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Lutte contre le trachome en Afrique subsaharienne

Anne-Marie Moulin
Jeanne Orfila
Doulaye Sacko
et al.

Part One. Synopsis and recommendations. English Version


Texte intégral

1In 2001, under the leadership of Philippe Lazar, the Institut de recherche pour le développement embarked on a series of expert group reviews. An expert group review aims at providing policy makers, on request, with a summary of the most recent, authenticated data from the scientific community in the various fields of particular importance for the development of countries in the southern part of the world. This information often arises from several branches of learning. As far as possible, the expert group review aims to bring together experts covering all aspects of a particular problem.

2Health is one of the priorities of development. Trachoma is a disease that imposes a very heavy burden on developing countries, especially in sub- Saharan Africa. It is an eye infection of the conjunctiva, causing blindness after several years of evolution in a certain number of cases.

3Three sets of circumstances argued in favor of an expert group review into trachoma in the Sahel countries and especially Mali:

  • the accumulation in recent years of accurate scientific knowledge about the cycle of the disease, from the biological and social science aspects,
  • the WHO’s option of a new strategy in fighting trachoma, using recent scientific data. The “SAFE“ strategy, adopted in 1997, is now beginning to be applied in several countries,
  • the willingness of the Malian government to take an energetic action in fighting the curse of trachoma, a source of suffering and disability.

4Trachoma, still currently the second cause of blindness in the world, can be prevented and treated. It survives in many countries because conditions favoring it are closely related to poverty and underdevelopment.

  • 1 A national survey, carried out in 1996, showed that one child in three suffered from active tracho (...)

5In certain West African countries, trachoma affects a third of children under 10, and causes blindness in many adults. Mali, particularly afflicted, has drawn special attention to this serious problem1.

6The Institut d’ophtalmologie tropicale de l’Afrique, IOTA, founded in 1954 in the Malian capital, Bamako, has, among its missions, informing health workers in the local countries about eye infections. In recent years, it has been particularly involved with trachoma.

7The Malian government carefully monitors the deployment of the WHO’s 1997 strategy. It has initiated a national trachoma control program. From the outset, the Malian minister for health has been keenly interested in conducting an expert group review that would place at the disposal of the principal actors and policy makers all the information needed to organize the fight against trachoma in the best possible way. He has offered to jointly finance the review with the IRD and IOTA.

8After negotiations with the World Bank and the European Union, a financial arrangement concluded with the assistance of the IRD resulted in a preliminary workshop in February 2002, which collected the important questions to be resolved by the specialists from representatives of policy makers. The specialists are international, coming from Mali, Burkina Faso, the USA, France, etc. They are expert in various subjects (ophthalmology, microbiology, epidemiology, public health, history, anthropology, economics, etc.) whose complementarity for tackling trachoma continued to be confirmed during the review.

9Questions from representatives of the various Malian ministries (concerned with health, women and the family, hydraulics, the environment, and education) were lengthily discussed by the specialists, and twenty-six questions were divided into three sets: epidemiology (8 questions), social sciences and hygiene (11), control strategies (7).

10The questions, jointly selected by the Malian authorities with operational responsibility and the specialists aware of the state and limits of scientific knowledge on the subject, were used to establish the specifications set out in the agreement signed by the IRD and the Malian government. They were shared between the specialists. There is abundant documentation, which has been used and analyzed critically.

11Three meetings of specialists were held in Bamako in December 2002 and June 2003 and in Paris in September 2003. A final workshop in November 2003 discussed the first version of the synopsis in a plenary session and wrote recommendations agreed by all the specialists.

12The synopsis, approved by the group, contains general information about the current state of knowledge on trachoma (physiopathology, clinical and laboratory, epidemiology, history, anthropology and the economics of health), followed by answers to the questions raised by the policy makers in the form of short summaries and related recommendations.

13The specialists have endeavored to envision the questions posed in the most concrete form possible. However, the practical translation of the recommendations is obviously the job of authorities receiving the report.

14Setting up and implementing a national trachoma control strategy is a full-scale operation that will doubtlessly contribute invaluable information about the disease.

15This report represents a document without precedent in its effort to summarize an infection that has not yet sufficiently attracted the attention of the public. It is primarily intended for the Malian government, which has followed the progress of the survey with great attention. Its conclusions and recommendations, together with explanations as clear as possible, should also interest neighboring governments affected by trachoma. It is also intended for international and nongovernmental organizations, and all local people working on eye infections and blindness.

16Written with the double goal of legibility and scientific accuracy, it should provide all those working on durable development with information for thought. It should give hope that a curable and preventable disease, which disappeared from Western Europe a short while ago, will finally pass into the pages of history. We hope that by interesting a wide audience in a little known disease with a low media profile, it will help to mobilize opinion.


1 A national survey, carried out in 1996, showed that one child in three suffered from active trachoma.

© IRD Éditions, 2006

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