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Greenland K, Collin C, Sinba Etu E, Guye M, Hika D, Macleod D, Schmidt WP, Shafi Abdurahman O, Last A, Burton MJ. Comparison of metrics for assessing face washing behaviour for trachoma control. PLoS Negl Trop Dis 2024; 18:e0012399. [PMID: 39141680 DOI: 10.1371/journal.pntd.0012399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 07/24/2024] [Indexed: 08/16/2024] Open
Abstract
There is currently no single, easy-to-use, reliable indicator to assess whether a face has been washed with soap in the context of trachoma elimination. This study aimed to compare survey report, script-based pictorial recall and facial cleanliness indicators as alternatives to structured observation for measuring face washing behaviour. This method validation study was nested in the Stronger-SAFE trial, Oromia Region, Ethiopia. Structured observation was conducted in randomly selected households for three hours from dawn. The primary caregiver in each household participated in a survey to capture (self)-reported behaviour and/or script-based pictorial recall, a routine-based diary activity to covertly capture information on face washing behaviour of themself and any children aged 1-12. Children 4-12 years old directly participated in the survey and pictorial recall in a subset of households. The facial cleanliness of children aged 1-12 was assessed qualitatively and using the quantitative Personal Hygiene Assessment Tool (qPHAT). Prevalence estimates, sensitivity, specificity and predictive values were computed for each behavioural indicator with observation data as the gold standard. The appropriateness of script-based pictorial recall was assessed using baseline and 3-month follow-up data. Baseline data were collected from 204 households in 68 clusters. Survey estimates of face washing and face washing with soap among caregivers and children were 32% to 60% and 5% to 31% higher than observed behaviour, respectively. Face washing prevalence estimates from pictorial recall were lower than survey estimates and comparable with observations for some face washing with soap indicators (0.3% to 13% higher than observations). Specificity of pictorial recall indicators was high (85% to 99%), but the sensitivity was low (0% to 67%), resulting in a low positive predictive value for all indicators. Both qualitative facial cleanliness indicators and qPHAT scores were poorly correlated with observed face washing earlier that morning. Pictorial recall overestimated face washing with soap among both caregivers and children following intervention delivery but not at baseline. Survey (self)-reported data on face washing is highly inaccurate. Script-based pictorial recall does not correctly classify those who wash their face with soap, and is subject to differential bias following intervention exposure, and facial cleanliness is a poor indicator of recent face washing in settings where faces become rapidly dirty again after washing. Alternatives to structured observation cannot be recommended to monitor the effectiveness of face washing interventions in community settings. Trial Registration ISRCTN registry ISRCTN40760473, https://doi.org/10.1186/ISRCTN40760473.
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Affiliation(s)
- Katie Greenland
- Department for Disease Control, London School of Hygiene & Tropical Medicine (LSHTM), London, United Kingdom
| | - Claire Collin
- Department for Disease Control, London School of Hygiene & Tropical Medicine (LSHTM), London, United Kingdom
| | - Edao Sinba Etu
- Berhan Public Health & Eye Care Consultancy, Addis Ababa, Ethiopia
| | - Meseret Guye
- The Fred Hollows Foundation Ethiopia, Addis Ababa, Ethiopia
| | - Demitu Hika
- The Fred Hollows Foundation Ethiopia, Addis Ababa, Ethiopia
| | - David Macleod
- International Statistics and Epidemiology Group, LSHTM, London, United Kingdom
- International Centre for Eye Health, Clinical Research Department, LSHTM, London, United Kingdom
| | - Wolf-Peter Schmidt
- Department for Disease Control, London School of Hygiene & Tropical Medicine (LSHTM), London, United Kingdom
| | - Oumer Shafi Abdurahman
- The Fred Hollows Foundation Ethiopia, Addis Ababa, Ethiopia
- International Centre for Eye Health, Clinical Research Department, LSHTM, London, United Kingdom
| | - Anna Last
- Department for Disease Control, London School of Hygiene & Tropical Medicine (LSHTM), London, United Kingdom
- International Centre for Eye Health, Clinical Research Department, LSHTM, London, United Kingdom
| | - Matthew J Burton
- International Centre for Eye Health, Clinical Research Department, LSHTM, 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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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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Sullivan KM, Harding-Esch EM, Keil AP, Freeman MC, Batcho WE, Bio Issifou AA, Bucumi V, Bella AL, Epee E, Bobo Barkesa S, Seife Gebretsadik F, Sanha S, Kalua KM, Masika MP, Minnih AO, Abdala M, Massangaie ME, Amza A, Kadri B, Nassirou B, Mpyet CD, Olobio N, Badiane MD, Elshafie BE, Baayenda G, Kabona GE, Kaitaba O, Simon A, Al-Khateeb TQ, Mwale C, Bakhtiari A, Westreich D, Solomon AW, Gower EW. Exploring water, sanitation, and hygiene coverage targets for reaching and sustaining trachoma elimination: G-computation analysis. PLoS Negl Trop Dis 2023; 17:e0011103. [PMID: 36780437 PMCID: PMC9925017 DOI: 10.1371/journal.pntd.0011103] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 01/14/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Trachoma is the leading infectious cause of blindness. To reduce transmission, water, sanitation, and hygiene (WaSH) improvements are promoted through a comprehensive public health strategy. Evidence supporting the role of WaSH in trachoma elimination is mixed and it remains unknown what WaSH coverages are needed to effectively reduce transmission. METHODS/FINDINGS We used g-computation to estimate the impact on the prevalence of trachomatous inflammation-follicular among children aged 1-9 years (TF1-9) when hypothetical WaSH interventions raised the minimum coverages from 5% to 100% for "nearby" face-washing water (<30 minutes roundtrip collection time) and adult latrine use in an evaluation unit (EU). For each scenario, we estimated the generalized prevalence difference as the TF1-9 prevalence under the intervention scenarios minus the observed prevalence. Data from 574 cross-sectional surveys conducted in 16 African and Eastern Mediterranean countries were included. Surveys were conducted from 2015-2019 with support from the Global Trachoma Mapping Project and Tropical Data. When modeling interventions among EUs that had not yet met the TF1-9 elimination target, increasing nearby face-washing water and latrine use coverages above 30% was generally associated with consistent decreases in TF1-9. For nearby face-washing water, we estimated a ≥25% decrease in TF1-9 at 65% coverage, with a plateau upon reaching 85% coverage. For latrine use, the estimated decrease in TF1-9 accelerated from 80% coverage upward, with a ≥25% decrease in TF1-9 by 85% coverage. Among EUs that had previously met the elimination target, results were inconclusive. CONCLUSIONS Our results support Sustainable Development Goal 6 and provide insight into potential WaSH-related coverage targets for trachoma elimination. Targets can be tested in future trials to improve evidence-based WaSH guidance for trachoma.
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Affiliation(s)
- Kristin M. Sullivan
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America,* E-mail:
| | - Emma M. Harding-Esch
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Alexander P. Keil
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Matthew C. Freeman
- Gangarosa Department of Environmental Health, Emory University, Atlanta, Georgia, United States of America
| | - Wilfrid E. Batcho
- Programme National De Lutte Contre Les Maladies Transmissibles, Ministère De La Santé, Cotonou, Benin
| | | | - Victor Bucumi
- Département En Charge des Maladies Tropicales, Négligées Ministère De La Santé Publique Et De La Lutte Contre Le Sida, Bujumbura, Burundi
| | - Assumpta L. Bella
- Programme National De Lutte Contre La Cécité, Ministère De La Santé Publique, Yaounde, Cameroon
| | - Emilienne Epee
- Department Of Ophthalmology, University of Yaoundé 1 Yaounde Centre, Yaoundé, Cameroun
| | - Segni Bobo Barkesa
- Neglected Tropical Disease Prevention and Control Program, Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Fikre Seife Gebretsadik
- Neglected Tropical Disease Prevention and Control Program, Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Salimato Sanha
- Programa Nacional De Saúde De Visão, Minsap, Bissau, Guinea-Bissau
| | | | - Michael P. Masika
- Department of Clinical Services, Ministry of Health, Lilongwe, Malawi
| | - Abdallahi O. Minnih
- Département Des Maladies Transmissibles, Ministère De La Santé Nouakchott, Nouakchott, Mauritania
| | - Mariamo Abdala
- Direcção Nacional De Saúde Pública Ministerio Da Saude, Maputo, Mozambique
| | | | - Abdou Amza
- Programme National De Santé Oculaire Ministère De La Santé Publique, Niamey, Niger
| | - Boubacar Kadri
- Programme National De Santé Oculaire Ministère De La Santé Publique, Niamey, Niger
| | - Beido Nassirou
- Programme National De Santé Oculaire Ministère De La Santé Publique, Niamey, Niger
| | - Caleb D. Mpyet
- Department of Ophthalmology, University of Jos, Jos, Plateau, Nigeria
| | - Nicholas Olobio
- Neglected Tropical Diseases Division, Department of Public Health, Federal Ministry of Health, Abuja, Nigeria
| | - Mouctar D. Badiane
- Programme National de Promotion de La Santé Oculaire, Ministère de la Santé et de L’Action sociale, Dakar, Senegal
| | - Balgesa E. Elshafie
- National Program for Prevention of Blindness, Federal Ministry of Health, Khartoum, Sudan
| | | | - George E. Kabona
- Neglected Tropical Disease Control Program, Ministry of Health, Dodoma, United Republic of Tanzania
| | - Oscar Kaitaba
- Neglected Tropical Disease Control Program, Ministry of Health, Dodoma, United Republic of Tanzania
| | - Alistidia Simon
- Neglected Tropical Disease Control Program, Ministry of Health, Dodoma, United Republic of Tanzania
| | | | - Consity Mwale
- Provincial Health Office, Ministry of Health, Lusaka, Zambia
| | - Ana Bakhtiari
- International Trachoma Initiative, Task Force for Global Health, Decatur, Georgia, United States of America
| | - Daniel Westreich
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Anthony W. Solomon
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Emily W. Gower
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
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Abstract
Trachoma is a neglected tropical disease caused by infection with conjunctival strains of Chlamydia trachomatis. It can result in blindness. Pathophysiologically, trachoma is a disease complex composed of two linked chronic processes: a recurrent, generally subclinical infectious-inflammatory disease that mostly affects children, and a non-communicable, cicatricial and, owing to trichiasis, eventually blinding disease that supervenes in some individuals later in life. At least 150 infection episodes over an individual's lifetime are needed to precipitate trichiasis; thus, opportunity exists for a just global health system to intervene to prevent trachomatous blindness. Trachoma is found at highest prevalence in the poorest communities of low-income countries, particularly in sub-Saharan Africa; in June 2021, 1.8 million people worldwide were going blind from the disease. Blindness attributable to trachoma can appear in communities many years after conjunctival C. trachomatis transmission has waned or ceased; therefore, the two linked disease processes require distinct clinical and public health responses. Surgery is offered to individuals with trichiasis and antibiotic mass drug administration and interventions to stimulate facial cleanliness and environmental improvement are designed to reduce infection prevalence and transmission. Together, these interventions comprise the SAFE strategy, which is achieving considerable success. Although much work remains, a continuing public health problem from trachoma in the year 2030 will be difficult for the world to excuse.
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Chavda VP, Pandya A, Kypreos E, Patravale V, Apostolopoulos V. Chlamydia trachomatis: quest for an eye-opening vaccine breakthrough. Expert Rev Vaccines 2022; 21:771-781. [PMID: 35470769 DOI: 10.1080/14760584.2022.2061461] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Chlamydia trachomatis, commonly referred to as chlamydia (a bacterium), is a common sexually transmitted infection, and if attended to early, it can be treatable. However, if left untreated it can lead to serious consequences. C. trachomatis infects both females and males although its occurrence in females is more common, and it can spread to the eyes causing disease and in some case blindness. AREA COVERED With ongoing attempts in the most impoverished regions of the country, trachoma will be eradicated as a blinding disease by the year 2022. A prophylactic vaccine candidate with established safety and efficacy is a cogent tool to achieve this goal. This manuscript covers the vaccine development programs for chlamydial infection. EXPERT OPINION Currently, the Surgery Antibiotics Facial Environmental (SAFE) program is being implemented in endemic countries in order to reduce transmission and control of the disease. Vaccines have been shown over the years to protect against infectious diseases. Charge variant-based adjuvant can also be used for the successful delivery of chlamydial specific antigen for efficient vaccine delivery through nano delivery platform. Thus, a vaccine against C. trachomatis would be of great public health benefit.
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Affiliation(s)
- Vivek P Chavda
- Department of Pharmaceutics and Pharmaceutical Technology, L M College of Pharmacy, Ahmedabad India
| | - Anjali Pandya
- Department of Pharmaceutical Sciences and Technology, Institute of Chemical Technology, Mumbai India
| | - Erica Kypreos
- Department of Immunology, Institute for Health and Sport, Victoria University, Melbourne VIC Australia
| | - Vandana Patravale
- Department of Pharmaceutical Sciences and Technology, Institute of Chemical Technology, Mumbai India
| | - Vasso Apostolopoulos
- Department of Immunology, Institute for Health and Sport, Victoria University, Melbourne VIC Australia
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Sanders AM, Dixon R, Stuck L, Kelly M, Woods G, Muheki EM, Baayenda G, Masika M, Kafanikhale H, Mwingira U, Wohlgemuth L. Evaluation of facial cleanliness and environmental improvement activities: Lessons learned from Malawi, Tanzania, and Uganda. PLoS Negl Trop Dis 2021; 15:e0009962. [PMID: 34843480 PMCID: PMC8659352 DOI: 10.1371/journal.pntd.0009962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 12/09/2021] [Accepted: 11/01/2021] [Indexed: 12/03/2022] Open
Abstract
The World Health Organization promotes the SAFE (Surgery, Antibiotics, Facial cleanliness, and Environmental improvements) strategy for trachoma control and prevention. The F&E components of the strategy focus on promotion of healthy hygiene and sanitation behaviors. In order to monitor F&E activities implemented across villages and schools in Malawi, Tanzania, and Uganda, an F&E Monitoring and Evaluation (FEME) framework was developed to track quarterly program outputs and to provide the basis for a pre and post evaluation of the activities. Results showed an increase in knowledge at the school and household levels, and in some cases, an increase in presence of hand/face washing stations. However, this did not always result in a change in trachoma prevention behaviors such as facial cleanliness or keeping compounds free of human feces. The results highlight that the F&E programs were effective in increasing awareness of trachoma prevention but not able to translate that knowledge into changes in behavior during the time between pre and post-surveys. This study also indicates the potential to improve the data collection and survey design and notes that the period of intervention was not long enough to measure significant changes. Trachoma control programs promote facial cleanliness, use of latrines, and emphasizes the importance of access to water as means to reduce trachoma transmission. To address these areas, various country ministries and supporting non-governmental organizations (NGOs) support the implementation of tailored behavior change programs. The process and results of evaluating these types of programs in Malawi, Tanzania, and Uganda are described here. The goal of this manuscript is to provide trachoma program managers and supporting NGOs with insights, recommendations, and data collection tools that could be used to support their efforts to conduct monitoring and evaluation of their current or future trachoma prevention activities.
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Affiliation(s)
| | | | - Logan Stuck
- Amsterdam Institute for Global Health and Development, Amsterdam, Netherlands
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