Sunday, August 23, 2009

Steps to prevent infectious blindness

There are many different causes of blindness, but the leading cause of infectious blindness in the world is Trachoma. According to the wikipedia article it's a very serious problem: "Globally, 84 million people suffer from active infection and nearly 8 million people are visually impaired as a result of this disease".

Like many other diseases, the spread of trachoma is not even across the world's countries, but instead it's found in traditional 3rd world countries.

The World Health Organization leads an effort of eliminating blinding trachoma as a public health concern by 2020

International efforts to eliminate trachoma as a blinding disease will be based on the WHO-developed strategy - a combination of interventions known by the acronym "SAFE" which stands for surgery for trichiasis (inturned eyelashes), antibiotics, facial cleanliness and environmental improvement. These interventions will be community-targeted and will seek community involvement through the primary health care approach.

This has been done with some success in Morocco, and it is certainly something which should be continued. There is, however, always room for studies trying to identify whether the efforts are focused on the right things for WHO to reach its goals. A study looking at this has been published in PLoS One.

Access to Water Source, Latrine Facilities and Other Risk Factors of Active Trachoma in Ankober, Ethiopia by Ilya Golovaty et al.


A cross-sectional community-based study was conducted during July 2007. A total of 507 children (ages 1–9 years), from 232 households were included in the study. All children were examined for trachoma by ophthalmic nurses using the WHO simplified clinical grading system. Interviews and observations were used to assess risk factors. Logistic regression procedures were used to determine associations between potential risk factors and signs of active trachoma.


Overall, the prevalence of active trachoma was found to be 53.9% (95%CI 49.6%–58.2%). Presence of fly-eye (fly contact with the eyelid margin during eye examination) (Odds Ratio (OR) = 4.03 95% CI 1.40–11.59), absence of facial cleanliness (OR = 7.59; 95%CI 4.60–12.52), an illiterate mother (OR = 5.88; 95%CI 2.10–15.95), lack of access to piped water (OR = 2.19; 95%CI 1.14–6.08), and lack of access to latrine facilities (OR = 4.36; 95%CI 1.49–12.74) were statistically significantly associated with increased risk of active trachoma.


Active trachoma among children 1–9 years of age in Ankober is highly prevalent and significantly associated with a number of risk factors including access to water and latrine facilities. Trachoma prevention programs that include improved access to water and sanitation, active fly control, and hygiene education are recommended to lower the burden of trachoma in Ankober, Ethiopia.

The prevalence of trachoma is very high among the sampled children in Ankober, so it's a good place to try to identify associations between risk factors and the spread of the disease.

The study pretty much supports the efforts currently being done, but places a high emphasis on access to clean water and sanitation, which is less emphasized in the WHO website (I presume it's included under "environmental improvement"). This might lead to some improvements in the efforts, making it possible for the WHO to reach its goal.

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