The number of people at risk from trachoma, the world's leading infectious cause of blindness, has been reduced from 115.7 million in April 2023 to 103.2 million in April 2024, the World Health Organization (WHO) has reported in its Weekly Epidemiological Record.

The trachoma progress update presents data on the implementation of the WHO-endorsed SAFE strategy (surgery, antibiotics, facial cleanliness, environmental improvement) in trachoma-endemic countries in 2023. It also estimates the global population at risk of trachoma as of 15 April 2024, which is based on district-level prevalence estimates submitted to WHO by national programs.

The record shows that 18 countries have been validated as having eliminated trachoma as a public health problem as of 15 April 2024; 39 countries are known to require interventions for trachoma; and three countries may require interventions, but the necessary investigations in suspected trachoma-endemic areas have not yet been completed.

The record reveals that 130,746 people were managed for trachomatous trichiasis (TT) in 2023. Of the 38 countries that reported TT surgery in 2023, 37 reported gender-disaggregated data, which show that 70% of people operated on for TT were female.

Additionally, the record shows that 33.9 million people were treated across 19 countries with antibiotics in 2023. Gender-disaggregated data were available from 17 countries, representing 99.6% of people treated with antibiotics for trachoma worldwide. This showed that 52% of individuals who received antibiotics were female. 

The presentation of gender disaggregated data is important to the global trachoma program because women are 1.8 times more likely to require TT management than men. Additionally, the record cites exploratory research that suggests women may be more likely to decline intervention than men.

“The trachoma progress update includes several encouraging indicators for the global trachoma program”, said PJ Hooper, Chair, International Coalition for Trachoma Control (ICTC). “The number of girls and women to receive antibiotics and have TT surgery is a positive indication that gender equity is being achieved. However, ongoing challenges, including limited financing, persistent and recrudescent trachoma, hard-to-reach populations and insecurity threaten the elimination of trachoma as a public health problem by 2030. ICTC is enthusiastic about the global progress to date and remains committed to bringing diverse stakeholders together to support national programs in implementing all components of the SAFE strategy”.

The number of TT cases managed and antibiotics distributed remained largely stable from the 129,224 TT cases managed and 33 million doses of antibiotics distributed in 2022. However, the number of people given antibiotics remains low against previous years, including 2021, which saw 64.6 million people treated. The 2023 trachoma progress update noted that this reduction is largely the result of a reduction in the availability of donated azithromycin.

As of April 2024, Ethiopia continued to account for the world’s largest burden of trachoma, with 61 million people living in trachoma-endemic areas, representing 59% of the global burden. However, in 2023, government leadership supported the distribution of antibiotics to nearly 22 million people and the management of over 98,000 TT cases. 

To date, 18 countries (Benin, Cambodia, China, Gambia, Ghana, Islamic Republic of Iran, Iraq, Lao People’s Democratic Republic, Malawi, Mali, 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 10 countries (Botswana, Burundi, Guatemala, India, Mauritania, Namibia, Pakistan, Papua New Guinea, Tunisia and Viet Nam) have reported achieving the prevalence targets for trachoma elimination.