Article

The SAFE strategy for trachoma control: Using operational research for policy, planning and implementation.

The Carter Center, Atlanta, Georgia, United States
Bulletin of the World Health Organisation (Impact Factor: 5.09). 09/2006; 84(8):613-9. DOI: 10.2471/BLT.05.28696
Source: PubMed

ABSTRACT

Trachoma is a neglected disease and also the world's leading infectious cause of blindness. It causes misery, dependency and is a barrier to development. Trachoma is controlled by a WHO-endorsed integrated strategy of surgery for trichiasis, antibiotic therapy, facial cleanliness and environmental improvement, which is known by the acronym SAFE. The strategy is based on evidence from field trials and is continually being refined by operational research that informs national policy and planning; the strategy has affected both programme delivery and implementation. As a result of the findings of operational research, surgery is now frequently conducted by paramedics in communities rather than by ophthalmologists in hospitals; yearly mass distribution of a single oral dose of azithromycin has replaced the use of topical tetracycline; and the promotion of better hygiene, face-washing and the use of latrines are used to reduce transmission. Those who implement programmes have been equal partners in conducting operational research thus reducing the "know-do" gap and minimizing the lag that often exists between the completion of trials and putting their results into practice. Operational research has become a part of practice. Although there are still many questions without answers, national programme coordinators have a reasonable expectation that trachoma control programmes based on SAFE will work.

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    • "It was estimated that the ultimate intervention goals would require antibiotic treatment for some 340 million people and trichiasis surgeries for 8.2 million [1] [5]. "
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    ABSTRACT: Trachoma is caused by Chlamydia trachomatis and is a leading cause of blindness worldwide. Mass distribution of azithromycin (AZM) is part of the strategy for the global elimination of blinding trachoma by 2020. Although resistance to AZM in C. trachomatis has not been reported, there have been concerns about resistance in other organisms when AZM is administered in community settings. We identified studies that measured pneumococcal prevalence and resistance to AZM following mass AZM provision reported up to 2013 in Medline and Web of Science databases. Potential sources of bias were assessed using the Cochrane Risk of Bias Tool. A total of 45 records were screened, of which 8 met the inclusion criteria. We identified two distinct trends of resistance prevalence, which are dependent on frequency of AZM provision and baseline prevalence of resistance. We also demonstrated strong correlation between the prevalence of resistance at baseline and at 2-3 months ( r = 0.759 ). Although resistance to AZM in C. trachomatis has not been reported, resistance to this commonly used macrolide antibiotic in other diseases could compromise treatment. This should be considered when planning long-term trachoma control strategies.
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    • "Th e eradication of chlamydia trachomatis infections in developing countries has been most diffi cult, despite the SAFE strategy (surgery for trichiasis, antibiotic therapy, facial cleanliness, environmental improvement) organized by WHO for eliminating blinding trachoma globally by the year 2020 (Atik et al 2006; Emerson et al 2006). Mass treatments for all individuals have been given in some African and Asian countries (e.g. "
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Congenital malformations (52%), systemic diseases (48%), and multiple impairments (50%) were common. The main ophthalmic groups of visual impairment were retinal diseases (35%), ocular malformations (29%), and neuro-ophthalmological disorders (29%). Optic nerve atrophy was the most common diagnosis of visual impairment (22%), followed by congenital cataract (11%), retinopathy of prematurity (10%), and cerebral visual impairment (8%). Genetic factors (42%) were the most common etiologies of visual impairment, followed by prenatal (30%) and perinatal (21%) factors. The highest rates of blindness were seen in cerebral visual impairment (83%) and retinopathy of prematurity (82%). Retinopathy of prematurity had developed in the children born at a gestational age of 32 weeks or earlier. Significant risks for visual impairment were found in the association with preterm births, prenatal infections, birth asphyxia, neonatal respiratory difficulties, mechanical ventilation lasting over two weeks, and hyperbilirubinemia. A rise in blind and multi-impaired children was seen during the study period, associating with increases in the survival of preterm infants with extremely low birth weight. The incidence of visual impairment in children born prematurely was seven times higher than in children born at full term. A reliable profile of childhood visual impairment was obtained. The importance of highly qualified antenatal, neonatal, and ophthalmological care was clearly proved. The risks associated with pre- and perinatal disorders during pregnancy must be emphasized, e.g. the risks associated with maternal infections and the use of tobacco, alcohol, and drugs during pregnancy. Obvious needs for gene therapies and other new treatments for hereditary diseases were also proved. Lasten näkövammaisuus Suomessa. Vuosina 1972-1989 täysiaikaisena ja keskosena syntyneiden lasten näkövammojen esiintyvyys, syyt ja monivammaisuus. Tutkimuksessa selvitettiin 1970- ja 1980-luvulla syntyneiden lasten näkövammaisuuden esiintyvyyttä, syitä ja riskitekijöitä Suomessa. Tutkimusaineisto saatiin näkövammarekisteristä, joka on yksi Stakesin valtakunnallisista tutkimus- ja tilastorekistereistä. Aineistoa täydennettiin Stakesin muista rekistereistä ja keskussairaaloiden potilastiedoista. Näkövammarekisteristä löytyi 556 lasta, jotka olivat syntyneet vuosina 1972-1989 ja olivat 1.1.1990 iältään alle 18-vuotiaita. Koko aineiston ikävakioitu näkövammaisuuden esiintyvyys oli 49/100 000, mistä sokeuden osuus oli 23/100 000 ja keskosten näkövammaisuuden osuus 11/100 000. Poikia oli 62% ja tyttöjä 38%. Poikien vammaisuus oli vaikeampaa kuin tyttöjen. Lisäksi lapsilla todettiin runsaasti muita terveydentilan ja toimintakyvyn häiriöitä. 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Samoin on jatkettava geeniterapian ja muiden perinnöllisten sairauksien uusien hoitojen kehittämistä.
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