Épidémiologie de la cataracte en stratégies avancées

But. Identifier les caractéristiques épidémiologiques de la cataracte diagnostiquée en stratégie avancée. Méthodologie. Nous avons mené une étude transversale descriptive documentaire dans la région du Centre au Cameroun. Etaient inclus tous les sujets présentant une cataracte diagnostiquée lors de nos stratégies avancées. Les variables étudiées étaient: l'âge, le genre, le type de déficience visuelle. Résultats. Le nombre total de patients examinés était de 3754 dont 193 ont présenté une cataracte, soit prévalence de la cataracte de 5,14 %. L'âge médian de la population était de 70 ans (min 12 ans et max 103 ans) ; il était de 70,5 ans chez les femmes et de 70 ans pour les hommes (P= 0,47). Le nombre d'yeux ayant présenté une cataracte était de 323 dont 164 yeux droits (50,77 %) et 159 yeux gauches (49,23 %). Un pourcentage de 54,80 % des yeux atteints de cataracte avaient une cécité. Conclusion. Les activités de stratégies avancées dans la région du Centre du Cameroun que nous avons menées ont été efficaces dans le dépistage des cas de cataracte dans nos communautés. Les patients âgés en sont les premières victimes et la cécité est fréquente chez ces derniers

Vision 2020 - the right to sight.

The unprecedented partnership for onchocerciasis control that followed Merck's decision to donate Mectizan has inspired the formation of a global initiative for the elimination of all avoidable blindness by the year 2020. 'Vision 2020, the Right to Sight', jointly co-ordinated by the World Health Organization's Programme for the Prevention of Blindness and Deafness and the International Agency for the Prevention of Blindness, was launched in 1999. This initiative's three pillars are disease control, human resource development, and infrastructure development. Vision 2020's achievements to date include the growth of the partnership, to include more than 60 member organizations, the revitalization of prevention activities, the completion of Vision-2020 plans in 40% of all countries and a reduction not only of blindness caused by onchocerciasis but also of blindness caused by trachoma. Cataract remains the leading cause of avoidable blindness.

2002 global update of available data on visual impairment: a compilation of population-based prevalence studies.

PURPOSE: For the past 25 years, the WHO Programme for the Prevention of Blindness and Deafness has maintained a Global Data Bank on visual impairment with the purpose of storing the available epidemiological data on blindness and low vision. The Data Bank has now been updated to include studies conducted since the last update in 1994. METHODS: An extensive literature search was conducted in international and national scientific and medical journals to identify epidemiological studies that fulfilled basic criteria for inclusion in the Data Bank, namely a clearly stated definition of blindness and low vision, and prevalence rates derived from population-based surveys. Sources such as National Prevention of Blindness Programmes, academic institutions or WHO country or regional reports were also investigated. RESULTS: Two-hundred-and-eight population-based studies on visual impairment for 68 countries are reported in detail, providing an up-to-date, comprehensive compilation of the available information on visual impairment and its causes globally.

Eliminating onchocerciasis as a public health problem: the beginning of the end.

Onchocerciasis is one of the diseases targeted by Vision 2020. It is the world's second leading infectious cause of blindness, responsible for at least one million blind or severely visually disabled people. The Onchocerciasis Control Programme (OCP) in sub-Saharan Africa will be closed down in 2002, after 27 years of operation. This is the clearest indication that the prospects of eliminating onchocerciasis as a public health problem may be achieved by the end of this decade. The programme's potential now is to serve as a model of global and multiple partnership, to address other poverty related, serious and intractable problems such as needless blindness in the world.

APOC's strategy of community-directed treatment with ivermectin (CDTI) and its potential for providing additional health services to the poorest populations. African Programme for Onchocerciasis Control.

Since its inauguration in 1995, the African Programme for Onchocerciasis Control (APOC) has made significant progress towards achieving its main objective: to establish sustainable community-directed treatment with ivermectin (CDTI) in onchocerciasis-endemic areas outside of the remit of the Onchocerciasis Control Programme in West Africa (OCP). In the year 2000, the programme, in partnership with governments, non-governmental organizations and the endemic communities themselves, succeeded in treating 20,298,138 individuals in 49,654 communities in 63 projects in 14 countries. Besides the distribution of ivermectin, the programme has strengthened primary healthcare (PHC) through capacity-building, mobilization of resources and empowerment of communities. The community-directed-treatment approach is a model that can be adopted in developing other community-based health programmes. The approach has also made it possible to bring to the poor some measure of intervention in some other healthcare programmes, such as those for malaria control, eye care, maternal and child health, nutrition and immunization. CDTI presents, at all stages of its implementation, a unique window of opportunity for promoting the functional integration of healthcare activities. For this to be done successfully and in a co-ordinated manner, adequate funding of CDTI within PHC is as important as an effective sensitization of the relevant policy-makers, healthworkers and communities on the value of integration (accompanied by appropriate training at all levels). Evaluation of the experiences in integration of health services, particularly at community level, is crucial to the success of the integration.

Delivery systems and cost recovery in Mectizan treatment for onchocerciasis.

The efficiency of on-going delivery systems and cost recovery in Mectizan (ivermectin, MSD) treatment for onchocerciasis are reviewed. The search is on for an effective system of Mectizan delivery, involving drug procurement, delivery from port to districts and distribution to eligible persons, which can be sustained by the endemic countries for many years. The mechanisms for procuring and clearing the drug at the ports, and the drug's integration into the existing delivery systems of each national health service, need to be improved. Although large-scale treatments by mobile teams or community-based methods evidently achieve high and satisfactory rates of coverage, they also incur high recurrent costs which have to be covered by external partners and are not sustainable by national health services. Cost-sharing is considered an important factor in a sustainable delivery system and community-directed treatment, in which the community shares the cost and ownership of local distribution and is empowered to design and implement it, is likely to be more cost-effective and sustainable.

Mectizan as a stimulus for development of novel partnerships: the international organization's perspective.

Following the free donation of Mectizan (ivermectin, MSD) by Merck & Co. in 1987, early efforts to mass distribute the drug came from non-governmental development organizations (NGDO), which had already established projects in Africa and Latin America by 1989. In the beginning, these projects were NGDO-specific and fairly independent from one another. Subsequently, the need to co-ordinate all attempts at Mectizan distribution led to the creation of the Onchocerciasis Eradication Programme of the Americas (OEPA), in 1991, and the NGDO Co-ordination Group for Ivermectin Distribution, in 1992. The latter was to become the 'prime mover' in Mectizan-distribution programmes, particularly in areas of Africa not monitored by the Onchocerciasis Control Programme in West Africa (OCP), until the advent of the African Programme for Onchocerciasis Control (APOC) in 1995. Once the co-ordination group had been established and its co-ordinator appointed, the Mectizan-distribution programme expanded rapidly, reaching 7 million people by 1995. However, the limited resources of the co-ordination group and the need to achieve a better co-ordinated and more comprehensive control of onchocerciasis ultimately led to the creation of the APOC in 1995. The international co-operation behind the APOC has inaugurated a unique type of global partnership, in which the success of the programme lies not with a single player, but with close working relationships and collaboration between many partners: donors; governments of endemic countries; NGDO; international organizations; and private institutions. This is a complex process, the success of which cannot be guaranteed. However, if it can be made to succeed, it will serve as a model to be used to address other serious and intractable development or health problems.

Effect of chloroquine prophylaxis during pregnancy on maternal haematocrit.

Two controlled trials of chloroquine prophylaxis during pregnancy were performed, one in Burkina Faso in 1987, on all pregnant women, and the other in Cameroon in 1992, on primigravidae only. Maternal haematocrit at delivery was found to be significantly higher in those women who had received chloroquine than in those who had not, both in Burkina Faso (37.4% v. 36.5%; P = 0.01) and in Cameroon (34.8% v. 32.8%; P = 0.02). Anaemia, defined as an haematocrit of < 30%, was also less common in those treated with chloroquine (6.3% v. 8.5% in Burkina Faso and 8.3% v. 18.4% in Cameroon) but this difference was not significant in either country. A slight improvement in haematological status when prophylaxis is given has also been observed in similar studies performed in other tropical countries. The present results confirm the usefulness of targeting antimalarial prophylaxis at pregnant women. Such prophylaxis during the first pregnancy also increases birthweight.