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

Abstract

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 >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 < 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.