West S, Muñoz B, Lynch M, Kayongoya A, Chilangwa Z, Mmbaga B B, Taylor H R
Dana Center for Preventive Ophthalmology, Johns Hopkins University, Baltimore, Maryland.
Lancet. 1995 Jan 21;345(8943):155-8. doi: 10.1016/s0140-6736(95)90167-1.
Observational studies have suggested that the prevalence of trachoma is lower in children with clean faces than in those with ocular or nasal discharge or flies on the face. We carried out a community-based randomised trial in three pairs of villages to assess the impact on trachoma of a face-washing intervention programme following a mass topical antibiotic treatment campaign. Six villages in Kongwa, Tanzania, were randomly assigned mass treatment plus the face-washing programme or treatment only. 1417 children aged 1-7 years in these villages were randomly selected and followed up for trachoma status and observations of facial cleanliness at baseline and 2, 6, and 12 months. At 12 months, children in the intervention villages were 60% more likely to have had clean faces at two or more follow-up visits than children in the control villages. The odds of having severe trachoma in the intervention villages were 0.62 (95% Cl 0.40-0.97) compared with control villages. A clean face at two or more follow-up visits was protective for any trachoma (odds ratio 0.58 [0.47-0.72]) and severe trachoma (0.35 [0.21-0.59]). This community-based participatory approach to face-washing intervention had variable penetration rates in the villages and was labour intensive. However, we found that, combined with topical treatment, community-based strategies for improving hygiene in children in trachoma-endemic villages can reduce the prevalence of trachoma.
观察性研究表明，面部清洁的儿童沙眼患病率低于有眼部分泌物、鼻部分泌物或面部有苍蝇的儿童。我们在三对村庄开展了一项基于社区的随机试验，以评估在大规模局部抗生素治疗活动后，洗脸干预计划对沙眼的影响。坦桑尼亚孔瓜的六个村庄被随机分配接受大规模治疗加洗脸计划或仅接受治疗。从这些村庄中随机挑选了1417名1至7岁的儿童，并在基线以及2个月、6个月和12个月时对其沙眼状况和面部清洁情况进行随访观察。在12个月时，干预村庄的儿童在两次或更多次随访中面部清洁的可能性比对照村庄的儿童高60%。与对照村庄相比，干预村庄中患严重沙眼的几率为0.62（95%可信区间0.40 - 0.97）。在两次或更多次随访中面部清洁对任何沙眼（优势比0.58 [0.47 - 0.72]）和严重沙眼（0.35 [0.21 - 0.59]）具有保护作用。这种基于社区的参与式洗脸干预方法在村庄中的渗透率各不相同，且劳动强度大。然而，我们发现，与局部治疗相结合，在沙眼流行村庄改善儿童卫生的社区策略可以降低沙眼的患病率。
