부산대학교 도서관

Trachoma is the leading infectious cause of blindness in the world and has been known to be a major public health problem in The Gambia for over 60 years. Nationwide blindness surveys, including trachoma, in 1986 and 1996 provided the foundation for a comprehensive plan to implement a trachoma elimination strategy. Impact and pre-validation surveillance surveys in 2011–13 demonstrated that active trachoma was below WHO threshold for elimination but trichiasis remained a public health problem. Trichiasis-only surveys in 2019 demonstrated that trichiasis was below WHO thresholds for elimination and in 2020 the Government of The Gambia completed and submitted its dossier for validation of elimination as a public health problem. Challenges that The Gambia faced on the pathway to elimination included effective use of data for decision making, poor trichiasis surgical outcomes, lack of access to antibiotic treatment for low prevalence districts, high attrition of ophthalmic nurses trained as trichiasis surgeons, unexpected active trachoma in madrassas, the misalignment of elimination of active trachoma and trichiasis, trichiasis in urban settings, and maintaining the quality of surgery post-elimination when trichiasis cases are rare. Elimination of trachoma does not end with the submission of an elimination dossier; The Gambia will need to sustain monitoring and support over the coming years. Author summary: The World Health Organization has validated that trachoma is no longer a public health problem in The Gambia as of April 2021. In this article, the authors summarize critical milestones achieved by The Gambia in its journey to elimination and the challenges to implementing the WHO-endorsed elimination strategy, including surgical management for people with trichiasis, antibiotics to all endemic communities, and uptake of face-washing practices and environmental improvements. In 1986, a national survey of blindness and low vision in The Gambia found that 17 per cent of blindness was caused by trachoma in the form of corneal opacity due to trichiasis. At this time, eye health services delivered by a trained eye health were limited to the Greater Banjul area, meaning people in remote locations were frequently left behind. This changed with the coordination of partners and donors strengthening the knowledge base of health workers on trachoma preventative measures and the capacity of ophthalmic nurses to deliver trichiasis surgical support to all trachoma-endemic communities. Final epidemiological surveys conducted in 2019 confirmed that there was sufficient evidence to show that elimination thresholds had been achieved all endemic areas prompting the formal submission of the country's elimination dossier to the WHO. [ABSTRACT FROM AUTHOR]