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. 2012 Apr 18;4(4):CD003659.
doi: 10.1002/14651858.CD003659.pub3.

Face washing promotion for preventing active trachoma

Henry O D Ejere  1 , Mahmoud B Alhassan, Mansur Rabiu
Affiliations

Face washing promotion for preventing active trachoma

Henry O D Ejere et al. Cochrane Database Syst Rev. .

Update in

Abstract

Background: Trachoma remains a major cause of avoidable blindness among underprivileged populations in many developing countries. It is estimated that about 146 million people have active trachoma and nearly six million people are blind due to complications associated with repeat infections.

Objectives: The objective of this review was to assess the effects of face washing on the prevalence of active trachoma in endemic communities.

Search methods: We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2011, Issue 8), MEDLINE (January 1950 to September 2011), EMBASE (January 1980 to September 2011), Latin American and Caribbean Health Sciences Literature Database (LILACS) (January 1982 to September 2011), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com) and ClinicalTrials.gov (www.clinicaltrials.gov). There were no date or language restrictions in the electronic searches for trials. The electronic databases were last searched on 2 September 2011. We checked the reference list of the included trials to identify further relevant trials. We used the Science Citation Index to search for references that cite the studies that are included in the review. We also contacted investigators and experts in the field to identify additional trials.

Selection criteria: We included randomized or quasi-randomized controlled trials, comparing face washing with no treatment or face washing combined with antibiotics against antibiotics alone. Participants in the trials were people normally resident in endemic trachoma communities.

Data collection and analysis: Two review authors independently extracted data and assessed trial quality. Study authors were contacted for additional information. Two clinically heterogeneous trials are included, therefore a meta-analysis was considered inappropriate.

Main results: This review included two trials with data from a total of 2560 participants. Face washing combined with topical tetracycline was compared to topical tetracycline alone in three pairs of villages in one trial. The trial found a statistically significant effect for face washing combined with topical tetracycline in reducing 'severe' active trachoma compared to topical tetracycline alone. No statistically significant difference was observed between the intervention and control villages in reducing ('non-severe') active trachoma. The prevalence of clean faces was higher in the intervention villages than the control villages and this was statistically significant. Another trial compared eye washing to no treatment or to topical tetracycline alone or to a combination of eye washing and tetracycline drops in children with follicular trachoma. The trial found no statistically significant benefit of eye washing alone or in combination with tetracycline eye drops in reducing follicular trachoma amongst children with follicular trachoma.

Authors' conclusions: There is some evidence that face washing combined with topical tetracycline can be effective in reducing severe trachoma and in increasing the prevalence of clean faces. Current evidence does not however support a beneficial effect of face washing alone or in combination with topical tetracycline in reducing active trachoma.

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References

References to studies included in this review

    1. Peach H, Piper S, Devanesen D, Dixon B, Jefferies C, Braun P, et al. Northern Territory Trachoma Control and Eye Health Committee's Randomised Controlled Trial of the Effect of Eye Drops and Eye Washing on Follicular Trachoma Among Aboriginal Children. Report of the Northern Territory Trachoma Control and Eye Health Committee Incorporated. 1987:1–33.
    1. West S, Munoz B, Lynch M, Kayongoya A, Chilangwa Z, Mmbaga BBO, et al. Impact of face-washing on trachoma in Kongwa, Tanzania. Lancet. 1995;345(8943):155–8. - PubMed

References to studies excluded from this review

    1. Edwards T, Cumberland P, Hailu G, Todd J. Impact of health education on active trachoma in hyperendemic rural communities in Ethiopia. Ophthalmology. 2006;113(4):548–55. - PubMed
    1. Khandekar R, Ton TK, Do Thi P. Impact of face washing and environmental improvement on reduction of active trachoma in Vietnam-a public health intervention study. Ophthalmic Epidemiology. 2006;13(1):43–52. - PubMed
    1. King JD, Ngondi J, Kasten J, Diallo MO, Zhu M, Cromwell EA, et al. Randomised trial of face-washing to develop a standard definition of a clean face for monitoring trachoma control programmes. Transactions of the Royal Society of Tropical Medicine and Hygiene. 2011;105:7–16. - PubMed
    1. Rubinstein RA, Lane SD, Sallam SA, Sheta AS, Gad ZM, Sherif AR, et al. Controlling blinding trachoma in the Egyptian Delta: Integrating clinical, epidemiological and anthropological understandings. Anthropology & Medicine. 2006;13(2):99–118. - PubMed
    1. Sutter E, Ballard R. Community participation in the control of trachoma in Gazankulu. Social Science and Medicine. 1983;17(22):1813–7. - PubMed

Additional references

    1. Bailey R, Lietman T. The SAFE strategy for the elimination of trachoma by 2020: will it work? Bulletin of the World Health Organization. 2001;79(3):233–6. - PMC - PubMed
    1. Emerson PM, Cairncross S, Bailey RL, Mabey DCW. Review of the evidence base for the ‘F’ and ‘E’ components of the SAFE strategy for trachoma control. Tropical Medicine and International Health. 2000;5(8):515–27. - PubMed
    1. Evans JR, Solomon AW. Antibiotics for trachoma. Cochrane Database of Systematic Reviews. 2011;(3) doi: 10.1002/14651858.CD001860.pub3. - DOI - PubMed
    1. Glanville JM, Lefebvre C, Miles JN, Camosso-Stefinovic J. How to identify randomized controlled trials in MEDLINE: ten years on. Journal of the Medical Library Association. 2006;94(2):130–6. - PMC - PubMed
    1. Higgins JPT, Altman DG, Sterne JAC, Green S, editors. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011) The Cochrane Collaboration; 2011. Chapter 8: Assessing risk of bias in included studies. Available from www.cochrane-handbook.org.

References to other published versions of this review

    1. Ejere HOD, Alhassan MB, Rabiu M. Face washing promotion for preventing active trachoma. Cochrane Database of Systematic Reviews. 2004;(3) doi: 10.1002/14651858.CD003659.pub2. - DOI - PubMed

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