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      Pilot study of the use of community volunteers to distribute azithromycin for trachoma control in Ghana Translated title: Etude pilote sur le recours à des volontaires appartenant à la communauté pour la distribution d’azithromycine dans la lutte contre le trachome au Ghana Translated title: Estudio piloto del uso de voluntarios de la comunidad para distribuir azitromicina contra el tracoma en Ghana

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          Abstract

          OBJECTIVE: To assess the skills of community health volunteers in diagnosing active trachoma and distributing azithromycin in the Northern Region of Ghana. METHODS: Six community health volunteers from Daboya were trained to diagnose trachoma and to treat the disease using azithromycin. They were also informed of the drug’s possible side-effects. Under supervision, each volunteer then examined, and if necessary treated, 15 households. The dose of azithromycin was determined by weight; height was also measured. Tablets were given in preference to suspension when possible. RESULTS: The volunteers’ diagnostic sensitivity for active trachoma was 63%; their specificity was 96%. At the household level, their ‘‘decision to treat’’ was correct in 83% of households. In 344 treatment episodes, volunteers planned a dose of azithromycin outside the range 15-30 mg/kg on only seven occasions (2.0% of all planned treatments). The volunteers’ drug management skills were good, the response of the community was excellent, and adverse reactions were infrequent. Diagnosis of active trachoma, record-keeping skills, and knowledge of side-effects were found to need greater emphasis in any future education programme. Most people aged four years or older were able to swallow tablets. For those taking tablets, the correlation between the data gathered for height and weight shows that calculating azithromycin doses by height is a valid alternative to calculating it by weight. CONCLUSION: Trained community health volunteers have a potential role in identifying active trachoma and distributing azithromycin. To simplify training and logistics, it may be better to base dosage schedules on height rather than weight for those taking tablets, which included most people aged four years or more in the population studied.

          Translated abstract

          OBJECTIF: Evaluer l’aptitude de volontaires appartenant à la communauté à diagnostiquer le trachome actif et à effectuer la distribution d’azithromycine dans la Région Nord du Ghana. MÉTHODES: Six volontaires appartenant à la communauté de Daboya ont été formés au diagnostic du trachome et à son traitement par l’azithromycine. Ils ont également été informés des éventuels effets secondaires du médicament. Chaque volontaire a ensuite, sous surveillance, examiné et si nécessaire traité 15 ménages. La dose d’azithromycine était déterminée d’après le poids du malade, dont le volontaire mesurait également la taille. Si possible, le médicament était administré sous forme de comprimés plutôt que de suspension. RÉSULTATS: La sensibilité du diagnostic du trachome actif par les volontaires était de 63 %, et sa spécificité de 96 %. Au niveau des ménages, la « décision de traiter » était correcte dans 83% des cas. Sur 344 épisodes de traitement, les volontaires n’ont prévu une dose d’azithromycine tombant en dehors de la gamme 15-30 mg/kg que dans 7 cas (2,0% de l’ensemble des traitements prévus). Les compétences des volontaires en matière de gestion du médicament étaient bonnes, la réponse de la communauté excellente et les réactions indésirables rares. A l’avenir, les programmes pédagogiques devraient insister davantage sur le diagnostic de trachome actif, la tenue des dossiers et les effets secondaires. Dès l’âge de 4 ans, la plupart des malades sont capables d’avaler des comprimés. Lorsque l’azithromycine est administrée sous forme de comprimés, la corrélation entre les données rassemblées selon la taille ou selon le poids montre qu’il est tout aussi valable de calculer les doses en fonction de la taille qu’en fonction du poids. CONCLUSION: Après formation, des volontaires appartenant à la communauté peuvent jouer un rôle utile en identifiant les cas de trachome actif et en procédant à la distribution d’azithromycine. Pour simplifier la formation et la logistique, il pourrait être préférable de baser le calcul de la posologie sur la taille plutôt que sur le poids pour les malades prenant des comprimés, c’est-à-dire, si l’on se réfère à la population étudiée, la plupart des malades à partir de 4 ans.

          Translated abstract

          OBJETIVO: Evaluar las aptitudes de voluntarios de salud de la comunidad para diagnosticar el tracoma activo y distribuir azitromicina. MÉTODOS: Se enseñó a seis voluntarios de salud de la comunidad de Daboya a diagnosticar el tracoma y a tratarlo con azitromicina. Se les informó también de los posibles efectos colaterales del medicamento. Tras esa capacitación, y siempre bajo supervisión, cada voluntario visitó y examinó 15 hogares, aplicando el tratamiento cuando lo consideró necesario. La dosis de azitromicina se determinó en función del peso; también se midió la talla. En la medida de lo posible se administraron comprimidos antes que la suspensión del medicamento. RESULTADOS: La sensibilidad diagnóstica de los voluntarios para el tracoma activo fue del 63%; y su especificidad, del 96%. En los hogares, su «decisión de tratar» fue correcta en un 83% de los casos. De un total de 344 episodios de tratamiento, sólo en siete ocasiones (2,0% de todos los tratamientos previstos) los voluntarios calcularon una dosis de azitromicina no comprendida entre 15 y 30 mg/kg. Los voluntarios demostraron desenvolverse bien con los fármacos, la respuesta de la comunidad fue excelente, y las reacciones adversas fueron infrecuentes. Hubo que admitir que en el futuro los programas de educación habrían de hacer más hincapié en el diagnóstico del tracoma activo, en las aptitudes para la anotación de los datos y en el conocimiento de los efectos secundarios. La mayoría de las personas de cuatro o más años eran capaces de tragarse los comprimidos. Entre quienes utilizaron comprimidos, la correlación entre los datos referentes a la estatura y al peso muestra que el cálculo de las dosis de azitromicina en función de la talla es una alternativa válida al cálculo en función del peso. CONCLUSIÓN: Los voluntarios de salud de la comunidad, debidamente capacitados, pueden ser una ayuda adicional para identificar el tracoma activo y distribuir azitromicina. A fin de simplificar la capacitación y la logística, conviene quizá basar las pautas de dosificación en la estatura en lugar del peso entre quienes tomen comprimidos, lo que significa la mayoría de las personas de cuatro o más años de edad en la población estudiada.

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          Most cited references9

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          A simple system for the assessment of trachoma and its complications.

          A simple grading system for trachoma, based on the presence or absence of five selected "key" signs, has been developed. The method was tested in the field and showed good observer agreement, the most critical point being the identification of severe cases of the disease. It is expected that the system will facilitate the assessment of trachoma and its complications by non-specialist health personnel working at the community level.
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            Azithromycin in control of trachoma.

            Trachoma is the leading cause of preventable blindness. Programmes to prevent blindness due to trachoma are based on community-wide treatment with topical tetracycline. We assessed the potential of community-wide azithromycin treatment for trachoma control. Pairs of villages in trachoma endemic areas of Egypt, The Gambia, and Tanzania were matched on trachoma rates in 1-10-year-old children. Villages were randomly assigned community-wide oral azithromycin treatment (three doses with intervals of 1 week) or treatment with 1% topical tetracycline (once daily for 6 weeks). Clinical examinations were done at baseline, 2-4.5 months, and 12-14 months after treatment. Chlamydia trachomatitis was identified by ligase chain reaction (LCR). Analyses were by intention to treat. Univariate comparisons and multivariate analyses were used to compare outcomes. LCR positivity was correlated with clinical severity, but about 30% of Egyptian and Gambian villagers with no active disease were LCR positive. Village-wide LCR positivity ranged from 16.5% (Tanzania) to 43.6% (Egypt). Treatment compliance was over 90% except in the tetracycline treatment village in Egypt. Of the participants initially LCR positive, 866 (95%) of 924 who received at least one azithromycin dose and 482 (82%) of 587 who received 28 days or more topical tetracycline, were negative at follow-up. At 1 year, village-wide LCR positivity rates were substantially lower than at baseline with both treatments; the decreases were greater with azithromycin than with tetracycline (93% vs 77% in Egypt, 78 vs 66% in The Gambia, 64 vs 55% in Tanzania). Similarly, greater reduction in clinical activity occurred after azithromycin. In multivariate analyses, factors associated with being LCR positive at 1 year were: not receiving azithromycin; age under 10 years; and LCR positivity at baseline. Community-wide treatment with oral azithromycin markedly reduces C. trachomatis infection and clinical trachoma in endemic areas and may be an important approach to control of trachoma.
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              Randomised controlled trial of single-dose azithromycin in treatment of trachoma.

              Blindness due to trachoma is a serious public health issue world wide. The currently recommended treatment of active trachoma with repeated doses of tetracycline eye ointment has many disadvantages. The new azalide antibiotic azithromycin is effective as a single oral dose in the chemotherapy of genital Chlamydia trachomatis infections, and we have assessed its efficacy for trachoma treatment. We carried out a randomised single-blind comparison of azithromycin (a single oral dose of 20 mg/kg) with conventional treatment (6 weeks of topical tetracycline plus erythromycin for severe cases) in two villages with endemic trachoma in The Gambia. The patients were followed up for 26 weeks from the start of treatment by an observer unaware of treatment allocation. By 6 months' follow-up, trachoma had resolved in 76 (78%) of 97 subjects who received azithromycin compared with 70 (72%) of 97 who were treated conventionally (95% CI for difference -6% to 18%). Compliance with both treatments was good, but that for conventional treatment could probably not be achieved outside the research setting. There were no significant differences in treatment effect, baseline characteristics, or re-emergent disease between the treatment groups. Azithromycin was well tolerated. As a systemic treatment effective in a single dose it has important potential for trachoma control.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                bwho
                Bulletin of the World Health Organization
                Bull World Health Organ
                World Health Organization (Genebra )
                0042-9686
                2001
                : 79
                : 1
                : 8-14
                Affiliations
                [1 ] London School of Hygiene and Tropical Medicine United Kingdom
                [2 ] Bawku Hospital Ghana
                [3 ] National Eye Care Programme Gambia
                Article
                S0042-96862001000100004
                2502898d-ca92-48db-97fd-543d890f6ba7

                http://creativecommons.org/licenses/by/4.0/

                History
                Product

                SciELO Public Health

                Self URI (journal page): http://www.scielosp.org/scielo.php?script=sci_serial&pid=0042-9686&lng=en
                Categories
                Health Policy & Services

                Public health
                trachome,azithromycine,auxiliaire santé publique,Ghana,trachoma,azithromycin,community health aides,tracoma,azitromicina,auxiliares de salud comunitaria

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