Trachoma control in Southern Zambia--an international team project employing the SAFE strategy.

PURPOSE To determine the prevalence of trachoma and to measure the impact of the SAFE strategy (World Health Organization GET 2020 strategy) for treating trachoma in the Gwembe District of Southern Zambia. DESIGN This is an observational study of the introduction of the SAFE strategy employing a collaborative approach and its impact on trachoma in the area. PARTICIPANTS Three thousand eight hundred ninety two persons in communities at 26 well sites in the Gwembe district of Southern Zambia were included in this study. METHODS New, clean water wells were drilled under local supervision for each of 26 identified villages. All people living in villages near the wells were screened for trachoma and then treated with antibiotic if required. Education on personal and environmental hygiene was provided by trained volunteers. Patients affected by trichiasis and corneal scarring received surgery, locally if possible. Attempts to control fly populations by cleaning villages, penning livestock, and digging latrines were undertaken. This was performed under advisement and consultation with local villagers and government officials. Data was collected on variables normally associated with trachoma and others relating to demographics, water quality, environment and hygiene. MAIN OUTCOME MEASURES Prevalence of trachoma in the area at two years post introduction of SAFE strategy. RESULTS The overall prevalence of trachoma in the area was 47% in 2001; however, the prevalence was 55% among children under 10 years. At two years post intervention, the overall prevalence of trachoma reduced to 7.6%, and decreased to 10.6% in children under 10 years, and 5.9% among adults. CONCLUSIONS Continued monitoring and risk factors will need to continue to be addressed in order to sustain this trachoma control project in this area of Zambia.