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Dyer CEF, Kalua K, Chisambi AB, Wand H, McManus H, Liu B, Kaldor JM, Vaz Nery S. Water, Sanitation, and Hygiene (WASH) Factors Influencing the Effectiveness of Mass Drug Administration to Eliminate Trachoma as a Public Health Problem in Malawi. Ophthalmic Epidemiol 2024; 31:127-133. [PMID: 36987395 DOI: 10.1080/09286586.2023.2194409] [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: 09/21/2021] [Accepted: 03/19/2023] [Indexed: 03/30/2023]
Abstract
PURPOSE Following a national population-based trachoma survey in Malawi one round of azithromycin mass drug administration (MDA) was carried out, with a post-MDA impact survey showing TF prevalence below 5% and considered eliminated as a public health problem. However, active trachoma was still present in over 200 children. We assessed whether water, sanitation, and hygiene (WASH) factors were associated with ongoing presence of TF in children aged 1-9 years following MDA. METHODS A secondary analysis was performed on a sub-set of the post-MDA impact survey data for children aged 1-9 years. We used a logistic regression analysis, adjusted for clustering at the household and village level. RESULTS Among 16,142 children aged 1-9 years, 209 (1.3%) had TF after MDA. Factors associated with a significantly lower odds of TF after MDA were living in a household with a handwashing facility (aOR: 0.37) and living in a household where water for washing is located further away from the home (30 min away aOR: 0.39, p = .034, or more than 1 h away aOR: 0.31, p = .018) compared with water in the yard. CONCLUSION The inverse association between a domestic handwashing facility and TF is consistent with previous findings, but the association of increasing distance to collect water for washing with a reduced risk of TF was unexpected and may reflect the impact of drought and unmeasured behavioural factors related to water usage. A more comprehensive collection of sociodemographic and WASH factor information in population-based trachoma surveys will provide insight into achieving and maintaining low levels of trachoma.
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Affiliation(s)
- Clare E F Dyer
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Khumbo Kalua
- Department of Ophthalmology, Kamuzu University of Health Sciences, Blantyre, Malawi
- Blantyre Institute for Community Ophthalmology, Lions Sight First Eye Hospital, Blantyre, Malawi
| | - Alvin B Chisambi
- Blantyre Institute for Community Ophthalmology, Lions Sight First Eye Hospital, Blantyre, Malawi
| | - Handan Wand
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Hamish McManus
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Bette Liu
- School of Population Health, University of New South Wales, Sydney, Australia
| | - John M Kaldor
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Susana Vaz Nery
- Kirby Institute, University of New South Wales, Sydney, Australia
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Kebede F, Jamal M. Prevalence of active trachoma infection and associated factors post-war resettled population in raya kobo districts, North East Ethiopia: A community-based cross-sectional study in 2022. Health Sci Rep 2023; 6:e1486. [PMID: 37554953 PMCID: PMC10404653 DOI: 10.1002/hsr2.1486] [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: 04/04/2023] [Revised: 07/25/2023] [Accepted: 07/26/2023] [Indexed: 08/10/2023] Open
Abstract
Background Active trachoma infection poses a serious threat to public health, particularly for those who live in an unprivileged area and has practiced open-field defecation. This study aimed to estimate the prevalence of active trachoma infection and associated factors in the post-war resettled population in Raya Kobo district, North East Ethiopia: a community-based cross-sectional study in 2022. Methods A community-based cross-sectional study was conducted among 602 participants randomly selected in 14 slum villages in Raya Kobo from February 16th to March 30th, 2023. After the data was collected using a semi-structured questionnaire and entered into Epi-data version 3.2. The study participants were chosen using a two-stage sampling process. Binary logistic regression was used to identify factors for active trachoma infection. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were claimed for the strength of association at p < 0.05. Results Overall, 602 (99.9%) study participants were included in the final analysis. At the end of the study period, 126 (20.9) participants developed active trachoma infection. On multivariable analysis, were aged ≥45 years (AOR = 7.9, 95% CI = 2.4-25.3), history of eye infection (AOR = 3.7, 95% CI = 2.4-10.4, p = 0.001), were poor wealth index (AOR = 9.2, 95% CI = 2.7-23.7), having separated kitchen (AOR = 4.05, 95% CI = 1.86-8.86), living with animals (AOR = 5.92, 95% CI = 2.31-14.7) and having got administration of mass-drug (AOR = 8.9, 95% CI = 2.36-33.6) were significant risk factors for active trachoma infection. Whereas, face washing practice regularly (AOR = 0.23, 95% CI = 0.127-0.43), and toilet availability (AOR = 0.35, 95% CI = 0.20-0.97) were preventive factors for active trachoma infection. Conclusion A significant prevalence of active trachoma infection was reported in the area as compared with previous findings and urgent clinical intervention, and the WHO critical SAFE strategies (surgery, antibiotics, facial cleanliness, and environmental improvement) implementation is highly needed in the area. In addition, healthcare providers should focus on information dissemination on proper latrine utilization, and washing the face regularly to prevent active trachoma infection is highly recommended.
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Affiliation(s)
- Fassikaw Kebede
- Department of Epidemiology and BiostaticsCollege of Health ScienceWoldia UniversityWoldiaEthiopia
| | - Muhammad Jamal
- Mersa Health CentreHabru Woreda North WolloNorth WolloEthiopia
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Sasanami M, Amoah B, Diori AN, Amza A, Souley ASY, Bakhtiari A, Kadri B, Szwarcwald CL, Ferreira Gomez DV, Almou I, Lopes MDFC, Masika MP, Beidou N, Boyd S, Harding-Esch EM, Solomon AW, Giorgi E. Using model-based geostatistics for assessing the elimination of trachoma. PLoS Negl Trop Dis 2023; 17:e0011476. [PMID: 37506060 PMCID: PMC10381061 DOI: 10.1371/journal.pntd.0011476] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 06/26/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Trachoma is the commonest infectious cause of blindness worldwide. Efforts are being made to eliminate trachoma as a public health problem globally. However, as prevalence decreases, it becomes more challenging to precisely predict prevalence. We demonstrate how model-based geostatistics (MBG) can be used as a reliable, efficient, and widely applicable tool to assess the elimination status of trachoma. METHODS We analysed trachoma surveillance data from Brazil, Malawi, and Niger. We developed geostatistical Binomial models to predict trachomatous inflammation-follicular (TF) and trachomatous trichiasis (TT) prevalence. We proposed a general framework to incorporate age and gender in the geostatistical models, whilst accounting for residual spatial and non-spatial variation in prevalence through the use of random effects. We also used predictive probabilities generated by the geostatistical models to quantify the likelihood of having achieved the elimination target in each evaluation unit (EU). RESULTS TF and TT prevalence varied considerably by country, with Brazil showing the lowest prevalence and Niger the highest. Brazil and Malawi are highly likely to have met the elimination criteria for TF in each EU, but, for some EUs, there was high uncertainty in relation to the elimination of TT according to the model alone. In Niger, the predicted prevalence varied significantly across EUs, with the probability of having achieved the elimination target ranging from values close to 0% to 100%, for both TF and TT. CONCLUSIONS We demonstrated the wide applicability of MBG for trachoma programmes, using data from different epidemiological settings. Unlike the standard trachoma prevalence survey approach, MBG provides a more statistically rigorous way of quantifying uncertainty around the achievement of elimination prevalence targets, through the use of spatial correlation. In addition to the analysis of existing survey data, MBG also provides an approach to identify areas in which more sampling effort is needed to improve EU classification. We advocate MBG as the new standard method for analysing trachoma survey outputs.
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Affiliation(s)
- Misaki Sasanami
- Lancaster Medical School, Lancaster University, Lancaster, United Kingdom
| | - Benjamin Amoah
- Faculty of Medicine, School of Public Health, Imperial College London, London, United Kingdom
| | - Adam Nouhou Diori
- Ophtalmologie de l’Hôpital Amirou Boubacar Diallo de Niamey, Niamey, Niger
| | - Abdou Amza
- Faculty of Health Sciences, Abdou Moumouni University of Niamey, Niamey, Niger
| | | | - Ana Bakhtiari
- International Trachoma Initiative, Task Force for Global Health, Decatur, Georgia, United States of America
| | - Boubacar Kadri
- Programme National de Sante Oculaire (PNSO), Niamey, Niger
| | - Célia L. Szwarcwald
- Institute of Scientific and Technological Communication and Information in Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | | | - Ibrahim Almou
- Programme National de Sante Oculaire (PNSO), Niamey, Niger
| | | | | | | | - Sarah Boyd
- International Trachoma Initiative, Task Force for Global Health, Decatur, Georgia, United States of America
| | - Emma M. Harding-Esch
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Anthony W. Solomon
- Global Neglected Tropical Diseases Programme, World Health Organization, Geneva, Switzerland
| | - Emanuele Giorgi
- Lancaster Medical School, Lancaster University, Lancaster, United Kingdom
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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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Reda G, Yemane D, Gebreyesus A. Prevalence and associated factors of active trachoma among 1-9 years old children in Deguatemben, Tigray, Ethiopia, 2018: community cross-sectional study. BMC Ophthalmol 2020; 20:144. [PMID: 32293359 PMCID: PMC7161230 DOI: 10.1186/s12886-020-01394-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 03/16/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Trachoma is a contagious infection of the eye. World Health Organization recommended three rounds of mass drug administration in districts where the prevalence of trachomatous follicular (TF) is ≥10% in children aged 1-9 years. Mass drug distribution was given to residents for three consecutive years with more than 90% coverage. However, the prevalence and associated factors of active trachoma in the study community after the intervention was not yet determined. Thus, this deals with the prevalence and associated factors of active trachoma among children aged 1-9 years. METHODS We conducted a Community based cross-sectional study among 502 children aged 1-9 in March 2018 in Deguatemben. A multi-stage sampling technique was applied. Selected children were examined for trachoma using 2.5x binocular loupe and graded based on the WHO simplified grading system. Mothers were interviewed for factors associated with trachoma using a structured questionnaire. Data was entered on Epi-Info and exported to SPSS for analysis. Both descriptive and inferential analyses were done with 95% confidence intervals (CIs) at a p-value < 0.05 for the final model. RESULTS The prevalence of active trachoma was found 21.5% (95% CI: 17.8-25.1%). Being 1 to 4 years old [AOR (95% CI) = 6.81(2.00-23.11)], not washing face [AOR (95% CI) =9.31(1.13-77.66)], not using soap [AOR (95% CI) =5.84(1.87-18.21)], unclean face [AOR(95% CI) = 18.22(4.93-69.32)] and mother's knowledge [AOR (95% CI) =0.06(0.02-0.19)] were found as independent predictors. CONCLUSION The prevalence declined from the baseline, but it is still a public health problem in the district. Personal-related factors were found to be associated with the disease. Health education of "Facial cleanness" and related factors is recommended to increase knowledge of the mothers on their children's care in addition to the provision of antibiotics.
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Affiliation(s)
| | - Dejen Yemane
- College of Health Sciences, Mekelle University, P.O.BOX:1871, Mekelle, Tigray, Ethiopia
| | - Aregawi Gebreyesus
- College of Health Sciences, Mekelle University, P.O.BOX:1871, Mekelle, Tigray, Ethiopia.
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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: 20] [Impact Index Per Article: 4.0] [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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Burr SE, Hart J, Samikwa L, Chaima D, Cooley G, Martin D, Masika M, Solomon AW, Bailey RL, Kalua K. Pgp3 seroprevalence and associations with active trachoma and ocular Chlamydia trachomatis infection in Malawi: cross-sectional surveys in six evaluation units. PLoS Negl Trop Dis 2019; 13:e0007749. [PMID: 31658258 PMCID: PMC6816554 DOI: 10.1371/journal.pntd.0007749] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 09/04/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Following one to five years of antibiotic mass drug administration (MDA) for the elimination of trachoma as a public health problem, programmes must conduct impact surveys to inform decisions on whether MDA is still needed. These decisions are currently based on the prevalence of trachomatous inflammation-follicular (TF), which, after MDA, correlates poorly with prevalence of ocular Chlamydia trachomatis infection. METHODOLOGY/PRINCIPAL FINDINGS Impact surveys in six evaluation units (EUs) of Malawi were used as a platform to explore associations between the prevalence of TF, ocular C. trachomatis infection and anti-Pgp3 antibodies one year after the third annual round of MDA. Participants were examined for trachoma using the World Health Organization simplified grading system. Ocular swabs and dried blood spots (DBS) were collected from children aged 1-9 years. Swabs were tested for C. trachomatis DNA using GeneXpert. DBS were assayed for anti-Pgp3 antibodies using ELISA. EU-level prevalence of TF in children aged 1-9 years ranged from 4.7% (95% CI 3.4-6.3) to 7.2% (95% CI 5.8-8.9). Prevalence of C. trachomatis infection in children ranged from 0.1% (95% CI 0.0-0.6) to 0.7% (95% CI 0.3-1.3) while Pgp3 seroprevalence ranged from 6.9% (95% CI 5.4-8.6) to 12.0% (95% CI 10.1-14.0) and increased with age. CONCLUSIONS/SIGNIFICANCE Based on current global policy, the prevalence of TF indicates that a further year of antibiotic MDA is warranted in four of six EUs yet the very low levels of infection cast doubt on the universal applicability of TF-based cut-offs for antibiotic MDA. Pgp3 seroprevalence was similar to that reported following MDA in other settings that have reached the elimination target however the predictive value of any particular level of seropositivity with respect to risk of subsequent infection recrudescence is, as yet, unknown.
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Affiliation(s)
- Sarah E. Burr
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
- College of Medicine, University of Malawi, Blantyre, Malawi
| | - John Hart
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Lyson Samikwa
- College of Medicine, University of Malawi, Blantyre, Malawi
| | - David Chaima
- College of Medicine, University of Malawi, Blantyre, Malawi
| | - Gretchen Cooley
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Diana Martin
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | | | - Anthony W. Solomon
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Robin L. Bailey
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Khumbo Kalua
- College of Medicine, University of Malawi, Blantyre, Malawi
- Blantyre Institute for Community Outreach, Blantyre, Malawi
- * E-mail:
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Elshafie BE, Osman KH, Macleod C, Hassan A, Bush S, Dejene M, Willis R, Chu B, Courtright P, Solomon AW. The Epidemiology of Trachoma in Darfur States and Khartoum State, Sudan: Results of 32 Population-Based Prevalence Surveys. Ophthalmic Epidemiol 2017; 23:381-391. [PMID: 27841721 PMCID: PMC5297557 DOI: 10.1080/09286586.2016.1243718] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Purpose: To complete the baseline trachoma map of Sudan by estimating the prevalence of trachoma and associated risk factors in the five Darfur States and Khartoum State. Methods: Using a standardized methodology developed for the Global Trachoma Mapping Project, we undertook a cross sectional, community-based survey in each of 32 evaluation units (EUs) covering all accessible districts. Results: We enumerated a total of 84,568 individuals, with 73,489 people (86.9%) examined from 20,242 households in 908 villages. The highest prevalence of trachomatous inflammation – follicular (TF) in children was found in El Fashir district (18.7%), and the lowest in El Malha district (0.0%). Five districts (El Fashir, Zalinji, Azoom, Maleet, and El Koma) were in the three EUs that had TF prevalences above the 10% threshold at which the World Health Organization recommends mass treatment with azithromycin, together with facial clean3liness and environmental improvement interventions, for at least 3 years. The highest trachomatous trichiasis prevalence in adults was found in the EU composed of Forbranga and Habillah (1.2%), and the lowest in the EU composed of As-salam and Belale districts in South Darfur (0.0%). TF in children was independently associated with younger age, unimproved sanitation in the household, having ≥5 children in the household, outside annual maximum temperatures <40°C, and living in an internally displaced persons camp. Conclusion: We found a high prevalence of trachoma in some areas of Darfur, but in general the prevalence throughout Darfur and Khartoum was low.
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Affiliation(s)
| | - Kamal Hashim Osman
- a National Program for Prevention of Blindness , Federal Ministry of Health , Khartoum , Sudan.,b Department of Ophthalmology , Al Neelain University , Khartoum , Sudan
| | - Colin Macleod
- c Clinical Research Department , London School of Hygiene & Tropical Medicine , London , UK.,d Sightsavers, Haywards Heath , UK
| | | | | | - Michael Dejene
- f Michael Dejene Public Health Consultancy Services , Addis Ababa , Ethiopia
| | | | - Brian Chu
- g Task Force for Global Health , Decatur , GA , USA
| | - Paul Courtright
- h KCCO International, Division of Ophthalmology , University of Cape Town , South Africa
| | - Anthony W Solomon
- c Clinical Research Department , London School of Hygiene & Tropical Medicine , London , UK.,i Department of Control of Neglected Tropical Diseases , World Health Organization , Geneva , Switzerland
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Sokana O, Macleod C, Jack K, Butcher R, Marks M, Willis R, Chu BK, Posala C, Solomon AW. Mapping Trachoma in the Solomon Islands: Results of Three Baseline Population-Based Prevalence Surveys Conducted with the Global Trachoma Mapping Project. Ophthalmic Epidemiol 2016; 23:15-21. [PMID: 27937043 PMCID: PMC5706973 DOI: 10.1080/09286586.2016.1238946] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: We sought to complete the baseline trachoma map of the Solomon Islands by establishing prevalences of active trachoma and trichiasis in the provinces of Choiseul, Western, Rennell-Bellona, and Temotu. Methods: Using the standardized methodology developed for the Global Trachoma Mapping Project, we conducted cross-sectional community-based surveys from September to November 2013. Choiseul and Western provinces were each mapped as separate evaluation units (EUs); Rennell-Bellona and Temotu were combined to form a third EU. Results: A total of 9819 individuals were sampled for inclusion, with 9224 (93.3%) consenting to examination, of whom 4587 (46.3%) were female. Survey teams visited 82 villages, and surveyed 2448 households. Two EUs had prevalences of trachomatous inflammation – follicular (TF) in 1–9-year-olds over the 10% threshold at which WHO recommends mass distribution of azithromycin for at least 3 years (Western 20.4%, 95% confidence interval, CI 15.6–26.3%; Rennell-Bellona/Temotu 22.0%, 95% CI 18.5–26.0%). Choiseul had a TF prevalence of 6.1% (95% CI 4.1–8.6%), and met the criterion for a single round of mass antibiotic distribution before re-survey. The adjusted prevalences of trichiasis in those aged 15+ years were 0.0% (95% CI 0.0–0.2%) in Choiseul, 0.16% (95% CI 0.0–0.5%) in Western, and 0.10% (95% CI 0–0.3%) in Rennell-Bellona/Temotu provinces. All three EUs require implementation of the facial cleanliness and environmental improvement components of the trachoma elimination strategy. Conclusion: Active trachoma is prevalent in the Solomon Islands. However, there is little evidence of the blinding complications of trachoma being a public health problem there. Further research into the explanation for this phenomenon is warranted.
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Affiliation(s)
- Oliver Sokana
- a Eyecare Department , Ministry of Health , Honiara , Solomon Islands
| | - Colin Macleod
- b Clinical Research Department , London School of Hygiene & Tropical Medicine , London , UK.,c Sightsavers, Haywards Heath , UK
| | - Kelvin Jack
- a Eyecare Department , Ministry of Health , Honiara , Solomon Islands
| | - Robert Butcher
- b Clinical Research Department , London School of Hygiene & Tropical Medicine , London , UK
| | - Michael Marks
- b Clinical Research Department , London School of Hygiene & Tropical Medicine , London , UK.,d Hospital for Tropical Diseases , London , UK
| | | | - Brian K Chu
- e Task Force for Global Health , Decatur , GA , USA
| | - Claude Posala
- a Eyecare Department , Ministry of Health , Honiara , Solomon Islands
| | - Anthony W Solomon
- b Clinical Research Department , London School of Hygiene & Tropical Medicine , London , UK
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10
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Kalua K, Chisambi A, Chinyanya D, Kamwendo Z, Masika M, Willis R, Flueckiger RM, Pavluck AL, Solomon AW. Completion of Baseline Trachoma Mapping in Malawi: Results of Eight Population-Based Prevalence Surveys Conducted with the Global Trachoma Mapping Project. Ophthalmic Epidemiol 2016; 23:32-38. [PMID: 27726469 PMCID: PMC5706967 DOI: 10.1080/09286586.2016.1230224] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: Following a first phase of trachoma mapping in Malawi with the Global Trachoma Mapping Project, we identified and mapped trachoma districts previously suspected to be non-endemic, although adjacent to districts with estimated trachoma prevalences indicating a public health problem. Methods: We conducted population-based surveys in eight evaluation units (EUs) comprising eight districts in Malawi (total population 3,230,272). A 2-stage cluster random sampling design allowed us to select 30 households from each of 30 clusters per EU; all residents aged 1 year and older in selected households were examined for evidence of trachomatous inflammation–follicular (TF) and trachomatous trichiasis (TT). Results: None of the eight EUs had a TF prevalence in 1–9-year-olds ≥10%, one district (Dedza) had a TF prevalence between 5.0% and 9.9%, and only one district (Karonga) had a trichiasis prevalence in adults ≥0.2%. Conclusion: The prevalence of TF and TT in six of eight EUs surveyed was consistent with an original categorization of trachoma being unlikely to be a public health problem. In the absence of formal surveys, health management information system data and other locally available information about trachoma is likely to be useful in predicting areas where public health interventions against trachoma are required.
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Affiliation(s)
- Khumbo Kalua
- a Department of Ophthalmology , University of Malawi, College of Medicine , Blantyre , Malawi.,b Blantyre Institute for Community Ophthalmology , Lions Sight First Eye Hospital , Blantyre , Malawi
| | - Alvin Chisambi
- b Blantyre Institute for Community Ophthalmology , Lions Sight First Eye Hospital , Blantyre , Malawi
| | - David Chinyanya
- b Blantyre Institute for Community Ophthalmology , Lions Sight First Eye Hospital , Blantyre , Malawi
| | - Zachariah Kamwendo
- b Blantyre Institute for Community Ophthalmology , Lions Sight First Eye Hospital , Blantyre , Malawi
| | | | - Rebecca Willis
- d International Trachoma Initiative , Task Force for Global Health , Decatur , GA , USA
| | - Rebecca M Flueckiger
- e Clinical Research Department , London School of Hygiene & Tropical Medicine , London , UK
| | - Alexandre L Pavluck
- e Clinical Research Department , London School of Hygiene & Tropical Medicine , London , UK
| | - Anthony W Solomon
- e Clinical Research Department , London School of Hygiene & Tropical Medicine , London , UK.,f Department of Control of Neglected Tropical Diseases , World Health Organization , Geneva , Switzerland
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A Cross-Sectional Population-Based Survey of Trachoma among Migrant School Aged Children in Shanghai, China. BIOMED RESEARCH INTERNATIONAL 2016; 2016:8692685. [PMID: 27610383 PMCID: PMC5005553 DOI: 10.1155/2016/8692685] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Revised: 07/28/2016] [Accepted: 07/28/2016] [Indexed: 11/17/2022]
Abstract
We investigated the prevalence of clinical trachoma in 154,265 children aged 6 to 16 years in 206 Shanghai migrant schools. Clean water availability in school, each child's facial cleanliness, eyelids, corneas, and the presenting distance visual acuities were examined. Trachoma was clinically diagnosed in accordance with the World Health Organization simplified classification. Eyes diagnosed with trachoma were swabbed to test for ocular Chlamydia trachomatis infections (OCTI) with a rapid latex immunochromatographic test. Among 153,977 students, no blindness was found related to trachoma. Trachoma was diagnosed in 8029 children (5.2%). In 87 schools clinical trachoma prevalence was higher than 5%. OCTI was confirmed in 2073 of 6823 trachoma diagnosed children (30.4%). Clinical trachoma prevalence was higher among females than males (p < 0.001), but gender comparison showed no statistical difference in the prevalence of OCTI (p = 0.077). Age and clinical trachoma (r = -0.014; p < 0.001) or OCTI (r = -0.026; p = 0.031) prevalence were negatively correlated. Clinical trachoma was different in different districts and counties (p < 0.001). Trachoma warrants close attention in Shanghai migrant children because the condition remains endemic in some schools.
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Malhotra S, Vashist P, Gupta N, Kalaivani M, Satpathy G, Shah A, Krishnan S, Azad R. Prevalence of Trachoma in Car-Nicobar Island, India after Three Annual Rounds of Mass Drug Administration with Azithromycin. PLoS One 2016; 11:e0158625. [PMID: 27391274 PMCID: PMC4938255 DOI: 10.1371/journal.pone.0158625] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 06/20/2016] [Indexed: 11/18/2022] Open
Abstract
Background A high proportion of active trachoma infection in children of Car-Nicobar Island was reported through the Trachoma Rapid Assessment survey conducted in year 2010 by the same researchers. Annual mass drug treatment with azithromycin was administered from years 2010–12 to all individuals residing in this island for reducing the burden of active trachoma infection. A cross-sectional prevalence survey was conducted in the year 2013 to assess the post-treatment burden of trachoma in this population. Methods In the 15 randomly selected compact segments from each village of the island, children aged 1–9 years were examined for evidence of active trachoma infection and participants aged ten years and above were examined for trachomatous trichiasis and corneal opacity. Results A total of 809 children (1–9 years) and 2735 adults were examined. Coverage with azithromycin for all the three rounds was more than 80%. The prevalence of active trachoma infection in children aged 1–9 years old was 6.8% (95% CI 5.1, 8.5) and Trachomatous Trichiasis (TT) was 3.9% (95% CI 3.2, 4.6). The risk factors associated with active trachoma infection were older age and unclean faces. The risk factors associated with TT were older age and lower literacy level. Conclusion Trachoma has not been eliminated from Car-Nicobar Island in accordance to ‘Global Elimination of Trachoma, 2020’ guidelines. Sustained efforts and continuous surveillance admixed with adequate programmatic response is imperative for elimination of trachoma in the island.
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Affiliation(s)
- Sumit Malhotra
- Department of Community Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Praveen Vashist
- Department of Community Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
- * E-mail:
| | - Noopur Gupta
- Department of Community Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Mani Kalaivani
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Gita Satpathy
- Department of Ocular Microbiology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Anita Shah
- Gobind Ballabh Pant Hospital, Port Blair, Andaman and Nicobar Islands, India
| | - Sujaya Krishnan
- Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - Rajvardhan Azad
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Katibeh M, Hosseini S, Yaseri M, Aminifar MN, Mahdavi A, Jafarinasab MR, Javadi MA. Prevalence and Risk Factors for Trachoma in Rural Areas of Sistan-va-Baluchestan Province, Iran: A Population-Based Study. Ophthalmic Epidemiol 2016; 22:208-13. [PMID: 26158579 DOI: 10.3109/09286586.2015.1037400] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To determine the prevalence of trachoma and risk factors associated with the disease in rural areas of the Sistan-va-Baluchestan province in Iran from 2012-2013. Population-based prevalence data for trachoma is lacking in this region. METHODS In this population-based cross-sectional study, 80 clusters were selected using a systematic and probability proportional to size method. All participants underwent clinical eye examinations according to the World Health Organization simplified trachoma grading system. The prevalence of follicular trachoma (TF) in children aged 1-9 years and the prevalence of trachomatous trichiasis (TT) in women aged over 15 years were the most important clinical indicators of trachoma. RESULTS The study surveyed 8187 individuals and analyzed 7912 participants (96.6%) including 3737 children aged 1-9 years and 4175 females >15 years. The prevalence of TF and TT in the relevant indicator groups were 0.59% (95% confidence interval, CI, 0.36-0.89%) and 0.02% (95% CI 0.00-0.13%), respectively. CONCLUSION Previously, trachoma prevalence data for this region were lacking. This study confirms that the Sistan-va-Baluchestan region is not endemic for trachoma. This has important implications for national trachoma elimination activities.
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Affiliation(s)
- Marzieh Katibeh
- Ophthalmic Epidemiology Research Center, Shahid Beheshti University of Medical Sciences , Tehran , Iran
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14
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Kalua K, Phiri M, Kumwenda I, Masika M, Pavluck AL, Willis R, Mpyet C, Lewallen S, Courtright P, Solomon AW. Baseline Trachoma Mapping in Malawi with the Global Trachoma Mapping Project (GTMP). Ophthalmic Epidemiol 2016; 22:176-83. [PMID: 26158575 PMCID: PMC4673584 DOI: 10.3109/09286586.2015.1035793] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: To determine the prevalence of trachoma in all suspected endemic districts in Malawi. Methods: A population-based survey conducted in 16 evaluation units from 12 suspected endemic districts in Malawi (population 6,390,517), using the standardized Global Trachoma Mapping Project (GTMP) protocol. A 2-stage cluster-random sampling design selected 30 households from each of 30 clusters per evaluation unit; all residents aged 1 year and older in selected households were examined for evidence of follicular trachoma (TF), intense trachomatous inflammation (TI), and trachomatous trichiasis (TT). Results: Four of the 16 evaluation units were found to be endemic for trachoma, with a prevalence range of 10.0–13.5% for TF and 0.2–0.6% for TT. Nine evaluation units had a TF prevalence between 5.0% and 9.9% while three evaluation units had a TF prevalence <5.0%. Conclusion: The prevalence rates of active trachoma in Malawi were not uniform among suspected endemic evaluation units, with rates higher than the World Health Organization (WHO) threshold for implementation of community-based control measures (TF ≥ 10.0%) in only 4 of the 16 evaluation units. Trachoma remains a disease of public health importance in some parts of Malawi and adjoining (unmapped) districts should be prioritized for mapping. According to the survey, an additional 3,169,362 people require intervention to reduce active disease and 1557 trichiasis surgeries are needed to reduce the prevalence of TT below WHO recommended thresholds.
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Affiliation(s)
- Khumbo Kalua
- Department of Ophthalmology, University of Malawi, College of Medicine , Blantyre , Malawi
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Prevalence of Active Trachoma and Its Associated Factors among Rural and Urban Children in Dera Woreda, Northwest Ethiopia: A Comparative Cross-Sectional Study. BIOMED RESEARCH INTERNATIONAL 2015; 2015:570898. [PMID: 25954753 PMCID: PMC4390108 DOI: 10.1155/2015/570898] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 02/15/2015] [Accepted: 03/12/2015] [Indexed: 11/22/2022]
Abstract
Background. Trachoma is the most common infectious cause of blindness worldwide. Once an epidemic in most parts of the world, it has largely now disappeared from developed countries. However, it continues to be endemic in many developing countries like Ethiopia. Even if several studies were conducted in different parts of Ethiopia, most of them did not show the independent predictors for rural and urban children separately. Therefore, this study aimed at assessing the prevalence and associated factors of active trachoma in urban and rural children. Methods. Community based comparative cross-sectional study was conducted in Dera woreda. Multistage sampling technique was used to select 671 children of one up to nine years of age. Data were collected by face to face interview and observation using a structured and pretested questionnaire. Binary Logistic Regression Model was fitted to consider adding independent predictors of outcome. Results. Out of 671 children, 20 (9.3%) of urban and 85 (18.6%) of rural children were positive for active trachoma. Having discharge on eye (AOR = 6.9, 95% CI: 1.79–27.89), presence of liquid waste around the main house (AOR = 5.6, 95% CI: 1.94–16.18), and living in households without latrine (AOR = 4.39, 95% CI: 1.39–13.89) were significantly associated with active trachoma of urban children. Rural children who had discharge on their eye (AOR = 5.86, 95% CI: 2.78–12.33), those who had unclean face (AOR = 4.68, 95% CI: 2.24–9.81), and those living in households with feces around their main houses (AOR = 1.94, 95% CI: 1.04–3.62) were significantly associated with active trachoma. Conclusion. The result showed that the prevalence of active trachoma in urban areas of the district was below WHO threshold of 10% to determine trachoma as public health problem. However, in rural areas of the district it is far from elimination of trachoma as a public health problem. Thus, in order to improve awareness of the community there is a need of health education programs regarding facial cleanliness, utilization of latrine, and proper solid waste and liquid waste disposal using multidisciplinary approach.
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Gelaw Y, Abateneh A. Blinding trachoma among refugees: complicating social disaster. Asian Pac J Trop Biomed 2015. [DOI: 10.1016/s2221-1691(15)30155-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Stocks ME, Ogden S, Haddad D, Addiss DG, McGuire C, Freeman MC. Effect of water, sanitation, and hygiene on the prevention of trachoma: a systematic review and meta-analysis. PLoS Med 2014; 11:e1001605. [PMID: 24586120 PMCID: PMC3934994 DOI: 10.1371/journal.pmed.1001605] [Citation(s) in RCA: 147] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 01/09/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Trachoma is the world's leading cause of infectious blindness. The World Health Organization (WHO) has endorsed the SAFE strategy in order to eliminate blindness due to trachoma by 2020 through "surgery," "antibiotics," "facial cleanliness," and "environmental improvement." While the S and A components have been widely implemented, evidence and specific targets are lacking for the F and E components, of which water, sanitation, and hygiene (WASH) are critical elements. Data on the impact of WASH on trachoma are needed to support policy and program recommendations. Our objective was to systematically review the literature and conduct meta-analyses where possible to report the effects of WASH conditions on trachoma and identify research gaps. METHODS AND FINDINGS We systematically searched PubMed, Embase, ISI Web of Knowledge, MedCarib, Lilacs, REPIDISCA, DESASTRES, and African Index Medicus databases through October 27, 2013 with no restrictions on language or year of publication. Studies were eligible for inclusion if they reported a measure of the effect of WASH on trachoma, either active disease indicated by observed signs of trachomatous inflammation or Chlamydia trachomatis infection diagnosed using PCR. We identified 86 studies that reported a measure of the effect of WASH on trachoma. To evaluate study quality, we developed a set of criteria derived from the GRADE methodology. Publication bias was assessed using funnel plots. If three or more studies reported measures of effect for a comparable WASH exposure and trachoma outcome, we conducted a random-effects meta-analysis. We conducted 15 meta-analyses for specific exposure-outcome pairs. Access to sanitation was associated with lower trachoma as measured by the presence of trachomatous inflammation-follicular or trachomatous inflammation-intense (TF/TI) (odds ratio [OR] 0.85, 95% CI 0.75-0.95) and C. trachomatis infection (OR 0.67, 95% CI 0.55-0.78). Having a clean face was significantly associated with reduced odds of TF/TI (OR 0.42, 95% CI 0.32-0.52), as were facial cleanliness indicators lack of ocular discharge (OR 0.42, 95% CI 0.23-0.61) and lack of nasal discharge (OR 0.62, 95% CI 0.52-0.72). Facial cleanliness indicators were also associated with reduced odds of C. trachomatis infection: lack of ocular discharge (OR 0.40, 95% CI 0.31-0.49) and lack of nasal discharge (OR 0.56, 95% CI 0.37-0.76). Other hygiene factors found to be significantly associated with reduced TF/TI included face washing at least once daily (OR 0.76, 95% CI 0.57-0.96), face washing at least twice daily (OR 0.85, 95% CI 0.80-0.90), soap use (OR 0.76, 95% CI 0.59-0.93), towel use (OR 0.65, 95% CI 0.53-0.78), and daily bathing practices (OR 0.76, 95% CI 0.53-0.99). Living within 1 km of a water source was not found to be significantly associated with TF/TI or C. trachomatis infection, and the use of sanitation facilities was not found to be significantly associated with TF/TI. CONCLUSIONS We found strong evidence to support F and E components of the SAFE strategy. Though limitations included moderate to high heterogenity, low study quality, and the lack of standard definitions, these findings support the importance of WASH in trachoma elimination strategies and the need for the development of standardized approaches to measuring WASH in trachoma control programs.
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Affiliation(s)
- Meredith E. Stocks
- Department of Environmental Health, Emory University, Atlanta, Georgia, United States of America
- International Trachoma Initiative, Taskforce for Global Health, Decatur, Georgia, United States of America
| | - Stephanie Ogden
- Department of Environmental Health, Emory University, Atlanta, Georgia, United States of America
- International Trachoma Initiative, Taskforce for Global Health, Decatur, Georgia, United States of America
- Children Without Worms, Taskforce for Global Health, Decatur, Georgia, United States of America
| | - Danny Haddad
- Emory Eye Center, Emory University, Atlanta, Georgia, United States of America
| | - David G. Addiss
- Children Without Worms, Taskforce for Global Health, Decatur, Georgia, United States of America
| | - Courtney McGuire
- Department of Environmental Health, Emory University, Atlanta, Georgia, United States of America
| | - Matthew C. Freeman
- Department of Environmental Health, Emory University, Atlanta, Georgia, United States of America
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Kalua K, Singini I, Mukaka M, Msyamboza K, Masika M, Bailey R. Scaling up of trachoma mapping in Salima District, Central Malawi. Health (London) 2014. [DOI: 10.4236/health.2014.61009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Vashist P, Gupta N, Rathore AS, Shah A, Singh S. Rapid assessment of trachoma in underserved population of Car-Nicobar Island, India. PLoS One 2013; 8:e65918. [PMID: 23799063 PMCID: PMC3683059 DOI: 10.1371/journal.pone.0065918] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2012] [Accepted: 04/30/2013] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To determine the burden of trachoma and its related risk factors amongst the native population of Car-Nicobar Island in India. METHODS Rapid assessment for trachoma was conducted in ten villages of Car-Nicobar Island according to standard WHO guidelines. An average of 50 children aged 1-9 years were assessed clinically for signs of active trachoma and facial cleanliness in each village. Additionally, all adults above 15 years of age in these households were examined for evidence of trachomatous trichiasis and corneal opacity. Environmental risk factors contributing to trachoma like limited access to potable water & functional latrine, presence of animal pen and garbage within the Nicobari hut were also noted in all villages. RESULTS Out of a total of fifteen villages in Car-Nicobar Island, ten villages were selected for trachoma survey depending on evidence of socio-developmental indicators like poverty and decreased access to water, sanitation and healthcare facilities. The total population of the selected clusters was 7277 in the ten villages. Overall, 251 of 516 children (48.6%;CI: 46.5-55.1) had evidence of follicular stage of trachoma and 11 children (2.1%;CI:1.0-3.4) had evidence of inflammatory stage of trachoma. Nearly 15%(CI:12.1-18.3) children were noted to have unclean faces in the ten villages. Trachomatous trichiasis was noted in 73 adults (1.0%;CI:0.8-1.2). The environmental sanitation was not found to be satisfactory in the surveyed villages mainly due to the co-habitance of Nicobari people with domestic animals like pigs, hens, goats, dogs, cats etc in most (96.4%) of the households. CONCLUSION Active trachoma and trachomatous trichiasis was observed in all the ten villages surveyed, wherein trachoma control measures are needed.
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Affiliation(s)
- Praveen Vashist
- Department of Community Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
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Lavett DK, Lansingh VC, Carter MJ, Eckert KA, Silva JC. Will the SAFE strategy be sufficient to eliminate trachoma by 2020? Puzzlements and possible solutions. ScientificWorldJournal 2013; 2013:648106. [PMID: 23766701 PMCID: PMC3671555 DOI: 10.1155/2013/648106] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 03/13/2013] [Indexed: 11/18/2022] Open
Abstract
Since the inception of (the Global Elimination of Blinding Trachoma) GET 2020 in 1997 and the implementation of the SAFE strategy a year later, much progress has been made toward lowering the prevalence of trachoma worldwide with elimination of the disease in some countries. However, high recurrence of trichiasis after surgery, difficulty in controlling the reemergence of infection after mass distribution of azithromycin in some communities, the incomplete understanding of environment in relation to the disease, and the difficulty in establishing the prevalence of the disease in low endemic areas are some of the issues still facing completion of the GET 2020 goals. In this narrative review, literature was searched from 1998 to January 2013 in PubMed for original studies and reviews. Reasons for these ongoing problems are discussed, and several suggestions are made as avenues for exploration in relation to improving the SAFE strategy with emphasis on improving surgical quality and management of the mass treatment with antibiotics. In addition, more research needs to be done to better understand the approach to improve sanitation, hygiene, and environment. The main conclusion of this review is that scale-up is needed for all SAFE components, and more research should be generated from communities outside of Africa and Asia.
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Affiliation(s)
- Diane K. Lavett
- Strategic Solutions, Inc., 1143 Salsbury Avenue, Cody, WY 82414, USA
| | - Van C. Lansingh
- International Agency for the Prevention of Blindness/VISION 2020 Latin America, 3720 San Simeon Circle, Weston, FL 33331, USA
- Hamilton Eye Institute, University of Memphis, Memphis, TN 38152, USA
| | - Marissa J. Carter
- Strategic Solutions, Inc., 1143 Salsbury Avenue, Cody, WY 82414, USA
| | - Kristen A. Eckert
- Strategic Solutions, Inc., 1143 Salsbury Avenue, Cody, WY 82414, USA
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Mpyet C, Lass BD, Yahaya HB, Solomon AW. Prevalence of and risk factors for trachoma in Kano state, Nigeria. PLoS One 2012; 7:e40421. [PMID: 22792311 PMCID: PMC3391244 DOI: 10.1371/journal.pone.0040421] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Accepted: 06/06/2012] [Indexed: 12/03/2022] Open
Abstract
Background In northern Nigeria, trachoma is an important public health problem, but there are currently few population-based data on prevalence of disease and no formal trachoma control programs. Methodology / Principal Findings In Kano state, Nigeria, we conducted a population-based cross-sectional survey using multistage cluster random sampling, combining examination for clinical signs of trachoma and application of questionnaires assessing potential household-level risk factors. A total of 4491 people were examined in 40 clusters, of whom 1572 were aged 1–9 years, and 2407 (53.6%) were female. In 1–9 year-olds, the prevalence of trachomatous inflammation–follicular (TF) was 17.5% (95% CI: 15.7–19.5%). In a multivariate model, independent risk factors for active trachoma were the presence of flies on the face (OR 1.98, 95% CI 1.30–3.02); a dirty face (OR 2.45, 95% CI 1.85–3.25) and presence of animal dung within the compound of residence (OR 3.46, 95% CI 1.62–7.41). The prevalence of trachomatous trichiasis in persons aged ≥15years was 10.9% (95% CI: 9.7–12.2%). Trichiasis was significantly more common in adult females than in adult males. Conclusion/Significance There is an urgent need for a trachoma control program in Kano state, with emphasis given to provision of good quality trichiasis surgery. Particular effort will need to be made to identify women with trichiasis and engage them with appropriate services while also taking steps to secure azithromycin for mass treatment and ensuring personal and environmental hygiene.
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Affiliation(s)
- Caleb Mpyet
- Department of Ophthalmology, Jos University Teaching Hospital, Jos, Nigeria.
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Edwards T, Smith J, Sturrock HJW, Kur LW, Sabasio A, Finn TP, Lado M, Haddad D, Kolaczinski JH. Prevalence of trachoma in unity state, South Sudan: results from a large-scale population-based survey and potential implications for further surveys. PLoS Negl Trop Dis 2012; 6:e1585. [PMID: 22506082 PMCID: PMC3323519 DOI: 10.1371/journal.pntd.0001585] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2011] [Accepted: 02/07/2012] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Large parts of South Sudan are thought to be trachoma-endemic but baseline data are limited. This study aimed to estimate prevalence for planning trachoma interventions in Unity State, to identify risk factors and to investigate the effect of different sampling approaches on study conclusions. METHODS AND FINDINGS The survey area was defined as one domain of eight counties in Unity State. Across the area, 40 clusters (villages) were randomly selected proportional to the county population size in a population-based prevalence survey. The simplified grading scheme was used to classify clinical signs of trachoma. The unadjusted prevalence of trachoma inflammation-follicular (TF) in children aged 1-9 years was 70.5% (95% CI: 68.6-72.3). After adjusting for age, sex, county and clustering of cases at household and village level the prevalence was 71.0% (95% CI: 69.9-72.1). The prevalence of trachomatous trichiasis (TT) in adults was 15.1% (95% CI: 13.4-17.0) and 13.5% (95% CI: 12.0-15.1) before and after adjustment, respectively. We estimate that 700,000 people (the entire population of Unity State) require antibiotic treatment and approximately 54,178 people require TT surgery. Risk factor analyses confirmed child-level associations with TF and highlighted that older adults living in poverty are at higher risk of TT. Conditional simulations, testing the alternatives of sampling 20 or 60 villages over the same area, indicated that sampling of only 20 villages would have provided an acceptable level of precision for state-level prevalence estimation to inform intervention decisions in this hyperendemic setting. CONCLUSION Trachoma poses an enormous burden on the population of Unity State. Comprehensive control is urgently required to avoid preventable blindness and should be initiated across the state now. In other parts of South Sudan suspected to be highly trachoma endemic, counties should be combined into larger survey areas to generate the baseline data required to initiate interventions.
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Affiliation(s)
- Tansy Edwards
- Medical Research Council Tropical Epidemiology Group, Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jennifer Smith
- Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Hugh J. W. Sturrock
- Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Lucia W. Kur
- Ministry of Health, Juba, Republic of South Sudan
| | - Anthony Sabasio
- Malaria Consortium South Sudan, Juba, Republic of South Sudan
| | - Timothy P. Finn
- Malaria Consortium South Sudan, Juba, Republic of South Sudan
| | - Mounir Lado
- Ministry of Health, Juba, Republic of South Sudan
| | - Danny Haddad
- International Trachoma Initiative, Decatur, Georgia, United States of America
| | - Jan H. Kolaczinski
- Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Malaria Consortium Africa Regional Office, Kampala, Uganda
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