15 November 2011

Kenya: Nation Setting Sights on Eliminating Blinding Disease

Photo: David Njagi
Tonke Nalakiti, 65, is all smiles after a successful eye operation at the Olenarau health center in Kajiado County, Kenya.

Olenarau — Had a community health worker not found him at the rural Kenyan village of Olenarau, 65-year-old Tonke Nalakiti would still be blaming his failing sight on old age.

But the health worker, who was trained to identify patients infected with trachoma, succeeded in convincing Nalakiti that his condition could be corrected through simple surgery and antibiotics.

After a swab of iodine and a jab of anesthesia to ease the pain of incision, the elder from the remote village south of the capital, Nairobi, had the infection surgically corrected in less than 15 minutes.

National surveys indicate that Nalakiti is among some 3.4 percent of patients in Kajiado County whose trachoma has reached the blinding stage, making it a serious public health problem in that region and many other similarly remote areas with little access to health care and screening.

The bacterial infection is spread by direct contact with eye, nose and throat secretions from others who are infected. Blinding trachoma is the most severe form of the disease and occurs in impoverished areas with poor access to clean water and adequate hygiene.

"Trachoma is a chronic eye infection that develops when one is below nine years," says John Soine, an ophthalmologist at Olenarau dispensary where Nalakiti currently goes for treatment. "The infection gets worse with age and by the time the eyelashes turn inwards blindness starts to set in."

Officials with the African Medical and Research Foundation (AMREF) estimate that of every 100 people screened for trachoma in Kajiado alone 17 will have active stage symptoms such as redness and irritation of the eyes. People aged 40 years and older are the most affected, they say.

The Trachoma Belt

The high prevalence of trachoma may continue to look like a generational problem to hundreds of others like Nalakiti who the community health workers are yet to reach. But to the Washington, D.C.-based Global Network on Neglected Tropical Diseases, the extent of trachoma infection in this part of Kenya with poor clean water access and sanitation is no anomaly.

The advocacy body, whose brief includes raising awareness on neglected tropical diseases (NTDs) and pooling funds to help eliminate them, estimates that more than 1.4 billion people in the world are affected by trachoma.

According to the Trachoma Atlas - a collaboration between the London School of Hygiene & Tropical Medicine, the International Trachoma Initiative at the Task Force for Global Health, and the Carter Center, both in the United States - the greatest burden of trachoma is found in sub-Saharan Africa.

It is particularly prevalent in the "trachoma belt" of Senegal, southern Mauritania, Mali, Burkina Faso, southern Algeria, Niger, northern Nigeria, Chad, Sudan, South Sudan, northern Ethiopia and Eritrea.

Kenya is also hard hit. A 2006 study by the East African Medical Journal identifies Kajiado, Samburu, Narok, West Pokot, Baringo and Meru North, as some of the most affected Kenyan regions.

Aiming Toward Eradication

The Alliance for Global Elimination of Trachoma set 2020 as the target year for the eradication of trachoma. To Nalakiti and many other poor households, this is good news because the Global Network lists trachoma among eight out of 10 NTDs that are designated for elimination in Kenya.

The others are leprosy, leishmaniasis, elephantiasis, river blindness, bilharzias, intestinal parasitic worms and guinea worm disease.

This promise appears to be gathering steam.

In September, the push to eradicate NTDs received a huge boost when a group of scientists, private sector leaders and non-governmental organizations (NGOs) announced a new collaboration that will see Kenya join the ranks of 30 African countries keen on eliminating NTDs.

Officials say the Neglected Tropical Disease NGDO Network (NTD NGDO Network), is counting on the few medical successes that have changed the course of human survival to drive its agenda.

Just as with other important medical breakthroughs - the discovery of penicillin to fight infection, the development of vaccines to prevent childhood diseases, and the use of antiretroviral drugs against HIV/Aids - eradication of NTDs is possible, according to Dr. Neeraj Mistry, managing director of the Global Network.

But it is a test that will need collective goodwill for success. As with emerging chronic illnesses, such as diabetes and heart disease, NTDs don't often register as health priorities in many countries. HIV/Aids, malaria and tuberculosis still gain the most attention and funding from governments and donor organizations.

But the Global Network's efforts seek to highlight the significant toll on health and development, especially for children, caused by NTDs.

While parasitic worms may not kill a child, the costs in terms of mental and physical debilitation radically reduce the quality of life and can needlessly shorten lifespan, health and development experts say.

Filling the Gaps

But often, private sector partners can step in to fill the gaps. For example, the pharmaceutical company GlaxoSmithKline (GSK) expects from next year to contribute about one billion treatment tablets annually to treat NTDs, once its South Africa-based factory is complete, according to John Musunga, GSK managing director and manager of pharmaceutical operations for East Africa.

"We have also opened our research facility in Spain for use by any scientist who is interested in researching on NTDs," says Musunga. "We are receiving proposals from different scientific groups. The facility is to be used free of charge to advance science in this area."

Back in Kajiado, it seems that basic information, along with targeted interventions such as medical missions to provide free surgeries, are critical elements in the strategy to eliminate trachoma.

The ophthalmologist Soine says his team at the dispensary can perform 350 to 530 eye surgeries in a year. But this is way below the envisioned 800 operations needed to meet the annual target in the county, he says.

"The main reason is because patients do not come to the hospital in the early stages of infection, but only come when it is too late," says Soine. "This explains the high prevalence because trachoma is a slow-eating disease." Perhaps because time is of the essence, the efforts by the NTD NGDO Network and a master plan on NTDs that Kenya is to unveil November could prove useful in reducing prevalence.

The first of its kind in the region, the plan is expected to provide guidance for control and elimination of five of the NTDs in Kenya.

"With support from WHO and other partners, the distribution of these diseases in the country has now been clearly mapped out," says Dr. Joyce Onsongo, the disease prevention and control officer representing Kenya at the World Health Organisation.

As for Nalakiti, he is hopeful that many more villagers will in the future be made to understand that trachoma is a disease that is caused by poor access to water and sanitation services.

"I believe I will soon regain my sight once the wound heals," says Nalakiti. "But I am appealing to community workers to reach out to other villagers who still think that blindness is caused by old age."

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