Malawi becomes first country in southern Africa to eliminate devastating trachoma eye disease

The blinding disease

* I would like to pay special tribute to our wonderful community health workers, many of them women

*Who played an instrumental role in getting us here,  freeing millions of our citizens from so much misery caused by these diseases

* We may be the first in the Southern African Development Community (SADC), but we are determined not to be the last

By Duncan Mlanjira

Malawi has become the first country in southern Africa and the fifth in Africa to eliminate blinding trachoma as a public health problem — a disease that affected 9.5 million people nationwide in 2014.

According to world health experts, the disease is a devastating condition which can turn eyelashes inwards so that they scrape painfully against the eyeball – and left untreated causes permanent sight loss.

The elimination, announced on September 21, follows 12 years of sustained action led by the Malawi government with a network of support spearheaded by the non-profit Sightsavers.

It is the first country-funded by The Queen Elizabeth Diamond Jubilee Trust to achieve this milestone. The Trust was established in 2012 to create a legacy for late Her Majesty Queen Elizabeth II, by eliminating trachoma in the Commonwealth.

Receiving the good news, President, Lazarus Chakwera said he was “proud to lead Malawi’s celebration in defeating yet another neglected tropical disease”.

“This success in eliminating trachoma – the world’s leading cause of infectious blindness, coming so soon after our country celebrated the elimination of elephantiasis in 2020, shows the fight against neglected tropical diseases can be won.

“I would like to pay special tribute to our wonderful community health workers, many of them women, who played an instrumental role in getting us here,  freeing millions of our citizens from so much misery caused by these diseases.

“We now hope to replicate this success across other NTDs. We may be the first in the Southern African Development Community (SADC), but we are determined not to be the last.

I urge my fellow Heads of State to endorse the Kigali Declaration on NTDs and commit to its delivery as a gateway to ending NTDs,” he said.

Malawi’s announcement follows recent elimination successes in other African countries, that include Morocco, Ghana, The Gambia and Togo.

Trachoma is the second neglected tropical disease (NTD) Malawi has eliminated in recent years, following its elimination of lymphatic filariasis in 2020.

Bright Chiwaula, Sightsavers’ Malawi Director said “eliminating a disease on this scale is a massive achievement for our country”.

“Today, 9.5 million people are no longer at risk of losing their sight to trachoma thanks to hard work, commitment and collaboration between government, health workers, volunteers and organisations like Sightsavers.

“Malawi’s triumph provides hope and encouragement to our neighbours still working to eliminate the disease. To these countries I say: the strategy we are using works, keep going!”

Trachoma is one of the leading causes of blindness worldwide. It stops children going to school and adults from working, trapping people in poverty.

To achieve elimination, the Ministry of Health and its partners followed the WHO-endorsed SAFE strategy which combines surgery to stop eyelashes scraping the eye, antibiotics to prevent and treat infection, and facial cleanliness and environmental improvements to stop infection spreading.

The disease affects largely rural and marginalised communities. In the past 20 years, the number of people at risk of trachoma has dropped by 92%, from around 1.5 billion people in 2002 to 125 million worldwide today, according to recent WHO figures.

But there is still an urgent need to finish the job — the condition still affects people in more than 40 countries, the vast majority of whom are in Africa. 

Malawi’s trachoma elimination plan was supported by the UK Department for International Development (now FCDO) to carry out the initial mapping of the disease.

The grants were managed by Sightsavers with drug donations from Pfizer. Subsequent work to achieve elimination was also supported by Sightsavers.

In congratulating Malawi for this achievement, Sightsavers CEO, Caroline Harper said the “timing of this announcement is poignant, coming just after the death of Her Majesty Queen Elizabeth II”.

“It was her Diamond Jubilee Trust which provided so much support to the trachoma programme in Malawi, intended to form part of her legacy for the Commonwealth.  

“We hope that other countries – in the Commonwealth and indeed all nations affected by trachoma, as well as partners and donors will be inspired by Malawi to redouble their efforts to eliminate this horrible disease.“

Dr Matshidiso Moeti, WHO Regional Director for Africa said as former WHO Representative for Malawi and “someone who knows the country well, it is with great joy that now I have the opportunity to join in congratulating the Government of Malawi on their remarkable success in eliminating trachoma”.

“What Malawi has achieved can and must be repeated throughout the continent.”

Niesha Foster, vice-president, product access, global health & social impact at Pfizer Inc, said her Pfizer is committed to fighting trachoma and are thrilled to hear of Malawi’s recent elimination of the disease as a public health problem.

“We are proud to have supported this elimination through our antibiotic donation program with the International Trachoma Initiative, and as per our announcement at the Kigali Summit on Malaria and Neglected Tropical Diseases in June, remain committed to donating antibiotic treatments for trachoma through 2030 in countries that need them.”

Malawi’s trachoma elimination plan included:

● Working with thousands of volunteers, trained to go into their communities to distribute 22.25 million drug treatments of Zithromax®, donated free of charge by Pfizer Inc;

● Training local surgeons to manage more than 6,000 advanced cases of trachoma;

● Supporting more than 250 schools to adopt improved hygiene and sanitation programmes and encouraging children to use their influence to encourage their families and communities to do the same.

Sightsavers — a registered UK charity — is an international organisation that works in more than 30 low and middle income countries to end avoidable blindness, treat and eliminate neglected tropical diseases, and promote equality of opportunity for people with disabilities.

Sightsavers vision is of a world where no one is blind from avoidable causes and people with disabilities participate equally in society.