BACKGROUND: A trachoma control programme was started in southern Sudan in 2001. We did a 3-year evaluation to quantify uptake of SAFE (surgery, antibiotics, facial cleanliness, and environmental change) interventions, and to assess the prevalence of active trachoma and unclean faces. METHODS: Cross-sectional surveys, including clinical assessment of trachoma (WHO simplified system) and structured questionnaires, were done in four intervention areas at baseline and follow-up. Process indicators were uptake of SAFE components; primary outcome indicators included trachomatous inflammation-follicular (TF) and unclean face in children aged 1-9 years. FINDINGS: There was heterogeneous uptake of SAFE between intervention areas. Surgical coverage was low in all areas (range 0.5% of 428 individuals in Katigiri to 6% of 5002 in Kiech Kuon), antibiotic uptake ranged from 14% of 1257 individuals in Kiech Kuon to 75% of 954 in Katigiri, health education ranged from 49% of 190 households in Kiech Kuon to 90% of 182 in Padak, and latrine coverage from 3% of households in Tali to 16% in Katigiri. Substantial decreases in prevalence of TF and unclean faces were recorded in Katigiri and Tali, two of three sites where uptake of antibiotics and health education was high: TF decreased by 92% (95% CI 87-96) and 91% (86-95), respectively, and unclean face decreased by 87% (78-94) and 38% (22-52), respectively. Moderate effects were recorded in Padak, an area with high coverage, with a 28% (14-41) decrease in TF and a 16% (7-25) decrease in unclean face. No evidence of decline was seen in Kiech Kuon, where uptake of antibiotics and health education was low, with a 2% (-10 to 12) decrease in TF and a 10% (-3 to 23) decrease in unclean face. INTERPRETATION: Our results show that substantial falls in active trachoma can occur where SAFE is implemented, and that good results could be achieved with the SAFE strategy in other trachoma-endemic areas.
BACKGROUND: A trachoma control programme was started in southern Sudan in 2001. We did a 3-year evaluation to quantify uptake of SAFE (surgery, antibiotics, facial cleanliness, and environmental change) interventions, and to assess the prevalence of active trachoma and unclean faces. METHODS: Cross-sectional surveys, including clinical assessment of trachoma (WHO simplified system) and structured questionnaires, were done in four intervention areas at baseline and follow-up. Process indicators were uptake of SAFE components; primary outcome indicators included trachomatous inflammation-follicular (TF) and unclean face in children aged 1-9 years. FINDINGS: There was heterogeneous uptake of SAFE between intervention areas. Surgical coverage was low in all areas (range 0.5% of 428 individuals in Katigiri to 6% of 5002 in Kiech Kuon), antibiotic uptake ranged from 14% of 1257 individuals in Kiech Kuon to 75% of 954 in Katigiri, health education ranged from 49% of 190 households in Kiech Kuon to 90% of 182 in Padak, and latrine coverage from 3% of households in Tali to 16% in Katigiri. Substantial decreases in prevalence of TF and unclean faces were recorded in Katigiri and Tali, two of three sites where uptake of antibiotics and health education was high: TF decreased by 92% (95% CI 87-96) and 91% (86-95), respectively, and unclean face decreased by 87% (78-94) and 38% (22-52), respectively. Moderate effects were recorded in Padak, an area with high coverage, with a 28% (14-41) decrease in TF and a 16% (7-25) decrease in unclean face. No evidence of decline was seen in Kiech Kuon, where uptake of antibiotics and health education was low, with a 2% (-10 to 12) decrease in TF and a 10% (-3 to 23) decrease in unclean face. INTERPRETATION: Our results show that substantial falls in active trachoma can occur where SAFE is implemented, and that good results could be achieved with the SAFE strategy in other trachoma-endemic areas.
Authors: Amza Abdou; Beatriz E Munoz; Baido Nassirou; Boubacar Kadri; Fati Moussa; Ibrahim Baarè; Joseph Riverson; Emmanuel Opong; Sheila K West Journal: Trop Med Int Health Date: 2010-01 Impact factor: 2.622
Authors: Isobel M Blake; Matthew J Burton; Anthony W Solomon; Sheila K West; María-Gloria Basáñez; Manoj Gambhir; Robin L Bailey; David C W Mabey; Nicholas C Grassly Journal: PLoS Negl Trop Dis Date: 2010-11-02
Authors: Jennifer R Evans; Anthony W Solomon; Rahul Kumar; Ángela Perez; Balendra P Singh; Rajat Mohan Srivastava; Emma Harding-Esch Journal: Cochrane Database Syst Rev Date: 2019-09-26
Authors: Takele Lakew; Wondu Alemayehu; Muluken Melese; Elizabeth Yi; Jenafir I House; Kevin C Hong; Zhaoxia Zhou; Kathryn J Ray; Travis C Porco; Bruce D Gaynor; Thomas M Lietman; Jeremy D Keenan Journal: PLoS Negl Trop Dis Date: 2009-08-25