Trachoma infections in Karamoja drop

Trachoma infections in Karamoja region have dropped significantly in the last 10 years, health experts have observed.

The infections which were between 57 and 65% at baseline 10 years ago, are now at 4 to 14%, figures from RTI International have revealed.

Benjamin Binagwa, the RTI International/ENVISION resident program advisor, said; "Much as infection levels have gone down significantly, there still remains a lot to be done to eliminate trachoma from Karamoja sub-region."

RTI is an independent, nonprofit institute that provides research, development, and technical services to government and commercial clients worldwide with an aim of improving human conditions by turning knowledge into practice.

Under the RTI/ENVISION project, Binagwa said, USAID has supported trachoma elimination since 2008 through funding the mapping of 18 districts for trachoma in order to expand interventions to all endemic districts.

He noted that over 161,000 government officials, teachers, health workers, and community drug distributors had been trained on skills needed to effectively carry out mass treatment campaigns.

His revelations came during celebrations to mark the 2016 World Sight Day at Nabilatuk playground in Nakapiripirit district recently.

Binagwa said they have also undertaken trachoma impact assessment surveys in 38 districts which have shown that Uganda is on track to eliminate trachoma as a public health problem by the year 2020.

Trachoma surgeries

The National Trachoma Program Manager in the Ministry of Health, Dr. Patrick Turyaguma, said they have carried out 21,239 trachoma trichiasis surgeries in 17 districts within Karamoja and Busoga regions since the project kicked off in 2014.

A total of 2,527 patients are yet to undergo surgeries in Karamoja and Busoga, which are being done in conjunction with implementing partners like Sight savers and Christian Blind Mission (CBM), noted Turyaguma.

"In 2014, a total of 9,325 surgeries were done in Busoga while 3,394 were done in Karamoja .A total of 4,246 surgeries were carried out in Busoga in 2015 while 3,548 were done in Karamoja. So far in 2016, 783 patients have undergone surgeries in Busoga while 1,121 surgeries have been done in Karamoja," he explained.  

The funding

The project director, Queen Elizabeth Diamond Jubilee Trust Trachoma initiative in Uganda, Michaela Kelly, said, "The trust has committed £6.5m (sh27.5b) for five years since April 2014 to March 2019 to support surgeries and improve sanitation and hygiene in Karamoja and Busoga regions.

Polly Karimari Ndyarugahi, the Lions Clubs of Uganda trachoma grant administrator said the Lions Clubs International Foundation and the Queen Elizabeth Diamond Jubilee Trust  Fund donated $1million (sh3.4b) to fight trachoma in Busoga and Karomoja sub-regions early this year.

The money was part of the $5m (sh17.3b) five-year grant (2015 - 2020) that the two Funds contributed to eliminate trachoma in the world.

Dr. Michael Kakinda, the project coordinator Lions Clubs of Uganda said the treatment of trachoma patients is being implemented through the Lions clubs of Uganda Trachoma Project. "We are working with Carter Centre as the coordinating partners, Sightsavers Uganda and CBM as implementing partners and the Ministry of Health who oversee how the project is being implemented."                

The Karamoja Affairs minister, John Byabagambi, noted that the high incidence of blindness in Karamoja was due to poor hygiene and sanitation resulting from open defecation thereby attracting flies that spread trachoma amongst locals.

According to the Ministry of Water and Environment Sector Performance report 2015, districts of Napak, Kaabong, Moroto, Kotido and Nakapiripiriti practice open defecation because of lack of toilets.

The minister observed, "Keeping hands clean through improved hand hygiene is one of the most important steps we can take to avoid getting sick and spreading germs to others."

Nakapiripirit case

The Nakapiripirit Health Education Officer, John Anguzu, said the district with a population of 189,901 people and 29,218 households, has only 9,174 (31.4%) people with access to pit latrines.

Quoting the District Health Information System (DHIS) 2015 report Anguzu said "poor hygiene   infections take 5% of the infections that affect people in Karamoja region."

Dr. Robert Mayeku, a consultant Ophthalmologist at Nabilatuk Health center IV in Nakapiripirit district said blinding trachoma is an infectious disease caused by bacterium chlamydia trachomatis.  

"Trachoma is a bacterial eye infection found in poor, isolated communities lacking basic hygiene, clean water, and adequate sanitation. It is easily spread from person to person through eye-seeking flies, hands, and clothes," he said.

Mayeku noted that repeated infection leads to scarring and inward turning of the eyelid — a very painful condition called trichiasis — eventually causing blindness if left untreated.

Mayeku said trichiasis (in-turning of eye lashes) leads to constant rubbing on the cornea, causing corneal ulcerations which heal by scaring and thus leading to corneal opacity.

"The disease robs people of their sight as repeated infection turns eyelashes inwards, scraping the cornea and eventually causing irreversible blindness. Flies act as physical vectors for transmission of chlamydia trachomatis. The responsible vector breeds in human excreta on the ground surface," he explained.

He said blinding trachoma was more common in females than males because of the role of women as caretakers of children who are the main reservoir of infection.