The burden of trachoma in the rural Nile Delta of Egypt: a survey of Menofiya governorate

Background-Evidence of widespread distribution of trachoma in Egypt had not been clarified as previous surveys were limited to individual communities which may not have been representative of the general population. The Nile Delta of Egypt presents a unique environment for trachoma to persist. Econo mic improvements in the past decade have affected even the poorest rural en vironments; availability of electricity is now found in many rural communit ies. Availability of water in Nile Delta has always been good but poor hygi enic conditions have been the primary factor in trachoma transmission. A su rvey of trachoma was undertaken in Menofiya governorate to determine if Egy pt should be identified as trachoma endemic and targeted for trachoma contr ol efforts. Methods-A multistage random cluster study design was used with the target p opulation defined as adults aged 50 and over and children aged 2-6 years fr om throughout the governorate. Among preschool children only trachoma was g raded while among adults presenting visual acuity and cause of vision loss or blindness were also recorded. Adults were interviewed regarding past tri chiasis surgery; those currently with trichiasis or a history of trichiasis surgery were also interviewed regarding outcome of surgery. Results-A total of 3272 children aged 2-6 and 3322 adults age 50+ were enum erated. Among the children 81.3% were examined and among the adults 73.0% w ere examined. Active trachoma (follicles (TF) and/or intense inflammation T I)) was found among 36.5% (95% confidence interval (Cl) 34.7-38.3%) of the children. TI was 1.89 (95% CI 1.22-2.94) times more common in rural childre n compared to urban children. The prevalence of trichiasis (TT) in adults w as 6.5%; women had an age adjusted odds of trichiasis of 1.68 (95% CI 1.18- 2.39) compared to men. Trichiasis was 2.11 times (95% CI 1.33-3.37) more co mmon in rural Menofiya compared to urban Menofiya. TT accounts for blindnes s (presenting vision <3/60) in 8% of patients and accounts for 13.2% of vis ual impairment. Overall, trichiasis surgical coverage was 34.4%, slightly h igher among men than women. The outcome of trichiasis surgery was poor in 4 4.4% of cases. Conclusion-Trachoma is a serious public health problem in Menofiya governor ate and a significant contributor to vision loss. These findings would sugg est that continued poor hygienic conditions in rural Egypt have limited the reduction of active trachoma even in the face of significant improvements in socioeconomic status. Furthermore, the high proportion of trichiasis sur gery cases with a poor outcome would indicate a need to reassess current su rgical practices in Egypt and improve training and monitoring.