Cumberland Phillippa, Edwards Tansy, Hailu Girum, Harding-Esch Emma, Andreasen Aura, Mabey David, Todd Jim
Centre of Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, London WC1N 1EH, UK.
Int J Epidemiol. 2008 Jun;37(3):549-58. doi: 10.1093/ije/dyn045. Epub 2008 Mar 20.
The International Trachoma Initiative (ITI) trachoma control programme based on the SAFE strategy (Surgery, Antibiotics, Facial cleanliness and Environmental improvement) was implemented in 2002 in two rural Ethiopian zones, with mass delivery of azithromycin starting in 2003. We evaluate the impact of combined antibiotic and health educational interventions on active trachoma and Chlamydia trachomatis detected from ocular swabs, in children aged 3-9 years. Method Three-year follow-up cross-sectional survey was carried out in 40 rural Ethiopian communities to evaluate the programme. Households were randomly selected and all children were invited for eye examination for active trachoma. In 2005, eye swabs were taken for Polymerase Chain Reaction (PCR) detection of ocular C. trachomatis DNA. Adult knowledge and behaviour related to trachoma were assessed.
Community summarized mean prevalence, overall, was 35.6% (SD = 17.6) for active trachoma, 34.0% (18.7) for trachomatous inflammation, follicular (TF) alone and 4.3% (5.3) for PCR positivity for C. trachomatis. After adjustment, odds of active trachoma were reduced in communities receiving antibiotics and one or two educational intervention components (OR = 0.35, 95% CI: 0.13-0.89 or OR = 0.31, 0.11-0.89, respectively). The odds of being PCR positive were lower in these intervention arms, compared with control (OR = 0.20, 0.06-0.62 and OR = 0.07, 0.02-0.30, respectively). Knowledge of treatment and preventative methods were reported with much higher frequency, compared with baseline.
Trachoma remains a public health problem in Ethiopia. Antibiotic administration remains the most effective intervention but community-based health education programmes can impact, to additionally reduce prevalence of C. trachomatis.
基于SAFE策略（手术、抗生素、面部清洁和环境改善）的国际沙眼倡议（ITI）沙眼控制项目于2002年在埃塞俄比亚两个农村地区实施，2003年开始大规模发放阿奇霉素。我们评估了抗生素和健康教育联合干预对3至9岁儿童眼部拭子中检测到的活动性沙眼和沙眼衣原体的影响。方法 在埃塞俄比亚40个农村社区进行了为期三年的随访横断面调查，以评估该项目。随机选择家庭，邀请所有儿童进行活动性沙眼眼部检查。2005年，采集眼部拭子进行聚合酶链反应（PCR）检测眼部沙眼衣原体DNA。评估了与沙眼相关的成人知识和行为。
总体而言，社区汇总的活动性沙眼平均患病率为35.6%（标准差=17.6），单纯滤泡性沙眼炎症（TF）为34.0%（18.7），沙眼衣原体PCR阳性率为4.3%（5.3）。调整后，接受抗生素和一或两个教育干预组成部分的社区中活动性沙眼的几率降低（分别为OR = 0.35，95%可信区间：0.13 - 0.89或OR = 0.31，0.11 - 0.89）。与对照组相比，这些干预组中PCR阳性的几率较低（分别为OR = 0.20，0.06 - 0.62和OR = 0.07，0.02 - 0.30）。与基线相比，治疗和预防方法的知晓率报告频率更高。
沙眼在埃塞俄比亚仍然是一个公共卫生问题。抗生素给药仍然是最有效的干预措施，但基于社区的健康教育项目也能产生影响，以进一步降低沙眼衣原体的患病率。
