Reduction of trachoma in a sub-Saharan village in absence of a disease control programme

Trachoma is a leading cause of blindness in the developing world and is most prevalent among people who live in poor rural communities in arid locations. We analysed the results of surveys of trachoma prevalence in Marakissa, a rural village in The Gambia. These surveys were undertaken in 1959, by the Medical Research Council, and in 1987 and 1996 by the Gambian National Eye Care Programme. During this 37-year period, the prevalence of active inflammatory trachoma among children aged 0–9 years fell from 65·7 cases per 100 children in 1959 to 2·4 cases per 100 children in 1996. The prevalence also fell dramatically among people of 10–19 years (52·5 to 1·4 per 100) and among people of 20 years and older (36·7 to 0 cases per 100). The dramatic fall in disease occurrence was paralleled by improvements in sanitation, water supply, education, and access to health care in the village. Of particular importance is that the decline in trachoma occurred without any trachoma-specific intervention.