Abstract
BackgroundAs highly trachoma-endemic countries approach elimination, some districts will have prevalences of trachomatous inflammation–follicular in 1–9-year-olds (TF1-9) of 5.0–9.9%. The World Health Organization (WHO) previously recommended that in such districts, TF prevalence be assessed in each sub-district (groupings of at least three villages), with three rounds of azithromycin treatment offered to any sub-district in which TF≥10%. Given the large number of endemic districts worldwide and the human and financial resources required to conduct surveys, this recommendation may not be practical. In a group of 8 Malawi districts with baseline TF prevalences of 5.0–9.9%, the Malawi Ministry of Health administered one round of azithromycin mass treatment, to the whole of each district, achieving mean coverage of ~80%. Here, we report impact surveys conducted after that treatment.MethodsWe undertook population-based trachoma surveys in 18 evaluation units of the 8 treated districts, at least 6 months after the MDA. The standardized training package and survey methodologies of Tropical Data, which conform to WHO recommendations, were used.ResultsEach of the 18 evaluation units had a TF1-9 prevalence <5.0%.ConclusionThe study demonstrates that in Malawi districts with TF of 5.0–9.9%, one round of azithromycin MDA with ~80% coverage associates with a reduction in TF prevalence to <5%. Further evidence for this approach should be collected elsewhere.
Highlights
Trachoma is thought to be a significant public health issue in at least 42 countries [1]
Core support to Tropical Data is provided by Department for International Development (DFID), the ENVISION project, the Fred Hollows Foundation, the International Trachoma Initiative, Orbis, the Queen Elizabeth Diamond Jubilee Trust, RTI International, Sightsavers, United States Agency for International Development (USAID) and the World Health Organization (WHO)
The views expressed in this article are the views of the authors alone and do not necessarily reflect the decisions, policies or views of DFID, the Governments of the USA or United Kingdom, USAID or WHO
Summary
As highly trachoma-endemic countries approach elimination, some districts will have prevalences of trachomatous inflammation–follicular in 1–9-year-olds (TF1-9) of 5.0–9.9%. The World Health Organization (WHO) previously recommended that in such districts, TF prevalence be assessed in each sub-district (groupings of at least three villages), with three rounds of azithromycin treatment offered to any sub-district in which TF!10%. Given the large number of endemic districts worldwide and the human and financial resources required to conduct surveys, this recommendation may not be practical. In a group of 8 Malawi districts with baseline TF prevalences of 5.0–9.9%, the Malawi Ministry of Health administered one round of azithromycin mass treatment, to the whole of each district, achieving mean coverage of ~80%. We report impact surveys conducted after that treatment
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