Indian Journal of Ophthalmology

: 1958  |  Volume : 6  |  Issue : 1  |  Page : 17--20

Trachoma control pilot project


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The Trachoma Control Pilot Project which is run by our Government through the Indian Council of Medical Research with the assistance of the WHO and UNICEF presented its second report last year. The director of the Project is Dr. Mohanlal and the Project is administered through the Muslim University Institute of Oph­thalmology, Aligarh.

Dr. Radovanovic, the senior WHO officer to the project heading a team of four other local officers, supported by a team of auxiliaries, carried out the preliminary survey programme from which certain very interesting conclusions have been drawn. The survey covered 29 villages (22,000 population) that were predominantly Hindus and also 3 (1,800 population) which were predominantly Maho­medans.

Objectives : The Government, with the assistance from the WHO and UNICEF, has the following objectives in connection with this plan

1.To develop an initial programme for a mass campaign against com­municable eye diseases through Primary Health Centres in the States of Rajasthan, Punjab and Uttar Pradesh by covering a total of 500,000 people and to integrate these activities within the general public health services of the coun­try;

2.To give additional training in con­trol measures against communic­able eye diseases to the ophthal­mologists, general physicians, nur­ses and auxiliary nurse-midwives in order to standardise methods of examination, diagnosis, treatment, recording, statistical analysis and evaluation - as required by the development of the campaign;

3.To continue in sectors of the com­pleted pilot project, well controlled trials of simplified or more econo­mical methods of treatment as the development of the activities may indicate;

4.To continue clinico-laboratory re­search by a study of the types of trachoma found in different parts of India;

5.To introduce at all levels a pro­gressive programme of health edu­cation in the light of the experi­ence obtained during the pilot project;

6.From the experience so gained to consider a country-wide national programme of mass control which would be effective, practicable and economically sound.

 The Programme

The programme included

1. A bacteriological survey of five villages (population 2,700) that were to act as controls.

2. The fly problem, keeping a quali­tative and quantitative estimation of the fly population.

3. Treatment survey (a) including pilot mass short-term treatment. It was given over a period of 3 months in 2,650 active cases with checks immediately on cessation of treatment and a second check 6 months later.

(b) School Programme in 42 schools (4,000 students), with eight schools (150 students) as con­trol. Treatment survey in 725 active cases was also carried out.

4. Propaganda and Health Education.

5. Statistic work.

By this project India has entered into the arena of trachoma as a world problem. As such it was necessary to study the clinical and epidemiological characteristics of trachoma in the dif­ferent parts of India since such charac­teristics may differ not only in different parts of the world but in different parts of India.

To start with, the group studied mostly the incidence and the clinical aspects only in Uttar Pradesh. Their conclusions are interesting and the con­clusions having been subjected to a statistical analysis for the first time are highly significant.

Among the important factors of the basic epidemiology of trachoma are, the relative incidence, severity and in­fectivity of trachoma in different age groups, the pattern of the disease with­in the family, the common source of infection and mode of transmission, depending upon such factors as environment, awy if life etc.

In view of these facts the first step was a preliminary epidemiological survey of the incidence and pattern of trachoma and factors favouring trans­mission of infection.

 Age Incidence

The age group 0-10 years proved to be the most significant in infection of the stages of Trachoma I, II and III. The age of onset is below one year (the earliest being 6 to 7 months) but mostly from 1-3 years in Trachoma I; Tra­choma II was found frequent a little later. It was also found from the surveys made in the States of Rajasthan, Punjab and Uttar Pradesh that there is no significant difference in incidence between the States.

 Sex Incidence

There is a very significant difference between males and females in the stage of Trachoma III. Among males, by the age of 25 less than 5% were found to be suffering from active trachoma, whereas among the females, the figures were higher and not until the age of 45 were they as low as 25%.

 Clinical Picture

In the cases taken in the age group 10-15, it was found that for Trachoma I and II there is no greater significance between males and females. From 15, the severity among females is much higher than in males. The same also holds true as far as cicatrices are concerned.

 Corneal Neovascularization and Infiltration

Again, the percentage is significantly much higher in females than in males.


Catarrhal conjunctivitis is usually most frequent up to 10 years. Compli­cations due to conjunctivitis show con­siderable increase with age and among women are higher than among males. Complications due to conjunctivitis alone are higher than those due to trachoma alone. Very often, however, the picture is combined, leucoma, sta­phyloma, trichiasis, entropion, etc., are all more frequent in females.

 Impairment of Vision

Attempts had been made to compare impairment of vision due to (1) tra­choma, (2) conjunctivitis, and (3) all other causes. Up to the age of 50, im­pairment of vision due to trachoma and associated bacterial infection was much higher than by other causes. By the age of 55, other causes became higher due to cataract, etc. In females, im­pairment of vision was higher than for males due to trachoma and other infec­tions.

 Socio-Economic Factors

(a) Habits of taking daily bath Among people taking daily baths the prevalence of active trachoma was higher than in those taking baths occa­sionally.

(b) Women working at home and on the land : Between the age of 25 and 55 there are about 15% of females working on the land. As regards those working at home, from the age of 20 up to 40-45, nearly 90% of the female population spend at least two hours a day cooking at open stoves exposed to smoke. This is also the age group suffering most from active trachoma.

(c) Different religions and active trachoma : It has often been stated that among Muslims there is a higher prevalence of trachoma. However, the figures do not show any significant dif­ference of trachoma between Muslims and Hindus.

(d) Cleaning habits of the people and active trachoma : There was no marked difference of incidence as a re­sult of the different ways people have of wiping themselves - some with towels, some on their saris or dhotis and some not at all. Those using a towel show a lower figure than those not wiping at all or wiping with a sari or dhoti.

(e) Economic level of the people and active trachoma : According to the local standards there was no significant difference in incidence between the poor and the middle and better off.

(f) Literacy and active trachoma incidence of active trachoma is higher among the illiterate than the literate, and higher among illiterate women than men.

(g) Use of eye cosmetics and active trachoma : In the method of application the effect of the same stick being used for several children did not prove to be so significant as had been presumed. The practice of using eye cosmetics in India, particularly among females, is very common and had been thought to play a very important part in transmission of infection; survey figures indicate however that there is no greater incidence in those who use cosmetics.

(h) School attendance and active trachoma: Children not attending school, both male and female, suffer more from active trachoma than those attending. This shows the very limited importance of the school programme alone in a mass campaign.

 Causes Contributing to the Transmission of the Disease

Surveys were made on people shar­ing beds with other people who have active trachoma and people sleeping alone, and children sleeping with non-trachomatous people. The figures show­ed 90% active trachoma among people sharing beds with other people with trachoma.

 Second Survey

Dr. Radovanovic further demonstra­ted findings of a second survey that had been carried out in five villages over a period of 12 months on associated conjunctivitis and trachoma.

(i) Seasonal conjunctivitis and trachoma : Acute and sub-acute con­junctivitis - the incidence rises in March, April and May and again by the end of the monsoon season in August and September.

(ii) Koch-Weeks : Was found fre­quent especially during the seasonal peak in the month of April. The high­est figures of symptomless 'carriers' were found in January.

 Fly Problem

The two most important flies in trans­mission of trachoma are M. sorbens and M. nebulo. The seasonal preval­ence indicates that sorbens increases in April and May and again in August -September. (In North Africa it was also found that sorbens, and particularly the female sorbens, was the most important factor in conjunctivitis in children).

 Treatment Programme

Two programmes had been called for in the plan of operations - (a) the pilot school programme and (b) the pilot mass campaign.

(a) Pilot school programme : In the schools, treatment was carried out every day, twice a day, during a period of 60 days.

A slight modification had to be made to the programme due to inaccurate data being supplied by the district school authorities, who gave the num­ber of children attending school too high.

As regards co-operation of school­teachers, there is every indication that this may be considered promising for the future. They are willing, provided the right approach is made.

The intermittent method of treat­ment proved to be very economic and practicable.

(b) Pilot mass campaign : This first experience with treatment of villagers showed that co-operation of the people in general was satisfactory. In all the villages where the survey was carried out (except in the five which were under the repeated monthly survey) all the villagers were submitted to treat­ment which was carried out twice daily on three consecutive days at fortnightly intervals with aureomycin 1% oint­ment. This was a preliminary attempt only, as there was very little epidemio­logical data available at that time.

Under supervision, treatment was carried out fairly satisfactorily by the auxiliary personnel, after some early difficulties had been straightened out. The total number of people treated was approximately 2,000 adults and 1,500 school children. In view of the different stages of trachoma, insufficient follow- up period and many other factors, it would be premature to base any sound conclusion on these 3,500 cases.

The treatment programme of the first year should be considered as a prelimi­nary step and should be given a follow-up period of one year. The experiences of the first year have shown the way of approach to the people and given valuable data for the future plan of action of the project and for the mass campaign which will follow the pilot project period.

 Health Education

The film 'Care of Eyes had been shown in some villages so that the people could see what was going to be done to them. This helped in getting good co-operation for them.

Thus the aims of the first year of work of the pilot project had been achieved and were enough for the Government to take action, and pre­pare a plan for subsequent years.