Sharing essential knowledge with health researchers and policy makers

Communities of practice

Associations between Active Trachoma and Community Intervention with Antibiotics, Facial Cleanliness, and Environmental Improvement (A,F,E)

2 May 2008

Chinnock

Source: PLoS Neglected Tropical Diseases (see original article)

Citation: Ngondi J, Matthews F, Reacher M, Baba S, Brayne C, et al. (2008) Associations between Active Trachoma and Community Intervention with Antibiotics, Facial Cleanliness, and Environmental Improvement (A,F,E). PLoS Negl Trop Dis 2(4): e229. doi:10.1371/journal.pntd.0000229

A study involving 1,712 children in 25 villages in southern Sudan provides support for the use of antibiotics, facial cleanliness, and environmental improvement in trachoma control activities. These measures are key features of the SAFE strategy advocated by the World Health Organization.

Author Summary

Trachoma is an infectious disease that is caused by a bacterium, Chlamydia trachomatis, and is the leading cause of preventable blindness estimated to be responsible for 3.6% of blindness globally. The World Health Organization (WHO) recommends a strategy for trachoma control known as SAFE—surgery, antibiotics, facial cleanliness, and environmental improvement. Regular evaluations of trachoma control activities are advocated for by the WHO for decision making, programme planning, and the rational use of programme resources. We undertook a survey to evaluate the effectiveness of the SAFE strategy following three years of interventions in four districts in southern Sudan. In this paper, we aimed to find out the relationship between the antibiotics, facial cleanliness, and environmental improvement (A,F,E) and active trachoma signs. Our study revealed that prevalence of active trachoma was less in children who had received treatment with azithromycin, had clean faces, had faces washed more frequently, and used latrines compared to children who had not received these interventions. The study findings are important since they make the case for implementing the A,F,E interventions together.

© 2008 Ngondi et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Source

Title:
Associations between Active Trachoma and Community Intervention with Antibiotics, Facial Cleanliness, and Environmental Improvement (A,F,E).

Authors:
Ngondi J, Matthews F, Reacher M, Baba S, Brayne C, Emerson P

References:
PLoS Negl Trop Dis 2008: Vol. 2 no. 4, pp. e229

Abstract:
BACKGROUND: Surgery, Antibiotics, Facial cleanliness and Environmental improvement (SAFE) are advocated by the World Health Organization (WHO) for trachoma control. However, few studies have evaluated the complete SAFE strategy, and of these, none have investigated the associations of Antibiotics, Facial cleanliness, and Environmental improvement (A,F,E) interventions and active trachoma. We aimed to investigate associations between active trachoma and A,F,E interventions in communities in Southern Sudan. METHODS AND FINDINGS: Surveys were undertaken in four districts after 3 years of implementation of the SAFE strategy. Children aged 1-9 years were examined for trachoma and uptake of SAFE assessed through interviews and observations. Using ordinal logistic regression, associations between signs of active trachoma and A,F,E interventions were explored. Trachomatous inflammation-intense (TI) was considered more severe than trachomatous inflammation-follicular (TF). A total of 1,712 children from 25 clusters (villages) were included in the analysis. Overall uptake of A,F,E interventions was: 53.0% of the eligible children had received at least one treatment with azithromycin; 62.4% children had a clean face on examination; 72.5% households reported washing faces of children two or more times a day; 73.1% households had received health education; 44.4% of households had water accessible within 30 minutes; and 6.3% households had pit latrines. Adjusting for age, sex, and district baseline prevalence of active trachoma, factors independently associated with reduced odds of a more severe active trachoma sign were: receiving three treatments with azithromycin (odds ratio [OR] = 0.1; 95% confidence interval [CI] 0.0-0.4); clean face (OR = 0.3; 95% CI 0.2-0.4); washing faces of children three or more times daily (OR = 0.4; 95% CI 0.3-0.7); and presence and use of a pit latrine in the household (OR = 0.4; 95% CI 0.2-0.9). CONCLUSION: Analysis of associations between the A,F,E components of the SAFE strategy and active trachoma showed independent protective effects against active trachoma of mass systemic azithromycin treatment, facial cleanliness, face washing, and use of pit latrines in the household. This strongly argues for continued use of all the components of the SAFE strategy together.

PMID: 18446204
Full text: HTML

Comments | Related Articles