The World Health Organization (WHO) estimates that 6 million worldwide are blind due to trachoma and more than 150 million people are in need of treatment.

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According to VISION2020, the estimated number of affected people has fallen from 360 million in 1985 to about 80 million today. Trachoma affects the poorest and most remote rural areas with blinding trachoma being widespread in the Middle East, North and Sub-Sahara Africa, parts of the Indian subcontinent, Southern Asia and China. Pockets of blinding trachoma occur in Latin America, Australia (among native Australians) and the Pacific Islands (Fiji, Kiribati, the Solomon Islands, Papua New Guinea and Vanuatu) where the disease is endemic.

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Roughly half of the global burden of active trachoma is concentrated in 5 countries (Ethiopia, India, Nigeria, Uganda and Sudan), and that of trichiasis in 4 countries (China, Ethiopia, Nigeria and Uganda). Overall, Africa is the most affected continent: 27.8 million cases of active trachoma (68.5% of all cases globally) and 3.8 million cases of trichiasis (46.6% of all) occur in 28/46 countries in the African Region. The highest prevalences of active trachoma have been reported from Ethiopia and Sudan, where the infection often occurs in more than 50% of children younger than 10 years; trichiasis is found in up to 19% of adults (Stein et al., 2006).

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There are approximately 10.6 million people with inturned eyelashes (entropion trichiasis), for which eyelid surgery is needed to prevent blindness. The majority of these people are women. An estimated 5.9 million adults are irreversibly visually impaired from corneal scarring due to trachoma (WHO).

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Trachoma is endemic in 55 countries: Afghanistan, Algeria, Australia, Benin, Brazil, Burkina Faso, Cambodia, Cameroon, Central African Republic, Chad, China, Côte d’Ivoire, Djibouti, Egypt, Eritrea,Ethiopia, Fiji, Gambia, Ghana, Guatemala, Guinea, Guinea-Bissau, India, Islamic Republic of Iran, Iraq, Kenya, Kiribati, Lao People’s Democratic Republic, Libyan Arab Jamahiriya, Malawi, Mali, Mauritania,Mexico, Morocco, Mozambique, Myanmar, Namibia, Nepal, Niger, Nigeria, Oman, Pakistan, Papua New Guinea, Senegal, Solomon Islands, Somalia, Sudan, Togo, Uganda, United Republic of Tanzania, Vanuatu, Vietnam, Yemen, Zambia and Zimbabwe (VISION2020).

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The following factors were considered to select high-risk communities: high population density, poor access to water, known high morbidity, low socio-economic status, and/or poor access to healthcare (WHO).

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Primary interventions advocated for preventing trachoma infection include improved sanitation, reduction of fly breeding sites and increased facial cleanliness (with clean water) among children at risk of disease. The scaring and visual change for trachoma can be reversed by a simple surgical procedure performed at village level which reverses the inturned eyelashes. Good personal and environmental hygiene has been proven to be successful in combating trachoma. Encouraging the washing of children's faces, improved access to water, and proper disposal of human and animal waste has been shown to decrease the number of trachoma infections in communities (Ophthalmic Epidemiology, 2009).

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According to VISION2020, there is a sex inequity, with women 4 times more likely to be visually impaired from trachoma than men (boys and girls are equally affected by active infection, while blindness is more common in women.), creating implications for child nurturing and productivity. In the long term, these contribute in different ways to the perpetuation of the vicious circle of poverty in already indigent and deprived populations.

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Through the WHO’s alliance formation of the Global Elimination of Blinding Trachoma (GET2020), several aspects have been emphasized in order to cope with the problem including: the introduction of newer antibiotic agents such as azithromycin, which however is problematic due to costs, the placement of trained personnel to perform trichiasis surgery that currently is lacking, the need for collaborative actions to address hygiene, and the integration of trachoma elimination interventions into each threatened area’s national primary eye care system.

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In 2008, about 60% of the population in need received preventive chemotherapy using antibiotics and about 45% received surgical care. Ghana, the Islamic Republic of Iran, Morocco and Oman have reported reaching their elimination targets (Stein et al., 2006).

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