Asmare Zufan Alamrie, Anley Denekew Tenaw, Belete Melaku Ashagrie, Dessie Anteneh Mengist, Zemene Melkamu Aderajew, Alemayehu Ermiyas, Moges Natnael, Kebede Natnael, Tsega Sintayehu Simie, Gebeyehu Asaye Alamneh, Anteneh Rahel Mulatie, Chanie Ermias Sisay
Department of Ophthalmology, School of Medicine and Health Science, Debre Tabor University, Debre Tabor, Ethiopia.
Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia.
PLoS One. 2025 Feb 20;20(2):e0312024. doi: 10.1371/journal.pone.0312024. eCollection 2025.
Although the Surgery, Antibiotic, facial cleanliness, and environmental improvement (SAFE) strategy was adopted in Ethiopia over the last five years, there is still a high incidence of trachoma in areas with poor hygiene. In Ethiopia, a systematic review and meta-analysis were conducted before the implementation of SAFE implying, a need for the update. Therefore, this review gives the updated pooled prevalence and associated factors of active trachoma in Ethiopia after the implementation of SAFE.
The literature search was performed from PubMed, Google Scholar, EMBASE, HINARI, Scopus, and Web of Sciences from January 1-30, 2024. Data were extracted by using a pre-tested and standardized data extraction format and analyzed using STATA 17 statistical software. I2 tests to appraise the heterogeneity across the included studies, a random-effect model to estimate the pooled prevalence, and a sub-group analysis to discern the viable source of heterogeneity were executed. Potential publication bias was also assessed by funnel plot, Egger's weighted correlation, and Begg's regression. The odds ratio with its 95% confidence was used to reckon the association between the prevalence and factors.
From 504 identified studies, 20 articles were included. After the SAFE intervention, the national pooled prevalence of active trachoma among children was 21.16% (95% CI 17.28, 25.04). Fly-eye contact(Adjusted odds ratio (AOR) = 3.83, 95% CI: 2.25, 6.52), facial uncleanliness(AOR = 5.48, 95% CI: 3.02, 9.96), non-utilization of latrine (AOR = 3.30, 95% CI: 2.10, 5.18), and retrieving water from river(AOR = 2.94; 95%CI: 1.42, 6.05) were significantly associated with active trachoma.
In Ethiopia, the pooled prevalence of active trachoma after SAFE intervention was much higher than the World Health Organization (WHO) threshold prevalence. It continues to pose a significant public health concern and is far from the elimination of trachoma as a public health problem. Fly-eye contact, facial cleanliness, latrine utilization, and source of water increase the odds of active trachoma. Therefore, it is imperative to fine-tune the intervention focus on personal hygiene-related activities in removing dirt, fly-eye contact, and a well-structured approach for both constructing and ensuring the functionality of household taps and latrines. Additionally, It is crucial to initiate a reliable SAFE intervention in Ethiopia.
尽管埃塞俄比亚在过去五年中采用了手术、抗生素、面部清洁和环境改善（SAFE）策略，但卫生条件差的地区沙眼发病率仍然很高。在埃塞俄比亚，在实施SAFE之前进行了一项系统评价和荟萃分析，这意味着需要更新。因此，本评价给出了SAFE实施后埃塞俄比亚活动性沙眼的最新合并患病率及相关因素。
于2024年1月1日至30日在PubMed、谷歌学术、EMBASE、HINARI、Scopus和科学网进行文献检索。使用预先测试和标准化的数据提取格式提取数据，并使用STATA 17统计软件进行分析。进行I2检验以评估纳入研究之间的异质性，使用随机效应模型估计合并患病率，并进行亚组分析以识别异质性的可行来源。还通过漏斗图、Egger加权相关性和Begg回归评估潜在的发表偏倚。使用比值比及其95%置信区间来计算患病率与因素之间的关联。
从504项已识别的研究中，纳入了20篇文章。SAFE干预后，儿童活动性沙眼的全国合并患病率为21.16%（95%CI 17.28，25.04）。蝇眼接触（调整后的比值比（AOR）=3.83，95%CI：2.25，6.52）、面部不清洁（AOR = 5.48，95%CI：3.02，9.96）、未使用厕所（AOR = 3.30，95%CI：2.10，5.18）和从河流取水（AOR = 2.94；95%CI：1.42，6.05）与活动性沙眼显著相关。
在埃塞俄比亚，SAFE干预后活动性沙眼的合并患病率远高于世界卫生组织（WHO）的阈值患病率。它仍然是一个重大的公共卫生问题，距离消除沙眼这一公共卫生问题还很遥远。蝇眼接触、面部清洁、厕所使用和水源增加了活动性沙眼的几率。因此，必须调整干预措施，重点关注与个人卫生相关的活动，如清除污垢、避免蝇眼接触，以及采用结构合理的方法来建造和确保家庭水龙头及厕所的功能。此外，在埃塞俄比亚启动可靠的SAFE干预至关重要。
