A critical review of the SAFE strategy for the prevention of blinding trachoma.
Trachoma is an ocular disease caused by repeated infection with Chlamydia trachomatis. It is the leading cause of infectious blindness globally, responsible for 5.9 million cases of blindness. Although trachomatous blindness is untreatable, it is eminently possible to prevent and the World Health Organization promotes the use of the SAFE strategy (surgery to treat end-stage disease, antibiotics to reduce the reservoir of infection, facial cleanliness, and environmental improvement to reduce transmission of C trachomatis) for this purpose. In this review we have assessed the evidence base supporting the elements of the SAFE strategy. We find strong support for the efficacy of the surgery and antibiotics components, although the optimal antibiotic regimens have not yet been established. The evidence for an effect of health education and environmental improvement is weaker, and depends mostly on cross-sectional observational studies.
Kuper
Hannah
H
Clinical Research Unit, Department of Infectious and Tropical Disease, London School of Hygiene and Tropical Medicine, London, UK. hannah.kuper@lshtm.ac.uk <hannah.kuper@lshtm.ac.uk>
Solomon
Anthony W
AW
Buchan
John
J
Zondervan
Marcia
M
Foster
Allen
A
Mabey
David
D
D000900:Anti-Bacterial Agents; D001766:Blindness / Q000517:prevention & control; D002692:Chlamydia trachomatis; D003140:Communicable Disease Control / Q000458:organization & administration*; D003430:Cross-Sectional Studies; D003906:Developing Countries; D004781:Environmental Exposure / Q000517:prevention & control*; D019317:Evidence-Based Medicine; D006801:Humans; D006920:Hygiene; D014141:Trachoma / Q000517:prevention & control*; D018508:Water Purification; D014944:World Health Organization
D000900:Anti-Bacterial Agents