Abstract
BackgroundTrachoma has been endemic in The Gambia for decades. National trachoma control activities have been in place since the mid-1980's, but with no mass antibiotic treatment campaign. We aimed to assess the prevalence of active trachoma and of actual ocular Chlamydia trachomatis infection as measured by polymerase chain reaction (PCR) in the two Gambian regions that had had the highest prevalence of trachoma in the last national survey in 1996 prior to planned national mass antibiotic treatment distribution in 2006.Methodology/Principal FindingsTwo stage random sampling survey in 61 randomly selected Enumeration Areas (EAs) in North Bank Region (NBR) and Lower River Region (LRR). Fifty randomly selected children aged under 10 years were examined per EA for clinical signs of trachoma. In LRR, swabs were taken to test for ocular C. trachomatis infection. Unadjusted prevalences of active trachoma were calculated, as would be done in a trachoma control programme. The prevalence of trachomatous inflammation, follicular (TF) in the 2777 children aged 1–9 years was 12.3% (95% CI 8.8%–17.0%) in LRR and 10.0% (95% CI 7.7%–13.0%) in NBR, with significant variation within divisions (p<0.01), and a design effect of 3.474. Infection with C. trachomatis was found in only 0.3% (3/940) of children in LRR.Conclusions/SignificanceThis study shows a large discrepancy between the prevalence of trachoma clinical signs and ocular C. trachomatis infection in two Gambian regions. Assessment of trachoma based on clinical signs alone may lead to unnecessary treatment, since the prevalence of active trachoma remains high but C. trachomatis infection has all but disappeared. Assuming that repeated infection is required for progression to blinding sequelae, blinding trachoma is on course for elimination by 2020 in The Gambia.
Highlights
Trachoma is the leading infectious cause of blindness worldwide.[1]
We conducted a survey of two Gambian regions to look at how much trachoma disease and C. trachomatis infection there is in the eyes
This means that using clinical signs alone to make treatment decisions in low prevalence settings like The Gambia can lead to the waste of scarce resources
Summary
Trachoma is the leading infectious cause of blindness worldwide.[1]. It is caused by repeated re-infection with the ocular serotypes (A, B, Ba and C) of the bacterium Chlamydia trachomatis, and is predominantly found in the poorest countries in the world. The World Health Organization (WHO) strategy for Global Elimination of Blinding Trachoma by the year 2020 (GET2020) is through employment of the SAFE strategy (Surgery for trichiasis, Antibiotics for active trachoma, Facial cleanliness, and Environmental improvement).[3] The Gambian National Eye Care Programme (NECP), established in 1986, expanded its national intervention programme to cover the whole country by 1996. We aimed to assess the prevalence of active trachoma and of actual ocular Chlamydia trachomatis infection as measured by polymerase chain reaction (PCR) in the two Gambian regions that had had the highest prevalence of trachoma in the last national survey in 1996 prior to planned national mass antibiotic treatment distribution in 2006
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