Face washing promotion for preventing active trachoma.
Face washing promotion for preventing active trachoma.
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DOI：
10.1002/14651858.cd003659.pub4
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发表时间：
2015-02-20
影响因子：
8.4
通讯作者：
Rabiu, Mansur
中科院分区：
文献类型：
--
作者：
Ejere, Henry O. D.;Alhassan, Mahmoud B.;Rabiu, Mansur
关键词：
FaceAnti-Bacterial Agents [administration & dosage]Baths [methods]Chlamydia trachomatisOphthalmic Solutions [therapeutic use]Randomized Controlled Trials as TopicSkin Care [methods]Tetracycline [administration & dosage]Trachoma [epidemiology; prevention & control]AdolescentChildChildPreschoolHumansInfant
沙眼仍然是许多发展中国家贫困人口中可避免的失明的主要原因。据估计，约有1.46亿人患有活动性沙眼，近600万人因与重复感染相关的并发症而失明。本综述的目的是评估在流行社区推广洗脸对预防活动性沙眼的影响。我们检索了CENTRAL（其中包含科克伦眼科和视力组试验注册表）（2015年第1期）、奥维德MEDLINE、奥维德MEDLINE过程中和其他非索引引文、奥维德MEDLINE日报、奥维德OLDMEDLINE（1946年1月至2015年1月），EMBASE（1980年1月至2015年1月），PubMed（1948年1月至2015年1月），拉丁美洲和加勒比健康科学文献数据库（LILACS）（1982年1月至2015年1月），对照试验荟萃登记（mRCT）（www.controlled-trials.com）（2014年1月10日访问），ClinicalTrials.gov（www.clinicaltrials.gov）和世界卫生组织（WHO）国际临床试验注册平台（ICTRP）（www.who.int/ictrp/search/en）。我们在试验的电子检索中没有使用任何日期或语言限制。我们最后一次检索电子数据库是在2015年1月26日。为了识别进一步的相关试验，我们检查了纳入试验的参考文献列表。此外，我们使用科学引文索引搜索引用了综述中包含的试验的出版物的参考文献。我们联系了该领域的研究人员和专家，以确定其他试验。我们纳入了随机对照试验（RCT）或准RCT，比较了洗脸与不治疗或洗脸与抗生素联合治疗与单独使用抗生素治疗。试验参与者是沙眼流行社区的居民。两位综述作者独立提取数据并评估试验质量。我们在需要时联系了试验作者以获取更多信息。两项试验符合我们的纳入标准，但由于方法学的异质性，我们没有进行荟萃分析。我们纳入了两项随机对照试验，提供了2447名受试者的数据。两项试验都在沙眼流行地区进行：北方澳大利亚和坦桑尼亚。一项试验的随访期为3个月，另一项试验为12个月;两项试验在最终访视时约有90%的受试者接受了随访。总体而言，由于试验未报告许多设计方法以及试验之间报告的结局差异，证据的质量不确定。在一项试验中，在三对村庄中将洗脸联合外用四环素与单独外用四环素进行了比较。该试验发现，在12个月时，与单独外用四环素相比，洗脸联合外用四环素可减少“严重”活动性沙眼（校正比值比（OR）0.62，95%可信区间（CI）0.40 ~ 0.97）;然而，在减少其他类型的活动性沙眼方面，试验没有发现干预村和对照村之间有任何重要差异。（调整后OR 0.81，95% CI 0.42 - 1.59）。在12个月的随访中，干预村的重度沙眼儿童（校正OR 0.35，95%CI 0.21至0.59）和任何沙眼儿童（校正OR 0.58，95%CI 0.47至0.72）的清洁面部患病率高于对照村。第二项试验比较了滤泡性沙眼儿童的洗眼与不治疗或局部四环素单独或联合洗眼和四环素滴剂。在三个月时，试验没有发现单独洗眼或与四环素滴眼液联合使用对减少滤泡性沙眼儿童滤泡性沙眼的益处的证据（风险比（RR）1.03，95%CI 0.96至1.11;一项试验，1143名参与者）。有证据表明，从一个试验，洗脸结合局部四环素可能是有效的，在减少严重的活动性沙眼，并在一年的随访中，在清洁的脸的患病率增加。目前的证据是不确定的有效性洗脸单独或结合外用四环素减少活动性或严重的沙眼。
Trachoma remains a major cause of avoidable blindness among underprivileged populations in many developing countries. It is estimated that about 146 million people have active trachoma and nearly six million people are blind due to complications associated with repeat infections. The objective of this review was to assess the effects of face washing promotion for the prevention of active trachoma in endemic communities. We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (2015, Issue 1), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to January 2015), EMBASE (January 1980 to January 2015), PubMed (January 1948 to January 2015), Latin American and Caribbean Health Sciences Literature Database (LILACS) (January 1982 to January 2015), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com) (accessed 10 January 2014), ClinicalTrials.gov (www.clinicaltrials.gov) and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 26 January 2015. To identify further relevant trials we checked the reference lists of the included trials. Also, we used the Science Citation Index to search for references to publications that cited the trials included in the review. We contacted investigators and experts in the field to identify additional trials. We included randomized controlled trials (RCTs) or quasi-RCTs that compared face washing with no treatment or face washing combined with antibiotics against antibiotics alone. Trial participants were residents of endemic trachoma communities. Two review authors independently extracted data and assessed trial quality. We contacted trial authors for additional information when needed. Two trials met our inclusion criteria; but we did not conduct meta-analysis due to methodological heterogeneity. We included two cluster-RCTs, which provided data from 2447 participants. Both trials were conducted in areas endemic to trachoma: Northern Australia and Tanzania. The follow-up period was three months in one trial and 12 months in the other; both trials had about 90% participant follow-up at final visit. Overall the quality of the evidence is uncertain due to the trials not reporting many design methods and the differences in outcomes reported between trials. Face washing combined with topical tetracycline was compared with topical tetracycline alone in three pairs of villages in one trial. The trial found that face washing combined with topical tetracycline reduced ’severe’ active trachoma compared with topical tetracycline alone at 12 months (adjusted odds ratio (OR) 0.62, 95% confidence interval (CI) 0.40 to 0.97); however, the trial did not find any important difference between the intervention and control villages in reducing other types of active trachoma (adjusted OR 0.81, 95% CI 0.42 to 1.59). Intervention villages had a higher prevalence of clean faces than the control villages among children with severe trachoma (adjusted OR 0.35, 95% CI 0.21 to 0.59) and any trachoma (adjusted OR 0.58, 95% CI 0.47 to 0.72) at 12 months follow-up. The second trial compared eye washing to no treatment or to topical tetracycline alone or to a combination of eye washing and tetracycline drops in children with follicular trachoma. At three months, the trial found no evidence of benefit of eye washing alone or in combination with tetracycline eye drops in reducing follicular trachoma amongst children with follicular trachoma (risk ratio (RR) 1.03, 95% CI 0.96 to 1.11; one trial, 1143 participants). There is evidence from one trial that face washing combined with topical tetracycline may be effective in reducing severe active trachoma and in increasing the prevalence of clean faces at one year follow-up. Current evidence is inconclusive as to the effectiveness of face washing alone or in combination with topical tetracycline in reducing active or severe trachoma.