Massive survey underway to find out prevalence
A massive survey is underway across 200 districts in eight States and two Union Territories of India to assess the prevalence of Trachoma Trichiasis (TT), a poor man’s disease causing blindness that was declared to have been eliminated from the country a few years ago.
Trachoma is a bacterial eye infection that damages the eyelids and causes the eyelashes to turn inwards. Its severe manifestation is Trichiasis which typically occurs in adulthood after multiple untreated infections.
Trichiasis is said to be present when turned-in eyelashes scratch the eyeball — a painful condition that may lead to progressive and irreversible visual impairment. Surgery is required in time to save the eye.
Trachoma is one of the 20 neglected tropical diseases (NTDs) affecting over a billion of the world’s poorest.
The Community Ophthalmology Division of AIIMS’ RP Centre in Delhi, headed by Prof Praveen Vashist, who is also popularly known as the “survey man”, in partnership with Tropical Data, a WHO initiative, has completed the survey, initiated last year, in 55 districts with the rate of prevalence so far found to be nearly 0.27 per cent.
The survey is being conducted in Punjab, Haryana, Rajasthan, Gujarat, Delhi, Himachal Pradesh, Uttarakhand and Uttar Pradesh and the UTs of Chandigarh and Car Nicobar Island in Andaman.
Incidentally, India had declared Trachoma elimination among children in 2018, but a few cases in the endemic States in adults have since been reported.
“The survey aims to assess the prevalence of Trichiasis, including blindness due to Trachoma, in the previously Trachoma-endemic States in India by identifying TT cases ‘unknown to the health system’, as well as study the effectiveness of implementation of Trachoma Surveillance and SAFE strategy in each district,” Dr JS Titiyal, Chief of the RP Centre, AIIMS, told The Pioneer.
He explained that the survey has been planned in the 200 districts in the States which were found to be hyper-endemic in previous Trachoma rapid assessment and prevalence surveys, and will be completed by 2023.
Dr Titiyal said, as many as 1,79,871 individuals have been examined and of them, 50 individuals were found to have TT. The cumulative prevalence of TT (unknown to the health system) is 0.27 per 1000 till now, he pointed out.
Trachoma prevalence has been found to be only 0.7% in India, much below the elimination criteria of infective trachoma as defined by the WHO.
The aim of this study is to estimate the prevalence of Trachoma in endemic States using protocol consistent with WHO recommendation.
“India had declared elimination of the disease among children. However, following detection of TT cases in some endemic States in adults, the present survey for the prevalence of the disease is being conducted,” said Prof Vashist.
As many as 19,662 children in the one to nine year age group were examined by trained ophthalmologists while 44,135 persons were examined in the 15 years and above age group.
Prof Vashist said women are blinded up to 4 times as often as men probably due to their close contact with infected children and their resulting greater frequency of infection episodes.
Globally, around 12 countries that have been validated by WHO for having eliminated trachoma as a public health problem are Cambodia, China, Iran, Lao People’s Democratic Republic, Gambia, Ghana, Mexico, Morocco, Myanmar, Nepal, Oman and Saudi Arabia.
The first National Trachoma Prevalence Survey and the Trachoma Rapid Assessment Surveys were conducted by the Dr RP Centre, AIIMS , in collaboration with National Programme for Control of Blindness & Visual Impairment, Union Health Ministry, from 2014 to 2017.
Active trachoma is considered eliminated if the prevalence of active infection among children below 10 years is less than 5 per cent.