Aims: To determine the coverage, outcome, and barriers to uptake of cataract s urgery in leprosy villages of north eastern Nigeria. Methods: People 30 years an d above resident in eight leprosy villages were examined....Aims: To determine the coverage, outcome, and barriers to uptake of cataract s urgery in leprosy villages of north eastern Nigeria. Methods: People 30 years an d above resident in eight leprosy villages were examined. Cataract blind people were questioned about the reasons they had not been treated. Subjects who had re ceived an operation for cataract were examined to determine the outcome and, whe re applicable, the causes of poor outcome. Results: 480 people were examined. Ca taract was the commonest cause of blindness. The cataract surgical coverage (peo ple) was 39.2%for orthodox surgery and 29.7%for couching. After surgery, visua l acuity ≥3/60 had been restored to 82.1%of eyes that had had orthodox surgery , but only 58.6%of eyes that had been couched. Cost was the commonest reason gi ven for not seeking treatment for cataract. Conclusions: Cataract is the major c ause of blindness in this population but cataract surgical needs are currently n ot being met. There is a need for better collaboration between leprosy control a nd ophthalmic services, improved education of people affected by leprosy, a comm itment to improving orthodox cataract surgery outcomes, and consideration of a p ossible role for traditional healers as sources of referral for orthodox surgica l services.展开更多
BACKGROUND: Trachoma, caused by repeated ocular infection with Chlamydia trach omatis, is an important cause of blindness. Current recommended dosing intervals for mass azithromycin treatment for trachoma are based on...BACKGROUND: Trachoma, caused by repeated ocular infection with Chlamydia trach omatis, is an important cause of blindness. Current recommended dosing intervals for mass azithromycin treatment for trachoma are based on a mathematical model. METHODS: We collected conjunctival swabs for quantitative polymerase chain re action assay of C. trachomatis before and 2, 6, 12, 18, and 24 months after mass treatment with azithromycin in a Tanzanian community in which trachoma was ende mic. For ethical reasons, at 6, 12, and 18 months, we gave tetracycline eye oint ment to residents who had clinically active trachoma. RESULTS: At baseline, 956 of 978 residents (97.8 percent) received either one oral dose of azithromycin or (if azithromycin was contraindicated) a course of tetracycline eye ointment. Th e prevalence of infection fell from 9.5 percent before mass treatment to 2.1 per cent at 2 months and 0.1 percent at 24 months. The quantitative burden of ocular C. trachomatis infection in the community was 13.9 percent of the pretreatment level at 2 months and 0.8 percent at 24 months. At each time point after baselin e, over 90 percent of the total community burden of C. trachomatis infection was found among subjects who had been positive the previous time they were tested. CONCLUSIONS: The prevalence and intensity of infection fell dramatically and rem ained low for two years after treatment. One round of very high cover age mas s treatment with azithromycin, perhaps aided by subsequent periodic use of tetra cycline eye ointment for persons with active disease, can interrupt the transmis sion of ocular C. trachomatis infection.展开更多
Background:Trachoma results from repeated episodes of conjunctival infection with Chlamydia trachomatis and is the leading infectious cause of blindness.To eliminate trachoma,control programmes use the SAFE strategy(S...Background:Trachoma results from repeated episodes of conjunctival infection with Chlamydia trachomatis and is the leading infectious cause of blindness.To eliminate trachoma,control programmes use the SAFE strategy(Surgery,Antibiotics,Face cleanliness,and Environmental improvement).The A component is designed to treat C trachomatis infection,and is initiated on the basis of the prevalence of the clinical sign trachomatous inflammation-follicular(TF).Unfortunately,TF correlates poorly with C trachomatis infection.We sought to assess a newly developed point-of-care(POC)assay compared with presence of TF for guiding the use of antibiotics for trachoma control.Methods:We compared performance outcomes of the POC assay and presence of TF using commercial PCR as a comparator in 664 children aged 1-9 years in remote,trachoma-endemic villages in Tanzania.Signs of trachoma were graded according to the WHO simplified trachoma grading system.Findings:Of 664 participants,128(19%)were positive for ocular C trachomatis infection by PCR.Presence of TF had a sensitivity of 64.1%(95% CI 55.8-72.4),specificity of 80.2%(76.8-83.6),and positive predictive value of 43.6%(36.5-50.7).By contrast,the POC assay had a sensitivity of 83.6%(77.2-90.0),specificity of 99.4%(98.8-100.0),and positive predictive value of 97.3%(94.2-100.3).Interagreements and intra-agreements between four novice operators were 0.988(0.973-1.000)and 0.950(0.894-1.000),respectively.Interpretation:The POC assay is substantially more accurate than TF prevalence in identifying the presence or absence of infection.Additional studies should assess the use of the assay in the planning and monitoring of trachoma control activities.展开更多
文摘Aims: To determine the coverage, outcome, and barriers to uptake of cataract s urgery in leprosy villages of north eastern Nigeria. Methods: People 30 years an d above resident in eight leprosy villages were examined. Cataract blind people were questioned about the reasons they had not been treated. Subjects who had re ceived an operation for cataract were examined to determine the outcome and, whe re applicable, the causes of poor outcome. Results: 480 people were examined. Ca taract was the commonest cause of blindness. The cataract surgical coverage (peo ple) was 39.2%for orthodox surgery and 29.7%for couching. After surgery, visua l acuity ≥3/60 had been restored to 82.1%of eyes that had had orthodox surgery , but only 58.6%of eyes that had been couched. Cost was the commonest reason gi ven for not seeking treatment for cataract. Conclusions: Cataract is the major c ause of blindness in this population but cataract surgical needs are currently n ot being met. There is a need for better collaboration between leprosy control a nd ophthalmic services, improved education of people affected by leprosy, a comm itment to improving orthodox cataract surgery outcomes, and consideration of a p ossible role for traditional healers as sources of referral for orthodox surgica l services.
文摘BACKGROUND: Trachoma, caused by repeated ocular infection with Chlamydia trach omatis, is an important cause of blindness. Current recommended dosing intervals for mass azithromycin treatment for trachoma are based on a mathematical model. METHODS: We collected conjunctival swabs for quantitative polymerase chain re action assay of C. trachomatis before and 2, 6, 12, 18, and 24 months after mass treatment with azithromycin in a Tanzanian community in which trachoma was ende mic. For ethical reasons, at 6, 12, and 18 months, we gave tetracycline eye oint ment to residents who had clinically active trachoma. RESULTS: At baseline, 956 of 978 residents (97.8 percent) received either one oral dose of azithromycin or (if azithromycin was contraindicated) a course of tetracycline eye ointment. Th e prevalence of infection fell from 9.5 percent before mass treatment to 2.1 per cent at 2 months and 0.1 percent at 24 months. The quantitative burden of ocular C. trachomatis infection in the community was 13.9 percent of the pretreatment level at 2 months and 0.8 percent at 24 months. At each time point after baselin e, over 90 percent of the total community burden of C. trachomatis infection was found among subjects who had been positive the previous time they were tested. CONCLUSIONS: The prevalence and intensity of infection fell dramatically and rem ained low for two years after treatment. One round of very high cover age mas s treatment with azithromycin, perhaps aided by subsequent periodic use of tetra cycline eye ointment for persons with active disease, can interrupt the transmis sion of ocular C. trachomatis infection.
文摘Background:Trachoma results from repeated episodes of conjunctival infection with Chlamydia trachomatis and is the leading infectious cause of blindness.To eliminate trachoma,control programmes use the SAFE strategy(Surgery,Antibiotics,Face cleanliness,and Environmental improvement).The A component is designed to treat C trachomatis infection,and is initiated on the basis of the prevalence of the clinical sign trachomatous inflammation-follicular(TF).Unfortunately,TF correlates poorly with C trachomatis infection.We sought to assess a newly developed point-of-care(POC)assay compared with presence of TF for guiding the use of antibiotics for trachoma control.Methods:We compared performance outcomes of the POC assay and presence of TF using commercial PCR as a comparator in 664 children aged 1-9 years in remote,trachoma-endemic villages in Tanzania.Signs of trachoma were graded according to the WHO simplified trachoma grading system.Findings:Of 664 participants,128(19%)were positive for ocular C trachomatis infection by PCR.Presence of TF had a sensitivity of 64.1%(95% CI 55.8-72.4),specificity of 80.2%(76.8-83.6),and positive predictive value of 43.6%(36.5-50.7).By contrast,the POC assay had a sensitivity of 83.6%(77.2-90.0),specificity of 99.4%(98.8-100.0),and positive predictive value of 97.3%(94.2-100.3).Interagreements and intra-agreements between four novice operators were 0.988(0.973-1.000)and 0.950(0.894-1.000),respectively.Interpretation:The POC assay is substantially more accurate than TF prevalence in identifying the presence or absence of infection.Additional studies should assess the use of the assay in the planning and monitoring of trachoma control activities.
