Schémann J-F, Guinot C, Traore L, Zefack G, Dembele M, Diallo I, Traore A, Vinard P, Malvy D
Institute of Research for Development (IRD), UR024, Centre IRD de Hann BP 1386, Dakar, Senegal.
Acta Trop. 2007 Jan;101(1):40-53. doi: 10.1016/j.actatropica.2006.12.003. Epub 2006 Dec 16.
Trachoma, caused by repeated ocular infections with Chlamydia trachomatis is an important cause of blindness. Mass azithromycin distribution is part of current recommended strategies for controlling trachoma. In order to ascertain an efficient strategy model at an acceptable cost, an intervention study was conducted in Mali between May 2000 and February 2002.
Three azithromycin administration strategies were evaluated: mass community-based treatment of all residents (strategy I), treatment of all children under 11 years of age and of women between 15 and 50 (strategy II), and treatment targeted to inhabitants of households where at least one child had clinically active trachoma diagnosed (strategy III). In a particular Malian area in which trachoma was known to be mesoendemic, three villages were selected for each of the three strategies. According to the strategy allocation, adults were eventually given a single dose of 1g azithromycin, and children a unique dose of 20 mg/kg. Moreover, cleanliness and washing of children's faces were assessed, and additional questions were addressed about education, environmental and socio-economic conditions for each household at baseline. Ophthalmic examination was performed at baseline and 1, 6 and 12 months after inclusion. The outcome variable was clinically active trachoma frequency 12 months after intervention among children under 11 years of age. A descriptive analysis was performed, and then logistic regression models were built to test the efficiency of the three strategies.
Among children under 11 years of age, the active trachoma prevalence fell dramatically in each strategy, from 23.7% to 6.4% in strategy I, from 20.8% to 6.8% in strategy II, and from 20.2% to 8.5% in strategy III. After adjustment on age (adjusted odds ratio [AOR] = 0.81; 95% confidence interval [95% CI]: 0.75-0.87) and on active trachoma occurrence at baseline (AOR = 3.81; [95% CI]: 2.70-5.39), the multiple logistic regression model showed that both strategies I and II gave similar results, while strategy III appeared significantly less effective (AOR = 1.56; [95% CI]: 1.00-2.43).
In mesoendemic trachoma areas, targeted treatment to all children under 11 years of age and women between 15 and 50 (strategy II) was as effective as indiscriminate mass distribution (strategy I) and more effective than treatment targeted to inhabitants of households where at least one child had active trachoma diagnosed (strategy III). Strategy II could therefore reduce the prevalence and intensity of trachoma infection at a lower cost than mass community-based treatment of all residents (strategy I).
沙眼是由沙眼衣原体反复眼部感染引起的，是导致失明的重要原因。大规模分发阿奇霉素是目前推荐的沙眼控制策略的一部分。为了以可接受的成本确定一种有效的策略模型，于2000年5月至2002年2月在马里进行了一项干预研究。
评估了三种阿奇霉素给药策略：对所有居民进行基于社区的大规模治疗（策略I）、对所有11岁以下儿童和15至50岁女性进行治疗（策略II），以及针对至少有一名儿童被诊断为临床活动性沙眼的家庭居民进行治疗（策略III）。在马里一个已知沙眼为中度流行的特定地区，为三种策略各选择了三个村庄。根据策略分配，成年人最终服用1克阿奇霉素单剂量，儿童服用20毫克/千克的单一剂量。此外，评估了儿童面部的清洁和清洗情况，并在基线时针对每个家庭提出了有关教育、环境和社会经济状况的其他问题。在基线时以及纳入研究后的1、6和12个月进行眼科检查。结果变量是11岁以下儿童干预后12个月时临床活动性沙眼的频率。进行了描述性分析，然后建立逻辑回归模型以测试三种策略的有效性。
在11岁以下儿童中，每种策略下活动性沙眼患病率均大幅下降，策略I从23.7%降至6.4%，策略II从20.8%降至6.8%，策略III从20.2%降至8.5%。在对年龄（调整后的优势比[AOR]=0.81；95%置信区间[95%CI]：0.75 - 0.87）和基线时活动性沙眼的发生情况（AOR = 3.81；[95%CI]：2.70 - 5.39）进行调整后，多重逻辑回归模型显示策略I和策略II产生了相似的结果，而策略III的效果明显较差（AOR = 1.56；[95%CI]：1.00 - 2.43）。
在沙眼中度流行地区，对所有11岁以下儿童和15至50岁女性进行靶向治疗（策略II）与不加区分的大规模分发（策略I）效果相同，且比针对至少有一名儿童被诊断为活动性沙眼的家庭居民进行治疗（策略III）更有效。因此，与对所有居民进行基于社区的大规模治疗（策略I）相比，策略II可以以更低的成本降低沙眼感染的患病率和严重程度。
