The Ghana Health Service plans to eliminate blinding trachoma by 2010 and has implemented the SAFE strategy since 2001. The programme impact was assessed in all endemic districts. A two-stage, cluster random sample of 720 households was selected in each of 18 endemic districts in Upper West and Northern Regions. All eligible residents were examined for trachoma signs. Household environmental risk factors were assessed. In total, 74,225 persons from 12,679 households were examined. Prevalence of trachomatous inflammation-follicular in 1-9 year-old children was 0.84% (95% CI 0.63-1.05, range of point estimates by district 0.14-2.81%) and prevalence of trichiasis in adults aged > or = 15 years was 0.31% (95% CI 0.24-0.38, range by district 0.00-1.07%). An estimated 4950 persons have trichiasis, of whom 72.6% are aged > or = 60 years and 71.4% are women. Latrines were observed in 11.6% of households and 79.2% of interview respondents reported use of an improved water source. Active trachoma is no longer a public health problem in Ghana after successful implementation of the SAFE strategy. The programme should maintain health education, advocate for improved water and sanitation and focus on providing surgery. Surveillance activities are needed to ensure sustained control.