Trachoma: Progress and Promise
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645


Interest in the economics of trachoma is high because of the refinement of a strategy to control trachomatous blindness, an ongoing global effort to eliminate incident blindness from trachoma by 2020, and an azithromycin donation program that is a component of trachoma control programs in several countries. This report comments on the economic distribution of blindness from trachoma and adds insight to published data on the burden of trachoma and the comparative costs and effects of trachoma control. Results suggest that 1) trichiasis without visual impairment may result in an economic burden comparable to trachomatous low vision and blindness so that 2) the monetary burden of trachoma may be 50% higher than conservative, published figures; 3) within some regions more productive economies are associated with less national blindness from trachoma; and 4) the ability to achieve a positive net benefit of trachoma control depends importantly on the cost per dose of antibiotic.


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  1. Nicholson W, 1990. Intermediate Microeconomics and Its Applications. Fifth edition. Chicago: The Dryden Press.
  2. Gravelle H, Dusheiko M, Sutton M, 2002. The demand for elective surgery in a public system: time and money prices in the UK National Health Service. J Health Econ 21: 423–449. [Google Scholar]
  3. Kenkel DS, 1995. Should you eat breakfast? Estimates from health production functions. Health Econ 4: 15–29. [Google Scholar]
  4. Gruber J, Kim J, Mayzlin D, 1999. Physician fees and procedure intensity: the case of cesarean delivery. J Health Econ 18: 473–490. [Google Scholar]
  5. Frick KD, Keuffel E, Bowman RJC. 2001. Epidemiological, demographic, and economic analyses: measurement of the value of trichiasis surgery in the Gambia. Ophthalmic Epidemiol 8: 191–201. [Google Scholar]
  6. Valdivia M, 2002. Public health infrastructure and equity in the utilization of outpatient health care services in Peru. Health Policy Plan 17 (suppl): 12–19. [Google Scholar]
  7. Clarke PM, 1998. Cost-benefit analysis and mammographic screening: a travel cost approach. J Health Econ 17: 767–787. [Google Scholar]
  8. Wright PJ, Fortinsky RH, Covinsky KE, Anderson PA, Landefeld CS, 2000. Delivery of preventive services to older black patients using neighborhood health centers. J Am Geriatr Soc 48: 124–130. [Google Scholar]
  9. Simon JL, Larson BA, Zusman A, Rosen S, 2002. How will the reduction of tariffs and taxes on insecticide- treated bednets affect household purchases? Bull World Health Organ 80: 892–899. [Google Scholar]
  10. Basu J, Friedman B, Burstin H, 2002. Primary care, HMO enrollment, and hospitalization for ambulatory care sensitive conditions: a new approach. Med Care 40: 1260–1269. [Google Scholar]
  11. Gold MR, Siegel JE, Russell LB, Weinstein MC, 1996. Cost-Effectiveness in Health and Medicine. New York: Oxford University Press.
  12. Liljas B, 1998. How to calculate indirect costs in economic evaluations. Pharmacoeconomics 13: 1–7. [Google Scholar]
  13. Koopmanschap MA, Rutten FF, van Ineveld BM, van Roijen L, 1995. The friction cost method for measuring indirect costs of disease. J Health Econ 14: 171–189. [Google Scholar]
  14. Lofland JH, Locklear JC, Frick KD, 2001. Different approaches to valuing the lost productivity of patients with migraine. Pharmacoeconomics 19: 917–925. [Google Scholar]
  15. Pauly MV, Nicholson S, Xu J, Polsky D, Danzon PM, Murray JF, Berger ML, 2002. A general model of the impact of absenteeism on employers and employees. Health Econ 11: 221–231. [Google Scholar]
  16. Boardman AE, Greenberg DH, Vining AR, Weimer DL, 1996. Cost-Benefit Analysis: Concepts and Practice. Upper Saddle River, NJ: Prentice Hall.
  17. Negrel AD, Mariotti SP, 1998. WHO alliance for the global elimination of blinding trachoma and the potential use of azithromycin. Int J Antimicrob Agents 10: 259–262. [Google Scholar]
  18. Kuper H, Solomon AW, Buchan J, Zondervan M, Foster A, Mabey D, 2003. A critical review of the SAFE strategy for the prevention of blinding trachoma. Lancet Infect Dis 3: 372–381. [Google Scholar]
  19. Bowman RJ, Soma OS, Alexander N, Milligan P, Rowley J, Faal H, Foster A, Bailey RL, Johnson GJ, 2000. Should trichiasis surgery be offered in the village? A community randomized trial of village vs. health centre-based surgery. Trop Med Int Health 5: 528–533. [Google Scholar]
  20. Holm SO, Jha HC, Bhatta RC, Chaudhary JS, Thapa BB, Davis D, Pokhrel RP, Yinghui M, Zegans M, Schachter J, Frick KD, Tapert L, Lietman TM, 2001. Comparison of two azithromycin distribution strategies for controlling trachoma in Nepal. Bull World Health Organ 79: 194–200. [Google Scholar]
  21. Lynch M, West S, Frick K, Mkocha H, 2003. Azithromycin treatment coverage in Tanzanian children using community volunteers. Ophthalmic Epidemiol 10: 167–175. [Google Scholar]
  22. Lynch M, West SK, Munoz B, Kayongoya A, Taylor HR, Mmbaga BB, 1994. Testing a participatory strategy to change hygiene behaviour: face washing in central Tanzania. Trans R Soc Trop Med Hyg 88: 513–517. [Google Scholar]
  23. Pruss A, Kay D, Fewtrell L, Bartram J, 2002. Estimating the burden of disease from water, sanitation, and hygiene at a global level. Environ Health Perspect 110: 537–542. [Google Scholar]
  24. Emerson PM, Lindsay SW, Walraven GE, Dibba SM, Lowe KO, Bailey RL, 2002. The flies and eyes project: design and methods of a cluster-randomised intervention study to confirm the importance of flies as trachoma vectors in The Gambia and to test a sustainable method of fly control using pit latrines. Ophthalmic Epidemiol 9: 105–117. [Google Scholar]
  25. Frick KD, West SK, 2001. The SAFE strategy for trachoma control: planning a cost-effectiveness analysis of the antibiotic component and beyond. Ophthalmic Epidemiol 8: 205–214. [Google Scholar]
  26. Frick KD, Mecaskey JW, 2002. Resource allocation to prevent trachomatous low vision among older individuals in rural areas of less developed countries. Doc Ophthalmol 105: 1–21. [Google Scholar]
  27. Evans TG, Ranson MK, Kyaw TA, Ko CK, 1996. Cost effectiveness and cost utility of preventing trachomatous visual impairment: lessons from 30 years of trachoma control in Burma. Br J Ophthalmol 80: 880–889. [Google Scholar]
  28. Frick KD, Colchero MA, 2002. Cost-effectiveness of alternative strategies to prevent trachomatous blindness. Expert Rev Pharmacoeconomics Outcomes Res 2: 219–228. [Google Scholar]
  29. Frick KD, Lietman TM, Osaki Holm S, Jha HC, Chaudhary JSP, Bhatta RC, 2001. Cost-effectiveness of trachoma control measures: comparing targeted household treatment and mass treatment of children. Bull World Health Organ 79: 201–207. [Google Scholar]
  30. Bowman RJ, Sillah A, Van Dehn C, Goode VM, Muquit M, Johnson GJ, Milligan P, Rowley J, Faal H, Bailey RL, 2000. Operational comparison of single-dose azithromycin and topical tetracycline for trachoma. Invest Ophthalmol Vis Sci 41: 4074–4079. [Google Scholar]
  31. Schemann JF, Sacko D, 1998. Strategies to control trachoma. Sante 8: 150–156. [Google Scholar]
  32. Frick KD, Hanson C, Basilion E, Colchero MA, 2003. Estimating the burden and economic impact of trachomatous visual loss. Ophthalmic Epidemiol 10: 121–132. [Google Scholar]
  33. Frick KD, Lynch M, West S, Munoz B, Mkocha H, 2003. Household willingness to pay for azithromycin treatment for trachoma control. Bull World Health Organ 81: 101–107. [Google Scholar]
  34. United Nations, 1978. Declaration of Alma-Ata. International Conference on Primary Health Care. Alma-Ata, USSR: United Nations.
  35. United Nations, 1979. Health for All by 2000. United Nations Summit. Geneva: United Nations.
  36. Sen A, 1999. Health in development. Bull World Health Organ 77: 619–623. [Google Scholar]
  37. Whitehead M, 1992. The concepts and principles of equity and health. Int J Health Serv 22: 429–445. [Google Scholar]
  38. Andersson F, Lyttkens CH, 1999. Preferences for equity in health behind a veil of ignorance. Health Econ 8: 369–378. [Google Scholar]
  39. Raz J, 1986. The Morality of Freedom. Oxford, United Kingdom: Clarendon.
  40. Evans T, Whitehead M, Diderichsen F, Bhuiya A, Wirth M, 2001. Challenging Inequities in Health: From Ethics to Action. New York: Oxford University Press.
  41. Woodward A, Kawachi I, 2000. Why reduce health inequalities? J Epidemiol Community Health 54: 923–929. [Google Scholar]
  42. Macinko JA, Starfield B, 2002. Annotated bibliography on equity in health, 1980–2001. Int J Equity Health 1: 1–20. [Google Scholar]
  43. Mooney G, Jan S, 1997. Vertical equity: weighting outcomes or establishing procedures? Health Policy 39: 79–87. [Google Scholar]
  44. Gakidou E, Murray C, Frenk J, 2000. Defining and measuring health inequality: an approach based on the distribution of health expectancy. Bull World Health Organ 78: 42–54. [Google Scholar]
  45. World Bank, 1990. World Development Report 1990: Poverty. Washington, DC: The World Bank.
  46. World Bank, 2001. World Development Report 2000/2001: Attacking Poverty. Washington, DC: The World Bank.
  47. United Nations Development Program, 2002. Human Development Report 2002. New York: Oxford University Press.
  48. Narayan D, Patel R, Schafft K, Rademacher A, Koch-Schulte S, 2000. Voices of the Poor: Can Anyone Hear Us? New York: Oxford University Press. Published for the World Bank.
  49. Frick KD, Melia BM, Buhrmann RR, West SK, 2001. Trichiasis and disability in a trachoma endemic area of Tanzania. Arch Ophthalmol 119: 1839–1844. [Google Scholar]
  50. Evans TG, Ranson MK, 1995.ndash;1996. The global burden of trachomatous visual impairment: II. assessing burden. Int Ophthalmol 19: 271–280. [Google Scholar]
  51. Murray CJL, Lopez AD, eds, 1996. The Global Burden of Disease. Boston: Harvard University Press. Published for the World Health Organization and the World Bank.
  52. http://data.bls.gov/cgi-bin/cpicalc.pl. Accessed on July 1, 2003.
  53. Smith AF, Smith JG, 1996. The economic burden of global blindness: a price too high! Br J Ophthalmol 80: 276–277. [Google Scholar]
  54. Shamanna BR, Dandona L, Rao GN, 1998. Economic burden of blindness in India. Indian J Ophthalmol 46: 169–172. [Google Scholar]
  55. Future Approaches to Trachoma Control, 1996. Report of a Global Scientific Meeting. Geneva: World Health Organization. June 17–20, 1996. Unpublished document WHO/PBL/96/56.
  56. World Development Indicators 2001. On CD-ROM. Washington, DC: The World Bank.
  57. Thylefors B, 1998. A global initiative for the elimination of avoidable blindness. Community Eye Health 11: 1–3. [Google Scholar]
  58. Perez-Casas C, Herranz E, Ford N, 2001. Pricing of drugs and donations: options for sustainable equity pricing. Trop Med Int Health 6: 960–964. [Google Scholar]
  59. West SK, Munoz B, Lynch M, Kayongoya A, Mmbaga BBO, Taylor HR, 1996. Risk factors for constant, severe trachoma among preschool children in Kongwa, Tanzania. Am J Epidemiol 143: 73–78. [Google Scholar]
  60. Katz J, West KP, Khatry SK, LeClerq SC, Pradhan EK, Thapa MD, Ram Shrestha S, Taylor HR, 1996. Prevalence and risk factors for trachoma in Sarlahi district, Nepal. Br J Ophthalmol 80: 1037–1041. [Google Scholar]
  61. Taylor HR, West SK, Mmbaga BBO, Katala SJ, Turner V, Lynch M, Munoz B, Rapoza PA, 1989. Hygiene factors and increased risk of trachoma in central Tanzania. Arch Ophthalmol 107: 1821–1825. [Google Scholar]
  62. Hsieh YH, Bobo LD, Quinn TC, West SK, 2000. Risk factors for trachoma: 6-year follow-up of children aged 1 and 2 years. Am J Epidemiol 152: 204–211. [Google Scholar]
  63. Zerihun N, 1997. Trachoma in Jimma Zone, South Western Ethiopia. Trop Med Int Health 2: 1115–1121. [Google Scholar]
  64. Congdon N, West S, Vitale S, Katala S, Mmbaga BBO, 1993. Exposure to children and risk of active trachoma in Tanzanian women. Am J Epidemiol 137: 366–372. [Google Scholar]
  65. Bailey R, Downes B, Downes R, Mabey D, 1991. Trachoma and water use; a case control study in a Gambian village. Trans R Soc Trop Med Hyg 85: 824–828. [Google Scholar]
  66. West S, Lynch M, Turner V, Munoz B, Rapoza P, Mmbaga BB, Taylor HR, 1989. Water availability and trachoma. Bull World Health Organ 67: 71–75. [Google Scholar]
  67. Brechner RJ, West S, Lynch M, 1992. Trachoma and flies. Arch Ophthalmol 110: 687–689. [Google Scholar]
  68. Emerson P, Lindsay S, Walraven G, Faal H, Bogh C, Lowe K, Bailey R, 1999. Effect of fly control on trachoma and diarrhoea. Lancet 353: 1401–1403. [Google Scholar]
  69. Courtright P, Sheppard J, Lane S, Sadek A, Schachter J, Dawson C, 1991. Latrine ownership as a protective factor in inflammatory trachoma in Egypt. Br J Ophthalmol 75: 322–325. [Google Scholar]
  70. Marx R, 1989. Social factors and trachoma: a review of the literature. Soc Sci Med 29: 23–34. [Google Scholar]
  71. Rabiu MM, Abiose A, 2001. Magnitude of trachoma and barriers to uptake of lid surgery in a rural community of northern Nigeria. Ophthalmic Epidemiol 8: 181–190. [Google Scholar]
  72. Collier LH, 1972. Some aspects of trachoma control and provisional estimates of the cost of vaccine production. Isr J Med Sci 8: 1114–1123. [Google Scholar]
  73. Frick KD, Colchero MA, Dean D, 2003. Modeling the economic net benefit of a potential vaccination program against ocular infection with Chlamydia trachomatis. Vaccine (in press).
  74. Munoz B, Aron J, Turner V, West S, 1997. Incidence estimates of late stages of trachoma among women in a hyperendemic area of central Tanzania. Trop Med Int Health 2: 1030–1038. [Google Scholar]
  75. Frick KD, 2002. Valuing improvements in lifetime endowments in markets with no borrowing. Atlantic Econ J 30: 191–195. [Google Scholar]
  76. http://www3.who.int/whosis/cea/Epitables/Model.cfm?path=whosis,cea,cea_epi,cea_epi_table1&language=english. Accessed on July 1, 2003.
  77. Taylor HR, Katala S, Munoz B, Turner V, 1991. Increase in mortality associated with blindness in rural Africa. Bull World Health Organ 69: 335–338. [Google Scholar]
  78. Blohme J, Tornqvist K, 2000. Visually impaired Swedish children. The 1980 cohort study-aspects on mortality. Acta Ophthalmol Scand 78: 560–565. [Google Scholar]
  79. Schemann JF, Leplege A, Keita T, Resnikoff S, 2002. From visual function deficiency to handicap: measuring visual handicap in Mali. Ophthalmic Epidemiol 9: 133–148. [Google Scholar]
  80. Brown GC, 1999. Vision and quality-of-life. Trans Am Ophthalmol Soc 97: 473–511. [Google Scholar]

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  • Received : 30 Jul 2003
  • Accepted : 29 Aug 2003

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