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National Trachoma Program

A glimpse of Trachoma Program in Nepal

Trachoma is one of the world's oldest infectious neglected diseases; trachoma is a chronic and contagious infection that over time scars the upper eyelid, causing the eyelashes to scratch the cornea and eventually causes blindness. The bacteria that causes trachoma can be spread easily on an infected person's hands or clothing, or may be carried by flies that have come into contact with discharge from the eye or nose of an infected person. Because trachoma is transmitted through close personal contact, it tends to occur in clusters, often infecting entire families and communities. Those who are infected by trachoma do not instantly go blind- the disease manifests gradually. It is still affecting large segments of the population in poorer areas. It is disease of social and economic concern. The disease attacks in the most productive years of person's life, affecting the economic well being of entire families and communities. Although surgical treatment is available in later stages of disease, the real opportunity is in preventing recurrent infection.

In Nepal, trachoma was the second leading cause of preventable blindness and was endemic in many areas of the country where prevalence rates was as high as 23% in several districts. ( Source: 1981 Epidemiological Survey of Eye in Nepal)

In the decades of 1990, NNJS has successfully reduced trachoma prevalence in endemic areas through the implementation of a community-based trachoma control program. While progress was made in disease reduction, there was still a tremendous amount of work to be accomplished. To this end, NNJS and MoHP, with support from ITI, initiated the "National Trachoma Program" in 2002 with the goal to eliminate trachoma from Nepal. In this initiation, NTD Integrated program of RTI is also on board to support NTP to eliminate blinding trachoma from Nepal since 2011.

After the establishment of National Trachoma Program, it was estimated from the national level workshop, conducted in 2004 that 40,000 people were suffering from advanced stages of the disease and require sight-saving surgery, and 8 percent (or 2.16 million people) of the nation's population were suffering from active infection. In ten years of SAFE implementation in the trachoma endemic districts of Nepal, the program has achieved a great success in combating trachoma. Active trachoma prevalence now has been reduced more than 90 percent in 12 program districts where SAFE was implemented, and blinding trachoma has been prevented in 18,000 people through Trichiasis surgery. The ultimate goal of the NTP is the elimination of blinding trachoma from Nepal by 2017.

NNJS/NTP is a non-governmental organization jointly implemented by the Nepal Netra Jyoti Sangh (NNJS), Ministry of Health and Population (MOHP) and Department of Water Supply and Sewerage (DWSS) and International Trachoma Initiative (ITI) since 2002 in Nepal and dedicated to the elimination of blinding trachoma by the year 2017 from the country.

Vision: Nepal free from blinding trachoma.

Goal: Eliminate blinding trachoma from Nepal by the year 2017

According to WHO, the trachoma elimination criteria has set for the prevalence of TF is less than 5% in children in 1-9 years old and prevalence of TT is less than 1 per 1000 population in all ages group. NTP will follow these set criteria and implement S & A components in the area until the elimination goal has been achieved.

Major achievements of National Trachoma Program

  • All 75 Districts have already been mapped for trachoma prevalence either by TRA or PBS.
  • 20 districts have been identified as trachoma endemic districts.
  • The WHO recommended SAFE strategy ( S - Surgery, A - Antibiotics F - Face Washing, E - Environmental Improvement) have been completed in 18 districts out of 20 endemic districts.
  • The SAFE is being implementing in two districts Achham & Baitadi.
  • The impact Survey after the program implementation has been completed in 17 districts. The prevalence of active trachoma is reduced almost by 90%. The results of survey is as follows:

View of Impact Survey results Vs Trachoma Prevalence before the program Implementation

Sr. No District TF Before Program % TF After Program %
1 Kailali 12.00 1.20
2 Kanchanpur 16.00 4.50
3 Chitwan 19.90 0.90
4 Nawalparasi 16.00 0.50
5 Bankey 9.70 3.30
6 Bardiya 7.00 1.10
7 Dang 13.20 1.10
8 Kapilvastu 28.10 2.70
9 Bara 12.20 0.00
10 Parsa 18.40 0.00
11 Rasuwa 12.50 0.00
12 Surkhet 14.00 3.00
13 Achham 21.20 5.90
14 Doti 32.70 0.10
15 Rolpa 11.40 0.30
16 Dailekh 11.60 1.05
17 Sarlahi 15.70 1.30

  • 25,000 TT surgeries have been conducted against the estimated backlog of 40,000 TT cases.
  • F&E activities have been carried out in all endemic districts.

    Future Plan
  • Complete the PBS in 13 districts where TF was recorded more than 5%.
  • Complete 1 year of SAFE implementation in two districts.
  • Complete the impact survey in two SAFE implemented districts.
  • Perform the TT surgeries as and when reported and found by out-reach search.
  • Start surveillance by providing training to district health networks.
  • Start Post endemic surveillance for three years in 20 SAFE implemented districts.
  • Declare trachoma elimination from Nepal.

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