title: Evaluation of three years of the SAFE strategy (Surgery, Antibiotics, Facial cleanliness and Environmental improvement) for trachoma control in five districts of Ethiopia hyperendemic for trachoma.
abstract: Trachoma surveys were conducted at baseline in five districts of Amhara National Regional State, Ethiopia (7478 participants in 1096 households) and at 3-year evaluation (5762 participants in 1117 households). Uptake of SAFE was assessed with programme monitoring data and interviews, and children (1-6 years) were swabbed for detection of ocular Chlamydia. At evaluation, 23,933 people had received trichiasis surgery; 93% of participants reported taking azithromycin at least once; 67% of household respondents (range 46-93) reported participation in trachoma health education; and household latrine coverage increased from 2% to 34%. In children aged 1-9 years percentage decline, by district, for outcomes was: 32% (95% CI 19-48) to 88% (95% CI 83-91) for trachomatous inflammation-follicular (TF); 87% (95% CI 83-91) to 99% (95% CI 97-100) for trachomatous inflammation-intense (TI); and 31% increase (95% CI -42 to -19) to 89% decrease (95% CI 85-93) for unclean face; and in adults percentage decline in trichiasis was 45% (95% CI -13 to 78) to 92% (95% CI 78-96). Overall prevalence of swabs positive for ocular Chlamydia was 3.1%. Although there were substantial reductions in outcomes in children and adults, the presence of ocular Chlamydia and TF in children suggests ongoing transmission. Continued implementation of SAFE is warranted.
authors.affiliation: The Carter Center, 1 Copenhill Avenue, Atlanta, GA, USA. jn250@cam.ac.uk
authors.forename: Jeremiah
authors.initials: J
authors.lastname: Ngondi
authors.forename: Teshome
authors.initials: T
authors.lastname: Gebre
authors.forename: Estifanos B
authors.initials: EB
authors.lastname: Shargie
authors.forename: Liknaw
authors.initials: L
authors.lastname: Adamu
authors.forename: Yeshewamebrat
authors.initials: Y
authors.lastname: Ejigsemahu
authors.forename: Tesfaye
authors.initials: T
authors.lastname: Teferi
authors.forename: Mulat
authors.initials: M
authors.lastname: Zerihun
authors.forename: Berhan
authors.initials: B
authors.lastname: Ayele
authors.forename: Vicky
authors.initials: V
authors.lastname: Cevallos
authors.forename: Jonathan
authors.initials: J
authors.lastname: King
authors.forename: Paul M
authors.initials: PM
authors.lastname: Emerson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D002692:Chlamydia trachomatis; D016000:Cluster Analysis; D004777:Environment; D005002:Ethiopia / Q000453:epidemiology; D006266:Health Education; D006801:Humans; D006920:Hygiene / Q000193:education / Q000592:standards*; D007223:Infant; D008875:Middle Aged; D014141:Trachoma / Q000453:epidemiology / Q000473:pathology / Q000517:prevention & control*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents