The World Health Organization (WHO) has validated Malawi as having eliminated trachoma— a bacterial eye infection that can cause irreversible blindness if untreated— as a public health problem.

Malawi becomes the first country in southern Africa and the fifth in Africa to achieve this significant milestone.

“Malawi’s achievement is life-changing for millions of children who were at risk of this devastating disease. Trachoma results in painful late complications leading to sight impairment, a life-long disability which causes significant emotional and economic hardship for families. With Malawi showing the way, I hope other endemic countries in southern Africa will prioritize the fight against neglected diseases that cause untold suffering to vulnerable populations”.

Dr Matshidiso Moeti, WHO Regional Director for Africa

Malawi was known to be endemic for trachoma since the 1980s. However, it was not until 2008 when surveys were conducted with support from WHO and Sightsavers, a non-governmental organization, that trachoma received due attention. In 2015, Malawi reported 7.6 million people were at risk of trachoma infection.

Following the surveys and with the support of WHO and partners, Malawi stepped up efforts against trachoma, establishing a national trachoma taskforce that implemented the WHO-recommended SAFE strategy to control trachoma.

This entailed training a cadre of mid-level eye clinicians on surgery to treat the blinding stage of trachoma, rolling out antibiotic mass drug administration with donations from Pfizer, and carrying out public awareness campaigns to promote facial cleanliness and personal hygiene. Stakeholders supported the improvement of water, sanitation and hygiene services at the district level. The country received significant funding from the Queen Elizabeth Diamond Jubilee Trust.

WHO noted in a statement that it is assisting Malawi’s health authorities to closely monitor communities where trachoma was previously endemic to ensure there is a rapid response to any resurgence of the disease.

Globally, Malawi joins 14 other countries that have been validated by WHO for having eliminated trachoma as a public health problem. These are Cambodia, China, Islamic Republic of Iran, Lao People’s Democratic Republic, Gambia, Ghana, Mexico, Morocco, Myanmar, Nepal, Oman, Saudi Arabia, Togo and Vanuatu.

Disease prevalence

Trachoma remains a public health problem in 42 countries with an estimated 125 million people living in areas endemic for the disease.

Trachoma is found mainly in the poorest and most rural areas of Africa, Central and South America, Asia, the Western Pacific and the Middle East. Africa is disproportionately affected by trachoma with 111 million people living in at-risk areas, which represents 89% of the global trachoma burden.

Significant progress has been made over the past few years and the number of people requiring antibiotic treatment for trachoma in Africa fell by 38% from 178 million in 2016 to 111 million as of June 2022.

Trachoma remains endemic in 28 countries in Africa

Despite Malawi’s success, the WHO noted that trachoma remains endemic in 28 countries in Africa, requiring urgent actions to totally eliminate the disease.

Trachoma is the leading infectious cause of blindness and is triggered by infection with the bacterium Chlamydia trachomatis. Infection spreads from person to person through contaminated fingers, fomites and flies that have come into contact with discharge from the eyes or nose of an infected person. Environmental risk factors for trachoma transmission include poor hygiene, overcrowded households, inadequate access to water and inadequate access or use of proper sanitation facilities.

Trachoma is an endemic disease that mostly affects underserved remote rural communities. Infection mainly affects children, becoming less common with increasing age. Repeated infections in early childhood result in late complications years to decades later. In adults, women are twice as likely than men to be affected by the blinding complications of trachoma, mainly due to their close contact with infected children.

Repeated infections in childhood lead to scarring of the inner side of the upper eyelids. In some individuals this leads to one or more eyelashes on the upper eyelids touching the eye, known as trachomatous trichiasis – a debilitating condition resulting in extreme pain with each blinking action of the eyelids.

Trachomatous trichiasis can be managed surgically, but, if left untreated, may lead to scarring of the cornea resulting in visual impairment and blindness. Trachoma can be eliminated using WHO’s SAFE strategy.