Mapping project on blindness shows how to find world’s neediest people

A member of the Global Trachoma Mapping Project team examines a man’s eyes near Khartoum, Sudan. © Kate Holt / Sightsavers

It’s not news that the poorest people on the planet suffer from diseases with simple and cheap treatments or cures. What may be less obvious is that the suffering persists in part because those offering treatments or cures can’t find those most in need.

Take trachoma, the world’s leading infectious cause of blindness – responsible for the impaired vision of about 2.2 million people worldwide, 1.2 million of whom are irreversibly blind.

With relatively cheap antibiotics and basic health care, trachoma can be easily prevented and cured – possibly even eradicated if everyone in need could be reached. Funding agencies, NGOs and pharmaceutical companies have long been willing to donate and distribute the drugs. The challenge has been determining where exactly trachoma is causing the most suffering.

This is the situation for many so-called ‘neglected tropical diseases,’ including as well such scourges as river blindness, roundworm infections and the parasitic ‘snail fever’ disease technically known as schistosomiasis. More than a billion people suffer from these diseases worldwide; but finding each individual to treat has been daunting, if not impossible.

That may be changing. Last month, researchers reported that they had completed the largest infectious disease survey in history by seeking to identify precisely who has trachoma. 

The Global Trachoma Mapping Project (GTMP) screened 2.6 million people for trachoma in 29 countries, completely changing the outlook for trachoma sufferers and for the elimination of the disease. Organizers believe the project may serve as a revolutionary new template for all kinds of disease mapping in global health.

Over the course of the three year project, the GTMP saw more than 1,200 workers travel from the snowy mountain ranges Pakistan to the islands of the Pacific and other remote regions of the globe to gather an accurate global map of where trachoma is found.

GTMP infographic 2016_v07 (1)

In each village, households were selected at random for examination; anyone found to have trachoma was treated with antibiotic ointment, and those with trachoma trichiasis (advanced trachoma, where the eyelashes turn in scrape the eyeball, causing excruciating pain and permanent blindness) were referred for surgery.

Mappers worked with ophthalmologists, epidemiologists and eye nurses, who were trained to diagnose and treat the different stages of trachoma, to use Android smartphones to capture and transmit the data to a team of analysts in the U.S.

Because the disease is spread through contact with infected clothing, hands or flies, surveyors collected data on age, sex, water, and nearby sanitation conditions. The quality of this data has helped identify which areas are affected by the disease, allowing aid and resources to be put to use where they are most needed. Over 46 million people are now eligible for district wide antibiotic mass drug administration for at least 3 years, and are to receive free antibiotics donated by Pfizer pharmaceutical company through the International Trachoma Initiative, according to Reuters.

According to the GTMP organizers, the WHO’s goal of eliminating the disease by 2020 is now within sight. The project has also helped raise the public profile of trachoma, leading to additional donations like that from the United Kingdom government an additional £39 million (US $56 million) towards elimination goals in various countries across Africa.

Another critical impact of the GTMP is that around 1,200 health workers around the world have been trained in new skills such as data entry and efficient disease diagnosis.

“It’s really important to train the local health workers,” said Caroline Harper, CEO of Sightsavers, in an interview with Humanosphere. “Not just doctors, but nurses, and the whole range of community health workers. Because there are some organizations that will fly doctors around, and that’s great, for that particular point in time, but it doesn’t change anything fundamentally on the ground.”

Founded and based in the U.K., Sightsavers is a global family of independent non-profits that supports the elimination of avoidable blindness, and the equality for people with disabilities, in 30 countries worldwide. For Sightsavers, Harper explained, it is critical for the fight against trachoma to train local health workers and to improve health financing and information systems that are capable of coping with new approaches and requirements for eradicating the disease.

 

With this training and with the methodology behind the success of the GTMP, similar projects can now also be implemented for other neglected tropical diseases, said Harper.

“We want to continue to expand,” Harper said, “Because it’s not just trachoma… We’ve got the mapping in place now, but we absolutely need to get more money for implementation.

“We’re also trying to scale up our work on cataracts, and on the health systems strengthening side. There’s still an enormous amount of work to do.”

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About Author

Lisa Nikolau

Lisa Nikolau is a Seattle-based journalist covering health, inequality and human rights in Latin America and worldwide. As a second-generation immigrant from Greece, Lisa’s objective is to encourage awareness of global issues and cultures through her stories. You can contact her at lisa.nikolau@humanosphere.org.