Ethiopia has the highest burden of trachoma, the leading infectious cause of blindness in the world. The Fred Hollows Foundation is working as part of a global effort to eliminate trachoma and end this form of avoidable blindness.
The Foundation supported a large-scale trachoma prevalence survey in the Oromia region of Ethiopia as part of the Global Trachoma Mapping Project, funded by the UK Department of International Development and conducted between December 2012 and May 2013. The mapping used cutting-edge smart-phone technology to record data identifying endemic trachoma districts and paved the way for similar mapping to be undertaken across the world.
Land-locked Ethiopia has a population of more than 90 million, based on World Health Organization estimates. Its economy is largely agricultural and more than 80 per cent of Ethiopians live in rural areas, most without access to safe drinking water or sanitation. These hot, dusty and unhygienic living conditions create the ideal environment for trachoma to prevail.
In the largest and most populous state, Oromia, trachoma is confirmed to be endemic; 27 million people are at risk of developing the disease and 200,000 are at risk of losing their sight without surgery. People who suffer eye damage and blindness can no longer do productive work and must rely on the care of other family members, usually girls.
Working with our partners in 2014 we:
- Treated 5,637,226 people with antibiotics for trachoma and over 7,000 lid surgeries to treat trichiasis were performed
- Screened 24,997 people
- Supported 280 cataract operations
- Trained 5,403 teachers and community health workers
- Trained 36 surgeons, 10 clinic support staff and supported 5,234 people to attend other courses
- Supplied $126,747 worth of equipment essential for tackling trachoma in Oromia region
About the Program
The Fred Hollows Foundation is working in collaboration with the Oromia Regional Health Bureau to eliminate trachoma in all 225 endemic districts by 2020. The key to achieving that aim lies in implementation of the SAFE strategy (where SAFE stands for Surgery, Antibiotics, Facial cleanliness and Environmental improvements), which is endorsed by the World Health Organization and designed to treat both the active disease and its causes. We are working with the Oromia Regional Health Bureau and other partners to deliver the SAFE strategy in 35 districts over the next five years, and will support the Oromia Regional Health Bureau to raise the funds necessary to eliminate trachoma from the remaining 190 endemic districts.
- Surgery - to prevent blindness by correcting in-turned lashes
- Antibiotics - to treat active infections
- Facial cleanliness - to stop the spread of infection
- Environmental improvements - to give populations better access to water and sanitation.
The Foundation’s contribution to implementation of the SAFE strategy includes co-ordinating antibiotic distribution to endemic districts – antibiotics are relatively inexpensive to distribute, costing less than 27 cents to treat one patient. We will be targeting five million doses a year. We are also working to increase the number and quality of surgeries carried out on people with advanced scarring of the eyelid that occurs in late-stage trachoma.
A crucial element of the SAFE strategy includes educating the community about personal hygiene and encouraging the practice of regular face-washing so that it becomes habitual. The Foundation’s work in Ethiopia has a strong focus on behaviour change as well as supplying the sanitation and water supply facilities necessary to practise good hygiene.
The Foundation also continues to partner with Light for the World in the Simien Mountains Eye Care Project in the Amhara Regional State. Its centrepiece is the establishment of a modern ophthalmic unit at the hospital in the town of Debark, 400 kilometres north of the capital, Addis Ababa.
There remain many obstacles to better eye health in Ethiopia. There is a shortage of trained eye health nurses and specialist doctors – the country has only 120 ophthalmologists, and most work in Addis Ababa. Medical infrastructure, equipment and supplies are in chronic short supply.
Treating people with trachoma is relatively cheap and simple; eliminating it is more difficult but it is within our reach. What is needed is a significant scale-up of the SAFE strategy, including resources, expertise and commitment from regional and local governments and development organisations in the water, sanitation and hygiene sectors.
Facts and figures
|Number of blind people||1.28 million blind and a further 2.96 million with low vision|
|Main causes of blindness||Cataract (50%), trachoma (11.5%), corneal scarring (8%), refractive error (8%) and glaucoma (5%)|
|Number of people with cataract blindness||638,720 (backlog)|
|Number of cataract operations performed annually||27,850 in 2009 (approximately 335 operations, per million people, per year)|
|Number of ophthalmologists||about 104 with another 46 cataract surgeons|
|Reasons for low cataract surgical rates and backlog||Lack of eye health infrastructure, consumables and equipment and a shortage of eye health personnel|
|Childhood eye health||9 million children aged 1-9 years with active trachoma|
|Life expectancy||59.7 years|
|Infant mortality rate (per 1,000 births)||68|
|Adult Literacy rate||39%|
|Population living on $1.25 a day||39%|
|Childred (0-5 years) underweight for age||33%|
|Number of doctors (per 10,000 people)||less than 0.5|
Source: National Five-Year Strategic Plan for Eye Health in Ethiopia 2003-2007 EC (2010/11 – 2014/15), Government of Ethiopia, UNDP Human Development Report 2013
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