Journey to N’Teklefe: Trachoma Mapping in Cote d’Ivoire

The drive to N’Teklefe in Cote d’Ivoire reminds me of my Peace Corps training in western Togo 18 years ago. The road is tinged pink from the bright red earth, and the distant green hills offer hints of thick, lush forests. Logging trucks blast past us with loads of enormous tree trunks.

Photo: Kouassi Ackoundou/ FHI 360/Cote d’Ivoire. Stephanie Palmer (middle), sits with the Act | West team and the Cote d'Ivoire NTDP staff and survey team
Photo: Kouassi Ackoundou/ FHI 360/Cote d’Ivoire. Stephanie Palmer (middle), sits with the Act | West team and the Cote d'Ivoire NTDP staff and survey team

Vendors line the road, holding up large rodents called agoutis and even a few monkeys, which they try to sell to passersby. Interspersed with the vendors, we pass numerous villages, each with a cemetery tightly packed with elaborate grave markers, fetishes, and shrines to the Virgin Mary.


I was traveling with Dr. Koizan Kadjo Gamael, Cote d’Ivoire’s Neglected Tropical Diseases Program (NTDP) Manager; Dr. Ago Lazare, the NTD Focal Point for the district of Daoukro; and two colleagues from FHI 360/Cote d’Ivoire, Christian Gongoue and Ackoundou Kouassi, both of whom work on USAID’s Act to End Neglected Tropical Diseases (NTDs) | West (Act | West) program. The purpose of our trip was to monitor trachoma mapping in a village called N’Teklefe, located about 40 kilometers from the town of Daoukro, the seat of Cote d’Ivoire’s Iffou Region and home of former President Aimé Henri Konan Bédié. Translated into English, N’Teklefe means, “I don’t like to fight myself” in Malinké, the local language.


Trachoma is a painful and infectious eye disease that can cause blindness when scarring from repeated infections cause the eyelashes to turn towards the eye and scrape the cornea. To make sure people with trachoma get the treatment they need, Cote d’Ivoire’s NTDP, Act | West, and other NTD partners are working together to determine and map areas where trachoma is a public health problem. This is defined as active trachoma (trachomatous inflammation—follicular, or TF) in over 5% of children 1 to 9 years of age, or advanced trachoma (trachomatous trichiasis, or TT) in over 0.2% of adults ages 15 and over in an evaluation unit (typically either part or all of a pre-defined health district). Trachoma infections can be prevented and treated through the World Health Organization (WHO)-endorsed SAFE strategy: Surgery for trichiasis, Antibiotics to treat infections, Facial cleanliness, and Environmental improvements (such as sanitation).     


Prior to leaving for the field, we met with Dr. Koizon; Dr. Lazare; Deputy Chief of Service of the Dakouro district health office Dr. Niamien N’Guessan Yves; Dr. Kouassi Bah, who was charged with epidemiological surveillance; and two members of the trachoma survey team—Trachoma Grader Dr. Clement Ty Robert and Trachoma Recorder Dr. Allibi-Sehi Françoise. Both members of the survey team were certified through Tropical Data ( The team was experienced, having first been certified through the Global Trachoma Mapping Project (GTMP), which preceded Tropical Data. In fact, Trachoma Grader Dr. Robert was Cote d’Ivoire’s first NTD technician!


After arriving in N’Teklefe, a neatly swept village located in a peninsula on the Comoe River, we met with the village chief, Mr. Boni Auguste Charles, who gave us permission to conduct the survey in the village and assigned Koffi Kouakou Darius, a village mechanic, to accompany our team. Along the way, Koffi told us that the chief had recently put him in charge of maintaining the village pumps, which supply the villagers with potable water.


Because access to clean water is a key piece of the trachoma SAFE strategy, taking care of the pumps is an important job. Normally, Koffi just has to keep the pumps greased so they will continue working properly. However, he related that he once had to close one of the pumps because the water wasn’t potable. And if they break, it’s his job to fix them, even though he is not paid for his efforts.


Koffi was ever the concerned village host. Walking from house-to-house together, he held an umbrella over my head to shade me from the intense sun. With his help, we were able to accompany the survey team on visits to about 10 of the 30 households that needed to be surveyed. On this day, we were pleased to report that the survey team found very little trachoma: only one case of TF and no TT in the visited households.


Unfortunately, not every village in Cote d’Ivoire has so few trachoma cases. To date, of the 28 evaluation units surveyed, 19 require at least one year (i.e., round) of mass drug administration (MDA) with Pfizer, Inc.-donated Zithromax®. Trachoma MDA in Cote d’Ivoire is supported financially and technically by Act | West and targets 100% of the population in districts warranting treatment. Depending on the prevalence, a district may receive from one to seven rounds of MDA before impact surveys are conducted to determine whether TF in children 1 to 9 years has fallen below 5%. 


Before leaving N’Teklefe, I spent some time speaking with my new friend Koffi. I asked him why he agreed to take care of the pumps without any compensation. His response was both genuine and heart-warming: “This work is important for me,” he said. “No one pays me anything, but it’s for everyone.”


By Stephanie Palmer, FHI 360 Technical Advisor for USAID’s Act to End NTDs | West program, written in collaboration with Senior Communication and Knowledge Management Specialist Kathy Sanchez