ITI Expands Trachoma Control Program in Vietnam, Launches New Program in Nepal

Initial success against trachoma in Vietnam, other countries leads to program expansion

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Journalists are invited to attend a briefing in Hanoi on the success of the first phase of the ITI’s Vietnam program and an overview of the upcoming second phase. The event will take place Wednesday, February 6 at the Horison Hotel, beginning at 8:30 am (Q&A begins at 10:40 am). Representatives from the ITI and the Vietnamese Ministry of Health will be available for comment. Telephone interviews and television b-rolls are also available. Online press kit can be accessed at www.trachoma.org.

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Millions of people at risk of blindness from trachoma in Vietnam and Nepal will soon benefit from the implementation of an advanced trachoma-fighting strategy that has already helped save the sight of more than five million people in six trachoma-endemic countries in the developing world, the International Trachoma Initiative (ITI) announced today.

The trachoma-fighting strategy — known by the acronym SAFE — will be introduced for the first time in Nepal, and expanded in Vietnam, where it was first introduced by the ITI in 2000. These two countries are among those with the highest rates of trachoma incidence in the world.

The new programs in Vietnam and Nepal will include a donation by the research-based pharmaceutical firm Pfizer of more than $20 million worth of its long-acting antibiotic Zithromax, which is effective in trachoma treatment with a single, annual oral dose.

Trachoma is the world’s leading cause of preventable blindness. Approximately six million people in developing countries are blind from trachoma, and ten percent of the world’s population is at risk of being blinded by it, making it a major public health threat. In Vietnam and Nepal, an estimated five million people are at risk of trachoma.

SAFE stands for: “S” for surgery to treat complications that may cause blindness if left untreated; “A” for antibiotics to treat active trachoma infections; “F” to encourage increased face washing to reduce disease transmission; and “E” for environmental changes to increase access to clean water and improved sanitation. SAFE is recommended by the WHO for trachoma control.

The ITI, which is the only international organization dedicated exclusively to the elimination of blinding trachoma, is introducing new programs in Vietnam and Nepal as part of its effort to eliminate blindness from trachoma worldwide by 2020. The ITI is also active in Morocco, Tanzania, Sudan, Mali and Ghana.

In December 2001, the group announced that it would add Nepal, Ethiopia and Niger to its list of program countries, bringing the total number of program countries to nine.

The ITI was founded by the New York-based Edna McConnell Clark Foundation and the research-based pharmaceutical health firm Pfizer Inc in 1998. At that time, the founding partners announced a $66 million effort to eliminate blinding trachoma in the original six program countries.

The decision to expand the ITI’s programs was largely the result of the dramatic success that the group has seen using the SAFE strategy in Vietnam and the other original program countries. The expansion included $200 million more worth of Pfizer’s Zithromax. Pfizer increased its commitment dramatically based on the ITI’s success in its original program countries.

“We have seen remarkable progress in the fight against trachoma in Vietnam, as well as in other program countries,” says Joseph A. Cook, MD, the ITI’s executive director. “We knew when we entered Vietnam that the disease’s characteristics in the country would provide some unique challenges as well as an experience that would be useful in the WHO’s goal of eliminating this cause of blindness completely,” Cook continued.

“However, the partnerships with the Vietnamese Ministry of Health and other government agencies, as well as with our international partners, have allowed us to progress significantly toward Vietnam’s goal of trachoma elimination by 2010 and has given us the confidence to move forward with the second phase of our program there without delay,” Cook added.

Trachoma in Vietnam

The ITI’s original program in Vietnam targeted 13 rural districts, mostly in the north of the country. Vietnam had been chosen as one of the ITI’s original program countries in part because the Vietnamese government had already had a large level of success in controlling the disease during the second half of the 20th Century. Disease prevalence had been as high as 60 percent in 1960, but government control efforts had contained prevalence to just 7.14 percent by 1995.

The ITI joined with the Vietnamese ministry of Health in 2000 to introduce the SAFE strategy, including the donation of $4.9 million worth of Pfizer’s Zithromax, in an effort to eliminate blindness from the disease in Vietnam by 2010. Approximately 1.8 million Vietnamese live in the provinces that were targeted by the ITI/Ministry of Health campaign. Of these, some two million are at risk of blinding trachoma.

In addition to the provision of Pfizer-donated Zithromax, the ITI provided an additional U.S. $1.5 million in funding over two years for implementation of the full trachoma program.

“The people of Vietnam are proud of the success we have enjoyed in the fight against trachoma over the last two years,” says Vietnamese minister of health Prof. Nguyen Van Thuong. We have long struggled to stop this disease of stealing the sight of our people, but now, with the assistance of the ITI and Pfizer, we are closer than ever to eliminating blinding trachoma from Vietnam,” he continued.

As a result of the first phase of this program in Vietnam, the prevalence of disease in children has been reduced by 75% in the 13 districts.

Following the execution of a large-scale rapid assessment to identify areas at elevated risk of trachoma as well as an epidemiological survey to set baseline, 11 new districts will be included in the second phase of the Vietnam effort. These districts are found largely in the Northern Highlands, Central Coastal, and Red River Delta provinces. While information is incomplete, it is estimated that during the course of Phase II, the program will cover more than one-third of the remaining trachoma-endemic districts in Vietnam.

Key to the Vietnam program’s success has been the work of local health providers and educators. The National Institute of Ophthalmology (NIO) organized physicians to conduct eyelid surgery at local health centers. NIO also trained community health workers and nurses will distribute Zithromax annually, fulfilling the “S” and “A” components of SAFE.

International Development Enterprises (IDE), another ITI partner in Vietnam, has focused on the “F” and “E” parts of the SAFE strategy in Vietnam, working closely with the Institute. IDE has put into place a multi-pronged approach in health education and health promotion throughout the eight provinces that have been targeted in the first phase. Part of this effort has been an expansion of the private-sector rainwater-harvesting program, especially in the more arid areas of the country. IDE has worked to stimulate market demand for improved water supplies through a comprehensive social marketing campaign.

More than 3,000 Health Workers and some 10,000 Schoolteachers and Woman Promoters have been trained on trachoma prevention and on communication skills in Vietnam.

Over one million people in the program communes were screened for active trachoma and Trichiasis. Treatment using Zithromax provided by ITI was made for infected children and their family members with 350,000 doses distributed. Trichiasis surgeries were conducted at community level for 6,300 patients.

Hygiene Education and Communication started with training of woman promoters and with group meetings for Women Union Members. It then followed by development, mass production and distribution of IEC materials such posters, leaflets, audio cassettes and videotapes, songs, poems, plays and games. The use of existing loudspeakers system at commune and district levels was maximized for broadcasting messages on trachoma, water, sanitation and hygiene.

Over one million people in the project areas have been reached through direct (meetings/home visits) and indirect (IEC materials/messages) contacts. The project has also supported the installation of 90 water tanks in the schools.
Initial research results from a 6-month follow-up study show that TF/TI rate in studied villages was brought down to 2%-5%, trichias was reduced by 40% and clean faces among children was up to 80%.

Trachoma in Nepal

Nepal’s only extensive survey on eye health, undertaken in 1981, identified trachoma as the country’s second-leading cause of blindness. The survey revealed that trachoma is clustered geographically, with the highest prevalence in the far western regions of Terai. Fifty percent of trachoma cases were found within a 100km radius, and 90% within a 200km radius, of Nepalgunj. In the two zones, Seti and Bheri, trachoma prevalence was 26.6%—almost four times the national rate. Additionally, certain ethnic groups were found to be disproportionately affected—notably the Ranatharus, Tharus, Thakuri, Magar, and Gurungs, with the highest prevalence among the Tharus. Finally, seasonal fluctuation yields higher rates in pre-monsoon months (May–June) than post-monsoon (Sept.–Nov.).

The ITI-supported program in Nepal will be implemented in seven districts: Kailali, Kanchanpur, Chitwan, Nawalparasi, Surkhet, Dailekh, and Jajarkot by a trachoma team, with representation from a number of organizations. The trachoma team, which will run a rolling program in each of the districts, consisting of trichiasis surgeons (ophthalmic assistants), health workers trained in eye health, and administrative support staff. Additionally, district surveillance systems will be established to ensure ongoing monitoring and evaluation of SAFE strategy impact and trachoma prevalence levels.

The trachoma-control effort in Nepal will be led by Nepal Netra Jyoti Sangh (Nepal Comprehensive Eyecare Program (NNJS)), a national nongovernmental organization which acts on behalf of the ministry of health to support prevention-of-blindness services throughout the country. With ITI support, NNJS will establish a ‘trachoma unit’, which will fall under the umbrella of NNJS. The unit will coordinate and manage implementation of the country plan; provide technical support; and train health workers in screening for trachoma and surgical techniques for trichiasis, distribution of Zithromax, health education, program monitoring, and the development of health education resources. The team will be made up of representatives from NNJS, local health-post staff, and other local organizations involved in delivery of all components of SAFE.

In addition, the BBC/World Service Trust will support the program through the development of an innovative communications strategy. The approach, which has proven successful in India for leprosy and Tanzania for trachoma, employs mass communications such as radio dramas and celebrity spots as well as community-based health education with drama, songs and posters.

The National Trachoma Taskforce, established in 1999, will monitor and advise partner organization’s trachoma-control activities in Nepal.

Targeting Trachoma

Trachoma, which is caused by the bacteria Chlamydia trachomatis, blinds women two to three times more often then men. It can be devastating to communities in endemic regions, blinding people during their prime working years and limiting their ability to provide for their families. Educational and economic achievement often remains low in these areas, hampered in part by the burden trachoma places on families and communities.

Trachoma is easily transmitted from person to person, particularly within families with small children. It first occurs in children, who often transmit the disease to others through frequent
contact. Flies may pass the bacteria from person to person. Blindness occurs only after multiple infections, usually when individuals are in their 40s or 50s. Women’s close contact with children may be the factor that makes them more likely than men to be blinded by trachoma.

Trichiasis is the result of repeated trachoma infections, which ultimately causes the eyelashes to turn inward and scratch the cornea. If trichiasis is not corrected, it results in blindness. More than 10,000 Vietnamese and Nepalis have trichiasis and need immediate corrective surgery to prevent blindness.

Since the 1950s, standard therapy has been tetracycline ointment applied directly to the eyes twice daily, for six weeks. With Zithromax®, however, a single annual oral dose treats active infection and is administered under trained supervision, resulting in much higher compliance rates.

International Trachoma Initiative
441 Lexington Ave., 16th Floor
New York, NY 10017-3910, USA
Telephone: 1-212-490-6460
Fax: 1-212-490-6461
Email: iti@trachoma.org
Web site: www.trachoma.org

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