The impact of medical services on trachoma in a Gambian village: antibiotics alone are not the answer.

We have measured the prevalence of active trachoma in children aged less than 15 years in the Gambian village of Keneba, which has had excellent free medical care and a continuous supply of antibiotics since 1974. The prevalence was 13%, with the peak prevalence (20%) occurring in the 2 to 3-year age group. Of 71 cases diagnosed, only 23 (33%) had complained of ocular symptoms in the previous 3 months, in spite of the fact that 66 (94%) had attended the clinic. Only five had been diagnosed as having trachoma by the duty paediatrician (7%). Compliance with treatment was poor, with only 29 subjects returning for continued treatment (41%), and at follow-up 16 months later 22 of 64 subjects still had active disease (34%). We conclude that the widespread use of antimicrobial agents does not preclude the persistence of endemic disease. Socio-economic improvement or behavioural changes appear necessary for the control of trachoma in endemic areas. In the meantime there is a need for greater awareness of the disease both among clinicians in endemic areas and among the communities afflicted.