Baseline trachoma prevalence in Guinea: Results of national trachoma mapping in 31 health districts

Determinants of Low Coverage of the Free Surgical Care Programme for Trachomatous Trichiasis in Rural Guinea in 2022

This study aimed to describe the experiences of healthcare personnel and patients in the organization of free surgical campaigns and care for trachomatous trichiasis in the health district of Siguiri in Guinea, including challenges experienced in providing surgical care. This was an explanatory qualitative study conducted in 2022 in the health district of Siguiri. A total of 20 participants were interviewed including patients (n = 7; 35%), community health workers (n = 4; 20%), health services managers, and healthcare providers (n = 8; 40%). Two main data collection technics were used: documentary review and in-depth individual interviews. All interviews were transcribed and manually coded using an Excel extraction spreadsheet. Data were analysed using inductive and deductive approaches. The results showed several organizational, structural, and community challenges that underlined the low surgical coverage of trachomatous trichiasis in the health district of Siguiri. Organizational challenges included the low involvement of local actors in planning activities, the limited timeframe of the campaigns, and the lack of logistics for activities supervision and patients' transportation to surgery sites. Structural challenges included the inadequacy of health centres to provide surgical services, poor health infrastructures, and sanitation conditions in some areas. Individual challenges included remoteness of surgical sites and costs associated with services provision including medicines. Community challenges included fear of surgery and the coincidence of the campaigns with agricultural and mining activities. The results of the study call on the national neglected tropical disease program and its partners to adopt and promote micro-planning of trachomatous trichiasis surgical activities, with the effective participation of local stakeholders in endemic health districts. They should also envision integrating the management of surgical treatment including costs associated with care (transportation, food, rehabilitation support for patients who have undergone surgery) and complications of surgical procedures for an expansion of the trachomatous trichiasis free surgical care coverage in endemic health districts in Guinea.

Prevalence of active trachoma among 1-9 years of age children in Ethiopia: a systematic review and meta-analysis

OBJECTIVE

The objective of this study is to determine the pooled prevalence of active trachoma among 1-9 years old children in Ethiopia.

DESIGN

A systematic review and meta-analysis were employed in accordance with the Preferred Reporting Items for Systematic Reviews.

DATA SOURCES

Medline/PubMed, Scopus, Web of Science, African Journal of Online and Google scholar databases were systematically explored to find studies published in English until July 2023.

ELIGIBILITY CRITERIA

The following criteria apply: (1) condition (Co): studies examined the prevalence of trachoma among children (1-9) years old; (2) context (Co): studies conducted in Ethiopia; (3) population (Pop): studies that were done among children (1-9) years old; (4) study type: observational studies and (5) language: studies published in English.

DATA EXTRACTION AND SYNTHESIS

The data were extracted using a Microsoft Excel spreadsheet. DerSimonian-Laird random effect model was used to estimate the pooled prevalence of active trachoma among 1-9 years old children. Cochrane Q-tests and I2 statistics were used across studies to assess heterogeneity. To identify possible publication bias, Egger's test was performed.

PRIMARY OUTCOME

Prevalence of active trachoma among children aged (1-9 years old)".

RESULTS

Overall, a total of 42 articles with 235 005 study participants were included in the final analysis. The estimated pooled prevalence of active trachoma using random effect model was 24% (95% CI 20% to 27%). The subgroup analysis by region revealed that the highest prevalence of trachoma was 36% (95% CI 13% to 58%) in the Tigray region, and publication year revealed the prevalence of trachoma was decreasing from 32% to 19% after 2015.

CONCLUSION

In this review, the pooled prevalence of active trachoma was found to be high in Ethiopia compared with WHO threshold level. This underscores the need for increased focus on high-risk age groups to decrease trachoma and to achieve the elimination of trachoma from the country by 2030.

Neglected tropical diseases in Republic of Guinea: disease endemicity, case burden and the road towards the 2030 target

Neglected tropical diseases (NTDs) predominantly affect vulnerable and marginalized populations in tropical and subtropical areas and globally affect more than one billion people. In Guinea, the burden of NTDs is estimated to be >7.5 disability-adjusted life years per million inhabitants. Currently the Guinea NTDs master plan (2017-2020) has identified eight diseases as public health problems: onchocerciasis, lymphatic filariasis, trachoma, schistosomiasis and soil-transmitted helminthiasis, leprosy, human African trypanosomiasis and Buruli ulcer. In this review we discuss the past and the current case burden of the priority NTDs in Guinea, highlight the major milestones and discuss current and future areas of focus for achieving the 2030 target outlined by the World Health Organization.

Prevalence and associated factors of active trachoma among 1-9 years of age children in Andabet district, northwest Ethiopia, 2023: A multi-level mixed-effect analysis

BACKGROUND

Trachoma is the chief cause of preventable blindness worldwide and has been earmarked for elimination as a public health problem by 2030. Despite the five-year Surgery, Antibiotics, Facial cleanliness, and Environmental improvement (SAFE)-based interventions in the Andabet district, the prevalence of trachomatous follicular (TF) was 37%. With such a high prevalence of TF, the determinant factors were not revealed. Besides, there were no reports on the overall prevalence of active trachoma (i.e.TF and or trachomatous intense (TI)).

OBJECTIVE

To determine the prevalence and associated factors of active trachoma among 1-9 years of age children in the Andabet district.

METHOD

A community-based cross-sectional study was conducted among children aged under nine years from March 1-30, 2023 in Andabet district, Northwest Ethiopia. Multi-stage systematic random sampling was employed to reach 540 children. A multilevel mixed-effect logistic regression analysis was employed to assess factors associated with active trachoma. We fitted both random effect and fixed effect analysis. Finally, variables with p<0.05 in the multivariable multilevel analysis were claimed to be significantly associated with active trachoma.

RESULT

In this study, the overall prevalence of active trachoma was 35.37% (95% CI: 31.32%, 39.41%). The prevalence of TF and TI was 31.3% and 4.07% respectively. In the multilevel logistic regression analysis ocular discharge, fly-eye contact, latrine utilization, and source of water were significantly associated with the prevalence of active trachoma.

CONCLUSION

In this study, the prevalence of active trachoma was much higher than the World Health Organization (WHO) threshold prevalence. Ocular discharge, fly-eye contact, latrine utilization, and source of water were independent determinants of active trachoma among children (1-9 years). Therefore, paying special attention to these high-risk groups could decrease the prevalence of a neglected hyperendemic disease, active trachoma.

The Prevalence of Trachomatous Trichiasis in People Aged 15 Years and Over in Six Evaluation Units of Gaoual, Labé, Dalaba and Beyla Districts, Guinea

PURPOSE

Trachoma is a public health problem in 42 countries. Inflammation associated with repeated ocular infection with Chlamydia trachomatis can cause the eyelid to scar and turn inwards, resulting in the eyelashes rubbing against the eyeball, known as trachomatous trichiasis (TT). In Guinea, baseline surveys conducted in 2013 reported inflammatory trachoma prevalences below the World Health Organization (WHO) threshold for elimination, but TT prevalences above threshold. Given this epidemiological context and time since baseline survey, TT-only surveys were conducted in selected districts to determine current TT prevalence. The results of this study provide critical data for assessing Guinea's achievement of trachoma elimination targets.

METHODS

Four health districts, consisting of six evaluation units (EU), were surveyed. In each EU, field teams visited 29 clusters with a minimum 30 households included in each. Participants aged≥15 years were examined by certified graders trained to identify TT and determine whether management had been offered.

RESULTS

A total of 22,476 people were examined, with 48 TT cases across the six EUs identified. Five of six EUs had an age-and-gender adjusted TT-prevalence unknown to the health system less than 0.2%, whereas one EU, Beyla 2, had an adjusted TT prevalence of 0.24%.

CONCLUSION

These TT-only surveys, along with findings from other trachoma interventions, suggest that Guinea is close to achieving elimination of trachoma as a public health problem. This study demonstrates the value of undertaking TT-only surveys in settings where baseline surveys indicated active trachoma prevalences below WHO elimination threshold, but TT prevalences above it.

Prevalence of active trachoma and associated factors among school age children in Debre Tabor Town, Northwest Ethiopia, 2019: a community based cross-sectional study

BACKGROUND

Trachoma is an infectious eye disease caused by Chlamydial trachomatis. It is a major health problem in poor nations, notably in Sub-Saharan Africa. Despite the severity of the problem, there was a scarcity of data on trachoma prevalence and associated factors among school-aged children in Debre Tabor town following SAFE and MDA.

OBJECTIVES

The goal of this study was to determine the prevalence of active trachoma and its associated factors among school-aged children in Debre Tabor, Northwest Ethiopia, in 2019.

METHODS

A community-based cross-sectional study was used among school-aged children. Structured interview questionnaires, an observational checklist, and a physical examination were used to collect data from study participants who were chosen using a systematic random sampling procedure. IBM SPSS 20 was used to enter data, which was then transferred to IBM SPSS 20 for bivariate and multivariable logistic regression analysis.

RESULT

A total of 394 children aged 5-15 had been screened and took part in the study, with 9.9% (95% CI: 6.9, 12.7) testing positive for active trachoma. Having an unimproved larine type (AOR = 5.18; 95%CI: 1.96, 13.69), improper solid waste disposal (AOR = 3.026; 95%CI: 1.17, 7.8), family size greater than four (AOR = 3.4; 95%CI: 1.22, 9.49), not using soap for face washing (AOR = 4.48; 95%CI: 1.46, 13.72) and an unclean face of the child during examination (AOR = 23.93; 95%CI: 8.25, 69.38) were found to be significant predictors of active trachoma.

CONCLUSION

Active trachoma among school-age children was high compared to the WHO's definition of trachoma as a public health problem. A family size of four, poor solid waste management, an unimproved type of latrine, an unclean child's face, and not using soap when washing one's face were all significant predictors of active trachoma. Promotion of behavioral determinants through health education programs like keeping facial cleanliness by washing their child's face with soap, managing solid waste properly, and installing improved latrines to reduce active trachoma needs to be in place.

Unequal geographic distribution of water and sanitation at the household and school level in Sudan

The Sudanese Government launched the National SDG-6 Plan and commences its implementation to achieve and sustain universal and equitable access to basic WASH services by 2030. It is critical to understand the geographical heterogeneity of Sudan and patterns in the inequality of access to safe drinking water and sanitation. Through such research, the disease control strategy can be optimized, and resource allocation can be prioritized. We explored spatial heterogeneity and inequality in access to improved water and sanitation across Sudan by mapping the coverage at both the state and district levels. We decomposed the inequality across Sudan into within-state, between-state, within-district, and between-state inequalities using the Theil L and Theil T indices. We calculated the Gini coefficient to assess the inequality of access to improved water and sanitation, based on the deviation of the Lorenz curve from the line of perfect equality. The study population was 105,167 students aged 8–13 at 1,776 primary schools across the country. Geographical heterogeneity was prominent in the Central Darfur, South Darfur, East Darfur, Kassala, West Kordofan, and Blue Nile States, all of which showed severe inequality in access to an improved latrine at the household level in terms of the Theil T or Theil L index. The overall inequality in the coverage of improved sanitation went beyond the warning limit of 0.4 for the Gini coefficient. The inequality in terms of the Theil L and Theil T indices, as well as the Gini coefficient, was always higher for improved sanitation than for improved water at the household level. Within-state inequality accounted for 66% or more of national inequalities in the distribution of improved sanitation and drinking water for both the Theil L and Theil T indices. This is the first study to measure geographical heterogeneity and inequalities in improved water and sanitation coverage across Sudan. The study may help to prioritize resource allocation to areas with the greatest water and sanitation needs.

Implementation of mass drug administration for neglected tropical diseases in Guinea during the COVID-19 pandemic

BACKGROUND

Guinea reported its first case of COVID-19 on March 12, 2020. Soon thereafter, a national state of emergency was declared, all land borders were closed, schools were shut down, and public gatherings were limited. Many health activities, including field-based activities targeting neglected tropical diseases (NTDs), were paused. The World Health Organization (WHO) issued updated guidance on the resumption of NTD field-based activities on July 27, 2020. In response, the Guinea Ministry of Health (MoH) and its partners planned and resumed mass drug administration (MDA) in mid-August to September 2020 in 19 health districts.

METHODOLOGY/PRINCIPAL FINDINGS

A risk-benefit assessment was conducted to identify potential risks associated with the MDA in the COVID-19 context. Following this assessment, a risk mitigation plan with barrier measures was developed to guide MDA implementation. These measures included COVID-19 testing for all national staff leaving Conakry, mask wearing, social distancing of two meters, and hand washing/sanitizing. A checklist was developed and used to monitor compliance to risk mitigation measures. Data on adherence to risk mitigation measures were collected electronically during the MDA. A total of 120 checklists, representing 120 community drug distributor (CDD) teams (two CDDs per team) and 120 households, were completed. Results indicated that washing or disinfecting hands was practiced by 68.3% of CDD teams, compared to 45.0% among households. Face masks to cover the mouth and nose were worn by 79.2% of CDD teams, while this was low among households (23.3%). In 87.5% of households, participants did not touch the dose pole and in 88.3% of CDD teams, CDDs did not touch the hands of the participants while giving the drugs. A large majority of CDD teams (94.2%) and household members (94.2%) were willing to participate in the MDA despite the pandemic. The epidemiological coverage was ≥65% for lymphatic filariasis, onchocerciasis and soil-transmitted helminths in 10 out of 19 HDs and ≥75% for schistosomiasis for school-aged children in 7 out of 11 HDs.

CONCLUSIONS/SIGNIFICANCE

Guinea was one of the first countries in Africa to resume MDA activities during the COVID-19 pandemic without causing an observed increase of transmission. The development of a risk mitigation plan and a method to monitor adherence to barrier measures was critical to this unprecedented effort. The rapid incorporation of COVID-19 barrier measures and their acceptance by CDDs and household members demonstrated both the adaptability of the National NTD Program to respond to emerging issues and the commitment of the MoH to implement NTD programs.