Review of the evidence base for the ‘F’ and ‘E’ components of the SAFE strategy for trachoma control

Abstract

SummaryCommunity control of trachoma as a blinding disease is based on the SAFE strategy of Surgery, Antibiotic therapy, Facial cleanliness and Environmental improvement. Surgery and antibiotic therapy currently dominate most programmes. Blindness from trachoma results from frequent infections repeated over many years, so ultimate success requires the reduction of transmission. This is only likely to be sustainable through the F and E components of SAFE. Environmental improvement with access to water, enhanced hygiene and better sanitation reduces trachoma transmission and the blinding sequelae eventually disappear. Transmission routes and factors that cause this are not known and consequently no single specific tool for F and E is in place. Evidence from intervention studies shows that the promotion of face-washing gave modest gains for intense effort and a pilot study showed that trachoma transmission was reduced in the absence of eye-seeking flies. Other studies have shown that latrines and improved access to water are associated with a lower prevalence of active trachoma. There is likely to be a long-term beneficial effect of a combination of improved water supplies, provision of latrines, facial hygiene promotion through established infrastructure and control of eye-seeking flies. Each of these interventions offers additional public health and other benefits in its own right. Further research on the routes of transmission, the role of hygiene and means of sustainable fly control should be a priority.

Evidencia clínica de tracoma en indígenas colombianos del departamento de Vaupés

“…y es el mecanismo más efectivo para controlar la enfermedad, pero el más difícil de implementar por la carencia de agua y por las costumbres, actitudes y cultura de las comunidades afectadas; E, mejoramiento ambiental (enviromental improvement), que abarca el suministro de agua y de vivienda adecuadas (1)(2)(3)(4)29). Diferentes evaluaciones de este programa han demostrado que produce un impacto significativo en el control del tracoma y de la ceguera (8)(9)(10)(11)(12). La meta de la OMS es eliminar la enfermedad para el año 2020 (11,29).…”

“…Se buscaron los signos cardinales del tracoma, pues los cambios que la enfermedad produce en el ojo tienen fases reconocibles clínicamente, que constituyen una forma aceptada de diagnóstico, con alta sensibilidad y que son (8)(9)(10)(11)(12) • Inflamación folicular por tracoma: presencia de cinco o más folículos en la conjuntiva del tarso de no menos de 0,5 mm.…”

Trachoma and Conjunctivitis

“…Antibiotic therapy is part of the WHO SAFE strategy for trachoma. 46 Azithromycin (Zithromax) 1 g PO as a single dose is recommended. Although, plasma concentrations may be low, because of long-tissue life and higher tissue concentrations, it may be valuable in treating intracellular organisms.…”

“…Among the SAFE strategy, Surgery (to correct eyelid defects that lead to blindness), Antibiotic therapy, Facial cleanliness and Environmental improvement (including clean water supplies), surgery and antibiotic therapy dominate most programmes that have been implemented. 46 Surgery has a sustained effect in preventing an individual going blind, but it www.intechopen.com has no effect on trachoma transmission. Prophylactic antibiotic reduces the transmission of infection but, unless frequently repeated, has no sustained effect on disease eradication.…”

“…Prophylactic antibiotic reduces the transmission of infection but, unless frequently repeated, has no sustained effect on disease eradication. 46 Of the antibiotics most commonly used, oral azithromycin is far easier to administer and thus achieves better patient compliance. 23,54 Antibiotic treatment might be successful if it is targeted at all children in an endemic area under 10 years of age.…”