Revue internationale du trachome et de pathologie oculaire tropicale et subtropicale et de sante publique : organe de la Ligue contre le trachome avec la collaboration de l'International Organization against Trachoma et des organisation...最新文献

In Viet-Nam the incidence of keratomycoses is increasing up to recent years. The role of subtropical climate and environmental conditions is pointed out. Among the causative fungi Aspergillus, Cephalosporium and fungi imperfecti are the most frequent, as opportunistic agents. Some clinical aspects are described, and the peculiar severity in evolution stressed on. In the absence of specific antifungal drugs, another method of management, using potassium iodide associated with Griseofulvin and auto-serum is proposed, while keratoplasty with full-thickness corneal graft during the active process may be indicated. These procedures permitted to save a notable number of eyes from total blindness or enucleation.

Corneal blindnesses make up a main public health problem in numerous developing countries where they constitute a sign of low sanitary level. The main diseases which cause corneal blindnesses are: Trachoma. Xerophthalmia. Measles. Corneal ulcerations and keratitis. Onchocercosis. Neonatorum ophthalmia. Leprosy. Injuries. Some therapeutic practices. Epidemiological analysis leads to the definition of risk groups: Small children. Isolated rural communities. Unhealthy urban communities. Out of place populations. Under-fed populations. Only a joint prevention can be able to fight against this social, economic, a human plague constituted by corneal blindnesses. Simple prevention measures which are often not very expensive, showed their efficiency. They are as follows: Individual and collective hygiene measures. Improvement of alimentary conditions. Earliness and quickness in ocular care. Vaccination against measles. Improvement of the care to mother and child. Sanitary education for prevention. These prevention tasks are supported by the health workers who are spread out inside the population. Their formation, the means they are granted with constitute a main priority which has to be taken into account in the choices and the decisions to be made in order to fight against blindness linked with cornea opacification with efficacy.

3005 primary school children from randomly selected primary schools in Jos and its environ were screened for trachoma. The schools were divided into 3 groups reflecting the socio-economic status, and the degree of personal hygiene of the pupils. The prevalence of trachoma was 7.5% in the group A schools attended by the children of the rich, 15.9% in the group B schools attended by children of the poor but living in the urban town and 19.4% in group C schools attended by children of the poor living in the sub-urban town. The difference in the prevalence and severity of trachoma in the 3 groups was found to be statistically significant (P less than 0.01). Trachoma was found to be more common in freshly scholarised pupils as compared to pupils in the terminal class. There was no difference in the frequency of trachoma among girls and boys in our study group. The type of water used in bathing was not found to be important in the prevalence of trachoma. The authors next discussed the simplicity of the Dawson's classification, the need to start a trachoma control programme in Nigeria and the possible role of community health workers in any programme for the eradication of trachoma.

A simplified scheme for the grading of trachoma and its complications has been developed by the W.H.O. Programme for the Prevention of Blindness. This scheme has been field-tested in several countries, and the results have demonstrated a good observer agreement. The development of training aids for the use of this scheme by non-specialist health personnel is in progress. This will include a slide series, two manuals for the clinical examination and for the analysis of the reliability of results obtained, plus a simple trachoma grading card for field staff. It is envisaged that these aids will be available as from 1991, and that they will allow a number of countries to set up a system for regular surveillance and evaluation of trachoma.

The authors are investigating cases of corneal blindness in Tunisia. In the rural areas of the southern part of Tunisia, the corneal blindness is the second cause for sight loss and is responsible for almost 25% of the cases of blindness. In areas where preventive blindness programs have been set up, the prevalence rate of blindness caused by corneal disease has risen from 25% to 8% within the past few years. The most frequent etiology is composed by trachoma, traumatism and corneal ulcers. The authors insist on better prevention and better treatment of corneal diseases.

Prevalence of blindness in developing countries is three to ten times higher than in developed countries. Needs for individual medical care are far from being met and this requires the implementation of comprehensive policies of prevention and treatment. Two distinct data sources are available to carry out these policies: direct ophthalmic surveys on representative population samples, and for some countries, a national census in which blindness cases are numbered out. In Togo, both sources are available; we have thus been able to analyse: data from the 1981 national census in which blindness is identified as a social handicap; and the results of 4 W.H.O. surveys conducted from 1982 to 1986, which measure blindness prevalence and analyse its causes. The analysis of both sources shows that: a national census cannot be a substitute for surveys which are the only means for determining blindness causes and implementing action programmes. nonetheless it provides exhaustive information, as well as data on geographical distribution and on age and sex pattern of blindness. It also allows the identification of high prevalence zones--not always spotted through a survey--and thus, the implementation of specific actions in affected zones. It appears, hence, that the question on blindness should be maintained in a national census; providing users bear in mind possible bias in blindness census, the fact that appreciation of blindness is a subjective exercise and also providing they don't yield to the temptation of drawing comparisons between blindness rates which don't cover the same realities.

Trachoma was severe in Viet-Nam before 2nd World War and was still severe a long time after. Years of fight allowed to ameliorate noticeably the state of this important blinding endemic disease. From 1986, according to the data, Trachoma decreased noticeably as, generally speaking, the prevalence of this illness cases is decreasing progressively. Trachoma also lose its intensity, its clinical picture becoming more moderated, its complications being less frequent. In this text, you will find some aquisitions in the study of the Trachoma in Viet-Nam on epidemiologic, clinico-pathologic and therapeutic points of view and concerning the various stages of Vietnamese experience in front of Trachoma.

Trachoma is the cause of one-quarter of world blindness. Corneal damage from trachoma is related to trichiasis, which may affect over 10% of adults in endemic communities. Relief of trichiasis is believed to prevent corneal damage and the provision of community-based lid surgery is a central strategy for trachoma control programs. This strategy is weakened by the dearth of information on the effectiveness of different trichiasis procedures. A systematic review of trichiasis surgery is presented and reports of treatment efficacy are reviewed. Conclusions are drawn as to which procedures seem most appropriate for trachomatous trichiasis in prevention of blindness programmes. It is suggested that further controlled clinical trials of appropriate trichiasis procedures are needed.