Truly the light is sweet, and a pleasant thing it is for the eyes to behold the sun (Ecclesiastes 11:7).
Sadly, over 7,000 people in the sunny Kajiado County have been denied this pleasant experience, their eyesight either having been compromised or completely destroyed by trachoma – an infectious eye disease caused by bacteria that may result in blindness after repeated re-infections. Kajiado has been named as one of the trachoma-endemic counties in Kenya where every person is at risk of contracting the disease.
In a remote corner of the county, 28-year-old Sioyomit Kinyut has walked across five kilometres of dry savannah with her five children aged between two and seven years to a makeshift medical camp set up under the shade of a large indigenous tree, where hundreds of community members have convened to receive preventive treatment for trachoma. Though she does not suffer from the disease, which is rampant in her traditionally pastoral community, she has attended the medical camp to receive preventive medicine.
Trachoma is the world's leading cause of preventable blindness. It is easily spread from one person to another and occurs where people live in crowded conditions with numerous flies and limited access to water and health care. Trachoma is a neglected disease, highly associated with poverty and most prevalent in pastoral communities including Kajiado County. Infection usually first occurs in childhood with the disease progressing over years as repeated infections cause scarring on the inside of the eyelid, earning it the name of the “quiet disease”. The eyelashes gradually turn inwards and rub on the cornea, which becomes scarred, leading to severe vision loss and, eventually, blindness.
According to a survey carried out in 2004 by Kenya’s Ministry of Health, AMREF and other key eye care partners in Kenya, active trachoma prevalence in Kajiado County stood at 28.1%, way above the WHO recommended threshold of 10%. Illiteracy, poverty and environmental factors such as acute water shortage were identified as contributing factors.
Sioyomit is a health worker trained by AMREF. She visits homes in her village to teach members of her community about hygiene and cleanliness, and the proper way to dispose of waste to keep flies away. Traditional Maasai houses are poorly ventilated. In the often dusty environments, children easily get dust blowing into their eyes while shortage of water inhibits hygiene.
Sioyomit recognises that education is key to the prevention of trachoma. “Some of the women had initially refused to take the preventive drugs, saying that they cause nausea or for superstitious reasons.” But such perceptions are changing, she says, as people recognise the fact that a person suffering from trachoma cannot be economically productive and that if it is not treated on time, trachoma can result in irreversible blindness.
About 67,000 people live with trachoma in Kenya, with more than 2.2 million at risk of infection. To address this situation AMREF, in collaboration with the Government of Kenya, is implementing the Integrated Trachoma Control Project using the World Health Organisation’s prescribed SAFE strategy within the counties of Samburu, Laikipia and Kajiado. SAFE is a comprehensive public health approach that combines treatment (Surgery and Antibiotics) with prevention (Facial cleanliness and Environmental improvement).
“Our aim,” says Mr Francis Dikir, Manager of the Integrated Trachoma Control Project, “is to completely eliminate blinding trachoma in Kenya or at least get the prevalence for active trachoma to below 10% by 2020.” He explains that active trachoma prevalence has dropped from 28% to 17.4% in the last five years largely due to vigorous and effective national annual trachoma Mass Drug Administration (MDA) campaigns and activities to improve access to water, sanitation and hygiene.
As a cost-cutting and value addition measure, the mass treatment campaign, which began in 2007, was carried out concurrently with a measles vaccination and vitamin A supplementation drive for children aged five years and below. This was a collaborative effort between the Government and non-governmental stakeholders including AMREF, Sight Savers International, Kenya Society for the Blind, Pfizer Inc, International Trachoma Initiative and Tata Chemicals Ltd (formerly Magadi Soda Company).
By 2013, the project hopes to have reduced the prevalence of active trachoma to less than 10% in the three earmarked counties ultimately contributing to global efforts to eliminate trachoma by 2020.
AMREF is a transparent organisation distributing funds of up to $85 million per year.
