Face washing promotion for reducing active trachoma

Ejere HOD, Alhassan MB, Rabiu M

Published Online:

January 21, 2009

Trachoma is an infectious eye disease. Active infection usually begins in childhood and is characterised by eye discharges, redness and irritation. Poor facial hygiene can lead to the disease spreading from person to person through eye-seeking flies or contaminated fingers. Face washing is promoted as part of the World Health Organization ' SAFE' strategy to eliminate blindness around the world. The review authors identified two randomised controlled trials with a total of 2560 participants set in Australia and Tanzania. One trial had face washing in combination with tetracycline as the intervention and tetracycline ointment alone as the control. The second trial compared eye washing to no treatment or to topical tetracycline alone or to a combination of eye washing and tetracycline drops in children with follicular trachoma. Both trials reported on active trachoma as an outcome measure but only one trial reported on severe trachoma and percentage of clean faces. The trials included in this review evaluated the effect of face washing over a three to 12 month period. There is some evidence that face washing combined with topical tetracycline can be effective in reducing severe trachoma and in increasing the prevalence of clean faces.

Abstract (click to read)

Background:

Trachoma remains a major cause of avoidable blindness among underprivileged populations in many developing countries. It is estimated that about 146 million people have active trachoma and nearly six million people are blind due to complications associated with repeat infections.

Objectives:

The objective of this review was to assess the effects of face washing on the prevalence of active trachoma in endemic communities.

Search strategy:

We searched the Cochrane Central Register of Controlled Trials - CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) in The Cochrane Library (Issue 3, 2007), MEDLINE (1966 to October 2007), EMBASE (1980 to October 2007), the reference lists of identified trials and the Science Citation Index. We also contacted investigators and experts in the field to identify additional trials.

Selection criteria:

We included randomised or quasi-randomised controlled trials, comparing face washing with no treatment or face washing combined with antibiotics against antibiotics alone. Participants in the trials were people normally resident in endemic trachoma communities.

Data collection and analysis:

Two review authors independently extracted data and assessed trial quality. Study authors were contacted for additional information. Two clinically heterogeneous trials are included, therefore a meta-analysis was considered inappropriate.

Main results:

This review included two trials with data from a total of 2560 participants. Face washing combined with topical tetracycline was compared to topical tetracycline alone in three pairs of villages in one trial. The trial found a statistically significant effect for face washing combined with topical tetracycline in reducing 'severe' active trachoma compared to topical tetracycline alone. No statistically significant difference was observed between the intervention and control villages in reducing ('non-severe') active trachoma. The prevalence of clean faces was higher in the intervention villages than the control villages and this was statistically significant. Another trial compared eye washing to no treatment or to topical tetracycline alone or to a combination of eye washing and tetracycline drops in children with follicular trachoma. The trial found no statistically significant benefit of eye washing alone or in combination with tetracycline eye drops in reducing follicular trachoma amongst children with follicular trachoma.

Authors' conclusions:

There is some evidence that face washing combined with topical tetracycline can be effective in reducing severe trachoma and in increasing the prevalence of clean faces. Current evidence does not however support a beneficial effect of face washing alone or in combination with topical tetracycline in reducing active trachoma.

This record should be cited as:

Ejere HOD, Alhassan MB, Rabiu M. Face washing promotion for preventing active trachoma. Cochrane Database of Systematic Reviews 2004, Issue 3. Art. No.: CD003659. DOI: 10.1002/14651858.CD003659.pub2

Assessed as up to date:

October 16, 2007

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Primary Review Group:

Eyes and Vision Group

Health topics:

Eyes & vision > Corneal disease > Trachoma

Infectious disease > Eye diseases > Trachoma

Infectious disease > Neglected tropical diseases > Trachoma

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Face washing promotion for reducing active trachoma

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