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. Epidemiology
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. 51 countries are currently classified as endemic for blinding trachoma. 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, due to their roles as caregivers in the family. Approximately 158 million people are living in areas were trachoma is common. An additional 229 million live where trachoma could potentially occur. Australia is the only developed country that has trachoma. In 2008, trachoma was found in half of Australias very remote communities. Elimination
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.
These environmental changes are likely to ultimately affect 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 a reduction of trachoma incidence. Antibiotics
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. Management
Antibiotics
Azithromycin (single oral dose of 20 mg/kg) or topical tetracycline (1% eye ointment twice 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.