Neglected Tropical Diseases (NTDs) and disability case study: Trachoma

ESMAEL HABTAMU: In this step, we will introduce a neglected tropical disease case study, focusing on trachoma and its impact on individual lives. Trachoma is a chronic neglected tropical infectious eye disease caused by the bacteria Chlamydia trachomatis. It is a leading cause of infectious blindness worldwide. Recurrent Chlamydia trachomatis infections caused chronic inflammation and conjunctival scarring, which forces eyelids to turn into the eye, causing the eyelashes to scratch the eye surface. This stage is called Trachomatous trichiasis and can lead to irreversible sight loss from corneal opacification if untreated. Patients also described the pain of Trachomatous trichiasis as feeling like a thorn was stabbing the eye.

The following are the long-term health care needs of trachoma cases. Firstly, people living in areas affected by trachoma would need access to water and sanitation facilities to prevent trachoma infection. Secondly, people who are affected by trachoma need sustainable eye care services. For instance, people with Trachomatous trichiasis need urgent corrective eyelid surgery to reverse the risk of blindness. Surgery is part of the SAFE strategy recommended by the WHO to control trachoma. SAFE stands for Surgery, Antibiotic distribution, Facial cleanliness, and Environmental improvements.

Certainly, trachoma is a preventable disease. But for instance, unlike cataract, once it has advanced to a stage where it causes significant vision loss, sight cannot be fully restored. Therefore, people with vision loss would need rehabilitation services to help them to participate fully in society.

The impact of trachoma on the individual can be devastating. It has major personal, social, and economic consequences for individuals, families, and communities.

It typically affects the poorest people, keeping them trapped in a cycle of poverty as the disease passes from one generation to the next. In a recent case control study in Ethiopia, we found that people living with trichiasis were from significantly poorer households than their neighbours without the condition.

There is also strong evidence that trichiasis markedly reduces quality of life, affecting people’s physical and mental health.

Trachoma also impairs ability to engage in social and economically-productive activities.

In a recent case control study, people with trichiasis reported substantially lower levels of overall health satisfaction than those without the condition. In this same study, 59% felt embarrassed of themselves. 91% worried that they might lose their remaining eyesight. 68% reported that they suffered sleep disturbances, confirming that trichiasis has a considerable impact on self-esteem. There is also evidence that Trachomatous trichiasis significantly reduces an individual’s capacity to carry out productive activities.

In a case control study, people with Trachomatous trichiasis were less likely to participate in productive and social activities and were more likely to report the difficulty in performing productive and social activities and seek assistance in performing productive and social activities than those without the condition, which in turn would have negative consequences for their household incomes. Another qualitative study in Niger showed that people with Trachomatous trichiasis reported social withdrawal and stigmatisation. We have shown therefore that trachoma and poverty are linked in a cycle and that trachoma may be disabling. So how do we address the needs of trachoma-affected communities? Comprehensive implementation of the SAFE strategy is important to prevent blindness from trachoma.

This strategy includes providing surgery to people with Trachomatous trichiasis who are often in pain and at high risk of becoming blind. A recent longitudinal study shows that the surgery not only reduces the risk of blindness but also improves people’s overall well-being and ability to be economically productive and contributing to improve the household income and wealth.

People who had trichiasis surgery about a year ago showed substantial improvement in quality of life scores and ability to execute productive and leisure activities, regardless of vision gains, suggesting that the surgery has a positive effect on individual lives and can hope to alleviate disability. Thank you for listening to this neglected tropical diseases case study, focusing on trachoma and the impact on individual lives. And please continue to contribute to the discussion in the comments area below.