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Dirt, flies, and trachoma

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Trachoma is the world’s second most prevalent cause of blindness. It is estimated that it affects some 146 million people worldwide and has blinded 6 million. It is a priority target of the World Health Organisation and the elimination of blindness due to trachoma by the year 2020 is the aim of the Alliance for the Global Elimination of Trachoma (GET 2020). The mainstays of this programme are surgery, antibiotic treatment, face washing, and environmental improvement (SAFE). Researchers in Mali (

) have sought a better understanding of the last two of these factors.

They performed a national survey between March 1996 and June 1997 examining a total of 15187 children under 10 years in 30 cluster samples in each of the country’s seven regions excluding the capital Bamako. The prevalence of active trachoma was 35%, and of intense trachoma 4%. The two factors most strongly linked with trachoma were a dirty face (dust on face or discharge from nose or eye) and flies on the face. Each of these was associated with a more than threefold increase in likelihood of trachoma. Other risk factors were a dry environment, living in a small village, overcrowding in the home, and relative poverty as judged by household possessions. Frequent bathing and face washing, and proximity to a water source, a medical centre, or a social organisation such as a women’s association all reduced the risk.

Improved hygiene and fly control together with general environmental and socioeconomic improvements will be important factors in the elimination of trachoma.

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