The impact of medical services on trachoma in a Gambian village: antibiotics alone are not the answer

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Abstract
We have measured the prevalence of active trachoma in children aged less than 15 years in the Gambian village of Keneba, which has had excellent free medical care and a continuous supply of antibiotics since 1974. The prevalence was 13%, with the peak prevalence (20%) occurring in the 2 to 3-year age group. Of 71 cases diagnosed, only 23 (33%) had complained of ocular symptoms in the previous 3 months, in spite of the fact that 66 (94%) had attended the clinic. Only five had been diagnosed as having trachoma by the duty paediatrician (7%). Compliance with treatment was poor, with only 29 subjects returning for continued treatment (41%), and at follow-up 16 months later 22 of 64 subjects still had active disease (34%). We conclude that the widespread use of antimicrobial agents does not preclude the persistence of endemic disease. Socio-economic improvement or behavioural changes appear necessary for the control of trachoma in endemic areas. In the meantime there is a need for greater awareness of the disease both among clinicians in endemic areas and among the communities afflicted.