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Shu’aibu J, Ajege G, Mpyet C, Dejene M, Isiyaku S, Tafida A, Kelly M, Emereuwa I, Courtright P. Optimizing Trichiasis Case Finding to Attain the Elimination of Trachoma as a Public Health Problem. Trop Med Infect Dis 2024; 9:157. [PMID: 39058199 PMCID: PMC11281651 DOI: 10.3390/tropicalmed9070157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 07/04/2024] [Accepted: 07/08/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND As national trachoma programmes increase efforts to reduce the burden of trachomatous trichiasis (TT), TT case finding and referral are critical public health programme components. Our research aimed to explore the most effective and efficient approaches to finding, referring, and managing TT cases. METHODS This was a prospective descriptive study, utilizing both routine programme data and primary data collection. This study compared four different approaches to finding TT cases across three different local government areas (LGAs) in Kano State, Nigeria. Each of the study LGAs was divided into four sub-units to accommodate the four different approaches. RESULTS The number of outreach attendees was 4795 across the four case finding approaches, and this varied hugely, with the smallest number and proportion (403, 0.26%) in settings only employing house-to-house case finding and the largest number and proportion (1901, 0.99%) when town criers were used. That said, the proportion of TT cases among people presenting at outreach was highest (32.5%) when house-to-house case finding was used and lowest (10.3%) when town criers were used. More female TT patients were found (53-70%) and had surgery (79-85%) compared to male cases, across all approaches. The average project expenditure for finding one TT case was similar for approaches that included house-to-house case finding (USD 5.4-6.3), while it was 3.5 times higher (USD 21.5 per TT case found) when town criers were used. DISCUSSION This study found that the house-to-house TT case finding approaches were the most efficient method with the highest yield of TT cases. Including other eye condition and/or vision testing yielded similar results but required more personnel and cost.
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Affiliation(s)
- Joy Shu’aibu
- Sightsavers, Abuja 900231, Nigeria
- Department of Family Medicine, Bingham University, Karu 961105, Nigeria
| | | | - Caleb Mpyet
- Sightsavers, Abuja 900231, Nigeria
- Department of Ophthalmology, University of Jos, Jos 930003, Nigeria
| | - Michael Dejene
- Public Health Consultancy Services, Addis Ababa 1169, Ethiopia
| | | | | | | | | | - Paul Courtright
- Kilimanjaro Centre for Community Ophthalmology, Division of Ophthalmology, University of Cape Town, Cape Town 7925, South Africa
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Wolle MA, Muñoz BE, Mgboji G, Naufal F, Kashaf MS, Mkocha H, West SK. Gender differences in trachomatous scarring prevalence in a formerly trachoma hyperendemic district in Tanzania. PLoS Negl Trop Dis 2024; 18:e0011861. [PMID: 38277341 PMCID: PMC10817155 DOI: 10.1371/journal.pntd.0011861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 12/13/2023] [Indexed: 01/28/2024] Open
Abstract
BACKGROUND Trachoma is a chronic conjunctivitis caused by the bacterium Chlamydia trachomatis. Repeated infections lead to trachomatous conjunctival scarring which can progress to potentially blinding trachomatous trichiasis (TT). In trachoma hyperendemic conditions, women compared to men have an increased risk of scarring and TT, which can progress to blinding corneal opacification. This study determined if there were gender differences in scarring prevalence and severity when trachoma prevalence approaches elimination, in a formerly trachoma hyperendemic region. METHODOLOGY/PRINCIPAL FINDINGS A cross-sectional prevalence study was conducted amongst adults age 15 years and older in Kongwa district, Tanzania in 2019. 3168 persons over age 15 years agreed to be examined and had at least one eye with a gradable image. Ocular photographs were graded for scarring according to a published four-step severity scale. Overall, about half of all study participants had scarring. However, more females (52.3%) had any scarring compared to males (47.2%), OR = 1.22 (95% CI = 1.05-1.43). For every year increase in age, there was a 6.5% increase in the odds of having more severe scarring (95% CI: 5.8%, 7.2%). Women were more likely than men to have severe scarring, OR 2.36 (95% CI: 1.84-3.02). Residence in a community with TF≥10% was associated with a 1.6-fold increased odds of any scarring. CONCLUSIONS/SIGNIFICANCE Overall scarring prevalence and more severe scarring prevalence was higher in females compared to males, even adjusting for age and community TF prevalence. The data suggest that processes occur that lead to women preferentially progressing towards more severe scarring compared to men.
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Affiliation(s)
- Meraf A. Wolle
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Beatriz E. Muñoz
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Glory Mgboji
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Fahd Naufal
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Michael Saheb Kashaf
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, United States of America
| | | | - Sheila K. West
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, United States of America
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3
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Sullivan KM, Harding-Esch EM, Batcho WE, Issifou AAB, Lopes MDFC, Szwarcwald CL, Vaz Ferreira Gomez D, Bougouma C, Christophe N, Kabore M, Bucumi V, Bella AL, Epee E, Yaya G, Trujillo-Trujillo J, Dejene M, Gebretsadik FS, Gebru G, Kebede F, Mathewos T, Cassama ETDS, Sanha S, Barasa E, Sultani HM, Watitu T, Tekeraoi R, Kalua KM, Masika MP, Traoré L, Minnih AO, Abdala M, Massangaie ME, Win Y, Apadinuwe SC, Mishra SK, Sharma S, Amza A, Kadri B, Nassirou B, Mpyet CD, Olobio N, Hussain A, Khan AA, Jambi G, Ko R, Kello AB, Badiane MD, Sarr B, Dalmar A, Elshafie BE, Kabona GE, Kaitaba O, Mwingira U, Simon A, Kanyi S, Awoussi MS, Togbey K, Baayenda G, Francis M, Tukahebwa EM, Bakhtiari A, Keil AP, Maselko J, Westreich D, Garae M, Taleo F, Al-Khateeb TQ, Mwale C, Solomon AW, Gower EW. Gender differences in the surgical management of trachomatous trichiasis: an exploratory analysis of global trachoma survey data, 2015-2019. Int Health 2023; 15:ii58-ii67. [PMID: 38048383 PMCID: PMC10695456 DOI: 10.1093/inthealth/ihad067] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 06/28/2023] [Accepted: 07/26/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Trachomatous trichiasis (TT) is a painful, potentially blinding eye condition that can be managed through epilation or surgery. Women are affected by TT approximately twice as often as men and are believed to face gendered barriers to receiving surgical care to prevent vision loss. METHODS We used data from 817 cross-sectional surveys conducted during 2015-2019 in 20 African countries to estimate the prevalence difference (PD) between female and male eyes for four outcomes potentially indicating gender-related differences in TT management: (1) received surgery and developed postoperative TT (PTT), (2) never offered surgery, (3) offered surgery but declined it, and (4) offered epilation but never offered surgery. RESULTS The prevalence was modestly elevated among female eyes compared with male eyes for having PTT (PD:1.8 [95% confidence limits (CL): 0.6, 3.0]) and having declined surgery for the eye (PD: 6.2 [95% CL: 1.8, 10.7]). The proportion offered epilation was similar by gender (PD:0.5 [95% CL: -0.4, 1.3]), while never having been offered surgery was somewhat more prevalent among male eyes (PD: -2.1 [95% CL: -3.5, -0.7]). CONCLUSIONS Our results suggest potential gender differences in TT management. More research is needed to determine the causes and implications of the observed differences.
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Affiliation(s)
- Kristin M Sullivan
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Emma M Harding-Esch
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Wilfrid E Batcho
- Programme National De Lutte Contre Les Maladies Transmissibles, Ministère De La Santé, Cotonou, Benin
| | | | | | - Celia Landmann Szwarcwald
- Institute of Scientific and Technological Communication and Information in Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | | | - Clarisse Bougouma
- Direction de la Protection de la Santé de la Population, Ministère de la Santé, Burkina Faso
| | - Nassa Christophe
- Attaché de Santé en Épidémiologie, Programme National de Lutte Contre Les MTN, Burkina Faso
| | - Martin Kabore
- L'unité d'élimination du trachome, PNMTN, Ouagadougou, Burkina Faso
| | - Victor Bucumi
- Département En Charge des Maladies Tropicales, Négligées Ministère De La Santé Publique Et De La Lutte Contre Le Sida, Bujumbura, Burundi
| | - Assumpta L Bella
- Programme National de Lutte Contre La Cecite, Ministère de la Santé Publique, Yaoundé, Cameroun
| | - Emilienne Epee
- Department Of Ophthalmology, University of Yaoundé Yaounde Centre/Ministère de la Santé Publique, Yaoundé, Cameroun
| | - Georges Yaya
- Ministère de la Santé Publique, Bangui, Central African Republic
| | - Julian Trujillo-Trujillo
- Subdirectorate of Communicable Diseases, Ministry of Health and Social Protection, Bogotá, Colombia
| | | | - Fikre Seife Gebretsadik
- Neglected Tropical Disease Prevention and Control Program, Ministry of Health, Addis Ababa, Ethiopia
| | - Genet Gebru
- Neglected Tropical Disease Prevention and Control Program, Ministry of Health, Addis Ababa, Ethiopia
| | - Fikreab Kebede
- Neglected Tropical Disease Prevention and Control Program, Ministry of Health, Addis Ababa, Ethiopia
| | - Tsedeke Mathewos
- Neglected Tropical Disease Prevention and Control Program, Ministry of Health, Addis Ababa, Ethiopia
| | | | - Salimato Sanha
- Programa Nacional De Sau´de De Visão, Minsap, Bissau, Guinea-Bissau
| | | | | | | | | | - Khumbo M Kalua
- Blantyre Institute for Community Outreach, Blantyre, Malawi
| | - Michael P Masika
- Department of Clinical and Medical Rehabilitation Services, Ministry of Health, Lilongwe, Malawi
| | - Lamine Traoré
- National Eye Health Program, Ministry of Health and Social Development, Mali
| | - Abdallahi O Minnih
- Département Des Maladies Transmissibles, Ministère De La Santé Nouakchott, Nouakchott, Mauritania
| | - Mariamo Abdala
- Direção Nacional de Saúde Pública, Ministerio Da Saude, Maputo, Mozambique
| | | | - Ye Win
- Department of Public Health, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | | | - Sailesh Kumar Mishra
- National Society for Comprehensive Eye Care, Nepal Netra Jyoti Sangh, Kathmandu, Nepal
| | | | - Abdou Amza
- Programme National De Santé Oculaire, Ministère De La Santé Publique, Niamey, Niger
| | - Boubacar Kadri
- Programme National De Santé Oculaire, Ministère De La Santé Publique, Niamey, Niger
| | - Beido Nassirou
- Programme National De Santé Oculaire, Ministère De La Santé Publique, Niamey, Niger
| | - Caleb D Mpyet
- Department of Ophthalmology, University of Jos, Jos, Plateau, Nigeria
| | - Nicholas Olobio
- Neglected Tropical Diseases Division, Department of Public Health, Federal Ministry of Health, Abuja, Nigeria
| | - Arif Hussain
- Community Ophthalmology, College of Ophthalmology & Allied Vision Sciences (COAVS), Mayo Hospital Lahore, Lahore, Pakistan
| | - Asad Aslam Khan
- College of Ophthalmology and Allied Vision Sciences, Mayo Hospital, Lahore, Pakistan
| | - Garap Jambi
- Prevention of Blindness Committee, PNG Eye Care, Boroko, Papua New Guinea
| | - Robert Ko
- National Department of Health, Waigani, Papua New Guinea
| | - Amir B Kello
- AF/UCU UHC/Communicable and Noncommunicable Diseases Unit, ESPEN, World Health Organization, Brazzaville, Republic of Congo
| | - Mouctar D Badiane
- Programme National de Promotion de La Santé Oculaire, Ministère de la Santé et de L'Action Sociale, Dakar, Senegal
| | - Boubacar Sarr
- Ministère de la Santé et de l'Action Sociale, Senegal
| | | | - Balgesa E Elshafie
- National Program for Prevention of Blindness, Federal Ministry of Health, Khartoum, Sudan
| | - George E Kabona
- Neglected Tropical Diseases Control Program, Ministry of Health, Dodoma, Tanzania
| | - Oscar Kaitaba
- Neglected Tropical Diseases Control Program, Ministry of Health, Dodoma, Tanzania
| | - Upendo Mwingira
- Neglected Tropical Diseases Control Program, Ministry of Health, Dodoma, Tanzania
| | - Alistidia Simon
- Neglected Tropical Diseases Control Program, Ministry of Health, Dodoma, Tanzania
| | - Sarjo Kanyi
- National Eye Health Programme, Ministry of Health and Social Welfare, Banjul, The Gambia
| | | | - Kwamy Togbey
- Programme National des Maladies Tropicales Negligées, Ministry of Health, Public Hygiene and Universal Access to Care, Lomé, Togo
| | - Gilbert Baayenda
- Neglected Tropical Diseases Control, Ministry of Health, Kampala, Uganda
| | - Mugume Francis
- Neglected Tropical Diseases Control, Ministry of Health, Kampala, Uganda
| | - Edridah M Tukahebwa
- Vector-Borne and Neglected Tropical Diseases, Ministry of Health, Kampala, Uganda
| | - Ana Bakhtiari
- International Trachoma Initiative, Task Force for Global Health, Decatur, Georgia, USA
| | - Alexander P Keil
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Joanna Maselko
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Daniel Westreich
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Mackline Garae
- Department of Neglected Tropical Diseases, Vanuatu Ministry of Health, Port Vila, Vanuatu
| | - Fasiah Taleo
- Department of Neglected Tropical Diseases, Vanuatu Ministry of Health, Port Vila, Vanuatu
| | | | - Consity Mwale
- Kitwe Teaching Eye Hospital, Ministry of Health, Kitwe, Zambia
| | - Anthony W Solomon
- Global Neglected Tropical Diseases Programme, World Health Organization, Geneva, Switzerland
| | - Emily W Gower
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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4
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Arney JK, Headland MK, Bertone AM, Meite A, Ettiegne-Traore V, Asemanyi-Mensah K, Dede Teiko Dzathor I, Kargbo-Labour I, Jalloh U, Houck P, Stukel D. Synthesis of findings from the literature and a qualitative research study on the impacts of gender, disability, and ethnicity in Neglected Tropical Diseases programs. PLoS Negl Trop Dis 2023; 17:e0011782. [PMID: 38048347 PMCID: PMC10721307 DOI: 10.1371/journal.pntd.0011782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 12/14/2023] [Accepted: 11/09/2023] [Indexed: 12/06/2023] Open
Abstract
INTRODUCTION Act to End NTDs | West, a USAID-funded program that supports national governments to eliminate or control five neglected tropical diseases (NTDs) in West Africa including trachoma, lymphatic filariasis (LF), onchocerciasis, schistosomiasis and soil-transmitted helminthiasis, conducted a gender and social inclusion analysis to determine how NTDs differentially impact various populations and how gender and social norms impact NTD programs to inform future programming. METHODS The study used a mixed methods approach including a literature review; primary qualitative data collection; and monitoring data in Côte d'Ivoire, Sierra Leone, and Ghana. RESULTS Women and girls face additional health risks from many NTDs compared to men and boys. In addition to differential health burden, the social and economic impacts of NTD-related disability or infertility can be particularly dire for women and girls. Men were somewhat less likely to participate in mass drug administration (MDAs) due to: lack of information about campaigns, lack of access due to work, and higher levels of mistrust of the government and concerns about side effects of the medicines. Pregnant and breastfeeding women were sometimes excluded by community drug distributors (CDDs) from certain types of MDAs for which they are eligible. Training participation rates for CDDs and supervisors were nearly universally higher for men than women, even though feedback on the effectiveness of female CDDs was overwhelmingly positive, and female CDDs often have more access to other women in conservative households. The role of a CDD can lead to career and social opportunities for women. However, challenges faced by CDDs were seen as a greater barrier for women, including transportation, safety, household responsibilities, lower education levels, and low or lack of wages. DISCUSSION Programs to address NTDs can promote equity and improve programming by increasing women's participation as CDDs and providing financial compensation. Additionally, programs should prioritize inclusive training for CDDs, and inclusive messaging about MDA for communities.
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Affiliation(s)
| | | | | | - Aboulaye Meite
- Programme National de Lutte Contre les Maladies Tropicales Négligées à Chimiothérapie Préventive, Ministry of Health, Abidjan, Côte d’Ivoire
| | | | - Kofi Asemanyi-Mensah
- Neglected Tropical Diseases Programme, Disease Control and Prevention Department, Ghana Health Service, Public Health Division, Accra, Ghana
| | | | - Ibrahim Kargbo-Labour
- Neglected Tropical Disease Programme, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Umu Jalloh
- Helen Keller International, Freetown, Sierra Leone
| | - Patricia Houck
- Helen Keller International, NYC, New York, United States of America
| | - Diana Stukel
- FHI 360, Washington, DC, United States of America
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5
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Seyum D, Fetene N, Kifle T, Negash H, Kabeto T, Gebre M, Data T, Tadele T, Abayo G, Wondimu A, Butcher R, Bakhtiari A, Willis R, Boyd S, Jimenez C, Negussu N, Tadesse F, Kebede F, Dejene M, Solomon AW, Harding-Esch EM, Sisay A. Prevalence of Trachoma from 66 Impact Surveys in 52 Woredas of Southern Nations, Nationalities and Peoples' and Sidama Regions of Ethiopia, 2017-2019. Ophthalmic Epidemiol 2023; 30:637-646. [PMID: 35473569 PMCID: PMC10581674 DOI: 10.1080/09286586.2022.2065313] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 04/01/2022] [Accepted: 04/07/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Trachoma is endemic in Southern Nations, Nationalities and Peoples' (SNNP) and Sidama regions of Ethiopia. We aimed to measure the prevalence of trachomatous inflammation-follicular (TF) among children aged 1 - 9 years and the prevalence of trachomatous trichiasis (TT) unknown to the health system among people aged ≥15 years following interventions for trachoma in 52 woredas of SNNP and Sidama regions. METHODS From 2017 - 2019, 66 two-stage cluster sampling cross-sectional population-based surveys were carried out in 52 woredas (third-level administrative divisions) using a standardized World Health Organization-recommended survey methodology. This included one impact survey in 40 woredas, two consecutive impact surveys in 10 woredas and three consecutive impact surveys in two woredas. Water, sanitation and Hygiene (WASH) access was assessed using a modified version of the United Nations Children's Fund/WHO Joint Monitoring Programme questionnaire. RESULTS By the end of this survey series, 15 (23%) of the woredas had met the active trachoma elimination threshold (TF prevalence <5%) and 12 (18%) had met the TT threshold (TT ≤ 0.2%). Regarding WASH coverage, 20% of households had access to an improved drinking water source within a 30-min journey and 3% had an improved latrine. There was strong evidence that TF was less common in 4 - 6-year-olds and 7 - 9-year-olds than 1 - 3-year-olds. CONCLUSION Based on the findings, further antibiotic mass drug administration is required in 37 woredas and active TT case finding is needed in 40 woredas. In these surveys, access to WASH facilities was very low; WASH improvements are required.
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Affiliation(s)
- Dawit Seyum
- Orbis International Ethiopia, Orbis International Ethiopia, Addis Ababa, Ethiopia
| | - N Fetene
- Orbis International Ethiopia, Orbis International Ethiopia, Addis Ababa, Ethiopia
| | - Tezera Kifle
- Orbis International Ethiopia, Orbis International Ethiopia, Addis Ababa, Ethiopia
| | - Habtamu Negash
- Orbis International Ethiopia, Orbis International Ethiopia, Addis Ababa, Ethiopia
| | - Temesgen Kabeto
- Orbis International Ethiopia, Orbis International Ethiopia, Addis Ababa, Ethiopia
| | - Mulatu Gebre
- Orbis International Ethiopia, Orbis International Ethiopia, Addis Ababa, Ethiopia
| | - Tadesse Data
- Orbis International Ethiopia, Orbis International Ethiopia, Addis Ababa, Ethiopia
| | - Tafese Tadele
- Southern Nations, Nationalities and Peoples’ Regional Health Bureau, Hawassa, Ethiopia
| | | | | | | | - Ana Bakhtiari
- ITI, Task Force for Global Health, Decatur, GEORGIA, USA
| | - Rebecca Willis
- ITI, Task Force for Global Health, Decatur, GEORGIA, USA
| | - Sarah Boyd
- ITI, Task Force for Global Health, Decatur, GEORGIA, USA
| | | | - Nebiyu Negussu
- Ministry of Health, Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Fentahun Tadesse
- Ministry of Health, Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Fikreab Kebede
- Ministry of Health, Federal Ministry of Health, Addis Ababa, Ethiopia
| | | | - Anthony W. Solomon
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Emma M. Harding-Esch
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Alemayehu Sisay
- Orbis International Ethiopia, Orbis International Ethiopia, Addis Ababa, Ethiopia
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6
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Baayenda G, Mugume F, Mubangizi A, Turyaguma P, Tukahebwa EM, Byakika S, Kahwa B, Kusasira D, Bakhtiari A, Boyd S, Butcher R, Solomon AW, Binagwa B, Agunyo S, Osilo M, Crowley K, Thuo W, French M, Plunkett E, Mosher AW, Harding-Esch EM, Ngondi J. Baseline Prevalence of Trachoma in Refugee Settlements in Uganda: Results of 11 Population-based Surveys. Ophthalmic Epidemiol 2023; 30:580-590. [PMID: 34488539 PMCID: PMC10581675 DOI: 10.1080/09286586.2021.1961816] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 06/29/2021] [Accepted: 07/20/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE There are several settlements in the Northern and Western Regions of Uganda serving refugees from South Sudan and Democratic Republic of Congo (DRC), respectively. Trachoma prevalence surveys were conducted in a number of those settlements with the aim of determining whether interventions for trachoma are required. METHODS An evaluation unit (EU) was defined as all refugee settlements in one district. Cross-sectional population-based trachoma prevalence survey methodologies designed to adhere to World Health Organization recommendations were deployed in 11 EUs to assess prevalence of trachomatous inflammation-follicular (TF) in 1-9-year-olds and trachomatous trichiasis (TT) unknown to the health system in ≥15-year-olds. Household-level water, sanitation and hygiene coverage was also assessed in study populations. RESULTS A total of 40,892 people were examined across 11 EUs between 2018 and 2020. The prevalence of TF in 1-9-year-olds was <5% in all EUs surveyed. The prevalence of trachomatous trichiasis (TT) unknown to the health system in ≥15-year-olds was <0.2% in 5 out of 11 EUs surveyed and ≥0.2% in the remaining 6 EUs. A high proportion of households had improved water sources, but a low proportion had improved latrines or quickly (within a 30-minute return journey) accessible water sources. CONCLUSIONS Implementation of the antibiotic, facial cleanliness and environmental improvement components of the SAFE strategy is not needed for the purposes of trachoma's elimination as a public health problem in these refugee settlements; however, intervention with TT surgery is needed in six EUs. Since instability continues to drive displacement of people from South Sudan and DRC into Uganda, there is likely to be a high rate of new arrivals to the settlements over the coming years. These populations may therefore have trachoma surveillance needs that are distinct from the surrounding non-refugee communities.
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Affiliation(s)
| | | | | | | | | | | | - Binta Kahwa
- Kampala International University Medical School, Kampala, Uganda
| | - Darlson Kusasira
- Refugees Department, Office of the Prime Minister, Kampala, Uganda
| | | | - Sarah Boyd
- Task Force for Global Health, Atlanta, Georgia, USA
| | - Robert Butcher
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Anthony W. Solomon
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | | | | | | | | | | | | | | | - Aryc W. Mosher
- United States Agency for International Development, Washington DC, USA
| | - Emma M. Harding-Esch
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
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7
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Alemayehu A, Mekonen A, Mengistu B, Mihret A, Asmare A, Bakhtiari A, Mengistu B, Jimenez C, Kebede D, Bol D, Tadesse F, Kebede F, Gebru G, Frawley H, Ngondi J, Jemal M, Brady M, Negussu N, Butcher R, McPherson S, Backers S, Solomon AW, Bejiga MD, Harding-Esch EM. Prevalence of Trachoma After Three Rounds of Antibiotic Mass Drug Administration in 13 Woredas of Gambella Region, Ethiopia. Ophthalmic Epidemiol 2023:1-9. [PMID: 38032947 DOI: 10.1080/09286586.2023.2248624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 08/11/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Following baseline surveys in 2013 and 2014, trachoma elimination interventions, including three rounds of azithromycin mass drug administration (MDA), were implemented in 13 woredas (administrative districts) of Gambella Regional State, Ethiopia. We conducted impact surveys to determine if elimination thresholds have been met or if additional interventions are required. METHODS Cross-sectional population-based surveys were conducted in 13 woredas of Gambella Regional State, combined into five evaluation units (EUs), 6─12 months after their last MDA round. A two-stage systematic (first stage) and random (second stage) sampling technique was used. WHO-recommended protocols were implemented with the support of Tropical Data. Household water, sanitation and hygiene (WASH) access was assessed. RESULTS The age-adjusted prevalence of trachomatous inflammation - follicular (TF) in 1-9-year-olds in the five EUs ranged from 0.3-19.2%, representing a general decline in TF prevalence compared to baseline estimates. The age- and gender-adjusted prevalence of trachomatous trichiasis (TT) unknown to the health system in those aged ≥ 15 years ranged from 0.47-3.08%. Of households surveyed, 44% had access to an improved drinking water source within a 30-minute return journey of the house, but only 3% had access to an improved latrine. CONCLUSION In two EUs, no further MDA should be delivered, and a surveillance survey should be conducted after two years without MDA. In one EU, one further round of MDA should be conducted followed by another impact survey. In two EUs, three further MDA rounds are required. Surgery, facial cleanliness and environmental improvement interventions are needed throughout the region.
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Affiliation(s)
- Addisu Alemayehu
- Act to End NTDs East, RTI International, Addis Ababa, Ethiopia End NTDs East, RTI International, Addis Ababa, Ethiopia
| | - Ademe Mekonen
- Health Promotion and Disease Prevention Core Process, Gambella Regional Health Bureau, Ethiopia
| | - Belete Mengistu
- Act to End NTDs East, RTI International, Addis Ababa, Ethiopia End NTDs East, RTI International, Addis Ababa, Ethiopia
| | - Addisalem Mihret
- Act to End NTDs East, RTI International, Addis Ababa, Ethiopia End NTDs East, RTI International, Addis Ababa, Ethiopia
| | - Aemiro Asmare
- Act to End NTDs East, RTI International, Addis Ababa, Ethiopia End NTDs East, RTI International, Addis Ababa, Ethiopia
| | | | - Bekele Mengistu
- Nekemte Specialized Hospital, Eastern Wollega Zone, Oromia Region, Ethiopia
| | | | - Demis Kebede
- Act to End NTDs East, RTI International, Addis Ababa, Ethiopia End NTDs East, RTI International, Addis Ababa, Ethiopia
| | - Doul Bol
- Health Promotion and Disease Prevention Core Process, Gambella Regional Health Bureau, Ethiopia
| | - Fentahun Tadesse
- Neglected Tropical Diseases Team, Disease Prevention and Control Directorate, Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Fikreab Kebede
- Neglected Tropical Diseases Team, Disease Prevention and Control Directorate, Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Genet Gebru
- Neglected Tropical Diseases Team, Disease Prevention and Control Directorate, Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Hannah Frawley
- Act to End NTDs East, RTI International, Washington, DC, USA
| | - Jeremiah Ngondi
- Act to End NTDs East, RTI International, Washington, DC, USA
| | - Mohammed Jemal
- Health Promotion and Disease Prevention Core Process, Gambella Regional Health Bureau, Ethiopia
| | - Molly Brady
- Act to End NTDs East, RTI International, Washington, DC, USA
| | - Nebiyu Negussu
- Neglected Tropical Diseases Team, Disease Prevention and Control Directorate, Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Robert Butcher
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Scott McPherson
- Act to End NTDs East, RTI International, Washington, DC, USA
| | - Sharone Backers
- Act to End NTDs East, RTI International, Addis Ababa, Ethiopia End NTDs East, RTI International, Addis Ababa, Ethiopia
| | - Anthony W Solomon
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | | | - Emma M Harding-Esch
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
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8
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Issifou AAB, Dare A, Badou GA, Harding-Esch EM, Solomon AW, Bakhtiari A, Boyd S, Jimenez C, Harte A, Burgert-Brucker CR, Sintondji FR, Dossa NI, M'Po NTN, Batcho W. Twenty-Three Population-Based Trachoma Prevalence Surveys in the Central and Northern Regions of Benin, 2018-2022. Ophthalmic Epidemiol 2023:1-11. [PMID: 38032921 DOI: 10.1080/09286586.2023.2265796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 03/14/2023] [Indexed: 12/02/2023]
Abstract
PURPOSE Trachoma is an infectious eye disease caused by Chlamydia trachomatis. Infection causes conjunctival inflammation, which can be manifested by the sign known as trachomatous inflammation-follicular (TF). Repeated inflammation leads to eyelid scarring, which in susceptible individuals can cause in-turning of the eyelashes, referred to as trachomatous trichiasis (TT). This article describes 23 population-based surveys conducted in northern and central Benin to determine TF and/or TT prevalence for trachoma elimination purposes. METHODS A total of 18 surveys estimated the prevalence of both TF and TT: two baseline surveys, eight impact surveys after implementation of interventions against trachoma, and eight surveillance surveys. Five other evaluation units (EUs) were surveyed for TT only. To estimate the TF prevalence, a target sample size of 1701 (baseline) and 1164 1-9-year-olds (impact and surveillance) was required, whereas 2818 ≥ 15-year-olds were required to estimate the less prevalent TT. In each EU, individuals were selected by two-stage cluster sampling and examined by certified graders for TF and/or TT. RESULTS A total of 68,613 people were examined. TF prevalence estimates were under the 5% elimination threshold in all surveys. TT prevalence estimates were above the 0.2% elimination threshold in all five TT-only surveys and in four impact surveys, ranging from 0.2-0.57. CONCLUSION TF prevalence in Benin is low, but TT was above 0.2% in nine districts. Increased case-finding and continuing efforts to improve surgery accessibility will be needed to reduce the burden of TT in Benin.
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Affiliation(s)
| | - Aboudou Dare
- Programme National de Lutte contre les Maladies Transmissibles, Ministère De La Santé, Cotonou, Benin
| | | | - Emma M Harding-Esch
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Anthony W Solomon
- Global Neglected Tropical Diseases Programme, World Health Organization, Geneva, Switzerland
| | - Ana Bakhtiari
- International Trachoma Initiative, Task Force for Global Health, Atlanta, Georgia, USA
| | - Sarah Boyd
- International Trachoma Initiative, Task Force for Global Health, Atlanta, Georgia, USA
| | | | - Anna Harte
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | | | | | - Wilfrid Batcho
- Programme National de Lutte contre les Maladies Transmissibles, Ministère De La Santé, Cotonou, Benin
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Wang EY, Kong X, Wolle M, Gasquet N, Ssekasanvu J, Mariotti SP, Bourne R, Taylor H, Resnikoff S, West S. Global Trends in Blindness and Vision Impairment Resulting from Corneal Opacity 1984-2020: A Meta-analysis. Ophthalmology 2023; 130:863-871. [PMID: 36963570 PMCID: PMC10355344 DOI: 10.1016/j.ophtha.2023.03.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 03/10/2023] [Accepted: 03/15/2023] [Indexed: 03/26/2023] Open
Abstract
TOPIC We provide global estimates of the prevalence of corneal blindness and vision impairment in adults 40 years of age and older and examine the burden by age, sex, and geographic region from 1984 through 2020. CLINICAL RELEVANCE Corneal opacities (COs) are among the top 5 causes of blindness worldwide, yet the global prevalence, regional differences, and risk factors are unclear. METHODS Abstracted data from the published literature and surveys were obtained from the Global Burden of Disease Vision Loss Expert Group. We supplemented this by an independent systematic literature search of several databases. Studies that provided CO vision impairment data based on population-based surveys for those 40 years of age or older were included, for a total of 244. For each of the 4 outcomes of blindness and moderate to severe vision impairment (MSVI) caused by trachomatous and nontrachomatous CO (NTCO), time trends and differences in prevalence by region, age, and sex were evaluated using a Poisson log-linear model with a generalized estimating equation method. Age-standardized estimates of global prevalence of blindness and MSVI were calculated using the 2015 United Nations standard populations. RESULTS The global prevalence of blindness resulting from NTCO in those 40 years and older was 0.081% (95% confidence interval [CI], 0.049%-0.315%); that of MSVI was 0.130% (95% CI, 0.087%-0.372%). A significant increase with age was found (prevalence rate ratio, 2.15; 95% CI, 1.99-2.32). Latin America and Europe showed the lowest rates, with 2- to 8-fold higher rates of blindness or MSVI in other regions. The global prevalence of blindness resulting from trachomatous CO in those 50 years and older was 0.0094% (95% CI, 0%-0.0693%); that from MSVI was 0.012% (95% CI, 0%-0.0761%). Blindness resulting from trachomatous CO and MSVI increased with age and female sex, and rates were significantly higher in the African regions. A decrease in trachomatous blindness rates over time was found (prevalence rate ratio, 0.91; 95% CI, 0.86-0.96). DISCUSSION An estimated 5.5 million people worldwide are bilaterally blind or have MSVI resulting from CO, with an additional 6.2 million unilaterally blind. Blindness resulting from trachomatous CO is declining over time, likely because of the massive scaleup of the global trachoma elimination program and overall socioeconomic development. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Erin Y Wang
- Dana Center for Preventive Ophthalmology, Johns Hopkins Medicine, Baltimore, Maryland
| | - Xiangrong Kong
- Dana Center for Preventive Ophthalmology, Johns Hopkins Medicine, Baltimore, Maryland
| | - Meraf Wolle
- Dana Center for Preventive Ophthalmology, Johns Hopkins Medicine, Baltimore, Maryland
| | - Nicolas Gasquet
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Joseph Ssekasanvu
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Silvio P Mariotti
- Department of Non-communicable Diseases, World Health Organization, Geneva, Switzerland
| | - Rupert Bourne
- Cambridge University Hospitals, and Vision and Eye Research Institute, School of Medicine, Anglia Ruskin University, Cambridge, United Kingdom
| | - Hugh Taylor
- Indigenous Eye Health Unit, Melbourne School of Population and Global Health, Melbourne, Australia
| | - Serge Resnikoff
- School of Optometry and Vision Science, University of New South Wales, and Brien Holden Vision Institute, Sydney, Australia, and Organization pour la Prévention de la Cécité, Paris, France
| | - Sheila West
- Dana Center for Preventive Ophthalmology, Johns Hopkins Medicine, Baltimore, Maryland.
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10
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Kanyi S, Hydara A, Sillah A, Mpyet C, Harte A, Bakhtiari A, Willis R, Jimenez C, Aboe A, Bailey R, Harding-Esch EM, Solomon AW, Joof BM. The Gambia Trachomatous Trichiasis Surveys: Results from Five Evaluation Units Confirm Attainment of Trachoma Elimination Thresholds. Ophthalmic Epidemiol 2023:1-9. [PMID: 37401113 DOI: 10.1080/09286586.2023.2213320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 04/12/2023] [Accepted: 05/09/2023] [Indexed: 07/05/2023]
Abstract
INTRODUCTION Trichiasis is present when in-turned eyelashes touch the eyeball. It may result in permanent vision loss. Trachomatous trichiasis (TT) is caused by multiple rounds of inflammation associated with conjunctival Chlamydia trachomatis infection. Surveys have been designed to estimate the prevalence of TT in evaluation units (EUs) of trachoma-endemic countries in order to help develop appropriate programme-level plans. In this study, TT-only surveys were conducted in five EUs of The Gambia to determine whether further intensive programmatic action was required. METHODS Two-stage cluster sampling was used to select 27 villages per EU and ~25 households per village. Graders assessed the TT status of individuals aged ≥15 years in each selected household, including the presence or absence of conjunctival scarring in those with TT. RESULTS From February to March 2019, 11595 people aged ≥15 years were examined. A total of 34 cases of TT were identified. All five EUs had an age- and gender-adjusted prevalence of TT unknown to the health system <0.2%. Three of five EUs had a prevalence of 0.0%. CONCLUSION Using these and other previously collected data, in 2021, The Gambia was validated as having achieved national elimination of trachoma as a public health problem. Trachoma is still present in the population, but as its prevalence is low, it is unlikely that today's youth will experience the exposure to C. trachomatis required to precipitate TT. The Gambia demonstrates that with political will and consistent application of human and financial resources, trachoma can be eliminated as a public health problem.
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Affiliation(s)
- Sarjo Kanyi
- The National Eye Health Programme, Ministry of Health, Banjul, Kanifing, The Gambia
| | - Abba Hydara
- Sheikh Zayed Regional Eye Care Center, Banjul, Kanifing, The Gambia
| | - Ansumana Sillah
- The National Eye Health Programme, Ministry of Health, Banjul, Kanifing, The Gambia
| | - Caleb Mpyet
- Department of Ophthalmology, University of Jos, Jos, Nigeria
- Sightsavers Nigeria Country Office, Kaduna, Nigeria
| | - Anna Harte
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Ana Bakhtiari
- International Trachoma Initiative, Task Force for Global Health, Atlanta, Georgia, USA
| | - Rebecca Willis
- International Trachoma Initiative, Task Force for Global Health, Atlanta, Georgia, USA
| | | | - Agatha Aboe
- Department of Ophthalmology, University of Jos, Jos, Nigeria
| | - Robin Bailey
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Emma M Harding-Esch
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Anthony W Solomon
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
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11
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Bah MM, Sakho F, Goepogui A, Nieba LC, Cisse A, Courtright P, Harte AJ, Burgert-Brucker C, Jimenez C, Lama PL, Sagno M, Bakhtiari A, Boyd S, Solomon AW, Kelly M, James F, Tenkiano MS, Harding-Esch EM, Dicko BM. The Prevalence of Trachomatous Trichiasis in People Aged 15 Years and Over in Six Evaluation Units of Gaoual, Labé, Dalaba and Beyla Districts, Guinea. Ophthalmic Epidemiol 2023:1-8. [PMID: 37377215 PMCID: PMC10581669 DOI: 10.1080/09286586.2023.2192269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 02/04/2023] [Accepted: 03/14/2023] [Indexed: 06/29/2023]
Abstract
PURPOSE Trachoma is a public health problem in 42 countries. Inflammation associated with repeated ocular infection with Chlamydia trachomatis can cause the eyelid to scar and turn inwards, resulting in the eyelashes rubbing against the eyeball, known as trachomatous trichiasis (TT). In Guinea, baseline surveys conducted in 2013 reported inflammatory trachoma prevalences below the World Health Organization (WHO) threshold for elimination, but TT prevalences above threshold. Given this epidemiological context and time since baseline survey, TT-only surveys were conducted in selected districts to determine current TT prevalence. The results of this study provide critical data for assessing Guinea's achievement of trachoma elimination targets. METHODS Four health districts, consisting of six evaluation units (EU), were surveyed. In each EU, field teams visited 29 clusters with a minimum 30 households included in each. Participants aged≥15 years were examined by certified graders trained to identify TT and determine whether management had been offered. RESULTS A total of 22,476 people were examined, with 48 TT cases across the six EUs identified. Five of six EUs had an age-and-gender adjusted TT-prevalence unknown to the health system less than 0.2%, whereas one EU, Beyla 2, had an adjusted TT prevalence of 0.24%. CONCLUSION These TT-only surveys, along with findings from other trachoma interventions, suggest that Guinea is close to achieving elimination of trachoma as a public health problem. This study demonstrates the value of undertaking TT-only surveys in settings where baseline surveys indicated active trachoma prevalences below WHO elimination threshold, but TT prevalences above it.
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Affiliation(s)
- Midiaou M. Bah
- Neglected Tropical Diseases, Sightsavers, Conakry, Guinea
| | - Fatoumata Sakho
- Ministère de la Santé, National Programme for the Control of Neglected Tropical Diseases, Conakry, Guinea
| | - André Goepogui
- Ministère de la Santé, National Programme for the Control of Neglected Tropical Diseases, Conakry, Guinea
| | - Luc C. Nieba
- Ministère de la Santé, National Programme for the Control of Neglected Tropical Diseases, Conakry, Guinea
| | | | - Paul Courtright
- Kilimanjaro Centre for Community Ophthalmology, Division of Ophthalmology, University of Cape Town, Cape Town, South Africa
| | - Anna J. Harte
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Clara Burgert-Brucker
- Neglected Tropical Diseases, RTI International, Washington, District of Columbia, USA
| | | | - Pierre L. Lama
- Ministère de la Santé, National Programme for the Control of Neglected Tropical Diseases, Conakry, Guinea
| | - Michel Sagno
- Ministère de la Santé, National Programme for the Control of Neglected Tropical Diseases, Conakry, Guinea
| | - Ana Bakhtiari
- International Trachoma Initiative, Task Force for Global Health, Atlanta, Georgia, USA
| | - Sarah Boyd
- International Trachoma Initiative, Task Force for Global Health, Atlanta, Georgia, USA
| | - Anthony W. Solomon
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Michaela Kelly
- Neglected Tropical Diseases, Sightsavers, Haywards Heath, UK
| | - Fiona James
- Neglected Tropical Diseases, Sightsavers, Haywards Heath, UK
| | | | - Emma M. Harding-Esch
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
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Muche N, Wasihun Y, Wondiye H, Bogale EK, Anagaw TF. Behavioral Responses for Face Cleanliness Message to Prevent Trachoma Among Mothers Having Children Age 1-9 Years Old, in Fogera District, Northwest Ethiopia: An Application of Extended Parallel Process Model. Int J Gen Med 2023; 16:1927-1941. [PMID: 37228742 PMCID: PMC10204751 DOI: 10.2147/ijgm.s412380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 05/12/2023] [Indexed: 05/27/2023] Open
Abstract
Background Trachoma is an eye disease caused by bacteria called Chlamydia trachomatis. This infection causes papillary and/or follicular inflammation of the tarsal conjunctiva referred to as active trachoma. Active trachoma prevalence among 1 to 9 years old children is 27.2% in Fogera district (study area). Many people still require the implementation of the face cleanliness components of the SAFE strategy. Even if face cleanness is an important component to prevent trachoma, there is limited research done on this area. Therefore, the purpose of this study is to assess behavioral responses to face cleanliness messages to prevent trachoma among mothers having children aged 1 to 9 years old. Methods A community-based cross-sectional study was conducted with the guidance of an extended parallel process model in Fogera District from December 01 to December 30, 2022. A multi-stage sampling technique was used to select 611 study participants. Interviewer administered questionnaire was used to collect the data. Bivariable and multivariable logistic regression analysis was done to identify predictors of behavioral responses using SPSS V.23 significant variables were declared by AOR at a 95% confidence interval and a p-value <0.05. Result Among the total participants, 292 (47.8%) were in danger control. Residence [AOR = 2.91; 95% CI: (1.44-3.86)], marital status [AOR = 0.79; 95% CI: (0.667-0.939)], level of education [AOR = 2.74; 95% CI: (1.546-3.65)], family size [AOR = 0.57; 95% CI: (0.453-0.867)], round trip to collect water [AOR = 0.79; 95% CI: (0.423-0.878)], having information about face washing [AOR = 3.79; 95% CI: (2.661-5.952)], Source of an information health facility [AOR = 2.76; 95% CI: (1.645-4.965)], school [AOR = 3.68; 95% CI: (1.648-7.530)], health extension workers [AOR = 3.96; 95% CI: (2.928-6.752)], Women development army [AOR = 2.809; 95% CI: (1.681-4.962)], knowledge [AOR = 2.065; 95% CI: (1.325-4.427)] self-esteem [AOR = 1.013; 95% CI: (1.001-1.025)], self-control [AOR = 1.132; 95%CI: (1.04-1.24)], and future orientation [AOR = 2.16; 95% CI: (1.345-4.524)] were found to be statistically significant predictors of behavioral response. Conclusion Less than half of the participants were in the danger control response. Residence, marital status, level of education, family size, face-washing information, source of information, knowledge, self-esteem, self-control, and future orientation were independent predictors of face cleanliness. Strategies of face cleanliness messages should give high attention to perceived efficacy with consideration of perceived threat.
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Affiliation(s)
- Natnael Muche
- Department of Health Promotion and Behavioural science, school of Public Health College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Yosef Wasihun
- Department of Health Promotion and Behavioural science, school of Public Health College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Habtamu Wondiye
- Department of Health Promotion and Behavioural science, school of Public Health College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Eyob Ketema Bogale
- Department of Health Promotion and Behavioural science, school of Public Health College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Tadele Fentabil Anagaw
- Department of Health Promotion and Behavioural science, school of Public Health College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
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Trujillo-Trujillo J, Meza-Cárdenas M, Sánchez SB, Zamora SM, Porras A, López de Mesa CB, Bernal Parra LM, Bernal Lizarazú MC, Miller H, Silva JC. Knowledge, Attitudes, and Practices of Hygiene and the Prevention of Trachoma in the Indigenous Population of the Colombian Amazon Vaupés Department. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4632. [PMID: 36901643 PMCID: PMC10001660 DOI: 10.3390/ijerph20054632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/23/2023] [Accepted: 03/02/2023] [Indexed: 06/18/2023]
Abstract
The Colombian program to end trachoma implements the component F of the SAFE strategy in the Vaupés department of the Amazon rainforest. Cultural, linguistic, and geographical barriers and the coexistence of an ancestral medical system demand the technical and sociocultural adaptation of this component. A cross-sectional survey combined with focus-group discussions to understand the knowledge, attitudes, and practices of the indigenous population related to trachoma was conducted in 2015. Of the 357 heads of households that participated, 45.1% associated trachoma with a lack of hygiene, and 94.7% associated the concept of hygiene with taking one or more body baths per day, using commercial or handcrafted soap. In total, 93% reported cleaning their children's faces and eyes more often when they have conjunctivitis, but 66.1% also did this with clothes or towels in use, and 52.7% of people shared towels; in total, 32.8% indicated that they would use ancestral medicine to prevent and treat trachoma. The SAFE strategy in Vaupés requires an intercultural approach to facilitate stakeholder support and participation to promote general and facial hygiene, washing clothes with soap, and not sharing towels and clothes to dry and clean children's faces for effective and sustainable elimination of trachoma as a public health problem. This qualitative assessment facilitated an intercultural approach locally and in other Amazonian locations.
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Affiliation(s)
- Julián Trujillo-Trujillo
- Ministry of Health and Social Protection, Bogotá 110311, Colombia
- Escuela de Ciencias de la Salud—ECISA, Universidad Nacional Abierta y a Distancia, UNAD, Bogotá 111511, Colombia
| | - Mónica Meza-Cárdenas
- Ministry of Health and Social Protection, Bogotá 110311, Colombia
- Grupo de Medicina Comunitaria y Salud Colectiva, Maestría en Epidemiología, Facultad de Medicina, Universidad El Bosque, Bogotá 110111, Colombia
| | | | | | - Alexandra Porras
- Grupo de Medicina Comunitaria y Salud Colectiva, Maestría en Epidemiología, Facultad de Medicina, Universidad El Bosque, Bogotá 110111, Colombia
| | | | - Luz Mery Bernal Parra
- Escuela de Ciencias de la Salud—ECISA, Universidad Nacional Abierta y a Distancia, UNAD, Bogotá 111511, Colombia
| | | | - Hollman Miller
- Department of Vaupés, Secretariate of Health, Mitú 970001, Colombia
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Tanywe AC, Green H, Fernandez R. Perceptions and practices of community members relating to trachoma in Africa: a qualitative systematic review. JBI Evid Synth 2022; 20:2445-2474. [PMID: 36065912 DOI: 10.11124/jbies-21-00401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE The objective of this review was to synthesize the perceptions and practices of community members relating to trachoma in Africa. INTRODUCTION Trachoma is the leading cause of blindness worldwide, and Africa is the worst-affected continent. Synthesized evidence relating to the disease has focused on various aspects including epidemiology, control, health education, facial cleanliness, interventions for trachomatous trichiasis, and the burden of trachoma on women. Currently, systematic reviews on perceptions and practices relating to trachoma are lacking despite the existence of primary studies. Filling this knowledge gap is critical for decision-making for effective community uptake of interventions. INCLUSION CRITERIA Qualitative studies on the perceptions and practices relating to trachoma in both health care and community settings in Africa were considered for inclusion. Studies with participants 14 years or older were considered, regardless of gender, health status, religion, or ethnicity. Perceptions included beliefs, perspectives, views, knowledge, and thoughts relating to trachoma. Practices included regular actions relating to trachoma, such as treatment and prevention behaviors. METHODS A search for studies in English was conducted in MEDLINE, CINAHL, Embase, PsycINFO, Sociological Abstracts, BioMed Central, Current Contents, Cochrane Library, and Google Scholar in May 2019 and updated in October 2021. Unpublished studies were searched in MedNar, Index to Thesis, ProQuest Dissertations and Theses Global, World Health Organization, and individual governments' commissioned trachoma reports. Two independent reviewers were involved in study selection, critical appraisal, and data extraction using the JBI tools. Data were synthesized using the JBI meta-aggregative approach. RESULTS Seven studies were included in this review. Participants were people either with or without trachoma. A total of 90 findings were extracted, from which 10 categories were produced and three synthesized findings derived from the categories. The synthesized findings are: understanding and awareness of trachoma influences perceptions of treatment and preventive methods; beliefs and behaviors influence treatment options; economic constraints, socio-cultural beliefs, and risk perceptions influence prevention behaviors and practices. CONCLUSION Various perceptions and practices relating to trachoma exist among community members in Africa. These perceptions and practices are influenced by knowledge, cultural beliefs, economic factors, and environmental factors. The findings suggest the need for decision-makers in policy and practice to consider and include these perceptions and practices when designing interventions to combat trachoma in endemic countries. However, due to the limited number of included studies and their methodological weaknesses, more high-quality studies are needed to have a deeper and broader view on these perceptions and practices.
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Affiliation(s)
- Asahngwa Constantine Tanywe
- Department of Anthropology, University of Yaounde, Cameroon.,The Cameroon Centre for Evidence Based Health Care: A JBI Centre of Excellence, Yaounde, Cameroon
| | - Heidi Green
- Centre for Research in Nursing and Health, St George Hospital, Kogarah, NSW Australia.,Centre for Evidence Based Initiatives in Health Care: A JBI Centre of Excellence, Wollongong, NSW, Australia
| | - Ritin Fernandez
- Centre for Research in Nursing and Health, St George Hospital, Kogarah, NSW Australia.,Centre for Evidence Based Initiatives in Health Care: A JBI Centre of Excellence, Wollongong, NSW, Australia.,School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
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15
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Abstract
Trachoma is a neglected tropical disease caused by infection with conjunctival strains of Chlamydia trachomatis. It can result in blindness. Pathophysiologically, trachoma is a disease complex composed of two linked chronic processes: a recurrent, generally subclinical infectious-inflammatory disease that mostly affects children, and a non-communicable, cicatricial and, owing to trichiasis, eventually blinding disease that supervenes in some individuals later in life. At least 150 infection episodes over an individual's lifetime are needed to precipitate trichiasis; thus, opportunity exists for a just global health system to intervene to prevent trachomatous blindness. Trachoma is found at highest prevalence in the poorest communities of low-income countries, particularly in sub-Saharan Africa; in June 2021, 1.8 million people worldwide were going blind from the disease. Blindness attributable to trachoma can appear in communities many years after conjunctival C. trachomatis transmission has waned or ceased; therefore, the two linked disease processes require distinct clinical and public health responses. Surgery is offered to individuals with trichiasis and antibiotic mass drug administration and interventions to stimulate facial cleanliness and environmental improvement are designed to reduce infection prevalence and transmission. Together, these interventions comprise the SAFE strategy, which is achieving considerable success. Although much work remains, a continuing public health problem from trachoma in the year 2030 will be difficult for the world to excuse.
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Gender bias within a diabetic retinopathy screening programme in Tanzania. Eye (Lond) 2022; 36:33-39. [PMID: 35590053 PMCID: PMC9159029 DOI: 10.1038/s41433-022-02004-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The Kilimanjaro Diabetic Programme has been running since 2010 and screens persons with diabetes for diabetic retinopathy (DR). It was noted that women were less likely to attend follow-up appointments compared to men. The aim of this study was to explore gender biases amongst persons registered with the screening programme. METHODS A prospective mixed-methods study was carried out using a questionnaire of closed-ended questions and a semi-structured interview guide. RESULTS Of the 300 participants included in the quantitative component of the study, 193 (64.3%) were female and 107 (35.7%) were male. Females were significantly less educated (p < 0.001) and self-reported as less likely to attend the tertiary hospital if referred (p = 0.022). Of the married participants, on multivariate analysis, men were significantly more likely to make both financial decisions in the household (p = 0.001) and to decide if, and when, family members should attend hospital compared to women (p = 0.0048), independent of age, education level and whether they were from an urban or rural area. Qualitative analysis of the 33 interviews revealed a good understanding of the threat to vision from DR, but limited appreciation of disease chronicity. A common theme was that men are regarded as the head of the household and therefore make the financial decisions; this was especially true in less educated families. CONCLUSION As screening and treatment facilities for DR are developed in SSA, it is important that strategies are employed to reduce the burden of blindness and visual impairment from the under-utilisation of diabetic eye care services by women.
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ul Hassan E, Kelly M, Waititu T, Olobio N, Kabona G, Mkocha H, Kivumbi P, Mwale C, Mubangizi A, Mugume F, Baayenda G, Mayeku R, Massangaie M, Mbofana MA, Cumaio M, Sisay A, Mersha T, Courtright P. OUP accepted manuscript. Int Health 2022; 14:i24-i28. [PMID: 35385863 PMCID: PMC8986360 DOI: 10.1093/inthealth/ihab086] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 11/25/2021] [Accepted: 12/15/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Michaela Kelly
- Sightsavers, 35 Perrymount Road, Haywards Heath, RH16 3BZ, UK
| | | | - Nicholas Olobio
- National Trachoma Project Manager, Federal Ministry of Health, Nigeria
| | - George Kabona
- Ministry of Health and Social Welfare, Dar es salaam, Tanzania
| | | | - Peter Kivumbi
- Sightsavers, Tanzania Office, Kinondoni District, Dar es Salaam
| | | | | | | | | | | | - Marilia Massangaie
- Department for Diseases Control and Prevention, National Directorate of Public Health, Ministry of Health, Maputo, Mozambique
| | | | | | | | - Tolossa Mersha
- Neglected Tropical Disease Specialist, Oromia Regional Health Bureau, Finfinnee, Ethiopia
| | - Paul Courtright
- Sightsavers, 35 Perrymount Road, Haywards Heath, RH16 3BZ, UK
- Kilimanjaro Centre for Community Ophthalmology, Division of Ophthalmology, University of Cape Town, Cape Town, South Africa
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Wolle MA, Muñoz BE, Naufal F, Kashaf MS, Mkocha H, West SK. Risk factors for the progression of trachomatous scarring in a cohort of women in a trachoma low endemic district in Tanzania. PLoS Negl Trop Dis 2021; 15:e0009914. [PMID: 34797827 PMCID: PMC8604323 DOI: 10.1371/journal.pntd.0009914] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 10/14/2021] [Indexed: 11/28/2022] Open
Abstract
Background Trachoma, a chronic conjunctivitis caused by Chlamydia trachomatis, is the leading infectious cause of blindness worldwide. Trachoma has been targeted for elimination as a public health problem which includes reducing trachomatous inflammation—follicular prevalence in children and reducing trachomatous trichiasis prevalence in adults. The rate of development of trachomatous trichiasis, the potentially blinding late-stage trachoma sequelae, depends on the rate of trachomatous scarring development and progression. Few studies to date have evaluated the progression of trachomatous scarring in communities that have recently transitioned to a low trachomatous inflammation—follicular prevalence. Methodology/Principal findings Women aged 15 and older were randomly selected from households in 48 communities within Kongwa district, Tanzania and followed over 3.5 years for this longitudinal study. Trachomatous inflammation—follicular prevalence was 5% at baseline and at follow-up in children aged 1–9 in Kongwa, Tanzania. 1018 women aged 15 and older had trachomatous scarring at baseline and were at risk for trachomatous scarring progression; 691 (68%) completed follow-up assessments. Photographs of the upper tarsal conjunctiva were obtained at baseline and follow-up and graded for trachomatous scarring using a previously published four-step severity scale. The overall cumulative 3.5-year progression rate of scarring was 35.3% (95% CI 31.6–39.1). The odds of TS progression increased with an increase in age in women younger than 50, (OR 1.03, 95% CI 1.01–1.05, p = 0.005) as well as an increase in the household poverty index (OR 1.29, 95% CI 1.13–1.48, p = 0.0002). Conclusions/Significance The 3.5-year progression of scarring among women in Kongwa, a formerly hyperendemic now turned hypoendemic district in central Tanzania, was high despite a low active trachoma prevalence. This suggests that the drivers of scarring progression are likely not related to on-going trachoma transmission in this district. Trachoma, a chronic conjunctivitis caused by Chlamydia trachomatis, presents with follicles (trachomatous inflammation—follicular, TF) in children which leads to trachomatous conjunctival scarring (TS) in young adults. TS can progress to the in-turning of eyelashes, trachomatous trichiasis (TT) which places individuals at high risk of irreversible vision loss. Few studies to date have evaluated the progression of TS in communities that have recently transitioned to a low trachoma prevalence. We studied the progression of TS in women in Kongwa, Tanzania a district that recently transitioned to a low prevalence of trachoma. We found that the overall cumulative progression of scarring was 35.3% over 3.5 years. The scarring progression rate observed is very similar to what we observed a decade prior in Kongwa when the trachoma prevalence was very high. Our findings suggest that once scarring has developed it continues to progress irrespective of the current trachoma environment. This has potential ramifications for trachoma elimination efforts. An area could achieve the elimination of TF and still have to deal with scarring progression, which may lead to the development of TT. If this occurs: 1) elimination of TT will be delayed which will delay the overall elimination of trachoma as a public health problem, and 2) the limited resources available to elimination programs may need to be re-allocated.
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Affiliation(s)
- Meraf A. Wolle
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, United States of America
- * E-mail:
| | - Beatriz E. Muñoz
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Fahd Naufal
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Michael Saheb Kashaf
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Harran Mkocha
- Kongwa Trachoma Project, Kongwa, United Republic of Tanzania
| | - Sheila K. West
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, United States of America
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Amoah B, Fronterre C, Johnson O, Dejene M, Seife F, Negussu N, Bakhtiari A, Harding-Esch EM, Giorgi E, Solomon AW, Diggle PJ. Model-based geostatistics enables more precise estimates of neglected tropical-disease prevalence in elimination settings: mapping trachoma prevalence in Ethiopia. Int J Epidemiol 2021; 51:468-478. [PMID: 34791259 PMCID: PMC9082807 DOI: 10.1093/ije/dyab227] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 09/29/2021] [Indexed: 12/05/2022] Open
Abstract
Background As the prevalences of neglected tropical diseases reduce to low levels in some
countries, policymakers require precise disease estimates to decide whether the set
public health targets have been met. At low prevalence levels, traditional statistical
methods produce imprecise estimates. More modern geospatial statistical methods can
deliver the required level of precision for accurate decision-making. Methods Using spatially referenced data from 3567 cluster locations in Ethiopia in the years
2017, 2018 and 2019, we developed a geostatistical model to estimate the prevalence of
trachomatous trichiasis and to calculate the probability that the trachomatous
trichiasis component of the elimination of trachoma as a public health problem has
already been achieved for each of 482 evaluation units. We also compared the precision
of traditional and geostatistical approaches by the ratios of the lengths of their 95%
predictive intervals. Results The elimination threshold of trachomatous trichiasis (prevalence ≤ 0.2% in individuals
aged ≥15 years) is met with a probability of 0.9 or more in 8 out of the 482 evaluation
units assessed, and with a probability of ≤0.1 in 469 evaluation units. For the
remaining five evaluation units, the probability of elimination is between 0.45 and
0.65. Prevalence estimates were, on average, 10 times more precise than estimates
obtained using the traditional approach. Conclusions By accounting for and exploiting spatial correlation in the prevalence data, we
achieved remarkably improved precision of prevalence estimates compared with the
traditional approach. The geostatistical approach also delivers predictions for
unsampled evaluation units that are geographically close to sampled evaluation
units.
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Affiliation(s)
- Benjamin Amoah
- Centre for Health Informatics, Computing and Statistics, Lancaster Medical School, Lancaster University, Bailrigg, Lancaster, UK
| | - Claudio Fronterre
- Centre for Health Informatics, Computing and Statistics, Lancaster Medical School, Lancaster University, Bailrigg, Lancaster, UK
| | - Olatunji Johnson
- Centre for Health Informatics, Computing and Statistics, Lancaster Medical School, Lancaster University, Bailrigg, Lancaster, UK
| | - Michael Dejene
- Michael Dejene Public Health Consultancy Services, Addis Ababa, Ethiopia
| | - Fikre Seife
- Disease Prevention and Control Directorate, Federal Ministry of Health, Addis Ababa, Ethiopia
| | | | - Ana Bakhtiari
- International Trachoma Initiative, Task Force for Global Health, Decatur, GA, USA
| | - Emma M Harding-Esch
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Emanuele Giorgi
- Centre for Health Informatics, Computing and Statistics, Lancaster Medical School, Lancaster University, Bailrigg, Lancaster, UK
| | - Anthony W Solomon
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Peter J Diggle
- Centre for Health Informatics, Computing and Statistics, Lancaster Medical School, Lancaster University, Bailrigg, Lancaster, UK
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Adafrie Y, Redae G, Zenebe D, Adhena G. Uptake of Trachoma Trichiasis Surgery and Associated Factors Among Trichiasis-Diagnosed Clients in Southern Tigray, Ethiopia. Clin Ophthalmol 2021; 15:1939-1948. [PMID: 34007146 PMCID: PMC8121670 DOI: 10.2147/opth.s302646] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 04/06/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Trachoma is the most common infectious cause of blindness in the globe. Trichiasis surgery is the best treatment option for this disease. Despite efforts done to eliminate blinding trachoma, there is limited evidence on the surgical uptake of trachoma trichiasis in Ethiopia. This study was aimed to assess the uptake of trachoma trichiasis surgery in Southern Tigray, Ethiopia. METHODS Mixed cross-sectional study was employed among 409 participants. Study participants were selected using a consecutive sampling technique. Pretested and interviewer-administered data were collected using a structured questionnaire. Binary and multivariable logistic regression was done to identify associated factors. Adjusted odds ratios 95% CI was estimated to show the strength and direction. Variables with p-values <0.05 were considered statistically significant. For qualitative data, 4 focus group discussions were conducted with 40 participants and described by thematic analysis then triangulated with quantitative findings. RESULTS About 234 (57.9%, 95% CI: (53.2, 62.9)) participants utilized trachoma trichiasis surgery (TT). History of trachoma trichiasis (TT) for >2 years [AOR: 0.4, 95% CI: (0.22, 0.72)], informed about surgery program by health workers [AOR: 0.3, 95% CI: (0.13, 0.71)], history of TT surgery [AOR: 0.18, 95% CI: (0.05, 0.6)], absence of someone to care the family [AOR: 14, 95% CI: (6.9, 28.6)], companion [AOR: 8.9, 95% CI: (4.3, 18.3)], nearby health facility [AOR: 2.4, 95% CI: (1.1, 5.4)], work load [AOR: 8.8, 95% CI: (4.6, 17)], fear [AOR: 4.3, 95% CI: (1.8, 10)], and believing eye drop can treat TT [AOR: 3.9, 95% CI: (1.4, 11)] were significantly associated factors. CONCLUSION More than half of the participants accepted the TT surgical uptake. Strengthening community awareness on proper eye care, and effective treatment options, and addressing the negative attitude towards surgical treatment in the community are important measures to achieve the elimination target of trachoma.
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Affiliation(s)
- Yeshialem Adafrie
- Department of Epidemiology, Ofla District Health Office, Tigray, Ethiopia
| | - Getachew Redae
- Department of Epidemiology, College of Health Science, Mekele University, Mekele, Ethiopia
| | - Dawit Zenebe
- Department of Epidemiology, College of Health Science, Mekele University, Mekele, Ethiopia
| | - Girmay Adhena
- Department of Reproductive Health, Tigray Regional Health Bureau, Tigray, Ethiopia
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Sanders AM, Adam M, Aziz N, Callahan EK, Elshafie BE. Piloting a trachomatous trichiasis patient case-searching approach in two localities of Sudan. Trans R Soc Trop Med Hyg 2020; 114:561-565. [PMID: 32307543 PMCID: PMC7405172 DOI: 10.1093/trstmh/traa022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 02/10/2020] [Accepted: 03/13/2020] [Indexed: 11/16/2022] Open
Abstract
Background Approximately 1.9 million people have become blind or visually impaired from trachoma, the leading cause of infectious blindness. Trachoma prevalence surveys conducted in Sudan have shown that thousands of Sudanese suffer from the advanced stages of the disease, trachomatous trichiasis (TT), and warrant sight-saving surgery. Sudan’s National Trachoma Control Program (NTCP) provides free TT surgery; however, given that many TT patients live in remote areas with limited access to health services, identifying patients and providing eye care services has proved challenging. For this reason, the Sudan NTCP piloted a systematic TT case-finding approach to identify patients. Methods In Gedarif state, 11 villages in Baladyat el Gedarif locality and 21 villages in West Galabat locality were included in a TT case-searching activity from September to November 2018. TT case finders were selected from the villages where the activity took place and were trained by ophthalmic medical assistants to identify possible patients. Results Of 66 626 villagers examined, 491 were identified as having TT by TT case finders. Of those, 369 were confirmed as true cases by the TT surgeons, a 75.2% (369/491) success rate. Conclusions The TT case-finding approach provides an example of an effective method for identifying TT patients and should be expanded to other parts of the country known to be endemic for trachoma.
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Affiliation(s)
| | | | | | | | - Belgesa E Elshafie
- National Program for Prevention of Blindness, Federal Ministry of Health, Khartoum, Sudan
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22
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Sanders AM, Abdalla Z, Elshafie BE, Elsanosi M, Nute AW, Aziz N, Callahan EK, Nash SD. Progress toward Elimination of Trachoma as a Public Health Problem in Seven Localities in the Republic of Sudan: Results from Population-Based Surveys. Am J Trop Med Hyg 2020; 101:1296-1302. [PMID: 31595874 PMCID: PMC6896892 DOI: 10.4269/ajtmh.19-0530] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Trachoma is the leading cause of infectious blindness in the world. After baseline surveys demonstrated that Sudan was endemic for trachoma, the Sudan Federal Ministry of Health (FMOH) Trachoma Control Program conducted trachoma prevention and treatment interventions in endemic localities. The Sudan FMOH conducted population-based trachoma prevalence surveys between September 2016 and April 2017 in seven localities across five states of Sudan to document current trachoma prevalence estimates and measure water, sanitation, and hygiene (WASH) indicators. Children aged 1–9 years were examined for five clinical signs of trachoma, and participants of all ages were examined for trachomatous trichiasis (TT). A household questionnaire was administered to gather demographic and WASH-related information. The prevalence of trachomatous inflammation-follicular (TF) in children aged 1–9 years ranged from 0.4% (95% CI: 0.1–1.1%) to 6.4% (95% CI: 3.3–11.9%). Trachomatous trichiasis in those aged 15 years and older ranged from 0.1% (95% CI: 0.0–0.6%) to a high of 4.4% (95% CI: 2.1–9.1%). Of seven localities surveyed, four localities had achieved the elimination threshold of less than 5% TF in children aged 1–9 years. Six localities still required interventions to achieve less than 0.2% TT in those aged 15 years and older. The presence of latrine ranged from a low of 10.8% (95% CI: 5.2–21.1%) to 88.4% (CI: 81.5–93.0%) and clean face among children ranged between 69.5% (95% CI: 63.5–75.0%) and 87.5% (95% CI: 81.2–91.9%). These results demonstrate that Sudan is within reach of eliminating trachoma as a public health problem.
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Affiliation(s)
| | | | - Belgesa E Elshafie
- National Program for Prevention of Blindness, Federal Ministry of Health, Khartoum, Sudan
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Tanywe AC, Matchawe C, Fernandez R, Lapkin S. Perceptions and practices of community members relating to trachoma in Africa: a qualitative systematic review protocol. JBI DATABASE OF SYSTEMATIC REVIEWS AND IMPLEMENTATION REPORTS 2019; 17:2350-2356. [PMID: 31290788 DOI: 10.11124/jbisrir-2017-003820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The objective of this systematic review is to synthesize and present the best available evidence on community perceptions and practices relating to trachoma in Africa. INTRODUCTION Globally, trachoma is the leading cause of blindness and is responsible for about 1.4% of all cases of blindness. The African continent is the worst affected, with about 1.9 million cases of trichiasis (61%). While interventions are currently being implemented to combat the disease in Africa, very little is known by decision makers about community perceptions and practices relating to trachoma, which may hinder successful implementation. INCLUSION CRITERIA Studies with participants, regardless of their health status, gender, religion and ethnicity, aged 14 and over conducted in any African country, will be considered. Studies on Africans, conducted out of the continent and those involving healthcare professionals, will not be included in this review. METHODS Qualitative studies, published in English from 1996 onwards. will be considered. Databases to be searched will include, but not be limited to: PubMed, CINAHL, Embase and PsycINFO. Study selection, critical appraisal and data extraction will be conducted by two independent reviewers, using the appropriate JBI methodology and any disagreement will be resolved by discussion or with a third reviewer. Qualitative findings will be synthesized using the appropriate JBI methodology, following the meta-aggregation approach. Where textual pooling is not possible, the findings will be presented in narrative form. The ConQual approach will be used to grade synthesized findings, and these will be presented in a Summary of Findings.
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Affiliation(s)
- Asahngwa Constantine Tanywe
- Cameroon Centre for Evidence Based Health Care: a Joanna Briggs Institute Centre of Excellence
- Centre for Behavioral and Social Research, Yaounde, Cameroon
| | - Chelea Matchawe
- Cameroon Centre for Evidence Based Health Care: a Joanna Briggs Institute Centre of Excellence
- Institute of Medical Research and Medicinal Plan Studies (IMPM), Yaounde, Cameroon
| | - Ritin Fernandez
- Centre for Evidence Based Initiatives in Health Care: a Joanna Briggs Institute Centre of Excellence
- St George Hospital, Sydney, Australia
- University of Wollongong, Wollongong, Australia
| | - Samuel Lapkin
- Centre for Evidence Based Initiatives in Health Care: a Joanna Briggs Institute Centre of Excellence
- St George Hospital, Sydney, Australia
- University of Wollongong, Wollongong, Australia
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Evans JR, Solomon AW, Kumar R, Perez Á, Singh BP, Srivastava RM, Harding‐Esch E. Antibiotics for trachoma. Cochrane Database Syst Rev 2019; 9:CD001860. [PMID: 31554017 PMCID: PMC6760986 DOI: 10.1002/14651858.cd001860.pub4] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Trachoma is the world's leading infectious cause of blindness. In 1996, WHO launched the Alliance for the Global Elimination of Trachoma by the year 2020, based on the 'SAFE' strategy (surgery, antibiotics, facial cleanliness, and environmental improvement). OBJECTIVES To assess the evidence supporting the antibiotic arm of the SAFE strategy by assessing the effects of antibiotics on both active trachoma (primary objective), Chlamydia trachomatis infection of the conjunctiva, antibiotic resistance, and adverse effects (secondary objectives). SEARCH METHODS We searched relevant electronic databases and trials registers. The date of the last search was 4 January 2019. SELECTION CRITERIA We included randomised controlled trials (RCTs) that satisfied either of two criteria: (a) trials in which topical or oral administration of an antibiotic was compared to placebo or no treatment in people or communities with trachoma, (b) trials in which a topical antibiotic was compared with an oral antibiotic in people or communities with trachoma. We also included studies addressing different dosing strategies in the population. DATA COLLECTION AND ANALYSIS: We used standard methods expected by Cochrane. We assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS We identified 14 studies where individuals with trachoma were randomised and 12 cluster-randomised studies. Any antibiotic versus control (individuals)Nine studies (1961 participants) randomised individuals with trachoma to antibiotic or control (no treatment or placebo). All of these studies enrolled children and young people with active trachoma. The antibiotics used in these studies included topical (oxy)tetracycline (5 studies), doxycycline (2 studies), and sulfonamides (4 studies). Four studies had more than two study arms. In general these studies were poorly reported, and it was difficult to judge risk of bias.These studies provided low-certainty evidence that people with active trachoma treated with antibiotics experienced a reduction in active trachoma at three months (risk ratio (RR) 0.78, 95% confidence interval (CI) 0.69 to 0.89; 1961 people; 9 RCTs; I2 = 73%) and 12 months (RR 0.74, 95% CI 0.55 to 1.00; 1035 people; 4 RCTs; I2 = 90%). Low-certainty evidence was available for ocular infection at three months (RR 0.81, 95% CI 0.63 to 1.04; 297 people; 4 RCTs; I2 = 0%) and 12 months (RR 0.25, 95% CI 0.08 to 0.78; 129 people; 1 RCT). None of these studies assessed antimicrobial resistance. In those studies that reported harms, no serious adverse effects were reported (low-certainty evidence).Oral versus topical antibiotics (individuals)Eight studies (1583 participants) compared oral and topical antibiotics. Only one study included people older than 21 years of age. Oral antibiotics included azithromycin (5 studies), sulfonamides (2 studies), and doxycycline (1 study). Topical antibiotics included (oxy)tetracycline (6 studies), azithromycin (1 study), and sulfonamide (1 study). These studies were poorly reported, and it was difficult to judge risk of bias.There was low-certainty evidence of little or no difference in effect between oral and topical antibiotics on active trachoma at three months (RR 0.97, 95% CI 0.81 to 1.16; 953 people; 6 RCTs; I2 = 63%) and 12 months (RR 0.93, 95% CI 0.75 to 1.15; 886 people; 5 RCTs; I2 = 56%). There was very low-certainty evidence for ocular infection at three or 12 months. Antimicrobial resistance was not assessed. In those studies that reported adverse effects, no serious adverse effects were reported; one study reported abdominal pain with azithromycin; one study reported a couple of cases of nausea with azithromycin; and one study reported three cases of reaction to sulfonamides (low-certainty evidence).Oral azithromycin versus control (communities)Four cluster-randomised studies compared antibiotic with no or delayed treatment. Data were available on active trachoma at 12 months from two studies but could not be pooled because of reporting differences. One study at low risk of bias found a reduced prevalence of active trachoma 12 months after a single dose of azithromycin in communities with a high prevalence of infection (RR 0.58, 95% CI 0.52 to 0.65; 1247 people). The other, lower quality, study in low-prevalence communities reported similar median prevalences of infection at 12 months: 9.3% in communities treated with azithromycin and 8.2% in untreated communities. We judged this moderate-certainty evidence for a reduction in active trachoma with treatment, downgrading one level for inconsistency between the two studies. Two studies reported ocular infection at 12 months and data could be pooled. There was a reduction in ocular infection (RR 0.36, 0.31 to 0.43; 2139 people) 12 months after mass treatment with a single dose compared with no treatment (moderate-certainty evidence). There was high-certainty evidence of an increased risk of resistance of Streptococcus pneumoniae, Staphylococcus aureus, and Escherichia coli to azithromycin, tetracycline, and clindamycin in communities treated with azithromycin, with approximately 5-fold risk ratios at 12 months. The evidence did not support increased resistance to penicillin or trimethoprim-sulfamethoxazole. None of the studies measured resistance to C trachomatis. No serious adverse events were reported. The main adverse effect noted for azithromycin (˜10%) was abdominal pain, vomiting, and nausea.Oral azithromycin versus topical tetracycline (communities)Three cluster-randomised studies compared oral azithromycin with topical tetracycline. The evidence was inconsistent for active trachoma and ocular infection at three and 12 months (low-certainty evidence) and was not pooled due to considerable heterogeneity. Antimicrobial resistance and adverse effects were not reported.Different dosing strategiesSix studies compared different strategies for dosing. There were: mass treatment at different dosing intervals; applying cessation or stopping rules to mass treatment; strategies to increase mass treatment coverage. There was no strong evidence to support any variation in the recommended annual mass treatment. AUTHORS' CONCLUSIONS Antibiotic treatment may reduce the risk of active trachoma and ocular infection in people infected with C trachomatis, compared to no treatment/placebo, but the size of the treatment effect in individuals is uncertain. Mass antibiotic treatment with single dose oral azithromycin reduces the prevalence of active trachoma and ocular infection in communities. There is no strong evidence to support any variation in the recommended periodicity of annual mass treatment. There is evidence of an increased risk of antibiotic resistance at 12 months in communities treated with antibiotics.
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Affiliation(s)
- Jennifer R Evans
- London School of Hygiene & Tropical MedicineCochrane Eyes and Vision, ICEHKeppel StreetLondonUKWC1E 7HT
| | - Anthony W Solomon
- World Health OrganizationDepartment of Control of Neglected Tropical DiseasesGenevaSwitzerland
| | - Rahul Kumar
- King George's Medical UniversityDepartment of PharmacologyLucknowUPIndia226003
| | - Ángela Perez
- Health Technology Assessment InstituteDeveloping Clinical Practice GuidelinesAutopista Norte # 118‐30 Off 201BogotáColombia110111
| | - Balendra P Singh
- King George's Medical UniversityDepartment of Prosthodontics, Crowns and BridgesShahmina RoadFaculty of Dental SciencesLucknowUttar PradeshIndia226003
| | | | - Emma Harding‐Esch
- London School of Hygiene & Tropical MedicineClinical Research Department, Facullty of Infectious and Tropical DiseasesLondonUK
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Hiep NX, Ngondi JM, Anh VT, Dat TM, An TV, Dung NC, Thang ND, Chu BK, Willis R, Bakhtiari A, Pavluck AL, Johnson J, Sidwell J, Brady M, Henry R, Mosher A, Porco TC, Lietman TM, Rotondo LA, Lewallen S, Courtright P, Solomon AW. Trachoma in Viet Nam: results of 11 surveillance surveys conducted with the Global Trachoma Mapping Project. Ophthalmic Epidemiol 2019; 25:93-102. [PMID: 30806534 PMCID: PMC6444206 DOI: 10.1080/09286586.2018.1477964] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Purpose: Following interventions against trachoma in Viet Nam, impact surveys conducted in 2003–2011 suggested that trachoma was no longer a public health problem. In 2014, we undertook surveillance surveys to estimate prevalence of trachomatous inflammation—follicular (TF) and trichiasis. Methods: A population-based prevalence survey was undertaken in 11 evaluation units (EUs) encompassing 24 districts, using Global Trachoma Mapping Project methods. A two-stage cluster sampling design was used in each EU, whereby 20 clusters and 60 children per cluster were sampled. Consenting eligible participants (children aged 1–9 years and adults aged ≥50 years) were examined for trachoma. Results: A total of 9391 households were surveyed, and 20,185 participants (98.8% of those enumerated) were examined for trachoma. EU-level TF prevalence in 1–9-year-olds ranged from 0% to 1.6%. In one cluster (in Hà Giang Province), the percentage of children with TF was 10.3%. The overall pattern of cluster-level percentages of children with TF, however, was consistent with an exponential distribution, which would be consistent with trachoma disappearing. Among people aged ≥50 years, prevalence of trichiasis by EU ranged from 0% to 0.75%; these estimates are equivalent to 0–0.13% in all ages. The prevalence of trichiasis unknown to the health system among people aged ≥50 years, by EU, ranged from 0% to 0.17%, which is equivalent to 0–0.03% in all ages. Conclusion: Findings suggest that trachoma is no longer a public health problem in any of the 11 EUs surveyed. However, given the high proportion of children with TF in one cluster in Hà Giang Province, further investigations will be undertaken.
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Affiliation(s)
- Nguyen Xuan Hiep
- a Viet Nam Institute of Ophthalmology, Ministry of Health , Hanoi , Viet Nam
| | | | - Vu Tuan Anh
- a Viet Nam Institute of Ophthalmology, Ministry of Health , Hanoi , Viet Nam
| | - Tran Minh Dat
- a Viet Nam Institute of Ophthalmology, Ministry of Health , Hanoi , Viet Nam
| | - Tran Van An
- a Viet Nam Institute of Ophthalmology, Ministry of Health , Hanoi , Viet Nam
| | - Nguyen Chi Dung
- a Viet Nam Institute of Ophthalmology, Ministry of Health , Hanoi , Viet Nam
| | - Nguyen Duy Thang
- a Viet Nam Institute of Ophthalmology, Ministry of Health , Hanoi , Viet Nam
| | - Brian K Chu
- c Task Force for Global Health , Decatur , GA , USA
| | | | | | | | | | | | | | - Rob Henry
- f United States Agency for International Development , Washington , DC , USA
| | - Aryc Mosher
- f United States Agency for International Development , Washington , DC , USA
| | - Travis C Porco
- g F.I. Proctor Foundation , San Francisco , CA , USA.,h Department of Ophthalmology , San Francisco , CA , USA.,i Department of Epidemiology & Biostatistics , University of California , San Francisco , CA , USA
| | - Thomas M Lietman
- g F.I. Proctor Foundation , San Francisco , CA , USA.,h Department of Ophthalmology , San Francisco , CA , USA.,i Department of Epidemiology & Biostatistics , University of California , San Francisco , CA , USA
| | | | - Susan Lewallen
- j Kilimanjaro Center for Community Ophthalmology, Division of Ophthalmology , University of Cape Town , Cape Town , South Africa
| | - Paul Courtright
- j Kilimanjaro Center for Community Ophthalmology, Division of Ophthalmology , University of Cape Town , Cape Town , South Africa
| | - Anthony W Solomon
- k Clinical Research Department , London School of Hygiene & Tropical Medicine , London , UK.,l London Centre for Neglected Tropical Disease Research , London , UK
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Prevalence of trachoma within refugee camps serving South Sudanese refugees in White Nile State, Sudan: Results from population-based surveys. PLoS Negl Trop Dis 2019; 13:e0007491. [PMID: 31194761 PMCID: PMC6592575 DOI: 10.1371/journal.pntd.0007491] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 06/25/2019] [Accepted: 05/24/2019] [Indexed: 11/04/2022] Open
Abstract
Background The world is witnessing mass displacement of populations which could impact global efforts to eliminate neglected tropical diseases such as trachoma. On the African continent, South Sudan has experienced high levels of population displacement. Population based baseline trachoma surveys were conducted among refugee camps in two Sudanese localities hosting South Sudanese refugee populations to determine whether the SAFE strategy was warranted. Methodology/Principal findings Cross-sectional, multi-stage, cluster-random surveys were conducted within refugee camps in each of two Sudanese localities, Al Salam and Al Jabalain. For survey sampling, multiple camps within each locality were combined to form the sampling frame for that locality. Household water, sanitation and hygiene indicators were assessed, and trachoma signs were graded by trained and certified graders. The prevalence of trachomatous inflammation-follicular (TF) in children aged one to nine years was 15.7% (95%CI: 12.1–20.2) in Al Salam and 10.6% (95%CI: 7.9–14.0) in Al Jabalain. The prevalence of trachomatous trichiasis (TT) in those 15 years above was 2.9% (95%CI: 1.8–4.8) in Al Salam and 5.0% (95%CI: 3.8–6.6) in Al Jabalain. The presence of water and sanitation was high in both survey units. Conclusion/ Significance Sudan has made progress in reducing the prevalence of trachoma within the country; however, the presence of over one million refugees from a neighboring trachoma hyper-endemic country could impact this progress. These surveys were the first step in addressing this important issue. The results demonstrate that at least three years of mass drug administration with azithromycin and tetracycline is needed in addition to the provision of TT surgical services. Additionally, it highlights that non-endemic or formerly endemic localities may have to adopt new strategies to provide services for refugee populations originating from hyper-endemic regions to ensure elimination of trachoma as a public health problem for all populations. Ministries of health in multiple countries have made progress in reducing the prevalence of trachoma, the leading cause of infectious blindness. With the increase in displaced populations throughout the world, the work of these national programs could be put at risk as formerly endemic or non-endemic districts now host large numbers of refugees from trachoma endemic regions. To properly respond, national programs must first assess the extent of the disease. We conducted baseline surveys in South Sudanese refugee camps located in two Sudanese localities to determine the prevalence of trachoma. These surveys showed that conducting prevalence surveys in refugee camp settings was possible. Trachoma was found to be present within the refugee camp population and programmatic interventions are required. The global community cannot expect to eliminate trachoma in the near future if displaced populations within countries and across country borders are not addressed.
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Sarr B, Sissoko M, Fall M, Nizigama L, Cohn D, Willis R, Fuller B, O'Neil M, Solomon AW. Prevalence of Trachoma in Senegal: Results of Baseline Surveys in 17 Districts. Ophthalmic Epidemiol 2019; 25:41-52. [PMID: 30806538 PMCID: PMC6444198 DOI: 10.1080/09286586.2017.1418897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Purpose: Senegal is endemic for trachoma, an infectious and potentially blinding eye disease. To complete the country’s district-level baseline map of trachoma, we conducted population-based surveys in 17 health districts that were suspected-endemic but had yet to be surveyed. Methods: We randomly selected 30 clusters (villages) per district and 30 households per village, and estimated the district-level prevalences of trachomatous inflammation—follicular (TF) in children aged 1–9 years, and trichiasis in persons aged ≥15 years. Data on household-level water, sanitation, and hygiene variables were also collected. Global Trachoma Mapping Project methods were followed in training, fieldwork, and data handling. Results: 25,704 children aged 1–9 years and 30,345 adults aged 15 years and above were examined. In children aged 1–9 years, the prevalence of TF was <5% in all 17 districts, with the exception of Saint-Louis (5.1%, 95% CI 3.2–7.5). Trichiasis prevalence in participants aged 15 years and above ranged by district from 0%–1.1% (95% CI 0.7–1.5), with 9 districts having trichiasis prevalences above the elimination threshold of 0.2%. Trichiasis was seen to be significantly less frequent in males than in females (0.17% [95% CI 0.12–0.24] versus 0.49% [95% CI 0.38–0.61], p < 0.001). The prevalence of trichiasis rose steeply with age; 62% of cases were observed in people aged 55 years or above. Conclusions: Active trachoma is not a public health problem in 16 of the 17 surveyed districts, and implementation of the full Surgery (S) – Antibiotics (A) – Facial cleanliness (F) – Environmental improvement (E) strategy is not a programmatic priority. Increased provision of trichiasis surgery is warranted in nine districts.
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Affiliation(s)
- Boubacar Sarr
- a Ministère de la Santé et de l'Action Sociale, Programme National de Promotion de la Santé Oculaire , Dakar , Senegal
| | - Mactar Sissoko
- a Ministère de la Santé et de l'Action Sociale, Programme National de Promotion de la Santé Oculaire , Dakar , Senegal
| | - Mawo Fall
- b RTI International , Dakar , Senegal
| | | | | | - Rebecca Willis
- e Task Force for Global Health, International Trachoma Initiative , Decatur , GA , USA
| | | | - Maggie O'Neil
- f RTI International , Research Triangle Park , NC , USA
| | - Anthony W Solomon
- g Clinical Research Department , London School of Hygiene & Tropical Medicine , London , UK
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Macleod CK, Porco TC, Dejene M, Shafi O, Kebede B, Negussu N, Bero B, Taju S, Adamu Y, Negash K, Haileselassie T, Riang J, Badei A, Bakhtiari A, Willis R, Bailey RL, Solomon AW. Optimising age adjustment of trichiasis prevalence estimates using data from 162 standardised surveys from seven regions of Ethiopia. Ophthalmic Epidemiol 2018; 26:161-168. [PMID: 30592237 PMCID: PMC6532728 DOI: 10.1080/09286586.2018.1555262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
PURPOSE The prevalence of trichiasis is higher in females and increases markedly with age. Surveys carried out in the daytime, particularly in developing countries, are prone to find older individuals and females at home at the time of the survey. Population-level trichiasis estimates should adjust sample proportions to reflect the demographic breakdown of the population, although the most accurate method of doing this is unclear. METHODS Having obtained data from 162 surveys carried out in Ethiopia as part of the Global Trachoma Mapping Project from 2012 to 2015, we used internal validation with both Brier and Logarithmic forecast scoring to test stratification models to identify those models with the highest predictive accuracy. Selection of partitions was undertaken by both simple random sampling (SRS) and cluster sampling (CS) over 8192 selections. RESULTS A total of 4529 (1.9%) cases of trichiasis were identified from 241,139 individuals aged ≥15 years from a total of 4210 kebeles and 122,090 households visited. Overall, the binning method using 5-year bands from age 15 to 69 years, with coarser binning in 20-year age-bands above this age, provided the best predictive accuracy, in both SRS and CS methodologies and for both the Brier and Logarithmic scoring rules. CONCLUSION The greatest predictive accuracy for trichiasis estimates was found by adjusting for sex and in 5-year age-bands from the age of 15 to 69 years and in 20-year age-bands in those aged 70 years and greater. Trichiasis surveys attempting to make population-level inferences should use this method to optimise surgery backlog estimates.
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Affiliation(s)
- Colin K Macleod
- a Clinical Research Department , London School of Hygiene & Tropical Medicine , London , UK
| | - Travis C Porco
- b Francis I. Proctor Foundation, Department of Ophthalmology , University of California, San Francisco , San Francisco , USA.,c Department of Epidemiology and Biostatistics , University of California, San Francisco , San Francisco , USA
| | - Michael Dejene
- d Michael Dejene Public Health Consultancy Services , Addis Ababa , Ethiopia
| | - Oumer Shafi
- e Federal Ministry of Health , Addis Ababa , Ethiopia
| | - Biruck Kebede
- e Federal Ministry of Health , Addis Ababa , Ethiopia
| | | | - Berhanu Bero
- f The Fred Hollows Foundation Ethiopia , Addis Ababa , Ethiopia
| | - Sadik Taju
- g Department of Ophthalmology , Addis Ababa University , Addis Ababa , Ethiopia
| | - Yilikal Adamu
- g Department of Ophthalmology , Addis Ababa University , Addis Ababa , Ethiopia
| | | | | | - John Riang
- j Gambella Regional Health Bureau , Gambella , Ethiopia
| | - Ahmed Badei
- k Department of Disease Prevention , Somali Regional State Health Bureau , Jigjiga , Ethiopia
| | - Ana Bakhtiari
- l Task Force for Global Health , Decatur , Georgia , USA
| | - Rebecca Willis
- l Task Force for Global Health , Decatur , Georgia , USA
| | - Robin L Bailey
- a Clinical Research Department , London School of Hygiene & Tropical Medicine , London , UK
| | - Anthony W Solomon
- a Clinical Research Department , London School of Hygiene & Tropical Medicine , London , UK.,m Department of Control of Neglected Tropical Diseases , World Health Organization , Geneva , Switzerland
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Dézoumbé D, Djada DA, Harba TT, Biao JE, Kali B, Bernasconi J, Hiron D, Bengraïne K, D’Souza S, Willis R, Bakhtiari A, Resnikoff S, Courtright P, Solomon AW. Prevalence of trachoma in the Republic of Chad: results of 41 population-based surveys. Ophthalmic Epidemiol 2018; 25:143-154. [PMID: 30806544 PMCID: PMC6444194 DOI: 10.1080/09286586.2018.1546877] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 10/12/2018] [Accepted: 11/06/2018] [Indexed: 11/04/2022]
Abstract
PURPOSE To estimate the prevalence of trachoma in suspected-endemic areas of Chad, and thereby determine whether trachoma is a public health problem requiring intervention. METHODS We divided the suspected-endemic population living in secure districts into 46 evaluation units (EUs), and used the standardized methodologies of the Global Trachoma Mapping Project. A two-stage cluster-sampling procedure was adopted. In each EU, the goal was to examine at least 1019 children aged 1-9 years by recruiting 649 households; all consenting residents aged ≥ 1 year living in those households were examined. Each participant was examined for trachomatous inflammation-follicular (TF), trachomatous inflammation-intense (TI), and trichiasis. RESULTS Two EUs had data that could not be validated, and were excluded from the analysis. GPS data for three other pairs of EUs suggested that EU divisions were inaccurate; data for each pair were combined within the pair. In the 41 resulting EUs, 29,924 households in 967 clusters were visited, and 104,584 people were examined. The age-adjusted EU-level prevalence of TF in 1-9-year-olds ranged from 0.0% to 23.3%, and the age- and gender-adjusted EU-level prevalence of trichiasis in ≥ 15-year-olds ranged from 0.02% to 1.3%. TF was above the WHO elimination threshold in 16 EUs (39%) and trichiasis was above the WHO elimination threshold in 29 EUs (71%). Women had a higher prevalence of trichiasis than did men in 31 EUs (76%). A higher ratio of trichiasis prevalence in women to trichiasis prevalence in men was associated (p = 0.03) with a higher prevalence of trichiasis at EU level. CONCLUSION Public health-level interventions against trachoma are needed in Chad. Over 10,000 people need management of their trichiasis; women account for about two-thirds of this total. The association between a higher ratio of trichiasis prevalence in women to that in men with higher overall trichiasis prevalence needs further investigation.
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Affiliation(s)
- Djoré Dézoumbé
- Programme national de lutte contre la cécité, Ministère de la Santé Publique, N’Djamena, Tchad
| | | | | | - Jean-Eudes Biao
- Organisation pour la Prévention de la Cécité, N’Djamena, Tchad
| | - Barka Kali
- Organisation pour la Prévention de la Cécité, N’Djamena, Tchad
| | | | - Doniphan Hiron
- Organisation pour la Prévention de la Cécité, Paris, France
| | | | | | | | | | | | - Paul Courtright
- Kilimanjaro Centre for Community Ophthalmology, Division of Ophthalmology, University of Cape Town, Cape Town, South Africa
| | - Anthony W. Solomon
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
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Baayenda G, Mugume F, Turyaguma P, Tukahebwa EM, Binagwa B, Onapa A, Agunyo S, Osilo MK, French MD, Thuo W, Rotondo LA, Renneker K, Willis R, Bakhtiari A, Harding-Esch EM, Solomon AW, Ngondi JM. Completing Baseline Mapping of Trachoma in Uganda: Results of 14 Population-Based Prevalence Surveys Conducted in 2014 and 2018. Ophthalmic Epidemiol 2018; 25:162-170. [PMID: 30806547 PMCID: PMC6444199 DOI: 10.1080/09286586.2018.1546879] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 10/02/2018] [Accepted: 11/06/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE We aimed to estimate the prevalence of trachomatous inflammation-follicular (TF) in children aged 1-9 years, trichiasis in adults aged ≥15 years, and water and sanitation (WASH) indicators in 12 suspected-endemic districts in Uganda. METHODS Surveys were undertaken in 14 evaluation units (EUs) covering 12 districts. Districts were selected based on a desk review in 2014 (four districts) and trachoma rapid assessments in 2018 (eight districts). We calculated that 1,019 children aged 1-9 years were needed in each EU to estimate TF prevalence with acceptable precision and used three-stage cluster sampling to select 30 households in each of 28 (2014 surveys) or 24 (2018 surveys) villages. Participants living in selected households aged ≥1 year were examined for trachoma; thus enabling estimation of prevalences of TF in 1-9 year-olds and trichiasis in ≥15 year-olds. Household-level WASH access data were also collected. RESULTS A total of 11,796 households were surveyed; 22,465 children aged 1-9 years and 24,652 people aged ≥15 years were examined. EU-level prevalence of TF ranged from 0.3% (95% confidence interval [CI] 0.1-0.7) to 3.9% (95% CI 2.1-5.8). EU-level trichiasis prevalence ranged from 0.01% (95% CI 0-0.11) to 0.81% (95% CI 0.35-1.50). Overall proportions of households with improved drinking water source, water source in yard or within 1km, and improved sanitation facilities were 88.1%, 23.0% and 23.9%, respectively. CONCLUSION TF was not a public health problem in any of the 14 EUs surveyed: antibiotic mass drug administration is not required in these districts. However, in four EUs, trichiasis prevalence was ≥ 0.2%, so public health-level trichiasis surgery interventions are warranted. These findings will facilitate planning for elimination of trachoma in Uganda.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Emma M. Harding-Esch
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Anthony W. Solomon
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
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Handley BL, Roberts CH, Butcher R. A systematic review of historical and contemporary evidence of trachoma endemicity in the Pacific Islands. PLoS One 2018; 13:e0207393. [PMID: 30440006 PMCID: PMC6237375 DOI: 10.1371/journal.pone.0207393] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 10/19/2018] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Trachoma is endemic in several Pacific Island countries. The aims of this study were to (a) identify future trachoma mapping needs in the Pacific and (b) to examine whether any temporal trends in trachoma prevalence could be ascertained from the historical literature on trachoma in the Pacific Islands. METHODS Human studies of trachoma and eye care in the Pacific Islands were identified from a systematic search of PubMed, EMbase, Scopus and Web of Science databases. A published quality assessment system for disease prevalence studies was modified to assess studies for quality and transparency. RESULTS Few general ophthalmic studies in the Pacific mention trachoma. In targeted studies of trachoma, cases have consistently been identified throughout the Pacific since the early twentieth century. The largest number of studies come from Papua New Guinea and Fiji, whereas some countries have no published data on trachoma. The majority of studies identified were published before the Alliance for the Global Elimination of Trachoma 2020 was convened, so lack the standardisation of population-based mapping which has been implemented in the past decade. CONCLUSIONS Population-based trachoma prevalence estimates have been recently generated in Papua New Guinea, Solomon Islands, Vanuatu, Kiribati and Fiji. There is insufficient evidence to assess whether there has been temporal change in trachoma prevalence in these countries over the past century. Cases of trachoma have been identified in some countries (for example, Nauru and Samoa) which have no recent population-based mapping data, but may be at risk of trachoma endemcitiy. Deployment of appropriate mapping strategies is warranted to identify whether interventions are required.
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Affiliation(s)
- Becca L. Handley
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Chrissy h. Roberts
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Robert Butcher
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Doyal L, Das-Bhaumik RG. Sex, gender and blindness: a new framework for equity. BMJ Open Ophthalmol 2018; 3:e000135. [PMID: 30246151 PMCID: PMC6146307 DOI: 10.1136/bmjophth-2017-000135] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 03/06/2018] [Accepted: 03/16/2018] [Indexed: 12/05/2022] Open
Abstract
Four-fifths of all blind or vision impaired people live in middle-income and low-income countries with the African region and parts of Asia and the Middle East bearing the heaviest burden. At the same time, we know that around two thirds of all blind people in the world are female. Hence, the poorest (and usually the oldest) women are most likely to have their lives limited by visual impairment. While recent strategies have focussed on international variations in eye health, very few have paid attention to the gender differences that are an inextricable element in these inequalities. This review will explore possible explanations for the advantage of men in the exercise of one of the most basic of human senses. It will show that this cannot be understood through the use of a biomedical approach alone. Broader social perspectives will also be needed in order to create an appropriate knowledge base for tackling global inequalities in blindness.
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Affiliation(s)
| | - Raja G Das-Bhaumik
- Moorfields Eye Hospital, London, UK
- UCL Institute of Ophthalmology, London, UK
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Ramke J, Palagyi A, Kuper H, Gilbert CE. Assessment of Response Bias Is Neglected in Cross-Sectional Blindness Prevalence Surveys: A Review of Recent Surveys in Low- and Middle-Income Countries. Ophthalmic Epidemiol 2018; 25:379-385. [PMID: 30059647 DOI: 10.1080/09286586.2018.1500613] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE Findings from cross-sectional blindness prevalence surveys are at risk of several biases that cause the study estimate to differ from the 'true' population prevalence. For example, response bias occurs when people who participate ('responders') differ from those who do not ('non-responders') in ways that affect prevalence estimates. This study aimed to assess the extent to which response bias is considered and occurs in blindness prevalence surveys in low- and middle-income countries (LMICs). METHODS We searched MEDLINE, EMBASE and Web of Science for cross-sectional blindness prevalence surveys undertaken in LMICs and published 2009-2017. From included studies, we recorded and descriptively analysed details regarding enumeration processes, response, and non-response, including the impact of non-response on results. RESULTS Most (95%) of the 92 included studies reported a response rate (median 91.7%, inter-quartile range 85.9-95.6%). Approximately half clearly described enumeration processes (49%), and reported at least one strategy to increase the response rate (53%); a quarter (23%) statistically compared responders and non-responders. When differential response was assessed, men were more likely to be non-responders than women. Two-thirds (65%) of the time a sociodemographic difference was found between responders and non-responders, a difference in blindness prevalence was also found. Only 13 studies (14%) commented on implications of non-response on prevalence estimates. CONCLUSIONS Response rates are commonly reported from blindness prevalence surveys, and tend to be high. High response rates reduce-but do not eliminate-the risk of response bias. Assessment and reporting of potential response bias in blindness prevalence surveys could be greatly improved.
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Affiliation(s)
- Jacqueline Ramke
- a Department of Epidemiology & Biostatistics, Faculty of Medicine and Health Sciences , University of Auckland , Auckland , New Zealand.,d Department of Infectious & Tropical Diseases, International Centre for Eye Health, Clinical Research Unit , London School of Hygiene and Tropical Medicine , London , United Kingdom
| | - Anna Palagyi
- b The George Institute for Global Health , University of New South Wales , Sydney , Australia
| | - Hannah Kuper
- c International Centre for Evidence in Disability, Clinical Research Unit, Department of Infectious & Tropical Diseases , London School of Hygiene and Tropical Medicine , London , United Kingdom
| | - Clare E Gilbert
- d Department of Infectious & Tropical Diseases, International Centre for Eye Health, Clinical Research Unit , London School of Hygiene and Tropical Medicine , London , United Kingdom
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Adhisesha Reddy P, Kishiki EA, Thapa HB, Demers L, Geneau R, Bassett K. Interventions to improve utilization of cataract surgical services by girls: Case studies from Asia and Africa. Ophthalmic Epidemiol 2017; 25:199-206. [PMID: 29125374 DOI: 10.1080/09286586.2017.1398340] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE Gender and blindness initiatives continue to make eye care personnel aware of the service utilization inequity strongly favouring men, yet interventions to reduce that inequity, particularly for girls, are under developed. METHODS This descriptive study gathered quantitative data on the degree of gender equity at five Child Eye Health Tertiary Facilities (CEHTFs) in Asia and Africa and conducted in-depth interviews with eye care personnel to assess their strategies and capacity to reduce gender inequity. Cataract surgery was utilized to assess the degree of inequity and success of interventions to reduce inequity in case finding, service utilization, and follow-up. RESULTS CEHTF administrative data showed significant gender inequity in cataract surgical services favouring boys in all settings. CEHTFs actively seek children through community and school-based outreach, yet do not have initiatives to reduce gender inequity. Little gender inequity was found among children receiving surgical and follow-up care, although two out of three children were boys. CEHTF staff, despite being aware, offered no effective means to reduce gender inequity involving cataract surgical services. Interventions that successfully increased service utilization by girls came from individual cases, involving extraordinary effort by a single eye care programme person. CONCLUSION Community-based case finders such as Anganwadi workers in India, Female Community Health Volunteers (FCHVs) in Nepal, and Key Informants (KIs) in Africa are necessary to identify children in need of cataract services, but insufficient to increase service utilization by girls. Secondary, often extra-ordinary community-based interventions by eye care personnel are needed in all settings.
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Affiliation(s)
- Priya Adhisesha Reddy
- a Aravind Eye Hospital and Post graduate Institute of Ophthalmology , Pondicherry , India.,b Rollins School of Public Health, Emory University , Atlanta , GA , USA
| | | | | | | | - Robert Geneau
- f Kilimanjaro Centre for Community Ophthalmology, Division of Ophthalmology , University of Cape Town , Cape Town , South Africa
| | - Ken Bassett
- e Seva Canada , Vancouver , BC , Canada.,g Department of Ophthalmology , University of British Columbia , Vancouver , BC , Canada
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Kilangalanga J, Ndjemba JM, Uvon PA, Kibangala FM, Mwandulo JLSB, Mavula N, Ndombe M, Kazadi J, Limbaka H, Cohn D, Tougoue JJ, Kabore A, Rotondo L, Willis R, Bio AA, Kadri B, Bakhtiari A, Ngondi JM, Solomon AW, For The Global Trachoma Mapping Project. Trachoma in the Democratic Republic of the Congo: Results of 46 Baseline Prevalence Surveys Conducted with the Global Trachoma Mapping Project. Ophthalmic Epidemiol 2017; 25:192-200. [PMID: 28850014 PMCID: PMC6319181 DOI: 10.1080/09286586.2017.1306869] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Purpose: Trachoma was suspected to be endemic in parts of the Democratic Republic of the Congo (DRC). We aimed to estimate prevalences of trachomatous inflammation–follicular (TF), trichiasis, and water and sanitation (WASH) indicators in suspected-endemic Health Zones. Methods: A population-based prevalence survey was undertaken in each of 46 Health Zones across nine provinces of DRC, using Global Trachoma Mapping Project methods. A two-stage cluster random sampling design was used in each Health Zone, whereby 25 villages (clusters) and 30 households per cluster were sampled. Consenting eligible participants (children aged 1–9 years and adults aged ≥15 years) were examined for trachoma by GTMP-certified graders; households were assessed for access to WASH. Results: A total of 32,758 households were surveyed, and 141,853 participants (98.2% of those enumerated) were examined for trachoma. Health Zone-level TF prevalence in 1–9-year-olds ranged from 1.9–41.6%. Among people aged ≥15 years, trichiasis prevalences ranged from 0.02–5.1% (95% CI 3.3–6.8). TF prevalence in 1–9-year-olds was ≥5% in 30 Health Zones, while trichiasis prevalence was ≥0.2% in 37 Health Zones. Conclusion: Trachoma is a public health problem in 39 of 46 Health Zones surveyed. To meet elimination targets, 37 Health Zones require expanded trichiasis surgery services while 30 health zones require antibiotics, facial cleanliness and environmental improvement interventions. Survey data suggest that trachoma is widespread: further surveys are warranted.
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Affiliation(s)
| | - Jean Marie Ndjemba
- b Neglected Tropical Diseases Unit, Ministère de la Santé Publique , Kinshasa , Democratic Republic of the Congo
| | - Pitchouna A Uvon
- b Neglected Tropical Diseases Unit, Ministère de la Santé Publique , Kinshasa , Democratic Republic of the Congo
| | - Felix M Kibangala
- b Neglected Tropical Diseases Unit, Ministère de la Santé Publique , Kinshasa , Democratic Republic of the Congo
| | | | - Nicaise Mavula
- c RTI International , Kinshasa , Democratic Republic of the Congo
| | - Martin Ndombe
- c RTI International , Kinshasa , Democratic Republic of the Congo
| | - Junior Kazadi
- d World Vision International , Kinshasa , Democratic Republic of the Congo
| | - Henry Limbaka
- e Christian Blind Mission , Kinshasa , Democratic Republic of the Congo
| | | | | | | | | | | | | | | | | | | | - Anthony W Solomon
- k Clinical Research Department , London School of Hygiene & Tropical Medicine , London , UK.,l Department of Control of Neglected Tropical Diseases , World Health Organization , Geneva , Switzerland
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Habtamu E, Wondie T, Aweke S, Tadesse Z, Zerihun M, Melak B, Gashaw B, Callahan K, Emerson PM, Bailey RL, Mabey DC, Rajak SN, Kuper H, Polack S, Macleod D, Weiss HA, Burton MJ. Impact of trichiasis surgery on daily living: A longitudinal study in Ethiopia. Wellcome Open Res 2017. [DOI: 10.12688/wellcomeopenres.11891.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Trachomatous trichiasis (TT) may lead to disability, impeding productive activities, resulting in loss of income. This study was conducted to determine if trichiasis surgery improves participation in productive and leisure activities, and ability to perform activities without difficulty or assistance. Methods: We recruited 1000 adults with trichiasis (cases) and 200 comparison participants, matched to every fifth trichiasis case on age (+/- two years), sex and location. The ‘Stylised Activity List’ tool, developed for the World Bank Living Standard Measurement Survey, was adapted to collect data on activity in the last week (participation in activity, difficulty with activity, requirement of assistance for activity), at baseline and 12 months later. All trichiasis cases received trichiasis surgery at baseline. Random effect logistic regression was used to compare cases and comparison participants. Results: There was strong evidence that trichiasis surgery substantially improves the ability of trichiasis cases to perform all the productive and leisure activities investigated without difficulty, with large increases in processing agricultural products, 21.1% to 87.0% (p<0.0001), farming, 19.1% to 82.4% (p<0.0001), and fetching wood, 25.3% to 86.0% (p<0.0001). Similarly, there was a significant increase in the proportion of cases who could perform activities without assistance, with the largest increases in animal rearing 54.2% to 92.0% (p<0.0001) and farming 73.2% to 96.4% (p<0.0001). There was no change in the proportion of comparison participants performing activities without difficulty or assistance. The change in most of the activities in cases was independent of visual acuity improvement and recurrent TT at 12 months. One year after trichiasis surgery, the proportion of cases reporting ocular pain reduced from 98.9% to 33.7% (p<0.0001). Conclusions: Eyelid surgery for TT improves functional capabilities regardless of vision gains. These data lend strong support to the view that TT surgery improves function and contributes to improved household income and wealth.
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Habtamu E, Wondie T, Aweke S, Tadesse Z, Zerihun M, Melak B, Gashaw B, Callahan K, Emerson PM, Bailey RL, Mabey DCW, Rajak SN, Kuper H, Polack S, Macleod D, Weiss HA, Burton MJ. Impact of trichiasis surgery on daily living: A longitudinal study in Ethiopia. Wellcome Open Res 2017; 2:69. [PMID: 29181451 PMCID: PMC5686479 DOI: 10.12688/wellcomeopenres.11891.2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2017] [Indexed: 11/20/2022] Open
Abstract
Background: Trachomatous trichiasis (TT) may lead to disability, impeding productive activities, resulting in loss of income. This study was conducted to determine if trichiasis surgery improves participation in productive and leisure activities, and ability to perform activities without difficulty or assistance. Methods: We recruited 1000 adults with trichiasis (cases) and 200 comparison participants, matched to every fifth trichiasis case on age (+/- two years), sex and location. The 'Stylised Activity List' tool, developed for the World Bank Living Standard Measurement Survey, was adapted to collect data on activity in the last week (participation in activity, difficulty with activity, requirement of assistance for activity), at baseline and 12 months later. All trichiasis cases received trichiasis surgery at baseline. Random effect logistic regression was used to compare cases and comparison participants. Results: There was strong evidence that trichiasis surgery substantially improves the ability of trichiasis cases to perform all the productive and leisure activities investigated without difficulty, with large increases in processing agricultural products, 21.1% to 87.0% (p<0.0001), farming, 19.1% to 82.4% (p<0.0001), and fetching wood, 25.3% to 86.0% (p<0.0001). Similarly, there was a significant increase in the proportion of cases who could perform activities without assistance, with the largest increases in animal rearing 54.2% to 92.0% (p<0.0001) and farming 73.2% to 96.4% (p<0.0001). There was no change in the proportion of comparison participants performing activities without difficulty or assistance. The change in most of the activities in cases was independent of visual acuity improvement and recurrent TT at 12 months. One year after trichiasis surgery, the proportion of cases reporting ocular pain reduced from 98.9% to 33.7% (p<0.0001). Conclusions: Eyelid surgery for TT improves functional capabilities regardless of vision gains. These data lend strong support to the view that TT surgery improves function and contributes to improved household income and wealth.
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Affiliation(s)
- Esmael Habtamu
- The Carter Center, Addis Ababa, Ethiopia.,International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | | | | | | | | | | | | | | | - Paul M Emerson
- International Trachoma Initiative, Atlanta, GA, 30030, USA
| | - Robin L Bailey
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - David C W Mabey
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Saul N Rajak
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Sarah Polack
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - David Macleod
- MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Helen A Weiss
- MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Matthew J Burton
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
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Harding-Esch EM, Kadimpeul J, Sarr B, Sane A, Badji S, Laye M, Sillah A, Burr SE, MacLeod D, Last AR, Holland MJ, Mabey DC, Bailey RL. Population-based prevalence survey of follicular trachoma and trachomatous trichiasis in the Casamance region of Senegal. BMC Public Health 2017; 18:62. [PMID: 28747198 PMCID: PMC5530574 DOI: 10.1186/s12889-017-4605-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 07/18/2017] [Indexed: 11/10/2022] Open
Abstract
Background Trachoma, caused by ocular infection with Chlamydia trachomatis, is the leading infectious cause of blindness worldwide. We conducted the first population-based trachoma prevalence survey in the Casamance region of Senegal to enable the Senegalese National Eye Care Programme (NECP) to plan its trachoma control activities. The World Health Organization (WHO) guidelines state that any individual with trachomatous trichiasis (TT) should be offered surgery, but that surgery should be prioritised where the prevalence is >0.1%, and that districts and communities with a trachomatous inflammation, follicular (TF) prevalence of ≥10% in 1–9 year-olds should receive mass antibiotic treatment annually for a minimum of three years, along with hygiene promotion and environmental improvement, before re-assessing the prevalence to determine whether treatment can be discontinued (when TF prevalence in 1–9 year-olds falls <5%). Methods Local healthcare workers conducted a population-based household survey in four districts of the Bignona Department of Casamance region to estimate the prevalence of TF in 1–9 year-olds, and TT in ≥15 year-olds. Children’s facial cleanliness (ocular and/or nasal discharge, dirt on the face, flies on the face) was measured at time of examination. Risk factor questionnaires were completed at the household level. Results Sixty communities participated with a total censused population of 5580 individuals. The cluster-, age- and sex-adjusted estimated prevalence of TF in 1–9 year-olds was 2.5% (95% Confidence Interval (CI) 1.8–3.6) (38/1425) at the regional level and <5% in all districts, although the upper 95%CI exceeded 5% in all but one district. The prevalence of TT in those aged ≥15 years was estimated to be 1.4% (95%CI 1.0–1.9) (40/2744) at the regional level and >1% in all districts. Conclusion With a prevalence <5%, TF does not appear to be a significant public health problem in this region. However, TF monitoring and surveillance at sub-district level will be required to ensure that elimination targets are sustained and that TF does not re-emerge as a public health problem. TT surgery remains the priority for trachoma elimination efforts in the region, with an estimated 1819 TT surgeries to conduct.
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Affiliation(s)
- Emma M Harding-Esch
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK.
| | - Julbert Kadimpeul
- Programme National de Lutte Contre la Cécité, Ministère de la Sante, Dakar, Sénégal
| | - Boubacar Sarr
- Programme National de Lutte Contre la Cécité, Ministère de la Sante, Dakar, Sénégal
| | - Awa Sane
- Programme National de Lutte Contre la Cécité, Ministère de la Sante, Dakar, Sénégal
| | - Souleymane Badji
- Programme National de Lutte Contre la Cécité, Ministère de la Sante, Dakar, Sénégal
| | - Mass Laye
- National Eye Health Programme, Ministry of Health and Social Welfare, Kanifing, Gambia
| | - Ansumana Sillah
- National Eye Health Programme, Ministry of Health and Social Welfare, Kanifing, Gambia
| | - Sarah E Burr
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK.,Disease Control and Elimination Theme, Medical Research Council Unit, The Gambia, Fajara, Banjul, Gambia
| | - David MacLeod
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Anna R Last
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Martin J Holland
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - David C Mabey
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Robin L Bailey
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
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Sanders AM, Stewart AEP, Makoy S, Chebet JJ, Magok P, Kuol A, Blauvelt C, Lako R, Rumunu J, Callahan EK, Nash SD. Burden of trachoma in five counties of Eastern Equatoria state, South Sudan: Results from population-based surveys. PLoS Negl Trop Dis 2017; 11:e0005658. [PMID: 28614375 PMCID: PMC5484542 DOI: 10.1371/journal.pntd.0005658] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 06/26/2017] [Accepted: 05/23/2017] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND In order to decrease the prevalence of trachoma within the country, the Republic of South Sudan has implemented components of the SAFE strategy in various counties since 2001. Five counties in Eastern Equatoria state were surveyed in order to monitor progress of programmatic interventions and determine if additional rounds of Mass Drug Administration with azithromycin were needed. METHODOLOGY/ PRINCIPAL FINDINGS Five counties (Budi, Lafon, Kapoeta East, Kapoeta South and Kapoeta North) were surveyed from April to October 2015. A cross-sectional, multi-stage, cluster-random sampling was used. All present, consenting residents of selected households were examined for all clinical signs of trachoma using the World Health Organization (WHO) simplified grading system. 14,462 individuals from 3,446 households were surveyed. The prevalence of trachomatous inflammation-follicular (TF) in children ages one to nine years ranged from 17.4% (95% Confidence Interval (CI): 11.4%, 25.6%) in Budi county to 47.6%, (95% CI: 42.3%, 53.0%) in Kapoeta East county. Trachomatous trichiasis (TT) was also highly prevalent in those 15 years and older, ranging between 2.6% (95% CI: 1.6%, 4.0%) in Kapoeta South to 3.9% (95% CI: 2.4%, 6.1%) in Lafon. The presence of water and sanitation were low in all five counties, including two counties which had a complete absence of latrines in all surveyed clusters. CONCLUSIONS/ SIGNIFICANCE To our knowledge, these were the first trachoma surveys conducted in the Republic of South Sudan since their independence in 2011. The results show that despite years of interventions, four of the five surveyed counties require a minimum of five additional years of SAFE strategy implementation, with the fifth requiring at minimum three more years.
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Affiliation(s)
- Angelia M. Sanders
- Trachoma Control Program, The Carter Center, Atlanta, Georgia, United States of America
- * E-mail:
| | - Aisha E. P. Stewart
- Trachoma Control Program, The Carter Center, Atlanta, Georgia, United States of America
| | - Samuel Makoy
- South Sudan Ministry of Health, Government of the Republic of South Sudan, Juba, Republic of South Sudan
| | - Joy J. Chebet
- The Carter Center-South Sudan, The Carter Center, Juba, Republic of South Sudan
| | - Peter Magok
- The Carter Center-South Sudan, The Carter Center, Juba, Republic of South Sudan
| | - Aja Kuol
- South Sudan Ministry of Health, Government of the Republic of South Sudan, Juba, Republic of South Sudan
| | - Carla Blauvelt
- The Carter Center-South Sudan, The Carter Center, Juba, Republic of South Sudan
| | - Richard Lako
- South Sudan Ministry of Health, Government of the Republic of South Sudan, Juba, Republic of South Sudan
| | - John Rumunu
- South Sudan Ministry of Health, Government of the Republic of South Sudan, Juba, Republic of South Sudan
| | - E. Kelly Callahan
- Trachoma Control Program, The Carter Center, Atlanta, Georgia, United States of America
| | - Scott D. Nash
- Trachoma Control Program, The Carter Center, Atlanta, Georgia, United States of America
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Dirani M, Keel S, Foreman J, van Wijngaarden P, Taylor HR. Prevalence of trachomatous trichiasis in Australia: the National Eye Health Survey. Clin Exp Ophthalmol 2017; 46:13-17. [PMID: 28598533 DOI: 10.1111/ceo.13003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 05/21/2017] [Accepted: 06/01/2017] [Indexed: 11/27/2022]
Abstract
IMPORTANCE Australia is the only developed country to still have pockets of endemic trachoma. The research provides up-to-date, population-based prevalence data of later complications of trachoma amongst a national sample of Indigenous adults. BACKGROUND To report the prevalence of trachomatous trichiasis (TT) in Indigenous Australians aged 40 years and older. DESIGN Population-based cross-sectional study. PARTICIPANTS A total of 1738 (41% male) Indigenous Australians aged 40 years or older, living amongst 30 randomly selected Australian sites, stratified by remoteness. METHODS Anterior segment examination was performed and trachoma grading for the presence of TT and corneal opacification (CO) was conducted using the WHO (WHO) simplified grading system. MAIN OUTCOME MEASURES Prevalence of TT. RESULTS A total of three (0.17%) participants had TT, and there were no confirmed cases of trachomatous CO in the NEHS. All three participants with TT were female and aged 40 years or older. Although they had likely spent their childhoods in more remote areas, two of the three confirmed cases resided in an urban and outer regional area at the time of their examinations. CONCLUSIONS AND RELEVANCE Our data are in line with ongoing national trachoma surveillance reports that suggest the prevalence of late sequences of trachoma appear to be decreasing in Australia.
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Affiliation(s)
- Mohamed Dirani
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
| | - Stuart Keel
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
| | - Joshua Foreman
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia.,Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
| | - Peter van Wijngaarden
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia.,Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
| | - Hugh R Taylor
- Indigenous Eye Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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Phiri I, Manangazira P, Macleod CK, Mduluza T, Dhobbie T, Chaora SG, Chigwena C, Katiyo J, Willis R, Bakhtiari A, Bare P, Courtright P, Macheka B, Midzi N, Solomon AAW. The Burden of and Risk Factors for Trachoma in Selected Districts of Zimbabwe: Results of 16 Population-Based Prevalence Surveys. Ophthalmic Epidemiol 2017; 25:181-191. [PMID: 28532208 PMCID: PMC6319166 DOI: 10.1080/09286586.2017.1298823] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Background: Trachoma, a leading cause of blindness, is targeted for global elimination as a public health problem by 2020. In order to contribute to this goal, countries should demonstrate reduction of disease prevalence below specified thresholds, after implementation of the SAFE strategy in areas with defined endemicity. Zimbabwe had not yet generated data on trachoma endemicity and no specific interventions against trachoma have yet been implemented. Methods: Two trachoma mapping phases were successively implemented in Zimbabwe, with eight districts included in each phase, in September 2014 and October 2015. The methodology of the Global Trachoma Mapping Project was used. Results: Our teams examined 53,211 people for trachoma in 385 sampled clusters. Of 18,196 children aged 1–9 years examined, 1526 (8.4%) had trachomatous inflammation–follicular (TF). Trichiasis was observed in 299 (1.0%) of 29,519 people aged ≥15 years. Of the 16 districts surveyed, 11 (69%) had TF prevalences ≥10% in 1–9-year-olds, indicative of active trachoma being a significant public health problem, requiring implementation of the A, F and E components of the SAFE strategy for at least 3 years. The total estimated trichiasis backlog across the 16 districts was 5506 people. The highest estimated trichiasis burdens were in Binga district (1211 people) and Gokwe North (854 people). Conclusion: Implementation of the SAFE strategy is needed in parts of Zimbabwe. In addition, Zimbabwe needs to conduct more baseline trachoma mapping in districts adjacent to those identified here as having a public health problem from the disease.
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Affiliation(s)
- Isaac Phiri
- a Department of Epidemiology and Disease Control , Ministry of Health and Child Care , Harare , Zimbabwe
| | - Portia Manangazira
- a Department of Epidemiology and Disease Control , Ministry of Health and Child Care , Harare , Zimbabwe
| | - Colin K Macleod
- b Clinical Research Department , London School of Hygiene & Tropical Medicine , London , UK.,c Sightsavers, Haywards Heath , UK
| | - Takafira Mduluza
- d Department of Biochemistry , Faculty of Sciences, University of Zimbabwe , Mt Pleasant , Harare , Zimbabwe.,e School of Laboratory Medicine and Medical Sciences , College of Health Sciences, University of KwaZulu-Natal , Durban , South Africa
| | - Tinashe Dhobbie
- a Department of Epidemiology and Disease Control , Ministry of Health and Child Care , Harare , Zimbabwe
| | | | - Chriswell Chigwena
- a Department of Epidemiology and Disease Control , Ministry of Health and Child Care , Harare , Zimbabwe
| | - Joshua Katiyo
- a Department of Epidemiology and Disease Control , Ministry of Health and Child Care , Harare , Zimbabwe
| | | | | | | | - Paul Courtright
- i KCCO International, Division of Ophthalmology , University of Cape Town , South Africa
| | - Boniface Macheka
- j Department of Ophthalmology , Parirenyatwa Group of Hospitals , Harare , Zimbabwe
| | - Nicholas Midzi
- k Department of Medical Microbiology , College of Health Sciences, University of Zimbabwe , Harare , Zimbabwe
| | - And Anthony W Solomon
- b Clinical Research Department , London School of Hygiene & Tropical Medicine , London , UK.,l Department of Control of Neglected Tropical Diseases , World Health Organization , Geneva , Switzerland
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Bero B, Macleod C, Alemayehu W, Gadisa S, Abajobir A, Adamu Y, Alemu M, Adamu L, Dejene M, Mekasha A, Habtamu Jemal Z, Yadeta D, Shafi O, Kiflu G, Willis R, Flueckiger RM, Chu BK, Pavluck AL, Solomon AW. Prevalence of and Risk Factors for Trachoma in Oromia Regional State of Ethiopia: Results of 79 Population-Based Prevalence Surveys Conducted with the Global Trachoma Mapping Project. Ophthalmic Epidemiol 2016; 23:392-405. [PMID: 27820657 PMCID: PMC6837860 DOI: 10.1080/09286586.2016.1243717] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE To complete the baseline trachoma map in Oromia, Ethiopia, by determining prevalences of trichiasis and trachomatous inflammation - follicular (TF) at evaluation unit (EU) level, covering all districts (woredas) without current prevalence data or active control programs, and to identify factors associated with disease. METHODS Using standardized methodologies and training developed for the Global Trachoma Mapping Project, we conducted cross-sectional community-based surveys from December 2012 to July 2014. RESULTS Teams visited 46,244 households in 2037 clusters from 252 woredas (79 EUs). A total of 127,357 individuals were examined. The overall age- and sex-adjusted prevalence of trichiasis in adults was 0.82% (95% confidence interval, CI, 0.70-0.94%), with 72 EUs covering 240 woredas having trichiasis prevalences above the elimination threshold of 0.2% in those aged ≥15 years. The overall age-adjusted TF prevalence in 1-9-year-olds was 23.4%, with 56 EUs covering 218 woredas shown to need implementation of the A, F and E components of the SAFE strategy (surgery, antibiotics, facial cleanliness and environmental improvement) for 3 years before impact surveys. Younger age, female sex, increased time to the main source of water for face-washing, household use of open defecation, low mean precipitation, low mean annual temperature, and lower altitude, were independently associated with TF in children. The 232 woredas in 64 EUs in which TF prevalence was ≥5% require implementation of the F and E components of the SAFE strategy. CONCLUSION Both active trachoma and trichiasis are highly prevalent in much of Oromia, constituting a significant public health problem for the region.
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Affiliation(s)
- Berhanu Bero
- a The Fred Hollows Foundation Ethiopia , Addis Ababa , Ethiopia
| | - Colin Macleod
- b Clinical Research Department , London School of Hygiene & Tropical Medicine , London , UK.,c Sightsavers, Haywards Heath , UK
| | - Wondu Alemayehu
- a The Fred Hollows Foundation Ethiopia , Addis Ababa , Ethiopia.,d Berhan Public Health and Eye Care Consultancy , Addis Ababa , Ethiopia
| | - Solomon Gadisa
- e Oromia Regional Health Bureau , Addis Ababa , Ethiopia
| | - Ahmed Abajobir
- a The Fred Hollows Foundation Ethiopia , Addis Ababa , Ethiopia
| | - Yilikal Adamu
- f Department of Ophthalmology, Faculty of Medicine , Addis Ababa University , Addis Ababa , Ethiopia
| | - Menbere Alemu
- g Task Force for Global Health , Addis Ababa , Ethiopia
| | - Liknaw Adamu
- h Lig Eye Care and Public Health Research , Addis Ababa , Ethiopia
| | - Michael Dejene
- i Michael Dejene Public Health Consultancy Services , Addis Ababa , Ethiopia
| | - Addis Mekasha
- e Oromia Regional Health Bureau , Addis Ababa , Ethiopia
| | | | - Damtew Yadeta
- e Oromia Regional Health Bureau , Addis Ababa , Ethiopia
| | - Oumer Shafi
- j Federal Ministry of Health , Addis Ababa , Ethiopia
| | - Genet Kiflu
- j Federal Ministry of Health , Addis Ababa , Ethiopia
| | | | | | - Brian K Chu
- k Task Force for Global Health , Decatur , GA , USA
| | | | - Anthony W Solomon
- b Clinical Research Department , London School of Hygiene & Tropical Medicine , London , UK
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Omar FJ, Kabona G, Abdalla KM, Mohamed SJ, Ali SM, Ame SM, Ngwalle A, Mbise C, Rotondo L, Willis R, Flueckiger RM, Massae PA, Bakhtiari A, Solomon AW, Ngondi JM. Baseline Trachoma Surveys in Kaskazini A and Micheweni Districts of Zanzibar: Results of Two Population-Based Prevalence Surveys Conducted with the Global Trachoma Mapping Project. Ophthalmic Epidemiol 2016; 23:412-417. [PMID: 27775454 PMCID: PMC5116987 DOI: 10.1080/09286586.2016.1235206] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Purpose: Based on health care records and trachoma rapid assessments, trachoma was suspected to be endemic in Kaskazini A and Micheweni districts of Zanzibar. This study aimed to investigate the prevalence of trachomatous inflammation–follicular (TF), and trachomatous trichiasis (TT) in each of those districts. Methods: The survey was undertaken in Kaskazini A and Micheweni districts on Unguja and Pemba Islands, respectively. A multi-stage cluster random sampling design was applied, whereby 25 census enumeration areas (clusters) and 30 households per cluster were included. Consenting eligible participants (children aged 1–9 years and people aged 15 years and older) were examined for trachoma using the World Health Organization simplified grading system. Results: A total of 1673 households were surveyed and 6407 participants (98.0% of those enumerated) were examined for trachoma. Examinees included a total of 2825 children aged 1–9 years and 3582 people aged 15 years and older. TF prevalence in 1–9-year-olds was 2.7% (95% confidence interval, CI, 2.7–4.1%) in Kazkazini A and 11.4% (95% CI 6.6–16.5%) in Micheweni. Among people aged 15 years and older, TT prevalence was 0.01% (95% CI 0.00–0.04%) in Kazkazini A and 0.21% (95% CI 0.08–0.39%) in Micheweni. Conclusion: Trachoma is a public health problem in Micheweni district, where implementation of all four components of the SAFE strategy (surgery, antibiotics, facial cleanliness, and environmental improvement), including mass drug administration with azithromycin, is required. These findings will facilitate planning for trachoma elimination.
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Affiliation(s)
- Fatma J Omar
- a Department of Eye Care , Ministry of Health , Zanzibar , Tanzania
| | - George Kabona
- b Iringa Regional Referral Hospital , Iringa , Tanzania
| | - Khalfan M Abdalla
- c Program for Neglected Tropical Diseases , Ministry of Health , Zanzibar , Tanzania
| | - Saleh J Mohamed
- c Program for Neglected Tropical Diseases , Ministry of Health , Zanzibar , Tanzania
| | - Said M Ali
- d Public Health Laboratory , Ivo de Carneri, Chake Chake, Pemba Island , Zanzibar , Tanzania
| | - Shaali M Ame
- d Public Health Laboratory , Ivo de Carneri, Chake Chake, Pemba Island , Zanzibar , Tanzania
| | - Abel Ngwalle
- e Sightsavers Tanzania , Dar es Salaam , Tanzania
| | | | | | | | | | | | | | - Anthony W Solomon
- i Clinical Research Department , London School of Hygiene & Tropical Medicine , London , UK
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Knowledge, practices and perceptions of trachoma and its control among communities of Narok County, Kenya. TROPICAL DISEASES TRAVEL MEDICINE AND VACCINES 2016; 2:13. [PMID: 28883957 PMCID: PMC5530922 DOI: 10.1186/s40794-016-0029-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 07/15/2016] [Indexed: 11/10/2022]
Abstract
Background Trachoma is the leading infectious cause of blindness in the world. It is commonly found in cultural groups with poor hygiene. Trachoma control includes Surgery, Antibiotics, Facial cleanliness and Environmental Improvement (SAFE). Potentially blinding and active trachoma are monitored using trachomatous trichiasis (TT) in adults and trachoma inflammation-follicular (TF) in children aged 1–9 years respectively. A cross-sectional study to assess the knowledge, practices and perceptions of trachoma and its control was conducted in the endemic communities in Narok County. Methods Qualitative methods were used for data collection. Using purposive sampling, 12 focus group discussions (FGDs) with single sex adult and young men and women groups of homogenous characteristics, 12 key informant interviews with opinion leaders and 5 in-depth interviews (IDIs) with trichiasis patients and 6 with persons who have undergone trichiasis surgery were conducted. Data was audio recorded, transcribed, coded and analyzed manually by study themes; knowledge, practices and perceptions of trachoma transmission, infection signs, prevention and control. Results Majority of the community members had knowledge of trachoma and its transmission. The practices that contributed to transmission of infection included: failure to wash faces and bathe regularly, sharing of water basins and towels for face washing, traditional methods of trachoma treatment and dirty household environment. Due to socio-cultural perceptions, toilets were unacceptable and use of bushes for human waste disposal was common. Poor perceptions on disease susceptibility, flies on children’s faces, latrine ownership and usage and separation of human and animal dwellings also played a role in the transmission of trachoma. Fear of loss of sight during surgery was a deterrent to its uptake and a desire to be able to see and take care of domestic animals promoted surgery uptake. Majority of the community members were appreciative of Mass Drug Administration (MDA) though side effect such as vomiting and diarrhoea were reported. Conclusion Poor practices and related socio-cultural perceptions are important risk factors in sustaining trachoma infection and transmission. Community members require health education for behavior change and awareness creation about surgery, MDA and its potential side effects for elimination of trachoma in Narok County, Kenya. Trial registration KEMRI SSC 2785. Registered 2 September 2014.
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Ramyil A, Wade P, Ogoshi C, Goyol M, Adenuga O, Dami N, Mpyet C. Prevalence of Trachoma in Jigawa State, Northwestern Nigeria. Ophthalmic Epidemiol 2016; 22:184-9. [PMID: 26158576 DOI: 10.3109/09286586.2015.1037399] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To determine the magnitude of trachoma and the prevalent forms of the disease, and to provide baseline data for the establishment of a trachoma control program in Jigawa State, northwestern Nigeria. METHODS A population-based cross-sectional survey was conducted in Jigawa State in May 2007 using a 2-stage cluster random sampling technique to select 4598 persons from 40 villages based on probability proportional to size. All participants were examined using a penlight and a 2.5 × binocular loupe for signs of trachoma, and graded using the World Health Organization (WHO) simplified grading system. RESULTS A total of 4598 people were seen with 99.96% coverage. Of these, 2460 (53.5%) were female and 2138 (46.5%) were male. Mean age was 21.6 years ( ± 19.8 years). The prevalence of follicular trachoma in children aged ≤9 years was 20.5% (95% confidence interval, CI, 18.7-22.4%) with no difference between the sexes. The prevalence of trichiasis in adults aged ≥15 years was 5%, and the prevalence was higher in females than males (odds ratio 2.60, 95% CI 2.06-3.28; p < 0.001). CONCLUSION Trachoma is a major problem in Jigawa State; there is a need to train trichiasis surgeons and empower them to carry out community-based surgery. District-level prevalence of trachoma needs to be determined to know which aspects of the WHO SAFE strategy (surgery, antibiotics, facial cleanliness and environmental improvements) need to be emphasized in each district.
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Affiliation(s)
- Alice Ramyil
- Department of Ophthalmology, University of Jos and Jos University Teaching Hospital , Jos , Nigeria
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Kalua K, Phiri M, Kumwenda I, Masika M, Pavluck AL, Willis R, Mpyet C, Lewallen S, Courtright P, Solomon AW. Baseline Trachoma Mapping in Malawi with the Global Trachoma Mapping Project (GTMP). Ophthalmic Epidemiol 2016; 22:176-83. [PMID: 26158575 PMCID: PMC4673584 DOI: 10.3109/09286586.2015.1035793] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: To determine the prevalence of trachoma in all suspected endemic districts in Malawi. Methods: A population-based survey conducted in 16 evaluation units from 12 suspected endemic districts in Malawi (population 6,390,517), using the standardized Global Trachoma Mapping Project (GTMP) protocol. A 2-stage cluster-random sampling design selected 30 households from each of 30 clusters per evaluation unit; all residents aged 1 year and older in selected households were examined for evidence of follicular trachoma (TF), intense trachomatous inflammation (TI), and trachomatous trichiasis (TT). Results: Four of the 16 evaluation units were found to be endemic for trachoma, with a prevalence range of 10.0–13.5% for TF and 0.2–0.6% for TT. Nine evaluation units had a TF prevalence between 5.0% and 9.9% while three evaluation units had a TF prevalence <5.0%. Conclusion: The prevalence rates of active trachoma in Malawi were not uniform among suspected endemic evaluation units, with rates higher than the World Health Organization (WHO) threshold for implementation of community-based control measures (TF ≥ 10.0%) in only 4 of the 16 evaluation units. Trachoma remains a disease of public health importance in some parts of Malawi and adjoining (unmapped) districts should be prioritized for mapping. According to the survey, an additional 3,169,362 people require intervention to reduce active disease and 1557 trichiasis surgeries are needed to reduce the prevalence of TT below WHO recommended thresholds.
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Affiliation(s)
- Khumbo Kalua
- Department of Ophthalmology, University of Malawi, College of Medicine , Blantyre , Malawi
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Gichangi M, Kalua K, Barassa E, Eliah E, Lewallen S, Courtright P. Task Shifting for Eye Care in Eastern Africa: General Nurses as Trichiasis Surgeons in Kenya, Malawi, and Tanzania. Ophthalmic Epidemiol 2016; 22:226-30. [PMID: 26158581 DOI: 10.3109/09286586.2015.1040924] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE There are approximately 8 million people with trachomatous trichiasis globally; in the year 2009, less than 160,000 people had surgery. These numbers are too low in order to achieve the goal of elimination of blinding trachoma by the year 2020. Task shifting approaches have led to the training of general nurses in trichiasis surgery in eastern Africa. The overall aim of this study was to determine the attrition and productivity (and the factors associated with productivity) of trichiasis surgeons in Kenya, Tanzania, and Malawi. METHODS A 3-year cohort study of trichiasis surgeons. RESULTS The overall response rate was 86%. Defining high productivity as 50+ operations per year per surgeon, only 16.1% of the trichiasis surgeons were highly productive. Among the surgeons, 27.9% were no longer at their site and ceased providing surgery (attrition) over the 3 years of study. High productivity was associated with having been trained by an experienced trainer, supervised by a clinical officer, having more than three surgical sets, and having an outreach program. CONCLUSION Attrition of general nurses trained in trichiasis surgery was high. Surgical productivity of trichiasis surgeons remained too low. It is likely that other approaches are needed to address the burden of trichiasis in the three countries. In terms of recommendations, training of trichiasis surgeons should be done in a "package," including a plan for provision of surgical equipment, continuous support and supervision, and outreach.
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Mousa A, Courtright P, Kazanjian A, Bassett K. A Community-based Eye Care Intervention in Southern Egypt: Impact on Trachomatous Trichiasis Surgical Coverage. Middle East Afr J Ophthalmol 2015; 22:478-83. [PMID: 26692721 PMCID: PMC4660536 DOI: 10.4103/0974-9233.167808] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose: The purpose of this study was to measure the impact of a community-based intervention on uptake of trichiasis surgery in Southern Egypt. Methods: Four villages where trachoma is endemic were randomly selected in the Samalout district, Egypt. Two villages were selected for intervention (intervention villages) and two matched villages for nonintervention (nonintervention villages). The intervention model provided community information sessions, door-to-door health education, screening, and improvements in the clinical capacity of eye care providers. The intervention was evaluated through two pre- and post-intervention community-based surveys that included the prevalence of trachoma and the utilization of eye care services at local hospitals. All patients with trichiasis answered a questionnaire regarding surgical utilization and barriers. Results: In the baseline survey, the trachomatous trichiasis (TT) surgical coverage was 22.7% (38.9% males, 16.7% females) in all villages. Following the intervention, the TT surgical coverage increased to 68% in villages that received the intervention (81.5% males, 60% females). Nonintervention villages had a TT surgical coverage of 26.1% (37.5% males, 20% females). In the intervention villages, the prevalence of TT significantly decreased from 9.4% (5.7% males, 11.8% females) to 3.8% (1.9% males, 5.1% females) (P = 0.013), in 2008. In nonintervention villages, there was a slight, but insignificant decrease in TT from 10.1% (3.1% males, 14.4% females) to 8.2% (3% males, 11.5% females) (P = 0.580). The major barriers to uptake of TT surgical services were: “Feeling no problem” (17.3%), “fear of surgery” (12.7%) and “cost” (12.7%). Conclusion: A community-based eye health education program with door-to-door screening significantly increased the uptake of TT surgical services. Although improvements to the delivery of surgical service are essential, they did not lead to any significant improvements in the nonintervention villages.
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Affiliation(s)
- Ahmed Mousa
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia ; Department of Ophthalmology, Gluaocma Research Chair, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Paul Courtright
- Kilimanjaro Centre for Community Ophthalmology International, Division of Ophthalmology, University of Cape Town, Cape Town, South Africa ; School of Population and Public Health, University of British Columbia, Vancouver, Canada ; British Columbia Centre for Epidemiologic and International Ophthalmology, University of British Columbia, Vancouver, Canada
| | - Arminee Kazanjian
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Ken Bassett
- British Columbia Centre for Epidemiologic and International Ophthalmology, University of British Columbia, Vancouver, Canada
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Ramke J, Zwi AB, Palagyi A, Blignault I, Gilbert CE. Equity and Blindness: Closing Evidence Gaps to Support Universal Eye Health. Ophthalmic Epidemiol 2015; 22:297-307. [DOI: 10.3109/09286586.2015.1077977] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Smith JL, Sivasubramaniam S, Rabiu MM, Kyari F, Solomon AW, Gilbert C. Multilevel Analysis of Trachomatous Trichiasis and Corneal Opacity in Nigeria: The Role of Environmental and Climatic Risk Factors on the Distribution of Disease. PLoS Negl Trop Dis 2015. [PMID: 26222549 PMCID: PMC4519340 DOI: 10.1371/journal.pntd.0003826] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The distribution of trachoma in Nigeria is spatially heterogeneous, with large-scale trends observed across the country and more local variation within areas. Relative contributions of individual and cluster-level risk factors to the geographic distribution of disease remain largely unknown. The primary aim of this analysis is to assess the relationship between climatic factors and trachomatous trichiasis (TT) and/or corneal opacity (CO) due to trachoma in Nigeria, while accounting for the effects of individual risk factors and spatial correlation. In addition, we explore the relative importance of variation in the risk of trichiasis and/or corneal opacity (TT/CO) at different levels. Data from the 2007 National Blindness and Visual Impairment Survey were used for this analysis, which included a nationally representative sample of adults aged 40 years and above. Complete data were available from 304 clusters selected using a multi-stage stratified cluster-random sampling strategy. All participants (13,543 individuals) were interviewed and examined by an ophthalmologist for the presence or absence of TT and CO. In addition to field-collected data, remotely sensed climatic data were extracted for each cluster and used to fit Bayesian hierarchical logistic models to disease outcome. The risk of TT/CO was associated with factors at both the individual and cluster levels, with approximately 14% of the total variation attributed to the cluster level. Beyond established individual risk factors (age, gender and occupation), there was strong evidence that environmental/climatic factors at the cluster-level (lower precipitation, higher land surface temperature, higher mean annual temperature and rural classification) were also associated with a greater risk of TT/CO. This study establishes the importance of large-scale risk factors in the geographical distribution of TT/CO in Nigeria, supporting anecdotal evidence that environmental conditions are associated with increased risk in this context and highlighting their potential use in improving estimates of disease burden at large scales. Trichiasis (TT) and corneal opacity (CO) are chronic stages of trachoma, which remains an important cause of blindness. This study used multilevel spatial models to investigate risk factors for TT/CO in Nigeria, including data for more than 13,500 adults aged 40 years and above collected in the 2007 National Blindness and Visual Impairment survey. Individual-level risk factors were consistent with those identified in other studies, including a higher risk in females, older individuals and those with lower socioeconomic status. After controlling for these factors, there was evidence that a number of environmental and climatic factors are associated with the distribution of TT/CO in Nigeria. These findings establish for the Nigerian context the importance of risk factors at different scales for the later stages of trachoma, supporting anecdotal evidence that hotter, drier environmental conditions are associated with increased risk.
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Affiliation(s)
- Jennifer L. Smith
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Global Health Group, University of California San Francisco, San Francisco, California, United States of America
- * E-mail:
| | - Selvaraj Sivasubramaniam
- Medical Statistics Team, Division of Applied Health Sciences, University of Aberdeen, United Kingdom
| | | | - Fatima Kyari
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- College of Health Sciences of University of Abuja, Abuja, Nigeria
| | - Anthony W. Solomon
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Clare Gilbert
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
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