Trachoma in Nepal

Population (est. 2004): 27 million
Human Development Rank:  142 out of 177

# Districts in country:  75
# Endemic Districts:  9  
# “Graduated” Districts: 5 (Kailali, Kanchanpur, Surkhet, Chitwan, and Nawalparasi) (as of 12/31/07)

# SAFE Program Districts in 2008:  10
Target Year for Elimination of Blinding Trachoma:  2010

Burden of Trachoma (estimated):  57,000

Trichiasis Backlog:  32,817 (as of 12/31/07)  

Active trachoma:  10.6 % from 24 population-based
trachoma prevalence surveys that have been completed
as of 2007 Q4.

National Trachoma Program began in 2002

Program Director: Mr. BB Thapa

Eyelid Surgeries and Antibiotic Treatments in Nepal
(2002-2008)
 


SAFE PARTNERS IN NEPAL 

Partners
NNJS= Nepal Netra Jyoti Sangh, 
MOHP = Ministry of Health and Population
DWSS = Department of Water Supply and Sewerage, Ministry of Housing and Physical Planning
Swiss Red Cross = SRC
HKI = Helen Keller International Nepal
UNICEF

Major Accomplishments, Developments and Challenges during 2007

Introduction

The SAFE activity is being implemented in the program districts according to the detailed implementation plan prepared and agreed upon with SAFE partners for 2007.  NTP has put tremendous efforts into getting funding for the implementation of the SAFE strategy during this year, and has succeeded in mobilizing national resources to implement the Surgery and Antibiotic components of the SAFE strategy in Nepal.

• Trichiasis Surgery:  The NNJS is the lead partner for implementation of the Surgery component. The NNJS eye hospitals organized outreach TT surgery camps and performed surgeries both from cataract camps and outreach TT surgery camps, targeting, in particular, trachoma cases in all program and non-program districts. During 2007, 1,477  surgeries have been performed against the 2007 national target of 2,000 (74%  % coverage).  In SAFE program districts, 822 TT Surgeries were performed against the 2007 target of 1,100 (75% coverage).

• Antibiotics Distribution:  The mass treatment with Zithromax is one of the major components of the NTP program in Nepal.  The NTP organized training program for all health paramedics for proper Zithromax dose calculation, treatment, side effect management, supervision, and for the monitoring of the Zithromax distribution campaigns in December 2007 and January 2008 in five  program districts (Rasuwa, Doti, Achham, Kapilvastu and Dang). During 2007, 2.5 million people were targeted for treatment in eight districts. Of the total 2007 target, 1,241,136 Zithromax treatments have been administered in three districts --- Surkhet, Dang and Kapilvastu.

            The respective District Public Health Offices from remaining SAFE districts will distribute Zithromax during the first and second quarters of 2008.  NTP received the first shipment only during the last week of October 2007, which delayed the start of the Zithromax distributors’ training, community sensitization, advocacy and distribution in the targeted districts. The district and village level MoHP network is an extremely useful and successful model for mass and targeted treatment in Nepal.   

Face Washing and Environmental Improvement

A total of 1,534 hand pumps / water taps have been installed in 2007 (96% of the targeted 1600), and 18,530  household latrines (109 % of the originally targeted 17,000) have been constructed in SAFE program districts.  As of the end of the last quarter, NTP had assessed clean faces in 8,000 children age 1-9 years old and 5,429 (68 %) clean faces were recorded.

The key messages on face washing and environmental improvement have been incorporated into the WATSAN IEC materials and disseminated through their regular training programs. Similarly, NTP printed trachoma handbills, trachoma brochures and face washing posters and disseminated them through DWSS all over the country. 

Identification of Disease Burden:

The NTP, along with its SAFE partners, has carried out detailed population-based trachoma prevalence surveys in 24 districts so far. During 2007, detailed surveys were conducted in Bajang, Bajura, Arghakhanchi, Rolpa, Dailekh, Jajarkot, Salyan and Pyuthan districts in the year 2007.

There is a plan to fully assess the trachoma disease burden throughout the country by the end of 2008 so that the actual planning for Zithromax treatments and TT surgeries will be identified. 

Lessons Learned/Solutions Proposed:

The NTP faced a big challenge during 2007 to mobilize financial resources for its existence.  However, the NTP succeeded in mobilizing national resources to perform TT surgeries and to distribute Zithromax in the country.  The budget necessary for face washing and environmental components, including human resources mobilization for SAFE coordination, is still unavailable to date.  The government of Nepal is committed to eliminating blinding trachoma from the country and has approved the necessary budget for the Antibiotic component.