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Effects of intervention with the SAFE strategy on trachoma across Ethiopia
  1. A A Roba1,
  2. A Wondimu2,
  3. D Patel3,
  4. M Zondervan3
  1. 1Sector de Oftalmologia, Hospital Central Da Beira, Beira, Mozambique
  2. 2Eyen Consult Plc, Addis Ababa, Ethiopia
  3. 3International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
  1. Correspondence to Dr Assegid Aga Roba, Consultant Ophthalmologist, Hospital Central Da Beira, 727- Aven. FPLM, Beira, Mozambique; agassegid{at}


Background/Aims The impact of the SAFE strategy (surgery, antibiotics, face washing, environmental hygiene), recommended to eliminate blinding trachoma, is not well explored. We determined the operational effectiveness of the whole SAFE intervention package.

Methods Analytical cross-sectional trachoma surveys were conducted in four program areas across Ethiopia before and after 3 years of intervention with the SAFE strategy. A total of 8358 children 1–9 years, 4684 people above 14 and 3572 households were assessed in the follow-up evaluations using methodologies recommended by the WHO. Effects were measured by comparing follow-up proportions with baseline estimates of four key indicators.

Results Coverage was 36% for trichiasis surgery, 59% for antibiotic and 57% for health-promotion services. Prevalence of trachoma trichiasis (TT) decreased from 4.6% (95% CI: 3.6% to 5.8%) down to 2.9% (CI: 2.1% to 3.9%). Prevalence of trachoma inflammation-follicular (TF) dropped from 36.7% (33.9% to 39.6%) to 18.4% (CI: 15.4% to 21.8%). The proportion of unclean faces and households not using latrines fell from 72.8% (68.9% to 76.4%) and 74.5% (69.9% to 78.7%) down to 47.0% (CI: 43% to 51%) and 51.7% (47.2% to 56.2%), respectively. All the reductions related with antibiotic (TF), face washing (clean face) and environmental (latrine) components were statistically significant except for Surgery (TT).

Conclusions Considerable decline in the magnitude of trachoma and its risk factors was observed in areas where the SAFE strategy was implemented. The coverage of services should be maintained or improved in order to eliminate blinding trachoma by the year 2020.

  • Blindness
  • effectiveness
  • SAFE strategy
  • trachoma
  • trichiasis
  • health services eval
  • infectious DI

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  • Funding World Vision-Ethiopia, ORBIS International. Sponsors covered costs of transportation, data collection and fees and consultation services and facilitated the surveys. Sponsors were not directly involved in data collection and analysis or write-up of this study.

  • Competing interests Currently, none of the authors have conflicting financial interest in the publication of this study. However, the first author used to be an employee of one of the organisations running one of the programs. The second author received professional fees for evaluating the rest of the three programs.

  • Ethics approval London School of Hygiene and Tropical Medicine provided ethical approval for the study in Enemor area. All the other surveys were approved and facilitated by the authorities of the respective provincial and district health office as operational studies incorporated in signed project document. All the surveys respected international conventions and national guidelines and laws regarding ethics in biomedical research.

  • Provenance and peer review Not commissioned; not externally peer reviewed.