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 It was all part of the day's work for some of the thousands of
people who have completed what the organizers say is the largest
ever survey of an infectious disease, examining 2.6 million people
in 29 countries for the eye infection trachoma.
"They faced tribal warfare and rogue villagers in Papua New Guinea
who spread a rumor that the teams were vampires," said Anthony
Solomon, chief scientist of the Global Trachoma Mapping Project (GTMP).
"They worked in Ethiopia's Afar region, one of the most hostile
territories in the world in which to conduct community-based
research, amid sandstorms, temperatures of 50 degrees Celsius and
deadly venomous spiders," he added.
The scale and quality of the survey mean trachoma, an extremely
painful disease which causes blindness, could be eliminated by 2020,
according to the GTMP organizers - the World Health Organization,
the Carter Center, and the international NGO Sightsavers.
"We know where it is, we know how prevalent it is, so we know what
to do," said Tom Millar, who co-led the project. "We're very hopeful
it can now be eliminated."
Trachoma is one of 17 so-called neglected tropical diseases
earmarked by the WHO to be controlled, eliminated or eradicated by
2020.
It has partly or completely blinded at least 1.8 million people, and
affects some of the poorest and most marginalized rural communities,
the WHO says.
"In countries like Ethiopia (prevalence) is mind-numbingly,
shockingly high – in some communities over 50 percent of the
population have trachoma," said Millar, who is neglected tropical
diseases operations director at Sightsavers.
Before the survey began in 2012, only one region in Ethiopia had
received support for tackling the disease. "They did not know what
to do. They were just looking into a black hole.
"Now they've mapped the whole country and they almost have funding
and support to deliver all the interventions for the country,"
Millar said.
"They are now talking about when they eliminate trachoma."
EYES SCRAPED BLIND
The disease is spread through contact with infected clothing, hands
or flies, and affects communities with little access to clean water
and sanitation.
Repeated infections make a person's eyelashes turn inwards, so that
they scrape the surface of the eyes with every blink.
"It's a hugely painful way to go blind," Millar said.
More than 550 teams of health ministry staff in the countries
surveyed were trained to spot the disease and use smartphones with
GPS systems to record the data. They also recorded water and
sanitation levels.
Trachoma rates were lower than expected in some countries including
Nigeria, Laos, Cambodia and Egypt.
"A lot of that is because, since this was first looked at in the
1980s and 1990s, there's been a lot of social and economic
development ... that has helped reduce the spread of the disease,"
Millar said.
Not everywhere could be mapped. Eighteen countries had districts
where it was too dangerous, including Borno and Adamawa states in
northeastern Nigeria which had to be left out because of the
militant Islamist group, Boko Haram.
Quite large areas in Ethiopia's Somali Region could not be mapped
because of not safe to go there.
"Without mapping we cannot launch interventions," said Solomon, who
is medical officer for trachoma at WHO.
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"But I think that's ok. If there are bullets in the air the biggest
health problem is not the risk of blindness in 20 or 30 years' time,
it's something much more visceral and immediate," he added.
COUNTRIES SUPPORT EACH OTHER
As well as gathering quality data, the survey has helped develop
strong ties between countries where the disease is endemic.
"We now have a lot of countries officially supporting each other,
and need very little in the way of external support. It's very
important for ... trachoma elimination in a lot of these countries,"
Solomon said.
To eliminate trachoma, people living in areas with high levels of
the disease need up to five years of antibiotic treatment, given
once a year.
Between 1987 and 2012, about 1,100 districts in the countries at
risk were mapped, leaving a further 1,200 districts that were
suspected of having trachoma.
"In 2012 everybody realized that the biggest hurdle to elimination
was the fact that we only had about 50 percent of the data
required," said Millar.
So Solomon and Millar spent months gathering experts to help work
out the best way to gather reliable data at speed and on a massive
scale.
"It felt like pushing boulders up hills at the beginning, but once
you got it to the top it was fantastic, and we struggled to hold
onto it on the way down the hill as the momentum has taken over,"
Millar said.
"The challenge now is: how does it encourage new funders to the
table to make sure that we get over the line and do eliminate by
2020," he added.
The quality of the survey's data means many districts have already
been enrolled to receive free antibiotics donated by Pfizer
pharmaceutical company through the International Trachoma
Initiative.
"If you're going to make an impact you've got to have the detailed
information ... and I don't see anything that's better than this
(survey)," said David Molyneux, professor at the Liverpool School of
Tropical Medicine.
Molyneux led a team of scientists that crisscrossed Nigeria checking
for guinea worm, declaring the country free of the disease in 2013.
He was also involved in a campaign to eliminate river blindness in
West Africa.
The app developed for the trachoma survey is also being trialled for
gathering information about other diseases on WHO's list, including
schistosomiasis, yaws, soil-transmitted helminth infections and
guinea worm disease.
(Reporting by Alex Whiting, editing by Tim Pearce. Please credit the
Thomson Reuters Foundation, the charitable arm of Thomson Reuters,
that covers humanitarian news, women's rights, trafficking,
corruption and climate change. Visit www.trust.org)
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