Rapid assessment for prioritisation of trachoma control at community level in one district of the Kaolack Region, Senegal

The objective of this study was to use a modified Lot Quality Assurance Sampling methodology to classify communities according to prevalence of active trachoma and to estimate the prevalence of trachoma and trichiasis in Nioro department, Kaolack Region, Senegal. A survey was conducted using two-stage cluster sampling to select 50 children aged 2-5 years in each of 33 clusters. In total 1,648 children were examined for active trachoma. Information on trachoma risk factors was collected through interviews with the mother or the household head of the child. Adults (>40 years) with trichiasis were identified through case finding. Nineteen clusters had a low prevalence of active trachoma in children aged 2-5 years (<20%), 11 had medium prevalence (20-40%) and three had high prevalence (>40%). The prevalence of active trachoma in children aged 2-5 years was 17.4% (95% CI 12.9-21.8%). Multivariate-adjusted predictors of active trachoma were: age, facial cleanliness, hygiene practices and keeping cattle in the household. The prevalence of trichiasis in adults aged over 40 years was 1.77% (95% CI 1.24-2.51), equating to 985 adults (95% CI 765-1250) with trichiasis in Nioro department. In conclusion, a survey using rapid methodology showed that trachoma is a problem of public significance in Nioro department, Senegal.     

儿童下睑赘皮性倒睫的手术矫正

目的介绍一种简单有效治疗儿童下睑赘皮性倒睫的手术方法。方法应用皮肤轮匝肌切除联合睫毛外翻缝线术治疗儿童下睑赘皮性倒睫46例92只眼,年龄3~12岁,平均5.4岁。术后随访观察6~24个月。结果治愈82只眼,治愈率89.1%;好转10只眼,好转率10.9%。随访期间无加重。5只眼复发,再次手术后均治愈。总有效率100%。结论皮肤轮匝肌切除联合睫毛外翻缝线术治疗儿童下睑赘皮性倒睫疗效确切,复发率低,无严重并发症。     

Trichiasis and geoclimatic factors in Mali

Several trachoma surveys conducted in sub-Saharan countries showed different geographical distributions of active trachoma and trichiasis. Trichiasis is more common in southern regions. We analysed the role of geoclimatic factors in determining the distributions of active trachoma and trichiasis in Mali. In each region a random sample of 30 clusters was examined. The prevalence of active trachoma among children and of trichiasis among women was compared, and geographical, environmental and social risk factors were assessed. Logistic regression models were constructed. Multiple regression analysis was applied and models were used to map the probability of active trachoma and trichiasis. The highest prevalence rates of active trachoma (TF/TI) were found in the northern part of Mali reaching 41.1% among children living north of the 15th parallel. Surprisingly, prevalence rates of trichiasis (TT) among women regularly increased from north to south (1.0% north of the 15th parallel vs. 2.8% south; OR=2.91, 95% CI 2.01-4.24). The two related predictive maps showed a gradient SSE/NNW for TF/TI very different from the gradient NS/SW for TT. These opposite spatial distributions could be explained by differences in the pathogenic agent, the natural history of the disease, population susceptibility, grading process or vulnerable group behaviour.     

倒睫激光疗效106例观察

目的 对氩激光光凝后的倒睫患者进行随诊,观察这种方法的临床效果.方法 应用氩激光治疗倒睫毛,将能量设为500～1000m W,时间为200m s,光斑50～200μm,使激光束对准倒睫毛的根部,产生2～3m m直径的小凹陷,继续激光破坏毛囊.激光后应用抗生素滴眼液一周.结果 73位患者106只眼接受了氩激光治疗.每根倒睫所需激光点数(53.7±19.1)点,68只眼经1次激光治愈,成功率64.2%,经3次激光,101只眼(95.3%)达到治愈效果.眼睑≤5个倒睫者,1次激光成功率78.9%;5～10个,33.3%;而超过10个倒睫的眼睑均需多次激光.沙眼1次激光成功率41.7%,睑缘炎72.4%,特发性倒睫81.8%.结论 氩激光光凝治疗倒睫是一安全、有效的方法.眼睑上的倒睫数越多,成功率越低.病因不同治疗效果也不同,其中沙眼的倒睫治疗效果差,需多次激光处理.     

儿童倒睫的筛查和早期整复治疗

目的 通过对儿童倒睫合并散光病例的筛查和随访,探讨倒睫与散光的相关性,及整复手术治疗的时机.方法 筛查眼科门诊16例不同程度倒睫合并散光的儿童患者,根据倒睫程度、类型及角膜和视力的情况,采取倒睫矫正整复手术及配戴矫正眼镜.结果 随访1至4年,16例患儿的矫正视力均有不同程度的上升,其中5例行埋线法矫正倒睫者,术后重睑外形美观.结论 儿童倒睫应早期诊断,对于合并角膜损伤,视力下降或存在眼球刺激症状者应及早手术治疗.     

Argon laser photocoagulation of ingrowing eyelashes (trichiasis)

We report the results of argon laser treatment in 30 patients with symptomatic ingrowing eyelashes. Permanent eyelash destruction was achieved in 71% of treated lashes. No local anaesthesia was found to be necessary. Complications were minimal and patient satisfaction was high. Presented at the British Medical Laser Association Autumn Meeting, Leeds 1993.     

Risk factors for trachomatous trichiasis in children: cross-sectional household surveys in Southern Sudan

We have previously documented blinding trachoma to be a serious public health problem in Southern Sudan, with an unusually high prevalence of trachomatous trichiasis (TT) among children. We aimed to investigate risk factors for TT in children in Southern Sudan. Cross-sectional surveys were undertaken in 11 districts between 2001 and 2006, and eligible participants were examined for trachoma signs. Risk factors were assessed through interviews and observations. Using logistic regression, associations between TT in children and potential risk factors were investigated. In total, 11155 children aged 1-14 years from 3950 households were included in the analysis. Overall prevalence of TT was 1.5% (95% CI 1.1-2.1). Factors independently associated with increased odds of TT in children aged 1-14 years were: increasing age (P(trend)<0.001); female gender (odds ratio=1.5; 95% CI 1.1-2.1); increasing proportion of children in the household with trachomatous inflammation-intense (TI) (P(trend)=0.002); and increasing number of adults in the household with TT (P(trend)<0.001). Our study revealed risk factors for TT in children consistent with those previously reported for TT in adults. While the associations of TT in children with TI in siblings and TT in adult relatives merit further investigation, there is an urgent need for trachoma prevention interventions and trichiasis surgery services that are tailored to cater for young children in Southern Sudan.