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      Epidemiology and control of trachoma: systematic review

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          Abstract

          Trachoma is the commonest infectious cause of blindness. Recurrent episodes of infection with serovars A–C of Chlamydia trachomatis cause conjunctival inflammation in children who go on to develop scarring and blindness as adults. It was estimated that in 2002 at least 1.3 million people were blind from trachoma, and currently 40 million people are thought to have active disease and 8.2 million to have trichiasis. The disease is largely found in poor, rural communities in developing countries, particularly in sub-Saharan Africa. The WHO promotes trachoma control through a multifaceted approach involving surgery, mass antibiotic distribution, encouraging facial cleanliness and environmental improvements. This has been associated with significant reductions in the prevalence of active disease over the past 20 years, but there remain a large number of people with trichiasis who are at risk of blindness.

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          Most cited references175

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          Global data on visual impairment in the year 2002.

          This paper presents estimates of the prevalence of visual impairment and its causes in 2002, based on the best available evidence derived from recent studies. Estimates were determined from data on low vision and blindness as defined in the International statistical classification of diseases, injuries and causes of death, 10th revision. The number of people with visual impairment worldwide in 2002 was in excess of 161 million, of whom about 37 million were blind. The burden of visual impairment is not distributed uniformly throughout the world: the least developed regions carry the largest share. Visual impairment is also unequally distributed across age groups, being largely confined to adults 50 years of age and older. A distribution imbalance is also found with regard to gender throughout the world: females have a significantly higher risk of having visual impairment than males. Notwithstanding the progress in surgical intervention that has been made in many countries over the last few decades, cataract remains the leading cause of visual impairment in all regions of the world, except in the most developed countries. Other major causes of visual impairment are, in order of importance, glaucoma, age-related macular degeneration, diabetic retinopathy and trachoma.
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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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              Global data on blindness.

              Globally, it is estimated that there are 38 million persons who are blind. Moreover, a further 110 million people have low vision and are at great risk of becoming blind. The main causes of blindness and low vision are cataract, trachoma, glaucoma, onchocerciasis, and xerophthalmia; however, insufficient data on blindness from causes such as diabetic retinopathy and age-related macular degeneration preclude specific estimations of their global prevalence. The age-specific prevalences of the major causes of blindness that are related to age indicate that the trend will be for an increase in such blindness over the decades to come, unless energetic efforts are made to tackle these problems. More data collected through standardized methodologies, using internationally accepted (ICD-10) definitions, are needed. Data on the incidence of blindness due to common causes would be useful for calculating future trends more precisely.
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                Author and article information

                Journal
                Trop Med Int Health
                Trop. Med. Int. Health
                tmi
                Tropical Medicine & International Health
                Blackwell Publishing Ltd (Oxford, UK )
                1360-2276
                1365-3156
                June 2010
                04 April 2010
                : 15
                : 6
                : 673-691
                Affiliations
                [1 ]London School of Hygiene and Tropical Medicine UK
                [2 ]Kilimanjaro Centre for Community Ophthalmology Moshi, Tanzania
                [3 ]Unité d’Ophtalmologie, Programme de Lutte Contre la Cécité, Région médicale de Zinguinchor Senegal
                Author notes
                Corresponding Author Victor H. Hu, KCCO, KCMC, P.O. Box 2254, Moshi, Tanzania. Tel.: +255 76 258 2948; E-mail: victor.hu@ 123456lshtm.ac.uk
                Article
                10.1111/j.1365-3156.2010.02521.x
                3770928
                20374566
                c9820ca4-7480-4281-b8ce-829f891f0586
                © 2010 Blackwell Publishing Ltd

                Re-use of this article is permitted in accordance with the Creative Commons Deed, Attribution 2.5, which does not permit commercial exploitation.

                History
                Categories
                Systematic Review

                Medicine
                chlamydia trachomatis,trachoma,epidemiology,control,review
                Medicine
                chlamydia trachomatis, trachoma, epidemiology, control, review

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