02813nas a2200421   4500000000100000008004100001653001300042653001500055653002300070653000900093653001100102653001200113653001100125653001100136653001300147653002100160653002800181653003000209653002100239653001000260653001700270653002600287100001300313700001200326700001500338700001200353700001300365700001400378700001200392700001100404700001500415700001400430245018500444300001100629490000700640520173000647022001402377       2010                            d10aTrachoma10aSanitation10aProgram evaluation10aMale10aInfant10aHygiene10aHumans10aFemale10aEthiopia10aEndemic Diseases10aDelivery of Health Care10aCommunity Health Services10aChild, Preschool10aChild10aAzithromycin10aAnti-Bacterial Agents1 aNgondi J1 aGebre T1 aShargie EB1 aAdamu L1 aTeferi T1 aZerihun M1 aAyele B1 aKing J1 aCromwell E1 aEmerson P00aEstimation of effects of community intervention with antibiotics, facial cleanliness, and environmental improvement (A,F,E) in five districts of Ethiopia hyperendemic for trachoma.  a278-810 v943 a<p><strong>AIMS: </strong>The WHO recommends the SAFE (surgery, antibiotics, facial cleanliness and environmental improvement) strategy for trachoma control. We aimed to investigate the association between active trachoma and community intervention with antibiotics, facial cleanliness, environmental improvement (A,F,E) components of SAFE in five trachoma hyperendemic districts of Amhara region, Ethiopia.</p>

<p><strong>METHODS: </strong>Cluster random surveys were undertaken to evaluate SAFE following 3 years of interventions. Children aged 1-9 years were examined for trachoma signs using the WHO simplified grading system and structured questionnaires used to assess uptake of A, F and E. Active trachoma signs (trachomatous inflammation-follicular (TF) and trachomatous inflammation-intense (TI)) were used to derive an ordinal severity score where TI was considered more severe than TF. Associations between active trachoma and potential factors were investigated using ordinal logistic multilevel regression models.</p>

<p><strong>RESULTS: </strong>A total of 1813 children aged 1-9 years were included in the analysis. Factors independently associated with reduced odds of active trachoma signs were: number of times treated with azithromycin (p-trend=0.026); months since last mass azithromycin distribution (p-trend&lt;0.001); clean face (OR=0.6; 95% CI 0.5 to 0.8); and household pit latrine (OR=0.8; 95% CI 0.7 to 0.9).</p>

<p><strong>CONCLUSION: </strong>These findings are important, since they make the case for continued implementing the A,F,E interventions simultaneously, and suggest appropriate timing of SAFE evaluations within 6-12 months after the last mass azithromycin distribution.</p>
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