Department of Ophthalmology, University of Malawi, College of Medicine, Blantyre, Malawi.
Blantyre Institute for Community Ophthalmology, Lions Sight First Eye Hospital, Blantyre, Malawi.
PLoS Negl Trop Dis. 2018 Jun 13;12(6):e0006543. doi: 10.1371/journal.pntd.0006543. eCollection 2018 Jun.
As highly trachoma-endemic countries approach elimination, some districts will have prevalences of trachomatous inflammation-follicular in 1-9-year-olds (TF1-9) of 5.0-9.9%. The World Health Organization (WHO) previously recommended that in such districts, TF prevalence be assessed in each sub-district (groupings of at least three villages), with three rounds of azithromycin treatment offered to any sub-district in which TF≥10%. Given the large number of endemic districts worldwide and the human and financial resources required to conduct surveys, this recommendation may not be practical. In a group of 8 Malawi districts with baseline TF prevalences of 5.0-9.9%, the Malawi Ministry of Health administered one round of azithromycin mass treatment, to the whole of each district, achieving mean coverage of ~80%. Here, we report impact surveys conducted after that treatment.
We undertook population-based trachoma surveys in 18 evaluation units of the 8 treated districts, at least 6 months after the MDA. The standardized training package and survey methodologies of Tropical Data, which conform to WHO recommendations, were used.
Each of the 18 evaluation units had a TF1-9 prevalence <5.0%.
The study demonstrates that in Malawi districts with TF of 5.0-9.9%, one round of azithromycin MDA with ~80% coverage associates with a reduction in TF prevalence to <5%. Further evidence for this approach should be collected elsewhere.
随着高度流行沙眼的国家接近消除目标，一些地区 1-9 岁儿童沙眼滤泡性炎症（TF1-9）的患病率将达到 5.0-9.9%。世界卫生组织（WHO）此前建议，在这些地区，应在每个分区（至少三个村庄的分组）评估 TF 患病率，并向 TF≥10%的任何分区提供三轮阿奇霉素治疗。鉴于全球流行地区数量众多，以及进行调查所需的人力和财力，这一建议可能不切实际。在马拉维的 8 个基线 TF 患病率为 5.0-9.9%的地区，马拉维卫生部对每个地区进行了一轮阿奇霉素大规模治疗，覆盖率约为 80%。在此，我们报告了该治疗后进行的影响调查。
我们在 8 个治疗地区的 18 个评估单位进行了基于人群的沙眼调查，至少在 MDA 后 6 个月进行。采用了符合世卫组织建议的 Tropical Data 的标准化培训包和调查方法。
每个评估单位的 TF1-9 患病率均<5.0%。
本研究表明，在 TF 为 5.0-9.9%的马拉维地区，一轮覆盖率约为 80%的阿奇霉素 MDA 治疗与 TF 患病率降至<5%相关。应在其他地方收集更多证据。
