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Elshafie BE, Elsanosi MSA, El Amin A, Butcher R, Willis R, Bakhtiari A, Jimenez C, Dejene M, Solomon AW, Harding-Esch EM, Binnawi KH. Trachoma Prevalence in Four Localities of Darfur Region, Sudan, following One Round of Antibiotic Mass Drug Administration. Ophthalmic Epidemiol 2023; 30:571-579. [PMID: 34423732 PMCID: PMC10581671 DOI: 10.1080/09286586.2021.1953538] [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: 01/07/2021] [Revised: 06/29/2021] [Accepted: 07/02/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The prevalence of trachomatous inflammation-follicular (TF) in 1-9-year-olds and of trachomatous trichiasis (TT) in ≥15-year-olds in four endemic evaluation units (EUs) of Darfur region, Sudan, was measured more than a year after the required single round of antibiotic mass drug administration (MDA). METHODS Surveys were conducted using highly standardised, World Health Organization-recommended methodologies. Individuals aged ≥1 year, resident in selected households, were chosen for the survey using a two-stage cluster sampling process. Consenting adults and children were examined for the signs TF and TT by graders trained to international standards. Prevalence of disease in key indicator groups was calculated and weighted to the underlying population structure. RESULTS A mean of 1,415 (range: 1,253-1,611) children aged 1-9 years were examined in each EU. The age-adjusted prevalence of TF in 1-9-year-olds in each of the four surveyed EUs was <5%. A mean of 1,139 people aged ≥15 years (range: 1,080-1,201) were examined in each EU. The estimated age- and gender-adjusted prevalence of TT in ≥15-year-olds was <0.2% in all four EUs. In general, the proportion of households with access to improved WASH facilities was generally lower in this study than in corresponding baseline studies. CONCLUSIONS No further MDA should be conducted in these four EUs for the next 2 years, at which point they should be re-surveyed to determine whether the prevalence of TF in 1-9-year-olds has remained <5%. Active TT case-finding is also not indicated. Environmental improvement and promotion of facial cleanliness measures should continue to be implemented to prevent disease recrudescence.
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Affiliation(s)
| | | | - Atif El Amin
- Sudan National Trachoma Control Programme, Khartoum, Sudan
| | - Robert Butcher
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | | | | | - Anthony W Solomon
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Emma M Harding-Esch
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
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Seyum D, Fetene N, Kifle T, Negash H, Kabeto T, Gebre M, Data T, Tadele T, Abayo G, Wondimu A, Butcher R, Bakhtiari A, Willis R, Boyd S, Jimenez C, Negussu N, Tadesse F, Kebede F, Dejene M, Solomon AW, Harding-Esch EM, Sisay A. Prevalence of Trachoma from 66 Impact Surveys in 52 Woredas of Southern Nations, Nationalities and Peoples' and Sidama Regions of Ethiopia, 2017-2019. Ophthalmic Epidemiol 2023; 30:637-646. [PMID: 35473569 PMCID: PMC10581674 DOI: 10.1080/09286586.2022.2065313] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 04/01/2022] [Accepted: 04/07/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Trachoma is endemic in Southern Nations, Nationalities and Peoples' (SNNP) and Sidama regions of Ethiopia. We aimed to measure the prevalence of trachomatous inflammation-follicular (TF) among children aged 1 - 9 years and the prevalence of trachomatous trichiasis (TT) unknown to the health system among people aged ≥15 years following interventions for trachoma in 52 woredas of SNNP and Sidama regions. METHODS From 2017 - 2019, 66 two-stage cluster sampling cross-sectional population-based surveys were carried out in 52 woredas (third-level administrative divisions) using a standardized World Health Organization-recommended survey methodology. This included one impact survey in 40 woredas, two consecutive impact surveys in 10 woredas and three consecutive impact surveys in two woredas. Water, sanitation and Hygiene (WASH) access was assessed using a modified version of the United Nations Children's Fund/WHO Joint Monitoring Programme questionnaire. RESULTS By the end of this survey series, 15 (23%) of the woredas had met the active trachoma elimination threshold (TF prevalence <5%) and 12 (18%) had met the TT threshold (TT ≤ 0.2%). Regarding WASH coverage, 20% of households had access to an improved drinking water source within a 30-min journey and 3% had an improved latrine. There was strong evidence that TF was less common in 4 - 6-year-olds and 7 - 9-year-olds than 1 - 3-year-olds. CONCLUSION Based on the findings, further antibiotic mass drug administration is required in 37 woredas and active TT case finding is needed in 40 woredas. In these surveys, access to WASH facilities was very low; WASH improvements are required.
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Affiliation(s)
- Dawit Seyum
- Orbis International Ethiopia, Orbis International Ethiopia, Addis Ababa, Ethiopia
| | - N Fetene
- Orbis International Ethiopia, Orbis International Ethiopia, Addis Ababa, Ethiopia
| | - Tezera Kifle
- Orbis International Ethiopia, Orbis International Ethiopia, Addis Ababa, Ethiopia
| | - Habtamu Negash
- Orbis International Ethiopia, Orbis International Ethiopia, Addis Ababa, Ethiopia
| | - Temesgen Kabeto
- Orbis International Ethiopia, Orbis International Ethiopia, Addis Ababa, Ethiopia
| | - Mulatu Gebre
- Orbis International Ethiopia, Orbis International Ethiopia, Addis Ababa, Ethiopia
| | - Tadesse Data
- Orbis International Ethiopia, Orbis International Ethiopia, Addis Ababa, Ethiopia
| | - Tafese Tadele
- Southern Nations, Nationalities and Peoples’ Regional Health Bureau, Hawassa, Ethiopia
| | | | | | | | - Ana Bakhtiari
- ITI, Task Force for Global Health, Decatur, GEORGIA, USA
| | - Rebecca Willis
- ITI, Task Force for Global Health, Decatur, GEORGIA, USA
| | - Sarah Boyd
- ITI, Task Force for Global Health, Decatur, GEORGIA, USA
| | | | - Nebiyu Negussu
- Ministry of Health, Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Fentahun Tadesse
- Ministry of Health, Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Fikreab Kebede
- Ministry of Health, Federal Ministry of Health, Addis Ababa, Ethiopia
| | | | - Anthony W. Solomon
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Emma M. Harding-Esch
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Alemayehu Sisay
- Orbis International Ethiopia, Orbis International Ethiopia, Addis Ababa, Ethiopia
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Szwarcwald CL, Lopes MDFC, Borges de Souza Junior PR, Vaz Ferreira Gómez D, Luna EJDA, da Silva de Almeida W, Damacena GN, Ribeiro Favacho JDF, Germano de Frias P, Butcher R, Boyd S, Bakhtiari A, Willis R, Jimenez C, Harding-Esch E, Saboyá-Díaz MI, Solomon AW. Population Prevalence of Trachoma in Nine Rural Non-Indigenous Evaluation Units of Brazil. Ophthalmic Epidemiol 2023; 30:561-570. [PMID: 34711133 PMCID: PMC10581672 DOI: 10.1080/09286586.2021.1941127] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 05/20/2021] [Accepted: 06/04/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To assess the contemporary prevalence of trachoma in Brazil's non-indigenous population, surveys of those thought to be at greatest risk of disease were conducted. METHODS Rural census tracts of non-indigenous population from nine mesoregions were selected to compose the survey evaluation units (EUs) by considering previously endemic municipalities at greatest risk of trachoma. In each of the nine EUs, we conducted a population-based prevalence survey. Every resident of selected households aged ≥ 1 year was examined for trachomatous inflammation - follicular (TF) and trachomatous trichiasis (TT). Additionally, data were collected on household-level access to water, sanitation, hygiene (WASH) and education. RESULTS A total of 27,962 individuals were examined across nine EUs. The age-adjusted TF prevalence in 1-9-year-olds was <5% in each EU. The age- and gender-adjusted prevalence of TT unknown to the health system in ≥15-year-olds was <0.2% in eight EUs; in one EU, it was 0.22%. The median number of households surveyed per EU with access to an improved drinking water source within a 30-minute roundtrip of the house was 66%. School attendance was >99% of surveyed children. CONCLUSIONS The prevalence of TF was well below the target for elimination as a public health problem in all EUs. Because EUs surveyed were selected to represent the highest-risk non-indigenous areas of the country, TF prevalence is unlikely to be ≥5% in non-indigenous populations elsewhere. In one EU, the prevalence of TT was above the target threshold for elimination. Further investigation and possibly improvement in TT surgical provision are required in that EU.
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Affiliation(s)
- Célia Landmann Szwarcwald
- Institute of Scientific and Technological Communication and Information in Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Maria de Fátima Costa Lopes
- Coordination of Surveillance of Zoonoses and Vector Transmission Diseases, Department of Immunization and Communicable Diseases, Health Surveillance Secretariat, Ministry of Health, Brasília, Brazil
| | | | - Daniela Vaz Ferreira Gómez
- Coordination of Surveillance of Zoonoses and Vector Transmission Diseases, Department of Immunization and Communicable Diseases, Health Surveillance Secretariat, Ministry of Health, Brasília, Brazil
| | | | - Wanessa da Silva de Almeida
- Institute of Scientific and Technological Communication and Information in Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Giseli Nogueira Damacena
- Institute of Scientific and Technological Communication and Information in Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | | | - Paulo Germano de Frias
- Board of Education and Research, Study Group on Health Assessment and Management, Professor Fernando Figueira Integral Medicine Institute (IMIP), Recife, Brazil
| | - Robert Butcher
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Sarah Boyd
- International Trachoma Initiative, Task Force for Global Health, Atlanta, Georgia, USA
| | - Ana Bakhtiari
- International Trachoma Initiative, Task Force for Global Health, Atlanta, Georgia, USA
| | - Rebecca Willis
- International Trachoma Initiative, Task Force for Global Health, Atlanta, Georgia, USA
| | | | - Emma Harding-Esch
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - 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, DC, USA
| | - Anthony W. Solomon
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
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Aquino-Canchari CR, Chavez-Bustamante SG. The 100 most cited articles on trachoma: a bibliometric analysis. Int Ophthalmol 2023; 43:4235-4246. [PMID: 37592115 DOI: 10.1007/s10792-023-02834-8] [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: 12/23/2022] [Accepted: 07/27/2023] [Indexed: 08/19/2023]
Abstract
OBJECTIVE Trachoma is the cause of blindness or visual impairment in 1.9 million people. Few bibliometric studies have been carried out, but none explore the characteristics of the 100 most cited articles on trachoma. METHODS A keyword-based search without time restriction was performed in September 2022 using the Scopus database. Search keywords include the following: "trachoma; trachome; tracoma; trachomatis." Two authors independently screened the literature and extracted data. The search result was obtained to classify the 100 articles according to their number of citations. RESULTS The Top 100 articles were published between 1957 and 2015 with a total of 11,102 citations (range 56-689). The country with the most significant contribution was the USA (n = 56). The Lancet was the most active journal (n = 15). Bailey RL was the author with the highest number of publications (n = 30). The Edna McConnell Clark Foundation (n = 26) was the most prominent funding entity. The type of original article was the most published (n = 83), in addition, the most frequent thematic area was prevention (n = 33). The most popular keywords were trachoma (n = 93), chlamydia trachomatis (n = 55), and azithromycin (n = 34). CONCLUSIONS The study provides new insight into trachoma research, information that may help healthcare providers, researchers, and stakeholders better understand trends and influential contributions. It highlights under-researched areas that could be the basis for future research.
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Affiliation(s)
- Christian Renzo Aquino-Canchari
- Facultad de Medicina Humana, Universidad Peruana los Andes, Sociedad Científica de Estudiantes de Medicina los Andes (SOCIEMLA), CC.HH Juan Parra del Riego, II Etapa, Block 2, Dpto:101, El Tambo, Huancayo, Peru.
| | - Sarai Gloria Chavez-Bustamante
- Facultad de Medicina Humana, Universidad Continental, Sociedad Científica Médico Estudiantil Continental (SOCIMEC), Huancayo, Peru
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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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Borlase A, Prada JM, Crellen T. Modelling morbidity for neglected tropical diseases: the long and winding road from cumulative exposure to long-term pathology. Philos Trans R Soc Lond B Biol Sci 2023; 378:20220279. [PMID: 37598702 PMCID: PMC10440174 DOI: 10.1098/rstb.2022.0279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 07/13/2023] [Indexed: 08/22/2023] Open
Abstract
Reducing the morbidities caused by neglected tropical diseases (NTDs) is a central aim of ongoing disease control programmes. The broad spectrum of pathogens under the umbrella of NTDs lead to a range of negative health outcomes, from malnutrition and anaemia to organ failure, blindness and carcinogenesis. For some NTDs, the most severe clinical manifestations develop over many years of chronic or repeated infection. For these diseases, the association between infection and risk of long-term pathology is generally complex, and the impact of multiple interacting factors, such as age, co-morbidities and host immune response, is often poorly quantified. Mathematical modelling has been used for many years to gain insights into the complex processes underlying the transmission dynamics of infectious diseases; however, long-term morbidities associated with chronic or cumulative exposure are generally not incorporated into dynamic models for NTDs. Here we consider the complexities and challenges for determining the relationship between cumulative pathogen exposure and morbidity at the individual and population levels, drawing on case studies for trachoma, schistosomiasis and foodborne trematodiasis. We explore potential frameworks for explicitly incorporating long-term morbidity into NTD transmission models, and consider the insights such frameworks may bring in terms of policy-relevant projections for the elimination era. This article is part of the theme issue 'Challenges and opportunities in the fight against neglected tropical diseases: a decade from the London Declaration on NTDs'.
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Affiliation(s)
- Anna Borlase
- Department of Biology, University of Oxford, Oxford OX1 3SZ, UK
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford OX3 7LF, UK
| | - Joaquin M. Prada
- Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7XH, UK
| | - Thomas Crellen
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford OX3 7LF, UK
- School of Biodiversity, One Health & Veterinary Medicine, Graham Kerr Building, University of Glasgow, Glasgow G12 8QQ, UK
- Wellcome Centre for Integrative Parasitology, Sir Graeme Davies Building, University of Glasgow, Glasgow G12 8TA, UK
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McCormick I, Kim MJ, Hydara A, Olaniyan SI, Jobe M, Badjie O, Sanyang NMB, Jarju G, Njai M, Sankareh A, Bastawrous A, Allen L, Mactaggart I, Burton MJ, Ramke J. Socioeconomic position and eye health outcomes: identifying inequality in rapid population-based surveys. BMJ Open 2023; 13:e069325. [PMID: 36882236 PMCID: PMC10008479 DOI: 10.1136/bmjopen-2022-069325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
OBJECTIVE Monitoring health outcomes disaggregated by socioeconomic position (SEP) is crucial to ensure no one is left behind in efforts to achieve universal health coverage. In eye health planning, rapid population surveys are most commonly implemented; these need an SEP measure that is feasible to collect within the constraints of a streamlined examination protocol. We aimed to assess whether each of four SEP measures identified inequality-an underserved group or socioeconomic gradient-in key eye health outcomes. DESIGN Population-based cross-sectional survey. PARTICIPANTS A subset of 4020 adults 50 years and older from a nationally representative sample of 9188 adults aged 35 years and older in The Gambia. OUTCOME MEASURES Blindness (presenting visual acuity (PVA) <3/60), any vision impairment (VI) (PVA <6/12), cataract surgical coverage (CSC) and effective cataract surgical coverage (eCSC) at two operable cataract thresholds (<6/12 and <6/60) analysed by one objective asset-based measure (EquityTool) and three subjective measures of relative SEP (a self-reported economic ladder question and self-reported household food adequacy and income sufficiency). RESULTS Subjective household food adequacy and income sufficiency demonstrated a socioeconomic gradient (queuing pattern) in point estimates of any VI and CSC and eCSC at both operable cataract thresholds. Any VI, CSC <6/60 and eCSC <6/60 were worse among people who reported inadequate household food compared with those with just adequate food. Any VI and CSC <6/60 were worse among people who reported not enough household income compared with those with just enough income. Neither the subjective economic ladder question nor the objective asset-wealth measure demonstrated any socioeconomic gradient or pattern of inequality in any of the eye health outcomes. CONCLUSION We recommend pilot-testing self-reported food adequacy and income sufficiency as SEP variables in vision and eye health surveys in other locations, including assessing the acceptability, reliability and repeatability of each question.
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Affiliation(s)
- Ian McCormick
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Min J Kim
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Abba Hydara
- Sheikh Zayed Regional Eye Care Centre, Banjul, Gambia
| | | | - Modou Jobe
- MRC Unit The Gambia at LSHTM, Banjul, Gambia
| | - Omar Badjie
- Directorate of Health Promotion and Education, Ministry of Health, Kotu, Gambia
| | | | - Gibril Jarju
- Directorate of Planning and Information, Ministry of Health, Kotu, Gambia
| | - Modou Njai
- Directorate of Health Promotion and Education, Ministry of Health, Kotu, Gambia
| | - Alhagie Sankareh
- Regional Directorate of Health Services, West Coast Health Region, Ministry of Health, Kanifing, Gambia
| | - Andrew Bastawrous
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Luke Allen
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Islay Mactaggart
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Matthew J Burton
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
- National Institute for Health Research Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Jacqueline Ramke
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
- School of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand
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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: 3] [Impact Index Per Article: 3.0] [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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Mavragani A, Wu Y, Meng Z, Li J, Xu L, Sun X, Zang S. Willingness to Use Mobile Health Devices in the Post-COVID-19 Era: Nationwide Cross-sectional Study in China. J Med Internet Res 2023; 25:e44225. [PMID: 36719823 PMCID: PMC9942786 DOI: 10.2196/44225] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 01/27/2023] [Accepted: 01/31/2023] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Despite the increased development and use of mobile health (mHealth) devices during the COVID-19 pandemic, there is little knowledge of willingness of the Chinese people to use mHealth devices and the key factors associated with their use in the post-COVID-19 era. Therefore, a more comprehensive and multiangle investigation is required. OBJECTIVE We aimed to probe Chinese attitudes regarding the use of mHealth and analyze possible associations between the attitude of willingness to use mHealth devices and some factors based on the socioecological model. METHODS A survey was conducted using quota sampling to recruit participants from 148 cities in China between June 20 and August 31, 2022. Data from the survey were analyzed using multiple stepwise regression to examine the factors associated with willingness to use mHealth devices. Standardized regression coefficients (β) and 95% CIs were calculated using multiple stepwise regression. RESULTS The survey contained a collection of 21,916 questionnaires and 21,897 were valid questionnaires, with a 99.91% effective response rate. The median score of willingness to use mHealth in the post-COVID-19 era was 70 points on a scale from 0 to 100. Multiple stepwise regression results showed that the female gender (β=.03, 95% CI 1.04-2.35), openness personality trait (β=.05, 95% CI 0.53-0.96), higher household per capita monthly income (β=.03, 95% CI 0.77-2.24), and commercial and multiple insurance (β=.04, 95% CI 1.77-3.47) were factors associated with the willingness to use mHealth devices. In addition, people with high scores of health literacy (β=.13, 95% CI 0.53-0.68), self-reported health rating (β=.22, 95% CI 0.24-0.27), social support (β=.08, 95% CI 0.40-0.61), family health (β=.03, 95% CI 0.03-0.16), neighbor relations (β=.12, 95% CI 2.09-2.63), and family social status (β=.07, 95% CI 1.19-1.69) were more likely to use mHealth devices. CONCLUSIONS On the basis of the theoretical framework of socioecological model, this study identified factors specifically associated with willingness of the Chinese people to use mHealth devices in the post-COVID-19 era. These findings provide reference information for the research, development, promotion, and application of future mHealth devices.
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Affiliation(s)
| | - Yibo Wu
- School of Public Health, Peking University, Beijing, China
| | - Zhiyu Meng
- Department of the First Clinical Medical College, Jinzhou Medical University, Jinzhou, China
| | - Jiayuan Li
- Department of the First Clinical Medical College, Jinzhou Medical University, Jinzhou, China
| | - Li Xu
- Department of Community Nursing, China Medical University, Shenyang, China
| | - Xinying Sun
- School of Public Health, Peking University, Beijing, China
| | - Shuang Zang
- Department of Community Nursing, China Medical University, Shenyang, China
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Adane B, Malede A, Sewunet B, Kumlachew L, Moges M, Woretaw L, Temesgen T, Bewket Y, Gete M, Yirdaw G, Ayele A, Adane M. Determinants of Trachomatous Inflammation-Follicular Among Children Aged 1 to 9 Years Old in a Rural Area of Gozamn District, Northwestern Ethiopia: A Matched Case-Control Study. ENVIRONMENTAL HEALTH INSIGHTS 2023; 17:11786302231169941. [PMID: 37122686 PMCID: PMC10134110 DOI: 10.1177/11786302231169941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 03/29/2023] [Indexed: 05/03/2023]
Abstract
Background Approximately 1.9 million people worldwide are blind or visually impaired due to trachoma, and trachoma remains endemic in 44 countries. Amhara in Ethiopia has the highest burden of trachoma in the world. A key indicator of whether active trachoma requires public health intervention is the incidence of trachomatous inflammation-follicular in children aged 1 to 9 years. However, limited study has been conducted on the determinants in rural communities. This study therefore aimed to fill this gap by identifying determinants in the Gozamn district of northwestern Ethiopia. Methods A community-based case-control study was carried out between March 15 and April 30, 2021. Five or more follicles on the epitaxial conjunctivae that are larger than 0.5 mm were considered a case. Controls were free of any sign of trachoma. A semi-structured questionnaire and an observational checklist were used to gather the data, and STATA version 14 was used for the analysis. Using a 95% confidence interval, both bivariable and multivariable conditional logistic regression was performed. Results A total of 726 mothers/caregivers participated in this study, with a participation rate of 98.4%. Children from poor families (mAOR = 4.68; CI: 2.80-6.21), households where the water source is far from home (>30 minutes) (mAOR = 4.91; KI: 1.37-12.56), mean daily water consumption (<20 l/c/d) (mAOR = 4.42; CI:1.71-11.39), face washing frequency less than once a day (mAOR = 10.64; CI: 2.58-18.84), cloth washing frequency once a month or less (mAOR = 9.18; CI: 2.20-18.62), and mothers or caregivers with poor knowledge of active trachoma (mAOR = 3.88; CI: 1.47-10.22) were determinants of trachomatous inflammation-follicular. Conclusions We conclude that infrequent faces and clothes washing; unavailability of water, children in poor families, and poor knowledge of mothers/caregivers were risk factors. Health education initiatives about active trachoma, its prevention, and control methods focusing on personal hygiene are so required.
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Affiliation(s)
- Balew Adane
- Department of Environmental Health Science, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
- Balew Adane, Department of Environmental Health Science, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Amhara 269, Ethiopia.
| | - Asmamaw Malede
- Department of Environmental Health Science, College of Medicine and Health Sciences, Wollo University, Wollo, Ethiopia
| | - Birhanu Sewunet
- Department of Environmental Health Science, College of Medicine and Health Sciences, Wollo University, Wollo, Ethiopia
| | - Lake Kumlachew
- Department of Environmental Health Science, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Mekonnen Moges
- Department of Environmental Health Science, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Lebasie Woretaw
- Department of Environmental Health Science, College of Medicine and Health Sciences, Wollo University, Wollo, Ethiopia
| | - Tegegn Temesgen
- Department of Environmental Health Science, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Yenewa Bewket
- Department of Environmental Health Science, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Menberu Gete
- Department of Nursing, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Getasew Yirdaw
- Department of Environmental Health Science, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Agernesh Ayele
- Department of Environmental Health Science, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Metadel Adane
- Department of Environmental Health Science, College of Medicine and Health Sciences, Wollo University, Wollo, Ethiopia
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Mengistu B, Wirtu F, Alemayehu A, Alene S, Asmare A, Backers S, Bakhtiari A, Brady M, Butcher RMR, Dayessa M, Frawley H, Gebru G, Jimenez C, Kebede F, Kejela A, McPherson S, Mihret A, Negussu N, Ngondi JM, Taddese F, Willis R, Wondimu A, Dejene M, Solomon AW, Harding-Esch EM. Prevalence of Trachoma in Benishangul Gumuz Region, Ethiopia, after Implementation of the SAFE Strategy: Results of Four Population-Based Surveys. Ophthalmic Epidemiol 2022:1-9. [PMID: 36511584 PMCID: PMC10578310 DOI: 10.1080/09286586.2022.2140439] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 09/02/2022] [Accepted: 10/21/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE We aimed to estimate the prevalence of trachomatous inflammation-follicular (TF) in 1-9-year-olds and trachomatous trichiasis (TT) unknown to the health system in ≥15-year-olds in Benishangul Gumuz (BGZ) region, Ethiopia. This will help to assess progress towards the elimination of trachoma as a public health problem and determine the need for future interventions against trachoma in the region. METHODS Cross-sectional population-based trachoma prevalence surveys were conducted in four evaluation units (EUs) of BGZ using World Health Organization-recommended survey methodologies. Individuals were examined for clinical signs of trachoma. Household access to water, sanitation and hygiene facilities (WaSH) was assessed. RESULTS A total of 11,778 people aged ≥1 year were examined. The prevalence of TF in 1-9-year-olds was <5% in three EUs and ≥5% in one EU. The prevalence of TT unknown to the health system in people aged ≥15-years was ≥0.2% in all four EUs. The proportion of households with an improved drinking water source within a 30-minute round-trip ranged from 27-60%. The proportion of households with an improved latrine ranged from <1-6%. CONCLUSIONS Surgical interventions for TT are required in all EUs in BGZ. One annual round of mass drug administration (MDA) of azithromycin is required in one EU before resurvey to reassess progress in lowering TF prevalence below the WHO elimination threshold of 5% in 1-9-year-olds. MDA should be stopped in the other three EUs and trachoma surveillance surveys should be conducted at least 24 months after the surveys described here. Ongoing strengthening of WaSH infrastructure may help sustain the low prevalence of trachoma.
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Affiliation(s)
- Belete Mengistu
- Act to End NTDs East, RTI International, Addis Ababa, Ethiopia
| | - Fikru Wirtu
- Health Promotion and Disease Prevention Core Process, Benishangul-Gumuz Regional Health Bureau, Ethiopia
| | | | - Shigute Alene
- Act to End NTDs East, RTI International, Addis Ababa, Ethiopia
| | - Aemiro Asmare
- Act to End NTDs East, RTI International, Addis Ababa, Ethiopia
| | - Sharone Backers
- Act to End NTDs East, RTI International, Addis Ababa, Ethiopia
| | | | - Molly Brady
- Act to End NTDs East, RTI International, Washington, DC, USA
| | - Robert M. R. Butcher
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Hannah Frawley
- Act to End NTDs East, RTI International, Washington, DC, USA
| | - Genet Gebru
- Neglected Tropical Diseases Team, Disease Prevention and Control Directorate, Ministry of Health, Ethiopia
| | | | - Fikreab Kebede
- Neglected Tropical Diseases Team, Disease Prevention and Control Directorate, Ministry of Health, Ethiopia
| | - Asfaw Kejela
- Act to End NTDs East, RTI International, Addis Ababa, Ethiopia
| | - Scott McPherson
- Act to End NTDs East, RTI International, Washington, DC, USA
| | | | - Nebiyu Negussu
- Neglected Tropical Diseases Team, Disease Prevention and Control Directorate, Ministry of Health, Ethiopia
| | | | - Fentahun Taddese
- Neglected Tropical Diseases Team, Disease Prevention and Control Directorate, Ministry of Health, Ethiopia
| | | | - Asfaw Wondimu
- Asfaw Wondimu Health Research and Consultancy, Addis Ababa, Ethiopia
| | | | - Anthony W. Solomon
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Emma M. Harding-Esch
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
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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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Trotignon G, Engels T, Saeed Ali S, Mugwang’a Z, Jones I, Bechange S, Kaminyoghe E, Adera TH, Schmidt E. Measuring equity of access to eye health outreach camps in rural Malawi. PLoS One 2022; 17:e0268116. [PMID: 35594293 PMCID: PMC9122225 DOI: 10.1371/journal.pone.0268116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 04/25/2022] [Indexed: 11/22/2022] Open
Abstract
Introduction Equity in the access and use of health services is critical if countries are to make progress towards universal health coverage and address the systematic exclusion of the most vulnerable groups. The purpose of this study was to assess if the Co-ordinated Approach To Community Health programme implemented by Sightsavers was successful in reaching the poorest population, women, and people living with disabilities in Kasungu district, Malawi. Methods Between April and September 2017, data on socio-economic status, household characteristics and functional disability were collected from patients attending at eye camps in Kasungu district, Malawi. Using asset-based tools to measure household wealth (EquityTool© and Simple Poverty Scorecard©) and the Washington Group Short Set of Questions, individuals were categorised by wealth quintiles, poverty status, and functional disability status and then compared to relevant representative national household surveys. In addition, a follow-up household survey was conducted to check the validity of self-reported household characteristics at eye camps. Results A total of 1,358 individuals participated in the study. The study shows that self-reported data on household characteristics and assets are reliable and can be collected in clinical settings (instead of relying on direct observations of assets). Individuals attending outreach camps were poorer in terms of relative wealth and absolute poverty rates compared to the rest of the population in Kasungu. It was estimated that 9% of the participants belonged to the poorest quintile compared to 4% for the population in Kasungu (DHS 2015–2016). The ultra-poverty rate was also lower among respondents (13%) compared to 15% for Kasungu district (IHS 2017). The functional disability rate was 27.5% for study participants, and statistically higher than the general population (5.6%, SENTIF 2017). Even though women are more at risks than men, 54% of the participants were men. Conclusions Our study shows that existing tools can be reliably used, and combined, if based on recent population data, to assess equity of access to health services for vulnerable groups of the population. The findings suggest that the programme was successful in reaching the poorest people of the Kasungu district population as well as those with disabilities through outreach camps but that more men than women were reach through the programme. Subsequently, our study showed that self-reported household characteristics are a reliable method to measure asset-based wealth of camps’ attendee. However, it is essential to use sub-national data (district or regional level) from recent surveys for the purpose of benchmarking in order to produce accurate results.
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Affiliation(s)
| | - Thomas Engels
- Sightsavers, Haywards Heath, West Sussex, United Kingdom
| | | | | | - Iain Jones
- Sightsavers, Haywards Heath, West Sussex, United Kingdom
| | | | | | | | - Elena Schmidt
- Sightsavers, Haywards Heath, West Sussex, United Kingdom
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14
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Wolle MA, Muñoz BE, Naufal F, Kashaf MS, Mkocha H, West SK. Risk factors for the progression of trachomatous scarring in a cohort of women in a trachoma low endemic district in Tanzania. PLoS Negl Trop Dis 2021; 15:e0009914. [PMID: 34797827 PMCID: PMC8604323 DOI: 10.1371/journal.pntd.0009914] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 10/14/2021] [Indexed: 11/28/2022] Open
Abstract
Background Trachoma, a chronic conjunctivitis caused by Chlamydia trachomatis, is the leading infectious cause of blindness worldwide. Trachoma has been targeted for elimination as a public health problem which includes reducing trachomatous inflammation—follicular prevalence in children and reducing trachomatous trichiasis prevalence in adults. The rate of development of trachomatous trichiasis, the potentially blinding late-stage trachoma sequelae, depends on the rate of trachomatous scarring development and progression. Few studies to date have evaluated the progression of trachomatous scarring in communities that have recently transitioned to a low trachomatous inflammation—follicular prevalence. Methodology/Principal findings Women aged 15 and older were randomly selected from households in 48 communities within Kongwa district, Tanzania and followed over 3.5 years for this longitudinal study. Trachomatous inflammation—follicular prevalence was 5% at baseline and at follow-up in children aged 1–9 in Kongwa, Tanzania. 1018 women aged 15 and older had trachomatous scarring at baseline and were at risk for trachomatous scarring progression; 691 (68%) completed follow-up assessments. Photographs of the upper tarsal conjunctiva were obtained at baseline and follow-up and graded for trachomatous scarring using a previously published four-step severity scale. The overall cumulative 3.5-year progression rate of scarring was 35.3% (95% CI 31.6–39.1). The odds of TS progression increased with an increase in age in women younger than 50, (OR 1.03, 95% CI 1.01–1.05, p = 0.005) as well as an increase in the household poverty index (OR 1.29, 95% CI 1.13–1.48, p = 0.0002). Conclusions/Significance The 3.5-year progression of scarring among women in Kongwa, a formerly hyperendemic now turned hypoendemic district in central Tanzania, was high despite a low active trachoma prevalence. This suggests that the drivers of scarring progression are likely not related to on-going trachoma transmission in this district. Trachoma, a chronic conjunctivitis caused by Chlamydia trachomatis, presents with follicles (trachomatous inflammation—follicular, TF) in children which leads to trachomatous conjunctival scarring (TS) in young adults. TS can progress to the in-turning of eyelashes, trachomatous trichiasis (TT) which places individuals at high risk of irreversible vision loss. Few studies to date have evaluated the progression of TS in communities that have recently transitioned to a low trachoma prevalence. We studied the progression of TS in women in Kongwa, Tanzania a district that recently transitioned to a low prevalence of trachoma. We found that the overall cumulative progression of scarring was 35.3% over 3.5 years. The scarring progression rate observed is very similar to what we observed a decade prior in Kongwa when the trachoma prevalence was very high. Our findings suggest that once scarring has developed it continues to progress irrespective of the current trachoma environment. This has potential ramifications for trachoma elimination efforts. An area could achieve the elimination of TF and still have to deal with scarring progression, which may lead to the development of TT. If this occurs: 1) elimination of TT will be delayed which will delay the overall elimination of trachoma as a public health problem, and 2) the limited resources available to elimination programs may need to be re-allocated.
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Affiliation(s)
- Meraf A. Wolle
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, United States of America
- * E-mail:
| | - Beatriz E. Muñoz
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Fahd Naufal
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Michael Saheb Kashaf
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Harran Mkocha
- Kongwa Trachoma Project, Kongwa, United Republic of Tanzania
| | - Sheila K. West
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, United States of America
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Meneghim RLFDS, Madeira NG, Ribolla PEM, Padovani CR, Schellini SA. Flies as possible vectors of inflammatory trachoma transmission in a Brazilian municipality. Rev Inst Med Trop Sao Paulo 2021; 63:e66. [PMID: 34495263 PMCID: PMC8428871 DOI: 10.1590/s1678-9946202163066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 07/23/2021] [Indexed: 12/04/2022] Open
Abstract
Trachoma is a keratoconjunctivitis caused by Chlamydia
trachomatis, considered an important leading cause of preventable
blindness in the world. This study aimed at verifying if flies can be the
vectors for trachoma in our municipality. Flies were assessed in the households
of children diagnosed with inflammatory trachoma at the municipality of
Botucatu, Sao Paulo State, Brazil. Fly traps were placed in the backyard of the
houses during 24 h, in each of the four weather seasons, over a period of one
year. The collected dipterans were taxonomically classified and the presence of
Chlamydia trachomatis in the flies was evidenced by using
the Polymerase Chain Reaction (PCR). During the studied period, 2,188 flies were
collected, mainly during the summer and the spring. The most common identified
fly was Musca domestica. All fly samples were negative for
Chlamydia trachomatis but several other different bacteria
were identified in these flies. The authors concluded that flies are probably
not the vectors for trachoma in the studied area. Further studies should be
conducted to evaluate other possible factors responsible for the maintenance of
the disease in our environment.
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Affiliation(s)
| | - Newton Goulart Madeira
- Universidade Estadual Paulista, Instituto de Biociências, Departamento de Parasitologia, Botucatu, São Paulo, Brazil
| | - Paulo Eduardo Martins Ribolla
- Universidade Estadual Paulista, Instituto de Biociências, Departamento de Parasitologia, Botucatu, São Paulo, Brazil
| | - Carlos Roberto Padovani
- Universidade Estadual Paulista, Instituto de Biociências, Departamento de Bioestatística, Botucatu, São Paulo, Brazil
| | - Silvana Artioli Schellini
- Universidade Estadual Paulista, Faculdade de Medicina, Departamento de Especialidades Cirúrgicas e Anestesiologia, Divisão de Oftalmologia, Botucatu, São Paulo, Brazil
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Children as messengers of health knowledge? Impact of health promotion and water infrastructure in schools on facial cleanliness and trachoma in the community. PLoS Negl Trop Dis 2021; 15:e0009119. [PMID: 33524050 PMCID: PMC7877774 DOI: 10.1371/journal.pntd.0009119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 02/11/2021] [Accepted: 01/11/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Health promotion is essential to the SAFE strategy for trachoma elimination. Schools are a valuable venue for health promotion. However, there is little literature about the impact of health education and water infrastructure in schools on facial cleanliness and trachoma in the community. Our study aimed to describe the current state of school health promotion in Kongwa, Tanzania, and to examine the transferability of health messages from schools to the community at large. METHODOLOGY/FINDINGS A cross-sectional survey was carried out in all 92 villages in Kongwa district, which included 85 primary schools. Data were collected on health messages and water infrastructure in the schools. A random sample of 3084 children aged 0-5 were examined for facial cleanliness in all villages. In 50 villages, a random sample of 50 children aged 1-9 per village were examined for follicular trachoma (TF). Thirty-seven (44.6%) schools had educational materials on face-washing. Fifty (60.2%) schools had a washing station. The presence of a health teacher was correlated with having posters on face washing in classrooms. The presence of face-washing materials was correlated with the availability of washing stations. Neither teachers mentioning face-washing in health curricula nor educational materials in classrooms were associated with clean faces or trachoma in the community. Having a washing station in the school was associated with lower community rates of trachoma. CONCLUSIONS Primary school health messages and materials on trachoma were not associated with clean faces or lower rates of trachoma in the community. The target audience for primary school health promotion is likely the students themselves, without immediate rippling effects in the community. A long-term perspective should be considered during the implementation of health promotion in schools. The goal of school health promotion should be training the next generation of parents and community health leaders in combatting trachoma.
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Prevalence of Active Trachoma and Associated Factors in Areka Town, South Ethiopia, 2018. Interdiscip Perspect Infect Dis 2020; 2020:8635191. [PMID: 33123195 PMCID: PMC7585665 DOI: 10.1155/2020/8635191] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 09/17/2020] [Accepted: 09/27/2020] [Indexed: 11/17/2022] Open
Abstract
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.
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Solomon AW, Hooper PJ, Bangert M, Mwingira UJ, Bakhtiari A, Brady MA, Fitzpatrick C, Jones I, Kabona G, Kello AB, Millar T, Mosher AW, Ngondi JM, Nshala A, Renneker K, Rotondo LA, Stelmach R, Harding-Esch EM, Malecela MN. The Importance of Failure: How Doing Impact Surveys That Fail Saves Trachoma Programs Money. Am J Trop Med Hyg 2020; 103:2481-2487. [PMID: 33025878 PMCID: PMC7695084 DOI: 10.4269/ajtmh.20-0686] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Trachoma programs use annual antibiotic mass drug administration (MDA) in evaluation units (EUs) that generally encompass 100,000–250,000 people. After one, three, or five MDA rounds, programs undertake impact surveys. Where impact survey prevalence of trachomatous inflammation—follicular (TF) in 1- to 9-year-olds is ≥ 5%, ≥ 1 additional MDA rounds are recommended before resurvey. Impact survey costs, and the proportion of impact surveys returning TF prevalence ≥ 5% (the failure rate or, less pejoratively, the MDA continuation rate), therefore influence the cost of eliminating trachoma. We modeled, for illustrative EU sizes, the financial cost of undertaking MDA with and without conducting impact surveys. As an example, we retrospectively assessed how conducting impact surveys affected costs in the United Republic of Tanzania for 2017–2018. For EUs containing 100,000 people, the median (interquartile range) cost of continuing MDA without doing impact surveys is USD 28,957 (17,581–36,197) per EU per year, whereas continuing MDA solely where indicated by impact survey results costs USD 17,564 (12,158–21,694). If the mean EU population is 100,000, then continuing MDA without impact surveys becomes advantageous in financial cost terms only when the continuation rate exceeds 71%. For the United Republic of Tanzania in 2017–2018, doing impact surveys saved enough money to provide MDA for > 1,000,000 people. Although trachoma impact surveys have a nontrivial cost, they generally save money, providing EUs have > 50,000 inhabitants, the continuation rate is not excessive, and they generate reliable data. If all EUs pass their impact surveys, then we have waited too long to do them.
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Affiliation(s)
- Anthony W Solomon
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Pamela J Hooper
- Task Force for Global Health, International Trachoma Initiative, Atlanta, Georgia
| | - Mathieu Bangert
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Upendo J Mwingira
- Neglected Tropical Disease Control Program, Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, United Republic of Tanzania
| | - Ana Bakhtiari
- Task Force for Global Health, International Trachoma Initiative, Atlanta, Georgia
| | | | - Christopher Fitzpatrick
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Iain Jones
- Sightsavers, Haywards Heath, United Kingdom
| | - George Kabona
- Neglected Tropical Disease Control Program, Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, United Republic of Tanzania
| | - Amir B Kello
- Expanded Special Project for Elimination of Neglected Tropical Diseases, World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Tom Millar
- Sightsavers, Haywards Heath, United Kingdom
| | - Aryc W Mosher
- United States Agency for International Development, Washington, District of Columbia
| | | | - Andreas Nshala
- Department of International Maternal and Child Health, Faculty of Medicine and Pharmacy, University of Uppsala, Uppsala, Sweden.,IMA World Health, Dar es Salaam, United Republic of Tanzania
| | - Kristen Renneker
- Task Force for Global Health, International Trachoma Initiative, Atlanta, Georgia
| | | | | | - Emma M Harding-Esch
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Mwelecele N Malecela
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
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19
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Solomon AW, Kello AB, Bangert M, West SK, Taylor HR, Tekeraoi R, Foster A. The simplified trachoma grading system, amended. Bull World Health Organ 2020; 98:698-705. [PMID: 33177759 PMCID: PMC7652564 DOI: 10.2471/blt.19.248708] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 07/06/2020] [Accepted: 07/07/2020] [Indexed: 11/27/2022] Open
Abstract
A simplified grading system for trachoma was published by the World Health Organization (WHO) in 1987. Intended for use by non-specialist personnel working at community level, the system includes five signs, each of which can be present or absent in any eye: (i) trachomatous trichiasis; (ii) corneal opacity; (iii) trachomatous inflammation—follicular; (iv) trachomatous inflammation—intense; and (v) trachomatous scarring. Though neither perfectly sensitive nor perfectly specific for trachoma, these signs have been essential tools for identifying populations that need interventions to eliminate trachoma as a public health problem. In 2018, at WHO’s 4th global scientific meeting on trachoma, the definition of one of the signs, trachomatous trichiasis, was amended to exclude trichiasis that affects only the lower eyelid. This paper presents the amended system, updates its presentation, offers notes on its use and identifies areas of ongoing debate.
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Affiliation(s)
- Anthony W Solomon
- Department of Control of Neglected Tropical Diseases, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Amir B Kello
- World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Mathieu Bangert
- Department of Control of Neglected Tropical Diseases, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Sheila K West
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, United States of America
| | - Hugh R Taylor
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Rabebe Tekeraoi
- Eye Department, Ministry of Health and Medical Services, South Tarawa, Kiribati
| | - Allen Foster
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, England
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20
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Kuper H. Neglected tropical diseases and disability-what is the link? Trans R Soc Trop Med Hyg 2020; 113:839-844. [PMID: 30892653 PMCID: PMC6903791 DOI: 10.1093/trstmh/trz001] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 12/13/2018] [Accepted: 01/17/2019] [Indexed: 01/05/2023] Open
Abstract
Neglected tropical diseases (NTDs) are a diverse group of infectious conditions that vary in their epidemiology, impact and control. They are among the most common conditions globally, affecting approximately one billion people. Many NTDs have long-term consequences, such as visual and physical impairments. As a result, people with NTDs may have difficulties in carrying out activities or participating in society—in other words, NTDs can cause disabilities. Additionally, NTDs are often strongly linked to stigma and can have mental health consequences. It is therefore important to incorporate rehabilitation within NTD programmes. Rehabilitation can be conceptualized narrowly in terms of the provision of clinical services (e.g. physiotherapy and assistive devices) or, more broadly, including efforts to improve employment, overcome stigma and enhance social participation of people with disabilities. Approximately 15% of the global population has a disability, and this large group must be considered when designing NTD programmes. Improving the inclusion of people with disabilities may require adaptations to NTD programmes, such as making them physically accessible or training staff about disability awareness. Without incorporating disability within NTD programmes, the quality of life of people with NTDs will suffer and global targets for elimination and management of NTDs will not be met.
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Affiliation(s)
- Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
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21
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Kassaw MW, Abebe AM, Tegegne KD, Getu MA, Bihonegn WT. Prevalence and associations of active trachoma among rural preschool children in Wadla district, northern Ethiopia. BMC Ophthalmol 2020; 20:346. [PMID: 32842993 PMCID: PMC7449018 DOI: 10.1186/s12886-020-01585-9] [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: 07/22/2019] [Accepted: 07/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Trachoma is a neglected eye disease and an important cause of preventable corneal blindness. In endemic areas, initial infection can occur in early childhood and following a recurrent episodes, it progresses to scarring and visual impairment. Trachoma disappeared from high income countries through enhancements of hygiene and sanitation but the disease is still a challenge in developing countries. In Ethiopia, data indicate that Amhara is the region with the highest prevalence of active trachoma. The aim of this study was to assess the prevalence and associations of active trachoma among rural preschool children in Wadla district, Amhara region, Ethiopia. METHODS In this study, 596 children were screened for signs of active trachoma by using cluster-sampling technique. Following pre-testing of the survey instrument in a different district, questions about socio-demographic status were delivered for heads of households. Integrated eye care workers, previously trained to undertake trachoma screening for one month, performed eye examination. The logistic regression model was used to look for associations of active trachoma. RESULTS The prevalence of active trachoma among rural preschool children in Wadla district was 22%. Low economic status (adjusted odds ratio [AOR]3.8 (95%CI 1.3-11.4), being 37-48 months old (4.2;1.5-12.0), living in a house with thatched roof (4.4;1.4-13.6), presence of flies in a home (4.6;2.1-9.9), once-weekly face-washing frequency (8.6;2.5-29.3), having a face that had not been washed for longer than a week (10.6;2.9-37.7), and not using soap (4.5;1.8-11.3) had association to active trachoma. CONCLUSION The prevalence of active trachoma among rural pre-school children in Wadla district was high. This indicates that Trachoma is still a public health problem in the district. This high prevalence calls for further interventions to prevent future trachomatis blindness.
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Affiliation(s)
| | - Ayele Mamo Abebe
- Department of nursing, Debre Berhan University, Debre Berhan, Ethiopia
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22
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Basha GW, Woya AA, Tekile AK. Prevalence and risk factors of active trachoma among primary school children of Amhara Region, Northwest Ethiopia. Indian J Ophthalmol 2020; 68:750-754. [PMID: 32317440 PMCID: PMC7350479 DOI: 10.4103/ijo.ijo_143_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Purpose: Trachoma is the leading infectious cause of blindness in the world. It is caused by conjunctival infection with the bacterium Chlamydia trachomatis. The objective of this study was to determine the prevalence and risk factors of active trachoma among primary school children in Amhara region, Ethiopia. Methods: A cross-sectional study was conducted from April to May 2018. Data on sociodemographic and health characteristics of a child were collected using a structured questionnaire and eye examination for this study. Bivariate and multiple logistic regression statistical analyses were used to determine the prevalence and risk factors of active trachoma among primary school children living in Amhara region, Northwest Ethiopia. Results: The prevalence of active trachoma among primary school children living in Amhara region was 10.3% in this study. The results of multiple logistic regression analysis revealed that children who wash their face at least two times per day (AOR = 0.37, 95% CI: 0.14–0.97), children with no flies on their face (AOR = 0.12, 95% CI: 0.10–0.30) had significantly lower risk of being infected by trachoma and children of households who spend 30 min to 1 h to fetch water (AOR = 10.02, 95% CI: 1.10–93.53) had significantly higher risk of being infected by trachoma in the study area. Conclusion: The result of this study showed that risk factors: frequency of face washing per day, presence of flies on child's face during interview, and time required to fetch water for the household were found to be significantly associated with trachoma. Therefore, the study recommends that any concerned bodies directed at prevention and control of trachoma among primary school children living in Amhara region should give special attention to these factors. Implementing the World Health Organization (WHO) endorsed SAFE (Surgery, Antibiotics, Facial cleanliness, Environmental improvement) strategy was recommended for the effective prevention and control of trachoma in the study area since the prevalence of active trachoma, 10.3% was higher than the WHO recommended thresholds (>10% prevalence).
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Affiliation(s)
- Garoma W Basha
- Department of Statistics, Bahir Dar University, Bahir Dar, Amhara, Ethiopia
| | - Ashenafi A Woya
- Department of Statistics, Bahir Dar University, Bahir Dar, Amhara, Ethiopia
| | - Abay K Tekile
- Department of Statistics, Bahir Dar University, Bahir Dar, Amhara, Ethiopia
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23
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Arunga S, Wiafe G, Habtamu E, Onyango J, Gichuhi S, Leck A, Macleod D, Hu V, Burton M. The impact of microbial keratitis on quality of life in Uganda. BMJ Open Ophthalmol 2019; 4:e000351. [PMID: 31909191 PMCID: PMC6936408 DOI: 10.1136/bmjophth-2019-000351] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 09/04/2019] [Accepted: 12/01/2019] [Indexed: 11/16/2022] Open
Abstract
Background Microbial keratitis (MK) is a frequent cause of sight loss in sub-Saharan Africa. However, no studies have formally measured its impact on quality of life (QoL) in this context. Methods As part of a nested case–control design for risk factors of MK, we recruited patients presenting with MK at two eye units in Southern Uganda between December 2016 and March 2018 and unaffected individuals, individually matched for sex, age and location. QoL was measured using WHO Health-Related and Vision-Related QoL tools (at presentation and 3 months after start of treatment in cases). Mean QoL scores for both groups were compared. Factors associated with QoL among the cases were analysed in a linear regression model. Results 215 case-controls pairs were enrolled. The presentation QoL scores for the cases ranged from 20 to 65 points. The lowest QoL was visual symptom domain; mean 20.7 (95% CI 18.8 to 22.7) and the highest was psychosocial domain; mean 65.6 (95% CI 62.5 to 68.8). At 3 months, QoL scores for the patients ranged from 80 to 90 points while scores for the controls ranged from 90 to 100. The mean QoL scores of the cases were lower than controls across all domains. Determinants of QoL among the cases at 3 months included visual acuity at 3 months and history of eye loss. Conclusion MK severely reduces QoL in the acute phase. With treatment and healing, QoL subsequently improves. Despite this improvement, QoL of someone affected by MK (even with normal vision) remains lower than unaffected controls.
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Affiliation(s)
- Simon Arunga
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK, UK.,Department of Ophthalmology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Geoffrey Wiafe
- Department of Ophthalmology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Esmael Habtamu
- London School of Hygiene and Tropical Medicine International Centre for Eye Health, London, UK.,Carter Center, Addis Ababa, Ethiopia
| | - John Onyango
- Department of Ophthalmology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Stephen Gichuhi
- Department of Ophthalmology, University of Nairobi, Nairobi, Kenya.,Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | | | - David Macleod
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - Victor Hu
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Matthew Burton
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
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24
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Gebrie A, Alebel A, Zegeye A, Tesfaye B, Wagnew F. Prevalence and associated factors of active trachoma among children in Ethiopia: a systematic review and meta-analysis. BMC Infect Dis 2019; 19:1073. [PMID: 31864307 PMCID: PMC6925509 DOI: 10.1186/s12879-019-4686-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 12/08/2019] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Alemu Gebrie
- Department of Biomedical Science, School of Medicine, Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia.
| | - Animut Alebel
- Department of Nursing, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Abriham Zegeye
- Department of Biomedical Science, School of Medicine, Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia
| | - Bekele Tesfaye
- Department of Nursing, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Fasil Wagnew
- Department of Nursing, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
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25
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Arunga S, Kintoki GM, Gichuhi S, Onyango J, Ayebazibwe B, Newton R, Leck A, Macleod D, Hu VH, Burton MJ. Risk Factors of Microbial Keratitis in Uganda: A Case Control Study. Ophthalmic Epidemiol 2019; 27:98-104. [PMID: 31640454 PMCID: PMC7446035 DOI: 10.1080/09286586.2019.1682619] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose: Microbial keratitis (MK), is a frequent cause of sight loss worldwide, particularly in low and middle-income countries. This study aimed to investigate the risk factors of MK in Uganda.Methods: Using a nested case control, we recruited healthy community controls for patients presenting with MK at the two main eye units in Southern Uganda between December 2016 and March 2018. Controls were individually matched for age, gender and village of the cases on a 1:1 ratio. We collected information on demographics, occupation, HIV and Diabetes Mellitus status. In STATA version 14.1, multivariable conditional logistic regression was used to generate odds ratios for risk factors of MK and a likelihood ratio test used to assess statistical significance of associations.Results: Two hundred and fifteen case-control pairs were enrolled. The HIV positive patients among the cases was 9% versus 1% among the controls, p = .0003. Diabetes 7% among the cases versus 1.4% among the controls, p = .012. Eye trauma was 29% versus 0% among the cases and controls. In the multivariable model adjusted for age, sex and village, HIV (OR 83.5, 95%CI 2.01-3456, p = .020), Diabetes (OR 9.38, 95% CI 1.48-59.3, p = .017) and a farming occupation (OR 2.60, 95%CI 1.21-5.57, p = .014) were associated with MK. Compared to a low socio-economic status, a middle status was less likely to be associated with MK (OR 0.29, 95%CI 0.09-0.89, p < .0001).Conclusion: MK was associated with HIV, Diabetes, being poor and farming as the main occupation. More studies are needed to explore how these factors predispose to MK.
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Affiliation(s)
- Simon Arunga
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK.,Department of Ophthalmology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Guyguy M Kintoki
- Department of Ophthalmology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Stephen Gichuhi
- Department of Ophthalmology, University of Nairobi, Nairobi, Kenya
| | - John Onyango
- Department of Ophthalmology, Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Rob Newton
- Department of Epidemiology, Uganda Virus Research Institute, Entebbe, Uganda
| | - Astrid Leck
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - David Macleod
- Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, UK
| | - Victor H Hu
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Matthew J Burton
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
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26
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Macleod CK, Binnawi KH, Elshafie BE, Sadig HE, Hassan A, Cocks N, Willis R, Chu B, Solomon AW. Unimproved water sources and open defecation are associated with active trachoma in children in internally displaced persons camps in the Darfur States of Sudan. Trans R Soc Trop Med Hyg 2019; 113:599-609. [PMID: 31612959 PMCID: PMC6792159 DOI: 10.1093/trstmh/trz042] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 04/01/2019] [Accepted: 05/30/2019] [Indexed: 11/13/2022] Open
Abstract
Purpose To estimate the proportion of children with trachomatous inflammation—follicular (TF) and adults with trachomatous trichiasis (TT) in internally displaced persons (IDP) camps in the Darfur States of Sudan and to evaluate associated risk factors. Methods IDP camps were identified from government census data. We conducted a subanalysis of data collected in these camps during 2014–2015 as part of surveys covering 37 districts of the Darfur States within the Global Trachoma Mapping Project. A random-effects hierarchical model was used to evaluate factors associated with TF in children or TT in adults. Results Thirty-six IDP camps were represented in the survey data, in which 1926 children aged 1–9 y were examined, of whom 38 (8%) had TF. Poor sanitation, younger age and living in a household that purchased water from a vendor were associated with TF in children aged 1–9 y. Of 2139 individuals examined aged ≥15 y, 16 (0.7%) had TT. TT was strongly independently associated with being older and living alone. Conclusion Trachoma is found at low levels in these camps, but still at levels where intervention is needed. Disease elimination in conflict-related settings presents a unique challenge for the trachoma community, and may require an innovative approach. Understanding how best to undertake trachoma elimination interventions in these areas should be prioritized.
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Affiliation(s)
- Colin K Macleod
- Clinical Research Department, London School of Hygiene & Tropical Medicine, Keppel Street, London, UK
| | - Kamal Hashim Binnawi
- National Program for Prevention of Blindness, Federal Ministry of Health, PO Box 303 Khartoum, Sudan.,Department of Ophthalmology, Al Neelain University, Khartoum, Sudan
| | - Balgesa Elkheir Elshafie
- National Program for Prevention of Blindness, Federal Ministry of Health, PO Box 303 Khartoum, Sudan
| | - Husam Eldin Sadig
- Faculty of Mathematical Sciences and Statistics, Al-Neelain University, Sudan
| | | | - Naomi Cocks
- Clinical Research Department, London School of Hygiene & Tropical Medicine, Keppel Street, London, UK
| | - Rebecca Willis
- Task Force for Global Health, 330 W Ponce de Leon Ave, Decatur, GA, USA
| | - Brian Chu
- Task Force for Global Health, 330 W Ponce de Leon Ave, Decatur, GA, USA
| | - Anthony W Solomon
- Clinical Research Department, London School of Hygiene & Tropical Medicine, Keppel Street, London, UK.,Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
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27
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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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Arunga S, Kintoki GM, Gichuhi S, Onyango J, Newton R, Leck A, Macleod D, Hu VH, Burton MJ. Delay Along the Care Seeking Journey of Patients with Microbial Keratitis in Uganda. Ophthalmic Epidemiol 2019; 26:311-320. [PMID: 31088316 PMCID: PMC7446038 DOI: 10.1080/09286586.2019.1616775] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Purpose To describe the care seeking journey and causes of delay among patients with Microbial Keratitis in Uganda. Methods A prospective cohort of patients presenting with microbial keratitis at the two main eye units in Southern Uganda (2016–2018). We collected information on demographics, home address, clinical history, and presentation pathway including, order of facilities where patients went to seek care, treatment advice, cost of care, and use of Traditional Eye Medicine. Presentation time was noted. We compared “direct” presenters versus “indirect” presenters and analysed predictors of delay. Results About 313 patients were enrolled. All were self-referred. Only 19% of the patients presented directly to the eye hospital. Majority (52%) visited one facility before presenting, 19% visited two facilities, 9% visited three facilities, and 2% visited four facilities. The cost of care increased with increase in the number of facilities visited. People in a large household, further distance from the eye hospital and those who used Traditional Eye Medicine were less likely to come directly to the eye hospital. Visiting another facility prior to the eye hospital and use of Traditional Eye Medicine aOR 1.58 (95%CI 1.03–2.43), p = .038 were associated with delayed presentation to the eye hospital. Conclusion This study provided information on patient journeys to seek care. Delay was largely attributable to having visited another health facility: a referral mechanism for microbial keratitis was non-existent. There is need to explore how these health system gaps can be strengthened.
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Affiliation(s)
- Simon Arunga
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine , London , UK.,Department of Ophthalmology, Mbarara University of Science and Technology , Mbarara , Uganda
| | - Guyguy M Kintoki
- Department of Ophthalmology, Mbarara University of Science and Technology , Mbarara , Uganda
| | - Stephen Gichuhi
- Department of Ophthalmology, University of Nairobi , Nairobi , Kenya
| | - John Onyango
- Department of Ophthalmology, Mbarara University of Science and Technology , Mbarara , Uganda
| | - Rob Newton
- Department of Ophthalmology, Uganda Virus Research Institute , Entebbe , Uganda
| | - Astrid Leck
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine , London , UK
| | - David Macleod
- Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine , London , UK
| | - Victor H Hu
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine , London , UK
| | - Matthew J Burton
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine , London , UK
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Flueckiger RM, Giorgi E, Cano J, Abdala M, Amiel ON, Baayenda G, Bakhtiari A, Batcho W, Bennawi KH, Dejene M, Elshafie BE, Elvis AA, François M, Goepogui A, Kalua K, Kebede B, Kiflu G, Masika MP, Massangaie M, Mpyet C, Ndjemba J, Ngondi JM, Olobio N, Turyaguma P, Willis R, Yeo S, Solomon AW, Pullan RL. Understanding the spatial distribution of trichiasis and its association with trachomatous inflammation-follicular. BMC Infect Dis 2019; 19:364. [PMID: 31039737 PMCID: PMC6492377 DOI: 10.1186/s12879-019-3935-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 03/24/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Whilst previous work has identified clustering of the active trachoma sign "trachomatous inflammation-follicular" (TF), there is limited understanding of the spatial structure of trachomatous trichiasis (TT), the rarer, end-stage, blinding form of disease. Here we use community-level TF prevalence, information on access to water and sanitation, and large-scale environmental and socio-economic indicators to model the spatial variation in community-level TT prevalence in Benin, Cote d'Ivoire, DRC, Guinea, Ethiopia, Malawi, Mozambique, Nigeria, Sudan and Uganda. METHODS We fit binomial mixed models, with community-level random effects, separately for each country. In countries where spatial correlation was detected through a semi-variogram diagnostic check we then fitted a geostatistical model to the TT prevalence data including TF prevalence as an explanatory variable. RESULTS The estimated regression relationship between community-level TF and TT was significant in eight countries. We estimate that a 10% increase in community-level TF prevalence leads to an increase in the odds for TT ranging from 20 to 86% when accounting for additional covariates. CONCLUSION We find evidence of an association between TF and TT in some parts of Africa. However, our results also suggest the presence of additional, country-specific, spatial risk factors which modulate the variation in TT risk.
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Affiliation(s)
| | - Emanuele Giorgi
- Lancaster Medical School, Lancaster University, Lancaster, Lancashire, UK
| | - Jorge Cano
- London School of Hygiene and Tropical Medicine, London, UK
| | - Mariamo Abdala
- Ophthalmology Department, Ministry of Health, Maputo, Mozambique
| | | | | | | | - Wilfrid Batcho
- Programme National de Lutte contre les Maladies Transmissibles, Ministère de la Santé, Cotonou, Benin
| | | | - Michael Dejene
- Michael Dejene Public Health Consultancy Services, Addis Ababa, Ethiopia
| | | | - Aba Ange Elvis
- Programme National de la Santé Oculaire et de la lutte contre l'Onchocercose, Abidjan, Côte d'Ivoire
| | - Missamou François
- Direction de Lutte contre la Maladie, Kinshasa, Ministere de la Santé Publique, Kinshasa, Democratic Republic of Congo
| | - André Goepogui
- Programmes National de Lutte contre l'Onchocercoses et les autres Maladies Tropicales Négligées, Ministère de la Sante, Conakry, Guinea
| | - Khumbo Kalua
- Blantyre Institute for Community Outreach, Blantyre, Malawi
| | | | - Genet Kiflu
- Federal Ministry of Health, Addis Ababa, Ethiopia
| | | | | | - Caleb Mpyet
- Sightsavers Nigeria, Kaduna, Nigeria.,Department of Ophthalmology, Jos University, Jos, Nigeria
| | - Jean Ndjemba
- Direction de Lutte contre la Maladie, Kinshasa, Ministere de la Santé Publique, Kinshasa, Democratic Republic of Congo
| | | | - Nicholas Olobio
- Nigeria Trachoma Elimination Program, Federal Ministry of Health, Abuja, Nigeria
| | | | | | - Souleymane Yeo
- Programme National de la Santé Oculaire et de la lutte contre l'Onchocercose, Abidjan, Côte d'Ivoire
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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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Ketema K, Tsegay G, Gedle D, Davey G, Deribe K. Food Insecurity among Households with and without Podoconiosis in East and West Gojjam, Ethiopia. EC NUTRITION 2018; 13:414-423. [PMID: 30101228 PMCID: PMC6086333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Household food insecurity remained one of the most crucial challenges to economic development and has been aggravated by household health conditions. Nearly one billion people are undernourished of which 98% in developing countries like Ethiopia. OBJECTIVE To assess households' food insecurity among podoconiosis patients and non-podoconiosis in East and West Gojjam Zone, Ethiopia, 2016. METHOD A community based comparative cross sectional study was conducted in East and West Gojjam, 2016. Multi-stage sampling technique was employed to select 208 podoconiosis and 400 non-podoconiosis household heads. Data was collected by using structured and pretested questionnaires. The collected data was cleaned, coded and entered into Epi data then exported to SPSS version 22. Descriptive and inferential statistics was performed. Both bivariate and multivariate logistic regression analyses was employed. The association was measured by adjusted odds ratio (AOR), 95%CI (confidence interval) and P < 0.05 was considered statistically significant. RESULT A total of 608 study participants were involved in this study. Food insecurity podoconiosis patients and non-podoconiosis household was 83.7%, 53% respectively (p = 0.0001). Podoconiosis and non- podoconiosis whose heads could not read and write AOR = 5.84, (95% CI: 2.14, 15.95) and AOR = 1.70, (95% CI: 1.06, 2.72) were food insecure respectively. Podoconiosis patients without off farm activities AOR = 4.90, (95% CI: 1.60, 14.95), not using fertilizer AOR = 4.38, (95% CI: 1.15, 16.67) and living at > 5 kilo meter distance from market AOR = 4.47, (95% CI: 1.38, 14.48) were food insecure. Non-podoconiosis heads with no perennial plant AOR = 2.11, (95% CI: 1.17, 3.34), not using improved seeds AOR = 2.20, (95% CI: 1.25, 3.87), no access to asset building program AOR = 2.07, (95% CI: 1.27, 3.34), living in medium and low altitude AOR = 8.87, (95% CI: 1.81, 43.40) and AOR = 10.04, (95% CI: 1.90, 52.93) were food insecure. CONCLUSION Food insecurity was higher among podoconiosis than non-podoconiosis households. Being a female, unable to read and write absence of off farm activities, not using of fertilizers and living in more distance from market were significantly associated with food insecurity among podoconiosis patients. Special emphasis should be given for improvement of food security of podoconiosis and non-podoconiosis households.
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Affiliation(s)
- Kassahun Ketema
- Department of Human Nutrition, Debra Markos University, College of Medicine and Health Sciences, Addis Ababa, Ethiopia
| | - Girmay Tsegay
- Department of Public Health, Debre Markos University, College of Medicine and Health Sciences, Debre Markos, Ethiopia
| | - Dereje Gedle
- Department of Public Health, Debre Markos University, College of Medicine and Health Sciences, Debre Markos, Ethiopia
| | - Gail Davey
- Brighton and Sussex Medical School, United Kingdom
| | - Kebede Deribe
- Medical School Teaching Building, BSMS, University of Sussex, Brighton, United Kingdom
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Livelihood opportunities amongst adults with and without disabilities in Cameroon and India: A case control study. PLoS One 2018; 13:e0194105. [PMID: 29630606 PMCID: PMC5890974 DOI: 10.1371/journal.pone.0194105] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 02/23/2018] [Indexed: 11/19/2022] Open
Abstract
Proven links between disability and poverty suggest that development programmes and policies that are not disability-inclusive will leave persons with disabilities behind. Despite this, there is limited quantitative evidence on livelihood opportunities amongst adults with disabilities in Low and Middle Income Countries. This study adds to the limited evidence base, contributing data from one African and one Asian Setting. We undertook a population-based case–control study of adults (18+) with and without disabilities in North-West Cameroon and in Telangana State, India. We found that adults with disabilities were five times less likely to be working compared to age-sex matched controls in both settings. Amongst adults with disabilities, current age, marital status and disability type were key predictors of working. Inclusive programmes are therefore needed to provide adequate opportunities to participate in livelihood prospects for adults with disabilities in Cameroon and India, on an equal basis as others. These findings are of crucial importance at this stage of the Sustainable Development Agenda, to ensure that the mandate of inclusive development is achieved.
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Garn JV, Boisson S, Willis R, Bakhtiari A, al-Khatib T, Amer K, Batcho W, Courtright P, Dejene M, Goepogui A, Kalua K, Kebede B, Macleod CK, Madeleine KIIM, Mbofana MSA, Mpyet C, Ndjemba J, Olobio N, Pavluck AL, Sokana O, Southisombath K, Taleo F, Solomon AW, Freeman MC. Sanitation and water supply coverage thresholds associated with active trachoma: Modeling cross-sectional data from 13 countries. PLoS Negl Trop Dis 2018; 12:e0006110. [PMID: 29357365 PMCID: PMC5800679 DOI: 10.1371/journal.pntd.0006110] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 02/06/2018] [Accepted: 11/13/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Facial cleanliness and sanitation are postulated to reduce trachoma transmission, but there are no previous data on community-level herd protection thresholds. We characterize associations between active trachoma, access to improved sanitation facilities, and access to improved water sources for the purpose of face washing, with the aim of estimating community-level or herd protection thresholds. METHODS AND FINDINGS We used cluster-sampled Global Trachoma Mapping Project data on 884,850 children aged 1-9 years from 354,990 households in 13 countries. We employed multivariable mixed-effects modified Poisson regression models to assess the relationships between water and sanitation coverage and trachomatous inflammation-follicular (TF). We observed lower TF prevalence among those with household-level access to improved sanitation (prevalence ratio, PR = 0.87; 95%CI: 0.83-0.91), and household-level access to an improved washing water source in the residence/yard (PR = 0.81; 95%CI: 0.75-0.88). Controlling for household-level water and latrine access, we found evidence of community-level protection against TF for children living in communities with high sanitation coverage (PR80-90% = 0.87; 95%CI: 0.73-1.02; PR90-100% = 0.76; 95%CI: 0.67-0.85). Community sanitation coverage levels greater than 80% were associated with herd protection against TF (PR = 0.77; 95%CI: 0.62-0.97)-that is, lower TF in individuals whose households lacked individual sanitation but who lived in communities with high sanitation coverage. For community-level water coverage, there was no apparent threshold, although we observed lower TF among several of the higher deciles of community-level water coverage. CONCLUSIONS Our study provides insights into the community water and sanitation coverage levels that might be required to best control trachoma. Our results suggest access to adequate water and sanitation can be important components in working towards the 2020 target of eliminating trachoma as a public health problem.
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Affiliation(s)
- Joshua V. Garn
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
| | - Sophie Boisson
- Department of Public Health, Environmental and Social Determinants of Health, World Health Organization, Geneva, Switzerland
| | - Rebecca Willis
- International Trachoma Initiative, The Task Force for Global Health, Decatur, GA, United States of America
| | - Ana Bakhtiari
- International Trachoma Initiative, The Task Force for Global Health, Decatur, GA, United States of America
| | | | - Khaled Amer
- Department of Ophthalmology, Ministry of Health, Cairo, Egypt
| | - Wilfrid Batcho
- Programme National de Lutte contre les Maladies Transmissibles, Ministère de la Santé, Cotonou, Bénin
| | - Paul Courtright
- Division of Ophthalmology, Kilimanjaro Centre for Community Ophthalmology International, University of Cape Town, Cape Town, South Africa
| | - Michael Dejene
- Michael Dejene Public Health Consultancy Services, Addis Ababa, Ethiopia
| | - Andre Goepogui
- Ministère de la Santé, Programme Oncho-Cécité-MTN, Conakry, République de Guinée
| | - Khumbo Kalua
- Department of Ophthalmology, Blantyre Institute for Community Ophthalmology, College of Medicine, Blantyre, Malawi, Malawi
| | - Biruck Kebede
- Disease Prevention and Control Directorate, Federal Ministry of Health, Addis Ababa, Ethiopia
| | | | | | | | - Caleb Mpyet
- Division of Ophthalmology, Kilimanjaro Centre for Community Ophthalmology International, University of Cape Town, Cape Town, South Africa
- Department of Ophthalmology, University of Jos, Jos, Nigeria
- Sightsavers, Kaduna, Nigeria
| | - Jean Ndjemba
- Direction de Lutte contre la Maladie, Kinshasa, Ministere de la Santé Publique, Republique Democratique du Congo
| | - Nicholas Olobio
- Department of Public Health, Federal Ministry of Health, Abuja, Nigeria
| | - Alexandre L. Pavluck
- International Trachoma Initiative, The Task Force for Global Health, Decatur, GA, United States of America
| | - Oliver Sokana
- Eye Department, Ministry of Health and Medical Services, Honiara, Solomon Islands
| | - Khamphoua Southisombath
- National Ophthalmology Center, Ministry of Health, Vientiane, Lao People’s Democratic Republic
| | | | - Anthony W. Solomon
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Matthew C. Freeman
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
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Habtamu E, Wondie T, Aweke S, Tadesse Z, Zerihun M, Melak B, Gashaw B, Callahan K, Emerson PM, Bailey RL, Mabey DC, Rajak SN, Kuper H, Polack S, Macleod D, Weiss HA, Burton MJ. Impact of trichiasis surgery on daily living: A longitudinal study in Ethiopia. Wellcome Open Res 2017. [DOI: 10.12688/wellcomeopenres.11891.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Trachomatous trichiasis (TT) may lead to disability, impeding productive activities, resulting in loss of income. This study was conducted to determine if trichiasis surgery improves participation in productive and leisure activities, and ability to perform activities without difficulty or assistance. Methods: We recruited 1000 adults with trichiasis (cases) and 200 comparison participants, matched to every fifth trichiasis case on age (+/- two years), sex and location. The ‘Stylised Activity List’ tool, developed for the World Bank Living Standard Measurement Survey, was adapted to collect data on activity in the last week (participation in activity, difficulty with activity, requirement of assistance for activity), at baseline and 12 months later. All trichiasis cases received trichiasis surgery at baseline. Random effect logistic regression was used to compare cases and comparison participants. Results: There was strong evidence that trichiasis surgery substantially improves the ability of trichiasis cases to perform all the productive and leisure activities investigated without difficulty, with large increases in processing agricultural products, 21.1% to 87.0% (p<0.0001), farming, 19.1% to 82.4% (p<0.0001), and fetching wood, 25.3% to 86.0% (p<0.0001). Similarly, there was a significant increase in the proportion of cases who could perform activities without assistance, with the largest increases in animal rearing 54.2% to 92.0% (p<0.0001) and farming 73.2% to 96.4% (p<0.0001). There was no change in the proportion of comparison participants performing activities without difficulty or assistance. The change in most of the activities in cases was independent of visual acuity improvement and recurrent TT at 12 months. One year after trichiasis surgery, the proportion of cases reporting ocular pain reduced from 98.9% to 33.7% (p<0.0001). Conclusions: Eyelid surgery for TT improves functional capabilities regardless of vision gains. These data lend strong support to the view that TT surgery improves function and contributes to improved household income and wealth.
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Habtamu E, Wondie T, Aweke S, Tadesse Z, Zerihun M, Melak B, Gashaw B, Callahan K, Emerson PM, Bailey RL, Mabey DCW, Rajak SN, Kuper H, Polack S, Macleod D, Weiss HA, Burton MJ. Impact of trichiasis surgery on daily living: A longitudinal study in Ethiopia. Wellcome Open Res 2017; 2:69. [PMID: 29181451 PMCID: PMC5686479 DOI: 10.12688/wellcomeopenres.11891.2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2017] [Indexed: 11/20/2022] Open
Abstract
Background: Trachomatous trichiasis (TT) may lead to disability, impeding productive activities, resulting in loss of income. This study was conducted to determine if trichiasis surgery improves participation in productive and leisure activities, and ability to perform activities without difficulty or assistance. Methods: We recruited 1000 adults with trichiasis (cases) and 200 comparison participants, matched to every fifth trichiasis case on age (+/- two years), sex and location. The 'Stylised Activity List' tool, developed for the World Bank Living Standard Measurement Survey, was adapted to collect data on activity in the last week (participation in activity, difficulty with activity, requirement of assistance for activity), at baseline and 12 months later. All trichiasis cases received trichiasis surgery at baseline. Random effect logistic regression was used to compare cases and comparison participants. Results: There was strong evidence that trichiasis surgery substantially improves the ability of trichiasis cases to perform all the productive and leisure activities investigated without difficulty, with large increases in processing agricultural products, 21.1% to 87.0% (p<0.0001), farming, 19.1% to 82.4% (p<0.0001), and fetching wood, 25.3% to 86.0% (p<0.0001). Similarly, there was a significant increase in the proportion of cases who could perform activities without assistance, with the largest increases in animal rearing 54.2% to 92.0% (p<0.0001) and farming 73.2% to 96.4% (p<0.0001). There was no change in the proportion of comparison participants performing activities without difficulty or assistance. The change in most of the activities in cases was independent of visual acuity improvement and recurrent TT at 12 months. One year after trichiasis surgery, the proportion of cases reporting ocular pain reduced from 98.9% to 33.7% (p<0.0001). Conclusions: Eyelid surgery for TT improves functional capabilities regardless of vision gains. These data lend strong support to the view that TT surgery improves function and contributes to improved household income and wealth.
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Affiliation(s)
- Esmael Habtamu
- The Carter Center, Addis Ababa, Ethiopia.,International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | | | | | | | | | | | | | | | - Paul M Emerson
- International Trachoma Initiative, Atlanta, GA, 30030, USA
| | - Robin L Bailey
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - David C W Mabey
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Saul N Rajak
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Sarah Polack
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - David Macleod
- MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Helen A Weiss
- MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Matthew J Burton
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
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Bangert M, Molyneux DH, Lindsay SW, Fitzpatrick C, Engels D. The cross-cutting contribution of the end of neglected tropical diseases to the sustainable development goals. Infect Dis Poverty 2017; 6:73. [PMID: 28372566 PMCID: PMC5379574 DOI: 10.1186/s40249-017-0288-0] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Accepted: 03/16/2017] [Indexed: 01/14/2023] Open
Abstract
The Sustainable Development Goals (SDGs) call for an integrated response, the kind that has defined Neglected Tropical Diseases (NTDs) efforts in the past decade.NTD interventions have the greatest relevance for SDG3, the health goal, where the focus on equity, and its commitment to reaching people in need of health services, wherever they may live and whatever their circumstances, is fundamentally aligned with the target of Universal Health Coverage. NTD interventions, however, also affect and are affected by many of the other development areas covered under the 2030 Agenda. Strategies such as mass drug administration or the programmatic integration of NTD and WASH activities (SDG6) are driven by effective global partnerships (SDG17). Intervention against the NTDs can also have an impact on poverty (SDG1) and hunger (SDG2), can improve education (SDG4), work and economic growth (SDG8), thereby reducing inequalities (SDG10). The community-led distribution of donated medicines to more than 1 billion people reinforces women's empowerment (SDG5), logistics infrastructure (SDG9) and non-discrimination against disability (SDG16). Interventions to curb mosquito-borne NTDs contribute to the goals of urban sustainability (SDG11) and resilience to climate change (SDG13), while the safe use of insecticides supports the goal of sustainable ecosystems (SDG15). Although indirectly, interventions to control water- and animal-related NTDs can facilitate the goals of small-scale fishing (SDG14) and sustainable hydroelectricity and biofuels (SDG7).NTDs proliferate in less developed areas in countries across the income spectrum, areas where large numbers of people have little or no access to adequate health care, clean water, sanitation, housing, education, transport and information. This scoping review assesses how in this context, ending the epidemic of the NTDs can impact and improve our prospects of attaining the SDGs.
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Affiliation(s)
- Mathieu Bangert
- Department of Control of Neglected Tropical Diseases, World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland
| | - David H. Molyneux
- Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Christopher Fitzpatrick
- Department of Control of Neglected Tropical Diseases, World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland
| | - Dirk Engels
- Department of Control of Neglected Tropical Diseases, World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland
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Burn H, Aweke S, Wondie T, Habtamu E, Deribe K, Rajak S, Bremner S, Davey G. Podoconiosis, trachomatous trichiasis and cataract in northern Ethiopia: A comparative cross sectional study. PLoS Negl Trop Dis 2017; 11:e0005388. [PMID: 28187129 PMCID: PMC5322969 DOI: 10.1371/journal.pntd.0005388] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 02/23/2017] [Accepted: 02/04/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Rural populations in low-income countries commonly suffer from the co-morbidity of neglected tropical diseases (NTDs). Podoconiosis, trachomatous trichiasis (both NTDs) and cataract are common causes of morbidity among subsistence farmers in the highlands of northern Ethiopia. We explored whether podoconiosis was associated with cataract or trachomatous trichiasis (TT) among this population. METHODS A comparative cross-sectional study was conducted in East Gojam region, Amhara, Ethiopia in May 2016. Data were collected from patients previously identified as having podoconiosis and from matched healthy neighbourhood controls. Information on socio-demographic factors, clinical factors and past medical history were collected by an interview-administered questionnaire. Clinical examination involved grading of podoconiosis by examination of both legs, measurement of visual acuity, direct ophthalmoscopy of dilated pupils to grade cataract, and eyelid and corneal examination to grade trachoma. Multiple logistic regression was conducted to estimate independent association and correlates of podoconiosis, TT and cataract. FINDINGS A total of 700 participants were included in this study; 350 podoconiosis patients and 350 healthy neighbourhood controls. The prevalence of TT was higher among podoconiosis patients than controls (65 (18.6%) vs 43 (12.3%)) with an adjusted odds ratio OR 1.57 (95% CI 1.02-2.40), p = 0.04. There was no significant difference in prevalence of cataract between the two populations with an adjusted OR 0.83 (95% CI 0.55-1.25), p = 0.36. Mean best visual acuity was 0.59 (SD 0.06) in podoconiosis cases compared to 0.44 (SD 0.04) in controls, p<0.001. The proportion of patients classified as blind was higher in podoconiosis cases compared with healthy controls; 5.6% vs 2.0%; adjusted OR 2.63 (1.08-6.39), P = 0.03. CONCLUSIONS Individuals with podoconiosis have a higher burden of TT and worse visual acuity than their matched healthy neighbourhood controls. Further research into the environmental and biological reasons for this co-morbidity is required. A shared approach to managing these two NTDs within the same population could be beneficial.
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Affiliation(s)
- Helen Burn
- Wellcome Trust Brighton and Sussex Centre for Global Health Research, Brighton and Sussex Medical School, Brighton, United Kingdom
| | | | | | - Esmael Habtamu
- The Carter Center, Addis Ababa, Ethiopia
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Kebede Deribe
- Wellcome Trust Brighton and Sussex Centre for Global Health Research, Brighton and Sussex Medical School, Brighton, United Kingdom
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Saul Rajak
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Sussex Eye Hospital, Brighton, Sussex, United Kingdom
| | - Stephen Bremner
- Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Gail Davey
- Wellcome Trust Brighton and Sussex Centre for Global Health Research, Brighton and Sussex Medical School, Brighton, United Kingdom
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Mohammadpour M, Abrishami M, Masoumi A, Hashemi H. Trachoma: Past, present and future. J Curr Ophthalmol 2016; 28:165-169. [PMID: 27830198 PMCID: PMC5093790 DOI: 10.1016/j.joco.2016.08.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 08/29/2016] [Accepted: 08/30/2016] [Indexed: 11/19/2022] Open
Abstract
Purpose To review the background, epidemiology and current management of trachoma in endemic areas and worldwide. Methods Review of literature. Results Trachoma is one of the leading causes of preventable blindness in developing countries. It was reported as one of the seven most neglected tropical diseases that can be prevented via drug administration. Its infliction is primarily aimed at those living in areas deprived of clean water and proper sanitation. It is estimated that trachoma is the cause of visual impairment in about 2.2 million people worldwide of which about 1.2 million are completely blind. With implementation of the SAFE (surgery, antibiotics, facial cleanliness, and environmental control) strategy with support from the International Trachoma Initiative (ITI) the incidence of trachoma has decreased significantly in the Middle East and North Africa region. Conclusion With the enhancement of socioeconomic and sanitary status of people, advent of new generations of antibiotics, training of expert ophthalmologists and eye care facilities the prevalence of trachoma is decreasing.
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Affiliation(s)
- Mehrdad Mohammadpour
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Corresponding author.
| | - Mojtaba Abrishami
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Masoumi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hassan Hashemi
- Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran
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Habtamu E, Wondie T, Aweke S, Tadesse Z, Zerihun M, Mohammed A, Zewudie Z, Callahan K, Emerson PM, Bailey RL, Mabey DCW, Rajak SN, Kuper H, Polack S, Weiss HA, Burton MJ. Impact of Trichiasis Surgery on Quality of Life: A Longitudinal Study in Ethiopia. PLoS Negl Trop Dis 2016; 10:e0004627. [PMID: 27078493 PMCID: PMC4831752 DOI: 10.1371/journal.pntd.0004627] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 03/23/2016] [Indexed: 12/30/2022] Open
Abstract
Background Trachomatous trichiasis significantly reduces vision and health related quality of life (QoL). Although trichiasis surgery is widely performed to treat trichiasis, there is little data on the effect of surgery on QoL. We measured the impact of trichiasis surgery on vision and health related QoL in a longitudinal study from Amhara Region, Ethiopia. Methodology/Principal Findings We recruited 1000 adult participants with trichiasis (cases) and 200 comparison participants, matched to every fifth trichiasis case on age (+/- two years), sex and location. Vision-related quality of life (VRQoL) and health-related quality of life (HRQoL) were measured using the WHO/PBD-VF20 and WHOQOL-BREF questionnaires respectively, at enrolment and 12 months after enrolment. All trichiasis cases received free standard trichiasis surgery immediately after enrolment. The mean difference in QoL scores between enrolment and follow-up for cases and comparison participants, and the difference-in-differences by baseline trichiasis status was analysed using random effects linear regression, the later adjusted for age, sex and socioeconomic status. At 12-months follow-up, data was collected from 980 (98%) and 198 (98%) trichiasis cases and comparison participants respectively. At this follow-up visit, VRQoL and HRQoL scores of trichiasis cases improved substantially in all subscales and domains by 19.1–42.0 points (p<0.0001) and 4.7–17.2 points (p<0.0001), respectively. In contrast, among the comparison participants, there was no evidence of improvement in VRQoL and HRQoL domain scores during follow-up. The improvement in VRQoL and HRQoL in cases was independent of the presence of visual acuity improvement at 12 months. Conclusions/Significance Trichiasis surgery substantially improves both VRQoL and HRQoL regardless of visual acuity change. Unprecedented effort is needed to scale-up trichiasis surgical programmes not only to prevent the risk of sight loss but also to improve overall wellbeing and health perception of affected individuals. We previously reported that Trachomatous Trichiasis (TT) has a profound impact on vision and heath related quality of life (QoL), even when vision is not impaired. The World Health Organization (WHO) recommends corrective eyelid surgery for trichiasis to reduce the risk of vision loss. However, trichiasis surgery may also improve overall wellbeing. There is very limited evidence on the long-term impact of trichiasis surgery on QoL. We measured vision and health-related quality of life of 1000 TT patients before and one year after receiving TT surgery and compared the QoL scores of these with the baseline and 1 year follow-up QoL score of 200 matched individuals who have never had trichiasis or trichiasis surgery. We found strong evidence that surgery substantially improves both vision and heath related QoL of TT case, even when there is no improvement in vision; while there was no evidence of improvement in the QoL of the trichiasis free participants. The results provide clear evidence that the benefit of trichiasis surgery goes beyond preventing the risk of blindness and improves the overall wellbeing and health perception of affected individuals, indicating the need to provide prompt surgical intervention for affected individuals.
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Affiliation(s)
- Esmael Habtamu
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
- The Carter Center, Addis Ababa, Ethiopia
- * E-mail:
| | | | | | | | | | | | | | - Kelly Callahan
- The Carter Center, Atlanta, Georgia, United States of America
| | - Paul M. Emerson
- International Trachoma Initiative, Atlanta, Georgia, United States of America
| | - Robin L. Bailey
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - David C. W. Mabey
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Saul N. Rajak
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Sarah Polack
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Helen A. Weiss
- MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Matthew J. Burton
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Hotez PJ. Neglected Tropical Diseases in the Anthropocene: The Cases of Zika, Ebola, and Other Infections. PLoS Negl Trop Dis 2016; 10:e0004648. [PMID: 27058728 PMCID: PMC4825952 DOI: 10.1371/journal.pntd.0004648] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Peter J. Hotez
- Departments of Pediatrics and Molecular Virology and Microbiology, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas, United States of America
- Sabin Vaccine Institute and Texas Children’s Hospital Center for Vaccine Development, Houston, Texas, United States of America
- James A. Baker III Institute for Public Policy, Rice University, Houston, Texas, United States of America
- Department of Biology, Baylor University, Waco, Texas, United States of America
- * E-mail:
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Lansingh VC. Trachoma. BMJ CLINICAL EVIDENCE 2016; 2016:0706. [PMID: 26860629 PMCID: PMC4748511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Active trachoma is caused by chronic infection of the conjunctiva by Chlamydia trachomatis, and is the world's leading infectious cause of blindness. Infection can lead to: scarring of the tarsal conjunctiva; inversion of the eyelashes (trichiasis), so that they abrade the cornea; and corneal opacity, resulting in blindness. Trachoma is a disease of poverty, overcrowding, and poor sanitation. Active disease affects mainly children, but adults are at increased risk of scarring. METHODS AND OUTCOMES We conducted a systematic overview, aiming to answer the following clinical question: What are the effects of interventions to prevent scarring trachoma by reducing the prevalence of active trachoma? We searched: Medline, Embase, The Cochrane Library and other important databases up to December 2014 (Clinical Evidence overviews are updated periodically; please check our website for the most up-to-date version of this overview). RESULTS At this update, searching of electronic databases retrieved 170 studies. After deduplication and removal of conference abstracts, 96 records were screened for inclusion in the overview. Appraisal of titles and abstracts led to the exclusion of 61 studies and the further review of 35 full publications. Of the 35 full articles evaluated, three previously included systematic reviews were updated, one systematic review and two RCTs were added at this update, and two RCTs and one further report were added the Comment sections. We performed a GRADE evaluation for nine PICO combinations. CONCLUSIONS In this systematic overview, we categorised the efficacy for seven interventions based on information about the effectiveness and safety of antibiotics, face washing (alone or plus topical tetracycline), fly control (through the provision of pit latrines, and using insecticide alone or plus antibiotics), and health education.
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Solomon AW. Optimising the management of trachomatous trichiasis. LANCET GLOBAL HEALTH 2016; 4:e140-1. [PMID: 26774709 DOI: 10.1016/s2214-109x(16)00004-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 01/02/2016] [Indexed: 11/24/2022]
Affiliation(s)
- Anthony W Solomon
- Department of Control of Neglected Tropical Diseases, WHO, Geneva, Switzerland.
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