The Cochrane Library and trachoma: an overview of reviews

Abstract

AbstractBackground:Trachoma is the leading infectious cause of blindness worldwide. Active trachoma is caused by the bacterium Chlamydia trachomatis. Recurrent infection over many years may lead to scarring of the conjunctiva, entropion, trachomatous trichiasis and corneal opacity.Objective:To summarize Cochrane reviews that assess the effect of SAFE strategy (surgery, antibiotics, face washing and environmental change) for trachoma in developing countries.Methods:The Cochrane Database of Systematic Reviews was searched for any intervention to prevent or treat trachoma. Data was extracted in duplicate and analyzed.Main Results:There were four systematic reviews addressing trachoma, all of which met the inclusion criteria. There was some evidence that the prevalence of active trachoma was reduced by the use of antibiotics. At three months, six of nine trials found a significant reduction in relative risk of active trachoma in the intervention groups. At 12 months, only three of six studies found a significant reduction. Oral azithromycin performed better than topical tetracycline at clearing infection at three months, but not at resolving clinical signs. There is evidence that face washing in combination with topical tetracycline antibiotics can reduce the prevalence of severe trachoma compared to face washing alone. Insecticide spray as a fly control measure significantly reduced trachoma and health education may be effective in reducing active trachoma.Full thickness incision of the tarsal plate was found to be the most successful type of surgery for trichiasis. Tarsal rotation surgery was also found to be more effective than non‐surgical techniques for minor trichiasis. This surgery was equally effective when performed by appropriate trained ophthalmic nurses and ophthalmologists and also when conducted in a health centre or village setting.Authors' Conclusions:There are no clinical trials of the full SAFE strategy for trachoma control on blindness prevention, or on reducing active trachoma, or ocular Chlamydia trachomatis infection. However, there is some evidence that separately supports each of the components of SAFE: surgery, antibiotics, facial cleanliness, and environmental improvements. Programmatically, continued delivery of the full SAFE strategy is warranted and can be expected to have a positive impact on the control of blinding trachoma. Copyright © 2007 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. The Cochrane Collaboration