Mali: achieving success along the path to trachoma elimination

Trachoma, the world’s leading infectious cause of blindness, affects over 300 million people globally. Caused by the bacterium Chlamydia trachomatis, the disease thrives in environments with poor access to water, sanitation, and hygiene. It is spread from one person to another by eye-seeking flies, and by sharing cloths used to wipe the eyes and hands. Repeated or persistent infection can lead to lid scarring and the inward-turning of the eyelid, so that each time a person blinks their eyelashes scrape against the globe of the eye. This incredibly painful condition, known as trichiasis, damages the cornea and eventually leads to blindness. The World Health Organization has endorsed the implementation of the SAFE Strategy, which is a combination of activities designed to eliminate blinding trachoma. S stands for surgery of the upper eyelid to correct trichiasis and preserve sight. A stands for the mass distribution of antibiotics (Pfi zer-donated Zithromax®, and tetracycline) to clear the eyelid of active infection. F stands for facial cleanliness to reduce the presence of infectious ocular and nasal discharge. E stands for environmental improvement to improve household access to water and latrines for better sanitation and hygiene. Implemented concurrently and successfully, the four components of the SAFE Strategy provide endemic countries with the tools needed to achieve trachoma elimination. Mali, a land-locked country with 16.8 million people in West Africa, has historically been a country with a heavy burden of trachoma. In the late 1990’s, the prevalence of active trachoma – also known as follicular trachoma (TF) – was found to range from 23.1% to 46.7% and the prevalence of trichiasis to be 2.5%. This evidence led to the implementation of a trachoma control programme through the National Blindness Prevention Programme (PNLC) in 1998. Since its inception, the PNLC has made signifi cant progress towards the goal of eliminating trachoma as a cause of blindness by 2015, ahead of the global elimination date of 2020. With support from a multitude of partners, the PNLC has become a leader in trachoma elimination across sub-Saharan Africa. Mali’s military coup d’état in March 2012 resulted in the loss of signifi cant donor support to its government, the seizure of the three northern regions (Gao, Kidal, Tombouctou) from the rest of the country, and unprecedented political and social instability. However, the persistence of the PNLC, together with continued fi nancial support from some partners, ensured that their important work continued in all accessible areas during this diffi cult time.