Trachoma elimination in The Gambia: sustaining the success story

The Gambia has become the second country in sub-Saharan Africa to successfully eliminate trachoma, the world’s number one infectious cause of blindness.

In April 2021, the World Health Organization (WHO) confirmed that trachoma is no longer a public health problem for the country.

This major accomplishment should be recognised and celebrated. Sightsavers has been tackling this painful and potentially blinding disease in the country for 35 years, and a key part of our work has been helping strengthen the health system so that it is prepared for this critical moment.

While The Gambia no longer needs intensive mass drug administration campaigns or widespread surgical outreach camps to manage advanced trachoma (known as trichiasis), the health system must now incorporate disease surveillance and management of incident cases into primary health care. It is these strong foundations and continued efforts that will truly consign trachoma to history.

Sightsavers directors Balla Musa Joof and Phil Downs have 40 years of combined experience working on neglected tropical diseases such as trachoma. Here they reflect on what this achievement means for The Gambia, what measures are needed to make sure trachoma is kept at bay there, and how other countries can learn from the experience and stay resilient during the COVID-19 pandemic.

So trachoma has been eliminated in The Gambia.
Does that mean work can stop?

Even though WHO has validated that trachoma is no longer a public health problem in The Gambia, and that large-scale interventions such as mass drug administration are no longer needed, the country still needs to remain on guard to make sure the disease doesn’t come back.

The fact that The Gambia had to manage two outbreaks of trachoma in two successive years at critical times in the elimination effort emphasises how important this is. On these occasions, concerted efforts, especially from the ministry of health surveillance team, controlled the outbreaks and ensured that the momentum needed to eliminate the disease wasn’t lost. So these integrated disease surveillance teams need to remain active to reduce the risk of resurgence.

But surveillance is only one example of the work that needs to continue. Other activities include:

• Strengthening health information systems to monitor the disease and use the available data to make decisions that will stop the disease re-emerging.
• Identifying and providing surgery for people with trichiasis who, for whatever reason, weren’t treated before elimination was validated.
• Maintaining the quality of surgical and treatment services through designated health facilities and hospitals.
• Continuing to promote eye care services so people are aware of them and encouraged to use them.
• Continuing behaviour change communications to educate communities on prevention methods such as hand and face washing and maintaining hygienic living environments.
• Prioritising resources for water and sanitation to improve access to safe water and create environments that are no longer susceptible to spreading trachoma.