No abstract

Trachoma is the most important infectious cause of blindness worldwide. In two rural populations in Ethiopia, a programme of preventative and treatment measures was initiated in May 2002. A baseline survey was conducted to evaluate the effect of this programme on the prevalence of active trachoma. A total of 1960 children aged 3-9 years, from 915 households in 40 communities, were examined for the presence of active trachoma. Demographic and household information was collected using questionnaires and household amenities and environmental conditions were observed. Overall, 72% of children had active trachoma. Twenty percent of children aged nine years had trachomatous scarring. In children, discharge in the eyes and flies on the eyes were significant indicators of trachoma (odds ratio [OR] = 3.0, 95% CI 1.94-4.55 and OR = 3.4, 95% CI 2.37-4.88, respectively). Frequency of washing children, a clean environment and hygienic disposal of excrement were significant preventative factors for active trachoma. Prevalence of active trachoma varies widely between and within districts. Risk factors comprise a mix of individual characteristics and household factors. This study demonstrates the need for broad target interventions and a flexible approach to the prevention of trachoma in high prevalence endemic rural populations.

Summaryobjectives To investigate risk factors for ocular Chlamydia trachomatis infection and active trachoma, comparing communities receiving or not receiving an intervention programme of community-wide azithromycin treatment and health education.methods In a 3-year post-intervention follow-up survey, 1722 children aged 3-9 years, from randomly selected households in 37 communities, were examined for signs of active trachoma and had samples taken to test for ocular C. trachomatis by polymerase chain reaction. Multivariate random effects logistic regression analyses considered interventions at community level, adjusting for other independent risk factors as appropriate.results Younger age, ocular discharge and flies on eyes were risk factors for active trachoma in communities with and without antibiotic treatment. After azithromycin treatment, odds of active trachoma were lower in children aged 6-9 years than in children aged 3-5 years (OR 0.48, 95% CI: 0.36-0.66) and higher for children with ocular discharge (OR 4.5, 95% CI: 2.6-7.7) or flies on their eyes (OR 2.5, 95% CI: 1.6-3.7). Odds of C. trachomatis infection were lower in children aged 6-9 years than in younger children (OR 0.47, 95% CI: 0.23-0.96); and in children who received 2 or 3 doses rather than 1 (OR 0.26, 95% CI: 0.08-0.88).conclusions In communities that received or did not receive the mass antibiotic treatment, the same risk factors for C. trachomatis and active trachoma were identified. Education and environmental improvements need to supplement antibiotic campaigns in order to positively impact on these remaining child level risk factors.

Trachoma remains a public health problem in Ethiopia. Antibiotic administration remains the most effective intervention but community-based health education programmes can impact, to additionally reduce prevalence of C. trachomatis.