Phillippa Cumberland

The purpose of this study was to investigate current patterns of management and outcomes of intermittent distance exotropia [X(T)] in the UK.

Background The International Trachoma Initiative (ITI) trachoma control programme based on the SAFE strategy (Surgery, Antibiotics, Facial cleanliness and Environmental improvement) was implemented in 2002 in two rural Ethiopian zones, with mass delivery of azithromycin starting in 2003. We evaluate the impact of combined antibiotic and health educational interventions on active trachoma and Chlamydia trachomatis detected from ocular swabs, in children aged 3–9 years. Method Three-year follow-up cross-sectional survey was carried out in 40 rural Ethiopian communities to evaluate the programme. Households were randomly selected and all children were invited for eye examination for active trachoma. In 2005, eye swabs were taken for Polymerase Chain Reaction (PCR) detection of ocular C. trachomatis DNA. Adult knowledge and behaviour related to trachoma were assessed. Results Community summarized mean prevalence, overall, was 35.6% (SD = 17.6) for active trachoma, 34.0% (18.7) for trachomatous inflammation, follicular (TF) alone and 4.3% (5.3) for PCR positivity for C. trachomatis. After adjustment, odds of active trachoma were reduced in communities receiving antibiotics and one or two educational intervention components (OR = 0.35, 95% CI: 0.13–0.89 or OR = 0.31, 0.11–0.89, respectively). The odds of being PCR positive were lower in these intervention arms, compared with control (OR = 0.20, 0.06–0.62 and OR = 0.07, 0.02–0.30, respectively). Knowledge of treatment and preventative methods were reported with much higher frequency, compared with baseline. Conclusions Trachoma remains a public health problem in Ethiopia. Antibiotic administration remains the most effective intervention but community-based health education programmes can impact, to additionally reduce prevalence of C. trachomatis.

Trachoma is the most important infectious cause of blindness worldwide. In two rural populations in Ethiopia, a programme of preventative and treatment measures was initiated in May 2002. A baseline survey was conducted to evaluate the effect of this programme on the prevalence of active trachoma. A total of 1960 children aged 3-9 years, from 915 households in 40 communities, were examined for the presence of active trachoma. Demographic and household information was collected using questionnaires and household amenities and environmental conditions were observed. Overall, 72% of children had active trachoma. Twenty percent of children aged nine years had trachomatous scarring. In children, discharge in the eyes and flies on the eyes were significant indicators of trachoma (odds ratio [OR] = 3.0, 95% CI 1.94-4.55 and OR = 3.4, 95% CI 2.37-4.88, respectively). Frequency of washing children, a clean environment and hygienic disposal of excrement were significant preventative factors for active trachoma. Prevalence of active trachoma varies widely between and within districts. Risk factors comprise a mix of individual characteristics and household factors. This study demonstrates the need for broad target interventions and a flexible approach to the prevention of trachoma in high prevalence endemic rural populations.