Mass treatment for trachoma: how does it all work?

Trachoma is the leading infectious cause of blindness and is endemic in 53 countries. An estimated 325 million people live in areas where they can be exposed to trachoma, and more than 7 million suffer from trichiasis, the final painful stage of this eye disease.

The World Health Organization (WHO) initiated a global programme to eliminate trachoma by 2020. At its core is the SAFE strategy: Surgery, Antibiotics, Facial cleanliness and Environmental improvement to reduce transmission. Trachoma control efforts have increased with mass drug administration (MDA) of azithromycin (Zithromax), an antibiotic donated by Pfizer Inc. The goal is 80% coverage in endemic areas for at least 3 years.

To maximise coverage, programme managers and health workers must understand the community's knowledge and health priorities as well as their attitudes and beliefs. This has been well demonstrated in other successful public health programmes in Africa, e.g. the Africa Program for Onchocerciasis Control (APOC)¹ and the Guinea Worm Program (GWP).² This article distils what has been learned from MDA programmes in Kenya, where trachoma control activities have been initiated in eight districts. Successful MDA programmes depend on completing all of the following activities in each district where MDA will take place.