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Uganda is a landlocked East African country bordered by Democratic Republic of Congo, Kenya, Rwanda, Sudan and Tanzania. The current population is estimated at 30, 262, 610 with approximately half of the population under 15 years old and half of the population 15 years of age and older. The population is comprised of a range of ethnic groups. Agriculture is the dominant sector of the economy with coffee as the principal export. Uganda's economy has stabilized over the past twenty years but it remains a heavily indebted country and in 2000 Uganda qualified for two debt relief programs. 1 Security concerns resulting from armed conflict prevail in the Northern regions of Uganda due to civil war as well as cattle rustling. Although Uganda has many lakes and rivers, access to water during the dry season is difficult in some areas including some areas targeted for trachoma control. The health sector administration closely follows the administrative divisions of the government. Recent redistricting has resulted in the creation many new districts and as a result some districts do not have all of the health services structures in place. Health services delivery is decentralized to the district level with the central level providing support for policy, standards, quality assurance, supervision, resource mobilization, coordination and research. Trachoma is a significant disabling health concern in Uganda. It is the second most common cause of preventable blindness in Uganda following cataracts. Until recently, interventions to reduce the burden of trachoma have been erratic. However, in 2003 a Trachoma Task Force was formed within the Ministry of Health MOH ; with leadership provided by the Trachoma Control Program housed within the Disability Prevention and Rehabilitation Section. The group formalized trachoma control in Uganda by creating Uganda-specific protocols to contain and treat the disease. Collaboration of this group with the International Trachoma Initiative ITI ; and the World Health Organization WHO ; resulted in adoption of the SAFE strategy Surgery, Antibiotics, Face washing and Environmental change ; and training of staff to conduct trachoma prevalence surveys. In 2006 the MOH surveyed the 24 known trachoma-endemic districts and seven of them were found to have high rates of active trachoma 10% ; . In the North East region, rates soared as high as 67%. Prevalence surveys are ongoing in other districts to obtain prevalence rates. In late 2006, the MOH was successful in receiving support from ITI to implement the mass antibiotic administration "A" ; component of the SAFE strategy. The current expansion plan is to provide mass drug administration MDA ; in seven districts this year, 15 districts next year and 24 districts in the following year. The MOH partners with other organizations such as Lions Aid Norway and Sight Savers International to implement the other elements of the strategy. In 2007, the MOH published The 3rd National Strategic Plan for the Prevention of Blindness in Uganda: January 2006-December 2010. The document references trachoma but does not detail a plan for implementation of the SAFE strategy. MDA is not new to Uganda. Several neglected tropical diseases NTD ; have been combatted with MDA for many years. Child Days and Child Days Plus annual campaigns have been used to reach and treat populations affected by infectious diseases as well as to immunize children. The month long campaign held in October embraces the concept of Integrated Disease Management, a conceptual notion of the WHO to use limited resources effectively. MDA using Zithromax to treat trachoma is included in the Child Days Plus scheduled for October 2007. Oversight of the management of NTDs in Uganda is the responsibility of the NTD Secretariat. The U.S. Agency for International Development USAID ; is currently funding this effort through their prime contractor, RTI International with technical support provided by the Schistosomiasis Control Initiative SCI ; of Imperial College London and methotrexate.

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