Burundi eliminates trachoma and sets example for disease control in Africa

The World Health Organization (WHO) has validated Burundi as having eliminated trachoma as a public health problem, making it the eighth country in WHO's African Region to reach this important milestone. Trachoma is also the first neglected tropical disease (NTD) to be eliminated in the country.

Eliminating a disease like trachoma is a major public health achievement that requires sustained effort and dedication. I congratulate the government and the people of Burundi and commend them for their hard work and commitment. It is great to see Burundi join the growing group of countries that have eliminated at least one NTD".

Dr. Tedros Adhanom Ghebreyesus, WHO Director-General

Trachoma is caused by the bacterium Chlamydia trachomatis and spreads through personal contact, contaminated surfaces and by flies that have been in contact with eye or nose discharge. Repeated infections can lead to scarring, in-turning of the eyelids, and ultimately blindness. Globally, the disease remains endemic in many vulnerable communities where access to clean water and sanitation is limited.

"This validation marks a major milestone in our commitment to health equity", said Dr Lydwine Baradahana, Minister of Public Health and the Fight Against AIDS, Burundi. "It is a collective victory made possible by nearly 20 years of national mobilization and international solidarity. I thank all the partners, community actors and institutions in Burundi and beyond who made this historic achievement possible".

Burundi's progress

Before 2007, with no reported cases or epidemiological studies, the extent of trachoma endemicity in Burundi was largely unknown. That year, the country launched an initiative to tackle NTDs, which included integrated mapping of soil-transmitted helminthiases, schistosomiasis, lymphatic filariasis and trachoma. Following the mapping, the Ministry of Public Health and the Fight Against AIDS conducted further investigations. Baseline surveys carried out in 2009–2010 confirmed that trachoma was endemic in parts of the country. This prompted introduction of interventions based on the WHO-recommended SAFE strategy for 2.5 million people who needed them across 12 health districts.

Burundi's trachoma elimination programme was supported technically and financially by CBM Christoffel Blindenmission, the END Fund, Geneva Global and WHO. The International Trachoma Initiative at the Task Force for Global Health donated azithromycin (Zithromax, Pfizer, New York NY, USA). WHO continues to support support the country's health authorities to monitor communities in which trachoma was previously endemic to ensure there is no resurgence of the disease.

This achievement reflects the government's resolve to protect its most vulnerable populations. Under the leadership of the Ministry of Public Health and the Fight Against AIDS, and with the dedication of community health workers, support from key partners, and WHO's technical guidance, this success was made possible" said Dr Xavier Crespin, WHO Representative in Burundi. "This win inspires us to press forward with the same determination to eliminate all remaining neglected tropical diseases."

Disease prevalence

Trachoma remains a public health problem in 32 countries with an estimated 103 million people living in areas requiring interventions against the disease. Trachoma is found mainly in the poorest and most rural areas of Africa, Central and South America, Asia, the Western Pacific and the Middle East.

The African Region is disproportionately affected by trachoma with 93 million people living in at-risk areas in April 2024, representing 90% of the global trachoma burden. Significant progress has been made in the fight against trachoma over the past few years and the number of people requiring antibiotic treatment for trachoma in the African Region fell by 96 million from 189 million in 2014 to 93 million as of April 2024, representing a 51% reduction.

There are currently 20 countries in WHO's African Region that are known to require intervention for trachoma elimination. These include: Algeria, Angola, Burkina Faso, Cameroon, Central Africa Republic, Chad, Côte d'Ivoire, Democratic Republic of the Congo, Eritrea, Ethiopia, Guinea, Kenya, Mozambique, Niger, Nigeria, South Sudan, United Republic of Tanzania, Uganda, Zambia and Zimbabwe. The seven countries in the region previously validated by WHO as having eliminated trachoma as a public health problem are Benin, Gambia, Ghana, Malawi, Mali, Mauritania and Togo. A further 4 countries in the WHO African Region (Botswana, Guinea-Bissau, Namibia and Senegal) claim to have achieved the prevalence targets for elimination.

Global progress

With today's announcement, a total of 57 countries have now eliminated at least one NTD. Of these, 24- (including Burundi)-have successfully eliminated trachoma as a public health problem. Other countries that have reached this milestone include Benin, Cambodia, China, Gambia, Islamic Republic of Iran, Lao People's Democratic Republic, Ghana, India, Iraq, Malawi, Mali, Mauritania, Mexico, Morocco, Myanmar, Nepal, Oman, Pakistan, Papua New Guinea, Saudi Arabia, Togo, Vanuatu and Viet Nam.