[Rapid trachoma assessment method (TRA): comparison with an exhaustive prevalence survey in a region of endemic trachoma in Mali]. / Une méthode d'appréciation rapide du trachome, l'"ART". Comparaison avec une enquête épidémiologique exhaustive dans une zone d'endémie du Mali.

In 1997, the World Health Organization (WHO) endorsed a new strategy aimed at controlling blinding trachoma by 2020. The WHO developed a rapid assessment method for trachoma (TRA) for identifying communities affected by blinding trachoma and for ranking villages with endemic trachoma in order of priority for intervention. We applied this method to communities in Mali in which trachoma was prevalent, and compared the results with those of a classical prevalence survey. Seven villages from the Dogon region were first investigated using the rapid method. Members of the local community were asked to identify individuals with suspected trichiasis, using a diagram to help them with recognition. The individuals thus identified were then examined by an ophthalmic nurse for confirmation of the diagnosis. Fifty children aged less than ten years from poorer households were then selected. These children underwent ophthalmic examination, using a magnification of 2.5, and trachoma status was established. The next day, the villages were visited by an ophthalmologist who examined all of the inhabitants. The rapid assessment method identified 18 of the 52 patients requiring surgery. This method had a sensitivity of 34.6% and a specificity of 98%. The prevalence of active trachoma among children was 29.0% in the exhaustive survey and 29.9% for the rapid assessment method. Overall sensitivity was 54.6% and overall specificity 79.6%, as the two methods did not identify the same individuals. The Kappa coefficient, estimating agreement between observers, was 0.34. The ranking of the villages in order of priority differed slightly for the two methods. With the rapid assessment method, five of the seven villages were classified as having a prevalence of over 20% whereas, with the exhaustive survey, six of the seven villages fell into this category. TRA was not designed to replace epidemiological survey and the prevalence of trachoma should not be inferred from this method. However, it is a useful tool for determining the order of priority for intervention of communities at risk.

[Strategies to control vitamin A deficiency]. / Stratégies de lutte contre les déficits en vitamine A.

Vitamin A deficiency is a major public health problem in the countries of the Sahel. It causes xerophthalmia and high rates of child mortality and it occurs mostly in underdeveloped regions. People of all ages may suffer from vitamin A deficiency but it is a particular problem in pre-school-age children. Each year, about 250,000 children throughout the world become blind due to vitamin A deficiency. Measles, pneumonia and diarrhea reduce the child's reserves of retinol and increase the dietary requirement for vitamin A. Improvement of social conditions is a radical approach to preventing vitamin A deficiency. Three strategies are currently in use: horticultural activities and health education; fortification of food products; distribution of high-dose vitamin A capsules.