Trachoma among adults in Damot Gale District,South Ethiopia

PURPOSE To determine the prevalence of trachoma and its risk factors among adults in the Damot Gale District of south Ethiopia. METHODS A cross-sectional, community based survey was conducted in the Damot Gale District of south Ethiopia. A multi-stage sampling method was used to select subjects. RESULTS Out of 924 eligible subjects, 855 were examined, for a response rate of 92.5%. Active trachoma [follicles (TF), intense inflammation (TI) or TF/TI] was found in 20.6% (95% CI: 17.8–23.4%) of the subjects. The prevalence of trachomatous trichiasis (TT) and corneal opacity (CO) was 6.8% (95% CI: 5.1–8.5%) and 2.1% (95% CI: 1.0–3.1%), respectively. Females were affected by active trachoma twice as often as males [OR 2.13 (95% CI: 1.67–3.50, P < 0.0001)]. The prevalence of blinding trachoma (TT and CO) was also significantly higher among females [OR 3.03 (95% CI: 1.58–5.89, P < 0.001)]. Literacy and face washing were found to be significantly associated with less prevalence of active trachoma. CONCLUSION The prevalence of both active and cicatricial trachoma among adults residing in the Damot Gale District of south Ethiopia is very high. Although children are the main reservoirs of active trachoma, intervention strategies should address the fact that a high prevalence of active trachoma is also found among adults residing in hyperendemic areas.     

A community-based trachoma survey: prevalence and risk factors in the Tigray region of northern Ethiopia

AIM: Trachoma is a public health problem in Ethiopia accounting for 35-50% of cases of blindness. This study aims to determine the prevalence of trachoma in Tigray and to evaluate whether common risk factors are also risk factors in this region. METHOD: A cross sectional community-based survey was conducted. From six districts, a total of 48 villages were selected by a multistage cluster random sampling technique. A total of 3900 people who were selected randomly from 1200 households were assessed for signs of trachoma. Ophthalmic nurses used a simplified clinical grading system to assess stages of trachoma while environmentalists assessed risk factors for trachoma. RESULTS: Of the 3900 people examined, 13% had trachomatous follicles (TF), 27% intense trachomatous inflammation (TI), 17.7% trachomatous scarring (TS), 3.4% trachomatous trichiasis (TT) and 0.3% had corneal opacity (CO). The presence of a kitchen with chimney had a protective effect on TS (Adjusted Odds Ratio [AOR] = 0.82; 95% Confidence Interval [CI]: 0.65-0.96) and TT (AOR = 0.80; 95% CI: 0.53; 0.97). Active trachoma was more prevalent among children (AOR = 0.97; 95% CI: 0.96-0.97), illiterates (AOR = 1.38; 95% CI: 1.13-1.69) and those who infrequently wash their face (AOR = 1.35; 95% CI: 1.18-1.54). CONCLUSIONS: Trachoma is hyperendemic in the Tigray region. Mass chemotherapy, the expansion of primary eye care services, and promotion of a regular face washing habit are recommended. We recommend further investigations on the effect of domestic use of biomass energy on trachoma.     

Trachoma prevalence and risk factors among preschool children in a central area of the city of São Paulo, Brazil

PURPOSE: To estimate the prevalence and severity of trachoma among preschool children and to identify the risk factors. METHODS: Cross-sectional study involving preschool children up to seven years of age residing in a neighborhood of the city of S?o Paulo, Brazil. RESULTS: A total of 1128 children were studied. Although most were of low socioeconomic status, access to good sanitary services was virtually universal. The prevalence of inflammatory trachoma was 4.7%. In the bivariate analysis, being 4-7 years of age and having classroom contact with a trachoma case were associated with the disease. Multivariate logistic regression showed that contact with trachoma in the classroom was an independent predictor of trachoma. CONCLUSIONS: Trachoma persists among children in low-income families, even in urban areas with good sanitation. To eliminate trachoma in a low endemic community, a sensitive surveillance system should be implemented to identify residual sources of infection.     

A Community-Based Trachoma Survey: Prevalence and Risk Factors in the Tigray Region of Northern Ethiopia

Aim: Trachoma is a public health problem in Ethiopia accounting for 35–50% of cases of blindness. This study aims to determine the prevalence of trachoma in Tigray and to evaluate whether common risk factors are also risk factors in this region. Method: A cross sectional community-based survey was conducted. From six districts, a total of 48 villages were selected by a multistage cluster random sampling technique. A total of 3900 people who were selected randomly from 1200 households were assessed for signs of trachoma. Ophthalmic nurses used a simplified clinical grading system to assess stages of trachoma while environmentalists assessed risk factors for trachoma. Results: Of the 3900 people examined, 13% had trachomatous follicles (TF), 27% intense trachomatous inflammation (TI), 17.7% trachomatous scarring (TS), 3.4% trachomatous trichiasis (TT) and 0.3% had corneal opacity (CO). The presence of a kitchen with chimney had a protective effect on TS (Adjusted Odds Ratio [AOR] = 0.82; 95% Confidence Interval [CI]: 0.65–0.96) and TT (AOR = 0.80; 95% CI: 0.53; 0.97). Active trachoma was more prevalent among children (AOR = 0.97; 95% CI: 0.96–0.97), illiterates (AOR = 1.38; 95% CI: 1.13–1.69) and those who infrequently wash their face (AOR = 1.35; 95% CI: 1.18–1.54). Conclusions: Trachoma is hyperendemic in the Tigray region. Mass chemotherapy, the expansion of primary eye care services, and promotion of a regular face washing habit are recommended. We recommend further investigations on the effect of domestic use of biomass energy on trachoma.     

Prevalence and risk factors for trachoma in Sarlahi district, Nepal.

AIMS: To estimate the prevalence of trachoma in preschool children in Sarlahi district, Nepal, and to identify risk factors for the disease. METHODS: A stratified random sample of 40 wards was selected for participation in a trachoma survey. Within each ward, a systematic 20% sample of children 24-76 months of age was chosen to determine the presence and severity of trachoma using the World Health Organisation grading system. RESULTS: A total of 891 children were selected and 836 (93.8%) were examined for trachoma from December 1990 to March 1991. The prevalence of active trachoma was 23.6% (21.9% follicular and 1.7% intense inflammatory). Cicatricial trachoma was not seen in this age group. The prevalence of trachoma ranged from 0 to 50% across wards with certain communities at much higher risk for trachoma than others. Three year old children had the highest prevalence of follicular (25.5%) and intense inflammatory trachoma (4.3%). Males and females had similar prevalence rates. Wards without any tube wells were at higher risk than those with one or more tube wells. Lower rates of trachoma were seen in families who lived in cement houses, had fewer people per room, more servants, more household goods, animals, and land. Hence, less access to water, crowding and lower socioeconomic status were risk factors for trachoma. CONCLUSIONS: Although follicular trachoma is prevalent, intense inflammatory trachoma is relatively rare and scarring was not observed in this preschool population. Hence, this population may not be at high risk for repeat infections leading to blindness in adulthood.     

陕西省南郑县3～7岁儿童沙眼患病调查

目的：：调查陕西省南郑县儿童沙眼的患病率,为沙眼的预防和治疗提供依据。方法：采用随机整群抽样调查方法。抽取南郑县农村50名6~7岁一年级学生进行沙眼快速评估,城区3~6岁学龄前儿童1533名进行扩大筛查。所有被调查对象均在2.5倍放大镜下进行临床检查和WHO表格记录,沙眼诊断标准按照世界卫生组织( WHO )制定的沙眼简化分级系统。沙眼患病率的比较采用χ2检验进行分析。结果：对50名农村6~7岁学生(男26例,女24例)的快速评估中,未检出活动性沙眼病例。城区受检1533名学龄前儿童,亦未检出活动性沙眼,并且无沙眼性倒睫和角膜混浊病例发生。结论：南郑县学龄前儿童无活动性沙眼病例检出,发生率远低于WHO要求的非流行区<5%的比例,在陕西省不属于公共卫生问题。     

Latrine ownership as a protective factor in inflammatory trachoma in Egypt.

We investigated the association between inflammatory trachoma in children aged 1-5 and environmental and sociodemographic risk factors in a rural Nile Delta hamlet. Inflammatory trachoma clustered in households, emphasising the child-to-child nature of transmission in the hamlet. Multiple logistic regression analysis revealed three factors predicting inflammatory trachoma in children: the absence of a latrine in the household, school-age siblings with inflammatory trachoma, and additional same-age siblings (with or without disease) in the household. In the Egyptian setting the presence of pit latrines in all houses, even when full and unscreened, might result in a reduction in trachoma prevalence in this population from the current 49% to 35%. The construction of pit latrines may offer the simplest and most acceptable environmental method for reducing trachoma in this trachoma endemic area.     

Risk of trachoma in a SAFE intervention area

To determine prevalence and risk factors of trachoma in communities receiving intervention with the SAFE strategy (surgery, antibiotic, face washing, environmental hygiene), a cross-sectional trachoma survey was undertaken in 2006 in the Enemor district of southern Ethiopia where the SAFE program has been implemented for over five years. A sample of 374 household heads and 2,080 individuals were interviewed and examined for trachoma using an established trachoma grading system of the World Health Organization. The most prominent risk factors were identified with logistic regression analysis. Among individuals >14 years of age, the prevalence of trichiasis was 9.04 % [confidence interval (CI) 7.4–10.6]. People >40 years of age [odds ratio (OR) 1.7; CI 1.2–2.7), women (OR 2.2; CI 1.1–4.3), and illiterates (OR 3; CI 1.4–6.8) had increased risk of trichiasis. Coverage of surgical and antibiotic services was 46 and 85.5 %, respectively. Prevalence of active follicular trachoma (TF) in children aged 1–9 years was 33.1 % (CI 29.4–37.1). Unclean faces (OR 5.9; CI 4.3–8.3) and not being in school (OR 2.1; CI 1.3–3.3) were significantly associated with TF. Clean faces were observed in 56.1 % of children and improved with age and schooling (P < 0.001, Chi-squared test). Household latrine use (74.4 %) was associated with knowledge about SAFE and economic level (P ≤ 0.004, Chi-squared tests). Elderly illiterate women remain at risk of becoming blind from trachoma even in intervention areas. Trachoma particularly affects children without clean faces or opportunity for schooling. Provision of SAFE services with high coverage should be sustained in trachoma-hyperendemic areas.     

The Epidemiology of Trachoma in the Five Northern Districts of Sierra Leone

Purpose: In 2008, a trachoma prevalence survey was conducted in the five northern districts of Sierra Leone to determine if and where specific components of the SAFE strategy (Surgery, Antibiotics, Face washing, Environmental change) should be initiated.

Methods: A cross-sectional survey at district level was implemented using two-stage random cluster sampling: probability proportionate sampling was used to select villages in the first stage and compact segment sampling of households in the second stage. Both eyes of 16,780 individuals were examined using the World Health Organization simplified trachoma grading system. Data were also collected on village- and household-level behavior and environmental factors related to trachoma.

Results: Prevalence of trachomatous inflammation-follicular (TF) in children aged 1–9 years was highest in Kambia at 3.52% (95% Confidence Interval (CI): 2.28–4.75%), while the prevalence of trachomatous trichiasis (TT) in persons over 15 years of age was highest in Port Loko at 0.27% (95% CI: 0.03–0.50%). Across all districts, the percentage of households reporting washing children’s faces less than once per day was very low, while latrine coverage and accessible and safe water sources were not highly prevalent.

Conclusions: In all districts but Koinadugu, TT prevalence was greater than the WHO elimination threshold, indicating the need for 1,016 TT surgeries to prevent blindness. District TF prevalence rates did not warrant mass antibiotic distribution. Although not required given the low prevalence of TF, we recommend the construction of 35,941 household latrines and provision of water sources within a 30-minute walk roundtrip for 17,551 households to bring Sierra Leone closer to reaching Millennium Development Goal 7.     

The burden of trachoma in the rural Nile Delta of Egypt: a survey of Menofiya governorate

BACKGROUND: Evidence of widespread distribution of trachoma in Egypt had not been clarified as previous surveys were limited to individual communities which may not have been representative of the general population. The Nile Delta of Egypt presents a unique environment for trachoma to persist. Economic improvements in the past decade have affected even the poorest rural environments; availability of electricity is now found in many rural communities. Availability of water in Nile Delta has always been good but poor hygienic conditions have been the primary factor in trachoma transmission. A survey of trachoma was undertaken in Menofiya governorate to determine if Egypt should be identified as trachoma endemic and targeted for trachoma control efforts. METHODS: A multistage random cluster study design was used with the target population defined as adults aged 50 and over and children aged 2-6 years from throughout the governorate. Among preschool children only trachoma was graded while among adults presenting visual acuity and cause of vision loss or blindness were also recorded. Adults were interviewed regarding past trichiasis surgery; those currently with trichiasis or a history of trichiasis surgery were also interviewed regarding outcome of surgery. RESULTS: A total of 3272 children aged 2-6 and 3322 adults age 50+ were enumerated. Among the children 81.3% were examined and among the adults 73.0% were examined. Active trachoma (follicles (TF) and/or intense inflammation (TI)) was found among 36.5% (95% confidence interval (CI) 34.7-38.3%) of the children. TI was 1.89 (95% CI 1.22-2.94) times more common in rural children compared to urban children. The prevalence of trichiasis (TT) in adults was 6.5%; women had an age adjusted odds of trichiasis of 1.68 (95% CI 1.18-2.39) compared to men. Trichiasis was 2.11 times (95% CI 1.33-3.37) more common in rural Menofiya compared to urban Menofiya. TT accounts for blindness (presenting vision <3/60) in 8% of patients and accounts for 13.2% of visual impairment. Overall, trichiasis surgical coverage was 34.4%, slightly higher among men than women. The outcome of trichiasis surgery was poor in 44.4% of cases. CONCLUSION: Trachoma is a serious public health problem in Menofiya governorate and a significant contributor to vision loss. These findings would suggest that continued poor hygienic conditions in rural Egypt have limited the reduction of active trachoma even in the face of significant improvements in socioeconomic status. Furthermore, the high proportion of trichiasis surgery cases with a poor outcome would indicate a need to reassess current surgical practices in Egypt and improve training and monitoring.     

Reduction of trachoma in the absence of antibiotic treatment: Evidence from a population-based survey in Malawi

PURPOSE. A survey was conducted in Chikwawa District, Malawi in order to compare the current prevalence of trachoma with a similar survey in 1983. METHODS. Using random cluster household sampling, children aged 1 to 6 and adults aged 50 or older were enumerated and examined for the presence of trachoma. RESULTS. Among the 1313 children enumerated, 1249 (95.1%) were examined and among the 1431 adults enumerated, 1221 (85.3%) were examined. The prevalence of active trachoma among the children was 13.9% (11.9–15.9%), 10.0% in males and 14.4% in females. The prevalence of active trachoma varied significantly among the 25 clusters, ranging from 3.9% to 38.2% with 5 clusters (20%) having a prevalence &gt;20%. Signs of trachomatous trichiasis were observed in 1.0% of adults examined. Active disease in 1999 was associated with a longer distance to the primary water source. CONCLUSIONS. Since 1983 there has been no mass antibiotic treatment programme in the district and little change in socioeconomic status. However, compared to the 1983 findings, active trachoma has been reduced by over 50% (p &lt; 0.001) and trachomatous trichiasis by over 80%. In the 16-year interim (especially in the past 7 years) health, water and hygiene programmes were initiated and we hypothesize that the reduction in active disease is likely due to these changes. Our findings suggest that sustained reductions in active trachoma can be achieved without community-based antibiotic distribution.     

山东省滕州市2676名农村小学生沙眼患病调查

目的 调查山东省滕州市农村小学生的沙眼患病情况.方法 采用以人群为基础的横断面调查方法.2008年4月至7月期间,在由山东省防盲办公室组织的山东省50岁及以上人群盲与低视力眼病流行病学调查中,在4个调查县(市、区)之一的滕州市采用随机整群抽样方法抽取27个村为调查点.将调查点所在地的16所农村小学进行编号,应用单纯随机抽样方法抽取8所小学,共2742名小学生,实查2676人,受检率为97.60%.采用世界卫生组织沙眼简易分期标准,在3倍放大镜下进行检查和记录.沙眼患病率的比较采用χ2检验进行分析.结果 2676名受检小学生中,检出活动性沙眼593例,患病率为22.16%[95%可信区间(CI):20.59%～23.73%];受检女性的沙眼患病率为25.79%(276/1070),高于男性的患病率19.74%(317/1606)(χ2=13.653,P=0.000).各年龄组之间沙眼患病率比较,差异无统计学意义(χ2=9.389,P=0.052).各级沙眼滤泡性沙眼、浸润性沙眼、瘢痕性沙眼的患病率分别为5.68%(152/2676)、19.21%(514/2676)、0.56%(15/2676);女性浸润性沙眼的患病率22.90%(245/1070)高于男生16.75%(269/1606)(χ2=15.638,P=0.000);滤泡性沙眼、瘢痕性沙眼的患病率在男女性之间差异无统计学意义(均P＞0.05);全部受检小学生中无沙眼性倒睫和角膜混浊病例发生.结论 山东省滕州市农村小学生沙眼患病率较高.建议采取群体普遍应用抗生素、改善个人卫生和居住环境、建立和完善初级眼保健体系等干预措施.     

武强县小学生沙眼流行病学调查

目的调查河北省武强县小学生沙眼的患病率,并分析其危险因素。方法采用随机整群抽样调查方法,抽取武强县7所学校小学生共计1622例,其中男817例,女805例;年龄6～16岁,平均（11.91±2.24）岁。所有被调查对象均进行临床检查,沙眼诊断标准参照世界卫生组织（WTO）制定的沙眼分期标准;从临床诊断为沙眼的患者中,随机抽样进行结膜刮片,镜检法检查沙眼包涵体,利用酶联免疫学与聚合酶链反应（PCR）检测沙眼衣原体;同时选择正常小学生作为正常对照。结果被调查的1622例小学生中,临床诊断为沙眼的379例,患病率为23.4%[95%置信区间（CI）：25.5%～21.3%],其中滤泡性沙眼（TF）307例（81%）,浸润性沙眼（TI）72例（19%）。患病率男为20.9%,女为25.8%,两者比较差异有统计学意义（χ2=5.455,P=0.020）。各年龄组沙眼患病率比较,差异有统计学意义（χ2=9.972,P=0.019）。从379例临床诊断沙眼中随机抽样了168例及正常对照组42例进行结膜刮片检查,沙眼包涵体均为阴性,酶联免疫学检测阳性64例（38.1%）,PCR检测阳性109例（64.9%）。危险因素分析表明沙眼的发生与城郊区居住、性别、年龄有关。结论武强县小学生中仍有沙眼流行,主要以TF为主,需针对危险因素开展沙眼防治。     

A Longitudinal Analysis of Chlamydial Infection and Trachomatous Inflammation Following Mass Azithromycin Distribution

Background: Mass azithromycin distributions are effective for clearing ocular strains of Chlamydia trachomatis, yet infection frequently returns in areas with hyperendemic trachoma. A better understanding of the factors associated with chlamydial reinfection could be helpful to plan trachoma elimination strategies.

Methods: This was a prospective cohort study conducted in a trachoma-hyperendemic region of Ethiopia in 2003. As part of a larger cluster-randomized trial, 21 villages were treated with a single mass azithromycin distribution and all children 5 years and younger were monitored for ocular chlamydia and clinically active trachoma at baseline and at 2 and 6 months following the treatment.

Results: In 20 villages with available data, azithromycin treatment coverage was 88.7% (95% confidence interval [CI] 85.7–91.8%). In total, 1005 children tested negative for ocular chlamydia at the 2-month visit, of whom 41 became infected by 6 months (1.0 incident chlamydia infections per 100 person-months, 95%CI 0.7–1.4). The presence of intense trachomatous inflammation (TI) at baseline was associated with incident infection at 6 months (incidence rate ratio 1.91, 95%CI 1.03–3.55). Ocular chlamydia infections clustered more within households than communities: (intraclass correlation coefficient 0.01 for communities and 0.29 for households six months posttreatment). Younger children were more likely to have persistent clinically active trachoma (P = 0.03).

Conclusions: More intensive antibiotic distributions may be warranted for younger children, for children with TI, and for households containing children with ocular chlamydia infections.     

海南省1～9岁儿童沙眼快速评估

目的:调查海南省1~9岁儿童沙眼患病情况,确定海南省沙眼高发流行和非流行区,为沙眼的防治方案的制定提供依据.方法:根据既往的相关文献、眼科专家访谈及实地摸底调查等方法确定调查地点.于2013年由海南省防盲办公室组织调查队在东方市、五指山市、乐东县、白沙县、保亭县、临高县、昌江县7个调查市县抽取小学生共计356名进行了沙眼快速评估工作,其中男192人,女164人,平均年龄7 (1~9)岁.采用世界卫生组织推荐的沙眼简化分级系统,对以上小学生进行沙眼快速评估调查.结果:在受检的356名小学生中,未发现有活动性沙眼的患者.结论:海南省1~9岁儿童的沙眼患病率<5%,活动性沙眼在海南省不再是一个公共卫生问题.     

无锡市滨湖区0～6岁儿童通过SureSight手持验光仪视力筛查结果分析

目的:了解无锡市滨湖区0~6岁儿童视力发育状况,为制定无锡市滨湖区儿童眼保健措施提供科学依据。方法:对无锡市滨湖区3695名0~6岁学龄前儿童运用SureSight手持验光仪视力快速检测眼屈光状态,参照由美国伟伦公司提供的各年龄段屈光筛查转诊标准来确定筛查结果。并且在筛查视力的同时完成全面的眼部检查。结果:视力筛查儿童总异常率为9.76%,可疑率为5.40%,我们发现随着幼儿年龄的增长异常和可疑检出率有上升趋势,并且各年龄段视力筛查结果有差异(χ²=15.913,P=0.014),但男孩和女孩之间无差异(χ²=7.200,P=0.066)。在各个年龄组中视力异常比例最高的是散光(13.89%、17.96%、17.62%、11.50%),其次是远视(0.35%、1.91%、3.60%、8.86%)和屈光参差(0.69%、0.67%、1.64%、2.07%)。五种类型在各年龄段中分布的比例如下:远视(4.38%)、近视(0.82%)、散光(15.65%)、屈光参差(1.42%)和其他屈光问题(0.466%)。0~3岁学龄前儿童散光患病率为6.94%(95%CI:4.90%~9.00%),3~4岁为8.98%(95%CI:7.80%~10.20%),4~5岁为8.81%(95%CI:7.70%~9.90%),5~6岁为5.75%(95%CI:4.80%~6.70%)。在不同年龄组中散光患病率无差异(χ²=0.872,P=0.929)。结论:从我们的筛查结果中发现散光是学龄前儿童最常见的屈光不正类型,其次是远视和屈光参差,但我们并没有发现近视,从而证实了先前的研究,即近视并没有在早期发展。最后我们强调应定期实施学龄前儿童视力筛查,倡导社会重视学龄前儿童视力保护及眼睛的健康管理。     

Prevalence and distribution of active trachoma in children of less than five years of age in trachoma endemic regions of Oman in 2005

BACKGROUND: Oman aims to achieve "Elimination of Blinding Trachoma" by 2010. For accreditation purposes, a trachoma survey was conducted in Oman in 2005, targeting children younger than five years. It was conducted in twenty wilayats (districts) of three trachoma endemic regions. The Omani children were surveyed at health institutions during a 'Polio Supplementary Immunization Campaign.' The authors present the outcome of this survey and recommend policies for trachoma control in the study area. METHODS: Eye health care supervisors examined Omani children sequentially in health centers. However, the timings and days of visit to these health centers were selected randomly. The presence of trachoma follicular (TF) was noted in the tarsal area. The prevalence of TF was calculated and its distribution was mapped. RESULTS: The coverage for the immunization of children of less than five years of age residing in the study area was greater than 97%. For trachoma evaluation, 4,205 children were examined. The prevalence of TF in children of less than five years of age was 0.59% (95% CI; 0.40-0.88). Sumail, Hamra and Izki wilayats of Dhakhiliya region and Barka and Al Awabi Wilayats of South Batinah region had a prevalence of TF greater than 1%. No wilayat of North Sharqiya region had > or =1% TF. The gender variation in TF was not significant. (RR = 0.97 [95% CI 0.46-2.05]). CONCLUSIONS: All the Wilayats of trachoma endemic regions of Oman seem to have a prevalence of TF lesser than 5%. The data on TF in children aged between six and ten will enable us to determine whether Oman has achieved the Ultimate Intervention Goals (UIGs) for the provision of antibiotic treatment for acute infection (the "A" component of the SAFE strategy for the "Elimination of Blinding Trachoma" for the year 2005). Such initiatives of trachoma screening during a supplementary vaccination campaign could prove a cost-effective approach for determining the trachoma status of a country.     

Prevalence of trachoma in a single community, 1975-2007

Background: To determine the change in the prevalence in active trachoma in children in a remote Aboriginal community over a 32‐year period. Design: Data used from two cross‐sectional studies repeated in the same community 32 years apart. Participants or Samples: Children aged 5–13 years living in the community. Methods: Thirty‐five mm photographs of the everted upper lid taken in 1975 and digital photographs taken in 2007 were graded using a fine trachoma‐grading scheme. Main Outcome Measure: The age‐specific prevalence and severity of trachoma was compared at the two time points. Results: Images were available from 82 children in 1975 and from 92 children in 2007. The overall prevalence of active trachoma (trachomatous inflammation follicular and or trachomatous inflammation intense) was 59% in 1975 and in 2007 was significantly lower at 23% (P < 0.001). The overall severity grades of active trachoma had also decreased significantly for each sign from 1975 to 2007 (all P values from the rank‐sum test were less than 0.001). However, in 2007, there were still some children with severe active trachoma and severe scarring still occurred. Conclusion: Although the prevalence and severity of active trachoma in children have decreased significantly over the last 30 years in this community, trachoma still remains a significant public health problem. One third of the children have active trachoma, a figure in excess of the threshold set as a public health problem by the World Health Organization.     

大同市小学生沙眼流行病学调查

目的 调查大同市小学生流行性沙眼的患病率,并分析其危险因素.方法 采用随机整群抽样调查方法.抽取大同市小学生共计1236人,其中男生624人,女生612人,年龄6～14岁,平均年龄(10±2)岁.所有被调查对象均进行临床检查,沙眼诊断标准参照世界卫生组织制定的简易沙眼分期标准;对临床诊断为沙眼的患者取结膜标本,进行免疫学与聚合酶链反应(PCR)检测沙眼衣原体.采用χ2检验分析沙眼患病率与学校、性别、年龄的关系,并对实验室检查结果进行统计学分析;采用Logistic回归分析沙眼患病的危险因素,先用Logistic单因素分析相父因素与沙眼患病率之间的关系,以P＜0.05作为入选条件,选取相关自变量,然后应用多因素非条件Logistic回归分析提取主要危险因素.结果 调查的:1236名小学生中,135例临床诊断为沙眼,沙眼患病率为10.9%[95%置信区间(CI):9.2%～12.6%],其中滤泡性沙眼(TF)117例,浸润性沙眼(TI)18例.男生沙眼患病率为8.8%,女生沙眼患病率为13.1%,女生沙眼患病率明显高于男生(P=0.016).各年龄组沙眼患病率比较,差异无统计学意义(P=0.801).临床诊断沙眼的135例小学生中,沙眼农原体免疫学检测阳性13例(9.6%),PcR检测阳性86例(63.7%).危险因素分析表明沙眼的发生与家人是否共用毛巾脸盆及是否经常揉眼睛等因素相关.结论 大同市小学生中仍有沙眼流行,需要针对危险因素开展沙眼防治.