Nepal eliminates trachoma as a public health problem

21 May 2018
Members of the survey team, Bishal Dhakal and Shravan Subedi, check the eye of Radha Thapa for clinical signs of trachoma.

Nepal has officially eliminated trachoma the World Health Organization (WHO) has announced, making it the first country in the WHO South-East Asia region to achieve this status.

Trachoma is the world’s leading infectious cause of blindness and one of 20 neglected tropical diseases (NTDs) that affect over one billion of the world’s poorest people. It is responsible for the visual impairment or blindness of 1.9 million people.

Nepal has been working towards the elimination of trachoma and other forms of preventable blindness since 1979 when it began the world's first national epidemiological survey on prevalence and causes of blindness.

Efforts were increased in 2002 when Nepal launched its National Trachoma Program, implementing the WHO-endorsed SAFE Strategy (surgery, antibiotics, facial cleanliness and environmental improvements) in all twenty of its trachoma endemic districts.

Nepal's elimination of trachoma as a public health problem demonstrates what can be achieved with strong national leadership, sustained investment and strategic partnerships

"Nepal's elimination of trachoma as a public health problem demonstrates what can be achieved with strong national leadership, sustained investment and strategic partnerships" said Serge Resnikoff, Chair of the International Coalition for Trachoma Control. "By eliminating trachoma, Nepal has profoundly improved the lives of people living in some of the most remote and impoverished communities".

Nepal's official validation of trachoma elimination comes just five days after the 20th anniversary of the World Health Assembly resolution 51:11 when Nepal and other WHO member states committed to take action and eliminate trachoma. Nepal is the sixth country to eliminate trachoma as a public health problem since adopting the resolution - joining Oman, Morocco, Mexico, Lao People's Democratic Republic and the Kingdom of Cambodia.  

The National Trachoma Program was led my Nepal's Ministry of Health and implemented by local NGO Nepal Netra Jyoti Sangh. Since 2009, the National Trachoma Program also received support from the NTD Control Program and ENVISION - two multi-country United States Agency for International Development (USAID) initiatives implemented by RTI International. 

Through the NTD Control Program and ENVISION, USAID supported further mapping of trachoma and helped the National Trachoma Program to effectively plan the delivery of trachoma interventions. ENVISION also provided supervision and financial support for mass drug administration campaigns using Zithromax, an antibiotic donated by Pfizer Inc. and managed by the International Trachoma Initiative.

WHO validation comes after more than 100 trachoma prevalence surveys were conducted from 1996 to 2018. The last set of surveys completed earlier this year were done with support from Tropical Data - a service that provides governments with real time data about disease prevalence. 

Throughout the world, scale up of the SAFE Strategy has contributed to a significant reduction in trachoma prevalence. The number of people at risk from trachoma reduced from 325 million in 2011 to 182 million in 2016. A record-breaking 260,000 surgeries were also recorded in 2016, increasing from 140,000 in 2014.

Despite significant scale up 3.2 million people require urgent surgery to treat trichiasis, the late blinding stage of trachoma. Trachoma is responsible for an annual productivity loss of up to eight billion dollars each year and is a major obstacle to the achievement of the 2030 Sustainable Development Goals, which explicitly call for an end to the epidemic of neglected tropical diseases.