RESUMO
PURPOSE: Trachoma, a blinding conjunctivitis, is the result of repeated infection with Chlamydia trachomatis. There are no recent data for the state of Roraima, Brazil, where it was thought that trachoma no longer existed. These data are derived from school children sampled in this state, with additional data collected from the contacts of children with trachoma. DESIGN: A population-based cross-sectional study with random sampling of students in grades 1 through 4 of all public schools within municipalities where the human development index was less than the national average in 2003. The sample was stratified according to population size. PARTICIPANTS: A sample size of 7200 was determined and a total of 6986 (93%) students were examined, along with an additional 2152 contacts. METHODS: All students were examined for trachoma according to World Health Organization criteria. Demographic data and contact information also was collected. The family and school contacts of students with trachoma then were located and examined. MAIN OUTCOME MEASURES: Prevalence and grade of trachoma, age, gender, race, and municipality location. RESULTS: The overall prevalence of trachoma was 4.5% (95% confidence interval [CI], 3.7%-5.3%), but there were municipalities within the state where the prevalence of inflammatory trachoma was more than 10%. The prevalence was greater in rural areas (4.9%; 95% CI, 3.7%-6.0%) compared with urban areas (3.9%; 95% CI, 2.9%-4.9%). Living in indigenous communities was associated with trachoma (odds ratio, 1.6; 95% CI, 0.9-2.6). An additional 2152 contacts were examined, and the overall trachoma prevalence was 9.3% (95% CI, 8.1-10.5). CONCLUSIONS: Trachoma continues to exist in Roraima, Brazil, where there are municipalities with a significant prevalence of disease. The indigenous population is highly mobile, crossing state and international borders, raising the possibility of trachoma in neighboring countries. Trachoma prevalence among the contacts of students with trachoma was higher than the school population, highlighting the importance of contact tracing. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Assuntos
Tracoma/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Brasil/epidemiologia , Criança , Pré-Escolar , Estudos Transversais , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , População , Prevalência , População Rural/estatística & dados numéricos , Instituições Acadêmicas , Distribuição por Sexo , Tracoma/classificação , Tracoma/diagnóstico , População Urbana/estatística & dados numéricos , Adulto JovemRESUMO
Purpose: Trachoma, a blinding conjunctivitis, is the result of repeated infection with Chlamydia trachomatis.There are no recent data for the state of Roraima, Brazil, where it was thought that trachoma no longer existed. These data are derived from school children sampled in this state, with additional data collected from thecontacts of children with trachoma.Design: A population-based cross-sectional study with random sampling of students in grades 1 through 4 of all public schools within municipalities where the human development index was less than the national averagein 2003. The sample was stratified according to population size. Participants: A sample size of 7200 was determined and a total of 6986 (93%) students were examined, along with an additional 2152 contacts. Methods: All students were examined for trachoma according to World Health Organization criteria. Demographic data and contact information also was collected. The family and school contacts of students with trachoma then were located and examined. Main Outcome Measures: Prevalence and grade of trachoma, age, gender, race, and municipality location. Results: The overall prevalence of trachoma was 4.5% (95% confidence interval [CI], 3.7%5.3%), but there were municipalities within the state where the prevalence of inflammatory trachoma was more than 10%. The prevalence was greater in rural areas (4.9%; 95% CI, 3.7%6.0%) compared with urban areas (3.9%; 95% CI, 2.9%4.9%). Living in indigenous communities was associated with trachoma (odds ratio, 1.6; 95% CI, 0.9 2.6). An additional 2152 contacts were examined, and the overall trachoma prevalence was 9.3% (95% CI, 8.110.5). Conclusions: Trachoma continues to exist in Roraima, Brazil, where there are municipalities with a significant prevalence of disease. The indigenous population is highly mobile, crossing state and international borders, raising the possibility of trachoma in neighboring countries. Trachoma prevalence...
Assuntos
Masculino , Feminino , Humanos , Chlamydia trachomatis , Tracoma , Tracoma/etnologia , Tracoma/prevenção & controleRESUMO
PURPOSE: To assess the ocular health practices within the neonatal units of the City of São Paulo, Brazil. METHODS: A questionnaire was sent to 36 neonatal units that performed 3000 or more deliveries during 2004. Data were collected on Credè's method of ophthalmia neonatorum prophylaxis, red reflex testing, retinopathy of prematurity (ROP) screening and treatment, and ophthalmic referral systems. RESULTS: All of the identified neonatal units completed the survey. Credè's method was used correctly in 31 (86%) units and the red reflex test was performed in 29 (81%) units. All units were aware of the risk factors for ROP, but the examination for its detection was executed on a routine basis in only 31 (86%) units and only 22 (61%) of the units were aware of the correct timing for the first examination for ROP. Treatment for ROP was done by the identifying hospital in 17 (55%) units and 14 (45%) hospitals transferred the neonate to an external service. After the patient's discharge, 30 (83%) neonatal units reported that they appropriately referred neonates for ophthalmic follow up. CONCLUSIONS: Prophylaxis against gonococcal conjunctivitis and the red reflex test need to be implemented more widely, tertiary referral systems need to be established in some services and the management of ROP should be improved. These recommendations may be achieved by designing and implementing guidelines around prevention and control activities to ensure that all avoidable ocular diseases are identified and managed appropriately within this vulnerable age group.
Assuntos
Técnicas de Diagnóstico Oftalmológico/estatística & dados numéricos , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Oftalmia Neonatal/diagnóstico , Padrões de Prática Médica/estatística & dados numéricos , Retinopatia da Prematuridade/diagnóstico , Brasil/epidemiologia , Diagnóstico Precoce , Humanos , Lactente , Recém-Nascido , Oftalmia Neonatal/epidemiologia , Oftalmia Neonatal/prevenção & controle , Avaliação de Resultados em Cuidados de Saúde , Qualidade da Assistência à Saúde , Retinopatia da Prematuridade/epidemiologia , Fatores de Risco , Inquéritos e QuestionáriosRESUMO
BACKGROUND: This paper reports population-based data on the prevalence and causes of visual impairment among children and adults in Botucatu, Brazil. METHODS: A population-based cross-sectional study was conducted involving a random start point and then systematic sampling of an urban Brazilian population in the city of Botucatu. There were approximately 3,300 individuals aged 1 to 91 years who were eligible to participate in the study. Of this sample, 2485 (75.3%) underwent ophthalmic examination. The ophthalmic examination included uncorrected (presenting) and best corrected distance visual acuity using standardized protocols. The primary cause of decreased visual acuity was identified for all patients with visual impairment. RESULTS: Presenting low vision and presenting blindness were found in 5.2% (95% CI: 4.3-6.1) and 2.2% (95% CI: 1.6-2.8) of the population, respectively. Unilateral presenting low vision and unilateral presenting blindness were found in 8.3% (95% CI: 7.2-9.5) and 3.7% (95% CI: 2.9-4.4) of the population respectively. Best corrected low vision was found in 1.3% of the population (95% CI: 0.9-1.7) and best corrected blindness was discovered in 0.4% of people (95% CI: 0.2-0.7). The main cause of presenting low vision was refractive error (72.3%) and cataract was the most prevalent cause of blindness (50%). CONCLUSION: The main causes of low vision and blindness in this Brazilian city were uncorrected refractive errors, cataract, and retinal diseases. Programs to further reduce the burden of visual impairment need to be targeted toward the correction of refractive error and surgery for cataracts.
Assuntos
Baixa Visão , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Catarata/complicações , Catarata/epidemiologia , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Masculino , Prevalência , Erros de Refração/complicações , Erros de Refração/epidemiologia , Doenças Retinianas/complicações , Doenças Retinianas/epidemiologia , Baixa Visão/epidemiologia , Baixa Visão/etiologiaRESUMO
PURPOSE: To determine the prevalence and demographic associations of refractive error in Botucatu, Brazil. METHODS: A population-based, cross-sectional prevalence study was conducted, which involved random, household cluster sampling of an urban Brazilian population in Botucatu. There were 3000 individuals aged 1 to 91 years (mean 38.3) who were eligible to participate in the study. Refractive error measurements were obtained by objective refraction. RESULTS: Objective refractive error examinations were performed on 2454 residents within this sample (81.8% of eligible participants). The mean age was 38 years (standard deviation (SD) 20.8 years, Range 1 to 91) and females comprised 57.5% of the study population. Myopia (spherical equivalent (SE) < -0.5 dropters (D)) was most prevalent among those aged 30-39 years (29.7%; 95% confidence interval (CI) 24.8-35.1) and least prevalent among children under 10 years (3.8%; 95% confidence interval (CI) 1.6-7.3). Conversely hypermetropia (SE > 0.5D) was most prevalent among participants under 10 years (86.9%; 95% CI 81.6-91.1) and least prevalent in the fourth decade (32.5%; 95% CI 28.2-37.0). Participants aged 70 years or older bore the largest burden of astigmatism (cylinder at least -0.5D) and anisometropia (difference in SE of > 0.5D) with a prevalence of 71.7% (95% CI 64.8-78.0) 55.0% (95% CI 47.6-62.2) respectively. Myopia and hypermetropia were significantly associated with age in a bimodal manner (P < 0.001), whereas anisometropia and astigmatism increased in line with age (P < 0.001). Multivariate modeling confirmed age-related risk factors for refractive error and revealed several gender, occupation and ethnic-related risk factors. CONCLUSIONS: These results represent previously unreported data on refractive error within this Brazilian population. They signal a need to continue to screen for refractive error within this population and to ensure that people have adequate access to optical correction.