消除可避免盲症的医学干预措施的局限性。
The limits of medical interventions for the elimination of preventable blindness.
作者信息
Goldschmidt Pablo, Einterz Ellen
机构信息
Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Paris France and Ophtalmo sans Frontières, Luçon, France.
Hôpital de District de Kolofata, Far North Region, Cameroon.
出版信息
Trop Med Health. 2014 Mar;42(1):43-52. doi: 10.2149/tmh.2013-26. Epub 2014 Feb 18.
BACKGROUND
Health authorities are working toward the global elimination of trachoma by the year 2020 with actions focused on the World Health Organization SAFE strategy (surgery of trichiasis, antibiotics, face washing and environmental changes) with emphasis on hygienist approaches for education.
OBJECTIVES
The present survey was performed to assess the sustainability of the SAFE strategy 3 years after trachoma was eliminated from 6 villages.
METHODS
In February 2013 a rapid trachoma assessment was conducted in 6 villages of Kolofata's district, Extreme north Region, Cameroon, where trachoma was eliminated in 2010. A total of 300 children (1-10 years) from 6 villages were examined by trained staff.
RESULTS
The prevalence of active trachoma (children aged > 1 and < 10 years) in 2013 was 15% and in at least 25% was observed absence of face washing and flies in their eyes and nose. Income level, quality of roads, hygiene, and illiteracy were similar in all the villages; they did not change between 2010 and 2013 and could not be analyzed as independent risk factors.
DISCUSSION
The heterogeneity of methods described for clinical trials makes it inappropriate to conduct meta-analysis for the present and for other SAFE-related trials. The results obtained after implementation the SAFE strategy (recurrence) reveal that the causes (infectious agents and dirtiness) and effects (illness) were not connected by illiterate people living under conditions of extreme poverty. So far, antibiotics, surgery and hygiene education are insufficient for the sustainability of trachoma elimination and highlight that hypothetic-deductive processes seem not operational after implementing the awareness campaigns. Trachoma recurrence detected in 2013 in sedentary populations of Kolofata receiving efficacious treatments against Chlamydia sp. suggest that the elimination goals will be delayed if strategies are limited to medical actions. Restricting efforts to repeated pharmacological and surgical interventions for people infected with susceptible bacteria could be understood as the hidden side of a passive attitude toward basic education actions.
背景
卫生当局正致力于到2020年在全球消除沙眼，行动重点是世界卫生组织的SAFE战略（倒睫手术、抗生素、面部清洁和环境改善），并强调采用卫生主义方法进行教育。
目的
本次调查旨在评估从6个村庄消除沙眼3年后SAFE战略的可持续性。
方法
2013年2月，在喀麦隆极北地区科洛法塔区的6个村庄进行了快速沙眼评估，这些村庄于2010年消除了沙眼。由经过培训的工作人员对来自6个村庄的300名儿童（1至10岁）进行了检查。
结果
2013年活动性沙眼（年龄大于1岁且小于10岁的儿童）患病率为15%，至少25%的儿童被观察到没有进行面部清洁，眼睛和鼻子中有苍蝇。所有村庄的收入水平、道路质量、卫生状况和文盲率相似；2010年至2013年期间没有变化，无法作为独立风险因素进行分析。
讨论
临床试验中描述的方法存在异质性，因此不适用于对本次及其他与SAFE相关的试验进行荟萃分析。实施SAFE战略（复发）后获得的结果表明，极端贫困条件下的文盲人群并未将病因（传染源和不卫生）与后果（疾病）联系起来。到目前为止，抗生素、手术和卫生教育对于沙眼消除的可持续性来说是不够的，并突出表明在开展宣传活动后，假设-演绎过程似乎不起作用。2013年在接受针对衣原体有效治疗的科洛法塔定居人群中检测到沙眼复发，这表明如果战略仅限于医疗行动，消除目标将被推迟。将努力局限于对感染易感细菌的人群进行反复的药物和手术干预，可以被理解为对基础教育行动持消极态度的隐藏一面。
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