TEHRAN — Concurrent with the 11th Festival of Ophthalmology and Visual Sciences of Professor Mohammad Gholi Chams (The father of modern ophthalmology in Iran and the founder of Farabi eye hospital) on February 21 World Health Organization (WHO) will laud Iran on elimination of trachoma, Mehr news agency reported.

Trachoma, a devastating eye disease caused by infection with the bacterium Chlamydia trachomatis, is spread through contact with infective eye or nose discharges, either directly from person to person, or mediated by flies. Active (inflammatory) trachoma occurs as a result of infection, and is common among preschool-aged children. Women are blinded up to four times as often as men, mainly due to their close contact with infected children.

Farzad Mohammadi, the coordinator of the event, explained that the Islamic Republic of Iran success in eradicating trachoma will be acclaimed by the WHO during the 11th Festival of Ophthalmology and Visual Sciences of Professor Mohammad Gholi Chams with Dr. Christoph Hamelmann, the WHO Representative in Iran in attendance. 

In late September 2018 WHO has validated the elimination of trachoma as a public health problem in the Islamic Republic of Iran. According to the WHO by achieving this milestone, the country becomes the third in WHO’s Eastern Mediterranean Region, after Oman in 2012 and Morocco in 2016, to overcome this centuries-old disease.

In a letter addressed to the Iranian Health Ministry, Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization, informed Iran that the country has successfully achieved elimination of trachoma as a public health problem.

The dossier of the Islamic Republic of Iran on elimination of trachoma as a public health problems which provides information on the current epidemiological situation of trachoma in the country and the systems for identifying and managing patients with trachomatous trichiasis was reviewed by an external Dossier Review Group (DRG) convened by the WHO Regional office for the Eastern Mediterranean, the letter reads. 

“I have the pleasure to inform you that based on the evidence provided in the dossier and the recommendation of the Dossier Review Group, WHO concludes that the Islamic Republic of Iran has achieved elimination of trachoma as a public health problem.”

Ghebreyesus highlighted that WHO recommends continued surveillance for trachoma and delivery of care for affected patients. 

Dr Ahmed Al-Mandhari, WHO Regional Director for the Eastern Mediterranean said that “WHO is pleased to have supported the Islamic Republic of Iran through the validation process.”

“But this achievement was made possible by the Government and people of Islamic Republic of Iran, who have worked tirelessly over decades to eliminate trachoma as a cause of preventable blindness and unnecessary suffering,” he added. 

Decades of fight against trachoma 

Trachoma was a major cause of visual impairment in Iran in the early decades of the 20th century.

In 1959, in rural areas of the district of Malayer, Hamedan province, two thirds of the population were infected by the disease. In 1961 a survey in the Dezful district, southern province of Khuzestan, showed that 91% of people were affected, including 62% with the active (inflammatory) form. At that time, prevalence in the capital, Tehran, was estimated to be 30–40%.

In 1972, tetracycline ointment was introduced as an essential medication in the Health facilities of Iran, and people, who needed it for treatment of active trachoma, were provided with free of charge ointments.

Ophthalmologists were trained during their residency programmes to perform surgical management of trichiasis: the advanced, sight-threatening form of trachoma. Health education campaigns designed jointly by the Ministry of Health and the Ministry of Education, including messages about washing hands and faces, were delivered as part of broad-based hygiene improvement initiatives in preschools and primary schools.

In 2013 and in an attempt to speed up the elimination process an awareness-raising programme in more than 20 000 schools in regions and localities endemic for the disease was introduced which benefited the regions by enhancing students’ school personnel’s, and parents’ as well as communities’ health. 

Meanwhile, the Steering Committee for the National Water Programme, a joint committee of the Ministry of Energy and the Environmental Health Centre of the Ministry of Health, allocated $500 million to improve water supply and sewerage systems in remote areas.

In 2004, assessments were undertaken in rural areas of four provinces (Bushehr, Kerman, Hormozgan, and Sistan-Baluchestan) in the southern and southeastern Iran, where trachoma was last recognized as a problem. These surveys showed nearly a complete absence of disease. Active trachoma was only seen in Sistan-Baluchestan, where less than 1% of children were affected by the disease.

In 2012–2013, a population-based prevalence study in rural areas of Sistan and Baluchestan re-estimated the prevalence of trachoma at 0.6% of children.

Trachoma is known to be a public health problem in 41 countries, and is responsible for the blindness or visual impairment of about 1.9 million people. In 2016, 190.2 million people lived in trachoma endemic areas and were at risk of trachoma blindness. 

Transmission is associated with poor sanitation and hygiene, which increase eye discharges and encourage the breeding of flies.

MQ/MG