International Coalition for Trachoma Control

The number of people at risk from trachoma, the world's leading infectious cause of blindness, fell from 125 million in 2022 to 115.7 in 2023, the World Health Organization (WHO) reported in its Weekly Epidemiological Record.

The progress update presents data on the implementation of the WHO-endorsed SAFE strategy (surgery, antibiotics, facial cleanliness, environmental improvement) in trachoma-endemic countries in 2022 as well as summaries based on district-level prevalence estimates held in the GET2020 database as of 25 April 2023.

The record shows that, as of 25 April 2023, there were 40 countries for which trachoma is a public health problem in at least part of the country. A further four countries may require interventions, but the necessary investigations in suspected trachoma-endemic areas have not yet been completed.

In 2022, 129,224 people were managed for trachomatous trichiasis (TT) worldwide, an 87% increase from the 69,266 managed in 2021. An estimated 73% of TT surgery globally in 2022 was performed in Ethiopia, which accounts for 52% of the global burden of trachoma. However, the number of people who received antibiotics for trachoma reduced to 64.6 million in 2021 to 32.8 million in 2022, which is largely due to a reduction in the availability of donated azithromycin.

“The trachoma progress update highlights that progress continues to be made against targets set in the global NTD road map,” said PJ Hooper, Chair, International Coalition for Trachoma Control. “The number of people at risk of trachoma continues to decline steadily and each year additional countries are validated as having eliminated trachoma as a public health problem. However, several challenges threaten further progress, including reduced availability of Zithromax® and insufficient funding for implementation. ICTC remains committed to working with all stakeholders to overcome these challenges so that together we may achieve our targets”.

There has been a 92% reduction in the number of people at risk of trachoma since 2002. The number of people requiring surgery for TT has likewise decreased by 80%, from 7.6 million in 2002 to 1.5 million in April 2023.

Ensuring equitable access to trachoma interventions continues to be a focus for national trachoma programs, particularly because the relative risk of TT among women is 1.8 times that of men. Of the 36 countries that reported conducting TT surgeries in 2022, 34 reported gender-disaggregated data (covering 99.7% of individuals operated on for TT worldwide). These data indicated that 71% of the surgeries performed in 2022 were on female patients. Furthermore, approximately equal numbers of women and men were given antibiotics for trachoma. Both of these indicators demonstrate gender equity in trachoma program interventions, at least at the global level.

To date, 17 countries (Benin, Cambodia, China, Gambia, Ghana, Islamic Republic of Iran, Lao People’s Democratic Republic, Mali, Malawi, Mexico, Morocco, Myanmar, Nepal, Oman, Saudi Arabia, Togo and Vanuatu) have been validated by WHO as having eliminated trachoma as a public health problem. A further five countries (Botswana, Burundi, Iraq, Mauritania and Tunisia) report having achieved the prevalence targets for elimination.