[Etiologies of papilledema in Cameroonian hospitals]. / Etiologies des œdèmes papillaires en milieu hospitalier camerounais.

Introduction: papilledema refers to the swelling of the head of the optic nerve, a major sign of many local, locoregional or systemic pathologies that may involve patients' visual or vital prognosis. This condition represents a diagnostic and therapeutic emergency frequently encountered in our facilities. Therefore, it is deemed and opportune to identify the most common etiologies observed in Cameroonian hospitals. Method: we conducted a documentary and descriptive study of patients with papilledema presenting to the Ophthalmology Department of the Hospital of Instruction, Application and Reference of the Armed Forces of Yaoundé from 1st October 2013 to 31st December 2016. The variables under investigation included epidemiological data (age, sex), clinical data (functional signs, visual acuity, appearance of the papilla and associated signs according to the Hoyt and Beesten classification), complementary examinations performed (fluorescein angiography, visual field, biology, radiography, CT scan) and the etiological diagnosis. Epi-info 3.5.3 software was used for statistical analysis and the Chi-square test was performed at a 5% significance level (p < 5%). Results: during the study period, papilledema was found in 26 out of 5023 patients, reflecting a rate of 0.5%. The average age of patients was 32.7± 10.9 years, ranging from 7 to 79 years, for 13 women and 13 men. Papilledema was bilateral in 15 (57.7%) patients and unilateral in 11 (42.3%), or 41 affected eyes. The etiologies were 11 (42,3%) inflammatory optic neuropathies, 5 (19,2%) arterial hypertension, 4 (15,4%) central retinal vein occlusions, 3 (11,5%) eye contusions, 2 (7,7%) hydrocephalus and 1 case (3,9%) of cerebral malaria. Conclusion: inflammatory and vascular optic neuropathies were the most common etiologies of papilledema in our facilities.

The increasing use of the WHO Safe Childbirth Checklist: lessons learned at the Yaoundé Gynaeco-Obstetric and Paediatric Hospital, Cameroon.

BACKGROUND: Safe childbirth remains a daunting challenge, particularly in low-middle income countries, where most pregnancy-related deaths occur. Cameroon's maternal mortality rate, estimated at 529 per 100,000 live births in 2017, is significantly high. The WHO Safe Childbirth Checklist (SCC) was designed to improve the quality of care provided to pregnant women during childbirth. The SCC was implemented at the Yaoundé Gynaeco-Obstetric and Paediatric Hospital to improve the quality of care during childbirth. METHODS: This study was a retrospective study to determine the adoption rate of the SCC and its association with maternal (eclampsia, perineal tears, and postpartum haemorrhage) and neonatal (stillbirth, neonatal asphyxia and neonatal death) complications. Data were collected 6 months after the introduction of the SCC. Multivariate binary logistic regression was used to analyse the association between the use of the SCC and maternofoetal complications. RESULTS: Out of 1611 deliveries conducted, 1001 records were found, giving a retrieval rate of 62%. Twenty-five records were excluded. During the study period, the checklists were used in 828 of 976 clinical notes, with an adoption rate of 84.8% and a utilization rate of 93.9% at 6 months. Severe preeclampsia/eclampsia was associated with the non-use of the SCC (2.1 vs 5.4%, p = 0.041). Stillbirth, neonatal asphyxia, and neonatal death rates were not significantly different between the checklist and non-checklist groups. However, for all neonatal outcomes, the proportion of complications was lower when the checklist was used. CONCLUSION: The use of the SCC was associated with significantly reduced pregnancy complications, especially for reducing the rates of severe pre-eclampsia/eclampsia. The use of the SCC increased to 93.9% of all deliveries within 6 months. We advocate for the use of the WHO Safe Childbirth Checklist in maternity units.

Assessment of Systems and Services for Management of Diabetes and Diabetic Retinopathy in Cameroon.

AIM: To evaluate systems and services for management of diabetes and diabetic retinopathy. METHODOLOGY: The National Program for Blindness Control conducted a nationwide descriptive study from 1st February to 31st October 2016. Data was collected using WHO's:"Tool Assessment of Diabetic Retinopathy and Diabetes Management Systems" adapted to the context. Using direct interviews, all previously identified stakeholders, were involved from all levels of management and throughout the territory. The IBM version 20 software permitted analysis. RESULTS: Out of the 48 individuals selected, 46 agreed to participate in the survey. Four participants (8.7%) worked at the central level of the Ministry of Public Health, 2 (4.4%) were NGOs partners, 6 (13%) diabetic patients, and 34 (73.9%) health staff. According to the answers of participants, diabetes stands among priorities in the national health policy. Diabetic care services have been integrated into the National action plan for Chronic Non-Communicable Diseases, but a specific program for control of diabetes has not been created neither are national guidelines recommended by the Ministry available. Some health facilities provide care for diabetes and its complications. Modern technologies for evaluation and follow-up of diabetes of its complications are available only in tertiary level hospitals and in some private clinics. The cost of care obtained is the responsibility of the patients and families. CONCLUSION: The political will to manage diabetes and diabetic retinopathy is recognized by stakeholders and beneficiaries but not translated into an effective program. A suitable implementation strategy is necessary.

Effectiveness and safety of azithromycin 1.5% eye drops for mass treatment of active trachoma in a highly endemic district in Cameroon.

OBJECTIVE: To evaluate the effectiveness and safety of azithromycin 1.5% eye drops under field conditions to reduce active trachoma in a highly endemic district in Cameroon. This is a follow-up of an initial report published in 2010. METHODS AND ANALYSIS: Three annual campaigns were performed in 2008, 2009 and 2010 to treat the population (~1 20 000 individuals) of the Kolofata Health District with topical azithromycin 1.5% (one drop in each eye, morning and evening for three consecutive days). The effectiveness of this intervention against active trachoma was assessed in children aged 1-9 years in cross-sectional studies prior to each mass treatment using a systematic sampling procedure (in 2008, 2009 and 2010) and then 1 year (2011) and 3 years (2013) after the last intervention among the villages with previously high active trachoma prevalence or never tested. RESULTS: The prevalence of trachomatous inflammation-follicular (TF) dropped from 24.0% (95% CI 20.7 to 27.5) before treatment to 2.8% (95% CI 2.2 to 3.7) 1 year after completion of the 3 year campaign. Trachomatous inflammation-intense was present in only 4 (0.2%) children 1 year after the third round of treatment. Three years after the last campaign, the surveillance survey among the most prevalent villages and villages never tested before showed a prevalence of 5.2% (95% CI 3.6 to 7.2) of active trachoma. Tolerance was excellent, with no report of treatment interruption, serious ocular or systemic adverse events. CONCLUSION: Annual mass treatment with azithromycin eye drops was shown to be effective in reducing TF to a level ≤5% one year after a 3-round annual mass treatment in an endemic region at the district level.

The global burden of trichiasis in 2016.

BACKGROUND: Trichiasis is present when one or more eyelashes touches the eye. Uncorrected, it can cause blindness. Accurate estimates of numbers affected, and their geographical distribution, help guide resource allocation. METHODS: We obtained district-level trichiasis prevalence estimates in adults for 44 endemic and previously-endemic countries. We used (1) the most recent data for a district, if more than one estimate was available; (2) age- and sex-standardized corrections of historic estimates, where raw data were available; (3) historic estimates adjusted using a mean adjustment factor for districts where raw data were unavailable; and (4) expert assessment of available data for districts for which no prevalence estimates were available. FINDINGS: Internally age- and sex-standardized data represented 1,355 districts and contributed 662 thousand cases (95% confidence interval [CI] 324 thousand-1.1 million) to the global total. Age- and sex-standardized district-level prevalence estimates differed from raw estimates by a mean factor of 0.45 (range 0.03-2.28). Previously non- stratified estimates for 398 districts, adjusted by ×0.45, contributed a further 411 thousand cases (95% CI 283-557 thousand). Eight countries retained previous estimates, contributing 848 thousand cases (95% CI 225 thousand-1.7 million). New expert assessments in 14 countries contributed 862 thousand cases (95% CI 228 thousand-1.7 million). The global trichiasis burden in 2016 was 2.8 million cases (95% CI 1.1-5.2 million). INTERPRETATION: The 2016 estimate is lower than previous estimates, probably due to more and better data; scale-up of trichiasis management services; and reductions in incidence due to lower active trachoma prevalence.

Ophthalmic Manifestations in Chronic Inflammatory Rheumatic Diseases at a Referral Hospital of Yaounde, Cameroon.

PURPOSE: To determine the profile of ophthalmic manifestations in chronic inflammatory rheumatic diseases (CIRD). METHODS: Observational study at the Yaounde Central Hospital and Innel Medical Centre (2004 to 2012). RESULTS: The study population (n = 36) consisted of 14 men and 22 women with average age of 47.9 ± 17.2 years. Cases of CIRD were rheumatoid arthritis (n = 16), systemic lupus erythematosus (n = 8), ankylosing spondylitis (n = 8), mixed connective tissue disease (n = 2), scleroderma (n = 1), and juvenile idiopathic arthritis (n = 1). Ophthalmic manifestations found in 22 (61.1%) patients were dry eye syndrome (n = 7), cataract (n = 6), anterior uveitis (n = 6), glaucoma (n = 4), and suspected maculopathy (n = 1). No association was found between steroids used and supcapsular cataract (p = 0.06) or glaucoma (p = 0.06). CONCLUSION: Ocular manifestations occurred in 61.1% of CIRD. Dry eye syndrome and anterior uveitis were commonly observed.

Peters plus anomaly in a Cameroonian child: a case report.

BACKGROUND: Peters' anomaly (PA) is a rare form of anterior segment dysgenesis characterized by corneal opacity with varied degree of anterior chamber affection with associated defects in the posterior layers of the cornea. CASE PRESENTATION: We report the case of a 3-month-old male infant with bilateral corneal opacity since birth who was transferred from the pediatric unit for further ophthalmic care. He was diagnosed with PA with subsequent systemic-associated malformations including craniofacial defects and skeletal defects. He was managed minimally with topical mydriatics and antiglaucomatous drugs. CONCLUSION: PA is an inevitable cause of blindness in developing countries due to poor infrastructure and limited resources.

Rheumatoid polyarthritis suspected in an HIV patient with scleritis, peripheral ulcerative keratitis, and anterior uveitis.

INTRODUCTION: Scleritis and peripheral ulcerative keratitis are ocular manifestations found in many inflammations and infections. Therefore, their association should prompt a search for inflammatory or infectious causes that may be life-threatening, especially in the context of AIDS due to HIV infection. FINDINGS: We report the case of a 37-year-old female, first seen in 2011 with a nodular scleritis in the right eye and a peripheral ulcerative keratitis, a necrotizing scleritis, and a granulomatous anterior uveitis in the left eye, in the context of chronic polyarthropathies that had evolved over 6 months. The patient was diagnosed with AIDS (HIV) in 2008 and was on antiretroviral therapy for the past 2 years. Ophthalmic workup was negative for opportunistic infections and potential causes of scleritis and peripheral ulcerative keratitis, and the patient was unresponsive to topical antibacterial and anti-inflammatory treatment. Ocular lesion resolution and articular swelling improvement was observed less than 6 weeks after sulfasalazine treatment. Based on American College of Rheumatology/European League Against Rheumatism classification criteria, and considering the good response to the treatment (sulfasalazine), diagnosis of rheumatoid arthritis was made in the absence of confirmatory lab tests results. CONCLUSION: In the context of ocular manifestations associated with polyarthropathies, coexisting pathologies should be considered. Diagnostic workup of chronic inflammatory rheumatism should be carried out, even in the context of HIV/AIDS.

Conservative management in congenital bilateral upper eyelid eversion.

Aim. To report the case of congenital bilateral upper eyelid eversion with severe chemosis that was successfully managed conservatively. Report. The patient was a six-hour-old male neonate with bilateral congenital upper eyelid eversion and severe chemosis, following uneventful delivery. Conservative management consisted of the application of antibiotic ointment and padding the exposed conjunctiva with 5% hypertonic saline-soaked gauze. The eyelids reverted spontaneously on day 3 and the condition was completely resolved by the third week. Conclusion. Congenital upper lid eversion is usually a benign condition which responds well to conservative treatment. Creating awareness amongst healthcare professionals is essential.

Prevalence of trachoma in the north region of Cameroon: results of a survey in 15 health districts.

BACKGROUND: To estimate the prevalence of trachoma in the North Region of Cameroon in order to facilitate the planning of trachoma control activities in this region, a survey was carried out in 2011 and 2012 in 15 health districts (HDs). METHODOLOGY: A cross-sectional, two-stage cluster random sampling survey was carried out. The survey focused on two target populations: children aged 1 to 9 years for the prevalence of Trachomatous Inflammation-Follicular (TF) and those aged 15 and over for the prevalence of Trachomatous Trichiasis (TT). The sample frame was an exhaustive list of villages and neighborhoods of HDs. The World Health Organization simplified trachoma grading system was used for the recognition and registration of cases of trachoma. PRINCIPAL FINDINGS: 30,562 children aged 1 to 9 years and 24,864 people aged 15 and above were examined. In children aged 1-9 years, the overall prevalence of TF was 4.2% (95% confidence intervals (CI): 4.0-4.5%). Three (3) of 15 HDs in the region showed TF prevalence of ≥ 10% (Poli, Rey Bouba, and Tcholliré). The overall TT prevalence was 0.25% (95% CI: 0.20-0.33%). There were estimated 1265 TT cases in the region. The prevalence of blindness was 0.01% (95% CI: 0.00-0.03%), low vision was 0.11% (95% CI: 0.07-0.17%), and corneal opacity was 0.22% (95% CI: 0.17-0.29%). CONCLUSIONS/SIGNIFICANCE: This survey provides baseline data for the planning of activities to control trachoma in the region. The overall prevalence of TF in the region is 4.2%, and that of TT is 0.2%; three HDs have a TF prevalence ≥ 10%. These three HDs are eligible for mass drug administration with azythromycin, along with the implementation of the "F" and "E" components of the SAFE strategy.

Prevalence of trachoma in the Far North region of Cameroon: results of a survey in 27 Health Districts.

BACKGROUND: Cameroon is known to be endemic with trachoma. To appreciate the burden of the disease and facilitate the national planning of trachoma control in the integrated control program for the neglected tropical diseases, an epidemiological mapping of trachoma was conducted in the Far North region in 2010-11. METHODOLOGY: A cross-sectional, cluster random sampling survey was carried out. The survey focused on two target populations: children aged 1 to 9 years for the prevalence of active trachoma and those aged 15 and over for the prevalence of trichiasis (TT). The sample frame was an exhaustive list of villages and neighborhoods of Health Districts (HDs). The World Health Organization simplified trachoma grading system was used for the recognition and registration of cases of trachoma. PRINCIPAL FINDINGS: 48,844 children aged 1 to 9 years and 41,533 people aged 15 and over were examined. In children aged 1-9 years, the overall prevalence of trachomatous inflammation-follicular (TF) was 11.2% (95% confidence intervals (CI): 11.0-11.5%). More girls were affected than boys (p = 0.003). Thirteen (13) of 27 HDs in the region showed TF prevalence of ≥10%. The overall TT prevalence was 1.0% (95% CI: 0.9-1.1%). There were estimated 17193 (95% CI: 12576-25860) TT cases in the region. The prevalence of blindness was 0.04% (95% CI: 0.03-0.07%) and visual impairment was 0.09% (95% CI: 0.07-0.13%). CONCLUSIONS/SIGNIFICANCE: The survey confirmed that trachoma is a public health problem in the Far North region with 13 HDs qualified for district-level mass drug administration with azithromycin. It provided a foundation for the national program to plan and implement the SAFE strategy in the region. Effort must be made to find resources to provide the surgical operations to the 17193 TT cases and prevent them from becoming blind.

Diabetic retinopathy at the Yaoundé Central Hospital in Cameroon: epidemiology and angiographic findings.

We carried out a cross-sectional analytical survey using data from patients who had done Fluorescein Angiography at the Yaounde Central Hospital Diabetic Retinopathy Prevention and Management Project between October 2007 and January 2010 to identify the risk factors, incidence and severity of different types of diabetic retinopathy. Data from 239 males (57.0%) and 180 females (43.0%) with diabetic retinopathy were included. Their mean age was 58.2 years. A majority of them were living with type II diabetes (96.2%). The mean duration of diabetes was 8.2 years. About sixty percent had both diabetes and hypertension. The average level of glycated haemoglobin was 9.72% (range 6-17.7%). Amongst the 419 patients with diabetic retinopathy, 292(69.7%) had non-proliferative diabetic retinopathy. One hundred and twelve (26.7%) of those with proliferative diabetic retinopathy had a formal indication for laser photocoagulation. Fifteen patients (3.6%) presented with complicated forms of proliferative diabetic retinopathy. Diabetic maculopathy was present in 30 patients (7.2%). Diabetic retinopathy is a frequent complication of diabetes in our setting which stems from inadequate emphasis on preventive measures. The technical requirements for managing some of the existing complications are still unavailable. Fluorescein Angiography is an important diagnostic tool which should be popularized.

Prevalence and causes of blindness at a tertiary hospital in Douala, Cameroon.

PURPOSE: The aim of this study was to determine the prevalence and causes of bilateral and unilateral blindness in the town of Douala and its environs based on data from the ophthalmic unit of a tertiary hospital in Douala. METHODS: We conducted a retrospective epidemiological survey of consultations at the eye unit of the Douala General Hospital over the last 20 years (from January 1, 1990 to December 31, 2009). RESULTS: Out of the 1927 cases of blindness, 1000 were unilateral, corresponding to a hospital prevalence of 1.84% and 927 cases were bilateral, corresponding to a hospital prevalence of 1.71%. No statistically significant difference was noted between the two (P = 0.14). The leading causes of bilateral blindness were cataract (50.1%), glaucoma (19.7%), and diabetic retinopathy (7.8%) while the leading causes of unilateral blindness were cataract (40.4%), glaucoma (14.1%), and retinal detachment (9.1%). Cataract (51.2%), cortical blindness (16.3%), and congenital glaucoma (10%) were the leading causes of bilateral blindness in children aged less than 10 years. CONCLUSION: Blindness remains a public health problem in the Douala region with a hospital prevalence which is relatively higher than the national estimate given by the National Blindness Control Program.

Secondary cataract: an epidemiologic and clinical survey at the Yaounde Gynaeco-obstetric and Paediatric Hospital.

OBJECTIVE: To determine the incidence and risk factors of secondary cataract. MATERIALS AND METHODS: A retrospective study involving a review of medical records in the ophthalmology unit of the Yaoundé Gynaeco-obstetric and Paediatric Hospital in Yaoundé, Cameroon, was carried out. All patients who had cataract surgery between January 2006 and September 2010 were included. Variables included age, sex, past medical history, morphology of primary cataract, type of surgery, intraocular lens implantation, site of implantation, intra- and postoperative complications, and the time lapse for the presentation of secondary cataract. Both univariate and bivariate analyses were carried out. The χ(2) test was used to compare proportions, and P-values <0.05 were considered statistically significant. RESULTS: A total of 864 eyes of 718 patients had cataract surgery. Ninety-two eyes developed posterior capsule opacification, giving an incidence of 10.65%. The mean age of patients who developed secondary cataract was 52.3 ± 23.05 years, with a range of 4 years to 84 years. Secondary cataract was more frequent in the age group of 0-20 years. The time lapse for presentation of secondary cataract was 64.7 ± 9.53 days, with a range of 1 to 504 days. Risk factors for the development of secondary cataract were age (P = 0.000), sex (P = 0.011), cortical cataract (P = 0.000), and postoperative inflammation (P = 0.000). CONCLUSION: The incidence of secondary cataract, though high in this study, is lower than that reported in other studies.

Indications for destructive eye surgeries at the Yaounde Gynaeco-Obstetric and Paediatric Hospital.

OBJECTIVE: To determine the indications and rate of acceptance for destructive eye surgeries at the ophthalmology unit of the Yaoundé Gynaeco-Obstetric and Paediatric Hospital. METHODS: A retrospective consecutive case series in which the medical records of all patients consulting in this unit over a 9-year period (2002 to 2010) were reviewed. Records in which destructive surgery was recommended were retained. Information collected included demographic data, eye affected, clinical diagnosis, acceptance or refusal of surgery, and the outcome in those in whom surgery was performed. RESULTS: A total of 48 patients had a recommendation for destructive eye surgery, of whom 30 (62.5%) were males and 18 (37.5%) were females. Mean age was 43.78 (SD = 28.11; range 1 month to 91 years). Children <10 years comprised 23.10%. The leading causes were endophthalmitis/panophthalmitis (47.9%), neoplasm (20.8%), and absolute glaucoma (14.6%). Surgery was done in 20 cases (41.7%). Evisceration was the most performed surgical procedure (50%), with endophthalmitis/panophthalmitis and neoplasm combined accounting for 65% of surgeries. CONCLUSION: The high rate of refusal is an indication of the psychological devastation undergone by patients or the families of children in whom eye removal is recommended. Awareness should be raised on preventive measures and the need to rapidly seek eye care.

[Prevalence and etiology of amblyopia of children in Yaoundé (Cameroon), aged 5-15 years]. / Prévalence et étiologies de l'amblyopie chez l'enfant camerounais de 5 à 15 ans à Yaoundé

PURPOSE: To determine the frequency of amblyopia and identify its causes in a population of children aged 5-15 years in Cameroon. SUBJECTS AND METHODS: This retrospective study examined the files of children aged 5-15 years seen in a private eye clinic in Yaounde from January 2008 through December 2010. The subjects underwent a complete ophthalmic examination including assessment of the best corrected visual acuity on a LogMAR chart, cycloplegic refraction measurements, and an orthoptic examination. The slit-lamp microscope and eye fundus examinations made it possible to rule out organic diseases. Statistical analysis was performed with Epi Info software, version 3.5.3, to analyze the the frequency and laterality of amblyopia according to age, sex, and refractive errors. RESULTS: Twenty-eight of the 314 patients studied had amblyopia, for a frequency of 8.9 % in the study population and 10.3 % in the subjects with ametropia (n = 271). The average age of children with amblyopia was 9.9 + / - 3 years. The frequency of amblyopia was higher among boys, but the difference was not statistically significant (p=0.3679). In order of frequency, the causes were refractive errors, for 93 % (26/28) of the children, and strabismus for 7 % (2/28). Astigmatism was the most frequent cause of ametropic amblyopia. Amblyopia had an anisometropic origin in 43 % (12/28) of cases. It was unilateral in 39.2 % (11/28) and bilateral in 61 % (17/28) of cases, severe in 18 %, moderate in 18 %, and mild in 64 %. CONCLUSION: Ten percent of the subjects in our series had amblyopia, mainly due to refractive errors. Amblyopia was most frequently bilateral and mild. A systematic ophthalmological examination in childhood could provide early detection and management of refractive errors that cause ocular morbidity.

Central corneal thickness in black Cameroonian ocular hypertensive and glaucomatous subjects.

PURPOSE: To evaluate central corneal thickness (CCT) in a black Cameroonian population of ocular hypertensive and glaucomatous subjects. MATERIAL AND METHODS: This was a prospective study undertaken with an ultrasonic pachymeter from January 2009 to December 2009 in an eye clinic (INNEL Medical center) in Yaoundé, Cameroon. RESULTS: One hundred subjects (200 eyes) were enrolled in the study. Sixty subjects were glaucomatous (primary open angle glaucoma, POAG group), and 40 ocular hypertensive (OHT group). The mean age of the sample was 52.60 ± 12.23 years. For the whole sample, CCT was 534.71 ± 37.95 µm in the right eye and 533.61 ± 37.67 µm in the left eye, with no statistically significant difference between the 2 eyes (P = 0.446). CCT in the POAG group was 526.30 ± 37.34 µm in the right eye and 524.90 ± 35.92 µm in the left eye. CCT in the OHT group was 547.32 ± 35.71 µm in the right eye and 546.67 ± 36.85 µm in the left eye. There was a statistically significant difference between CCT of the 2 groups (right eye: P = 0.013; left eye: P = 0.007). CONCLUSION: Mean CCT of ocular hypertensive subjects was thicker than CCT of glaucomatous ones in our Cameroonian sample. However, in both ocular hypertensive or glaucomatous patients, CCT of black Cameroonians is thinner than that reported in other studies in Caucasian populations.

Elimination of active trachoma after two topical mass treatments with azithromycin 1.5% eye drops.

BACKGROUND: Following an epidemiological study carried out in 2006 showing a high prevalence of blinding trachoma in the Far North Region of Cameroon, a trachoma elimination programme using the SAFE strategy was initiated: three yearly trachoma mass treatments were to be performed. METHODOLOGY/PRINCIPAL FINDINGS: The entire district population (120,000 persons) was treated with azithromycin 1.5% eye drops in February 2008 and January 2009. To assess the effect of treatment on the prevalence of active trachoma, three epidemiological studies were conducted on a representative sample of children aged between 1 and 10 years. The first study was performed just prior to the first treatment, the second just prior to the 2nd treatment and the third one, one year later. The prevalence of active forms of trachoma (TF + TI) dropped from 31.5% (95%CI 26.4-37.5) before treatment to 6.3% (95%CI 4.1-9.6) one year after first treatment; a reduction of nearly 80%. One year after the second treatment, the prevalence decreased to 3.1% (95%CI 2.0-4.9), a total reduction of 90%. Furthermore, there were no more TI cases (only TF). There was no report of serious or systemic side effects. Tolerance was excellent. CONCLUSIONS/SIGNIFICANCE: Active trachoma mass treatment with azithromycin 1.5% eye drops is feasible, well tolerated, and effective.