SAFE strategy for trachoma — DTM&H MCQ
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Correct answer: B — Surgery for trichiasis, Antibiotics (azithromycin), Facial cleanliness, Environmental improvement
The correct answer is B: Surgery for trichiasis, Antibiotics (azithromycin), Facial cleanliness, Environmental improvement. This is the WHO SAFE strategy, the internationally endorsed framework for trachoma elimination that underpins UK Diploma in Tropical Medicine and Hygiene teaching and UK-supported NTD programmes in Ethiopia. Surgery corrects trichiasis to prevent corneal damage and blindness, mass antibiotic distribution (single-dose azithromycin) clears ocular Chlamydia trachomatis infection and interrupts transmission, facial cleanliness reduces eye-seeking fly contact and ocular discharge spread, and environmental improvement (safe water access, sanitation, fly control) reduces community-level transmission. Each letter corresponds precisely to a defined, evidence-based pillar recommended for endemic districts such as those in Ethiopia, which carries the world's largest trachoma burden. Why the other options are wrong: E. Screening, Active case finding, Follow-up, Education: this is a generic disease-control framework, not the defined WHO acronym; it omits the essential surgical and antibiotic components specific to trachoma pathology. A. Surveillance, Azithromycin distribution, Fly control, Evaluation: mixes programme monitoring terms with only one correct SAFE element (antibiotics); it omits surgery for trichiasis and misassigns letters that do not match WHO terminology. C. Screening, Antibiotic prophylaxis, Face washing, Eyelid surgery: reorders correct concepts under the wrong letters and mislabels antibiotics as prophylaxis rather than mass treatment for active infection; the SAFE order and definitions are fixed by WHO. D. Surgery, Anti-inflammatory drops, Facial care, Eradication: anti-inflammatory drops have no role in trachoma control, and eradication (elimination as a public health problem) is a programme goal, not an intervention pillar. Key point: SAFE stands specifically for Surgery (trichiasis), Antibiotics (azithromycin), Facial cleanliness, and Environmental improvement, the four WHO-defined pillars for trachoma elimination.
Reference: World Health Organization, Trachoma fact sheet (2024), who.int/news-room/fact-sheets/detail/trachoma