Population-based prevalence survey of follicular trachoma and trachomatous trichiasis in the Casamance region of Senegal

Prevalence of active trachoma and its associated factors among 1–9 years of age children from model and non-model kebeles in Dangila district, northwest Ethiopia

Background

Trachoma is the leading infectious disease that leads to blindness worldwide, especially in developing countries. Though Ethiopia had targeted a trachoma elimination program by 2020, the problem worsens, particularly in the Amhara Region. Even though sustained intervention measures are undertaken across the region, it is unclear why trachoma is still a significant public health problem. So, this study assessed the prevalence of active trachoma and associated factors among 1–9 years of age children from model and non-model kebeles in Dangila district Amhara Region, Northwest Ethiopia.

Methods

A community-based comparative cross-sectional study was conducted from 20^th September 2019 to 29^th October 2019. A multistage stratified random sampling technique was used to reach 704 children from model and non-model kebeles. Samples were allocated proportionally to model and non-model kebeles. A structured and pretested data collection tool and observational checklist was used to manage the necessary data. Data were coded and entered in Epidata version 4.6, and further analysis was done using SPSS version 20 software. Bivariable and multivariable logistic regression analysis was employed to identify factors associated with active trachoma. Adjusted Odds Ratios (AOR), p-value, and respected Confidence Interval (CI) were used to report the findings.

Results

Seven hundred four children were included in this study, with a response rate of 97.8%. The overall prevalence of active trachoma was 6% (95% CI: 4.5, 8.1). The prevalence of active trachoma among non-model and model Kebele was not significantly different. Still, the prevalence of active trachoma among children from model Kebele were [4.5%, (95% CI: 2.4%, 7.1%)] relatively lower compared with non-model kebeles, [7.6%, 95% CI: (4.9%, 10.9%)]. Moreover, not using latrine (AOR = 4.29, 95% CI: 1.96, 9.34), fly-eye contact (AOR = 2.59, 95% CI: 1.11, 6.03), presence of sleep in eyes (AOR = 2.46, 95% CI: 1.10, 5.47), presence of ocular discharge (AOR = 2.79, 95% CI: 1.30, 6.00), presence of nasal discharges (AOR = 2.67, 95% CI: 1.21, 5.90) and washing faces with soap (AOR = 0.22, 95% CI: 0.07, 0.69) were found significantly associated with the prevalence of active trachoma among children 1–9 years old.

Conclusions

The prevalence of active trachoma in the model and non-model kebeles was high and did not show a statistical difference. Attention to be given to latrine utilization, washing face with soap, and other personal hygiene activities.

Prevalence of Active Trachoma and Associated Factors in Areka Town, South Ethiopia, 2018

Background

Globally, 1.2 billion people live in trachoma endemic areas, 40.6 million people are suffering from active trachoma, and 48.5% of the global burden of active trachoma is distributed in five countries including Ethiopia. However, there is no evidence or no conducted survey/research data or document regarding trachoma prevalence in Areka Town. We, therefore, did a study to assess the prevalence of active trachoma and associated factors in Areka Town in South Ethiopia.

Methods

A community-based cross-sectional study was employed. A total of 586 children aged 1-9 years were involved. We compiled a structured questionnaire from the relevant literature and pretested before use. A range of data was collected on the sociodemographic, facility, and service-related, and environmental factors. The outcome variable was measured by using frequencies, cross-tabulation, and percent. Multivariate logistic regression was applied to control potential confounders and to identify the predictors.

Results

This study revealed that 37.9% of children aged 1-9 years have active trachoma (95% CI: 34%-42%). Households without latrine (AOR = 6.88; 95% CI: 2.13-22.18), openly disposing domestically produced waste (AOR = 4.62; 95% CI: 2.41-8.83), cooking in the same room (AOR = 5.13; 95% CI: 2.21-11.88), and using the cooking room without a window (AOR = 2.28; 95% CI: 1.11-4.69) were more likely to have their children develop active trachoma. Similarly, children with caretakers having inadequate knowledge about trachoma (AOR = 8.10; 95% CI: 2.04-32.17) were more likely to develop active trachoma. However, households consuming more than 20 liters of water per day were 82% (AOR = 0.18; 95% CI: 0.07-0.44) less likely to have their children develop active trachoma while compared to those consuming less than the figure.

Conclusions

The prevalence of active trachoma in the children aged 1-9 years in the study area was found to be high, and it is much higher than the WHO elimination threshold.

Prevalence and associated factors of active trachoma among children in Ethiopia: a systematic review and meta-analysis

BACKGROUND

Trachoma is the commonest infectious cause of blindness. It is prevalent in areas where personal and community hygiene is poor, and it mainly affects deprived and marginalized communities most importantly in Ethiopia. Hence, the aim of this study was to determine the prevalence and associated factors of active trachoma among children in Ethiopia.

METHOD

A systematic review and meta-analysis was employed to determine the prevalence of active trachoma and associated factors among children in Ethiopia. We searched databases, including PubMed, Google Scholar, Science Direct, EMBASE and Cochrane Library. To estimate the prevalence, studies reporting the prevalence of active trachoma and its associated factors were included. Data were extracted using a standardized data extraction format prepared in Microsoft excel and the analysis was done using STATA 14 statistical software. To assess heterogeneity, the Cochrane Q test statistics and I² test were used. Since the included studies revealed considerable heterogeneity, a random effect meta- analysis model was used to estimate the pooled prevalence of active trachoma. Moreover, the association between factors and active trachoma were examined.

RESULTS

The result of 30 eligible studies showed that the overall prevalence of active trachoma among children in Ethiopia was 26.9% (95% CI: 22.7, 31.0%). In the subgroup analysis, while the highest prevalence was reported in SNNP (35.8%; 95% CI: 22.7, 48.8), the lowest prevalence was reported in Oromia region (20.2%; 95% CI: 12.2, 28.2). Absence of latrine: OR 6.0 (95% CI 2.0, 17.5), the unclean faces of children: OR 5.5 (95% CI 2.8, 10.9), and no reported use of soap for washing: OR 3.3 (95% CI 1.8, 6.0) have shown a positive association with active trachoma among children.

CONCLUSION

From this review, it has been concluded that active trachoma among children is still a public health problem in different districts of Ethiopia. The prevalence of almost all studies are significantly higher than WHO target for elimination. Absence of latrine, unclean faces of children, no reported use of soap for washing are the important factors associated with active trachoma among children.

Household Survey of Trachoma among Children Living in Pernambuco, Brazil

This study analyzed the association between individual and household factors and the incidence of trachoma among a population aged between 1 and 9 years in the state of Pernambuco. This was a population-based household study conducted using a population-based sample of residents from 96 census sectors of the 1778 sectors considered to be at social risk in the state. The estimated odds ratio of the univariate analysis presented a confidence interval of 95%. Weights and clusters were adjusted through the Generalized Linear and Latent Mixed Model (GLLAM) method. Trachoma cases were the dependent variable in the multivariate analysis. The independent variables were selected through the stepwise forward method, with an input criterion of 20% (p < 0.20) and an output criterion of 10% (p < 0.10). The prevalence was 6.65%. Trachoma was associated with a female sex, age of 5–9 years, either the absence of use or infrequent use of soap to wash the hands and face, the presence of nasal secretion, a lack of piped water from a public supply system, a greater number of rooms used for sleeping, a greater number of people living in the same household, and a family income of up to one minimum monthly wage. The prevalence of follicular trachoma in Pernambuco was higher than what is recommended by the World Health Organization (WHO).

Prevalence of Trachoma in Senegal: Results of Baseline Surveys in 17 Districts

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.

Optimising sampling regimes and data collection to inform surveillance for trachoma control

It is estimated that 190 million individuals are at risk of blindness from trachoma, and that control by mass drug administration (MDA) is reducing this risk in many populations. Programs are monitored using prevalence of follicular trachoma disease (TF) in children. However, as programs progress to low prevalence there are challenges interpreting this indirect measure of infection. PCR and sero-surveillance are being considered as complementary tools to monitor low-level transmission, but there are questions on how they can be most effectively used. We use a previously-published, mathematical model to explore the dynamic relationship between TF and PCR throughout a control program and a sero-catalytic model to evaluate the utility of two cross-sectional sero-surveys for estimating sero-conversion rates. The simulations show that whilst PCR is more sensitive than TF at detecting infection, the probability of detecting at least one positive individual declines during an MDA program more quickly for PCR than for TF (for the same sample size). Towards the end of a program there is a moderate chance of a random sample showing both low PCR prevalence and higher TF prevalence, which may contribute to the lack of correlation observed in epidemiological studies. We also show that conducting two cross-sectional sero-surveys 10 years apart can provide more precise and accurate estimation of epidemiological parameters than a single survey, supporting previous findings that whilst serology holds great promise, multiple cross-sections from the same community are needed to generate the most valuable information about transmission. These results highlight that the quantitative dynamics of infection and disease should be included alongside the many logistical and practical factors to be considered in designing a monitoring and evaluation strategy at the operational research level, in order to help subsequently inform data collection for individual country programs. Whilst our simulations provide some insight, they also highlight that some level of longitudinal, individual-level data on reinfection and disease may be needed to monitor elimination progress.