Trachoma Control as a Vehicle Toward International Development and Achievement of the Millennium Development Goals

Caused by bacterial infection, trachoma is the leading infectious cause of blindness in the world and is currently endemic in approximately 53 countries. Estimates report that 2.2 million people are visually impaired as a result of trachoma, 1.2 million of whom are irreversibly blind, and another 7.3 million persons are living with the late, disabling stages of the disease [1]. Trachoma is exacerbated by poverty, unsanitary living conditions, crowding, and the eye-seeking fly Musca sorbens. The World Health Organization (WHO) has endorsed the SAFE strategy for trachoma control, which stands for surgery, antibiotics, facial cleanliness, and environmental changes. The latest reports indicate that at least 110 million people live in areas where trachoma is suspected to be endemic and implementation of SAFE is necessary [2]. In the late 1990s, member states of the World Health Assembly passed a resolution calling for the elimination of blinding trachoma as a public health problem by 2020 and established the Global Alliance for the Elimination of Trachoma by 2020 (GET2020) to support this goal. Since then, considerable efforts have been made at both the international and national levels to control and reduce trachoma transmission and prevalence [1]. In light of these recent efforts, experience and anecdotal evidence gathered by leaders in the field suggest that the interventions employed as part of the SAFE strategy might work beyond trachoma-specific end goals; specifically, the basic interventions provided through SAFE can foster development and reduce poverty at the household and community levels. Intuitively, the conjecture makes sense: reductions in disease burden should work to increase productivity and income, while improvements in water sanitation and hygiene (WASH) increase quality of life and improve overall health. Taken together, the interventions could break the cycle of poverty and stimulate development. Evidence from the literature in support of this claim (using the goals outlined by the United Nations [UN] Millennium Development Goals [MDGs] as a metric for development) is slim at best. While publications documenting the effectiveness of trachoma control in reducing trachoma burden are plentiful, studies measuring the impact of SAFE on development are less robust. A review of the present evidence base does prove to be hypothesis-generating, however. Analyzing each goal separately, there is a rational basis to support the argument that trachoma control works to improve development.