International Journal of Innovative Research and Knowledge

Volume-6 Issue-11, November 2021

Title: Effectiveness and efficacy of implementing the “SAFE” strategy for the elimination of trachoma and other related blindness in African communities: A Systematic Review and a meta-analysis

Author: Dr. Innocent SSEMANDA, Dr. Patrick Kaonga, Dr. Choolwe Jacobs, Dr. J. M. O. Tukei & Dr. Oluseye A. Ogunbayo


Implementation of the ‘SAFE’ strategy remains critical in the prevention of chlamydial trachomatis infection and other trachoma-related blindness among children and adults in Africa. Trachoma is the commonest blindness-causing infectious disease and the World Health Organization (WHO) has recognizedthe ‘SAFE’ strategy for its  elimination. The elimination strategy is summarized by the acronym "SAFE", which means Surgery for advanced disease, Antibiotics to clear Chlamydia trachomatis infection, Facial cleanliness, and Environmental improvement, to reduce trachoma transmission.  This review aim to establish the extent of evidence, for the ‘SAFE’ strategy in eliminating chlamydial trachomatis infections, and preventing trachoma-related blindness among children and adults in Africa. A systematic review and a meta-analysiswas conducted from six electronic databases to retrieve randomized controlled trial studies that evaluated the effectiveness,and efficacyof either mass administration of antibiotics, surgery, facial cleanness, and environmental improvement intervention towards trachoma prevention and elimination.Pooled odds ratio (POR) with 95% confidence intervals were generated using random effect models. We conducted a subgroup analysis and sensitivity analysis within a stratum, and meta-analysis regression to assess the effect of the individual study intervention. ARevMan review manager 5.3, and  STATA version 15 (Stata-Corp, College Station, TX) were used for analysis. The summary effect measured from the 38eligible studies included inthe meta-analysis were categorized as mass administration of antibiotics, facial cleanness, or environmental improvement, and their pooled effect measures were (OR=0.62, 95% CI [0.33, 1.15], p=0.13), and (OR=0.67, 95% CI [0.39, 1.16], p=0.15) respectively, and these findings suggest non-significant interventions towards Trachoma preventionand elimination effort. Surgery for advanced Trachomatous trichiasis had increased odds of (OR=3.10, 95% CI [1.36, 7.08], p=0.0007), favoring communities without trichiasis surgery interventions. The pooled overall summary effect measure of ‘SAFE’ strategy program component suggests a statistically non-significant probability of (OR=0.86, 95% CI [0.55, 1.36], p=0.52), I2= 99%, p=0.001,to eliminate chlamydial trachomatis infections andits related blindness in Africa. This review found no statistical difference between communities and individuals who received the SAFE strategy intervention and those in the control group. These results indicate that there is no significant evidence that the implementation of the ‘SAFE’ strategy program componentseliminate chlamydial trachomatis infections,nor  reduce the prevalenceof trachoma-related blindness among children and adults in Africa.

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ISSN: 2213-1356

Publisher: Scholar Touch Publishers

Area/Scope: Business, Economics & Management; Social Science, Literature, Arts & Humanities; Engineering & Technology; Life Science & Physical Science, Health & Medical Science

Frequency: Monthly

Format: Online & Print

Language: English

Review Process: Double Blinded

Access: Open Access