@article{PAR00001525,
  title = {{L}ongitudinal evaluation of three azithromycin distribution strategies for treatment of trachoma in a sub-{S}aharan {A}frican country, {M}ali},
  author = {{S}ch{\'e}mann, {J}ean-{F}ran{\c{c}}ois and {G}uinot, {C}. and {T}raore, {L}. and {Z}efack, {G}. and {D}embele, {M}. and {D}iallo, {I}. and {T}raore, {A}. and {V}inard, {P}. and {M}alvy, {D}.},
  editor = {},
  language = {{ENG}},
  abstract = {{O}bjectives: {T}rachoma, caused by repeated ocular infections with {C}hlamydia trachomatis is an important cause of blindness. {M}ass azithromycin distribution is part of current recommended strategies for controlling trachoma. {I}n order to ascertain an efficient strategy model at an acceptable cost, an intervention study was conducted in {M}ali between {M}ay 2000 and {F}ebruary 2002. {M}ethods: {T}hree azithromycin administration strategies were evaluated: mass community-based treatment of all residents (strategy 1), treatment of all children under 11 years of age and of women between 15 and 50 (strategy {II}), and treatment targeted to inhabitants of households where at least one child had clinically active trachoma diagnosed (strategy 111). {I}n a particular {M}alian area in which trachoma was known to be mesoendemic, three villages were selected for each of the three strategies. {A}ccording to the strategy allocation, adults were eventually given a single dose of {I} g azithromycin, and children a unique dose of 20 mg/kg. {M}oreover, cleanliness and washing of children's faces were assessed, and additional questions were addressed about education, environmental and socio-economic conditions for each household at baseline. {O}phthalmic examination was performed at baseline and 1, 6 and 12 months after inclusion. {T}he outcome variable was clinically active trachoma frequency 12 months after intervention among children under {I} {I} years of age. {A} descriptive analysis was performed, and then logistic regression models were built to test the efficiency of the three strategies. {R}esults: {A}mong children under 11 years of age, the active trachoma prevalence fell dramatically in each strategy, from 23.7% to 6.4% in strategy 1, from 20.8% to 6.8% in strategy 11, and from 20.2% to 8.5% in strategy {III}. {A}fter adjustment on age (adjusted odds ratio [{AOR}] = 0.81; 95% confidence interval [95% {C}l]: 0.75-0.87) and on active trachoma occurrence at baseline ({AOR} = 3.81; [95% {C}l]: 2.70-5.39), the multiple logistic regression model showed that both strategies {I} and {II} gave similar results, while strategy {III} appeared significantly less effective ({AOR} = 1.56; [95% {CI}]: 1.00-2.43). {C}onclusion: {I}n mesoendemic trachoma areas, targeted treatment to all children under {I} {I} years of age and women between 15 and 50 (strategy 11) was as effective as indiscriminate mass distribution (strategy 1) and more effective than treatment targeted to inhabitants of households where at least one child had active trachoma diagnosed (strategy 111). {S}trategy 11 could therefore reduce the prevalence and intensity of trachoma infection at a lower cost than mass community-based treatment of all residents (strategy 1).},
  keywords = {trachoma ; azithromycin ; effectiveness ; community based intervention ; {M}ali},
  booktitle = {},
  journal = {{A}cta {T}ropica},
  volume = {101},
  numero = {1},
  pages = {40--53},
  ISSN = {0001-706{X}},
  year = {2007},
  DOI = {10.1016/j.actatropica.2006.12.003},
  URL = {https://www.documentation.ird.fr/hor/{PAR}00001525},
}