The Limits of Medical Interventions for the Elimination of Preventable Blindness

Goldschmidt, Pablo; Einterz, Ellen
January 2014
Tropical Medicine & Health;2014, Vol. 42 Issue 1, p43
Academic Journal
Back ground Health authorities are working toward the global elimination of trachoma by the year 2020 with actions focused on the World Health Organization SAFE strategy (surgery of trichiasis, antibiotics, face washing and environmental changes) with emphasis on hygienist approaches for education. Objectives: The present survey was performed to assess the sustainability of the SAFE strategy 3 years after trachoma was eliminated from 6 villages. Methods: In February 2013 a rapid trachoma assessment was conducted in 6 villages of Kolofata's district, Extreme north Region, Cameroon, where trachoma was eliminated in 2010. A total of 300 children (1-10 years) from 6 villages were examined by trained staff. Results: The prevalence of active trachoma (children aged > 1 and < 10 years) in 2013 was 15% and in at least 25% was observed absence of face washing and flies in their eyes and nose. Income level, quality of roads, hygiene, and illiteracy were similar in all the villages; they did not change between 2010 and 2013 and could not be analyzed as independent risk factors. Discussion: The heterogeneity of methods described for clinical trials makes it inappropriate to conduct metaanalysis for the present and for other SAFE-related trials. The results obtained after implementation the SAFE strategy (recurrence) reveal that the causes (infectious agents and dirtiness) and effects (illness) were not connected by illiterate people living under conditions of extreme poverty. So far, antibiotics, surgery and hygiene education are insufficient for the sustainability of trachoma elimination and highlight that hypothetic-deductive processes seem not operational after implementing the awareness campaigns. Trachoma recurrence detected in 2013 in sedentary populations of Kolofata receiving efficacious treatments against Chlamydia sp. suggest that the elimination goals will be delayed if strategies are limited to medical actions. Restricting efforts to repeated pharmacological and surgical interventions for people infected with susceptible bacteria could be understood as the hidden side of a passive attitude toward basic education actions.


Related Articles

  • Risk Factors for Ocular Chlamydia after Three Mass Azithromycin Distributions. Ayele, Berhan; Gebre, Teshome; Moncada, Jeanne; House, Jenafir I.; Stoller, Nicole E.; Zhou, Zhaoxia; Porco, Travis C.; Gaynor, Bruce D.; Emerson, Paul M.; Schachter, Julius; Keenan, Jeremy D. // PLoS Neglected Tropical Diseases;Dec2011, Vol. 5 Issue 12, p1 

    Background: An important component of the World Health Organization's comprehensive trachoma elimination strategy is the provision of repeated annual mass azithromycin distributions, which are directed at reducing the burden of ocular chlamydia. Knowledge of characteristics associated with...

  • Prevalence of Trachoma in Unity State, South Sudan: Results from a Large-Scale Population-Based Survey and Potential Implications for Further Surveys. Edwards, Tansy; Smith, Jennifer; Sturrock, Hugh J. W.; Kur, Lucia W.; Sabasio, Anthony; Finn, Timothy P.; Lado, Mounir; Haddad, Danny; Kolaczinski, Jan H. // PLoS Neglected Tropical Diseases;Apr2012, Vol. 6 Issue 4, p1 

    Background: Large parts of South Sudan are thought to be trachoma-endemic but baseline data are limited. This study aimed to estimate prevalence for planning trachoma interventions in Unity State, to identify risk factors and to investigate the effect of different sampling approaches on study...

  • Mass Treatment with Azithromycin for Trachoma Control: Participation Clusters in Households. Ssemanda, Elizabeth N.; Munoz, Beatriz; Harding-Esch, Emma M.; Edwards, Tansy; Mkocha, Harran; Bailey, Robin L.; Sillah, Ansumana; Stare, Dianne; Mabey, David C. W.; West, Sheila K. // PLoS Neglected Tropical Diseases;Oct2010, Vol. 4 Issue 10, p1 

    Background: Mass treatment to trachoma endemic communities is a critical part of the World Health Organization SAFE strategy. However, non-participation may not be at random, affecting coverage surveys and effectiveness if infection is differential. Methodology/Principal Findings: As part of the...

  • The SAFE strategy for the elimination of trachoma by 2020: will it work? Bailey, Robin; Lietman, Tom // Bulletin of the World Health Organization;2001, Vol. 79 Issue 3, p233 

    Focuses on the adoption of SAFE strategy by the GET 2020 programme launched by World Health Organization trachoma elimination. Components of the strategy; Description of trachoma as the leading cause of preventable blindness; Use of antibiotics for infectious trachoma.

  • Impact of Annual Targeted Treatment on Infectious Trachoma and Susceptibility to Reinfection. Atik, Berna; Ton Ton Kim Thanh; Vu Quoc Luong; Lagree, Stephane; Dean, Deborah // JAMA: Journal of the American Medical Association;9/27/2006, Vol. 296 Issue 12, p1488 

    The article presents a medical study evaluating the effectiveness of azithromycin treatments for active trachoma and Chlamydia trachomatis infection rates in Vietnam. The article discusses the World Health Organization's SAFE strategy, which stands for Surgery for trichiasis; Antibiotics for...

  • Profound and Sustained Reduction in Chlamydia trachomatis in The Gambia: A Five-Year Longitudinal Study of Trachoma Endemic Communities. Burton, Matthew J.; Holland, Martin J.; Makalo, Pateh; Aryee, Esther A. N.; Sillah, Ansumana; Cohuet, Sandra; Natividad, Angels; Alexander, Neal D. E.; Mabey, David C. W.; Bailey, Robin L. // PLoS Neglected Tropical Diseases;Oct2010, Vol. 4 Issue 10, p1 

    Background: The elimination of blinding trachoma focuses on controlling Chlamydia trachomatis infection through mass antibiotic treatment and measures to limit transmission. As the prevalence of disease declines, uncertainty increases over the most effective strategy for treatment. There are...

  • The Added Value of Water, Sanitation, and Hygiene Interventions to Mass Drug Administration for Reducing the Prevalence of Trachoma: A Systematic Review Examining. Travers, Anyess; Strasser, Sheryl; Palmer, Stephanie L.; Stauber, Christine // Journal of Environmental & Public Health;2013, Vol. 2013, p1 

    Trachoma is the leading cause of infectious blindness worldwide. The SAFE strategy, the World Health Organization-recommended method to eliminate blinding trachoma, combines developments in water, sanitation, surgery, and antibiotic treatment. Current literature does not focus on the...

  • BLINDING TRACHOMA: PROGRESS TOWARDS GLOBAL ELIMINATION BY 2020.  // UN Chronicle;Mar-May2006, Vol. 43 Issue 1, p71 

    The article reports on the move of several countries to eradicate the blinding trachoma as part of its efforts to achieve the goal set by the World Health Assembly in 1998 to eliminate the disease by 2020. Countries such as Morocco and Oman has announced it had successfully established remedy by...

  • Correlation of Clinical Trachoma and Infection in Aboriginal Communities. Michel, Claude-Edouard C.; Roper, Katrina G.; Divena, Magda A.; Lee, Helen H.; Taylor, Hugh R. // PLoS Neglected Tropical Diseases;Mar2011, Vol. 5 Issue 3, p1 

    Background: Trachoma is the leading infectious cause of blindness due to conjunctival infection with Chlamydia trachomatis. The presence of active trachoma and evidence of infection are poorly correlated and a strong immunologicallymediated inflammatory response means that clinical signs last...


Other Topics