Face washing promotion for preventing active trachoma

 

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 the Cochrane Central Register of Controlled Trials - CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) in The Cochrane Library (Issue 3, 2007), MEDLINE (1966 to October 2007), EMBASE (1980 to October 2007), the reference lists of identified trials and the Science Citation Index. We also contacted investigators and experts in the field to identify additional trials.

Selection criteria

We included randomised or quasi-randomised 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.

 

Plain language summary

Face washing promotion for reducing active trachoma

Trachoma is an infectious eye disease. Active infection usually begins in childhood and is characterised by eye discharges, redness and irritation. Poor facial hygiene can lead to the disease spreading from person to person through eye-seeking flies or contaminated fingers. Face washing is promoted as part of the World Health Organization ' SAFE' strategy to eliminate blindness around the world. The review authors identified two randomised controlled trials with a total of 2560 participants set in Australia and Tanzania. One trial had face washing in combination with tetracycline as the intervention and tetracycline ointment alone as the control. The second 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. Both trials reported on active trachoma as an outcome measure but only one trial reported on severe trachoma and percentage of clean faces. The trials included in this review evaluated the effect of face washing over a three to 12 month period. 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.

 

摘要

背景

洗臉運動來預防急性砂眼

在許多未開發國家,砂眼依然是貧窮人群中一個可避免眼盲的主要原因之一.預估一億四千六百萬人有急性砂眼且近六百萬人因反覆性感染而併發眼盲. 盲.

目標

此回顧的目的是去評估洗臉對於流行國家急性砂眼盛行率的效果.

搜尋策略

我們於 Cochrane Library 搜尋 Cochrane Central Register of Controlled Trials  CENTRAL (包含 Cochrane Eyes and Vision Group trials register)(Issue 2, 2004), MEDLINE (1966 年至 2004年二月), EMBASE (1980年至 2004年二月),被確認的文獻的參考文獻及the Science Citation Index. 我們也與研究者和此領域的專家接觸來取得另外的研究.

選擇標準

我們含括比較洗臉與沒有治療或洗臉並用抗生素與只用抗生素的randomised 或 quasirandomised controlled trials. 在這些“試驗”的參試者是正常住在砂眼流行社區的人.

資料收集與分析

兩位審者獨立擷取資料和評估實驗品質.接洽作者以取得額外資料. 總共包含有兩個不同臨床性質的試驗,以此綜合分析並不恰當.

主要結論

此回顧兩個研究共從2560個參試者的到資料. 一個研究於三配對的村落比較洗臉並局部使用四環黴素(tetracycline)與局部使用四環黴素.此研究發現洗臉並局部使用四環黴素在降低嚴重砂眼較只有局部使用四環黴素有明顯統計學的效果. 於介入與控制組的村落在降低不嚴重的砂眼上沒有明顯的統計上差異. 在臉部清潔上的普遍性,介入組的村落較控制組的村落高且有統計差異. 另一研究於有濾泡性砂眼的孩童比較洗臉與無治療或與只有局部使用四環黴素或合併洗臉和四環黴素眼藥水. 此研究發現於濾泡性砂眼的孩童,只有洗臉或合併使用四環黴素眼藥,在降低濾泡性砂眼上並無統計學上明顯的效果.

作者結論

洗臉並局部使用四環黴素,有些證據顯示可降低嚴重型砂眼並增加清潔臉部的普遍性.然而目前的證據無法支持單獨洗臉或合併使用局部四環黴素可降低急性砂眼.

翻譯人

本摘要由高雄榮民總醫院王曉萍翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

洗臉運動增加臉部的清潔,當合併使用局部抗生素可降低嚴重型砂眼.砂眼是一種傳染性的眼睛疾病. 急性感染通常始於孩童期,特徵是眼睛有分泌物,發紅及刺激感.不良的臉部清潔可經由接觸過眼睛的蒼蠅或污染的手指促使疾病從人傳給人.洗臉推行運動被視為一項可降低傳播的策略.此回顧証明洗臉可促進臉部清潔.洗臉對於降低急性砂眼的效應僅於當嚴重型砂眼.