Twenty five years ago medical scientists working in Southern Africa clarified the natural history of trachoma and how it affected vision impairment and eventual blindness in rural communities. After this, doctors attempted to take appropriate actions against the disease. Initial surveys indicated a blindness prevalence rate of 760/100,000 among rural Africans compared to 100/100,000 among the white population. Trachoma was found to be the main cause of blindness. It was found mostly among children under 15 years to a very high degree and seemed to start soon after birth. Vaccine development failed and mass treatment was started. Control measures which did not reach the community, the population at risk, and which did not affect ways of living were found to be ineffective. Community health programmes were thus started but only in a few areas. Further, it was found that non-medical control strategies would be more effective and efficient. Improvement of living standards is one such strategy.
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