Reduction of trachoma in a sub-Saharan village in absence of a disease control programme

Lancet. 1997 May 24;349(9064):1511-2. doi: 10.1016/s0140-6736(97)01355-x.


Background: Trachoma is a leading cause of blindness in the developing world and is most prevalent among people who live in poor rural communities in arid locations.

Methods: We analysed the results of surveys of trachoma prevalence in Marakissa, a rural village in The Gambia. These surveys were undertaken in 1959, by the Medical Research Council, and in 1987 and 1996 by the Gambian National Eye Care Programme.

Findings: During this 37-year period, the prevalence of active inflammatory trachoma among children aged 0-9 years fell from 65.7 cases per 100 children in 1959 to 2.4 cases per 100 children in 1996. The prevalence also fell dramatically among people of 10-19 years (52.5 to 1.4 per 100) and among people of 20 years and older (36.7 to 0 cases per 100).

Interpretation: The dramatic fall in disease occurrence was paralleled by improvements in sanitation, water supply, education, and access to health care in the village. Of particular importance is that the decline in trachoma occurred without any trachoma-specific intervention.

PIP: Trachoma, an eye infection caused by Chlamydia trachomatis, is a leading cause of blindness in developing countries. Risk factors include lack of facial cleanliness, poor access to water supplies, lack of latrines, and a large number of flies. Its prevalence is disproportionately high among women and children in poor rural communities. To assess trends in the prevalence of active inflammatory trachoma in Marakissa, a typical small rural village in the Gambia divided into family compounds, the results of eye examinations conducted in 1959, 1987, and 1996 were compared. Among children under 10 years of age, the prevalence of active trachoma infection dropped from 65.7 cases per 100 in 1959 to 2.4 per 100 in 1996. Declines were also recorded among children 10-19 years old (from 52.5 to 1.4/100) and among those 20 years and older (from 36.7 to 0 cases/100). This dramatic fall, which occurred without any specific trachoma control programs in the area, is presumed attributable to both improvements in socioeconomic standards and the training of village health workers and traditional birth attendants in eye care.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Blindness / etiology
  • Child
  • Developing Countries
  • Education
  • Entropion / epidemiology
  • Eyelashes
  • Eyelid Diseases / epidemiology
  • Gambia / epidemiology
  • Health Promotion
  • Health Services Accessibility
  • Humans
  • Longitudinal Studies
  • Prevalence
  • Rural Health / statistics & numerical data
  • Sanitation
  • Trachoma / classification
  • Trachoma / epidemiology
  • Trachoma / prevention & control*
  • Water Supply
  • World Health Organization