Clinical features of trachoma. (a) Active trachoma in a child, characterised by a mixed papillary (TI) and follicular response (TF). (b) Tarsal conjunctival scarring (TS). (c) Entropion and trichiasis (TT). (d) Blinding corneal opacification (CO) with entropion and trichiasis (TT). From Hu VH,et al.; Epidemiology and control of trachoma: systematic review PRIME PubMed, via wikimedia commons.

A leading cause of blindness, the eye disease trachoma,是地方性44个国家and has caused impaired vision or blindness in 1.9 million people.

Trachoma is is the result of an infection with衣原体沙眼，，，，a bacterium that causes a roughening of the inner surface of the eyelids. The initial symptoms are similar to conjunctivitis, with low level irritation and ocular discharge. Reinfection can occur multiple times.

If untreated, recurrent infections result in more severe symptoms leading to the eyelids turning inwards with the eyelashes rubbing on the eye causing沙眼tous inflammation—follicular（提皮病）。角膜的疤痕会导致不可逆的失明。

This is a disease of crowded living conditions, poor sanitation, lack of water for washing and the presence of flies. The bacterium is spread via direct contact with secretions from the eyes or nose of an infected person, or indirectly, via clothing or transmission on the legs and mouthparts of flies.

在儿童中，沙眼尤其普遍，非洲贫穷的农村地区的一个常见地点是流淌的鼻子和粘眼睛的儿童，经常受到苍蝇的困扰。

如果有10％的儿童受影响，则可以用抗生素治疗抗生素，并建议基于社区的抗生素治疗。可以通过手术治疗晚期病例。

减少传输

1993年，WHO采取了通过首字母缩写来减少传输的策略：

• 手术
• 抗生素
• 面部清洁
• Environmental improvement

为了到2020年取消，这是在WHO成员国成功实施的，直到COVID-19发生大流行为止。因此，得知尽管如此，但谁宣布沙眼不再是冈比亚的公共卫生问题，这让人特别令人满意。

冈比亚的沙眼

冈比亚是西非一个相对较小的国家，沿着冈比亚河两侧延伸，人口在很大程度上是农村。早在1959年，沙眼被认为是公共卫生问题，当发现一个村庄中有超过65％的幼儿被感染时。基于Medical Research Council法贾拉（Fajara）的中心扩展到包括其他被忽视的热带疾病计划，并在1986年进行了全国调查发现，沙眼瘤是冈比亚的17％的失明病例。十年后，另一项调查发现，这将减少到5％，但该国的所有地区都需要干预呈滴虫病。

The trachoma elimination experience

Agatha Aboe和她的团队有最近描述的the tribulations and successes involved in the journey to eliminate this disease from The Gambia.

从1997年开始与基线映射来识别where and who has trachoma, the Government based its programme for elimination on the SAFE strategy. It was backed by multiple partnerships, including theBritish Medical Research Council和London School of Hygiene and Tropical Medicine。为培训卫生工作者提供了资源，提供基础设施和车辆，并为所有级别的卫生工作者提供薪水。

该程序的核心集中在面部清洁度和环境改善上，但此外，pfizer含有的抗生素阿奇霉素和三症眼科手术的大规模给药是免费提供给患者的。

At ground level, the programme relied upon community volunteers, referred to asNyateros（摘自Mandinka的意思是“眼睛的朋友”），学校老师和乡村卫生工作者。他们接受了两天的培训，并配备了火炬，视敏度图和海报，以便他们在必要时可以转介患者进行手术。

遇到的管理和问题

At the community level, various routes were used to communicate the necessity for daily face washing with clean water and soap, proper hand washing, keeping domestic animals away from houses and the proper location of pit latrines. This was aided by a government clean water and sanitation project.

Between 2001-2020, ninety-four Gambian ophthalmic nurses were trained as trichiasis surgeons. However, some poor surgical outcomes were discovered, which could have affected the uptake of surgery, and some nurses required further training.

最终，煽动了由监督眼科医生进行的全国季度监视。一个特殊的问题是眼科护士的消耗，其中许多人搬进了助产士以获得更高的薪水。

在广播和通过乡村卫生工作者上进行社区信息计划之前，大规模抗生素治疗是根据斑纹症的患病率进行区域管理的。该筛查，决策计划（关于整个社区还是应对家庭的治疗）和治疗本身需要大量的人力，而且很昂贵。

Other problems included the extension of trachoma surveillance from school-based surveys to include madrasas, when it was recognised that active cases were occurring in these.

监测案件以满足两人的确认要求，因为他们的两个标准的年龄符号不同，对政府提出了质疑。当消除活性沙瘤（主要在儿童中）时，全国范围内的监视被停止了，无法监测以消除成人中的斑岩症病例。然后，必须进行其他绘画调查。

展望未来

不可避免地需要继续进行监测和持续手术。但是，使用WHO安全策略消除气管瘤，冈比亚应在达到2030年全球淘汰的新目标之前，要祝贺冈比亚。希望他们也可以克服满足全球截止日期。