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Kreis AJ, Gower EW, Kropp M, Kello AB, Nouhoum G, Resnikoff S, Talero SL, Solomon AW. The prevention and management of postoperative trachomatous trichiasis: A systematic review. Surv Ophthalmol 2024; 69:93-102. [PMID: 36878359 DOI: 10.1016/j.survophthal.2023.02.008] [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: 11/02/2022] [Revised: 02/24/2023] [Accepted: 02/27/2023] [Indexed: 03/07/2023]
Abstract
Among ocular infections, trachoma is the main cause of blindness. Repeated conjunctival Chlamydia trachomatis infections lead to trichiasis, corneal opacification, and visual impairment. Surgery is often needed to relieve discomfort and preserve vision; however, a high postoperative trachomatous trichiasis (PTT) rate has been observed in various settings. We wanted to know why, whether PTT rates could be reduced, and how to manage the PTT that occurs. We performed a search of the literature. Of 217 papers screened, 59 studies were identified for inclusion as potentially relevant, the majority having been excluded for not directly concerning PTT in humans. Preventing PTT is a major challenge. Only one published trial, the STAR trial in Ethiopia, has reported a cumulative PTT rate <10% one year after surgery. The literature on the management of PTT is sparse. Though no PTT management guidelines are available, high-quality surgery with a low rate of unfavorable outcomes for PTT patients is likely to require enhanced training of a smaller group of highly-skilled surgeons. Based on the surgical complexity and the authors' own experience, the pathway for patients suffering from PTT should be studied further for improvement.
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Affiliation(s)
- Andreas J Kreis
- Experimental Ophthalmology, University of Geneva, Geneva, Switzerland; Department of Ophthalmology, University Hospitals of Geneva, Geneva, Switzerland.
| | - Emily W Gower
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Martina Kropp
- Experimental Ophthalmology, University of Geneva, Geneva, Switzerland; Department of Ophthalmology, University Hospitals of Geneva, Geneva, Switzerland
| | - Amir B Kello
- World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Guirou Nouhoum
- Techniques and Technologies of Bamako, Institut d'Ophtalmologie Tropicale d'Afrique, University of the Sciences, Bamako, Mali
| | - Serge Resnikoff
- Organisation pour la Prévention de la Cécité, Paris, France; School of Optometry & Vision Science (SOVS), University of New South Wales, Sydney, Australia
| | - Sandra L Talero
- Research Department of Development and Innovation, Superior School of Ophthalmology, Barraquer Institute of America, Bogotá, Colombia
| | - Anthony W Solomon
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
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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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Harding-Esch EM, Burgert-Brucker CR, Jimenez C, Bakhtiari A, Willis R, Dejene Bejiga M, Mpyet C, Ngondi J, Boyd S, Abdala M, Abdou A, Adamu Y, Alemayehu A, Alemayehu W, Al-Khatib T, Apadinuwe SC, Awaca N, Awoussi MS, Baayendag G, Badiane Mouctar D, Bailey RL, Batcho W, Bay Z, Bella A, Beido N, Bol YY, Bougouma C, Brady CJ, Bucumi V, Butcher R, Cakacaka R, Cama A, Camara M, Cassama E, Chaora SG, Chebbi AC, Chisambi AB, Chu B, Conteh A, Coulibaly SM, Courtright P, Dalmar A, Dat TM, Davids T, DJAKER MEA, de Fátima Costa Lopes M, Dézoumbé D, Dodson S, Downs P, Eckman S, Elshafie BE, Elmezoghi M, Elvis AA, Emerson P, Epée EEE, Faktaufon D, Fall M, Fassinou A, Fleming F, Flueckiger R, Gamael KK, Garae M, Garap J, Gass K, Gebru G, Gichangi MM, Giorgi E, Goépogui A, Gómez DVF, Gómez Forero DP, Gower EW, Harte A, Henry R, Honorio-Morales HA, Ilako DR, Issifou AAB, Jones E, Kabona G, Kabore M, Kadri B, Kalua K, Kanyi SK, Kebede S, Kebede F, Keenan JD, Kello AB, Khan AA, KHELIFI H, Kilangalanga J, KIM SH, Ko R, Lewallen S, Lietman T, Logora MSY, Lopez YA, MacArthur C, Macleod C, Makangila F, Mariko B, Martin DL, Masika M, Massae P, Massangaie M, Matendechero HS, Mathewos T, McCullagh S, Meite A, Mendes EP, Abdi HM, Miller H, Minnih A, Mishra SK, Molefi T, Mosher A, M’Po N, Mugume F, Mukwiza R, Mwale C, Mwatha S, Mwingira U, Nash SD, NASSA C, Negussu N, Nieba C, Noah Noah JC, Nwosu CO, Olobio N, Opon R, Pavluck A, Phiri I, Rainima-Qaniuci M, Renneker KK, Saboyá-Díaz MI, Sakho F, Sanha S, Sarah V, Sarr B, Szwarcwald CL, Shah Salam A, Sharma S, Seife F, Serrano Chavez GM, Sissoko M, Sitoe HM, Sokana O, Tadesse F, Taleo F, Talero SL, Tarfani Y, Tefera A, Tekeraoi R, Tesfazion A, Traina A, Traoré L, Trujillo-Trujillo J, Tukahebwa EM, Vashist P, Wanyama EB, WARUSAVITHANA SD, Watitu TK, West S, Win Y, Woods G, YAJIMA A, Yaya G, Zecarias A, Zewengiel S, Zoumanigui A, Hooper PJ, Millar T, Rotondo L, Solomon AW. Tropical Data: Approach and Methodology as Applied to Trachoma Prevalence Surveys. Ophthalmic Epidemiol 2023; 30:544-560. [PMID: 38085791 PMCID: PMC10751062 DOI: 10.1080/09286586.2023.2249546] [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: 03/09/2023] [Accepted: 08/11/2023] [Indexed: 12/18/2023]
Abstract
PURPOSE Population-based prevalence surveys are essential for decision-making on interventions to achieve trachoma elimination as a public health problem. This paper outlines the methodologies of Tropical Data, which supports work to undertake those surveys. METHODS Tropical Data is a consortium of partners that supports health ministries worldwide to conduct globally standardised prevalence surveys that conform to World Health Organization recommendations. Founding principles are health ministry ownership, partnership and collaboration, and quality assurance and quality control at every step of the survey process. Support covers survey planning, survey design, training, electronic data collection and fieldwork, and data management, analysis and dissemination. Methods are adapted to meet local context and needs. Customisations, operational research and integration of other diseases into routine trachoma surveys have also been supported. RESULTS Between 29th February 2016 and 24th April 2023, 3373 trachoma surveys across 50 countries have been supported, resulting in 10,818,502 people being examined for trachoma. CONCLUSION This health ministry-led, standardised approach, with support from the start to the end of the survey process, has helped all trachoma elimination stakeholders to know where interventions are needed, where interventions can be stopped, and when elimination as a public health problem has been achieved. Flexibility to meet specific country contexts, adaptation to changes in global guidance and adjustments in response to user feedback have facilitated innovation in evidence-based methodologies, and supported health ministries to strive for global disease control targets.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Amza Abdou
- Programme National de Santé Oculaire, Niger
| | | | | | | | | | | | - Naomie Awaca
- Ministère de la Santé Publique, Democratic Republic of Congo
| | | | | | | | | | | | | | | | | | | | - Clarisse Bougouma
- Programme national de lutte contre les maladies tropicales négligées (PNMTN), Burkina Faso
| | | | - Victor Bucumi
- National Integrated Programme for the Control of Neglected Tropical Diseases and Blindness (PNIMTNC), Burundi
| | | | | | | | | | | | | | | | | | - Brian Chu
- International Trachoma Initiative, USA
| | | | | | - Paul Courtright
- Division of Ophthalmology, University of Cape Town, Cape Town, South Africa, South Africa
| | - Abdi Dalmar
- Ministry of Human Development and Public Services, Somalia
| | | | | | | | | | | | | | | | | | | | | | - Ange Aba Elvis
- Programme National de la Santé Oculaire et de la lutte contre l’Onchocercose, Côte d’Ivoire
| | | | | | | | | | | | | | | | | | | | - Jambi Garap
- Port Moresby General Hospital, Papua New Guinea
| | | | | | | | | | | | | | | | | | - Anna Harte
- London School of Hygiene & Tropical Medicine, UK
| | - Rob Henry
- U.S. Agency for International Development, USA
| | | | | | | | | | | | - Martin Kabore
- Programme national de lutte contre les maladies tropicales négligées (PNMTN), Burkina Faso
| | | | - Khumbo Kalua
- Blantyre Institute for Community Outreach, Malawi
| | | | | | | | | | | | | | | | | | | | - Robert Ko
- Port Moresby General Hospital, Papua New Guinea
| | - Susan Lewallen
- Division of Ophthalmology, University of Cape Town, Cape Town, South Africa, South Africa
| | | | | | - Yuri A Lopez
- SACAICET / MINISTERIO DEL PODER POPULAR PARA LA SALUD, Venezuela
| | | | | | | | | | | | | | | | | | | | | | | | - Aboulaye Meite
- Ministère de la Santé et de l’Hygiène Publique, Cote d’Ivoire
| | | | | | | | | | | | | | - Aryc Mosher
- U.S. Agency for International Development, USA
| | | | | | | | | | | | | | | | | | | | - Cece Nieba
- Ministère de la Santé et de l’Hygiene Publique, Guinea
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Oliver Sokana
- Solomon Islands Ministry of Health and Medical Services, Solomon Islands
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Alemayehu A, Mekonen A, Mengistu B, Mihret A, Asmare A, Bakhtiari A, Mengistu B, Jimenez C, Kebede D, Bol D, Tadesse F, Kebede F, Gebru G, Frawley H, Ngondi J, Jemal M, Brady M, Negussu N, Butcher R, McPherson S, Backers S, Solomon AW, Bejiga MD, Harding-Esch EM. Prevalence of Trachoma After Three Rounds of Antibiotic Mass Drug Administration in 13 Woredas of Gambella Region, Ethiopia. Ophthalmic Epidemiol 2023:1-9. [PMID: 38032947 DOI: 10.1080/09286586.2023.2248624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 08/11/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Following baseline surveys in 2013 and 2014, trachoma elimination interventions, including three rounds of azithromycin mass drug administration (MDA), were implemented in 13 woredas (administrative districts) of Gambella Regional State, Ethiopia. We conducted impact surveys to determine if elimination thresholds have been met or if additional interventions are required. METHODS Cross-sectional population-based surveys were conducted in 13 woredas of Gambella Regional State, combined into five evaluation units (EUs), 6─12 months after their last MDA round. A two-stage systematic (first stage) and random (second stage) sampling technique was used. WHO-recommended protocols were implemented with the support of Tropical Data. Household water, sanitation and hygiene (WASH) access was assessed. RESULTS The age-adjusted prevalence of trachomatous inflammation - follicular (TF) in 1-9-year-olds in the five EUs ranged from 0.3-19.2%, representing a general decline in TF prevalence compared to baseline estimates. The age- and gender-adjusted prevalence of trachomatous trichiasis (TT) unknown to the health system in those aged ≥ 15 years ranged from 0.47-3.08%. Of households surveyed, 44% had access to an improved drinking water source within a 30-minute return journey of the house, but only 3% had access to an improved latrine. CONCLUSION In two EUs, no further MDA should be delivered, and a surveillance survey should be conducted after two years without MDA. In one EU, one further round of MDA should be conducted followed by another impact survey. In two EUs, three further MDA rounds are required. Surgery, facial cleanliness and environmental improvement interventions are needed throughout the region.
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Affiliation(s)
- Addisu Alemayehu
- Act to End NTDs East, RTI International, Addis Ababa, Ethiopia End NTDs East, RTI International, Addis Ababa, Ethiopia
| | - Ademe Mekonen
- Health Promotion and Disease Prevention Core Process, Gambella Regional Health Bureau, Ethiopia
| | - Belete Mengistu
- Act to End NTDs East, RTI International, Addis Ababa, Ethiopia End NTDs East, RTI International, Addis Ababa, Ethiopia
| | - Addisalem Mihret
- Act to End NTDs East, RTI International, Addis Ababa, Ethiopia End NTDs East, RTI International, Addis Ababa, Ethiopia
| | - Aemiro Asmare
- Act to End NTDs East, RTI International, Addis Ababa, Ethiopia End NTDs East, RTI International, Addis Ababa, Ethiopia
| | | | - Bekele Mengistu
- Nekemte Specialized Hospital, Eastern Wollega Zone, Oromia Region, Ethiopia
| | | | - Demis Kebede
- Act to End NTDs East, RTI International, Addis Ababa, Ethiopia End NTDs East, RTI International, Addis Ababa, Ethiopia
| | - Doul Bol
- Health Promotion and Disease Prevention Core Process, Gambella Regional Health Bureau, Ethiopia
| | - Fentahun Tadesse
- Neglected Tropical Diseases Team, Disease Prevention and Control Directorate, Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Fikreab Kebede
- Neglected Tropical Diseases Team, Disease Prevention and Control Directorate, Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Genet Gebru
- Neglected Tropical Diseases Team, Disease Prevention and Control Directorate, Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Hannah Frawley
- Act to End NTDs East, RTI International, Washington, DC, USA
| | - Jeremiah Ngondi
- Act to End NTDs East, RTI International, Washington, DC, USA
| | - Mohammed Jemal
- Health Promotion and Disease Prevention Core Process, Gambella Regional Health Bureau, Ethiopia
| | - Molly Brady
- Act to End NTDs East, RTI International, Washington, DC, USA
| | - Nebiyu Negussu
- Neglected Tropical Diseases Team, Disease Prevention and Control Directorate, Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Robert Butcher
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Scott McPherson
- Act to End NTDs East, RTI International, Washington, DC, USA
| | - Sharone Backers
- Act to End NTDs East, RTI International, Addis Ababa, Ethiopia End NTDs East, RTI International, 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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Diallo AO, Bayissasse B, Sisay A, Seyum D, Weaver J, Munoz B, Merbs SL, Gower EW. Effectiveness of Trachomatous Trichiasis Case-identification Approaches in Ethiopia. Epidemiology 2023; 34:909-920. [PMID: 37757880 DOI: 10.1097/ede.0000000000001656] [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] [Indexed: 09/29/2023]
Abstract
BACKGROUND Trachoma control programs use multiple approaches to identify individuals with trachomatous trichiasis (TT). Evidence is limited regarding which approaches are most effective and cost-efficient. METHODS We evaluated the effectiveness of two TT case-identification approaches in Ethiopia: community mobilization to encourage self-referral for centralized screening and house-to-house screenings conducted by case finders. We compared the number of true cases found per 1000 population and costs associated with case identification under each approach, stratified by villages that received one or multiple screening visits. RESULTS We conducted screenings in 396 villages. In villages receiving one house-to-house visit, case finders identified 14,229 suspected cases, of whom 10,513 (73.9%) presented for TT confirmation. A median of 17.2% (interquartile range [IQR]: 9.1%-27.8%) of those presenting truly had TT (positive predictive value). In single-visit villages, the community mobilization approach yielded higher rates of confirmed cases than the house-to-house approach (1.5 [IQR: 1.1, 2.6] vs. 1.1 [IQR: 0.5, 1.9] cases per 1000 population), and the median cost of identifying a TT case was less ($5.59 vs. $31.18) using community mobilization than house-to-house. In multiple-visit villages, additional screening visits increased the median rate of confirmed cases to 2.5 per 1000 population in community mobilization villages, but the rate remained unchanged in house-to-house villages. CONCLUSIONS Community mobilization-based TT case finding had a higher yield than house-to-house, at a substantially lower cost. Future research should examine whether additional tools to aid case finders in their diagnosis increases case-finding efficiency and accuracy and whether TT prevalence and surgical program duration impact case-finding success.
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Affiliation(s)
- Alpha Oumar Diallo
- From the Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | | | - Dawit Seyum
- Orbis International Ethiopia, Addis Ababa, Ethiopia
| | - Jerusha Weaver
- From the Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Beatriz Munoz
- Department of Ophthalmology, Johns Hopkins School of Medicine, Baltimore, MD
| | - Shannath L Merbs
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, MD
| | - Emily W Gower
- From the Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Department of Ophthalmology, University of North Carolina at Chapel Hill, Chapel Hill, NC
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He J, Chen A, Zou M, Young CA, Jin L, Zheng D, Jin G, Congdon N. Time trends and heterogeneity in the disease burden of trachoma, 1990-2019: a global analysis. Br J Ophthalmol 2023; 107:337-341. [PMID: 34593412 DOI: 10.1136/bjophthalmol-2021-319621] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 09/18/2021] [Indexed: 11/04/2022]
Abstract
PURPOSE To evaluate the epidemiological trends and associated risk factors of disease burden due to trachoma. METHODS Data for the country-specific disability-adjusted life year (DALY) number, rate and age-standardised rate of trachoma together with related data of other common eye diseases were acquired from the Global Burden of Disease Study 2019 database. The Socio-Demographic Index (SDI), Human Development Index (HDI), inequality-adjusted HDI and other related indices were obtained from published data or publicly available databases. Regression analyses were conducted to evaluate the associations between potential risk factors and the age-standardised DALY burden of trachoma. RESULTS The global DALY burden due to trachoma decreased by 37% from 1990 to 2019 and decreased by 69.8% after adjusting for age and population growth, and, in available 1990-2019 data, had the greatest reduction in attributable DALYs of all common eye disease, with the others analysed being cataract, glaucoma, refractive disorders and age-related macular degeneration. Women had higher age-standardised DALY burden due to trachoma than men (p<0.001). The African region (p<0.001) had the heaviest burden among global regions. The age-standardised DALY rate was higher in countries with lower income (p<0.001) and lower SDI (p<0.001). Higher disease burden due to trachoma was associated with lower HDI (β=-48.102, 95% CI -86.888 to -9.316, p=0.016), lower SDI (β=-48.063, 95% CI -83.702 to -12.423, p<0.001) and lower expected years of schooling (β=-2.352, 95% CI -3.756 to -0.948, p=0.002). CONCLUSIONS The global disease burden due to trachoma decreased from 1990 to 2019 and it had the greatest reduction compared with other common eye diseases. Lower HDI, socioeconomic status and educational level were related to a higher national disease burden of trachoma. Our findings could provide necessary information for trachoma control and prevention.
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Affiliation(s)
- Jingxin He
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Aiming Chen
- Department of Pharmacy, Fifth Affiliated Hospital of Sun Yat- sen University, Zhuhai, China
| | - Minjie Zou
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Charlotte Aimee Young
- Department of Ophthalmology, Third Affiliated Hospital, Nanchang University, Nanchang, People's Republic of China
| | - Ling Jin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Danying Zheng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Guangming Jin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Nathan Congdon
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China.,Centre for Public Health, Queen's University Belfast, Belfast, UK.,Orbis International, New York, New York, USA
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Nayel Y, Taylor M, Montasser AS, Elsherif M, Diab MM. Perceptions of ophthalmologists on the impact of trachoma in Egypt: a mixed-methods, nationwide survey. BMC Infect Dis 2023; 23:27. [PMID: 36650425 PMCID: PMC9847179 DOI: 10.1186/s12879-022-07862-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 11/09/2022] [Indexed: 01/18/2023] Open
Abstract
PURPOSE Understanding the perception and practices of ophthalmologists for trachoma is important to develop interventions aimed at disease elimination in Egypt. The survey investigated: (1) the views and practice patterns of Egyptian ophthalmologists for trachoma and (2) the influence of geographic location, setting, and years of practice on ophthalmologists' perceptions. METHODS A questionnaire sent to ophthalmologists currently working in Egypt collected information on: (1) demographics, (2) caseload and practice patterns for trachoma, (3) 13 Likert scale questions regarding the current state of trachoma, and (4) two open-ended written response questions. RESULTS Of the 500 recipients, 194 ophthalmologists participated. 98% of the respondents reported seeing trachoma patients in their practice. 28.8% agreed that trachoma is currently an active health problem in Egypt, with ophthalmologists in public practice having significantly higher agreement scores compared to private practitioners (p = 0.030). Rural ophthalmologists were significantly more likely to agree that a targeted trachoma control program is needed in their location of practice compared to their urban counterparts (p < 0.001). Open-ended questions revealed recurrent themes, including the rural distribution of trachoma patients and the high volume of patients with corneal opacity. CONCLUSION Ophthalmologists' experiences with trachoma in Egypt differed based on practice setting, years in practice, and location, and the overall perception of the impact of the disease remains low. However, there was widespread agreement that trachoma is present in communities across the country. Practitioners in rural areas and in the public sector shared a disproportionate burden of the trachoma caseload. The perspectives of such ophthalmologists must be emphasized in decision-making related to trachoma interventions.
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Affiliation(s)
- Yassin Nayel
- grid.464520.10000 0004 0614 2595American University of the Caribbean School of Medicine, Cupecoy, Sint Maarten
| | - Matilda Taylor
- grid.17091.3e0000 0001 2288 9830Faculty of Medicine, University of British Columbia, Vancouver, BC Canada
| | - Ahmed S. Montasser
- grid.412093.d0000 0000 9853 2750Department of Ophthalmology, Faculty of Medicine, Helwan University, Helwan, Egypt
| | - Mohamed Elsherif
- grid.22903.3a0000 0004 1936 9801Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Mostafa M. Diab
- grid.411170.20000 0004 0412 4537Department of Ophthalmology, Faculty of Medicine, Fayoum University, Al Fayoum, Egypt
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Saboyá-Díaz MI, Carey Angeles CA, Avellaneda Yajahuanca RDS, Meléndez Ruíz SK, Cabrera R, Honorio Morales HA, Pachas PE, Guardo M, Renneker KK, Muñoz BE, West SK. Associated factors of the co-occurrence of trachoma and soil-transmitted helminthiases in children 1 to 9 years old in rural communities of the Amazon basin in Loreto Department, Peru: Results from a population-based survey. PLoS Negl Trop Dis 2022; 16:e0010532. [PMID: 35877683 PMCID: PMC9312473 DOI: 10.1371/journal.pntd.0010532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 05/24/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND There is evidence of the occurrence of trachoma in Peru, and studies have shown that soil-transmitted helminthiases (STH) are affecting rural communities in the Amazon basin in Loreto Department. This study was done to estimate trachoma prevalence, STH prevalence, and the associated factors for both diseases in children aged 1-9 years in rural communities of Peru. METHODOLOGY A population-based cross-sectional survey was carried out in rural communities of Loreto. A standardized survey questionnaire with individual and household risk factors related to both diseases was used. Ocular examination was done for all participants aged one year and above, and eye swab samples were collected from children with follicular trachoma (TF). Anthropometric measurements, stool samples for STH, and blood samples for hemoglobin measurement were taken from children. PRINCIPAL FINDINGS TF prevalence was 7.74% (95% CI 5.08-11.63%), STH prevalence was 49.49% (95% CI 25.00-52.43%), and prevalence of co-occurrence of both diseases was 5.06% (95% CI 2.80-8.98%) in children aged 1-9 years. Being at age 3-8 years old (AOR = 6.76; 95% CI 1.346-33.947), have an unclean face (AOR = 24.64; 95% CI 6.787-89.444), and having been dewormed in the last six months (AOR = 2.47; 95% CI 1.106-5.514), were risk factors of TF. Being a female (AOR = 0.22; 95% CI 0.103-0.457) was associated with decreased odds of TF. Having been dewormed in the last six months (AOR = 0.30; 95% CI 0.139-0.628) was a preventative factor for STH. Risk factors for children with both diseases mirrored the findings for risk factors for individual diseases. CONCLUSIONS Neglected tropical diseases and associated risk factors overlap in communities living in vulnerable conditions in the Amazon basin of Peru. These findings support the need to implement integrated interventions, including mass drug administration, water, sanitation, and hygiene for both diseases in the study area.
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Affiliation(s)
- Martha Idalí Saboyá-Díaz
- Communicable Diseases and Environmental Determinants of Health Department, Pan American Health Organization, Washington, District of Columbia, United States of America
| | | | | | | | | | | | - Paul E. Pachas
- National Center of Public Health, National Institute of Health of Peru, Lima, Peru
| | - Monica Guardo
- Health Surveillance, Disease Prevention, and Control, Pan American Health Organization, Guatemala City, Guatemala
| | - Kristen K. Renneker
- International Trachoma Initiative, The Task Force for Global Health, Decatur, Georgia, United States of America
| | - Beatriz E. Muñoz
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Sheila K. West
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, United States of America
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Abstract
Trachoma is a neglected tropical disease caused by infection with conjunctival strains of Chlamydia trachomatis. It can result in blindness. Pathophysiologically, trachoma is a disease complex composed of two linked chronic processes: a recurrent, generally subclinical infectious-inflammatory disease that mostly affects children, and a non-communicable, cicatricial and, owing to trichiasis, eventually blinding disease that supervenes in some individuals later in life. At least 150 infection episodes over an individual's lifetime are needed to precipitate trichiasis; thus, opportunity exists for a just global health system to intervene to prevent trachomatous blindness. Trachoma is found at highest prevalence in the poorest communities of low-income countries, particularly in sub-Saharan Africa; in June 2021, 1.8 million people worldwide were going blind from the disease. Blindness attributable to trachoma can appear in communities many years after conjunctival C. trachomatis transmission has waned or ceased; therefore, the two linked disease processes require distinct clinical and public health responses. Surgery is offered to individuals with trichiasis and antibiotic mass drug administration and interventions to stimulate facial cleanliness and environmental improvement are designed to reduce infection prevalence and transmission. Together, these interventions comprise the SAFE strategy, which is achieving considerable success. Although much work remains, a continuing public health problem from trachoma in the year 2030 will be difficult for the world to excuse.
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Malik M, Strang N, Campbell P, Jonuscheit S. Exploring eye care pathways, patient priorities and economics in Pakistan: A scoping review and expert consultation study with thematic analysis. Ophthalmic Physiol Opt 2022; 42:694-716. [PMID: 35318687 PMCID: PMC9310639 DOI: 10.1111/opo.12977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 02/16/2022] [Accepted: 02/16/2022] [Indexed: 11/29/2022]
Abstract
Purpose As the prevalence of eye diseases increases, demand for effective, accessible and equitable eye care grows worldwide. This is especially true in lower and middle‐income countries, which have variable levels of infrastructure and economic resources to meet this increased demand. In the present study we aimed to review the literature on eye care in Pakistan comprehensively, with a particular focus on eye care pathways, patient priorities and economics. Methods A systematic scoping review was performed to identify literature relating to eye care in Pakistan. Searches of relevant electronic databases and grey literature were carried out. The results were analysed through a mixed methods approach encompassing descriptive numerical summary and thematic analysis. To consolidate results and define priority areas for future study, expert consultation exercises with key stakeholders were conducted using qualitative semi‐structured interviews. Results One hundred and thirty‐two papers (published and unpublished) were included in the final review. The majority (n = 93) of studies utilised a quantitative design. Seven interlinked themes were identified: eye care pathways, burden of eye disease, public views on eye‐related issues, workforce, barriers to uptake of eye care services, quality of eye care services and economic impact of blindness. Research priorities included investigating the eye care workforce, the quality and efficiency of current eye care services, eye care services available in rural Pakistan and the costs and benefits related to eye care provision and sustaining eye care programmes. Conclusions To the best of our knowledge, this is the first review to synthesise evidence from papers across the field relating to eye care in Pakistan. As such, this work provides new insights into the achievements of the national eye health programme, challenges in eye care in Pakistan and priority areas for future research.
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Affiliation(s)
- Manal Malik
- Department of Vision Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Niall Strang
- Department of Vision Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Pauline Campbell
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Sven Jonuscheit
- Department of Vision Sciences, Glasgow Caledonian University, Glasgow, UK
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11
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Merbs SL, Talero SL, Tadesse D, Sisay A, Bayissasse B, Weaver JU, Gower EW. A New Surgical Technique for Postoperative Trachomatous Trichiasis. Ophthalmic Plast Reconstr Surg 2021; 37:595-598. [PMID: 34570049 PMCID: PMC8571053 DOI: 10.1097/iop.0000000000002055] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The World Health Organization has identified management of postoperative trichiasis (PTT) as one of the key remaining areas of focus needed to eliminate blinding trachoma as a public health problem. We developed the Bevel-Rotation Advancement Procedure (B-RAP) to treat individuals who need repeat trichiasis surgery. METHODS Scarring caused by trichiasis surgery can cause the eyelid to become thick and distorted, making repeat surgery more difficult. To minimize eyelid thickness following B-RAP, a beveled incision of the tarsus is made allowing a marginal rotation of the eyelash fragment. Dissection between the anterior and posterior lamellae above the beveled incision and removal of scar tissue allows the marginal rotation to be combined with a posterior lamellar advancement to treat severely scarred eyelids with PTT and eyelid contour abnormalities (ECAs). RESULTS Two surgeons performed B-RAP on 44 eyelids of 30 patients with PTT. The number of prior trachomatous trichiasis (TT) surgeries ranged from 2 to more than 4. At the 3-6 months postoperative visit, 37 eyelids (84%) had no recurrence of PTT. Three eyelids had central lashes touching; the remaining eyelids with recurrent PTT had nasal and temporal lashes touching. Fifteen eyelids (34%) had ECAs, but only 1 was severe. CONCLUSIONS B-RAP was developed considering the altered eyelid anatomy found in the postsurgical eyelid with TT. Thinning of the eyelash fragment and removal of postoperative scar tissue improves the ability to advance and stabilize the eyelash fragment after external rotation. B-RAP shows promise as a procedure for improving outcomes of repeat trichiasis surgery.
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Affiliation(s)
- Shannath L. Merbs
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Sandra L. Talero
- Innovation and Research Department, Escuela superior de oftalmología del Instituto Barraquer de América. Bogotá, Colombia
| | - Demissie Tadesse
- Inclusive Health Initiative, CBM International, P.O. Box 694, Addis Ababa, Ethiopia
| | | | | | - Jerusha U. Weaver
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Emily W. Gower
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
- Department of Ophthalmology, University of North Carolina, Chapel Hill, North Carolina, USA
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Wurihan W, Weber AM, Gong Z, Lou Z, Sun S, Zhou J, Fan H. GrgA overexpression inhibits Chlamydia trachomatis growth through sigma 66- and sigma 28-dependent mechanisms. Microb Pathog 2021; 156:104917. [PMID: 33940135 PMCID: PMC8187326 DOI: 10.1016/j.micpath.2021.104917] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 04/01/2021] [Accepted: 04/02/2021] [Indexed: 01/21/2023]
Abstract
The obligate intracellular bacterium Chlamydia trachomatis is an important human pathogen with a biphasic developmental cycle comprised of an infectious elementary body (EB) and a replicative reticulate body (RB). Whereas σ66, the primary sigma factor, is necessary for transcription of most chlamydial genes throughout the developmental cycle, σ28 is required for expression of some late genes. We previously showed that the Chlamydia-specific transcription factor GrgA physically interacts with both of these sigma factors and activates transcription from σ66- and σ28-dependent promoters in vitro. Here, we investigated the organismal functions of GrgA. We show that overexpression of GrgA slows EB-to-RB conversion, decreases RB proliferation, and reduces progeny EB production. In contrast, overexpression of a GrgA variant without the σ28-binding domain shows significantly less severe inhibitory effects, while overexpression of a variant without the σ66-binding domain demonstrates no adverse effects. These findings indicate that GrgA plays important roles in the expression regulation of both σ66-dependent genes and σ28-dependent genes during the chlamydial developmental cycle.
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Affiliation(s)
- Wurihan Wurihan
- Department of Pharmacology, Robert Wood Johnson Medical School, Rutgers The State University of New Jersey, Piscataway, NJ, 08854, USA
| | - Alec M Weber
- Department of Pharmacology, Robert Wood Johnson Medical School, Rutgers The State University of New Jersey, Piscataway, NJ, 08854, USA
| | - Zheng Gong
- Department of Pharmacology, Robert Wood Johnson Medical School, Rutgers The State University of New Jersey, Piscataway, NJ, 08854, USA
| | - Zhongzi Lou
- Department of Pharmacology, Robert Wood Johnson Medical School, Rutgers The State University of New Jersey, Piscataway, NJ, 08854, USA; Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, 730046, China
| | - Samantha Sun
- Department of Pharmacology, Robert Wood Johnson Medical School, Rutgers The State University of New Jersey, Piscataway, NJ, 08854, USA
| | - Jizhang Zhou
- Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, 730046, China
| | - Huizhou Fan
- Department of Pharmacology, Robert Wood Johnson Medical School, Rutgers The State University of New Jersey, Piscataway, NJ, 08854, USA.
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Last A, Versteeg B, Shafi Abdurahman O, Robinson A, Dumessa G, Abraham Aga M, Shumi Bejiga G, Negussu N, Greenland K, Czerniewska A, Thomson N, Cairncross S, Sarah V, Macleod D, Solomon AW, Logan J, Burton MJ. Detecting extra-ocular Chlamydia trachomatis in a trachoma-endemic community in Ethiopia: Identifying potential routes of transmission. PLoS Negl Trop Dis 2020; 14:e0008120. [PMID: 32130213 PMCID: PMC7075638 DOI: 10.1371/journal.pntd.0008120] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 03/16/2020] [Accepted: 02/06/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Trachoma elimination efforts are hampered by limited understanding of Chlamydia trachomatis (Ct) transmission routes. Here we aimed to detect Ct DNA at non-ocular sites and on eye-seeking flies. METHODS A population-based household survey was conducted in Oromia Region, Ethiopia. Ocular and non-ocular (faces, hands, clothing, water containers and sleeping surfaces) swabs were collected from all individuals. Flies were caught from faces of children. Flies, ocular swabs and non-ocular swabs were tested for Ct by quantitative PCR. RESULTS In total, 1220 individuals in 247 households were assessed. Active trachoma (trachomatous inflammation-follicular) and ocular Ct were detected in 10% and 2% of all-ages, and 21% and 3% of 1-9-year-olds, respectively. Ct was detected in 12% (95% CI:8-15%) of tested non-ocular swabs from ocular-positive households, but in none of the non-ocular swabs from ocular-negative households. Ct was detected on 24% (95% CI:18-32%) of flies from ocular-positive households and 3% (95% CI:1-6%) of flies from ocular-negative households. CONCLUSION Ct DNA was detected on hands, faces and clothing of individuals living in ocular-positive households suggesting that this might be a route of transmission within Ct infected households. In addition, we detected Ct on flies from ocular-positive households and occasionally in ocular-negative households suggesting that flies might be a vector for transmission within and between Ct infected and uninfected households. These potential transmission routes may need to be simultaneously addressed to suppress transmission.
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Affiliation(s)
- Anna Last
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Bart Versteeg
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Oumer Shafi Abdurahman
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
- The Fred Hollows Foundation, Ethiopia
| | - Ailie Robinson
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | | | | | | | - Katie Greenland
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Alexandra Czerniewska
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Nicholas Thomson
- Department of Pathogen Molecular Biology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Parasites and microbes, Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, United Kingdom
| | - Sandy Cairncross
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - David Macleod
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Anthony W. Solomon
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - James Logan
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Matthew J. Burton
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Solomon AW, Bella ALF, Negussu N, Willis R, Taylor HR. How much trachomatous trichiasis is there? A guide to calculating district-level estimates. COMMUNITY EYE HEALTH 2019; 31:S5-S8. [PMID: 31086446 PMCID: PMC6390516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Anthony W Solomon
- Medical Officer for Trachoma: Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | | | - Nebiyu Negussu
- Neglected Tropical Diseases Team Leader: Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Rebecca Willis
- Data and Analytics Team Manager: International Trachoma Initiative, Task Force for Global Health, Decatur GA, USA
| | - Hugh R Taylor
- Harold Mitchell Professor of Indigenous Eye Health: University of Melbourne, Melbourne, Australia
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