Simplification and improvement of height-based azithromycin treatment for paediatric trachoma.

Recent data showing that azithromycin is safe at higher dosages than previously documented provide an opportunity to explore several important improvements in the efficiency and effectiveness of height-based treatment of paediatric trachoma. The purpose of this study is to examine the feasibility of a single standardised schedule for application in any trachoma-endemic region. Data for 60813 children from Asia, North and sub-Saharan Africa were analysed. A height schedule maximizing the number of children receiving treatment of 20-40 mg/kg, a conservative estimate of the safe and effective treatment range for paediatric trachoma, was developed. Using the standardised schedule, 97.7% of children aged 6 to 59 months receiving oral suspension and 96.7% of children aged 60 months to 15 years receiving tablets would have received treatment within a dosage range of 20-40 mg/kg. Less than 1% of all children would have received treatment less than 20 mg/kg. These findings suggest that the schedule presented in this paper is likely to yield safe and effective treatment for a broad range of populations vulnerable to trachoma while substantially improving the efficiency of height-based treatment.

Height as a proxy for weight in determining azithromycin treatment for paediatric trachoma.

Azithromycin (Zithromax, Pfizer Inc., New York, NY, USA) is effective in the control of blinding trachoma. Community-based azithromycin treatment is recommended by the World Health Organization as part of a multipronged strategy aimed at the global elimination of binding trachoma by the year 2020. Paediatric trachoma is treated with azithromycin according to weight at a target dosage of 20 mg/kg. However, conventional weight-based treatment may be problematic in the field due to the logistical difficulties associated with weight scales. We assessed the accuracy of using height as a proxy for weight to determine azithromycin treatment in 4 countries--Viet Nam, Tanzania, Ghana, and Mali--where mass treatment programmes are underway. Population-based data collected from 1988 to 2000 were analysed using least squares regression. Height treatment schedules were developed for each data set. The accuracy of each schedule was evaluated according to the percentage of children receiving treatment within a dosage range of 20-30 mg/kg, a conservative estimate of the safe and effective treatment range for paediatric trachoma. Using height to determine dose, 89-95% of children would receive a dosage of 20-30 mg/kg. In these populations, height-based treatment is a reliable alternative to conventional weight-based treatment. Methods for developing height schedules presented in this analysis could be applied to other regions and therapeutics.

Estimating the burden and economic impact of trachomatous visual loss.

OBJECTIVE: To estimate the burden (disability-adjusted life years) and economic impact (potential productivity loss) associated with trachomatous visual loss. DATA: National survey data on trachomatous blindness or visual impairment since 1980. METHODS: The primary results summarized studies for countries with known or suspected blinding trachoma within World Development Report demographic regions. The number of cases was based on the year 2000 population. The years of life with disability calculation used the age-sex distribution of trachomatous visual loss. The one-year potential productivity loss calculation used the agricultural value added per worker in 1998. RESULTS: Countries with known or suspected blinding trachoma have 3.8 million cases of blindness and 5.3 million cases of low vision and a potential productivity loss of 2.9 billion US dollars (1995 US dollars). Prevalent cases of trachomatous visual loss yield 39 million lifetime DALYs. CONCLUSIONS: For resource allocation, the burden of disease can be compared with the expected costs of eradication of trachomatous blindness.