Cartography of trachoma in Mali: results of a national survey

Prior to a campaign to eliminate blinding trachoma, a survey of the prevalence of the disease was conducted in the seven administrative regions of Mali between March 1996 and June 1997. In each region (with the exception of Bamako District) a random sample of thirty clusters was taken from the general population, in accordance with the principle of probability proportionate to the size of the communities. All children under 10 years of age and all women over 14 years were examined. The simplified coding proposed by WHO was used for data gathering. A total of 15,310 children and 11,530 women were examined. The prevalence of active trachoma, follicular (TF) or intense (TI), was estimated to be 34.9% among children under 10 years of age (95% CI: 32.3-37.6). The prevalence of TI showing the intensity of trachoma was 4.2% (95% CI: 3.5-5.0) among the same children. The prevalence increased up to the age of 3 years, when it reached 49.2%. The prevalence of TF/TI was 35.7% among boys and 34.3% among girls. The prevalence of entropion trichiasis among women over 14 years of age was 2.5% (95% CI: 2.1-2.9), and 1% had central corneal opacity (95% CI: 0.8-1.3). These prevalences increased with age, such that 10% of women over 70 years of age had trichiasis. By region of the country, the prevalence ranged from 23.1% of active trachoma among children in Ségou, to 46.2% in Gao. The prevalence of entropion trichiasis was 0.65% in Gao region and 3.9% in Koulikoro region. This survey allows the trachoma treatment needs of Mali to be quantified. We estimate that 1.09 million children under 10 years are carriers of active trachoma and require local or general antibiotic treatment. If all the under-10-year-olds from all villages where TF/TI exceeded 20% were to be treated, a total of 2.436 million children would be involved. A total of 85,000 adults should have surgery to correct trichiasis and avoid the onset of blindness.