Background: Trachoma is the world’s leading cause of preventable blindness and occurs where people live in poor conditions with limited access to water and health care. Prior to this study, it was considered an eliminated disease in Rwanda; however its prevalence had not been recently assessed in the country.
Objectives: To determine the pattern of active trachoma, trichiasis and trachoma related risk factors in Rwanda. The objective was also to produce by spatial analysis a map of the distribution of trachoma based on the result of this TRA.
Design: A cross-sectional study, based on Trachoma Rapid Assessment (TRA), was conducted from December 2007 to January 2008.
Setting: Nine selected districts of Rwanda.
Methods: Fifty children from 15 to 20 households per selected village were examined and environmental data were collected from households. All children aged 1 to 9 years were examined for active trachoma and all persons aged 15 years or more for Trachomatous Trichiasis (TT) and Corneal Opacity (CO).
Results: In total, 102 of the 1375 examined children had active trachoma and 20 of the 96 adults examined had trichiasis. Gatsibo and Nyaruguru districts were the most affected by active trachoma with a prevalence of 15.3% and 12.6% respectively. A positive association was found between the presence of active trachoma and the occurrence of children with unclean faces; however no correlation was found between the presence of active trachoma and the absence of functional latrine or the walking distance to the nearest water source. Kayonza and Gicumbi districts had a higher number of trichiasis cases and 5.2% of these had developed corneal opacity, with only one patient having undergone surgery.
Conclusion: Up to recently, trachoma was considered eliminated from Rwanda; but this TRA showed that the rate of active trachoma, at least in Gatsibo and Nyaruguru districts, is well above the threshold for treatment, according to the International Trachoma Initiative and WHO. There is a need of a baseline survey in the two districts to orientate on the strategies to be used for the control of trachoma so that Rwanda can be a trachoma free country as proposed by the WHO vision 2020 initiative.
World Health Organization website: http: //www.who.int.
Mariotti, S.P. New steps towards eliminating blinding trachoma. N. Engl. J. Med. 2004; 351: 2004-2007.
World Health Organization. Trachoma control: a guide for program managers. Published jointly by the World Health Organization, the London School of Hygiene and Tropical Medicine, and the International Trachoma Initiative. Geneva, WHO; 2006.
National census service (2003) The Rwanda 2002 census of population and housing. Kigali: National Census Service. 50 p.
Mathenge, W., Nkurikiye, J., Limburg, H. and Kuper H. Rapid assessment of avoidable blindness in western Rwanda: Blindness in a postconflict
July 2009 East African Journal of Ophthalmology
setting. Plos Medicine. 2007; 4(e217): 1187-1194.
Australia and New Zealand Horizon Scanning Network. Rapid point-of-care test for the detection of Chlamydia in individuals at risk of trachoma, Canberra, ANZHSN; June 2006, 2P
Ezz, al Arab, G., et al. The burden of trachoma in the rural Nile Delta of Egypt: a survey of Menofiya governorate. Brit. J. Ophthalmol. 2001; 85(12): 1406-1410.
Schémann, J.F., et al. Rapid trachoma assessment method: comparison with an exhaustive prevalence survey in a region of endemic trachoma in Mali, Institut d’ophtalmologie tropicale de l’Afrique, Bamako, 2000; 10(1): 59-64.
Astle, W., et al. Trachoma Control in Southern Zambia, an International Team Project Employing the SAFE Strategy. Ophthalmic. Epidemiol. 2006, 13(4): 227-236.
AL-Khatib, T. R2apid assessment of trachoma in 9 governorates and Socotra island in Yemen, Faculty of medicine and Health sciences, University of Sana’a. La revue de santé de la Mediterranée. 2006; 12 (5).
Meheus, A., et al. Santé et maladie au Rwanda, Faculté de médicine, épidémiologie et médicine sociale universitaire Instelling Antwerpen, 1982, 590-600.
Gordon, J., et al.The epidemiology of eye disease, second edition, 2003, ISBN 034080892 (HB), P 171-176.
Tielsh, J.M., et al. The epidemiology of trachoma in the southern Malawi. Am. J. Trop. Med. Hyg. 1988; 38(2): 393-399.
Luna et al. Epidemiology of trachoma in Bebedouro state of Sao Paulo, Brazil, prevalence and risk factors. Int. J. Epidemiol. 1992; 21: 169-177.
Rabiu, M., et al. Cochrane Database syst. rev. Environmental sanitary interventions for preventing active trachoma. 2007 Oct 17th; (4): CD004003.
Baggaley, R.F., et al. Distance to water source and altitude in relation to active trachoma in Rombo district, Tanzania. Trop. Med. Int. Health 2006; 11 (2): 220-227.
Schémann, J.F., et al. Risk factors for trachoma in Mali. Int. J. Epidemiol. 2002; 31(1): 194- 201.