Abstract
To estimate the prevalence and describe the distribution of trachoma among schoolchildren in Brazilian municipalities. Cross-sectional study, using cluster sampling, of the schoolchildren population of the Brazilian municipalities with Human Development Index - Municipal lower than the national average. This trachoma prevalence survey was conducted by the Ministry of Health, in the period 2002-2007. There were 119,531 schoolchildren selected from 2,270 schools located in 1,156 municipalities. The selected schoolchildren underwent an external ocular examination, with a magnifying glass (2.5X), to detect clinical signs of trachoma according to the WHO criteria. The prevalence of trachoma, by state and national level, and their respective 95% confidence intervals were estimated. Chi-square and Chi-square for trends tests were used to compare categorical variables. There were 6,030 cases of trachoma detected, resulting in a prevalence of 5.0% (95%CI 4.5;5.4). There was no significant difference between the sexes. The prevalence of trachoma was 8.2% among children under 5 years of age, decreasing among higher age groups (p < 0.01). There was a significant difference in prevalence between urban and rural areas, 4.3% versus 6.2% respectively (p < 0.01). Cases were detected in 901 municipalities (77.7% of the sample), in all regions of the country. In 36.8% of the selected municipalities, the prevalence was higher than 5%. The study shows that trachoma is a significant public health problem in Brazil, contradicting the belief that the disease had been controlled in the country. The survey provides a baseline for evaluating planned interventions aimed at achieving the goal of global certification of elimination of trachoma as a cause of blindness in Brazil by 2020.
Highlights
Trachoma, an inflammatory disease of the eye affecting the cornea and conjunctiva, the evolution of which involves chronic relapse, is caused by Chlamydia trachomatis serotypes A, B, Ba and C and is the main cause of preventable blindness in the world
The study shows that trachoma is a significant public health problem in Brazil, contradicting the belief that the disease had been controlled in the country
The survey provides a baseline for evaluating planned interventions aimed at achieving the goal of global certification of elimination of trachoma as a cause of blindness in Brazil by 2020
Summary
An inflammatory disease of the eye affecting the cornea and conjunctiva, the evolution of which involves chronic relapse, is caused by Chlamydia trachomatis serotypes A, B, Ba and C and is the main cause of preventable blindness in the world. The World Health Organization (WHO) estimates that there are 41 million individuals, worldwide, with active trachoma and 7.6 million with trichiasis, the clinical sequelae of the disease, while 1.3 million suffer serious visual impairment and blindness.[9,13] Trachoma is linked to poor socioeconomic conditions and poor sanitation and hygiene. Various studies realized after the mid 1980s, in different regions and states, found prevalence varying between 1.5% and 47.7% for active trachoma and from 0.1% to 2.0% for trichiasis, including indigenous populations.[1,2,5,6,7,8,11,12,14,15] The Ministry of Health carried out a national survey in 1974-1976 and, concluding that trachoma had been eradicated in some regions and was at sub-endemic level in others, prioritized work in specific areas, so-called “endemic pockets”, in which prevalence reached 30%.4 various studies realized after the mid 1980s, in different regions and states, found prevalence varying between 1.5% and 47.7% for active trachoma and from 0.1% to 2.0% for trichiasis, including indigenous populations.[1,2,5,6,7,8,11,12,14,15]
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