Designed for: Substantially expanded over the PRO 1 the PRO 2 has the necessary lightweight professional medical equipment to service a medium sized group on trips into remote areas. Able to treat: Will treat a variety of situations ranging from snakebites, eye injuries, blisters and burns. Kit Features: With its extensive equipment store this kit is perfect to in the car or around the home. The second stage of trachoma is characterized by linear scarring of the upper tarsal conjunctiva (Arlt's line) leading to in-turning of the upper lid (entropian). The third stage of trachoma is in-turning of the upper lid causing the lashes to turn inward and abrade the cornea creating a condition called trachomatous trichiasis (TT) in adults with trichiasis. The fourth stage of trachoma is corneal scarring causing reduced vision as shown in the right eye of this patient.
The constant close proximity of mothers to chronically infected children eads to a much higher incidence of vision threatening trachoma in women. Trachoma has been declining in many areas of the world largely due to increased use of antibiotics and some improvements in sanitation and water supply as well as economic developments; however it remains the second leading cause of blindness in Africa.
The bulk of research on trachoma has been carried out in Tanzania, Ethiopia, Gambia, Mali, and Malawi where studies have shown that women account for about 75% of all trachomatous trichiasis and subsequent blindness due to corneal scarring. Prevalence of trachomatous trichiasis (TT), a chronic form of trachoma, is estimated to be 3.1% for Ethiopia.
The Southern Nation Nationality Peoples Region (SNNPR), where an ORBIS Rural Program is located, is the third most populated (~ 15 million) region in Ethiopia among the 9 regional states and two city administrations.
ORBIS works in 4 zones and one special Woreda (district) in the SNNP region with an estimated population of 6 million. Frick et al., in 20035 attempted to assess the economic impact of trachomatous visual loss using national survey data on trachomatous blindness or visual impairment occurring since 1980. In 2002 and 2003, ORBIS International Ethiopia (Enemor Woreda), in collaboration with World Vision Ethiopia (Artuma Fursi Woreda ) and The Carter Center (Ebnat Woreda) implemented the World Health Organization’s initiatives known by the acronym “SAFE” as a strategy for the control of blinding trachoma and its effects: Surgery, Antibiotic, Facial cleanness and Environmental hygiene. Equip and supply health centers to deliver trichiasis surgery and primary eye care service to reduce backlog of trichiasis through both static and outreach services. Determine the recurrence of TT after surgery with and without Zithromax treatment at time of surgery. Reduce prevalence of active trachoma through antibiotic (Zithromax) treatment aimed at reducing the pool of infection and interrupting transmission, as well as providing treatment of active infections through mass distribution at health facilities. Provide information and education activities to the population to create awareness on how to prevent trachoma through the use of antibiotics. Carry out a variety of different studies on ways to improve the distribution of Zithromax and to determine the effectiveness of this treatment. Increase the level of understanding and awareness about the value of face washing through education in schools and in the community by producing and distributing educational materials. Raise awareness to increase utilization of appropriate sanitary methods for the human and animal waste and household rubbish.
ORBIS has employed the WHO endorsed SAFE strategy for control of trachoma as described above in the belief that reducing one or more of the factors in the transmission of the bacteria that causes trachoma, Chlamydia Trachomatis, will reduce the prevalence of blindness from trachoma.
It would be best to simply prevent trachoma by encouraging better personal hygiene, improved environmental cleanliness, and by controlling the flies that serve as vectors of transmission.
Trachoma causes blindness after repeated infections of the eye, resulting in scarring of the conjunctiva that subsequently pulls the eyelid margins inward (i.e. The second component of the SAFE strategy is treatment of the entire affected communities with a potent antibiotic known as Azithromycin (Zithromax). Implementation of the SAFE strategy begins with building the capacity of rural eye care facilities starting with training of various cadres of eye care workers. Teachers in primary schools are trained to inform their students about the prevention of trachoma through personal and environmental hygiene. All cadres mentioned above should receive close support including annual refresher training to keep them motivated and to help them stay current with methods to provide quality eye care.
As part of the overall support to communities to practice the whole SAFE package, it is necessary to address the overall problems of sanitation, something outside of the usual expertise of a blindness prevention organization such as ORBIS. A large proportion of the population is unaware that trachoma is a “water washed” disease, and one that can be prevented by personal hygiene including face washing with soap every day.

In addition to the lack of overall awareness, clean water and adequate sanitation facilities are lacking in many areas, especially rural villages.
The majority of the population affected with trachoma is rural and lives in a low socioeconomic status.
There is poor resource allocation on the part of the government particularly for human resources. The PRO 2 has an extra storage pocket (in comparison to the PRO 1) that folds down from the kit allowing easy and quick identification of medical equipment in an emergency. It is caused by Chlamydia Trachomatis – a microorganism which spreads through contact with eye discharge from the infected person (on towels, handkerchiefs, fingers, etc.) and through transmission by eye-seeking flies. Also shown: pits at the superior limbus (Heberts pits) a characteristic reaction with trachoma. While trachoma is prevalent throughout much of sub-Saharan Africa, accurate statistics are not readily available because in some areas there is too little reliable information to even estimate the burden of disease (WHO 2006).
Although the prevalence of active disease is similar for boys and girls, adult women tend to be more severely affected because of the aforementioned interaction with infected children. This disparity is largely due to poor sanitation and inadequate water supply seen predominantly in rural areas. This means there are an estimated 1.3 million people age 15 and above who are at risk of blindness unless treated urgently. It is located in the southern part of the country and has more than 45 different ethnic groups.
The prevalence of active trachoma in this region is 33%, which is third in magnitude behind the Amhara and Oromia regions which are the two largest regional states of the country. Between 2000 and 2001, a comprehensive assessment of the extent of blindness and low vision, including the prevalence of trachoma, was conducted in the Gurage zone to learn more about the magnitude of eye health problems from trachoma.
However, once trachoma is prevalent and is considered a public health problem, it is necessary to apply all four components of the SAFE strategy for control. Mass treatment is indicated when the level of active trachoma in a district is 10% or higher as measured by trachoma follicular index (TFI). This is an important strategy for controlling flies which transmit the infecting agent for trachoma and which flourish in an unclean environment. These workers include health professionals such as nurses who will lead the rural primary eye care service, perform eyelid surgeries on patients with TT, and provide other treatment for active trachoma. Community level eye care personnel such as Health Extension Workers (HEWs) and volunteers such as Community Health Agents (CHAs) and Women Group Leaders (WGLs) are trained to teach community members about trachoma and tell them about preventive measures such as face washing and environmental cleanliness.
It is also important to produce targeted and effective key messages that these community eye care workers can use to educate community members.
This can be addressed by collaboration with other agencies who deal with clean water and sanitation utilizing their expertise and resources.
Many people are not aware that trachomatous trichiasis (TT) can be treated and blindness prevented in some cases through surgical interventions.
This is mainly due to scarcity of trained eye care professionals, lack of infrastructure and supplies, and insufficient allocation of budget for eye care. Part of this is due to attrition of IECWs resulting from the lack of a career pathway for eye care providers that would attract them to the job and make them remain in a given location. This contributes to inadequate monitoring and evaluation and allocation of funds to cover operational costs for eye care services. Training of more eye care professionals including volunteers: Ensure availability of at least two IECWs (or a sufficient number according to population) to provide primary eye care services in each of the existing health centers in all project areas. Strengthening ownership of the program by partners: This will ensure sustainability of services through integration of eye care into the general health services, increasing financial allocation, and cost recovery. Establishing linkage between rural eye care units with higher level eye centers: Establish linkage of Primary Eye Care Units (PECUs) with Secondary Eye Care Units (SECUs) for technical support, referral, and backup for the PECUs.
Identify and collaborate with organizations working in the area of water and sanitation in the project areas: Strive to create a common understanding among all stakeholders on their roles for ensuring availability of clean water and sanitation for preventing eye disease.
Trachoma is more likely to occur when general hygiene and cleanliness is lacking, water supply is limited, and environmental control with management of waste is inadequate. Trachoma, once endemic in most of the world, is responsible at present for more than 3% of the world’s blindness.

In some areas trachoma is holoendemic meaning that every child has active trachoma and every adult shows some evidence of conjunctival scarring. Training for nurses enabling them to perform trichiasis surgery was initiated in 2000 and a study of the outcome of surgeries done by these trained nurses known as Integrated Eye Care Workers (IECWs) compared with that done by ophthalmologists was conducted.
Additional funding for this effort was obtained from International Trachoma Initiative (ITI) and Pfizer. It is aimed primarily at eliminating transmission of the infecting agent from unclean faces by flies, and as a means of maintaining individuals in a trachoma free state after initial treatment is received through MDA.
Breeding of flies can be reduced by proper disposal of refuse through burying or burning and of human and animal waste by using latrines and other appropriate methods that eliminate breeding places for flies. Nurses who are trained for one month in primary eye care including TT surgery are called Integrated Eye Care Workers (IECWs).
These community eye care workers also identify and refer patients to Primary Eye Care Units (PECUs) where they can receive medical and surgical treatment for trachoma as needed.
There is a need for local decision makers to acknowledge that lack of eye care is a significant health problem. Even if services are available, surgery or medical treatment is unaffordable not only due to direct cost, but also indirect costs associated with transportation, accommodation, and food for most patients.
In addition, collaborate with all stakeholders while continuing to explore ways in which primary eye care is included in the training for health professionals with an emphasis on prevention.
The universities should provide backup support to Secondary Eye Care Unit activities in all areas of eye health care. Fortunately this number continues to get smaller as a result of socio-economic development and current control programs for this disease.2 In spite of this, trachoma continues to be hyper-endemic (active trachoma more than 40%) in many of the poorest and most remote areas of Africa, Asia, Central and South America, Australia and the Middle East. This ORBIS initiated project was the first of its kind designed to implement the SAFE strategy in Ethiopia.
The Mass Drug Administration (MDA) addresses two important issues: the pool of infection at the community level, and treatment of active infection. This is a key component of trachoma control in that it reduces the rate of re-infection with trachoma.
When one or two IECWs are trained per health center, TT surgery sets are provided (three per center); sterilization equipment and supplies are also provided initially. Train every new graduate health professional to be skilled in providing basic eye care; this could ensure continuity of services. This leads to a condition called entropion which in turn creates a condition that is called trachomatous trichiasis with the lashes rubbing on the eyeball, abrading the conjunctiva and cornea, leading to scarring of the cornea (the clear front of the eye). In hyper-endemic areas, active disease is most common in pre-school children with prevalence rates as high as 60-90%.2 Trachoma tends to strike the most vulnerable members of communities who are women and children.
It included mass treatment of the affected populations with Zithromax donated by Pfizer and trachomatous trichiasis (TT) surgeries for affected individuals along with education on face washing and environmental improvement for all at the community level. This helps individuals to remain free of trachoma that is also controlled with positive personal hygiene practices. In order to be more effective, it is necessary to integrate the primary eye care activities within the regular health service to make it sustainable. If untreated, this constant rubbing of the lashes on the cornea results in irreversible corneal opacity and eventually blindness.
Adult women are at much greater risk of developing the blinding complication of trachoma than are adult men. This changes the cornea from a clear transparent window to one that will not allow normal passage of light through the cornea, reducing vision and eventually causing blindness. This increased risk has been explained by the fact that women generally spend more time in close contact with children who are the main reservoir of the infection. Trachomatous trichiasis can be reversed by performing surgery on the in-turned eyelid returning it to the original (normal) position.

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