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67-480: Helen Keller's three major areas of expertise are eye health, healthcare, and nutrition. Its eye health programs address the major causes of blindness in the world, including cataract, trachoma , and onchocerciasis , and treating refractive error . Its nutrition programs include vitamin A, iron/folate, and multi-micronutrient supplementation, fortification of commonly used foods, dietary diversification, community- and school gardening, as well as school health activities,

134-459: A condition where the eyes fail to produce tears. Dead epithelial and microbial cells accumulate on the conjunctiva and form debris that can lead to infection and possibly blindness. Decreasing night blindness requires the improvement of vitamin A status in at-risk populations. Supplements and fortification of food have been shown to be effective interventions. Supplement treatment for night blindness includes massive doses of vitamin A (200,000 IU) in

201-403: A daily per capita consumption of vegetables of 160g, more than double of the 71g for non-participating households. Vitamin A deficiency causes blindness and increases mortality rate for young children and women. The deficiency can be prevented with two doses of high potency vitamin A capsules every year. With the cost of providing the capsules at $ 1 per person per year, vitamin A supplementation

268-551: A day for six weeks). Azithromycin is preferred because it is used as a single oral dose. Although it is expensive, it is generally used as part of the international donation program organized by Pfizer . Azithromycin can be used in children from the age of six months and in pregnancy. As a community-based antibiotic treatment, some evidence suggests that oral azithromycin was more effective than topical tetracycline, but no consistent evidence supported either oral or topical antibiotics as being more effective. Antibiotic treatment reduces

335-532: A discharge of pus . The later structural changes of trachoma are referred to as "cicatricial trachoma". These include scarring under the eyelid (tarsal conjunctiva) that leads to distortion of the eyelid with buckling of the lid (tarsus) so the lashes rub against the eye (trichiasis). This can lead to corneal opacities and scarring and then to blindness. Linear scars present in the sulcus subtarsalis are called Arlt's lines (named after Carl Ferdinand von Arlt ). In addition, blood vessels and scar tissue can invade

402-510: A goal of the elimination of VAD by 2010. The prevalence of night blindness due to VAD is also high among pregnant women in many developing countries. VAD also contributes to maternal mortality and other poor outcomes in pregnancy and lactation . VAD also diminishes the ability to fight infections. In countries where children are not immunized , infectious diseases such as measles have higher fatality rates. As elucidated by Alfred Sommer , even mild, subclinical deficiency can also be

469-474: A problem, as it may increase children's risk of developing respiratory and diarrheal infections, decrease growth rate, slow bone development, and decrease likelihood of survival from serious illness. VAD is estimated to affect about one-third of children under the age of five around the world. It is estimated to claim the lives of 670,000 children under five annually. Around 250,000–500,000 children in developing countries become blind each year owing to VAD, with

536-470: A public-health problem; China, Gambia, Iran, Iraq, and Myanmar make that claim, but have not sought certification. Eradication of the bacterium that causes the disease is seen as impractical; the WHO definition of "eliminated as a public-health problem" means less than 5% of children have any symptoms, and less than 0.1% of adults have vision loss. Having already donated more doses (about 700 million since 2002) of

603-591: A reduction of trachoma incidence. WHO Guidelines recommend that a region should receive community-based, mass antibiotic treatment when the prevalence of active trachoma among one- to nine-year-old children is greater than 10%. Subsequent annual treatment should be administered for three years, at which time the prevalence should be reassessed. Annual treatment should continue until the prevalence drops below 5%. At lower prevalences, antibiotic treatment should be family-based. Azithromycin (single oral dose of 20 mg/kg) or topical tetracycline (1% eye ointment twice

670-491: A route of mechanical transmission. Untreated, repeated trachoma infections result in entropion (the inward turning of the eyelids), which may result in blindness due to damage to the cornea. Children are the most susceptible to infection due to their tendency to get dirty easily, but the blinding effects or more severe symptoms are often not felt until adulthood. Blinding endemic trachoma occurs in areas with poor personal and family hygiene. Many factors are indirectly linked to

737-609: A synergistic fashion. This approach is mostly applied to communities that have difficult access to labor and food markets," in the words of the jury's citation. In 2014, they also won the Kravis Prize in Nonprofit Leadership. The vitamin A supplementation program is, as of 2024, one of GiveWell 's top four recommendations. GiveWell estimates that the cost to avert a death through this program ranges from $ 1000 to $ 8500 on average. Trachoma Trachoma

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804-845: Is President and Chief Executive Officer, joining in November 2023. Prior to Helen Keller Intl, Bouchie served as Chief Impact Officer at the LEGO Foundation and has led institutional fundraising, advocacy, and program efforts for organizations including ChildFund International, CARE USA, Save the Children, and the Aga Khan Foundation. Helen Keller is a partner in Compact2025 , a partnership that develops and disseminates evidence-based advice to politicians and other decision-makers aimed at ending hunger and undernutrition in

871-569: Is a cost-efficient initiative. Helen Keller started the vitamin A supplementation project in Bangladesh in 1978. Its partnership with the GOB began in 1982. The Bangladesh Nutritional Blindness Study was conducted, and it indicated that there was a high prevalence of vitamin A deficiency. By 2005, vitamin A deficiency among children 12 to 59 months, as measured by prevalence of night blindness, has decreased to 0.04% from 3.76% in 1982. Sarah Bouchie

938-468: Is a lack of vitamin A in blood and tissues . It is common in poorer countries, especially among children and women of reproductive age, but is rarely seen in more developed countries. Nyctalopia (night blindness) is one of the first signs of VAD, as the vitamin has a major role in phototransduction ; but it is also the first symptom that is reversed when vitamin A is consumed again. Xerophthalmia , keratomalacia , and complete blindness can follow if

1005-683: Is a leading cause of blindness. Helen Keller International helps prepare health care systems to identify and treat diabetic retinopathy. In collaboration with Chittagong Eye Infirmary and Training Complex and the Diabetes Association of Bangladesh, Helen Keller began a pilot project in 2009 to improve patients' access to sight-saving diabetic retinopathy treatment regardless of their ability to pay. This programme aims to reduce malnutrition and increase food availability through creation of home gardens and small farms for raising livestock. In collaboration with local NGOs, Helen Keller provides

1072-483: Is already infected, washing one's face is encouraged, especially a child, to prevent reinfection. Some evidence shows that washing the face combined with topical tetracycline might be more effective in reducing severe trachoma compared to topical tetracycline alone. The same trial found no statistical benefit of eye washing alone or in combination with tetracycline eye drops in reducing follicular trachoma amongst children. If not treated properly with oral antibiotics ,

1139-420: Is an infectious disease caused by bacterium Chlamydia trachomatis . The infection causes a roughening of the inner surface of the eyelids . This roughening can lead to pain in the eyes, breakdown of the outer surface or cornea of the eyes, and eventual blindness . Untreated, repeated trachoma infections can result in a form of permanent blindness when the eyelids turn inward . The bacteria that cause

1206-419: Is characterized by white lumps in the undersurface of the upper eyelid (conjunctival follicles or lymphoid germinal centres) and by nonspecific inflammation and thickening, often associated with papillae. Follicles may also appear at the junction of the cornea and the sclera (limbal follicles). Active trachoma can often be irritating and have a watery discharge. Bacterial secondary infection may occur and cause

1273-601: Is found in many foods. Vitamin A in food exists either as preformed retinol – an active form of vitamin A – found in animal liver, dairy and egg products, and some fortified foods, or as provitamin A carotenoids, which are plant pigments digested into vitamin A after consuming carotenoid-rich plant foods, typically in red, orange, or yellow colors. Carotenoid pigments may be masked by chlorophylls in dark green leaf vegetables, such as spinach. The relatively low bioavailability of plant-food carotenoids results partly from binding to proteins – chopping, homogenizing or cooking disrupts

1340-477: Is huge, particularly with regard to covering treatment costs and productivity losses as a result of increased visual impairment, and in some cases, permanent blindness. The global estimated cost of trachoma is reported between $ US2.9 and 5.3 billion each year. By including the cost for trichiasis treatment, the estimated overall cost for the disease increases to about $ US 8 billion. Vitamin A deficiency Vitamin A deficiency ( VAD ) or hypovitaminosis A

1407-1000: Is often seen in VAD; suppressed synthesis of retinol binding protein (RBP) due to protein deficiency leads to reduced retinol uptake. Excess alcohol consumption can deplete vitamin A, and a stressed liver may be more susceptible to vitamin A toxicity. People who consume large amounts of alcohol should seek medical advice before taking vitamin A supplements. In general, people should also seek medical advice before taking vitamin A supplements if they have any condition associated with fat malabsorption such as pancreatitis , cystic fibrosis , tropical sprue , and biliary obstruction . Other causes of vitamin A deficiency are inadequate intake, fat malabsorption, or liver disorders. Deficiency impairs immunity and hematopoiesis and causes rashes and typical ocular effects (e.g., xerophthalmia, night blindness). Initial assessment may be made based on clinical signs of VAD. Conjunctival impression cytology can be used to assess

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1474-454: Is preferred because it can be used as a single oral dose. After scarring of the eyelid has occurred, surgery may be required to correct the position of the eyelashes and prevent blindness. Globally, about 80 million people have an active infection. In some areas, infections may be present in as many as 60–90% of children. Among adults, it more commonly affects women than men – likely due to their closer contact with children. The disease

1541-570: Is the cause of decreased vision in 2.2 million people, of whom 1.2 million are completely blind. Trachoma is a public health problem in 42 countries across Africa, Asia, the Middle East, and Central and South America. There are 136.9 million people at risk. It results in US$ 8 billion of economic losses a year. It belongs to a group of diseases known as neglected tropical diseases . The bacterium has an incubation period of 5 to 10 days, after which

1608-622: Is the only developed country that has trachoma. In 2008, trachoma was found in half of Australia's very remote communities. In 1996, the WHO launched its Alliance for the Global Elimination of Trachoma by 2020, and in 2006, the WHO officially set 2020 as the target to eliminate trachoma as a public-health problem. The International Coalition for Trachoma Control has produced maps and a strategic plan called 2020 INSight that lays out actions and milestones to achieve global elimination of blinding trachoma by 2020. The program recommends

1675-435: Is the only developed country—Australian Aboriginal people who live in remote communities with inadequate sanitation are still blinded by this infectious eye disease. India's Health and Family Welfare Minister JP Nadda declared India free of infective trachoma in 2017. The term is derived from Neo-Latin trāchōma , from Greek τράχωμα trākhōma , from τραχύς trākhus "rough". The economic burden of trachoma

1742-534: The Indian Council for Medical Research. This potentially blinding disease remains endemic in the poorest regions of Africa, Asia, and the Middle East and in some parts of Latin America and Australia. Currently, 8 million people are visually impaired as a result of trachoma, and 41 million have an active infection. Of the 54 countries that the WHO cited as still having blinding trachoma occurring, Australia

1809-688: The President of Malta ) was entrusted with the supervision of a campaign in Malta to treat trachoma using sulfonamide tablets and drops. Due to improved sanitation and overall living conditions, trachoma virtually disappeared from the industrialized world by the 1950s, though it continues to plague the developing world to this day. Epidemiological studies were conducted in 1956–1963 by the Trachoma Control Pilot Project in India under

1876-727: The conjunctiva , known as Bitot's spots , and ulceration and necrosis of cornea keratomalacia can be seen. Conjunctival epithelial defects occur around lateral aspect of the limbus in the subclinical stage of VAD. These conjunctival epithelial defects are not visible on a biomicroscope, but they take up black stain and become readily visible after instillation of kajal (surma); this is called "Imtiaz's sign". A process called dark adaptation typically causes an increase in photopigment amounts in response to low levels of illumination. This occurs to an enormous magnitude, increasing light sensitivity by up to 100,000 times its sensitivity in normal daylight conditions. VAD affects vision by inhibiting

1943-619: The 20th century (Australia being a notable exception), this disease persists in many parts of the developing world , particularly in communities without adequate access to water and sanitation. It is grouped as a neglected tropical disease which is a target for preventive chemotherapy. Environmental improvement: Modifications in water use, fly control, latrine use, health education, and proximity to domesticated animals have all been proposed to reduce transmission of C. trachomatis . These changes pose numerous challenges for implementation. These environmental changes are likely to ultimately affect

2010-590: The Global Alliance for Vitamin A (GAVA), which is an informal partnership between Nutrition International , Helen Keller International , UNICEF , WHO , and CDC . About 75% of the vitamin A required for supplementation of preschool-aged children in low- and middle-income countries is supplied through a partnership between Nutrition International and UNICEF, with support from Global Affairs Canada . An estimated 1.25 million deaths due to vitamin A deficiency have been averted in 40 countries since 1998. In 2013,

2077-511: The NGO Gardening and Nutrition Education Surveillance Project (NGNESP) which expanded the programme to communities across the country in 1993. By 2012, 900,000 households and 4.5 million people are participating in the project, with the help of 52 local NGOs. Women organise 90% of the gardens. A 2002 research shows that in a three months period, households participating in the HFP consumed had

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2144-460: The SAFE protocol for blindness prevention: Surgery for trichiasis, Antibiotics to clear infection, Facial cleanliness, and Environmental improvement to reduce transmission. This includes sanitation infrastructure to reduce the open presence of human feces that can breed flies. As of 2018, Cambodia, Ghana, Iran, Laos, Mexico, Nepal, Morocco, and Oman have been certified as having eliminated trachoma as

2211-570: The United States. The last cases were found among Native American populations and in Appalachia, and those in the boxing, wrestling, and sawmill industries (prolonged exposure to combinations of sweat and sawdust often led to the disease). In the late 19th and early 20th centuries, trachoma was the main reason for an immigrant coming through Ellis Island to be deported." In 1913, President Woodrow Wilson signed an act designating funds for

2278-438: The affected eye, or trichiasis with a superimposed bacterial infection. Trachoma is caused by Chlamydia trachomatis , serotypes (serovars) A, B, and C. It is spread by direct contact with eye, nose, and throat secretions from affected individuals, or contact with fomites (inanimate objects that carry infectious agents), such as towels and/or washcloths, that have had similar contact with these secretions. Flies can also be

2345-424: The affected individual experiences symptoms of conjunctivitis , or irritation similar to " pink eye ". Blinding endemic trachoma results from multiple episodes of reinfection that maintains the intense inflammation in the conjunctiva. Without reinfection, the inflammation gradually subsides. The conjunctival inflammation is called "active trachoma" and is usually seen in children, especially those in preschool. It

2412-404: The clinical course of trachoma into four stages: The World Health Organization recommends a simplified grading system for trachoma. The Simplified WHO Grading System is summarized below: Trachomatous inflammation, follicular (TF)—Five or more follicles of >0.5 mm on the upper tarsal conjunctiva Trachomatous inflammation, intense (TI)—Papillary hypertrophy and inflammatory thickening of

2479-655: The coming 10 years, by 2025. Helen Keller International has received the 2014 BBVA Foundation Frontiers of Knowledge Award in the Development Cooperation category for agricultural programs that help families and villages to raise their own nutritious foods. "Hunger and low dietary diversity reduce cognitive function, physical capacity, resistance to disease and quality of life and lifetime earnings. Heller Keller International champions Homestead Food Production, an innovative, interdisciplinary program that promotes improved agricultural and nutritional practices in

2546-584: The conversion of carotene to retinol varies from person to person and bioavailability of carotene in food varies. Along with poor diet, infection and disease are common in many developing communities. Infection depletes vitamin A reserves which in turn make the affected individual more susceptible to further infection. Increased incidence of xerophthalmia has been observed after an outbreak of measles, with mortality correlated with severity of eye disease. In longitudinal studies of preschool children, susceptibility to disease increased substantially when severe VAD

2613-448: The country. The NSP data have also been used by the GOB to improve or develop nutrition and health programmes such as the national vitamin A capsule distribution program. NSP has proven to be an excellent tool to aid long-term planning in health policies, to provide input for programme management and evaluation and to give timely warning of the need for intervention to prevent critical deterioration in food consumption. Diabetic retinopathy

2680-451: The deficiency is more severe. Vitamin A deficiency is the world's leading cause of preventable childhood blindness , and is critical to achieving Millennium Development Goal 4 to reduce child mortality. About 250,000 to 500,000 malnourished children in the developing world go blind each year from a deficiency of vitamin A, around half of whom die within a year of becoming blind. The United Nations Special Session on Children in 2002 set

2747-403: The disease can be spread by both direct and indirect contact with an affected person's eyes or nose. Indirect contact includes through clothing or flies that have come into contact with an affected person's eyes or nose. Children spread the disease more often than adults. Poor sanitation, crowded living conditions, and not enough clean water and toilets also increase spread. Efforts to prevent

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2814-436: The disease include improving access to clean water and treatment with antibiotics to decrease the number of people infected with the bacterium. This may include treating, all at once, whole groups of people in whom the disease is known to be common. Washing, by itself, is not enough to prevent disease, but may be useful with other measures. Treatment options include oral azithromycin and topical tetracycline . Azithromycin

2881-414: The disease is a public health problem in 42 countries. Of these, Africa is considered the worst affected area, with over 85% of all known active cases of trachoma. Within the continent, South Sudan and Ethiopia have the highest prevalence. In many of these communities, women are three times more likely than men to be blinded by the disease , likely due to their roles as caregivers in the family. Australia

2948-485: The drug than it has sold during the same time period, the drug company Pfizer has agreed to donate azithromycin until 2025, if necessary, for elimination of the disease. The campaign unexpectedly found distribution of azithromycin to very poor children reduced their early death rate by up to 25%. The disease is one of the earliest known eye afflictions, having been identified in Egypt as early as 15 BCE. Its presence

3015-646: The early 20th century, trachoma was essentially controlled in Europe, although cases were reported until the 1950s. Today, most victims of trachoma live in underdeveloped and poverty-stricken countries in Africa , the Middle East , and Asia . In the United States, the Centers for Disease Control says, "No national or international surveillance [for trachoma] exists. Blindness due to trachoma has been eliminated from

3082-407: The eradication of the disease. Immigrants who attempted to enter the U.S. through Ellis Island , New York, had to be checked for trachoma. During this time, treatment for the disease was by topical application of copper sulfate . By the late 1930s, a number of ophthalmologists reported success in treating trachoma with sulfonamide antibiotics. In 1948, Vincent Tabone (who was later to become

3149-577: The form of retinyl palmitate to be taken by mouth, which is administered two to four times a year. Intramuscular injections are poorly absorbed and are ineffective in delivering sufficient bioavailable vitamin A. Fortification of food with vitamin A is costly, but can be done in wheat, sugar, and milk. Households may circumvent expensive fortified food by altering dietary habits. Consumption of yellow-orange fruits and vegetables rich in carotenoids , specifically beta-carotene , provides provitamin A precursors that can prevent VAD-related night blindness. However,

3216-828: The highest prevalence in Southeast Asia and Africa. According to the World Health Organization (WHO), VAD is under control in the United States, but in developing countries, VAD is a significant concern. Globally, 65% of all children aged 6 to 59 months received two doses of vitamin A in 2013, fully protecting them against VAD (80% in the least developed countries ). Vitamin A deficiency is the most common cause of blindness in developing countries. The WHO estimated in 1995 that 13.8 million children had some degree of visual loss related to VAD. Night blindness and its worsened condition, xerophthalmia , are markers of Vitamin A deficiency; collections of keratin in

3283-696: The plant proteins, increasing provitamin A carotenoid bioavailability. Vegetarian and vegan diets can provide sufficient vitamin A in the form of provitamin A carotenoids if the diet contains carrots, carrot juice, sweet potatoes, green leafy vegetables such as spinach and kale, and other carotenoid-rich foods. In the U.S., the average daily intake of β-carotene is in the range 2–7 mg. Some manufactured foods and dietary supplements are sources of vitamin A or β-carotene. Treatment of VAD can be undertaken with both oral vitamin A and injectable forms, generally as vitamin A palmitate . Global efforts to support national governments in addressing VAD are led by

3350-508: The presence of xerophthalmia which is strongly correlated with VAD status (and can be used to monitor recovery progress). Several methods of assessing bodily vitamin A levels are available, with HPLC the most reliable. Measurement of plasma retinol levels is a common laboratory assay used to diagnose VAD. Other biochemical assessments include measuring plasma retinyl ester levels, plasma and urinary retonioic acid levels, and vitamin A in breast milk. μg RAE (2001) per 100 g Vitamin A

3417-421: The presence of trachoma including lack of water, absence of latrines or toilets, poverty in general, flies, close proximity to cattle, and crowding. The final common pathway, though, seems to be the presence of dirty faces in children, facilitating the frequent exchange of infected ocular discharge from one child's face to another. Most transmission of trachoma occurs within the family. McCallan in 1908 divided

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3484-404: The prevalence of vitamin A deficiency was 29% in low-income and middle-income countries, remaining highest in sub-Saharan Africa and South Asia . A 2017 review (updated in 2022) found that vitamin A supplementation in children five years old and younger in 70 countries was associated with a 12% reduction in mortality rate . The review reported that synthetic vitamin A supplementation may not be

3551-512: The production of rhodopsin , the photopigment responsible for sensing low-light situations. Rhodopsin is found in the retina and is composed of retinal (an active form of vitamin A) and opsin (a protein). Night blindness caused by VAD has been associated with the loss of goblet cells in the conjunctiva, a membrane covering the outer surface of the eye. Goblet cells are responsible for secretion of mucus , and their absence results in xerophthalmia,

3618-705: The promoter regions of specific genes, thus activating transcription and stimulating T cell replication. Vitamin A deficiency will often entail deficient retinol intake, resulting in a reduced number of T-cells and lymphocytes , leading to an inadequate immune response and consequently a greater susceptibility to infections. In the presence of dietary deficiency of vitamin A, VAD and infections reciprocally aggravate each other. In addition to dietary problems, other causes of VAD are known. Iron deficiency can affect vitamin A uptake; other causes include fibrosis , pancreatic insufficiency , inflammatory bowel disease , and small-bowel bypass surgery. Protein energy malnutrition

3685-456: The promotion of breastfeeding and complementary feeding, and nutritional surveillance to provide critical data to governments and other development partners. Each year, Helen Keller's programs benefit millions of children and families. George A. Kessler, also known as the "Champagne King," was a passenger on the RMS ; Lusitania in 1915 when it was torpedoed by a German U-boat . When he

3752-444: The rate of recurrence is higher in more advanced disease. The WHO-recommended SAFE strategy includes: Children with visible nasal discharge, discharge from the eyes, or flies on their faces are at least twice as likely to have active trachoma as children with clean faces. Intensive community-based health education programs to promote face-washing can reduce the rates of active trachoma, especially intense trachoma. If an individual

3819-404: The risk of active trachoma in individuals infected with chlamydial trachomatis. For individuals with trichiasis, a bilamellar tarsal rotation procedure is warranted to direct the lashes away from the globe. Evidence suggests that use of a lid clamp and absorbable sutures would result in reduced lid contour abnormalities and granuloma formulation after surgery. Early intervention is beneficial as

3886-555: The seedlings, chicks, start up materials and technical skills to communities. Varieties of fruits and vegetables are grown in these home gardens to provide supplies of nutrient rich foods all year round. The objectives are to increase participants' micro-nutritional intakes by consuming a wider variety of foods, develop communities and empower women. HFP started in 1990 as a pilot project in Bangladesh with 1000 households participating. It includes nutrition education to complement home gardening. Following initial success, Helen Keller launched

3953-708: The symptoms may escalate and cause blindness, which is the result of ulceration and consequent scarring of the cornea . Surgery may also be necessary to fix eyelid deformities. Without intervention, trachoma keeps families in a cycle of poverty , as the disease and its long-term effects are passed from one generation to the next. As of 2011, about 21 million people are actively affected by trachoma, with around 2.2 million people being permanently blind or have severe visual impairment from trachoma. An additional 7.3 million people are reported to have trichiasis . As of June 2022, 125 million individuals live in trachoma endemic areas and are at risk of trachoma-related blindness, and

4020-541: The transmission of ocular infection by means of lack of facial cleanliness. Particular attention is required for environmental factors that limit clean faces. A systematic review examining the effectiveness of environmental sanitary measures on the prevalence of active trachoma in endemic areas showed that use of insecticide spray resulted in significant reductions of trachoma and fly density in some studies. Health education also resulted in reductions of active trachoma when implemented. Improved water supply did not result in

4087-407: The upper cornea (pannus). Resolved limbal follicles may leave small gaps in the pannus (Herbert's pits). Most commonly, children with active trachoma do not present with symptoms, as the low-grade irritation and ocular discharge is just accepted as normal, but further symptoms may include: The most important complication to look out for is a corneal ulcer , which is caused by intense rubbing of

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4154-475: The upper tarsal conjunctiva obscuring more than half the deep tarsal vessels Trachomatous scarring (TS)—Presence of scarring in tarsal conjunctiva. Trachomatous trichiasis (TT)—At least one ingrown eyelash touching the globe, or evidence of epilation (eyelash removal) Corneal opacity (CO)—Corneal opacity blurring part of the pupil margin Although trachoma was eliminated from much of the developed world in

4221-995: The world in Africa, Asia and the United States. Global headquarters are located in New York City, and programs are also developed and administered through regional offices, currently located in Senegal and Phnom Penh , as well as through 18 country offices and an additional development office in Paris. Helen Keller has country offices in Burkina Faso , Bangladesh , Cameroon , Cambodia , Côte d'Ivoire , Democratic Republic of Congo, Guinea, Kenya, Madagascar, Mali , Mozambique , Nepal , Niger , Nigeria , Philippines , Senegal , Sierra Leone , and Tanzania . Helen Keller Intl has launched and completed several initiatives to combat malnutrition and blindness in Bangladesh. This program

4288-589: Was also recorded in ancient China and Mesopotamia. Trachoma became a problem as people moved into crowded settlements or towns where hygiene was poor. It became a particular problem in Europe in the 19th century. After the Egyptian Campaign (1798–1802) and the Napoleonic Wars (1798–1815), trachoma was rampant in the army barracks of Europe and spread to those living in towns as troops returned home. Stringent control measures were introduced, and by

4355-516: Was fighting for his life in the cold waters of the Atlantic off the coast of Ireland, he vowed that if he survived, he would devote much of his time and substantial financial resources to a worthwhile cause. The cause he chose was assisting Allied soldiers blinded in the service. He later befriended Helen Keller and helped found the organization that became Helen Keller International. As of 2024, Helen Keller International works in 20 countries around

4422-442: Was present. While VAD can make measles worse, Vitamin A supplements do not prevent measles, high doses may be dangerous, and vaccines remain the most effective was to prevent the disease. The reason for the increased infection rate in vitamin A deficient individuals is that killer T-cells require the retinol metabolite retinoic acid to proliferate correctly. Retinoic acid is a ligand for nuclear retinoic acid receptors that bind

4489-573: Was started by Helen Keller in 1990 to monitor the health impact of severe flooding in Bangladesh. It is a collaborative effort which involves the Government of Bangladesh (GOB), international and local Non-Governmental Organisations (NGO). The programme essentially provides up-to-date and dependable information on the prevalence of malnutrition and morbidity in children, household socioeconomic characteristics and food prices . Data are collected by authorities in selected rural districts and urban slums in

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