Case Study Project 2.docx Trachoma IN Morocco PDF

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Group work case study / essay on Tracking Trachoma ( blindness ) in Morocco ...

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Identification of how Trachoma Intervention Reduces Prevalence Rate of Respective Disease in Affected Demographics Analysis by: Julian Hermanson, Meaghan Kane, Katlyn Jones, Taylor Nguyen Due: November 06, 2017 University of South Florida: Foundations of Global Health

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Summary/ Meaghan Kane Trachoma is a contagious bacterial infection affecting the eye covering, cornea, and eyelids (Weinstock, 2015). It is caused by a small, parasitic, bacteria found predominantly in areas that have substandard sanitation in forms such as unsanitary water supply and ineffective or depleted hygiene practices. Trachoma can be spread either through direct contact with an infected individual’s eyes or nose or through indirect contact through third party substances such as clothes from infected persons (Weinstock, 2015). A more predominant method for continual transmission of the infection in underdeveloped regions of the world is through flies laying their eggs on human feces and the eggs mature into adult flies and carry the infection spreading it from person to person. The infection is also known as the day nursery infection because children readily pass it on to their caretakers (Weinstock, 2015). Trachoma is the leading cause of preventable blindness in the world, with a majority of the population living in poor, tropical or semitropical countries (Weinstock, 2015). Due to the nature of the infection, signs and symptoms are do not become present in an individual until it as significantly progressed into the stages of infection. It causes irritation of the eyes, redness of the eyes and lids, and if left untreated or is reoccurring can cause scarring of the cornea resulting in decreased vision loss or even total blindness (Weinstock, 2015). Treatment for trachoma consists of a single dose antibiotic and for best results anyone in contact with the infected individual should receive the pill. If the infection has already progressed to scaring stages corrective surgeries can be performed and if the stages of blindness are in effect a cornea transplant can attempt to correct the damage (Weinstock, 2015). An alarming 5.4 percent of the population in Morocco as of 1992 was found to still suffer

Julian Hermanson 3 Meaghan Kane Katlyn Jones Taylor Nguyen from the infection (Controlling trachoma in Morocco; Millions saved). The areas of the country predominantly displaying the disease were poor or rural provinces in the southeast. An alarming 625,000 people in the country communicated vision loss from trachoma during this time period (Controlling trachoma in Morocco). The climate of Morocco and the status of the country, specifically the sanitary conditions were not well equipped for promoting healthy lifestyles, increasing the prevalence and spread of the infection. The lack of medical officials to treat the infection in a timely manner promoted the increased transmission and increased severity of the status of trachoma in the country (Controlling trachoma in Morocco). Trachoma Intervention / Julian Hermanson Several organizations such as WHO – World Health Organization and ITI – International Trachoma Initiative continue to collaborate in order to achieve its goal of eradicating trachoma in Morocco by 2020 (Skolnik, 2016). Trachoma is developed by the bacterium Chlamydia Trachomatis, and the second leading cause of blindness besides cataracts (Skolnik, 2016). It is highly contagious and spread by direct contact with nose and eye secretions, infected clothing, and fluid – seeking flies. Trachoma is not an issue in North America and Europe, but still an epidemic in dry, hot, and overcrowded locations with poor sanitation and poverty (Skolnik, 2016). The prevalence rate is higher among women and children since they are living in close proximity and being taken care of by the mothers in the household. In children ages two to five years, repeated infections occur up to 90%, which in turn leads to painful in-turning of the eyelash and eventually blindness (Skolnik, 2016). To confront the trachoma epidemic, Morocco in 1991, formed the NBCP – National Blindness Control Program to eliminate this communicable disease by 2005 (Skolnik, 2016). Between 1997 – 1999, the program

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implemented a strategy to treat trachoma called the SAFE strategy which was founded by Edna McConnell Clark foundation. SAFE provides surgery, antibiotics, face washing education, and environmental change (Solomon, 2016). This is a four - part strategy that puts emphasis on behavioral change and to provide cleaner living conditions. Also, inexpensive surgeries, teaching children how to properly wash their face, and antibiotics were given to prevent Trichiasis and the scarring of the eye tissue which led to a reduction in repeated or severe infections (Solomon, 2016). In the mid 1990’s, Pfizer discovered Zithromax or Azithromycin, which is a one dose cure in replacement of Tetracycline, which needed to be taken over the course of six weeks and one of the reasons why patients were not as compliant before in taking all of the medications (Solomon, 2016). Pfizer donated the drug to Morocco and other countries affected by trachoma, such as China, Ghana, Gambia, Iran, Mexico, Myanmar, and Oman (Solomon, 2016). The International Trachoma Initiative, a private – public partnership merged with the Clark Foundation and in between 1999 – 2003, the SAFE strategy led to a 75% decrease in trachoma cases in Morocco (Solomon, 2016). Plus, the prevalence rate in children under ten years old was reduced by 90% since 1997 (Solomon, 2016). The Moroccan government financed most of the programs with the help of ITI and UNICEF, which they had contributed $225,000. In addition, Pfizer donated tens of millions of dollars’ worth of Zithromax (Azithromycin) to Morocco as one of the largest patented drug donations in history (Solomon, 2016). Morocco’s government commitment and SAFE strategy was critical to the program’s success and the four key factors listed by ITI was due to scientific evidence, response to local situations, health promotion through educational classes, and disease control by providing

Julian Hermanson 5 Meaghan Kane Katlyn Jones Taylor Nguyen treatment options. The people affected the most by trachoma in Morocco lived in five rural provinces: Errachidia, Figuig, Quarzazate, Tata, and Zagora (Solomon, 2016). As of 2015, more than 185,000 people with Trichiasis received corrective surgery world- wide and about 56 million were treated with the antibiotic, azithromycin (Solomon, 2016). An estimate of $1 billion is required to expand and sustain efforts in order to eliminate trachoma by 2020 (Solomon, 2016). It’s vital that in public health programs or relief efforts to address epidemics in areas affecting a certain population more so than others. Impact/ Katlyn Jones Trachoma is the leading cause of preventable blindness with almost 10% of the population at risk. Before the SAFE program, 8 million people are already visually impaired from the disease and 84 million are affected in some way. This disease is common in rural areas that are limited to healthcare and clean water. Aside from the suffering that joins the disease, people are also unable to work which results in productivity losses estimating $2.9 billion a year (Trachoma, 2004). In 1997 the battle against trachoma began with the SAFE strategy. The strategy promoted unity of prevention activities, improved participation across areas, and promoted a community based approach. The Moroccan government has financed most of the program. There has also been support from external sources such as the United Nations Children’s fund and a partnership with the International Trachoma Initiative. The pharmaceutical company Pfizer has donated over $72 million worth of the antibiotic Zithromax that is used for treatment of the disease (CASE 10, 2016). Zithromax is a one-time antibiotic which is more cost effective than the 6 - week course of tetracycline that was previously used.

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There are three different options for eliminating the disease, prevention with sanitation efforts, antibiotics for treatment, and surgery. A cost benefit analysis was completed by the World Health Organization in order to see which have the biggest impact for the cheapest cost.

Antibiotics are difficult to distribute to the rural areas that are common for the presence of trachoma and this causes it to be an expensive treatment option. Surgeries improve quality of life and are offered at a low cost for the government and therefore community members. Improving water and sanitation efforts has brought economic benefits to the community as well as health benefits. These efforts are not costly or difficult which makes community willingness to participate greater than other treatment options. To improve sanitation, basic latrines and wells were constructed and community members were taught health safety and the importance of washing their faces (Montgomery, 2006). The disease has decreased in children drastically with the number of cases going down by 99% since the program began in 1997 (CASE 10, 2016). Dr Ala Alwan, WHO Regional Director for the Eastern Mediterranean, states “Morocco has made a significant contribution to our goal to achieve global elimination of trachoma.” Summarization: Taylor Nguyen When analyzing the impacts of the intervention, the group identified that the intervention was successful. This was due to its cost effectivity, intervention awareness, prevention focus, and accurate strategy in deliverance. Since Nonprofit organizations such as WHO, and ITI are leading stakeholders in providing aid to demographic hotspots in the Trachoma map, deliverance of these interventions are more facilitated than if they were to be provided via smaller and “freelanced” organizations. Moreover, large stakeholder organizations are able to obtain larger

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degrees of funding from other stakeholders, organizations, and nonprofits as they are credible fundraisers. ITI and organizations such as NBCP and SAFE provide education and less costly intervention which facilitates in the spread of prevention. By locating the demographic that is most affected: women and children in population-dense regions, these orgs provide these inexpensive procedures and education seminars led by volunteers and physicians (Skolnik, 2016). Our ideals aligned with those of our sources in a plethora of aspects. The group believes that prevention and treatment are equally invaluable in intervening, since it can reduce prevalence rate of the disease while minimizing blindness rates. Skolnik defines the mission of these interventions as focusing on prevention by providing education in hygiene and infrastructural modifications (Skolnik, 2016; Montgomery, 2006). More over, it also takes care of treatment, where the intervening organizations provide necessary surgeries as well as antibiotics (Skolnik, 2016). According to Solomon, prevalence rates of Trachoma reduced by “90%” since 1997. These were due to the efforts of Clark foundation and SAFE strategy (Solomon, 2016). By implementing intervention in forms of prevention and treatment, these stakeholders were successful. The group believes that since these organizations were effective in both aspects, they were successful and aligned with our ideals of intervention. The intervention is cost effective. This is due to utilizing volunteers as well as non profit organization. Although the intervention prioritized, it lacks addressing long term prevention. While it is important to dedicate efforts in education to reduce spread, focusing aid in formulating vaccines would be equally as important. This could lead to weaknesses in prevention if infrastructures that maintain sanitation became dilapidated and increased spread. The only

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difference in intervention that we would provide is to focus more financial aid in research for vaccines which could be cheaply produced.

Works Cited Controlling trachoma in Morocco; Millions saved. Center for Global Development. Retrieved from https://www.cgdev.org/page/case-10-controlling-trachoma-morocco Montgomery, M. (2006). Sustaining Trachoma Control and Elimination. 40-41. Retrieved November 01, 2017. Skolnik, R. (2016). Global Health 101. New Haven, CT: Jones & Bartlett Learning. Weinstock, F. J. (2015). What is trachoma. Trachoma. Retrieved from https://www.medicinenet.com/trachoma/article.htm

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