Steps to prevent infectious blindness

There are many different causes of blindness, but the leading cause of infectious blindness in the world is Trachoma. According to the wikipedia article it's a very serious problem: "Globally, 84 million people suffer from active infection and nearly 8 million people are visually impaired as a result of this disease".

Like many other diseases, the spread of trachoma is not even across the world's countries, but instead it's found in traditional 3rd world countries.

The World Health Organization leads an effort of eliminating blinding trachoma as a public health concern by 2020

International efforts to eliminate trachoma as a blinding disease will be based on the WHO-developed strategy - a combination of interventions known by the acronym "SAFE" which stands for surgery for trichiasis (inturned eyelashes), antibiotics, facial cleanliness and environmental improvement. These interventions will be community-targeted and will seek community involvement through the primary health care approach.

This has been done with some success in Morocco, and it is certainly something which should be continued. There is, however, always room for studies trying to identify whether the efforts are focused on the right things for WHO to reach its goals. A study looking at this has been published in PLoS One.

Access to Water Source, Latrine Facilities and Other Risk Factors of Active Trachoma in Ankober, Ethiopia by Ilya Golovaty et al.

Methods

A cross-sectional community-based study was conducted during July 2007. A total of 507 children (ages 1–9 years), from 232 households were included in the study. All children were examined for trachoma by ophthalmic nurses using the WHO simplified clinical grading system. Interviews and observations were used to assess risk factors. Logistic regression procedures were used to determine associations between potential risk factors and signs of active trachoma.

Results

Overall, the prevalence of active trachoma was found to be 53.9% (95%CI 49.6%–58.2%). Presence of fly-eye (fly contact with the eyelid margin during eye examination) (Odds Ratio (OR) = 4.03 95% CI 1.40–11.59), absence of facial cleanliness (OR = 7.59; 95%CI 4.60–12.52), an illiterate mother (OR = 5.88; 95%CI 2.10–15.95), lack of access to piped water (OR = 2.19; 95%CI 1.14–6.08), and lack of access to latrine facilities (OR = 4.36; 95%CI 1.49–12.74) were statistically significantly associated with increased risk of active trachoma.

Conclusion

Active trachoma among children 1–9 years of age in Ankober is highly prevalent and significantly associated with a number of risk factors including access to water and latrine facilities. Trachoma prevention programs that include improved access to water and sanitation, active fly control, and hygiene education are recommended to lower the burden of trachoma in Ankober, Ethiopia.

The prevalence of trachoma is very high among the sampled children in Ankober, so it's a good place to try to identify associations between risk factors and the spread of the disease.

The study pretty much supports the efforts currently being done, but places a high emphasis on access to clean water and sanitation, which is less emphasized in the WHO website (I presume it's included under "environmental improvement"). This might lead to some improvements in the efforts, making it possible for the WHO to reach its goal.

Organ transplant tourism

I had missed this, but via Slate, I became aware that the WHO proposes global agenda on transplantation

This week, at the second Global Consultation on Transplantation the World Health Organization (WHO) presented countries and other stakeholders with a blueprint for updated global guiding principles on cell, tissue and organ donation and transplantation.

Those principles aim to address a number of problems: the global shortage of human materials - particularly organs - for transplantation; the growing phenomenon of 'transplant tourism' partly caused by that shortage; quality, safety and efficacy issues related to transplantation procedures; traceability and accountability of human materials crossing borders.

There is a worldwide shortage of organ donors, which leads to a shortage of organs. And as the WHO make clear, it's a serious problem.

Recent estimates communicated to WHO by 98 countries show that the most sought after organ is the kidney. Sixty-six thousand kidneys were transplanted in 2005 representing a mere 10% of the estimated need. In the same year, 21 000 livers and 6 000 hearts were transplanted. Both kidney and liver transplants are on the rise but demand is also increasing and remains unmatched.

Of course, such shortages have some pretty obvious consequences.

Reports on 'transplant tourism' show that it makes up an estimated 10% of global transplantation practices. The phenomenon has been increasing since the mid-1990's, coinciding with greater acceptance of the therapeutic benefits of transplantation and with progress in the efficacy of the medicines - immuno-suppressants - used to prevent the body's rejection of a transplanted organ.

The organs are not harvested from tourists and other unwilling victims, as the urban legends often claims, instead they are bought from poor people. In Pakistan the practice is widespread, as this Reuters' article makes clear.

"There are villages that are in the poorer parts of Pakistan where as many as 40 to 50 percent of the population of the village we know only has one kidney," Moazam told the briefing.

She said donors are often promised as much as 150,000 rupees ($2,500) for an organ but may only get a fraction of that after brokers' fees and associated medical costs are paid.

And of course, the donators don't get proper medical care afterwards, thus risking their lives.

China is also an option used by some, and here there is some evidence that many of the organs are from some of the thousands of people executed each year. Something which China's Deputy Health Minister Huang Jiefu admitted last november.

As the article in the last link makes clear, the 'transplant tourism' in China has direct negative consequences for the average Chinese in need of an rogan transplant.

Many transplant recipients are foreigners who pay large sums of money to avoid long waiting lists in their own countries. Currently, more than 1 million Chinese people are waiting for transplants.

Foreigners, however, are taking priority because they can pay more for organs, with kidneys reaching around NZ$90,000 and livers $193,000.

Unsurprising, I am in full agreement with Dr Howard Zucker, who stated

"Human organs are not spare parts," said Dr Howard Zucker, WHO Assistant Director-General of Health Technology and Pharmaceuticals. "No one can put a price on an organ which is going to save someone's life."

However, as long as people in some parts of the world have a hard time getting their basic needs covered, there is an organ shortage, and there are people willing to buy organs from others, this problem will continue to exist.
I think the WHO is on the right track in making it harder to deal in organs, but the basic problem of an organ shortage also needs to be addressed. One way we all can help addressing that problem, is to register as an organ donor if possible.