The Epidemiology of Trachoma in the Lower Shire Valley of Southern Malawi and Implications for the “SAFE” Strategy

Aims: To determine the prevalence of trachoma and associated risk factors in the Lower Shire Valley of Southern Malawi.
Study Design: Population based cross sectional study.
Place and Duration of Study: Lower Shire Valley of southern Malawi between July and October 2012.
Methodology: Children aged 1-9 years (total 2957) were assessed for clinical signs of active trachoma follicular (TF) and adults aged 15 and above (total 2247) were assessed for signs of trachoma trichiasis (TT), which is potentially blinding trachoma. A questionnaire survey was conducted to explore the potential risk factors.
Results: A total of 2957 children aged 1-9 years who were assessed for clinical signs of TF and 2247 adults aged 15 and above were assessed for signs of TT.The prevalence of TF among children aged 1-9 years was found to be 18.5% (95% CI 16.4-20.8) in Nsanje and 7.8% (95% CI 6.6-9.2) in Mwanza districts respectively. The prevalence of TT in adults aged 15 and above was 0.5% (95% CI: 0.1-0.9) in Nsanje district and 0.2% (95% CI: 0.1-0.4) in Mwanza district, respectively. In regards to risk factors, only the presence of a dirty face was associated with trachoma follicular (TF) in Nsanje and Mwanza districts (P< 0.001).
Conclusion: In this study, prevalence of active trachoma infections was 18.5% in Nsanje and 7.8% in Mwanza district. Dirty face was associated with trachoma follicular in both districts. According to WHO, Nsanje therefore needs a SAFE (Surgery, Antibiotics, Face Washing and Environmental) control strategy.