Researchers have discovered ongoing transmission of trachoma, a leading cause of blindness, in several districts of Mozambique despite years of intervention efforts. The study combined clinical examinations, Chlamydia trachomatis infection testing, and antibody serology to gain a comprehensive understanding of trachoma prevalence and transmission in four districts. The findings highlight the need for continued vigilance and a coordinated approach to tackling this neglected tropical disease.
A Persistent Challenge in Mozambique
Trachoma, a contagious eye infection caused by the bacterium Chlamydia trachomatis, remains a major public health concern in many parts of the world, including Mozambique. Despite global efforts to eliminate trachoma as a public health problem by 2030, some districts in Mozambique have continued to struggle with persistent or recrudescent (resurgent) cases of the disease.
Uncovering the Full Picture
In this study, researchers conducted an enhanced trachoma impact survey in four districts of Mozambique, incorporating additional diagnostic tools beyond the standard clinical examinations. They tested for the presence of Chlamydia trachomatis infection in children’s eyes and measured the levels of antibodies against the pathogen in their blood.
Persistent Transmission in Unexpected Places
The results were surprising. Three of the four districts had trachomatous inflammation-follicular (TF) prevalence below the 5% elimination threshold, indicating progress in their trachoma control efforts. However, the researchers found that ocular Chlamydia trachomatis infection and antibody levels were still relatively high in these districts, suggesting ongoing transmission of the disease.
The Importance of Comprehensive Monitoring
The study highlights the value of incorporating additional diagnostic tools, such as infection testing and serology, alongside the traditional clinical assessments. These complementary measures provided a more comprehensive understanding of trachoma transmission in the study districts, revealing that the decline in clinical signs of trachoma did not necessarily reflect a true reduction in Chlamydia trachomatis infection.
Addressing the Underlying Drivers
The researchers also examined the local water, sanitation, and hygiene (WASH) conditions in the study districts, as these environmental factors are known to play a crucial role in trachoma transmission. They found that the district with the highest trachoma prevalence also had the poorest WASH infrastructure, with a large proportion of households relying on open defecation and lacking access to basic hygiene facilities.
Towards Sustained Elimination
The findings from this study underscore the importance of continued vigilance and a multifaceted approach to trachoma elimination. While some districts in Mozambique have made progress, the persistent transmission of the disease in others highlights the need for a more comprehensive and sustained effort to address the underlying drivers of trachoma, including improving WASH conditions and strengthening surveillance and response mechanisms.
By incorporating advanced diagnostic tools and a holistic understanding of the local context, the researchers have provided valuable insights that can guide Mozambique’s trachoma control program and contribute to the global effort to eliminate this neglected tropical disease.
Author credit: This article is based on research by Henis Mior Sitoe, William E. Oswald, Felizmina Zita, Mawo Fall, Tamimo Momade, Molly W. Adams, Rebecca M. Flueckiger, Scott McPherson, Sabrina Eyob, Thuy Doan, Thomas M. Lietman, Benjamin F. Arnold, Karana Wickens, Sarah Gwyn, Diana L. Martin, Mabula Kasubi, Sarah Boyd, Ana Bakhtiari, Cristina Jimenez, Anthony W. Solomon, Emma M. Harding-Esch, Upendo J. Mwingira, Jeremiah M. Ngondi.
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