The epidemiology of trachoma in southern Malawi

A population-based prevalence survey of ocular disease was conducted in the Lower Shire Valley of Malawi in 1983. A total of 5;436 children less than 6 years of age and 1;664 persons greater than or equal to 6 years were examined. The prevalence of inflammatory trachoma peaked in the 1-2-year-old age group at 48.7 percent and declined rapidly with age to less than 5 percent by age 15. The prevalence of cicatricial trachoma was low in young children and climbed gradually with age to greater than 40 percent among those greater than or equal to 50 years. Risk factors for infLammatory disease in young children included low socioeconomic status of the family; long walking distance to the household's primary source of water; absence of a latrine in the family compound; and presence of trachoma among siblings. Indices of crowding practices were not associated with inflammatory disease. An apparent inverse association of facewashing and inflammatory trachoma in children did not hold up when adjusted for other risk factors

Trachoma grading: observer trials conducted in southern Malawi

A variety of grading schemes have been proposed for the clinical classification of inflammatory trachoma. During a population based study of ocular disease conducted in southern Malawi we tested a simplified version of the current WHO grading scheme. Intraobserver agreement statistics were less than satisfactory for three of four graders. Interobserver agreement when compared against either a well experienced standard ophthalmologist or a consensus grade improved over time for two of the three graders. However; initial agreement for all three graders was only fair to moderate. Previous studies of trachoma grading schemes support these unsatisfactory results. A new system of classification is needed that is both accurate and reliable in a field setting

Ocular disease and ophthalmic services in Malawi

About 1 percent of the population of Malawi is blind. The major contributors are cataract (40 percent ); trachoma and other infections (15 percent ) and measles /Vitamin A deficiency (15 percent ). There are 3 ophthalmologists in government service. However; one serves as the director of medical services; and is therefore frequently burdened with administrative duties. In addition; one missionary ophthalmologist and 25 ophthalmic auxiliaries are available. Two of the ophthalmic auxiliaries are being trained to perform cataract surgery to aid the ophthalmologists in attacking the current backlog of approx. 24;000 blind cataract patients in the country. Trachoma and onchocerciasis are present regionally; although the latter by itself does not appear to be a major cause of vision loss. In children under age five; the major causes of blindness are measles and protein-energy-malnutrition (PEM) and its associated hypovitaminosis A. Previous surveys in Malawi have been either clinic/hospital-based or have been local population-based studies. In order to establish a realistic plan of preventive and therapeutic action; a comprehensive series of country-wide population-based ocular disease prevalence surveys is planned over the next five years. The information will enable the Ministry of Health to more equitably disperse trained ophthalmic personnel and to obtain appropriate supplies and drugs in a rational manner