A Good Problem: Why New Training Methods are Needed to Eliminate Trachoma

28 Jul 2023
Participants gather for a global 'training of trainers' event in Nairobi, Kenya, using the newest photo-based training methods. Photo credit: RTI International

By Jeremiah Ngondi, RTI International and Caleb Mpyet, Sightsavers

Globally, around 116 million people are at risk of a disease that can leave their eyes scarred and blinded. This painful neglected tropical disease (NTD) is called trachoma. It thrives in places where clean water is scarce, sanitation is poor, and flies buzz around.

The good news - since 2002, the World Health Organization (WHO) estimates there has been a 92% reduction in the number of people needing treatment for trachoma. Already, 17 countries have successfully eliminated trachoma as a public health problem. Just this spring, Benin and Mali achieved elimination of trachoma as a public health problem.

As even more countries get closer to eliminating this NTD, a new challenge is emerging: How to keep the health workforce well-trained on identifying signs of trachoma, given that there is less and less of the disease around the world. For health professionals, training typically involves a mix of textbook learning and real-world clinical experience. But what do you do when cases of trachoma are harder to find?

Earlier this month, the Tropical Data program piloted a new form of training that will help to overcome this problem. We went back to the classroom with a global refresher course for more than 93 health professionals from 33 countries, all who are championing efforts to eliminate trachoma.

Global Efforts to Eliminate Trachoma

Let’s start with how we got here. In the early 2000’s, there was little information on the prevalence of trachoma around the world, except for WHO's list of countries considered endemic for the disease. In 2012, the Global Trachoma Mapping Project was born to support health ministries in undertaking the world’s largest disease survey to map trachoma, district by district.

This effort established a clearer picture of where trachoma was prevalent, and gave health ministries the information they needed to create targeted strategies to eliminate it. In order to be confident in these assessments, there was also a global investment in training health workers to identify trachoma and collect and record that data.

With a global map of trachoma (minus a few exceptions due to insecurity) and a trained health workforce, we knew we couldn’t stop there. That’s how Tropical Data emerged as a global initiative, which could continue to support health ministries in assessing the impact of their trachoma programmes while providing training to health workers to ensure that countries were collecting high-quality data for decision-making. Today, 50 countries around the world have partnered with Tropical Data in supporting nearly 3,500 trachoma surveys.

Tailoring Training for Trachoma Today

A trachoma grader assesses the eyes of a child during a Tropical Data global training of trainers event in Senegal, 2017. Photo Credit: RTI International/Shea Flynn

High-quality data has been a key player in the elimination of trachoma. In order to maintain this, we need to ensure that health workers can accurately identify the disease.

Previously, Tropical Data held global 'training of trainer' workshops where health workers learn how to identify trachoma, conduct surveys, and use an app to record findings. For the graders learning to identify trachoma, these workshops paired classroom-based learning with clinical experience, gained from examining the eyes of children with the disease. This first-hand experience was a crucial part of ensuring health workers were prepared to train teams of other health workers in their respective countries to complete the surveys. These health workers are often skilled eye health professionals.

A participant at our July 2023 training event practices assessing eyes for trachoma using the photo-based curriculum. Photo credit: RTI International

However, thanks to the incredible progress toward the global elimination of trachoma as a public health problem, it is becoming less and less likely that graders will find enough clinical cases in many communities to provide them with hands-on clinical experience. It’s a good problem to have, as it is a sign that these public health efforts are showing tremendous impact. As we plan for the future, we need to ensure that we can train health workers without relying on finding trachoma in the communities.

In July 2023, Tropical Data introduced a new training approach that can solve this problem. We have moved over to a new curriculum where we are using more than a decade's worth of clinical photos of trachoma from all over the world when training health workers to identify signs of trachoma.

Trainees will now be shown a variety of photographs and tested with different types of assessment methods, so clinical diagnosis will still be standardized. The training program won't all be about classroom learning though, as trainees are still expected to demonstrate clinical eye examination skills on live patients of all ages before they are certified as trachoma graders.

At a recent training event in Nairobi, Kenya, more than 93 health professionals gathered to refresh their skills and provide critical feedback on this new curriculum, to ensure we maintain the highest standards for trachoma surveys for years to come. As trachoma efforts progress, we need to ensure the health workforce knows how to spot it, prevent it, and provide care for those affected by it. These skills remain essential to eliminating the disease around the world, especially among groups who are often left behind when it comes to health services.

Trachoma is the world’s leading infectious cause of blindness, but the goal of eliminating it is in sight. With quality survey data, a trained health workforce, and new resources, countries are closer than ever to ending this debilitating disease.

The Tropical Data program is run by a consortium of partners including the International Trachoma Initiative (ITI), the London School of Hygiene & Tropical Medicine, RTI International through the USAID Act to End NTDs | East program,  and Sightsavers. It is made possible thanks to the support of governments in endemic countries, along with a range of international donors.