Population (est. 2004):  10,852,147
Human Development Rank:  156th out of 177

Burden of Trachoma (estimated):
TT Prevalence (2000) – 2%
Trichiasis:   90,000
TF Prevalence (2000) -- 7.5% 
Active Infection:  320,000
At risk of infection:  6 million
# Districts in Senegal -- 63
# Trachoma-endemic districts – 17
# Graduated Districts – 0
Target date for elimination of blinding trachoma:  2015

National Program for Trachoma Control:
Trachoma Control Program began in 2004
National Program Coordinator: Boubacar Sarr
 

Eyelid Surgeries and Antibiotic Treatments in Senegal  --- 2004-2008

SAFE Partners in Senegal

                                                       PARTNERS

National Blindness Prevention Program, Ministry of Health: Overall program coordination
and management
AmeriCares: Reception and clearance of Zithromax
WHO: Prevalence survey design
HKI: Behavioral change communications
Organisation pour la Prévention de la Cécité (OPC): Surgery
Ministry of Water (MOW): Water provision

Major Accomplishments, Developments and Challenges during 2007

Introduction

      It was in 2005 that the program truly got underway with the first Zithromax distribution campaign.  The campaign was to take place in 2004, but problems related to the decentralized nature of the program and the heavily bureaucratic climate in Senegal caused several delays.  Though obstacles still remain, the TCP program continues has continued to move forward during 2007, and will undoubtedly move forward at a more rapid rate in the future since some of the major obstacles have been overcome.

Trichiasis Surgery and Antibiotic Distribution:

• Surgery:  The TT Surgery target for 2007 was set at 6,000 --- 2,114 TT Surgeries were completed (35% of the target).  Early in 2007, funds from a private foundation finally become available to the Trachoma Control Program and were specifically targeted to increase the uptake of TT surgeries in the district of Thiès.  The goal of this project is to eliminate the backlog of trichiasis surgeries in Thiès, a district that has always had a very weak performance with regard to TT surgeries, operating on less than 1,000 cases per year from 2000 until 2006.  The results of the project are quite promising:  during 2007 (nine months of activity since the project started only in March 2007), 1,049 TT operations were completed in Thiès alone!   In all the other program districts, 1,065 TT Surgeries were carried out during this same period.

• Antibiotics:   One district that was not able to complete its distribution in 2006, distributed 212,164 Zithromax treatments during Q1.  The target for 2007 was 775,000 Zithromax treatments, but the districts scheduled for distribution during 2007 Q3 were not able to carry out the MDA.  Unfortunately, protracted bureaucratic difficulties with Customs and the Finance Department delayed the release of the Zithromax that had been shipped. Exorbitant taxes were demanded by the government, amounting to 2.5% of the value of the shipment. A waiver of this tax has been requested by Pfizer West Africa that is responsible for receiving and storing these shipments; negotiations are still ongoing. 

Burden of Disease Surveys:  Prevalence surveys were not carried out as planned during 2007 in Darou Mousty and Linguère.  Although it would have been possible to mobilize the necessary resources for these surveys, they were postponed due to the bureaucratic problems mentioned above that kept the Zithromax treatments unavailable for the planned 2007 MDAs.  

Face Washing and Environmental Improvement:

      Much has been done and continues to be done in the area of water, sanitation, and hygiene in the country.   The work is being carried out by the Government of Senegal with the support of a variety of national and international agencies.  The trachoma program focuses on the S and A components of SAFE and piggybacks onto the work of the extensive water and sanitation community in the country to address the F and E components at little additional cost. A telling statistic is that 90% of the country’s population need to travel 200 meters or less to meet their household water needs.  This is a testament to the important work already being done in water and sanitation and justifies the program’s emphasis on S and A.  Unfortunately, during 2007, there was minimal activity in the F&E components due to lack of financial and human resources.  

Lessons Learned/Solutions Proposed

• Surgery:  In order to increase TT surgery uptake, relays of Community Volunteer Teams have proven useful in order to recruit TT patients.  The current strategy will be revised to make greater use of the Head Nurses at the health clinics for TT operations.  A mobile team will be equipped for each district to facilitate the organization and realization of more surgery campaigns.  Such district mobile teams will guarantee more flexibility in scheduling and implementing the surgeries.  This new strategy is being utilized in the Thiès TT Surgery Project mentioned above.

• Zithromax Distribution: Before scheduling an MDA, it is important to verify that the shipment of Zithromax will be ready for use at that time.  A certain lead time is needed to ensure that all administrative details have been taken care of, and that adequate personnel will be available for the scheduled MDA.

Face Cleaning & Environmental Improvement:  A workshop focusing on the F&E components of the Trachoma Control Program’s district leaders was held during Q2 2007.  The purpose of this workshop was to ascertain existing resources and needs in these two components of the SAFE strategy that have not been given much attention until now due to lack of financial and human resources.  To overcome this obstacle, a similar funding mechanism to the one found in 2006 for the distribution of Zithromax will be sought to ensure the implementation of valuable F&E activities.