title: The impact of medical services on trachoma in a Gambian village: antibiotics alone are not the answer.
abstract: We have measured the prevalence of active trachoma in children aged less than 15 years in the Gambian village of Keneba, which has had excellent free medical care and a continuous supply of antibiotics since 1974. The prevalence was 13%, with the peak prevalence (20%) occurring in the 2 to 3-year age group. Of 71 cases diagnosed, only 23 (33%) had complained of ocular symptoms in the previous 3 months, in spite of the fact that 66 (94%) had attended the clinic. Only five had been diagnosed as having trachoma by the duty paediatrician (7%). Compliance with treatment was poor, with only 29 subjects returning for continued treatment (41%), and at follow-up 16 months later 22 of 64 subjects still had active disease (34%). We conclude that the widespread use of antimicrobial agents does not preclude the persistence of endemic disease. Socio-economic improvement or behavioural changes appear necessary for the control of trachoma in endemic areas. In the meantime there is a need for greater awareness of the disease both among clinicians in endemic areas and among the communities afflicted.
authors.affiliation: Department of Clinical Sciences, London School of Hygiene and Tropical Medicine.
authors.forename: D C
authors.initials: DC
authors.lastname: Mabey
authors.forename: R M
authors.initials: RM
authors.lastname: Downes
authors.forename: B
authors.initials: B
authors.lastname: Downes
authors.forename: R L
authors.initials: RL
authors.lastname: Bailey
authors.forename: D T
authors.initials: DT
authors.lastname: Dunn
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000600:supply & distribution; D002648:Child; D002675:Child, Preschool; D003151:Community Health Centers / Q000706:statistics & numerical data*; D005714:Gambia / Q000453:epidemiology; D006801:Humans; D007223:Infant; D010349:Patient Compliance; D015995:Prevalence; D014141:Trachoma / Q000188:drug therapy / Q000453:epidemiology*
chemical_list: D000900:Anti-Bacterial Agents