The Limits of Medical Interventions for the Elimination of Preventable Blindness

Abstract

Background: 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 meta-analysis 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.

Household Survey of Trachoma among Children Living in Pernambuco, Brazil

“…An analysis on the risk factors for trachoma provides important information for planning and implementing actions in disease control programs [5,14,15,23]. The present study revealed factors that were associated with occurrences of the disease, using households as the database.…”

“…To reach the global elimination of trachoma as a cause of blindness by 2020, WHO established a goal of carrying out population-based surveys among samples to verify the epidemiological situation [7,11,12] and implementing the SAFE strategy to control trachoma (S-surgery in cases of trachomatous trichiasis; A-antibiotic therapy in cases of active trachoma; F-facial hygiene; and E-environmental improvements) [13]. Use of the SAFE strategy has been shown to be a tool for reducing the prevalence of active forms of the disease [14].…”

Social Sciences for the Prevention of Blindness

“…As largely reported, the antibiotic (azithromycin) administered to treat trachoma is bioavailable and highly active against the intracellular microorganisms triggering trachoma ( Chlamydiae ) [ 41 , 42 ]. This antibiotic eradicates Chlamydia from the conjunctival cells in a few weeks and dramatically reduces the clinical signs of active trachoma (follicles in the conjunctiva) [ 8 , 9 , 43 ]. Moreover, azithromycin treatments revealed no evidence that Chlamydiae lost their susceptibility to this antibiotic by post-transcriptional methylation of the 23S bacterial ribosomal-RNA, either plasmid or chromosome-mediated [ 44 , 45 ].…”

“…In fact, 14 trials that included 3,587 participants and 15 trials that included 8,678 did not allow highlighting of the real impact of antibiotic treatment on the long-term elimination of clinical active trachoma, showing first, that clinical signs of trachoma re-emerged in treated communities, and second, that Chlamydia genomes were detected in conjunctival samples after repeated implementation of the four components of the SAFE strategy. The evidence at this point suggests that trachoma was partially reduced but not eliminated by repeatedly implementing the WHO strategy [ 43 , 47 – 49 ]. These facts suggest that the microbiological episteme makes it unreasonable to justify the repeated administration of active antibiotics in the same district to the same people (5, 7, 9 times or even more) to treat susceptible germs, and therefore that further analysis cannot be restricted to mathematical predictors, laboratory results or the opinions of eye-surface specialists [ 11 , 43 , 49 , 50 ].…”

“…The evidence at this point suggests that trachoma was partially reduced but not eliminated by repeatedly implementing the WHO strategy [ 43 , 47 – 49 ]. These facts suggest that the microbiological episteme makes it unreasonable to justify the repeated administration of active antibiotics in the same district to the same people (5, 7, 9 times or even more) to treat susceptible germs, and therefore that further analysis cannot be restricted to mathematical predictors, laboratory results or the opinions of eye-surface specialists [ 11 , 43 , 49 , 50 ]. At this point, special attention should be paid to efforts made in Morocco, Oman, Nepal and Gambia for the elimination of preventable blindness from bacterial origin.…”