What is Trachoma and why is it important?
Trachoma is the most common cause of infectious blindness (six million people worldwide are blind from trachoma). Additionally, it is estimated that at any given time there are 40 million children and adults who have active trachoma infection that could lead to blindness. Trachoma is caused by the organism Chlamydia trachomatis. The infection spreads from eye to eye through eye seeking flies which are attracted to, and feed on ocular and nasal secretions. Female Musca sorbens flies lay their eggs in waste and faeces, preferring human faeces, but they also breed in faeces from other animals. Trachoma is mainly found in very poor rural communities which lack sanitation and sufficient water for personal hygiene, because of this it tends to be most common in Africa, the Middle East, and parts of Asia. Public health interventions to address Trachoma focus on the “SAFE” strategy which includes four components: i) surgery to reduce risk of blindness, ii) antibiotic treatment for those with current infection, iii) facial cleanliness and iv) environmental changes such as sanitation.
A lot is still unknown about the epidemiology of trachoma, and because it is a disease of poverty and water scarcity it has not always attracted much international attention. The World Health Organisation and its partners are aiming to eliminate trachoma as a public health threat by 2020 and as such funding and research into trachoma has increased in recent years.
Our key contributions and research in this area:
Trachoma control has largely been centred around the “S” and “A” components of the “SAFE” strategy, but in recent years more attention has been paid to the importance of face washing and environmental change to stopping transmission of trachoma. Researchers within theenvironmental health group have previously reviewed the impact of “F” and “E” interventions and our behaviour change model has been applied to trachoma.
Our current projects in this area:
We have recently partnered with the Fred Hollows Foundation to conduct formative research into “F” and “E” components of trachoma control in Oromia, Ethiopia. This research sought to explore, in a real-world, high-burden setting, what some of the sub-optimal hygiene practices contributing to trachoma transmission may be. Key research questions included:
- What are the current practices pertaining to water collection / priorities for use; face washing and wiping, handwashing and bathing; defecation and stool disposal; animal husbandry and faeces disposal; garbage disposal; fly control; sleeping arrangements; and laundry?
- Who carries out these behaviours, where, and using what?
- How do the social, physical and biological environment influence water use, personal and other hygiene practices, sanitation practices and sleeping arrangements?
- How do knowledge of trachoma, rational decision-making processes, different motivations and cues influence practice of the behaviours of interest?
- What are the opportunities for intervention, and are potential intervention strategies acceptable to the community and considered feasible?
Full list of publications related to trachoma:
- Formative Research to inform design of a behaviour change intervention for the “F” and “E” of the SAFE strategy in Oromia, Ethiopia. Greenland, K., White, S et al. 2016
- Research to inform the development of behaviour change interventions for the “F” and “E” of the SAFE strategy in Turkana and Marsabit, Kenya. Danquah L, Rono H, Greenland K, Gilbert C, 2013.
- Emerson P.M., CAIRNCROSS S., Bailey R.L., Mabey D.C.W. 2000. A review of the evidence for the “F” and “E” components of the SAFE strategy for trachoma control. Tropical Medicine & International Health 5 (8): 515-527.
- CAIRNCROSS S. 1999. Water and trachoma. Journal of Community Eye Health 12 (32) 58-59.