the Ministry of Health adopted a policy of decentralisation and devolution which enabled the health service to maximise available resources for trachoma elimination in endemic regions. This facilitated the development of a localised approach – called ‘une politique de proximité’ in French – which has proved appropriate for addressing the population’s needs more effectively.
- It brings the health service closer to the community addressing its concerns and operating with greater impact and efficiency.
- It establishes direct communication between the state and its partners on the ground – local communities and civilian partners. This helps to identify the most relevant touch points in community life and lets the programme develop a better balance with regards to methods of public intervention.
- It achieves greater coherence and effective multi-sectoral coordination of local level action.
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