The Carter Center Trachoma Control Program

With support from the William H. Donner Foundation and in collaboration with the Amhara Regional Health Bureau, The Carter Center delivers interventions to control trachoma for the entire at-risk population of the Amhara region in Ethiopia. With support from the Donner Foundation and others, over the past year, The Carter Center helped to restore the sight of more than 116,000 people. Programs supporting eye surgery, health education, and antibiotic distribution relieve needless human suffering and facilitate economic development.

Caused by the bacteria Chlamydia trachomatis, trachoma is the leading cause of infectious blindness worldwide. In response to repeated infections, the eyelids become scarred and begin to rotate so that eyelashes scratch the surface of the cornea—causing unbearable pain and leading to disabling sight loss. Today, trachoma is endemic in over 50 countries, primarily in Africa and Asia, where the eye disease clusters in crowded areas of high poverty with limited access to water and poor sanitation. Globally, 232 million people are at risk for trachoma and over four million are at immediate risk for blindness from trichiasis. Over two million people are already visually impaired as a result of trichiasis, including over one million who are permanently blind, of whom the majority are women.

To control trachoma, the World Health Organization endorses the SAFE strategy, which includes: Surgery to correct trachomatous trichiasis (TT); Antibiotics to treat infection and prevent transmission; Facial cleanliness to prevent the bacteria from spreading; and Environmental improvement to promote the use of household pit latrines to reduce the fly population that transmits infection from person-to-person. Implementation of the SAFE strategy has led to the elimination of blinding trachoma as a public health program in several countries in Africa and Asia.

In Ethiopia, The Carter Center partners with the Amhara Regional Health Bureau (ARHB) to put the full SAFE strategy into action. Ethiopia has the highest known burden of trachoma in the world, with an estimated minimum of 67 million Ethiopians at risk of infection. The most recent data in 2014 shows that an additional 790,000 Ethiopians are in need of treatment for TT, the advanced stage of the disease. Of these, 487,000 of the affected individuals are estimated to be in Amhara. It is estimated that this debilitating bacterial disease is responsible for one-third of all the 960,000 cases of blindness and six million cases of vision impairment in the country. The economic implications of the disease are devastating, and even those not directly infected may be forced to forego their normal activities to care for those who have been disabled

Despite the logistical challenges presented by the limited number of roads and the rugged terrain, the program still manages to operate on thousands of persons and distribute millions of doses of antibiotic each year, a success that has put the program on track to reach the goal of eliminating blinding trachoma in Amhara by 2020. The program works because of the firm commitment of government officials, health extension workers, and thousands of community volunteers who deliver the drugs and health education to communities. In 2016, The Carter Center assisted 111,687 TT surgeries in Amhara, a record for the program. Since 2001, the program has assisted 567,568 surgeries in the Amhara region. The cumulative total of azithromycin treatments delivered in Amhara since 2001 is 141,114,968. These are delivered through Trachoma Weeks-campaigns during which antibiotics for trachoma are offered annually to the whole population of the Amhara region. Throughout the year, the complete SAFE strategy is being implemented in 3,459 kebeles (sub-districts), with ongoing latrine projects and school health programs. The program is currently working with the regional bureaus of health and education to implement a revised curriculum to schools that puts a greater focus on prevention and treatment of trachoma. The school trachoma health program will include training 15,000 teachers across the region in order to roll out the new curriculum in all schools. The program continues to support the construction of household latrines in Amhara. Since 1999, The Carter Center has assisted the construction of over 3.4 million latrines since program inception in 2001.

Several guests of The Carter Center, including Anita Winsor from the Donner Foundation, traveled to Ethiopia in 2016 for the launch of a Trachoma MDA campaign. Ms. Winsor and her guest, Mr. Behrends, participated in the launch ceremony and field visits to observe the SAFE strategy.

One of the strengths of The Carter Center is a diversified base of support including corporations, major foundations, and governments. However, it is the ongoing support from small foundations like the William H. Donner Foundation that is critical to complete our mission. The Donner Foundation's support is helping to make substantial progress in the fight against blinding trachoma in the Amhara region. Trachoma control is critical for the immediate relief of needless human suffering as well as economic development. With support of the Donner Foundation, many more children and adults in the Amhara region of Ethiopia have access to all components of the SAFE strategy to prevent blinding trachoma. The Carter Center is deeply grateful for the partnership and generous financial support, and looks forward to continuing to work together to eliminate blinding trachoma as a public health problem from the Amhara region.