Evaluation of three years of the SAFE strategy (Surgery, Antibiotics, Facial cleanliness and Environmental improvement) for trachoma control in five districts of Ethiopia hyperendemic for trachoma
Transactions of the Royal Society of Tropical Medicine and Hygiene
The Carter Center, 1 Copenhill Avenue, Atlanta, GA, United States; Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, United Kingdom; The Carter Center, P.O. Box 13373, Woreda 17, Kebele 19, Addis Ababa, Ethiopia; Ministry of Health, Prevention of Blindness Team, P.O. Box 1234, Addis Ababa, Ethiopia; The F.I. Proctor Foundation, University of California San Francisco, San Francisco, CA, United States
Trachoma surveys were conducted at baseline in five districts of Amhara National Regional State, Ethiopia (7478 participants in 1096 households) and at 3-year evaluation (5762 participants in 1117 households). Uptake of SAFE was assessed with programme monitoring data and interviews, and children (1-6 years) were swabbed for detection of ocular Chlamydia. At evaluation, 23 933 people had received trichiasis surgery; 93% of participants reported taking azithromycin at least once; 67% of household respondents (range 46-93) reported participation in trachoma health education; and household latrine coverage increased from 2% to 34%. In children aged 1-9 years percentage decline, by district, for outcomes was: 32% (95% CI 19-48) to 88% (95% CI 83-91) for trachomatous inflammation-follicular (TF); 87% (95% CI 83-91) to 99% (95% CI 97-100) for trachomatous inflammation-intense (TI); and 31% increase (95% CI -42 to -19) to 89% decrease (95% CI 85-93) for unclean face; and in adults percentage decline in trichiasis was 45% (95% CI -13 to 78) to 92% (95% CI 78-96). Overall prevalence of swabs positive for ocular Chlamydia was 3.1%. Although there were substantial reductions in outcomes in children and adults, the presence of ocular Chlamydia and TF in children suggests ongoing transmission. Continued implementation of SAFE is warranted. © 2008 Royal Society of Tropical Medicine and Hygiene.
azithromycin; antiinfective agent; article; bacterium culture; Chlamydia trachomatis; endemic disease; environmental sanitation; Ethiopia; eye surgery; health care delivery; health education; health program; health survey; human; infection control; interview; outcome assessment; personal hygiene; prevalence; sanitation; trachoma; treatment outcome; adolescent; adult; aged; child; Chlamydia trachomatis; cluster analysis; education; environment; evaluation study; hygiene; infant; middle aged; pathology; preschool child; standards; trachoma; very elderly; young adult; Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Child; Child, Preschool; Chlamydia trachomatis; Cluster Analysis; Environment; Ethiopia; Health Education; Humans; Hygiene; Infant; Middle Aged; Trachoma; Young Adult; Chlamydia; Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Child; Child, Preschool; Chlamydia trachomatis; Cluster Analysis; Environment; Ethiopia; Health Education; Humans; Hygiene; Infant; Middle Aged; Trachoma; Young Adult