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Srivathsan A, Abdou A, Al-Khatib T, Apadinuwe SC, Badiane MD, Bucumi V, Chisenga T, Kabona G, Kabore M, Kanyi SK, Bella L, M’po N, Masika M, Minnih A, Sitoe HM, Mishra S, Olobio N, Omar FJ, Phiri I, Sanha S, Seife F, Sharma S, Tekeraoi R, Traore L, Watitu T, Bol YY, Borlase A, Deiner MS, Renneker KK, Hooper PJ, Emerson PM, Vasconcelos A, Arnold BF, Porco TC, Hollingsworth TD, Lietman TM, Blumberg S. District-Level Forecast of Achieving Trachoma Elimination as a Public Health Problem By 2030: An Ensemble Modelling Approach. Clin Infect Dis 2024; 78:S101-S107. [PMID: 38662700 PMCID: PMC11045026 DOI: 10.1093/cid/ciae031] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024] Open
Abstract
Assessing the feasibility of 2030 as a target date for global elimination of trachoma, and identification of districts that may require enhanced treatment to meet World Health Organization (WHO) elimination criteria by this date are key challenges in operational planning for trachoma programmes. Here we address these challenges by prospectively evaluating forecasting models of trachomatous inflammation-follicular (TF) prevalence, leveraging ensemble-based approaches. Seven candidate probabilistic models were developed to forecast district-wise TF prevalence in 11 760 districts, trained using district-level data on the population prevalence of TF in children aged 1-9 years from 2004 to 2022. Geographical location, history of mass drug administration treatment, and previously measured prevalence data were included in these models as key predictors. The best-performing models were included in an ensemble, using weights derived from their relative likelihood scores. To incorporate the inherent stochasticity of disease transmission and challenges of population-level surveillance, we forecasted probability distributions for the TF prevalence in each geographic district, rather than predicting a single value. Based on our probabilistic forecasts, 1.46% (95% confidence interval [CI]: 1.43-1.48%) of all districts in trachoma-endemic countries, equivalent to 172 districts, will exceed the 5% TF control threshold in 2030 with the current interventions. Global elimination of trachoma as a public health problem by 2030 may require enhanced intervention and/or surveillance of high-risk districts.
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Affiliation(s)
- Ariktha Srivathsan
- Francis I. Proctor Foundation, University of California, San Francisco, California, USA
| | - Amza Abdou
- Programme National de Santé Oculaire, Ministère De La Santé Publique, Niamey, Niger
| | - Tawfik Al-Khatib
- Prevention of Blindness Program, Ministry of Public Health & Population, Sana'a, Yemen
| | | | - Mouctar D Badiane
- Programme National de Promotion de La Santé Oculaire, Ministère de la Santé et de L'Action sociale, Dakar, Sénégal
| | - Victor Bucumi
- Département En Charge des Maladies Tropicales Négligées, Ministère De La Santé Publique Et De La Lutte Contre Le Sida, Bujumbura, Burundi
| | - Tina Chisenga
- Ministry of Health Public Health Department, Lusaka, Zambia
| | - George Kabona
- Neglected Tropical Disease Control Program, Ministry of Health and Social Welfare, Dar Es Salaam, United Republic of Tanzania
| | - Martin Kabore
- Programme national de lutte contre les maladies tropicales négligées, Ministère de la santé et de l'hygiène publique, Ouagadougou, Burkina Faso
| | - Sarjo Kebba Kanyi
- The National Eye Health Programme, Ministry of Health and Social Welfare, Banjul, Kanifing, The Gambia
| | - Lucienne Bella
- Programme National De Lutte Contre La Cécité, Ministère De La Santé Publique, Yaoundé, Cameroon
| | - Nekoua M’po
- Programme National De Lutte Contre Les Maladies Transmissibles, Ministère De La Santé, Cotonou, Benin
| | - Michael Masika
- Department of Clinical Services, Ministry of Health, Lilongwe, Malawi
| | - Abdellahi Minnih
- Département Des Maladies Transmissibles, Ministère De La Santé Nouakchott, Nouakchott, Mauritania
| | - Henis Mior Sitoe
- Direcção Nacional De Saúde Pública Ministerio Da Saude, Maputo, Mozambique
| | | | - Nicholas Olobio
- National Trachoma Elimination Programme, Federal Ministry of Health, Abuja, Nigeria
| | | | - Isaac Phiri
- Department of Epidemiology and Disease Control, Ministry of Health & Child Welfare, Harare, Zimbabwe
| | - Salimato Sanha
- Programa Nacional De Saúde De Visão, Minsap, Bissau, Guinea-Bissau
| | - Fikre Seife
- Federal Ministry of Health, Addis Ababa, Ethiopia
| | | | - Rabebe Tekeraoi
- Eye Department, Ministry of Health and Medical Services, South Tarawa, Kiribati
| | - Lamine Traore
- Programme National de la Santé Oculaire, Ministère de la Santé, Bamako, Mali
| | | | - Yak Yak Bol
- Neglected Tropical Diseases Programme, Ministry of Health, Juba, South Sudan
| | - Anna Borlase
- Department of Biology, University of Oxford, Oxford, United Kingdom
| | - Michael S Deiner
- Francis I. Proctor Foundation, University of California, San Francisco, California, USA
| | - Kristen K Renneker
- International Trachoma Initiative, The Task Force for Global Health, Decatur, Georgia, USA
| | - P J Hooper
- International Trachoma Initiative, The Task Force for Global Health, Decatur, Georgia, USA
| | - Paul M Emerson
- International Trachoma Initiative, The Task Force for Global Health, Decatur, Georgia, USA
| | - Andreia Vasconcelos
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, United Kingdom
| | - Benjamin F Arnold
- Francis I. Proctor Foundation, University of California, San Francisco, California, USA
| | - Travis C Porco
- Francis I. Proctor Foundation, University of California, San Francisco, California, USA
| | - T Déirdre Hollingsworth
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, United Kingdom
| | - Thomas M Lietman
- Francis I. Proctor Foundation, University of California, San Francisco, California, USA
| | - Seth Blumberg
- Francis I. Proctor Foundation, University of California, San Francisco, California, USA
- Department of Medicine, University of California, San Francisco, California, USA
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Dyer CEF, Kalua K, Chisambi AB, Wand H, McManus H, Liu B, Kaldor JM, Vaz Nery S. Water, Sanitation, and Hygiene (WASH) Factors Influencing the Effectiveness of Mass Drug Administration to Eliminate Trachoma as a Public Health Problem in Malawi. Ophthalmic Epidemiol 2024; 31:127-133. [PMID: 36987395 DOI: 10.1080/09286586.2023.2194409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 03/19/2023] [Indexed: 03/30/2023]
Abstract
PURPOSE Following a national population-based trachoma survey in Malawi one round of azithromycin mass drug administration (MDA) was carried out, with a post-MDA impact survey showing TF prevalence below 5% and considered eliminated as a public health problem. However, active trachoma was still present in over 200 children. We assessed whether water, sanitation, and hygiene (WASH) factors were associated with ongoing presence of TF in children aged 1-9 years following MDA. METHODS A secondary analysis was performed on a sub-set of the post-MDA impact survey data for children aged 1-9 years. We used a logistic regression analysis, adjusted for clustering at the household and village level. RESULTS Among 16,142 children aged 1-9 years, 209 (1.3%) had TF after MDA. Factors associated with a significantly lower odds of TF after MDA were living in a household with a handwashing facility (aOR: 0.37) and living in a household where water for washing is located further away from the home (30 min away aOR: 0.39, p = .034, or more than 1 h away aOR: 0.31, p = .018) compared with water in the yard. CONCLUSION The inverse association between a domestic handwashing facility and TF is consistent with previous findings, but the association of increasing distance to collect water for washing with a reduced risk of TF was unexpected and may reflect the impact of drought and unmeasured behavioural factors related to water usage. A more comprehensive collection of sociodemographic and WASH factor information in population-based trachoma surveys will provide insight into achieving and maintaining low levels of trachoma.
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Affiliation(s)
- Clare E F Dyer
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Khumbo Kalua
- Department of Ophthalmology, Kamuzu University of Health Sciences, Blantyre, Malawi
- Blantyre Institute for Community Ophthalmology, Lions Sight First Eye Hospital, Blantyre, Malawi
| | - Alvin B Chisambi
- Blantyre Institute for Community Ophthalmology, Lions Sight First Eye Hospital, Blantyre, Malawi
| | - Handan Wand
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Hamish McManus
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Bette Liu
- School of Population Health, University of New South Wales, Sydney, Australia
| | - John M Kaldor
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Susana Vaz Nery
- Kirby Institute, University of New South Wales, Sydney, Australia
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Ageed A, Khan M. Eliminating Trachoma in Africa: The Importance of Environmental Interventions. Cureus 2024; 16:e52358. [PMID: 38234389 PMCID: PMC10792353 DOI: 10.7759/cureus.52358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2024] [Indexed: 01/19/2024] Open
Abstract
Subsequent to the failure of the World Health Organisation (WHO) of achieving their target to eliminate trachoma by the year 2020, the most effective strategy in eliminating trachoma must be re-examined to accomplish the new target of eradication by the year 2030. Whilst antibiotic therapy is a core foundation of this elimination strategy, another important factor is the state of the environmental conditions in trachoma endemic countries. This manuscript aimed to identify the impact of environmental improvement strategies on the prevalence of trachoma and the significance of environmental improvement alongside the use of antibiotic treatment to achieve trachoma elimination. Two independent literature searches were conducted up until the 5th of July 2021. Two main databases were used to carry out these literature searches, namely, Ovid EMBASE and Ovid MEDLINE. All of the relevant references were found using MeSH and free text terms. Key terms used were 'trachoma', 'water', 'sanitation', 'hygiene' and 'environmental Improvement'. The exclusion criteria included non-African-based studies, review papers, protocols and case reports. A total of 17 studies were included for this review. Living within a close range of a water source was significantly associated with reduced risk of trachoma infection. Water obtained from piped water sources was associated with the lowest rates of active trachoma. Studies on facial cleanliness evidenced a strong association with reduced prevalence of trachoma. Whilst the provision of latrine facilities found was significantly associated with reduced prevalence of trachoma, there was no significant difference between the use of private latrine facilities over communal latrine facilities. The use of repeated scheduled antibiotic treatments over single-use antibiotic distribution had a greater impact both short term and long term on the prevalence rates of trachoma. Nonetheless, prevalence rates increased again following the commencement of treatment. Mass antibiotic treatment has been proven to have a greater impact on lowering the prevalence of trachoma initially, but this impact is not sustainable due to the rise in prevalence rates following the completion of treatment. A holistic approach, therefore, must be implemented with evidence showing that an emphasis on longer-term environmental methods should be implemented to compliment antibiotic distribution. Prioritisation of specific interventional measures should be tailored according to local epidemiology; nonetheless, these measures form the backbone of a trachoma elimination strategy to eliminate trachoma by the year 2030.
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Affiliation(s)
- Ahmed Ageed
- Hospital Medicine, University Hospitals of Leicester NHS Trust, Leicester, GBR
| | - Maaz Khan
- Medical Education, Royal Surrey County Hospital, Guildford, GBR
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Gebreselassie G, Negash K, Tsegaye S, Makonnen M, Deneke B, Desalegn M, Harding-Esch EM, Harte A, Solomon AW, Boyd S, Bakhtiari A, Hassen MA, Hambali A, Dejene M, Beckwith C, Tadesse F, Seifu F, Kiflu G, Kebede F. Prevalence of trachoma in Somali region, Ethiopia: results from trachoma impact surveys in 50 woredas. Int Health 2023; 15:ii30-ii37. [PMID: 38048381 PMCID: PMC10695430 DOI: 10.1093/inthealth/ihad063] [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: 04/15/2023] [Revised: 07/16/2023] [Accepted: 08/01/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Following interventions to eliminate trachoma in Somali region, Ethiopia, we aimed to re-estimate the prevalence of trachomatous trichiasis (TT) and trachomatous inflammation-follicular (TF) at woreda level and identify the factors associated with the disease. METHODS We implemented cross-sectional community-based surveys in 50 trachoma-endemic woredas, using a standardized survey. Households were the secondary sampling unit. Surveys were undertaken through a combination of interviews of household heads and direct inspection of water, sanitation and hygiene (WASH) access, plus clinical evaluation of eligible household members for TT and TF. RESULTS Overall, 41 (82%) of the 50 woredas had met the WHO-recommended active trachoma elimination threshold (prevalence of TF <5% in 1-9-y-olds) and 42 (84%) had met the TT threshold (prevalence of TT unknown to the health system <0.2% in ≥15-y-olds). Only 18% of households had access to an improved drinking water source within a 30-min trip and only 25% had an improved latrine. CONCLUSIONS Additional rounds of antibiotic mass drug administration, plus interventions to enhance facial cleanliness and improve the environment, are required in nine woredas. TT surgical campaigns are needed in eight woredas. Greater access to WASH is required across all the woredas that were surveyed.
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Affiliation(s)
| | | | | | | | | | | | - Emma M Harding-Esch
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Anna Harte
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Anthony W Solomon
- Global Neglected Tropical Diseases Programme, World Health Organization, Geneva, Switzerland
| | - Sarah Boyd
- Task Force for Global Health, Decatur GA, USA
| | | | | | | | | | | | | | - Fikre Seifu
- Ethiopia Ministry of Health, Addis Ababa, Ethiopia
| | - Genet Kiflu
- Ethiopia Ministry of Health, Addis Ababa, Ethiopia
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Adimassu NF, Assem AS, Fekadu SA. Postoperative trachomatous trichiasis: a systematic review and meta-analysis study. Int Health 2023; 15:623-629. [PMID: 36852770 PMCID: PMC10629961 DOI: 10.1093/inthealth/ihad014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 01/04/2023] [Accepted: 02/10/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Trachomatous trichiasis is the potential stage of trachoma in which the eyelashes scratch the surface of the globe, ultimately causing corneal opacity, visual impairment and blindness. The aim of this systematic review and meta-analysis is to obtain the pooled prevalence and associated factors of postoperative trachomatous trichiasis (PTT) in World Health Organization (WHO) trachoma-endemic regions. METHODS An inclusive literature search was undertaken using PubMed, Cochrane Library, Science Direct and Google Scholar databases from 30 May 2022 to 28 June 2022. I2 statistics and funnel plots were used to determine heterogeneity and publication bias among included studies. A random effects model was used to estimate pooled prevalence, incidence and odds ratios (ORs) with the respective 95% confidence intervals (CIs) using RevMan 5.4 software. RESULTS Eighteen articles were included in this meta-analysis and systematic review. The pooled prevalence of PTT was 19% (range 18-21). PTT was lower among young adults compared with old adults (OR 0.63 [95% CI 0.44 to 0.92]), single-dose oral azithromycin as compared with tetracycline eye ointment users (OR 0.82 [95% CI 0.69 to 0.99]) and minor trichiasis before surgery as compared with major trichiasis (OR 0.63 [95% CI 0.47 to 0.85]). CONCLUSIONS The incidence of PTT was higher than the WHO's recommendation. Prescribing single-dose oral azithromycin after surgery, periodic training for trichiasis surgeons, close follow-up and health education after surgery are crucial to minimize the recurrence.Study protocol registration on PROSPERO: CRD42022336003.
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Affiliation(s)
- Nebiyat Feleke Adimassu
- Department of Optometry, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Abel Sinshaw Assem
- Department of Optometry, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Sofonias Addis Fekadu
- Department of Optometry, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Shafi Abdurahman O, Last A, Macleod D, Habtamu E, Versteeg B, Dumessa G, Guye M, Nure R, Adugna D, Miecha H, Greenland K, Burton MJ. Trachoma risk factors in Oromia Region, Ethiopia. PLoS Negl Trop Dis 2023; 17:e0011679. [PMID: 37934731 PMCID: PMC10629622 DOI: 10.1371/journal.pntd.0011679] [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: 06/28/2023] [Accepted: 09/21/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND Trachoma, the leading infectious cause of blindness, is caused by the bacterium Chlamydia trachomatis (Ct). Despite enormous disease control efforts and encouraging progress, trachoma remains a significant public health problem in 44 countries. Ethiopia has the greatest burden of trachoma worldwide, however, robust data exploring transmission risk factors and the association between socio-economic status is lacking from some regions. This is the first study to investigate these factors in this South-Eastern region of Oromia, Ethiopia. METHODOLOGY/PRINCIPAL FINDINGS A total of 1211 individuals were enrolled from 247 households in Shashemene Rural district in Oromia Region between 11th April and 25th June 2018, of whom 628 (51.9%) were female and 526 (43.4%) were children aged 1-9 years. Three standardised ophthalmic nurses examined each participant for the presence of active trachoma using the WHO simplified trachoma grading system. Conjunctival swab samples were collected from the upper tarsal conjunctiva of the left eye of each participant. Ct was detected using quantitative PCR. Risk factor data were collected through structured interviews and direct observations. Clinical signs of trachomatous inflammation-follicular among children aged 1-9 (TF1-9) were observed in at least one eye of 106/526 (20.2%) and trachomatous inflammation-intense among children aged 1-9 (TI1-9) were observed in at least one eye of 10/526 (1.9%). We detected Ct by PCR in 23 individuals, of whom 18 (78.3%) were in children aged 1-9 years. Among the 106 children aged 1-9 years with TF, 12 (11.3%) were Ct PCR positive and among 20 children aged 1-9 years with TI, 4 (20.0%) were Ct PCR positive. In a multivariable model, adjusting for household clustering, active trachoma was associated with younger age, the poorest households (aOR = 2.56, 95% CI 1.21-5.51), presence of flies on the face (aOR = 2.87, 95% CI 1.69-6.46), and ocular discharge (aOR = 1.89, 95% CI 1.03-3.24). Pre-school children face washing more than once a day had lower odds of having active trachoma (aOR = 0.59, 95% CI 0.19-0.84). The same was true for washing children's clothing at least once per week (aOR = 0.27, 95% CI 0.33-1.02). CONCLUSION/SIGNIFICANCE Younger age, personal hygiene in this age group (presence of ocular and nasal discharges, infrequent washing of faces and clothing) and fly-eye contacts are potential risk factors for trachoma in this setting, suggesting that hygiene interventions and environmental improvements are required to suppress transmission to ensure sustained reduction in disease burden Further studies are needed to evaluate these interventions for trachoma control and elimination. Trachoma remains a disease associated with lower socio-economic status, emphasising the need for continued implementation of control measures in addition to poverty reduction interventions in this region.
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Affiliation(s)
- Oumer Shafi Abdurahman
- International Centre for Eye Health, Clinical Research Department, Faculty of Infectious and Tropical diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- The Fred Hollows Foundation, Addis Ababa, Ethiopia
| | - Anna Last
- International Centre for Eye Health, Clinical Research Department, Faculty of Infectious and Tropical diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - David Macleod
- International Centre for Eye Health, Clinical Research Department, Faculty of Infectious and Tropical diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Esmael Habtamu
- International Centre for Eye Health, Clinical Research Department, Faculty of Infectious and Tropical diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Bart Versteeg
- International Centre for Eye Health, Clinical Research Department, Faculty of Infectious and Tropical diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - Meseret Guye
- The Fred Hollows Foundation, Addis Ababa, Ethiopia
| | - Rufia Nure
- The Fred Hollows Foundation, Addis Ababa, Ethiopia
| | - Dereje Adugna
- Oromia Regional Health Bureau, Addis Ababa, Ethiopia
| | - Hirpha Miecha
- Oromia Regional Health Bureau, Addis Ababa, Ethiopia
| | - Katie Greenland
- Environmental Health Group, Department for Disease Control, Faculty of Infectious and Tropical. Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Matthew J. Burton
- International Centre for Eye Health, Clinical Research Department, Faculty of Infectious and Tropical diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- National Institute for Health Research Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
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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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Asmare ZA, Assefa NL, Abebe D, Nigatu SG, Alimaw YA. Trachoma prevention practice and associated factors among mothers having children aged under nine years in Andabet district, northwest Ethiopia, 2022: A multi-level analysis. PLoS Negl Trop Dis 2023; 17:e0011433. [PMID: 37390045 DOI: 10.1371/journal.pntd.0011433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 06/02/2023] [Indexed: 07/02/2023] Open
Abstract
BACKGROUND The world health organization (WHO) adopted the Surgery, Antibiotic, facial cleanliness, and environmental improvement (SAFE) strategy for the prevention of trachoma, and different prevention strategies have been employed in Andabet district. Trachoma still has a high prevalence despite these efforts. So, it is imperative to assess ground trachoma prevention practice (TPP) since there are insufficient studies in the study area. OBJECTIVE To determine the magnitude and factors associated with TPP among mothers having children aged under nine years in Andabet district, Northwest Ethiopia. METHOD A community-based cross-sectional study involving 624 participants was conducted June 1-30, 2022. Systematic random sampling was carried out to select study participants. Multi-level binary logistic regression analysis was used to identify factors associated with poor TPP. Descriptive and summary statistics were performed and variables with p-value < 0.05 in the best-fitted model were declared to be significantly associated with poor TPP. RESULTS In this study, the proportion of poor TPP was found to be 50.16% (95%CI = 46.23, 54.08). In the multi-variable multi-level logistic regression; having no formal education (AOR = 2.95; 95%CI: 1.41,6.15) and primary education (AOR = 2.33; 95%CI:1.04, 5.24), being a farmer (AOR = 3.02; 95%CI:1.73,5.28), and merchant (AOR = 2.63; 95%CI:1.20, 5.75), time taken to water point >30 minutes (AOR = 4.60,95CI:1.30,16.26) and didn't receive health education about trachoma (AOR = 2.36;95CI:1.16,4.79) were significantly associated with poor TPP. CONCLUSION The proportion of poor TPP was high relative to other studies. Level of education, occupation, time taken to the water point, and health education were significantly associated with poor TPP. Therefore, taking special attention to these high-risk groups could decrease the poor TPP.
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Affiliation(s)
- Zufan Alamrie Asmare
- Department of Ophthalmology, School of Medicine and Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Natnael Lakachew Assefa
- Department of Optometry, School of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Dagmawi Abebe
- Department of Ophthalmology, School of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Solomon Gedlu Nigatu
- Department of Epidemiology & Biostatistics, Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Yezinash Addis Alimaw
- Department of Optometry, School of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
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9
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He J, Chen A, Zou M, Young CA, Jin L, Zheng D, Jin G, Congdon N. Time trends and heterogeneity in the disease burden of trachoma, 1990-2019: a global analysis. Br J Ophthalmol 2023; 107:337-341. [PMID: 34593412 DOI: 10.1136/bjophthalmol-2021-319621] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 09/18/2021] [Indexed: 11/04/2022]
Abstract
PURPOSE To evaluate the epidemiological trends and associated risk factors of disease burden due to trachoma. METHODS Data for the country-specific disability-adjusted life year (DALY) number, rate and age-standardised rate of trachoma together with related data of other common eye diseases were acquired from the Global Burden of Disease Study 2019 database. The Socio-Demographic Index (SDI), Human Development Index (HDI), inequality-adjusted HDI and other related indices were obtained from published data or publicly available databases. Regression analyses were conducted to evaluate the associations between potential risk factors and the age-standardised DALY burden of trachoma. RESULTS The global DALY burden due to trachoma decreased by 37% from 1990 to 2019 and decreased by 69.8% after adjusting for age and population growth, and, in available 1990-2019 data, had the greatest reduction in attributable DALYs of all common eye disease, with the others analysed being cataract, glaucoma, refractive disorders and age-related macular degeneration. Women had higher age-standardised DALY burden due to trachoma than men (p<0.001). The African region (p<0.001) had the heaviest burden among global regions. The age-standardised DALY rate was higher in countries with lower income (p<0.001) and lower SDI (p<0.001). Higher disease burden due to trachoma was associated with lower HDI (β=-48.102, 95% CI -86.888 to -9.316, p=0.016), lower SDI (β=-48.063, 95% CI -83.702 to -12.423, p<0.001) and lower expected years of schooling (β=-2.352, 95% CI -3.756 to -0.948, p=0.002). CONCLUSIONS The global disease burden due to trachoma decreased from 1990 to 2019 and it had the greatest reduction compared with other common eye diseases. Lower HDI, socioeconomic status and educational level were related to a higher national disease burden of trachoma. Our findings could provide necessary information for trachoma control and prevention.
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Affiliation(s)
- Jingxin He
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Aiming Chen
- Department of Pharmacy, Fifth Affiliated Hospital of Sun Yat- sen University, Zhuhai, China
| | - Minjie Zou
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Charlotte Aimee Young
- Department of Ophthalmology, Third Affiliated Hospital, Nanchang University, Nanchang, People's Republic of China
| | - Ling Jin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Danying Zheng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Guangming Jin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Nathan Congdon
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China.,Centre for Public Health, Queen's University Belfast, Belfast, UK.,Orbis International, New York, New York, USA
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10
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López YA, Talero SL, León Donado JP, Álvarez ÁM, Magris M, Hernández T, Bermúdez M, Villalobos N, Saboyá-Díaz MI. Trachoma Rapid Assessments in Venezuela, an Example of the Integration of Data Gathering with Service Delivery in Hard-to-reach Populations. Ophthalmic Epidemiol 2021; 29:100-107. [PMID: 34379575 DOI: 10.1080/09286586.2021.1904512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
A) PURPOSE The objective of the study was to assess the presence of trachoma in high priority districts in the Amazon state of Venezuela (the Bolivarian Republic of), and use trachoma data gathering platform to offer integrated primary health care services to underserved hard-to-reach populations living in the border with Colombia. B) METHODS Trachoma Rapid Assessments (TRA) were conducted in indigenous communities of three municipalities of the Amazonas State of Venezuela from June 2018 to April 2019 using the World Health Organization (WHO) guidelines. Integrated health services were delivered based on the identified needs of the population of the assessed communities. C) RESULTS 1,185 children aged 1-9 years were examined for trachoma in the three municipalities, of which 6.92% had active trachoma; 994 people 15 years and above were examined for trachomatous trichiasis (TT) finding two cases (0.2%). 1,635 people were examined for other health-related problems and the most common diagnoses were intestinal parasites (54.74%), eye diseases (16.81%), cavities (7.34%), scabies (5.56%), headache (4.40%), and malaria (2.81%); additionally, 2,233 vaccine doses were provided to children and adults to complete vaccination series. D) CONCLUSION The results of the TRA in the Amazon state of Venezuela suggest that trachoma could be a public health problem and standardized population-based surveys to establish the prevalence and determine the interventions to implement are needed.
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Affiliation(s)
- Yuri Andrea López
- Malaria Unit, Amazonas Centre for Research and Control of Tropical Diseases "Simón Bolivar" (CAICET) of Ministry of Popular Power for Health, Puerto Ayacucho, Amazonas State, Bolivarian Republic of Venezuela
| | - Sandra Liliana Talero
- Innovation and Research Department, Escuela Superior de Oftalmología, Instituto Barraquer de América, Bogotá, Colombia
| | - Juan Pablo León Donado
- Ophthalmology Department, Hospital Militar Universitario "Dr. Carlos Arvelo", Caracas, Bolivarian Republic of Venezuela
| | - Ángel Manuel Álvarez
- Communicable Diseases and Environmental Determinants of Health, Pan American Health Organization (PAHO), Caracas, Bolivarian Republic of Venezuela
| | - Magda Magris
- Research Department, Amazonas Centre for Research and Control of Tropical Diseases "Simón Bolivar" (CAICET) of Ministry of Popular Power for Health, Puerto Ayacucho, Amazonas State, Bolivarian Republic of Venezuela
| | - Tulia Hernández
- Surveillance and Health Situation Analysis, Evidence and Intelligence for Action in Health Department, Pan American Health Organization (PAHO),Caracas, Bolivarian Republic of Venezuela
| | - Marisela Bermúdez
- Vice Minister of Collective Health Networks of the Ministry of Popular Power for Health, Caracas, Bolivarian Republic of Venezuela
| | - Neris Villalobos
- Immunizations Program, Pan American Health Organization (PAHO),Caracas, Bolivarian Republic of Venezuela
| | - Martha Idalí Saboyá-Díaz
- Neglected, Tropical, and Vector-Borne Diseases Unit, Communicable Diseases and Environmental Determinants of Health Department, Pan American Health Organization (PAHO), Washington D.C., USA
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11
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Blumberg S, Prada JM, Tedijanto C, Deiner MS, Godwin WW, Emerson PM, Hooper PJ, Borlase A, Hollingsworth TD, Oldenburg CE, Porco TC, Arnold BF, Lietman TM. Forecasting Trachoma Control and Identifying Transmission-Hotspots. Clin Infect Dis 2021; 72:S134-S139. [PMID: 33905484 PMCID: PMC8201580 DOI: 10.1093/cid/ciab189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background Tremendous progress towards elimination of trachoma as a public health problem has been made. However, there are areas where the clinical indicator of disease, trachomatous inflammation—follicular (TF), remains prevalent. We quantify the progress that has been made, and forecast how TF prevalence will evolve with current interventions. We also determine the probability that a district is a transmission-hotspot based on its TF prevalence (ie, reproduction number greater than one). Methods Data on trachoma prevalence come from the GET2020 global repository organized by the World Health Organization and the International Trachoma Initiative. Forecasts of TF prevalence and the percent of districts with local control is achieved by regressing the coefficients of a fitted exponential distribution for the year-by-year distribution of TF prevalence. The probability of a district being a transmission-hotspot is extrapolated from the residuals of the regression. Results Forecasts suggest that with current interventions, 96.5% of surveyed districts will have TF prevalence among children aged 1–9 years <5% by 2030 (95% CI: 86.6%–100.0%). Districts with TF prevalence < 20% appear unlikely to be transmission-hotspots. However, a district having TF prevalence of over 28% in 2016–2019 corresponds to at least 50% probability of being a transmission-hotspot. Conclusions Sustainable control of trachoma appears achievable. However there are transmission-hotspots that are not responding to annual mass drug administration of azithromycin and require enhanced treatment in order to reach local control.
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Affiliation(s)
- Seth Blumberg
- Francis I Proctor Foundation, University of California San Francisco, San Francisco, CA, USA.,Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Joaquin M Prada
- Faculty of Health and Medical Sciences, School of Veterinary Medicine, University of Surrey, Guildford, UK
| | - Christine Tedijanto
- Francis I Proctor Foundation, University of California San Francisco, San Francisco, CA, USA
| | - Michael S Deiner
- Francis I Proctor Foundation, University of California San Francisco, San Francisco, CA, USA
| | - William W Godwin
- Francis I Proctor Foundation, University of California San Francisco, San Francisco, CA, USA
| | - Paul M Emerson
- International Trachoma Initiative, The Task Force for Global Health, Decatur, Georgia, USA
| | - Pamela J Hooper
- International Trachoma Initiative, The Task Force for Global Health, Decatur, Georgia, USA
| | - Anna Borlase
- Nuffield Department of Medicine, Medical Sciences Division, University of Oxford, Oxford, UK
| | - T Deirdre Hollingsworth
- Nuffield Department of Medicine, Medical Sciences Division, University of Oxford, Oxford, UK
| | - Catherine E Oldenburg
- Francis I Proctor Foundation, University of California San Francisco, San Francisco, CA, USA.,Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA.,Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
| | - Travis C Porco
- Francis I Proctor Foundation, University of California San Francisco, San Francisco, CA, USA.,Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA.,Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
| | - Benjamin F Arnold
- Francis I Proctor Foundation, University of California San Francisco, San Francisco, CA, USA.,Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
| | - Thomas M Lietman
- Francis I Proctor Foundation, University of California San Francisco, San Francisco, CA, USA.,Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA.,Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA.,Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA
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12
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Wright HR, Turner A, Taylor HR. Trachoma and poverty: unnecessary blindness further disadvantages the poorest people in the poorest countries. Clin Exp Optom 2021; 90:422-8. [DOI: 10.1111/j.1444-0938.2007.00218.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Heathcote R Wright
- Centre for Eye Research Australia, The University of Melbourne, WHO Collaborating Centre for the Prevention of Blindness, East Melbourne VIC, Australia
- Vision CRC, University of New South Wales, Sydney NSW, Australia
E‐mail:
| | - Angus Turner
- Centre for Eye Research Australia, The University of Melbourne, WHO Collaborating Centre for the Prevention of Blindness, East Melbourne VIC, Australia
| | - Hugh R Taylor
- Centre for Eye Research Australia, The University of Melbourne, WHO Collaborating Centre for the Prevention of Blindness, East Melbourne VIC, Australia
- Vision CRC, University of New South Wales, Sydney NSW, Australia
E‐mail:
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13
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Cheke RA, Little KE, Young S, Walker M, Basáñez MG. Taking the strain out of onchocerciasis? A reanalysis of blindness and transmission data does not support the existence of a savannah blinding strain of onchocerciasis in West Africa. ADVANCES IN PARASITOLOGY 2021; 112:1-50. [PMID: 34024357 DOI: 10.1016/bs.apar.2021.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Onchocerciasis (also known as 'river blindness'), is a neglected tropical disease (NTD) caused by the (Simulium-transmitted) filarial nematode Onchocerca volvulus. The occurrence of 'blinding' (savannah) and non-blinding (forest) parasite strains and the existence of corresponding, locally adapted Onchocerca-Simulium complexes were postulated to explain greater blindness prevalence in savannah than in forest foci. As a result, the World Health Organization (WHO) Onchocerciasis Control Programme in West Africa (OCP) focused anti-vectorial and anti-parasitic interventions in savannah endemic areas. In this paper, village-level data on blindness prevalence, microfilarial prevalence, and transmission intensity (measured by the annual transmission potential, the number of infective, L3, larvae per person per year) were extracted from 16 West-Central Africa-based publications, and analysed according to habitat (forest, forest-savannah mosaic, savannah) to test the dichotomous strain hypothesis in relation to blindness. When adjusting for sample size, there were no statistically significant differences in blindness prevalence between the habitats (one-way ANOVA, P=0.68, mean prevalence for forest=1.76±0.37 (SE); mosaic=1.49±0.38; savannah=1.89±0.26). The well-known relationship between blindness prevalence and annual transmission potential for savannah habitats was confirmed and shown to hold for (but not to be statistically different from) forest foci (excluding data from southern Côte d'Ivoire, in which blindness prevalence was significantly lower than in other West African forest communities, but which had been the focus of studies leading to the strain-blindness hypothesis that was accepted by OCP planners). We conclude that the evidence for a savannah blinding onchocerciasis strain in simple contrast with a non-blinding forest strain is equivocal. A re-appraisal of the strain hypothesis to explain patterns of ocular disease is needed to improve understanding of onchocerciasis epidemiology and disease burden estimates in the light of the WHO 2030 goals for onchocerciasis.
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Affiliation(s)
- Robert A Cheke
- Natural Resources Institute, Department of Agriculture, Health & Environment, University of Greenwich at Medway, Kent, United Kingdom; London Centre for Neglected Tropical Disease Research (LCNTDR), Department of Infectious Disease Epidemiology, Faculty of Medicine, School of Public Health, Imperial College London, London, United Kingdom
| | | | - Stephen Young
- Natural Resources Institute, Department of Agriculture, Health & Environment, University of Greenwich at Medway, Kent, United Kingdom
| | - Martin Walker
- London Centre for Neglected Tropical Disease Research, Department of Pathobiology and Populations Sciences, Royal Veterinary College, Hatfield, United Kingdom
| | - Maria-Gloria Basáñez
- London Centre for Neglected Tropical Disease Research (LCNTDR), Department of Infectious Disease Epidemiology, Faculty of Medicine, School of Public Health, Imperial College London, London, United Kingdom; MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Faculty of Medicine, School of Public Health, Imperial College London, London, United Kingdom.
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14
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Nasir MA, Elsawy F, Omar A, Haque SO, Nadir R. Eliminating Trachoma by 2020: Assessing Progress in Nigeria. Cureus 2020; 12:e9450. [PMID: 32760636 PMCID: PMC7392186 DOI: 10.7759/cureus.9450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Trachoma is a neglected tropical disease that causes an eye infection which can lead to blindness if left untreated. In 1998, the World Health Organisation (WHO) launched a new goal to eradicate trachoma by 2020. Over the years, in partnership with the WHO, an effective strategy plan was devised to help tackle and control the disease. This involved surgery for trichiasis, antibiotic treatment, facial cleanliness, and environmental improvement (SAFE). Consequently, the number of people affected by trachoma has significantly decreased in recent times. Despite this, trachoma remains a major public health concern in 44 countries worldwide, including Nigeria. Although improvements have been seen throughout Nigeria, the disjointed application of the SAFE strategy has delayed progress compared to other countries. Providing quality treatment to those with trachoma, in addition to improving preventative measures are challenges faced throughout the country. However, a multi-pronged approach emulating the methods of other countries is recommended to achieve trachoma elimination. This review aims to evaluate the progress and challenges faced in Nigeria with regards to eliminating trachoma.
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Affiliation(s)
| | - Fayez Elsawy
- Medicine, Manchester University, Manchester, GBR
| | | | - Shah O Haque
- Medicine, Manchester University, Manchester, GBR
| | - Rans Nadir
- Medicine, Imperial College London, London, GBR
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15
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Mabey D. How many neglected tropical diseases can we eliminate by 2030? Trans R Soc Trop Med Hyg 2020; 114:473-475. [PMID: 32621491 DOI: 10.1093/trstmh/traa050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 06/17/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- David Mabey
- Clinical Research Department, London School of Hygiene & Tropical Medicine
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16
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Reda G, Yemane D, Gebreyesus A. Prevalence and associated factors of active trachoma among 1-9 years old children in Deguatemben, Tigray, Ethiopia, 2018: community cross-sectional study. BMC Ophthalmol 2020; 20:144. [PMID: 32293359 PMCID: PMC7161230 DOI: 10.1186/s12886-020-01394-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 03/16/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Trachoma is a contagious infection of the eye. World Health Organization recommended three rounds of mass drug administration in districts where the prevalence of trachomatous follicular (TF) is ≥10% in children aged 1-9 years. Mass drug distribution was given to residents for three consecutive years with more than 90% coverage. However, the prevalence and associated factors of active trachoma in the study community after the intervention was not yet determined. Thus, this deals with the prevalence and associated factors of active trachoma among children aged 1-9 years. METHODS We conducted a Community based cross-sectional study among 502 children aged 1-9 in March 2018 in Deguatemben. A multi-stage sampling technique was applied. Selected children were examined for trachoma using 2.5x binocular loupe and graded based on the WHO simplified grading system. Mothers were interviewed for factors associated with trachoma using a structured questionnaire. Data was entered on Epi-Info and exported to SPSS for analysis. Both descriptive and inferential analyses were done with 95% confidence intervals (CIs) at a p-value < 0.05 for the final model. RESULTS The prevalence of active trachoma was found 21.5% (95% CI: 17.8-25.1%). Being 1 to 4 years old [AOR (95% CI) = 6.81(2.00-23.11)], not washing face [AOR (95% CI) =9.31(1.13-77.66)], not using soap [AOR (95% CI) =5.84(1.87-18.21)], unclean face [AOR(95% CI) = 18.22(4.93-69.32)] and mother's knowledge [AOR (95% CI) =0.06(0.02-0.19)] were found as independent predictors. CONCLUSION The prevalence declined from the baseline, but it is still a public health problem in the district. Personal-related factors were found to be associated with the disease. Health education of "Facial cleanness" and related factors is recommended to increase knowledge of the mothers on their children's care in addition to the provision of antibiotics.
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Affiliation(s)
| | - Dejen Yemane
- College of Health Sciences, Mekelle University, P.O.BOX:1871, Mekelle, Tigray, Ethiopia
| | - Aregawi Gebreyesus
- College of Health Sciences, Mekelle University, P.O.BOX:1871, Mekelle, Tigray, Ethiopia.
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17
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Khan AA, Florea VV, Hussain A, Jadoon Z, Boisson S, Willis R, Dejene M, Bakhtiari A, Mpyet C, Pavluck AL, Gillani M, Qureshi B, Solomon AW. Prevalence of Trachoma in Pakistan: Results of 42 Population-Based Prevalence Surveys from the Global Trachoma Mapping Project. Ophthalmic Epidemiol 2020; 27:155-164. [PMID: 31916887 PMCID: PMC7048080 DOI: 10.1080/09286586.2019.1708120] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Purpose: Previous phases of trachoma mapping in Pakistan completed baseline surveys in 38 districts. To help guide national trachoma elimination planning, we set out to estimate trachoma prevalence in 43 suspected-endemic evaluation units (EUs) of 15 further districts. Methods: We planned a population-based trachoma prevalence survey in each EU. Two-stage cluster sampling was employed, using the systems and approaches of the Global Trachoma Mapping Project. In each EU, residents aged ≥1 year living in 30 households in each of 26 villages were invited to be examined by trained, certified trachoma graders. Questionnaires and direct observation were used to evaluate household-level access to water and sanitation. Results: One EU was not completed due to insecurity. Of the remaining 42, three EUs had trichiasis prevalence estimates in ≥15-year-olds ≥0.2%, and six (different) EUs had prevalence estimates of trachomatous inflammation—follicular (TF) in 1–9-year-olds ≥5%; each EU requires trichiasis and TF prevalence estimates below these thresholds to achieve elimination of trachoma as a public health problem. All six EUs with TF prevalences ≥5% were in Khyber Pakhtunkhwa Province. Household-level access to improved sanitation ranged by EU from 6% to 100%. Household-level access to an improved source of water for face and hand washing ranged by EU from 37% to 100%. Conclusion: Trachoma was a public health problem in 21% (9/42) of the EUs. Because the current outbreak of extremely drug-resistant typhoid in Pakistan limits domestic use of azithromycin mass drug administration, other interventions against active trachoma should be considered here.
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Affiliation(s)
- Asad Aslam Khan
- Ministry of National Health Services, Regulations and Coordination, Islamabad, Pakistan.,College of Ophthalmology and Allied Vision Sciences, King Edward Medical University, Lahore, Pakistan.,Mayo Hospital, Lahore, Pakistan
| | - Victor V Florea
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Arif Hussain
- College of Ophthalmology and Allied Vision Sciences, King Edward Medical University, Lahore, Pakistan
| | - Zahid Jadoon
- Pakistan Institute of Community Ophthalmology, Hayatabad Medical Complex, Peshawar, Pakistan
| | - Sophie Boisson
- Department of Public Health, The Environment and Social Determinants of Health, World Health Organization, Geneva, Switzerland
| | - Rebecca Willis
- International Trachoma Initiative, Task Force for Global Health, Decatur, GA, USA
| | - Michael Dejene
- Michael Dejene Public Health Consultancy Services, Addis Ababa, Ethiopia
| | - Ana Bakhtiari
- International Trachoma Initiative, Task Force for Global Health, Decatur, GA, USA
| | - Caleb Mpyet
- Department of Ophthalmology, University of Jos, Jos, Nigeria.,Sightsavers, Kaduna, Nigeria.,Kilimanjaro Centre for Community Ophthalmology International, Division of Ophthalmology, University of Cape Town, Cape Town, South Africa
| | - Alexandre L Pavluck
- International Trachoma Initiative, Task Force for Global Health, Decatur, GA, USA
| | | | - Babar Qureshi
- Neglected Tropical Diseases, CBM, Oakington, Cambridge, UK.,Eastern Mediterranean Region Alliance for Trachoma Control, Cairo, Egypt
| | - Anthony W Solomon
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland.,Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK.,London Centre for Neglected Tropical Disease Research, London, UK
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18
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Maritim P, Zulu JM, Jacobs C, Chola M, Chongwe G, Zyambo J, Halwindi H, Michelo C. Factors shaping the implementation of the SAFE strategy for trachoma using the Consolidated Framework for Implementation Research: a systematic review. Glob Health Action 2019; 12:1570646. [PMID: 30773102 PMCID: PMC6383623 DOI: 10.1080/16549716.2019.1570646] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: The SAFE strategy (surgery for trichiasis, antibiotics for active infection, facial cleanliness and environmental improvement) is the World Health Organization (WHO) recommended guideline for the elimination of blindness by trachoma by the year 2020. Objective: While evaluations on the implementation of the SAFE strategy have been done, systematic reviews on the factors that have shaped implementation are lacking. This review sought to identify these factors. Methods: We searched PUBMED, Google Scholar, CINAHL and Cochrane Collaboration to identify studies that had implemented SAFE interventions. The Consolidated Framework for Implementation Research (CFIR) guided development of the data extraction guide and data analysis. Results: One hundred and thirty-seven studies were identified and only 10 papers fulfilled the eligibility criteria. Characteristics of the innovation – such as adaptation of the SAFE interventions to suit the setting and observability of positive health outcomes from pilots – increased local adoption. Characteristics of outer setting – which included strong multisectoral collaboration – were found to enhance implementation through the provision of resources necessary for programme activities. When community needs and resources were unaccounted for there was poor compatibility with local settings. Characteristics of the inner setting – such as poor staffing, high labour turnovers and lack of ongoing training – affected health workers’ implementation behaviour. Implementation climate within provider organisations was shaped by availability of resources. Characteristics of individuals – which included low knowledge levels – affected the acceptability of SAFE programmes; however, early adopters could be used as change agents. Finally, the use of engagement strategies tailored towards promoting community participation and stakeholder involvement during the implementation process facilitated adoption process. Conclusion: We found CFIR to be a robust framework capable of identifying different implementation determinants in low resource settings. However, there is a need for more research on the organisational, provider and implementation process related factors for trachoma as most studies focused on the outer setting.
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Affiliation(s)
- Patricia Maritim
- a Department of Health Promotion, Economics and Policy, School of Public Health , University of Zambia , Lusaka , Zambia
| | - Joseph Mumba Zulu
- a Department of Health Promotion, Economics and Policy, School of Public Health , University of Zambia , Lusaka , Zambia
| | - Choolwe Jacobs
- b Department of Epidemiology and Biostatistics, School of Public Health , University of Zambia , Lusaka , Zambia
| | - Mumbi Chola
- b Department of Epidemiology and Biostatistics, School of Public Health , University of Zambia , Lusaka , Zambia
| | - Gershom Chongwe
- b Department of Epidemiology and Biostatistics, School of Public Health , University of Zambia , Lusaka , Zambia
| | - Jessy Zyambo
- b Department of Epidemiology and Biostatistics, School of Public Health , University of Zambia , Lusaka , Zambia
| | - Hikabasa Halwindi
- a Department of Health Promotion, Economics and Policy, School of Public Health , University of Zambia , Lusaka , Zambia
| | - Charles Michelo
- b Department of Epidemiology and Biostatistics, School of Public Health , University of Zambia , Lusaka , Zambia
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19
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Missamou F, Marlhand H, Dzabatou-Babeaux ASP, Sendzi S, Bernasconi J, D'Souza S, Bakhtiari A, Millar T, Willis R, Bengraïne K, Resnikoff S, Solomon AW. A Population-Based Trachoma Prevalence Survey Covering Seven Districts of Sangha and Likouala Departments, Republic of the Congo. Ophthalmic Epidemiol 2019; 25:155-161. [PMID: 30806542 PMCID: PMC6444200 DOI: 10.1080/09286586.2018.1546878] [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: 01/15/2023]
Abstract
PURPOSE We set out to estimate the prevalence of trachoma and access to water and sanitation in seven suspected-trachoma-endemic districts of northern Congo, surveyed as a single evaluation unit. METHODS From a complete list of rural villages in the seven districts, we systematically selected 22 with probability proportional to village size. In selected villages, we included all households where there were fewer than 25 in total, or used compact segment sampling to select a group of approximately 20 households by random draw. In each selected household, all consenting residents aged ≥1 year were examined by Global Trachoma Mapping Project-certified trachoma graders, and data collected on household-level access to water and sanitation. RESULTS In November and December 2015, 466 households were visited in 22 villages, and 2081 (88%) of 2377 residents of those households were examined. No examined individual had trichiasis. The age-adjusted prevalence of the active trachoma sign trachomatous inflammation-follicular (TF) in 1-9-year-olds was 2.5% (95%CI 0.9-4.5%). Only 39% (95%CI 35-44%) of households had access to an improved source of drinking water. Only 10% (95%CI 7-13%) of households had access to an improved sanitation facility. CONCLUSION Trachoma is not a public health problem in this part of Congo. Access to water and sanitation is inadequate.
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Affiliation(s)
- François Missamou
- a Directorate-General for the Fight against Communicable Diseases and HIV/AIDS , Ministère de la Santé et de la Population , Brazzaville , Congo
| | - Hemilembolo Marlhand
- a Directorate-General for the Fight against Communicable Diseases and HIV/AIDS , Ministère de la Santé et de la Population , Brazzaville , Congo
| | - Angelie S Patrick Dzabatou-Babeaux
- a Directorate-General for the Fight against Communicable Diseases and HIV/AIDS , Ministère de la Santé et de la Population , Brazzaville , Congo
| | - Samuel Sendzi
- a Directorate-General for the Fight against Communicable Diseases and HIV/AIDS , Ministère de la Santé et de la Population , Brazzaville , Congo
| | | | | | | | | | | | - Karim Bengraïne
- b Organisation pour la prevention de la cécité , Paris , France
| | - Serge Resnikoff
- b Organisation pour la prevention de la cécité , Paris , France
| | - Anthony W Solomon
- e Clinical Research Department , London School of Hygiene & Tropical Medicine , London , UK.,f Department of Control of Neglected Tropical Diseases , World Health Organization , Geneva , Switzerland
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Mwale C, Mumbi W, Funjika M, Sokesi T, Silumesii A, Mulenga M, Mutati G, Kwendakwema D, Chelu C, Adamu Y, Alemayehu W, Al-Khatib T, Bakhtiari A, Dejene M, Massae PA, Mpyet C, Nwosu C, Willis R, Courtright P, Solomon AW. Prevalence of Trachoma in 47 Administrative Districts of Zambia: Results of 32 Population-Based Prevalence Surveys. Ophthalmic Epidemiol 2019; 25:171-180. [PMID: 30806543 PMCID: PMC6444202 DOI: 10.1080/09286586.2018.1546880] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Purpose: A number of previous administrative-district-level baseline trachoma prevalence estimates in Zambia required verification. We used methodologies and systems for trachoma surveys considered to represent international best practice in order to generate reliable estimates of the prevalence of trachoma. Methods: Between March 2016 and July 2017, we undertook 32 population-based prevalence surveys covering 47 administrative districts. In each of the 32 evaluation units (EUs), we selected 31 households in each of 24 clusters. In selected households, trained, certified graders examined all residents aged 1 year and above for evidence of trachomatous inflammation—follicular (TF) and trichiasis. In eyes that had trichiasis, the presence or absence of trachomatous scarring (TS) was recorded, and the subject was asked about previous trichiasis management recommendations from health workers. Results: Five EUs (encompassing seven administrative districts) had prevalence estimates of trichiasis+TS unknown to the health system in ≥15-year-olds of ≥0.2%, and require public-health-level implementation of trichiasis surgery services. Eleven EUs (encompassing 16 administrative districts) had TF prevalence estimates in 1–9-year-olds of ≥5%. Intervention with the A, F and E components of the SAFE strategy for trachoma elimination is required for nearly 1.5 million people. Conclusion: Trachoma is a public health problem in some parts of Zambia. The Ministry of Health will continue to partner with other stakeholders to implement the multi-sectoral SAFE strategy. Consideration should be given to re-surveying other suspected-endemic administrative districts in which surveys using older methodologies returned TF prevalence estimates ≥5%.
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Affiliation(s)
- Consity Mwale
- a Lusaka Provincial Health Office , Lusaka , Zambia.,b University Teaching Eye Hospital , Lusaka , Zambia
| | - Willard Mumbi
- c Ophthalmology Unit , Kabwe General Hospital , Kabwe , Zambia
| | - Misa Funjika
- d Ophthalmology Unit , Ndola Teaching Hospital , Ndola , Zambia
| | - Teddy Sokesi
- d Ophthalmology Unit , Ndola Teaching Hospital , Ndola , Zambia
| | | | - Muma Mulenga
- b University Teaching Eye Hospital , Lusaka , Zambia
| | - Grace Mutati
- b University Teaching Eye Hospital , Lusaka , Zambia
| | | | | | - Yilikal Adamu
- g Department of Ophthalmology, Faculty of Medicine , Addis Ababa University , Addis Ababa , Ethiopia
| | - Wondu Alemayehu
- h The Fred Hollows Foundation , Addis Ababa , Ethiopia.,i Berhan Public Health and Eye Care Consultancy , Addis Ababa , Ethiopia
| | - Tawfik Al-Khatib
- j Prevention of Blindness Program , Ministry of Public Health & Population , Sana'a , Yemen.,k Department of Ophthalmology, College of Medicine , University of Sana'a , Sana'a , Yemen.,l Eye Unit , Al-Thawra Hospital , Sana'a , Yemen
| | | | - Michael Dejene
- n Michael Dejene Public Health Consultancy Services , Addis Ababa , Ethiopia
| | | | - Caleb Mpyet
- p Department of Ophthalmology , University of Jos , Jos , Nigeria.,q Sightsavers , Kaduna , Nigeria.,r Kilimanjaro Centre for Community Ophthalmology International, Division of Ophthalmology , University of Cape Town , Cape Town , South Africa
| | | | | | - Paul Courtright
- r Kilimanjaro Centre for Community Ophthalmology International, Division of Ophthalmology , University of Cape Town , Cape Town , South Africa
| | - Anthony W Solomon
- s Clinical Research Department , London School of Hygiene & Tropical Medicine , London , UK.,t Department of Control of Neglected Tropical Diseases , World Health Organization , Geneva , Switzerland
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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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Wilson N, Goodhew B, Mkocha H, Joseph K, Bandea C, Black C, Igietseme J, Munoz B, West SK, Lammie P, Kasubi M, Martin DL. Evaluation of a Single Dose of Azithromycin for Trachoma in Low-Prevalence Communities. Ophthalmic Epidemiol 2018; 26:1-6. [PMID: 30543311 PMCID: PMC6352373 DOI: 10.1080/09286586.2017.1293693] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Purpose: Trachoma, caused by repeated ocular infection with Chlamydia trachomatis, is the leading infectious cause of blindness worldwide and is targeted for elimination as a public health problem. We sought to determine whether a one-time azithromycin mass treatment would reduce trachomatous inflammation–follicular (TF) levels below the elimination threshold of 5% in communities with disease prevalence between 5 and 9.9%. Methods: The study was conducted in 96 sub-village units (balozis) in the Kongwa district of Tanzania which were predicted from prior prevalence surveys to have TF between 5 and 9.9%. Balozis were randomly assigned to the intervention and control arms. The intervention arm received a single mass drug administration of azithromycin. At baseline and 12-month follow-up, ocular exams for trachoma, ocular swabs for detection of chlamydial DNA, and finger prick blood for analysis of anti-chlamydial antibody were taken. Results: Comparison of baseline and 12-month follow-up showed no significant difference in the overall TF1-9 prevalence by balozi between control and treatment arms. In the treatment arm there was a significant reduction of ocular infection 12 months after treatment (p = 0.004) but no change in the control arm. No change in Pgp3-specific antibody responses were observed after treatment in the control or treatment arms. Anti-CT694 responses increased in both study arms (p = 0.009 for control arm and p = 0.04 for treatment arm). Conclusion: These data suggest that a single round of MDA may not be sufficient to decrease TF levels below 5% when TF1-9 is between 5 and 9.9% at baseline.
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Affiliation(s)
- Nana Wilson
- a Division of Parasitic Diseases and Malaria , Centers for Disease Control and Prevention , Atlanta , GA , USA
| | - Brook Goodhew
- a Division of Parasitic Diseases and Malaria , Centers for Disease Control and Prevention , Atlanta , GA , USA
| | | | - Kahaliah Joseph
- c National Center for Emerging, Zoonotic, and Infectious Diseases, Centers for Disease Control and Prevention , Atlanta , GA , USA
| | - Claudiu Bandea
- c National Center for Emerging, Zoonotic, and Infectious Diseases, Centers for Disease Control and Prevention , Atlanta , GA , USA
| | - Carolyn Black
- c National Center for Emerging, Zoonotic, and Infectious Diseases, Centers for Disease Control and Prevention , Atlanta , GA , USA
| | - Joseph Igietseme
- c National Center for Emerging, Zoonotic, and Infectious Diseases, Centers for Disease Control and Prevention , Atlanta , GA , USA
| | - Beatriz Munoz
- d Wilmer Eye Institute, Johns Hopkins University , Baltimore , MD , USA
| | - Sheila K West
- d Wilmer Eye Institute, Johns Hopkins University , Baltimore , MD , USA
| | - Patrick Lammie
- a Division of Parasitic Diseases and Malaria , Centers for Disease Control and Prevention , Atlanta , GA , USA
| | | | - Diana L Martin
- a Division of Parasitic Diseases and Malaria , Centers for Disease Control and Prevention , Atlanta , GA , USA
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Tesfazion A, Zecarias A, Zewengiel S, Willis R, Mebrahtu G, Capa E, Mpyet C, Al-Khatib T, Courtright P, Solomon AW. Progress Towards Elimination of Trachoma as a Public Health Problem in Eritrea: Results of a Systematic Review and Nine Population-based Prevalence Surveys Conducted in 2014. Ophthalmic Epidemiol 2018; 25:121-130. [PMID: 30806541 PMCID: PMC6444204 DOI: 10.1080/09286586.2018.1545036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 09/21/2018] [Accepted: 11/01/2018] [Indexed: 11/16/2022]
Abstract
PURPOSE To assess Eritrea's progress towards elimination of trachoma as a public health problem, we reviewed and compiled current knowledge on the distribution and burden of trachoma in Eritrea, then undertook further population-based surveys where indicated, with support from the Global Trachoma Mapping Project (GTMP). METHODS For the systematic review, undertaken in March 2014, we searched (1) PubMed, using the terms ((blind* or trachoma or trichiasis) AND Eritrea); (2) the online database of rapid assessments of avoidable blindness; (3) our own grey literature collections; and (4) the Global Atlas of Trachoma database. In June and July 2014, we conducted nine population-based prevalence surveys, for each of which 30 villages were systematically selected with probability proportional to population size; in each village, 30 households were systematically selected. All consenting residents of selected households aged ≥1 year were examined by GTMP-certified graders for signs of trachoma. Data on household-level access to water and sanitation were also collected. RESULTS One previous rapid assessment of avoidable blindness, three peer-reviewed publications, and two grey literature reports detailing sets of trachoma prevalence surveys conducted in 2006 and 2011, respectively, were located. Post-intervention impact surveys were needed in seven evaluation units (EUs, framed at sub-Zoba-level: population range 40,000-120,000) of Debub and Northern Red Sea, while baseline surveys were needed in two EUs of Anseba. Four of the seven impact survey EUs and both baseline survey EUs returned trachomatous inflammation-follicular prevalences in 1-9-year-olds of ≥5%; six of the seven impact survey EUs and one of the two baseline survey EUs returned trichiasis prevalences in ≥15-year-olds of ≥0.2%. The prevalence of access to water and sanitation varied widely between EUs. CONCLUSION Interventions are still required in Eritrea to eliminate trachoma as a public health problem. Data from these surveys will guide the Ministry of Health to undertake programme planning using a sound evidence base.
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Affiliation(s)
- Andeberhan Tesfazion
- National Program for the Prevention of Blindness, Ministry of Health, Asmara, Eritrea
| | - Alem Zecarias
- National Program for the Prevention of Blindness, Ministry of Health, Asmara, Eritrea
| | - Solomon Zewengiel
- National Program for the Prevention of Blindness, Ministry of Health, Asmara, Eritrea
| | | | | | - Eva Capa
- The Fred Hollows Foundation, Sydney, Australia
| | - Caleb Mpyet
- Department of Ophthalmology, University of Jos, Jos, Nigeria
- Sightsavers, Kaduna, Nigeria
- Kilimanjaro Centre for Community Ophthalmology, Division of Ophthalmology, University of Cape Town, Cape Town, South Africa
| | - Tawfik Al-Khatib
- Department of Ophthalmology, College of Medicine, University of Sana’a, Sana’a, Yemen
- Prevention of Blindness Program, Ministry of Public Health & Population, Sana’a, Yemen
- Eye Unit, Al-Thawra Hospital, Sana’a, Yemen
| | - 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
- London Centre for Neglected Tropical Diseases Research, London, UK
- 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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Last A, Burr S, Alexander N, Harding-Esch E, Roberts CH, Nabicassa M, Cassama ETDS, Mabey D, Holland M, Bailey R. Spatial clustering of high load ocular Chlamydia trachomatis infection in trachoma: a cross-sectional population-based study. Pathog Dis 2018; 75:3791466. [PMID: 28472466 PMCID: PMC5808645 DOI: 10.1093/femspd/ftx050] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 05/02/2017] [Indexed: 11/12/2022] Open
Abstract
Chlamydia trachomatis (Ct) is the most common cause of bacterial sexually transmitted infection and infectious cause of blindness (trachoma) worldwide. Understanding the spatial distribution of Ct infection may enable us to identify populations at risk and improve our understanding of Ct transmission. In this study, we sought to investigate the spatial distribution of Ct infection and the clinical features associated with high Ct load in trachoma-endemic communities on the Bijagós Archipelago (Guinea Bissau). We collected 1507 conjunctival samples and corresponding detailed clinical data during a cross-sectional population-based geospatially representative trachoma survey. We used droplet digital PCR to estimate Ct load on conjunctival swabs. Geostatistical tools were used to investigate clustering of ocular Ct infections. Spatial clusters (independent of age and gender) of individuals with high Ct loads were identified using local indicators of spatial association. We did not detect clustering of individuals with low load infections. These data suggest that infections with high bacterial load may be important in Ct transmission. These geospatial tools may be useful in the study of ocular Ct transmission dynamics and as part of trachoma surveillance post-treatment, to identify clusters of infection and thresholds of Ct load that may be important foci of re-emergent infection in communities.
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Affiliation(s)
- Anna Last
- Clinical Research Department, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Sarah Burr
- Disease Control and Elimination Theme, Medical Research Council Unit The Gambia, PO Box 273 Banjul, Atlantic Boulevard, Fajara, The Gambia
| | - Neal Alexander
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Emma Harding-Esch
- Clinical Research Department, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Chrissy H Roberts
- Clinical Research Department, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Meno Nabicassa
- Programa Nacional de Saúde de Visão, Ministério de Saúde Publica, PO Box 50, Avenida de Unidade Africana, Bisssau, Guiné Bissau
| | | | - David Mabey
- Clinical Research Department, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Martin Holland
- Clinical Research Department, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Robin Bailey
- Clinical Research Department, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
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Zambrano AI, Muñoz BE, Mkocha H, Dize L, Gaydos CA, Quinn T, West SK. Measuring Trachomatous Inflammation-Intense (TI) When Prevalence Is Low Provides Data on Infection With Chlamydia trachomatis. Invest Ophthalmol Vis Sci 2017; 58:997-1000. [PMID: 28535271 PMCID: PMC5308676 DOI: 10.1167/iovs.16-20421] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose Clinical trachoma is the current measure of effectiveness of antibiotic and environmental improvements in trachoma endemic communities. Impact assessments measure only trachomatous inflammation-follicular (TF). Trachomatous inflammation-intense (TI) is not used for decisions on stopping mass drug administration (MDA) or achieving intervention goals. We tested the supposition that TI was not associated with Chlamydia trachomatis when disease prevalence is low. Methods In 35 communities undergoing MDA as part of a larger project, 110 children ages 1 to 9 years were randomly selected in each community for surveys at baseline, 6, and 12 months. Both eyelids were graded for TF and TI, and a swab for detection of C. trachomatis infection was taken. Results Overall TF prevalence was 5% at baseline. Cases of TI alone constituted 15% of trachoma; 37% of TI cases had infection. At 6 and 12 months, the proportion of trachoma cases that had TI only was 13% and 20%; infection rates were similar to the rates in cases with TF alone. Conclusions Despite low prevalence of trachoma, infection rates for TF alone and TI alone were similar at each time point. The exclusion of cases of TI alone when reporting trachoma prevalence discards additional information on infection. Trachomatous inflammation-intense could be considered as part of impact surveys.
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Affiliation(s)
- Andrea I Zambrano
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Beatriz E Muñoz
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | | | - Laura Dize
- International Chlamydia Laboratory, Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland, United States
| | - Charlotte A Gaydos
- International Chlamydia Laboratory, Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland, United States
| | - Thomas Quinn
- International Chlamydia Laboratory, Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland, United States 4National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, United States
| | - Sheila K West
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, Maryland, United States
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Kalua K, Chisambi A, Chinyanya D, Kamwendo Z, Masika M, Willis R, Flueckiger RM, Pavluck AL, Solomon AW. Completion of Baseline Trachoma Mapping in Malawi: Results of Eight Population-Based Prevalence Surveys Conducted with the Global Trachoma Mapping Project. Ophthalmic Epidemiol 2016; 23:32-38. [PMID: 27726469 PMCID: PMC5706967 DOI: 10.1080/09286586.2016.1230224] [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: 11/15/2022]
Abstract
Purpose: Following a first phase of trachoma mapping in Malawi with the Global Trachoma Mapping Project, we identified and mapped trachoma districts previously suspected to be non-endemic, although adjacent to districts with estimated trachoma prevalences indicating a public health problem. Methods: We conducted population-based surveys in eight evaluation units (EUs) comprising eight districts in Malawi (total population 3,230,272). A 2-stage cluster random sampling design allowed us to select 30 households from each of 30 clusters per EU; all residents aged 1 year and older in selected households were examined for evidence of trachomatous inflammation–follicular (TF) and trachomatous trichiasis (TT). Results: None of the eight EUs had a TF prevalence in 1–9-year-olds ≥10%, one district (Dedza) had a TF prevalence between 5.0% and 9.9%, and only one district (Karonga) had a trichiasis prevalence in adults ≥0.2%. Conclusion: The prevalence of TF and TT in six of eight EUs surveyed was consistent with an original categorization of trachoma being unlikely to be a public health problem. In the absence of formal surveys, health management information system data and other locally available information about trachoma is likely to be useful in predicting areas where public health interventions against trachoma are required.
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Affiliation(s)
- Khumbo Kalua
- a Department of Ophthalmology , University of Malawi, College of Medicine , Blantyre , Malawi.,b Blantyre Institute for Community Ophthalmology , Lions Sight First Eye Hospital , Blantyre , Malawi
| | - Alvin Chisambi
- b Blantyre Institute for Community Ophthalmology , Lions Sight First Eye Hospital , Blantyre , Malawi
| | - David Chinyanya
- b Blantyre Institute for Community Ophthalmology , Lions Sight First Eye Hospital , Blantyre , Malawi
| | - Zachariah Kamwendo
- b Blantyre Institute for Community Ophthalmology , Lions Sight First Eye Hospital , Blantyre , Malawi
| | | | - Rebecca Willis
- d International Trachoma Initiative , Task Force for Global Health , Decatur , GA , USA
| | - Rebecca M Flueckiger
- e Clinical Research Department , London School of Hygiene & Tropical Medicine , London , UK
| | - Alexandre L Pavluck
- e Clinical Research Department , London School of Hygiene & Tropical Medicine , London , UK
| | - Anthony W Solomon
- e Clinical Research Department , London School of Hygiene & Tropical Medicine , London , UK.,f Department of Control of Neglected Tropical Diseases , World Health Organization , Geneva , Switzerland
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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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Gambhir M, Grassly NC, Burton MJ, Solomon AW, Taylor HR, Mabey DC, Blake IM, Basáñez MG. Estimating the Future Impact of a Multi-Pronged Intervention Strategy on Ocular Disease Sequelae Caused by Trachoma: A Modeling Study. Ophthalmic Epidemiol 2016; 22:394-402. [PMID: 26653262 PMCID: PMC4841017 DOI: 10.3109/09286586.2015.1081249] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Purpose: Trachoma control programs are underway in endemic regions worldwide. They are based on the SAFE strategy (Surgery for trichiasis, Antibiotic distribution, Facial cleanliness, and Environmental improvement). Although much is known about the effect of community-wide treatment with antibiotics on the prevalence of Chlamydia trachomatis, the impact of the SAFE strategy on severe ocular disease sequelae (the main focus of the Global Elimination of blinding Trachoma by 2020 program) remains largely unknown. Methods: We use a mathematical model to explore the impact of each of the components of the SAFE strategy, individually and together, on disease sequelae, arising from repeat infection and subsequent conjunctival scarring. We ask whether two elimination goals, to reduce the prevalence of trachomatous trichiasis to 1 per 1000 persons, and the incidence of corneal opacity to 1 per 10,000 persons per annum, are achievable, and which combinations of interventions have the greatest impact on these indicators. Results: In high prevalence communities (here, >20% infection of children aged 1–9 years), a combination of efforts is needed to bring down sustainably the prevalence and incidence of ocular disease sequelae. Conclusion: The mass delivery of antibiotics is highly beneficial for the clearance of infection, inflammation and prevention of subsequent scarring, but needs to be supplemented with sustained reductions in transmission and surgery to consider realistically the elimination of blindness by the year 2020.
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Affiliation(s)
- Manoj Gambhir
- a Department of Epidemiology and Preventive Medicine , Monash University , Melbourne , Victoria , Australia
| | - Nicholas C Grassly
- b Department of Infectious Disease Epidemiology , Imperial College London , London, UK .,c MRC Centre for Outbreak Analysis and Modelling , Department of Infectious Disease Epidemiology, Imperial College London , London, UK
| | - Matthew J Burton
- d Clinical Research Department , Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine , London , UK , and
| | - Anthony W Solomon
- d Clinical Research Department , Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine , London , UK , and
| | - Hugh R Taylor
- e Indigenous Eye Health Unit, Melbourne School of Population Health, The University of Melbourne , East Melbourne, Victoria, Australia
| | - David C Mabey
- d Clinical Research Department , Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine , London , UK , and
| | - Isobel M Blake
- b Department of Infectious Disease Epidemiology , Imperial College London , London, UK .,c MRC Centre for Outbreak Analysis and Modelling , Department of Infectious Disease Epidemiology, Imperial College London , London, UK
| | - María-Gloria Basáñez
- b Department of Infectious Disease Epidemiology , Imperial College London , London, UK
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Maco V, Encalada M, Wong C, Marcos LA. Historical Aspects of Endemic Trachoma in Peru: 1895-2000. PLoS Negl Trop Dis 2016; 10:e0004116. [PMID: 26766118 PMCID: PMC4713155 DOI: 10.1371/journal.pntd.0004116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Affiliation(s)
- Vicente Maco
- Institute of Tropical Medicine Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
- * E-mail:
| | | | - Carlos Wong
- Institute of Ophthalmology Wong, San Isidro, Lima, Peru
| | - Luis A. Marcos
- Institute of Tropical Medicine Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
- Departments of Medicine, Microbiology and Molecular Genetics, Stony Brook University, Stony Brook, New York, United States of America
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Habtamu E, Wondie T, Aweke S, Tadesse Z, Zerihun M, Zewdie Z, Callahan K, Emerson PM, Kuper H, Bailey RL, Mabey DCW, Rajak SN, Polack S, Weiss HA, Burton MJ. Trachoma and Relative Poverty: A Case-Control Study. PLoS Negl Trop Dis 2015; 9:e0004228. [PMID: 26600211 PMCID: PMC4657919 DOI: 10.1371/journal.pntd.0004228] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 10/22/2015] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Trachoma is widely considered a disease of poverty. Although there are many epidemiological studies linking trachoma to factors normally associated with poverty, formal quantitative data linking trachoma to household economic poverty within endemic communities is very limited. METHODOLOGY/PRINCIPAL FINDINGS Two hundred people with trachomatous trichiasis were recruited through community-based screening in Amhara Region, Ethiopia. These were individually matched by age and gender to 200 controls without trichiasis, selected randomly from the same sub-village as the case. Household economic poverty was measured through (a) A broad set of asset-based wealth indicators and relative household economic poverty determined by principal component analysis (PCA, (b) Self-rated wealth, and (c) Peer-rated wealth. Activity participation data were collected using a modified 'Stylised Activity List' developed for the World Bank's Living Standards Measurement Survey. Trichiasis cases were more likely to belong to poorer households by all measures: asset-based analysis (OR = 2.79; 95%CI: 2.06-3.78; p<0.0001), self-rated wealth (OR, 4.41, 95%CI, 2.75-7.07; p<0.0001) and peer-rated wealth (OR, 8.22, 95% CI, 4.59-14.72; p<0.0001). Cases had less access to latrines (57% v 76.5%, p = <0.0001) and higher person-to-room density (4.0 v 3.31; P = 0.0204) than the controls. Compared to controls, cases were significantly less likely to participate in economically productive activities regardless of visual impairment and other health problems, more likely to report difficulty in performing activities and more likely to receive assistance in performing productive activities. CONCLUSIONS/SIGNIFICANCE This study demonstrated a strong association between trachomatous trichiasis and relative poverty, suggesting a bidirectional causative relationship possibly may exist between poverty and trachoma. Implementation of the full SAFE strategy in the context of general improvements might lead to a virtuous cycle of improving health and wealth. Trachoma is a good proxy of inequality within communities and it could be used to target and evaluate interventions for health and poverty alleviation.
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Affiliation(s)
- Esmael Habtamu
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- The Carter Center, Addis Ababa, Ethiopia
| | | | | | | | | | | | - Kelly Callahan
- The Carter Center, Atlanta, Georgia, United States of America
| | - Paul M. Emerson
- International Trachoma Initiative, Atlanta, Georgia, United States of America
| | - Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Robin L. Bailey
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - David C. W. Mabey
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Saul N. Rajak
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sarah Polack
- International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Helen A. Weiss
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Matthew J. Burton
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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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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Last AR, Burr SE, Weiss HA, Harding-Esch EM, Cassama E, Nabicassa M, Mabey DC, Holland MJ, Bailey RL. Risk factors for active trachoma and ocular Chlamydia trachomatis infection in treatment-naïve trachoma-hyperendemic communities of the Bijagós Archipelago, Guinea Bissau. PLoS Negl Trop Dis 2014; 8:e2900. [PMID: 24967629 PMCID: PMC4072588 DOI: 10.1371/journal.pntd.0002900] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2013] [Accepted: 04/11/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Trachoma, caused by ocular infection with Chlamydia trachomatis, is hyperendemic on the Bijagós Archipelago of Guinea Bissau. An understanding of the risk factors associated with active trachoma and infection on these remote and isolated islands, which are atypical of trachoma-endemic environments described elsewhere, is crucial to the implementation of trachoma elimination strategies. METHODOLOGY/PRINCIPAL FINDINGS A cross-sectional population-based trachoma prevalence survey was conducted on four islands. We conducted a questionnaire-based risk factor survey, examined participants for trachoma using the World Health Organization (WHO) simplified grading system and collected conjunctival swab samples for 1507 participants from 293 randomly selected households. DNA extracted from conjunctival swabs was tested using the Roche Amplicor CT/NG PCR assay. The prevalence of active (follicular and/or inflammatory) trachoma was 11% (167/1508) overall and 22% (136/618) in 1-9 year olds. The prevalence of C. trachomatis infection was 18% overall and 25% in 1-9 year olds. There were strong independent associations of active trachoma with ocular and nasal discharge, C. trachomatis infection, young age, male gender and type of household water source. C. trachomatis infection was independently associated with young age, ocular discharge, type of household water source and the presence of flies around a latrine. CONCLUSIONS/SIGNIFICANCE In this remote island environment, household-level risk factors relating to fly populations, hygiene behaviours and water usage are likely to be important in the transmission of ocular C. trachomatis infection and the prevalence of active trachoma. This may be important in the implementation of environmental measures in trachoma control.
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Affiliation(s)
- Anna R. Last
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Sarah E. Burr
- Disease Control and Elimination Theme, Medical Research Council Unit, The Gambia, Fajara, The Gambia
| | - Helen A. Weiss
- MRC Tropical Epidemiology Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Emma M. Harding-Esch
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Eunice Cassama
- Programa Nacional de Saúde de Visão, Ministério de Saúde Publica, Bisssau, Guiné Bissau
| | - Meno Nabicassa
- Programa Nacional de Saúde de Visão, Ministério de Saúde Publica, Bisssau, Guiné Bissau
| | - David C. Mabey
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Martin J. Holland
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Robin L. Bailey
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Kappagoda S, Ioannidis JPA. Prevention and control of neglected tropical diseases: overview of randomized trials, systematic reviews and meta-analyses. Bull World Health Organ 2014; 92:356-366C. [PMID: 24839325 DOI: 10.2471/blt.13.129601] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Revised: 12/18/2013] [Accepted: 01/02/2014] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE To analyse evidence from randomized controlled trials (RCTs) on the prevention and control of neglected tropical diseases (NTDs) and to identify areas where evidence is lacking. METHODS The Cochrane Central Register of Controlled Trials and PubMed were searched for RCTs and the Cochrane Database of Systematic Reviews and PubMed were searched for meta-analyses and systematic reviews, both from inception to 31 December 2012. FINDINGS Overall, 258 RCTs were found on American trypanosomiasis, Buruli ulcer, dengue, geohelminth infection, leishmaniasis, leprosy, lymphatic filariasis, onchocerciasis, rabies, schistosomiasis or trachoma. No RCTs were found on cysticercosis, dracunculiasis, echinococcosis, foodborne trematodes, or human African trypanosomiasis. The most studied diseases were geohelminth infection (51 RCTs) and leishmaniasis (46 RCTs). Vaccines, chemoprophylaxis and interventions targeting insect vectors were evaluated in 113, 99 and 39 RCTs, respectively. Few addressed how best to deliver preventive chemotherapy, such as the choice of dosing interval (10) or target population (4), the population coverage needed to reduce transmission (2) or the method of drug distribution (1). Thirty-one publications containing 32 systematic reviews (16 with and 16 without meta-analyses) were found on American trypanosomiasis, dengue, geohelminths, leishmaniasis, leprosy, lymphatic filariasis, onchocerciasis, schistosomiasis or trachoma. Together, they included only 79 of the 258 published RCTs (30.6%). Of 36 interventions assessed, 8 were judged effective in more than one review. CONCLUSION Few RCTs on the prevention or control of the principal NTDs were found. Trials on how best to deliver preventive chemotherapy were particularly rare.
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Affiliation(s)
- Shanthi Kappagoda
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, United States of America (USA)
| | - John P A Ioannidis
- Stanford Prevention Research Center, Stanford University School of Medicine, 1265 Welch Road, MSOB X306, Stanford, California, 94305-5411, USA
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Stocks ME, Ogden S, Haddad D, Addiss DG, McGuire C, Freeman MC. Effect of water, sanitation, and hygiene on the prevention of trachoma: a systematic review and meta-analysis. PLoS Med 2014; 11:e1001605. [PMID: 24586120 PMCID: PMC3934994 DOI: 10.1371/journal.pmed.1001605] [Citation(s) in RCA: 147] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 01/09/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Trachoma is the world's leading cause of infectious blindness. The World Health Organization (WHO) has endorsed the SAFE strategy in order to eliminate blindness due to trachoma by 2020 through "surgery," "antibiotics," "facial cleanliness," and "environmental improvement." While the S and A components have been widely implemented, evidence and specific targets are lacking for the F and E components, of which water, sanitation, and hygiene (WASH) are critical elements. Data on the impact of WASH on trachoma are needed to support policy and program recommendations. Our objective was to systematically review the literature and conduct meta-analyses where possible to report the effects of WASH conditions on trachoma and identify research gaps. METHODS AND FINDINGS We systematically searched PubMed, Embase, ISI Web of Knowledge, MedCarib, Lilacs, REPIDISCA, DESASTRES, and African Index Medicus databases through October 27, 2013 with no restrictions on language or year of publication. Studies were eligible for inclusion if they reported a measure of the effect of WASH on trachoma, either active disease indicated by observed signs of trachomatous inflammation or Chlamydia trachomatis infection diagnosed using PCR. We identified 86 studies that reported a measure of the effect of WASH on trachoma. To evaluate study quality, we developed a set of criteria derived from the GRADE methodology. Publication bias was assessed using funnel plots. If three or more studies reported measures of effect for a comparable WASH exposure and trachoma outcome, we conducted a random-effects meta-analysis. We conducted 15 meta-analyses for specific exposure-outcome pairs. Access to sanitation was associated with lower trachoma as measured by the presence of trachomatous inflammation-follicular or trachomatous inflammation-intense (TF/TI) (odds ratio [OR] 0.85, 95% CI 0.75-0.95) and C. trachomatis infection (OR 0.67, 95% CI 0.55-0.78). Having a clean face was significantly associated with reduced odds of TF/TI (OR 0.42, 95% CI 0.32-0.52), as were facial cleanliness indicators lack of ocular discharge (OR 0.42, 95% CI 0.23-0.61) and lack of nasal discharge (OR 0.62, 95% CI 0.52-0.72). Facial cleanliness indicators were also associated with reduced odds of C. trachomatis infection: lack of ocular discharge (OR 0.40, 95% CI 0.31-0.49) and lack of nasal discharge (OR 0.56, 95% CI 0.37-0.76). Other hygiene factors found to be significantly associated with reduced TF/TI included face washing at least once daily (OR 0.76, 95% CI 0.57-0.96), face washing at least twice daily (OR 0.85, 95% CI 0.80-0.90), soap use (OR 0.76, 95% CI 0.59-0.93), towel use (OR 0.65, 95% CI 0.53-0.78), and daily bathing practices (OR 0.76, 95% CI 0.53-0.99). Living within 1 km of a water source was not found to be significantly associated with TF/TI or C. trachomatis infection, and the use of sanitation facilities was not found to be significantly associated with TF/TI. CONCLUSIONS We found strong evidence to support F and E components of the SAFE strategy. Though limitations included moderate to high heterogenity, low study quality, and the lack of standard definitions, these findings support the importance of WASH in trachoma elimination strategies and the need for the development of standardized approaches to measuring WASH in trachoma control programs.
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Affiliation(s)
- Meredith E. Stocks
- Department of Environmental Health, Emory University, Atlanta, Georgia, United States of America
- International Trachoma Initiative, Taskforce for Global Health, Decatur, Georgia, United States of America
| | - Stephanie Ogden
- Department of Environmental Health, Emory University, Atlanta, Georgia, United States of America
- International Trachoma Initiative, Taskforce for Global Health, Decatur, Georgia, United States of America
- Children Without Worms, Taskforce for Global Health, Decatur, Georgia, United States of America
| | - Danny Haddad
- Emory Eye Center, Emory University, Atlanta, Georgia, United States of America
| | - David G. Addiss
- Children Without Worms, Taskforce for Global Health, Decatur, Georgia, United States of America
| | - Courtney McGuire
- Department of Environmental Health, Emory University, Atlanta, Georgia, United States of America
| | - Matthew C. Freeman
- Department of Environmental Health, Emory University, Atlanta, Georgia, United States of America
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Smits HL. Prospects for the control of neglected tropical diseases by mass drug administration. Expert Rev Anti Infect Ther 2014; 7:37-56. [DOI: 10.1586/14787210.7.1.37] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Lange FD, Baunach E, McKenzie R, Taylor HR. Trachoma elimination in remote Indigenous Northern Territory communities: baseline health-promotion study. Aust J Prim Health 2014; 20:34-40. [DOI: 10.1071/py12044] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Accepted: 09/09/2012] [Indexed: 11/23/2022]
Abstract
Identify trachoma knowledge, attitudes and practice of staff in clinics, schools and community workplace settings to optimise trachoma-elimination health-promotion programs in the Katherine West Health Board region of the Northern Territory. Prior to the introduction of a suite of health promotion resources the Indigenous Eye Health Unit and Katherine West Health Board conducted a baseline survey of open, multi-choice and closed questions regarding knowledge, attitudes and practices in relation to trachoma with 72 staff members over a 6-month period in 2010−11. Data were analysed for differences between settings. Two significant barriers and one enabling factor were identified. One in five staff members in clinics and 29% of staff members in schools were unaware they lived and worked in a trachoma-endemic area. One-third of school staff and 38% of clinic staff considered it normal for children to have dirty faces. However, the majority of participants felt comfortable talking about hygiene issues with others. The presence of dirty faces in young Indigenous children underpins the continuing prevalence of trachoma. Increasing the awareness of the health effects of children’s nasal and ocular secretions and changing community acceptance of dirty faces as the norm will reduce the risk of trachoma and other childhood infections. Staff in clinics, schools and community work settings can play a role in trachoma elimination by actively encouraging clean faces whenever they are dirty and by including face washing in holistic hygiene and health education. Staff in schools may need additional support. Trachoma-elimination health promotion should increase awareness of trachoma prevalence and encourage all who work and live in remote Indigenous communities to take action to promote facial cleanliness and good hygiene practices.
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Rotondo LA, Ngondi J, Rodgers AF, King JD, Kamissoko Y, Amadou A, Jip N, Cromwell EA, Emerson PM. Evaluation of community intervention with pit latrines for trachoma control in Ghana, Mali, Niger and Nigeria. Int Health 2013; 1:154-62. [PMID: 24036560 DOI: 10.1016/j.inhe.2009.08.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Trachoma is the leading cause of preventable blindness worldwide and is controlled with an integrated strategy of treatment and prevention which includes latrine provision and promotion. We aimed to evaluate the latrine uptake, construction, and usage in villages participating in latrine promotion programmes supported by The Carter Center in Ghana, Mali, Niger and Nigeria where 113 457 new latrines have been reported from 2002 to 2008. In each country a two stage cluster random sampling design was used to select villages and households for evaluation. Household heads were interviewed using a standardised structured questionnaire and latrines were inspected. The sample included 1154 households (Ghana: 326; Mali: 293; Niger: 300; and Nigeria: 235). Overall, 813 (70.5%, 95% confidence interval [CI] 65.7-74.8) had pit latrines, ranging from 30.3% of households in Niger to over 92.0% of households in Ghana and Mali. Of those with latrines 762 (93.7%) were found to be usable and 659 (86.5%) were in use. Overall 659/1154 (57.1%) of households in the targeted communities were using latrines at least 12 months after latrine promotion was initiated. Latrine promotion had been successful increasing access to sanitation in different country contexts and demonstrates the target population are willing to construct, use and maintain household latrines.
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Affiliation(s)
- Lisa A Rotondo
- The Carter Center, 1 Copenhill Avenue, Atlanta, GA 30307, USA
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Stoller NE, Gebre T, Ayele B, Zerihun M, Assefa Y, Habte D, Zhou Z, Porco TC, Keenan JD, House JI, Gaynor BD, Lietman TM, Emerson PM. Efficacy of latrine promotion on emergence of infection with ocular Chlamydia trachomatis after mass antibiotic treatment: a cluster-randomized trial. Int Health 2013; 3:75-84. [PMID: 21785663 DOI: 10.1016/j.inhe.2011.03.004] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The World Health Organization (WHO) recommends environmental improvements such as latrine construction in the integrated trachoma control strategy, SAFE. We report a cluster-randomized trial assessing the effect of intensive latrine promotion on emergence of infection with ocular Chlamydia trachomatis after mass treatment with antibiotics.Twenty-four communities in Goncha Seso Enesie woreda, Amhara Regional State, Ethiopia, were enumerated, and a random selection of 60 children aged 0- 9 years in each was monitored for clinical signs of trachoma and ocular chlamydial infection at baseline, 12 and 24 months. All community members were offered treatment with a single dose of oral azithromycin or topical tetracycline. After treatment, 12 subkebeles were randomized to receive intensive latrine promotion. Mean cluster ocular infection in the latrine and the non-latrine arms were reduced from 45.5% (95% CI 34.1-56.8%) and 43.0% (95% CI 31.1-54.8%) respectively at baseline to 14.6% (95% CI 7.4-21.8%) and 14.8% (95% CI 8.9-20.8%) respectively at 24 months (P=0.93). Clinical signs fell from 72.0% (95% CI 58.2-85.5%) and 61.3% (95% CI 44.0-78.5%) at baseline to 45.8% (36.0-55.6%) and 48.5% (34.0-62.9%) respectively at 24 months (P=0.69). At 24 months, estimated household latrine coverage and use were 80.8% and 61.7% respectively where there had been intensive latrine promotion and 30.0% and 25.0% respectively in the single treatment only arm. We were unable to detect a difference in the prevalence of ocular chlamydial infection in children due to latrine construction.
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Affiliation(s)
- Nicole E Stoller
- F.I. Proctor Foundation, University of California San Francisco, USA
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Quicke E, Sillah A, Harding-Esch EM, Last A, Joof H, Makalo P, Bailey RL, Burr SE. Follicular trachoma and trichiasis prevalence in an urban community in The Gambia, West Africa: is there a need to include urban areas in national trachoma surveillance? Trop Med Int Health 2013; 18:1344-52. [PMID: 24033501 DOI: 10.1111/tmi.12182] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Urban areas are traditionally excluded from trachoma surveillance activities, but due to rapid expansion and population growth, the urban area of Brikama in The Gambia may be developing social problems that are known risk factors for trachoma. It is also a destination for many migrants who may be introducing active trachoma into the area. This study aimed to determine the prevalence and risk factors for follicular trachoma and trichiasis in Brikama. METHODS A community-based cross-sectional prevalence survey including 27 randomly selected households in 12 randomly selected enumeration areas (EAs) of Brikama. Selected households were offered eye examinations, and the severity of trachoma was graded according to WHO's simplified grading system. Risk factor data were collected from each household via a questionnaire. RESULTS The overall prevalence of trachomatous inflammation-follicular (TF) in children aged 1-9 years was 3.8% (95% CI 2.5-5.6), and the overall prevalence of trichiasis in adults aged ≥15 years was 0.46% (95% CI 0.17-1.14). EA prevalence of TF varied from 0% to 8.4%. The major risk factors for TF were dirty faces (P < 0.01, OR = 9.23, 95% CI 1.97-43.23), nasal discharge (P = 0.039, OR = 5.11, 95% CI 1.08-24.10) and residency in Brikama for <1 year (P = 0.047, OR = 7.78, 95% CI 1.03-59.03). CONCLUSIONS Follicular trachoma can be considered to have been eliminated as a public health problem in Brikama according to WHO criteria. However, as the prevalence in some EAs is >5%, it may be prudent to include Brikama in surveillance programmes. Trichiasis remains a public health problem (>0.1%), and active case finding needs to be undertaken.
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Affiliation(s)
- E Quicke
- School of Medicine, University of Birmingham, Birmingham, UK
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41
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Haile M, Tadesse Z, Gebreselassie S, Ayele B, Gebre T, Yu SN, Stoller NE, Gaynor BD, Porco TC, Emerson PM, Lietman TM, Keenan JD. The association between latrine use and trachoma: a secondary cohort analysis from a randomized clinical trial. Am J Trop Med Hyg 2013; 89:717-20. [PMID: 24002488 DOI: 10.4269/ajtmh.13-0299] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Latrine use has been promoted as a component of an integrated strategy for trachoma control. As part of a randomized trial in Ethiopia, 12 communities received a mass azithromycin distribution followed by a latrine promotion intervention. A random sample of children ages 0-9 years in each community was monitored longitudinally for ocular chlamydia. After latrine construction ended, those communities with a higher proportion of households using latrines were more likely to experience a reduction in the prevalence of ocular chlamydia. Specifically, for each 10% increase in latrine use, there was a 2.0% decrease (95% confidence interval = 0.2-3.9% decrease) in the community prevalence of ocular chlamydia over the subsequent year (P = 0.04).
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Affiliation(s)
- Meron Haile
- Francis I. Proctor Foundation, University of California, San Francisco, California; The Carter Center, Addis Ababa, Ethiopia; Departments of Ophthalmology and Epidemiology and Biostatistics, University of California, San Francisco, California; The Carter Center, Atlanta, Georgia; Institute for Global Health, University of California, San Francisco, California
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The added value of water, sanitation, and hygiene interventions to mass drug administration for reducing the prevalence of trachoma: a systematic review examining. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2013; 2013:682093. [PMID: 23990843 PMCID: PMC3749592 DOI: 10.1155/2013/682093] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Accepted: 07/01/2013] [Indexed: 12/05/2022]
Abstract
Trachoma is the leading cause of infectious blindness worldwide. The SAFE strategy, the World Health Organization-recommended method to eliminate blinding trachoma, combines developments in water, sanitation, surgery, and antibiotic treatment. Current literature does not focus on the comprehensive effect these components have on one another. The present systematic review analyzes the added benefit of water, sanitation, and hygiene education interventions to preventive mass drug administration of azithromycin for trachoma. Trials were identified from the PubMed database using a series of search terms. Three studies met the complete criteria for inclusion. Though all studies found a significant change in reduction of active trachoma prevalence, the research is still too limited to suggest the impact of the “F” and “E” components on trachoma prevalence and ultimately its effects on blindness.
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Abstract
PURPOSE OF REVIEW To review recent clinical and epidemiological studies regarding the prevention, diagnosis, and treatment of trachoma. RECENT FINDINGS Newer studies propose novel diagnostic tests that appear sensitive for the detection of ocular chlamydial infection. For example, recent studies with ribosomal RNA-based nucleic acid amplification tests (NAATs) have demonstrated improved sensitivities compared to DNA-based NAATs; and the progression of scarring has now been characterized with confocal microscopy. Immunologic studies have further explored the etiology of clinical sequelae, suggesting that chronic inflammation can lead to progressive scarring even in the absence of Chlamydia. Mass oral azithromycin distributions remain a mainstay of treatment; studies have assessed the appropriate frequency and duration of treatment programs. Current studies have also explored ancillary effects of azithromycin distribution on mortality and bacterial infections. SUMMARY Trachoma programs have had remarkable success at reducing chlamydial infection and clinical signs of trachoma. Recent work suggests improved methods to monitor infection and scarring, and better ways to distribute treatment. Whereas studies continue to demonstrate reduction in infection in hyperendemic areas, more work is necessary to achieve elimination of this blinding disease.
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Abstract
Trachoma, caused by Chlamydia trachomatis (Ct), is the leading infectious blinding disease worldwide. Chronic conjunctival inflammation develops in childhood and leads to eyelid scarring and blindness in adulthood. The immune response to Ct provides only partial protection against re-infection, which can be frequent. Moreover, the immune response is central to the development of scarring pathology, leading to loss of vision. Here we review the current literature on both protective and pathological immune responses in trachoma. The resolution of Ct infection in animal models is IFNγ-dependent, involving Th1 cells, but whether this is the case in human ocular infection still needs to be confirmed. An increasing number of studies indicate that innate immune responses arising from the epithelium and other innate immune cells, along with changes in matrix metalloproteinase activity, are important in the development of tissue damage and scarring. Current trachoma control measures, which are centred on repeated mass antibiotic treatment of populations, are logistically challenging and have the potential to drive antimicrobial resistance. A trachoma vaccine would offer significant advantages. However, limited understanding of the mechanisms of both protective immunity and immunopathology to Ct remain barriers to vaccine development.
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Wank R, Laumbacher B, Fellerhoff B. A new look at chronicChlamydiainfections and the role of the MHC/HLA in diseases of the CNS. FUTURE NEUROLOGY 2013. [DOI: 10.2217/fnl.12.70] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Chlamydia has attracted increased attention as a possible cause of atheromatous plaques, cerebrovascular diseases, multiple sclerosis, Alzheimer’s disease and schizophrenia. The Chlamydia species are obligate intracellular parasites. The unique biphasic life cycle of Chlamydia permits the parasite to persist in cells for years. Acute Chlamydia infections can be recognized serologically in the peripheral blood through observation of rising antibody titers or molecularly using various PCR methods. However, the identification of chronic Chlamydia infection is hampered by many hurdles. This has initiated controversial discussions about the true involvement of Chlamydia, particularly in the CNS. The aspects of the discussion will be inspected as well as the vulnerability of the neuronal MHC to immune reactions.
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Affiliation(s)
- Rudolf Wank
- Immunotherapy Research Center IMMUNIS e.V, Pettenkoferstr. 8, 80336 München, Germany
| | - Barbara Laumbacher
- Immunotherapy Research Center IMMUNIS e.V, Pettenkoferstr. 8, 80336 München, Germany
| | - Barbara Fellerhoff
- Institut für Immunologie, LMU München, Goethestr, 31, 80336 München, Germany
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Edwards T, Smith J, Sturrock HJW, Kur LW, Sabasio A, Finn TP, Lado M, Haddad D, Kolaczinski JH. Prevalence of trachoma in unity state, South Sudan: results from a large-scale population-based survey and potential implications for further surveys. PLoS Negl Trop Dis 2012; 6:e1585. [PMID: 22506082 PMCID: PMC3323519 DOI: 10.1371/journal.pntd.0001585] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2011] [Accepted: 02/07/2012] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Large parts of South Sudan are thought to be trachoma-endemic but baseline data are limited. This study aimed to estimate prevalence for planning trachoma interventions in Unity State, to identify risk factors and to investigate the effect of different sampling approaches on study conclusions. METHODS AND FINDINGS The survey area was defined as one domain of eight counties in Unity State. Across the area, 40 clusters (villages) were randomly selected proportional to the county population size in a population-based prevalence survey. The simplified grading scheme was used to classify clinical signs of trachoma. The unadjusted prevalence of trachoma inflammation-follicular (TF) in children aged 1-9 years was 70.5% (95% CI: 68.6-72.3). After adjusting for age, sex, county and clustering of cases at household and village level the prevalence was 71.0% (95% CI: 69.9-72.1). The prevalence of trachomatous trichiasis (TT) in adults was 15.1% (95% CI: 13.4-17.0) and 13.5% (95% CI: 12.0-15.1) before and after adjustment, respectively. We estimate that 700,000 people (the entire population of Unity State) require antibiotic treatment and approximately 54,178 people require TT surgery. Risk factor analyses confirmed child-level associations with TF and highlighted that older adults living in poverty are at higher risk of TT. Conditional simulations, testing the alternatives of sampling 20 or 60 villages over the same area, indicated that sampling of only 20 villages would have provided an acceptable level of precision for state-level prevalence estimation to inform intervention decisions in this hyperendemic setting. CONCLUSION Trachoma poses an enormous burden on the population of Unity State. Comprehensive control is urgently required to avoid preventable blindness and should be initiated across the state now. In other parts of South Sudan suspected to be highly trachoma endemic, counties should be combined into larger survey areas to generate the baseline data required to initiate interventions.
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Affiliation(s)
- Tansy Edwards
- Medical Research Council Tropical Epidemiology Group, Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jennifer Smith
- Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Hugh J. W. Sturrock
- Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Lucia W. Kur
- Ministry of Health, Juba, Republic of South Sudan
| | - Anthony Sabasio
- Malaria Consortium South Sudan, Juba, Republic of South Sudan
| | - Timothy P. Finn
- Malaria Consortium South Sudan, Juba, Republic of South Sudan
| | - Mounir Lado
- Ministry of Health, Juba, Republic of South Sudan
| | - Danny Haddad
- International Trachoma Initiative, Decatur, Georgia, United States of America
| | - Jan H. Kolaczinski
- Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Malaria Consortium Africa Regional Office, Kampala, Uganda
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Goldschmidt P, Einterz E, Bates M, Abba F, Chaumeil C, Bensaid P. Contributions to the Improvement of Living Conditions among Neglected Populations with Trachoma. Trop Med Health 2012; 40:1-6. [PMID: 22949800 PMCID: PMC3426827 DOI: 10.2149/tmh.2011-25] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2011] [Accepted: 12/01/2011] [Indexed: 11/11/2022] Open
Abstract
Objective: Trachoma (Chlamydia-triggered blinding infection) provoked irreversible visual impairment in about 8 million people in 2011, and the prevalence among children with dirty faces is more than three fold that among children with clean faces. In 250 villages with a high prevalence of trachoma (Kolofata district, Far North Region, Cameroon), the lack of water for facial cleanliness was reported during trachoma awareness campaigns. The objective of this study was to determine if the lack of water was linked with the absence of means to dig wells. Methods: Wells, waterholes, motorcycles, irrigation pumps, electricity, goats and oxen, cell phones and distance from waterholes were recorded in January 2011 in 50 randomized villages of Kolofata’s district. Results: The number of villages with <25 goats and <5 oxen was 0 and the number of adults owning <1 goat was 0. The cost of a pail of water was 0.01 USD. Motorcycles, cell phones and televisions have been reported in more than 66% of villages. The cost for the construction of lined shaft wells ranged between 15–35 goats and 0.5–3 oxen; the cost for drinking water wells ranged between 50–200 goats and 3–30 oxen. Discussion: No link between the means for digging wells at the village level and access to water was found. Social solidarity, which refers to a social debt owed by each person to his/her group, should be added to training guides to gauge its ability to release people from the dead end of having to wait for external assistance to gain access to water.
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Affiliation(s)
- Pablo Goldschmidt
- Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Paris, France
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Abstract
BACKGROUND Trachoma remains a significant cause of blindness in many parts of the world. The major route to blindness involves upper lid entropion leading to trachomatous trichiasis (TT), which promotes progressive corneal opacification. The provision of surgery to correct TT in the populations most severely affected is a major challenge for the global effort to eliminate trachoma blindness by the year 2020. Most attention has focused on increasing the quantity of TT surgery performed, and large numbers of non-doctor operators have been trained to this end. Surgical audit by those performing TT surgery is not a routine part of any national trachoma control programme, and no effective mechanism exists for identifying surgeons experiencing poor outcomes. The authors propose a methodology for surgical audit at the level of the individual surgeon based on Lot Quality Assurance. METHODS A set number of patients operated on previously for upper eyelid TT are examined to detect the recurrence of TT. The number of recurrent cases found will lead to categorisation of the TT surgeon to either 'high recurrence' or 'low recurrence' with reasonable confidence. The threshold of unacceptability can be set by individual programmes according to previous local studies of recurrence rates or those from similar settings. CONCLUSIONS Identification of surgeons delivering unacceptably high levels of recurrent TT will guide managers on the need for remedial intervention such as retraining.
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Affiliation(s)
- John C Buchan
- Kissy UMC Eye Hospital, PO Box 115, 41 East Kissy Bye-Pass Road, Freetown, PMB 8803, Sierra Leone.
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Wright HR, Keeffe JE, Taylor HR. Barriers to the implementation of the SAFE strategy to combat hyperendemic trachoma in Australia. Ophthalmic Epidemiol 2011; 17:349-59. [PMID: 21090909 DOI: 10.3109/09286586.2010.528135] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Australia is the only developed country in the world that still has endemic levels of blinding trachoma. The SAFE (Surgery, Antibiotics, Facial cleanliness, Environmental improvement) strategy is an effective public health intervention that has been successfully used to eliminate blinding trachoma in some of the poorest countries of the world. Yet the SAFE strategy has not been systematically implemented in Australia. We undertook semi-structured interviews to identify some of barriers to the implementation of the SAFE strategy within remote indigenous communities of Australia. METHODS Health care professionals who were responsible for delivering trachoma control programs throughout the Northern Territory were asked to participate in a semi-structured interview. Quantitative analysis was performed using an existing strategic management framework. RESULTS Fourteen individuals were interviewed. Responses were grouped into 19 categories; 12 from the existing strategic management framework and 7 additional categories that were created for ideas unique to the trachoma control program in Australia. CONCLUSIONS A number of key themes emerged from the interview and are presented in a literary style. From these key themes critical success factors for the implementation of a sustainable trachoma control program were identified. With the election of the Rudd government there has been a renewed interest in "closing the gap" between the health of indigenous and non-indigenous Australians. A federal government funding package of $58 million over four years has just been announced to tackle trachoma. It is hoped that the findings of this research can assist in making sure that money achieves its goal.
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Affiliation(s)
- Heathcote R Wright
- Center for Eye Research Australia, University of Melbourne, WHO Collaborating Centre for the Prevention of Blindness, East Melbourne Vic, Australia.
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Harding-Esch EM, Edwards T, Mkocha H, Munoz B, Holland MJ, Burr SE, Sillah A, Gaydos CA, Stare D, Mabey DCW, Bailey RL, West SK. Trachoma prevalence and associated risk factors in the gambia and Tanzania: baseline results of a cluster randomised controlled trial. PLoS Negl Trop Dis 2010; 4:e861. [PMID: 21072224 PMCID: PMC2970530 DOI: 10.1371/journal.pntd.0000861] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2010] [Accepted: 09/29/2010] [Indexed: 11/23/2022] Open
Abstract
Background Blinding trachoma, caused by ocular infection with Chlamydia trachomatis, is targeted for global elimination by 2020. Knowledge of risk factors can help target control interventions. Methodology/Principal Findings As part of a cluster randomised controlled trial, we assessed the baseline prevalence of, and risk factors for, active trachoma and ocular C. trachomatis infection in randomly selected children aged 0–5 years from 48 Gambian and 36 Tanzanian communities. Both children's eyes were examined according to the World Health Organization (WHO) simplified grading system, and an ocular swab was taken from each child's right eye and processed by Amplicor polymerase chain reaction to test for the presence of C. trachomatis DNA. Prevalence of active trachoma was 6.7% (335/5033) in The Gambia and 32.3% (1008/3122) in Tanzania. The countries' corresponding Amplicor positive prevalences were 0.8% and 21.9%. After adjustment, risk factors for follicular trachoma (TF) in both countries were ocular or nasal discharge, a low level of household head education, and being aged ≥1 year. Additional risk factors in Tanzania were flies on the child's face, being Amplicor positive, and crowding (the number of children per household). The risk factors for being Amplicor positive in Tanzania were similar to those for TF, with the exclusion of flies and crowding. In The Gambia, only ocular discharge was associated with being Amplicor positive. Conclusions/Significance These results indicate that although the prevalence of active trachoma and Amplicor positives were very different between the two countries, the risk factors for active trachoma were similar but those for being Amplicor positive were different. The lack of an association between being Amplicor positive and TF in The Gambia highlights the poor correlation between the presence of trachoma clinical signs and evidence of C. trachomatis infection in this setting. Only ocular discharge was associated with evidence of C. trachomatis DNA in The Gambia, suggesting that at this low endemicity, this may be the most important risk factor. Trial Registration ClinicalTrials.gov NCT00792922 Trachoma is caused by Chlamydia trachomatis and is the leading infectious cause of blindness. The World Health Organization's (WHO) control strategy includes antibiotic treatment of all community members, facial cleanliness, and environmental improvements. By determining how prevalent trachoma is, decisions can be made whether control activities need to be put in place. Knowing what factors make people more at risk of having trachoma can help target trachoma control efforts to those most at risk. We looked at the prevalence of active trachoma and C. trachomatis infection in the eyes of children aged 0–5 years in The Gambia and Tanzania. We also measured risk factors associated with having active trachoma or infection. The prevalence of both active trachoma and infection was lower in The Gambia (6.7% and 0.8%, respectively) than in Tanzania (32.3% and 21.9%, respectively). Risk factors for active trachoma were similar in the two countries. For infection, the risk factors in Tanzania were similar to those for TF, whereas in The Gambia, only ocular discharge was associated with infection. These results show that although the prevalence of active trachoma and infection is very different between the two countries, the risk factors for active trachoma are similar but those for infection are different.
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Affiliation(s)
- Emma M Harding-Esch
- Clinical Research Unit, Department of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom.
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