7 October 2013

Tanzania: Trachoma - a Defiant Health Hazard

KAMBO Maganga was born in Mauno Village, Kondoa District 35 years ago. He was born to a family of peasants who eked out a living tilling the land and raising cattle.

He spent most of his childhood helping out in the farm and tending cattle. He liked cattle and always took them to pastureland. Despite ownership of many head of cattle and food crop farms his family was generally poor and lived in squalid conditions.

Kambo shared his flat-roof mud hut (tembe) with goats, sheep and heifers. His father, a victim of leprosy, penned his herd of cattle close to Kambo's hut. Kambo was taken to a nearby primary school when he attained seven years of age.

He says he was bright in the classroom and even entertained the wild dream of becoming an architect or even an airplane pilot when he attained adulthood. But nature was not kind enough to young Kambo. He caught a vicious eye infection from time to time and had difficulty studying.

Invariably, his eyes kept itching and welling. His father took him to a dispensary where antibiotics and eye ointments were administered. Often, he got a modicum of relief and returned to the classroom. But the infection returned only a few weeks later. He had to seek medical intervention afresh.

Finally, the inevitable happened - his eyelids got stiff and his eyes got incurably destroyed. He could only see through an imaginary, hazy mist. He dropped out of school feeling devastated. As fate would have it, Kambo's illness progressed defiantly despite a medical fight-back.

Today, Kambo has moved to Dar es Salaam to try his luck as a beggar. He spends most of the day seated on a small stone near Mnazi Mmoja bus stand begging for alms. Apart from being totally blind, Kambo is also a leper with missing limbs. Kambo is not an isolated case.

Dozens of blind beggars work the streets of Dar es Salaam, looking for alms. Hundreds, possibly thousands more live in other urban centres in the country trying to make ends meet. Thousands of others live in villages mainly in rural Dodoma where the problem is most prevalent.

Trachoma is not a new problem in Dodoma Region. It has been wreaking havoc here since time immemorial and may have been exported to other regions. Medics say the begging fraternity who move from one urban centre to another looking for livelihood may have shunted the problem into other regions.

The government, with support from the World health Organization (WHO) and Alliance for Global Elimination of Trachoma, has embarked upon an ambitious anti-trachoma crusade that envisages total elimination of the eye ailment by the year 2020.

Trachoma victims think this is far-fetched. The campaign involves large-scale distribution of medical drugs and educating victims on how to avoid acceleration to total blindness. Potential victims have been shown what to do to avoid infection. The campaign will also seek to provide the most affected villages with clean tap water.

A former eye specialist with the Dodoma General Hospital, Dr Shaibu Maarifa, says the initiative would initially concentrate on 26 districts that have been determined to have the biggest population of trachoma trichiasis victims. Trachoma has been detected in all mainland regions and Zanzibar.

The 26 districts, where trachoma is most prevalent, are in Dodoma, Singida, Arusha, Mwanza, Shinyanga, Mtwara, Lindi, Coast and Tanga regions. Dr Maarifa says Dodoma Region is the most affected with Dodoma Rural District leading.

The district is home to 44 per cent of all victims. He says a recent survey indicates that over 60 per cent of children in the region aged between one year and 10 years carry the disease. A regional report on the illness also shows that between 2001 and 2003 medical centres received a total of 12,768 victims with varying degrees of attack. A total of 4,599 eye operations (eyelid corrections) were carried out during the period (2001-2003).

The rest of the cases received medical drugs. Dr Maarifa says Kongwa, Kondoa and Mpwapwa districts also harbour numerous cases of trachoma, many of which remain undocumented. Trachoma is a chronic inflammation that mainly affects the inside of the upper eyelid (tarsal conjuctiva) due to repeated severe infections or attacks by a causative organism or agent called chlomydia trachmatis.

These agents are produced by tiny flies (musca sorbient) that are much smaller than the common housefly (musca domestica). The tiny flies breed the agents normally in an open pit latrine, animal dung or human faeces. People living near animal enclosures risk contracting the ailment.

The flies later introduce the agents (chlomydia trachmatis) into human eyes when they settle on the eyelashes to feed on the watery discharge (tongotongo). Gray lumps (follicles) or small swellings appear in the inner side of the eyelids after an incubation period of one month.

A victim who experiences the uncomfortable itchy sensation is likely to rub the infected eye with the back of his hand. He may, unwittingly rub the other eye with the same hand transferring the trachoma causing agents and ending up with a tricky health conundrum. Affected eyes redden and develop an itchy sandy sensation with a continual watery discharge.

The irritation develops into an inflammation that disturbs blood vessels in the area. Later on the swellings disappear as the case advances into an ugly trachoma scar. Both eyelids contract with the insides getting rougher. Repeated infections worsen the eyelids' condition with the scars developing folds and the itching sensation worsening.

After about 20 years the continual scratching of the eyeballs as a result of callous eyelids damages the cornea. The cornea, which is the transparent protective covering of the eye whose job is to shield the iris and pupil from the elements develops scars as well as impairing vision and finally culminating in total blindness.

This final stage ensues after the victim has endured repeated infections. Nearly all victims of trachoma wander into total blindness between the ages of 20 and 40 years. There is no evidence to show that trachoma blinds young children but the illness is to blame for plunging children into misery -- having to live with itchy, watering eyes.

The illness is not fatal. Dr Maarifa says trachoma could be avoided by maintaining good personal hygiene. "Washing your face twice a day and improving environmental and sanitary conditions can save your sight," he says. Like the more serious cholera, trachoma ravages communities that live in overcrowded conditions.

Trachoma can easily pass from one victim to another even through the mundane handshake. If a victim mops his itching eyes with a handkerchief and then passes the kerchief to a second person, that person might catch a trachoma infection if he mops his eyes too. Most infections occur during the dry season when the trachoma carriers, the tiny flies, find it difficult to find liquids to feed on.

"The flies can be pestering when they discover that your eyes are watery," says Dr Maarifa. "They keep coming back when you swat them," he says. Dusty winds that travel in open landscapes without being interrupted by leafy trees also transport trachoma trichiasis causative agents.

The agents can easily settle in unprotected eyes. Tall trees help to break the speed of fast winds and catch the dust that can introduce trachoma infections. Trachoma is mostly prevalent in rural villages where sanitation is poor.

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